# 4866

GSK (Glaxo Smith-Kline), manufacturers of the adjuvanted Pandemrix vaccine that has been linked by media reports to a small number of cases of narcolepsy in children – has released a statement today for journalists and investors.

 

Reports of narcolepsy in Europe following vaccination with Pandemrix™

WEBWIRE – Friday, September 03, 2010

London UK - GSK initially became aware of possible cases of narcolepsy following vaccination with the adjuvanted H1N1 pandemic vaccine Pandemrix through adverse event reports received by the Swedish Medical Products Agency, and subsequently via media reports in Finland.

 

Information on the individual cases remains limited at present, but GSK is conducting its own investigation in an effort to gather as much additional data as possible regarding the reported cases, and is working closely with key regulatory authorities, including the European Medicines Agency (EMA).

(Continue . . .)

Although some media reports – particularly those by anti-vaccination activists – have worded stories to suggest that a `probable link’ between the vaccine and these cases of narcolepsy has been established . . .  right now, there is no proof of causation.

With further investigation, a link may be established. Flu vaccines have a good safety record, but on rare occasions serious side effects have been noted.

That said, the background rates of narcolepsy are poorly understood, and the condition is generally believed to be under-diagnosed.

It will take time to know whether the vaccine was responsible for this upsurge in reported cases. 

But other possibilities exist.

Greater scrutiny, better reporting systems, and the public’s concern over the vaccine’s safety might well account for a greater number of diagnoses of narcolepsy in children over the past 6 months.

Essentially, the harder we look for diseases, the more we are likely to find.

We’ll simply have to wait to see where these investigations lead.

# 4865

In the wake of yesterday’s report that credited the Brown Headed Gull with spreading the H5N1 virus from China and Tibet down to Thailand, we get another study that minimizes the impact that migratory waterfowl may have in spreading the virus across long distances.

The study appears in the British Ecological Society’s Journal of Applied Ecology, and claims that the global spread of the H5N1 virus through migratory birds is possible . . . but unlikely.

By studying 19 species of waterfowl, and making assumptions as to how long they may be able to carry the highly pathogenic H5N1 virus asymptomatically, these researchers say that there is a `limited window of opportunity’ for the virus to be spread over long distances by migratory waterfowl.

The press release may be read at:

Satellite data reveal why migrating birds have a small window to spread bird flu

The entire study is available for viewing at the link below:

Potential spread of highly pathogenic avian influenza H5N1 by wildfowl: dispersal ranges and rates determined from large-scale satellite telemetry

1. Nicolas Gaidet, Julien Cappelle, John Y. Takekawa, Diann J. Prosser, Samuel A. Iverson, David C. Douglas, William M. Perry, Taej Mundkur, Scott H. Newman

Although a lengthy study, the bottom line is summed up by points 3 & 4 of the author’s summary:

3. Our results indicate that individual migratory wildfowl have the potential to disperse HPAI H5N1 over extensive distances, being able to perform movements of up to 2900 km within timeframes compatible with the duration of asymptomatic infection.

4. However, the likelihood of such virus dispersal over long distances by individual wildfowl is low: we estimate that for an individual migratory bird there are, on average, only 5–15 days per year when infection could result in the dispersal of HPAI H5N1 virus over 500 km.

These results are based, of course, on a limited number of species, and calculations are predicated on assumptions based on the pathogenesis of HPAI in captive birds.

While likely not the last word on the subject, this study offers new insight into the potential of intercontinental spread of HPAI via migratory waterfowl.

Note: This is day 3 of National Preparedness Month.  Follow this campaign on Twitter by searching for the #NPM10 hash tag.

# 4863

There are some who believe that it is unfair, or somehow unethical, to ask those with greater financial means to prepare for disasters while some with fewer resources may be unable to do so.

A noble idea, I suppose.

But the reality is that the more people who are prepared before a crisis, the fewer people that will need emergency assistance later.

And by being prepared, you are in a better position to offer help to a friend, a neighbor, a relative, or your community.

Prepping is ethical.   And it isn’t just me saying that.

In October, 2008 I wrote a blog which highlighted the John’s Hopkins Study entitled Ethics and Severe Pandemic Influenza: Maintaining Essential Functions through a Fair and Considered Response. 

It included the following snippet from the summary provided on  the Johns Hopkins Berman Institute of Bioethics website.

. . .  individuals and families who can afford it should do their best to prepare for any disaster. The paper notes, the more initiative the general public exercises in stockpiling several weeks’ worth of food, water, paper goods, batteries medicines, and other needed supplies, the less vulnerable they will be to a break in the supply chain.

 

It is important for leaders to communicate to the middle class and the wealthy that it is their responsibility to prepare for self-sufficiency in order to free up scarce supplies and allow first responders to direct their attention towards those too poor or vulnerable to prepare themselves.

While this may not have been the main thrust of this paper’s message, it is a powerful component.    One that bloggers such as myself have been trying to promote for several years.

As long as our supply chains are intact, grocery store shelves are full and capable of being restocked, and no major shortages exist it is not hoarding, selfish, or unethical to be stockpiling a reasonable amount of emergency supplies for you, your family, and others you might be able to assist during a disaster.

During a crisis relief agencies will have their hands full trying to help those who were unable to prepare, or who lost their preps due to a disaster.

By being prepared in advance, you take some of the burden off these agencies, which will allow them to concentrate their efforts on helping those less able to help themselves.

 

And by being prepared, you are in a better position to help others.

 

And that’s a win-win situation. For you, your family, and your community.

The American Red Cross sponsors a Do More Than Cross Your Fingers preparedness campaign, with spokesperson Jamie Lee Curtis that can get you started. 

You’ll find scores of other Red Cross videos on the RED CROSS YOUTUBE CHANNEL.  You can also follow the Red Cross on Twitter by subscribing to @RedCross.

While 72 hours is considered the minimum amount of  time you and your family should be prepared for, there is nothing that says you shouldn’t strive to do better than that. 

 

A week or more of emergency supplies is a laudable goal.

And of course, the Red Cross isn’t alone in promoting disaster preparedness. For more information, you’ll want to visit.

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

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

It’s the ethical thing to do.

Sungai Penuh – Livestock Service of Kabupaten (municipal) Kerinci, Jambi Province, found bird flu H5N1 had infected chickens in Dusun Sungai, Akar Desa Pelayang Raya, Kota Sungai Penuh. Confirmation was done by Participatory Disease Surveillance and Response (PDSR) of Kabupaten Kerinci. Meanwhile, samples have been sent to Bukit Tinggi laboratory for further check.

Swine flu has claimed 16 lives this winter, and a further 14 people are fighting it in intensive care units. 

The sixteenth person to die was a 50-year-old man who suffered from underlying health conditions and died at Auckland Hospital on August 21. 

This brings to five the total number of H1N1-related patient deaths at Auckland City Hospital this year, said the Auckland District Health Board. 

Deputy director of public health Darren Hunt said swine flu numbers appeared to be falling but there was regional variation, with areas such as Canterbury still experiencing increased cases. 

“The number of calls to Healthline are still higher than normal, though the number of calls requiring assessment of influenza-like illness seems to be decreasing,” Dr Hunt said. 

“It’s still important to seek medical advice early, particularly for people with underlying medical conditions or who are severely overweight or pregnant, as they are at greater risk of a more severe illness.” 

By midday yesterday, 631 people had been hospitalised with confirmed cases of swine flu.

Meanwhile, Radio Zealand reports 102 H1N1 patients are in intensive care units.

# 4862

A story today out of Thailand that blames gulls, not storks, for introducing bird flu to that nation and possibly spreading it across south east Asia.

Using satellite telemetry, researchers have detailed the the complete migratory routes of the brown headed gull (Larus brunnicephalus), which summers in central Asia and winters on the tropical coast and inland lakes of southern Asia.

They’ve also detected the H5N1 virus in some small percentage of these migrating gulls, leading them to believe that it is the brown headed gull that has spread the virus to Thailand.

First a link to the news  report, then some follow up.

Study blames gulls, not storks, for bringing in bird flu

By Pongphon Sarnsamak
The Nation
Published on September 3, 2010

A study has found that the bird that carried the influenza virus H5N1 into Thailand was a gull, not the openbill stork.

Those with good memories may recall that last June I ran a report on H5N1 Bird Deaths In Tibet. The China Tibet Information Center cited the deaths of 171 wild bird from around Naqu Lake, and listed the species as:

• 141 brown-headed gulls
• 27 bare-headed geese
• 1 chough
• 1 wigeon 

And if we go back to 2007, during a time when H5N1 was making inroads into Western Europe, one of the concerns mentioned was the Black Headed Gull, as I wrote of in UK Vet Warns Of Migratory Bird Threat.

The whole migratory-birds-spreading-H5N1 issue is a contentious one, with some groups defending wild birds and pointing their fingers at poultry producers and smuggling.

The poultry industry generally cries fowl (sorry), and blames wild birds instead.

As a dispassionate observer, without a bird in this fight, I can see how both contribute to the spread of the virus.  Which I suspect makes me not very popular in either camp.

Up until now, gulls have been a low profile suspect in the spread of bird flu.  Now, with this new study, they may need to come under more scrutiny.

Since this is day two of National Preparedness Month and with Hurricane Earl expected to force thousands of coastal residents from their homes in the next 24 hours, this seems an appropriate day to re-run a preparedness blog on bug out bags from last January.

# 4861

Inside My Bug Out Bag

If you had to abandon your home right now, with say . . . two minutes to get out (think fire, earthquake, chemical spill, gas leak,  tornado, flood . . .) could you evacuate yourself and your family – along with a few necessary items – in that space of time?

To evacuate with the bare essentials – spare clothes, copies of important ID papers, Rx Medications, 72 hours of food, a toiletry kit, and a small amount of money – with just a couple of minutes advance warning becomes a lot easier if you create a Bug Out Bag (BOB) in advance.

Last August, I wrote a blog called What About BOB?.  In it, I review the recommendations of Ready.gov.  A bug-out-bag should be a smaller version of a much larger emergency supply that every household should maintain.

While a BOB should provide for 72 hours of your family’s needs, you should be prepared to stay at home, without outside assistance, for at least 2-weeks.

Monday, August 17, 2009

What About BOB?

# 3635

(Ready.gov 3 minute video)

 

It’s wildfire season out west, hurricane season along the Atlantic and Gulf Coasts and just about anywhere else floods, earthquakes, tornados, and all manner of other disasters could conspire to force you and your family from your home with very little notice.

 

Having an emergency `to go’ kit or `BOB’ is an important preparation, and could be lifesaving in an emergency.

 

(Continue . . . )

While everyone’s BOB will be a little different, I thought I’d take you on a photo tour of mine today.   Some of my choices, given my training and needs, might be different from yours.

You should consult the Ready.gov website for specific recommendations about what you should include in your kit.

Everything I’ve got fits into a single duffle bag.

I keep mine stocked (and checked for freshness every 6 months), and easily accessible in my home.  If I had to leave on a moment’s notice, at least I’d be leaving with more than the clothes on my back.

You’ll notice in the pictures below just about everything is kept in plastic bags. 

First comes the electronics.  

While I would obviously want to grab my cellphone (and my beloved iPod) on the way out the door, some basics that stay in the bag are an LED Lantern, a battery operated radio, extra batteries, a small pocket knife, and a hand-crank flashlight.

Next in line is 72 hours of food. 

I’ve a couple of MREs, a couple of `pouch meals’ that can be eaten warm or cold, some soup mixes, some instant oatmeal, and (don’t forget) something to eat and drink out of, and some plastic utensils.

Next come some basic `survival’ items.  

Water (I usually carry 4 or 5 pints), hat, spare glasses, sun block, essential computer backups on flash drives, a copy of my medical history, and some plastic sheeting, duct tape, and some light rope.   

With those last three items, I have the makings of an emergency shelter if need be.

Next comes a combination toiletry kit (toothbrush, paste, floss, toilet paper, small garbage bags)/mini first aid kit.  I’ve also got some aspirin, and 3 prescriptions I’d hate to be caught without in an emergency.

Tucked away inside this kit I also have some quarters, some folding money, and copies of my driver’s license, a list of emergency phone numbers, and copies of some other important papers.

I also threw in a pair of reef-runners.   Light mesh shoes that are good for walking in water.  They dry out quickly.   Admittedly, they are a bit bulky, but this is Hurricane country, and dry shoes could be a godsend in a crisis.

And lastly, I’ve some dry clothes and a fleece blanket.  Everything, of course, bagged to keep dry.

There you have it.

Everything I need to stay warm, dry, nourished, and reasonably comfortable for 72 hours.  Plus the added benefit of having two sources of light, an emergency radio, a little cash, a mini first aid kit, and some basic toiletries.

Things that would take me precious minutes to gather up during an emergency.  Time I simply might not have.

 

 

Of course, you’d be hard pressed to put everything for a family of four into one bag.  So each family member should have their own BOB.

 

Some items, like the radio, lights, and first aid kit needn’t be duplicated in each bag. 

We all think that it will never happen to us.  That nothing could drive us out of our homes with a moment’s notice, and without time to pack up some essentials.

But every year in the United States thousands of families find themselves in exactly that situation.  A  house fire, a flood, a tornado . . . even an earthquake . . . can occur with no advance warning. 

I keep my BOB within arm’s reach of my first aid kit, and would hopefully be able to grab both, even in an emergency.   Frankly, I’d feel naked without it.

Over the years, having a well stocked first aid kit has come in very handy.  It is amazing the peace of mind that comes from being ready for an emergency.

I do these things because preparing is easy.

It’s worrying that is hard.

For more preparedness information, you may wish to visit these sites.

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

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

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

“Bird flu? What bird flu? That was last year, right?” 

So spoke my rental car driver, commenting on the purpose of my June visit to Riau’s capital, Pekanbaru. 

He did not know that a four-year-old girl had died of the deadly disease a few weeks before my arrival. 

One of the managing editors of the Riau Post, the province’s leading newspaper, was not aware of the child’s death either. 

“I’m almost sure the latest bird flu fatality in Riau was in 2009,” the editor told me. 

Risk communication expert Peter Sandman once said that the level of media attention equals the level of public attention. The fewer reports the media publishes on bird flu, the less people notice that it is still around. 

In the public mind, bird flu has died down. Nobody pays attention to the once-global threat  anymore – not even those who were in charge of controlling it during its outbreak from 2005 to 2009, when Indonesia was ground zero for avian influenza. 

When the central government decided to dissolve the national committee on avian influenza control and pandemic preparedness (Komnas FBPI) last year, people assumed the war against H5N1 was over. 

And when both the international community and the country’s leaders claim that Indonesia has done well in controlling bird flu, Indonesians have even more reason to dismiss the worry from their minds. 

Reality bites. The virulent bug is still around, searching for more hosts and breeding places to multiply, looking for ways to spread more rapidly, infect humans more easily and kill them more quickly – to accomplish the virus’ most outstanding achievement: high morbidity and high mortality. 

The death of the Riau toddler serves as a warning for us to remain vigilant. Yes, it is just one death. But it always starts with one. One is not unimportant, especially this particular one, because so much is still unexplained. 

“The risk factor has yet to be found,” says Askardiya R. Patrianov, the head of Riau’s Livestock and Animal Health Office. 

“We can’t explain how the girl contracted bird flu,” says Ernawati Balia, head of Communicable Disease Control at the province’s health office. 

Local media reported that no poultry living around the girl’s family home tested positive for H5N1. Her family did not keep poultry. The official reports of both the health and the animal health offices say vets checked everything that could serve as the virus’ host, from chicken droppings to soil, but found nothing related to virus exposure. 

“We have to carry out a scientific study to discover the cause,” says Patrianov. Askardiya believes that studies by animal health experts, virologists or microbiologists will determine the risk factors. Was it the air she breathed, the water she drank or the environment she lived in? Could the virus have been transmitted via a medium other than poultry? Is it the same virus strain or has it evolved or, to use the experts’ term, “mutated”? 

“Those are some of the key questions to be answered,” he adds. 

Solving the mystery would perhaps remind people that bird flu is still around.

# 4860

Arkanoid Legent has a story this morning from the Asahi Shimbun in Japan with this attention getting headline:

Mutated avian flu can infect humans

BY YURI OIWA THE ASAHI SHIMBUN

A strain of highly pathogenic avian influenza (H5N1) that mutated in pigs in Indonesia has acquired the ability to infect humans, researchers have found.

(Continue . . .)

If all of this sounds a bit familiar, it may be because I wrote about this study at some length in mid-August (see EID Journal: Asymptomatic H5N1 In Pigs). 

While obviously an important piece of field research - one that illustrates why we need to do a much better job of surveillance of pigs (and other mammals) for emerging viruses – the headline and lede may be just a tad overstated.

Since this story is likely to get a good deal of play over the next few days, a revisiting of the original study seems in order.

First, the setup for the research via some excerpts (slightly reformatted for readability) from the EID Journal abstract . . . then some discussion.

DOI: 10.3201/eid1610.100508

Nidom CA, Takano R, Yamada S, Sakai-Tagawa Y, Daulay S, Aswadi, D, et al. Influenza A (H5N1) viruses from pigs, Indonesia. Emerg Infect Dis. 2010 Oct;[Epub ahead of print]

Influenza A (H5N1) Viruses from Pigs, Indonesia

Pigs have long been considered potential intermediate hosts in which avian influenza viruses can adapt to humans. To determine whether this potential exists for pigs in Indonesia, we conducted surveillance during 2005–2009.

Pigs have long been suspected as being ideal `mixing vessels’ for influenza because they possess both avian-like (SAα2,3Gal) and human-like (SAα2,6Gal) receptor cells in their respiratory tract.

That means pigs are susceptible to human, swine, and avian strains of flu.  And they are capable of being infected by more than one flu virus at a time.

This opens the possibility for two flu viruses to swap genetic material inside a pig, and create a hybrid (reassortant) strain as depicted in the illustration below (other hosts can cause reassortments, too).

This is essentially how the 2009 H1N1 pandemic virus was born, although it took multiple gene swaps over a period of years before it emerged into the human population.

The highlights of this latest study were:

Researchers found that during the period of 2005-2007 that 7.4% of pigs surveyed in Indonesia carried the H5N1 virus.

 

Phylogenic analysis showed at least 3 separate introductions into the pig population.

 

More recent surveillance (2008-2009) did not turn up any active infections, but 1% of pigs tested carried antibodies to the H5N1 virus.

 

The pigs were asymptomatic, but the evidence points to ongoing transmission within the pig population.

 

In one sample researchers found an adaptation of the virus to human-like receptor cells via an Ala134Ser mutation (swaping alanine with serine) at position 134.

The last point is obviously a concern.

But just as obviously, if only one instance was detected – and that was at least 3 years ago – then that particular mutation isn’t exactly thriving in Indonesia’s pig population.

The point is . . .  if it happened once, it could obviously happen again. 

And the next time, the reassorted virus could be more biologically `fit’, and start efficiently spreading to other pigs, and eventually perhaps to humans. 

Which is why surveillance of farm animals (particularly, but not exclusively, pigs) is so important. 

And not just in Indonesia.

Despite the danger posed by emerging viruses there is considerable reluctance to testing herds of swine, both here in the US, and around the world.  

Pig owners fear negative publicity, or a culling of their herds, should anything be found. And of course, surveillance costs money.

 

`Swine flu’ proved to be an expensive public relations nightmare for the pork industry, and so pig farmers are understandably wary.

 
As the authors point out, the asymptomatic carrying of these viruses is of particular concern.  There are no outward signs to alert a farmer than their herd is sick.

This could lead to infected pigs being transported to new areas, or intermingled with uninfected swine, spreading a new virus further. 

The important point to this story is not so much the one human-adapted virus they discovered in 2007, but what we need to be looking for today.  

And in far too many places around the world, simply are not.

In a small village in Koh Kong province, poultry farmer Keo Sok is learning that healthy practices can be good for business. 

The Sre Ambel district man is one of 71 farmers in Koh Kong participating in an NGO-led programme aimed at reducing the risks from so-called bird flu, the A(H5N1) influenza virus. 

The training has taught him to keep his chickens in pens rather than letting them run free, to feed them properly rather than letting them eat insects or rotten vegetables cast off from the family’s dinner, and to separate the hens from the chicks – a practice that allows hens to lay eggs faster, he said. 

Now, the farmer is starting to see the rewards. Whereas before he only managed to feed five hens, he now keeps 20, as well as other chickens. 

“My chickens rarely die, and they mature fast since I started following these bio-security measures,” Keo Sok said. 

The NGO CARE Cambodia started its Community Based Avian Influenza Risk Reduction project in 2006. It now spans three border provinces – Svay Rieng, Prey Veng and Koh Kong – where transmission risks were seen as higher because of their proximity to countries that have reported outbreaks of avian influenza. 

The programme includes setting up “demonstration farms” where farmers can observe safe poultry-keeping practices. 

Proponents of the project said they quickly discovered benefits beyond the health goals. 

“The demonstration farm was originally intended for disease prevention,” said Cecilia Dy, CARE’s avian influenza project coordinator. But by following the practices prescribed at the farms, she said, “they get more economic benefit from having healthy poultry for eating and selling”.