With everyone on tenterhooks over the confusing outbreak of human bird flu cases in Pakistan and the first reported case in Burma (aka Myanmar), WHO is taking the opportunity to give its member nations a pep talk about swift reporting. Since there is evidence the reporting might not have been so terribly swift in that case, one must assume they consider this a "teachable moment" rather than an exemplar:
The World Health Organisation (WHO) on Sunday praised Asian countries for swiftly reporting the latest bird flu cases after Pakistan and Myanmar were hit by a resurgence of the disease.Asia-Pacific spokesman Peter Cordingley said prompt notification was helping keep the virus in check after Pakistan announced its first human death and Myanmar revealed its first human case.
"People have learned that hiding cases just makes things worse," Cordingley told AFP [Agence France Presse].
This month China, which has previously been accused of withholding information, reported its 27th bird flu death and Indonesia, the worst hit country, reached 93.
Outbreaks have also been reported among poultry in Germany and Russia as bird flu, which has killed more than 200 people worldwide since late 2003, re-emerges. (Agency France Presse)
Getting countries to report promptly will remain a struggle. There are lots of reasons for delay, many of them specific to particular geographic regions, political realities and functioning infrastructure. In the Pakistan and Myanmar cases things could have been much worse but they could also have been better. Maybe it wouldn't have made a difference but the principle is clear and WHO is trying to punch it home. WHO has had its own credibility problems, of course. Maybe this is a good time to give them a pep talk, too. More transparency, please.
But there is a curious coda to the WHO news story (a story WHO clearly wanted told, so we assume they also want this part told, too). Cordingly observes that flu season was upon us, that birds got the flu, too, even before humans, and because of wild bird migration and human caused poultry movement (legal and illegal) bird flu will continue to spread unless ... unless what?
"This virus will continue. We cannot fight it on a public health front, it depends on how farmyards and chickens are raised and that is a long-term fight," he said.
What's the take home lesson here? What does it mean to say we "cannot fight it on the public health front"? Vaccines for humans and poultry are surely weapons on the public health front. More importantly, however, public health and social service systems are the public health front. I would think an essential message here would be that along with trying to stop a pandemic emerging from the current panzootic of avian influenza, an effort that is likely to fall short, we should be preparing for the consequences of a pandemic.
That means turning our attention to the global, national and local public health front. Or am I missing something?
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Does anyone remember the swine flu problem, in which public health officials were blamed for causing a panic, since the swine flu did not spread as expected, and some people died after receiving the vaccine? Therefore please do not expect public health officials to risk being blamed for again causing a panic, by providing adequate information regarding what is really happening with bird flu. This is called CYA (cover your ass). They will inform you of the arrival of a pandemic long after it has arrived.
If you want to really know when it arrives, just watch the obituary column in your local newspaper. In 1918 the column grew very long. In just one week in Philadelphia, 6000 people died of Spanish Flu.
The WHO doctors going to Pakistan should be admired for their bravery. They are risking their lives. But one reporter in Pakistan stated the poultry industry is so powerful, it will shut down any attempt by the government to inform the world of what is happening in regard to the spread of bird flu through human to human contact, because it would devaste the poultry industry and harm the tourism industry.
WHO should have already declared Stage 4 for bird flu, since there is now evidence of increased human to human transmission. There are already almost 40 reported human clusters in the world. And more may be reported soon.
But no government officials in countries where there are large numbers of human clusters will allow this to happen, due to the negative economic consequences.
Therefore, please do not expect to be informed as to what is really happening in Pakistan, and keep reading the local obituary columns.
Revere, You are right! Think about the popular document called Ten things you need to know about pandemic influenza (http://www.who.int/csr/disease/influenza/pandemic10things/en/index.html). As you know this document is dated 14 October 2005.
In my opinion, after two years, this document needs an update for two main reasons (with your experience maybe you could find other dozens of good reasons):
1. Data and Statistics are old and deserve to be updated
In 2005 WHO started a process that is in progress.
2. Countries at central and local level are working on pandemic preparedness, in most cases with a low perception of the issue coming from health workers themselves. The world needs a signal of leadership.
I also think that people like you and all the guys you mentioned in the post called Pakistan: the waiting game (I would like to consider myself in that group) have to do some pressure on WHO asking them to simply do their work: lead in advocacy.
"This virus will continue. We cannot fight it on a public health front, it depends on how farmyards and chickens are raised and that is a long-term fight,"
What does he really mean here? The virus will continue. True. until it has infected every corner of the planet and eventually, every human and bird. Does 'fight it' mean 'stop it from spreading' Then, right again, public health measures may slow the spread and, at best, keep a 'pandemic' from happening. I don't really see the effort and planning necessary to achieve this actually happening, but it is a way of 'fighting' on the public health front. In the long-term, our relationship to animals is the issue--probably too late to do anything about H5N1 (or any of the other 30 or so new diseases that have already 'emerged' from this pathological relationship in the last 30 years). So right again.
But what is the conclusion to draw here? What is he suggesting we do? Not bother with the 'public health front'? Reform our animal production system? (great, but it won't stop H5N1)
Pakistan, a human cluster in a remote, low-intensity war zone, an ungovernable (but not uncommunicated) area, a very powerful national poultry lobby, an authoritarian central government--formula for disaster.
Correction: There were 600 deaths in Philadelphia in one week during the Spanish Flu pandemic, not 6000.
Sorry
Ciao, Daniel: Just saw your excellent site the other day. My Italian is not very good although I could read it a bit. Keep up the good work. This is a global effort. At least in Italy you have one of the world's best public health systems, unlike the US. Maybe someday we will catch up.
H5N1 avian flu: Spread by drinking water into small clusters:
Human to human and contact transmission of influenza occur - but are overvalued immense. In the course of Influenza epidemics in Germany recognized clusters are rarely (9% of the cases in the season 2005).
In temperate climates the lethal H5N1 avian flu virus will be transferred to humans strong seasonal in the cold via cold drinking water, as with the birds feb/mar 2006.
Recent research must worry: So far the virus had to reach the bronchi and the lungs in order to infect humans. Now it infects the upper respiratory system (mucous membranes of the throat e.g. when drinking and mucous membranes of the nose and probably also the conjunctiva of the eyes as well as the eardrum e.g. at showering). In a few cases (Viet Nam, Thailand) stomach and intestine by the H5N1 virus were stricken but not the bronchi and the lungs. The virus might been orally taken up, e.g. when drinking contaminated water.
The performance to eliminate viruses of the drinking water processing plants in Germany regularly does not meet the requirements of the WHO and the USA/USEPA. Conventional disinfection procedures are poor, because microorganisms in the water are not in suspension, but embedded in particles. Even ground water used for drinking water is not free from viruses.
In temperate climates the strong seasonal waterborne infections like norovirus, rotavirus, salmonellae, campylobacter and - differing from the usual dogma - influenza are mainly triggered by drinking water dependent on the drinking water temperature (in Germany minimum feb/mar � maximum august). There is no evidence that influenza primary is transmitted by saliva droplets. In temperate climates the strong interdependence between influenza infections and environmental temperatures can�t be explained with the primary biotic transmission by saliva droplets from human to human with temperatures of 37.5�C. There must be an abiotic vehicle like cold drinking water. There is no other appropriate abiotic vehicle. In Germany about 98% of inhabitants have a central public water supply with older and better protected water. Therefore in Germany cold water is decisive to virulence of viruses.
In hot climates/tropics the flood-related influenza is typical after extreme weather and natural after floods. Virulence of Influenza virus depends on temperature and time. If young and fresh H5N1 contaminated water from low local wells, cisterns, tanks, rain barrels or rice fields is used for water supply water temperature for infection may be higher as in temperate climates.
Dipl.-Ing. Wilfried Soddemann
eMail soddemann-aachen@t-online.de
http://www.dugi-ev.de/information.html
Epidemiological Analysis:
http://www.dugi-ev.de/TW_INFEKTIONEN_H5N1_20071019.pdf
This nearly got lost. At least five times, this evening:
"...we should be preparing for the consequences of a pandemic."
Agreed, Revere. Just the same as we initially agreed, in the very beginning -- and in the first observed, and clearly recognized manifestation -- of this peculiar phenomenon. This is what is left to us. And it is not as though there was ever anything else that we could ever do, here, to begin with. As collectively myopic as we obviously are.
We simply did not possess the capacity -- ever -- to insist upon establishing "the ground rules." We had no idea what they might be, to begin with. We had no "will," and we had no true appreciation of the real dangers, here. And we still don't. And that was glaringly evident, from the very beginning.
And the time is growing short.
we should be preparing for the consequences of a pandemic.
That means turning our attention to the global, national and local public health front. Or am I missing something?
I don't think you are missing something, I think you are correct! In this age of instant viral transplant via jumbo jet or ocean cargo vessel steps need to be thought out and taken and refined upon.
Dave Briggs :~)
Assuming that the news reports from WHO are correct, and that the most recent cases in Pakistan actually did occur in November (never mind that little issue of reports of people being hospitalized this last Saturday), I have a real problem calling the reporting of a disease four weeks later as "prompt". This is especially so when there are concurrent statements about Pakistan's poultry industry trying to hush any reporting of infections. "Prompt" reporting like this could allow the virus to go around the world several times. I'm just glad that SARS was reported even more promptly. AnnieRN