Tuesday, August 19, 2008

August 18 Flu Update

CIDRAP reports on trends in Indonesia's bird flu cases. This is a very revealing piece of work....

Of the 125 patients who were hospitalized, 104 were diagnosed with pneumonia immediately or shortly after admission.

The authors report there were 11 case clusters that involved 28 patients. Infected patients who were not part of clusters were more likely to die, but researchers did not find any differences between cluster patients and noncluster patients in terms of when they presented to a healthcare facility, whether they received oseltamivir, or how soon they received the drug.

Patients with secondary cases were more likely to survive than primary case-patients, and they received antiviral treatment about 3 days earlier than primary case-patients. The investigators acknowledge that secondary cases may have involved other early interventions as well. They also report that patients who had indirect exposure to the virus were more likely to die.

Maryland "Nurse Detectives" work on bird flu and other diseases.

A PR firm won an award for a its pandemic influenza materials.

Bird flu is used as a reason not to require free range poultry in California.

Effect Measure blogs the story we ran yesterday about the antibodies in 1918 flu survivors. (Which is all over the media today, by the way.) Along with some scientific explanation, Revere adds some cogent perspective.

We still don't know how typical these people are. After all, they apparently didn't get sick in 1918 despite being infected and they have a good enough immune system to last into their nineties. Maybe most of us aren't so lucky and have waning immunity with the years. But this is some slick work and now that we have the actual antibodies in sufficient quantity to study we can begin to ask what features of the 1918 virus made it vulnerable. How much of this is transferable to bird flu, the current pandemic worry, is difficult to say. These antibodies didn't protect against or react with H5 flu viruses so they aren't a therapy for bird flu. But understanding the basic science of influenza virus is always a plus.

Debate breaks out on ProMed about whether it should report suspected (not officially confirmed) cases from Indonesia.


At 6:05 PM, Blogger Wulfgang said...


It seems to me that the overwhelming problem (ref: the CIDRAP article) with Indonesian data and analysis is that it is suspect. There is no way anybody can tell if it is complete or accurate, because of the credibility problem with their health department and inconsistent reporting.

The one statement however, that seems to stand out in their report that deserves considerable attention, is the amazing statement, “of the 125 patients who were hospitalized, 104 were diagnosed with pneumonia immediately or shortly after admission”. This situation seems to me to potentially represent a very serious secondary infection scenario that could cause deadly consequences on a much larger scale, primarily because of lack of ventilators and sufficient antibiotic stockpiles. I sincerely hope the CDC, HHS, and state health emergency planners are paying attention.

Thank goodness ProMED has made the decision to continuing reporting “suspect” bird flu human cases in Indonesia. ProMED remains one of the most vital and accurate independent sources of accurate news on the disease front that has remained unadulterated and mostly politics-free. Reporting unsubstantiated suspect cases is not an issue of creating unnecessary alarm or despondency – rather, whether they appreciate it or not, they are serving as one of primary “early warning systems” for the entire medical and public health community. They have already proven this with SARS.

Unfortunately, people have to recognize that Indonesia is not the “norm”, and in fact, the government is being non-responsive and purposefully evasive with the limited and highly-controlled H5N1 information that they do release. In fact, we have a situation in Indonesia that is almost identical to China in 2002 when SARS erupted: On November 16, 2002 an outbreak of what is believed to be SARS, otherwise known as Yellow Pneumonia, began in the Guangdong province of China. The PRC prevented its press from reporting on SARS and lagged in reporting the situation to the World Health Organization, delaying the initial report. Initially, it did not even provide information for Chinese provinces other than Guangdong. We all know the rest of the story: with a lot of luck, coupled with many unfortunate innocent deaths, we avoided a deadly plague that could have overwhelmed the entire world.

The SARS outbreak of 2002 is a timely reminder to all of us of the importance of being prepared against all communicable diseases, and where the control of H5N1 requires the stakeholder mentality that the entire world is vulnerable. It is vitally important that organizations like ProMED stay on top of their news releases out of Indonesia, so we avoid another SARS situation, or far, far worse.

Indonesia is only worried about their tourist economy. Thus far, it has not demonstrated any sense of true responsibility. Their most trusted allies are Mahmoud Ahmadinejad and Hugo Chavez. What does that tell everybody ?



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