Pandemic preparedness
revere | January 29, 2008Since the antiviral agent oseltamivir (Tamiflu) has been touted as the global savior should a bird flu pandemic materialize the idea has been haunted by the specter of Tamiflu resistance. What if H5N1 becomes resistant to the drug? Is all lost? Now it is being reported in the media that the European Centre for Disease Control and Prevention has found that the predominant circulating seasonal flu virus in Europe this year, H1N1, is showing an unexpectedly high rate of Tamiflu resistance (19/148 isolates tested). This is much more than what has been seen in the past and was from patients not…
revere | January 27, 2008There's no vaccine for the influenza subtype, H5N1, of most concern as the agent of the next pandemic but evidence exists that there is some cross-reactivity with existing seasonal vaccines (it's not clear how much if any, but it might not take much) or that previous vaccination with seasonal vaccine produces a much quicker response to an H5N1 vaccine. Moreover there remains a substantial toll in morbidity and mortality from the seasonal influenza which the current vaccines are designed for. So strategies to encourage key populations to get the existing flu vaccine are of interest to public…
revere | January 24, 2008Predictable as clockwork, no sooner does the Director General of the World Organization for Animal Health (OIE), M. Bernard Vallat tell us that things are looking up for bird flu then we have a massive outbreak threatening to devastate the poultry industry of India. So the poultry problem is neither stable nor under control, whatever M. Vallat says (and I daresay he probably regrets saying it). The Indian problem is a big deal, with reports of villagers eating birds that died of the virus and violent resistance to culling efforts. Clearly India was unprepared for this poultry outbreak,…
revere | January 23, 2008In 2006 there were 115 confirmed cases (WHO case count) of H5N1 in humans with 79 deaths. In 2007 the figures are 86 cases and 59 deaths. Some have taken this as evidence H5N1 is less of a problem (latest data here). That's not how I read it, however. Seasonal flu numbers bounce around from year to year, too, and if this year is better than last year it isn't because flu is disappearing. Still, let's take a look at the numbers a little more closely and see where the differences are. Here's the WHO Table:
21 January 2008
Country
2003
2004
2005
2006
2007
2008
Total
cases
deaths…
revere | January 21, 2008A report late last night by Helen Branswell alerted me to a tabulation from a new tracking system WHO is putting into place to answer demands from a number of member states in the developing world that there be more transparency in how isolates of avian influenza (bird flu) submitted to WHO are used and by whom. About a third of confirmed cases have been registered in Indonesia, although that country has provided less than a quarter of the isolates, a reflection of the refusal by the country's health minister, Dr. Siti Fadilah Supari, to provide any more specimens until matters of vaccine…
revere | January 21, 2008We've complained enough about the unwise words of M. Vallat, Director General of the World Organization for Animal Health (OIE; see here and here). Nor was it the first time (May 2007).
What I didn't say was that whenever I hear an official like M. Vallat assure us that everything is stable, a chill runs down my spine. Invariably shortly afterward things start to come apart. These folks have an uncanny sense of timing. So now we have bird flu in Iran again for the first time since 2006 and the virus is marching relentlessly across India (things have gotten messy with culling teams attacked…
revere | January 17, 2008When we complained the other day about World Organization for Animal Health (OIE) Director General Bernard Vallat's ill-considered remarks about how stable H5N1 was and that earlier fears were "overblown" we were not alone. Mike Osterholm at CIDRAP issued a similar remonstrance and the latter was publicized by the folks at Avian Flu Trackers on a press release that was picked up by a number of papers. Now DG Vallat is busy trying to extricate his foot from his mouth (or wherever he lodged it):
At an informal meeting with the press on 10/1/08 , the Director General of the OIE, Dr Bernard…
revere | January 15, 2008Most of us read the Federal Government pandemic flu plan as having two components: the first is procurement of vaccines and antivirals for stockpiles and sale to states at a discount; the second is to leave everything to the locals. The American Civil Liberties Union (ACLU) sees it differently and they may well be right. They see the federal pandemic flu plan as containing a covert but not subtle command and control law enforcement core. Whatever you think of the ACLU (and I confess to be ambivalent because they caved in to McCarthyite enemies of civil liberties in the 1950s; they have since…
revere | January 13, 2008I'm not sure who Professor David Alexander, the Robert Gordon University in Aberdeen, Scotland is (he's identified as an adviser to NAOA and the UK Government on pandemic flu) but I think he's got it right:
The public would put themselves at risk because they would not trust politicians to tell the truth if the country was hit by a major outbreak of bird flu, a world expert on disaster management has claimed.
Professor David Alexander, of the Robert Gordon University in Aberdeen, has been appointed as an adviser to both Nato and the UK Government on the issue of pandemic flu.
Alexander says…
revere | January 11, 2008An AP report in The Daily Star (Egypt) says the head of the World Organization for Animal Health (OIE) is complaining that fears of a flu pandemic caused by H5N1 are overblown. He's talking to the press so presumably he understands that he has to be careful how he says things. So we also have to assume that when Bernard Vallat said that he meant to send a message. But what is the message?
Vallat said the H5N1 virus has proved extremely stable, despite concerns that it could mutate into a form that could spread easily among humans.
"We have never seen such a stable strain," Vallat said.
He…
revere | January 10, 2008Whenever confirmed human cases of bird flu appear in an area there usually follows heightened sensitivity to new cases of severe pneumonia. Are they bird flu too? Severe pneumonia is pretty common, so you can't automatically assume that "if it quacks like a duck and walks like a duck it must be a duck." It turns out there are a lot of birds that look like ducks that aren't ducks, at least when it comes to influenza-like illnesses. On the other hand, "testing negative" with PCR, which on its own is a pretty sensitive and specific test is also not foolproof. "On its own" means under the best…
revere | January 6, 2008The big newswires and health agencies are relatively quiet, but word keeps leaking out of Egypt that there are a lot of suspect bird flu cases:
CAIRO: Hospitals nationwide reportedly quarantined more human cases suspected of being infected with the H5N1 bird flu virus.
According to Al-Masry Al-Youm newspaper, Damietta -- where the latest Bird Flu victim Hanem Atwa Ibrahim, 50, died late on Monday Dec. 31 in a Cairo hospital -- hosts the largest number of cases with five people suspected of carrying the virus, while the Upper Egyptian city of Qena came next, with two cases, followed by El-…
revere | January 4, 2008With the turn of the calendar there is always both hope and anxiety about the year ahead. This is nice because it gives pundits and bloggers something to write about. Just before Christmas The Times of London published\ a "leading article" (unsigned), Black Swans and Bird Flu, which was about the anxiety part, assessing the threats, and planning for them in advance:
Living at risk, it has been said, is akin to jumping off the cliff and building your wings on the way down. Not everyone would be content with such a strategy. Some would not venture close to the edge, even if that meant missing a…
revere | December 31, 2007Everyone seems to have an opinion about whether bird flu will be the next terrible global pandemic. In current parlance "bird flu" means human infection with the highly pathogenic avian influenza/A subtype H5N1. There is no doubt that this is the 800 pound gorilla in the global health room at the moment, but not because it is more likely to become a pandemic (NB: pandemic by definition is a globally dispersed sudden increase in infection among humans; the same situation for animals is called a panzootic, and it is plausible to say we have an H5N1 panzootic for birds now). On the basis of…
revere | December 28, 2007Former Pakistani Prime Minister Benazir Bhutto, despite a bevy of bodyguards, was assassinated yesterday. Pakistan is a dangerous place, especially for pro-American politicians or those thought to be pro-Western officials. It's something to think about when you read that WHO and the US reference laboratory NAMRU-3 each sent teams to the politically unstable and hostile-to-the-West northern regions of Pakistan to gather information about the recent cluster of bird flu cases. WHO's team was in Peshawar, north of Islamabad. Here's what Middle East expert Juan Cole said about Peshawar the other…
revere | December 27, 2007Bird flu is still flu and one expects an uptick of cases during "flu season" which usually gets underway in earnest in December. So from that perspective it isn't a surprise that December has seen human fatalities from bird flu in six countries: Pakistan, China, Vietnam, Egypt, Burma and, of course, Indonesia. Once the Pakistani cases are officially confirmed and added to the December tally for this flu season it will make it the worst December yet, but we shouldn't read too much into this. Flu seasons are notoriously variable and the numbers bounce around a lot from year to year. But . . .…
revere | December 26, 2007The Toronto Sun has another one of the "such and such a city/state/country isn't prepared for a pandemic" stories. The judgment comes from the 2007 Auditor General of Ontario's annual report. Yawn. Like it's so easy to know what to do, right? Maybe not. So the Report has some recommendations:
The report says the ministry "does not have assurance that all members of the health system knew what to do in planning for and during a pandemic."
As a result, the report lists recommendations that would serve to help prepare Ontario for such a catastrophic flu bug. The recommendations include, among…
revere | December 22, 2007WHO [World Health Organization] is now saying that human to human (H2H) transmission has not been ruled out in China or Pakistan:
China:
The World Health Organization said Friday it was impossible to say whether a case of bird flu in China involving a 52- year-old man was due to human-to-human transmission - but, even if it was, it was down to very close contact between the victims.
The Assistant Director-General for Health Security at WHO, Dr David Heymann, said the only proven transmission of this nature so far, in Indonesia and Thailand, had been as a result of very 'close contact' in a '…
revere | December 21, 2007It's been less than a week since the first reports out of Pakistan that cases of bird flu were appearing there. At the time we warned that the coming of flu season meant these kinds of reports were to be expected, but by the weekend concern increased as a family cluster appeared. As common in the early days of an outbreak news reports were contradictory and confusing. We elected to wait. By Sunday, some excellent reporting by Helen Branswell and diligent combing of the news by flusites allowed us to make a preliminary summary. We fully expected more surprises.
The biggest surprise so far is…
revere | December 19, 2007We have occasion to comment often here about how the same bird flu story is spun different ways. A case in point is reporting on statements made by the head of Indonesia's National Avian Influenza Committee, Bayu Krisnamurthi and the two different directions Agence France Presse and Reuters took the story.
Here's AFP:
Indonesian bird flu officials said Tuesday they were investigating several recent avian influenza deaths where the victims were believed to have not come into contact with infected poultry.
"In the last three to four months, we have had four cases where the poultry in the…