EID Journal: Challenges of Influenza Pandemic Preparedness

 

# 2034

 

 

 

The CDC's Journal of Emerging Infectious Diseases (EID) June issue has an article on the need for greater international preparation for a global influenza pandemic.  

 

First the abstract, then some discussion.

 

 

Oshitani H, Kamigaki T, Suzuki A. Major issues and challenges of influenza pandemic preparedness in developing countries.

Emerg Infect Dis [serial on the Internet]. 2008 Jun [date cited]. Available from http://www.cdc.gov/EID/content/14/6/875.htm

 

 

 

 

Volume 14, Number 6–June 2008

Perspective

Major Issues and Challenges of Influenza Pandemic Preparedness in Developing Countries

Hitoshi Oshitani,* Taro Kamigaki,* and Akira Suzuki*
*Tohoku University Graduate School of Medicine, Sendai, Japan

 

Abstract

Better preparedness for an influenza pandemic mitigates its impact. Many countries have started developing and implementing national influenza pandemic preparedness plans.

 

However, the level of preparedness varies among countries. Developing countries encounter unique and difficult issues and challenges in preparing for a pandemic. Deaths attributable to an influenza pandemic could be substantially higher in developing countries than in industrialized countries.

 

Pharmaceutical interventions such as vaccines and antiviral agents are less likely to be available in developing countries. The public health and clinical infrastructure of developing countries are often inadequate to deal with a widespread health crisis such as an influenza pandemic.

 

Such an event will inevitably have a global effect. Therefore, improving pandemic preparedness in every country, particularly developing ones, is urgently needed.

 

 

 

 

While the 1918 pandemic was considered horrific even in developed countries, the death rate was much higher in poorer nations.   Exact numbers are not known, but anecdotal reports put the CFR (case fatality ratio) several times higher in Asia, Latin America, and Sub-Saharan African than was seen in the United States and Europe.

 

As to why some nations fared worse during the Spanish flu than others?  Well, some of the theories mentioned in this article include:

 

• lack of access to adequate medical care
• weak public health infrastructures,
• housing conditions and population density
• nutritional status and
• co-existing medical conditions.

 

 

Giving the aging (and likely less susceptible) population of developed nations, and the higher prevalence of AIDS in many poorer countries - along with the factors listed above - It is entirely predictable that the next influenza pandemic will have a similarly larger impact on the developing world, as well. 

 

The authors cite three major issues that developing nations must face during the next pandemic.

 

• Availability of Vaccines and Antiviral Agents in Developing Countries
• Limitations of Pharmaceutical Interventions
• Lack of Medical and Public Health Infrastructure to Cope with an Influenza Pandemic

 

 

In other words, the same problems and limitations that kill millions of people each year for lack of decent medical care will exacerbate the death toll in a pandemic.

 

Obvious, perhaps.  But worth repeating.

 

The authors go on to list those areas where improvements must be made, including:

 

• Improving Planning Process
• Increasing Availability of Antiviral Agents and Vaccines
• Providing Better Medical Care
• Developing Feasible Mitigation Strategies
• Strengthening International Collaboration
• Strengthening Core Capacities

 

 

Again, no startling revelations here. 

 

But then, the problem has never been in identifying our problems or even coming up with solutions. The difficulty has always been in finding the political will and the financial resources to implement them.

 

As a species, we obviously failed to learn the lessons from the last great pandemic.

 

A pity that we may someday be forced to learn them all over again. 

 

The hard way.

USDA Releases Genetic Sequences

 

 

# 2033

 

 

In what is good news for researchers worldwide, the USDA has released the genetic sequencing of 150 avian influenza viruses to Genbank, a publicly accessible database of genetic information.

 

While we worry about the H5N1 virus, currently circulating in Asia and the Middle East, birds worldwide carry a variety of avian influenza viruses.  

 

Most, luckily, do not affect mankind.

 

But viruses evolve.  They can rapidly mutate.  And when a single host is infected by two different viruses, it is possible for them to swap genetic material through a process called reassortment, and a new strain can arise.

 

And sometimes these new strains can cause pandemics.

 

It is therefore essential that we monitor the evolution and spread of all types of avian viruses.   Not just the H5N1 bird flu. 

 

 

It is also imperative that we publicly share all of this data, and that it not languish for months or years on some researcher's hard drive awaiting publication in a peer reviewed journal.   

 

While we are seeing more of this sharing of scientific data in recent years,  it is far from being a universal practice.

 

This is from the USDA news page.

 

 

 

 

Avian Influenza Genome Sequences Released

By Sharon Durham
May 30 , 2008

 

WASHINGTON, May 30, 2008--The complete genetic coding sequences of 150 different avian influenza viruses were released today by U.S. Department of Agriculture (USDA) scientists and government, industry and university collaborators. The information improves scientific understanding of avian influenza, a virus that mainly infects birds but that can also infect humans.

 

"This is a major milestone in avian influenza research," said David Suarez, research leader of the Exotic and Emerging Avian Viral Diseases Research Unit at the Southeast Poultry Research Laboratory (SEPRL) operated at Athens, Ga., by the Agricultural Research Service (ARS). ARS is the chief intramural scientific research agency of USDA. Suarez oversees the ARS avian influenza virus repository at SEPRL.

 

"This sequence information, deciphered by our large team, will help researchers better understand virus biology and improve diagnostic tests for avian influenza viruses," Suarez added.

 

Today's release to GenBank, the National Institutes of Health's genetic sequence database, was part of a special sequencing project supported by the presidential initiative on avian influenza. Partners involved in collecting the viruses included USDA's Animal and Plant Health Inspection Service's Wildlife Services, as well as researchers at the University of Georgia (UGA), Ohio State University (OSU) and the University of Alaska-Fairbanks, and others.

 

After the virus isolates were prepared at SEPRL, the virus' noninfectious genetic material, called ribonucleic acid or RNA, was sent to industry collaborator SeqWright Corporation in Houston, Texas, which used its expertise to fully sequence the genome of each virus. The sequence information was reviewed and annotated at SEPRL for release to GenBank.

 

"The project's ultimate goal is to sequence 900 avian influenza viruses from the SEPRL repository," said Suarez. "These include avian influenza viruses collected from both poultry and wild bird species in the United States and around the world."

 

The sequence information will be combined with studies comparing the viruses' ability to infect and cause disease in several poultry species including chickens, turkeys and domestic ducks. The analysis of the sequence and biological data will provide new insights into how these viruses cause disease in man and animals. The biological characterization was performed with collaborations with UGA, OSU and University of Delaware collaborators.

Vietnam To Test Second Human Bird Flu Vaccine

 

# 3032

 

 

Being careful not to put all of their egg-based vaccine technology into one basket, Vietnam has announced a second vaccine candidate will begin limited human testing.

 

This from VNS.

 

 

 

 

Second Vietnamese bird flu vaccine set for human tests

 

(30-05-2008)

KHANH HOA — The Vaccine and Medical Biological Institute in Nha Trang City has asked the Ministry of Health to test its H5N1 influenza vaccine on humans, after the vaccine worked successfully on animals.

 

The first 5,000 doses of vaccine were successful in a trial on rats and chickens. The institute administered a further 5,000 doses on test animals and also received good results.

 

Last year, the World Health Organisation supported the institute with US$2.7 million to build a vaccine factory with the capacity to produce 500,000 to 1,000,000 doses each year.

 

Construction of the factory is underway in Dien Khanh District, with the plant set to begin production early next year.

 

In order to fight the avian flu epidemic, the institute worked with the Pasteur Institute in HCM City and the National Institute of Hygiene and Epidemics in Ha Noi to study and produce the vaccine with different methods.

 

Earlier this month, thirty volunteer students and staff from the Military Medical Institute received the second shot of the nation’s first H5N1 vaccine, produced by the National Institute for Hygiene and Epidemics’ Vaccine and Bio-technology Products No.1 Company. — VNS

CIDRAP Updates Their Pandemic Influenza Overview

 

 

# 2031

 

 

CIDRAP (Center For Infectious Disease Research & Policy), at the University of Minnesota, maintains one of the best infectious disease resources anywhere on the planet. 

 

I keep a link to their website on my side bar, and I hit their site every day.  Sometimes several times a day.  

 

CIDRAP has maintained several living documents, basically overviews of what we know about bird flu and pandemic influenza, for several years.  They update them every few months, and I refer to them often when I am blogging.

 

If you desire a one-stop-shopping knowledge base on bird flu and pandemic influenza, look no further.

 

These documents were updated again yesterday.  Below are the tables of contents for the three overviews, with embedded links.

 

 

 

Pandemic Influenza

Last updated May 29, 2008

Agent
Laboratory Testing for Influenza
General Considerations
Historical Perspective
Pandemics of the 20th Century
Lessons From Past Pandemics
The Pandemic Severity Index
The Current H5N1 Threat
Vaccine Development
Use of Antiviral Agents
Community Mitigation Strategies
Pandemic Preparedness Planning
Hospital Pandemic Preparedness Planning
Infection Control Considerations
References

 

Note: Information on avian influenza is available in the overviews "Avian Influenza (Bird Flu): Implications for Human Disease" and "Avian Influenza (Bird Flu): Agricultural and Wildlife Considerations" in the Avian Flu section of this site.

 

 

 

 

Avian Influenza (Bird Flu): Implications for Human Disease

Last updated May 29, 2008

Agent
Laboratory Testing for Avian Influenza in Humans
Summary of Avian Influenza in Humans
The Current Outbreak of H5N1 in Birds and Other Animals
H5N1 in Humans: Epidemiologic Features
H5N1 in Humans: Clinical Features
Treatment and Prophylaxis
Current Status of H5N1 Candidate Vaccines
Current WHO and CDC Travel Recommendations
Use of Seasonal Flu Vaccine in Humans at Risk for H5N1 Infection
Surveillance Considerations
Influenza Pandemic Considerations
Infection Control Recommendations
Guidance to Protect Workers from Avian Influenza Viruses
Food Safety Issues
References

 

 

 

 

Avian Influenza (Bird Flu): Agricultural and Wildlife Considerations

Last updated May 29, 2008

Definition of Avian Influenza
Agent
Hosts
Transmission
Key Outbreaks of HPAI in Domestic Avian Populations
Current Status of H5N1 in Asia, Europe, and Africa
Surveillance for H5N1 in the United States
HPAI As a Biological Weapon
Clinical Features in Domestic Birds
Necropsy Lesions
Differential Diagnosis in Birds
Laboratory Diagnosis in Birds
Treatment
Prevention
Outbreak Control in Poultry
References

Pandemics And School Closures

 

 

# 2030

 

 

 

One of the `hot button' issues when it comes to mitigating a pandemic is the prospect of prolonged school closures.    While no one wants to place children at greater risk during a pandemic, there are concerns that closing the schools could have severe repercussions in our communities.

 

 

Pandemics, and pandemic waves, come in all types and severities.  The CDC has developed a scale for ranking these events, similar to the Saffir-Simpson scale for hurricanes.    

 

Future Pandemics will be ranked from Category 1 (mild) to Category 5 (severe)  based on the CFR (Case Fatality Ratio) of the virus.

 

 

Figure A.  Pandemic Severity Index

 

 

While the preliminary Community Strategy for Pandemic Influenza Mitigation calls for the closing of schools for up to 12 weeks, it does so only in a severe Category 4 or Category 5 pandemic wave.

 

 

Table A.  Summary of the Community Mitigation Strategy by Pandemic Severity

 

(click to enlarge)

 

 

The severity of pandemic waves can be difficult to define until after they have passed:

 

• There may be a certain amount of `fog of war', where information is slow in coming, particularly from overseas 
• The CFR and/or the attack rate could change in the middle of a pandemic wave
• Even if the CFR is low, there could be unexpected sequelae among those who recover from the illness.

 

 

Predictions, and even real time assessments, are likely to be difficult. In 1918, the first pandemic wave in the Spring was generally described as `mild', and it wasn't until the flu returned in the fall that it became a killer.

 

 

As epidemiologist's like to point out.  If you've seen one pandemic . . . you've seen one pandemic.

 

 

All of this could make it difficult for emergency planners to know when to `pull the trigger' and close the schools.   The feeling among most health officials is, better to do so too early than too late.

 

But of course this opinion isn't universally held. 

 

There are concerns that closing the schools would force working parents to stay home with their kids,  that kids that depend on the school lunch program will go without proper nutrition, and that kids will congregate in other places, negating the beneficial effects of school closures.

 

Valid arguments, all.   

 

But when weighed against the potential loss of thousands (perhaps tens  or even hundreds of thousands) of children's lives, they do seem to lose much of their persuasiveness.

 

 

There are 80 million children in the United States under the age of 20, and past pandemics have shown that the young are often more grievously affected by novel viruses.   The potential for disaster here is too great to ignore. 

 

While school closings may not be a panacea, they are likely to reduce the spread of any virus, and help reduce a pandemic's impact.  

 

Assuming they are done in time.

 

 

Lisa Schnirring, of CIDRAP news, has the details of a recent study done on the closing of schools in North Carolina for 10 days in 2006, showing less impact than expected. 

 

 

 

Survey finds little disruption with short school closure

Lisa Schnirring  Staff Writer

 

May 29, 2008 (CIDRAP News) – A survey of North Carolina families affected by a 10-day school closure due to a sharp rise in influenza-related absences found that the measure didn't cause families major hardships, but many did not heed a recommendation to avoid large gatherings.

 

The findings by researchers at the US Centers for Disease Control and Prevention (CDC) and the North Carolina Department of Health and Human Services were published yesterday as an early online article in Emerging Infectious Diseases (EID).

 

School closures are among the nonpharmaceutical interventions that public health experts hope could mitigate the effects of a flu pandemic. Few studies have gauged the negative effects of school closures, which could include conflicts with parents' work schedules, forced changes in childcare arrangements, and a lack of meals for children who depend on federally subsidized school breakfast and lunch programs.

 

Up close to a school closure

The authors of the EID report seized a relatively rare opportunity to study the effects of a school closure in November 2006, when officials from a rural school district in western North Carolina canceled school for 10 days after a widespread influenza B outbreak struck many students and staff.

 

The day before officials closed the schools, 17% of children in the school district were sick along with 10% of staff members. Officials said they closed the schools because of a shortage of staff.

          (Continue reading . . .)

 

 

While not a perfect match to a pandemic scenario (10 days vs 3 months), this report does give some hope that the effects of school closures might not be as severe as some critics have suggested.

 

If and when the next pandemic starts it is going to take swift and decisive action on the part of emergency planners to mitigate its effects.  Not everything thing they do will work perfectly, or as expected.  

 

But with luck, layered appropriate measures can, and will, reduce the morbidity and mortality of the next global health crisis.

HHS's Next Webcast On June 4th

 

 

# 2029

 

 

 

As I mentioned earlier this week, since March of this year the HHS has been producing a series of Webcasts on preparing for an influenza pandemic.  

 

Previous editions are archived here, here, and here.

 

Next week, a new program will air, dealing with workplace issues during a pandemic.   Your input prior to this Webcast is being solicited by the HHS (details below).

 

In July, an program on home care during a pandemic is scheduled.

 

These programs generally run a bit over an hour, and are well worth your time.

 

 

 

 

 

PlanFirst Webcasts on Pandemic Influenza

Background

On March 13, 2008, the U.S. Department of Health and Human Services launched PlanFirst, a regular Webcast series on pandemic planning. The goal of the PlanFirst Webcasts is to help states, local communities, employers, faith-based and civic organizations, and families and individuals learn more about pandemic planning.

June 4th Webcast

Please join us June 4 for a live discussion to help employers prepare the workplace for an influenza pandemic.

• Speakers from the Department of Labor's Occupational Safety and Health Administration
  • Andrew Levinson, MPH
    Acting Director, Office of Biological Hazards
    Directorate of Standards and Guidance
  • Patricia Bray, MD, MPH, FACOEM
    Acting Director, Office of Occupational Medicine
    Directorate of Science, Technology, and Medicine
• Resources for the Webcast

• • Guidance on Preparing Workplaces for an Influenza Pandemic  (PDF - 313 KB) (Occupational Safety & Health Administration)

  • Proposed Guidance on Stockpiling of Respirators and Facemasks in Occupational Settings (Occupational Safety and Health Administration)
  • Federal Register Notice on Proposed Guidance on Stockpiling of Respirators and Facemasks in Occupational Settings

 

No registration is required. Email your questions for the Webcast panelists before and/or during the program to hhsstudio@hhs.gov. Please include your first name, state and town.

 

 

 

Future Webcasts

A PlanFirst Webcast is scheduled for July 8, 2:00 EDT, focusing on home care during an influenza pandemic.

 

Previous Webcasts

Earlier Webcasts, on the State planning and assessment process, aired on March 13, April 2 and April 30, 2008.

The pandemic influenza PlanFirst Webcasts are brought to you by the U.S. Department of Health and Human Services. 

In The Wake Of SARS, Singapore Prepares

 

 

# 2028

 

 

The recent (and not unexpected) lull in bird flu news, while welcome, gives us no reason to believe that the pandemic threat has receded. The number of reported cases has traditionally gone down in the summer months, only for us to see a resurgence in activity in the Fall. 

 

As demonstrated by this story from Singapore, now is the time to be preparing for the next health crisis.

 

 

S'pore gets ready to tackle next health crisis head-on

 

By Salma Khalik, Health Correspondent

 

SINGAPORE was caught off-guard five years ago when the severe acute respiratory syndrome (Sars) swept through the country, prompting one hospital to close its doors to non-Sars patients.

 

Never again.

 

The Government is spending $12 million to gear up for any health crisis that could arise, such as a killer flu pandemic.

 

Some 130 beds in the six public hospitals will be retrofitted to ensure that they can double as ICU (intensive care unit) beds should the need arise. Equipping each with breathing apparatus and monitors for vital signs will cost about $100,000.

 

They are not needed now, as the hospitals already have 188 ICU beds, which have a year-round occupancy rate of under 70 per cent, and 16 more on standby.

 

A Health Ministry (MOH) spokesman told The Straits Times that disease experts have said it is only a matter of time before the arrival of a pandemic, which can sweep through a country and fell large numbers of people in weeks.

 

She added that since no one can say when or how hard the next pandemic will strike, 'we need to make sure that we have certain capabilities in place to meet the challenges of such health emergencies'.

 

Existing beds in the general, isolation and high-dependency wards will be fitted with extra oxygen points and uninterrupted power supply. For now, though, these beds will continue to be used in their current capacity.

 

The ministry will also buy ventilators and monitors.

 

Public hospitals have added more isolation rooms to house patients with highly infectious diseases. There are now 492 such rooms, up from just 135 when Sars hit; another 112 will be added soon.

 

Other preparations MOH has made include stocking up on over a million doses of flu medicine Tamiflu, enough for a quarter of the population, at a cost of $35 million; it also has six months' supply of personal protective gear such as masks and gloves.

 

Last month, Parliament gave the Health Minister sweeping powers to commandeer the use of private hospitals and manpower in a health crisis.

In Late Spring A Young Man's Fancy Turns To . . .

 

# 2027

 

 

Everyone remembers' their first time. 

 

Mine was in 1960, and her name was Donna. 

 

There would be others as I grew older; unforgettable nights like the one I spent in a cheap motel with Betsy in 1965, and an all-nighter  with a coquettish Agnes in 1972 just after graduation.   And I'll never forget those three wild and crazy days I spent aboard my boat with Elena in 1985.

 

In 1968, the `summer of love', I hooked up briefly with Abby, Brenda, and Gladys.   All three were tepid affairs, minor dalliances at best, although for a while I thought Gladys had possibilities.

 

In the end, they all fizzled out.

 

There were others along the way. Many were little more than minor flirtations.  Brief encounters in the night, over almost before they'd begun.  Their names grow hazy with the passing years, although I can still remember some of the electric anticipation I felt at the time. 

 

 

The queen of them all, however, was Camille.    Beautiful, powerful, unforgettable Camille.  An unparalleled force of nature. 

 

A wonder to behold.   

 

I suppose I was lucky that Camille passed me by, not even giving this poor mortal a glance.  I was just one of her many admirer's from afar.  Part of me though, yearned to have met her up close and personal.   

 

The hubris of youth, I suppose.

 

And yet, despite missing out on that experience, she taught me just how powerful such an encounter can be  . . .  if the conditions are just right.   

 

 

 

 

 

 

 

Hurricane Camille

Duration
August 14 – August 22    1969

Intensity
190 mph (300 km/h), 905 mbar

 

 

 

 

What?  With the Atlantic Hurricane Season just three days away, you thought I was talking about something else?

 

Shame on you.

 

 

 

Donna, Betsy, Agnes, Gladys . . .they were all hurricanes I experienced growing up in Florida.   

 

 

This year, the forecast is for an above average hurricane season, with as many as 15 named storms,  8 Hurricanes, 4 of which could be major. If the forecast holds true, 2008 could be long remembered on the Atlantic and Gulf coasts.

 

 

Tropical Cyclone Forecast for 2008

(1950-2000 Averages  in parenthesis)         

• Named Storms 15 (9.6)*
• Named Storm Days  80 (49.1)
• Hurricanes  8 (5.9) 
• Hurricane Days  40 (24.5)
• Intense Hurricanes 4 (2.3)
• Intense Hurricane Days  9 (5.0)
• Net Tropical Cyclone Activity  160 (100%)

 

We've seen two below-average hurricane seasons in a row, and many have let their guard down.   But hurricanes, like pandemics, are a fact of life.  They come around on a regular basis, and we must be prepared for them.

 

Sadly, most are not.

 

This from a Mason-Dixon Poll conducted last year surveying 1,100 adults living in Atlantic and gulf states:

 

• *53 percent said they don't feel vulnerable to hurricanes or related tornadoes.

• *52 percent have no family plan, and 61 percent have no hurricane survival kit.

• *88 percent have taken no steps to make their homes stronger

• *One in four said they would not start to prepare until hurricanes were 24 to 36 hours away. One in five said they'd wait until 24 hours.

• *11 percent say they're responsible for a disabled or elderly person, but one third of those said they had no plan for that person.

• *16 percent said they might not or would not leave even if ordered to do so.

• Thirty percent said that, if they left, they'd travel not to friends or relatives nearby but as far as they could go. Emergency managers fear a scenario in which cars stuck in gridlock are wiped out by a storm.

• *43 percent said they wouldn't wait for an all clear before heading home.

• *One in five believed it was the government's responsibility to provide supplies in the first few days, or weren't sure who was responsible. Emergency managers have said families need to have everything they'll need for three to five days on their own.

• *78 percent said they did not know storm surge is the greatest killer in a storm.

• *More than half believed tornados can occur only within three miles of a storm. Actually, a hurricane can spawn tornadoes hundreds of miles away.

• *96 percent did not know garage doors are the part of a home most likely to fail. Nearly half still believe masking tape will keep windows from shattering.

• *21 percent said they weren't sure their homeowner's insurance policy included replacement coverage. More than four in 10 had not reviewed their insurance policies with an agent in the past year, some in more than five years.

• A fourth did not know standard policies don't cover flooding and homes need a separate federal flood insurance policy.

 

As a native Floridian, one who has ridden out many storms, I can only shake my head in wonder.   It's not like we don't have major information campaigns every year.  Hurricane preparedness is shouted from the highest rooftops by officials, and we even have a tax-holiday here in Florida for hurricane prep items.

 

But few, apparently are listening.  Or if they are listening, they simply don't believe it can happen here, or to them.

 

Of course it can, and eventually will, to millions of people.

 

Although the really big storms (which today are co-ed) don't usually show up until late summer, June 1st marks the beginning of the 2008 Hurricane season.

 

If you are prepared for a pandemic, you are already prepared for a hurricane . . .or an earthquake . . . or a flood. 

 

If you aren't, then it's time to get cracking.  

 

 

 

Epilogue

 

 

If you've never experienced the full fury of a hurricane, it may be difficult to understand how anyone can view them as I do; as breathtaking forces of nature. 

 

Yes, they are destructive, capable of unleashing untold misery . . . but they are also amazingly efficient (and often beautiful when viewed from afar) heat engines, serving as a conveyor belt of essential moisture and heat from the tropics to the higher latitudes.  

 

Many parts of our world would be far less hospitable places if it were not for tropical storms and hurricanes.

 

They are part of nature, and something we must learn to live with. . .  and yes, even appreciate.

 

Australia: Pandemic Plan Criticized

 

# 2026

 

 

 

While this story highlights Australia, the same could be said for many other countries as well, including the United States.   Very little has been done to integrate our primary care givers, the General Practitioners, into state and national pandemic plans.

 

The idea that a pandemic is simply a public health problem is both naïve and dangerous.  It will take a coordinated effort, by all agencies, and by all practitioners, to help mitigate a pandemic.

 

Most doctors I've talked to have received little or no guidance on what to expect during the next pandemic.   They have no idea whether antivirals will be available, in what quantity, or how they will be distributed.  Some are woefully unaware of the pandemic threat.

 

They've been basically left out of the loop.

 

State and local plans are great, and necessary, but unless they filter down to the local level, and to the individual medical practices, they will have little impact on patients and the health care community.

 

 

This from ABC (Australian Broadcasting Corporation)  News.

 

 

 

 

 

GPs sidelined in bird flu fight: study

By David Mark

 

• Audio: Flu pandemic plans flawed: review (The World Today)

 

It's been 11 years since six people in Hong Kong died after contracting the H5N1 virus more commonly known as bird flu.

 

Since then, more than 240 people have died from the disease.

 

That number may seem large, but it pales compared to the hundreds of thousands or millions that could die if the virus mutates and a pandemic takes hold.

 

Australia has a plan to fight a pandemic, but the Australian National University's Associate Professor Mohammed Patel says it's a flawed one.

 

"The national plan mentions general practice very infrequently, besides it's not the national plan that's the critical one here, it's the state plans," Professor Patel told The World Today.

 

"Do they spell out very clearly how general practices will work with each other?

 

"The answer is those details, operational details are not covered in the current plans."

 

Professor Patel has compared the plans of all state governments in Australia with similar strategies in Canada, New Zealand, Great Britain and the US, and found Australia comes up short.

 

"The first deficiency is that the key role of general practices is not highlighted and the likely reason is that the drivers in these plans are health departments, particularly those responsible from a population health perspective," he said.

 

"Health departments do the public health side, but the clinical practice is run by so-called private small businesses, which are general practitioners.

 

"The two are very poorly integrated in these plans."

 

Rod Pearce, chairman of the Australian Medical Association's Council of General Practice, says the group feels that GPs have been excluded from the planning process.

 

(Cont.)

H7 Study Available Online At PNAS

 

# 2025

 

 

The study that has grabbed the attention of the news media over the past 48 hours, indicating that the H7 subtypes of avian flu may be adapting to human receptor cells, appears in this week's issue of PNAS (Proceedings of the National Academy of Science).

 

Earlier coverage on this study may be read here and here.

 

 

Below is the abstract from the published study, slightly reformatted for easier web reading.  The entire article is available online  here.

 

 

 

 

 

 

Contemporary North American influenza H7 viruses possess human receptor specificity: Implications for virus transmissibility

Jessica A. Belser^*,, Ola Blixt, Li-Mei Chen^*, Claudia Pappas^*, Taronna R. Maines^*, Neal Van Hoeven^*, Ruben Donis^*, Julia Busch, Ryan McBride, James C. Paulson, Jacqueline M. Katz^*, and Terrence M. Tumpey^*,

*Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333; Emory University, Atlanta, GA 30322; and Departments of Physiological Chemistry and Molecular Biology, The Scripps Research Institute, La Jolla, CA 92037

 

Edited by Peter Palese, Mount Sinai School of Medicine, New York, NY, and approved March 21, 2008 (received for review February 7, 2008)

 

Avian H7 influenza viruses from both the Eurasian and North American lineage have caused outbreaks in poultry since 2002, with confirmed human infection occurring during outbreaks in The Netherlands, British Columbia, and the United Kingdom. The majority of H7 infections have resulted in self-limiting conjunctivitis, whereas probable human-to-human transmission has been rare.

 

Here, we used glycan microarray technology to determine the receptor-binding preference of Eurasian and North American lineage H7 influenza viruses and their transmissibility in the ferret model. We found that highly pathogenic H7N7 viruses from The Netherlands in 2003 maintained the classic avian-binding preference for 2–3-linked sialic acids (SA) and are not readily transmissible in ferrets, as observed previously for highly pathogenic H5N1 viruses.

 

However, H7N3 viruses isolated from Canada in 2004 and H7N2 viruses from the northeastern United States isolated in 2002–2003 possessed an HA with increased affinity toward 2–6-linked SA, the linkage type found prominently on human tracheal epithelial cells.

 

We identified a low pathogenic H7N2 virus isolated from a man in New York in 2003, A/NY/107/03, which replicated efficiently in the upper respiratory tract of ferrets and was capable of transmission in this species by direct contact. These results indicate that H7 influenza viruses from the North American lineage have acquired sialic acid-binding properties that more closely resemble those of human influenza viruses and have the potential to spread to naïve animals.

A Funny Thing Happened On My Way To Order Business Cards

 

# 2024

 

 

 

Today I went to a local print shop to order some new business cards for an event I'll be attending next week, and spoke with the lady behind the counter.  She appeared to be about 40, well spoken, and well educated. 

 

She saw my card which referenced `pandemics', and a curious look came over her.  

 

What pandemic?  She asked.

 

And so I told her, briefly, about the concern that we will someday face another pandemic.   I explained how, historically, every 30 or 40 years a novel influenza virus comes out of the wild and spreads around the world.  And I told her about the H5 and H7 bird flu strains currently circulating.

 

She said she was totally unaware of the threat.  She had no idea the government maintained a pandemic flu website, and was astonished that they were recommending every family have 2-weeks of food, water, and supplies in their homes.

 

She did remember the term `bird flu' from a few years back, but assumed that threat was over and done with.

 

Needless to say, I rocked her world a little bit today. She was a bit indignant that the news wasn't telling her about the threat, and she vowed to visit www.pandemicflu.gov  and this blog to keep informed.     

 

The sad thing is, she probably represents the vast majority of the people out there, and not just here in America, but worldwide.

 

 

The pandemic threat for most people is surreal, the stuff of cheap disaster movies and Stephen King novels.    Despite PSA's, and government websites, and hundreds of newspaper articles  . . . the message just isn't getting through.

 

 

The fear, often expressed, that we might unnecessarily frighten people by talking about a pandemic is, I believe, misplaced.   Most people, when confronted with the facts, seem to handle the subject without difficulty. 

 

 

But first, you have to get their attention.   And right now, we aren't doing that very well.

 

As a kid, I grew up in the age of Civil Defense.  Bert the Turtle taught us to `duck and cover',  we had fire drills, and practiced school evacuations every week.   Bomb shelters, and Geiger counters, CONALRAD alerts were commonplace.  

 

Duck and Cover

 

As an 8-year-old during the Cuban Missile Crisis I could tell you how much shielding you would need to protect yourself from alpha, beta, and gamma rays.  And I knew the signs of radiation sickness.

 

Terrible you say, to subject a child to such things? 

 

Well, that's the way things were in the late 1950's and early 1960's.  And I don't think I, or any of my compatriots, was any the worse for it. 

 

Fifty years ago we weren't afraid to openly talk about the threat of atomic annihilation.  We actually planned and worked to survive it.  Admittedly, some of the advice given back then may have lacked firm scientific basis, but the idea of informing the public was a good one.

 

Sometime in the 1980's it was decided that a nuclear war, with our bigger warheads, wasn't survivable, and the civil defense network was disbanded. Perhaps they were right about that.

 

But unlike a nuclear war, a pandemic is survivable. A well publicized `civil defense' posture makes perfect sense. 

 

We need to be handing out literature in schools, and discussing with parents when schools will be closed at the PTA.  We need PSA's running on all TV stations.  And we need our politicians to talk openly about the pandemic threat.

 

In short, we need every family to become pandemic aware, and pandemic prepared.    And for that to happen, pandemic preparedness has to come out of the closet.  

 

If my generation could handle the prospect of atomic war in elementary school, I should think most adults could handle the idea of a pandemic preparedness today.

 

Let's face it, if people can't handle talking about a pandemic, they are going to be in pretty bad shape if it comes to actually dealing with one. 

That Was The Flu Season That Was

 

# 2023

 

 

Maryn McKenna has an excellent review of the 2007-2008 flu season in her article just published in the Annals Of Emergency Medicine. 

 

Maryn, as most of you know, is the award winning science writer and author of Beating Back The Devil, who writes frequently for CIDRAP and who has her own blogsite called Superbug.

 

 

 

 

 

Volume 51, Issue 6, Pages 739-741 (June 2008)

 

Vaccine Mishap, Flu Outbreak Overwhelm EDs, Highlight Lack of Surge Capacity

Maryn McKenna (Special Contributor to Annals News & Perspective)

 

 

Article Outline

 

• No Matter Where in the Country You Went, This Flu Season Was Dire

• Ineffective Vaccine

• Crowding, the Real Pandemic

• Bracing for Disaster

• References

• Copyright

 

Dr. Rita Cydulka knew it was a bad flu season when she ran out of alphabet.

 

“Like most emergency rooms, we're overcrowded and we have to use hall beds; we use letters to designate them, and we usually go from A to something like H,” said Cydulka, who is associate professor and vice-chair of emergency medicine at Case Western Reserve University School of Medicine. “But in the height of February, we went from A to Z. And then we started again, and we went from AA to ZZ.”

 

Cydulka had a lot of company. After a slow ramp-up, the 2007-2008 flu season hit the US with unusual force. Flu was “widespread,” the most severe measure, in 49 of the 51 US public health jurisdictions in the third week of February, according to the Centers for Disease Control and Prevention.1 In emergency departments (EDs), perennial sentinels for flu's impact, “widespread” did not begin to describe the problem: Talking about it, physicians around the country use words like “severe” and “slammed.”

 

(Continue reading . . . )

H7's Coming Out Party

 

 

# 2022

 

 

Yesterday a study was released that said some members of the H7 family of influenza viruses are gradually becoming better adapted to human receptor cells, and that they too pose a pandemic risk.

 

While readers of this, and other flu blogs, were hardly surprised  by this revelation (see It Isn't Just Bird Flu), apparently the mainstream press was jolted briefly into consciousness over the continuing pandemic threat.

 

A few of yesterday's headlines covering the story:  

 

 

Scientists warn of flu strain evolution Some strains of bird flu are coming ever closer... Islamic Republic of Iran Broadcasting News Network - Headlines 05:01

 

Bird flu strains are evolving: study SBS World News Australia - Environment 00:33

 

Evolution of flu strains points to higher risk of pandemic The Straits Times - Latest News 00:06

 

Evolution of flu strains points to higher risk of pandemic: study Yahoo! US - Health 23:09 26-May-08

 

North American bird flu viruses becoming more adapted to humans: study myTELUS - Ontario 22:58 26-May-08

 

Evolution of flu strains points to higher risk of pandemic: study (AFP) Yahoo! US - Health 22:49 26-May-08

 

Mild Bird-Flu Strains in Canada, U.S. Gained Ability to Attack... Bloomberg - Canada 22:26 26-May-08

 

Scientists identify new strain of bird flu The Times - Science 22:17 26-May-08

 

 

 

Of course, for consistently superior coverage of pandemic issues, we've come to rely on Helen Branswell of the Canadian Press.  She gives us the facts without the hyperbole, and has an understanding of the subject matter that few reporters can match.

 

Ms. Branswell is one of a small handful of excellent reporters who cover pandemic issues regularly, and does it very well indeed.

 

Follow the link for the entire story, this is just a snippet.

 

 

 

 

Study: Bird flu viruses adapting to humans

By HELEN BRANSWELL The Canadian Press
Tue. May 27 - 4:32 AM

 

TORONTO — North American avian flu viruses of the H7 subtype — like the one responsible for British Columbia’s massive poultry outbreak in 2004 — seem to have adapted to more easily invade the human respiratory tract, a new American study suggests.

 

Experts say the findings underscore the fact that H7 flu viruses pose a significant pandemic threat and that surveillance for cases in wild birds, poultry and people ought to be a high priority.

 

"I think this is certainly amongst the most dangerous (avian flu) viruses out there," said virologist Dr. Ron Fouchier, with the Erasmus Medical Centre in Rotterdam, the Netherlands.

 

"And I think we need to continue to develop vaccines for H7 just as well as H5(N1)."

 

Fouchier was commenting on a study published Monday by the journal Proceedings of the National Academy of Sciences. He was not involved in the work.

 

(Cont.)

 

 

The upshot of all of this is that the pandemic threat has never gone away, despite the downturn in mainstream media coverage.   The H5N1 virus still remains very much in the lead as our prime candidate, but the H7 subtypes are in the running too, as are the H9's.  Or we could get blind-sided by something completely unexpected.

 

Preparedness remains the key.  

 

It won't matter what strain of virus sparks the next pandemic if you, your community, and our public health systems are prepared. But for that to happen, people need to accept the risk exists, and begin taking steps to help their communities prepare.

 

After all, being forewarned does us little good if we don't put that knowledge to use.

Get Pandemic Ready: Why Three Months? Pt. 2

 

# 2021

 

 

 

This is part II of a 2-part blog on Get Pandemic Ready's rationale for stockpiling 90 days worth of food, water, and essential supplies in anticipation of a pandemic or other disaster. 

 

Part I is here, and should be read first.

 

 

 

 

Why Three Months

 (Continued)

 

 

III.  The Critical Infrastructure is At Risk During a Pandemic Wave

 

Our lives are supported by critical complex systems:  health care, electricity, water, sewer, etc.  These are the  complex systems we take for granted; however they can  break down quickly if people are not there to run them. When workers (or their families) get pandemic flu, the critical infrastructure may degrade or fail.  See “About  Pandemics” on the homepage for information on how these critical systems affect you personally.

 

A degraded or failed infrastructure has grave implications, affecting both our personal welfare and the economy.  They are inseparable - both need to be healthy for us to get through a flu pandemic

Our supply chain is complex and fragile.  Your breakfast bowl of cornflakes illustrates this.   Where did it come from? 

 

The corn was grown (a complex process in itself requiring farm workers and supplies) and then shipped to the factory.  Next it was shelled and then put in a steam pressure cooker.  From there, it was processed into flakes and packaged, dried (to reduce moisture), and then put through rollers to flatten into a flake.  These were toasted briefly in a hot gas oven, sprayed with supplements, and then packaged.  All of this requires working machinery and labor, as well as numerous supplies that have to be created elsewhere and delivered to the factory. 

 

Your box of cornflakes journeys from the factory warehouse to distributors and finally to your local grocery store.  Store workers unload the truck and stock your cornflakes on the shelves, where you can buy them as long as the store is open, the cashier is at work, and the power is on so that the computer inventory systems, the cash registers, and the scanners function.  If you pay with plastic, the system must be able to query your bank electronically to approve your purchase.  

 

Your cornflakes were produced by a complex process depending on petroleum, electricity, natural gas, several types of transportation (needing healthy drivers and healthy refinery workers), materials (corn, plastic, cardboard, etc.), and people (such as farmers, laborers, drivers, refinery workers, plant workers, truckers, machinists, stockers and checkers) to keep things going.  This complex process requires a near-perfect infrastructure to keep running. 

 

 

Add to this the “just-in-time” business model adopted universally over the last decades.  Supplies are not kept on-site, but rather ordered “just-in-time” from regional warehouses. Consequently, your grocery store has approximately three days of cornflakes on the shelves.  The former warehouse is now on wheels.

 

Finally, during a pandemic, border closings (or restrictions on international or interstate travel and shipping, to slow the spread of flu), will greatly slow or stop lines of supply.

 

Bottom line:  The critical infrastructure is at risk during a pandemic.

• What should businesses do?  While most of our infrastructure is privately owned, its continued operation in a pandemic is a matter of national security. The US Department of Homeland Security has written Pandemic Influenza: Guide for Critical Infrastructure and Key Resources, strongly encouraging businesses to build and test pandemic plans. 

•  Supply chains may be interrupted for 6 to 8 weeks, and essential workers and processes need to be identified to keep the critical infrastructure running.  Many businesses have yet to start, and some solutions are costly.

Link: Pandemic Influenza - Preparedness, Response, and Recovery

• What should you do?  Three months of cornflakes would be a good idea.  Three months of other basic supplies is also a good idea.

 

IV. Three Months of Supplies Makes Economic Sense
Storing at least 12 weeks of supplies makes excellent economic sense, particularly for those on tight budgets. 
Storing 12 weeks of supplies now will enable you to take advantage of sales at the store and allow you to be able to wait for a sale before restocking. 

 

Your family will also be more protected if you lose your job.  Any funds that you have will be able to be put toward other necessities instead of food.

 

Shelf-stable foods allow you to buy in bulk, which is generally more cost efficient.

 

Food prices are rising sharply.  They will most likely continue to do so due to global economic conditions.  By keeping a stock of at least 12 weeks of food, you will be able to not only take advantage of sales as mentioned before, but also will be paying less for food than you will be a couple of months from now.

 

One last reason is the price gouging that will most likely take place during a pandemic.  With supplies uncertain for both the retailer AND the consumer, prices are likely to rise.  Stocking now will enable you to get the most for your dollar before any price increases happen.

 

V. Three Months of Supplies Makes Sense for Communities

 

If you have been working towards 3 months of supplies, you will be more likely to have resources to share in a time of need with trusted friends, extended family members, and neighbors.  

 

Essential workers and wage earners will find it easier to report  to work if they believe their families have the supplies and provisions they need to get through the pandemic wave.

 

People who are less worried about meeting their daily survival needs will contribute to greater social order.  If a neighbor’s child needs to be cared for so the parent can work, for example, you may be more willing to help out if you have already taken care of your own family’s food and other basic needs. 

 

VI. Respected Institutions Recommend Three Months of Home Stockpiling

 

 

The growing consensus of opinion is leaning towards preparing for long-term disruption.

 

[US State Department] Due to varying conditions overseas, Americans abroad should evaluate their situation and prepare emergency supplies accordingly (non-perishable food, potable water, medicines, etc.) for the possibility of sheltering-in-place for at least two and up to twelve weeks.  How to Prepare for "Sheltering-In-Place"

A team of nutritionists and dietitians at the University of Sydney, Australia, suggests individual households stockpile at least three months of food in preparation for a pandemic.  They support their findings with an excellent food chart in the Medical Journal of Australia.

 

The US government recognizes that they (“the government”) cannot take care of your basic needs.

“Local communities will have to address the medical and nonmedical effects of the pandemic with available resources. This means that it is essential for communities, tribes, States, and regions to have plans in place to support the full spectrum of their needs over
the course of weeks or months…” National Strategy for Pandemic

 

 

VII. Summary - Why Three Months

 

Preparing for three months allows you to face the disruptions that will come with a pandemic in relative safety and comfort.  Nearly everything in our lives comes from somewhere else.  Food, medicine, water, electricity, money, and health care all require society to be fully functioning in order to bring these goods to you.  During a pandemic, these systems will suffer.  Some will fail outright.  You may find yourself having to work with what you have on hand at the start of the pandemic.  The more supplies you have, the more choices you have.

 

The solution begins with each individual.  You must take responsibility for your own survival:  Do you want to be hungry during a pandemic?  Do you want to have to risk infection to get supplies?  Do you want to risk your family?  With three months of food, water (or purification capability), medications and other basic supplies, you have the basics to be well fed during a wave, and the tools to replenish supplies between waves. 

 

Having more than three months enables you to go even longer or to share with people in need.  By stocking food, you will be in charge of your own survival and that of your family.

The important thing is that sound science and reason strongly suggest that the time to begin is NOW.

 

 

Get Pandemic Ready: Why Three Months? Pt. 1

 

# 2020

 

 

The pandemic preparedness movement has sparked a number of grassroots organizations working to better prepare our communities for a possible pandemic.  While many have been mentioned in this blog, two are very near and dear to my heart;  the Readymoms and Get Pandemic Ready. 

 

I've highlighted the Readymom's many times, including here, here and here, and will do so again in the near future.

 

Today I'll highlight Get Pandemic Ready, a website hosted by  Nez Perce County, Idaho that provides practical preparedness solutions for individuals and families. 

 

One of the big debates over preparedness is over how much food, water, medicine and essential supplies would be prudent for each family stockpile?  

 

The US federal government recommends  2 weeks (although they wouldn't object if you stored more), many state and local health departments advocate 2 or 3 months, and late last year the Australian Food Lifeboat plan recommended 90 days.

 

In an attempt to clarify why Get Pandemic Ready advocates 90 days of supplies, the authors have put together this guide. 

 

Due to the length, I'm splitting it into two parts.

 

 

 

 

 

Why Three Months

 

In November 2007, the US Department of Health and Human Services (HHS) launched its “Take the Lead” campaign, asking local leaders to help their communities prepare for pandemic flu.

 

 

“Preparing for a pandemic influenza outbreak involves everybody. The threat of pandemic influenza is real, and America needs leadership from respected community members to prepare our towns and cities, reduce the impact of pandemic flu on individuals and families, and reduce or even prevent serious damage to the economy.”

Pandemicflu.gov

 

 

HHS recommends leaders encourage their communities to prepare by storing 2 weeks of food, medication, water and other essential supplies.  This is a good start.  But once people complete it, they need to continue towards the goal of at least a 3 month supply.

 

 
Obtaining three months supplies is doable.  See "Small Spaces, Small Budgets" in the ‘downloads’ section of the homepage for affordable ideas. Start with two weeks.  Once you've reached this goal, go for four weeks, then eight, and then twelve.

 

Why We Recommend Three Months

I.      Households May Be Sick Longer Than 2 Weeks

II.    Three Months May Be The Length of a Pandemic Wave

III.   The Critical Infrastructure is at Risk During a Pandemic

IV.    Three Months of Supplies Makes Economic Sense

V.      Three Months of Supplies Makes Sense for Communities

VI.     Respected Institutions Recommend Three Months of Home Stockpiling

VII.   Summary

 

 

 

I.     Households May be Sick Longer than 2 Weeks

 

 

An infectious disease takes time to spread through a family or  household.   Many families see this happen with the common cold: the virus may take up to 6 weeks to go through the entire family, passing from person to person.  

 

In a severe pandemic, according to the CDC, all family members in the household will be asked to stay at home and avoid going to work or the store if a family member is sick, for at least 7 days after the last person started showing symptoms.  If a family is large, everyone may be staying home for quite some time until it is clear that no one could still be contagious.  A long absence from work may result in a loss of income.

 

“Members of households with ill individuals may be recommended to stay home for an incubation period, 7 days (voluntary quarantine) following the time of symptom onset in the household member. If other family members become ill during this period, the recommendation is to extend the time of voluntary home quarantine for another incubation period, 7 days from the time that the last family member becomes ill.” Community Strategy for Pandemic Influenza Mitigation, Feb. 2007

Use of Nonpharmaceutical Interventions by Pandemic Severity Category

 

Even in a mild or moderate pandemic, with very ill children, parents may not wish or may not be able to leave their children, or may be sick themselves and unable to get to the store.  Outside help may not be available if an entire community is sick at one time. 

 
For comfort, convenience and peace of mind, it would be a good idea to stock up on the things you would want to get you through a longer time frame than just 2 weeks.

 

II.   Three Months May Be the Length of a Pandemic Wave

Infectious disease hits a community in “waves”.  In a community, at first a few people will be sick, and then many.  The peak of infection is the time that a community is hit hardest, where there will be the most sick people and fewest resources.   There can be several waves during a pandemic. 

 

Planners at the CDC are planning for at least 12 weeks per wave in a community for a severe pandemic.  See Appendix 6, page 86, Interim Pre-pandemic Planning Guidance

 

 

Some government planners basing planning on this 12 week period include:

[Discussing school closures] “In addition, planning for dismissal of students from schools and school-based activities and closure of childcare programs, in combination with means to reduce out-of-school social contacts and community mixing for these children, should encompass up to 12 weeks of intervention in the most severe scenarios.” Interim Pre- Pandemic Planning Guidance - CDC

 

“The population may be directed to remain in their homes under self-quarantine for up to 90 days per wave of the outbreak to support social distancing practices.” Pandemic Influenza: Best Practices and Model Protocols – US Department of Homeland Security

 

Because a wave may last as long as 12 weeks, schools may be closed, and social distancing may be in effect for at least this length of time.  By stocking the supplies that you will need during a pandemic, you can reduce your need to go out in public.

 

• Staying home reduces your chance of becoming infected or bringing the infection home to your family.
• “Sheltering In Place” would eliminate your chance of becoming infected completely.  

 

The more supplies you have at home, the more effectively you can protect yourself and your family during a pandemic.

 

 

Part II will be published later today.

 

In the interest of full disclosure, I am a minor contributor to the Get Pandemic Ready website.

 

This is an excellent resource, and I highly recommend it.

Study: H7 Strains Evolving

 

 

# 2019

 

 

What little media attention we've seen surrounding pandemic flu over the past few years has been largely focused on the H5N1 bird flu virus. Scientists know, however, that there are other influenza's out there in the running to spark the next pandemic.  

 

The H7 virus, while a dark horse candidate, has already made a small number of campaign appearances.

 

The following is a list of known of human H7 infections since 2002 (stats borrowed from CIDRAP's Summary of Avian Influenza Cases in Humans)

 

• 2002 H7N2 1 case  United States (Virginia) Evidence of infection was found in one person in Virginia following a poultry outbreak

 

• 2003 H7N7 89 cases (1 death) The Netherlands  During an outbreak of H7N7 avian influenza in poultry, infection spread to poultry workers and their families in the area (see References: Fouchier 2004, Koopmans 2004, Stegeman 2004). Most patients had conjunctivitis and several complained of influenza-like illness. The death occurred in a 57-year-old veterinarian. Subsequent serologic testing demonstrated that additional case-patients had asymptomatic infection.

 

• 2003 H7N2 1 New York The source of exposure was not determined

 

• 2004 H7N3 2 cases Canada (British Columbia)   Two poultry workers became ill during an outbreak of H7N3 avian influenza in poultry (see References: Health Canada 2004). Both had conjunctivitis.

 

• And 4 people were confirmed to have contracted H7N2 in the UK last year.

 

 

 

Today, according to AFP, a study has been released in PNAS (Proceedings of the National Academy of Sciences) suggesting that the RBD (receptor binding domain) of the H7N2 virus may be evolving to more easily infect humans.

 

 

RBD's are the area of a virus that allows it to attach to receptor cells in a host's body.   Different viruses are attracted to different types of cells, which explains why some viruses that affect man, don't affect other species, or vice versa.

 

Receptor cells have strands of sugar (carbohydrate) molecules on their surface. These carbohydrate molecules -  called glycans' - form a dense sugary coating to all animal cell membranes.

 

When a virus meets a compatible receptor cell, they bind.  And infection ensues.

 

For more detailed background on receptor binding domains you can read posts here and here.

 

 

The referenced study does not yet appear to be online at PNAS, so detailed comment will have to wait until I can read it. 

 

A hat tip to Dutchy on Flutrackers for finding this article.  I will try to follow up on this in the next few days. 

 

 

 

 

 

Evolution of flu strains points to higher risk

(AFP)
26 May 2008

 

CHICAGO - Some strains of bird flu are coming ever closer to developing the traits they need to cause a human pandemic, a study released Monday said.

 

Researchers who analysed samples of recent avian flu viruses found that a few H7 strains of the virus that have caused minor, untransmissible infections in people in North America between 2002 and 2004 have increased their affinity for the sugars found on human tracheal cells.

 

 

Subsequent tests in ferrets suggested that these viral strains were not readily transmissible.

 

But one strain of the H7N2 virus, a low pathogenic avian flu strain isolated from a man in New York in 2003, replicated in the ferret's respiratory tract and was passed between infected and uninfected ferrets suggesting it could be transmissible in humans.

 

The investigators said the evidence suggests that the virus could be evolving toward the same strong sugar-binding properties of the three worldwide viral pandemics in 1918, 1957 and 1968.

 

(cont.)