Monday, March 31, 2008

More On The Indonesian Nurse

 

# 1843

 

CORRECTION:   While the headline of this news report appeared to state that the Nurse had died, it now appears that isn't true.  Etriani, according to this report, is improving.

 

My Thanks to Commonground on FT for setting me straight.   In my haste to depart this morning, I'm guilty of drive-by reading.

 

 

 

Yesterday it was reported that a 29 year-old Indonesian nurse had been placed in isolation suspected of having bird flu.  Tests are pending, and as of right now it is unknown if the nurse actually has the H5N1 virus.

 

Etriani (29) had apparently been caring for two other suspected bird flu patients,  Edi Satria (21) who died last Wednesday, and his sibling Anisa (22 months) who reportedly tested positive for the H5N1 virus yesterday.

 

 

Anytime a health care worker contracts bird flu we pay particularly close attention because presumably they had been taking routine precautions against infection.   It is a bit soon to draw any conclusions from this case, however.

 

 

 

A hat tip to Cottontop on the Wiki for this translation.

 

 

 

 

 

The nurse was expected by AI Rawat Pasien died

on Monday, March 31 2008 - 12:09 wib
Rus Akbar - Okezone

 

Padang - Etriani (29), the nurse RSUP Bukittinggi that became the patient was expected by bird flu evidently had treated the patient was expected by the illness that afterwards died, Edi Satria.

 

Edi Satria (21) died last Wednesday March 19.
His brother, Anisa (33 months) at this time still underwent the maintenance because of being expected by bird flu also.

 

"Apart from treating Edi Satria, Etriani could also treat Anisa in RSUP Bukittinggi, before being brought to RSUP M. Jamil," said RSUP public relations M. Jamil Irayanti when being met in his office, Street Perintis of Independence, Padang, on Monday (31/3/2008).

 

Concerning the Anisa condition and Atriani, both of them are currently treated in space of the floor isolation 3, the internal disease part RSUP M. Jamil, Padang, while being waiting for results of the laboratory of Jakarta.


 

"Anisa and Etriani have begun to improve."

 

Etriani the temperature and breathless has decreased, whereas Anisa, apart from already did not use the respirator, he could have eaten bread, tuturnya. (jri)

HHS Blog Redux

 

# 1842

 

 

Last year I was invited, along with a dozen others, to write for the HHS's Pandemic Leadership Blog.   If you've not visited this site, there is a wealth of pandemic related blogging and information to be had there; nearly 3 dozen blogs, and more than 1000 readers comments. 

 

Given my absence this week, I thought it would be appropriate to rerun one of my essays from that project.   Hopefully it may inspire you to go and read some of the other offerings there.

 

In the year since this essay was written, the HHS has provided toolkits that provide at least some of the resources to empower the public that I was asking for in this blog.   The main message, that we are the solution, remains just as vital as it was a year ago.

 

 

 

 

 

The Stuff That Solutions Are Made Of

 

 

· 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 made of. The States and Federal government can make plans, and prepare on a macro level, but ultimately we are the ones who will have to answer the call in our communities.

 

We’ve grown accustomed to treating our nation like a 5 star resort, where if a problem with the accommodations crops up, we call the front desk and complain.

 

 

Hello? I’d like to report a pandemic in my room. Please send someone up right away. Thanks

 

 

Under normal circumstances, that’s how things work. We pay our taxes, and in return we expect the government to handle the big problems for us while we concentrate on working, raising our families, and chasing the fabled American Dream. We aren’t always satisfied with the results, but that’s our system, and so we generally sigh, accept what we get, and go on.

 

Sometimes though, perhaps once in a generation, a crisis comes along that is simply too big for the government to handle alone. When that happens, they must turn to the people for help. The last time the government did this was during World War II, and history shows it was the right move. In fact, the efforts on the home front made the difference in the outcome of that war.

 

The corollaries between then and now are remarkable.

 

In 1941, we watched from a distance as the war in Europe raged on, and while we we’re sympathetic to those fighting aggression and annexation in Europe, we felt we were protected by two vast oceans; that it wasn’t our war. We lent support to England and Russia with the lend-lease program, but were unwilling to join the fight.

 

It wasn’t until after Pearl Harbor, and the destruction of the Pacific Fleet, that we felt our backs were against the wall and our nation rallied. It was, we realized, no longer a European problem; it was our problem too.

 

After the shock of December 7th, we rapidly mobilized a great nation.

 

Millions of men and women flocked to recruiting stations to enlist, knowing full well they were going in harm’s way. My father was one of them, all of 17 years of age when he joined the navy. From cities and farms they came, because their nation needed them.

 

During those early dark days of 1942 the outcome of the war was in real doubt, as we’d joined in late, and were starting with a diminished military and an economy still lagging from the effects of a decade long depression. There were many who believed the war was lost before it started, and we should simply capitulate.

 

But a miracle of sorts occurred. Not unlike the one we need today.

 

On the home front millions more joined the war effort.

 

Housewives took off their aprons and donned tool belts, went to work in shipyards and airplane factories, and the legend of Rosie the Riveter was born. Ordinary citizens, many too old for active service, volunteered to become block wardens and aircraft spotters. Teenagers rolled bandages or served donuts for the Red Cross, and volunteers worked in VA hospitals and USO clubs around the nation. Everyone recycled for the war effort, housewives collected grease, and people accepted the need for ration coupons and meatless Tuesdays.

 

The media, radio and movies mostly, rallied the nation with what today is considered blatant propaganda, but there can be no doubt that their efforts enabled us to meet an almost impossible challenge. Bing Crosby, Bob Hope, the Andrews Sisters, and hundreds of other celebrities lent their voices to the war effort. They told us to buy war bonds, and we did. They reminded us to recycle, and we did.

 

They told us to believe in ourselves, and that we could win.

 

And we did.

 

We went from a badly weakened military to a fighting force in a matter of months. In time, hundreds of aircraft began to roll off of assembly lines each week, and by the end of the war, the Navy was launching a new liberty ship nearly every day.

 

It was a remarkable achievement.

 

Looking back, it took more than a government and a military to win that war. It took the help and full cooperation of the American people. Right now, while we face a different threat, the solutions are the same.

 

As in 1940, we aren’t preparing for the battle to come, we are sleeping peacefully, unaware of the gathering storm. Unlike 70 years ago, we need to reawaken the American spirit and rally the nation before we see an attack on our soil.

 

The government, despite their best efforts, cannot fight a pandemic alone. They will need our help. But for that to happen, they must be willing to enable our participation.

 

During WWII, there were people called ‘dollar-a-year-men‘, business executives and community leaders who served their nations at little or no pay. The government paid their expenses, but they donated their time. They did it because they felt it was their patriotic duty: an old, but honorable concept. They weren’t part of the government, or the military, but we’re recognized by those entities as genuine partners in the war effort. They lent their time, support, and expertise, because they realized their country needed them.

 

We need to reawaken that spirit. Enable it, and encourage it.

 

One of the best reservoirs of talent available to the government today are members of flu forums, sometimes called flubies, who already are well informed, passionate, and ahead of the curve on pandemic preparation. Some of them are already giving presentations in their communities, but there are many more who would, if encouraged.

 

Pandemic flu preparedness isn’t something that can be adequately conveyed to the public in 30-second public service announcements, or drive-by newspaper articles. The subject is too complex, and people need to have their questions answered. In my experience, it takes an hour just to hit the high points.

 

The best, and perhaps the only effective way to get the message out are through community town hall style meetings.

 

We need knowledgeable people who can do responsible presentations in every school, church, community center, and civic organization in the nation. Citizens need to know how to prepare, what to expect, and how to deal with it. But in order for this to happen, the government must enable, encourage, and most importantly, sanction these presentations.

 

The message can be standardized, and presented without raising undo alarm. But it mustn’t be watered down or sugar coated. The public won’t panic if they are properly informed. Panic only comes from an absence of knowledge. While the primary message should be about pandemic flu, this is also an opportunity to present an ‘all-threats‘ preparedness message, one that would pertain not only to a pandemic, but also to hurricanes, earthquakes, and other natural disasters.

 

Imagine the cumulative impact of having hundreds of community pandemic awareness meetings each month across this country? The message would be picked up by local media, and the word would be spread by attendee’s to families and friends. We would have an opportunity to instill a preparedness meme in our country, which would serve us well in any crisis. And we can tailor each presentation to the audience, increasing its effectiveness.

 

Retired doctors and nurses, and yes, even old retired medics like myself, can begin teaching home flu care and preventative hygiene classes in our communities. The government has already acknowledged that most flu victims won’t be able to receive hospital care. The next step is to empower people to care for their loved ones in a pandemic.

 

Local health departments are understaffed and under budgeted. They don’t have time to visit every civic organization, trailer park clubhouse, church and school to deliver this message.

 

Thirty years ago, during the Swine Flu scare of 1976, as a young medic I was enlisted by the local Health Department to do exactly that, and during that summer I spoke at dozens of venues. These presentations were considered a great success, and the audiences were very receptive.

 

Oh, I understand the reluctance. Can you trust us? Can we be professional? Can we deliver the message without sparking undo panic or alarm?

 

I believe the answer to all of those questions is ‘yes’.

 

Many of us in the flubie community are products of the cold war. Most of us are in our 40’s or 50’s. We grew up under the specter of the A-bomb. We learned to ‘duck and cover’ as children, and knew not to look at the flash. We remember the civil defense films, shown in every classroom in the nation during the 1960’s, and the tense days of the Cuban Missile Crisis. At the age of 8, I probably knew more about fallout shelters and radiation sickness than most Americans know about pandemic flu today.

 

We didn’t panic, or act recklessly then, and we won’t now.

 

In fact this early tempering on the forge of the cold war was probably responsible for my becoming a paramedic, an Instructor for the American Red Cross, and a member of my county’s Civil Defense team. Admittedly a misspent youth, but one I am unapologetic for.

 

If you can’t trust us, whom can you trust?

 

Start small, if need be. Initiate a pilot program. Go to the flu forums and ask for volunteers. Pick the best dozen representatives you can find. We’re all on record; it wouldn’t take much to determine whom you can trust. Give them letters of introduction and some preparedness pamphlets and see what they can do in their communities.

 

You might be pleasantly surprised. It doesn’t always take a multi-million dollar advertising campaign to get the word out.

 

I get very little traction talking about pandemic flu in my community because I’m a private citizen, with no bona fides. As far as I can see, there is little or no pandemic preparation or awareness here, and no one wants to listen to a retired paramedic. I have no official standing, and so I am easily dismissed.

 

Legitimize our efforts, enable us to get our foot in the door, and you will have an army of hard-working, dedicated foot soldiers in the field.

 

Give us enough levers, even small ones, and we’ll help move the world for you.

 

It’s really as simple as that.

 

Community education, while vital, is just the beginning.

 

While there is much planning going on at the Federal and State levels, distressingly little appears to be happening at the community level. Most local governments are waiting for direction and funding from higher up, or are ignoring the problem altogether. Few communities have the budget to gear up for a pandemic, and so few are actively doing anything to prepare. Many, mistakenly still believe the State or Federal government will move in to handle any crisis.

 

To solve this impasse we need community volunteers, working in partnership with local governments, to prepare for a pandemic. We should be thinking along the lines of a State or Federally sanctioned Volunteer Pandemic Corps, where citizens can band together to help their communities solve local problems.

 

Once again, members of flu forums who have considered and discussed these issues could be major assets to these organizations.

 

How do we ensure the delivery of food and supplies to local communities? How do we distribute needed medicines to families? Who will check on the elderly, or infirmed, during a pandemic? What about single parents who are stricken by the virus? Who cares for them, or their children? What becomes of the 27 million Americans who live alone if they become ill? Who will step in to take over the jobs of fallen essential workers?

 

These are problems that will require local solutions, and yet are beyond the scope and capacity of most local governments. Somehow, we must find ways to deal with them.

 

It should be noted that those of us over the age of 40 may be particularly useful in a pandemic. This virus, much like the Spanish Flu of 1918, prefers young adults and children. Thus far, 90% of its victims have been under the age of 40. Baby boomers, such as myself, run less of a risk of infection or death than do younger people.

 

Since the goal of any rational society is to protect the next generation, some of us who are less vulnerable must ultimately step up and take on some of the risks during a pandemic. No, its not a pleasant thought. No one wants to go in harm’s way. But it is the responsible thing for us to do.

 

It is my hope we can create an army of graying volunteers, thin of hair, but not of spirit, to do those jobs during a pandemic we wouldn’t wish upon our children.

 

If a volunteer can drive a truck, check on a neighbor, hand out a flyer, join a neighborhood watch, work a telephone, tend to the sick, cook a meal, operate a Ham Radio, or watch the child of someone who is ill, they can be an essential relief worker.

 

You don’t have to put on a uniform, or wear a badge, to be a hero to your community. All you have to do is think like one. And act like one. Pretty soon, you’ll be one.

 

No, not everyone will volunteer to work during a pandemic. I understand that. Not everyone is suited for it. There are personal risks involved. It takes a special type of person, often one without family responsibilities, to undertake this sort of assignment in a crisis. But there are more of them out there than you know. You just have to ask them to come forth.

 

Officials are often loath to ask for help from the public. They see it as an admission of failure on their part. But the real failure would be in not asking, when the need is this obvious. They can’t handle a pandemic alone. They know it. We know it.

 

It’s time to reach for a solution.

 

Cynicism towards all levels of government runs rampant in our society. People, quite frankly, don’t trust the government. They feel disenfranchised, isolated, and patronized. The government correspondingly has grown wary of its own citizens. We’ve gotten to the point where we talk at each other, instead of to each other.

 

While it may sound idealistic, working together to fight a pandemic could help heal that rift.

 

Even if a pandemic doesn’t occur in the near-term, by working together on solutions, we would become a stronger, safer, and more unified nation. We’d be better prepared for the next earthquake, hurricane, or flood. And those are threats we know we will face.

 

Trust is a two-way street. If the government can show some faith in its citizens by asking for their help, citizens will naturally begin to trust the government more.

 

An unavoidable side effect, I suppose.

 

But it’s one, in time, I believe we could learn to live with.

 

AFD On Hiatus

 

 

The time has come once again for me to make one of my twice annual treks to Missouri to see my Lyme Disease specialist.   I will  have very limited Internet access while I'm gone, and probably none until at least next Sunday.  

 

While this hardly qualifies as a pleasure trip, I hope to recharge my batteries a bit while I'm gone, and will stay a few extra days at St. Augustine Beach on my way home. 

 

Luckily things are pretty quiet.

 

While I'm gone my readers will have plenty of bird flu resources at hand. Flublogia doesn't lack for talented bloggers.

 

Crawford Kilian, the dean of flu bloggers, updates the news several times each day on Crof's Blog.  While I'm on the road, if I can get a net connection, that's where I'll be checking.

 

The Coming Influenza Pandemic?  links to the major stories of the day, although it doesn't update until late each day.

 

Scott McPherson's blog, while it doesn't update every day, offers unique in-depth analysis of developments on the flu front.

 

SophiaZoe's A Journey Through The World Of Pandemic Influenza is always interesting, thought provoking, and well written.

 

And finally the Revere's of Effect Measure  can be counted on to explain the science behind public health issues like Avian Flu, XDR-TB, and Chikungunya, among other things.

ComputerWorld: New Strategies For New Disasters

# 1840


The scribes at ComputerWorld have been urging preparation for a flu pandemic for at least a couple of years. Recently they added my buddy Scott McPherson to their blogging role, and he too bangs this drum loudly.


Other articles, many by Patrick Thibodeau, covering IT's preparation for a pandemic, have appeared in that trade magazine. Today, an new article by Mary K. Pratt appears.


New strategies for new disasters

Events like 9/11 and Hurricane Katrina have brought disaster to ITs doorstep. But many companies are still applying old strategies to new disaster scenarios.

By Mary K. Pratt


March 31, 2008 (Computerworld) Here's a tricky question: Could your company operate during a flu pandemic?


Nearly 3,000 financial services organizations tested their answers to that question with a disaster drill last September. The exercise showed that the financial sector could continue to operate during a pandemic, but it also revealed stress points throughout the industry. For instance, many recovery plans laid the groundwork for employees to telecommute -- a smart move in a scenario that could leave thousands homebound -- but the existing infrastructure couldn't handle the increased traffic.


"When you have [so many more] people working from home, the Internet is going to slow to a crawl, and that's if it's even recoverable in all parts of the country," says Nick Benvenuto, managing director and global head of business continuity at Protiviti Inc., a risk management consulting firm in Menlo Park, Calif.


That drill highlights the status of many companies vis-a-vis disaster recovery: They have disaster plans, but those plans aren't adequately designed to handle an actual event.


Instead, many business executives, including top IT managers, are relying on old procedures and technologies that might work for small-scale, brief disasters -- a regional power outage, for example -- but would fall woefully short during a catastrophe like another major hurricane or terrorist attack.

(Continue reading . . . .)



An interesting article on a serious problem:


It isn't enough to have a disaster plan, the plan must be realistic in its scope and recovery protocol. Often, plans are poorly designed, or may be adequate for a short term disruption, but fall apart quickly during a major crisis.


While problems exist in the IT sector, at least most of the big players have some kind of plan, even if it may not be adequate. For millions of medium and small businesses, disaster planning isn't even considered.


Many disaster plans are a product of `due diligence. A company or an agency is told they must have a disaster plan, and so they create one, but they never test it, and they pray they never need to implement it.


Many suffer from gaps, where success is based on the hope that `a small miracle will occur' along the way. Even some of the State pandemic plans suffer from this mindset.


Last year FEMA declared 63 major disasters within the United States -Floods, Tropical Storms, and tornadoes mostly- proving it doesn't take a pandemic to ruin your whole day.


The ability of companies to weather these events is based largely on how well they prepared. Serious disaster planning is crucial, and all too often ignored until it is too late.


Does your company have a serious disaster recovery plan? Has it been tested? Does it include a pandemic scenario? Is it realistic?


The time to find out is now, before a disaster strikes.

Indonesia Confirms Two Bird Flu Deaths

 

 

# 1839

 

 

Confirmation this morning of the story I reported yesterday - the death of a 15-year-old boy last week was due to the H5N1 virus.  Plus another bird flu death announced; that of an 11-year-old girl from Bekasi. 

 

Lastly, the 22 month old child mentioned as a suspect in yesterday's report has tested positive for the H5N1 virus.

 

Here is how Reuters is reporting the story.

 

 

Two Indonesian youths die of bird flu

 

JAKARTA - TWO Indonesian youths have died from bird flu, a health ministry official said on Monday, taking the confirmed death toll in the country worst affected by the virus to 107.

 

A 15-year-old boy from Subang, in West Java, died on Wednesday in an area where chickens had died, said Mr Nyoman Kandun, director general of communicable disease control at the ministry.

 

An 11-year-old girl from Bekasi, east of Jakarta, who died on Friday also tested positive for the virus, the official said.

 

'There were dead chickens in the boy's neighbourhood, but in the girl's case it is still unclear,' Mr Kandun said via a mobile phone text message.

 

Mr Kandun dismissed the possibility of more bird flu cases in the same family after the boy's brother died recently.

 

Confirmed cluster cases raise concerns over human-to-human transmission.

 

'It is not correct that there is a cluster in Subang,' Mr Kandun said, adding that the brother has died of dengue fever.

 

Earlier on Monday, a 22-month-old girl from Sumatra's Bukit Tinggi tested positive for bird flu and the health ministry was checking her neighbourhood for possible backyard farming.

 

'Her condition is improving, and she is being treated at a Padang hospital,' Ms Lily Sulistyowati, a health ministry spokesman, said by telephone.

 

Including the latest deaths, Indonesia has had 132 confirmed cases of the virus.

 

 

 

The denial of a possible cluster in the case of the 15-year-old, whose brother died a week early, is not entirely unexpected.   Officials are loathe to describe any patient as having the bird flu virus until they have tested positive twice, a test that was probably never run on the boy. 

 

The brother could have died of Dengue, as originally diagnosed.  But we'll never know.   The coincidence, that both brothers should die a week apart from different infectious diseases, however, is a bit hard to swallow.

 

A similar situation exists in Padang, where a 22-month old has just tested positive for the virus.  A 21 year old sibling died less than 2 weeks ago of `inflammation of the lung'. 

 

The last case mentioned yesterday, that of a 29 year-old nurse in isolation, wasn't updated in this report.

Sunday, March 30, 2008

Indonesia: Local Media Reporting Possible Cluster

 

# 1838

 

 

While we've heard nothing official out of Indonesia in recent days newshounds on the Internet have been following several stories in the Indonesian press regarding suspect cases of bird flu.   

 

While often these cases turn out to be something other than bird flu, we sometimes get early confirmation of genuine cases through the local media. 

 

 

Today, the Indonesian press is reporting that a 15-year-old boy who died last Wednesday has tested positive for the H5N1 virus.   This boy's 6-year-old brother died a week earlier, supposedly from Dengue.   While it may be impossible to confirm the younger boy's death from bird flu, this does have the earmarks of a cluster.

 

Additionally, a 60 year old has also entered the same hospital suspected of bird flu.

 

A hat tip to Commonground on Flutrackers for this translation.

 

 

Agus died Positive H5NI, RSHS the Arrival Again the Suspect Patient


Agus Yuhadi (15), the Patient suspect Avian Influenza (AI) from the Cimeta Village, Kecamatan Bulansari, Kabupaten Subang, was stated positive was attacked by the virus H5N1.


That was based on results of the sample inspection of blood as well as germs on Agus's throat, moments before the patient died, last Wednesday (26/3).

From these results, the Kesehatan Service of the West Javanese province will send the team of investigation to the location of Agus's residence.

Was like this it was said the Sub Dinas Penyehatan Lingkungan Head and the Dinas Settlement of the Health of the West Javanese province, Wahyu Suryaputra, on Friday (28/3).

According to Wahyu, his side received the news that stated Agus positive was attacked by the bird flu virus through the short message or short massage service (the SMS).

Named, from results of the test as well as germs of the blood laboratory in the patient's throat, the Penelitian Dan Pengembangan Kesehatan Hall (Balitbangkes) Jakarta, stated Agus positive was infected H5N1.

 

<snip>

 

R (60), the resident of the Jero Valley, Nagreg, of Kabupaten Bandung entered isolation space after three days experienced the fever, the cough and breathless.


According to Hidayat, relatives of the patient, R maintained five chickens.


Every day the patient maintained this chicken including cleansing the pen that was far-off of his house.

Around the last two days, one chicken belonging to the patient died suddenly, not long after approximately 70 chickens belonging to his neighbour also died suddenly.

 

 

One of the things we watch for are Health Care workers falling ill after caring for a bird flu patient.  This can be an early sign of transmissibility.    Local media is now reporting on a nurse, E (29) who has been reconciled to the hospital with bird flu symptoms. 

 

It isn't clear what contact this nurse may have had with any bird flu patients, and bird flu has not been confirmed in this case.

 

 

Hat tip to History Lover on the Wiki for this translation.

 

Nurse Bird Flu Suspect Patient Returns to RS M Djamil Padang

March 30, 2008,  


Hat-tip bgw in Mt, Reporter : Ade Irwansyah

PADANG--MI:  At RS M Djamil Padang City, Sumatra Barat a nurse returned to be treated as a suspect bird flu patient, Sunday, March 30.

 

The female patient with the initial E, 29, was being treated at RS Ahmad Mukhtar Bukittinggi City.  She was reconciled from the aforementioned hospital and is being treated at RS M Djamil Padang, Sunday, March 30, around 2.00 WIB.  

 

The condition of E at this time is she spent the night in the intensive installation disease room (Irna) C in RS M Djamil, adjacent to A, a toddler aged two and a half years,  who also was taken from RS Akhmad Mukhtar and received the same treatment at RS M Djamil Padang since last Sunday, March 24.

 

"The patient suffers similar symptoms to bird flu, such as a high fever, coughing and restricted breathing," said Irayanti, Head of Medical Services at Medik RS M Djamil Meanwhile the condition of A is not yet improving.  Until this time, the toddler was still attached to assistive breathing equipment.  Consequently she was even given an infusion."

 

 

 

And lastly, we have another child hospitalized with bird flu symptoms, and once again, a sibling recently died of a lung infection.  

 

 

A hat tip to Commonground on Flutrackers for this translation.

 

 

The suffering of casualties's Family Suspect Bird Flu, the House is Now Quiet not Have Inhabitants

 


The ordeal that struck the couple Zul Azmi and Fatma, the medical official RSSN Bukittinggi and PNS that having an address in Lambah Nagari Sianok VI Suku Kecamatan IV Koto Agam indeed did not yet end.

 


Although one life of their child, Edi Satria (21) was called by the Lord because of the inflammation diagnosis of the lungs, now the daughter of the couple's youngest child, Anisa (21 months) also was claimed as suspect bird flu.

 

 

Anisa that according to the temporary medical test was expected as the patient suscpect bird flu, till at this time still was lain alongside in isolation space RSU M. Jamil Padang.


 

This unfortunate child was treated since last Monday (24/3), and till now was not yet it was known certain whether positive or negative was affected by the virus avian influenza (bird flu) . The house Be Now Quiet Have Inhabitants.

 

It may be several days before any of these suspected cases are either confirmed or ruled out as having bird flu. 

Vietnam: Call For Tougher Bird Flu Action


# 1837

 

 

Two stories out of Vietnam this morning.  

 

First, that nation is importing 60 million doses of bird flu vaccine (for poultry) from China this month.  Vietnam began its  nationwide vaccination campaign in August 2005, and attributes much of their success in containing the virus to that practice.

 

Over the past year, however, this strategy has seen some cracks appear in its veneer with renewed outbreaks of the virus around the country.  Last week an inquiry was ordered into vaccinated poultry that reportedly died from the bird flu virus.

 

 

 

Vietnam imports bird flu vaccine from China

 

 

 

 

 

 

 

Sixty million bird flu vaccine doses are expected to arrive in Vietnam Saturday from China, according to the Vietnamese Ministry of Agriculture and Rural Development on Friday.

 

The ministry said it had to import the vaccine this month instead of in April as planned, because of increasing bird flu outbreaks in the country.

 

Ten provinces, mostly in the north, have reported outbreaks of the disease this year.

 

The Mekong Delta risked a massive outbreak due to farming of free-range ducks in many provinces and poor control of poultry transport and trade, according to health officials earlier this week.

 

Of the 106 human bird flu cases confirmed in Vietnam since 2003, 52 have been fatal.

 

In related news, the Health Ministry announced Friday the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunization) pledged to aid nearly US$2.15 million for a massive measles vaccination program here.

 

 

 

Meanwhile, concerns are running high that April and May could see massive outbreaks of bird flu, particularly in the Mekong Delta area. 

 

Officials are blaming poor compliance with bird flu regulations and are demanding better enforcement.

 

 

 

 

 

Southern metro gets tough on bird flu

 

District leaders should beef up measures against the illegal slaughter and transport of bird flu-infected poultry to contain the spread of the H5N1 virus, said a Ho Chi Minh City vice mayor Saturday.

 

 

At an emergency meeting on combating bird flu, vice chairman of the HCMC People’s Committee Nguyen Thanh Tai said several districts had been too lax in fighting poultry smugglers and illicit slaughterhouses.

 

He lambasted leaders of Go Vap District in particular, accusing the authorities for allowing illegal poultry slaughtering and transport to continue right under their noses.

 

Tai asked city hall to keep a closer eye on the development of any bird flu outbreaks, which have at times been described as epidemic.

 

He asked agencies concerned to punish those that flout anti-bird flu directives.

 

The city’s Pasteur Institute also announced Thursday that a man’s Wednesday death in which bird flu had allegedly been the cause was in fact a case of pneumonia, not the avian virus.

 

Of the 106 human bird flu cases confirmed in Vietnam since 2003, 52 have been fatal.

 

The latest confirmed victim was an 11-year-old boy who died last week in the northern province of Ha Nam.

 

Ten provinces, mostly in the north, have reported outbreaks of the disease this year, but health officials said Monday that the Mekong Delta faced the risk of a massive outbreak due to free-range duck breeding and the poor control of poultry transport and trade in several provinces.

Source: SGGP

Can Surveillance Stop A Pandemic?

 

# 1836

 

 

Well, according to microbiologist and bird flu expert Yi Guan, it can.

 

Prof Guan believes that with proper surveillance, bird flu viruses can be detected and eradicated before they `mature' into a human adapted form.  This maturation he believes, is a slow process, giving man time to intervene. 

 

The `catch' is that it requires `proper surveillance'.

 

In many parts of the world surveillance is minimal, and sometimes non-existent.  The ability to stop a virus that evolves in a place like Hong Kong or Thailand might exist, but what of a virus that matures in Myanmar, Cambodia, Nigeria, or even Indonesia?

 

 

Professor Guan is no doubt correct that proper surveillance is an important goal, and that it might interdict a bird flu virus before it can adapt to humans.  

 

We are, unfortunately, a long way off from that becoming a reality.

 

 

 

 

March 30, 2008
 

Proper surveillance can stop flu pandemic: expert

 

HONG KONG - AN influenza pandemic can be avoided if proper disease surveillance and control measures are carried out promptly and thoroughly, leading bird flu expert and microbiologist Yi Guan said.

 

Prof Guan, who studied the H5N1 bird flu virus after it showed up in people in Hong Kong in 1997 and has tracked its footprints all over the world ever since, is convinced that the world can stop the bug in its tracks if it has enough resolve.

 

'If proper surveillance is in place for animals and humans, yes, we can stop pandemic influenza forever. Not just for H5N1, it may also work for other subtypes of viruses,' he said in an interview over the weekend. 'We have the ability to remove pandemics if we have a long-term strategy.'

 

<snip>

 

'Pandemics don't happen suddenly, they have an early phase, mature phase, outbreak phase. The virus changes step by step, it takes a long cooking time,' he said.

 

'If a virus gets into humans in the early phase, the transmission ability is very low. At most, they infect their families, but it can't go further into the community.

 

'This phase is the golden point to control. Once it matures and becomes (efficient in) human-to-human (transmission), it will be too late.' -- REUTERS

Bangladesh: Warmer Temperatures Slowing Bird Flu Spread

 

#  1835

 

 

While reports of bird flu outbreaks among poultry in Bangladesh continued throughout the summer and fall last year, the real explosion in cases wasn't reported until December and January.    Officials are now reportedly seeing a reduction in the number of outbreaks with the arrival of warmer weather.

 

This from Xinhua News.

 

 

 

 

 

 

 

 

Bird flu situation improves in Bangladesh with temperature rising

www.chinaview.cn 2008-03-30 16:44:39
 

    DHAKA, March 30 (Xinhua) -- With the rise of temperature, bird flu that battered the growing poultry industry in Bangladesh now started to ease off, an expert of the Livestock Department said Sunday.

 

    Sujas Kanti Bhoumik, a technical officer of the Livestock Department, told Xinhua that the situation of bird flu is gradually improving with the rise of temperature.

 

    An official at the Bird Flu Control Room told Xinhua that some 1,536,542 chickens, ducks and pigeons have been culled so far till Saturday since the virus broke out in March last year.

 

    The official said the disease affected 486 commercial farms and42 private farms in 47 districts out of 64 districts in the country.

 

    The government agencies are campaigning through electronic media and SMS services that there is no danger of eating chickens and eggs if cooked and boiled at 70 degree Celsius.

 

    Physicians said there is no reason for the people to be panic about the virus as there is no human infection case in Bangladesh.

 

    People who were earlier panic at the spreading of virus and stopped eating chickens and eggs are now changing their mindset. Many households started eating well cooked chickens and eggs.

 

    The Bangladesh Poultry Industries Association (BPLA) said the deadly virus led to the closure of more than 50 percent of the farms, turning nearly five million people jobless. The BPIA said about 100 billion taka (about 1.43 billion US dollars) were invested in the poultry sector. 

Saturday, March 29, 2008

From Russia With Lvov

 

# 1834

 

 


Dmitri Lvov is the Director of the Ivanovsky Research Institute of Virology at the Russian Academy of Medical Sciences, and has been very vocal over the threat of a bird flu pandemic in the past. 

 

 

Lvov has gone as far as to predict as many as 1 billion people could die in a severe pandemic, a number several times higher than most scientists are willing to contemplate.

 

 

Lvov attended this week's International Conference on Bird Flu in Bali, and gave this newspaper interview.

 

 

 

Bird flu can mutate to infect humans
29.03.08 14:25

 

The international medical community has met in Bali for the Sixth International Bird Flu Summit to discuss the possibility of mutations in the avian flu virus leading to human pandemics, RIA Novosti reported.

 

Attending the summit was Dmitry Lvov, director of the Ivanovsky Research Institute of Virology at the Russian Academy of Medical Sciences.

 

The danger of mutations, Lvov warns, is considerable, and the situation is potentially highly alarming.

 

The H5N1 virus needs only one or two amino acid changes to become transmittable between humans, to produce mutations and hybrid cells,” Lvov said. “Nobody knows when these killers may appear, for everything depends on the specific features of the virus’s receptors. So far, it can provoke pathologies after reaching the lower parts of the respiratory tract. The ordinary flu virus hits the upper sectors.”

 

The scientist said: “Since H5N1 mutations never stop, the virus could eventually ‘learn’ to hit the upper parts of humans’ respiratory tract. This would be very bad, but in the worst scenario bird and flu viruses will infect the same recipient, for example a pig, whose organism is susceptible to both viruses. There is one chance in a million of that, but this one chance could result in a global catastrophe that would claim millions of lives.”

 

The scale of danger is huge. Any country will be completely defenseless against the disease, because quarantines will not help, as the Spanish Flu pandemic of 1918-1919 showed,” Lvov said.

 

- The virus has not yet overcome the genetic barrier, yet humans are dying of bird flu, although mainly in East Asia. Why?

 

- About 400 humans have contracted bird flu. So far, it is extremely difficult to contract bird flu, for molecular and genetic reasons. You must have direct contact with an infected bird to catch the disease, for example, by drinking the infected bird’s blood (some nations do this) or “kissing” the infected hen. I was told that a girl started giving the kiss of life to her favorite hen, which she had nurtured since it was an egg. As a result, the child died.

 

In other words, hygiene has now become a matter of life and death. So far, there have not been any cases of virus transmission between humans.

 

-Bird flu has existed since prehistoric times. What has provoked the appearance of its current, highly virulent form?

 

- Birds are the natural carriers of bird flu. The virus and birds have lived together for 300 million years, so that wild fowl have become immune to it. But when conditions change, the bird flu genome changes too, producing new, highly virulent strains. To keep living, viruses must mutate. Sometimes new and dangerous strains infect humans, spreading across the globe incredibly fast.

 

Scientists reported 40 years ago that birds carry all the pandemic flu strains, although not all scientists accepted that view immediately. The first proponents of this theory were Robert Webster, of St Jude’s Children’s Research Hospital, Memphis, Tennessee; Professor Graeme Laver of Australia; and myself. We were ridiculed then. Unfortunately, we have now been proved right.

(Cont. )

Friday, March 28, 2008

Vietnamese Suspect Negative For Bird Flu

 

# 1833

 

 

Proof once again how difficult it can be to differentiate between bird flu and other viral infections.   This case, which looked suspiciously like bird flu, turned out to be acute pneumonia instead.

 

 

 

 

Vietnamese man died of pneumonia, not bird flu

 

 

A man who died in Ho Chi Minh City on Wednesday was not infected with the H5N1 virus, or bird flu, as was previously suspected.

 

The director of the city’s Pasteur Institute announced Thursday that the cause of death was, in fact, acute pneumonia.

 

The patient was hospitalized in Pham Ngoc Thach Hospital Tuesday with breathing difficulties, a cough and high fever, symptoms similar to those of avian influenza.

 

The death was under suspicion since the deceased’s family in the central province of Nghe An said there had been a bird flu outbreak in the province two months ago.

 

According to the institute, however, the patient’s immune system had been weakened by a pre-existing kidney condition that led to pneumonia.

More On Yesterday's Indonesian Suspect Case

 

# 1832

 

 

 

Yesterday we learned of a 15 year-old-boy who died in a Bandung hospital, now suspected of having bird flu.  

 

New information today is that the boy's younger brother died last week in the same hospital, from what was believed to have been Dengue Fever.

 

Dengue fever is, of course, quite common in Indonesia.  Diagnosis is generally based on clinical symptoms, not on blood tests.  While most patients recover, a small percentage of Dengue patients develop Dengue hemorrhagic fever, a complication that is life threatening.

 

The symptoms of Dengue vary, but can include high fever, joint pain, headache, pain behind the eyes, and rash.   These symptoms are also common to a variety of viral illnesses, including bird flu.   

 

To have two members of the same family die from Dengue would be unusual, but not unheard of.  It does raise suspicions, however.  Tests are being run, and so it will be  a few days before we know if this boy had the H5N1 virus or not. 

 

 

 

 

 

Suspected bird flu patient dies

,  ,    |  Fri, 03/28/2008 11:27 AM  |  The Archipelago

BANDUNG: A 15-year-old boy from Subang, West Java, suspected of suffering from bird flu died Wednesday evening just one hour after being admitted to Hasan Sadikin Hospital in Bandung to receive intensive medical treatment.

 

Hadi Jusuf, head of the hospital's bird flu mitigation team, said the condition of the patient, identified only as AY, was very poor upon arrival at the hospital at 4:30 p.m.

 

"He had breathing difficulties and was unconscious. Moreover he had acute lung wounds," Hadi explained Thursday.

 

AY had been treated at Cieereng Hospital four days earlier, his high body temperature leading doctors to believe he suffered from dengue fever.

 

A week earlier AY's younger brother died at the same hospital due, according to the hospital doctors, to dengue fever, Hadi said.

 

AY's blood samples had been sent to a laboratory at the Ministry of Health in Jakarta to ascertain whether AY was infected by the H5N1 virus or not, Hadi said. -- JP

Bali Conference: The Need For New Antivirals

 

# 1831

 

 

This week an international bird flu conference is being held on the island of Bali, where representatives of 25 nations have gathered to discuss the problems and progress of dealing with the H5N1 virus.

 

Of the many concerns, our limited arsenal of antiviral drugs is high on the list.   While still considered our most effective medicine against bird flu, worries abound that resistant strains of H5N1 may develop.

 

This from the Jakarta Post.

 

 

 

 

 

 

More effective medication needed in fighting bird flu

Dicky Christanto ,  The Jakarta Post ,  Denpasar   |  

Fri, 03/28/2008 1:28 PM  |  Bali

 

More effective medication is needed to fight the H5N1 virus that causes Avian Influenza, as symptoms of resistance toward Osetamivir, the current medicine, had appeared in bird flu patients in some regions, an official at an Avian Influenza Summit said.

 

"We have learnt some bird flu patients in Hong Kong and Vietnam have shown resistance to old medicines," head of the National Working Group on Avian Influenza Eradication Amin Subandrio told reporters at the summit held at Nusa Dua resort Thursday.

 

"That's why we gather here, to find out whether or not we are ready to tackle the possibility that people are becoming immune to bird flu medication," Amin said.

 

Representatives from 25 countries attended the two-day summit, including from the U.S., Japan, South Korea, Indonesia and Kenya, who discussed the need for new medication to fight the AI virus

 

An exhibition demonstrating medical breakthroughs in treating bird flu by pharmaceutical companies from participating countries was also held.

 

Many countries are currently using Osetamivir, locally known as Tamiflu, to treat patients diagnosed with bird flu.

 

Tamiflu must be given to bird flu patients early as it reacts with the virus while it is still in the patient's blood. Once the virus enters the patient's lungs, the tablet is not much use, Amin said.

 

"We must then mix it with other medication to avoid further damage," he said.

 

The disease has killed 105 of the 129 people who have contracted the disease in Indonesia.

 

Amin said Tamiflu was still needed to treat patients suffering from bird flu.

 

"But we must be very careful not to give this medication to people who haven't been officially diagnosed with bird flu. If we do, they could become resistant to the medication in future," he said.

 

With new bird flu medication expected to be available in five to ten years time, campaigns on the necessary precautions to take were essential to avoid the disease, Amin said.

Thursday, March 27, 2008

Malda: Four Cullers Under Observation

 


# 1830

 

 

We've seen cullers under observation before in West Bengal, yet thus far, none have tested positive for the bird flu virus.   Since test results are pending, we'll have to wait to see if this lucky streak continues.

 

 

 

 

 

Bird flu not confirmed in humans: West Bengal official

March 27th, 2008 - 5:31 pm ICT

 

Kolkata, March 27 (IANS) The West Bengal government Thursday said there has been no confirmation of bird flu in humans, a day after four workers involved in culling operations were put under medical supervision for “suspected symptoms”.

 

No one has tested positive with bird flu symptoms in Malda district. A medical team, comprising 17 experts from the union health ministry, is constantly monitoring the situation there,” West Bengal Health Services Director Sanchita Bakshi told IANS.

 

The union health ministry had issued a statement Wednesday in the national capital on four state Animal Resources Development (ARD) workers, involved in culling and mop-up activities in Malda, being found with symptoms of bird flu.

 

The expert team has examined all of them and no human infection has been confirmed so far,” Bakshi said, adding that the surveillance team has been working in the affected areas for the past two weeks.

 

The bird flu virus resurfaced at a state-run poultry farm at English Bazaar in Malda two weeks ago. About 200 chickens have died at the poultry farm since March 13.

 

The H5N1 virus that causes avian influenza has hit parts of 13 out of 19 districts in the state. Around four million poultry birds were culled in West Bengal.

Switzerland: Duck Tests Positive For H5N1

 

 

 

# 1829

 

 

Another indication that asymptomatic ducks may be silently spreading the H5N1 bird flu virus comes from Switzerland, where an apparently healthy looking duck has tested positive for the disease.

 

Since healthy birds are rarely tested for the virus, we honestly have little idea how prevalent the infection might be.     Recent studies have shown that mallard ducks can carry the virus without becoming symptomatic. 

 

 

 

 

 

 

 

Swiss report first bird flu case in 2 years

27 Mar 2008 11:31:52 GMT

Source: Reuters

 

ZURICH, March 27 (Reuters) - Switzerland reported the first case of H5N1 bird flu in the country in two years in a duck on Sempachersee lake, veterinary authorities said on Thursday.

 

The duck, the 33rd case of bird flu in Switzerland, showed no signs of illness, the Federal Veterinary Office said in a statement.

 

The other 32 discovered cases of bird flu were all reported in early 2006, on Lake Geneva and Lake Constance.

 

Experts fear the H5N1 strain could mutate into a form easily transmitted from person to person, leading to a pandemic that could kill millions worldwide. (Reporting by Sam Cage; Editing by Elizabeth Piper)

Vietnam: Vaccine Concerns And A Suspicious Death

 


# 1828

 

 

A huge part of Vietnam's bird flu strategy is the vaccination of all domestic fowl.  Early on, in 2006 and the first half of 2007, this campaign appeared to be extremely successful.  

 

Over the past 12 months, however, bird flu outbreaks have returned to Vietnam, as have human cases.  Carelessness on the part of farmers, or incomplete vaccination of flocks, has been blamed in the past. 

 

Now birds known to have been vaccinated have died of bird flu, and so inspectors are investigating.   Since vaccinations don't convey immediate immunity, it is possible the birds contracted the disease before the vaccine could take effect.

 

Meanwhile, doctors are testing samples from a 20-year-old man who died in a local hospital, suspected of bird flu.

 

 

 

 

 

Last Updated: Thursday, March 27, 2008 14:06:53 Vietnam (GMT+07)

Inspection ordered after vaccinated birds die of bird flu

 

The Animal Health Department will examine vaccinated poultry in Hanoi and some provinces after bird flu outbreaks were reported at farms that had taken part in vaccination programs.

 

The Ministry of Agriculture and Rural Development said Wednesday the department would check the immunity of 57 vaccinated fowls from Hanoi and 28 cities and provinces.

 

Officials in the central province of Quang Nam reported two outbreaks last Monday and Tuesday in Dai Loc and Nui Thanh districts that killed 800 ducks.

 

A third of the dead birds in Nui Thanh had been vaccinated on March 12 but local animal health officials said they could have contracted the bird flu virus before building up antibodies against the disease.

 

The deputy chief of the Department of Agriculture and Rural Development, Nguyen Thanh Son, said though vaccination and other programs had been carried out in many provinces, carelessness, especially among farmers, had caused bird flu outbreaks.

 

Meanwhile, Ho Chi Minh City’s Pham Ngoc Thach Hospital said the death of a patient Wednesday was possibly due to the H5N1 strain of bird flu. The 20-year-old man had been hospitalized the previous day with breathing difficulty, cough, high fever and acute pneumonia.

 

His family in the northern province of Nghe An said there had been a bird flu outbreak in the province two months ago when the patient was still there.

 

The city’s Pasteur Institute is testing samples from the deceased man to identify the cause of death.

 

Of the 106 human bird flu cases confirmed in Vietnam since 2003, 52 have been fatal.

 

The latest confirmed victim was an 11-year-old boy in the northern province of Ha Nam who died last week.

 

Ten provinces, mostly in the north, have reported outbreaks of the disease this year but health officials said Monday the Mekong Delta faced the risk of a massive outbreak due to farming of free-range ducks in many provinces and poor control of poultry transport and trade in provinces like Dong Thap, Kien Giang, An Giang and Hau Giang.

Bird Flu Returns To Jalpaiguri

 

# 1827

 

 

New outbreaks of bird flu continue to erupt in West Bengal nearly six weeks after the original crisis was deemed `under control'.   This time, it is the Jalpaiguri District in the north.

 

A not-so-gentle reminder just how difficult it is to eradicate the H5N1 virus once it settles into an area.

 

 

 

 

 

Jalpaiguri declared bird flu-affected
27 Mar 2008, 1317 hrs IST,PTI

 

JALPAIGURI: Jalpaiguri became the third district to be declared bird flu-hit for the second time after Malda and Murshidabad, with death of 112 chicken reported from its Sadar sub-division, official sources said on Thursday.

 


The deaths occurred among backyard poultry in Boalmari under Jalpaiguri Sadar sub-division, Banamali Roy of Jalpaiguri Zilla Parishad said.

 

Samples sent to the High Security Animal Diseases Laboratory (HSADL) in Bhopal had tested positive for H5N1 virus, Roy said.

 

The district administration has convened a meeting on Thursday to chalk out a strategy to combat the situation, Roy said.

 

Over a week ago, avian flu was reported from English Bazar in Malda and Raghunathganj and Jiaganj areas in Murshidabad district.

 

Avian flu deaths among poultry had been reported earlier from Falakata area in Jalpaiguri district.

Indonesia: Suspected Bird Flu Fatality

 

# 1826

 

 

This story, carried in The Straits Times, doesn't provide much in the way of detail, other than the suspicion that this 15-year-old boy died of bird flu.    Tests are pending, and often take a couple of days to come back.

 

 

 

 

 

March 27, 2008

Indonesian boy dies of suspected bird flu

JAKARTA - A 15-year-old Indonesian boy has died of suspected bird flu, a doctor said on Thursday.

 

The boy, identified only as AY, was being transferred to a hospital in West Java when he died late Wednesday, said Hadi Yusuf, head of the facility's bird flu team.

 

'He has a history of contact with poultry on the family's own backyard farm,' Dr Yusuf said.

 

Tissue samples have been set away to be tested for the H5N1 virus, he added.

 

Two positive results are needed before Indonesian authorities confirm a human bird flu infection.

 

Indonesia has the world's highest number of human bird flu victims, with 105 known fatal cases.

 

Experts fear the virus, which is usually spread directly from birds to humans, could mutate into a form easily transmissible between people, sparking a deadly global pandemic.

 

Eleven people have died of bird flu in Indonesia this year, 10 of them from Jakarta and its surrounding areas. -- AFP

Wednesday, March 26, 2008

The Duck-Rice Paddy Connection

 

 

# 1825

 

 

Ducks increasingly appear to be a major factor in the spread of the H5N1 bird flu virus, particularly in Asia, as evidenced by this latest report published in PNAS,  Mapping H5N1 highly pathogenic avian influenza risk in Southeast Asia

Marius Gilbert*,{dagger}, Xiangming Xiao{ddagger}, Dirk U. Pfeiffer§, M. Epprecht, Stephen Boles{ddagger}, Christina Czarnecki{ddagger}, Prasit Chaitaweesub||, Wantanee Kalpravidh**, Phan Q. Minh{dagger}{dagger}, M. J. Otte{ddagger}{ddagger}, Vincent Martin{ddagger}{ddagger}, and Jan Slingenbergh{ddagger}{ddagger}

 

 

The following is how the FAO (UN Food and Agriculture Organization) reported this story.

 

 

 

 

Ducks and rice play key role in avian influenza outbreaks

 

New scientific findings published

26 March 2008, Rome – Ducks, people and rice paddies – rather than chickens – are the major factors behind outbreaks of H5N1 highly pathogenic avian influenza in Thailand and Viet Nam, and are probably behind outbreak persistence in other countries of the region such as Cambodia and Lao PDR.

 


In "Mapping H5N1 highly pathogenic avian influenza risk in Southeast Asia: ducks, rice and people", just published in the latest issue of the Proceedings of the National Academy of Sciences of the United States (PNAS), a group of experts from FAO and associated research centres looked at the series of waves of H5N1 highly pathogenic avian influenza (HPAI) in Thailand and Viet Nam between early 2004 and late 2005.

 

Initiated and coordinated by FAO senior veterinary officer Jan Slingenbergh, the researchers applied a modelling technique to establish how different factors contributed to spread of the virus, including the numbers of ducks, geese and chickens, human population size, rice cultivation and local geography. The numbers of ducks and people, and the extent of rice cultivation emerged as the most significant factors, even though the two countries had fought outbreaks in two different ways.

 

Strong link

The paper notes that there is a strong link between duck grazing patterns and rice cropping intensity. Ducks feed mainly on leftover rice grains in harvested paddy fields, so free-ranging ducks in both countries are moved to many different sites in line with rice harvest patterns,

 

In Thailand, for example, the proportion of young ducks in flocks was found to peak in September-October; these rapidly growing young ducks can therefore benefit from the peak of the rice harvest in November-December. Meat ducks are slaughtered around the Chinese New Year, a time when the volume of sales-related duck movement rises considerably.

 

These peaks in congregation of ducks indicate periods in which there is an increase in the chances for virus release and exposure, and rice paddies often become a temporary habitat for wild bird species.


Defining this pattern was made possible through the use of satellite mapping of rice paddy agriculture over time, cropping intensity and duck grazing locations. The intersections among these, together with the chronology of disease outbreaks, helped the scientists pinpoint critical situations in time when HPAI risk was greatest.

 

Virus evolution may become easier to predict

According to Slingenbergh, "we now know much better where and when to expect H5N1 flare-ups, and this helps to target prevention and control. In addition, with virus persistence becoming increasingly confined to areas with intensive rice-duck agriculture in eastern and southeastern Asia, evolution of the H5N1 virus may become easier to predict."

 

FAO estimates that approximately 90 percent of the world’s 1.044 billion domestic ducks are in Asia. China and Viet Nam account for the bulk of this – 775 million or 75 percent.

 

Thailand has about 11 million ducks.

 

In Thailand during 2005, long-distance duck travelling greatly diminished because farmers and traders had to provide a health certificate for the animals. The local movements of ducks decreased when the government started to support in-door keeping of ducks, offering feed subsidies and construction of enclosures. Together, these measures stopped the H5N1 transmission cycle and since late 2005 Thailand has suffered only sporadic outbreaks.

 

Viet Nam started nationwide vaccination of all poultry at the end of 2005, including the Mekong delta which is home to 50 million ducks. This large-scale vaccination was repeated in 2006/07. Initially, human infections disappeared and levels of disease in poultry fell noticeably. Only gradually did H5N1 viruses re-appear, mostly in unvaccinated ducks and particularly in the Mekong delta.

 

Now, says Slingenbergh, interventions based on knowledge of hotspots and local rice-duck calendars is called for, in order to target disease control and replace indiscriminate mass vaccination.

Hong Kong To Reopen Schools Next Week

 

 

# 1824

 

 

The deaths of four school children earlier this month led to the closure of all of Hong Kong's schools  with fears of a `killer flu' running rampant in the media. 

 

Tests have now shown that the flu viruses detected in Hong Kong have not mutated to a more dangerous strain.  A grim reminder that even seasonal flu can be deadly for young children.

 

 

 

 

 

 

Hong Kong schools to reopen after flu outbreak

 

Hong Kong will resume classes for schoolchildren next week after scientists confirmed that seasonal flu viruses in the city had not mutated to become more vicious, public health officials say.

 

The outbreak had no links to H5N1 bird flu, but the decision to shut schools brought back memories of 2003, when an outbreak of Severe Acute Respiratory Syndrome (SARS) hit Hong Kong.

 

Hong Kong shut elementary schools for two weeks in March to contain a seasonal influenza outbreak after two children who contracted the flu died.

 

But experts later said they found no evidence that the children had been infected by virus strains that were more virulent or aggressive, which opened up the possibility that their deaths might have been linked to other causes.

Culler Under Observation In Malda

 

# 1823

 

 

The culling operation in Malda, West Bengal is reportedly winding down but now we are getting word of a culler who has been hospitalized with a fever, and cough. 

 

Tests are pending, so this is all precautionary at this point.  

 

 

 

 

 

 

Suspect case of human avian influenza in Malda, WB

Kolkata, Wed, 26 Mar 2008 NI Wire

Culling operation is still ongoing in the two bird flu affected blocks of Malda district, West Bengal. Department of Animal Husbandry is in an ongoing mission to mop up all areas suspected to be affected by the deadly avian influenza.

 

Meanwhile, reports are coming to have a sick culling worker, who is under medical observation.

 

Reports of his blood samples are awaited; whether he had only common cough with high fever or infected with any sign of human avian influenza.

 

 

Earlier too, as per the official report, workers involved in culling/mop-up activities were sent for medical supervision but no positive case have been reported so far.

 

 

Local reports suggest that the mopping operation is very slow as a result authority has to continue for the second day on Wednesday with house-to-house search.

 

Department of Animal Husbandry had on Monday declared the completion of the culling drive to be over after revising an earlier target of 44,000 to 23,500. However to ensure full safety the administration has to undertake the mopping operation with full security as some villages in the Malda district are in oppose to culling.

Tuesday, March 25, 2008

Ventilator Triage During A Pandemic

 

 

# 1822

 

 

The New York Times this morning is giving some welcome coverage to a serious issue; Who gets a ventilator during a pandemic?

 

With somewhere over 100,000 ventilators in this country, and with between 80% and 90% in use, the number of available ventilators at any given time is probably no more than 25,000-30,000 nationwide.  

 

In a severe pandemic, the US government has estimated that as many as 750,000 people could require a ventilator.   Obviously, many who could benefit from a ventilator, won't have access. 

 

Decisions will have to be made as to who gets a ventilator, and who does not.  And harder still . . . when do we decide to remove a patient from a ventilator in order to give that resource to someone else?

 

These are ethical dilemmas that need to be confronted now, before a pandemic strikes. 

 

 

 

 

Guidelines for Epidemics: Who Gets a Ventilator?

 

By CORNELIA DEAN

Published: March 25, 2008

 

It may sound unthinkable — the idea of denying life support to some people in a public health disaster like an epidemic. But a new report says doctors, health care workers and the public need to start thinking about it.

 

PLANNING AHEAD There is no shortage of ventilators now, but what if there was?

 

Allocation of Ventilators in an Influenza Pandemic: Planning Document (PDF)

 

The report, by New York State health officials, grows out of the work of a group formed in 2006 to plan for the possibility of an influenza pandemic. The group focused on the breathing machines called ventilators.

 

 

Right now, there are enough ventilators to go around. But in an epidemic, there could be a severe shortage of machines and, more important, doctors and nurses to run them. At that point, the new report says, doctors and hospitals would have no choice but to start taking some people off the machines so that others could live.

 

 

Removal “is absolutely the crux of the problem,” said a lead author of the study, Dr. Tia Powell, who has spent much of her career studying medical ethics. “There are people who might survive who won’t get a chance at a ventilator if someone who is likely to die even with a vent is using it.”

 

 

Before an epidemic strikes, the report says, the public should confront the issue to ensure that any such triage decisions reflect community views, as well as ethical and clinical standards.

US Sets Up Strategic Flu Depot In Thailand

 

 

# 1821

 

 

While the odds of actually stopping a pandemic outbreak anywhere in the world are slim, the attempt will still be made, and those involved will need rapid access to PPE's (Personal Protective Equipment) and other supplies. 

 

To that end, the United States has created the first of three planned emergency influenza supply depots, this one located near the Bangkok (Suvarnabhumi) Airport.

 

This from the Bangkok Post.

 

 

 

 

Flu stockpiles

 

The US on Tuesday launched Asia's first avian influenza combat depot in Thailand, to supply emergency kits to fight any new outbreaks in and around Thailand of the H5N1 virus.

 

"The Regional Distribution Centre in Thailand, the first of three regional supply centres that are being established worldwide, will help ensure countries in Asia will be able to take fast action to counter avian influenza without endangering the lives of the rapid-response teams," said US Ambassador Eric John.

 

The centre, in a warehouse near Suvarnabhumi airport, is stocked with 45,000 pieces of personal protective equipment, 440 decontamination kits, 10 laboratory specimen kits and four training packs, valued in all at $548,300 - about 17.25 million baht.

 

The project is sponsored by the US Agency for International Development (USAid) for speedy deployment to contain avian influenza outbreaks in the Asian region.

 

Avian influenza, also known as bird flu, has killed millions of chickens and ducks since it first broke out in Asia in 2003, and has also claimed 235 human lives worldwide - 17 of them Thai.

 

Scientists fear the virus could mutate and cause a global epidemic.

 

"There were fewer human deaths last year than in 2006," said John. "But the threat remains. Avian influenza still is a critical problem in this region." (dpa)