Bloggers catch US State Dept. on bird flu preps

They can never give the ultimate advice to the American public since there will never be the level of inventory available within the U.S. to back it up. It was a lesson from y2k. The y2k czar, John Koskinen, told a press club function in 1999 quite frankly that whether or not he thought it appropriate, a recommendation of even one extra can of beans per week to toss in the pantry would outstrip what America had available. We are a just-in-time society, and that will not change anytime soon.

In contrast, urging the mere 60,000 Americans in Hong Kong, a pittance compared to the overall population, is doable. Those foreign nationals can take the advice, or not, at their own peril, but they will have been warned.

Better the State Department not give a reason for the discrepancy, because it will just be smoke & mirrors if they do.

Lengthy discussion and archiving about how the situation evolved here:

http://www.curevents.com/vb/showthread.php?t=62445

Brooks: Of course what they did was change and then delete the advice.

But there wasn't any reason to change the advice. They could have given a bogus reason that seems to apply to HK but not the rest of us.

My real point is they will never give a recommendation of 3 months here in the U.S. Now now. Not during the middle of a pandemic.

The DOS has always given its own medical advice including, e.g., mandatory mefloquine chemoprophylaxis in marginally malarious regions.

I would not read into this one way or another.

2 weeks or 12 weeks doesn't matter. If a pandemic hits and some people have lots stored up and a large number of other people don't, when things get tight for the large number without things will get tough for the large number with.

Red, K: I think I was agreeing with both of you. Or were you agreeing with me?

Revere, what I was saying is that if any expatriot or wealthy person in Hong Kong wants to truely protect themselves, they should leave at the first sign of H5N1 rather than stockpile for riding it out. Or if very wealthy they should stockpile for lots and lots of people. If in a crowde place like Hong Kong a few well off people are going to try to quarentine themselves with 12 weeks of supplies they need to be able to defend those supplies from desperate people. No doubt if a pandemic hits there much will be disrupted and many poorer people will be desperate enough to break down walls and doors to survive. I can't see where you addressed that in your post.

For a visual of what things might be like watch the foreigners flee Shanghai as the Japanese invade during WWII in the movie Empire of the Sun. Watch the deference the Chinese paid to the foreigners disappear overnight. This will be quite different from SARS. http://www.imdb.com/title/tt0092965/

I don't think all this happened because there was a reason to change the advice itself. Rather it was most likely HHS taking an exception to the idea that anyone else other than themselves should have final say over recommendations. To the extent that the original consulate newsletter referred people to the HHS guidance for more information, it is an implicit acknowledgement that this should be HHS's area of expertise.

I don't know if there might have been some internal discussions about 12 weeks of preps which HHS is not ready to roll out yet, but if there is, it would explain this screw-up. I wouldn't imagine diplomats of all people to be so adventurous as to come up with their own recommendations for a pandemic!

After all, they are the people who INVENT protocol!

As to diplomats not being adventurous -- have you ever lived overseas in a developing country? You have to be adventurous. Maybe even a little crazy. And you have to know the difference between what is officially being said and what keeps you alive. I am sure they are networking with sources to try to find out what in hades is going on. They may well be telling the government things the government just doesn't want to hear or believe. Wouldn't be the first time. And the current administration is so open to listening! Not.

My dad opened the American Embassy in what is now Burkina Faso in the early 60s. We lasted 14 months, out of a typical 24 month tour. My sister got malaria, ameobic dysentary and malaria again. She was bitten by a monkey and endured 21 rabies shots in the stomach. She was 10 years old and weighed 49 lbs when my dad cabled Washington that we were leaving.

Interestingly, we'd been visited by an African who'd lived in Paris and studied western medicine. He said something to the effect of "take your daughter home before she stays here forever." This was weeks after our friend's father, another American diplomat, was airlifted out to Paris with what we called jungle fever. Too late. He died 48 hours later.

Dad was one of the youngest American Embassy personnel, a code clerk, who stayed at the American legation in Shanghai as the Japanese were invading. He could never speak about it: but we learned how to purify water, handle firearms and keep at least a month's supply of food and necessitites.

I can well believe that despite the official changes to the website, in-country diplomats are preparing.

As we are.

Sara,

I didn't mean not adventurous in that way, but in being sticklers to protocol. :-)

Also check this out, curtesy of a poster at the Flu Wiki forum. http://tinyurl.com/y2h6mx

Seems like someone at the US Embassy in Tunisia didn't get the removal memo.

Let's see how long it takes for THEM to remove that page.

I will repeat what I have said and it has been echoed more than once here by others. They CANT tell us the truth because if it doesnt come it will cause a diaster, if it does come it will cause a disaster, if it comes and its a high path event with catastrophic kill rate it will cause a disaster.

I think they are kind of opting for the "keep pushing 'em" school of thought. I dont know if that will work but it is slowly getting in front of the right people. Latest numbers are encouraging about 20% of businesses are taking some action and now about 8% of the population is food/medicine prepared. Compared to a year ago this is great.

It could be like Osterholm said a couple of weeks ago... We may get absolutely no warning when it fixes and then attacks.

M. Randolph Kruger - where do you get those "latest numbers" from? Where in the world is that happening? We should keep an eye on that - not the virus' evolution, but our evolution.

I know the reveres have pushed this time and again, but it is imperative that we mobilize our immediate neighborhoods. I am slow to fully incorporate other's ideas sometimes. With this one, it was a "yeah, fine, that's great if I had the time or energy to instruct and mobilize and care for my neighbors, but this flu looks like an 'every man for himself' situation." So I only concerned myself with getting my own supplies in place.Then I got to thinking. I live alone. If my neighbors don't prepare, they're going to come to my door with their hungry kids and ask if I can spare any food. Knowing me, I won't be able to say no. But even if I did, next time they came back they'd be hungrier and angrier and more desperate, and would simply take what I have. (And no, I won't get a gun and shoot them. My life is not more important than theirs.) Therefore my own survival depends upon my neighbors being prepared as well. So, in my 'copious spare time' I have decided to tromp around the neighborhood next week handing out flyers and setting up a meeting at my house. I'm not an expert, but I'm as good as they're going to get I'm afraid. I write this in hopes the rest of you will see the necessity in this and decide to follow suit. It's like the firefighters in "Backdraft" said: "you go, we go". Like it or not, I'm afraid we are all in this together.

I just finished reading the last two parts of revere's wonderful paper on influenza viruses. My questions are relevant to those, but it's a little late to ask on that thread, so forgive me for going a little off topic here. Question: hemagglutinin (HA) is the "H" of H5N1, correct? So what is the essential differences between H5, H3 etc? And what is the N site, and what are the differences between the different numbered Ns? And since the picture is obviously, as you said, incredibly complex, little known or understood even by experts, and still unravelling, again how do they determine if an H5N1 discovered in a migratory bird is "Low Path" or "High Path"? Is there a key difference in genetic sequence they look for?
If this has all been covered before, just please steer me to the links and I'll search it out myself. Thank you!!

(Would that mean, start here, Mary?)

http://scienceblogs.com/effectmeasure/2006/10/influenza_virus_science_b…

MiH: Yes, the HA are the 16 different H's that are on the outside of the influenza A virus. Originally the subtypes were based on whether they cross-reacted to antibodies of another type but now sequence analysis is used to distinguish them. The HAs are responsible for latching on to the host cell. They are glycoproteins. So are the NAs, the neuraminidases, but their function is to act as enzymes. They cut the connection between the sialic acid and the HA when it comes time for the newly replicated virion to bud off from the host cell it used to make copies of itself. If you inhibit NA you prevent the new virus from being released. Tamiflu and Relenza are neuraminidase inhibitors. They don't "kill" the virus or prevent it from replicating. They prevent it from being released after it has replicated. Like HA, there are 9 different subtypes of the neuraminidases. Within each subtype there are also variants that can confuse the immune system.

Low path and high path are descriptions of the effect of the virus on poultry. High path kills poultry, low path doesn't. One determinant of hi path viruses is the presence of extra amino acids at a particular part of the HA glycoprotein. HA has to be cleaved into two parts in order for the virus to replicate. When that cleavage site is narrow, only a few or one enzyme on the host cell can do the trick. It is found in the respiratory system. But with the extra "polybasic" aminoacids adjacent to the cleavage site enzymes in other tissues can also work and the virus can replicate in multiple organ systems. Low path viruses can evolve to high path ones.

I am leaving out a lot of detail here, but I hope it is enough to answer some of your questions. Check around the internet and you'll find lots of other (probably better) explanations.

Is it possible that someone reaching for the '2' hit both '1' and '2' in the same keystroke and failed to find it on proofreading?

I handed out my county's pandemic preparedness flyer with the Halloween candy this year. Figured in keeping with the season, it would scare the adults.

Lisa: I thought of that but a look at the original, as I recall, was that 12 was spelled out as twelve.

It could be like Osterholm said a couple of weeks ago... We may get absolutely no warning when it fixes and then attacks.

Randy, I missed Osterholm's comments, whereever they were. Can you provide a link to them?

On an unrelated note, it may be a fortuitous thing for State Department personnel that many American embassies abroad have turned into hulking fortresses. I would much rather "shelter in place" in one of those monsters rather than do so in civilian accomodations. If there ever is a genuine H5N1 pandemic, conditions in large urban areas will probably get very ugly very quickly.

(Recalling from memory: back in the early 1960s, Norbert Weiner, the mathematician who introduced the theory of cybernetics, was once taken on a tour of the Los Angeles Department of Water and Power. His hosts had thought he would be impressed by the very high level of informational coordination being employed to make the whole thing work. Instead, Weiner was stunned into a depressed silent state. When asked, he said he had found it shocking how fragile were the infrastructural lifelines on which so huge a city was critically dependent. Two things has changed since then: LA is now a hell of a lot bigger. And its life support is now even more brittle than it was then. Joy.)

Marquer, looking for the original post from two or three weeks back but here is where Nbarro was quoted saying the same thing from the San Fran Chronical 10-17-06.

"Although H5N1 is widespread in birds, no strain that has emerged so far is adept at crossing the species boundary to infect humans. Since 2003, 256 people have been infected with H5N1, resulting in 151 deaths, according to the World Health Organization. Even more rare are cases of the virus jumping directly from person to person -- a necessary ingredient for a pandemic. But the chances of such a strain emerging increase with each new infection. The worst-case scenario is that a person would be infected simultaneously with bird flu and a regular human flu, giving the two viruses a chance to reshuffle their genetic elements to create a deadly strain that spreads easily from person to person. Dr. David Nabarro, who coordinates the United Nations' efforts against human and avian influenza, said the new data are a reminder that H5N1 is constantly evolving.
"I don't think it's a sign that we're getting any closer to pandemic flu," Nabarro said. "Frankly, I don't know how we're going to know when pandemic flu gets close. We're just going to get hit by it."

Lugon-Trying to find the public posting on those numbers that I am encouraged by. It was part of a full Harvard paper on it. Some of the information wasnt pushed out to the public though and only a survey. They said 20% of the businesses were doing "something" about it. Brother that could mean that they are putting posters up in the bathrooms. As for the people its not a significant increase by any stretch.... The way they worded the survey apparently only asked if they could last I believe for a month or some very short time without being in the crapper on it.

Will continue to try to get you the actual data. You can contact me at memphisservices@bellsouth.net if you want what is surely the PDF file on it. You can also have a pandemic preparedness list if you want that too along with some nifty combat medical and biowarfare training manuals. Dr. Lugon, calling Dr. Lugon.

The number was spelled out and does seem to reflect difficulty in setting policy on this. With most people ignoring the 2 week advise it is probably hard to go to 12 weeks. I'm wondering if it may have been stimulated by the PNAS paper on the 'new' Fujian like strain in south China that also seemed to prompt Taiwan into ordering human H5N1 vaccine against this target apparently against WHO advise. 12 weeks doesn't seem unreasonable and probably especially wise for embassies that could be struck with sudden travel restrictions. Hopefully this 'fit and start' will at least help motivate individuals and especially communities to make more preparations.

Avian Flu
American Citizens Services Newsletter

Pandemic Influenza -- Preparing for Possible Shelter-In-Place
U.S. Consulate General for Hong Kong and Macau

November 3, 2006

The U.S. Department of State recently sent a cable to all diplomatic and consular posts entitled "Pandemic Influenza: Preparing for Possible Shelter-In-Place". The cable's main intent was to provide guidance to all staff regarding "shelter-in-place". That is, in the event of severe pandemic influenza with high morbidity, the public may be advised to self-quarantine. Therefore, current guidance notes that families should be prepared to "shelter-in-place" for up to twelve weeks, and maintain sufficient food and water supplies to accommodate that entire period.

Just as in the United States, U.S. government employees and their families overseas have primary responsibility for maintaining adequate supplies of food to shelter-in-place. This also applies to private U.S. citizens . For the long term, families are advised to store foods that are non-perishable, do not require refrigeration, or preparation (including the use of water), or cooking. The cable also advises that families should store one gallon of water per person per day.

Potable Water

Please note that at this time, Hong Kong's water supply is potable. In the event of complete infrastructure breakdown, water supply that is currently potable in some areas or countries may not remain so. However, water can be purified in several ways. Boiling is a reliable method for killing microbes and parasites. Bring water to a rolling boil and continue boiling for at least ten minutes. Also, regular Clorox Bleach isn't just a laundry-aid, it's a lifesaver (use only regular Clorox bleach, not Fresh Scent or Lemon Fresh). In an emergency, one gallon of Regular Clorox Bleach purifies 3,800 gallons of drinking water. First, let water stand until particles settle. Filter the particles if necessary with layers of cloth, coffee filters, or fine paper towels. Pour the clear water into an uncontaminated container and add Regular Clorox Bleach per the below indicated ratio, mix well, and wait 30 minutes. Water should have a slight bleach odor.

Ratio of Clorox Bleach to Water for Purification:

2 drops of Regular Clorox Bleach per quart of water
8 drops of Regular Clorox Bleach per gallon of water
1/2 teaspoon Regular Clorox Bleach per five gallons of water If water is cloudy, double the recommended dosages of Clorox Bleach.

To insure that Clorox Bleach is at its full strength, rotate or replace your storage bottle every three months. Also, don't forget to sanitize the water storage containers. To sanitize containers and utensils, mix one tablespoon of Regular Clorox Bleach with one gallon of water, creating a Sanitizing Solution. Always wash and rinse the items first, then let each item soak in Clorox Bleach Sanitizing Solution for two minutes. Drain and air dry.

Please remember that water in dehumidifiers is also potable, but be sure to sanitize the dehumidifier water container.

Emergency Supply List

The U.S. Government's "one-stop" web site on avian influenza, www.PandemicFlu.gov, provides a sample list of foodstuffs and other emergency supplies for stocking:

Examples of food and non-perishables:

Ready-to-eat canned meats, fish, fruits, vegetables, beans and soups Protein or fruit bars Dry cereal or granola Peanut butter or nuts Dried fruit Crackers Canned juices Bottled water Canned or jarred baby food and formula Pet food

Examples of medical, health and emergency supplies:

Prescribed medical supplies such as glucose and blood-pressure monitoring equipment Soap and/or alcohol-based (60% - 95%) hand wash Medicines for fever, such as acetaminophen or ibuprofen Thermometer Anti-diarrhea medication Vitamins Fluids with electrolytes Cleansing agents Flashlight Batteries Portable radio Manual can opener Garbage bags Tissues, toilet paper

To better help plan for "shelter-in-place", all U.S. citizens are encouraged to refer to the www.PandemicFlu.gov website, as well as the World Health Organization website ( www.who.int/en/). Please also visit the U.S. Consulate General website for further information: Avian Flu.

We will continue to distribute and share pertinent information on Influenza Pandemic Preparedness as we receive it.

http://hongkong.usconsulate.gov/ci_avian_2006110301.html

What was the source of the Kent Nickell material? Is this direct from a government source or is it paraphrasing? It is exactly the kind of advice that needs to be followed by anyone who is concerned about a pandemic or other event that disrupts the normal supply chain.

I would recommend 6 months of supplies, not 3 and certainly not 2 weeks. Would this cause a panic if "the government" issue such advice? Doubtful, but the blog community would piss themselves for reasons I don't quite comprehend.

This whole pandemic topic has a certain surreal nature to it, reminiscent of the civil defense arguments in the Cold War. As I see it, you need to personally get ready to ride out the Big One hoping it never comes to that. The prepared stand a good chance of living and the unprepared have a far worse outlook. That I think is what upsets many people, a pandemic is going to suck even if it's relatively mild and there will be a lot of preventable deaths without the right plans and material in place ahead of time. Unfortunately, the plans and material will probably never be adequate if adminstered by government at any level, it has to be done by the individual to be successful. In my opinion of course.

It will take a 1960's moonshot effort to get enough "stuff" in place to maintain the populace for the 3-12 months it takes for a true pandemic to run it's course, I don't see that kind of commitment from Democrat or Republican officals.

Thanks Stu, I agree that the preparation needed esp on an international level is massive (Dr. Nabarro has been at a tough job)

My suppositions are largely based on these 2 articles...

I thought this was an interesting article re Taiwan ordering human H5N1 vaccine apparently against the new Fujian-like strain. WHO is recommending against stockpiling vaccine because there seems to be little cross reactivity between different strains of the virus but these are difficult decisions for national authorities. It would be interesting to know more about any international level of quality control over these vaccines. If things deteriorate we will probably see a number of 'rogue' vaccines.

CDC places order for H5N1 vaccine

STAFF WRITER, WITH CNA
Friday, Nov 03, 2006

The Center for Disease Control (CDC) has ordered 190,000 doses of avian influenza vaccine to enhance the nation's flu-fighting capability amid renewed pandemic warnings, a senior official said yesterday.
According to CDC Deputy Director Chou Chih-hao (周志浩), the government decided to procure the vaccine from two foreign suppliers after a new resistant strain of the highly pathogenic H5N1 virus deadly to humans and poultry was found to have spread through Asia.

Chou quoted a report by scientists in Hong Kong and the US as saying that the new virus -- dubbed the "Fujian-like" strain -- may have mutated in response to vaccination programs designed to halt the disease in farm flocks.

Noting that the strain emerged last year and has already spread throughout China as well as to Hong Kong, Thailand, Laos and Malaysia, the report said that the spread of this virus over such a large geographical region within a short period of time directly challenges current disease control measures.

Against this backdrop, Chou said the CDC has spent nearly NT$60 million (US$1.81 million) purchasing 190,000 doses of the vaccine against the H5N1 virus from two foreign companies.

The vaccine is 70 percent to 80 percent effective and has a shelf life of between six months and two years, Chou said.

Nevertheless, Chou added that although the vaccine has been proven safe and effective in preventing avian influenza in humans in initial clinical tests, it has not yet been approved for commercial sale.

Therefore, Chou said, the vaccine will be stockpiled for emergency epidemic control use or domestic clinical testing.

"Basically, only frontline medical and epidemic control personnel will get vaccinated," Chou said, adding that the vaccine will not be available to members of the public.

According to the procurement contracts, Chou said, the vaccine will be delivered by the end of this year.

"The vaccine will be ready for use if an avian flu outbreak occurs this winter," he said.

If each medical professional gets two doses of the vaccine, Chou said, the stockpile will be enough to cover 90,000 individuals, or one-third of the country's health care personnel.

Moreover, Chou said, the CDC has also kept in stock enough doses of Tamiflu -- an oral anti-viral drug for treatment of influenza -- for 2.3 million people, or 10 percent of the nation's population in accordance with the recommendation of the WHO.

http://www.taipeitimes.com/News/taiwan/archives/2006/11/03/2003334581

and

This pdf seems to be a good description of where we're at on a number of H5N1 issues. It talks about the vaccine problem as well as problems with diagnostic tests and a number of other issues. A few of the things I found most interesting...

-Domestic ducks and geese, and not chickens, have been identified as the true vectors of disease transmission in poutry.
-Enhancement is needed in international collaboration in the surveillance of wild birds and in the sharing of data from such surveillance efforts.
-Agreed that governments should not rush to place orders for pre-pandemic vaccines when so many fundamental scientific questions are still outstanding
-Mallard ducks are now regarded as the 'champion' vectors; mute swans are highly susceptible birds that are thought to serve as sentinels, but probably not vectors of virus transmission
-Studies show that cat-to-cat transmission can occur in both domestic cats and tigers
-From 1997-2002, most virus shedding in ducks occurred via faeces. More recently, however, most virus shedding has occurred via the respiratory tract; this route of virus shedding does, however, continue to cause contamination of water sources used by the birds.

Influenza research at the human and animal interface
Report of a WHO working group

Geneva, Switzerland, 21-22 September 2006

WHO/CDS/EPR/GIP/2006.3

- English [pdf 98kb] http://www.who.int/csr/resources/publications/influenza/WHO_CDS_EPR_GIP…

Contents

- Introduction
- Executive summary
- Detection and diagnosis of human H5N1 infections
- Protecting humans: vaccines and antiviral drugs
- Surveillance in birds and other animals: assessing the coming risks
- Deciphering the virulence and pathogenicity of H5N1 infections in humans
- List of participants