Influenza Virus Mashup

(Tue, 31 Jan 2012 13:07:00 +0000)

Photo Credit – FAO

# 6111

Virologist Chairul Anwar Nidom of the Institute of Tropical Disease, Airlangga University probably knows more about how the H5N1 virus is evolving in Indonesia than anyone else.

Regular readers of this blog have come across his name dozens of times over the past few years, including here, here, and here. 

 

Dr. Nidom demonstrated in 2006 that 20% of feral cats he tested in Jakarta carried antibodies to the H5N1 virus (see here), and his team has detected the bird flu virus in pigs as well (see When Pigs Flu).

 

 

Today we’ve a long article by Dr. Nidom appearing in the Indonesian newspaper Kompas on the fight against bird flu, and some of the obstacles that lie ahead.

The bad news here is that his remarks are in the Indonesian language (Bahasan), and we must content ourselves with machine translations which can sometimes lose a bit in the process.

Despite this impediment, we can glean a good deal from Dr. Nidom’s article. A hat tip to Diane Morin and Sharon Sanders of FluTrackers for this find.

I’ve links to two different translations below - which I encourage you to read - followed by a bullet list of some of his main points.

As you’ll see, the finished product varies somewhat between the Google Translation and the Microsoft translation. It really takes reading both of them to get the most out of this story.

Via Microsoft’s Bing Translator:

The Fight Against Bird Flu 

and from Google’s Translator:

Warring Against Bird Flu

Among the points raised by Dr. Nidom:.

• Of the 33 provinces in Indonesia, 32 are endemic areas of bird flu in poultry and other animals.

• Control measures have not made visible progress over the past eight years.

• The National Commission on Bird Flu was disbanded last year, and they still await the Disease Control National Zoonoses program which they hope will have more impact.

• Unlike most cases in the past, officials have been unable to establish a link to infected poultry in the recent human cases in Bali, Jakarta and Tangerang.

• Dr. Nidom asks for a fatwa, or religious regulation so victims of bird flu or other contagious diseases can be autopsied (rarely done now due to cultural, societal, and religious reasons).

• He goes on to say that hospitals need to be trained to recognize and treat the H5N1 virus, and that it is likely that many cases go undiagnosed. He likens the number of cases we see to the `tip of the iceberg’.

• He calls for vaccination (when available) for people at the highest risk – particularly those living in the `triangle of bird flu, namely Jakarta, West Java, and Jakarta’, and suggests that Oseltamivir be made available over the counter.

• Dr. Nidom warns that the co-circulation of influenza viruses (H1N1, H3N2, H5N1)  in Indonesia may lead to a reassortment, producing new – potentially dangerous – strains.

• At one point Dr. Nidom states (ToggleText  Translation): In 2006, was carried out by the "artificial" mutation in the virus H5N1 from the poultry in Indonesia without the coalition. Evidently the virus H5N1 the poultry that formed a coalition with H3N2 more virulent (see PNAS: H3N2 And H5N1 Reassortment).

• One of the concerns expressed by Dr. Nidom in the past  is that vaccines – as they lose their effectiveness – could mask the symptoms of bird flu in poultry, but still allow the virus to spread. (see Bird Flu: Confusing Reports Out Of Indonesia).  He reports today: Healthy chickens positive for bird flu are located in Riau, Central Java, East Kalimantan, West Kalimantan and South Kalimantan.

• Dr. Nidom warns that a (shift/drift/coalition) of the virus could result in human-to-human transmission of the virus and concludes by saying: It is very important for Indonesia to confront the pandemic, given our region an ideal place of the coalition. All strains are available, while structuring the environment of animals and humans remains unclear.

While these are most of the highlights, there is more to glean from this article, and should we see a better translation I’ll certainly post the link.

In the meantime, there is much to consider here.

Science has published Adaptations of Avian Flu Virus Are a Cause for Concern. It's a PDF. Excerpt:

Dr. Vincent Racaniello is already tweeting some responses. It's going to be a lively day. 

Via ABC Rural: Japan suspends imports of Australian poultry products. Excerpt:

Japan has suspended imports of all Australian chicken meat and eggs after avian influenza was reported on a farm in Victoria. 

Up to 25,000 ducks have been destroyed on two farms north of Melbourne after the low pathogenic form of the disease was found last Friday, January 27th. 

Now the Japanese Government has responded by not allowing any Australian poultry products, including meat and eggs, nor egg derived products, like cake and ice-cream. 

The move is despite efforts by Australian authorities to reassure consumers all poultry products, even from affected farms, are safe to eat and "the risk to human health is negligible." 

Australia's Department of Agriculture's Biosecurity division says "Australian exporters of locally processed foods containing small amounts of egg products should first contact their buyer and confirm import conditions for Japan prior to export." 

In a statement this afternoon DAFF Biosecurity says it "will continue to work closely with Australian industries and relevant trading partners to ensure there is minimal disruption to trade."

(Mon, 30 Jan 2012 19:46:00 +0000)

BSL-4 Lab Worker - Photo Credit –USAMRIID

# 6110

We are now 10 days into the self-imposed 60 day moratorium on the conducting (and publication) of controversial H5N1 research, and the meeting to discuss the future direction of such work in Geneva is still more than a couple of weeks away.

Meanwhile, the war of words - and the battle for the hearts and minds of the public - continues full throttle with advocates on both sides of this issue making their case in the media.

Today PBS Newshour has posted responses from three experts to a series of questions about this debate.

Richard H. Ebright - a molecular biologist at Rutgers

Vincent Racaniello - a microbiologist at Columbia, and author of the Virology Blog

Carl Zimmer, a journalist, author, and blogger

As you might imagine, there is a considerable difference of opinion over what should be done. Follow the link below to read:

SCIENCE — January 30, 2012 at 11:54 AM EDT

Experts Weigh in on Bird Flu Research

By: David Pelcyger

For earlier coverage of this story, you may wish to revisit:

Nature: Yoshihiro Kawaoka Talks About His H5N1 Research

WHO: Will Host H5N1 Talks In Geneva

ScienceMag: Ron Fouchier Interview On The H5N1 Research Moratorium

Science Magazine: Public Health, Biosecurity, and H5N1

There’s an old saying that Academic infighting is so vicious, because the stakes are so low. But in this case, both sides view the stakes here as being enormously high.

Biosecurity and concerns over public safety versus revered and well established principles of Scientific Freedom.

Given the tenor of some of the discussions I’ve seen over the past couple of weeks, the gulf between these two sides doesn’t seem to be getting any narrower.

(Mon, 30 Jan 2012 13:57:00 +0000)

# 6109

FEMA and Ready.gov, along with organizations like the American Red Cross (and indeed, this blog), spend a great deal of time trying to convince individuals, families, businesses and communities to prepare for emergencies and disasters.

The standardized advice is that everyone needs to be prepared to deal with a disaster for at least 3 days (meaning having a first aid kit, emergency supplies, and a plan) before help arrives.

Sure . . .  they’d like you to be prepared for longer . . .  but few enough Americans can be bothered to prepare for even 72 hours.

 

I personally advocate a minimum of a week’s worth of supplies (two would be better), but then I live in the heart of hurricane country, and am admittedly a bit of a belt-and-suspenders kind of guy (see NPM11: Living The Prepared Life).

There are some post-disaster aftershocks, however, that even two weeks of supplies won’t prepare you for.

The recent earthquakes in Haiti and in Fukushima, Japan – along with  Hurricane Katrina in New Orleans – have shown how communities can be forever changed by a disaster.

With our short attention span, and the news media’s proclivity for moving on to the next big disaster or story, we often forget that the struggle to rebuild devastated communities can take years.

And sometimes, for some of the people caught in harm’s way, there is no going back to the way things used to be.

Today, in a sobering news story by ABC (Australian Brocasting Corp), we learn that the first of what may eventually become 5,000 homes are to be demolished in the wake of their recent series of earthquakes near Christchurch, NZ.

The land they were built on experienced significant liquefaction during the September 2010 and February 2011 earthquakes, and so homes will not be rebuilt on these lots.

NZ begins demolishing Christchurch suburbs

By New Zealand correspondent Dominique Schwartz

Updated January 30, 2012 18:50:35

As this story indicates, that despite some compensation offered by the government, many residents have lost tens (or even hundreds) of thousands of dollars and say they have `no way of moving forward’.

With tremors continuing (see map above), those who escaped with only minor or moderate damage get nerve-wracking daily reminders that the ground beneath their feet could move violently again at any time.

And for those who would like to move away and start anew, the reality is that there are few buyers willing to purchase a home or a business in an area where the ground continues to shake.

Not all of the aftershocks of a disaster are seismic in nature. Some are economic, while others can be psychological.

While often hidden from view, the psychological impact of a disaster can be enormous and ongoing. Last year in Post Disaster Stress & Suicide Rates we looked at the impact of disaster-related PTSD (Post Traumatic Stress Disorder).

Although a good disaster plan and emergency kit are imperative to get you through the opening hours and days of a disaster, knowing how to help friends, family, and neighbors deal with the psychological effects of a disaster can be equally important.

Luckily, there are things that can be done - even by the layperson - to help reduce the psychological impact of a disaster. 

A few resources you may wish to revisit:

In Psychological First Aid: The WHO Guide For Field Workers we looked a simple guidebook anyone can use to help others in emotional distress.

The CDC also provides a website which contains a number of resources devoted to coping with disasters.

Coping With a Disaster or Traumatic Event

Trauma and Disaster Mental Health Resources

The effects of a disaster, terrorist attack, or other public health emergency can be long-lasting, and the resulting trauma can reverberate even with those not directly affected by the disaster. This page provides general strategies for promoting mental health and resilience. These strategies were developed by various organizations based on experiences in prior disasters.

As does the National Center For PTSD - including videos - on how to provide Psychological First Aid.

Psychological First Aid: Field Operations Guide

For Disaster Responders

Developed jointly with the National Child Traumatic Stress Network, PFA is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism: to reduce initial distress, and to foster short and long-term adaptive functioning.

A small reminder that not all wounds are readily visible to the naked eye, and that the proper bandage for them may not always reside inside your first aid kit.

Mike Coston at Avian Flu Diary has an excellent post today: Surviving A Different Kind Of Aftershock. Excerpt (but read the whole thing):

The recent earthquakes in Haiti and in Fukushima, Japan – along with  Hurricane Katrina in New Orleans – have shown how communities can be forever changed by a disaster.   

With our short attention span, and the news media’s proclivity for moving on to the next big disaster or story, we often forget that the struggle to rebuild devastated communities can take years.   

And sometimes, for some of the people caught in harm’s way, there is no going back to the way things used to be.

Via Antara News: Bird flu in Bogor still restricted to chickens. Excerpt:

Bogor city health authorities have ascertained that no people in a ward where a number of chickens have been dying suddenly since Thursday (Jan 9) have contracted Avian Influenza (AI). 

"We have made on-the-spot checks and taken data and we can say that so far nobody in the neighborhood has been infected with the H5N1 virus," Dwi Susanto, a member of the Bogor City Health Office`s surveillance team, said on Saturday. 

Two people in Kampung Kayu Manis in Bogor city's Tanah Sareal ward where the chickens died were found to be sick but a medical check showed them to be suffering from the common flu, he said.

Thanks to Emmy Fitri for tweeting me the link to this story in The Jakarta Globe: Bird Flu Fears in Indonesia: Flap Over Jakarta Pet Market Move. Excerpt:

Despite lingering fears about the spread of bird flu in the country with the world’s highest number of fatalities from the deadly avian influenza virus, Indonesia’s largest pet market has survived several attempts to relocate it. 

Located in East Jakarta, Pasar Pramuka is one of the 23 pet markets in Jakarta that sell birds. It boasts no fewer than 152 stores selling anything from various pigeon breeds and ducks to ornamental chickens. 

The market, which is popular with many Jakarta shoppers, sits just 5m from the densely populated Pal Meriam residential area — a clear challenge to municipal laws that ban poultry from being reared within 25m of residential areas. 

While the laws specifically refer to farmed poultry and slaughterhouses, it is clear that pet birds would pose similar risks of spreading bird flu to humans. 

But the people living near Pasar Pramuka are not worried. 

“The pet market has been around for 30 years. We haven’t had anyone here catching bird flu,” Evaldi, 46, who lives about 20m from the market, said as his six-year-old son Razaq Gumanti, played with his pet bird. 

His neighbor Damiri, too, told The Straits Times: “They have been keeping Pasar Pramuka market very clean, probably the cleanest market in the country. As long as they keep up with that hygiene work, we should not be worried.” 

It is the kind of response that frustrates Ipih Ruyani, Jakarta’s top bureaucrat overseeing the culling of sick poultry and checking on whether poultry handlers keep to the rules. 

“Their typical argument is: We have been living with live poultry for years. If there were bird flu, we would have caught it a long time ago,” she said, sighing. 

Jakarta’s municipal government has been trying to move Pasar Pramuka for the past four years but has been facing delays from a combination of protests from stallholders and the public, as well as slow bureaucracy. 

The first attempt was made in 2007, the year 37 people died from bird flu in Indonesia. The country accounts for almost half of human bird flu fatalities, and saw 45 people die in 2006.

(Sun, 29 Jan 2012 17:42:00 +0000)

# 6108

When I saw the reports on Friday about India’s Health Ministry’s attempts to downplay reports of totally drug resistant tuberculosis, I was immediately reminded of the old joke about the doctor who couldn’t cure you, but for a small fee he’d touch up your X-rays.

Today, Maryn McKenna takes a closer look at India’s denials (which are similar to the official reaction we saw last year over NDM-1)  in her Superbug Blog.

Follow the link to read:

TDR-TB: The Indian Government Denies It

• By Maryn McKenna
• January 29, 2012 

An update to the news two weeks ago of totally drug-resistant tuberculosis, TDR-TB, being identified in India (and earlier in Italy and Iran): The Indian government has announced that it doesn’t exist, and is putting pressure on the physicians who identified it to say they made a mistake.

(Continue . . . )

The February issue of Emerging Infectious Diseases is now online, and this article caught my eye: Pathogenic Responses among Young Adults during the 1918 Influenza Pandemic. The abstract, re-paragraphed:

Of the unexplained characteristics of the 1918–19 influenza pandemic, the extreme mortality rate among young adults (W-shaped mortality curve) is the foremost. Lack of a coherent explanation of this and other epidemiologic and clinical manifestations of the pandemic contributes to uncertainty in preparing for future pandemics. 

Contemporaneous records suggest that immunopathologic responses were a critical determinant of the high mortality rate among young adults and other high-risk subgroups. 

Historical records and findings from laboratory animal studies suggest that persons who were exposed to influenza once before 1918 (e.g., A/H3Nx 1890 pandemic strain) were likely to have dysregulated, pathologic cellular immune responses to infections with the A/H1N1 1918 pandemic strain. The immunopathologic effects transiently increased susceptibility to ultimately lethal secondary bacterial pneumonia. 

The extreme mortality rate associated with the 1918–19 pandemic is unlikely to recur naturally. However, T-cell–mediated immunopathologic effects should be carefully monitored in developing and using universal influenza vaccines.