Sunday, September 30, 2007

The Week Ahead

 

# 1145

 

 

A delightfully quiet Sunday Morning, as far as Flu news is concerned.

 

This coming week the Senate Committee on Homeland Security and Governmental Affairs will hold hearings on Pandemic issues.    It appears that these hearings will be available for viewing, live on the web at http://www.senate.gov/~gov_affairs/.

 

A Hat Tip to SusanC on the Wiki for posting this information.

 

 

 

 

 

 

10/02/07
10:00 AM
Preparing the National Capital Region for a Pandemic

 

Title: Preparing the National Capital Region for a Pandemic

Date: 10/2/07

Time (EST): 10:00 AM

Place: Dirksen Senate Office Building, Rm. 342

Due to the globalization of the world economy and more frequent international travel a pandemic influenza is becoming more likely. The National Capital Region (NCR) has worked with Federal Emergency Management Agency and the Department of Health and Human Services to develop an emergency response plan. Last year, the NCR released a strategic plan to address preparedness and collaboration efforts of the area jurisdiction, which include the District of Columbia, Maryland, Virginia, 12 local jurisdictions, three branches of federal government, and over four million Americans. However, this strategic plan does not explain how the NCR should respond to any particular emergency. Since emergency response is a local responsibility, as recognized by the National Response Plan, each local jurisdiction has developed its own set of emergency operations. Thus, those operations plans prescribe how the jurisdiction in the NCR would respond to an emergency such as a pandemic outbreak. This hearing will examine the various pandemic response plans in the region and the overall preparedness of the NCR in the event of such an emergency.

 

 

 

 

10/03/07
2:30 PM
Pandemic Influenza: State and Local Efforts to Prepare

 

U.S. Senate Committee on Homeland Security and Governmental Affairs

Ad Hoc Subcommittee on State, Local, and Private Sector Preparedness and Integration

Title: Pandemic Influenza: State and Local Efforts to Prepare

Date: 10/3/07

Time (EST): 2:30 PM

Place: Dirksen Senate Office Building, Rm. 342

 

 

 

 

10/04/07
2:30 PM
Forestalling the Coming Pandemic: Infectious Disease Surveillance Overseas

 

 

U.S. Senate Committee on Homeland Security and Governmental Affairs

Subcommittee on Oversight of Government Management, the Federal Workforce, and the District of Columbia

Title: Forestalling the Coming Pandemic: Infectious Disease Surveillance Overseas

Date: 10/4/07

Time (EST): 2:30 PM

Place: Dirksen Senate Office Building, Rm. 342

Due to the evolving nature of infectious diseases, environmental changes, and the easiness of global travel, the nature of newly emerging disease is increasingly transnational and is disproportionately zoonotic (diseases that can be transmitted to humans). Thus, we need to detect not only emerging disease, but zoonotic disease outbreaks, which depend on establishing effective new partnerships between disciplines, institutions, and nations. There are a number of executive branch agencies with programs in place to help developing countries monitor the outbreak of infectious disease and to provide the U.S. with early warning of potential public health emergencies. These programs were most recently reviewed by the Government Accountability Office (GAO). This hearing will examine the results of the GAO report, assess the effectiveness of the U.S.-funded programs to assist other countries in monitoring emerging infectious disease and how those programs help the U.S. provide early warning of imminent public health threats, and work being done by the animal health community to identify emerging zoonotic disease.

Saturday, September 29, 2007

That Was The Summer That Was

 

#  1144

 

 

The International Society for Infectious Diseases (ISID) provides detailed reporting and analysis of emerging infectious diseases via daily email alerts called promed-mail.   For those interested in such things, subscribing is free and easy to do.   

 

Today Promed has released a review of worldwide influenza reporting for this past summer (May 20th - Sept 15th).    The full report can be accessed here.   The orginal source for this material is the CDC's Morbidity and Mortality Weekly Report.

 

While only a small number of the total cases of flu are sampled and identified each year, it is hoped that the results are reasonably representative of what is happening in the field.    As you will see, this summer was a mixed bag, with no single flu stain taking the lead.

 

Even at this late date it is impossible to know which strain of flu will take off this winter, so you can imagine how difficult it must be for scientists to decide on what strains to include in each year's vaccine, which must be decided on six months in advance. 

 

This year's vaccine will contain antigens for two Influenza A viruses (H1N1 & H3N2), and 1 Influenza B virus.  The strain of H1N1 included is known as A/Solomon Islands/3/2006   while the H3N2 strain included is A/Wisconsin/67/2005.    The B virus strain included comes from the B/Victoria/02/87 lineage.     

 

It is a guessing game each Spring trying to decide, months in advance, which of the circulating flu viruses will dominate in the fall.  Some years scientists hit it pretty close, other years they don't.

 

The good news is that of the very small sample of H1N1 viruses collected and analyzed this summer, all of them were antigenically similar to this year's vaccine component  (A/Solomon Islands/3/2006).

 

It should be noted, however, that only 4 H1N1 samples were analyzed.

 

Less encouraging, are the results of the H3N2 sampling, as explained in this excerpt from the promed-mail report.

 

Of the 94 influenza A (H3) viruses that were characterized (4 from Europe, 78 from Latin America, 4 from Asia, 2 from Africa, and 6 from the United States), 17 (18 percent) were antigenically similar to A/Wisconsin/67/2005, the H3N2 component of the 2007-08 influenza vaccine, whereas 77 (82 percent) had reduced titers to A/Wisconsin/67/2005.

 

Basically, only 18 percent of the samples received were a good match with this year's vaccine.  That means that if the H3N2 virus becomes the dominate strain this winter, this year's flu shots will likely be less effective than hoped. 

 

The `B' Component of the vaccine may be problematic this year as well.  There are currently two major strains of B Influenza circulating in the world, the B/Victoria and the B/Yamagata lines.   This year, the decision was made to include the B/Victoria lineage in the vaccine.

 

This, again, from Promed-Mail.

 

Of the eight influenza B isolates collected during 20 May-8 Sep 2007 and characterized at CDC, one belonged to the B/Victoria lineage (from Asia). This B/Victoria-lineage virus was similar to B/Ohio/01/2005; B/Ohio/01/2005 is antigenically equivalent to B/Malaysia/2506/2004, the recommended influenza B component for the 2007-08 influenza vaccine. The remaining 7 influenza B viruses (3 from South America, 3 from Asia, and one from the United States) belonged to the B/Yamagata lineage.

 

In other words, 7 out of 8  Influenza B viruses sampled over the summer don't match this year's vaccine.

 

It must be remembered that these samplings represent only a minute fraction of the number of cases of influenza over the past few months, and may not be predictive of our upcoming season. 

 

How all of this will work out over this flu season remains to be seen.  This past summer has been a rough flu season south of the equator, with South Africa, New Zealand, and Australia all reporting unusually severe influenzas this year.   Again, not predictive, but certainly a cause for concern. 

 

Even if this  year's vaccine isn't a perfect match for the influenzas circulating this winter, authorities still are recommending that people avail themselves of the flu shots.  

 

Again from Promed-mail:

 

 

Although many of the recently examined influenza A (H3) viruses show reduced reactivity with sera produced against the A/Wisconsin/67/2005 (H3N2) vaccine strain (the H3N2 component of the 2007-08 influenza vaccine), vaccination is still the best means of protection against influenza and influenza-related complications.

 

Even in years in which the match between the vaccine strains and circulating strains is not exact and protection against illness is reduced, the vaccine can still mitigate the severity of illness and reduce the likelihood of severe outcomes such as hospitalization and death.

 

While this year's vaccine may not be the ideal match for what may be coming, I'll be rolling up my sleave anyway.  

 

 

As an interesting aside, Promed also reports that 2 cases of novel influenza were reported this summer in the United States. (reformated for readability)

 

 

There were 2 cases of human infection with swine influenza virus reported in the United States during August [2007].

 

Although human infection with swine influenza is uncommon, sporadic cases occur in most years, usually among persons in direct contact with ill pigs or who have been in places where pigs might have been present (e.g., agricultural fairs, farms, or petting zoos).

 

The sporadic cases detected in recent years have not resulted in sustained human-to-human transmission or community outbreaks; however, human infections with swine influenza viruses or any other nonhuman or novel influenza virus should be identified quickly and investigated.

 

Clinicians should consider swine influenza A in the differential diagnosis among patients with influenza like illness (ILI) who have had recent contact with pigs.

 

And that was the summer that was.

Friday, September 28, 2007

Meanwhile, South Of The Border . . . .

 

# 1143

 

 

Sometimes stories pop up that are, at best, tenuously linked to bird flu.  I generally try to avoid these speculative reports, at least until we get more solid information.  Most turn out to be false alarms.

 

Today WorldNetDaily, a netzine with a decidedly conservative bent, is carrying an article about an outbreak of a mysterious disease in Mexico and linking it possibly to `bird flu'. 

 

This report, which comes from a Spanish website called  El Universal, doesn't provide enough detail to conclude, one way or another, whether this outbreak is the result of bird flu.  The symptoms are non-specific, and no deaths have been reported.  

 

Frankly, this could be almost anything.  There is nothing about the symptoms (extreme headaches, stomachaches, vomiting, diarrhea and other weaknesses) that screams `avian flu'. 

 

 

I normally wouldn't even bring a highly speculative report like this up, except it has been picked up by the newsfeeds now, and has been posted to some of the flu forums.  

 

 

Every day, somewhere in the world, there is an outbreak of something.  Water borne illnesses, mosquito borne illnesses, food borne illnesses, and even infectious diseases.  We live in a world filled with pathogens.  While avian flu is always a possibility, it comes pretty far down the list of likely suspects. 

 

 

Obviously, any outbreak of an infectious and (as yet) unidentified disease is something to watch.  And how well local authorities react to a disease outbreak, even if it doesn't turn out to be bird flu, can tell us a lot about their preparedness for a pandemic. 

 

 

For those interested, here is the WND article.   For now, I remain skeptical that this is a bird flu related illness.

 

 

As always, Caveat Lector.  

 

 

 

 

Dozens in Mexican city ill with suspected avian flu
Raises concerns over international implications of epidemic


Posted: September 28, 2007
1:00 a.m. Eastern

© 2007 WorldNetDaily.com

Dozens of people in a Mexican city are gravely ill with what is being treated as a possible outbreak of avian flu, according to a new report from a Spanish-language website.

 

El Universal is confirming that authorities in a neighborhood in Guanajuato 45 patients have been given medical attention at the area's hospital after they reported symptoms including extreme headaches, stomachaches, vomiting, diarrhea and other weaknesses.

 

The cases have developed over the last two weeks, and "feel [like] death," according to Silvia Villalobos, one of the victims who spoke to El Universal correspondent Xochitl Alvarez in Spanish.

(cont.)

Lancet Podcast: Interview With Professor Jiang Gu

 

# 1142

 

 

This week's issue of The Lancet contains an important study on the autopsy results of two avian flu victims.  

 

Yesterday, I blogged on this study here.

 

The Lancet also provides, on occasion, audio interviews with the principal researchers, and does so today with an interview with Professor Jiang Gu.

 

 

 

The Lancet 29 September 2007  (mp3, 16.3Mb)
Professor Jiang Gu from Beijing University, China, discusses the H5N1 research article in this week's issue. The virus was found in human tissue other than the lungs after autopsy of two avian influenza cases in China. Also discussed is the lead editorial concerning the overuse of surrogate markers in clinical trials

 

An excellent interview, with a great deal of detail not included in the news articles. 

 

Well worth listening to.

More Canadian Coverage

 

# 1141

 

With the news of the Saskatoon outbreak, the number of Canadian visitors to this site has spiked in the past 24 hours.  

 

Welcome, one and all. 

 

Some of you may not be familiar with all of the flu bloggers, and there are two right now who are covering the Canadian story extensively:  Crawford Kilian, who resides in Canada, and my buddy Scott McPherson, who is a fellow Floridian. 

 

Crof has updated this story at least 5 times in the past 24 hours, and Scott has written an insightful analysis.  

 

One of the nicest things about blogging on avian flu is the company I get to keep.  Genuine class acts.  And I look forward to reading their opinions and information each and every day.

 

And the list extends beyond just these two guys.   The Revere's at Effect Measure,  SophiaZoe, and our newcomer S. Edwards of Crisis Ready are all excellent reads and valuable resources and should be on your list of daily stops. 

 

Of course, I hope you will take the opportunity to return here as well. 

Thursday, September 27, 2007

Not Your Father's Influenza (Redux)

 

# 1140

 

 

Nearly a year ago, in blog #198 entitled  Not Your Father's Influenza  I outlined some of the early findings presented in a WHO (World Health Organization) document that made it clear the H5N1 virus wasn't just another influenza virus. 

 

Quoting from Influenza Research At the Human and Animal Interface:

 

The disease caused in humans by the H5N1 virus was described as fundamentally different from that caused by normal influenza. In H5N1 infection, the disease syndrome typically shows progressive primary viral pneumonia, acute respiratory distress, marked leukopenia and lymphopenia, and (in some cases) diarrhoea and liver or renal dysfunction. What might explain this severity?


Some limited findings suggest that the virus might cause disseminated infection, affecting multiple organs. In some patients with a fatal outcome, virus has been detected in faeces, serum, and blood plasma. However, respiratory pathology remains the primary cause of death.

 

Tomorrow, the Lancet will publish a study by researchers at the Infectious Disease Center at China's Peking University that gives further credence to the idea that the H5N1 virus infects humans in ways not normally seen in influenza viruses.

 

 

 

Bird Flu May Pass to Fetus via Womb

Bird Flu Virus May Not Stay Only in the Lungs, Researchers Report

By Miranda Hitti
WebMD Medical News

Reviewed by Louise Chang, MD

Sept. 27, 2007 -- The H5N1 bird flu virus may be able to pass from a pregnant woman to her fetus via the womb.

 

That news appears in tomorrow's edition of The Lancet.

 

The researchers -- who included Professor Jiang Gu, MD, of the Infectious Disease Center at China's Peking University -- studied autopsy results from a Chinese woman who died of bird flu when she was about four months pregnant.

 

Gu and colleagues found traces of the H5N1 bird flu virus in the woman's fetus.

 

The pregnant woman -- and an unrelated Chinese man who also died of bird flu -- had the bird flu virus in their lungs. They also had the bird flu virus in other parts of their bodies, including their trachea, brain, and lymph system.

 

"In addition to the lungs, H5N1 influenza virus infects the trachea and disseminates to other organs including the brain," Gu's team writes, adding that "the virus could also be transmitted from mother to fetus across the placenta."

 

The new molecular techniques used by Gu and colleagues "have pitfalls," so the findings should be checked in lab tests, write Wai Fu Ng, MD, and colleagues in an editorial published with the study.

 

Ng works in the pathology department of Hong Kong's Royal Margaret Hospital.

 

 

Although the number of autopsy's that have been conducted on H5N1 victims has been small, primarily due to cultural and religious barriers to conducting post mortem examinations in Moslem and Asian countries, the few that have been completed paint a grim picture of a virus that doesn't play by the rules.

 

Those of us who have been watching the clinical picture of this virus unfold over the past year or two probably aren't terribly surprised by the revelations from this new study.  We've had bits and pieces of supporting information, and hints along the way. 

 

This is more of a confirmation of what many of us have long suspected.

 

The 60% CFR (Case fatality ratio) among identified H5N1 victims is a pretty strong indication that we aren't dealing with a standard, run of the mill, influenza virus.   While we hope the lethality and virulence of this virus will attenuate, so far it hasn't shown any signs of doing so.

 

For better or worse, pandemic planners around the world have latched onto the idea that the worst case scenario is a 2% CFR, and in some cases, they aren't even planning for that.  

 

Maybe we get lucky.  Maybe the H5N1 virus never acquires pandemic capability, or maybe somehow it loses 90% of it's lethality before doing so.  In which case, we may be semi-prepared for the next pandemic.  

 

The question is, do you feel lucky? 

 

Well, do you?

Canada Reports H7N3 Bird Flu Outbreak

 

# 1139

 

 

The good news is, this isn't H5N1.   The bad news is, it's another bird flu virus popping up, something that seems to be happening at an increasing rate around the globe these past few years. 

 

 

A few months ago, we saw outbreaks of the H7N2 virus in England in poultry, along with a small number of human infections.

 

In 2004, two cullers experienced conjunctivitis and headaches, and tested positive for the H7N3 virus after  an outbreak among poultry in British Columbia.   They recovered fully.  17 Million birds were culled in that incident.

 

In the spring of 2003, there were 89 confirmed human cases of H7N7 influenza stemming from an outbreak in poultry in the Netherlands, with one fatality. 

 

While the H7 family of avian flu viruses aren't thought to be as virulent or as deadly as the H5N1 virus, they do have some pandemic potential.  

 

 

Avian flu confirmed in Saskatchewan

50,000 birds at poultry farm to be destroyed
Last Updated: Thursday, September 27, 2007 | 12:41 PM CT
CBC News

Avian influenza has been confirmed at a large chicken farm near Regina, officials with the Canadian Food Inspection Agency said Thursday.

 

The H7N3 strain of the virus found at Pedigree Poultry at Regina Beach is fatal to birds, but is not dangerous to humans, the agency said. All 50,000 birds at the farm will be destroyed with carbon dioxide gas over the next few days.

 

"We could consider the entire premise to be infected," CFIA veterinary specialist Sandra Stephens said.

 

Stephens said the farm produced eggs to be hatched at another facility, but the virus can't spread through eggs. 

 

Earlier in the day, the road to the farm was blocked off about a kilometre away, and an official in a car was making sure nobody tried to get through. The official told a CBC reporter anyone coming out would be disinfected.

 

Officials with the local rural municipality were issuing cautions to the public.

 

"I would advise people to just stay away from the area because if there is a disease issue, we don't need to have any of this spread about either in our area, or any other area," said Jim Hipkins, reeve for the rural municipality of Lumsden.

 

Vehicles leaving the farm Wednesday were seen having their tires washed. People walking in the area were also seen having their footwear sprayed down.

 

Stephens said equipment and tools at the facility will be cleaned and disinfected in the days ahead. A three-kilometre zone has been established around the farm, but it's believed the facility is the only one in the area with poultry, she said.

 

Nobody knows how the infection spread to the farm, but the virus is commonly carried by migrating waterfowl, she said. 

 

Regina Beach is about 55 kilometres northwest of Regina.

(Cont.)

A Trillion Here, A Trillion There . . .

 

# 1138

 

 . . .  And pretty soon you're talking real money.

 

With apologies to Everett Dirkson, inflation being what it is, we have to add a few zeros these days. 

 

Today we have a new estimate of the costs of a pandemic, both in dollars, and in lives.   

 

This from DowJones's Market Watch.

 

 

Bird flu pandemic could cost $4.4 trillion: survey

By Aude Lagorce

Last Update: 7:28 AM ET Sep 27, 2007

 

LONDON (MarketWatch) -- A bird flu pandemic could lead to global economic losses of up to $4.4 trillion and the death of more than 140 million people, according to a study by the Marsh and the Albright Group released at the 5th International Bird Flu summit on Thursday. The study also found that an epidemic would reach the U.S. within two weeks of the first outbreak and that 25% of the world's population would fall ill, with work absenteeism rising to at least 35%. End of Story

UK: Seasonal Vaccine Delays (Again)

 

# 1137

 

 

For the fourth year in a row vaccine manufacturers are having problems delivering seasonal flu jabs in the UK on schedule.   

 

One has to wonder just how realistic projections that a pandemic vaccine would roll off the manufacturing lines within four to six months really are when delays during times of normalcy seem to be the rule, not the exception.

 

 

 

 

Flu campaign hit by new vaccine delay

27-Sep-07

 

Further delays have hit UK flu supplies, as the DoH prepares to launch this year’s campaign.

 

Novartis has warned GP practices to expect delays to supplies due to packaging problems.

It expects to be back on track by mid-October, but nationwide TV and poster campaigns are expected to start at the beginning of the month.

 

A Novartis spokeswoman said: ‘We had a minor hiccup, but essentially everyone will receive some vaccine.’

 

The latest set back follows announcements by GSK in August that deliveries of flu vaccine would be later than planned due to slower than anticipated growth of one of the component strains.

 

For the fourth year running, GPs may face havoc as to ensure at-risk groups are immunised.

 

Dr George Kassianos, RCGP vaccine spokesman and Berkshire GP, said: ‘Our advice last year was to place orders with more than one manufacturer. We’ve got to sit tight and wait.’

 

GPs whose supplies are delayed must make sure the elderly and immunosuppressed receive the vaccine first, he added.

 

This is despite claims by US experts last week that vaccinating the elderly against flu may be pointless.

 

A review article in the Lancet Infectious Diseases said there is little evidence that vaccinating the over-70s against flu reduced mortality rates.

 

Excess mortality studies have been unable to confirm a decline in the number of flu deaths since 1980, despite vaccine uptake increasing from 15 to 65 per cent, say Dr Lone Simonsen, from the George Washington University, and colleagues.

 

But Dr Kassianos said this finding may be because too few people are being vaccinated, meaning herd immunity is not achieved.

 

‘The vaccination is working, it is our international influenza system that cannot fully match this unpredictable virus,’ he explained.

Bird Flu Reportedly Returns To Thailand























#1136


After a series of outbreaks among poultry during the spring, bird flu news emerging from Thailand has all but stopped these past few months. Of course, in an all too familiar story, the H5N1 virus has a nasty habit of popping back up even after disappearing for months.


This outbreak appears, thankfully, small.


H5N1 found in Thailand's Phichit province

www.chinaview.cn 2007-09-27 17:29:46

BANGKOK, Sept. 27 (Xinhua) -- Preecha Ruengchan, governor of northern Thailand's province of Phichit, called an urgent meeting with livestock officials on Thursday after birds there were found to have died without cause.


Preecha is considering whether to declare Phichit the bird flu zone, local newspaper Bangkok Post reported.


Thawatpong Paekwamdee, chief of Taphan Hin district of the province, said that test result of carcasses of chickens raised by a villager were found to have the H5N1 virus. The local authorities have killed 90 chickens within 1-km radius from the location.


Transportation of birds is prohibited in the area unless receiving authorization from authorities, who are keeping a close watch on the spread of the virus within 5-km radius.


Wednesday, September 26, 2007

Flu Shots For The Elderly May Have Limited Benefits

 

# 1135

 

 

Conventional wisdom just isn't what it used to be.

 

The idea that flu shots might not be protective of the elderly has come up before, but we lack good studies proving, one way or the other, how effective vaccinations are for those over 80. 

 

 

The Revere's of Effect Measure have produced an excellent analysis of this story.

 

 

Flu Shots May Have Little Mortality Benefit in Older Adults

By Crystal Phend, Staff Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
September 25, 2007

 

 

WASHINGTON, Sept. 25 -- Influenza vaccination may save many fewer older patients' lives than generally claimed, according to researchers here.

 

Action Points

  • Explain to interested patients that this review of influenza vaccination does not support a large mortality benefit in older adults.
  • Point out that the CDC recommends annual influenza vaccination for all adults age 65 and older.

 

The reason is that estimates of a 50% or greater reduction in all-cause mortality have emerged from cohort studies fraught with selection bias, asserted a review article in the October issue of The Lancet Infectious Diseases.

 

But the real effect with flu shots for those 65 and older during December through March could not have been any greater than 5% to 10%, said Lone Simonsen, Ph.D., of George Washington University here, and colleagues. That's the flu-related mortality burden found in studies of excess all-cause mortality.

 

Aside from these cohort studies, the evidence is too weak to show any mortality benefit in older adults, who account for 90% of influenza deaths each year, Dr. Simonsen and colleagues added.

 

However, even a partially effective vaccine is better than no vaccine at all, the researchers said.

 

"While awaiting an improved evidence base for influenza vaccine mortality benefits in elderly people, we suggest that this group should continue to be vaccinated against influenza," they wrote.

(cont.)

 

What we know, or what we think we know, is constantly changing.  This is particularly true in medicine.

 

When I was a young medic, 30 years ago, every doctor knew that the very first thing you did for someone in cardiac arrest (after initiating CPR) was to give them a bolus of 1 or 2 amps of Sodium Bicarb to reverse acidosis.  Even before attempting to cardiovert.   Conventional wisdom said that you couldn't cardiovert an acidotic heart. 

 

And so usually 2 amps of bicarb went in as a matter of course.  Because everyone knew that was the right thing to do.  

 

Trouble is, even with our cardiac meds and defibrillators and advanced training, we were losing a lot of patients.   By the mid-1980's it became apparent that the bolus of bicarb wasn't helping, and in fact, was probably hurting.  

 

By 1986 several scientific studies had demonstrated that rapid provision of effective ventilation and artificial circulation were entirely adequate means of managing the small amount of respiratory- (or metabolic-) acidosis that accompanied common cardiac arrests.  Administration of even 1 amp of Bicarb was linked to poor outcomes. 

 

How could we have gotten it so wrong?   

 

Not only was the problem of acidosis in cardiac arrest overblown, we were reducing our patient's chances of recovery by treating it!

 

Our scientific knowledge is constantly changing.  What seemed like a perfectly good idea in 1980 had become obsolete (indeed, regarded even as dangerous) by 1986.   No doubt, some of what we believe to be true or prudent today may be disproved or abandoned five or ten  years from now. 

 

Like it or not, we make most of our advances through trial and error.  Medicine is still very much an art.

 

Not much solace for those who are on the receiving end of erroneous assumptions, I suppose.  

 

But we are making progress. 

Bangladesh Reports Fresh Outbreak In Poultry

 

# 1134

 

 

 

 

Bird flu detected in NW Bangladesh

www.chinaview.cn 2007-09-26 21:10:50
 

    DHAKA, Sept. 26 (Xinhua) -- Some 6,000 chickens were culled at Sahapur village in Sadar sub-district in Bangladesh's northwestern Bogra district, 170 km of capital Dhaka Tuesday night following the detection of avian influenza virus in a poultry farm.

 

 

    The private news agency UNB on Wednesday reported that Nakul Saha, owner of the poultry farm, took several dead chickens for laboratory test on suspicion that they might have died of bird flu.

 

 

    The laboratory test confirmed that the chickens died of avian influenza.

 

 

    The avian influenza virus was first detected in a poultry farm in Savar, 25 km west of the Dhaka in March this year. Laboratory test results showed the existence of influenza virus of H5N1 variety. Tens of thousands of poultry birds were culled.

Massive Cull In Russia

 

# 1133

 

Nearly 3 weeks ago 500 chickens died on a farm in Krasnodar, Russia.  A cull of 22,000 birds was undertaken.  Now Novosti, the Russian News agency, is reporting on an expansion of that cull.

 

 

 

 

 

All poultry to be culled at farm after bird flu outbreak

26/ 09/ 2007

KRASNODAR, September 26 (RIA Novosti) - About 250,000 birds are to be culled at a poultry farm in south Russia's Krasnodar Territory following an outbreak of bird flu earlier this month, Russia's agriculture watchdog said Wednesday.

 

A total of 170,600 birds have been slaughtered at the Lebyazh-Chepiginskoye farm and the remaining 77,500 are due to be culled in the near future, Alexander Skorikov, the head of the animal health department at Russia's agriculture watchdog said.

 

September 5 about 22,000 birds were culled at the farm after a regional laboratory identified the lethal H5N1 virus in dead birds at the farm.

 

In 2005 1.3 million birds were culled in Russia, in 2006 the figure stood at 1.04 million, but this year the figure had dropped to around 260,000.

 

Krasnodar Territory is on the route taken by migrating birds in winter and is subject to a higher risk of bird flu as a result, although, according to the World Health Organization (WHO), most of the spread is through poultry and the poultry trade.

 

Since late 2003, according to the World Health Organization, when the virus first hit Asia, the deadly H5N1 strain of bird flu has killed at least 191 people out of 317 known cases.

 

No human deaths from bird flu have been recorded in Russia.

Recycling Isn't Always A Good Thing

 

 

# 1132

 

 

While I'm generally heartened when I see an article in the mainstream press about the threat of a pandemic, all too often I end up dismayed by the careless slinging of `facts' in these articles.   

 

Case in point, this article from the Tulsa World.    The statements in this article that caught my eye I've highlighted in red.

 

 

U.S. expected to see bird-flu pandemic soon

 

By KIM ARCHER World Staff Writer
9/26/2007


A bird-flu pandemic likely will reach U.S. shores in the next decade, Dr. Kristy Bradley, deputy state epidemiologist for the Oklahoma State Department of Health, said Tuesday.

 

"Prior to the last decade or so, the thought was the influenza from birds would be mild or just cause conjunctivitis in humans," she said at the second annual Prevention Conference, being held through Wednesday at the Tulsa Marriott Southern Hills hotel, 1902 E. 71st St.

 

But "bells went off" in 1997 when 18 people in Hong Kong contracted bird flu and six died from it, Bradley said.

 

"Bird flu" refers to an influenza from a virus found chiefly in birds, but infections can occur in humans.

 

"We've been tracking H5N1 (a strain of bird flu) since 1997," Bradley said. "It has continued to spread to parts of Africa and the Middle East and continues to cause a lot of problems in Asia."

 

The questions are whether the U.S. should worry about a bird-flu pandemic and whether the nation is prepared to respond to a massive outbreak of the virus, she said.

 


"We do get a little more concerned about the H5N1 virus because it's not behaving like any other bird flu we've seen," Bradley said.

 

It has shown resistance to antiviral medications, and human-to-human transmission has been confirmed, she said.

 

"We always have that possibility we could have an imported case in our country," she said.

 

Depending on its severity, a U.S. bird-flu pandemic could mean that 43 million to 100 million people would be infected and an estimated 89,000 to 207,000 people would die, according to the U.S. Centers for Disease Control and Prevention.

 

Between 314,000 and 733,000 Americans would be hospitalized, again depending on the severity of the outbreak, Bradley said.


"Hospitals would be stretched to the max," she said.

 

The economic impact of a U.S. bird-flu pandemic is estimated at between $71 billion and $166 billion, Bradley said.

 

"That can seem pretty daunting," she said.

 

Both the federal government and Oklahoma health authorities have plans in place to respond to such a crisis, Bradley said.

 

Vaccines typically are the first line of defense for a flu outbreak, although authorities are limited to speculation about which strain of virus will prompt an epidemic.

 

The U.S. has begun stockpiling 40 million doses -- at two doses per person -- of prepandemic H5N1 bird flu vaccine. Oklahoma is set to receive 20,000 doses of the vaccine, Bradley said.

 


After five years, the medication loses its effectiveness, so the doses must be thrown out and new ones brought in, she said.

 

"This is the hedging and the risks you take, because you cannot predict how effective it will be," Bradley said.

 

State plans include prioritizing who will get the vaccine based on risk factors for complications, she said.

 

Any flu pandemic that hits the U.S. most likely would originate from a bird influenza, Bradley said.

 

"As you can see, it's very much up in the air," she said. "Nature generally has the upper hand."

 

 

The numbers quoted in this article, particularly for the expected attack rate, fatality rate, and economic impact are quite a bit lower than the federal government and many states have been using for planning purposes.  

 

What gives?

 

Well, these numbers come from a paper published in 1999 entitled  The Economic Impact of Pandemic Influenza In the United States: Priorities for Intervention   by  Martin I. Meltzer, Nancy J. Cox, and Keiji Fukuda
Centers for Disease Control and Prevention, Atlanta, Georgia, USA

 

This is an excerpt from the abstract:

 

We estimated the possible effects of the next influenza pandemic in the United States and analyzed the economic impact of vaccine-based interventions. Using death rates, hospitalization data, and outpatient visits, we estimated 89,000 to 207,000 deaths; 314,000 to 734,000 hospitalizations; 18 to 42 million outpatient visits; and 20 to 47 million additional illnesses. Patients at high risk (15% of the population) would account for approximately 84% of all deaths. The estimated economic impact would be US$71.3 to $166.5 billion, excluding disruptions to commerce and society.

 

 

The numbers, as you can see, are identical to those used in the article.

 

Unfortunately, this study is nearly a decade old, and doesn't take into account the data we've acquired since that time.  The Federal government currently is looking at a 2% CFR (Case fatality ratio), and upwards to a 10% hospitalization rate.  

 

In other words, 2 million fatalities . . .  not 207,000.  And 10 million hospitalizations . . . not 734,000

 

The State of Florida's pandemic assumptions include 640,000 hospitalizations in that state alone, along with 128,000 fatalities.   The numbers used in this article are roughly 1/10th of current assumptions.

 

As far as the vaccine information provided, I'm genuinely confused.  I suspect the reporter has mixed up pre-pandemic vaccines with Tamiflu, but I'm not sure.   The reference to throwing it out after 5 years would suggest Tamiflu (although vaccine has a shelf life, too).  

 

Admittedly no one knows what the next pandemic will bring.  The estimates from 1999 could end up being closer to reality than today's assumptions.   We'll know for sure when the next pandemic is over.

 

Granted, not every reporter can follow and understand pandemic issues like Helen Branswell or Maryn Mckenna.   I understand that.  It takes a science background, a genuine interest in the subject, and a firm commitment to stay current.  That's why we bloggers tend to  hold the really good reporters in such high regard.   They are a rarity. 

 

Despite its failings, however, this article may do some good. 

 

It may raise some awareness.   And for that the reporter should get some credit.  The average person won't remember the numbers, I suppose, and will likely come away with the idea that a pandemic would be bad.

 

And right now, even that message isn't getting out.  

Tuesday, September 25, 2007

Suspected Death In Indo Tests Negative

 

 

# 1131

 

Over the weekend there was much speculation that a 30-year-old woman from Bandung had died of the H5N1 virus.   Tests have reportedly come back negative. 

 

 

 

 

Tests clear suspected bird flu death in Indonesia
(AFP)
25 September 2007

JAKARTA - Two tests on samples from an Indonesian woman feared to have died of bird flu at the weekend have cleared her of carrying the virus, a health ministry official said Tuesday.

 

“Both test results were negative,” said Ningrum, a doctor on duty at the health ministry’s bird flu information centre.

 

She was referring to a 30-year-old woman who died in hospital in the West Java city of Bandung on Saturday displaying symptoms of infection with the H5N1 virus.

 

Two tests, usually of samples of blood and tissue, must come back positive for the virus before a victim is confirmed as infected in Indonesia, where the death toll of 85 from avian influenza is the highest in the world.

Take The `A' Strain

 

 

# 1130

 

 

As that venerable sage, Yogi Berra, reportedly once said, "It's tough to make predictions, especially about the Future."

 

Of course, that doesn't stop people from trying. 

 

Today we have an article from KUNA, the Kuwait News Agency, warning that this year's seasonal flu in France (and presumably elsewhere) will be particularly virulent. 

 

First the article, then a discussion.

 

 

Four million French to be hit by forthcoming flu outbreak

Health    9/25/2007 1:53:00 PM

PARIS, Sept 25 (KUNA) -- Around four million people in France are expected to contract the flu virus this winter, a relatively high number compared with previous outbreaks of the debilitating illness.

 

French daily "Liberation" quoted health sources as saying, in its edition published on Tuesday, that this years outbreak could take on "pandemic" proportions due to climatic factors and the strain of virus expected to hit the country.

 

Flu specialists here told the newspaper that predictions indicate that the flu will be the same as the one that hit Australia in July and August and it could hit France between October 2007 and the beginning of 2008.

 

The effect of the "El Nino" climate system will provide either neutral or cold conditions in France during the above period and the range of flu cases could be between 3.2 million and 4.7 million, with a median of four million, the health sources said.

 

France will begin selling vaccines against the flu on September 28 and these are available free of charge for children and elderly people, while others must pay for inoculation.

 

Last year, some two million people contracted the flu in France. (end) jk.rk KUNA 251353 Sep 07NNNN

 

 

To be clear, this article is about seasonal flu, not the emergence of  a novel pandemic strain such as H5N1. 

 

Flu seasons vary widely from year to year in severity, and as we've seen this summer in Australia and New Zealand, occasionally overwhelm the health care system.    There are now fears that the rough flu season just now coming to a close in the Southern Hemisphere may be a harbinger of things to come north of the equator this winter.

 

While we remain concerned that the H5N1 virus, or another novel strain, will acquire the ability to be easily transmitted between humans, even in a mild flu year tens of thousands succumb to garden variety `A' Strains of the Influenza virus. 

 

Some years, the toll goes higher.

 

As a young medic I got a front row seat to a particularly bad flu year in 1977.    Out of left field, the H1N1 virus reappeared after a 20 year hiatus, and cut a swath through the population.

 

No, it wasn't a pandemic.  But it was close. 

 

Emergency rooms were swamped, many doctors and nurses (and EMT's) were out with the flu, and staffed hospital beds were almost impossible to find.  Elective surgeries were canceled for weeks.  It was a mess.

 

And of course, many people died.

 

Of course, the big question is, are we due for another bad flu year?Something beyond what we normally see?

 

Yogi Berra got it right, predicting the future is tough.  

 

But the severe flu that has been circulating in South Africa, Australia, and New Zealand over the past few months may be headed in our direction.  Some scientists have suggested that this `A' Strain has drifted genetically, thus making it more virulent. 

 

Flu season is just around the corner.  Flu shots should be available in most places in the next couple of weeks.  


While they may not be completely protective (particularly if the virus has `drifted'), this year seems to be a good year to get that shot.  

 

Just in case.

Monday, September 24, 2007

The End To Half-Fast Testing?

 

 

#1129

 


Our  inablity to rapidly and accurately detect the H5N1 virus has been a major barrier to controling outbreaks, both in poultry, and in humans. 

 

Today, it can literally take days to confirm if a patient has the H5N1 virus.  Precious time that we can't afford to squander should the virus acquire the ability to pass easily from human to human.   

 

The only real hope of quashing an outbreak lies in it's early detection. 

 

The newswires have been abuzz of news of a 30-minute test, developed by the Singapore-based Institute of Molecular and Cell Biology, that reportedly could solve this problem.

 

We've heard of rapid test kits before, of course, but thus far they have not been widely distributed.    If the early press on this test is accurate, and if it can be quickly manufactured and widely distributed, then perhaps this test will truly make a difference.

 

 

 

 

 

 

Portable bird flu detector

 

Last Modified: 24 Sep 2007
Source: PA News

Scientists have revealed a portable bird flu detector that can spot the deadly H5N1 virus in less than 30 minutes.

 

The palm-sized device uses throat swabs or stool samples from humans and poultry.

 

Dr Masafumi Inoue, one of the researchers from the Singapore-based Institute of Molecular and Cell Biology, said it could help fight an outbreak by providing early warnings.

 

Current bird flu tests take about three to four hours to complete and must be conducted in a laboratory, he said.

 

The device could potentially be 40 to 100 times cheaper than current bird flu detection tests, said Dr Inoue. It can also be adapted to test for severe acute respiratory syndrome, HIV and hepatitis B.

 

Research on the testing tool was published in an advance online edition of the journal Nature Medicine.

 

"It may well be the answer to all our prayers, but we don't know anything about it yet," said Peter Cordingley, spokesman for the World Health Organisation's Western Pacific region.

 

Avian influenza has killed at least 200 people worldwide, but remains hard for people to catch. Experts fear it could mutate into a form that spreads easily among humans, potentially sparking a pandemic.

Indonesia Heats Up (Again)

 

# 1128

 

 

Avian Flu news has, thankfully, been fairly slow during my recent absence.  Yesterday, however, we learned of the suspected death of a 30-year-old woman from West Bandung of the H5N1 virus, and today we now get this report from Xinhua news.

 

 

 

 

2 Indonesian children hospitalized with bird flu symptoms

www.chinaview.cn 2007-09-24 16:15:44

 

 

    JAKARTA, Sept. 24 (Xinhua) -- Two Indonesian children were in critical condition at a hospital in Riau Province with doctors strongly suspecting them of having developed bird flu symptoms in the country where 84 people already died of the virus, according to local media on Monday.

 

    The two boys age one and three are being treated in isolated rooms at the Arifin Ahmad Hospital in the provincial capital of Pekanbaru, leading news website Detikcom said.

 

    "They are suffering high fever and respiratory problems," Dr. Azizman Saad with the hospital was quoted by Detikcom as saying, adding "the condition of their lungs is deteriorating, with excessive activities of liquid production."

 

    Laboratory tests by the hospital indicated that the two patients had bird flu but further tests in Jakarta are needed for confirmation.

 

    Over the last two years, bird flu killed three people in Riau alone.

Thursday, September 13, 2007

AFD On Hiatus

 

 

The time has come once again for me to make one of my twice annual treks to Missouri to see my Lyme Disease specialist.   I will  have very limited Internet access while I'm gone, and probably none until at least Weds. of next week.   I expect to return on the 23rd, and should be  blogging on the 24th.

 

While this hardly qualifies as a pleasure trip, I hope to recharge my batteries a bit while I'm gone, and will stay a few extra days at St. Augustine Beach on my way home. 

 

Luckily things are pretty quiet.

 

While I'm gone my readers will have plenty of bird flu resources at hand. Flublogia doesn't lack for talented bloggers.

 

Crawford Kilian, the dean of flu bloggers, updates the news several times each day on Crof's Blog.  While I'm on the road, if I can get a net connection, that's where I'll be checking.

 

The Coming Influenza Pandemic?  links to the major stories of the day, although it doesn't update until late each day.

 

Scott McPherson's blog, while it doesn't update every day, offers unique in-depth analysis of developments on the flu front.

 

SophiaZoe's A Journey Through The World Of Pandemic Influenza is always interesting, thought provoking, and well written.

 

And finally the Revere's of Effect Measure  can be counted on to explain the science behind public health issues like Avian Flu, XDR-TB, and Chikungunya, among other things.

Wednesday, September 12, 2007

WHO : `The Threat Of Avian Flu As Serious As Ever'

 

# 1127

 

 

With the northern hemisphere's flu season on the horizon, and the H5N1 virus continuing to mutate and spread geographically, we are reminded that the pandemic threat remains, and that the world is poorly equipped to deal with a serious pandemic.

 

Well worth reading the entire article, particularly the comments made by New Zealand's Health Minister Pete Hodgson on the fragility of our infrastructure.

 

 

 

 

Pacific Health Officials Confront Avian Flu Fears

By Kurt Achin
Seoul
12 September 2007

Achin report (mp3) - download 530K audio clip
Listen to Achin report (mp3) audio clip

The World Health Organization says the threat of avian flu is as serious as ever.  Members of the WHO's western Pacific region are in South Korea to discuss ways to combat bird flu.  VOA's Kurt Achin is at the meeting in Jeju, South Korea, and reports that many countries do not have the minimum systems in place to deal with an outbreak.

 

World Health Organization Director for Communicable Diseases Tee Ahsian gave delegates a grim status report on avian flu.

 

"In the western Pacific region, the avian influenza situation remains serious and the human influenza pandemic threat shows no sign of abating," Ahsian said.  "... The virus has become formally entrenched in many parts of Asia and much capacity-building work to address the challenges lies ahead."

 

WHO members are addressing avian flu among a host of other health concerns during their week-long meeting in Jeju, South Korea. 

 

During this season, migratory birds criss-cross Asia, spreading a highly contagious and lethal form of flu known as H5N1 - which is transmissible to humans.  Since the most recent outbreak appeared in Asia in 2003, the virus has killed about 200 people. 

 

Most of the human cases were contracted through contact with sick birds or their feces.  But there have been documented cases of human-to-human transmission - which is what has scientists worried.

 

Doctors warn the H5N1 virus is dangerously close to mutating so that is would pass easily between humans - which could spark a global pandemic that could kill millions of people worldwide.

(Cont.)

Update: Congo Outbreak Identified As Ebola

 

# 1126

 

 

Nearly 2 weeks ago reports began coming in of a deadly infectious disease hitting villages in the Democratic Republic of the Congo very hard.  On September 2nd, I covered the story here, and at that time there was no diagnosis. 

 

We now have confirmation, via the CDC, that this outbreak is due to the Ebola virus.

 

 

Congo confirms deadly illness outbreak as Ebola

10:11, September 12, 2007

 

An illness that has killed more than 160 people in southeastern the Democratic Republic of the Congo has been confirmed as Ebola, a highly contagious fever that kills up to 90 percent of people infected and has no cure or treatment.

 

The United States' Centers for Disease Control and Prevention in Atlanta and another lab in Gabon confirmed the disease as a hemorrhagic fever, and specifically as Ebola, Health Minister Makwenge Kaput said on national television on Monday. He did not provide further details.

 

According to the World Health Organization (WHO), five samples have tested positive for Ebola. About 40 more samples are still pending.

 

At least 167 people have died in the affected region since late August and nearly 400 have fallen ill, said Jean-Constatin Kanow, the chief medical inspector for the affected province. Kinshasa, the capital, is 690 km northwest of the area.

 

Some of the patients have improved after being given antibiotics, which would have no impact on Ebola, WHO experts said. The experts said that led them to suspect that shigella, a diarrhea-like disease, or typhoid has broken out in the same area. Symptoms for the three diseases are similar in early stages. In severe cases of shigella and typhoid, hemorrhaging can also occur.

 

In the Congolese hospital where patients were being treated - a mud hut with a corrogated roof - patients are not being isolated. That means that patients who have shigella, which is not usually a fatal disease, might be mixed with those who have Ebola, putting them at risk at catching the highly fatal fever.

 

"There's no way we can be sure at this time how many cases are shigella and how many cases are Ebola," said Gregory Hartl, a WHO spokesman.
Yesterday, WHO issued an alert to its international partners, requesting more doctors and other experts, to travel to the Congo to help contain the outbreak. Experts from Medecins Sans Frontieres are already treating patients, but more help is needed.

(Cont.)

Indonesia Resumes Sharing Virus Samples

 

# 1125

 

In the on-again, off-again world of sharing vital virus samples with the WHO and CDC, Indonesia is reportedly on-again.   At least that's the word coming out of the conference in Bali.   How long this state of affairs will last remains to be seen.

 

 

Sep 11, 2007

Indonesia resumes sharing bird flu samples

 

NUSA DUA (Indonesia) - A UN official and Indonesian minister said on Tuesday that Indonesia had resumed sending samples of the bird flu virus infecting humans to the World Health Organisation.

 

Indonesia said last month that it had stopped sending samples until it was guaranteed access to affordable medicines to treat victims of the deadly virus, though it then shared one to prove it had not mutated.

 

Scientists carefully monitor the samples to check for mutations that could allow the H5N1 virus to spread easily among humans, leading to a global pandemic with the potential to kill millions.

 

'Indonesia is now sharing viral materials... There are two cases that I know have or will be made available to the WHO,' said David Nabbaro, the UN system coordinator for avian and human influenza.

 

He told reporters on the margins of a two-day meeting between the Indonesian government and its partners in fighting avian influenza that sharing viral materials was vital for public health.

 

'But countries got very uncomfortable about sharing data and samples when there was no certainty that what they are sharing would be used to their benefit,' he said.

 

Indonesia's welfare minister Aburizal Bakrie confirmed that Indonesia was now sharing the virus material, with two samples recently sent on.

 

The meeting is being held on the resort island of Bali, where two fatalities from bird flu were reported last month, raising fears of an impact on the vital tourism industry there.

 

'I would like to take this opportunity to say again that Bali is safe and we prove that today by having this international meeting here in Nusa Dua,' Mr Bakrie told the meeting according to a copy of his speech.

 

Another 83 people have died in other parts of Indonesia since the first human infection case was discovered in mid-2005, the highest toll in the world.

 

'When it comes to highly pathogenic avian influenza caused by the H5N1 virus, Indonesia is the country that is facing the biggest challenge,' Mr Nabbaro said. -- AFP

Tuesday, September 11, 2007

Indonesia To Produce Oseltamivir

 

# 1124

 

In addition to a vaccine, Indonesia now plans to produce their own generic Tamiflu for domestic consumption.  This from Antara News.

 

 

 

 

09/11/07 21:27

Indonesia to start producing Tamiflu

Denpasar (ANTARA News) - Indonesia will start producing oseltamivir (tamiflu) pills in an adquate amount this year in anticipation of the possibility of a further spread of the bird flu virus.


Coordinating Minister for People`s Welfare Aburizal Bakrie said here on Tuesday the drug would be produced in an adequate quantity so the country no longer needed to import it.

Clarifying the Quotes

 

# 1123

 


Yesterday Margaret Chan, Director General of the WHO, was misquoted by at least one news agency as saying the H5N1 virus would cause the next pandemic.   

 

You can read about this in my post When Words Collide.

 

Last night I received a url to the transcript of Ms. Chan's speech, which should clarify matters.   The AFP account, as I suspected, was correct.

 

Quoting the pertinent part of her speech:

 

""We have lived under the looming threat of an influenza pandemic for four years.

 

When resources are scarce and priorities are numerous, it is difficult to balance concern about an unpredictable yet potentially catastrophic event against the need to address so many real and pressing problems.

 

I am often asked if the effort invested in pandemic preparedness is a waste of resources. Has public health cried “wolf” too often and too loudly?

 

Not at all. Pandemics are recurring events. We do not know whether the H5N1 virus will cause the next pandemic.

 

But we do know this: the world will experience another influenza pandemic, sooner or later.

 

Recent concern has stimulated enormous research, and we know much more about influenza viruses and pandemics than we did four years ago. Moreover, public health must pay close attention to any severe new disease, like H5N1 avian influenza.

 

This disease is poorly understood, takes its toll on previously healthy children and young adults, and kills close to 64% of those infected.""

 

 

My thanks to Christine McNab, Acting Director of the  Department of  Communications of Director-General's Office for sending me this url.

The Flaw In The Ointment

 

#  1122

 

Yesterday the GAO released a study showing shortfalls in the Federal Pandemic Flu Response plans citing overlapping areas of responsibility, and a lack of training and testing as the major failings.

 

 

 

Feds See Problems With Bird Flu Plans

 

WASHINGTON (Map, News) - Federal investigators said Monday that the nation's preparedness for a potential influenza pandemic is hindered by a lack of training and testing.

 

The Government Accountability Office said the Bush administration's bird flu plan provides a broad description of the responsibilities of federal agencies. For example, the Department of Health and Human Services is to lead the medical response. Homeland Security would lead other aspects of the response. But, there would undoubtedly be overlapping responsibilities that are not clearly defined.

 

Since the release of the plan in May 2006, national pandemic exercises involving multiple agencies have not been conducted. Such exercises would show which agencies understand their responsibilities, the GAO said.

 

Rep. Henry Waxman, D-Calif., one of the lawmakers to request the report, said he was alarmed that key federal leadership roles were not adequately defined or tested.

 

"It is vital to resolve questions of turf, responsibility, and performance in advance, rather than in the heat of an actual pandemic," said Waxman, chairman of the House Committee on Oversight and Government Reform.

(Cont.)

 

In the past two years the Federal Government, Individual State Governments, and various agencies have become very good at producing elaborate and comprehensive looking pandemic plans, often with glossy artwork covers and lots of charts and graphs inside.  

 

A mandate was issued 2 years ago that every Federal agency, and every state, must have a comprehensive pandemic plan.  Since then thousands of pages have been generated; some good, some bad, some simply incomprehensible.   

 

As I've read many of these plans, both on the Federal and State levels, I've come away with an uneasy feeling that many of these were produced just to show due diligence.   Not all, but a lot. In some cases the writers appear to be more concerned about meeting a requirement than producing a workable plan.

 

The variance between state plans, with some states planning for a repeat of the mild 1957 pandemic, while others are gearing up to face a 1918 style disaster, shows how little leadership there's been on the Federal level.   At a minimum,  you'd think the states would all be planning for the same level of disaster.   

 

Many of these plans have sizable gaps in them, where they state that authorities should plan to deal with various crises, yet fail to indicate how they should do so.   

 

A prime example of `and then a miracle happens', is the admission that hospitals will be quickly overrun, and that ad hoc flu facilities must be established in schools or civic centers.    Exactly who will man these facilities, and where they will get their medical supplies, is generally left unsaid.  

 

The HHS (Department of Health and Human Services) will be responsible for the medical related aspects of a pandemic, but Homeland Security will reportedly handle most other aspects.   Already we've seen conflicts in internal documents from these agencies, and right now it isn't clear where the lines of responsibility will be drawn.

 

The last thing we will need during a crisis is gridlock or a turf war between lead agencies.  

 

DHS and HHS both agree that more training and testing is needed, and support those recommendations by the GAO.   More tests and drills are already planned.

 

Unfortunately, for all of the failings of the Federal plans, they are far superior to most State and Local plans.  And it will be at the state and local level where the real battle against a pandemic will take place. 

 

All pandemics, like politics, are local.  And many cities and communities  have no plan at all.

 

Should a pandemic strike anytime in the foreseeable future, I expect the response at the Federal, State, and local levels to be chaotic at best.  DHS and HHS will be issuing mandates on the Federal level, while 50 governors, and thousands of mayors and EOC's (Emergency Operations Centers) will likely be ignoring them and doing pretty much whatever they think is advisable (or possible) at the time. 

 

Obviously, we need more time to prepare.   Years, not months.   Maybe we get them, maybe we don't.

Monday, September 10, 2007

Wanna Buy A Duck?

 

# 1121

 

 

The title is for Joe Penner fans out there.  (I'll explain after the news)

 

 

Bird-flu found in German frozen ducks - were any eaten?

 

Posted : Mon, 10 Sep 2007 12:28:06 GMT

 

Berlin - Ducks infected with the H5N1 bird-flu virus might have been eaten by unsuspecting Germans, but would not have infected anyone once the meat was roasted, a state health official said Monday. He spoke after more than a third of a million ducks had been slaughtered at poultry farms and incinerated to curb an outbreak of the disease 140 kilometres north of Munich, in Germany's Bavaria state.

 

H5N1 avian influenza had been found in 18 deep-frozen ducks set aside as batch samples at a poultry-company slaughterhouse.

 

In Germany's biggest-ever animal-health cull, a total of 365,000 ducks were being destroyed in the small towns of Wachenroth and Schwandorf. The killing was set to be completed by Monday night.

 

Asked if infected meat from the Wachenroth butchery could have reached shops, Roland Eichhorn of the Bavarian consumer affairs ministry said, "We can't completely exclude that."

 

But he said that commerce officials moved after the first sign of the outbreak and impounded all meat produced at the farms on or after July 30. Federal animal-health scientists believed the outbreak began August 1.

 

"This type of duck is casseroled, and then the meat poses no danger to the consumer," Eichhorn said.

 

Pro-animal groups voiced rage at the cull, and said poultry farms should be made illegal.

 

Water birds are especially susceptible to the H5N1 virus, which can be fatal to humans. The fight against its spread is driven by the fear that the virus could mutate and possibly cause massive loss of human life worldwide.

 

 

Authorities are quick to diminish any threat to public health by stating that once cooked, these frozen ducks could be consumed safely.  Of course, that leaves out the whole `defrost it on the counter, handle it, and prepare it for dinner' phase.     

 

In places like Indonesia we hear almost weekly that someone contracted the virus after `preparing, cooking, and consuming'  infected fowl. 

 

Of course, millions of fowl are prepared each day in Indonesia, and while many of them are likely infected,  only a handful of human infections occur.  So while the odds of contracting the virus that way are remote, they are not zero.

 

Comforting.

 

Rather than spewing the message that the meat is safe once cooked, it might behoove officials to emphasize the safe handling of raw, potentially infected poultry.  You know. In the interest of public health and safety.

 

But if they did that, no one would wanna buy a duck.

 

 

For those interested, Joe Penner was a radio comedian in the mid-1930's whose catchphrase was `Wanna buy a duck?'.     Early in his career he would walk out on stage with some object under his arm, and ask "Wanna buy a  . . .".   It didn't get many laughs. 

 

Then one day he did it with a wooden duck under his arm.  The audience roared with laughter.  Ducks, you see, are inherently funny.   

 

A legend was born.

 

He made a  handful of movies, mostly forgettable, and is largely forgotten today. 

Malaysia Declares Itself Free Of Virus

 

# 1120

 

While it may seem like tempting fate to shout it too loudly, Malaysia reports they have gone 3 months without a new outbreak of the H5N1 virus, and consider themselves free of the virus.

 

 

 

 

 

Malaysia declares free of bird flu

10/09/2007 -- 5:04 PM

Ha Noi (VNA) - Malaysia has declared itself free of bird flu, three months after the last outbreak of the virulent H5N1 strain was detected in Kampung Paya Jaras Hilir, Selangor in June.

 

Malaysian Agriculture and Agro-based Industry Minister Tan Sri Muhyiddin Yassin made the announcement on September 10.

 

The last outbreak of bird flu that occurred in Kampung Paya Jaras Hilir was the first case of the virus in Malaysia since an outbreak in March last year. –Enditem

When Words Collide

 

# 1119

 

 

Over the weekend Margaret Chan, Director General of the World Health Organization, either made a very surprising statement . . .  or she didn't

 

It depends on which news account you read.

 

Radio Australia is reporting the story this way:

 

 

WHO says human flu pandemic 'inevitable'

 

 

Last Updated 10/09/2007, 18:57:02

 

The World Health Organisation is warning against complacency in the fight against bird flu, saying another human influenza pandemic is inevitable sooner or later.


Director general Margaret Chan told a regional meeting of the organisation that the H5N1 bird flu will cause the next pandemic.

The meeting was told that bird flu deaths in the Western Pacific, which excludes Indonesia, have fallen in the past year but it is still entrenched in several countries.

The WHO says if a human pandemic breaks out in the region, rapid containment will be its highest priority.

Such an effort will require the deployment of anti-viral drugs, personal protection equipment and other supplies.

A stockpile was established in Singapore in April with the support of Japan and the Association of Southeast Asian Nations.

 

 

  H5N1 will cause the next pandemic?

 

If Ms. Chan really said this, it goes far beyond any statement she's made before.  The problem is . . . AFP (Agence France-Presse)  is reporting quite a different story. 

 

 

WHO warns over complacency on bird flu

by Park Chan-Kyong 2 hours, 16 minutes ago

JEJU ISLAND, South Korea (AFP) - The World Health Organisation warned Monday against complacency in the fight against bird flu, saying another human influenza pandemic is inevitable sooner or later.

 

"I am often asked if the effort invested in pandemic preparedness is a waste of resources," director general Margaret Chan told a regional meeting of the world organisation.

 

"Has public health cried wolf too often and too loudly?" she said in a speech.

 

"Not at all. Pandemics are recurring events. We do not know whether the H5N1 (avian influenza) virus will cause the next pandemic. But we do know this: the world will experience another influenza pandemic sooner or later."

 

WHO regional director Shigeru Omi noted that bird flu deaths in the Western Pacific -- which excludes Indonesia -- had fallen from 19 two years ago to five in the past year.

 

But he said the virus was still "entrenched" in several countries.

 

"Because the virus continues to evolve and mutate, we must maintain constant vigilance," he said.

 

 

"We do not know whether the H5N1 (avian influenza) virus will cause the next pandemic."  - Margaret Chan

 

 

This, of course, is the longstanding position of the WHO, and most reputable scientists. 

 

H5N1 is a strong contender to become the next pandemic strain, but there are no guarantees.  Another virus could rear it's ugly head, or there could be some limiting factor with the H5N1 virus that prevents it from becoming a pandemic strain.

 

How two reputable news agencies could come away with stories that differed by 180 degrees on such an important point is hard to fathom.   Where both articles agree, however, is over the danger of complacency about the next pandemic. 

 

Another one will come.  Maybe sooner, maybe later.  But it will happen.  

 

And that's the bottom line.