Avian Flu Diary

NSABB Statement, mBio Commentaries & A `Dual Use’ Webinar

2012-01-31T11:32:00.001-05:00

# 6112

About an hour ago a 3-page PDF statement from the NSABB appeared on Science/ AAAS.org’s Public Health, Biosecurity, and H5N1 Forum, providing that committee's rationale for requesting the redaction from science journals of key portions of recent controversial `dual use’ H5N1 research.

30 JANUARY 2012 | POLICY FORUM

Adaptations of Avian Flu Virus Are a Cause for Concern

K. I. Berns et al.

Members of the National Science Advisory Board for Biosecurity explain its recommendations on the communication of experimental work on H5N1 influenza.

Full Text (PDF)

Comments

Meanwhile, mBio has published four views on all of this from Paul S. Keim, Vincent R. Racaniello, Robert G. Webster, and Arturo Casadevall & Thomas Shenk.

I’m headed there now to read:

Mammalian-Transmissible H5N1 Influenza: the Dilemma of Dual-Use Research

Robert G. Webster doi:10.1128/mBio.00005-12

Science Should Be in the Public Domain

Vincent R. Racaniello doi:10.1128/mBio.00004-12

The NSABB Recommendations: Rationale, Impact, and Implications

Paul S. Keim doi:10.1128/mBio.00021-12

The H5N1 Manuscript Redaction Controversy

Arturo Casadevall and Thomas Shenk doi:10.1128/mBio.00022-12

And on Thursday night, many of the major players in the world of influenza virology and biosecurity will convene for a 2 hour panel discussion, to be webcast by the New York Academy of Sciences (this appears to be a Pay-per-view event for non-members).

Here is the Press Release from the New York Academy of Sciences

Dual use research: H5N1 influenza virus and beyond

Experts to discuss controversial studies on avian flu virus at live event

WHAT: Dual Use Research: H5N1 Influenza Virus and Beyond

WHEN: Feb. 2, 6pm to 8pm

WHERE: The New York Academy of Sciences

REGISTER: www.nyas.org/H5N1

The US National Science Advisory Board for Biosecurity (NSABB) recently recommended that journals Nature and Science remove certain methodological details from controversial studies on the avian influenza virus (H5N1) to minimize the risk of these findings being misused by would-be bioterrorists. On February 2 from 6pm to 8pm, the Emerging Infectious Diseases & Microbiology Discussion Group of the New York Academy of Sciences presents Dual Use Research: H5N1 Influenza Virus and Beyond, a discussion between scientists, publishers, and legal experts that will explore the myriad issues surrounding the impending publication of these two studies and measures that will need to be undertaken to ensure the security of future such research.

To weigh in on matters of censorship and public safety, W. Ian Lipkin, MD, Center for Infection & Immunity at Columbia University, will moderate a panel discussion with Arturo Casadevall, MD, PhD, Albert Einstein College of Medicine, and member, NSABB; Laurie Garrett, PhD, Council on Foreign Relations; Barbara R. Jasny, PhD, Science; Veronique Kiermer, PhD, Nature Publishing Group; Michael T. Osterholm, PhD, MPH, Center for Infectious Disease Research and Policy, University of Minnesota, and member, NSABB; Peter Palese, PhD, Mount Sinai School of Medicine; Vincent Racaniello, PhD, Columbia University; and Alan S. Ruldolph, PhD, Defense Threat Reduction Agency.

###

Attendees must register at www.nyas.org/H5N1. Media must RSVP to Diana Friedman, dfriedman@nyas.org.

C. A. Nidom On Bird Flu In Indonesia

2012-01-31T08:07:00.001-05:00

Photo Credit – FAO

# 6111

Virologist Chairul Anwar Nidom of the Institute of Tropical Disease, Airlangga University probably knows more about how the H5N1 virus is evolving in Indonesia than anyone else.

Regular readers of this blog have come across his name dozens of times over the past few years, including here, here, and here.

Dr. Nidom demonstrated in 2006 that 20% of feral cats he tested in Jakarta carried antibodies to the H5N1 virus (see here), and his team has detected the bird flu virus in pigs as well (see When Pigs Flu).

Today we’ve a long article by Dr. Nidom appearing in the Indonesian newspaper Kompas on the fight against bird flu, and some of the obstacles that lie ahead.

The bad news here is that his remarks are in the Indonesian language (Bahasan), and we must content ourselves with machine translations which can sometimes lose a bit in the process.

Despite this impediment, we can glean a good deal from Dr. Nidom’s article. A hat tip to Diane Morin and Sharon Sanders of FluTrackers for this find.

I’ve links to two different translations below - which I encourage you to read - followed by a bullet list of some of his main points.

As you’ll see, the finished product varies somewhat between the Google Translation and the Microsoft translation. It really takes reading both of them to get the most out of this story.

Via Microsoft’s Bing Translator:

The Fight Against Bird Flu

and from Google’s Translator:

Warring Against Bird Flu

Among the points raised by Dr. Nidom:.

Of the 33 provinces in Indonesia, 32 are endemic areas of bird flu in poultry and other animals.

Control measures have not made visible progress over the past eight years.

The National Commission on Bird Flu was disbanded last year, and they still await the Disease Control National Zoonoses program which they hope will have more impact.

Unlike most cases in the past, officials have been unable to establish a link to infected poultry in the recent human cases in Bali, Jakarta and Tangerang.

Dr. Nidom asks for a fatwa, or religious regulation so victims of bird flu or other contagious diseases can be autopsied (rarely done now due to cultural, societal, and religious reasons).

He goes on to say that hospitals need to be trained to recognize and treat the H5N1 virus, and that it is likely that many cases go undiagnosed. He likens the number of cases we see to the `tip of the iceberg’.

He calls for vaccination (when available) for people at the highest risk – particularly those living in the `triangle of bird flu, namely Jakarta, West Java, and Jakarta’, and suggests that Oseltamivir be made available over the counter.

Dr. Nidom warns that the co-circulation of influenza viruses (H1N1, H3N2, H5N1) in Indonesia may lead to a reassortment, producing new – potentially dangerous – strains.

At one point Dr. Nidom states (ToggleText Translation): In 2006, was carried out by the "artificial" mutation in the virus H5N1 from the poultry in Indonesia without the coalition. Evidently the virus H5N1 the poultry that formed a coalition with H3N2 more virulent (see PNAS: H3N2 And H5N1 Reassortment).

One of the concerns expressed by Dr. Nidom in the past is that vaccines – as they lose their effectiveness – could mask the symptoms of bird flu in poultry, but still allow the virus to spread. (see Bird Flu: Confusing Reports Out Of Indonesia). He reports today: Healthy chickens positive for bird flu are located in Riau, Central Java, East Kalimantan, West Kalimantan and South Kalimantan.

Dr. Nidom warns that a (shift/drift/coalition) of the virus could result in human-to-human transmission of the virus and concludes by saying: It is very important for Indonesia to confront the pandemic, given our region an ideal place of the coalition. All strains are available, while structuring the environment of animals and humans remains unclear.

While these are most of the highlights, there is more to glean from this article, and should we see a better translation I’ll certainly post the link.

In the meantime, there is much to consider here.

PBS: Ebright, Racaniello, & Zimmer Weigh In On Bird Flu Research

2012-01-30T14:46:00.001-05:00

BSL-4 Lab Worker - Photo Credit –USAMRIID

# 6110

We are now 10 days into the self-imposed 60 day moratorium on the conducting (and publication) of controversial H5N1 research, and the meeting to discuss the future direction of such work in Geneva is still more than a couple of weeks away.

Meanwhile, the war of words - and the battle for the hearts and minds of the public - continues full throttle with advocates on both sides of this issue making their case in the media.

Today PBS Newshour has posted responses from three experts to a series of questions about this debate.

Richard H. Ebright - a molecular biologist at Rutgers

Vincent Racaniello - a microbiologist at Columbia, and author of the Virology Blog

Carl Zimmer, a journalist, author, and blogger

As you might imagine, there is a considerable difference of opinion over what should be done. Follow the link below to read:

SCIENCE -- January 30, 2012 at 11:54 AM EDT

Experts Weigh in on Bird Flu Research

By: David Pelcyger

For earlier coverage of this story, you may wish to revisit:

Nature: Yoshihiro Kawaoka Talks About His H5N1 Research

WHO: Will Host H5N1 Talks In Geneva

ScienceMag: Ron Fouchier Interview On The H5N1 Research Moratorium

Science Magazine: Public Health, Biosecurity, and H5N1

There’s an old saying that Academic infighting is so vicious, because the stakes are so low. But in this case, both sides view the stakes here as being enormously high.

Biosecurity and concerns over public safety versus revered and well established principles of Scientific Freedom.

Given the tenor of some of the discussions I’ve seen over the past couple of weeks, the gulf between these two sides doesn’t seem to be getting any narrower.

Surviving A Different Kind Of Aftershock

2012-01-30T08:57:00.001-05:00

# 6109

FEMA and Ready.gov, along with organizations like the American Red Cross (and indeed, this blog), spend a great deal of time trying to convince individuals, families, businesses and communities to prepare for emergencies and disasters.

The standardized advice is that everyone needs to be prepared to deal with a disaster for at least 3 days (meaning having a first aid kit, emergency supplies, and a plan) before help arrives.

Sure . . . they’d like you to be prepared for longer . . . but few enough Americans can be bothered to prepare for even 72 hours.

I personally advocate a minimum of a week’s worth of supplies (two would be better), but then I live in the heart of hurricane country, and am admittedly a bit of a belt-and-suspenders kind of guy (see NPM11: Living The Prepared Life).

There are some post-disaster aftershocks, however, that even two weeks of supplies won’t prepare you for.

The recent earthquakes in Haiti and in Fukushima, Japan – along with Hurricane Katrina in New Orleans – have shown how communities can be forever changed by a disaster.

With our short attention span, and the news media’s proclivity for moving on to the next big disaster or story, we often forget that the struggle to rebuild devastated communities can take years.

And sometimes, for some of the people caught in harm’s way, there is no going back to the way things used to be.

Today, in a sobering news story by ABC (Australian Brocasting Corp), we learn that the first of what may eventually become 5,000 homes are to be demolished in the wake of their recent series of earthquakes near Christchurch, NZ.

The land they were built on experienced significant liquefaction during the September 2010 and February 2011 earthquakes, and so homes will not be rebuilt on these lots.

NZ begins demolishing Christchurch suburbs

By New Zealand correspondent Dominique Schwartz

Updated January 30, 2012 18:50:35

As this story indicates, that despite some compensation offered by the government, many residents have lost tens (or even hundreds) of thousands of dollars and say they have `no way of moving forward’.

With tremors continuing (see map above), those who escaped with only minor or moderate damage get nerve-wracking daily reminders that the ground beneath their feet could move violently again at any time.

And for those who would like to move away and start anew, the reality is that there are few buyers willing to purchase a home or a business in an area where the ground continues to shake.

Not all of the aftershocks of a disaster are seismic in nature. Some are economic, while others can be psychological.

While often hidden from view, the psychological impact of a disaster can be enormous and ongoing. Last year in Post Disaster Stress & Suicide Rates we looked at the impact of disaster-related PTSD (Post Traumatic Stress Disorder).

Although a good disaster plan and emergency kit are imperative to get you through the opening hours and days of a disaster, knowing how to help friends, family, and neighbors deal with the psychological effects of a disaster can be equally important.

Luckily, there are things that can be done - even by the layperson - to help reduce the psychological impact of a disaster.

A few resources you may wish to revisit:

In Psychological First Aid: The WHO Guide For Field Workers we looked a simple guidebook anyone can use to help others in emotional distress.

The CDC also provides a website which contains a number of resources devoted to coping with disasters.

Coping With a Disaster or Traumatic Event

Trauma and Disaster Mental Health Resources

The effects of a disaster, terrorist attack, or other public health emergency can be long-lasting, and the resulting trauma can reverberate even with those not directly affected by the disaster. This page provides general strategies for promoting mental health and resilience. These strategies were developed by various organizations based on experiences in prior disasters.

As does the National Center For PTSD - including videos - on how to provide Psychological First Aid.

Psychological First Aid: Field Operations Guide

For Disaster Responders

Developed jointly with the National Child Traumatic Stress Network, PFA is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism: to reduce initial distress, and to foster short and long-term adaptive functioning.

A small reminder that not all wounds are readily visible to the naked eye, and that the proper bandage for them may not always reside inside your first aid kit.

Referral: McKenna On India’s Denial Of TDR-TB

2012-01-29T12:42:00.001-05:00

# 6108

When I saw the reports on Friday about India’s Health Ministry’s attempts to downplay reports of totally drug resistant tuberculosis, I was immediately reminded of the old joke about the doctor who couldn’t cure you, but for a small fee he’d touch up your X-rays.

Today, Maryn McKenna takes a closer look at India’s denials (which are similar to the official reaction we saw last year over NDM-1) in her Superbug Blog.

Follow the link to read:

TDR-TB: The Indian Government Denies It

By Maryn McKenna

January 29, 2012

An update to the news two weeks ago of totally drug-resistant tuberculosis, TDR-TB, being identified in India (and earlier in Italy and Iran): The Indian government has announced that it doesn’t exist, and is putting pressure on the physicians who identified it to say they made a mistake.

(Continue . . . )

The Kolkata Crow Mystery

2012-01-29T09:24:00.001-05:00

Indian House Crow – Photo Credit Wikipedia

# 6107

Roughly two months ago crows by the hundreds (some say thousands) began falling from their perches and dying in Jharkhand, India.

By mid-December the Indian Veterinary Research Institute (IVRI), Bhopal, confirmed that it was the H5N1 virus that was behind these deaths. (see EpiSouth Bulletin eweb_195_15_12__11.pdf).

You can find additional AFD coverage of this event in Media Report: H5N1 Killing Crows In Jharkhand and several from Crofsblog, including India: ‘New bird flu strain killed Jharkhand crows’.

Today the Times of India is reporting (h/t Emily on FluTrackers) that after ignoring dying crows in the capital city of Kolkata for weeks, West Bengal authorities are finally launching an investigation.

Govt gets cracking on crow deaths
TNN | Jan 29, 2012, 07.36AM IST

KOLKATA: After ignoring the mysterious crow deaths in the city for nearly two months, the state government flew into action mode on Saturday and sent scientists to Rabindra Sarovar to gather carcasses and blood samples.

TOI on Friday first reported on crows dropping dead all over the city.

(Continue . . . )

Somewhat remarkably, two weeks after the discovery of H5N1 in Jharkhand crows, India declared itself to be bird flu free, leading to some highly critical media coverage (see Dying crows deny India is bird flu free).

There are other possible causes of the crow deaths in Kolkata; insecticides, accidental poisoning, and Newcastle disease to name a few.

But with the recent positive test results in neighboring Jharkhand positive for H5N1, concerns are running high that the virus may be behind these deaths as well.

NYTs: The Bird Flu Research Controversy Continues

2012-01-29T08:05:00.001-05:00

BLS-4 Lab – Photo Credit CDC PHIL

# 6106

The weekend edition of the New York Times contains a `dialog’ – well, actually letters to the editor – received over the past few days by some well known academics and researchers on the volatile subject of H5N1 research.

The recent successes in turning the H5N1 virus into a more transmissible virus have raised alarms among many of those in the bio-security field (see The Furor Over H5N1 Research Continues).

At the same time, many scientists are decrying what they see as heavy-handed attempts to halt, or censor what they see as crucial research.

You’ll find a lot of familiar names weighing into the NYTs dialog today, including Tom Inglesby, Philip Alcabes, and Vincent Racaniello.

Sunday Dialogue: Bird Flu Experiments

The World Health Organization has tentatively scheduled a meeting of experts in Geneva in a couple of weeks with hopes of resolving some of the thornier issues involved.

But as we continue to see by the arguments coming from both sides of this debate - there is a sizable chasm separating them – making a workable compromise coming out of this meeting far from assured.

Stay tuned.

EuroFlu: H3N2 Dominates But Overall Activity Is Low

2012-01-27T08:53:00.001-05:00

# 6105

Photo Credit- EuroFlu Report.

In stark contrast to this time last year - when much of Europe was seeing significant H1N1 influenza activity - reports of flu for week 3 of 2012 (while rising slowly) - remain low across Europe - and predominantly H3N2 related.

Influenza activity continues to rise slowly in the WHO European Region due to A(H3N2)

This issue is based on data for week 3/2012 reported by 46 Member States in the WHO European Region.

Consultation rates for influenza-like illness (ILI) and acute respiratory infection (ARI) continue to be relatively low in most countries of the Region, but with many countries reporting increasing activity.

29 % of sentinel specimens tested positive for influenza, which is an increase over last week: 95% of these were influenza A.

Of the 352 influenza A viruses from sentinel sources that were subtyped, 99 % were A(H3N2).

Comment

Influenza activity has increased consistently over the past several weeks, but influenza detections remain low compared to the same period of the 2010/2011 season. Influenza A and B viruses are co-circulating in the Region, with the vast majority of detections in both outpatient clinics and hospitals being A(H3N2).

We’ll get the latest FluView and FluWatch numbers later today for the United States and Canada.

Eurosurveillance: Older People May Be Susceptible To The H3N2v Virus

2012-01-27T08:08:00.001-05:00

# 6104

The detection of a new swine H3N2v virus among a handful of people across five states in recent months has sparked concerns that a new influenza virus might be trying to establish a foothold in the human population.

Since the infections reported in the 2nd half of 2011 were predominantly among young children, there has been some speculation that those over the age of 20 might have some limited immunity to this strain.

The CDC, in their January 6th MMWR Update: Influenza A (H3N2)v Transmission and Guidelines — Five States, 2011, writes:

Limited serologic studies conducted to date indicate that young children have little preexisting immunity to influenza A (H3N2)v viruses. Because the hemagglutinin genes of these viruses are related to human influenza A (H3N2) viruses that circulated in the 1990s, older children and adults might have limited immunity against these viruses

Yesterday the Journal Eurosurveillance printed an article called:

Cross-reactive antibody to swine influenza A(H3N2) subtype virus in children and adults before and after immunisation with 2010/11 trivalent inactivated influenza vaccine in Canada, August to November 2010

by DM Skowronski, G De Serres, NZ Janjua, JL Gardy, V Gilca, M Dionne, ME Hamelin, C Rhéaume, G Boivin

As the title might suggest, this isn’t exactly `light’ reading.

Luckily we’ve the talented Helen Branswell to lead us through this medical morass, in her report for the Canadian Press. As with any Branswell article, you would be well served to follow the link and read the whole thing.

Older adults may also be vulnerable to new swine influenza virus, study suggests

By: Helen Branswell, The Canadian Press

Briefly, the Eurosurveillance study finds indications that acquired immunity carried by adults from exposure to similar viruses that were circulating prior to 1990 may wear off as adults age.

Since years when the H3N2 seasonal flu dominates often result in a more severe flu season, any decline in immunity among the elderly elicits concern.

Right now, the H3N2v virus hasn’t shown the ability to spread efficiently in the human population, although some human-to-human transmission has occurred.

But over time, it may acquire that ability.

Which is why the CDC is working on a vaccine (see H3N2v Vaccine Trials) for this new strain should the need arise.

Meanwhile, with the exception of reports out of Mexico where they are seeing a large number of H1N1 cases, influenza reports in North America and Europe remain well below average for this time of year.

Australia Finds LPAI H5 On Two Duck Farms

2012-01-27T07:20:00.001-05:00

Victoria, Australia – Credit Wikipedia

# 6103

Overnight the wire services have been abuzz with news of the discovery of a low pathogenic form of of avian influenza (LPAI) on a couple of duck farms in Victoria, Australia.

A few samples of the media coverage include:

Chicken safe to eat, despite Victorian bird flu

Bird flu detected in ducks near Melbourne

Bird flu outbreak sparks duck cull

While all of the stories (rightfully) point out that this is a low-path strain - and not considered to be a serious health hazard to humans – noticeably absent from any of the above reports is any identification of the strain of avian flu detected.

There are, of course, a great many LPAI strains out there, but only the H5s and H7s are required to be reported to the OIE because of their potential to evolve into a more pathogenic strain.

For a good background on avian influenza in agriculture I would invite you to visit CIDRAP’s Avian Influenza (Bird Flu): Agricultural and Wildlife Considerations - Last updated January 21, 2012

A visit to Victoria’s Department of Primary Industries website solves the subtype mystery (stated to be H5), which is included in the following statement by Victoria’s Chief Veterinary Officer, Dr Andrew Cameron.

Chief Veterinary Officer’s Avian Influenza Update

27 January 2012

The Department of Primary Industries (DPI) has quarantined a commercial duck farm in two locations north-west of Melbourne after birds there tested positive to Low Pathogenic Avian Influenza (LPAI).

DPI Chief Veterinary Officer, Dr Andrew Cameron said analytical tests carried out at the Australian Animal Health Laboratory at Geelong, Victoria, had given a positive response to low pathogenic H5 subtype avian influenza virus, prompting authorities to act immediately.

This low pathogenic subtype of avian influenza is not the highly pathogenic H5N1 virus affecting poultry and humans throughout much of Asia. The wider community is not at risk from this incident.”

Dr Cameron has said, “The virus is relatively harmless now, but we do not want to take the risk it could linger in bird populations and mutate to a more virulent strain.”

The farm has been placed under strict quarantine and no birds, eggs, meat or associated equipment can be taken off the property.

The Consultative Committee for Emergency Animal Diseases (CCEAD) will meet on Friday 27 January, to discuss containment, surveillance and next steps.

Victoria’s Acting Chief Health Officer Dr Rosemary Lester reinforced the assurances that the public is not at risk. “Our poultry meat and eggs continue to be safe under normal food handling and cooking arrangements” she said.

For further information about Avian Influenza review the links below or call 1300 135559.

In Victoria, strict biosecurity guidelines apply to all poultry farms to prevent poultry, feed and water from mixing with wild birds. This minimises the risk of disease. It is a good practice to protect the food and water used for your pet birds and to ensure wild birds cannot come into contact with them. Finally, it is important for all of us to follow good hygiene practices to minimise the risk of any disease, such as washing hands after contact with animals and birds and, in particular, not handling sick or dead birds. These are sensible precautions that will prevent many diseases, not just AI.

Dr Andrew Cameron
Chief Veterinary Officer, Victoria

You’ll find another press release on this site, providing greater detail on the steps that are being taken to eradicate this virus.

Media release: Swift Action to Contain Avian Influenza

27 January 12

Hong Kong: H5N1 Infected Goose Carcass Found On Beach

2012-01-26T08:34:00.001-05:00

#6102

With an avian punctuality usually reserved for the arrival of swallows to Capistrano or the buzzards to Hinckley, Ohio - January once again finds an H5N1 infected bird carcass on the beaches of Hong Kong.

Located adjacent to mainland China - which has a long history of H5N1 outbreaks in poultry and in wild birds – Hong Kong sits at the outflow of the Pearl River to the sea.

Photo Credit- Wikipedia

The Pearl River Delta serves as a catchment area for dozens of tributaries flowing out of the highly industrialized and economically booming Guangdong Province, has been described as one of the more heavily polluted waterways in the world.

Industries, and farms, are known to use these rivers as a convenient disposal system, and what gets dumped upstream flows out to the sea past Lantau island.

In the winter of 2009, we saw a number of decomposed poultry carcasses wash up on the beaches of Hong Kong, presumably carried to the sea via the Pearl River, which flows out of Guangdong Province, China.

Some of my blog coverage of those events included:

Hong Kong Authorities Investigating More Dead Birds

All Eyes On Mainland China

More Concerns Surface Over China

Chinese authorities denied knowledge of any bird flu outbreaks in Guangdong Province and eventually the number of dead birds showing up on shore declined.

Again, over the winter of 2010-2011 we saw multiple reports of badly decomposed poultry carcasses washing up on Hong Kong beaches.

H5N1 Infected Chicken Carcass On Hong Kong Beach

Hong Kong: More H5N1 Infected Chickens Wash Up On Beach

And today, via Hong Kong’s Centre for Health Protection, we get this report of a badly decomposed goose carcass on the beach near Sham Tseng.

While this report doesn’t explicitly state that the carcass washed ashore, that has been the pattern observed in past years.

Goose carcass found in Sham Tseng tests positive for H5N1 virus

Ends/Thursday, January 26, 2012

A spokesman for the Agriculture, Fisheries and Conservation Department (AFCD) said today (January 26) that a goose carcass found in Sham Tseng was confirmed to be H5N1 positive after laboratory testing.

The goose carcass was found and collected at Anglers' Beach, 13 milestone, Castle Peak Road, Sham Tseng, on January 20. It was highly decomposed when found and required a series of tests before H5N1 avian influenza was confirmed today.

The spokesman said there were no poultry farms within 3 kilometres of where the dead goose was found. AFCD staff have conducted inspections and found no evidence of any backyard poultry being kept there. AFCD will continue to monitor the situation and conduct inspections of the area.

In view of the case, the AFCD has phoned poultry farmers to remind them to strengthen precautionary and biosecurity measures against avian influenza. Letters have been issued to farmers, pet bird shop owners and licence holders of pet poultry and racing pigeons reminding them that proper precautions must be taken.

The spokesman said the department would conduct frequent inspections of poultry farms and the wholesale market to ensure that proper precautions against avian influenza have been implemented. The department will continue its wild bird monitoring and surveillance.

"People should avoid personal contact with wild birds and live poultry and their droppings. They should clean their hands thoroughly after coming into contact with them. The public can call 1823 for follow-up if they come across suspicious sick or dead birds, including the carcasses of wild birds and poultry," the spokesman said.

(Continue . . . )

Admittedly one infected carcass doesn’t tell us much about what may –or may not – be going on upstream from Hong Kong, but it will be interesting to see if – as in years past – more of them continue to show up over the next few months.

Nature: Yoshihiro Kawaoka Talks About His H5N1 Research

2012-01-25T13:50:00.001-05:00

BSL-4 Lab Worker - Photo Credit –USAMRIID

# 6101

Although two scientists, working independently and a half-a-world-apart have recently created a more transmissible version of the H5N1 virus, it has been the work of Ron Fouchier at Erasmus University that has garnered the most press.

The reason is pretty simple.

Fouchier announced his findings at a scientific conference late last summer (see Katherine Harmon’s Sci-Am article and in a follow up to this story in New Scientist: Five Easy Mutations), while Yoshihiro Kawaoka has – until now - refrained from discussing his work publicly.

Today in a Nature commentary, flu virologist Yoshihiro Kawaoka breaks his silence and talks about his research into the H5N1 virus, and why such research should continue.

H5N1: Flu transmission work is urgent

Yoshihiro Kawaoka

Nature (2012)
doi:10.1038/nature10884 Published online
25 January 2012

Yoshihiro Kawaoka explains that research on transmissible avian flu viruses needs to continue if pandemics are to be prevented.

Taking a different approach than that used by Fouchier, Kawaoka created a reassortant virus combining H5N1 and the 2009 H1N1 virus, which while transmissible between ferrets, was no more pathogenic than regular flu.

As you might expect, Helen Branswell is already all over this story, and you can find her take on it at:

The Canadian Press - ONLINE EDITION

Researcher at heart of bird flu studies controversy reveals details of his findings

By: Helen Branswell, The Canadian Press

Situational Awareness: Google Public Alerts

2012-01-25T13:07:00.001-05:00

Google Alerts Page – Close up on the United States

# 6100

By now, just about everyone on the Internet is familiar with Google maps, and the broad range of information they can display. Google Earth has redefined the way we look at maps and terrain, satellite imagery, storm tracks and data.

Today, Google has unveiled their latest creation - a Public Alerts Page that allows the user access to real-time emergency alerts from all around the world.

As you mouse over color-shaded areas of the map, specific warnings are displayed. Clicking on the embedded markers will pop up a display, such as the one below:

Part and parcel to good emergency preparedness is situational awareness, and tools like this can quickly provide warnings of current or potential hazards.

Last summer, in NOAAWatch: Your Daily All-Hazards Briefing, I wrote about several other websites that you can use to gauge and monitor potential threats.

NOAA, the National Oceanic and Atmospheric Administration has a terrific all Hazards Monitor page for anyone wanting a heads up on what threats to be cognizant of.

While the home page provides links to dozens of resources ranging from the NWS, EPA and USGS to the World Meteorological Organization, the DAILY BRIEFING PAGE nicely compiles the most important information on a single page.

Now, getting a daily all-threats briefing can be as easy as clicking a single link.

Another important resource is NOAA WEATHER RADIO (NWR).

Once thought of as mainly a source of local weather information, NWR has now become an `All-Hazards' alert system as well. Working with the FCC’s Emergency Alert System, NWR provides warning and post-event information for natural disasters, man-made disasters, and local public safety information.

Like having an emergency kit and a first aid kit - having a weather radio is an important part of being prepared.

Of course, just knowing about the threats isn’t enough. You have to make use of that information. And NOAAWatch provides some links for that as well:

· Ready America - DHS
· Plan Ahead - FEMA
· Preparedness for People With Disabilities
· HHS - Disasters & Emergencies
· American Red Cross
· DisasterAssistance.gov

You’ll also find a long list of preparedness essays on this site by searching on PREPARE or NPM11.

More Conflicting Bird Flu Reports Out Of Indonesia

2012-01-25T07:42:00.001-05:00

# 6099

One of the hazards of blogging about bird flu is that the news we get out of countries where the virus is endemic and most active (Egypt, Indonesia, China, Vietnam, Bangladesh, Cambodia) is often fragmented, contradictory, or heavily state controlled.

You soon learn that relying too much on machine translations from Arabic, Indonesian, Vietnamese, or Chinese language sources risks compounding a felony, as that can add another layer of ambiguity to what is sometimes already less than accurate local reporting.

But some days, that’s all we have to go on.

Case in point, several days ago an 18-year-old man was hospitalized in Tangerang, Indonesia suspected to have been infected by the H5N1 virus. The local papers first reported him as a bird flu suspect, then yesterday the Jakarta Globe reported that he was not infected.

Tangerang Bird Flu Scare a False Alarm

January 24, 2012

A man in Tangerang thought to have bird flu has tested negative for the virus, the Health Ministry said on Tuesday.

Instead of being the end of this story, today local media is reporting that this unfortunate young man died of respiratory failure . . . and, you guessed it . . . bird flu is still suspected.

This translation comes from the always excellent Arkanoid Legent website:

Again, Bird Flu Patient Dies

After 5 days treated in isolation space bird flu, RO, 18 years, men who indicated suspect bird flu died. RO died at 12:30 pm in the isolation room bird flu Tangerang District Hospital.

"The patient died at 12.30 pm, due to respiratory failure," said Head of Public Relations Tangerang District Hospital, Achmad Muchlis to VIVAnews.com , Wednesday, January 25, 2012. Dikatakanya, since entering the room isolation, the condition of critically ill patients and no progress.

Until finally died of respiratory failure. "Until now there has been no official information related to the correct patient infected with bird flu," he said."

Although we don’t know right now with certainty that this patient died from H5N1, suspicions run high.

If sounds a bit familiar, you may recall that last week we learned of a 5-year-old girl (see Indonesian MOH Announces Bird Flu Fatality) who died from the bird flu virus after first being declared free from infection (see 5-Year-Old Brother of Bird Flu Victim Cleared by Doctors Dofa Fasila | January 10, 2012).

Testing for the H5N1 virus in Indonesia has always been difficult, particularly once a patient is placed on antivirals. We’ve seen some cases where patients tested negative up until a post-mortem exam of lung tissue could confirm the diagnosis.

Newshounds are currently watching several other suspected H5N1 cases in Indonesia, including that of a 4-year-old who died after 6 days of treatment in the hospital at Bekasi.

This translation, again, is from Arkanoid Legent:

Allegedly Infected with Bird Flu, Boy 4 Year Deaths

JAKARTA : Nazril Ilham (4) single-child couples Maimunah (25) and Mohammed Enzen (24), of Kampung Sungai Bintaro Branch 4 RT 1.1 Hurip Jaya Village, District Babelan, Dies Bekasi District. Suspected Bird Flu Nazriel.

The victim died after being treated for six days in hospital Anna Bekasi. The atmosphere of grief is still visible at the funeral home shortly after the victim was buried in the cemetery not far from his home, Wednesday (01/24/2012). Surprisingly burial victims without assisted the hospital or health department Bekasi.

Gert van der Hoek at FluTrackers has a report this morning from MetroTVnews that a hospital in North Suluwesi is treating two suspected bird flu patients.

Kandow Hospital is Treating Two Bird Flu Suspects

National / Wednesday, January 25, 2012
Metrotvnews.com, Manado: Two people are now in intensive care at the Hospital Professor Kandow in Manado, North Sulawesi. Patient origin Bolaang Mongondow and Minahasa, North Sulawesi, was allegedly exposed to bird flu.

The two residents that are 81-year-old AP, the village residents Bintauna, Bolmon District, and RP was 4 years old, a resident Kanonang, Minahasa regency. When taken to the hospital, the patient experienced high fever and shortness of breath accompanied by flu.

Previously the two patients was treated in the clinic area where each of them. Until now, both patients are still undergoing intensive care in a bird flu isolation room
MetroTVnews

While obviously suspected, we’ll have to wait for laboratory confirmation before we can know if any of these cases are due to the H5N1 virus. There are, after all, other illnesses that can mimic the symptoms of bird flu.

And it is quite possible – given the limits of testing -that for some of these cases, we’ll never know their H5N1 status with absolute certainty.

And one final example of how stories can quickly change, last Friday the Indonesian Minister of Health Endang Rahayu Sedyaningsi was quoted in the media as worrying that oseltamivir may be losing effectiveness against the Indonesian strains of bird flu (see Indonesia: MOH Suspects H5N1 May Be Gaining Antiviral Resistance).

Three days later, in what appears to be a bit of hasty `damage control’, we get a newspaper column penned by Professor Tjandra Y. Aditama, Director General of Disease Control and Environmental Health, Ministry of Health, Jakarta, Indonesia.

Oseltamivir is still OK to Overcome Bird Flu

24/01/2012

Tamiflu Oseltamivir by the brand as we know as a drug used to treat bird flu. The research data from 6 countries including Thailand, Vietnam, Cambodia, Turkey, Egypt and Indonesia showed substantial recovery.

This was conveyed by the Director General of Disease Control and Environmental Health (P2PL) Ministry of Health, Prof. Dr. Tjandra Yoga Aditama SpP (K), MARS, DTM & H, DTCE to SEHATNEWS.com in Jakarta.

Of the 188 who were treated with oseltamivir, 88 or 47 percent had recovered healing. Of 56 untreated oseltamivir, 7 who recovered (or only 12%) "So there are real differences between the use of oseltamivir with that do not use drugs," said Tjandra.

Data from the World Health Organization says that of 81 cases using oseltamivir global, 21 gain in the first 2 days of fever. Of the 21 men, 18 survived, three died.

The statistics cited above appear to come from an older study of H5N1 outcomes (with and without Tamiflu treatment) conducted across several Asian nations. No cite was given, so I have not been able to run it down.

While encouraging for the global stage (as is this 2010 study), this is not the most convincing evidence that might have been offered by D.G. Aditama for the current state of antiviral sensitivity in Indonesia.

And so it goes.

We view the events in Indonesia, China, Vietnam, and other nations through a fogged and oft times distorted lens. What light that comes through can sometimes give us a hint of what is happening, but details are often absent, or badly mangled.

Welcome to the world of flu blogging and internet news hounding, where the motto is, and will probably always be:

Caveat Lector.

Bangladesh: Nipah Claims 5 Lives

2012-01-24T16:12:00.001-05:00

Nipah/Hendra Virus & Fruit Bat Home Range – WHO

# 6098

Last summer the movie `Contagion’ showed the world how a bat virus might mutate, evolve, and eventually move into the human population. While the movie used a fictionalized MEV-1 virus, it was based on the all-too-real Nipah Virus, which first came to prominence in the 1990s after a deadly outbreak in Malaysia in 1998.

While human infections with Nipah (or its Australian cousin Hendra) have been relatively uncommon, when they have occurred they have proven particularly lethal, with fatality rates pushing 60%.

During the Malaysian outbreak in 1998, the virus jumped to local swine herds from bats, and along with infecting hundreds of people caused the loss over 100 lives. The virus was then exported via live pigs to Singapore, where 11 more people died.

Over the past decade, Nipah has sparked a number of small outbreaks across Southern Asia, although the most intense activity has been centered around Bangladesh.

Over the past 48 hours we’ve seen some reports coming out of Bangladesh indicating that several people have been infected with the Nipah virus. Nipah reports out of this region typically come between December and May.

Today, the IEDCR issued the following statement, indicating there have been 5 fatalities thus far.

Nipah Outbreak at Joypurhat in January 2012

From 20 January 2012, two clusters of Nipah were identified in the Joypurhat Municipality area and Khetlal upazila of Joypurhat district. A joint team of IEDCR and ICDDR,B are working in the field now.

Till date (23 rd January 2012), the team identified 3 cases from the municipal area and 2 cases from Khetlal. All 5 cases have died. Laboratory tests for Nipah were done in IEDCR. All four samples collected from suspected cases were positive for Nipah.

Map Credit- Wikipedia

CIDRAP has a nicely done Overview of the Nipah Virus including the clinical symptom chart below:

Exactly how the Nipah virus is transmitted from human-to-human isn’t well understood, although it is thought to be mostly through direct contact with respiratory secretions or other bodily fluids.

For now - while Human-to-human transmission has been documented - only limited outbreaks have been reported.

Last February, in Bangladesh: Updating The Nipah Outbreak I wrote about a couple of EID Journal studies that looked at Nipah transmission between humans.

The World Health Organization has this to say about the human-to-human transmission of the Nipah Virus.

Transmission

During the initial outbreaks in Malaysia and Singapore, most human infections resulted from direct contact with sick pigs or their contaminated tissues. Transmission is thought to have occurred via respiratory droplets, contact with throat or nasal secretions from the pigs, or contact with the tissue of a sick animal.

In the Bangladesh and India outbreaks, consumption of fruits or fruit products (e.g. raw date palm juice) contaminated with urine or saliva from infected fruit bats was the most likely source of infection.

During the later outbreaks in Bangladesh and India, Nipah virus spread directly from human-to-human through close contact with people's secretions and excretions. In Siliguri, India, transmission of the virus was also reported within a health-care setting, where 75% of cases occurred among hospital staff or visitors. From 2001 to 2008, around half of reported cases in Bangladesh were due to human-to-human transmission.

Reducing the risk of infection in people

In the absence of a vaccine, the only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus.

Public health educational messages should focus on the following.

Reducing the risk of bat-to-human transmission. Efforts to prevent transmission should first focus on decreasing bat access to date palm sap. Freshly collected date palm juice should also be boiled and fruits should be thoroughly washed and peeled before consumption.

Reducing the risk of human-to-human transmission. Close physical contact with Nipah virus-infected people should be avoided. Gloves and protective equipment should be worn when taking care of ill people. Regular hand washing should be carried out after caring for or visiting sick people.

Reducing the risk of animal-to-human transmission. Gloves and other protective clothing should be worn while handling sick animals or their tissues, and during slaughtering and culling procedures.

While the Nipah Virus may not pose anywhere near as great of a threat to the world as a pandemic influenza, it does point out the need for increased surveillance and improved public health programs around the world.

FluTrackers: Assessment Of H5N1 In China

2012-01-24T10:50:00.001-05:00

# 6097

The newshounds on the major flu forums do an incredible job searching for, translating, and analyzing media reports of infectious diseases from all over the world. I’ve said it before, but much of what I do in this blog is only possible due to their efforts.

In terms of organization, quality, and volume of information, it would be hard to find a more impressive repository of emerging disease news than one can find at FluTrackers.com.

With two recent high profile human infections from the H5N1 virus in China (and others being reported in Indonesia, Cambodia, Egypt, and Vietnam), along with the ongoing controversy over the merits and dangers of H5N1 research, media attention has once more turned towards bird flu.

Sharon Sanders, Editor of FluTrackers, has distilled the combined efforts of the FluTrackers team into a handy overview of the H5N1 risks in China based on information they have been able to accumulate.

Anyone wanting a crash course on the H5N1 situation in China need only follow the embedded links to get a grasp of the situation. As this overview emphasizes, state control of local media makes making definitive statements difficult.

FluTrackers.com Risk Assessment of H5N1 type influenza in China

The FluTrackers Team
January 24, 2012

We feel that we can not say with 100% certainly what the exact situation is but this is our opinion based on the facts as we ascertain them as of this date and time.

Humans are at continuous risk of exposure to H5N1 poultry.

1) China has an endemic H5N1 problem in poultry. We know this for several reasons:

a) There have been warnings over the years to clean eggs shells due to surface contamination including H5N1:

China - Experts Call for More Stringent Standards for Cleaning Eggs - Avian Flu Mentioned As Risk May 2011

China - Nutrition Society warns on poultry egg shells, meat, and storage due to avian influenza H5N1 contamination January 2012

2) There are numerous H5N1 drills to train emergency personnel how to react to human and poultry outbreaks. A sample of recent drills includes:

China - Human Bird Flu H5N1 Drill held in Qinzhou, Guangxi province – January 2012

China - CDC Holds Suspected Human H5N1 Emergency Drill in Binzhou City, Shandong province December 2011

China - Emergency Poultry Bird Flu Drill Held in Rizhao City, Shandong province December 2011

China - Major H5N1 Poultry Farm Drill Held in Jangmen, Guangdong province November 2011

3) There are recent H5N1 poultry outbreaks in countries that border China: Tibet, Vietnam (Human), Vietnam (poultry), Hong Kong (wild bird), Hong Kong (poultry), Bhutan, & Nepal

4) The Russian health minister warned citizens on January 4, 2012 to be vigilant about H5N1 when traveling in China here.

5) Other hints and tips in the Chinese press regarding H5N1 status:

China - "Raw" poultry not allowed on trains in Shenzhen due to bird flu fears January 15, 2012

Ministry of Health: human infection of highly pathogenic avian influenza surveillance will be strengthened for the sporadic cases January 2012

China - Shanghai public health requires all medical institutions to monitor carefully for unexplained pneumonia November 2011

6) No country, where H5N1 has become endemic in the environment, has been able to successfully eliminate this disease. Indonesia, Vietnam, and Egypt, each experiencing current poultry and human H5N1 cases, are the most outstanding examples of this unfortunate phenomena. Therefore, despite the fact that China is not reporting any current H5N1 outbreaks in poultry we believe they occur and this is a constant threat to human health.

We see no evidence of sustained and efficient H5N1 infection between humans in China. However, we feel this risk is unknown since China is not forthcoming, generally, about its disease status.

On June 14, 2011 the Ministry of Health announced a creation of a “black list” for media that do not report government sanctioned information. We feel this represents a risk to human health, in general, in China.

The risk of human contamination from H5N1 positive wild birds is unknown in China.Hong Kong reports sporadic cases of H5N1 in wild birds but there are no corresponding human infections that result from contact with such wild birds.

The risk of human contamination from animals (other than poultry), or the environment, in general, is not known.

Many studies have demonstrated that animals can harbour the H5N1 virus, including domestic cats and dogs. In an H5N1 endemic environment, it should be assumed that there are many possible vectors for infection.

It is unclear how the most recent human cases of H5N1 were infected here and here. The government of China denied any human-to-human transmission in the Shenzhen case. The government also denied H5N1 poultry as the source. There were some press announcements that contact with a wild bird may have been the cause of the human case in Shenzhen. If this is true, then, logically, there must be many human cases of H5N1 in China amongst people who frequent parks and other outdoor venues. We feel this scenario, while possible, is not likely.

In conclusion, we feel there is a risk to the human population in China from H5N1 type influenza. A culture of hand washing, avoidance of wild birds and poultry, sanitary contact with domestic pets, and social distancing in public is advisable.

Survey: Gen X & The 2009 Pandemic

2012-01-24T07:40:00.001-05:00

# 6096

Generation X – that is, the generation born after the post-war baby boom - comprise about 80 million Americans who are now in their 30s and 40s.

The University of Michigan’s Institute for Social Research - in conducting their Longitudinal Study of American Youth - has collected data from roughly 3,000 participants aged 36 to 40 on how they perceived and reacted to the 2009 H1N1 pandemic.

While this study reports that Gen X responded reasonably well to the pandemic, only about 20% appear to have availed themselves of the flu shot.

And despite believing they were `well informed’ on the subject of pandemic flu, overall they scored only moderately well when tested on 5 areas of general flu knowledge.

Gen Xers indicated they trusted their family practitioner, and the NIH the most when it came to flu information, and Youtube videos, drug companies the least.

Here is the press release, I don’t find the study available yet on the Lsay.org website.

Generation X: How young adults deal with influenza

ANN ARBOR, Mich. -- Only about one in five young adults in their late 30s received a flu shot during the 2009-2010 swine flu epidemic, according to a University of Michigan report that details the behavior and attitudes of Generation X.

But about 65 percent were at least moderately concerned about the flu, and nearly 60 percent said they were following the issue very or moderately closely.

Using survey data collected from approximately 3,000 young adults during the 2009-2010 H1N1 influenza epidemic—the first serious infectious disease this group had ever experienced—The Generation X Report explores how Americans ages 36-39 kept abreast of the issue and what actions they eventually took to protect themselves and their families.

"These results suggest that young adults in Generation X did reasonably well in their first encounter with a major epidemic," said Jon D. Miller, author of The Generation X Report. "Those with minor children at home were at the greatest risk, and they responded accordingly, with higher levels of awareness and concern."According to Miller, understanding Gen X reactions to this recent threat may help public health officials deal more effectively with future epidemics.

The results show that a majority of Generation X young adults felt that they were "well informed" or "very well informed" about the issue. However, they scored only moderately well, overall, on an Index of Influenza Knowledge, a series of five items designed to test the level of knowledge about viral infections generally and about the swine flu epidemic specifically.

Miller directs the Longitudinal Study of American Youth at the U-M Institute for Social Research. The study, funded by the National Science Foundation since 1986, now includes responses from approximately 4,000 Gen Xers—those born between 1961 and 1981.

Among the other findings:

Young adults with minor children at home were most likely to follow the news about influenza closely and were most concerned about the swine flu epidemic.

Young adults were most likely to report getting information about the epidemic from friends, co-workers and family members. In the month before the survey, they reported having about nine such conversations, compared to getting news about the flu less than three times via print or broadcast media, and about five times from searching the Internet.

The most trusted sources of information about the influenza epidemic were physicians, followed by the National Institutes of Health, pharmacists at local drug stores and nurses from county health departments. The least trusted sources were YouTube videos, drug company commercials and Wikipedia articles.

(Continue . . . )

Academics Debate Odds Of Tokyo Earthquake

2012-01-23T09:11:00.001-05:00

(Mashup of an original map from USGS depicting 3 areas and 4 major earthquakes over the past year on the ring of fire)

# 6095

Just before noon on September 1, 1923 a massive - and by all reports long-duration - 7.9 magnitude earthquake struck beneath Sagami Bay devastating Tokyo, the port city of Yokohama, and several nearby prefectures.

The timing of the quake, at lunchtime, meant many people were cooking when it struck, and that – combined with winds from an offshore typhoon – contributed to the firestorm that swept Tokyo.

Estimates vary, but more than 100,000 people are believed to have perished.

Since 1960, September 1st has been designated as an annual "Disaster Prevention Day" in Japan.

With the horrific events from last year’s Tohoku 9.0 earthquake, tsunami, and resultant nuclear crisis still fresh, the prospect of Japan enduring another great quake continues to haunt.

The Japanese government has stated that there is a 70% of a strong earthquake striking the capital over the next 30 years, but some academics see the threat as being much closer in time.

Over the past year, seismologists have detected an increase in the number of small quakes in and around the nation’s capital. A scenario not unlike what was seen in the lead up to last year’s massive quake.

This from the Tokyo Times.

The “Big One” was preceded by 1,000 smaller quakes

Monday, January 23, 2012

More than a thousand small, repeating earthquakes migrated towards the epicenter of the 2011 Tohoku Quake in the month before the disaster, scientists have learned.

(Continue . . . )

Today, the news wires are filled with stories on a report issued from researchers at the University of Tokyo that claims the likelihood of a strong (7+) Tokyo quake is greater than the government has maintained.

Major Tokyo quake more likely than government says: academics

(Reuters) - A major earthquake is far more likely to hit Tokyo in the next few years than the government predicts, researchers at the University of Tokyo said on Monday, warning companies and individuals to be prepared for such an event.

There is a 70 percent chance a magnitude 7 quake will jolt the southern part of the Tokyo metropolitan area in the next four years, the university's Earthquake Research Institute said.

(Continue. . .)

As I wrote last year in Divining Japan’s Seismic Future, Japan does not lack for devastating earthquake potential.

The most widely anticipated seismic event is the Tokai Earthquake – expected to be an 8+ magnitude, and forecast to occur between the Bay of Suruga and Cape Omasezaki in Shizuoka Prefecture sometime in the near future.

Major earthquakes have occurred in this region every 100-150 years, with the most recent recorded in 1498, 1605, 1707 and 1854.

That puts the Tokai region 157 years since their last major quake, and in the estimation of Dr Kiyoo Mogi – Japan’s leading seismologist – well overdue for another. In 1969, Dr Mogi began warning that the Tokai area was particularly vulnerable, and today the area is monitored continually by the JMA.

Which is why the Prime Minister of Japan called upon Chubu Electric to shut down its No. 4 and No. 5 reactors at the Hamaoka nuclear plant last May, located roughly 200 km south-west of Tokyo.

As for the seismic threat to the Tokyo region, Shinichi Sakai - associate professor at the earthquake research institute - is quoted today as saying:

"The government, individuals and corporations should make preparations for that now"

For more on earthquakes, you may wish to revisit:

UN Agency Warns On Global Seismic Risks

The Great Central U.S. Shakeout:2012

NPM11: Are You Earthquake Prepared?

WHO: Will Host H5N1 Talks In Geneva

2012-01-22T07:41:00.001-05:00

# 6094

On Friday a coalition of H5N1 researchers offered a 60 day moratorium on controversial bird flu research in order to `allow time for international discussion’ (see Scientists Announce 60 Day Moratorium On Some H5N1 Research).

Late yesterday the World Health Organization announced that they will host talks in Geneva among a small group of scientists next month. As you might expect, @HelenBranswell of the Canadian Press is all over this story.

Follow the link to read her coverage:

Meeting to address bird flu research impasse: WHO

The Canadian Press

Date: Saturday Jan. 21, 2012 5:39 PM ET

A small -- in relative terms -- group of technical experts will be invited to Geneva in mid-February to begin the difficult task of trying to break an impasse arising from the proposed publication of controversial bird flu research, the World Health Organization revealed Saturday.

(Continue . . .)

With both sides seemingly solidly entrenched,we’ll have to wait to see whether any substantial compromises can be forged during this relatively short 60 day time-out.

China Reports 2nd Bird Flu Fatality In A Month

2012-01-22T07:13:00.001-05:00

# 6093

On the heels of recent human H5N1 infections reported in Indonesia, Egypt, Vietnam, and Cambodia - China has announced their second bird flu fatality in less than a month.

This time it reportedly involves a 39-year-old man living in Guizhou, a province in southern China.

The AP and AFP are reporting this patient, who was described as being in critical condition several hours ago, as having died on Sunday (AP link)

Here is the official notification from the Hong Kong Centre For Health Protection.

Notification of a human case of H5N1 in Guizhou

The Centre for Health Protection (CHP) of the Department of Health received notification from the Ministry of Health (MoH) today (January 22) concerning a confirmed human case of influenza A (H5N1) in Guizhou.

A CHP spokesman said the patient was a 39-year-old man living in Guizhou. He developed symptoms on January 6 and was admitted to a hospital on the same day. He is now in critical condition. The man did not report obvious exposure history to poultry before the onset of symptoms.

Laboratory tests on the patient's specimen by the Chinese Centre for Disease Control and Prevention yielded a positive result for H5N1.

The CHP is maintaining close liaison with the MoH to obtain more information on the case. We will heighten our vigilance and continue to maintain stringent port health measures in connection with this development, the spokesman said.

The spokesman reminded members of the public to remain vigilant against avian influenza infection and to observe the following measures:

Avoid direct contact with poultry and birds or their droppings; if contacts have been made, they should wash hands thoroughly with soap and water;

Poultry and eggs should be thoroughly cooked before eating;

Wash hands frequently;

Cover nose and mouth while sneezing or coughing, hold the spit with tissue and put it into covered dustbins;

Avoid crowded places and contact with sick people with fever;

Wear a mask when you have respiratory symptoms or need to take care of patients with fever;

When you have fever and influenza-like illnesses during a trip or when coming back to Hong Kong, you should consult doctors promptly and reveal your travel history.

For further information on avian influenza, please visit the CHP website: www.chp.gov.hk.

Ends/Sunday, January 22, 2012
Issued at HKT 15:44
NNNN

Despite the standard cautions about exposure to poultry listed above, the AFP report indicates - that like the case in Guangdong province in late December - this victim claimed no known contact with poultry over the past 30 days.

The report goes on to say that 71 contacts of this victim are being monitored, but none have developed any signs of illness.

This recent spate of cases comes amid the traditional Lunar New Years celebration, a 6-week period which sees hundreds of millions of Asians returning to home and family to celebrate each year.

The Lunar New Year occurs on January 23rd this year, and as they do every year, public health officials will be on the lookout for any signs of unusual disease outbreaks in the wake of this mass migration.

The recent spike in human H5N1 infections is something we see each winter, but fortunately we’ve yet to see any signs of sustained human-to-human transmission of this virus.

Nevertheless, as these cases continue to trickle in scientists keep watch for any signs that might indicate the virus is adapting better to humans.

Indonesia To Increase Surveillance For H5N1: MOH

2012-01-21T09:46:00.001-05:00

Photo Credit – FAO

# 6092

My thanks to Arkanoid Legent for picking up on this Jakarta Post story on the proposed government response to the two recent bird flu deaths in north Jakarta.

Bird flu alert raised after death of Jakarta siblings

Elly Burhaini Faizal, The Jakarta Post, Jakarta | Sat, 01/21/2012 12:31 PM

While you should follow the above link to read the entire story (which relates in some detail the events leading the deaths of these siblings) the Minister of Health Endang Rahayu Sedyaningsih is quoted as saying that the will conduct sentinel surveillance for the H5N1 virus in people presenting with influenza-like-illness, both in hospitals and community health centers.

“In the community health centers, we take specimens from people seemingly infected by the flu and test to see whether they have the seasonal flu virus only or H5N1.” - Indonesian MOH

Yesterday, the Health Minister was quoted as being concerned that the high fatality rate among known H5N1 cases in Indonesia might be due to growing antiviral resistance (see Indonesia: MOH Suspects H5N1 May Be Gaining Antiviral Resistance).

What is not known, of course, is whether there are mild, or subclinical cases going uncounted in Indonesia. Most researchers suspect that there are, but how many is anyone’s guess.

What is desperately needed in Indonesia, Egypt, and other places where the virus is endemic are systematic seroprevalence studies, to determine the actual rate of infection.

Without them, we are basically just guessing.

Earlier this week we learned that a mild case of H5N1 was picked up by routine surveillance from a sample taken from an outpatient seen last October at a sentinel flu clinic (see WHO Updates H5N1 In Egypt & Indonesia).

Lastly, it should be noted the newshounds at FluTrackers and the Flu Wiki are watching multiple suspected cases of H5N1 infection in Egypt and Indonesia being reported in the local media.

Given that this is cold & flu season, it is certainly possible that some (or even all) of these cases have something other than bird flu.

When we get more solid information, I’ll post it.

AFD Turns 6

2012-01-21T08:04:00.001-05:00

# 6091

Yesterday marked my sixth blogiversary at Avian Flu Diary - my very first essay under this banner , A humble Beginning – having appeared on January 20th, 2006.

Looking back at the prose and content of that first entry, that essay was aptly named. Of course, I never expected anyone to actually read it.

I originally created this blog as a personal diary, and to hopefully let a handful of friends and relatives stay updated on the pandemic threat.

I had no idea anyone else would ever discover it, otherwise I assure you, I’d have worked harder on coming up with a better name.

While it is my name on the masthead, this blog is by no means a solitary effort.

Each day I rely upon the newshounds on the flu forums (I frequent FluTrackers and the Flu Wiki) to help dig up, and translate, news items from all around the world. They not only find these tidbits of information, they often provide analysis as well.

While I mention them often, you can read my tribute to these terrific volunteers in Newshounds: They Cover The Pandemic Front.

If I had to do all of this research personally, I wouldn’t have time left to blog. So my heartfelt thanks go out to each and every one of these newshounds.

I’m blessed to be part of a greater blogging community we call Flublogia, including (but not limited to) Crof at Crofsblog, Arkanoid Legent, BFIC, Scott McPherson, Ironorehopper at A Time’s Memory along with related, but non-flu-centric blogs like Maryn McKenna’s Superbug blog, Ian York’s Mystery Rays, and Vincent Racaniello’s Virology blog.

Class acts every one.

And beyond Flublogia, there are other terrific bloggers who specialize in public health and/or science related issues, such as The Pump Handle, and Jim Garrow’s The Face of the Matter blog, and David Dobb’s Neuron Culture.

You’ll find more examples on my sidebar.

Of course, I’ve also been fortunate to be able to rely upon the great reportage from ace medical and science writers like Helen Branswell of the Canadian Press, Maggie Fox of the National Journal, Jason Gale of Bloomberg News, Lisa Schnirring & Robert Roos at CIDRAP, and everyone’s favorite `scary disease girl’; Maryn McKenna.

But I owe a special thanks to my `inner circle’, the people with whom I’ve spoken often, and who have provided me with wise counsel, good ideas, and when needed – a reality check - along the way.

In no particular order, they include:

Sharon Sanders of FluTrackers, Lisa at CIDRAP, my good buddy and fellow blogger Scott McPherson, Chacal in England, Cheryl, my high school buddy Cliff, and the always insightful and supportive Camille.

You guys are terrific.

And not listed – but deeply appreciated - are the scores of others who have graciously emailed, twittered, phoned, left comments telling me what they’d like to see me do with my blog, or found other ways to connect with me over the years.

Many of them you’ll find mentioned in my yearly Thanksgiving roll call blog, so I won’t repeat that list here today.

And lastly, there are the readers of this blog.

I can see, using my site meter software, many of the identities of those who visit each day (not people’s names, but IP addresses and domains).

I’m constantly amazed and delighted at the number of hospitals, universities, government agencies, and big corporations who elect to come here. This blog may not draw huge numbers of visitors, but their quality is undeniable.

Thank you.

In short, this blog has been a wonderful journey. One that has brought many new friends, and an avalanche of new knowledge into my life.

While six years is a long time in `internet years’, I look forward to continuing into the future; hopefully for as long as I can find something new and interesting (even if only to me) to write about.

It Gives You Fever

2012-01-21T07:37:00.001-05:00

# 6090

Amid blogging the sound and fury of this past week’s controversial bird flu news, I’ve spent a number of good hours enjoying a freshly minted copy of Peter Christian Hall’s pandemic novel American Fever, which he was kind enough to send me.

You may recall that twice in 2009 (Catching An American Fever, A Recurrent Fever) I wrote about the genesis of this online novel, which is written through the eyes of a New York City flu blogger as he watches his world unravel into a dystopian nightmare during an H5N1 pandemic.

Hall - a well established writer, journalist, and filmmaker – has seen his works published in The Huffington Post, Reuters, and Rolling Stone – just to name a few.

Peter recently interviewed Crof, Scott McPherson, Cottontop, and myself for an article on flu bloggers, and our reaction to the movie Contagion, for The Huffington Post (see Contagion Grips 'Flublogia').

In American Fever Peter weaves real-life flu bloggers into his narration, referring to (and providing links) to most of Flublogia as the novel progresses.

The web version remains online (edited, tightened up, and better than ever) which you can access for free, but now there is an e-book, and a printed version you can purchase.

Although I miss the ability to click and follow embedded links (of which Peter provides hundreds), personally I find it a lot easier to read a printed novel than one that is online.

It’s probably an age/eyesight issue.

Since I’m not a professional book reviewer, for a true literary dissection I’ll refer you to a couple of reviews of American Fever (here and here) that have appeared elsewhere.

For my part I’ll say that I thoroughly enjoyed the novel, and actually learned (and in some cases re-learned) a few things about flu in the process.

I do hope that Peter’s dark vision of what happens to outspoken flu bloggers during an H5N1 pandemic never comes to pass.

I keep repeating to myself . . . It’s only fiction . . .

Bottom line: American Fever – catch it, before it catches you.

Branswell On The Research Moratorium

2012-01-20T20:55:00.001-05:00

# 6089

Tonight Helen Branswell provides us with context and comments from no less than Ron Fouchier, Dr. Anthony Fauci, and Michael Osterholm on the big flu story of the day; the 60 day moratorium being offered on conducting certain types of bird flu research.

At this point I’m going to do the sensible thing; step aside and invite you to follow the link below to read the whole story.

Flu scientists halt research on lab-made viruses for 60 days to foster talks

Helen Branswell, Friday, January 20, 2012 8:4 PM

ScienceMag: Ron Fouchier Interview On The H5N1 Research Moratorium

2012-01-20T16:52:00.001-05:00

BSL-4 Lab Worker - Photo Credit –USAMRIID

#6088

Via Science Magazine’s Insider coverage, we get a lengthy interview (translated & edited for clarity and brevity) with Erasmus University Flu researcher Ron Fouchier, whose revelations of creating a transmissible form of H5N1 at a scientific conference last September has unleashed a firestorm of debate.

Earlier today he, along with 38 other prominent flu researchers, agreed to a 60 day moratorium on controversial genetic research on the H5N1 virus to to `allow time for international discussion.’

As you’ll read, this debate has badly polarized scientists and policy makers. Follow the link to read:

Flu Researcher Ron Fouchier: 'It's a Pity That It Has to Come to This'

by Martin Enserink on 20 January 2012, 3:42 PM |

In a statement posted today on the Web sites of Nature and Science, a group of 39 influenza researchers announced a 2-month moratorium on studies that make the avian influenza strain H5N1 more transmissible between mammals. The moratorium is intended to allow time for an international debate about this type of research, which some people say has the potential to help bioterrorists.

(Continue . . . )

To prevent this from becoming a one-sided debate (both sides are raising valid & important issues), you’ll find opposing views expressed in a series of opinion pieces published yesterday in Public Health, Biosecurity, and H5N1 via Science Magazine’s Science Express.

You’ll also find a series of news articles that cover this ongoing controversy, along with a link to Science’s Special Online Collection: Influenza page at THIS LINK.

For background on this growing controversy, you may wish to revisit these earlier blogs:

Nature: 10 Expert Opinions On The H5N1 Research Dilemma

WHO To Take Role In Sorting Out Bird Flu Research Controversies

The Furor Over H5N1 Research Continues

Scientists Announce 60 Day Moratorium On Some H5N1 Research

2012-01-20T13:42:00.001-05:00

# 6087

While I was immersed in writing my last blog, the news broke that a letter - signed a veritable `who’s who’ of international H5N1 researchers - has offered a 60 day moratorium on certain types of H5N1 research to `allow time for international discussion.’

As you might expect, Science Magazine already has detailed coverage of this development.

In Dramatic Move, Flu Researchers Announce Moratorium on Some H5N1 Flu Research, Call for Global Summit

by David Malakoff, Martin Enserink, Gretchen Vogel, Jon Cohen on 20 January 2012, 12:42 PM

Indonesia: MOH Suspects H5N1 May Be Gaining Antiviral Resistance

2012-01-20T13:10:00.001-05:00

# 6086

In Indonesia the antiviral Tamiflu ® (Oseltamivir) has been distributed fairly liberally over the past 6 years whenever there has been a suspected case of H5N1.

Households, whole neighborhoods - sometimes entire villages - have been placed on prophylactic antivirals in what is commonly called a `Tamiflu Blanket’. The idea is to stop or prevent household or community transmission of the virus.

And the fact that we’ve seen only a few clusters of the H5N1 virus over the years is suggestive that this policy may have been at least partially successful.

But the fear when you use antivirals is that over time, the targeted virus will develop resistance.

That happened in 2008 with the old seasonal H1N1 virus (which was supplanted by pandemic H1N1 in 2009), and in recent months we’ve seen small indications that it may be occurring in some strains of the new H1N1 virus (see NEJM: Oseltamivir Resistant H1N1 in Australia).

So far, most of the H5N1 cases we’ve seen have appeared to be sensitive to oseltamivir, although a few resistant cases have been documented in Indonesia and Egypt.

See CIDRAP’s 2007 article Tamiflu-resistant H5N1 strain surfaces in Egypt and 2005 article Tamiflu resistance in avian flu victims sparks concern.

One of the striking features about Indonesia’s H5N1 cases is the high CFR (Case fatality rate) of 82% – even with antiviral treatment – which is more than double that seen in Egypt (35%).

Today, Indonesia’s Health Minister Endang Rahayu Sedyaningsi is quoted in the media as worrying that oseltamivir may be losing effectiveness against the Indonesian strains of bird flu.

A hat tip to Diane Morin on FluTrackers for finding the following article which appears in Media Indonesia. The original link to the Indonesia (Bahasa) language version is HERE.

The following is a machine translation.

Indonesia Health Minister Suspected Bird Flu Immune Drug

Authors: Cornelius Eko Susanto

Friday, January 20, 2012 22:47 pm

JAKARTA - MICOM: Health Minister Endang Rahayu Sedyaningsih suspect in Indonesia has occurred the possibility of resistance (drug resistance) to the drug oseltamivir.

The hypothesis was made based on the presence of some positive victims of bird flu in Indonesia are still died despite oseltamivir have been given early on.

"I suspect resistance to oseltamivir has been happening in Indonesia. That is why the death rate of bird flu patients here reaches more than 80% when oseltamivir was given, "said Minister of Health at a press conference after the ministerial coordination meeting to discuss bird flu on Friday (20 / 1), in Jakarta.

Himself said, there may exist specific genes in the H5N1 virus in Indonesia that caused the H5N1 virus in Indonesia is more virulent than the H5N1 viruses that exist in other countries.

"Honestly, I was curious as a former researcher with the possibility of the existence of this gene," he said.

If there is resistance to oseltamivir, Indonesia no longer has a drug to counteract the spread of the H5N1 virus. Because, oseltamivir is the only drug that can kill the flu virus, although with certain prerequisites and conditions.

In the market, oseltamivir sold under the brand Tamiflu. (Tlc/OL-5)

Based on this article, this theory appears predicated on anecdotal observations; mostly the high CFR. What is needed now is genetic sequencing of these isolates to look for known resistance markers.

One of the big concerns over Indonesia’s prolonged refusal to share samples of the H5N1 virus was that the virus would mutate or change without the world being aware what was happening.

With new virus sharing agreements put into place last year, hopefully the world will get a good look at the viral evolution in Indonesia and be able to document if any serious changes have occurred.

Stay tuned.

The Tamiflu Controversy Continues

2012-01-20T08:07:00.001-05:00

Photo Credit – Wikipedia

# 6085

The debate over the effectiveness of oseltamivir (Tamiflu ®) is back in the news once more with the release of a new Cochrane group analysis that finds insufficient evidence to prove that the drug reduces flu complications and transmission.

If it seems we’ve been here before, you are right (see Effect Measure’s The Tamiflu doesn't work non-story from 2009).

Many researchers point out anecdotal and observational data showing that early administration of oseltamivir does reduce complications from influenza, and can be lifesaving.

As an example, In 2010 we saw an observational study that appeared in JAMA (see Study: Antivirals Saved Lives Of Pregnant Women) that strongly suggested that Tamiflu was life saving for some patients with pandemic flu.

And again in 2010, in BMJ: Efficacy of Oseltamivir In Mild H1N1, we saw a study which suggested that the administration of oseltamivir may have significantly reduced the incidence of pneumonia among otherwise healthy pandemic H1N1 patients.

And lastly, in Study: Antiviral Therapy For H5N1, we saw the largest study to date on the outcomes of H5N1 patients who either received, or did not receive, antiviral treatment.

The research appears in the IDSA’s Journal of Infectious Diseases. The bottom line is essentially out of 308 cases studied, the overall survival rate was a dismal 43.5%.

But . . . of those who received at least one dose of Tamiflu . . . 60% survived . . . as opposed to only 24% who received no antivirals.

Alas, these are observational studies, which are not considered the `best evidence’ by most scientists.

Ideally what researchers want are a series of well mounted Randomized controlled trials (RCTs) – long considered the `gold standard’ for drug research. But these are expensive, and difficult to conduct ethically when trying to evaluate a potentially life saving drug.

So we are left with is a choice that reminds one of the one offered by Chico Marx in the 1933 classic Duck Soup (“Who you gonna believe, me or your own eyes?”).

Choosing between observational data that suggests a clinical benefit verses a lack of well mounted studies that actually prove a benefit.

Complicating matters, there are ongoing charges that Roche Laboratories has not been forthcoming with all of the data that has been requested by the Cochrane group.

Admittedly, there are other concerns when it comes to use of oseltamivir, including the possibility of incurring side effects and the (potential, at least) of generating resistant strains of the influenza virus.

Robert Roos of CIDRAP News takes us on a detailed journey down this rabbit hole, with as good a summary of the issues as you are apt to find anywhere.

Review renews questions about oseltamivir benefits

Robert Roos News Editor

Jan 19, 2012 (CIDRAP News) – A lengthy new analysis of unpublished clinical trial data is renewing questions about the effectiveness of the influenza drug oseltamivir (Tamiflu), saying that although the drug shortens flu symptoms by about a day, there is no evidence that it reduces hospital admissions.

(Continue . . .)

Despite a lot of unanswered questions, for now at least, oseltamivir remains one of the few pharmacological options likely to be available during a pandemic.

WHO Updates H5N1 In Egypt & Indonesia

2012-01-19T11:47:00.001-05:00

# 6084

The World Health Organization has posted updates on the Indonesian fatality I blogged about this morning (see Indonesian MOH Announces Bird Flu Fatality), along with two new cases of H5N1 infection in Egypt.

First, the Indonesian case where the girl is listed simply as a `family contact’ of case # 183.

Avian influenza – situation in Indonesia - update

19 January 2012 - The Ministry of Health of Indonesia has announced one new confirmed case of human infection with avian influenza A(H5N1) virus.

The case is a 5 year-old female from Jakarta Province. She was identified by a surveillance team during an investigation in the area on 7 January 2012 and was referred to a hospital. On 13 January 2012, she had breathing difficulties. Her condition deteriorated and she died on 16 January 2012.

Epidemiological investigation indicated that she was a family contact of case 183, and frequently had direct contact with the same pigeons as that case, and the same household environment.

Surveillance of other contacts has not identified further cases.

Of the 184 cases confirmed to date in Indonesia, 152 have been fatal.

Next stop, Egypt, where the MOH has reported two new cases.

Avian influenza - situation in Egypt - update

19 January 2012 - The Ministry of Health and Population of Egypt has notified WHO of two cases of human infection with avian influenza A (H5N1) virus.‪

The first case is a 2 year-old female from Cairo Governorate. She visited Helwan Fever Hospital as an outpatient on 30 October 2011 with symptoms of influenza-like-illness (ILI). The case was confirmed by RT-PCR at the Central Public Health Laboratory through periodic testing of samples collected from ILI outpatients from sentinel ILI surveillance sites.

The epidemiological team investigated the case after confirmation of the laboratory test. Retrospective investigation through data collected from her family identified a positive history of exposure to backyard poultry. Samples from the case have been sent to the US Naval Medical Research Unit No. 3 (NAMRU-3) for further sequencing.

The second case is a 31 year-old male from Fayium governorate. He developed symptoms on 1 January 2012, received oseltamivir on 14 January 2012 and is still hospitalised under the critical care unit. The case was confirmed by the Central Public Health Laboratory, a National Influenza Center of the WHO Global Influenza Surveillance Network.

Epidemiological investigations into both the cases indicated that they had exposure to backyard poultry.

Of the 159 cases confirmed to date in Egypt, 55 have been fatal.

A bit unusually, the first case appears to have been treated as an outpatient, and was not hospitalized. Her infection was picked up later as part of a routine screening of samples collected from sentinel ILI surveillance sites.

Egypt has case fatality rate among known H5N1 cases of about 35% - which is less than half that reported by Indonesia (82%). It is fair to assume that surveillance doesn’t pick up every case, so these numbers may be artificially inflated.

Whether the difference between these two regions is due to the varying strains that are circulating, more vigilant surveillance in Egypt, or differences in medical care is difficult to know.

This trend was particularly noticeable during the first half of 2009, when a string of about a dozen toddlers were found to have contracted what appeared to be a milder form of the H5N1 virus.

The CFR dropped (temporarily) to about 10%.

While a milder form of bird flu might sound like a good thing, several top virologists have warned that it might signal a better adaptation to human physiology.

Back in 2009, Dr. Robert Webster of St Jude Children’s Research Hospital and Dr. John Oxford of of Queen Mary, University of London – both expressed concern over the trend in Egypt (see Meanwhile, Back In Egypt . . .).

As these sporadic cases continue to trickle in, it is worth remembering that the world remains at Pre-pandemic Phase III on the H5N1 virus. Which is why we continue to watch for signs that the virus is adapting better to humans.

Science Magazine: Public Health, Biosecurity, and H5N1

2012-01-19T11:09:00.001-05:00

BSL-4 Lab Worker - Photo Credit –USAMRIID

# 6083

My thanks to Lisa at CIDRAP for pointing me this morning in the direction of an an avalanche of commentaries on Public Health, Biosecurity, and H5N1 published online ahead of print via Science Magazine’s Science Express.

These opinion pieces are penned by some of the most respected names in the world of influenza research.

For background on this growing controversy, you may wish to revisit these earlier blogs:

Nature: 10 Expert Opinions On The H5N1 Research Dilemma

WHO To Take Role In Sorting Out Bird Flu Research Controversies

The Furor Over H5N1 Research Continues

I’ve only just begun to read these papers, but wanted to provide my readers with the links as soon as possible.

Public Health, Biosecurity, and H5N1

H5N1 Debates: Hung Up on the Wrong Questions

Daniel R. Perez

Published online 19 January 2012

DOI:10.1126/science.1219066]

Abstract

Full Text (PDF)

Life Sciences at a Crossroads: Respiratory Transmissible H5N1

Michael T. Osterholm and

Donald A. Henderson

Published online 19 January 2012

DOI:10.1126/science.1218612]

Abstract

Full Text (PDF)

The Limits of Government Regulation of Science

John D. Kraemer and

Lawrence O. Gostin

Published online 19 January 2012

DOI:10.1126/science.1219215]

Abstract

Full Text (PDF)

Restricted Data on Influenza H5N1 Virus Transmission

Ron A. M. Fouchier,

Sander Herfst,

and Albert D. M. E. Osterhaus

Published online 19 January 2012

[DOI:10.1126/science.1218376]

Abstract

Full Text (PDF)

You’ll also find a series of news articles that cover this ongoing controversy, along with a link to Science’s Special Online Collection: Influenza page at THIS LINK.

Indonesian MOH Announces Bird Flu Fatality

2012-01-19T06:43:00.001-05:00

UPDATED 0800hrs EST – See Bottom

# 6082

Ten days ago we learned of the death of a 23 year-old man living in north Jakarta from the H5N1 virus, presumably contracted from pigeons he was raising (see Bird Flu Suspect Dies In Indonesia).

At the time, there were media reports that this man’s sibling (ASR, age 5) was also ill and hospitalized, but it was reported on January 9th that he/she tested negative for the H5N1 virus.

5-Year-Old Brother of Bird Flu Victim Cleared by Doctors

Dofa Fasila | January 10, 2012

Health authorities in Jakarta on Monday gave the 5-year-old brother of a young man who recently died of bird flu a clean bill of health.
The toddler, identified only as A.S.R., was hospitalized with a fever and cough on Saturday, the same day his 23-year-old brother, P.D.Y., died of the disease.

We know that testing for the H5N1 virus has always been difficult, particularly once a patient is placed on antivirals, and we’ve seen some cases where patients tested negative repeatedly up until their demise, and bird flu infection was only established post-mortem.

Which is why many observers of the bird flu situation in Indonesia take negative test results with a grain of salt.

Today, via a statement released from the Indonesian Ministry of Health (h/t Gert van der Hoek on FluTrackers), we now learn that a 5 year old girl from the same neighborhood (with exposure to pigeons) has died after testing positive for the virus on January 13th.

Most of the details match those of the 5 year-old referenced above (excluding gender), so it seems likely they are one in the same. Hopefully we’ll get a clarification of gender, and exact relationship to the first victim (if any), when the WHO updates this case.

The following is a machine translation from the Sehat Negeriku (Healthy Country) website maintained by the Ministry of Health’s Center for Public Communication. While a lengthy update, conspicuous by its absence is any direct mention of the first fatality, the 23 year old who died on January 7th.

I’ve bolded a few passages.

Bird Flu Case Update

January 19, 2012 | 3:16 pm

Ministry of Health, through the Directorate General of Disease Control and Environmental Health announced a new case of H5N1 have been confirmed by the Center for Biomedical and Health The basic technology, Health Research Agency.

The case on behalf of the U.S. (female, 5 years) who Tanjung Priok, North Jakarta, Jakarta Province. U.S. surveillance teams discovered during investigations in the region on January 7, 2012. He experienced symptoms of fever since the day before and was referred to the department of Friendship. The U.S. immediately get in the intensive care isolation room, according to the administration of examinations suspect bird flu.

On January 13, 2012, the patient experienced shortness of breath, and performed medical acts in accordance with procedures. At that time examination Polymirasea Chain Reaction (PCR), virus-infected patients tested positive for H5N1. Because of his condition continued to decline, eventually the patient died on January 16, 2012 at around 2:00 pm.

Based on the epidemiological investigation into the patient's house and the surrounding environment by Kemenkes Team and the local health office, and obtained the relevant information that is often brought into the workplace workshop PD (bird flu positive patients) where there are domesticated pigeons, are often invited to the ranch owned by friends of pigeons PD, and are often given food without washing hands after holding a dove.

With the increase of these cases, the cumulative number of bird flu in Indonesia since 2005 until this news broadcast is 184 cases with 152 deaths.

Director General of Disease Control and Environmental Health (PP and PL), Prof. dr. Tjandra Yoga Aditama, Sp (K), MARS, DTM & H, DTCE, vocal point as the International Health Regulations (IHR) have also been informed of this case to the WHO.

(Continue . . .)

Although we continue to see isolated human infections around the world, for now H5N1 is primarily a threat to poultry.

The virus remains poorly adapted to human physiology, and despite ample opportunities in places like Egypt and Indonesia, only causes rare, sporadic infections.

Still, with 20+ clades of the virus out there, continually mutating and adapting, the concern is that one of these days the virus will figure out how to infect humans efficiently.

So we watch these isolated cases with considerable interest, looking for any signs of enhanced transmission.

UPDATE:

Arkanoid Legent - one of the best newshounds on the net - has an update from the Antara News agency which indicates this latest victim is the niece (translated as nephew) of the first fatality.

Indonesia : Ministry of Health stated AS death positive bird flu

Machine translated article from Antara :

" Ministry of Health (Kemkes) in a statement here on Thursday, said the death of the girl with the initials AS (5) on Monday (16 / 1) is positive for bird flu.

AS is the nephew of PD (23) who died on January 7, 2012 ago and also tested positive for bird flu and the two alleged victims have contracted the H5N1 virus from the same source of pet birds PD.

"Since entering the hospital, AS have been given help and given medication, but is this bird flu death rate is quite high," said Director General of Disease Control and Environmental Health (P2PL) Tjandra Yoga Aditama when contacted by AFP on Thursday."

UN Agency Warns On Global Seismic Risks

2012-01-18T12:30:00.001-05:00

Seismically active areas of the world

# 6081

While major earthquakes are normally associated with the Pacific rim, or parts of Asia and the middle-east, in truth many other regions of the world are at some risk of serious seismic activity.

Last December, in WHO e-Atlas Of Natural Disaster Risks To Europe, we looked at some of the seismic risks to Europe, and in April of 2011 (see UNDP: Supercities At Seismic Risk) we saw a report that stated that half of the world’s supercities (urban areas with 2 million – 15 million inhabitants) are at high risk for seismic activity.

According to the Centre Sismologique Euro- Méditerranéen (CSEM) there have been nearly 750 (mostly minor) Euro-Med earthquakes recorded over the past two weeks.

While large earthquakes are rare in central, western, or northern Europe, they are not unheard of.

In 1356, on the evening October 18th - the Feast day of Saint Luke the Evangelist – perhaps the strongest quake in central Europe’s history struck in the evening, destroying the Swiss town of Basel and leveling practically every major structure within 30 kilometers of the city.

The quake was preceded by a foreshock between 7 and 8 pm, with the main quake striking around 10pm. It was felt as far away as Zürich, Konstanz and even in Île-de-France.

While seismographs were not invented 650 years ago, estimates put this quake at between 6.2 and 6.5 on the modern Richter scale.

Le tremblement de terre qu a eu lieu en 1356. - Karl Jauslin (1842–1904)

In 1755, on November 1st (All Saint’s Day), what would prove to be one of the deadliest earthquakes to ever strike Europe literally destroyed Lisbon, Portugal along with dozens of fishing villages along the coast, and sent Tsunami waves crashing into the UK, Northern Africa, and the Caribbean.

The quake, which occurred a couple of hundred kilometers offshore, was estimated to have been 8.2 or greater on the Richter scale.

Tremendous tsunamis (20+ meters) were reported in Northern Africa, and smaller waves washed ashore in the Caribbean and the Atlantic Coast of the New World many hours later.

Lest anyone think this is simply `ancient history’ - never to be repeated - a somewhat smaller quake (7.8 magnitude) struck in roughly the same area in 1969.

While damage was moderate, and only a minor (1+ meter) tsunami was generated, 13 people were killed and many more injured.

The bottom line is that earthquakes (and tsunamis) can and do occur even in places that are not considered seismically active. And while rare, they can produce catastrophic results.

All of which serves as prelude to a Press release issued today from the United Nations International Strategy For Disaster Reduction (UNIDSR.Org) warning against ignoring seismic threats.

UNISDR warns against ignoring seismic threats as quakes wreak havoc for second year

302 human impact disasters claimed 29,782 lives; affected 206 million and inflicted record economic damages of $366 billion in 2011

Geneva, 18 January 2012 – For two consecutive years the long-term disasters trend has been bucked by major earthquakes which claimed thousands of lives and affected millions in both 2010 and 2011, according to new statistics published today by CRED and the UN office for disaster risk reduction, UNISDR.

UNISDR Chief, Margareta Wahlström, said today: “The Great East Japan Earthquake and the accompanying tsunami is a reminder to us all that we cannot afford to ignore the lessons of history no matter how forgotten. The many major cities located in seismic zones need to take seriously the probability of return events even if many years have passed since the last seismic event of major magnitude.

“In 2010 we saw this phenomenon as well when over 220,000 people died in Haiti which had not been hit by an earthquake of such strength for almost 200 years. Unless we prepare for the worst then many earthquake-prone urban areas around the world are destined to see even greater loss of life in the future as more and more people move to cities.”

Figures released today by the Centre for Research on the Epidemiology of Disasters (CRED) at a UNISDR-hosted press conference in Geneva showed that 20,943 people lost their lives in earthquakes last year out of a total of 29,782 people directly killed by 302 disasters. The earthquake fatalities included 19,846 who died in Japan while the remainder were largely accounted for by the October earthquake in Turkey.

(Continue . . . )

The EM-DAT Project is supported by USAID.

2011 Disaster Statistics [PDF 217.41 kB]

Press release [PDF 167.53 kB]

Date: 18 Jan 2012
Sources: United Nations International Strategy for Disaster Reduction Secretariat (UNISDR)

While we can’t predict where the next earthquake will occur, or do anything to stop it, we can prepare to deal with one when it happens.

For good, solid information on how prepare for `the big one’ (even if you live someplace other than Los Angeles), I would recommend you download, read, and implement the advice provided by the The L. A. County Emergency Survival Guide.

While US-centric, FEMA has an earthquake hazard webpage with a lot of resources that would be of use to just about anyone, including the following preparedness information.

Earthquake Information for Individuals and Families

Below are links to earthquake-related information of use to individuals and families. There are many things that you can do to reduce the chances that you or members of your family will be injured, or that your property will be damaged, by earthquakes. Use the following resources to help make your family, your home, and your community more resistant to the potentially dangerous and damaging effects of earthquakes.

What to Do During an Earthquake
Everyone living in or visiting seismically active regions needs to learn—and practice—how to protect themselves in an earthquake. This fundamental seismic safety information can save lives and reduce injuries.

Earthquake Preparedness at Home
Learn about what to do at home before, during, and after earthquakes. Topics include how to strengthen your home, secure its contents, and prepare yourself and your family to react safely, take cover, survive on your own, stay in contact, and care for people, pets, and property.

Earthquake Publications and Tools—Individuals and Families
Browse and access FEMA publications that provide in-depth guidance on protecting residential structures, their contents, and their occupants from earthquake hazards. All can be downloaded online, and most can be ordered in print or on compact disc.

Earthquake Contacts
Find individuals and organizations that you can go to for more information about earthquake risk-reduction activities in your state, in your region, or at FEMA.

Emergencies happen every day. Disasters, admittedly, less often.

But in either event, preparedness is key.

At a bare minimum, every household should have a disaster plan, a good first aid kit (and the knowledge to use it), and emergency supplies to last a minimum of 72 hours during a disaster.

Personally, I’d be uncomfortable with anything less than a week.

To become better prepared as an individual, family, business owner, or community to deal with these types of disasters: visit the following preparedness sites.

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

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

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

H5N1 Reports From Cambodia, Vietnam, & Egypt

2012-01-18T07:41:00.001-05:00

# 6080

This is the time of year when bird flu reports tend to increase, and so it is not surprising that we are seeing a number of reports on human and avian infections coming from the `usual suspects’; Cambodia, China, Vietnam, India, and Egypt.

First stop, a report in the Vietnamese Media (h/t Tetano on FluTrackers) describing a very recent fatality, ostensibly from the H5N1 bird flu virus. I’ve only printed an excerpt, you can read the entire machine translation on this FluTrackers thread.

A/H5N1 flu appears in the West, who died

Thứ Tư, 18/01/2012 - 14:01

(Dân trí)-hospitalized in a State of fever accompanied by cough and fatigue coal report, male patients L.V.N (age 18) quickly lapsed into respiratory failure leading to death. Sample test results at the Institut Pastuer TPHCM swabs showed patients were positive for influenza A/H5N1.

at the emergency meeting discusses disease prevention projects at the time of the year by the Department of Health organizes creative 16/1, DR. Le Royal San, HO CHI MINH CITY Institute Deputy Pastuer said: 'influenza A/H5N1 were re-appeared in the southern region. Victims are young men age 18 worked as shepherds duck in Hau Giang Province

Trying to glean details from a machine translation is always fraught with danger, but it appears that an 18 y.o. male showed up at a Kien Giang province hospital with fever, cough, and fatigue after several days of illness in early January.

On the 10th, the hospital sent out samples to the Institut Pastuer for H5N1 testing, but before positive test results could be returned, the patient went into respiratory failure and died.

While this article strongly indicates H5N1, until this case is reported to the World Health Organization by Vietnam’s Health Ministry, it remains a suspected case.

Next stop, while not unexpected, sad news nonetheless out of Cambodia, where the 2 y.o. we learned about last Friday in critical condition with bird flu has died.

Bird flu-infected Cambodian boy died

Updated January 18, 2012 01:54 PM
PHNOM PENH (Xinhua) -- A 2-year-and-7 month-old boy from northwestern province of Banteay Meanchey had died early Wednesday from avian influenza A (H5N1) virus after being admitted to hospital for about a week, said a senior health official.

"The boy passed away at 2:00 a.m. early Wednesday due to critical condition," Sok Touch, director of the Health Ministry' s anti-communicable disease department, told Xinhua over telephone on Wednesday.

He said the boy was the nineteenth person in Cambodia to become infected with H5N1 virus, and the first person died this year. "To date, 17 persons had died from H5N1 in Cambodia," he said.

(Continue . . .)

And finally, over the past few days we’ve seen an increase in the number of news reports coming out of Egypt on suspected H5N1 cases being treated in local hospitals.

Egypt is extremely proactive in isolating and treating suspected bird flu patients, and so the vast majority that have been hospitalized over the years have turned out to be false alarms.

Whether any of this current crop of suspect cases turns out to be actually due to the H5N1 virus is something we’ll have to wait to see.

That said, a sample of the kind of reports we are getting from the Arabic media follows. A hat tip to Sharon Sanders for this report.

Book a housewife, on suspicion of bird flu in Menoufia

Menoufia Mohammed Issawi
18-1-2012 | 12:41

Detained by the Directorate of Health Affairs Menoufia woman named Sahar Samir Stone (25 years - housewife) within the Fever Hospital angle Naoura martyrs on suspicion of being infected with bird flu after the onset of symptoms of illness. Dr. Ayman Abdel Moneim, Under the Ministry of Health Menoufia, it was taking a sample of the blood of the patient, and sent to labs central Ministry of Health for analysis, also announced that the Directorate of Veterinary Medicine for the cause of injury the victim is exposed to dead birds, has been clearing house of eligibility, and to take samples in contact with the house and take preventive measures adopted in this regard.

(FluTrackers Link)

Typically, from Thanksgiving through the end of April is the height of `bird flu season’, although sporadic cases can appear anytime of the year. You can easily see the pattern in the FAO chart below, which lists confirmed human cases by month and country.

Which means that if 2012 follows the pattern, we should be hearing about a fair number of cases – both human and in birds – over the next few months.

Lancet: Mass Gatherings And Health

2012-01-17T08:24:00.001-05:00

# 6079

Whenever there is a mass gathering (or migration) of people, the thoughts of public health officials inevitably turn to the prospect of having to deal with, and hopefully contain, outbreaks of disease.

With the upcoming Summer Olympics in London this year, it is not surprising that the The Lancet has devoted considerable space to a six-part series covering many of the public health issues that come with managing mass gatherings.

Concerns go well beyond infectious diseases like measles, influenza, and norovirus, and also involve terrorist attacks, crushing injuries from unruly crowds, food borne illnesses, and sanitation.

These articles are (unfortunately) behind a pay wall, but summaries are available (free registration req.), as is a short audio presentation where John McConnell discusses the background to the series.

Mass Gatherings Health

Published January 16, 2012

Executive summary

A six-part series describes the scope of the emerging specialty of mass-gatherings health. Mass gatherings are events such as religious occasions, music festivals, or sports events that attract enough people to exceed the capacity of routine health and public safety measures. Managing such events requires providing for all eventualities from infectious disease outbreaks to security against terrorist attacks. Thus mass gatherings health is a topic that goes beyond the scope of typical public health provision.

(Continue . . .)

This issue pops up nearly every year, and with good reason. Epidemiologists remember well the lessons of 1918, where it was demonstrated that influenza epidemics can surge in the wake of large gatherings.

During the fall wave of the Spanish Flu most cities instituted strict public health ordinances; they closed schools, movie houses, pool rooms, restaurants . . even churches.

Those cities that took these measures generally saw much lower levels of death and illness.

But Philadelphia went ahead with a massive Liberty Loan parade on September 28th of that year, apparently heartened by the low number of flu cases reported in Pennsylvania to that point.

Days after Philadelphia’s Liberty Loan parade in September 1918, which was attended by 200,000 people, hundreds of cases of influenza were reported. [Credit: Naval Historical Center]

What happened next is best demonstrated by the following graph, which depicts an explosion of pandemic flu cases beginning just days after the parade.

The chart above, taken from the PNAS journal article entitled Public Health Interventions and Pandemic Intensity During the 1918 Influenza Pandemic , shows the excess mortality in two American cities.

The tall spike represents Philadelphia, while the lower curve represents St. Louis.

Over the next three weeks, at least 6,081 deaths from influenza and 2,651 deaths from pneumonia were registered in Pennsylvania, most occurring in Philadelphia (CDC source).

So it is little wonder that we saw some amount of angst during the lead up to the 2010 World Cup games over the concern that it might enhance the spread of the 2009 H1N1 pandemic virus (see Russia Urges Sports Fans Not To Travel To World Cup Game).

Each year there are multiple mass gatherings which could conceivably facilitate disease transmission; including the Super bowl, Mardi Gras, and Carnival in Rio, and the Hajj.

But the granddaddy of all human migrations takes place each winter across Asia, with the celebration of the Lunar New Year. It is expected that more than 2 billion passenger journeys – mostly by crowded train –will be made in China alone over this six week period.

This year, the lunar New Year will fall on January 23rd, but the festivities span several weeks.

In many Asian cultures it is a long held tradition that people return home to attend a reunion dinner with their families on the eve of the lunar New Year. They stay a few days, then return to the cities from whence they came.

All of which provides opportunities pathogens to hitch rides to remote areas of the world where they may not have arrived yet, and for viruses to be carried from rural areas back to the cities.

Due to the potential for disease transmission (including mosquito borne illnesses, food poisoning, flu, etc.) during this very busy holiday period, the CDC posts some travel advice each year to those planning a trip to Asia.

Good Luck. Good Health. Good Cheer. Happy Lunar New Year!

The good news is, that while mass gatherings provide greater opportunities for disease outbreaks, history has shown that serious outbreaks like that which followed the 1918 Philadelphia parade are a rarity.

Still, public health authorities must anticipate and prepare for the worst, even though it probably won’t occur. This is hardly wasted energy.

After all, we’ll never know the number of outbreaks that have been prevented by proactive measures over the years.

The old saying is true, `When public health works, nothing happens’.

PNAS: A Hypothesis On The Effects Of La Niña On Influenza Reassortment

2012-01-16T16:48:00.001-05:00

# 6078

We have an interesting hypothesis being offered today by a pair of well-respected researchers (Jeffrey Shaman of Columbia University's Mailman School of Public Health and Marc Lipsitch of the Harvard School of Public Health), who note that the weather patterns prior to the pandemics of 1918, 1957, 1968 and 2009 all showed the Pacific ocean to be in a La Niña cycle.

We know, of course, that correlation doesn’t necessarily imply causation, but an apparent association between two events can often provide a useful starting point for further scientific investigation.

And that’s what these researchers are calling for.

Whether this correlation is casual, or is simply coincidental, is for now unknown.

For those unfamiliar with the basics of El Niño and La Niña, a very brief overview:

The Pacific Ocean cycles between an El Niño pattern (warmer) and a La Niña (colder) than normal water temperatures in the Equatorial Pacific Ocean.

These water temperature cycles can have major effects on climate and weather far removed from the Pacific. During La Niña years, for example, the Atlantic Hurricane season is usually more active.

La Niña (December 2000)

El Niño (December 1997)

Sea surface temperature anomalies (°C)

Photo Credit- NOAA

La Niña's occur every 2 to 7 years, and over the past 62 years 14 have been observed. During that time, we saw 3 pandemics (1957, 1968, 2009).

Graph Credit- Wikipedia

We’ve the Press Release from Columbia University's Mailman School of Public Health, but after a quick visit to the PNAS journal website I wasn’t able to locate the article online. I imagine it will be online shortly.

Does the La Niña weather pattern lead to flu pandemics?

Public release date: 16-Jan-2012

Worldwide pandemics of influenza caused widespread death and illness in 1918, 1957, 1968 and 2009. A new study examining weather patterns around the time of these pandemics finds that each of them was preceded by La Niña conditions in the equatorial Pacific. The study's authors--Jeffrey Shaman of Columbia University's Mailman School of Public Health and Marc Lipsitch of the Harvard School of Public Health—note that the La Niña pattern is known to alter the migratory patterns of birds, which are thought to be a primary reservoir of human influenza. The scientists theorize that altered migration patterns promote the development of dangerous new strains of influenza.

The study findings are currently published online in PNAS.

To examine the relationship between weather patterns and influenza pandemics, the researchers studied records of ocean temperatures in the equatorial Pacific in the fall and winter before the four most recent flu pandemics emerged. They found that all four pandemics were preceded by below-normal sea surface temperatures—consistent with the La Niña phase of the El Niño-Southern Oscillation. This La Niña pattern develops in the tropical Pacific Ocean every two and seven years approximately.

The authors cite other research showing that the La Niña pattern alters the migration, stopover time, fitness and interspecies mixing of migratory birds. These conditions could favor the kind of gene swapping—or genetic reassortment—that creates novel and therefore potentially more variations of the influenza virus.

"We know that pandemics arise from dramatic changes in the influenza genome. Our hypothesis is that La Niña sets the stage for these changes by reshuffling the mixing patterns of migratory birds, which are a major reservoir for influenza," says Jeffrey Shaman, PhD, Mailman School assistant professor of Environmental Health Sciences and co-author of the study.

Changes in migration not only alter the pattern of contact among bird species, they could also change the ways that birds come into contact with domestic animals like pigs. Gene-swapping between avian and pig influenza viruses was a factor in the 2009 swine flu pandemic.

For the record, the Pacific is currently in a La Niña cycle, and the forecast is for it to remain so well into the Northern Hemisphere spring of 2012.

This is an interesting hypothesis, and should promote some fascinating avenues of investigation.

Nature: 10 Expert Opinions On The H5N1 Research Dilemma

2012-01-16T11:45:00.001-05:00

# 6077

The Journal Nature, which has been covering the H5N1 research controversy since the issue erupted, has solicited the opinions of 10 experts in influenza research on how to deal with the current H5N1 research controversy.

As you will find, the issues are complex, and answers that are going to satisfy everyone (or perhaps, anyone) are going to be very hard to find.

Follow the link below to read:

Preventing pandemics: The fight over flu

Nature (2012) doi:10.1038/481257a

Published online 15 January 2012

A proposal to restrict the planned publication of research on a potentially deadly avian influenza virus is causing a furor.

Ten experts suggest ways to proceed.

You’ll find opinions voiced by such influenza luminaries as:

Ron Fouchier & AB Osterhaus

John Steinbruner

Kwok-Yung Yuen

D. A. Henderson

Lynn Klotz & Ed Sylvester

Jeffery K. Taubenberger

Richard H. Ebright

David L. Heymann

Nature has also set up a special portal to allow readers to access the growing backlog of news and opinion surrounding this issue.

Mutant flu

Scientists have created a form of the H5N1 avian flu virus that is transmissible between mammals, raising fears that it could trigger a human pandemic if it escapes from the lab - either through accidental release or as part of a bioterror attack. As debate rages over how much of the research should be published, and whether there is sufficient oversight of such work, you can follow all Nature's coverage of the issue here.

WHO Confirms Bird Flu Case In Cambodia

2012-01-16T07:22:00.001-05:00

# 6076

Last Friday we learned of Cambodia’s first H5N1 case of 2012 via an article in the China Daily (see Xinhua News: 1st Cambodian H5N1 Case Of 2012). Today, we’ve confirmation from the World Health Organization on their Global Alert & Response page.

Avian influenza – situation in Cambodia

16 January 2012 - The Ministry of Health (MoH) of the Kingdom of Cambodia has announced a confirmed case of human infection with avian influenza A (H5N1) virus.

The case was a 2 year-old male from Banteay Meanchey Province. He developed symptoms on 3 January 2012 and was admitted to hospital on 9 January 2012. He is on Tamiflu and has been ventilated.

There have been reports that boy was exposed to sick poultry in his village. He is the 19th person in Cambodia to become infected with the H5N1 virus; to date, 16 of these cases have died from complications of the disease.

The National and local Rapid Response Teams (RRT) are conducting outbreak investigation and response following the national protocol. Hospital staff who had contact with the case have been offered oseltamivir. To date, none of the human contacts have tested positive for A (H5N1).

Last year saw a major spike in the number of reported H5N1 cases in Cambodia - with 8 total - and all were fatal. Over the previous 4 years Cambodia had recorded only one case each year.

In 2011 the majority of cases were detected in Prey Veng Province (n=4) in the southern region of the country, but individual cases were reported in four other regions, including Banteay Meanchey Province.

With just one exception, all of the Cambodian cases over the past year have involved young children.

In January of 2011 we saw a 19 year old mother, and her child, succumb to the virus ( see WHO Update On Cambodian H5N1 Fatalities).

Although we continue to see isolated human infections around the world, for now H5N1 is primarily a threat to poultry.

The virus remains poorly adapted to human physiology, and despite ample opportunities in places like Egypt and Indonesia, only causes rare, sporadic infections.

The concern, of course, is that over time that could change.

And so the world remains at Pre-pandemic Phase III on the H5N1 virus, and we continue to watch for signs that the virus is adapting better to humans.

WHO To Take Role In Sorting Out Bird Flu Research Controversies

2012-01-15T14:48:00.001-05:00

UPDATED at Bottom

BSL-4 Lab Worker - Photo Credit –USAMRIID

# 6075

My thanks to Helen Branswell (@CP_Branswell) for tweeting a notice about a brief article appearing via The Canadian Press Online Edition this afternoon, indicating that the World Health Organization is offering to play a role in detangling the complex issues surrounding bird flu research.

As probably everybody knows by now, the recent successes in the laboratory in turning the H5N1 virus into a more transmissible virus have raised alarms among many of those in the bio-security field.

At the same time, many scientists are decrying attempts to halt, or censor this type of research.

For background on all of this, I would refer you to The Furor Over H5N1 Research Continues.

Details on how all of this will play out are scant at this hour, but I’m certain we’ll be hearing more about this story in the very near future.

The Canadian Press - ONLINE EDITION

WHO will take a role in solving issued raised by bird flu studies controversy

By: The Canadian Press

Posted: 01/15/2012 12:46 PM

UPDATED: Helen Branswell has a longer, more in-depth article on these developments which you can now read at :

WHO will help resolve bird flu studies controversy

The Opposite Of Worry

2012-01-15T12:22:00.001-05:00

# 6074

One doesn’t have to scan too many newspaper headlines, or visit too many websites these days, without concluding that deep-rooted feelings of uncertainty and fear permeate our modern society.

Worries over a prolonged economic crisis, tensions in the Middle-East, H5N1 research, natural disasters, and even farfetched Mayan doomsday prophesies seem to abound in the media each day.

If you are feeling a bit inundated by these non-stop scare stories, you are not alone. Every morning I scan hundreds of news items, looking for something worthy of blogging on, and in so doing I’m exposed to scores of these stories every day.

While it is pretty easy to discount the more fanciful of these stories, the truth is, every year millions of people are caught up in disasters and emergencies all around the globe.

It doesn’t take a Mayan prophesy fulfilled to ruin your entire day.

Tornadoes, earthquakes, floods, hurricanes, and all manner of natural and manmade disasters can strike practically anywhere or at any time - and while worrying about them is counter productive – preparing for them makes a great deal of sense.

FEMA, along with Ready.gov, and a variety of other agencies and organizations, promote personal, family, and community preparedness for all types of emergencies.

They know that it isn’t if another disaster will strike, it is only a matter of when and where.

Accordingly, Ready.gov has a new video Preparing Makes Sense, which you can view on the FEMA Youtube Channel.

In a little over 4 minutes, you’ll get an excellent short course on how to prepare for a disaster.

As I wrote during National Preparedness Month in PM11: Living The Prepared Life, being prepared for emergencies both large and small has paid off often in my life.

To learn how to prepare as an individual, family, business owner, or community I would invite you to visit the following sites and use THIS LINK to access some of my preparedness blogs.

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

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

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

While hyperbolic headlines and `worst-case scenarios’ being promoted by the media may keep many people up at night, I discovered long ago the secret to sleeping soundly is that preparing is easy.

It’s worrying that’s hard

Referral: Crof On Cholera

2012-01-15T09:50:00.001-05:00

# 6072

Crof, who has covered the Haitian cholera epidemic and subsequent local and international repercussions since the outbreak began, continues his exemplary coverage this weekend.

Fifteen months after it emerged, cholera continues to claim lives and exact a miserable toll on that impoverished Caribbean nation.

You’ll find several new reports well worth reading this weekend on Crofsblog regarding a fresh outbreak in Pestel, including:

Haiti: Dr. John Carroll on cholera in Pestel, January 14, 2012 (updated)

Haiti: Cholera in Pestel so far

Haiti: More cholera news from Pestel

Resistant TB: The Limits Of Surveillance & Reporting

2012-01-14T09:06:00.001-05:00

# 6071

With practically any disease you’d care to mention the number of cases that we see, and are counted, generally represent only a small subset of the total.

As the chart from the CDC below indicates, public health officials are usually only aware of the `tip of the disease pyramid’.

Many people suffering an illness do not become sick enough to seek medical care (or may live in an area where such care, or testing is unavailable). Those that see a doctor may not be properly diagnosed. And those that are diagnosed may not be reported to the health department.

When the World Health Organization announced the detection of the 571st human H5N1 infection, or the ECDC reports that 4,200 people were infected by the E. coli O104:H4 outbreaks in Germany and France, everyone in the public health arena understood that those numbers are unlikely to include all of the cases out there.

Reporting and surveillance – even in technologically advanced regions like the United States and Europe – are simply not that good.

So when we learn – as we have this week – of a dozen cases of `totally resistant tuberculosis’ in India, it’s a pretty fair assumption that there are more cases out there, as yet undetected.

The question is: How many?

While the answer to that question remains elusive, we’ve some troubling hints today from an article that appears in the Indian Express.

The story revolves around an interview with Dr John Kenneth, Professor and Head, Infectious Diseases, St John’s Research Institute. The article can be accessed at the following link:

The new, deadly TB strain may be more widespread

Johnson T A : Bangalore, Sat Jan 14 2012, 03:47 hrs

While the headline, that this new form of resistant TB `may be more widespread’ is practically a given - what is worrisome are the percentages being reported.

Dr. Kenneth states that his group has unpublished data showing that out of one hundred TB patients they had randomly selected for drug susceptibility studies, six were found to be `totally drug resistant’.

Additionally out of these 100 cases, 30 were found to be multi-drug resistant (MDR), and 13 were defined as being extensively drug resistant (XDR).

Dr. Kenneth admits that there may be some selection bias in the 100 patients selected for this study, and that all cases tested were randomly selected from among TB patients at only one treatment facility.

Until this study is published, we are lacking details on how the screening for drug resistance was done, and exactly how `totally drug resistant’ was defined. This is an issue that the ECDC brought up earlier this week, when they cautioned against the use of the term TDR-TB (see ECDC Comment On Drug Resistant TB In India).

Whether these results reflect the prevalence of resistant TB across a wider region is – for now, at least – unknowable.

For more on all of this, you can’t do better than Maryn McKenna’s coverage on her Superbug Blog. Her latest entry (which includes links to her radio interview yesterday) can be read at:

Totally Drug-Resistant TB: A Patient Is Missing

By Maryn McKenna
January 14, 2012 |

For some more background on Tuberculosis, which kills 1.7 million people each year, last March I wrote a blog titled World TB Day: March 24th.

Some of the resources I cited that day may be of interest.

(From the 2011 TB Progress Report)

The World Health Organization released a new report and a factsheet on MDR-TB & XDR-TB in advance of this yearly event on the the status of Tuberculosis around the world and the progress being made in its control.

WHO progress report 2011

Towards universal access to diagnosis and treatment of MDR and XDR-TB by 2015

While progress has been cited in the global fight against tuberculosis, the addition of a new supposedly `totally resistant’ form of TB to the mix complicates matters enormously.

Yesterday the WHO published the following notice:

Tuberculosis that is “resistant to all drugs”

13 January 2012 | Geneva | WHO's Stop TB Department has just published a briefing note with "Frequently Asked Questions" to provide information on tuberculosis that is resistant to all drugs.

In 2006, the first reports of extensively drug-resistant tuberculosis (XDR-TB), an even more severe form of drug resistant TB than multidrug-resistant TB (MDR-TB), began to appear. Within a year of the first reports of XDR-TB, isolated cases were reported in Europe that had resistance to all first-line anti-TB drugs (FLD) and second-line anti-TB drugs (SLD) that were tested. In 2009, a cohort of 15 patients in Iran was reported which were resistant to all anti-TB drugs tested. The terms “extremely drug resistant” (“XXDR-TB”) and “totally drug-resistant TB” (“TDR-TB”) were given by the respective authors reporting this group of patients. Recently, another study has been published that describes 4 patients from India with resistance to all tested drugs.

To access the Frequently Asked Questions please click here.

Xinhua News: 1st Cambodian H5N1 Case Of 2012

2012-01-13T14:34:00.001-05:00

# 6071

After seeing only 4 cases of H5N1 infection in humans over between 2007 and 2010, Cambodia suddenly become the focus of renewed attention after 8 fatal cases were reported during 2011.

Today, Xinhua News Service – via the China Daily Newspaper – is reporting the first Cambodian H5N1 infection of the new year.

A hat tip to Tetano on FluTrackers for picking up this story.

This latest case is reportedly from Banteay Meanchey Province, in the northwestern corner of the country, which is the same region where the 7th fatality of 2011 was reported last July.

Cambodia finds first case of H5N1 infection in human in 2012

Updated: 2012-01-13 22:48:00

(Xinhua)

PHNOM PENH, January 13 (Xinhua) -- A 2-year-old boy from northwestern Cambodian province of Banteay Meanchey was infected with avian influenza H5N1 virus, Cambodia's Ministry of Health and the World Health Organization announced Friday.

The patient is currently in "critical condition" in Angkor Hospital for Children in Siem Reap province.

The boy became sick on January 3 with fever, cough, runny nose and vomiting, the statement said, adding that he was initially treated by local private practitioners, but his conditions worsened and he was admitted to Angkor Hospital for Children on January 9.

"The diagnosis of the clinical samples on January 12 found that the boy had contact with sick or dead poultry prior to becoming sick," it said.

The boy is the nineteenth person in Cambodia to become infected with the fatal H5N1 virus, and the first such victim this year, said the statement. Of all the nineteen cases, 16 died.

"Avian influenza is still a threat to the health of Cambodians. This is the first case of H5N1 infection in human this year, and children appear to be most vulnerable," the Minister of Health Mam Bunheng said in the statement.

Reports on last year’s cases include:

Cambodia: 8th Fatal H5N1 Case Of 2011

Cambodia: 7th Bird Flu Fatality Of 2011

Cambodia: 6th Bird Flu Fatality Of 2011

Cambodia Reports 5th Bird Flu Fatality

IRIN: Cambodia’s Bird Flu Risk "under control" – Experts

Cambodia: 4th Bird Flu Fatality Of 2011

WHO Update On Cambodian H5N1 Fatalities

For now, bird flu remains primarily a threat to poultry. The virus remains poorly adapted to human physiology, and despite ample opportunities to cause illness in humans, the virus only causes rare, sporadic infections.

CDC FluView & ECDC WISO: Flu Activity Remains Low

2012-01-13T13:30:00.001-05:00

# 6070

While the calendar says we are well into this year’s flu season, reported influenza activity in North America and Europe continues to run well below average.

Today the CDC’s latest FluView report indicates that most of the country is reporting minimal ILI influenza-like-illness activity.

The following chart shows that the seasonal spike normally seen during the winter in influenza-like-illness has yet to appear.

So far, what little influenza activity that has been documented has been predominantly influenza A, and the bulk of those H3N2.

Excerpts from this week’s FluView Report follows:

2011-2012 Influenza Season Week 1 ending January 7, 2012

All data are preliminary and may change as more reports are received.

Synopsis:

During week 1 (January 1-7, 2012), influenza activity increased in the United States, but remains relatively low.

U.S. Virologic Surveillance: Of the 3,199 specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division, 108 (3.4%) were positive for influenza.

Pneumonia and Influenza (P&I) Mortality Surveillance: The proportion of deaths attributed to P&I was below the epidemic threshold.

Influenza-associated Pediatric Mortality: No influenza-associated pediatric deaths were reported.

Outpatient Illness Surveillance:The proportion of outpatient visits for influenza-like illness (ILI) was 1.4%, which is below the national baseline of 2.4%. All 10 regions reported ILI below region-specific baseline levels. Two states experienced low ILI activity, New York City and 48 states experienced minimal ILI activity, and the District of Columbia had insufficient data.

Geographic Spread of Influenza: The geographic spread of influenza in two states was reported as regional; seven states reported local activity; 37 states reported sporadic activity; the District of Columbia, Guam, the U.S. Virgin Islands and four states reported no influenza activity, and Puerto Rico did not report.

Similarly, influenza in Europe seems to be running below average as well, and unlike last year – where they saw mostly H1N1 – this year it is the H3N2 virus that dominates.

This is from the ECDC’s WISO report (Weekly influenza surveillance overview).

Weekly influenza surveillance overview, 2 - 8 January 2012 - Week 1

Surveillance reports - 13 Jan 2012

Available as PDF in the following languages:

This document is free of charge.

ABSTRACT

During week 1/2012, low influenza activity was notified by all 26 of the 27 countries reporting (Malta reported medium activity) with five countries (Italy, Netherlands, Norway, Spain and Sweden) now indicating local or regional spread.

Of 625 sentinel specimens collected and tested during week 1/2012, 81 (13%) were positive for influenza viruses. Though less than the percentage reported in week 52 (which will have been affected by the Christmas/New Year holiday), it shows an upward progression since last month.

Of 632 influenza A viruses sub-typed from sentinel and non-sentinel sources since week 40/2011, 588 (93%) were of the H3 subtype. No antiviral resistance has been detected as yet.

Since week 40/2011, 157 severe acute respiratory infection (SARI) cases have been reported by six countries. Fifty-five of them were confirmed influenza-positive cases and of those typed or sub-typed 14 were A(H1N1)pdm09, 17 were A(H3) and four were influenza B viruses.

Influenza transmission is showing some progression in Europe this season and is currently dominated by A(H3N2) viruses.

Given the unpredictability of influenza, it is too soon to know how the rest of the season will progress.

NPR Science Friday: McKenna On Resistant TB

2012-01-13T09:00:00.001-05:00

# 6069

Later today (Friday, January 13th) Maryn McKenna will be a guest during the first hour (2 –3 pm EST) on NPR’s Science Friday to discuss the recent detection of a dozen cases of tuberculosis in India said to be `totally resistant’ to current antibiotic treatment.

Friday, January 13th, 2012

New Tuberculosis Strain Thwarts All Antibiotics

Physicians in India have discovered a strain of tuberculosis they call ‘TDR’ for ‘Totally Drug-Resistant’--meaning there is no antibiotic available to fight it. Maryn McKenna, author of Superbug , discusses the possible origins of the strain, and what options--if any--doctors have to treat it.

Guests

Maryn McKenna
Author, "Superbug: The Fatal Menace of MRSA," (Free Press, 2010)
Blogger, Wired
Atlanta, Georgia

Maryn, who is Flublogia’s resident expert on everything drug resistant, has written twice this week about this new development in her Superbug Blog, links to which you’ll find below:

Totally Resistant TB: Earliest Cases in Italy

By Maryn McKenna

January 12, 2012

India Reports Completely Drug-Resistant TB

By Maryn McKenna

January 9, 2012 |

Reminder: ScienceLive Chat Today On H5N1 Research

2012-01-12T12:37:00.001-05:00

# 6068

Each week Science Magazine holds an online chat with top experts on the hottest topics in science as part of their ScienceLive Series. And this week, the debate over conducting, and publishing, potentially dangerous H5N1 research is front and center.

Today, Thursday, January 12th at 3 pm EST, join moderator Martin Enserink who will welcome CIDRAP director Michael Osterholm and Johns Hopkins University Bloomberg School of Public Health Virologist Andrew S. Pekosz for an hour long discussion.

The details from Science Magazine:

Live Chat: Should Science be Censored?

by Martin Enserink on 10 January 2012, 1:43 PM See below for the chat box.

Join us each Thursday at 3 p.m. EST for a live conversation with leading scientists and expert reporters.

Today's Topic

The debate continues about two papers that resulted in H5N1 influenza strains that are more easily transmissible between mammals and may have the potential to trigger a pandemic. Last month, the National Science Advisory Board for Biosecurity (NSABB) recommended that key details be redacted from the studies, which are under review at Nature and Science. Some say that's a blow to scientific freedom; others argue the studies should never have been done in the first place.

This week, we'll talk about the benefits and risks of the H5N1 transmissibility studies and whether they should be published in full. Also on the table: Should experiments that could help aspiring bioterrorists be more tightly regulated--and if so, how? Our guests are two influenza experts, including a member of the NSABB.

Join us for the live chat at 3 p.m. EST on Thursday, 12 January, on this page. You can leave your questions in the comment box below before the chat starts.

ECDC Comment On Drug Resistant TB In India

2012-01-12T10:35:00.001-05:00

# 6067

While more than a little discomfiting, in recent years we’ve grown accustomed to hearing about MDR-TB (multi-drug resistant tuberculosis), and XDR-TB (extensively drug resistant Tuberculosis).

These varyingly resistant forms of Tuberculosis have come about primarily as the result of incomplete, irregular, or inappropriate treatment and management of infected patients. Patient compliance for long-term treatment has long been a major obstacle.

Until now – as difficult as treatment might have been - there has always been some combination of antibiotics that could be used to treat even the most resistant of TB cases.

All that appeared to change a few weeks ago when it was announced in an ahead-of-print letter to the journal Clinical Infectious Diseases that a four cases of TDR (totally drug resistant) tuberculosis had been identified in India. A follow up news report indicated that there are now at least 12 known cases in one hospital alone.

For more background on this announcement, I would invite you to read Maryn McKenna’s recent blog entry called India Reports Completely Drug-Resistant TB.

Today the ECDC has published their own comments on this development, along with links to other TB-related documents, on their website.

One of the points being made in the comments section (excerpted below) is that the term TDR-TB is as yet not well defined, and may be misleading.

Total drug resistant TB is a relative notion and depends on the local drugs available and tested on. This term/expression should either be avoided or should be defined worldwide. The World Health Organization (WHO) has internationally-endorsed treatment recommendations for the treatment of drug-susceptible, MDR-TB and XDR-TB.

Successful treatment of TB is possible but requires full support from the health care system by offering optimal diagnostic services, high-quality drugs for the full time of treatment and support to the patient in fulfilling the treatment. To make this happen, strong TB diagnostic services and processes that ensure the rational use of TB drugs (1,2,3) are essential in order to be able to test all suspected TB cases for drug-resistance and to identify resistance as soon as possible to enable appropriate therapy. Furthermore, ensuring treatment outcome monitoring of all cases is vital.

Follow the link below to read the entire comment.

New drug resistant form of tuberculosis reported in India

12 Jan 2012

In a recent scientific article (Udwadia, F et al. Clin. Infect. Dis. 2011, Dec 21, Eprint) four cases of so-called total drug resistant tuberculosis (TB) were reported from India. According to the article, these patients have shown resistance to all the first line TB drugs and to seven second line anti-TB drugs.

With the existing forms of multi-drug and extensively drug resistant TB (M/XDR-TB) this so-called total drug resistant TB would indicate that none of the known TB combination regimens would be effective for such patients.

Read more:

Read the ECDC comment on this in our full

Public Health Development “New drug resistant form of tuberculosis reported in India”

ECDC Tuberculosis Programme

Tuberculosis, a global challenge: discover the ECDC Spotlight

Get the facts: read the ECDC special report “Progressing towards TB elimination”

Download the report “Tuberculosis surveillance in Europe 2009”

Discover the Spotlight “Tackling tuberculosis in children: towards a TB-free generation

Keep in touch with ECDC on facebook

Read the ECDC/WHO co-authored article “Tackling the spread of drug-resistant tuberculosis in Europe”

This story is just beginning to unfold, and I’m sure we’ll hear a lot more about it – and whether or not this new form of tuberculosis is indeed, as the study authors dubbed it - `totally resistant’ – in the coming months.

Oxygen Delivery & The Emergency Patient: Revisited

2012-01-12T08:56:00.001-05:00

Photo Credit – Wikipedia Commons

# 6066

In October of 2010 I wrote a blog called BMJ: Oxygen Delivery and COPD that looked at a fascinating, but controversial study out of Australia that looked at high flow oxygen treatment compared with titrated oxygen treatment in the pre-hospital (ambulance/paramedic) setting.

Although long ago, in a galaxy far, far away . . . (when I was a paramedic) . . . it was standard operating procedure to limit oxygen to 2 liters for COPD patients, in recent decades the trend has been to go with high flow (6 - 10 liters/min) supplemental oxygen.

In the (BMJ 2010; 341:c5462) study referenced last year, researchers followed the pre-hospital or in-hospital mortality rates of 405 patients with presumed COPD (chronic obstructive pulmonary disease) who received either high flow oxygen or titrated oxygen (2 l/m) in the ambulance or emergency department.

What they found was (from the abstract):

Titrated oxygen treatment reduced mortality compared with high flow oxygen by 58% for all patients (relative risk 0.42, 95% confidence interval 0.20 to 0.89; P=0.02) and by 78% for the patients with confirmed chronic obstructive pulmonary disease (0.22, 0.05 to 0.91; P=0.04).

Patients with chronic obstructive pulmonary disease who received titrated oxygen according to the protocol were significantly less likely to have respiratory acidosis (mean difference in pH 0.12 (SE 0.05); P=0.01; n=28) or hypercapnia (mean difference in arterial carbon dioxide pressure −33.6 (16.3) mm Hg; P=0.02; n=29) than were patients who received high flow oxygen.

While this issue is far from settled, we’ve a new retrospective study that appears in the Archives of Internal Medicine that lends weight to the argument that when it comes to oxygen for emergency patients, less may be more.

Supplemental Oxygen Therapy in Medical Emergencies: More Harm Than Benefit?

Alexander D. Cornet, MD; Albertus J. Kooter, MD; Mike J. L. Peters, MD, PhD; Yvo M. Smulders, MD, PhD

Arch Intern Med. Published online January 9, 2012. doi:10.1001/archinternmed.2011.624

This study is, sadly, behind a pay wall. So those of us without a subscription must rely on other summaries.

Luckily, Frederik Joelving of Reuters gives us the highlights, in his report titled:

Extra oxygen may harm emergency patients: report

By Frederik Joelving

NEW YORK | Wed Jan 11, 2012 4:34pm EST

(Reuters Health) - That oxygen mask they strap on patients rushed to the ER after a heart attack or a stroke? It could be doing more harm than good in many cases, Dutch researchers say in a new report.

<SNIP>

"There is not a single study that points to beneficial effects," said Dr. Yvo Smulders, a professor at VU University Medical Center in Amsterdam. "All of the evidence that we found points to detrimental effects."

(Continue . . .)

Smulders' team reviewed 18 previously conducted studies that looked at patient outcomes following oxygen treatment for common medical emergencies that included heart attacks, strokes, cardiac arrest, and COPD.

What they claim to have found is little or no evidence that high-dose oxygen improves survival, and weak evidence that it may even be detrimental.

And not just for COPD patients.

The authors suggest that hyperoxia (excessive oxygen levels in the lungs, blood, or tissues) may cause hemodynamic changes that may actually increase myocardial ischemia (depriving heart muscle of oxygen) during a heart attack.

They also propose that a relationship exists between hyperoxia and greater mortality and complications in non-cardiac emergencies as well.

You’ll find another (brief) summary of this paper on the NHS National Electronic Library for Medicines (NeLM) website.

Supplemental high-dose oxygen therapy linked to more harm than benefit in medical emergencies?

Reference: Archives of Internal Medicine, published early online on 9 January 2012

Source: Archives of Internal Medicine

Date published: 10/01/2012 16:56

Since it is counter-intuitive to reduce the amount of oxygen we give to those already suffering respiratory difficulties, I suspect it will take a lot more evidence before these findings are widely accepted.

Still, it is absolutely fascinating that a debate that raged among EMS providers nearly 40 years ago - when I was a fledgling EMT-II - still continues unresolved.

WHO Updates Indonesian H5N1 Cases

2012-01-11T09:24:00.001-05:00

# 6065

While it doesn’t add substantially to what has previously been reported, the World Health Organization has today updated their GAR (Global Alert and Response) page to include the recent bird flu fatality in Jakarta (see Bird Flu Suspect Dies In Indonesia).

A hat tip to @GertvanderHoek on FluTrackers for the twitter head’s up.

Avian influenza – situation in Indonesia

11 January 2012 - The Ministry of Health of Indonesia has announced one new confirmed case of human infection with avian influenza A(H5N1) virus.

The case is a 23 year-old male from Jakarta Province. He developed symptoms on 31 December 2011, was admitted to hospital on 6 January 2012 and died on 7 January 2012.

An epidemiological investigation conducted by the Ministry of Health and local health officers indicated that he raised pigeons, and there was a sick pigeon he nursed that subsequently died.

Laboratory tests have confirmed infection with avian influenza A(H5N1) virus. Of the 183 cases confirmed to date in Indonesia, 151 have been fatal.

We are still awaiting word on four suspected cases in South Sulawesi (see Indonesia: 4 Bird Flu Suspects Isolated).

The H5N1 virus remains poorly adapted to human physiology and only causes rare, sporadic infections in people. The concern is that over time that may change, so we watch these cases with interest.

Hong Kong To Lower Bird Flu Response Level

2012-01-11T08:48:00.001-05:00

Photo Credit – FAO

# 6064

On December 21st, Hong Kong Health authorities raised their bird flu response level from `Alert’ to `Serious’ after a dead chicken found at the Cheung Sha Wan Temporary Wholesale Poultry Market tested positive for the H5N1 virus.

The following week, in the neighboring city of Shenzhen, a bus driver died from the H5N1 virus, heightening concerns (see Hong Kong: Suspected Human H5N1 Infection In Neighboring Shenzhen).

As no additional cases (human or in poultry) have been detected in Hong Kong over the past 21 days, Secretary for Food and Health, Dr York Chow, has announced the lowering of the alert response is set for tomorrow, January 12th.

This also means that the ban on the sale of live poultry, in effect for the past three weeks, will be lifted. This press release from Hong Kong’s government website (http://www.info.gov.hk):

Sale of live chickens in Hong Kong to resume tomorrow

Wednesday, January 11, 2012
Issued at HKT 18:26

The Secretary for Food and Health, Dr York Chow, announced today (January 11) that wholesale and retail of live poultry in Hong Kong will resume tomorrow (January 12). Imports of live poultry including day-old chicks from the Mainland can also resume on January 12, except for live poultry from a designated import control zone in Shenzhen.

After the detection of the highly pathogenic H5N1 avian influenza (AI) virus in a chicken carcass sample taken from the Cheung Sha Wan Temporary Wholesale Poultry Market (Wholesale Poultry Market) during regular surveillance by the Agriculture, Fisheries, and Conservation Department (AFCD) on December 20 last year, the Government declared the Wholesale Poultry Market an infected place and suspended the dispatch of live chickens from local farms to the market as well as import of live poultry for 21 days.

Dr Chow convened the third meeting of the Steering Committee on AI this morning to sum up the follow-up actions on AI over the past three weeks. Participants at the meeting included AFCD, the Food and Environmental Hygiene Department (FEHD) and the Centre for Health Protection (CHP) of the Department of Health.

"Since the detection of AI in the Wholesale Poultry Market, AFCD completed three rounds of inspections on all 30 chicken farms in Hong Kong in the last three weeks. Local farmers were found to have strictly complied with bio-security and environmental hygiene requirements. No abnormality was found with the chickens. AFCD has also tested about 4,500 samples collected from local farms and all were found negative for H5 AI virus," Dr Chow said.

(Continue . . . )

Laurie Garrett: Keeping Superbugs Away From Terrorists

2012-01-11T08:23:00.001-05:00

# 6064

As the debate over policing scientific research to prevent potentially dangerous information from getting into the hands of terrorists heats up, we’ve another commentary today from Pulitzer-prize winning journalist and author Laurie Garrett.

You may recall that Ms. Garrett weighed in on this topic in mid-December (see Referral: Laurie Garrett On The Bird Flu Research Controversy).

Although the focus is currently on H5N1 research (and its potential for bioterrorism) these issues are hardly new, nor are they restricted to influenza.

From a 100 percent lethal form of mousepox developed by Australian researchers in 2001, to the use of reverse genetics to create reassortant influenza viruses, scientists around the globe are increasingly able to tweak and genetically manipulate pathogens in the laboratory.

I’ve blogged often on (legitimate and important) research projects to create reassortant (and potentially deadlier or more transmissible) viruses for study in the laboratory.

Last July in H5N1: A Rite Of Passage we looked at how serial passage studies are conducted, and at one in particular that appeared in the Journal of Animal and Veterinary Advances that looked at increases in pathogenicity (in mice) of two H5N1 viruses after six serial passages in quail.

Another study published that month, profiled in PNAS: Reassortment Potential Of Avian H9N2, we looked at the reassortment potential of the avian H9N2 virus and H1N1.

And in Study: Reassorted H1N1-H5N1 Produced Virulent Strain, we looked at work conducted by researchers at St. Jude Children’s Research Hospital who created several reassortant 2009 pH1N1 viruses with individual genes borrowed from a 1997 H5N1 virus.

Rapid advances in scientific knowledge and technology over the past decade now enable even small labs to do the kind of research once thought impossible. Added to that, the internet facilitates private, back channel sharing of information like never before.

With this proliferation and decentralization of scientific research and technology come many thorny problems to address.

Prime among them is whether it is desirable (or even possible) in today’s digitally interconnected world to restrict access to - or the pursuit of - potentially dangerous scientific knowledge.

Follow the link to read Ms. Garrett’s commentary on this complex, and difficult topic:

Laurie Garrett: Keeping superbugs away from terrorists

LAURIE GARRETT | senior fellow for global health, Council on Foreign Relations | Posted: Wednesday, January 11, 2012 4:00 am

A reminder, tomorrow at 3PM EST Science Magazine will hold a one hour online chat on science and censorship (see ScienceLive Chat On H5N1 Research And Censorship).

ScienceLive Chat On H5N1 Research And Censorship

2012-01-10T16:09:00.001-05:00

# 6063

Each week Science Magazine holds an online chat with top experts on the hottest topics in science as part of their ScienceLive Series.

And this week you’d be hard pressed to find a hotter topic than the ongoing debate over the conducting and publishing of H5N1 bird flu transmissibility research (see The Furor Over H5N1 Research Continues).

On Thursday, January 12th at 3 pm EST, moderator Martin Enserink will welcome CIDRAP director Michael Osterholm and Johns Hopkins University Bloomberg School of Public Health Virologist Andrew S. Pekosz for an hour long discussion.

The details from Science Magazine:

Live Chat: Should Science be Censored?

by Martin Enserink on 10 January 2012, 1:43 PM See below for the chat box.

Join us each Thursday at 3 p.m. EST for a live conversation with leading scientists and expert reporters.

Today's Topic

The debate continues about two papers that resulted in H5N1 influenza strains that are more easily transmissible between mammals and may have the potential to trigger a pandemic. Last month, the National Science Advisory Board for Biosecurity (NSABB) recommended that key details be redacted from the studies, which are under review at Nature and Science. Some say that's a blow to scientific freedom; others argue the studies should never have been done in the first place.

This week, we'll talk about the benefits and risks of the H5N1 transmissibility studies and whether they should be published in full. Also on the table: Should experiments that could help aspiring bioterrorists be more tightly regulated--and if so, how? Our guests are two influenza experts, including a member of the NSABB.

Join us for the live chat at 3 p.m. EST on Thursday, 12 January, on this page. You can leave your questions in the comment box below before the chat starts.

I’ll post a reminder on Thursday morning, since given the topic and the participants, this should be a terrific discussion.

A Farewell To BFIC

2012-01-10T08:13:00.001-05:00

# 6062

I’m saddened to discover that Ida at BFIC has posted a notice on their website that they are shutting down their blog.

The Bird Flu Information Corner- a joint project between Kobe University in Japan and the Institute of Tropical Disease, Airlangga University, Indonesia – has been an invaluable source of information on influenza activity in Indonesia for several years.

Their contribution to Flublogia will be greatly missed. Here is the announcement.

A Notification from Administrator

Posted by Ida on January 10, 2012

This activity has been managed by researchers both in Kobe University (KU), Japan, and Institute of Tropical Disease (ITD), Airlangga University, Indonesia, under the support by the “Japan Initiative for Global Research Network on Infectious Diseases (J-GRID)” program.

Since it has established, we tried to cover the almost all H5N1 outbreak news in animals and human. We hope this simple activity played some roles for global information sharing and for controlling/preparing to this kind of worldwide infectious disease.

Following to generational change, we’re closing this blog. Last but not the least, all of our gratitude to all friends who have worked on BFIC together under the kindred soul!

Indonesia: 4 Bird Flu Suspects Isolated

2012-01-10T07:59:00.001-05:00

# 6062

Overnight the newshounds on FluTrackers and the Flu Wiki have been closely following media reports coming out of Indonesia regarding a number of bird flu suspects from Gowa regency in South Sulawesi.

Thus far, all we seem to have are machine translated (from Bahasan) accounts, which admittedly, can be difficult to fully comprehend. A quick search of the Jakarta Post this morning turned up no mention of this event.

You can follow the evolution of this story via this FluTrackers Thread.

Briefly, reports indicate that in the past couple of weeks 3 villagers have died with supposed `bird-flu-like’ symptoms, and now 4 people are in isolation at Sudirohusodo Wahidin General Hospital, Makassar, South Sulawesi.

As far as I can tell, no one has tested positive for the H5N1 virus, so all of these – for now, anyway – are just suspected cases.

There are also reports indicating a number of others are hospitalized, or being treated, from the village as well.

A recent story from tvOne News, with a short video, can be viewed at the link below (text Google translated).

Suspected Bird Flu Infected, 4 Citizens Gowa Insulated

Tuesday, January 10, 2012 17:29 pm

Gowa Suspected bird flu, four citizens of Gowa regency, South Sulawesi, was recently forced to be isolated in the Hospital Dr. Wahidin Sudirohusodo, Makassar. All four patients had isolated after three other people died from the disease.

The four residents are still a family that Nasir, Nurbaya, Nusmiati and Wahid. Currently the fourth condition of these patients began to gradually improve.

To ensure that the cause of disease, the doctors are still awaiting results of blood tests from the lab.

Earlier, in the last two weeks three village residents Erelembang, Gowa regency is still one of this family died because of illness. The three men were allegedly infected with avian influenza virus disease.

If some of these cases turn out to be due to the H5N1 virus (suspected, but certainly not proven at this point), then this would represent a significant cluster. There are, of course, other illnesses that could produce similar symptoms and outcomes.

We’ll obviously await word of test results from these patients with considerable interest.

The Furor Over H5N1 Research Continues

2012-01-10T07:12:00.001-05:00

BSL-4 Lab Worker - Photo Credit –USAMRIID

#6061

Over the weekend the New York Times / International Herald Tribune ran a scathing editorial weighing in on the recent debate over H5N1 bird flu research called An Engineered Doomsday.

As you have doubtless heard by now, Ron Fouchier of Erasmus University Medical Center in the Netherlands announced the creation of an airborne H5N1 strain (in ferrets, anyway) last August at a medical conference in Malta (see Katherine Harmon’s Sci-Am article and in a follow up to this story in New Scientist: Five Easy Mutations).

Halfway across the world, Yoshihiro Kawaoka, a highly respected virologist at the University of Wisconsin-Madison School of Veterinary Medicine announced the creation of a comparable H5N1 super flu at roughly the same time.

In November alarm bells were raised by bio-terrorism experts, who warned that this information in the wrong hands could be catastrophic (see NPR: Bio-Terrorism Concerns Over Bird Flu Research).

The National Science Advisory Board for Biosecurity (NSABB) was asked to review Fouchier’s work to ascertain whether it was too sensitive to publish, and in December they recommended that only a redacted version of the work be released.

Specifically, their non-binding recommendation reads:

NSABB recommended that the general conclusions highlighting the novel outcome be published, but that the manuscripts not include the methodological and other details that could enable replication of the experiments by those who would seek to do harm.

This weekend a NYT’s editorial called for the destruction of this new H5N1 strain (or turning it over to an few government-controlled laboratories BSL-4 containment facilities). They also questioned, given the dangers involved, whether this sort of research should have been permitted in the first place.

Given the influence that an editorial from the NYTs carries, it is only fair to present some dissenting views. Below you’ll find links to three of them.

Yesterday Professor Vincent Racaniello posted a response to this editorial on his website. You’ll find that a vigorous debate continues in the comment section.

N.Y. Times: H5N1 ferret research should not have been done

9 January 2012

Next an opinion piece by author and journalist Peter Christian Hall that appears on the Reuters The Great Debate analysis and opinion page.

The Great Debate

As a biological weapon, H5N1 is for the birds

by Peter Christian Hall on Mon, Jan 9, 2012

And lastly, a report from the Milwaukee-Wisconsin Journal Sentinel Online, where a professor who oversees bio-safety operations at the University of Wisconsin-Madison defends the work (and safety) of H5N1 research conducted by Yoshihiro Kawaoka.

Professor defends safety of UW's bird flu research

By Karen Herzog of the Journal Sentinel

This debate is far from over, and the decisions ultimately reached could have far-reaching effects. For more on all of this you may wish to revisit some earlier blogs on the subject, including:

The Biosecurity Debate On H5N1 Research

Referral: Laurie Garrett On The Bird Flu Research Controversy

The Bird Flu Research Debate Continues

McKenna On TDR Tuberculosis

2012-01-09T15:33:00.001-05:00

# 6060

Three days ago Crof picked up on a story regarding Totally Drug Resistant (TDR) tuberculosis being reported in India (see India: New TB strain is "totally drug-resistant" (updated)).

Today, everybody’s favorite scary-disease girl - author and journalist Maryn McKenna - brings us additional background and information on this ominous development via her Superbug Blog.

Follow the link below to read:

India Reports Completely Drug-Resistant TB

By Maryn McKenna January 9, 2012 |

Maryn’s second book, SUPERBUG: The Fatal Menace of MRSA was published in 2010 to sterling reviews (you can read my review here). Her Superbug Blog continues to be one the best resources on antibiotic resistance issues available online.

Maryn is also the author of Beating Back The Devil, the inside story of the CDC’s Epidemic Intelligence Service.

2011: A Year Of Catastrophic Losses

2012-01-09T10:11:00.001-05:00

Credit Munich Reinsurance Company (Munich Re) via Reliefweb

# 6059

If it seemed to you as if we talked about an inordinate number of large, deadly, and expensive natural disasters during 2011, you’re right.

According to Munich Re, NatCatSERVICE, while 2010 saw more loss of life (primarily due to the Haitian earthquake), 2011 was the costliest year ever in terms of natural disasters, with about US$ 380 billion in economic losses.

You can find detailed analysis, including maps, charts, and graphs at the following PreventionWeb links:

Munich Re: Worldwide distribution of natural catastrophes in 2011

Munich Re: Review of natural catastrophes 2011 - Earthquakes result in record loss year

2011 Largest natural catastrophes [PDF 222.43 KB]

2011 Natural catastrophes worldwide [PDF 67.50 KB]

The map of 2011 disasters at the top of this blog depicts 820 events, and shows that no area of the globe is immune to natural catastrophes.

Last month in Weathering Heights: A Year For The Record Books, we looked at the record number of billion-dollar-plus weather disasters in the United States during the last year.

Each year September is designated National Preparedness Month, and agencies like NOAA, FEMA, and READY.GOV work year round to promote awareness and action.

Truly, the time to prepare for a disaster – weather related or otherwise – is now.

Everyone needs an appropriate disaster plan, just as everyone should have a good first aid kit, a `bug-out bag’, and sufficient emergency supplies to last a bare minimum of 72 hours.

Like death and taxes, disasters are inevitable. A few of my general preparedness blogs help you along include:

When 72 Hours Isn’t Enough

In An Emergency, Who Has Your Back?

An Appropriate Level Of Preparedness

The Gift Of Preparedness 2011