Thursday, May 25, 2006

AVIAN FLU: WHERE WE STAND TODAY

The past week has seen an explosion in Avian Flu News, and so I thought I’d take a few moments to consolidate where we stand, and explain why scientists are as nervous as long tailed cats in a room full or rocking chairs.


First, the current human cases we are aware of:

(Note: this synopses is derived from Heather’s work on FluWiki. Thanks Heather)

IRAN

  • Family Cluster - Kermanshah (Northwest Region)
    • 5 Family Members - 2 dead; 3 in hospital
      • A 41M and a 26F sister have died. Health Minister says they are negative for BF.
      • A 30 year old family member is in a coma; 2 other members in hospital.

ROMANIA

  • Family Cluster - Brasov County (Bucharest)
    • 3 Family Members - all in hospital
      • 31M and his sons 3M, 17M.
    • Quarantines in Bucharest has been scaled back. Some neighborhoods on the outskirts of town are still locked down.
  • Ploest
    • 2 people in hospital; contact with infected birds.

CHINA

  • Tibet and Qinghai Province - 400 bar-headed geece and ruddy shelducks are dead from BF. The two locations are on the same migratory route.

INDONESIA

  • Family Cluster - Karo (Medan/North Sumatra)
    • 8 Family Members - 7 dead; 1 recovering (25M brother/Jonnes Ginting)
    • Family Member Information
      • 39F - died 5/4 - index case/Brenata Boru Karo (onset 4/27)
      • 15M - died 5/9 - her son/Roy Karo
      • 28F - died 5/10 - her sister/A. Boru (onset 5/4)
      • 17M - died 5/12 - her son/Boni Karo
      • 1.5F - died 5/14 - her niece/Brenata
      • 10M - died 5/13 - her nephew/Raffael Ginting
      • 32M - died 5/22 - nephew’s father/Dowes Ginting (onset 5/15)
    • A total of 57 samples sent to Hong Kong. 6 of these tested negative.
    • 33 people under observation some of which are being given Tamiflu.
    • H2H2H transmission acknowledged by WHO.

  • Surabaya (East Java)
    • 38F (caterer) Confirmed; Onset - 5/2; Died 5/12
    • 18M (shuttlecock worker) locally confirmed; Rept. - 5/18; Condition - critical
    • 11 people tested - The caterer’s (38F) sister is in quarantine. 8 other family members and 2 nurses involved in her treatment are being tested.

  • Bandung (West Java)
    • 13M suspected; Onset - 5/13; Condition - critical; Exp. - poultry farm
    • 10(?) and brother 18M died 5/23 from suspected BF; Onset 5/19; admitted to hospital 5/22.
    • Possible other sibling with symptoms treated at home.


There are others, no doubt, that have gone undetected, who are in hiding or who have died and have been quietly buried. And whatever is going on in Africa has to date, happened beneath the radar screen. Over 6,000 people die each day in Africa due to AIDS, Dysentery, Cholera, famine, and other causes. Few ever see a doctor, and literally hundreds could die of Avian Flu before anyone noticed.


The WHO, after years of maintaining that the only route to infection was thru sick birds, and that there was `no evidence’ of Human to Human (H2H) transmission of the virus, has now admitted they have had strong suspicions of H2H transmission for quite some time, but state it has never been `efficient’.


The CFR (Case Fatality Rate) of the virus remains extraordinarily high. Among those who receive modern medical care in countries like Egypt, it has run about 30%. In places like Indonesia, even when medical care is provided, 70% of the victims have died. This makes this virus, while difficult to catch, more than 10 x’s more deadly than the Spanish Flu of 1918.


The increase in human cases, along with the large clusters in Indonesia, worry scientists greatly that this virus may break out into a pandemic strain sooner rather than later. No, it is not inevitable. This virus could still die out, and leave us wondering what happened, just like the Swine flu of 1976. But fears run high that we are seeing the prelude to a global pandemic.


If that should happen, what we still don’t know is the attack rate of this virus. In 1918, 30% of the world caught the Spanish Flu. Roughly 50 million people died. The CFR of that virus was only about 5%, maybe less. If this virus maintains its lethality, and were to attack 30% of the worlds’ population, the death toll would be staggering.


Promises of a vaccine available within 6 months are laughable. Perhaps some experimental doses might be developed, but our global production capabilities are such that unless some miraculous breakthrough is made in the technology of vaccine manufacturing, it would take years before enough vaccine could be developed.


Scientists have acknowledged that if H5N1 goes pandemic, it could be more devastating than a world war, and the death toll could reach into the hundreds of millions. The effects on the economy, and the fabric of society, are unknowable, but are presumed to be very bad indeed.


So we remain in a tense waiting game for now. The virus continues to spread, and is learning how to infect new hosts (dogs, cats, pigs, humans). Attempts are being made to monitor any new clusters that might indicate a mutation to a pandemic strain. But few scientists believe that it can be contained if that should happen. Many fear the clock is running.



Tick. . . Tick . . . Tick . . .





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