Influenza Virus Mashup

Via Viet Nam News: Experts call for bird flu control strategy. Excerpt:

The latest outbreak of bird flu has affected the provinces of Dien Bien and Nam Dinh in the north, Nghe An and Khanh Hoa in the central region, and Soc Trang and Ca Mau in the south, Ministry of Agriculture and Rural Development representative Hoang Van Nam told a meeting in Ha Noi yesterday.

“Bird flu has continued to spread in these provinces and killed thousands of poultry since its re-emergence in December, despite efforts to prevent contagion,” Nam told the gathering of governmental experts and representatives from the UNDP and non-governmental organisations. 

Nguyen Huy Nga, director of the Ministry of Health’s Department of Preventive Medicine and Environment, said that since the first bird flu case in 2003, 115 human cases had been reported in Viet Nam, 58 of which resulted in deaths. 

In 2010, three human cases have been reported in the provinces of Khanh Hoa, Tien Giang and Tuyen Quang, resulting in one death. 

The threat of a human epidemic of bird flu has risen due to the continued presence of the virus among poultry and because public awareness of proper handling and preparation of poultry remained low. 

The risk was particularly high in the Cuu Long (Mekong) Delta region as ducks were migrating during harvest time. 

About 95 per cent of human cases showed the person had a history of exposure to poultry infected with the A/H5N1 virus, Nga said, noting that the evidence of human-to-human transmission remained scant – although there were instances in which groups of infected persons had lived in the same households. 

The Integrated National Operational Programme for Avian Influenza 2006-10, commonly known as the Green Book, would help reduce the health risk to humans from bird flu by instituting methods to control the disease at its source in domestic poultry, detecting and responding promptly to human cases, and preparing for the medical consequences of a human pandemic, said Deputy Minister of Agriculture and Rural Development Bui Ba Bong. 

The total cost for the programme from the State budget, public sector and ODA was estimated at US$250 million, Bong said.

Via The Guardian: Britain sends South Africa 42m condoms in HIV fight before World Cup. This is more worrisome than swine flu breaking out during the Hajj. Excerpt:

Britain is to give 42m condoms to South Africa in response to a request for an extra billion as part of an HIV prevention drive before the World Cup, the government will announce today. 

The request for British help in stockpiling sufficient condoms for the expected influx of thousands of football supporters in three months’ time was made during President Jacob Zuma’s recent visit to the UK to meet the Queen. 

“Obviously there’s a big focus on the World Cup coming up and a huge increase in the number of people coming into South Africa,” said the international development minister, Gareth Thomas, who will announce the £1m funding today at an emergency summit in London on HIV prevention and treatment. 

“The South Africans have identified themselves the need to get more condoms in place. South Africa specifically asked for British assistance and we are responding to that request.” 

He pointed out that the fans would inevitably spill over into neighbouring African countries with high HIV rates, which would also need to take precautions. 

The South African government estimates that up to half a million visitors could travel to the country, raising fears of a rise in prostitution and sex trafficking from neighbouring countries and eastern Europe, and creating a potential HIV timebomb. 

Last week South Africa’s Central Drug Authority warned that 40,000 prostitutes were expected to arrive for the month-long tournament. 

South Africa is embroiled in a struggle to combat the world’s biggest HIV caseload and to convince its population of the importance of safe sex. 

The South African health minister, Aaron Motsoaledi, expressed concern that the message was being ignored because people believe HIV can now be easily treated.

(Mon, 08 Mar 2010 14:57:00 +0000)

 

 

# 4413

 

 

Amid word this weekend that a 31st bird flu Fatality (details are sketchy) has been announced  by the Egyptian Ministry of Health, we get this brief report from IRIN News on Egypt’s attempts to combat the virus.

 

First the IRIN report, then what we know about the latest fatality.

 

IIn Brief: New plan to fight bird flu in Egypt

Photo: Doaa Shaarawy/Save the Children

Specialists raise awareness of bird flu in high-risk areas by disseminating materials on a village-to-village basis (file photo)

CAIRO, 8 March 2010 (IRIN) - Egypt is moving to curb the spread of avian influenza (H5N1) after a recent upsurge in infections, the Egyptian Health Ministry says.

 

The sale of poultry between any of Egypt’s 29 governorates is to be banned, and a major Health Ministry-led awareness campaign will alert the public to the dangers of raising birds at home, Sabir Galal, deputy chief of the Veterinary Medicine Section at the Health Ministry, told IRIN. “Bird flu has become endemic in this country… The fear now is that the virus can assume more dangerous forms in the days to come,” he said.

 

The Ministry also said it would stop inoculating birds after vaccines had proved incapable of stopping the virus from spreading.

 

With 105 infections to date, including 30 deaths, Egypt is the world’s third most affected country by avian influenza, according to the World Health Organization.
ae/ed/cb

 

First, a note about the case counts and fatalities numbers out of Egypt. The numbers are rapidly changing, and media reports over the weekend are suggesting a 31st fatality.   

 

Newshounds Commonground, Twall, and Sharon Sanders are tracking these reports on this thread on FluTrackers, and hopefully we’ll get some clarification in the next day or so.   For now, the numbers are `fluid’.

 

The H5N1 situation in Egypt’s poultry is bad, and appears to be getting worse.  Hence the new plan of attack.

 

Earlier this year it was announced that the sale of live poultry would be banned in Egypt by later this summer.

 

Thu, 04/02/2010 - 21:54

Live poultry sales to be banned as of July

Mona Yassin

A government-appointed committee for combating the H5N1 and H1N1 viruses–known respectively as bird and swine flu–decided Thursday to ban the sale of live poultry nationwide, starting in July.

 

According to Environment Minister Maged George, live poultry will be gradually phased out to be replaced by frozen poultry produced by licensed slaughterhouses.

 

And perhaps most significantly, Egypt now appears ready to abandon the routine vaccination of poultry against the H5N1 virus – a practice that has been subject to much criticism over the years.

 

The OIE (World Organization For Animal Health) has long maintained that vaccination of poultry cannot be considered a long-term solution to combating the avian flu virus.

 

In Avian influenza and vaccination: what is the scientific recommendation?, the OIE reiterates their strong recommendation that humane culling be employed to control avian influenza, and advising that vaccines should only be used as a temporary measure.

 

While the OIE concedes that some nations may require the use of vaccines for `several years’, they strongly urge that countries move away from that program and towards the more conventional culling policy.

 

Vaccines are a particularly attractive solution to countries where poultry makes up a substantial portion of some of their people’s wealth and/or food security.    

 

Culling – while often more effective in controlling bird flu - is traumatic, expensive, and often difficult to implement - which has presented a dilemma to governments in places like Egypt, India, Indonesia, and parts of Asia.

 

The down side to vaccines is that, over time, the virus can evolve to evade the protective shield offered by the injection, and can infect and spread in poultry `silently’, without showing classic symptoms.

 

Indonesia, like Egypt, has used vaccines but their bird flu problems persist.  Something that Dr. C.A. Nidom has warned about.

 

Poultry Indonesia Printing Edition, March 2009

(excerpts)

Chairul Anwar Nidom, a virologist with the Tropical Disease Centre at Airlangga University in Surabaya, said a common policy on bird flu was lacking among government agencies, making controlling the disease more difficult.

 

Nidom criticized the government’s policy of vaccinating poultry rather than culling, believing that it masks the virus, and ultimately contributes to its mutation.

 

Vietnam appeared to be having good success with vaccinations up until 2007, but since that time bird flu has begun to re-emerge. 

 

And last year, concerns were expressed by doctors in China (see Zhong Nanshan On Asymptomatic Poultry) that asymptomatic vaccinated birds were spreading the H5N1 virus to humans. Meanwhile, in a rebuttal, China Defends Poultry Vaccination Program.

 

A year ago, I wrote an essay entitled OIE: Countries That Vaccinate Poultry Need An `Exit Strategy’.

 

It appears that Egypt may finally be prepared to adopt this exit strategy.

Via Mauricio Beltran’s Precavido blog: Estado do Pará tem pelo menos 9 mortes pela gripe suína (H1N1) apenas neste ano. [State of Pará has at least 9 H1N1 deaths so far this year] Excerpt, with my translation:

Segundo dados de diversos jornais da região, com informações coletadas por colega leitora do blog que gentilmente enviou os links, o estado do Pará já possui ao menos 9 casos confirmados de óbitos causados pela gripe suína (H1N1) apenas neste ano.

According to data from various regional journals, collated by a colleague-reader who kindly sent the links, the state of Pará now has at least 9 H1N1 deaths so far this year.

The rest of the post provides details on the cases. And it raises a worrying issue: Without the efforts of individuals like Mauricio Beltran and his colleague, even ordinary Brazilians would have little sense of what’s going on in their own country.

It’s just another example of a problem I’m increasingly aware of since I started covering other diseases like dengue and malaria: Outside the immediate hot zone of an outbreak, no one cares—or even wants to know. If all politics is local, so are pandemics.

Via The New Times: Swine flu reported in Burera. Excerpt:

One month after the situation had stabilized; new cases of the influenza A, H1N1 commonly known as Swine flu have been confirmed in Burera district, Northern Province. 

This was revealed yesterday, by Dr. Justin Wane, the Head of the Swine flu response team in the Ministry of Health. According to Wane, at the beginning of February, the infection rate went down completely with only one or two cases reported in a week. 

However, with the seasonal flu at hand, infections were projected to increase. 

“We received reports that cases of swine flu in Burera were on the increase. Samples were taken for testing and at the beginning of last week, there were six laboratory confirmed cases in this district,” he said. 

“We are still conducting more tests so we are yet to have an updated report. There number of seasonal flu cases at the moment is also high and one problem we are facing is that most people are confusing these common flu infections to the influenza A H1N1.”

Via Daily News Egypt: Swine flu on the decline in Egypt. Excerpt:

Swine flu cases in Egypt are substantially declining, with the rate of weekly reported cases falling to almost half, the Ministry of Health announced. 

“Swine flu in Egypt is declining, the number of reported cases this week went down to 22, in comparison to 44 cases reported last week,” said Amr Kandil, deputy Minister of Health for Preventive Medicine.  

The total number of cases is 16,125, according to the latest swine flu report. Three deaths were reported last week, bringing the total number of fatalities to 272. 

The World Health Organization echoed a similar view. “In North Africa and West Asia, influenza activity is low,” it said in its situation update released on Friday March 5. 

Around the country, the rate of swine flu cases reported has been declining and will continue to do so until April, Abdel Rahman Shahin, official spokesman of the Ministry of Health, had said previously. 

Out of the 22 cases of swine flu reported this week, only seven were reported in schools. 

Due to the substantial decline, the Ministry of Health is currently considering not shutting down any classrooms where the virus appears and limiting the precautionary measures to giving the students who show swine flu symptoms one week off, explains Kandil.

(Mon, 08 Mar 2010 13:56:00 +0000)

 

 

# 4412

 

 

 

Twice since the emergence of the novel H1N1 virus (once in May and again in October) I’ve written an essay entitled An Appropriate Level Of Concern where I attempted to outline my sense of the seriousness of the pandemic, and the logical things people should be doing to prepare for it.

 

While the pandemic of 2009 has yet to play its final card, early on indications were that we were facing a high morbidity-low mortality event; a virus that would cause a lot of illness, but thankfully very few deaths.

 

And so my advice was predicated on this assumption. What I characterized as a `middle ground’ approach; one that relied on maintaining a general level of preparedness, not a reactionary response to this particular pandemic threat.

Specifically, I suggested that everyone :

 

1. have a good family and business emergency plan
2. have acquired at least a 2-week supply of emergency supplies
3. routinely practice good flu hygiene
4. get the appropriate vaccines when they are available
5. have and are a flu buddy
6. are looking out for your neighbors and greater community

 

In October I stated:

 

I see no need to hunker down at home, or to live in fear over this virus.  This is a serious situation, of course. And tragically, this virus will claim thousands of lives over the next few months.

 

It certainly deserves your attention, vigilance, and respect.

 

But not your fear.

 

Which pretty much echoed my level of concern from the previous May; that the pandemic was likely to be serious, but not devastating.

 

I, of course, didn’t adopt this cautious, middle ground approach based strictly on my own observations. This was essentially the message of the CDC, and other agencies of the HHS from the start of the outbreak.  

 

If you listened directly to Admiral Anne Schuchat of the CDC, Dr. Anthony Fauci of NIAID, or Dr. Bruce Gellin of the National Vaccine Program Office you got a pretty good sense of the true seriousness of the pandemic.  

 

If you took your cue from the tabloid press, wacky websites, or sometimes even the mainstream press . . . well your perceptions may have been skewed a bit. 

 

Now that the pandemic has gone – if not away, at least out of the headlines – the tendency of many will be to let down their guards. To assume the threat has passed, and to forget about preparedness.

 

And that would be a mistake.

 

Disasters, large and small, happen every day around the world.   It doesn’t take a pandemic, or an earthquake, or a hurricane to ruin your entire day.

 

As a paramedic I often came face-to-face with the unhappy results that occur when people are  unprepared to deal with an emergency.

 

I’ve seen people badly injured (and sometimes killed) because they, or someone around them, lacked the knowledge of what to do in an emergency or because they simply didn’t have a proper first aid kit.

 

We are entering Tornado season for southern and Midwestern states, and having lost my roof to one back in 1978, I can assure you there is nothing more abrupt (and likely to make a a lifelong impression) than being struck by one of these monsters in the middle of the night.

 

 

This map shows the areas of greatest danger, but practically all regions of the nation can see tornadoes.

 

The National Weather Service’s Lower Mississippi River Forecast Center said, based on anticipated snow melt and forecasts of rainfall, there’s an above average flood potential this spring.

 

Hurricane season along the Atlantic and Gulf coasts, and wildfire season in the western states, are but a few months away.

And it’s always earthquake season.

 

Are you ready?

Most Americans are woefully unprepared to deal with emergencies.  This despite dozens of major disasters (often weather related) that occur every year in this country.

 

And each and every day, thousands of people are injured in automobile, work related, and household accidents.

 

Everyone should have a well equipped first aid kit in their car, workplace, and home . . . and everyone should know the basics of first aid.    If you’ve never taken a first aid course, contact your local chapter of the American Red Cross.

 

Agencies like FEMA, READY.GOV and the HHS are constantly trying to get the preparedness message out, so that when (not `if’) a disaster does occur, human losses can be minimized.

 

For more information on how to prepare for emergencies, up to and including a pandemic, the following sites should be of assistance.

 

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

 

A few of my (many) preparedness essays include:

 

FEMA Asks: Are You Earthquake Prepared?

Inside My Bug Out Bag

Red Cross Unveils `Do More Than Cross Your Fingers’ Campaign

The Gift Of Preparedness

Pandemic Solutions: Flu Buddies

 

At a bare minimum, every household should have a disaster plan, a good first aid kit (and the knowledge to use it), and emergency supplies to last a minimum of 72 hours during a disaster.  

 

Anything less is simply inappropriate.

I can’t tell you when the next disaster will strike, or where, or even by what means.   But I can assure you that millions of people will be affected by some type of disaster or emergency in the coming year.

 

And the advantage always goes to those who are prepared.

Via IRIN: New plan to fight bird flu in Egypt. Excerpt:

Egypt is moving to curb the spread of avian influenza (H5N1) after a recent upsurge in infections, the Egyptian Health Ministry says. 

The sale of poultry between any of Egypt’s 29 governorates is to be banned, and a major Health Ministry-led awareness campaign will alert the public to the dangers of raising birds at home, Sabir Galal, deputy chief of the Veterinary Medicine Section at the Health Ministry, told IRIN. 

“Bird flu has become endemic in this country… The fear now is that the virus can assume more dangerous forms in the days to come,” he said. 

The Ministry also said it would stop inoculating birds after vaccines had proved incapable of stopping the virus from spreading.

Via The Ottawa Citizen: Prevention post-mortem. Excerpt:

…Canada resisted pulling out all the stops for H1N1. This was not the full pandemic flu plan in action. That plan, adopted in 2004 but not yet used, is far more sweeping. It involves setting up 165 mobile hospitals that hold up to 200 patients each, and using refrigeration trucks or even hockey arenas as makeshift morgues. 

So the impression that the Canadian response to H1N1 was a gross overreaction is mistaken. Besides, there is a spinoff benefit of all the H1N1 vaccinations: A huge number of Canadians now have some protection for when the next H1N1 virus hits, just as exposure to the 1957 virus gave protection this year. 

If there’s an area where the WHO and Canadian officials should perform better, it probably is communication. The term “pandemic” was never properly understood. It refers more to geography than lethality — that is, a pandemic is a global outbreak, rather than a virus that is necessarily a major killer. 

H1N1 was indeed a global outbreak, and therefore a pandemic in a technical sense, but the WHO should, before another mutant flu bug arises, develop a scale that measures danger to health as well as geographic spread.

Via the Indian government’s Press Information Bureau: Consolidated status of influenza A H1N1 as on 8th March 2010. It reports 29,837 confirmed cases with 1,395 deaths.