As If We Didn't Already Have A Reason To Prepare

 

# 831

 

 

Tomorrow is the official begining of the Altantic Hurricane season.  And for 35 million Americans, or roughlly 12% of the population, that means for the next six months we must keep a wary eye on the tropics.

 

Of course, if you've prepared for a pandemic, you are already well prepared for a hurricane.

 

Eight-Five percent of coastal residents have never experienced a major hurricane.  They are, after all, fairly infrequent, and impact a relatively small area of the coastline when they strike.   Some people, who have ridden through the fringes of a hurricane, or a direct hit from a category 1 or 2 storm,  think they've been through a major hurricane. 

 

But they are wrong.

 

Even Katrina, as catastrophic as it was to the city of New Orleans, was only a weak Category 3 storm when it made landfall.  The Category 5 storms, which are fortuantely rare, are far, far worse.

 

It has been mostly a matter of luck that a category 5 storm hasn't struck, dead center, on a populated region of our coastline.  As more and more of the coast is built up, the odds go up that it will happen, with devastating results.

 

The National Hurricane Center is forecasting nearly a 75% chance that a major hurricane will cross our coastline in the next 6 months.  Somewhere . . .  between Brownsville, Texas and New England.   And of course, as we saw in 2004-and 2005,  we could see more than one. 

 

As a second generation Floridian, I've lived with hurricanes all of my life.  Hurricane season is accepted as part of life here.  Many of us prepare each year, but many do not.  At the last minute, hundreds of thousands of people will likely flock to grocery and hardware frantically scooping up last minute supplies.  Plywood, generators, and gasoline will become premium items. 

It will be, just as it is before every landfalling storm, a bit of a madhouse.

 

The same apathy towards preparing in advance for a hurricane can be seen in the lack of preparation for a pandemic.  People are content to wait till the last minute, confident they will be able to get what they need.  Many will be tragically mistaken.

 

We don't know that a major hurricane will strike this year, although the odds are pretty good.  We don't know if a pandemic will strike this year or next, and frankly, we don't have a handle on those odds.  There are some who believe them to be fairly high. 

 

But given the likely fallout from either disaster, it just makes sense to be prepared in advance.  Buying a windup radio and sticking it in your closet isn't as much fun as going out for a pizza and beer, but someday that could be a lifeline for you and your family.  Having a pantry full of food, particularly if it is stuff you normally wouldn't eat, seems like a waste.  But if you ask the people of New Orleans, they'd tell you it beats cold army rations.

 

Disasters happen.   Hurricanes, tornadoes, earthquakes, even pandemics.  They come, usually with little warning. 

 

And when they strike, we need to be ready.

UK: 17 With Symptoms And New Farm Under Scrutiny

 

# 830

 

 

The news out of Wales continues with more reports of suspected infections with the H7N2 virus. Additionally, another small holding hundreds of kilometers away is reporting dead or dying poultry.  Whether this is due to H7N2,  H5N1, Newcastle Disease, or some other cause is now under investigation.

 

First, the new cases, as outlined in this report from News Wakes.

 

 

 

17 have bird flu symptoms

31/5/2007

By 3pm yesterday, Wednesday, 17 avian flu contacts had been identified who have or have had symptoms of a flu like illness or conjunctivitis.

No one is seriously ill.

 

It is eight days since a 1km restriction zone was placed around Tn Llwyn farm in Llanfihangel Glyn Myfyr, near Corwen, Denbighshire, after 15 chickens died from H7N2 avian flu.

 

As a precaution, pupils in Years 5 and 6 at Ysgol Henllan, Denbighshire, have been offered tamiflu to protect them from the very slight risk of infection with the H7 virus.

 

This precautionary action has been taken because a child in Year 5, linked to the smallholding near Corwen, is believed to have avian flu. The child is responding to treatment at home.

 

Twelve children and two teachers have been identified as being in prolonged close contact with the child in the classroom on the days when there was a very small risk of the child being infectious. The parents of each child are being contacted by staff at the National Public Health Service for Wales.

 

Only these children and staff have been offered tamiflu, an antiviral medication which reduces the severity of any impact of the infection.

 

Dr Brendan Mason, a consultant epidemiologist with the National Public Health Service for Wales, said, “This is an unusual step for us to take because the risk of the infection being passed from the child to other pupils is so small.

 

However, this particular virus usually only affects birds and is relatively unknown in humans. Its clinical characteristics have not been fully defined.
The National Public Health Service for Wales (NPHS) has identified 256 people who may have had contact with the avian flu:

* 39 in the household setting (up eight on the day before)
* 14 in school (unchanged)
* 203 in the workplace setting (28 up on the day before)

 

Of the 256 contacts, 79 have come out of the incubation period for avian flu.

The full list of contacts is constantly changing as possible contacts are added to or taken off the database. Contacts are added if contact was possible. They are taken off if detailed questioning shows that there was no contact.

(Cont.)

 

 

The outbreak in Chard, England is about as far away from North Wales as you can get in the United Kingdom.  Chard is located in the South Western part of England. 

 

Until tests are run, it is impossible to know if this is an avian flu outbreak. Obviously, nerves are running high in the UK right now, and any poultry die off is suspicious.   This from the Western Gazette, in Somerset.

 

 

SYMPTOMS MAY BE OF BIRD FLU 

15:00 - 31 May 2007

Officials have launched an investigation at a smallholding in a village near Chard amid fears of an outbreak of avian flu.

 

Melanie Johnson, of Hillside, Stony Knaps, called a vet to her home on Tuesday after noticing possible signs of the contagious disease, better known as bird flu, in one of the 200 hens she keeps on her small-holding.

Vets from the Department for Environment, Food and Rural Affairs were called and have carried out tests. The results are expected in the next few days.

Miss Johnson said: "I was shocked. My first thought was it was bound to come down here eventually but why has it come to me?

"The thought of losing those birds is devastating. If it is bird flu I want to make other people aware and urge them to look out for the signs.

"I rang my vet and explained the situation, and she said it sounded very similar to bird flu so she had to pass it on to Defra. They said they could not rule out the possibility that it was bird flu.

"I have had some healthy birds that have died suddenly and they are very worried about that because sudden death is another symptom of bird flu. It is absolutely terrifying."

Her farmhouse and its acre of grounds has been served with a notice of restriction and DEFRA vets were carrying out further blood and saliva tests on another 30 birds, which have been separated from the main brood, as the Western Gazette went to press.

No birds are allowed to be moved from the site and vehicle tyres and footwear must be washed if entering or leaving her property.

(cont.)

Wales: Number of Infections Rises to 13

 

# 829

 

While still just a tempest in a teapot, the outbreak of H7N2 in the UK  is worrisome.   The H7 virus has been almost exclusively seen in avian species, and while a low pathogenic strain, the H7N7 version claimed one life in the Netherlands during an outbreak in 2003 involving 89 people.  

 

Whenever a disease primarily found in animals jumps to humans, we sit up and take notice.  Sometimes the effects are profound, as in H5N1, and sometimes they are mild, as we've seen in the H7 infections.  But the H7 virus continues to mutate, and could reassort with another flu virus, and that could complicate matters down the road.

 

Whether this outbreak of H7 proves to be more than a brief aberration or not is yet to be seen.  But it is a reminder that there are numerous pathogens out there, some worse than others, and that we must remain vigilant if we are to prevent the next pandemic.

 

 

 

Bird flu symptom cases rise to 13

May 31 2007

by Madeleine Brindley, Western Mail

 

THE number of people with symptoms of bird flu rose to 13 in Wales yesterday.

 

The National Public Health Service (NPHS) for Wales last night said these 13 have – or have had – flu-like symptoms or conjunctivitis.

 

They include a healthcare worker, who was working at Ysbyty Glan Clwyd, a patient treated at Ysbyty Gwynedd and a child at Ysgol Henllan, near Denbigh.

 

Health officials have also identified 220 people who have had contacts with either poultry infected with H7N2 bird flu, the Ty’n Llwyn smallholding at the centre of the outbreak, or people who have experienced symptoms.

 

But none of the 69 patients who were in contact with the man treated at Ysbyty Gwynedd have shown any symptoms of the illness, officials said.

 

A total of 79 people who were in contact with the healthcare worker have been given the anti-viral medicine Tamiflu.

 

Dr Marion Lyons, lead consultant in communicable disease control for the NPHS, said, “North West Wales NHS Trust staff have contacted all 69 patients and staff who had been in contact with the patients at Ysbyty Gwynedd. No one reported symptoms of conjunctivitis or flu-like illness in the time period when the flu could have been incubating. So, I am pleased to conclude that there has been no spread of the flu in the hospital.”

 

Local health boards and other primary care services have introduced a system to help identify patients who may be suffering mild flu-like symptoms or conjunctivitis. Officials expect this to lead to a rise in the number or people suspected of contracting the disease. Dr Lyons said, “We have been looking more closely at these and I expect to identify some new cases of people who could have avian flu.”

 

It also emerged last night that everyone who has become ill is directly connected either with the infected poultry or the first few cases of illness.

 

There have been no cases of illness in people with more distant contacts. Tests on 12 of the affected people in Wales have revealed that two have tested positive for the H7 subtype of the virus which was isolated from the affected poultry.

(cont.)

Indonesian Vaccine Trial? Not So Fast

 

# 828

 

Earlier today, the Health Minister of Indonesia, Sit Fadilah Supari, announced that human trials of a bird flu vaccine developed by Baxter would begin in July.

 

Hours later, a spokesman for Baxter refuted that statement.   This from the AP.

 

 

 

Baxter: No avian flu trials announced for Indonesia

 

 

CHICAGO (AP) -- Drug manufacturer Baxter Healthcare Corp. said Wednesday it has not announced plans for clinical tests of a bird flu vaccine in Indonesia, contradicting the country's top health official.

 

Health minister Siti Fadilah Supari told The Associated Press on Tuesday that Indonesia will stockpile millions of doses of the vaccine. She said Baxter's "clinical trial involving hundreds of participants will start in July" and should be concluded by October.

 

Hours later, Baxter spokesman Chris Bona said the Deerfield, Ill.-based company has a "memorandum of understanding" with the Indonesian government to continue discussions about a possible avian flu outbreak, but has not made a supply agreement.

 

"We haven't announced the start of clinical trials in Asia," he said. The company has previously announced clinical trials of the vaccination in Europe.

(cont.)

Indonesia Announces Another Bird Flu Death

 

# 827

 

 

Details are sparse in the English Press so far, but Reuters is reporting on the death of a 45 year-old man from Grobogan, who died on Monday .  Newshounds on the Internet have been aware of this case, and following it, for several days.

 

 

 

Indonesian man dies of bird flu - health ministry

Wed 30 May 2007 16:46:12 BST

JAKARTA, May 30 (Reuters) - A 45-year-old Indonesian man from central Java has died of bird flu, a health ministry official said on Wednesday.

The man from Grobogan died on Monday after being hospitalised on May 17, Joko Suyono of the ministry's bird flu centre said by telephone.

Authorities were still investigating, but the man was believed to have slaughtered and eaten a sick chicken, while dead fowl were found near his home, the official said.

Vietnam On Verge of H5N1 Crisis

 

# 826

 

A few short months ago, Vietnam was hailed as a success story in their fight against the H5N1 virus, and rightly so.   They'd gone more than a year without a reported human infection, and the number of outbreaks in poultry had decreased dramatically.   

 

Last February, the Minister of Agriculture and Rural Affairs was ready to declare the country free of the virus.

 

All too quickly, the situation has changed.

 

This from Reuters.

 

 

Vietnam issues warning over bird flu spread

Wed 30 May 2007, 9:18 GMT

 

(Updates with agriculture minister warning provinces)

HANOI, May 30 (Reuters) - Vietnam is on the brink of another bird flu epidemic in poultry, the agriculture minister told provincial authorities on Wednesday after the H5N1 virus has spread rapidly over the past month.

 

The virus has infected ducks and chickens in 11 provinces and Can Tho city in May at the beginning of summer. The development is unusual because experts say the virus normally appears to thrive best in cool temperatures and weakens in warmer weather.

 

Last week, the Southeast Asian country reported its first human case of H5N1 bird flu virus infection in a year and a half, a 30-year-old man in a province neighbouring Hanoi.

 

"The recent outbreaks were found mainly in waterflowl flocks that have not been vaccinated," Agriculture Minister Cao Duc Phat said in what was described as an urgent telegraph to People's Committees in all 64 provinces and cities.

 

"Now the development of the epidemic is very complicated. The risk of the epidemic's further development and spreading on a large scale is very high," Phat's message said.

 

It called for the vaccination of "100 percent of ducks".

 

Bird flu has killed 42 people in Vietnam since it re-surfaced in Asia in late 2003.

 

The communist-run country took drastic steps in 2004 and 2005 to control the nationwide spread of the virus, including mass vaccination of poultry and banning the sale of birds in markets in major cities.

 

But it was flared up repeatedly in rural areas, including a number of southern provinces early this year.

(cont.)

Indonesia To Begin Vaccine Trials In July

 

# 825

 

Indonesia, the country thus far plagued most by the H5N1 virus, will begin clinical trials of a human vaccine this summer.   Their hope is to have, eventually, 20 million doses of vaccine. 

 

With a population of 235 million, that would be enough for 8.5% of their population.   Not enough, obviously.

 

And yet, when to compared to the United States, they will have more than twice as much vaccine for their population.  Our prepandemic vaccine supplies are enough to inoculate, optimistically, perhaps 8 million people.   Or about 2.6% of the population. 

 

It is unknown how effective any prepandemic vaccine will be, due to mutational changes in the virus that could render a vaccine made from an older strain ineffective.  Most scientists believe that a truly effective vaccine cannot be made until a pandemic strain emerges, and the inoculation can be matched to the virus.

 

 

 

Baxter to carry out clinical trial of bird flu vaccine on Indonesians in July

 

JAKARTA (AP): U.S. drug manufacturer Baxter Healthcare Corp. will carry out clinical trials of a bird flu vaccine in Indonesia in July, the health minister said, adding that the country will initially stockpile 2 million doses.

 

"But when we are getting closer to a pandemic, we will move to stockpile at least 20 million," Siti Fadilah Supari told The Associated Press late Tuesday, adding that she "hopes that will never happen."

 

Bird flu has killed at least 186 people since it began ravaging Asian poultry stocks in 2003, two out of five of them Indonesians, according to the World Health Organization. It remains hard for people to catch, but experts fear it could mutate into a form that spreads easily among people, potentially sparking a pandemic that could kill millions worldwide.

 

Under a tentative deal reached in February, Indonesia agreed to provide Baxter with samples of its H5N1 virus in exchange for the drug manufacturer's expertise in vaccine production.

 

Supari said Baxter's "clinical trial involving hundreds of participants will start in July" and should be concluded by October.

 

Baxter is now able to produce 3 million doses of the vaccine per week, she said, declining to say whether Indonesia has a ready stockpile at present.

 

The Deefield, Illinois-based company was not immediately available to comment. (**)

H7N2 Concerns Spread In The UK

 

# 824

 

 

The symptoms are reportedly mild, and not life threatening, but the recent outbreak of H7N2 in Wales remains a concern because a low pathogenic virus could evolve into a nastier strain over time. 

 

From humble beginnings, the number of potential contacts has increased dramatically, now exceeding 200.  Most are reportedly still without symptoms, and the Tamiflu is for prophylactic use.

 

This from The Daily Mail

 

 

Bird flu warning for two hospitals

Last updated at 20:20pm on 29th May 2007

 

Patients and staff at two hospitals in North Wales are being offered anti-viral drugs after coming into contact with people who may be ill with bird flu.

 

At Ysbyty Glan Clwyd hospital, Bodelwyddan, near Rhyl, 79 patients and staff spent some time with a healthcare worker who is suspected to be ill with an H7 strain of the virus.

 

They are being offered the drug Tamiflu, which minimises the symptoms associated with flu.

 

At Ysbyty Gwynedd hospital, Bangor, 69 patients and staff associated with an A & E unit are being called because they may have been in contact with a patient carrying the virus.

 

The development came as health chiefs were trying to stamp out the spread of a virus which has been traced to chickens on a small farm near Corwen, North Wales.

 

Previously, some 12 children aged nine and ten and two teachers at a school in the area have been treated with Tamiflu.

 

The 14 had been in contact with a nine-year-old girl who is thought to have fallen ill with the virus after visiting the farm at the centre of the alert.

Vietnam Orders Aggressive Campaign

 

# 823

 

 

A month long campaign to either cull, or vaccinate, all water fowl has been ordered by the Minister of Agriculture and Rural Development, in Vietnam.  An ambitious undertaking, to say the least.

 

And one that speaks to just how worried officials are in that country

 

 

 

 

Vietnam agriculture minister ups ante in bird flu fight

 

Minister of Agriculture and Rural Development (MARD) Cao Duc Phat has instructed the poultry industry to immediately vaccinate or cull all water fowls.

 

Speaking at a session of the National Steering Committee for Bird Flu Control and Prevention Tuesday, he stressed the importance of the directives saying he and his deputy Bui Ba Bong would directly supervise activities to contain the epidemic in the north and the month-long countrywide sterilization campaign beginning June 1.

 

The committee met to consider the increasing number of outbreaks of bird flu over the last month.

According to reports from veterinary missions that have been examining bird flu-infected localities, the immune rate of poultry is very low due to poor vaccination practices and uncontrolled hatching.

Head of MARD’s Veterinary Department, Bui Quang Anh, said bird flu had so far been reported in ten provinces and cities and fresh outbreaks had been found in the northern Nam Dinh and Ninh Binh provinces and southern Dong Thap province.

This month over 49,000 birds have been found either dead or have been culled by health workers.

H7 May Have Pandemic Potential

 

# 822

 

Despite the soothing words from the various agencies in the UK over the past couple of days; that the outbreak of H7N2 is `mild' and poses `little danger to public health', there are some scientists who aren't quite as confident.

 

While H7N2 has, to date, produced only mild symptoms; it too mutates, just like all influenza viruses.   The mild virus of today could become more troublesome days, weeks or months from now.  

 

As I pointed out in April, It Isn't Just Bird Flu we need to worry about.  There are a host of pathogens, including numerous influenza viruses, that have pandemic, or epidemic potential. 

 

This from the International  Herald Tribune.

 

 

Mild bird flu in Britain has pandemic potential, experts say

The Associated Press

Published: May 29, 2007

 

LONDON: The four presumed human H7N2 bird flu cases identified in Britain last week are a reminder that the next flu pandemic could be sparked by a virus other than the feared H5N1 strain, experts say.

 

While the global health community's attention in recent years has targeted the H5N1 virus, which has killed at least 186 people worldwide since 2003, some experts worry that attention is being diverted from seemingly less dangerous bird flu subtypes like H7.

 

"There may be a bit of complacency when it comes to recognizing the pandemic potential of H7 viruses," World Health Organization bird flu expert Dr. Michael Perdue said Monday.

 

Last week, British authorities confirmed that four people apparently tested positive for H7N2, a mild strain of bird flu, after 15 chickens at a small farm in Wales died. Health officials are currently investigating 36 people who may also be infected, of whom 11 have symptoms of flu or conjunctivitis.

 

Having so many human cases at once is a potential concern. In Asia, where H5N1 has circulated most widely, millions of people have been exposed to millions of infected birds, resulting in about one new infection per week.

 

"Here, we're talking about a small number of birds and yet we still have four cases," Perdue said. "Unless there's something unusual about the contact with birds, that suggests the virus is finding new ways of getting into humans."

 

The H7 subtype has previously sparked human outbreaks. In a large outbreak in the Netherlands in 2003, 89 human cases were reported, mostly of conjunctivitis, as well as one death. There were also at least three likely instances of human-to-human transmission involving family members of poultry workers. In the case of the single fatality, officials noticed that particular virus had about 10 mutations.

 

British officials have been quick to reassure the public that the "low pathogenic" H7N2 virus — in comparison to the "highly pathogenic" H5N1 virus — poses little risk to the population. Indeed, H7N2 appears to cause only mild symptoms such as eye infections.

 

But low pathogenic viruses can quickly morph into highly pathogenic ones, sometimes within weeks. Too little is known about flu viruses to predict with any certainty which ones are most lethal for humans.

 

"The pandemic risk from low pathogenic avian viruses is almost as bad as that from highly pathogenic avian viruses," said Dr. Angus Nicoll, an influenza expert at the European Centre of Disease Prevention and Control.

(cont.)

 

I still consider H5N1 to be our biggest worry today, but I'm not turning my back on the rest of the field. 

 

You never know when a dark horse candidate will make a run.

A Cure For Bird Flu?

 

# 821

 

 

Apparently, if you believe the newspapers, we can all go home now.  The crisis is over, and we now have a cure for bird flu.

 

The headlines, and quotes I've seen make it sound like the battle has been won.

 

Blood 'key' To Cure

 

Hope of bird flu cure breakthrough 

 

 

First one of the more responsible articles, then a reality check.

 

 

Scientists claim bird flu breakthrough

 

Scientists claim to have made a breakthrough in efforts targeting the spread of bird flu.

They have found that antibodies taken from survivors of the human form of avian influenza are effective at neutralising the H5N1 strain in mice.

 

Researchers in Vietnam, the US and Switzerland have established that antibodies taken from adult sufferers also provide immunity for those who are subsequently exposed to infection of the virus.

 

Experiments showed that mice injected with the antibodies had significantly less of the virus in their lungs and next to no virus in their brain or spleen.

 

Many humans who have died from the H5N1 strain had the virus spread from their lungs to elsewhere in the body.

 

The antibodies appear to be effective up to 72 hours after the initial infection takes place.

 

"This is particularly important as people who have become infected with the virus do not tend to report to their local healthcare facilities until several days after the onset of illness," Dr Cameron Simmons of the Oxford University clinical research unit in Vietnam said.

 

"We are optimistic that these antibodies, if delivered at the right time and at the right amount, could… provide a clinical benefit to humans with H5N1 infections," she added.

 

This is, of course, vital research and it has produced encouraging results. 

 

But, having a `cure', and being able to produce it in sufficient quantity, and delivering it to millions of concurrently infected people at the same time, are two different things.  

 

Despite the the happy last-minute endings in TV shows, and movies, it isn't enough to have a cure in a test tube.   You have to be able to deliver it to the patient.

 

And that assumes the `cure' works as well in humans, as it does in mice.  Maybe, maybe not.

 

During a pandemic crisis, 90% of those infected are unlikely to see the inside of a hospital.   How many of those, do you suppose, will have access to this new serum within 72 of falling ill?   Not many, at least not any time soon.

 

Yes, this is important research, and it may well lead to new treatment options down the road.  The scientists involved are to be applauded for their work.   In time, perhaps years, it may even help us put a dent in a pandemic.  It may even have usefulness in dealing with seasonal flu.

 

But today, while the newspapers are having a heyday proclaiming a `cure' is at hand, it is still far from saving us from a pandemic.   It has yet to be tested in humans.   We don't know how effective, or safe it will be. There are questions over how much can be produced, and how to deliver it to millions of needy patients.

 

In other words, it is a step forward, and an important one; but we don't have a `cure' yet.

 

I'm slightly encouraged, but you'll pardon me if I'm not quite ready to jump on this bandwagon. 

The Stuff Solutions Are Made Of

 

# 820

 

 

My latest blog entry on the HHS Pandemic Flu Leadership Blog Summit is now up. 

 

 

· What do I need from the Department of Health and Human Services — or others — to be able to make a contribution ?

 

 

While a pandemic would be an overwhelming event, one that no government could possibly handle on their own, we have a secret weapon at our disposal, one that could well change the course and outcome of a crisis.

 

That weapon? We, the people.

 

Ordinary citizens like you and I. We are the stuff that solutions are...

 

Read the rest HERE

WHO: More Human Cases Likely

 

# 819

 

Actually, a fairly safe prediction, given the track record to date.  No matter.  After last week's announcement by the OIE that bird flu may be nearing the `end of a cycle', it's a good reminder that we aren't out of the woods yet.

 

 This from Novosti, the Russian News Agency.

 

Human cases of bird flu likely in SE Asia, Egypt in 2007 - WHO 

28/ 05/ 2007

 

NOVOSIBIRSK, May 28 (RIA Novosti) - New human outbreaks of the deadly bird flu virus are highly probable in Southeast Asia and Egypt in 2007, an infectious diseases specialist with the World Health Organization (WHO) said Monday in Novosibirsk, Siberia.

 

The H5N1 virus has already become endemic in Southeast Asia, affecting primarily domestic flocks, Caroline Brown told a press conference at the second international seminar for infectious diseases services in the Commonwealth of Independent States (CIS), and consequently human infections will continue rising there.

 

She said the virus has also become entrenched in countries closer to Europe, such as Egypt, where small private farms have mainly been hit, adding that as a result new human infections are in effect inescapable.

 

However, Brown said the situation in Europe was more stable and predictable, and that any potential outbreak will likely be episodic and not part of a regional epidemic, in which case European veterinary services will be able to control any localized appearance of the disease.

 

With the recently confirmed H5N1 death of a five-year-old Indonesian girl, the human death toll out of 307 cases around the world has risen to 186, according to the World Health Organization (WHO).

 

The second hardest-hit country after Indonesia is Vietnam, where 94 human bird flu cases have been registered and the death toll hit 42. Vietnam suffered damage worth $200 million, as over 40 million domestic birds, or some 15% of the total, died of the virus or were culled.

Many Questions, Few Answers

 

# 818

 

The announcement that China has another H5N1 infected human, this time a soldier in the PLA, has raised a good deal many questions.  Thus far, we have very little in the way of answers.

China remains closed-mouthed about what goes on within its borders.  Often, it is weeks before they admit when they have an outbreak in poultry, or a human case.  Their first reaction, historically, has been to deny they have a problem.

 

Their reluctance to share information on SARS in 2003, and the tragic results that ensued, should be a reminder that diseases know no borders, and China's problems can quickly become a problem for the rest of the world.

 

All we know right now is that a soldier, supposedly stationed in the Fujian province, has tested positive for H5N1.   Those he has been in contact with are being monitored, although we have no reports of any spread of the illness.

 

This from AP news.

 

 

WHO: Bird flu continues to be public health threat in China as new case reported in military

By AUDRA ANG
Associated Press Writer

BEIJING (AP) -- China's latest reported case of bird flu - a soldier - has left questions about how he contracted the virus and shows that the disease remains a public health threat, the World Health Organization said Monday.

 

China's Health Ministry announced Saturday that the 19-year-old soldier who was hospitalized May 14 with a fever and a cough had contracted the H5N1 bird flu.

 

The announcement did not further identify the soldier or how he might have contracted the disease - questions the WHO said it was pressing the Health Ministry to answer.

 

Joanna Brent, the WHO's spokeswoman in Beijing, said the ministry told the health body Monday that the soldier was stationed in the southern province of Fujian but did not have any more details.

 

"One individual H5N1 case is not in itself cause for alarm but its occurrence shows that the virus is still circulating and a continuing public health threat," Brent said.

 

According to her, the ministry also said Monday people who had close contact with the soldier were under medical observation but showed no signs of disease.

 

"Again there's been a human case without a poultry outbreak warning and so there needs to be strengthened surveillance," Brent said.

(cont.)

 

The number of cases reported by China, given their immense population, is small compared to other countries where H5N1 is endemic.  Many people, including myself, doubt we are getting the full story.  Their piecemeal dispersal of virus samples, and information, does little to promote their credibility.

 

As a sovereign nation, China has a right to deal with internal problems as it sees fit, but as a member of a greater world community, it has a responsibility to do more than protect its own interests.  China needs to take openness and transparency seriously.

 

Until that happens, China remains a black hole of information to the rest of us.  And that endangers everyone on the planet.

The Flubie Brigade

 

# 817

 

 

As the Pandemic Flu Leadership Blog Summit moves into its second week, the question before us changes from "Why prepare for a pandemic?"  to "What do I need from the Department of Health and Human Services — or others — to be able to make a contribution?"

 

I'm certain we will see a great number of creative ideas come forth from the bloggers, and those who are commenting online.  I hope you will join in with your suggestions, as well.  We need input from all sectors.   There is no one answer to this question.

 

I wrote this week's HHS blog entry, which I will post in the next day or two,  more than a week ago.  In fact, I wrote it before the first blog I posted last Monday.  `How' was simply more interesting to me than `Why'.  

 

By now, most of us know `why'. 

 

In it I present two initiatives that I believe the federal or state governments could undertake at minimal cost to educate and help prepare local communities.  But there was a problem.  

 

For it to work, it would require the participation of hundreds of flubies, members of flu forums, from around the country.  To find out if they would rally to the cause, last week I posted a poll on two flu forums, and the response was overwhelmingly positive.

 

I really wasn't surprised, but I was heartened by the response.

 

For you see, flubies are not only knowledgeable, the are passionate about pandemic preparedness   They understand that it isn't enough that they are prepared, their communities must be prepared as well.

 

Many are already out there giving presentations in their communities, often printing up leaflets at their own expense, and donating their time and energy to getting the message out.   But it isn't easy.  Local officials aren't always receptive to private citizens promoting the message, even though we are being encouraged to do so by our own government.

 

The flubie community is remarkably diverse, robust, and talented; and yet we find ourselves often ignored or marginalized in our own communities.   Remarkable given that our members include doctors, nurses, scientists, respiratory technicians, business owners, housewives, computer specialists, EMT's, Firefighters, LEO's, and representatives from practically every sector of society.   

 

But our message, the need to prepare for a pandemic, isn't always warmly received.  Understandable, I suppose, as it requires not only accepting the possibility of a pandemic, but a willingness to do something proactive about it.

 

And both can be hard to sell.

 

But if we are to be prepared when the next pandemic comes, we must get this message out, and local preparations must begin in earnest.   Once a pandemic begins, it will be too late to play catch up.

 

Today there are hundreds of well informed, dedicated, and rational flubies that gather on a handful of flu forums.  They meet in cyberspace, often without ever meeting in person, and work together to discuss and solve pandemic issues. 

 

Dedicated newshounds diligently comb through obscure media sources in faraway places like Yogayarta, Indonesia or Islamabad, Pakistan for the latest news.  They translate, and interpret news articles, giving us a better perspective of what is really happening on the ground in these countries.

 

Preppers share tips and techniques on how to prepare for a pandemic.  Activists promote awareness.  And doctors and scientists discuss openly the challenges we will face.

 

Two of the better known forums are Flu Wiki and Flutrackers, where you will find an impressive array of knowledge and information, but they are not alone. Some forums, like PFP, are geared more towards preparedness, while others focus on community activism, or scientific discussions.  I maintain a list of many of the popular forums in my sidebar.  Each has a unique flavor, and role in the greater flu community.

 

These flubies are perhaps our greatest natural resource when preparing for a pandemic.  They are motivated, informed, and passionate. 

 

We need to recognize them, and utilize them.

 

I hope you will join us at the HHS blog Summit this week, and for the next month, as we explore ways to improve our preparedness for the next pandemic.  

 

Your participation, and most importantly, your input, is essential.

Closing Schools Early In A Pandemic

Closing Schools Early In A Pandemic

# 816

For many of us, the chart above illustrates our greatest concern about the next pandemic.

Simply put, the virus appears to prefer children and young adults.

We've seen this sort of pattern before with novel viruses. In 1918, a disproportionately high number of healthy young adults succumbed from the Spanish Flu, while the excess death rates in those over 65 actually dropped. And this is exactly the opposite of what we normally see with seasonal influenza.

While seasonal flu normally claims thousands of lives each year, it usually exacts its toll from the elderly, or those with compromised immune systems, or other concurrent health problems. For healthy children, and adults, the flu is rarely life threatening.

While we can't be assured that the demographics of the attack rate, and mortality, of the H5N1 virus will remain constant if it should become a pandemic, the evidence is fairly strong that the young will be at higher risk of contracting the virus, and of dying from it.

Thus far, 90% of the cases we've seen have been under the age of 50, and roughly half have been under the age of 20. The highest mortality has been seen in those aged 10 to 19 years of age. Teenagers. High school kids.

Grim statistics for a society that treasures the next generation.

Exactly why younger people appear to be more susceptible to the virus is unknown. It may be that the older we become, the more flu viruses we've been exposed to, and we may have picked up some form of limited immunity. Some of it may be due to the role of children in developing countries, where they may be more likely to come in contact with infected birds than older adults. And the numbers may be skewed slightly by the higher ratio of young people in some of these countries.

Right now, we simply don't know.

But based on the evidence to date, we have to assume that young adults and children will be at the highest risk during a pandemic. And that has far reaching consequences.

Primarily, though, it amplifies the need to close schools early.

Waiting until 20% or 30% of the students are out with the flu during a pandemic would be, in my opinion, a tragic mistake. By then, many of the students would have been exposed, and have carried the virus back to their homes. As difficult of a decision as it might be, and regardless of the social impacts it might cause, closing schools early will save lives.

There is surprising resistance to this idea. In some school districts they have yet to decide when, or even if, they will close the schools.

There are some who worry about the loss of federal funds to school districts, or the impact on working families when they no longer have the day-care option, or subsidized lunch programs, provided by schools. Both are genuine concerns, but they pale in comparison to the costs to society, and more importantly to families, if the virus is allowed to propagate through the school system unchecked.

Our school systems would recover if they were forced to close for a few months, families would find ways to cope with not having a built-in day care option. They do so every summer, when school is out of session. Students could catch up on their studies, even if they missed a semester. There are worse things in life, and in a pandemic, to deal with.

What we can't afford is to lose is a large number of our children. That trumps every other consideration, and that should be our primary concern.

The emotional trauma of losing our children would be incalculable. We don't expect to outlive our offspring, it isn't the natural order of things. There is no grief that can compare to that of a parent who loses a child.

The debate over closing schools, and whether it would cause other problems, reminds me of my early years as a CPR instructor. Occasionally a student would balk, and say "What if I break the guy's ribs? I might puncture a lung!".

Both are possible side effects, but neither are as bad as not doing CPR, because without it, the patient dies.

Sometimes, it simply comes down to that. We act, or the patient dies.

We won't be able to painlessly mitigate the effects of a pandemic. There are no easy, foolproof solutions. Everything we do will have side effects. And not all of them will be pleasant.

• If we close public gatherings, such as theaters and sporting events, we will force some businesses to close, and put some people out of work. It's unavoidable.

• If we ask those exposed to the virus, but not sickened, to stay home, many sectors of the economy will suffer, but it may be the best way to slow the spread of the virus.

• And if we ask people to avoid crowds, we may derail our public mass transportation system, and that could affect the economy as well.

Everything we do will have consequences. Some positive, some negative. And it will be a balancing act to determine what things are worth the costs.

Closing the schools early would entail a cost, no doubt. It would inconvenience a great many people, and disrupt many lives.

But in the end, the decision must be made as to which is worse; absorbing the societal costs of closing the schools, or risk losing our children?

And in my mind, there is no contest.

Vietnam: Bird Flu Continues To Spread

 

#815

 

While long hailed as having made great strides in controlling the H5N1 virus, Vietnam is now dealing with a new and serious outbreak.   Proving, I suppose, just how difficult it is to contain once it become endemic in an area.

 

 

Bird flu spreads in Vietnam

Sun May 27, 2:53 AM ET

HANOI (AFP) - Bird flu has spread to another northern province in Vietnam, bringing to nine the number of localities hit by the deadly virus, the government said Sunday.

 

Some 250 fowl died Friday at a farm in Hoa Lu district of Ninh Binh province, 100 kilometers (62 miles) south of Hanoi, the national animal health department said on its website.

 

The rest of the almost 2,000-strong flock were culled immediately after test results showed they were carrying the H5N1 virus, it said.

 

Bird flu outbreaks have now been reported in provinces across Vietnam, with the north the worst affected.

 

On Friday, Vietnam health officials confirmed a farmer in northern Vinh Phuc province has been infected with avian influenza, the first human case in the country since late 2005.

 

He remained in critical condition in a Hanoi hospital, doctors said.

 

Vietnam is one of the countries hardest hit by bird flu, with 42 human fatalities between 2003 and 2005.

UK: The Count Of Suspected H7N2 Cases Is 11

 

# 814

 

After hinting yesterday that the number of suspected infections from the outbreak of H7N2 on a small holding in Wales had increased, today we learn the number of people showing symptoms is 11. 

 

Thus far, H7N2 has been a far less serious infection than the H5N1 strain.  But it is worrisome anytime a new flu variant, even a mild one, crosses over from birds to man. 

 

This from the BBC.

 

 

 

11 ill as bird flu tests continue

 

Tests are being carried out at a farm near Pwllheli, Llyn Peninsula

 

Officials investigating two possible cases of bird flu in north Wales have traced 26 people who may have been in contact with the disease.

 

Eleven of these people have shown flu-like symptoms, but none has been seriously ill.

 

Officials said there was not a "significant risk" to public health.

 

One mild form of bird flu has been confirmed at a smallholding in Conwy, and tests should reveal if there is a second case on a Llyn Peninsula farm.

 

The National Public Health Service for Wales defined possible contacts of bird flu as people who had been in contact with affected premises, or have either handled or come very close to known infected poultry.

 

It also included those who had had close contact with another person who has or is suspected as having bird flu.

 

Four people - two from Wales and two from north-west England - have been found to have contracted bird flu following the outbreak at Corwen.

 

A further four are being treated as having had the disease.

 

The latest figures come as officials examine two properties.

 

The confirmed case involved a smallholding at Llanfihangel Glyn Myfyr, near Cerrigydrudion, Conwy.

 

Owners Tony Williams and Barbara Cowling, who have tested negative for the virus, called in a vet after their Rhode Island Red chickens began to die.

 

An outbreak was confirmed at the Conwy smallholding on Thursday

 

They bought the chickens at Chelford Market at Macclesfield, Cheshire, some 70 miles (112 km) away, on 7 May.

(cont.)

Pandemic Flu Leadership Blog Summit Update

 

# 813

 

Now 5 days into this Internet summit, we have 7 blogs posted, and several hundred comments.   More blogs are to come in the next few days, and many more over the coming weeks. 

 

With the addition of new blogs, older blogs are shuffled off to the second page, so look for the `Next Page' icon at the bottom of the front page to read more.

 

With more than a dozen bloggers, and 5 weeks to run, hopefully we will see 60 blogs or more from community and national leaders, and a good deal of feedback from citizens. 

 

This week has focused on Why We Need To Prepare For A Pandemic,  while next week, we will begin to explore some answers to how we can achieve that goal. 

 

Bloggers who have contributed as of this writing include:

 

Secretary Michael O. Leavitt   HHS

Greg Dworkin M.D.  of  Founding Editor of Flu Wiki

Pierre Omidyar   Founder & Chairman of eBay

Nedra Weinreich   President and Founder of Weinreich Communications

Rebecca Patton    President American Nurses Association

Albert Ruesga  Founding Editor  White Courtesy Telephone

 

And my own humble entry, under my real name Michael Coston (aka Fla_Medic).

 

While the discourse has been passionate at times, it has been sane, and respectful.  We are off to a good start, but we need your participation, and your thoughts.  

 

I've placed a perma-link to the event at the top of my sidebar.  You can go directly to the first page of the summit simply by clicking it. 

 

Please take the time to visit often and make your views known. 

 

This is a bold experiment by the HHS, and one we should all partake in. 

UK: Virologists Now Suspect Up To 9 May Be Infected

 

 

# 812

 

While only 4 positive tests have been detected, virologists are suggesting that as many as 9 people who are now exhibiting flu-like symptoms after contact with infected fowl should be suspected of being infected with the H7N2 virus.

 

Human-to-human transmission has not been ruled out, and scientists are seriously looking at that possibility, according to Sky News.

 

This is not the deadly H5N1 virus, and its symptoms, thus far, have been mild.  

 

 

Four People Test Positive For Bird Flu

Updated: 07:21, Saturday May 26, 2007

Nine people have developed bird flu-like symptoms after coming into contact with birds on a chicken farm in north Wales - although only four are said to have contracted the virus.

 

No sign of deadly H5-N1 strain

 

Health officials have stressed that the type of flu found is not the potentially deadly H5-N1 strain.

 

The outbreak was on a smallholding in Corwen where 15 chickens died. A further 30 birds were slaughtered.

 

The Health Protection Agency (HPA) carried out tests on specimens from nine people associated with the incident - seven from Wales and two from north west England.

 

Of the four positive results, two were from Wales and two were from north west England.

 

The National Public Health Service for Wales (NPHS) said virologists had advised that the five people who had not tested positive should also be considered to have had the H7 influenza virus.

 

It said 23 people have been identified who have been in contact with the chickens on the smallholding in the last seven days or with people who have been ill.

 

Dr Christianne Glossop, Chief Veterinary Officer for Wales, previously said it was not the most dangerous H5N1 strain but H7N2 low pathogenic avian influenza.

 

Dr Marion Lyons, Consultant in Communicable Disease Control at the NPHS for Wales, said: "The source of the outbreak of illness is clearly identified as the chickens on the smallholding.

 

"These have all been culled so the original source has been destroyed.

 

"Although the number of people involved is very small, we could be dealing with some spread of the H7 flu virus within the household setting. We are treating this possibility very seriously."

China Reports Soldier Infected With H5N1

 

# 811

 

They are monitoring other soldiers and the PLA Central Committee is `highly concerned'.   It sounds like it, since this is rather quick notification to the outside world, given China's past history.

 

 

 

China confirms new human case of bird flu

www.chinaview.cn 2007-05-26 13:38:49 

    BEIJING, May 26 (Xinhua) -- China's Ministry of Health has confirmed a new human case of bird flu, the ministry announced on its website Saturday.

 

    A 19-year-old man surnamed Cheng, who is a soldier in the People's Liberation Army (PLA), is now receiving treatment at an army hospital, the ministry said.

 

    The website did not indicate in which part of the country Cheng was stationed nor how he may have come in contact with the virus.

 

    Calls to the ministry were unanswered at Saturday noon.

 

    Cheng developed symptoms of fever, cough and pneumonia on May 9. He was sent to an army hospital on May 14 and has been hospitalized since then.

 

    Tests by local Centre for Disease Control and Prevention (CDC) on May 18 show that he had been infected with bird flu virus strain H5N1. The result was confirmed by Chinese and PLA CDCs on Wednesday.

 

    The website did not indicate the status of Cheng's condition.

 

    The ministry said leaders of the State Council and the Central Committee of PLA were "highly concerned" by the case.

 

    They have ordered the army to cooperate with local health bureau to closely monitor those who have had close contact with the patient. So far, none of them have shown symptoms of the disease.

 

    According to the website, China's Health Ministry has conveyed the information to the World Health Organization, health agencies in Hong Kong, Macao, Taiwan, and some countries.

Britain: 4 People Test Positive for H7N2

 

# 810

 

Additional testing of people, and their contacts is ongoing, but thus far the Health Protection Agency has confirmed that 4 people who had contact with poultry from the afflicted farm in Wales  have tested positive for the H7N2 virus.

 

While a form of bird flu, H7N2 isn't thought to be as serious as the H5N1 strain.  We've seen outbreaks of other H7 variants in the past, such as the one in the Netherlands which resulted in 89 known infections, and most of those were mild, although 1 person did die.

 

What will be of great interest is if they find the H7N2 flu has been passed on to contacts of those directly infected from poultry.  So far, there is no indication that has happened.

 

This from 24dash.com

 

 

Four people test positive for bird flu after Wales outbreak

 

Publisher:  Jon Land
Published: 25/05/2007 - 23:19:59 PM

Four people have tested positive for for bird flu after an outbreak of the virus on a north Wales farm, the Health Protection Agency confirmed today.

 

Dr Christianne Glossop, Chief Veterinary Officer for Wales, previously said it was not the most dangerous H5N1 strain but H7N2 low pathogenic avian influenza.

 

The Health Protection Agency (HPA) carried out tests on specimens from nine people associated with the incident - seven from Wales and two from north west England.

 

Of the four positive results, two were from Wales and two were from north west England.

 

The remaining five were negative, the HPA said.

 

Yesterday, 30 chickens were slaughtered at the smallholding in Corwen after 15 birds died.

 

The dead birds were 22-week-old Rhode Island Red chickens which were bought by the smallholding two weeks ago.

 

One of the new chickens died the day after it was taken to the farm and all later died.

 

Tests were carried out after the farm's owners contacted their own vet.

 

A 1km restriction zone was been set up around the farm, stopping birds and bird products being moved in or out of the area.

 

Everyone entering the site has been taking flu drug Tamiflu as a precaution.

Pat Troop, chief executive of the Health Protection Agency, said: "As a routine precaution, we have tested those who were associated with the infected or dead birds and reported flu-like symptoms.

 

"We tested samples from nine people in our laboratories and confirmed infection in four.

 

"These test results confirm that human infection with the avian flu virus has occurred. The cases so far have been associated with the infected birds."

 

She said it was important to remember that H7N2 avian flu remains largely a disease of birds.

 

"The virus does not transmit easily to humans. Worldwide, almost all human H7N2 infections documented so far, including those associated with this most recent incident, have been associated with infected poultry."

 

Three of the nine people were treated in hospital but were later discharged.

 

(cont.)

Vietnam: Two More Outbreaks In Poultry Reported

 

# 809 

A busy week for new outbreaks given the OIE report on Monday that such occurrences were on the decline.

 

 

Bird flu hits two more Vietnamese localities 

Bird flu has stricken Hai Phong city and Bac Giang province in Vietnam's northern region over the past few days, raising the total number of affected localities nationwide to eight, according to a local veterinary agency on Friday.

 

The disease has killed 320 out of 500 ducks in a farm in Hai Phong's Kien Thuy district, and infected over 970 fowls in Bac Giang's Yen Dung district since May 21, according to the Department of Animal Health under the Ministry of Agriculture and Rural Development.

 

The affected fowls have been tested positive to bird flu virus strain H5N1, said the department.

 

Local veterinary agencies have culled all fowls in affected flocks, disinfected affected areas, and established quarantine checkpoints around the areas.

 

Bird flu has hit eight Vietnamese cities and provinces, namely Quang Ninh, Son La, Nam Dinh, Hai Phong and Bac Giang in the northern region, Nghe An in the central region, and Can Tho and Dong Thap in the southern one, since early this month.

 

Bird flu outbreaks in Vietnam, starting in December 2003, have killed and led to the forced culling of dozens of millions of fowls in the country.

China Virus Samples Arrive In US

 

# 808

 

After more than a year of promises, two virus samples from humans infected by the H5N1 virus have arrived for analysis here in the US.  One vital sample, from a soldier who died in 2003, was not included.

 

 

WHO: Chinese bird flu samples have arrived in US

By AUDRA ANG
Associated Press Writer

BEIJING (AP) -- Two out of three promised virus samples from recent human cases of bird flu in China have arrived in the United States, the World Health Organization said Friday. The samples are the first sent by Beijing in a year.

 

The sample updates of the H5N1 virus from China's Health Ministry are awaiting customs clearance, said Joanna Brent, a spokeswoman for WHO's Beijing office.

 

They include specimens from a 2006 case in Xinjiang in China's far west, and a case in the southern province of Fujian in 2007, Brent said.

 

But a sample from a 24-year-old soldier who died in 2003 in Beijing was not part of the batch, she said. The Health Ministry in April had promised one from that case, which was disclosed last year after new tests determined he had succumbed to the disease.

 

The ministry "says the procedures for sharing the Beijing 2003 samples involve the military and are extremely complex," Brent said.

 

The Chinese military, a power unto itself in China, and is usually secretive about its operations.

 

China has already sent six bird flu virus samples from humans to WHO's designated laboratories.

 

Two of them were dispatched in December 2005 and the others in May 2006, state media have reported. Since then, five new human cases have been reported in China.

(cont.)

 

 

The case counts we get out of China are suspect, but even given their numbers, that there have only been 5 cases since the last shipment, one has to wonder why they only released 2 of them. 

 

We need, and should have, samples from every human case.  Unfortunately, what we need, and what we can get, often are separated by a sizable gap.

Meanwhile, In Indonesia . . .

Meanwhile, In Indonesia . . .

# 807

If I wanted to, I could post at least a half dozen entries each day on outbreaks in Indonesia. The local media is filled with stories of bird deaths, culling operations, and warnings to beware of `flu burung'.

We also get, almost daily, reports of people being hospitalized for suspected bird flu. Unfortunately, we rarely get any follow up reporting. According to media reports, however, there are 20 people currently being treated for H5N1 infections in Indonesia. It is impossible to tell from the accounts if they have tested positive, or are merely suspected of infection.

The newshounds on the Flu forums are attempting to follow these, and other reported cases, from media reports. It is tedious, often mind-numbing work.

First, nearly all of the stories are printed in Bahasa, the language of Indonesia. Our tireless volunteer newshounds scan dozens of media outlets for Indonesian phrases like 'flu burung', or 'Mutasi' (mutation), or 'Pilik' (common cold) in order to segregate bird flu related articles from the rest. They then run these selected articles through translation software to convert them to English.

Given the limitations of translation software, sometimes the results are still indecipherable, and often comical. Last year, one headline read "Bird Flu Discovered By the Dog", which was a report on a dog that died, apparently of H5N1.

Once an article is translated, it is then posted, and the details are extracted and placed in spreadsheets. Often details, such as patient names, initials, or locations are left out of these articles, or simply wrong. It makes keeping track very difficult.

Yet amazingly, when Indonesia announced last week that 15 people had tested positive for H5N1, and 13 had died, since they stopped reporting to the WHO in January, those numbers were almost exactly what the newshounds had tracked. An astounding feat, by any measure.

There are many cases that simply fall into the `unknown' category. Hospitalized, or treated for H5N1, but never officially diagnosed one way or another. Some of these patients die, and we still get no official word on them.

The chart below is the current case count, as tracked by the newshounds on Flu Wiki, and compiled by Michelle in OK, for 2007. All 533 patients were mentioned in local news reports as having been suspected of `flu burung'. Only 22 have been officially diagnosed.

As you can see, we have 17 deaths, unexplained, and only 166 that were publicly reported to have tested negative. There have been 328 with symptoms, for which we have had no follow up reports.

Most of these `unknowns' are likely not H5N1. And no one is suggesting otherwise. Indonesia suffers from Dengue, Chikungunya, and a variety of other tropical diseases which can mimic flu burung. The vast majority of these unknowns probably are the result of these other pathogens.

If the reports of 20 hospitalized patients with H5N1 are true, however, it would indicate that at least some of these `unknowns' are bird flu cases. And there may be others that have been misdiagnosed. It is impossible to know for sure.

I present them mostly to give the reader some idea of the sheer number of cases that our dedicated newshounds have tracked since January of this year. We owe all of them, from all of the flu forums, a debt of gratitude.

If a sudden uptick in cases should occur, we will likely learn about it from them, and in the meantime, they have established a baseline to compare it to.

So while an isolated outbreak of H7N2 in Wales has caught the attention of the English press, we need to remember that the pot continues to simmer in places like Indonesia and Egypt, and most of it flies below the media's radar.

Wales: Awaiting Tests On Two People

 

# 806

 

The outbreak of H7N2 in Wales, while not as alarming as H5N1, is a cause for concern, and authorities appear to be treating it seriously.

 

The virus has been described as LPAI (Low Pathogenic Avian Influenza) of the type H7N2.     When we talk about avian influenza's, we talk in terms of Low vs. High pathogenic diseases.   Low pathogenic diseases are less dangerous, but may evolve over time into a highly pathogenic disease. 

 

At one time H5N1 was primarily a low pathogenic disease.

 

Tests are being performed on the couple who run the small holding where the outbreak occurred. Results are due today.  Reportedly they are showing some flu symptoms.

 

We've seen H7N2 cross over to humans before, but it has rarely been detected.   How often this really occurs is unknown, since we don't type every flu case that comes into the doctor's office, but it is assumed to be rare.

 

There are a number of avian influenzas that have crossed over to humans in the past decade, and it does appear to be increasing in frequency.  In the Netherlands, in 2003, H7N7 infected 89 people, killing one, stemming from an outbreak in poultry.   We've seen sporadic cases of H9N2 in Hong Kong, with children infected in 1999 and in 2003.

 

H5N1 is currently the most active of the avian influenzas, and the one we watch with the most concern.  But it is certainly not the only one capable of sparking the next pandemic.

 

This from BBC News.

 

 

Results due from bird flu tests

 

Thirty birds from the smallholding have been slaughtered

 

Results of tests carried out on two people at a smallholding in north Wales where a case of bird flu has been confirmed are expected to become known.

 

A 1km restriction zone remains in place around the farm in Conwy after the "low pathogenic" H7N2 strain of bird flu was found in chickens which died there.

 

The couple who live at the smallholding had tests after showing flu symptoms.

 

Wales's chief vet, Christianne Glossop, said it was a "top priority" to find the source of the disease.

 

The bird flu was confirmed at the small farm at Llanfihangel Glyn Myfyr, near Cerrigydrudion in Conwy on Thursday.

 

The owners bought 15 Rhode Island Red chickens two weeks ago but all have since died.

 

Samples were first sent for testing on 17 May, before the virus was confirmed on Thursday.

 

Health officials stresses the disease found was the H7N2 strain of bird flu, not the more virulent H5N1 strain of the virus.

 

Thirty other birds on the site were slaughtered on Thursday by four people wearing protective clothing and face masks as a precaution.

 

(cont.)

Pakistan: 5 Outbreaks In Poultry This Week

 

 

#805

 

H5N1 continues to pop up in poultry farms on the outskirts of Pakistan's Capitol, Islamabad.   This week alone, 5 farms have reported outbreaks.

 

 

 

Pakistan confirms fifth H5N1 outbreak this week

 

Reuters

Pakistani authorities have detected the H5N1 strain of bird flu at two more poultry farms on the outskirts of Islamabad, taking to five the number of outbreaks found this week, a government official said on Friday.

 

Several outbreaks of the H5N1 strain of bird flu have been found in poultry this year in Pakistan, where the deadly virus first appeared in early 2006. Pakistan has had no human cases.

 

"We have discovered two more cases in the same area where the virus was found in three poultry farms early this week," said Food and Agriculture Ministry official Rafiq-ul-Hassan Usmani.

 

Samples were gathered on Wednesday after the death of more than 3,000 birds on the two farms in the Chak Shezad area. The samples tested positive for the H5N1 strain and authorities culled the remaining 4,000 chickens on Thursday.

 

Usmani said authorities had stepped up surveillance in the area, which is known as "poultry pocket" because of its more than 40 commercial chicken farms.

 

"My hunch is that birds on many of these farms are not getting the vaccination, and the free movement of workers and birds within the area is also causing the spread," he said.

 

Health officials had been sent to examine farm workers, he said.

(cont.)

Wales: `Bird Flu' But Not H5N1

 

# 804

 

 

The announcement this afternoon that the bird deaths in Wales wasn't due to H5N1 is good news.  Unfortunately, the officials aren't telling us what strain of bird flu caused these deaths.  

 

Perhaps they simply don't know yet.

 

 

 

 

Bird flu found in Wales but not deadly H5N1

24/05/2007

LONDON (Reuters) - Authorities confirmed an outbreak of bird flu in Wales on Thursday, but said it was not the H5N1 strain, which is potentially deadly to humans and has caused scares in the past.

 

Christianne Glossop, the country's chief veterinarian, told a news conference that tests had shown it was another strain.

 

Earlier the Welsh assembly announced it was investigating a suspected bird disease outbreak at a farm in North Wales.

 

Britain has been on the watch for bird disease after Europe's biggest turkey producer Bernard Matthews was forced to destroy 160,000 turkeys because of a bird flu outbreak in England earlier this year.

 

 

 

 

UPDATE:  The Guardian is carrying more details, and has reported the disease is of the  H7N2 variety.

 

 

 

Bird flu case confirmed in N Wales

Press Association
Thursday May 24, 2007 2:28 PM

A case of bird flu in north Wales has been confirmed by experts.

 

Doctor Christianne Glossop, Wales' Chief Veterinary Officer, said the strain is H7N2 low pathogenic avian influenza, which is different from the highly pathogenic H5N1 strain currently circulating in Asia.

 

Speaking at a press briefing at the National Assembly for Wales in Cardiff, she said that chickens had been dying at the North Wales smallholding over the past two weeks.

 

Fifteen 22-week-old Rhode Island chickens were bought by the smallholding two weeks ago, bringing their total number of birds to 45 chickens and two geese.

 

 

H7N2 has been known to infect humans, but there are only 2 cases that I'm aware of over the past decade.  Neither subject experienced severe illness, and both recovered.

 

One was in Virgina, in 2002, and another in NY state in 2003

Waiting For The Light To Change

 

 

# 803

 

 

The first 48 hours of the Pandemic Flu Leadership Blog Forum is now complete, and we have 4 essay's online, and scores of comments.   This 5-week experiment has just begun, and we have yet to hear from most of the bloggers.  New essays will be posted in the coming days. 

 

I urge all of my readers to visit, and participate.  This is an important experiment in communications between the government and its people.

 

Many of those leaving  comments are from the flubie community, and it is obvious from the content just how knowledgeable and passionate they are on the subject.   While they list many concerns, primary among them is that the message to prepare simply hasn't resonated to the local level.

 

We've heard from frustrated nurses who fear they will be forced to abandon their jobs during a pandemic because their hospitals aren't preparing.  Their concern, and anger, is understandable. The inaction on the part of some medical facilities places them in an impossible situation.

 

Many have complained that their local officials appear clueless on the pandemic threat, and really don't want to hear about it.   While State and Federal preparations are ongoing, that concept just hasn't trickled down.

 

And of course, there is a certain amount of frustration that those of us in the Flubie community are regarded as loons in our communities, even though we are conveying essentially the same message to our friends and neighbors that the Federal government has been saying for 18 months. 

 

But unless people visit official panflu preparedness websites, like www.pandemicflu.gov, most of them don't understand how seriously the threat of a pandemic is regarded.  Hopefully, this blog summit will help raise some awareness.

 

The federal government has a pandemic plan, which offloads most of the responsibilities to each individual state.   Understandable, since no central government could begin to tackle all of the problems likely to surface during a pandemic involving 300 million people.

 

States were told to develop pandemic plans, and most of them have.  Some states are still working on draft plans, and have yet to come up with a finalized version.  But in the ones I've seen, they seem to ignore the local response, and simply implore local communities to prepare.  There is little or no practical guidance as to how they should accomplish that.  

 

So local governments are left without a clue, as are small businesses, health care facilities, and individual citizens.   The good news is, the bureaucracy at the state and federal levels are probably going to be prepared.  The bad news is, the remainder of the country is sitting on hold, waiting for direction.

 

It's as if everyone is sitting at a traffic signal that is stuck on a 4-way red flasher, waiting for it to turn green.

 

Part of the problem is money.   Most local communities don't have the resources to prepare without state or federal assistance. And so they have decided to wait, and ignore the problem, until they see some funding.

 

But mostly, I think it's a reluctance to risk committing to preparing for what remains a nebulous threat.   Everybody is waiting for someone else to take the lead, resulting in a classic Alphonse and Gaston act. ( "After you, sir!" and "No, my dear sir, after you!")   Except it isn't out of politeness, it's out of fear of being a pioneer.

 

They know you can always tell who the pioneers are. They are the ones with arrows in their backs.

 

Obviously someone needs to break this impasse, and get the ball rolling on the local level. 

 

Otherwise, we run a real danger of procrastinating until we run out of time.