Influenza Virus Mashup

(Tue, 19 Aug 2008 14:58:00 +0000) CIDRAP reports on trends in Indonesia’s bird flu cases. This is a very revealing piece of work….

Of the 125 patients who were hospitalized, 104 were diagnosed with pneumonia immediately or shortly after admission.

The authors report there were 11 case clusters that involved 28 patients. Infected patients who were not part of clusters were more likely to die, but researchers did not find any differences between cluster patients and noncluster patients in terms of when they presented to a healthcare facility, whether they received oseltamivir, or how soon they received the drug.

Patients with secondary cases were more likely to survive than primary case-patients, and they received antiviral treatment about 3 days earlier than primary case-patients. The investigators acknowledge that secondary cases may have involved other early interventions as well. They also report that patients who had indirect exposure to the virus were more likely to die.

Maryland “Nurse Detectives” work on bird flu and other diseases.

A PR firm won an award for a its pandemic influenza materials.

Bird flu is used as a reason not to require free range poultry in California.

Effect Measure blogs the story we ran yesterday about the antibodies in 1918 flu survivors. (Which is all over the media today, by the way.) Along with some scientific explanation, Revere adds some cogent perspective.

We still don’t know how typical these people are. After all, they apparently didn’t get sick in 1918 despite being infected and they have a good enough immune system to last into their nineties. Maybe most of us aren’t so lucky and have waning immunity with the years. But this is some slick work and now that we have the actual antibodies in sufficient quantity to study we can begin to ask what features of the 1918 virus made it vulnerable. How much of this is transferable to bird flu, the current pandemic worry, is difficult to say. These antibodies didn’t protect against or react with H5 flu viruses so they aren’t a therapy for bird flu. But understanding the basic science of influenza virus is always a plus.

Debate breaks out on ProMed about whether it should report suspected (not officially confirmed) cases from Indonesia.

(Mon, 18 Aug 2008 02:53:00 +0000) South Korea says it is now bird flu free.

Interesting study looked at the blood of 1918 flu survivors. Yes, after all this time, they still have the antibodies. What an amazing thing our immune system is.

This is something that never seems to get resolved. Did the Spanish Flu kill on its own, or through opportunistic bacterial infections (which would help to render the likelihood of a killer pandemic as low in the anti-biotic era.)

(Sun, 17 Aug 2008 13:20:00 +0000) …..

(Sat, 16 Aug 2008 13:52:00 +0000) FAO is consulting with Vietnam and recommends that the country change its poultry vaccination schedule. Vaccination has been widely employed in Vietnam, to mixed results.

FAO is also recommending that Vietnam have private-public cost sharing on vaccination programs. Wonder how that will work with small farmers?

Do skyrocketing poultry imports into China indicate more knowledge than they say they have about avian flu outbreaks?

This story is similar, about avian influenza and the food supply in Africa.

Japan has donated Tamiflu to Vietnam.

(Fri, 15 Aug 2008 01:35:00 +0000) Study on Indonesia shows that 80% of cases are fatal. Oddly, it reaffirms that every anti-virals help, but notes that goal is rarely achieved.

Would GPs show up for work during a pandemic? Australia thinks they may not.

Of course, the if pandemic flu broke out in China during the Olympics, it would have huge pandemic potential because everyone would scatter to the four corners of the Earth after the Olympics were over. Here, a reporter from Edmonton looks at that very situation.

Researchers continue to make comments about H9 causing a pandemic, here on CIDRAP.

ProMed has an interesting story on bird flu in swans which they say merits a close read.

I suspect that they demonstrate why adult swans are found dead. The question is how far can a sick swan fly — ’sick’ is a variable term — and survive, if it even wished to fly while convalescing from this infection; to appreciate risk this should be recalculated as the prevalence rate of infected flying swans.

Developments in Nigeria (new strain) have Ghana worried.

Nature blog has the raspberries for British press, which gives more attention to a quck flu testing machine than it does to a new strain in Nigeria.

Here’s a story on the flu testing machine.

Bird flu testing has a higher priority in Nigeria.

Laos has a new law that will reform veterinary service.

Cleveland Plain Dealer runs bird flu primer.

N. Sulawesi has distributed poultry vaccines, but there isn’t enough for all the chickens.

Chinese researchers are testing a combination of statins and caffeine to fight bird flu.

Interesting reader comments from Indonesia when there was a suspected cluster of 13 people.

(Thu, 14 Aug 2008 11:47:00 +0000)

(Wed, 13 Aug 2008 13:07:00 +0000) Commentary posted on ProMed criticizes the site’s decision not to post suspected Indonesian cases until the government confirms them.

Is H9N2 a more likely pandemic candidate?

Hong Kong has opted to begin importing poultry from Britain again.

This columnist said that Obama passed a law requiring the government to report on pandemic prep.

Azerbaijan says it needs help preparing for a pandemic.

“Citizen” column on unthinkable and unstoppable pandemic.

(Tue, 12 Aug 2008 12:55:00 +0000) Today’s big news….Nigeria has reported a new strain of bird flu, raising many questions, as below

“The detection of a new avian influenza virus strain in Africa raises serious concerns as it remains unknown how this strain has been introduced to the continent,” said Scott Newman, International Wildlife Coordinator of FAO’s Animal Health Service.

The fatality rate is falling this year in Indonesia, but I wonder, given the small sample sizes, about relevance.

Meanwhile, N. Sumatra is remaining alert.

In the UK, a man was prosecuted for improperly disposing of bird carcasses.

Cambodia is holding educational seminars to train the people who work in live markets on how to control bird flu.

The US has given funds to Ethiopia to help combat avian influenza, among other things.

(Mon, 11 Aug 2008 02:00:00 +0000) …..and we’re back.

13 people in Indonesia were tested for bird flu….they are all reported to be negative.

San Juan health official tells local audience that a pandemic is likely.

The Japanese are helping to fight animal diseases in Myanmar.

A bird flu planning meeting was held in Thailand.

The test results from the 13 Indonesians came back negative. This from Singapore’s The Straights Times:

Indonesian villagers test negative for bird flu: health ministry

JAKARTA - THIRTEEN people in Indonesia suspected of having bird flu have tested negative for the feared disease, the country’s health ministry said on Saturday.

Experts from the World Health Organisation (WHO) arrived Friday in the affected village in North Sumatra to help investigate a possible outbreak after three people died and the 13 were admitted to hospital.

‘All specimens collected from suspect cases have given negative results’.

‘They are all recovered’, I Nyoman Kandun, director general of the ministry’s communicable diseases department said on a text message.

Officials and residents in Asahan district in North Sumatra province said villagers began showing symptoms of avian flu after a large number of chickens died suddenly last week in Air Batu village.

The local husbandry office took preventive action this week by slaughtering and burning some 400 chickens and ducks.

The ministry, which has stopped giving regular bird flu updates, announced earlier this week that the human toll from avian influenza in Indonesia had risen to 112 following the recent death of a 19-year-old man.

I will not belabor the issues of accuracy of the tests. We all know they are fraught with false negatives. However, if all thirteen villagers have indeed already recovered then it is highly unlikely that they were suffering an H5N1 infection. Unlikely though it is, it is not guaranteed, however at this point in time, it’s a good enough assumption.

It’s “good enough” because the Indonesian government has proven to be less than fully transparent with the rest of the world, we have a test that is officially only presumptive at best, but mostly because there isn’t a thing any of us can do about what is or isn’t happening in the village of Air Batu and to its residents.

Can we take comfort in the fact that WHO arrived on the scene and if there were a genuine cause for greater concern we would be well served by their presence and actions? Maybe. Maybe not.

As I typed that sentence it came as something of a surprise to me that I actually do take comfort in the WHO’s presence. Perhaps a sign I have not lost all of my naïveté, or perhaps my expectations have eroded so severely that the World Health Organization represents, at least to me, our Last Best Hope for anonymous Indonesian villagers and their 6.x billion neighbors.

Then again, perhaps it’s a combination of being naïve with very low expectations. Hey, isn’t there a term for that? Yeah, I think there is, and I think it’s something along the lines of “clueless”.

SZ