Public health preparedness
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…
revere | December 17, 2007With 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-…
revere | December 16, 2007If I knew for sure what was going on with the reported human bird flu outbreak in Pakistan's northwest border region I'd tell you. At this point it appears no one knows for sure -- not WHO, not CDC, not even the Pakistani authorities. The region where the cases are reported is near the Afghan border and is not under firm government control. The unsettled political situation merely adds to the usual confusion inevitable in the early days of any outbreak. We are all looking for a pandemic signal embedded in a lot of noise, difficult enough, but we don't even know what the signal sounds or looks…
revere | December 15, 2007As noted yesterday, it's flu season. That includes bird flu. So we are seeing cases pop up. Yet another in Indonesia and the father-son cases in China. Then reports out of Pakistan of the first human cases on the Indian sub-continent. Those case are as yet unconfirmed. Now WHO is confirming cases in Burma (aka Myanmar), the first in that military dictatorship not known for being open about what goes on there:
The World Health Organisation (WHO) announced Myanmar's first human case of bird flu, the victim a seven-year-old girl who survived the disease.
The girl, from the northeastern Shan…
revere | December 14, 2007China tries to close the door on a possible H2H while Pakistan opens the door to human bird flu cases on the Indian sub-continent. First China. Two recent cases, a fatal case of a 24 year old male followed after a period of some days by the infection of his father raised the issue whether the son passed the H5N1 infection to the father. No one wants this to be the case and the Chinese, who are hosting the summer Olympics in Beijing have a lot at stake. The spin on this, though, is incomprehensible:
China's health authorities said here on Monday that no human-to-human transmission had been…
revere | December 12, 2007The dramatic infectious agents like MRSA, Ebola and bird flu get the headlines but there are a lot of others out there, some of them capable of being just as nasty. Consider the new variant of adenovirus serotype 14, for example:
Infectious-disease expert David N. Gilbert was making rounds at the Providence Portland Medical Center in Oregon in April when he realized that an unusual number of patients, including young, vigorous adults, were being hit by a frightening pneumonia.
"What was so striking was to see patients who were otherwise healthy be just devastated," Gilbert said. Within a day…
revere | December 10, 2007The debate about how much wild migratory birds contribute to the spread of highly pathogenic influenza/A H5N1 goes on. According to a sensible Commentary in Nature (Dec. 6) it needn't. We should have taken steps some time ago to answer an answerable question. But we didn't and still haven't initiated those steps:
Two years ago, some believed that H5N1 viruses were poised to spread around the globe on the wings of migrating wild birds. A massive effort was mounted to track their movement but, as of September 2007, very few positive birds have been found in tests of over 300,000 healthy wild…
revere | December 6, 2007As an (unplanned) follow-up to today's morning post about public health use of the internet we have tonight's event in Second Life, a chance to meet and chat with wiki partner DemFromCT:
Our next installment of the Virtually Speaking interview series takes place TONIGHT, Thursday, at 6pm Pacific/9 pm Eastern.
We are very excited that DemFromCT can join us to talk about public health policy, in particular preparedness for a pandemic. He and I have been trading comments on some skepticism I have about this, so this is going to be an especially interesting discussion.
All skeptics are welcome…
revere | December 5, 2007Most people in the developed world think of measles as a pesky but fairly benign childhood disease. For the current generation, who has had the benefit of immunization with measles vaccine, it is also a historical curiosity. Not so for the developing world, where measles has been a major killer of children and infants. Africa has become the poster child for failed public health programs so it is nice to be able to say that when it comes to measles prevention, Africa is a special success story:
Africa, which has long had the most measles deaths, has seen the biggest drop, 91 percent. In many…
revere | December 5, 2007Indonesian Health Minister, Siti Fadilah Supari, has reiterated her refusal to share isolates of H5N1 virus (it's unclear if this is her decision alone or is the considered decision of the Indonesian government). This came at the current inter-minsterial conference on bird flu on underway in Delhi (how many of these conferences are there, anyway? It seems like every week there's another one.) Her demand is that every isolate have a Material Transfer Agreement (MTA) requiring a statement each time the isolate is shared with another laboratory, stating it is only for diagnostic purposes and not…
revere | December 3, 2007I'm traveling so I'll let other bloggers do the heavy lifting. And I can always count on flu bloggers of note, Crof and SophiaZoe. Both discuss and link to reports of H5N1 in refrigerated turkey meat sold in stores in Poland (I particularly recommend SZ's excellent summary of the safety issues). While I don't have a lot to add to their coverage, I'd like to inject just one more issue related to finding the virus in meat
An ongoing debate is the relative contributions of migratory (wild) birds and domestic poultry to spreading H5N1 geographically. There is evidence for both mechanisms, and…
revere | November 29, 2007Nonpharmaceutical interventions (NPIs) are in the news again. Yesterday was the dust up over Howard Markel and colleagues' JAMA article from last August that appeared in CIDRAP News calling into question some of the historical data on the effectiveness of isolation and quarantine and now it's an article in British Medical Journal that purports to show that some kinds of physical interventions like masks, gowns and handwashing might be better bets than vaccines and antivirals should a pandemic come our way:
Face masks and regular hand-washing are more likely to halt the spread of a deadly flu…
revere | November 28, 2007A Commentary by John Barry (author of The Great Influenza) in CIDRAP News and accompanying meta-commentary by CIDRAP Director Mike Osterholm highlight an interesting controversy about a JAMA article by Michigan's Howard Markel and colleagues. Markel's article was a detailed compilation of public health responses to the 1918 influenza pandemic in 43 cities in the US with the aim of telling whether any was associated with better community outcomes. The Markel paper bore the following conclusion:
These findings demonstrate a strong association between early, sustained, and layered application of…
revere | November 26, 2007Indonesia's health minister, Siti Fadilah Supari, has answered the question whether the recently concluded Geneva summit on sharing of influenza viruses had produced sufficient agreement to induce that country to begin sharing again. Her answer seems to be "no":
Indonesia's health minister reiterated Sunday that she would not send bird flu specimens to the World Health Organization, saying poor nations needed assurances that any pandemic vaccines developed from the virus would be affordable.
Siti Fadilah Supari made the comments on her return from Geneva, where the WHO held an…
revere | November 24, 2007As you will see from the account below the fold, the flu summit was a contentious and complicated affair. Only time will tell if it was even a qualified success, but there are reasons to be hopeful. Tip of the hat to Ed Hammond, one of the NGO participants, who provided the public health community with his perspective at a time when no one else was talking. This involved late hours for him at the end of long days. We are grateful.
Here's his wrap-up:
Influenza Meeting Ends in Qualified Success
At the end of contentious meetings like the one on policies for sharing flu virus it is tempting to…