Bird Flu under reported in poor countries

http://www.nytimes.com/2006/05/31/health/31cnd-flu.html?hp&ex=1149134400&en=8621f4a82f75b2d8&ei=5094&partner=homepage

Latest Indonesian update

WHO is monitoring the situation in Indonesia and so far the news still god news.

The World Health Organization has just released the following update
to the situation in Indonesia.  Let's keep our fingers crossed and hope
that everything is contained.

Avian influenza ­ situation in Indonesia ­ update 16


31 May 2006


Situation update


Indonesian health authorities and WHO have further
strengthened their response to the family cluster of cases
in Kubu Simbelang village, Karo District, North Sumatra. As
of today, 54 surviving family members and other close
contacts of cases have been identified and placed under
voluntary home quarantine. All of these people, with the
exception of pregnant women and infants, are receiving the
antiviral drug, oseltamivir, for prophylactic purposes.
Public health teams visit these people daily, checking for
symptoms.


In addition, active house-to-house surveillance for
influenza-like illness is being conducted throughout the
village, which has around 400 households. A command post for
fever surveillance has been functioning in the village since
last week.


As of today, no new cases suggestive of H5N1 infection have
been detected since 22 May. This finding is important as it
indicates that the virus has not spread beyond the members
of this single extended family. No hospital staff involved
in the care of patients, in some instances without adequate
personal protective equipment, have developed the disease.
The last person in the cluster, who developed symptoms on 15
May and died on 22 May, refused hospitalization. He moved
between two villages while ill, accompanied by his wife. The
wife is under surveillance and has not developed symptoms.


Despite multiple opportunities for the virus to spread to
other family members, health care workers or into the
general community, it has not, on present evidence, done so.


Current level of pandemic alert


Based on an assessment of present evidence, WHO has
concluded that the current level of pandemic alert is
appropriate and does not need to change. The level of
pandemic alert remains at phase 3. This phase pertains to a
situation in which occasional human infections with a novel
influenza virus are occurring, but there is no evidence that
the virus is spreading in an efficient and sustained manner
from one person to another.


WHO has recommended continued close monitoring of the
situation in Kubu Simbelang for the two weeks following 22
May, the date when the last known case in the cluster died.
As a precautionary measure, Indonesian authorities have
decided to extend this recommended period to three weeks.


Preliminary results of the investigation


This information differs in some details from information
released in previous updates, but is derived from extensive
investigations by senior national and international
epidemiologists, from WHO and the US Centers for Disease
Control and Prevention, who have developed a clearer picture
of the situation.


The cluster involves an initial case and seven subsequent
laboratory-confirmed cases. All cases are members of an
extended family: sisters and brothers and their children.
Family members resided in four households. Three households
were next-door neighbours in the village of Kubu Simbelang,
Karo District, North Sumatra. The fourth household was
located about 10 kilometres away in the nearby village of
Kabanjahe.


The initial case in the cluster was a 37-year-old woman who
sold fruits and chillies at a market in the village of
Tigapanah. Her stand was located about 15 metres away from a
stand where live chickens were sold. The investigation
uncovered no reports of poultry die-offs in the market.
However, the woman kept a small number of backyard chickens,
allowed into the house at night. Three of her chickens
reportedly died before she became ill. She is also known to
have used chicken faeces from these household chickens as
fertilizer in her garden.


A parallel agricultural investigation has not, to date,
detected H5N1 virus in PCR tests of approximately 80 samples
from poultry, other livestock and domestic pets, and chicken
fertilizer taken from the vicinity.


The initial case developed symptoms on 24 April, was
hospitalized on 2 May, and died on 4 May. No samples were
collected for testing prior to her burial, but she is
considered part of the cluster as her clinical course was
compatible with H5N1 infection.


The initial case had one sister and three brothers. The
sister and two of the brothers subsequently developed
infection. The remaining cases occurred among children in
these families.


The confirmed cases include five males and two females with
an average age of 19 years (range from 1 to 32 years). Six
out of the seven confirmed cases developed symptoms between
3 May and 5 May. These cases include two sons of the initial
case, her brother from Kabanjahe, her sister, the sister's
baby, and the son of a second brother living in an adjacent
house. This second brother, the last case in the cluster,
developed symptoms on 15 May. Six out of the seven cases
were fatal.


Exposures


On the night of 29 April, nine family members spent the
night in a small room with the initial case at a time when
she was severely ill, prostrate, and coughing heavily. These
family members included the initial case and her three sons;
the brother from Kabanjahe village, his wife, and their two
children; the 21-year-old daughter of another brother (who
did not become infected); and another young male visitor.
Following this event, three family members ­ the woman's two
sons and the visiting brother from Kabanjahe ­ developed
symptoms from 5 to 6 days later.


The woman's sister, who lived in an adjacent house,
developed symptoms at the same time, as did her 18-month-old
daughter. Prior to symptom onset, this sister, accompanied
by her daughter, provided close personal care of the initial
case.


The last case in the cluster provided close care for his son
throughout his hospital stay, from 9­13 May. The son was a
frequent visitor in the home of the initial case and was
present there on 29 April.

Google to follow infected birds

This in from Ann.Experts are using Google's mapping software to help prepare for the arrival of the bird flu. The software will help identify areas with affected flocks and isolate them from other flocks. The bird flu is expected to arrive this summer. See article below

thanks Ann:

http://today.reuters.com/news/newsArticle.aspx?type=technologyNews&storyID=2006-05-30T230035Z_01_N25133792_RTRUKOC_0_US-BIRDFLU-MAPPING.xml

Pigeons

http://news.scotsman.com/latest_international.cfm?id=797742006

While songbirds fed in backyard feeders do not seem at risk, my favorite boyhood bird does seem to be in trouble. One of the Indonesian deaths was due to a fellow cleaning pigeon feces out of a gutter. And this story of a pigeon game stopped shows the extent that the bird flu has affected raising pigeons. I'm wondering what will happen to all the pigeon racers here if migratory birds bring the bird flu this way.

Of course, Indonesia just goes about business as usual:

http://news.yahoo.com/s/ap/20060520/ap_on_he_me/bird_flu_ignored_warnings

And is isn't that there wasn't other warnings:

http://discuss.agonist.org/smf/?board=6%3baction=display%3bthreadid=20552

Other pigeon notes, some of them reassuring:

http://www.abc.net.au/news/newsitems/200510/s1487872.htm

http://www.msnbc.msn.com/id/12466226/

http://www.purebredpigeon.com/avianflu.htm

http://www.healthcentral.com/newsdetail/408/1508144.html

Latest from Indonesia

http://abcnews.go.com/Health/wireStory?id=2003790

http://www.abc.net.au/news/newsitems/200605/s1648827.htm

http://abcnews.go.com/Health/AvianFlu/wireStory?id=1997826

http://www.nytimes.com/2006/05/24/world/asia/24birdflu.html

Well, no pandemic yet. Maybe we will be lucky and slip out of it with H5N1.

Analysis of the Indonesian cluster

Scary week. But it was good to see the flu covered by the New York Times and National Public Radio. Somehow they managed to fit this topic in between corruption and incompetency of government action (Iraq, stolen Veteran's SSN, corruption in Congress, increasing debt, gas problems)


As far as I can tell while the cluster in Indonesia is a scary one ( the virus moved from bird to person, then to another person and then AGAIN to yet another person) it does not signal the beginning pandemic. There was no change in the nature of the hook the virus uses to infect and so it will not move efficiently from person to person. That explains why, even though the stupid Indonesians actually sent the infected people back out into the larger community for a while (until they got sicker and returned to the hospital to die) no spread seemed to be occuring in Indonesia.

It all does point out how unprepared some of these countries are. This is not the first such cluster in Indonesia. This virus has been hanging around for a couple years now and every so often there is a scare there because a cluster developes. Folks figured that Vietnam would be the most likely source of pandemic, but that country has gotten their ducks in line (so to speak) and pretty much pushed the damn bug out of the poultry population.

But Indonesia is another story.

Also worrying was that our government sent a huge shipment of Tamiflu to some "unnamed" Asian country this week. I hate it when we have to make everything a secret. It was an odd move because supposedly we are trying to stockpile Tamiflu here and definitely do not have enough for a real pandemic if it happened this week. So why send it abroad? One logical conclusion is that some American leaders thought this was going to happen this week in Indonesia. I wish they'd tell us a little more intelligent information about these things instead of that paternalizing, simplistic little speech that Leavitt gives, suggesting that everyone weekly put a can of tuna fish and a box of powdered milk under his bed. His idea of self reliance. His positioning post Katrina in order to establish that the Federal government can be of no help in pandemic emergency. It is the pre FDR theory of governemnt, every person for themselves.

Blue, red, conservative, liberal aside. The most frustrating thing in modern politics is that we are treated more and more like children than citizens. Of course, the real question is why we consistently like to put stupid people in office. If anyone looks smart in the race, the average American bristles and votes the other way.

Great news for chickens

http://abcnews.go.com/US/wireStory?id=1991394

And of course what keeps the chicks safe, keeps us safe too, in a trickle down sort of way.

http://www.blogger.com/img/gl.link.gif

http://abcnews.go.com/International/wireStory?id=1995111

So there was a human to human transmission but apparently no recombination or mutation to suggest that there will be more. Hope Indonesia gets its act together soon.

Buffalo 1918 survivor

http://www.suntimes.com/output/health/cst-nws-flu21.html

This Buffalo woman's blood may hold the clue to a vaccine.

Probably not mutated In Indonesia

http://archive.gulfnews.com/articles/06/05/20/10041314.htmlLooks like we got lucky again in Indonesia, but I sure hope they get their act together soon.

indonesia - bad

http://www.abc.net.au/am/content/2006/s1642346.htm

People and Pigs have it in Indonesia

http://today.reuters.com/News/CrisesArticle.aspx?storyId=JAK28830

Very worrisome news from Indonesia.

Pigs can act as mixing vessels in which human and bird flu viruses can swap genes, leading to a strain that can easily infect people and pass from person to person.

http://www.shns.com/shns/g_index2.cfm?action=detail&pk=INSURANCEFIRMS-05-16-06

Here is how a pandemic might affect the insurance industry.

Indonesia - not good news

There is a recnt cluster of bird flu fatalities in Indonesia which has health officials worrying about the possibility that the flu was able to spread from person to person. Keep an eye on that news.

Bird Flu ABC special

While I was away Elizabeth taped the bird flu ABC special for me and I've just watched it. It did seem to cover briefly all the aspects of the flu, but in much too much a sensational manner for my taste. Here are the weaknesses as I see them:

1. While ARDS was mentioned once in passing, I doubt that any viewers really got the sense of cytokline storm that hit the first victim and accounted for his early death. Certainly is was not explained as it would have been say in an episode of CSI.

2. I just damned sick of seeing the insides of bodies on all these current television shows. I've buried most of my family and learned what killed them and why without having to see inside their body cavities. This is just exploitive sensationalism.

3. The ending was unrealistic. It is highly unlikely that two mutations would occur in such a short time and from my understanding of the 1918 precedent they cite, this was simply two waves of the same virus strain as it moved in and out of a population. There have been three pandemics this century and another will come in some form, some time. When has there ever been two in a row? And what are the odds that they would be both worst case senarios? The pandemics in 1957 and 1968 did not capture my attention at the time. They were mild killers.

4. Survival techniques were not dramatically developed. Everyone did the wrong things. Once couple was plain lucky and so they could dance on the top of a building, but no one managed to survive by preparation. Part of this is because they present the urban and suburban population but no one from rural America. Quarrantine was seen as a stupid idea imposed by government, rather than the major way of waiting out the distribution of vaccine. The message again was that communities somehow working in close connection with one another (without masks or gloves by the way) could win somehow just with a smaltzy sense of love. The truth is that small groups, hunkered down and staying out of group meetings have the best chance of survival especially if they get some food in ahead of time.

5. In the end this movie provided no hope. It was like the fighting of the movie monster. Just when you thought the coast was clear, up comes Jason again out of the lake, his chain saw running. I see pandemic as very different from other massive disasters (global warming, nuclear war) because the individual and small family group can prepare and provide, as long as they don't wait until the last minute. And the wait in quarrantine is just until vaccine gets distributed and the 50% of people who do contract (but do not die from the flu) get working again. The movie might have shown an example of a rural family who had provided ahead of time and who waited out the vaccine manufacturing and distribution delays?

6. On the other hand it did present some of the problems: food and supply shortages, insurance company defaults, economic difficulties, panic in the streets, looting and loss of lawful control of populations, overcrowding of hospitals. It did a good job showing the need to take respirators away from very sick people because there are not enough of them available in today's hospitals. And the politics seemed very believable. It balanced the information on the effectiveness of Tamiflu. Good cast too. I like these actors, especially old Stacy Keach and Justina Machado, who is such a cutie.

7. Mass graves is an exaggeration.

And in the end I am glad they did it because it rasies the consciousness of people. But we had guests this weekend whose final resistance to preparing even a bit was to say, "I don't think I really want to survive such a disaster anyway." This movie would not help those folks move from fatalism to acts of survival.

This review seems pretty sound:

http://www.pandemicflu.gov/news/birdfluinamerica.html

Still more good news

http://www.nytimes.com/2006/05/10/health/10cnd-flu.html?_r=1&ex=1147492800&en=34534b3b2a87983d&ei=5087%0A&oref=slogin

If the flu fails to show up here in the Fall, we will be spared a lot of difficulty for the poultry industry and lessen the chance of more dire circumstances.


And if this science is good, this strain may never mutate and we may have time to prepare for the eventual pandemic.

less likely

http://www.nytimes.com/2006/03/23/science/23flu.html?ex=1147752000&en=f7d8dff884b46054&ei=5070%3Ca%20href=%22http://www.nytimes.com/2006/03/23/science/23flu.html?ex=1147752000&en=f7d8dff884b46054&ei=5070%22%3E%3C/a%3E

Meanwhile some countries lie and drag feet

http://www.washingtonpost.com/wp-dyn/content/article/2005/10/19/AR2005101902147.html


Here is the problem. When governments are too corrupt to act, the disease has a chance to get a foothold.

Good news

http://www.nytimes.com/2006/05/14/world/asia/14flu.html?ex=1305259200&en=41357a0296e3fda5&ei=5089&partner=rssyahoo&emc=rss

Good news here. As it wanes, the odds of mutation go down too.

Here is a note to ponder

This came from the company that I bought masks and gloves from last month:

Greetings,

You have purchased products at our site http://www.respirators.us .

As a result of a number of factors surrounding the Avian Flu scare (including
the ABC movie on the Bird Flu) we have been informed by our manufacturers that
a shortage in mask/respirator stock will occur very soon.

We apologize in advance and we will remove all products from our site that are
not available.

Regards,

Respirators Inc.

Bird Flu Survey

http://abcnews.go.com/Health/wireStory?id=1872540


I don't know where these concerned people are, but I don't hear a thing about this issue. This is a good article, however, and touches on many relevant issues.