Saturday, February 28, 2009

Governor Kathleen Sebelius Nominated To Head HHS


# 2847





Governor Kathleen Sebelius



It appears that the media speculation, placing Kansas Governor Kathleen Sebelius at the top of President Obama's list to head up the HHS, was correct.  


This from the Washington Post.







Sebelius Accepts HHS Post

By Ceci Connolly

Kansas Gov. Kathleen Sebelius accepted President Obama's nomination to become Health and Human Services Secretary this afternoon, according to administration officials. Sebelius will replace former senator Thomas A. Daschle, who withdrew from consideration last month.


"This evening, the President asked Kansas Governor Kathleen Sebelius to serve as his Secretary of Health and Human Services, and she accepted," one administration official said. "The President will formally announce the nomination on Monday afternoon at the White House."

(Continue. . .)

Nepal: More Bird Deaths Spark Bird Flu Fears


# 2846






Morang District, Nepal




Five weeks after bird flu was first detected in Nepal (see Add Nepal To The List) new reports of sudden bird deaths are still coming in.  The latest comes from the Morang District of eastern Nepal, where 1,000 birds supposedly died in recent days.


This from


Bird flu feared as hundreds of chicken die near Biratnagar


Two days after the government completed its culling and killing operation of poultry and poultry products in Sharanamati VDC of Jhapa to control bird-flu detected in the area a week ago, almost 1,000 chickens in farms in Tankisinuwari of Morang district have died sending a pang of panic among the locals.


Some 400 chickens belonging to Dinesh Sitaula and 600 chickens belonging to Kiran Kafle died on Friday and Saturday, news reports said. The chickens started salivating and had swollen heads before they died, said the owners. The locals are scared of a bird-flu outbreak with flocks of chicken dying.


Initial investigation on the samples have tested negative to bird-flu, according to technicians from the Regional Animal Disease Diagnosis Laboratory (RADDL), Biratnagar.


Veterinary technicians have collected samples of the dead chicken for further investigation. The samples have been brought to Kathmandu for further tests. Feb 28 09

Indonesia: Suspected Bird Flu Death In Bekasi


# 2845



Reporting on suspected cases out of Indonesia is often an exercise in frustration.   Depkes, the Indonesian Ministry of Health, only bothers to confirm cases every few months, and then, rarely provides any details.


Officially, Indonesia has reported zero human cases for 2009, despite numerous local media reports of suspected (and sometimes locally confirmed) cases.


Today the Jakarta Post is reporting on the death of an 8 year old from Bekasi, suspected of having the H5N1 virus.



Bekasi resident allegedly dies of bird flu

The Jakarta Post ,  Bekasi   |  Sat, 02/28/2009 7:35 PM  |  Jakarta


An eight-year-old Bekasi resident died Saturday morning after being hospitalized at Persahabatan Hospital in East Jakarta with symptoms that link the case to bird flu, reports.


The Bekasi health agency's head of disease control Rudi Ruhdiat said And, a resident of Sukaraya village, had been buried this afternoon.


And was taken to Persahabatan Hospital Saturday morning after undergoing treatment at Annisa Hospital in Cikarang since Friday night.


Doctors said the child had been suffering from pneumonia, fever and coughing. Family members reported some chickens had died and were buried around his home.


And's death was the second in the village this month alone; the first death was reported early in February. (ewd)

UK: Unvaccinated Health Care Workers Spread Flu


# 2844



The TimesOnline is reporting today that only 14% of the UK's frontline Health Care Workers (HCWs) received a flu shot before the 2008-09 flu season.   This low vaccination rate, Health Authorities contend, puts vulnerable patients at risk.


Proving once again, that a hospital is no place to send a sick person.


Here in the United States the compliance rate is higher, but still only about 42% of our HCWs get an annual flu shot.  In recent months, some health care facilities have taken steps to try to make getting the yearly jab mandatory.


I wrote about how one Alaskan hospital is confronting this issue in a December blog entitled: Ongoing Debate: Mandatory Flu Shots For Health Care Workers? 


Their policy? 


Either get the flu shot, or look for other employment.


Last October, APIC (Association for Professionals in Infection Control and Epidemiology)  released a statement recommending mandatory flu shots for health care workers, which I blogged about in APIC Seeking Mandatory Flu Shot For HCWs.



I admit I'm not completely comfortable with the idea of a `mandatory' flu shot for HCW's, even though I believe that HCW's should get a flu shot every year.   In the interest of full disclosure, I take an annual flu shot, and have done so for many years.



We find ourselves at the precarious intersection of a person's right to choose whether or not to take a vaccine, and a hospital's need to protect patients, and other employees, from potentially contagious individuals.   


There are economic, moral, and liability issues involved here, and no easy answers.


Influenza kills thousands of people each year, and undoubtedly a fair number of those people contract the virus while in a hospital, doctor's office, or nursing home setting.  


Unvaccinated HCW's are probably the cause of at least some of those deaths


Of course, even vaccinated HCW's can spread the flu


Even during years when the vaccine is a good match, it is generally only about 70% - 80% effective.  


And HCW's can also spread the virus from patient to patient by failing to wash or sanitize their hands, or through inanimate objects (dinner trays, stethoscopes, long sleeves,etc.) that move about a hospital.


Obviously, you will never completely eliminate the nosocomial transmission of influenza.  But the first tenant of medicine is, after all:  Primum non nocere -  "First, do no harm." 


The question becomes, is it reasonable to mandate that health care workers take a flu vaccine every year?   And how much liability does a hospital have if it allows unvaccinated HCW's to deal with patients?


Public Health Officials, hospital administrators, and infection control teams are increasingly finding themselves in the middle of a battle between individual employee's rights, and protecting their staff, patients, and the public.


In 2006, a U.S. District Court in Seattle ruled that the Virginia Mason Medical Center couldn't force nurses to take flu shots.  Undoubtedly this ruling will be tested again in the future.


Now, after a particularly bad flu season in the UK, the debate over mandatory flu shots for NHS workers is front and center. 


A hat tip to Carol@SC on the Flu Wiki for posting this report from the TimesOnline.


From The Times

February 28, 2009

Flu spread by unvaccinated NHS frontline staff

Nurse giving an injection


Most health workers ignored advice to have a flu vaccination, exacerbating infections in hospital

Sam Lister, Health Editor


Health workers have been blamed for putting vulnerable patients at risk and worsening the winter’s flu outbreak by refusing to have flu jabs.


Fewer than one in seven frontline NHS staff had a flu jab last year, The Times has learnt, despite a recommendation that they do so. The Royal College of General Practitioners called last night for hospital doctors, GPs, nurses, carers and other staff to have compulsory jabs or be banned from contact with patients other than in exceptional circumstances.


Figures to be published next week by the Department of Health will show that the vast majority of health professionals ignored government advice that everyone in direct contact with patients be immunised.


Of the hundreds of patients seriously affected by staff transmission of flu, some were infected while being treated in high-dependency wards.


The health department figures show that only 14 per cent of frontline workers had a flu jab before the 2008-09 season, despite warnings from Sir Liam Donaldson, the Chief Medical Officer for England, that immunisation rates had to improve.


The flu outbreak over Christmas and the new year was the worst for eight years, with more than 60 cases per 100,000 head of population. About 2,000 deaths are attributed to flu annually – although the number can rise to more than 10,000 in bad years. The number for this winter has not yet been released.


Some hospitals suffered serious flu outbreaks exacerbated by staff transmission of the highly contagious virus, while shortages of workers put pressure on accident and emergency departments. Anecdotal reports suggest that on occasion patients brought to hospital by ambulance had to wait for up to five hours because staff were so overstretched by absenteeism and higher admission rates caused by flu.


At Royal Liverpool University Hospital, nearly 100 patients caught flu, including on high-dependency wards treating blood diseases and kidney problems.


Low levels of vaccination among staff were identified by the Health Protection Agency as a significant factor in the outbreak. When health chiefs in Liverpool asked any unvaccinated staff to get a jab to help to control the outbreak, almost 1,300 came forward.


(Continue . . . )

Friday, February 27, 2009

Branswell  Updates The Baxter H5N1 Story

PLEASE SEE the March 17th Update of this story.  

A Few More Details On The Baxter Mishap

# 2843

Helen Branswell, science and medical reporter for The Canadian Press, brings us another in-depth report on the `serious error' by Baxter Pharmaceuticals that allowed the H5N1 virus to be accidentally sent to a lab in the Czech Republic.

Since Ms. Branswell is simply one of the best science reporters around, I'll  step out of the way and let her explain it. 

Follow the link to read the full article.

Baxter: Product contained live bird flu virus
By Helen Branswell, THE CANADIAN PRESS
Last Updated: 27th February 2009, 3:26pm
The company that released contaminated flu virus material from a plant in Austria confirmed Friday that the experimental product contained live H5N1 avian flu viruses.
And an official of the World Health Organization’s European operation said the body is closely monitoring the investigation into the events that took place at Baxter International’s research facility in Orth-Donau, Austria.
“At this juncture we are confident in saying that public health and occupational risk is minimal at present,” medical officer Roberta Andraghetti said from Copenhagen, Denmark.
“But what remains unanswered are the circumstances surrounding the incident in the Baxter facility in Orth-Donau.”
The contaminated product, a mix of H3N2 seasonal flu viruses and unlabelled H5N1 viruses, was supplied to an Austrian research company. The Austrian firm, Avir Green Hills Biotechnology, then sent portions of it to sub-contractors in the Czech Republic, Slovenia and Germany.
The contamination incident, which is being investigated by the four European countries, came to light when the subcontractor in the Czech Republic inoculated ferrets with the product and they died. Ferrets shouldn’t die from exposure to human H3N2 flu viruses.
(Continue . . .)

Updates On the Aichi and UK Poultry Outbreaks



#  2842



According to documents filed with the OIE (World Animal Health Organization), the outbreak at the quail farm in Japan is a low pathogenic virus.


Here is a partial screen shot of part of the OIE report.





This makes far more sense than what was reported earlier today, that the virus was highly pathogenic, yet no birds had died.  As I remarked in my earlier blog:


No excess mortality in the birds has been reported, which is a bit unusual for a `highly pathogenic' strain.  For now officials are assuming this is an `attenuated virulent type of H7'.



Meanwhile, word  has come that the outbreak at two Bernard Mathews Farms in Norfolk and Suffolk are from the low pathogenic H6N1 virus.


Low risk bird flu on Norfolk farm identified as the H6 virus


27 February 2009

Government tests have now identified a strain on bird flu found on a Norfolk farm as the H6N1 virus.

As reported yesterday, the flu affecting birds at Bernard Matthews' breeder farm at Yaxham, near Dereham, was very quickly ruled out as the deadly H5 or H7 strain of avian influenza.

This afternoon the firm said tests have now confirmed the birds have a virus, but one of low risk to humans.

A statement from the firm said: “Further testing has identified the type as H6N1. This is a virus type that has been isolated in both wild birds and commercial poultry flocks in Europe over the last few years.”

Government agency Defra started tests for bird flu on Arran Farm at Yaxham and another at Ubbeston near Halesworth in Suffolk after the firm brought it to their attention.

(Continue . . .) 

Vietnam: MOA Calls For Animal Disease Controls


# 2841


Vietnam, which has reported two bird flu fatalities since the first of the year (the article only mentions 1), now is battling outbreaks in poultry in 11 provinces.  


The MOA (Minister of Agriculture) is calling for stricter controls in an attempt to contain the outbreak.


Vietnam is also seeing a resurgence in other animal diseases, prompting a call for better checkpoints on their borders.


On February 8th of this year, ProMED Mail reported.

[There have been 5 provinces reporting foot-and-mouth disease (FMD) within the last 21 days in Viet Nam. They include Son La, Long An, Kon Tum, Hoa Binh, and Quang Binh provinces.


Additionally, there have been multiple reports of  Porcine Reproductive and Respiratory Syndrome (PRRS) in Quang Ninh and Quang Nam provinces.





Agriculture ministry urges bird flu control










Minister of Agriculture and Rural Development Cao Duc Phat Thursday asked ministries, sectors and localities to apply strict bird flu controls next month.


The ministry has instructed relevant agencies to build a series of new check-points along Vietnam’s borders to prevent animal diseases from entering the country, Phat said at a meeting held in Hanoi, chaired by Standing Deputy Prime Minister Nguyen Sinh Hung.


The ministry also suggested that provinces, which lack vaccines, should apply to the Department of Animal Health today for additional supplies, Phat said.


So far this year, 13 provinces and cities have been badly hit by bird flu, with a total of more than 52,000 fowl culled, equalling nearly half of last year’s total, department head Bui Quang Anh said at the meeting.


Currently, 11 bird flu-hit localities still haven’t controlled the epidemic, he said.


Over the past two months, bird flu has also infected three people in the country, killing one of them, Anh said.

Webster: Better Drugs Needed To Fight A Pandemic


# 2840




The rise in Tamiflu resistance among one seasonal flu strain over the past year has intensified concerns over how well our stockpiled Oseltamivir (Tamiflu) and Zanamivir (Relenza) will work during a pandemic.   


Both work as neuraminidase inhibitors.


Beginning in late 2007, laboratory analysis of influenza viruses in northern Europe began picking up a small number of resistant samples.


The resistant virus is H1N1, which is only one of several circulating strains of flu viruses.   The H3N2 virus, thus far, remains sensitive to the drug, as does the influenza B virus in circulation.


This resistance is caused by a mutation, known as H274Y, where a single amino acid substitution (histidine (H) to tyrosine (Y)) occurs at the neuraminidase position 274.


Since then, the number of resistant H1N1 viruses around the world has risen steeply, approaching 100% of the samples being tested in some regions.  


While we can't know what virus will spark the next pandemic, we worry most about the H5N1 bird flu virus.   It is circulating in birds, has been detected in 65 countries, and causes high mortality in humans.


Unfortunately, the H5N1 bird flu virus shares a very similar N Protein (neuraminidase) with the now resistant H1N1, which leads many scientists to fear the bird flu virus could acquire resistance rapidly during a pandemic.


This report is from Reuters, and it contains an interview with Dr. Robert G. Webster.  


Webster is suggesting that oseltamivir (Tamiflu) and zanamivir (Relenza) be tested in combination with other antivirals like ribavirin and amantadine.


Follow the link to read the article in its entirety.




Experts say new drugs needed to fight flu pandemic


27 Feb 2009 10:56:00 GMT

Source: Reuters

By Tan Ee Lyn

HONG KONG, Feb 27 (Reuters) - Experts on Friday urged governments on Friday to diversify their stockpiles of drugs and called for more new medicines to fight what could be the world's next flu pandemic caused by the H5N1 bird flu virus.


Many advanced countries stock up on oseltamivir and zanamivir, two varieties of the same class of drugs that stops the H5N1 virus from multiplying.


But oseltamivir has proven to be largely useless in fighting the H1N1 seasonal human influenza virus and experts are questioning how well, and how long, the drug would stand up against the H5N1 virus, should it unleash a pandemic.


"We have been extremely foolish on our policies of stockpiling drugs. We have been stockpiling two varieties of the same drug," virologist Robert Webster at the St Jude Children's Hospital in the United States said at a medical conference in Hong Kong.


He said the resistance of the H1N1 virus to oseltamivir was as high as 98 percent worldwide.


"The likely scenario is that the (H5N1) virus will become resistant when you start using more and more (of one) drug, you get resistant (H5N1) mutants," he told Reuters later.


(Continue . . .)

Japan: Further Details On H7 Outbreak On Quail Farm


# 2839



This morning we're getting a bit more detail on the what they are calling a highly pathogenic H7 avian virus detected in Aichi Prefecture yesterday. 


The location is a rather large quail farm near Toyohashi, and this discovery may lead to the culling of 280,000 birds.


Avian influenza antibodies were apparently detected during routine testing of random birds in mid-February, and the strain identified as H7 on the 27th. 


No excess mortality in the birds has been reported, which is a bit unusual for a `highly pathogenic' strain.  For now officials are assuming this is an `attenuated virulent type of H7'.


Further testing will be needed to determine the N (neuraminidase) type for this virus, and its actual virulence. 


This from the Asahi Shimbun.



Bird flu detected at quail farm in Aichi





H7 bird flu was detected at a quail farm in Toyohashi, Aichi Prefecture, the first time the highly pathogenic virus has been found in Japan in 84 years, officials said Friday.


None of the quails on the farm has died, leading farm ministry officials to believe the virus is probably the attenuated virulent type of H7.


The last time H7 avian flu was found in Japan was in 1925, when the virus infected chickens.


This is also the first time a highly pathogenic bird flu virus has been discovered on a farm in the country since the H5N1 virus was confirmed in Miyazaki Prefecture in January 2007 and in Okayama Prefecture the following month.


The Toyohashi farm where the virus was detected holds about 320,000 quails and is a large producer of eggs. About 280,000 adult quails on the farm are expected to be culled to contain the virus.


The farm ministry and other authorities will restrict movements of fowl, eggs and feed within a 10-kilometer radius of the farm. If the virus is identified as being of attenuated virulence, the radius will be reduced to 5 km.




The virus was detected after a regular checkup by the Aichi prefectural government on Feb. 18. Among the blood serums of 10 birds collected that day, two tested positive for a bird flu virus antibody on Wednesday.


Additional tests at the farm all produced negative results.


However, after the samples from Feb. 18 were sent to the National Institute of Animal Health in Tsukuba, Ibaraki Prefecture, for analysis, the H7 virus was identified Friday morning.

(Continue . . .)

Thursday, February 26, 2009

Japan: Highly Pathogenic H7 Detected In Aichi Prefecture


# 2838



Toyohashi, Aichi Prefecture




This report has just come over the wires, and there isn't a lot of detail available yet. 


From the Kyodo News.



Highly pathogenic H7 bird flu virus detected in Aichi Pref.



     The highly pathogenic H7 bird flu virus has been detected in quails in Toyohashi, Aichi Prefecture, the prefectural government said Friday.

     The quails were being kept by a farm family in the city, according to the local authority.



While we worry most about highly pathogenic H5N1, HPAI (Highly Pathogenic Avian Influenza) H7 has caused severe damage to poultry holdings in a number of countries. 


Millions of birds were culled in Pakistan in between 1997 and 2003 due to the H7N3 virus, and 30 million birds were culled in the Netherlands in 2003 due to an outbreak of H7N7.




Chart from CIDRAP Avian Influenza (Bird Flu): Agricultural and Wildlife Considerations


While we worry less about the impact of H7 viruses on human health than we do the H5 virus, human infections have been recorded.  They have generally been mild.


This from CIDRAP's Avian Influenza (Bird Flu): Implications for Human Disease on the 2003 Netherlands outbreak.


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.


More recently, 4 people in Wales contracted H7N2 during an outbreak on a poultry farm in 2007.  There were no fatalities.



Hopefully we'll get more detail on this discovery of HPAI H7 in Japan over the next few days.

Vietnam Reports Another Bird Flu Fatality



# 2837



For the second time in a week, Vietnam is reporting an H5N1 fatality, this time a 32-year old man from the northern province of Ninh Binh.


The WHO's 2nd Vietnamese Avian Flu Update of 2009, released on February 18, listed the man in serious condition.



Avian influenza – situation in Viet Nam - update 2

18 February 2009 -- The Ministry of Health in Viet Nam has reported a new confirmed case of human infection with the H5N1 avian influenza virus. The case has been confirmed at the National Institute of Hygiene and Epidemiology (NIHE).


The case is a 32-year old man from Kim Son district, Ninh Binh province. He developed symptoms on 5 February 2009 and was hospitalized on 13 February 2009. He is currently in a serious condition. The case is known to have had recent contact with sick poultry prior to the onset of his illness.



This death makes the 54th confirmed fatality from the H5N1 virus in Vietnam since 2003.




Feb 26, 8:51 PM EST

Vietnam reports 2nd bird flu death of the year


HANOI, Vietnam (AP) -- A health official says a 32-year-old man from northern Vietnam has died of bird flu, in the country's second death from the disease this year.


The man was from the northern province of Ninh Binh and died Wednesday at a disease clinic in Hanoi.


Vu Van Can, deputy director of the Ninh Binh health department, says the man tested positive for bird flu, and that he became ill after slaughtering and eating ducks his family raised.


Last week, a 23-year-old woman from the northern province of Quang Ninh died of bird flu, becoming the first person in Vietnam to die of the disease in 2009.

More On The Baxter `Vaccine' Story

PLEASE SEE March 17th Update of this story.  Some of the early newspaper accounts had incorrect details.

A Few More Details On The Baxter Mishap

# 2836

By now, most of my readers are aware that Baxter International in Austria accidentally sent `vaccine samples' contaminated with the H5N1 virus to labs in In the Czech Republic, Slovenia, and Germany.

The problem was only discovered after lab ferrets began dying after receiving the vaccine (see Ferreting Out A Problem In the Laboratory).  
According to Baxter's director of global bioscience communications, Christopher Bona, the contaminated substance wasn't a `vaccine', but a `liquid virus product'.
There are still a great many unanswered questions. 
Many of these questions are posed by the Revere's at Effect Measure this morning.
Michelle Fay Cortez and Jason Gale of Bloomberg had early coverage of the story in Baxter’s Vaccine Research Sent Bird Flu Across European Labs.
And today, the Canadian Press has a story on it as well.  There's no byline, but this appears to be written by Helen Branswell.  It is a long, but informative read. 
Follow the links to read it in its entirety.

Officials investigate how bird flu viruses were sent to unsuspecting labs

Provided by: Canadian Press
Written by: Medical Reporter, THE CANADIAN PRESS
Feb. 25, 2009

Officials are trying to get to the bottom of how vaccine manufacturer Baxter International Inc. made "experimental virus material" based on a human flu strain but contaminated with the H5N1 avian flu virus and then distributed it to an Austrian company.
That company, Avir Green Hills Biotechnology, then disseminated the supposed H3N2 virus product to subcontractors in the Czech Republic, Slovenia and Germany. Authorities in the four European countries are looking into the incident, and their efforts are being closely watched by the World Health Organization and the European Centre for Disease Control.
Though it appears none of the 36 or 37 people who were exposed to the contaminated product became infected, the incident is being described as "a serious error" on the part of Baxter, which is on the brink of securing a European licence for an H5N1 vaccine. That vaccine is made at a different facility, in the Czech Republic.
"For this particular incident ... the horse did not get out (of the barn)," Dr. Angus Nicoll of the ECDC said from Stockholm.
"But that doesn't mean that we and WHO and the European Commission and the others aren't taking it as seriously as you would any laboratory accident with dangerous pathogens - which you have here."
Accidental release of a mixture of live H5N1 and H3N2 viruses - if that indeed happened - could have resulted in dire consequences. Nicoll said officials still aren't 100 per cent sure the mixture contained live H5N1 viruses. But given that ferrets exposed to the mixture died, it likely did.
(Continue . . .)

UK: Testing For Avian Flu On Two Poultry Farms




# 2835



UK suffolk Norfolk



In November of 2007 the counties of Suffolk and Norfolk were the site of several bird flu outbreaks which resulted in the culling of nearly 70,000 birds on at least 6 farms.


Today we are learning of a new investigation by Defra, the UK's Department for Environment, Food, and Rural Affairs into a possible avian flu infection on two farms in the Suffolk-Norfolk region.


While the strain has not been identified, suspicions are of a `low-path' variety, given that no excess mortality in the flocks has been reported.


Defra has placed movement restriction on birds out of these two farms, but has not advised any culling as yet.   


As a precaution, some farm workers have been placed on prophylactic Tamiflu.


Further tests are ongoing.





Tests for bird flu on two farms



More tests are taking place to identify the strain on flu


Birds on two poultry farms in Suffolk and Norfolk have tested positive for a strain of avian flu.


Vets from Defra carried out the tests at Bernard Matthews breeder sites in Ubbeston in Suffolk and near Yaxham in Norfolk.


The birds tested positive for avian influenza but not the highly pathogenic H5 or H7 types.


Defra has not advised a cull of the birds but has placed a movement restriction on them.


A Defra spokesman said: "A routine veterinary investigation is ongoing at poultry premises into the possible presence of a notifiable avian disease. Laboratory tests are ongoing and there is no conclusion yet.


Further tests

"Routine veterinary investigations into notifiable diseases occur on a regular basis.


"It is a legal requirement to notify the Animal Health Agency of the possibility of such diseases whenever these cannot be ruled out by a vet or an animal keeper as part of the diagnosis of illness in animals or birds."


A second series of tests is taking place to identify the strain of influenza.

Tangerang: 2 Bird Flu Suspects Test Negative


# 2834



One of the difficulties in pinpointing human infections from the H5N1 virus is that early on, it can mimic dozens of other diseases. 


And of course, the opposite is true.  


Dengue, Chikungunya, seasonal influenzas, community acquired pneumonia's, and a host of other viral fevers can look a lot like bird flu, particularly in the early stages of the disease.


Perhaps the most common admission chart entry here in the United States, and I suspect around the world, is FUO : Fever of Undetermined Origin.


It takes time to run lab tests, grow bacterial cultures, and to come up with a definitive diagnosis.   In the meantime, in those areas where H5N1 is prevalent, it makes sense to isolate suspected cases.


Today Indonesian Health Officials are announcing that two previously suspected bird flu cases from Tangerang have tested negative for the virus.


A hat tip to Dutchy on Flutrackers for posting this item.




Two Tangerang residents test negative for bird flu

The Jakarta Post ,  Jakarta   |  Thu, 02/26/2009 1:53 PM  |  Jakarta

Tangerang health agency on Thursday said two residents of Kampung Geruduk, Tangerang, who were suspected of having contracted the avian influenza virus had tested negative for the deadly disease.


“Both tests came back negative,” health agency official Yully Soenar said, as quoted by on Thursday.


The 15-year-old Maya Suparni and 2-year-old Muhammad Heru were being treated in the bird flu isolation unit at Tangerang General Hospital for almost a week.


The pair were admitted to the unit when the hospital found they had high fever and difficulty breathing, and local authorities reported that there was dead poultry near their places of residence.

Yully said the symptoms found were indicative of acute respiratory infection disease and bronchitis. (dre)


Webster On China's `Silent' Bird Flu Infections



# 2833



Robert G. Webster is regarded as the father of influenza virology, having correctly posited more than 4 decades ago that human flu's are derived from bird flu's.  


Webster holds the Rose Marie Thomas Chair in Virology at St. Jude Children's Research Hospital, and is also a fellow of the Royal Society of London, the Royal Society of Medicine and the Royal Society of New Zealand, and a member of the National Academy of Sciences of the United States.


According to the St. Jude's Childrens Hosptial Bio, Webster's curriculum vitae contains over 400 original articles and reviews on influenza viruses.


So when Robert Webster talks, people listen.


Today Reuters has an interview with Dr. Webster regarding the recent human cases detected in China and Vietnam.   Webster believes that asymptomatic ducks, harboring `silent infections', may be to blame.


A hat tip to newshound Kobie on the Flu Wiki for posting this article.


Follow the link to read the article in its entirety.




Blame ducks for bird flu?

Thu, Feb 26, 2009


HONG KONG, Feb 26 (Reuters) - A leading virologist said on Thursday that ducks are to blame for the resurgence of the H5N1 bird flu virus in China and Vietnam, and called for wider surveillance and vaccination of ducks to stop the problem.


The virus has infected at least 14 people in both countries since the start of this year, killing seven of them.


Experts said what was mystifying about the latest round of outbreaks was the absence of the disease in poultry in China despite the human infections. H5N1 is passed primarily from animal to human.



Robert Webster, a leading H5N1 expert, told a medical conference in Hong Kong that 'silent infections' of H5N1 in ducks may be the reason behind the human cases in China.


Most types of ducks are not sickened by the virus and in most countries in Asia, they mingle freely with chickens, providing ample opportunity for the virus to jump between species.


'The problem is in the ducks in Asia, there is no visible disease in these birds,' said Webster of the St Jude Children's Research Hospital in the United States.


The absence of visible infection in poultry makes it harder to track the disease and take preventive measures.


'In China, there is no disease (in poultry) ... I suspect there are some viruses in duck populations that they (authorities) don't know about ... Maybe there are silent infections, it's a vast country.'


Webster said it was very difficult to get farmers to vaccinate their apparently healthy ducks, especially when these exercises cost a lot of money.

(Continue . . .)



Waterfowl are known to be reservoirs of avian influenza viruses. The virus is largely asymptomatic in them, allowing the birds to migrate and spread the disease.


The idea that ducks may be behind the spread of the virus in S.E. Asia isn't new, of course.  Having Dr. Webster voice his concerns, however, may induce some countries to work harder at controlling this viral reservoir.


As I said, when Webster speaks, people listen. 


One final note, I'm somewhat perplexed by the numbers cited in this article stating that:


The virus has infected at least 14 people in both countries since the start of this year, killing seven of them.


As far as I know, China has only publicly confirmed 7 cases (although an 8th is strongly suspected) with 5 fatalities, and Vietnam has only confirmed 2 cases with 1 fatality. 

Wednesday, February 25, 2009

Vietnam Reporting Bird Flu In Eleven Provinces


# 2832



The number of Vietnamese provinces reporting outbreaks of bird flu in poultry continues to escalate, with 11 provinces reporting the virus this year. 


Authorities warn that more provinces may be affected in the coming days and weeks.

This from Xinhua News.





Bird flu hits 11 provinces of Vietnam nationwide 2009-02-26 11:21:51

    HANOI, Feb. 26 (Xinhua) -- Bird flu continues to spread wide in Vietnam with another newly-infected northern Dien Bien province, raising the number of Vietnamese provinces hit by the virus to 11, according to Vietnam's Department of Animal Health under the Ministry of Agriculture and Rural Development on Thursday.


    In Dien Bien province, bird flu has broken out in two communes of the province, leading to the culling of about 1,460 ducks and more than 1,000 their eggs, said the department, Vietnam watchdog of bird flu.


    Samples of dead ducks found in the province tested positive to the H5N1 virus, said the department.


    It is likely that Vietnam will see more bird flu outbreaks in more provinces in coming days, said the department.


    So far this year, 11 provinces of Vietnam nationwide have been hit by avian flu, including four provinces in Mekong Delta, namely Ca Mau, Soc Trang, Hau Giang and Bac Lieu, four northern provinces of Bac Ninh, Quang Ninh, Ninh Binh and the newly-confirmed Dien Bien, two central provinces of Nghe An and Quang Tri, and southern province Khanh Hoa, said the department.

Vitamin D To Ward Off Flu?


# 2831




Even without the possibility of an influenza pandemic looming sometime in the future, colds and flu's exact a heavy toll in terms of lives, lost productivity, and misery every year.  


Influenza-like illnesses(ILI's) lead to thousands of deaths each year in the United States, and hundreds of thousands of deaths worldwide. 


Vaccines are our best protection against seasonal influenza viruses, but they don't offer complete protection.


And given the wide variety of respiratory viruses that circulate each year that aren't covered by the vaccine, it would certainly be desirable if there were something simple you could do to help protect yourself against them.


Over the past couple of days the media has been reporting on a study that suggests that Vitamin D might offer some sort of protection against respiratory viruses.  


Too Little Vitamin D May Mean More Colds and Flu U.S. News & World Report

Vitamin D Levels Linked to Respiratory Tract Infections Lower ... Modern Medicine

Vitamin D may protect against common cold CNN


This is not the first time that Vitamin D has been linked to preventing colds and flu, although no conclusive studies have been published. 


The anecdotal evidence, however, is interesting.


Today's study, which appears in the February 23rd edition of the Archives of Internal Medicine,  shows an inverse relationship between a person's  level of serum 25-hydroxyvitamin D and a recent bout with a cold or flu. 


Those who had recently experienced an ILI or other respiratory illness, were more likely to have lower than normal Vitamin D levels.


The median serum level of 25-hydroxyvitamin D, among more than 18,000 people tested, was 29 ng/ml.


Those with a serum level below 10 ng/ml (considered very low), were 40% more likely to have had a recent respiratory illness than those with a serum level above 30 ng/ml.


The link between Vitamin D levels and the risk for respiratory infections was stronger in those with asthma or COPD.



Certainly not conclusive evidence, but intriguing nonetheless.  


The problem with this study is that it looks backwards, not forwards.   Researchers can't know, with certainty, that the subjects who reported recent infections had low vitamin D levels before they got sick.


Since the half-life of Vitamin D in the body is normally about 15 days,  researchers are inclined to believe that the lower levels detected were probably present prior to  infection.


But it is also possible that having a cold or flu could somehow lower a person's Vitamin D level, if for no other reason than they are probably inside more, and exposed less to the UV rays of the sun.


In other words, the jury is still out.


The desirable level of Vitamin D is a subject of much debate, although the NIH lists levels below 20 ng/ml as being inadequate for good health.    


Some researchers advocate a level ≥30 ng/ml, although a recent government-sponsored expert panel concluded that insufficient data was available to support these higher levels.


So, until clinical trials are conducted, the value of taking extra Vitamin D to help ward off colds and flu's remains unproven.


But we do know that many people have inadequate levels of Vitamin D in their systems, particularly during the winter months. 


So while we don't know if a little extra vitamin D will help protect you from a cold or flu - like eating chicken soup when you have a cold - if you're considering trying it . . .  it probably wouldn't hurt.

Indonesian: Two Children Suspected Of H5N1 Infection




# 2830



From the Bird Flu Information Corner, which over the past few months has become one of our best sources of information out of Indonesia, we get a report of two children (ages 5 and 1) hospitalized, and suspected of having the H5N1 virus.


No positive tests have been announced, and their condition appear to be relatively stable.   They remain, however, in isolation.


A big hat tip to Ida at BFIC for this translation.



Klaten, Central Java ::: Two children suspected bird flu infection

February 26, 2009

25/02/2009 17:49 Suara Merdeka

Dozen of chickens died. Two toddlers in Klaten suspected.


Two children, Roslik Wahyu Adiarta (5) and his/her cousin Wisnu Candra (1), residents of Dusun Kemalang, Desa Dompol, Kecamatan Kemalang, treated at RSUP Dr Soeradji hospital on Wednesday (25/2) as bird flu suspect patients. These two children are developing fever, flu, and breathing difficulty after dozen of chickens belong to the family suddenly died.


Patients are relatives and their houses are close to each other. Roslik was admitted to hospital on Tuesday evening (24/2) 21.00 after few days developing fever. Patient was admitted to public health center before, but the fever and breathing problem did not recover.


Investigation showed history of dead fowls among the neighborhood, therefore victim was redirected to RSUP for bird flu observation where Roslik is placed at isolation unit 2nd floor. Wisnu founded to develop same symptom after that and admitted to RSUP on Wednesday (25/2).


Wisnu’s mother, Triyanti (28) said that her child had fever and breathing problem after sudden death of 15 chickens in their village observed. Those death chickens tested bird flu infection by Agricultural Service and Livestock Subdivision.


The two suspects are still under observation. Blood and swab sample also have been taken for further examination. Patients also examined every 8 hours at isolation unit. Current result showed no specific bird flu infection signs such as pneumonia, acute lung inflammation or leukocyte depression.


Source: Indonesia local newspaper, Suara Merdeka.

Klaten, East Java




The Bird Flu Information Corner is a weblog developed based on collaboration work between Kobe University, Japan and Institute of Tropical Disease, Airlangga University, Indonesia in bird flu research.

Japan Runs The Numbers


# 2829



From the Asahi Shimbun today we get this story about a study conducted by Japan's National Institute of Infectious Diseases that looked at the interventions that would be needed in order to reduce the impact of a pandemic.


Out of a population of roughly 34 million (just in Tokyo), they theorize half could become infected with a novel pandemic strain if no efforts were made to reduce human contact.


This attack rate of 50% is almost twice what most countries have envisioned, although the UK has recently spoken about numbers in that range.  


The higher the attack rate, the greater of an impact a pandemic would have on society, health care providers, and the economy.  And of course, the greater the human toll as well.


By closing all schools, and reducing commuter traffic by 40%, they believe they can reduce the attack rate to a more manageable 25%.


First today's article, then a quick flashback to December 2008.


A hat tip to Carol@SC on the Flu Wiki for posting this story.




New flu could infect 17 million in Tokyo area





More than half the population of the Tokyo metropolitan area could contract a new strain of influenza if nothing is done after one carrier brings the virus to the capital, according to a study.


The study by the National Institute of Infectious Diseases calls for all schools to close and 40 percent of commuters to stay at home to keep the infection rate at 25 percent or lower, the level the central government envisions in dealing with new strains of influenza.


"The key to preventing the spread of infection is the degree of measures to restrict people from going out," said Yasushi Ohkusa, a senior research scientist at the institute who took part in the study.


The scenario of the institute is based on data from a council on traffic planning in the Tokyo metropolitan area.


The council tracked down how 34 million people in Tokyo and Kanagawa, Saitama and Chiba prefectures, as well as southern Ibaraki Prefecture, move and where they are during the day.


The institute came up with a scenario in which a company employee is infected with a new strain of flu while overseas and returns home to Hachioji, Tokyo, on the third day of infection. The employee develops symptoms after reporting to work in Tokyo's Marunouchi district on the fourth day.


After a hospital diagnoses the employee with a new type of flu, local governments start taking action on the seventh day.


The spread of the flu will reach its peak around the 25th day, according to the scenario.


The study predicts that 51.6 percent of residents in the Tokyo metropolitan area will contract the flu if no measures are taken.


If all schools are closed and the number of commuters is reduced by 40 percent after local governments ask residents to stay home, the infection rate will fall to 19.1 percent, the study predicted.


The institute says that if the number of commuters is further reduced by 60 percent, the infection rate will be lowered to 9.5 percent, the same level as that of regular, seasonal influenza.(IHT/Asahi: February 25,2009)



Last December I ran a blog about a Japanese study conducted on commuter trains, to determine what carrying capacity they could maintain during a pandemic and still allow for reasonable social distancing.


The verdict was that they could carry only 20% of their usual traffic, which is a far cry from the 60% envisioned by today's report.  See Japan: Social Distancing Test On Commuter Trains for more details.

Here is just a snippet from one of the articles.



Flu epidemic measures tested on train riders

Kyodo News

A research institute for the transport ministry conducted a test Monday on how far apart passengers should be while riding on commuter trains in the event of a new type of influenza outbreak.


Safe distance: In a test of passenger control steps to be taken during a possible flu epidemic, officials from a labor ministry research institute measure the distance between mask-wearing subjects in Adachi Ward, Tokyo, on Monday. KYODO PHOTO


According to the Policy Research Institute for the Land, Infrastructure, Transport and Tourism Ministry, passengers would be required to keep a distance of 1 to 2 meters to prevent the infection spreading by coughs or sneezes.



Mega cities such as Tokyo or New York, where millions of people rub shoulders every day, are more likely to see high attack rates than say, Springfield, Missouri or  Keokuk, Iowa. 


The more close contacts a person has, the more likely they are to either contract, or pass on, the virus.  


Mitigation efforts, such as closing schools and limiting the number of people allowed on commuter trains, ought to reduce the transmission of the virus.  


They do come with a price, both socially and economically.  


But then, so would a 50% attack rate.


The logistics of deciding who gets priority for public transit, controlling the boarding onto the trains, and dealing with the economic outfall from employee absenteeism are sizable.


Which is why its is a good thing they are looking into the feasibility of this now, instead of waiting until a pandemic begins.

H7 Bird Flu Virus Found In Czech Poultry



# 2828



As happens from time to time, a poultry flock has been found to harbor a (presumably) LPAI (Low Pathogenic Avian Influenza) virus.  In this case, it appears to be one of the H7 variety.


This is not the highly pathogenic, and very dangerous, H5N1 bird flu.




Bird flu appears in Czech Republic


25 February 2009


Hodonin, South Moravia, Feb 24 (CTK) - Czech vets on Tuesday discovered a virus of bird flu when checking the breeding of waterfowl in the Rybarstvi Hodonin fishing company, local vet authority head Jaroslav Salava told CTK.


It was discovered in nine out of the 60 randomly checked geese near the Pisecensky pond. However, it is not the risky type H5N1, but the much less dangerous H7 stem, Salava said.


Nevertheless, vets will still order the putting down of all the roughly 3000 geese and 350 ducks, Salava said.


An area with the 1-km radius was created around the focus of the epidemic, Salava said, adding that special veterinary measures for the disinfection of the farms and movement of people and poultry┼ż would be in effect there.


Salava said the staff and locals were not exposed to any serious danger in the area.


"The found H7 stem is among the low pathogenic stems of bird flu with a minimum risk. The transfer of the infection to humans can be discounted," Renata Vaverkova from the regional sanitation authority told CTK.


The low pathogenic stem of bird flu was recently discovered also in Germany, France, Belgium and Italy.


There are about 90 ponds with the acreage of 520 hectares in the Hodonin region.



Although the officials quoted in the above news article go out of their way to discount any human threat from the virus, human infections have occurred from H7, although they are usually mild. 


As an example, in 2003 there was an outbreak of an H7 strain among poultry in the Netherlands where 89 people were confirmed infected by the virus.  Most exhibited mild symptoms, although one person died.


This article from May of 2008 appeared in CIDRAP News, discusses H7's pandemic potential.



Some avian flu H7 viruses growing more human-like


Robert Roos * News Editor

May 28, 2008 (CIDRAP News) – Scientists have found evidence that North American avian influenza viruses of the H7 subtype are becoming more like human flu viruses in their ability to attach to host cells, which suggests they may be improving their capacity to infect humans.


The investigators determined that several recent North American H7 viruses have an increased ability to bind to a type of receptor molecule that is abundant on human tracheal cells and is less common in birds. Their results were published this week by the Proceedings of the National Academies of Science.


The finding—which comes as the deadly Eurasian H5N1 virus continues to be seen as the likeliest candidate to spark a pandemic—"underscores the necessity for continued surveillance and study of these [North American H7] viruses as they continue to resemble viruses with pandemic potential," says the report. The study was done by scientists from the US Centers for disease Control and Prevention (CDC), Emory University in Atlanta, and the Scripps Research Institute in La Jolla, Calif.


H7 viruses have caused a number of disease outbreaks in poultry in Europe and North America in recent years, though far fewer than the widespread outbreaks caused by the H5N1 virus. H7 viruses also have occasionally infected humans, typically causing only mild conjunctivitis. But a veterinarian died of an H7N7 infection during the devastating poultry outbreaks in the Netherlands in 2003.




Tuesday, February 24, 2009

Bloomberg Updates The Baxter Vaccine Mishap Story

PLEASE SEE March 17th Update of this story.  Some of the Original newspaper accounts had incorrect details.

A Few More Details On The Baxter Mishap


# 2827

In what could have been a major incident, Baxter International in Austria accidentally sent vaccine samples contaminated with the H5N1 virus to labs in In the Czech Republic, Slovenia, and Germany.

The problem was only discovered after lab ferrets began dying after receiving the vaccine (see Ferreting Out A Problem In the Laboratory).  

While early details of this case came out on February 17th, we've not heard much since then.

Jason Gale and Michelle Fay Cortez of Bloomberg news have delved deeper into this disturbing story, and bring us fresh details.  Follow the link to read the story in its entirety.

Baxter’s Vaccine Research Sent Bird Flu Across European Labs
By Michelle Fay Cortez and Jason Gale
Feb. 24 (Bloomberg) -- Researchers from Baxter International Inc. in Austria unintentionally sent samples contaminated with the bird flu virus to laboratories in the Czech Republic, Slovenia and Germany, raising concern about the potential spread of the deadly disease.
The contamination was discovered after ferrets were injected with the vaccine, according to BioTest s.r.o, a biotechnology company based in Konarovice that was working with the immunization in the Czech Republic.
The vaccine came from Deerfield, Illinois-based Baxter, which reported the incident to the Austrian Ministry of Health, Sigrid Rosenberger, a spokeswoman for the ministry, said in a telephone interview today. The vaccine was prepared for use in laboratories, and none of the workers exposed have fallen ill.
“This was infected with a bird flu virus,” Rosenberger said. “There were some people from the company who handled it. They went to the hospital and were tested and were cleared. There have been no infections.”
The Austrian health ministry reported the incident to the European Union and plans to conduct its own audit, she said. The vaccine has been destroyed, according to Rosenberger.
Chris Bona and Laura Grossmann, Baxter spokespeople, didn’t immediately return phone calls placed before business hours. Roland Bettschart, who handles media enquiries for Baxter in Vienna, said a “laboratory glitch” occurred and the company would send a formal statement soon.
The World Health Organization “is aware of the situation and is consulting with the ministers of health of the countries involved to ensure that all public risks arising from this event have been identified and managed appropriately,” said Gregory Hartl, a spokesman in Geneva.
(Continue . . .)

Study: Global Bird Flu Production Capacity


# 2826



I'll admit going into this entry, that I'm a bit skeptical at some of the numbers presented in the article below.   About once a year, we get one of these updated estimates of our global vaccine production capability.


First the article, then a bit of discussion.





Bird flu vaccine production still lags - study


Tue Feb 24, 2009 5:59am EST


GENEVA, Feb 24 (Reuters) - Drug companies have increased their capacity to make bird flu vaccines by 300 percent in the past two years but will still need four years to meet global demand in the event of a pandemic, a study said on Tuesday.


It also said doses of vaccine tailored to the actual strain of pandemic influenza that emerges will not be available until four months after that strain is identified.


"We found that considerable progress has been made to enhance the production capacity of pandemic influenza vaccine," Adam Sabow, partner at consultanting firm Oliver Wyman which conducted the study, said in a statement.


"While capacity still falls short of global need during a pandemic, the surplus capacity during the inter-pandemic period creates opportunities for preparedness efforts," he said.


Oliver Wyman carried out the study with the World Health Organisation (WHO) and International Federation of Pharmaceutical Manufacturers and Associations (IFPMA).




In the most likely case, manufacturers could produce 2.5 billion doses of pandemic vaccine in the 12 months following receipt of the production strain, requiring four years to satisfy global demand, the study said.


In the current best-case scenario, 7.7 billion doses could be produced in the first 12 months, requiring 1.5 years to satisfy global demand, it said. Production was expected to increase significantly over the next five years.



First, let me stipulate that I've not read this study yet.  I made a quick visit to the Oliver Wyman website, but could not find it posted.  Nor could I find it on the WHO website.  Perhaps it will show up later.


We'll use their `most likely scenario' of a global output of 2.5 billion doses in the first year of a pandemic.    I won't quibble about supply chain issues, employee absenteeism, or other impediments to manufacturing.   


They may, or may not happen.  We'll assume that manufacturers are able to overcome these adversities.


Vaccination would require two shots per person, 30 days apart, to confer partial immunity.   So there would be enough vaccine for roughly 1.25 billion people in the first year of a pandemic.


The question becomes . . . can we deliver 2.5 billion doses of vaccine, in the midst of a raging pandemic, to 1.25 billion people during the first year?


The logistics of doing that during ongoing supply chain, transportation, and human resource crises will be horrendous. 


Perhaps not impossible, but very difficult.


Some groups, like the military, health care workers and first responders should be relatively easy to target.  They are easily scheduled, tracked, and prioritized.


Delivering vaccines to the general public will be more problematic.


Below you will find the prioritization for pandemic vaccines proposed for the United States.   Other countries will, no doubt, apply their own standards. 



(click to enlarge)


Four to six months into a pandemic, vaccines should begin to come off the manufacturing line.  They must then be packaged, equitably divided up, and then (through a series of steps) shipped to tens of thousands of PODS (Points of Distribution) in dozens of countries each week.  Probably in small lots.


These dispersal points (health departments, hospitals, local governments) must then arrange to have syringes (which may be in short supply), trained personnel (also likely to be in short supply), and security on hand.


In the United States alone, according to the USGS there more more than 35,000 cities, towns, or villages.  Expand that just to the 11 or so vaccine producing nations, and you are talking hundreds of thousands of locations.   


While there may not be vaccine PODs in every one of these locations, we are still probably talking about tens of thousands of distribution points around the world.  


With just a few million doses a week coming off the assembly line for each country, how does a central government decide where to send the vaccine each week?  


In the US, the vaccines will probably be sent to each state (on a per capita basis), but then each state must decide how to disperse it.


In week 26 of a pandemic, will some committee here in Florida decide that Tampa gets an allocation, but Winter Haven won't?  Jacksonville gets lucky, but St. Augustine will have to wait? 


Those are the kind of decisions that someone will have to make.  Public health departments, already seeing cuts in their budgets, will be put in an almost impossible situation.


And each POD will have to selectively administer the vaccine - not once, but twice, a month apart - to prioritized individuals.


Just a few of the problems these PODS will face include:


  • How willing will people be to stand in line, perhaps for hours, with hundreds of other people during a pandemic?   I know some localities are talking about drive-thru vaccination clinics, but that assumes everyone has access to a car and gasoline, six or twelve months into a pandemic. In place likes New York City, or New Orleans, where car ownership is low, that idea won't go very far. 


  • How do these PODs keep track of who has already received their first, or even second dose?   Many in the public may decide that if two doses are good, three would be better.  Will they issue cards?  What if someone loses their card?  Keeping track of who is, or isn't vaccinated, may become a big issue. 


  • Since pregnancy is considered a high risk factor, here in the United States pregnant women are included in the first tier of vaccinations.  Exactly how will these PODs determine if a woman is pregnant?  On site pregnancy tests?  Requiring a letter (which may be difficult to get in a pandemic) from a doctor ?


  • The same problem will arise when vaccinating tier 2 `essential personnel'  (pharmacists, mortuary workers, utilities workers, community services etc.).  How do you verify these people are essential?   Vaccinate at their workplaces?  If so, you've increased the number of PODs you need to staff.  Who gets inoculated first?  Pharmacists, utility workers, or `critical government' employees?   A community probably won't get enough vaccine to do everyone in the same tier at the same time.  



Well, you get the idea. 


Manufacturing a vaccine is just the beginning of the vaccination process.  Our ability to actually deliver a prioritized vaccine to billions of people over a short period of time has never been tested. 


So, while I'm happy to see that progress is being made on the manufacturing end, an awful lot of things would have to go exceedingly well - under the worst possible conditions - to get billions of people vaccinated in the first couple of years of a pandemic.


Something to shoot for, of course. But it may not be possible.

UN: Vietnam Needs To Renew Bird Flu Vigilance


# 2825



Two years ago Vietnam was looked upon as a bird flu success story.  


Once known as the most bird-flu affected nation on earth, Vietnam went through all of 2006 and the first half of 2007 without reporting a human case.  Even reports in poultry were rare.


It seemed, at least for a time, that through a combination of public education, disinfection of poultry farms, and a rigorous vaccination program that Vietnam had beaten back the virus. 


But starting in the summer of 2007, the virus began to show up again.  Poultry began dying, and people once again began to get infected.  Eight people in 2007 and six in 2008.  Ten of them did not survive.


Today, less than 60 days into 2009, Vietnam has reported two cases of H5N1 in humans, with one fatality.   At least 10 provinces are battling outbreaks.


Vietnam is not back to the `bad old days' of 2005 - which saw 61 human infections - but they are seen as definitely moving in the wrong direction.


Today the WHO and the FAO have issued an appeal to Vietnam to renew their efforts to combat the virus.


This report from Reuters.





Vietnam needs to renew bird flu vigilance -UN bodies


Tue Feb 24, 2009 2:32am EST

HANOI, Feb 24 (Reuters) - Two United Nations bodies warned that renewed vigilance was necessary to prevent the further spread of deadly bid flu in Vietnam, which has reported three new cases in as many months, with one person dying.

The H5N1 strain has infected poultry in 10 Vietnamese provinces, and at the weekend a 23-year-old woman died of the disease in the northern province of Quang Ninh.

"The animal and public health sectors need to work closely together to minimise the ever-present threats of avian influenza and other animal-based diseases passing to humans," said Andrew Speedy, Vietnam representative of the Food and Agriculture Organisation (FAO).

Jean-Marc Olive, representative of the World Health Organisation (WHO), said there was a "real possibility" of human-to-human transmission.

"If this occurs we could see the start of a new influenza pandemic," he said in a joint WHO-FAO statement.

(Continue . . .)



Meanwhile, the WHO has released their latest Avian Flu update on Vietnam. 



Avian influenza – situation in Viet Nam - update 3


24 February 2009 -- The Ministry of Health in Viet Nam has announced the death of a previously confirmed case of H5N1 infection. The 23 year old female from Dam Ha District, Quang Ninh Province died on 21 February.


Of the 109 cases confirmed to date in Viet Nam, 53 have been fatal.