Tuesday, March 31, 2009

CIDRAP Dissects Recent Study On Avian Flu In Indonesian Swine

 

# 2960

 

 

 

 

Robert Roos, News Editor of CIDRAP (Center for Infectious Disease Research & Policy),  has an excellent overview of a new paper that has recently come out in The Archives of Virology, by Takano R, Nidom CA, Kiso M, et al. entitled A comparison of the pathogenicity of avian and swine H5N1 influenza viruses in Indonesia.

 

Roos also interviews Richard Webby, PhD, a virologist and flu researcher at St. Jude Children’s Research Hospital in Memphis, about this paper.

 

Highly recommended that you follow the links and read this review in its entirety.

 

 

 

H5N1 virus may be adapting to pigs in Indonesia

Robert Roos * News Editor

Mar 31, 2009 (CIDRAP News) – Scientists report that H5N1 avian influenza viruses may be adapting to pigs, as evidenced by the finding that H5N1 viruses isolated from pigs in Indonesia were less harmful to mice than were H5N1 viruses from chickens.

 

The finding suggests that in growing in pigs, the virus may have become less harmful to mammals in general, the authors report. That sounds reassuring, but the authors say it may mean the virus is one step closer to turning into a human pandemic strain.

 

In the study, scientists from Japan and Indonesia collected viruses from chickens and pigs in Indonesia, grew them in laboratory cell cultures, and used them to infect mice. They found that the viruses from pigs were less lethal to mice than the viruses from chickens, according to their recent report in the Archives of Virology.

 

"We found that swine isolates were less virulent to mice than avian isolates, suggesting that the viruses became attenuated during their replication in pigs," the report states.

 

An intermediate host

 

Pigs are seen as a possible intermediate host that can help avian flu viruses adapt to humans, because the epithelial cells in pigs' trachea can be infected by both avian and human flu viruses, the article notes. If avian and human viruses infected a pig at the same time, they could mix or reassort, giving rise to a novel strain that might be able to spread in humans. The flu pandemics of 1957-58 and 1968-69 were caused by avian-human hybrid viruses, though it is not known if they arose in pigs.

 

(Continue . . . )

Study: Unstructured Event-Based Global Infectious Disease Surveillance Systems

 


# 2959

 

 

 

Just available online today from the CDC’s Journal of Emerging Infectious Diseases – in an ahead of print article – we get an overview of three of the automated infectious disease surveillance systems being used on the Internet.

 

The study, entitled - Use of Unstructured Event-Based Reports for Global Infectious Disease Surveillance M. Keller et al.  (429 KB, 15 pages) – gives deep background on the creation and functioning of Global Public Health Intelligence Network (GPHIN), Healthmap, and Episider.

 

DOI: 10.3201/eid1505.081114
Suggested citation for this article: Keller M, Blench M, Tolentino H, Freifeld CC, Mandl KD, Mawudeku A, et al. Use of unstructured event-based reports for global infectious disease surveillance. Emerg Infect Dis. 2009 May; [Epub ahead of print]

This study is a good read, particularly if you are interested in how semi-automated data mining for infectious disease outbreaks is accomplished, and the limitations of these types of systems.

 

As the authors state, there is a certain amount of `background noise’ and `clutter’ that comes from these automated systems. 

 

Still, during the very early days of testing  of GPHIN – between July 1998 and August 2001, WHO retrospectively verified 578 outbreaks, of which 56% were initially picked up and disseminated by GPHIN.

 

That’s not bad for an automated system.

 

GPHIN requires a paid subscription, but the other two event gathering websites are free to access.

 

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Healthmap (see above) was begun in 2006, and is fully interactive.  I first wrote about HealthMap in July of 2008 (see HealthMap On The Web)

 

 

EpiSider (below) also uses a user interactive map, and provides some very interesting graphing capabilities as well.

 

image

 

 

As the CDC EID Journal study points out (reformatted for readability):

 

Discussion


Despite their similarities, the 3 described event-based public health surveillance systems are highly complementary; they monitor different data types, rely on varying levels of automation and human analysis, and distribute distinct information.

GPHIN, being the longest in use, is probably the most mature in terms of information extraction.

In contrast, HealthMap and EpiSPIDER, being comparatively recent programs, focus on providing extra structure and automation to the information extracted.

 

 

And of course, these aren’t the only disease information gathering systems mining data from the Internet.  

 

 

Our flu forum newshounds (see Newshounds: They Cover The Pandemic Front) perform similar duties, and of course ProMED Mail is a well established infectious disease Surveillance System.

 

Recently,  Google.org unveiled their Flutrends website, and now Twitter is even getting into the act with a mashup called SickCity

 

In 2003, the first inkling that a serious disease outbreak (SARS) had occurred in China came  from `Internet Chatter’ that the sale of Vinegar had gone through the roof in China.

 

In China, boiling vinegar in the home is a traditional way to protect the inhabitants against respiratory diseases.

 

As Helen Branswell of the Canadian Press reminded us, in her article last May entitled SARS memories linger 5 years later, it was the monitoring of the Internet that produced the first clues that something very bad was happening in China:

 

Surging vinegar sales in China grabbed the attention of the folks who regularly scour the globe for what might be budding disease outbreaks, like those who work for the Canadian-led Global Public Health Intelligence Network.

 

"We were getting lots of rumours, like a lot of sales of vinegar," explains Dick Thompson, who was the spokesperson for the World Health Organization's communicable diseases section at the time.

 

 

There is a pretty good chance that our first inkling that a new SARS, or some other infectious disease outbreak, will come first from a news story, or forum chatter, off the Internet.  


The hope is, if we can pinpoint an outbreak early enough, public health officials might be able to contain an epidemic before it gets out of control.

 

And while things may not turn out that way, it is certainly something to shoot for.

Zero Hour: Virtual Heroes

 

# 2958

 

UPDATED:  This afternoon, without further explanation, the following notice was posted on the NEMSPI website regarding use of the software by the general public:

 

Effective March 31, 2009 at 5 pm, the game is NOT available for the General Public, only for EMS Professionals. We expect to resolve this issue within the next couple business days.

I’ll post a notice when they’ve resolved whatever issue they have right now.

 

 

 

In 1993, a group of renegade computer programmers did what no one thought was possible at the time; they created an immersive 3-D gaming environment that would run on the (then 80386 processors were top of the line) computers of the time. 

 

It was called  DooM (tm) – and it changed computer gaming forever.

 

Fast forward more than 15 years and home computers have gotten much faster, and the software has grown even more realistic. 

 

In 2002, the United States Army released the first in a long series of PC interactive games designed to give players a taste for what real combat was like. 

 

image

(screen shot from America’s Army)

 

 

Conceived by Colonel Casey Wardynski and managed by the U.S. Army's Office of Economic and Manpower Analysis (OEMA) at the United States Military Academy, West Point, New York – the project called America’s Army (also known as AA or Army Game Project) has produced some of the finest simulations available on home computers today. 

 

They are not only entertaining and informative, they are a serious training tool as well.

 

Taking a page from the Army’s successful implementation of this virtual gaming environment, the National Emergency Medical Services Preparedness Initiative – part of George Washington University – has spent 2 years designing a an EMT/Paramedic training tool called ZERO HOUR- AMERICA’S MEDIC.

 

This virtual game/training system has 4 built in scenarios; A SARS-like pandemic, and earthquake, a derailment with chemical leak,  and a sports complex explosion.

 

The intent is to show medics what it is like to deal with a MCE (mass casualty event).  The scenarios, and resources, change with each game play.   Here is how the authors describe the game:

 

 

 

EMS providers playing the game will be tasked with completing a wide variety of missions based on the National Planning Scenarios and designed to push players' skills to the limit. Both new and experienced EMS providers are likely to find the missions extremely challenging because their complexity mirrors that which is seen in real disasters and large-scale events.

 

Players must deal with chaos, panic, large volumes of patients, and needs that far exceed available resources. Each time EMS providers play the game, they'll have different resources to work with, different scene hazards to deal with, different patients to treat, and different resources they can call upon. As EMS providers know all too well, there are no "winners" in a disaster - all you can do is the best you can do with the resources that you have.

 

 

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Screen shots from the demo

 

There are roughly 900,000 EMT’s and Paramedics in the United States, and most have never come face to face with a true MCE.  The ability to `game’ these scenarios in a life-like manner, to train (and make inevitable mistakes) on a simulator, is invaluable.

 

I sure wish I’d have had that sort of training available when I was a young medic!  

 

The game is available for a small fee ($14.95) from the NEMSPI website.  Be sure to check the system requirements before downloading.

 

A `demo’ of the game/trainer is available to view as well.

 

Play Zero Hour


Zero Hour

View a demo

Tokelau Reports `Flu’ Epidemic

 


# 2957

 

 

 

The Tokelau Islands lie about 500 km (311 miles) north of Samoa, and are comprised of 3 island; Atafu, Nukunonu,  and Fakaofo

 

They are, as they say, just a bit off the beaten path. 

 

Over the past several days, reports of an ILI (Influenza-like-Illness) have been coming in (via radiotelephone) from the islands. 

 

Reportedly about 10% of the population is ill.

 

It is, admittedly, pretty early in the flu season south of the equator to be seeing a major outbreak of influenza.   Health officials from the WHO and New Zealand are enroute to provide assistance and try to identify the strain of influenza involved.

 

Despite the publicity and medical interest, there is no reason at this time to suspect that this is anything more exotic than seasonal flu.

 

 

In the meantime the islands are putting into practice some of the social distancing measures we would expect to see during a pandemic; schools are closed, public gatherings are cancelled, and the sick are being told to stay home.

 


This from the BBC.

 

 

 

Flu epidemic hits Pacific island

Tokelau map

Medical officials from New Zealand are trying to get aid to the remote South Pacific islands of Tokelau, which have been hit by a flu epidemic.

 

The tiny archipelago, where one in 10 people are sick, is a 26-hour boat ride from its nearest neighbour, Samoa.

 

Most of the 150 people affected are children. Four have been hospitalised so far, according to media reports.

Public gatherings have been cancelled, schools closed, and sick people have been told to stay home.

 

Health officials from New Zealand and the World Health Organization are due to arrive with vaccines on Wednesday.

 

"This is an isolated population so there is not a high level of immunity," New Zealand's deputy director of public health, Fran Mcgrath, told the Australian Broadcasting Corporation.

(Continue . . . )

Indonesia: Media Says Riau Fatality Was Positive H5N1

 

# 2956

 

 

From the indefatigable Dutchy on Flutrackers, this morning we get this report indicating a `local confirmation’ of a bird flu fatality  last Thursday in Riau, Indonesia. 

 

The details of this case were widely covered last week (see Suspected Bird Flu Fatality in Pekanbaru and BFIC On The Indonesian Suspects).

 

Of course, it isn’t really official until Depkes – the Health Ministry -say’s it’s official. 

 

And that hasn’t happened yet.

 

And it may not happen for weeks, if it ever happens at all.   The Health Ministry releases information on human cases only rarely, and usually without significant detail.

 

So, despite this `local confirmation’ - for now - this case hangs in that ethereal realm somewhere in between `suspected’ and `confirmed’.    

 

 

This report comes from the Riau Terkini.

 

 

On Tuesday, March 31 2009


Wahyu Positive Bird Flu


Wahyu was stated positive bird flu after results of his sample that was taken some time before evidently positive. Regrettably, City Health Service did not yet get official results.

 

Riauterkini-Pekanbaru-Wahyu (2.9), that died last week was stated positive bird flu after the sample of his blood was accepted Health Service Provinsi Riau.

 

Positive him the revelation died because bird flu was sent Head of the Health Service Riau, Mursal Amir via his mobile phone. We just received the sample this morning.

 

Wahyu was positive bird flu, said Mursal. The temporary assumption, Wahyu was affected by the bird flu virus from the poultry that died was not far from his house.

 

Concerning the step in anticipation against this case, Diskes (= Health Service, ed) , continued Mursal, has collected data on people that was round Wahyu. Both the closest person and the paramedic who treated Wahyu during in the hospital.

 

In the meantime, Plt Kadiskes Pekanbaru, Rini Hermiyati that was contacted in the place was separated admitted to not yet getting the report produced by the sample. I still could not the report. Knew from where? , he said. If quite positive, he continued, has been protap dealt with the case of bird flu.

 

How if positive, or the negative. That was certain, continued Rini, while 21 days were carried out by observation for people that had been round Wahyu during still lived. The certain number, I did not know. From the close family had 6 people.

 

That not to mention from the paramedic RSUD Arifin Ahmad, he added. Did not close the possibility, these people suffered the sign was the same as Wahyu.

 

Rini like definitely was not yet there are those that had the hot and feverish sign high although he could get the report. The sign, yesterday was available... Later I asked previously that the observer, said Rini without continued said-he said .

 

 

 

This story indicates that local officials in Riau have not been officially notified, and therefore are not taking all of the `control measures’ that they would if a positive result were announced.

Monday, March 30, 2009

Indonesia: Suspect Case In Bandung

 


# 2955

 

 

 

Although keeping track of the human cases (suspected at this point) of H5N1 in Indonesia is an often frustrating task, that doesn’t stop our volunteer newshounds from around the world from trying.

 

Indonesia hasn’t officially acknowledged any human infections for 2009, although local media reports suggest that they’ve certainly had at least a few.   

 

The policy of Depkes, the Ministry of Health, is not to discuss such matters as they occur, but rather to release updated tally’s every few months.   They feel that talking about incidents as they occur makes for `bad publicity’ for their nation.

 

Depkes also continues to stymie the WHO and the rest of the world by refusing to release virus samples obtained within Indonesia.   This stalemate has gone on for more than two years.

 

 

Today we get a report of a suspected human bird flu (H5N1) case in Bandung, an area that has seen human cases in the past.

 

image

 

 

Ida at the Bird Flu Information Corner has a translation of a newspaper article that appeared in the Indonesian newspaper Detik.

 

 

Bandung, West Java ::: Bird flu suspect

March 31, 2009

Bandung, West Java – A resident of Kampung pasir Konci Desa Sarijaya Kecamatan Majalaya Kabupaten Karawang, named R (50) suspected to contract bid flu virus. Victim was admitted to Hasan Sadikin hospital, 8 pm Sunday (29/3) by recommendation of Dewi Sri clinic, Karawang.

 

According to R’s wife, Raisem (40), her husband developed fever and breathing difficulty signs. He was then brought to Ramerta clinic and then directed to Dewi Sri clinic. “Doctor at Dewi Sri clinic said that my husband has developed bird flu symptoms, but no device to confirm it,” said Raisem.

 

Raisem also mentioned that her husband had fever and breathing problem before, on Saturday (21/3). But then the symptoms had recovered on Monday (23/3). During this last two weeks number of chickens were found suddenly dead in victim’s area. “My husband is the only who developed symptoms”, she added.

 

Source: Indonesia newspaper, Detik.

 

The Bird Flu Information Corner is a joint endeavor between Kobe University, Japan and Institute of Tropical Disease, Airlangga University, Indonesia.

 

 

Another version of this story, this time translated and posted by Sally and Dutchy on Flutrackers, comes from SOLOPOS Digital Media.

 

 

RS Hasan Sadikin treated a person suspect AI


Bandung ---- A patient suspect (was expected) bird flu, Rajim (50) Sand locked RT 08/VII the Village Sarijaya the Majalaya Subdistrict, was treated in RSHS Bandung.

 

The wife of the patient Rasiem (40), on Monday (30/3), said, Rajim began to be treated in RSHS on Sunday night exact at 20.00 WIB.

 

"My husband was beforehand treated in the Hospital of Dewi Sri Karawang continued the doctor's words there (RS Dewi Sri), was told to be brought to RSHS Bandung," said Rasiem.

 

He said, because of the limitations of the implement in RS Dewi Sri, the patient was reconciled by the doctor in RS Dewi Sri Karawang to be brought and undergo the maintenance that was more intensive in RSHS Bandung.

He said, around two weeks ago in his residence of many sudden chickens died, including his four kept chickens.

 

"Approximately two weeks ago, the neighbouring chicken in the mother's house many that died, including the chicken had the mother," he said.

 

After the incident, Rajim threw his kept chicken that died to the river near his house, said Rasiem that was met in the Poinciana Tree waiting room of RSHS Bandung away.

 

According to Rasiem, not long after threw his kept chicken that died, away Rajim was at once attacked breathless and high fever.

 

"Was finished discarded the chicken to the river, the husband" of the "mother at once was breathless continued his body high fever," he said.

 

Was based on information that was assembled from public relations of RSHS Bandung, information about the condition for the patient who was expected suspect this bird flu will be announced by the doctor this afternoon, around 15.00 WIB.

 

 

Three things of note here:

 

  • First, this is just a suspected case.  Test results have not been released (and may not be for some time).

  • Second, unlike most of the victims we see of bird flu, this one is (barely) in his 50’s.   While not unheard of, 90% of cases we’ve seen happen in people under the age of 50.

  • And third, as we often see reported, dead chickens were disposed of by throwing them into the river.   This has at least the potential of spreading the disease further – particularly to wild birds (but conceivably to people as well).

 

 

Reports such as the two above are a routine occurrence out of Indonesia.  Far too often, there is never any follow up, and these stories become `orphaned’.  

 

Luckily for us the volunteer newshounds on the flu forums remain tenacious and undeterred.  

 

For more information about how these newshounds work  you might enjoy reading:

 

Newshounds: They Cover The Pandemic Front

WHO Updates Egypt And Case Chart

 


# 2954

 

 

The WHO (World Health Organization) has updated their  Disease Outbreak News page to reflect the latest H5N1 case reported out of Egypt.  

 

 

Here is the Egyptian Update and the new chart with a Hat tip to BirdFluGov  (and an assist by KobieT) on Twitter.

 

 

 

Avian influenza - situation in Egypt - update 9

 

30 March 2009 -- The Ministry of Health and Population of Egypt has reported a new confirmed human case of avian influenza. The case is a two and a half year old female from Qena District, Qena Governorate. Her symptoms began on 23 March. She was admitted to Qena Fever Hospital on 24 March where she was started on oseltamivir the same day (24 March) and remains in a stable condition. Infection with H5N1 avian influenza was confirmed by the Egyptian Central Public Health Laboratory on 26 March.

 

Investigations into the source of infection indicate a history of close contact with dead and sick poultry prior to becoming ill.

Of the 60 cases confirmed to date in Egypt, 23 have been fatal.

 

 

 

 

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(Click To Go To Page)

Food Insecurity And The Control Of Bird Flu

 

 

 

# 2953

 

 

Around the world, about 1 person in 6 lives with daily food insecurity – in other words – hunger.  

 

The FAO (Food & Agriculture Organization) estimates  that over 1 Billion people will go hungry this year, and that about 2/3rds of them live in the Asia/Pacific region.

 

Over the past two years more than 100 million more people, according to the FAO, have fallen to the ranks of the daily food insecure.

 

The reasons for this include higher food prices, the global economic recession, along with crop losses due to changing climate patterns and diseases.

 

Reuters has a report on this growing food insecurity this morning.  First the article, then some discussion about how this might affect bird flu control measures – particularly in the Asia-Pacific regions.

 

 

Food security still a problem as hunger rises: FAO

Mon Mar 30, 2009 7:20am EDT

BANGKOK (Reuters) - A fall in grain prices has led to the impression that food security is no longer a concern, but the number of people without enough to eat is still rising in a world facing recession, the United Nations said Monday.

 

"The level of prices is still 19 percent above the average of 2006 ... so we're still in a period of high prices," Jacques Diouf, director-general of the U.N.'s Food and Agricultural Organization (FAO), told reporters at a conference in Bangkok.

 

In addition, recent FAO studies showed that even though prices had fallen in international markets, retail prices in most developing countries had not.

 

"Not only is the crisis here, but it's been worsened by the financial and economic crisis," Diouf said.

 

Stocks for cereals were at a 30-year low, and he described the situation as "very fragile."

 

(Continue . . . )

 

Against this backdrop of increasing food insecurity, rising food costs, and recession we also have a serious zoonotic disease – bird flu – becoming endemic in many regions of the Asia-Pacific region.

 

Poultry - whether factory-farm produced or from backyard flocks - is a major source of income, and food, for hundreds of millions of people living around the world.   

 

China, which produces more poultry than anyplace else on earth, reportedly raises about 15 Billion birds each year.  

 

Anything that seriously threatens their poultry industry also raises the specter of mass hunger in the world’s most populous nation.

 

China, like Indonesia and Egypt, has adopted poultry vaccination as their primary method of controlling the H5N1 bird flu virus.   They have, for years, conducted mass poultry vaccination drives several times each year.

 

Recently, however, we’ve seen growing evidence that these vaccines may not be preventing the disease – but that they are only hiding the symptoms.    

 

Asymptomatic, but infected birds, have become the new concern.

 

(see The Winter Of Our Disbelief for more details)

 

 

Leading scientists such as Zhong Nanshan of China, have stated,"The existing vaccines can only reduce the amount of virus, rather than totally inactivating it.

Dr. C.A. Nidom, whose name has appeared often in this blog, was quoted earlier this month in Poultry Indonesia as saying:

 

Poultry Indonesia Printing Edition, March 2009

(excerpts)

Chairul Anwar Nidom, a virologist with the Tropical Disease Centre at Airlangga University in Surabaya, said a common policy on bird flu was lacking among government agencies, making controlling the disease more difficult.

 

Nidom criticized the government’s policy of vaccinating poultry rather than culling, believing that it masks the virus, and ultimately contributes to its mutation.

 

 

The OIE (World Organization For Animal Health) recently reaffirmed their long-standing position that vaccination of poultry cannot be considered a long-term solution to combating the avian flu virus.

 

In Avian influenza and vaccination: what is the scientific recommendation?, the OIE reiterates their strong recommendation that humane culling be employed to control avian influenza, and advising that vaccines should only be used as a temporary measure.

 

While the OIE concedes that some nations may require the use of vaccines for `several years', they strongly urge that countries move away from that program and towards the more conventional culling policy. 

 

They call this shift away from vaccines an `Exit Strategy’, something which China has shown no move towards.

 

 

For now, at least, most of the nations currently utilizing poultry vaccines don’t appear to be moving towards any `exit strategy’.   

 

Despite growing concerns over asymptomatic poultry, and the danger that might pose to humans, the need to preserve their poultry industry is great – particularly in times of increasing food insecurity.

 

The Agriculture Ministries of many nations are caught in the middle. 

 

A move towards culling, and away from vaccines, would involve the loss of huge quantities of badly needed food.  Something that could become politically destabilizing in some regions.

 

Culling is also far more problematic when you are dealing with millions of small holdings – backyard chicken coops – instead of more centralized factory farms.  

 

And the greatest impact would be in the areas currently most affected by hunger today.

 

The Asia-Pacific region.

 

Despite the downsides to using vaccines, the pressures of food insecurity today make it very difficult for nations like China, Vietnam, and Indonesia to move away from their use.  

 

The choice in many of these countries literally boils down to increasing hunger today in order to decrease the possibility of a pandemic someday in the future.

 

All of which goes to show just how complex and difficult the decisions are when trying to eradicate H5N1 around the world.  

Laos: Phongsaly Province Still At Risk Of Additional Outbreaks

 

 

# 2953

 

 

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Phongsaly province

 

 

 

While we don’t often get reports from this area, over the past several months we’ve heard of several localized outbreaks of bird flu in poultry in Northern Laos.

 

On March 9th (see One Month Later, Laos Still Dealing With Bird Flu) we learned of the ongoing attempts to quell outbreaks in Luang Namtha Province. 

 

Today’s report tells of neighboring Phongsaly province's recent bout with avian flu (see Laos: H5N1 outbreak in Phongsaly province on Crofsblog Feb 19th), and the difficulties they have in controlling the virus.

 

This report from Xinhua News.

 

 

 

Lao province at risk of bird flu outbreak

www.chinaview.cn 2009-03-30 16:27:52

    HANOI, March 30 (Xinhua) -- Many areas of Phongsaly province of Laos are at risk of infection from the H5N1 bird flu virus as local people are continuing to bring in poultry and eggs illegally from neighboring countries, the Lao newspaper Vientiane Times reported Monday.

 

Provincial authorities find it hard to identify when and where there's a virus outbreak as people can walk or drive across and engage in casual trade of poultry easily at border areas without checkpoints, said provincial Livestock and Fisheries Deputy Head Somnith Keoboun-ngune.

 

Last month there was an outbreak of the virus in Khua district, Phongsaly province. Now the outbreak is over and the district was declared bird-flu free today, said Somnith.

 

To prevent the spread of the virus to other districts, the provincial avian influenza control committee together with district and village committees culled about 2,600 poultry in 11 villages and set up checkpoints, said Somnith.

 

The provincial livestock and fisheries sector will work with the sectors concerned in leading a public campaign about bird flu, said Somnith.

Sunday, March 29, 2009

UK: NHS Booklet On Pandemic Flu For Businesses

 

 

# 2952

 

 

 

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The NHS is the National Health Service, and they’ve just released a new, simple, and fairly generic booklet on pandemic influenza geared for businesses.   

 

The booklet is available as a 27-page  PDF File.

 

Old hands at pandemic preparedness won’t find much new here, but for businesses that have yet to seriously prepare, this makes a good primer.

 

While this is released by, and for the UK, it could certainly be used as an introduction to pandemic flu for businesses in any country.

 

 

Pandemic flu guidance for businesses: risk assessment in the occupational setting

  • Document type: Guidance

  • Author: Department of Health and Health Protection agency in collaboration with the Health and Safety Executive, Department for Business, Enterprise and Regulatory Reform and Cabinet Office.

  • Published date: 27 March 2009

  • Publication format: A4

  • Gateway reference: Not required

  • Pages: 27

  • Copyright holder: Crown

 

 

As the introduction explains, preparing for a pandemic is everyone’s business:

 

Everyone will be involved in the fight against pandemic influenza (flu) in terms of managing the impact it will have on society and preventing further spread of the infection.


This booklet explains how businesses can help reduce the spread of flu. it provides information to allow businesses to assess the types of measures that may be used in their particular occupational setting.

 

Introduction

The Health Protection agency and the department of Health have worked closely with the healthcare sector and certain non-healthcare services, such as the police and fire and rescue services, to develop pandemic influenza infection control guidance for specific occupational settings (available Here)

However, it is not possible to outline detailed pandemic influenza infection control guidance for every occupation or to cover every conceivable scenario where a person might be exposed to the risk of infection from flu.


With this in mind, this simple and generic guidance has been developed to raise awareness of the measures that may be employed to reduce the spread of the flu virus at work. it aims to:


●● allow businesses to evaluate potential situations where there may be possible exposure to the flu virus


●● describe the steps that can be taken to moderate any potential exposure to the flu virus in the workplace

●● set out the measures that might be used to reduce the spread of the flu virus in the workplace

●● provide a matrix that can be used to consider the best ways of reducing the spread of flu in a work environment

●● put into context the relative value of personal protective equipment, including the wearing of face masks,1 when compared with other environmental and organisational approaches.


Information on pandemic flu specific to businesses can be found on the UK resilience website   

 

 

 

A hat tip to UK-Bird on the Flu Wiki for  posting this link.

Watching Egypt (Again)

 

 

# 2951

 

 

 

March has been a busy  month for Human H5N1 infections in Egypt, with their 9th case of the year confirmed last Thursday.  Egypt has seen more cases in the first 90 days of this year than they saw in all of 2008 (8 cases, with 4 fatalities). 

 

The good news is, so far at least, all of the confirmed cases have recovered.

 

We continue to see new news reports of suspect cases being tested.  Nothing unusual about that, of course.  Over the past three years thousands of people have been tested for the virus in that country.

 

Despite all of this testing, however, only 60 people have tested positive for the virus.

 

For that reason, I tend not to mention `suspect’ cases in Egypt until we get something more definitive.

 

Nevertheless, we watch these reports with interest.  

 

One report, yesterday, indicated a possible bird flu fatality – that of a 45 day old infant. 

 

This case appears unconfirmed as yet.  I mention it because it has been posted on a number of the flu forums.

 

Tests are pending.  If positive, we should hear in the next couple of days.  This is just one of several news reports on suspect cases this weekend.

 

When we know more, I’ll post on it.

 

 

The H5N1 bird flu virus is endemic in Egypt, with well over 1,000 outbreaks reported in poultry since the virus was first detected there in 2006.

 

Unlike most other countries battling bird flu, Egypt does not have a compensation program for farmers who lose birds due to culling. As a result, many people are reluctant cooperate and notify authorities if their birds sicken or die.

 

An interactive map, showing human cases and poultry outbreaks for 2008-2009 can be viewed by clicking the image below.

 

image

 

 

One of the best web resources for information regarding Egypt’s bird flu situation is the SAIDR home page: Strengthening Avian Influenza Detection and Response in Egypt

Hawaii Looking For Public Input On Vaccine Priority In A Pandemic

 

# 2950

 

 

Last July, we received the long-awaited guidance from the HHS (Dept. of Health and Human Services) on pandemic vaccine allocation called Guidance on Allocating and Targeting Pandemic Influenza Vaccine.

 

Pandemic vaccines are almost certainly to be in very short supply during the first year of a pandemic, with little or none available until 5 months into a crisis.  After that, vaccine should begin to come off production lines, but even then, only in limited quantities.

 

Accordingly, since there won’t be enough vaccine to inoculate everyone at the same time, priority groups needed to be established.

 

 

image

(Click to Enlarge)

 

 

There are variations to these tiers at different pandemic levels (Cat 1-5).

 

 

The one's listed here assume a CAT 4 or CAT 5 pandemic. Tier 1 priorities remain the same at all pandemic intensities, but adjustments may be made to lower tiers depending on the virulence of a pandemic.

 

 

 clip_image002

 

 

As you may have noted, these recommendations are packaged in what the HHS calls `Guidance’.   Individual states, ultimately, still have a large say in how they will dispense vaccines during a pandemic.  

 

Each state will receive an allocation of vaccines as it becomes available in proportion to the State’s population.  They are encouraged to use the Federal guidelines, but it is not mandated. 

 

Hawaii will begin a public education campaign next month, and open up a dialog with their residents, on who should receive priority for scarce vaccines during a pandemic.

 

What follows is a rather long, and detailed, story from the Honolulu Advertiser.   I’ve only posted excerpts.  It is well worth reading in its entirety.

 

 

 

Hawaii working on list of who gets shots first in flu pandemic

Public's input wanted on who'll be vaccinated first if outbreak strikes

By Dan Nakaso
Advertiser Staff Writer

State health officials want the public's views on deciding who should get vaccinated — and who should not — against the next flu pandemic that reaches the Islands.So far, a wide-ranging advisory group of about a dozen community members representing religious groups, the chamber of commerce and even an expert in mediation have been working to set up a system that will help determine who will be inoculated first and who will have to face the pandemic unarmed, at least until more vaccine can be manufactured and shipped to Hawai'i.

 

The final determination will rest with Gov. Linda Lingle.

 

"The decision is with the governor," said Lingle spokesman Russell Pang.

 

There is no way to stockpile vaccine for an unknown virus that has yet to arrive. And no way to calculate how much vaccine will be needed, how many people will be infected and how many could die, according to Bill Gallo, senior management official with the Centers for Disease Control and Prevention in Honolulu.

 

So it could take months before federal officials isolate the virus, create a vaccine for it and send it to Hawai'i.

 

By then, untold lives could be lost.

 

"It is a very sobering scenario to be thinking about," said Jim Tollefson, president and CEO of the Chamber of Commerce of Hawai'i who sits on the advisory committee. "But it's best to be prepared and educated."

 

<snip>

 

public campaign

 

To that end, the Health Department plans a public education campaign that will begin next month to explain the project and get community opinions.

 

"We're responsible for making science-based decisions all the time," said Dr. Sarah Y. Park, state epidemiologist and chief of the Disease Outbreak Control Division. "Without neglecting the scientific basis for our state's pandemic planning, this project gives us a unique opportunity to focus on the values-based aspects of some of our decision-making. We encourage everyone to participate in the public activities and let their voice be heard."

 

Park is the principal investigator for Hawai'i's pandemic priorities grant.

 

Hawai'i's position as a gateway to and from Asia makes any potential pandemic of particular concern since air travel could quickly spread the disease. To guard against such problems, a disease surveillance and quarantine system was begun at Honolulu International Airport in 2005. It was the nation's first such system, and it screens sick passengers as they arrive for signs of serious illness.

 

Hawai'i and five other states have been chosen to participate in a federal program to carry out further pandemic planning.

 

<snip>

  • Three live one-hour broadcasts on KHNL in April. A panel of speakers will discuss who should get vaccinations during a pandemic and solicit viewer opinions on air and via e-mail. The shows are tentatively scheduled from 8 to 9 p.m. April 15, 22 and 29.
  • An "Alternate Reality Game" will be available in late April or early May. Details are still being worked out, but the game is aimed at Island residents. People on the Mainland probably will be able to access the game as potential tourists.
  • Community-based meetings around O'ahu from April through May 30, still to be scheduled.
  • Reach Dan Nakaso at dnakaso@honoluluadvertiser.com.

  • Saturday, March 28, 2009

    Study: (H5N1): Effects Of Physico-Chemical Factors On Its Survival

     

     

    # 2949

     

     

    Actually, the full name of the study which just appeared in the Virology Journal is:

     

    Avian influenza virus (H5N1); effects of physico-chemical factors on its survival

    Muhammad Akbar Shahid, Muhammad Abubakar1, Sajid Hameed2 and Shamsul Hassan

     

    And before you turn away, this study is actually more interesting than it sounds.

     

    The authors wanted to find out how long, and under what conditions, the H5N1 virus can survive intact in the environment, and the best ways to kill it.    

     

    Answers to which are of interest to just about all of us.

     

    Even if the virus never obtains pandemic capability, it still remains an environmental hazard (to poultry, and to people) in areas where it has become endemic.  

     

    Right now, that includes countries like Egypt, Indonesia, China, India, Pakistan, and Vietnam . . . but someday it could also include the United States, Canada, and Europe.  

     

    And the threat isn’t limited to just the H5 viruses, there are H7 and H9 viruses in circulation that are of concern as well.

     

    Vaccination of poultry is considered, at best, to be a stopgap measure.  Eradication of infected birds and the disinfecting of contaminated environments is the preferred method of control.

     

    Researchers in Pakistan isolated the H5N1 virus during an outbreak in 2006 and cultivated it in embryonated chicken eggs. 

     

    They then harvested the allanto-amniotic (AAF) fluid containing the virus, and used it in a variety of environmental and chemical tests to see how long the virus remained viable.

     

    The results are illuminating.

     

    Some excerpts from the study follow, with the first regarding viability at various temperatures, and the effects of UV light:

     

    Avian influenza virus H5N1 retained its infectivity at 4°C for more than 100 days although HA activity was decreased.

     

    Virus lost its infectivity after 24 h  when kept at room temperature (28°C).

     

    Virus tolerated 15 min exposure to 56°C however it was inactivated at 56°C after 30 min of exposure.

     

    Ultraviolet light had no deleterious effect on the virus replicating ability even after 60 minutes of exposure (Table 1).

     

     

    Virus samples were exposed to Acid (pH < 7) and Basic  (pH > 7) solutions to determine at what level of acidity or alkalinity were viruses inactivated.

     

     

    It was observed that H5N1 subtype lost its viability when exposed to pH 1, 3, 11 and 13 after 6 h while it remained viable at pH 7 for all contact times (6, 12, 18 and 24 h).

     

    It retained its virulence at pH 5 for 18 h but got inactivated after 24 h.

     

    Virus retained its infectivity at pH 9 for more than 24 h (Table 2).

     

    To give the lay person some idea of the relative acidity and alkalinity of various common substances, I’ve reproduced a chart from the Wikipedia.

     

    image

     

     

    The prolonged contact time required to inactivate the virus even at relatively high and low pH levels tends to makes their use problematic to control the virus.

     

    With regards to commonly used disinfecting agents in laboratories and hospitals, better results were achieved:

     

     

    H5N1 was inactivated with formalin (0.2, 0.4 and 0.6% after 15 minutes)

     

    Iodine crystals (0.4 and 0.6% after 15 minutes)

     

    Phenol crystals (0.4 and 0.6% after 15 minutes)

     

    CID 20 (0.5% after 60 minutes and 1.0% after 15 minutes)

    Virkon®-S (0.2% after 45 minutes, 0.5 and 1.0% after 15 minutes)

     

    Zeptin10% (0.5% after 45 minutes, 1% after 30 minutes and 2% after 15 minutes)

     

    KEPCIDE300 (0.5% after 30 minutes and 1% after 15 minutes) and KEPCIDE 400 (0.5 and 1.0% after 15 minutes) at 28°C.

     

    And finally, soap and detergents were tested:

     

    Lifebuoy, Surf Excel and Caustic soda inactivated the virus at 0.1, 0.2 and 0.3% concentration after 5 minutes contact time while a concentration of 0.05% was not enough to kill virus (Table 4).

     

    The authors make it clear that:  Each commercial preparation is the result of careful formulation and any modification can reduce the efficacy.

    In other words, use according to directions!

     

    While the virus is relatively easily inactivated by commonly used disinfecting methods, left unchallenged, at low temperatures and in a suitable medium, the virus can remain viable for days, weeks, or even months.

     

    All of this, right now, is mostly of concern to those charged with maintaining bio-security measures at farms and hatcheries in the wake of avian influenza virus outbreaks, it could someday have broader implications.

     

    This study is another step along the path of understanding how avian flu viruses survive (or not) in the environment, and how to eradicate them.

    Garut Siblings Test Negative For H5N1

     


    # 2948

     

     

     

    For the past 4 or 5 days the Indonesian media has been following two siblings (see Suspect Cases In Indonesia) from Garut who were hospitalized, suspected of having the H5N1 bird flu virus.

     

    Since the symptoms of bird flu are practically indistinguishable from many other viral infections (particularly early in the course of the illness)  we often see people isolated in Hot-zone countries when they have certain symptoms and a history of exposure to poultry.

     

    As often happens, after several days, test results come back to show that they did not have the bird flu virus.

     

    While the tests for the H5N1 virus are not 100% reliable, when patients show rapid improvement and test negative, the assumption is generally made that they never had the virus in the first place.

     

     

    This report, via Dutchy at Flutrackers, from Antara.

     

     

    Two Suspect Bird Flu Patients stated Negative


    Garut (Antara) - Two patients suspect bird flu (Avian Influenza/AI) in the Garut Regency, that beforehand was treated intensive to RSU isolation space Dr Slamet since last Monday (23/3) currently were stated by the negative from this illness.


    The RSU head local Dr Widjayanti Utoyo, SPM to Antara in his office on Saturday said results of the laboratory research and the development of the health (Litbangkes) the Department of Health menunjukan the two older brother-sibling the sufferer suspect this bird flu berkondisi serelogis (-), as well as wiped off the nose/the throat (-).

     

    Moreover the inspection "real time Gel base" also (-), so as both of them consisted NY. Aning (30) and Eka (35) was stated berkondisi H5N1 the negative (-), he said.


    Both of them, the resident of the Pabrik Lebak Cintamaya Kecamatan Cigedug Village, at once was accompanied came home after results of bird flu of the negative were received from this Litbangkes laboratory.

     

     

    Another case, one that has received less attention, that of a 2 year-old from Ngawi, has also tested negative according to a translated report via the Bird Flu Information Corner.

     

     

    Bird flu suspect from Ngawi tested negative.

    March 28, 2009

    Bird flu suspect from Ngawi tested negative.

    Ngawi – Tadi Riyanto (2) resident of Desa Sidokerto Karangjati was tested negative bird flu infection. Laboratory result to the boy’s blood sample showed negative bird flu infection.

     

    Flu symptoms and fever accompanying was confirmed as bronchitis. The result also supported with chest x-ray by Kabupaten Ngawi hospital. “X-ray showed that Tadi is in a good condition. His trombosit level also good, “said Siska the nurse who was taking care of Tadi.

     

    The hospital has allowed Tadi to return home. According to the hospital he was no longer developing fever and the flu signs had disappeared. His appetite had recovered and he was able to return into activity. His coughing was still observed although it was reduced.

     

    Now Tadi is taking medicine from the doctor to diminish his bronchitis. He also should do check up and routine control at local public health center

    Friday, March 27, 2009

    Referral: Soapacabana Video

     


    # 2947

     

     

    It’s Friday . . . bird flu news is thankfully slow . . .  and we all could use a good laugh now and then.  

     

    That makes this the perfect time to visit Maryn McKenna’s always excellent Superbug Blog to watch a video she has posted today:

     

     

    Germs: All-singing, all-dancing, all urging you to wash your hands

     

     

    Watch the video to the end.  The `outtakes’ are hilarious!

     

    And while you’re there, if you haven’t already discovered the more serious side to the Superbug blog, look around. 

     

    It is one of the best, and most informative health related blogs on the internet.

    Fed Agencies Embracing `New Media’

     


    # 2946

     

     

    A couple of years ago, the HHS undertook what was then a bold experiment.  They created a Pandemic Leadership Blog – invited a dozen or so people to contribute articles – and allowed the public to comment freely.

     

    What followed was a sometimes rambunctious, but nonetheless enlightening discourse between the bloggers, Federal Officials, and the public.

     

    The contributors were not told what they could or could not say in their blogs, nor were the blogs edited or `pre-screened’ by the HHS.    I know, because I was one of the contributors.

     

    That took a good deal of courage on the part of the HHS.

     

    But in the end, despite some bumps along the way, the project turned out to be a very positive one.  It even helped inspire former Secretary of the HHS, Michael Leavitt, to blog regularly on the Internet.  

     

    He became the first Cabinet Level Agency head to do so.

     

    From that humble beginning, the HHS and other Federal Agencies have begun to move more towards using the Internet to get their message out to the public – and just as importantly – to listen to the public’s concerns and suggestions.

     

    Over the past few months I’ve blogged about Twitter, and I have a list of government twitter feeds in my sidebar.    I use Twitter every day, although I don’t tend to `tweet’ much myself.   It is another source of information, streaming to my desktop as I work.

     

    Here are just a few of the more than 40 Twitter feeds I follow:

     

    Twitter Feeds

     

     

    In fact, the next article from MSNBC came to me via a tweeted link this morning.

     

     

     

    Federal government: Star of YouTube, Flickr?

     

    Agencies will step up use of videos and photos on social networking sites

     

    Image: CDC "tweet" on Twitter

    The Centers for Disease Control and other federal agencies are already using Twitter to relay information, and will soon be on YouTube and Flickr.

    By Suzanne Choney

    msnbc.com

    updated 9:09 a.m. ET, Thurs., March. 26, 2009

    The federal government, keeping in line with President Barack Obama’s directive for a more “transparent" and open government, will soon be a staple on YouTube, Flickr, Vimeo and blip.tv, with similar plans in the works for social networking sites Facebook, MySpace and Ning.com, officials said Wednesday.

     

    “We know that about every minute, 15 hours of video is uploaded to YouTube, and there’s about 50 million people that use Facebook,” said Martha Dorris, associate administrator of the General Services Administration's Office of Citizen Services and Communications. “That’s where the public is going to get their information, and they don’t necessarily always go to government Web sites.”

     

    The timing of the announcement coincides with Thursday's first White House online town hall about the economy, where the president will answer some questions from the public, and the event will be streamed live on WhiteHouse.gov.

    (Continue . . . )

     

     

     

     

    The HHS is currently building their New Media site, and they are looking for your input on how it should look, and what information it should contain.  The conversation is ongoing, and you are invited to join in.

     

     

    image

     

    Help us build our Web site!

     

    This site will be the public face and primary teaching and communications tool for the HHS Center for New Media.

     

    We want to use the tools of social and new media to shape both the Center and its Web site. Everything you see here is draft, in development, presented for you to react to, discuss, pick-apart or build on.

     

    We have some high-level navigation (horizontal tabs). We’ve hinted at what some pages might contain. We are compiling information on new media tools onto our tool page. We have a wire frame presenting possible content topics.

     

    And we have several discussion threads underway (right sidebar). Jump in. What do you like? Dislike? How do we grow this? What’s totally missing? How can we connect people (and projects)? How can we involve the larger community (across and outside government)? How can we push the envelope?

     

    If you have other suggestions for discussion topics, let us know. It’s your site to build!

     

    Thanks for being here. Bookmark us. We hope you check in often.

     

     

     

    FEMA has a Youtube Channel with (as of today) 70 videos available.  That number will continue to  expand over time.

     

    image

     

    Other agencies are making plans to establish a presence on sites like Youtube, Blip.tv, and Vimeo.   

     

    A little more than 85 years ago commercial radio changed the way the world received information.   For the first time, information could be transmitted instantaneously across vast distances.


    Less than thirty years later Television revolutionized communications again. 

     

    Today, a third – and, perhaps even more powerful wave of technology is catching hold.  

     

    Some call it Social Media, others call it New Media.  

     

    But by any name,  it is the wave of the future.

    TED Talks And Dr. Nathan Wolfe

     


    # 2945

     

     

    I am an unabashed fan of the online TED Talks.

     

    TED stands for Technology, Entertainment, Design.  Each year they hold a 4 day long event at Long Beach, California where 50 people are urged to give the 18-minute talk of their lives.

     

    And what talks they are!   

     

    I was first turned onto the TED Talks when a friend sent me a link to the winner of 2006’s TED Prize, Dr. Larry Brilliant's presentation on his dream of a new global system that can identify and contain pandemics before they spread.

     

    If you’ve never seen this speech, I urge you to watch it now.

     

    image

    (Click Image to view video)

     


    Ted calls these talks Ideas Worth Spreading.  And that they certainly are.

     

    With more than 200 videos now online, and that number growing each year, the TED archive is an inspiring wellspring of new and important ideas by the best and brightest minds in the world.

     

    This week’s entry on the TED website is a talk by Nathan Wolfe, the world famous virus hunter and founder of the Global Viral Forecasting Initiative (GVFI).   I wrote about Dr. Wolfe just recently (see Nathan Wolfe: Virus Hunter) in this blog. 

     

    The work he is doing is both important, and fascinating.   Here is how the TED website describes his talk:

     

     

    image

    About this talk

    Virus hunter Nathan Wolfe is outwitting the next pandemic by staying two steps ahead: discovering new, deadly viruses where they first emerge -- passing from animals to humans among poor subsistence hunters in Africa -- before they claim millions of lives

    About Nathan Wolfe

    Armed with blood samples, high-tech tools and a small army of fieldworkers, Nathan Wolfe hopes to re-invent pandemic control -- and reveal hidden secrets of the planet's dominant lifeform: the virus. Full bio and more links

     

     

     

    image

    (Click Image to view video)

     

     

    TED Talks are as varied (and interesting) as the world that surround us.  You could spend a lot of time exploring this website.

     

    While not every talk will be everyone's cup of tea, the TED website gets my highest recommendation.

    Thursday, March 26, 2009

    Egypt Announces 60th Human Bird Flu Infection

     


    # 2944

     

     

     

    For the 5th time during this month of March, and for the 9th time thus far in 2009, Egypt has announced another human H5N1 infection.  

     

    This time of  a 2 1/2 year-old girl from Qina named Israa Abdel Shafi.  She is reportedly in stable condition.

     

    This from the Kuwait News Agency.

     

     

     

     

    Egypt declares 60th Bird Flu case

    Health    3/26/2009 9:28:00 PM

    CAIRO, March 26 (KUNA) -- An Egyptian girl has been infected with the Bird Flu virus, bringing the number of these cases in the country to 60.


    A spokesman of the Health Ministry said on Thursday Israa Abdel Shafi, aged two years and six months, was hospitalized in the province of Qina in southern Egypt.


    The girl suffered from high fever and coughing after she mingled with dead birds suspected of bearing the virus. Her condition was described as stable after she given the required medications.


    Egypt declared flare-up of the disease in February 2006. Up to 22 people had died as a result of the disease. (end) bna.rk KUNA 262128 Mar 09NNNN

    You’ve Seen The News Reports, Now Read The Book

     

     

    # 2943

     

     

    The past couple of days have brought a number of news reports about the dangers of Severe Space Weather Events.  

     

    Several of the cable news stations have run reports, and The New Scientist published an article this week which opens with the following scenario:

     

     

    Space storm alert: 90 seconds from catastrophe

    • 23 March 2009 by Michael Brooks

    IT IS midnight on 22 September 2012 and the skies above Manhattan are filled with a flickering curtain of colourful light. Few New Yorkers have seen the aurora this far south but their fascination is short-lived. Within a few seconds, electric bulbs dim and flicker, then become unusually bright for a fleeting moment. Then all the lights in the state go out. Within 90 seconds, the entire eastern half of the US is without power.

     

    A year later and millions of Americans are dead and the nation's infrastructure lies in tatters. The World Bank declares America a developing nation. Europe, Scandinavia, China and Japan are also struggling to recover from the same fateful event - a violent storm, 150 million kilometres away on the surface of the sun.

    (Continue . . .)

     

     

    While solar storms might seem far afield from this blog’s normal territory (and a  remote threat), they can be viewed as another reason for people to get prepared to deal with any disaster.  

     

    Perhaps another `Carrington Event’, like the one that occurred in 1859, won’t happen again in our lifetimes.

     

    But there are no guarantees of that.

     

    Besides, we will always have hurricanes, floods, tornadoes, earthquakes, and pandemics to deal with – which are good enough reasons to be get prepared, and stay prepared.  

     

    Preparations for most disasters; having an adequate emergency kit, and an emergency plan – means you will be better able to deal with any emergency.  

     

    Up to and including a solar storm.

     

     

     

    The report (Severe Space Weather Events--Understanding Societal and Economic Impacts Workshop Report), funded by NASA and issued by the US National Academy of Sciences (NAS) is available online via the National Academies Press.  

     

    You may view the 132 report for free.

     

    If you are pressed for time, you can choose to `skim’ each chapter, reading just selected excerpts, or you can download the executive summary.

     

    This is a fascinating report, and it reminds us just how fragile our modern infrastructure really is. 

     

     

    If you are unfamiliar with the National Academies Press, here is how they describe themselves:

     

    The National Academies Press

    The National Academies Press (NAP) was created by the National Academies to publish the reports issued by the National Academy of Sciences, the National Academy of Engineering, the Institute of Medicine, and the National Research Council, all operating under a charter granted by the Congress of the United States. The NAP publishes more than 200 books a year on a wide range of topics in science, engineering, and health, capturing the most authoritative views on important issues in science and health policy. The institutions represented by the NAP are unique in that they attract the nation's leading experts in every field to serve on their award-winning panels and committees. This is the right place for definitive information on everything from space science to animal nutrition.

     

     

    Many of these titles are available for free, online.   A great resource, particularly for those with an interest in scientific research.

     

     

    For more information on how to prepare for emergencies of all types,  please visit the following sites.

     

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

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

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

     

    For Pandemic Preparedness Information: HHS Individual Planning Page

     

    For more in-depth emergency preparedness information I can think of no better resource than  GetPandemicReady.Org.   

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