bird flu
revere | July 4, 2006A new fatality from H5N1 infection in Indonesia has been confirmed by the WHO reference lab in Hong Kong. So what's new? Nothing in particular except it gives me an opportunity to point out something that has been bothering me about how health officials are characterizing the risk of getting infected from this virus. First the report (via Reuters):
The victim died on 16 Jun 2006 in Tulungagung in East Java province after being admitted to hospital on 8 Jun 2006, I Nyoman Kandun, director general for communicable disease control at the health ministry, told Reuters. The infection was confirmed…
revere | July 3, 2006The suspicion that China is not as open about disease outbreaks within its borders was not helped last week when a Research Correspondence in The New England Journal of Medicine from eight Chinese scientists reporting an early case of H5N1 infection was the subject of mysterious emails to the journal's editors asking it be withdrawn (see here and here). The source of the emails has not been established and the authors say they stand by their results. The whole affair was (or should be) an embarrassment to the Chinese authorities.
The major problem in China, however, has not been the Health…
revere | July 1, 2006Influenza is a seasonal disease. Some seasons are worse than others. In some locations they can be even more deadly than 1918 pandemic influenza (see post here). What characteristic, then, distinguishes a pandemic outbreak from "regular" seasonal influenza if it is not severity?
Severity is, on average, a characteristic of pandemic strain outbreaks because it involves a virus to which the general population has no or little previous immunity. There is another feature of pandemic outbreaks of importance: age distribution. Limited but fairly reliable evidence indicates that pandemic outbreaks…
revere | June 30, 2006The momentum is building to release the sequestered flu sequence data. The prestigious scientific journal Nature today published a strongly worded editorial, excerpts of which you can read Nature senior correspondent Declan Butler's blog:
Indonesia has become the hot spot of avian flu, with the virus spreading quickly in animal populations, and human cases occurring more often there than elsewhere. Yet from 51 reported human cases so far -- 39 of them fatal -- the genetic sequence of only one flu virus strain has been deposited in GenBank, the publicly accessible database for such information…
revere | June 30, 2006The question has been broached here before by our commenters: if a pandemic is a threat to our civil infrastructure, how do we know the internet will continue to function? It's fine to tell workers to telecommute, but what if the information highway the commuters travel is grid locked?
Good questions without good answers. But information technology professionals are at least thinking about it. The IT trade mag, Computer World, has a story about a simulation held recently at the world Economic Forum by management consulting firm Booz Allen Hamilton. The scenario was pandemic flu arriving in…
revere | June 27, 2006One of the knocks on the alarms about bird flu is that it is just another in a series of false alarms like Y2K, West Nile and SARS. Not true. Pandemic influenza is indeed another in a series of alarms, but the only one that might conceivably be considered a false alarm (and this isn't even sure) is Y2K. Let's take them one at a time.
The investment in fixing the Y2K bug was substantial on the part of business and government world wide, extending over several years prior to 2000. It is difficult to say what the results might have been without that investment. In many respects it is similar to…
revere | June 27, 2006The first half of 2006 is coming to an end. So far it was the world's worst for avian influenza, as the disease spread to birds across Asia, Europe and Africa, with new human cases being reported every couple of days.Since January, at least 54 people have died from the H5N1 avian influenza strain in Azerbaijan, Cambodia, China, Djibouti, Egypt, Indonesia, Iraq and Turkey, according to the World Health Organization. That compares with 19 fatalities in Vietnam and Cambodia in the first six months of 2005. Human cases create opportunity for the virus to mutate into a lethal pandemic form.
[snip…
revere | June 27, 2006The fact seven people in Azerbaijan contracted bird flu from wild birds has been assumed for some time and now has been officially confirmed by researchers in Germany:
Four people have died after catching avian flu from infected swans, in the first confirmed cases of the disease being passed from wild birds, scientists have revealed.
The victims, from a village in Azerbaijan, are believed to have caught the lethal H5N1 virus earlier this year when they plucked the feathers from dead birds to sell for pillows. Three other people were infected by the swans but survived.
Andreas Gilsdorf, an…
revere | June 26, 2006Mount Sinai School of Medicine has just entered into "a territory limited license agreement with Avimex Animal Health" to produce a new biological that combines an H5 flu vaccine combined with portion of another important disease virus for commercial poultry, Newcastle Disease.The privately owned world-leader in the avian influenza H5 emulsified vaccine market will use Mount Sinai's patented live recombinant Newcastle disease technology that contains an insertion of the H5 gene, for use in Brazil, India, Japan, Mexico, and Taiwan.
Inventors, Peter Palese, PhD, Chairman and Professor,…
revere | June 25, 2006The war in Iraq is going down as history's most dangerous for journalists. War correspondents have some idea what they are getting into, however. Reporters covering local funerals of bird flu victims and poultry culling operations are usually general beat reporters and didn't sign up for ultra hazardous duty. Now the Indonesian press corps is starting to worry.
''I really feel strongly that the issue of health and safety of reporters covering avian flu must be addressed by the management of news organizations,'' said Daenk Haryono of the North Sumatra-based 'Harian Global' daily.
''Many…
revere | June 24, 2006Helen Branswell, whose sources and reporting are the best, has a fascinating follow-up to the Chinese report in the New England Journal of Medicine the other day giving clinical details of a human case of bird flu in China that occurred a full two years before China officially reported any cases and a month prior to any reports in the current outbreak, thought to have started in Vietnam in late 2003.
Shortly before the paper was officially published in the Correspondence section of the journal but after it had gone out to subscribers by First Class mail, the editors received multiple…
revere | June 23, 2006Indonesia registered its 51st official case and 39th death this week, a 13 year Jakarta boy who had helped his grandfather slaughter sick chickens, took sick a week later and was dead less than a week after that. There's more discouraging news from this benighted bird flu hotspot.
The Indonesian Ministry of Health says the people in the village where the large family cluster with human to human transmission have refused to be tested or have their chickens tested. WHO has been saying repeatedly that there is no evidence of infection beyond blood relations in this cluster (Jakarta Post). If…
revere | June 22, 2006The latest chapter in the Chinese Disease Cover-up Follies involves a just published report in the New England Journal of Medicine by eight Chinese doctors reporting the genetic sequences of an H5N1 case that occurred in November of 2003. Old news. Except China didn't officially report its first case until two years later, November 2005. Just as the first issues of the journal were reaching NEJM's subscribers, were notified that one or more of the authors wished to withdraw the paper. Too bad. Too late.
Meanwhile, the World Health Organization is expressing shock at the reporting lapse and…
revere | June 22, 2006The Center for Infectious Disease Research and Policy (CIDRAP) is a resource for all manner of information on infectious diseases and especially avian influenza. At their website one can find a technical overview which compiles a lot of bird flu information scattered over many sources. But it is a technical overview (although not overly specialized). Some of the entries may not be self evident even to physicians. We've selected one example because it interests us and we think it might interest others. It's just a couple of sentences but will seem counterintuitive to many.
Laboratory tests do…
revere | June 21, 2006I once read the restaurant industry in the US (and probably elsewhere) is one of the highest mortality businesses around. About half of new restaurants don't make it through the first year. It is a tough business, long hours, low wages for most. Immigrant labor is common.
Some restaurants do very well for their owners, but most don't. The industry is always looking over its shoulder at the next problem and their are many. In the US, immigration reform, paying (or trying to avoid paying) health insurance for workers, fending off legislative attempts to force them to pay even half a living…
revere | June 21, 2006Old soldiers -- and young ones, too -- do die, but if there's a flu pandemic with a lot of absenteeism in the workforce, the VA has plans to let them just fade away. Or something like that.Families of veterans who die during a bird flu outbreak shouldn't count on burying their loved ones in any of the 120 national cemeteries. The Department of Veterans Affairs foresees closing the military graveyards in a pandemic because of staffing problems.
The VA buries more than 250 veterans and eligible family members a day -- about 93,000 a year. Itoperates cemeteries in 39 states and Puerto Rico.…
revere | June 20, 2006There is currently no vaccine for a pandemic strain of H5N1 avian influenza, and if a pandemic strain does emerge it will take at least 6 months to get the first batches of one. Currently the productive capacity for influenza vaccines is so overmatched by the needs of a global population, only a tiny fraction of those that will need it could be immunized.
The current experimental (and relatively ineffectual) vaccines for H5N1 are not for a pandemic strain but for a strain current in southeast asia that is still poorly transmissible from person to person. It is thought an easily transmissible…
revere | June 20, 2006As you read this a meeting of more than three dozen avian flu experts should be convening in Jakarta to discuss the disastrous state of public health in that country. Many poor countries have disastrous public health systems, but Indonesia has something else: a huge population of people living in close contact with a huge population of poultry infected with an influenza A subtype (the H5N1 subtype) that has crossed the bird/human species line. Influenza A is a major killer of human beings worldwide, but the global population has substantial (at least partial) immunity to the circulating…
revere | June 19, 2006One of the distinctive things about influenza outbreaks in humans is its seasonality. That's why we call "ordinary" influenza seasonal influenza. Interestingly, we don't know what controls that seasonality, nor do we know if it also is a factor in pandemic strains. Pandemic strains are different in many ways and perhaps seasonality will be one of them. The second wave of 1918 started in August.
The question is even muddier when it comes to avian influenza, as WHO is acknowledging.
"We do know that the bird flu virus can survive for a time in colder weather, but it's really not clear at this…
revere | June 18, 2006An interesting article, The effect of temperature and UV light on infectivity of avian influenza virus (H5N1, Thai field strain) in chicken fecal manure, has appeared in Southeast Asian J Trop Med Public Health(2006 Jan;37(1):102-5). I can only read the abstract as no library around here carries this journal.
The authors took normal chicken fecal manure (pH 8.23 and 13.7% moisture) divided into three portions, each inoculated with a Thai field strain of H5N1 highly pathogenic avian influenza virus at high dose. They incubated the first portion at 25o C (that's 77 o F. for the Celsius…