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Jack's posts with tag: pandemic
 Confirmation of Sustained H5N1 Transmission in Pakistan
Recombinomics Commentary 2:14
December 28, 2007
Citing information from Pakistan's health ministry, John Rainford, a WHO spokesman in Geneva, identified the man as a 25-year-old from the Peshawar area who became ill on Nov 21, was hospitalized Nov 23, and died Nov 28.
"He is the third of four brothers who developed proven or suspected pneumonia with illness onset dates between 29 October and 21 November," Rainford told CIDRAP News. "The brothers provided care for one another and had close personal contact in both the home and hospital."
According to previous reports, the family group was among eight people in Pakistan's North-West Frontier province, near the Afghan border, who were previously diagnosed with avian flu on the basis of preliminary tests in Pakistan. The eight included four brothers and a cousin from the same family, plus three other people. Another brother also had a flu-like illness but died without being tested.
The other patients who tested positive have been described as a man and his niece who were involved in poultry culling, plus a male farm worker.
Although the WHO Pakistan situation update did not contain the critical dates, the above CIDRAP report provides some of the key information to demonstrate sustained human-to-human (H2H) transmission through multiple generations in Pakistan. The above information indicates the index case developed symptoms October 29. Media reports indicate the first fatality died November 19, suggesting his disease onset was well into November. The second fatality developed symptoms November 21, providing an H2H2H transmission chain of index case to first fatality to second fatality. However, there were two other brothers and cousin with symptoms, so the chain may have additional internal links. The above description does not include the two health care workers, who are still questionable.
In addition to the large cluster, the small cluster of a man and his niece may represent another H2H cluster. The above discussion does not include their disease onset dates.
Thus, the above large cluster appears to be represent the most sustained H2H H5N1 transmission chain reported to date, but the sample handling is nothing short of an major disaster. The samples from most of the cases, which were positive cases based on clinical and epidemiological data, have not been lab confirmed by NAMRU-3 or Mill Hill due to sample collection after the start of Tamiflu treatment, sample degradation due multiple tests involving freeze / thaws, packaging and shipping issues, coupled with reporting delays and a lack of transparency.
These false negatives and lack of transparency continue to increase pandemic concerns.
 Bird Flu Spreads Among Humans - WHO
New Vision (Kampala)
NEWS
21 October 2007
Posted to the web 22 October 2007
By Hilary Bainemigisha
Kampala
THE H5N1 strain of bird flu has finally managed to spread from person to person, according to officials of the World Health Organisation (WHO).
Until now, it was spread from birds to humans. They warned that if the bird flu virus mutated to easily spread between humans, it could spark a global pandemic, killing millions.
According to a new study of deaths in Indonesia last year, bird flu could have spread between humans on several occasions. Person to person infection was suspected but could not be confirmed.
In the village of Sumatran, seven family members contracted the H5N1 strain of bird flu, one of the biggest clusters in the world. They died before being tested.
In Thailand, when a mother was hospitalised with avian influenza, her daughter, who lived away from bird-rearing contracted the virus when she came to visit her in hospital.
The Fred Hutchinson Cancer Research Centre in Seattle, US also examined a second family cluster outbreak in Turkey last year, but did not have the evidence to confirm or refute human-to-human transmission.
The researchers have for the first time proved that the virus has spread between a "cluster" of people.
Indonesia, with 84 bird flu deaths, the highest toll in the world, has tried to downplay fears of the spread.
The head of research at the Indonesian health ministry, Triono Soendono, said the findings were "just one" piece of research.
But the WHO assistant director for communicable diseases, David Heymann, said it was likely the Sumatran virus was spread by human-to-human contact.
"We believe there has likely been transmission through intimate or close contact," he said.
Dr. Sam Okware, the commissioner, community health, who is also the chairman of the National Task Force on the disease, said it was sad news.
"But we are also improving capacity and training for surveillance to handle it every day. The laboratory at the Virus Research Institute is ready," he affirmed.
Dr. Chris Rutebarika, the assistant commissioner for disease control in the Ministry of Agriculture, urged Ugandans not get so worried about the developments.
"Considering the magnitude of researched data, the human-to-human spread is still academic and not worrying." Rutebarika said the taskforce was getting ready and had just concluded four simulation studies in Jinja, Mbale, Arua and Kasese districts.
He added that the public was being sensitised and a compensation policy had been drafted. "We are at a better stage than last year. We just lack money and training."
 Overuse of Tamiflu could give rise to resistant flu strain
AFP, PARIS
Thursday, Oct 04, 2007, Page 6 Swedish scientists say that Tamiflu -- the frontline weapon in the eventuality of a bird-flu pandemic -- cannot be broken down by sewage systems and this could help the virus mutate dangerously into a drug-resistant strain. Countries around the world are stockpiling Tamiflu in the belief it will help curb any future outbreak of H5N1 avian flu among humans. Tamiflu, whose lab name is oseltamivir, is not a cure for flu but can ease its symptoms, thus aiding vulnerable patients such as the elderly and reduce the time of illness, thus easing the burden on caregivers. Scientists led by Jerker Fick, a chemist at Umea University, tested the survivability of the Tamiflu molecule in water drawn from three phases in a typical sewage system. The first was raw sewage water; the second was water that had been filtered and treated with chemicals; the third was water from "activated sludge," in which microbes are used to digest waste material. Tamiflu's active ingredient survived all three processes, which means that it was released in the wastewater leaving the plant. The finding is important because of the risk that Tamiflu, if overprescribed, could end up in the wild in concentrations high enough to let H5N1 adapt to this crucial drug, the authors said. Flu viruses are common among waterfowl, especially dabbling ducks such as mallards which often forage for food near sewage outlets. "The biggest threat is that resistance will become common among low pathogenic influenza viruses carried by wild ducks," said co-author Bjoern Olsen, professor of infectious diseases at the University of Uppsala and University of Kalmar. These avian viruses could then recombine with ordinary human flu viruses, creating new strains that are resistant to Tamiflu, he said. "Antiviral medicines such as Tamiflu must be used with care and only when the medical situation justifies it," Olsen warned. "Otherwise, there is a risk that they will be ineffective when most needed, such as during the next influenza pandemic," he said. The study, published online yesterday by the open-access Public Library of Sciences, pointed the finger at Japan. It quoted figures from Swiss maker Roche, which estimated that in the 2004 to 2005 influenza season, 16 million Japanese fell ill with flu, of whom 6 million received Tamiflu. At such dosages, the amount of Tamiflu released into the Japanese environment is roughly equivalent to what is predicted in areas where the drug would be widely used in a pandemic. Coincidentally, "Japan also has a high rate of emerging resistance to Tamiflu," the paper said. A 2004 study published in The Lancet found that among a small group of infected Japanese children, 18 percent had a mutated form of the virus that made these patients between 300 and 100,000 times more resistant to Tamiflu.
http://www.taipeitimes.com/News/world/archives/2007/10/04/2003381649
 Bird flu virus mutating into human-friendly formThu Oct 4, 2007 8:00pm EDT By Maggie Fox, Health and Science Editor NEW YORK, Oct 4 (Reuters) - The H5N1 bird flu virus has mutated to infect people more easily, although it still has not transformed into a pandemic strain, researchers said on Thursday. The changes are worrying, said Dr. Yoshihiro Kawaoka of the University of Wisconsin-Madison. "We have identified a specific change that could make bird flu grow in the upper respiratory tract of humans," said Kawaoka, who led the study. "The viruses that are circulating in Africa and Europe are the ones closest to becoming a human virus," Kawaoka said. Recent samples of virus taken from birds in Africa and Europe all carry the mutation, Kawaoka and colleagues report in the Public Library of Science journal PLoS Pathogens. "I don't like to scare the public, because they cannot do very much. But at the same time it is important to the scientific community to understand what is happening," Kawaoka said in a telephone interview. The H5N1 avian flu virus, which mostly infects birds, has since 2003 infected 329 people in 12 countries, killing 201 of them. It very rarely passes from one person to another, but if it acquires the ability to do so easily, it likely will cause a global epidemic. All flu viruses evolve constantly and scientists have some ideas about what mutations are needed to change a virus from one that infects birds easily to one more comfortable in humans. Birds usually have a body temperature of 41 degrees Celsius (106 degrees F), and humans are 37 degrees C (98.6 degrees F) usually. The human nose and throat, where flu viruses usually enter, is usually around 33 degrees C (91.4 degrees F). "So usually the bird flu doesn't grow well in the nose or throat of humans," Kawaoka said. This particular mutation allows H5N1 to live well in the cooler temperatures of the human upper respiratory tract. H5N1 caused its first mass die-off among wild waterfowl in 2005 at Qinghai Lake in central China, where hundreds of thousands of migratory birds congregate. That strain of the virus was carried across Asia to Africa and Europe by migrating birds. Its descendants carry the mutation, Kawaoka said. "So the viruses circulating in Europe and Africa, they all have this mutation. So they are the ones that are closer to human-like flu," Kawaoka said. Luckily, they do not carry other mutations, he said. "Clearly there are more mutations that are needed. We don't know how many mutations are needed for them to become pandemic strains."
Say you're infected with a highly drug-resistant form of a deadly contagious disease. Should you get on an international flight with a few hundred other people in the enclosed space of a plane, potentially infecting them? Even if physicians who have tested you recommend against such travel? Well sure, why not -- if the doctors didn't explicitly forbid you from traveling, or legally compel you not to travel, how bad can it be? Aside from coughing up blood and having your tissue necrotize to the consistency of soft, white cheese until you die, it's not such a big deal. An as-yet unidentified Georgia man with dual Russian-American citizenship was diagnosed with tuberculosis in early May, and healthRome, and things got a little more serious. officials advised him not to fly. But he'd already arranged for a wedding and honeymoon in Europe, so he went anyway. Then the Centers for Disease Control contacted him while he was in To recap, the gentleman in question flew from Atlanta to Paris on May 12 aboard Air France. From there he went to Greece for his wedding, and then the CDC found him in Rome and informed him that not only was he infected with tuberculosis, but a particularly nasty strain of tuberculosis. Again he was urged not to fly, and again, he ignored the warnings:I thought to myself: You're nuts. I wasn't going to do that. They told me I had been put on the no-fly list and my passport was flagged, The man reasoned that though he could care less about infecting other people, he wasn't so foolish as to allow himself to be treated by Italian doctors. They're crazy! But he began to worry about the CDC stopping him at the airport, so he and his new wife hatched a daring, complex plan -- they flew from Prague to Montreal via Czech Air on May 24, then drove across the border into the United States. No problems! Tuberculosis Man called the CDC, and they promptly flew him back to Atlanta and put him under the first federal quarantine since 1963. Astoundingly, T-Man finds this inappropriately demeaning: I'm a very well-educated, successful, intelligent person. This is insane to me that I have an armed guard outside my door when I've cooperated with everything other than the whole solitary-confinement-in-Italy thing. He's simply too high-class for quarantine, you hear? Even his deadly pathogens are well-educated, successful, and intelligent. Looks like he'll be spending some time in a Denver isolation chamber to contemplate his unfair lot in life. Maybe somebody else he infected will get the next cell over. CDC quarantines air passenger with deadly tuberculosis strain [AP]
Man With Rare TB: I Sneaked Back Into U.S. [CBS] -- Chris Mohney
Thu Dec 28, 2006 at 06:29:34 AM PSTIf
you don't write about a problem, does it go away? Whether it's global
warming, Afghanistan or H5N1 the answer is no. The headline is from Bloomberg:
Bird flu killed three members of a family in Egypt, pushing the
number of fatalities worldwide this year to 79, more than reported in
the previous three years combined...
"In the second half of 2006, there was a steep decline in the number
of case reports, although similar declines occurred in 2004 and 2005,
but were then followed by resurgences," the influenza team at the
European Centre for Disease Surveillance and Control in Stockholm wrote
in a Dec. 21 report in Eurosurveillance Weekly
Females are over-represented among H5N1 patients aged 10-29 years,
possibly because it is usually young people and women who look after
domestic poultry, the influenza team said.
``Human-to-human transmission, as indicated by cluster size, is
still extremely inefficient, as it was a decade ago when the first
human-to-human transmission took place in Hong Kong..."
The total number of infected is 261 worldwide, with the virus
killing 157 as of today (a case fatality rate of 60%. In comparison,
the devastating Spanish Flu of 1918 had a 2.5% CFR). So what's the big
deal about a few hundred overseas cases? As John Oxford put it while reviewing Michael Greger's book on the topic:
However, the book fails to confront the question I am asked daily:
"Why are you so worried about 151 deaths from H5N1?" Well, go back to
1916, to Etaples in northern France, where a form of flu causing heliotrope cyanosis
(a characteristic lavender coloration of the face) with a case fatality
of 60% was beginning to spread. There were 145 cases. At some point in
the next two years it mutated to become more infectious and 30 times
less virulent. Then it killed 50 million people. Doesn't this ring a
nasty bell?
So are we doomed? Of course not. H5N1 may never become the pandemic
strain (or it may), but some other influenza A inevitably will
(pandemics happens about three times every century), with varying
effects - just like category 5 hurricanes). The point of keeping up
with the news is to remain aware, so that policy decisions that stray
into the political realm become more understandable. And policy will be
made.
For example, this is a previous diary on policy decisions being considered:
Okay, so it's Science Friday, but what's that got to do with politics? Well, if your local school board has to consider the ramifications of closing the schools for 8-12 weeks, shouldn't you be involved in the process? I'd think as a parent or as an employer you'd want to be. Expect
a policy announcement in January from the Feds on the topic of NPIs and
community mitigation. Stay educated so you're in a position to be part
of the process at the local level, where it counts. And recognoze that
this isn't just an issue for specialty sites like Flu Wiki. This is an issue for all of us.
Why would folks want to close the schools? Because St. Louis did in 1918, and Philadelphia didn't. See slide from .pdf presentation by Ben Schwartz (HHS):
 In fact, school closings are at the top of the pack of non-pharmaceutical interventions to discuss. So while old and tired comments about Rumsfeld and Tamiflu are still made, the discussion has moved beyond that.
Policy is coming down the pike. it will involve you and your
community. The schools may be used to teach parents and kids about
potential school closures and how to do modest preps and planning to
function during that time frame, which could last weeks. None of that
is accidental, and none of it is in a vacuum. So, the reason to stay
abreast of the news is to understand that preparation needs to be done
in advance of a pandemic, and not during. Like hurricane, blizzard and
other disaster prep, it is insurance for that which we hope never
happens, but sometimes does.
You can always learn more here. And knowledge is power, not hype.
LA Woman Hospitalized With Bubonic PlagueApr 18 9:15 PM US/Eastern By ALICIA CHANG AP Science Writer LOS ANGELES A woman was hospitalized earlier this month with bubonic plague, the first confirmed human case in Los Angeles County in more than two decades, health officials said Tuesday. The woman, who was not identified, was admitted April 13 with a fever, swollen lymph nodes and other symptoms. A blood test confirmed she had contracted the bacterial disease. The woman was placed on antibiotics and is in stable condition, officials said. Bubonic plague is not contagious, but if left untreated it can morph into pneumonic plague, which can be spread from person to person. Bubonic plague is usually transmitted to humans from the bites of fleas infected by dead rodents. Health officials suspect the woman was exposed to fleas in her central Los Angeles home, said Dr. Jonathan Fielding, the county's director of public health. The woman's family was also placed on antibiotics as a precaution, but there's no evidence they were infected. The case is unusual because it occurred in an urban area, Fielding said. Most bubonic plague outbreaks happen in rural communities. Health officials said there was no cause for panic because the disease is not easily transmissible. "There's no cause for alarm in the community," Fielding said. Health officials went to the woman's home Monday to trap squirrels and other wild animals. Blood samples from the animals will be sent to a lab to determine if any are infected. An estimated 10 to 20 Americans contract plague each year, mostly in rural communities. About one in seven cases is fatal, according to federal statistics. The last human cases of plague in Los Angeles County occurred in 1984 when three people contracted the disease. Two of those cases were travel-related and the third involved a person exposed to a sick animal. All three survived. Bubonic plague, also known as the Black Death, killed an estimated 25 million people in Europe between 1346 and 1351. The last major urban outbreak in the U.S. occurred in Los Angeles in 1924-25, when at least 30 people died. In California, bubonic plague is prevalent among squirrels in the Angeles National Forest and other parks. Health officials regularly warn campers and hikers to take precaution against the disease by avoiding infected animals. The plague is considered a bioterrorism agent and state law requires that doctors report suspected cases to local health departments.
 Link: http://www.pandemicflu.gov/One stop access to U.S. Government avian and pandemic flu information. Managed by the Department of Health and Human Services. 
Possible Path to Humans for Avian Flu Found
March 16, 2006
By Sara Goudarzi
LiveScience Staff Writer
New mutations in parts of the avian flu virus might provide a possible
route for the virus to enter the human population. But scientists
cautioned there was no cause for alarm.
Looking at a sample of the H5N1 virus isolated from a Vietnamese boy
who died from the bird flu in 2004, researchers found a type of
mutation that could provide a possible "foothold" for the virus in the
human population.
The findings are detailed in the March 16 issue of the journal Science.
The H5N1 strain of the flu virus is, for the moment, specific to birds
and not humans. However, much like the deadly 1918 Spanish flu, H5N1
could cross species, infect many and potentially reach pandemic
proportions.
In order for the virus to jump from birds to humans, the protein on the
virus has to change so that it can bind itself to human cells and find
a new home.
Scripps Research Institute researcher Ian Wilson and colleagues
wondered: If they put two mutations onto the H5N1 virus similar to the
1918 version, could it enter humans? It could not.
Wilson and colleagues then imposed the mutations that likely happened
to the 1968, Hong Kong flu strain onto the current avian flu virus.
"We got some binding to the human lung cell, but it wasn't dramatic,"
Wilson told LiveScience.
This suggests a possible route for the virus to enter human cells. But
scientists advise that the news is not all that grim.
"If it happens, it's something to be concerned about. But, there has
not been any changes like it yet, and hasn't been for several years,"
Wilson said.
http://www.livescience.com/humanbiology/060316_flu_morph.html
A Look at What Could Happen at Home, Work, School and in Your Community
By ADRIENNE MAND LEWIN
March 12, 2006 — - We've all heard the doomsday
scenarios of what could happen if an avian flu pandemic takes a grip on
the United States: millions dead, millions more sick, basic utilities
and services unavailable, hospitals overrun and unable to cope,
communities reduced to devastation like something out of Stephen King's
"The Stand."
What's known is human-to-human transmission of bird flu is
inevitable as H5N1, a type of bird-flu virus, mutates. "It's going to
happen," said Dr. Joseph Agris, a Houston physician. "It's no question.
It's just a question of when."
But what will actually occur in your life if there is a
pandemic? Will you go to work? Will your kids stay home from school?
How will your community services work if employees are sick? Is your
local hospital prepared to deal with the influx of people who fall ill?
First of all, the virus may not be as intense in human cases in
the United States as it has been elsewhere in the world because the flu
in general tends to weaken as it reaches North America, said Agris, CEO
of the Agris-Zindler Children's Foundation, which makes medical trips
around the world to care for children.
"Right now what I'm seeing seems scary," he said, "but I think
it's going to be less of a problem by the time it gets here than what
is anticipated."
That doesn't mean, however, that an outbreak would be easy.
"Even if you take the smallest number possible -- 1 percent of the
sickest portion of the U.S. population getting the disease -- that's a
million and a half people who'll either get sick or die," he added.
Even facing this threat, it is important to keep a sense of
control, said David Ropeik, who teaches risk communication at the
Harvard School of Public Health and who co-wrote "Risk: A Practical
Guide for Deciding What's Really Safe and What's Really Dangerous in
the World Around You."
"The risk you can't do anything about feels scarier than the
one you can," Ropeik said. "Washing your hands a lot, sneezing into
your elbow, knowing that avoiding crowded places if there's a flu
epidemic of any kind, those are applicable. ... They're emotionally
reassuring in the face of some new threat. New threats are always
scarier than ones we've lived with for a while. It's just their
newness."
Getting Things Ready at Home
Best-case scenario: People abide by imposed quarantines, work from
home if possible and ride out the course of the virus with minimal
health problems.
Worst-case scenario: People are forced to stay home but fail to
stock the necessary food and supplies and venture back out, catching
bird flu and infecting their families.
According to health experts, there are basic steps that everyone should
take to stay healthy, and they are the same as what you'd do to avoid
any flu: Wash your hands often, don't shake hands with others, cover
your mouth when coughing or sneezing, avoid crowds.
At the same time, you should stock up on essential items in
case you get stuck at home for extended periods because of your own
illness or quarantines.
"I think every person should have a little stockpile of food
and water, a little bit like the air-raid shelters in the Cold War,"
said Arthur Caplan, director of the Center for Bioethics at the
University of Pennsylvania. "The No. 1 strategy in protecting yourself
from avian flu is to minimize contact with others."
Agris agreed, saying people should "stock up on a certain
amount of basics -- dried foods, pastas, extra canned goods, bottled
water -- a small amount of that will go a long way."
Caplan said people should also have a supply of high-quality
HEPA, or high efficiency particulate air filter, masks and "a lot of
soap -- you have to wash your hands."
For more information on how you and your family can prepare, click here.
Businesses Brace for 'Global Blizzard'
Best-case scenario: People work from home when possible and business
gets done while children and sick family members are cared for.
Worst-case scenario: Mildly symptomatic people go to work on mass
transit, infecting other commuters and co-workers, which only
intensifies the spread of bird flu. Businesses are crippled by mass
illness and supply-chain disruptions. The nation's food supply is
compromised.
Make no mistake: Dragging yourself to work with even a few flulike
symptoms could be devastating to those who commute with you and work
beside you. Experts said employers will have to cope with absences
because of illness, the need of their employees to care for others, and
their reluctance to ride mass transit. They also should put policies in
place to prevent the spread of the virus at work.
Dr. Eric Toner, senior associate at the Center for Biosecurity
at the University of Pittsburgh Medical Center, said that in addition
to figuring out who could telecommute and how businesses could function
on a reduced staff, companies should provide masks, cancel meetings and
increase "social distance" to reduce transmission from person to
person. They'll also need to reconsider sick leave policies.
"It's important not to have sick people coming to work," Toner
said. "That's the worst thing possible. But what if people exceed their
available sick time? For businesses that have contact with the public
and their employees get sick, is that covered under workers
compensation?"
Michael Osterholm, director of the Center for Infectious
Disease Research and Policy at the University of Minnesota, hosted a
recent national summit for businesses on planning for pandemic flu. The
discussion has begun, he said, but there's a long way to go for
companies, as their response will help determine how the virus spreads.
"We have to look at this as a 12- to 18-month global blizzard,"
Osterholm said. "What companies are now beginning to realize is, even
if they have business preparedness and continuity plans for other
disasters, none of them have really been planned for addressing a
pandemic."
Economic impact will be severe, he said. "Unfortunately, they
understand today that they live in a global, just-in-time economy that
has basically no surge capacity," Osterholm said, adding, "Part of that
is due to the fact that much of planning depends on things beyond the
organization -- outsourced supply chains, transportation, utilities,
any number of things like that."
Osterholm noted that 80 percent of all drugs in the country use
raw ingredients that come from offshore, which will be hard to come by
in a global pandemic. "Every country will be in it," he said.
"Everything will be in really short supply at a pandemic and needed
around the world."
Regarding employees' health, telecommuting is an option for
some jobs but far from for all. "For many industries, you can't
telecommute. You can't make steel or grow food at home," he said. "The
second thing is, no one really knows for certain the actual capacity of
the Internet system today if everybody were to use it for primary
[communication]."
Agris said it will be important not to shut down the nation's
transportation, or cities will not be able to get critical supplies.
"You need to keep transportation open and keep those people healthy who
handle the warehouses," he said.
For more information on how businesses can prepare, click here.
Will Hospitals Help or Hinder?
Best-case scenario: Well-prepared hospitals have a stockpile of
masks, gowns and gloves, as well as staff trained to manage an influx
of patients and set priorities for the neediest cases, which will help
keep the virus from spreading.
Worst-case scenario: Hospitals lack basic supplies and end up
spreading the infection from unsanitary conditions rather than treating
the sick.
The health care system's response to a pandemic will be crucial to how
it plays out, experts said. But what happens if doctors and nurses
panic and don't want to jeopardize their own health by treating others?
"Pay close attention to what happens to health care workers,"
Caplan said. "Get them in to work. They have to feel as safe as
possible. ... I'm very worried that since we've turned health care so
much into a business, people will say, 'I'm just an employee. I'm not
going to put myself at special risk.'"
And assuming they do come in to work, how many hospitals will be ready
for mass illness? Toner said it would be tough to organize.
"Very few hospitals, if any, are well-prepared," Toner said.
"No hospitals have adequate supplies of basic items to last through a
pandemic. Nobody in modern business, particularly hospitals, have
stockpiles of anything anymore because we have this just-in-time supply
chain."
And that could prove to be deadly. "Hospitals not only will be
unable to protect their staff and patients, they likely will become
major amplifiers of the epidemic because the sick people will infect
other people," he said. "If the pandemic is like 1918 or worse, which
is possible, people won't be able to stay at home. This will be a life
and death decision."
What about those who are uninsured or in the country illegally?
Caplan said the health care industry must figure out who will pay to
treat the sick.
"Insurance companies, managed care companies, HMOs -- they have to make
it clear that they're going to pull out the rules and people can get
what they need, including illegal aliens," he said. "If we do have a
pandemic, have an emphasis on getting to the doctor, not having people
worried they're going to be deported."
For more information on how health care providers can prepare, click here.
Will Uncle Sam Help?
Best-case scenario: The federal government, already preparing,
clearly communicates an action plan for a bird-flu pandemic. Local
governments reach out to residents to provide resources, keep order and
ensure calm prevails.
Worst-case scenario: Communities cannot provide essential services due to extensive employee illnesses, panic ensues.
Despite extensive preparations being made by the federal government in
vaccine supplies and public education, there likely won't be much for
it to do if a pandemic strikes.
"Once the pandemic starts, very little can be expected from the
government," Toner said. "This is not meant to be critical of the
government, but there's only so much that the government can do, and it
can't do it in 5,000 communities at one time."
Perhaps its most important role will be providing information, Caplan
said. "I think from the point of view of the government, they need to
have some very clear and transparent rules in place so that the public
understands what's going on," he said. "If they have to restrict your
movement, if they have to quarantine people, why it's going on, that
it's not permanent but will last a few weeks."
Caplan said such things as imposing a quarantine and
determining how to ration masks would be difficult. "People are
skeptical, too," he said. "because they watched the response to Katrina
and they're not sure they can trust the authorities."
For more information on how communities can prepare, click here.
School's Out -- For a While, at Least
Best-case scenario: Schools shut down for extended periods of time,
saving the lives of many children, teachers and staff who could be
infected in close quarters.
Worst-case scenario: Schools stay open, parents who must work send their children to school, hastening the spread of infection.
Experts said it is very likely that schools and day care centers will
be shut down as soon as a pandemic begins. "They're incubators for
infection," Caplan said.
But Toner said he is skeptical that it will be completely
effective. "I'm not sure that it's the right thing to do, if for no
other reason than a few weeks is not enough," he said.
But if you don't send kids to school, what are you going to do
with them? "Most parents can't stay home to take care of kids," he
said, "and if they do, they can't go to work. Most people need to work.
Day care is worse. There are not any great options, but I think the
school systems will decide to close."
For more information on how schools can prepare, click here.
Take a Deep Breath
In preparing for a bird-flu pandemic, two things are certain: Knowledge
is good, panic is bad. But the more we know, the more frightened we
tend to get, which doesn't help in the panic area.
"The more aware we are of a risk, the more afraid we are," said
Ropeik, the risk expert. "Awareness will be up, and so will our worry,
with the first bird in North America, and then just magnify that a
zillionfold with the first human case in North America or the United
States. And magnify that a zillionfold when word breaks out anywhere in
the world should the mutation happen that allows it to become human to
human."
Not to say bird flu is not scary -- it just may not be as bad
as we expect. "The two factors, newness and awareness, are
characteristics of risk that make them seem scarier," he said. "Now
sometimes they really are scarier and sometimes they aren't, but the
fear bells will be hit with those -- people will go to hospitals a lot
more, rush to doctors for any kind of vaccine, the price of Tamiflu on
eBay will go sky high and people's stress levels will rise."
And worrying, he said, can only make everything worse. "Stress
suppresses your immune system," he said, "so the more worried you are
about getting sick, the more likely it is that you will, or that your
sickness will be worse or possibly fatal because your worry is making
it harder for your immune system to protect itself."
His advice? Be prepared, but also be calm.
"Stay informed and try to keep things in perspective," he said, "so you don't stress out about any risk."
 Bird flu 'causes first dog death'
A stray dog has died of bird flu in the Caspian nation of Azerbaijan, health officials have said - thought to be the first time the virus has killed a dog.
Azerbaijan reported its first three human deaths from bird flu on Monday.
The World Health Organization has yet to confirm bird flu caused the human deaths, but said the US Navy lab that carried out the tests was reliable.
The deaths of the three young Azeri women would take the WHO total for human deaths from bird flu to 101.
There have been no confirmed cases of one person passing the virus to another. Most people who have contracted it are thought to have been in close contact with domestic poultry.
But scientists fear the virus could mutate into a form that can pass from person to person.
Germany has reported at least three cat deaths from bird flu, which has been spreading from South-East Asia since 2003.
Quarantine
The deadly H5N1 strain of the virus was discovered in migratory bird flocks in Azerbaijan last month.
The government has taken measures to quarantine the two regions where the women died, with entry and exit to their villages being controlled.
Cars were being disinfected and domestic poultry was being confined, Reuters news agency reported.
The dog that died was found in the capital Baku on 9 March, health officials said.
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/europe/4811284.stm
There Are "About Even Odds" That Virus Could Mutate to Easily Transmitted Form, He Tells 'World News Tonight'
By JIM AVILA and MEREDITH RAMSEY
March 14, 2006 — - Dr. Robert Webster is one of the
few bird flu experts confident enough to answer the key question: Will
the avian flu switch from a terrible hazard to birds to become a real
threat to humans? There are "about even odds at this time for
the virus to learn how to transmit human to human," he told ABC's
"World News Tonight." Webster, the Rosemary Thomas Chair at St. Jude
Children's Research Hospital in Memphis, Tenn., is credited with being
the first scientist to find the link between human flu and bird flu.
Webster and his team of sceintists are working to find a way to beat
the virus if it morphs. He has even been dubbed the "Flu Hunter."
Right now, H5N1 is strictly a bird flu. It can be transmitted from bird
to human, but only by direct contact with the droppings and excretions
of birds.
But viruses mutate, and the big fear among the world's scientists is
that the bird virus will join the human flu virus, change its genetic
code and emerge as a new and deadly flu that can spread airborne from
human to human.
"I personally believe it will happen and make personal preparations," Webster said.
Frightening Warning
He has even stored a three-month supply of food and water at his home to prepare for an outbreak.
"Society just can't accept the idea that 50 percent of the population
could die. And I think we have to face that possibility," Webster said.
"I'm sorry if I'm making people a little frightened, but I feel it's my
role."
Most scientists won't put it that bluntly, but many acknowledge that
Webster could be right about the flu becoming transmissible among
humans -- even though they believe the 50 percent figure could be too
high.
Researcher Dr. Anne Moscon, of New York Weill Cornell Medical Center,
said that a human form may not mutate this year or next -- or ever --
but it would be foolish to ignore the dire consequences if it did.
"If bird flu becomes not bird flu but mutates into a form that can be
transmitted between humans, we could then have a spread like wildfire
across the globe," Moscona said.
No one knows how long or how many mutation changes it would take for bird flu to become a direct threat to humans.
"It may not do it. There may just be too many changes. The virus may not be able to be a human virus," Moscona said.
But that hasn't stopped Moscona from searching for new types of
anti-viral treatments that both prevent and slow the spread of bird
flu.
"I don't think that once we have human-to-human transmission, it's going to be possible to contain it," she said.
That is why nearly every viral scientist in America, perhaps the world,
is waiting and watching the avian flu virus to see if it remains just a
threat to birds, or changes its genetic code and becomes just as deadly
to humans.
Officials Advise Stocking Up on Provisions -- and Warn That Infected Birds Cannot Be Prevented From Flying In
By BRIAN ROSS
March 13, 2006 — - In a remarkable speech over the
weekend, Secretary of Health and Human Services Michael Leavitt
recommended that Americans start storing canned tuna and powdered milk
under their beds as the prospect of a deadly bird flu outbreak
approaches the United States.
Ready or not, here it comes.
It is being spread much faster than first predicted from one wild flock
of birds to another, an airborne delivery system that no government can
stop.
"There's no way you can protect the United States by building a big
cage around it and preventing wild birds from flying in and out," U.S.
Secretary of Agriculture Michael Johanns said.
U.S. spy satellites are tracking the infected flocks, which started in
Asia and are now heading north to Siberia and Alaska, where they will
soon mingle with flocks from the North American flyways.
"What we're watching in real time is evolution," said Laurie Garrett, a
senior fellow for global health at the Council on Foreign Relations.
"And it's a biological process, and it is, by definition,
unpredictable."
Industry Precautions
America's poultry farms could become ground zero as infected flocks fly over. The industry says it is prepared for quick action.
"All the birds involved in it would be destroyed, and the area would be
isolated and quarantined," said Richard Lobb of the National Chicken
Council. "It would very much [look] like a sort of military operation
if it came to that."
Extraordinary precautions are already being taken at the huge chicken
farms in Lancaster County, Pa., the site of the last great outbreak of
a similar bird flu 20 years ago.
Other than the farmers, everyone there has to dress as if it were a visit to a hospital operating room.
"Back in 1983-1984, we had to kill 17 million birds at a cost of $60
million," said Dr. Sherrill Davison, a veterinary medicine expert at
the University of Pennsylvania.
Can It Be Stopped?
Even on a model farm, ABC News saw a pond just outside the protected barns attracting wild geese.
It is the droppings of infected waterfowl that carry the virus.
The bird flu virus, to date, is still not easily transmitted to humans.
There have been lots of dead birds on three continents, but so far
fewer than 100 reported human deaths.
But should that change, the spread could be rapid.
ABC News has obtained a mathematical projection prepared by federal
scientists based on an initial outbreak on an East Coast chicken farm
in which humans are infected. Within three months, with no vaccine,
almost half of the country would have the flu.
That, of course, is a worst-case scenario -- one that Lobb says the
poultry industry is determined to prevent with an aggressive strategy
to contain and destroy infected flocks and deny the virus the
opportunity to mutate to a more dangerous form but one that experts say
cannot be completely discounted.
The current bird flu strain has been around for at least 10 years and
has taken surprising twists and turns -- not the least of which is that
it's now showing up in cats in Europe, where officials are advising
owners to bring their cats inside. It's advice that might soon have to
be considered here.
by DemFromCT
Iraq is not an easy place to get anything done. Some Iraqi farmers are letting their birds loose rather than
slaughter them and the lack of a proper shipping container has kept the
tissue sample of a man suspected of dying of bird flu sitting in
Baghdad despite reports it was being tested abroad.
Poor communications, scarce equipment and the dangers of the insurgency are all plaguing efforts to combat bird flu in Iraq.
Meanwhile Nigeria is reporting H5N1 in at least 3 different states. The presence of H5N1 in Africa is so worrisome that the WHO took the unusual step of announcing a statement by its Director General. In part it said: This latest outbreak confirms that no country is immune to H5N1.
Every country is at risk. Every country must prepare. There is a risk
that outbreaks of H5N1 infection in birds could spread within Nigeria
and into neighbouring countries. Nigeria is one of several African
countries located on the Black Sea-Mediterranean flyway used by
migratory birds. Human and animal health services must be on high
alert, sharing information and quickly reporting any signs of disease
in birds or humans that could be due to H5N1 avian influenza.
African health systems are already struggling to cope with children and
adults suffering from HIV/AIDS, tuberculosis, malaria, respiratory
infections and other infectious conditions. Human cases of H5N1 may be
difficult to distinguish from other illnesses. We simply do not know
what the impact of exposure to avian influenza will be on the many
people who may be already immunocompromised and in a fragile state of
health. Health workers must be fully alert and samples must be taken
and sent to laboratories. When human cases of H5N1 are identified,
coordinated human and animal health investigations will be essential.
If the H5N1 virus changes to allow it to pass easily from person to
person, and it goes unchecked, this could trigger an influenza
pandemic. H5N1 is spreading rapidly across the world. All countries
must take measures to protect human health against avian flu, and
prepare for a pandemic.
There is no time to waste. We are ready to help all African countries take measures to reduce the risks of H5N1. The
presence of HIV and H5N1 together has worried virologists for some
time. Robert Webster, a well-known senior virologist at St. Jude's had
this to say back in November: QUESTIONER: Laurie Garrett, Council on Foreign Relations.
Dr.
Webster, you're really the godfather of flu research. Among flu
scientists you wear the crown. So I had the question for you.
And,
Steve [Wolinksy], since you are, also -- your other hat is HIV research, I'd ask
you the same question -- does the section of the migratory bird flyway
that's likely to fill in in the next few weeks, is that which heads to
Africa. And in Africa we have an unprecedented problem. They have a
massive population of people infected with HIV.
Would you please
speculate on what you think would happen when an individual who is HIV
positive becomes exposed to a bird or in some other way acquires an
infection of H5N1?
WEBSTER: Well, thank you for the crown. I'm not sure that I wear it comfortably at the moment -- not at all.
My
great concern I think I'm sharing with you is that if this virus and
when this virus gets into Africa into the HIV-positive people, who are
immunosuppressed, what happens in an immunosuppressed person we know
with influenza in cancer patients, the virus is shed for an extended
period of time, and it gives the virus the chance to accumulate the
mutations of adaptation to humans.
And so this -- you put your finger on the great worry that we all have for this virus getting into Africa along with HIV.
African
countries have few resouces and even fewer organized health and
veterinary systems in place to deal with an extensive bird flu outbeak.
Culling is both expensive and time consuming. As in Iraq, knowing what
to do doesn't translate into getting done so easily. On top of that
Nigeria has been the center of the WHO's polio eradication program,
plagued by mistrust, rumor and suspicion from within, although recently deemed back on track.
As H5N1 continues its inexorable spread around the globe,
affecting bird populations, it increases its exposure to humans. Each
encounter is another chance for the virus to pick up mutations making
it easier to spread from human to human. By next year, every country on
the planet, including the US, is likely be affected. The economic toll
is likely to run in the billions.
This is still not a pandemic.
Human to human transmission is still rare, though more cases are being
reported each day (China and Indonesia have recently reported new
cases). But there's nothing in the news that's reassuring, and each new
case in each new country reminds us that we have a ways to go in regard to pandemic preparedness. And the virus continues to mutate with each new infection.
Forget about labeling this as hype. The story's becoming harder to
ignore even if you wanted to. And no one in the medical or science
community is blowing this off. We need to keep a very close eye on this
deadly virus, and keep another eye on government preparation plans.
The opportunity to rebuild some of our decaying public health
infrastructure and create more resilient communities is there. Let's
see what we do with the opportunity.
 Bird flu mutation sparks concern
Genetic tweak makes virus favour human nose and throat.
Declan Butler
Researchers have sequenced the bird flu viruses that killed two people in Turkey in early January, and say that one of them contains a worrying mutation.
This genetic tweak can make the H5N1 virus more adapted to humans than to birds, and more adapted to the nose and throat than to the lungs. This latter effect could help to increase the chances of bird flu being transmitted between people, researchers say.
They add that many more mutations would probably be necessary before the virus is capable of sparking a full-blown pandemic, in which disease spreads like wild fire from person to person.
The samples of H5N1 virus, taken from the first two victims who died of bird flu in Turkey, were sequenced at a World Health Organisation (WHO) collaborating centre at the National Institute for Medical Research in London, UK. The results were announced on Thursday 12 January, along with confirmation of two new cases: bird flu has now also struck Sanliurfa Province, near Turkey's southern border with Syria, and Siirt Province, in the eastern part of Turkey.
The total number of reported human cases has now reached 18 in less than two weeks, three of which have been fatal.
In a bind
The WHO has released details of only one of the mutations found in the viruses. This genetic change results in a substitution of the amino acid serine by another amino acid, asparagine, at a specific position in one of the virus's proteins; a protein that helps the flu virus to bind to receptors on host cells.
This mutation has been observed twice before: in a father and son in Hong Kong in February 2003, and in one fatal case in Vietnam last year. It is known to increase the affinity of the virus for human receptors over poultry ones.
Until samples from the remaining cases are sequenced over the coming week, it is unknown how many of these came from viruses with the same mutation. If many prove to have the same tweak, this may help to account for the relatively large size of Turkey's rapid outbreak. The WHO's current explanation for the spate of cases is simply that people are bringing chickens into their homes during the harsh Turkish winter.
Nose and throat
The mutation also has a secondary effect, which may be more worrying.
There are two subtypes of receptors in the human respiratory tract: alpha 2.3, which occurs mainly in the lower respiratory tract; and alpha 2.6, which occurs mainly in the nose and throat. Human flu viruses typically show a preference for the 2.6 receptors, whereas H5N1 strains typically prefer 2.3.
This is good news for those worried about bird flu, since human-to-human transmission is thought to be more likely via droplets coughed from the nose and throat than from infections lower down. But the mutation found in the Turkey viruses is also known to be able to increase the affinity for H5N1 to the 2.6 receptors, points out Sylvie van der Werf, head of the Laboratory of Molecular Genetics of Respiratory Viruses at the Pasteur Institute in Paris, France.
Van der Werf adds that this affinity will, however, be affected by other genetic changes in the virus, which at present are an unknown factor.
Multiple mutations
Thankfully, one mutation alone is unlikely to lead to efficient human-to-human transmission. The genetic changes that would allow this to happen are poorly understood, but are thought to require an exact combination of changes in multiple genes.
"Adaptation to humans is a polygenic trait. It requires mutations in each of the eight segments of the virus's genome. Every one has to be correctly optimized to ensure human-to-human transmission," explains Edward Holmes, who is studying virus evolution at Pennsylvania State University in Philadelphia. "You are talking multiple mutations across the entire genome."
That's an improbable, but not impossible event.
Researchers continue to examine the genome of bird flu viruses, and are taking measures to stop the spread of disease among birds and people in Turkey.
A mutated strain of bird flu has genetic make up that increases its chance of transferring to people.
 Turkish deaths put Europe on bird flu alert
Jonathan Leake and Gareth Jenkins
THE number of Turkish people thought to be infected with avian flu rose to more than 50 this weekend, prompting concern that the disease may be about to spread into Europe.
Yesterday a British laboratory confirmed that a Turkish brother and sister who died last week had the feared H5N1 strain of avian flu.
A third child from the same family in Dogubayazit, in eastern Turkey, has now died of avian flu and dozens more suspected cases have emerged.
“The laboratory in the UK said that they have detected H5N1 in samples of the two fatal cases,” said Maria Cheng, a spokeswoman for the World Health Organisation. They are the first fatalities outside East Asia.
The disease is most likely to have been carried to Turkey by migratory birds, which have already spread it across Asia and parts of Russia. Last year a number of birds with the illness were found in Europe. The fear is that these will cross-infect domestic poultry, which will pass the disease on to humans.
Yesterday six more children who have tested positive for avian flu remained in a critical condition in the Turkish city of Van, near Dogubayazit. Another 24 suspected cases are being treated in a special ward in the university |
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