Sunday, January 31, 2010

Contrarians At The Gate

 

 

# 4309

 

 

Although I am not a scientist, I try to keep this blog centered around what passes for our currently accepted understanding of medicine, scientific research, and emerging infectious diseases.   

 

Not that science is always right.  It isn’t.

 

Our knowledge base – and more importantly, our understanding of how things work - is constantly changing.   I would like to be an optimist, and say `constantly expanding’, but things don’t always progress in a linear fashion.

 

There are many areas, of course, where we have no answers.  Or just partial answers.  And many of the things we believe to be true today will eventually be discarded into the `bad idea’ pile of tomorrow.   

 

That’s how science works.  Absolutes are few and far between.  And the process of getting there is often messy.

 

For some, this lack of definitive answers – or immutable truths – renders science useless . . .  or at least highly suspect.  Since it isn’t always perfect, and our understandings are subject to change, they place science into the realm of guesswork or speculation. 

 

They don’t understand that knowledge isn’t a destination . . . it’s a journey.    

 

Historically science has always labored under the burden of public misconception and distrust.   Advances in science usually mean change.  And while change can be good, it isn’t always so. 

 

And for those who prefer (or depend) on the status quo being maintained . . .  well science can be a threat.

 

The popular public perception of scientific research – at least up until the 1940s – was that of the mad scientist.   The Dr. Frankenstein, who meddles with things not meant for man to know – or of the inventor’s of mustard gas or chlorine used during World War I.

 

Gradually, during the 1950s and 1960s (when I grew up), science took on a new, more positive image.  

 

Space flight, jet planes, even computers  .  .  we were entering a world of science-fiction-turned fact. And I suspect that for a lot of us raised during that period, we view science a bit differently than those that came along later. 

 

My heroes growing up were writers like Isaac Asimov (whose numerous non-fiction books tried to explain science to the layman), the Mercury Astronauts, Don Herbert (aka Mr. Wizard) and Dr. Frank Baxter.

 

Okay, I was a geek before it was fashionable.

 

Frank C. Baxter (left) and Eddie Albert from Our Mr. Sun

Frank C. Baxter (left) and Eddie Albert from Our Mr. Sun

 

For those with long memories, Frank Baxter was the `scientist’ host of a series of educational films from the 1950’s created by Bell Laboratories.   If you’ve never seen any of these Bell Science presentations, I have several archived on my other blog.  

 

You can read my tribute to the man in my essay Remembering Dr. Frank Baxter.

 

So I come by this reverence – or at least respect - for science honestly.  I grew up believing that though science we can make the is world a better place.

 

And most days, I still do.

 

But I’m genuinely worried that the proliferation (and apparent popularity) of conspiracy-driven fringe-pseudoscience diminishes those prospects greatly.   

 

The anti-vaccine hysteria of 2009, which obviously turned a lot of people off from the flu shot, is a prime example.  Next time we may be hit by a much more virulent virus, and this sort of anti-vaccine fear mongering could end up costing a lot of lives.

 

My generation, which saw the possibilities of the future, seems to have been followed by a cynical and suspicious Generation X-Files which sees shadowy conspiracies behind every government agency.  

 

Vaccines, they believe, are poisons used to depopulate the planet.  Pandemics aren’t naturally occurring events, they are man-made in a laboratory somewhere.  Our government’s only interest is to enrich big pharma.   And just about everything the government does is a prelude to martial law . . . 


 

My RSS feed aggregator brings me hundreds of news articles, editorials, and blog posts from around the world each day.  And a disturbing (and growing) percentage fall into the categories above.

 

This sort of dreck is apparently very popular, and drives a lot of traffic to these sites.   Let’s face it.  In the Internet business model, traffic equals revenue.  

 

Like the carnival side show, it really doesn’t matter what’s inside the tent.  All that matters is that people are enticed into paying their `one thin dime, 1/10th of a dollar’ to take a peek. 

 

The sad thing here is that there are hundreds of really good journalists and bloggers out there that work diligently to provide good information and analysis, but their efforts are increasingly being overshadowed by these contrarians at the gate.

 

While I sometimes succumb to temptation and attempt to highlight and critique some of the more egregious examples of this internet drivel, most days I try to resist.  

 

The last thing I want is to drive traffic to these sites.  Besides . . . once you start down that path . . . where do you stop?   

 

I’d have time for little else. 

 

So I usually swallow hard and choose to highlight a good journalist, website, or blogger instead  (see Reliable Sources In Flublogia).  

After all, ‘Tis said it is better to light a candle than curse the darkness ‘

 

Sadly, though, it never is as cathartic as a good old fashioned rant.

 

Not even close.

Saturday, January 30, 2010

Haiti: Worries Over Epidemic Risks

 

 

# 4208

 

 

Although there is absolutely never a good time for any city to endure a 7.0 earthquake, Port-au-Prince, Haiti had the small bit of luck to see their disaster come during their dry season.  

 

Temperatures and humidity's are at their lows for the year, and hurricane season is still six months away.

 

 

image

 

The rainy season is coming, however.  And that will only add to the misery – and the potential for disease – in the refugee camps. 

 

Already health care workers are reporting cases of measles, diarrhea, and tetanus in the recovery area.  With sanitation problems, difficulties in getting clean drinking water, and the close quarters people now find themselves living in – the potential for further outbreaks is increasing.


This from the VOA News.

 

 

 

WHO: Risk of Epidemics in Haiti Increasing

World Health Organization says people are at great risk of getting diarrhea, cholera and other water borne diseases because of the bad sanitary conditions and contaminated water.

 

Lisa Schlein | Geneva 30 January 2010

A camp of makeshift tents sprawls at Port-au-Prince's golf course, where many Haitians displaced by the earthquake have set up shelter, 25 Jan 2010

Photo: UN//Marco Dormino

A camp of makeshift tents sprawls at Port-au-Prince's golf course, where many Haitians displaced by the earthquake have set up shelter, 25 Jan 2010

The World Health Organization says the risk of epidemics breaking out in earthquake-devastated Haiti is increasing as the rainy season approaches.  WHO says it already is receiving reports of a growing number of cases of diarrhea, measles and tetanus.

 

The World Health Organization says it is worried about an explosion of diseases in Haiti.  It says people are at great risk of getting diarrhea, cholera and other water borne diseases because of the bad sanitary conditions and contaminated water.

 

It says contagious diseases such as measles can spread like wildfire in the overcrowded, squalid resettlement camps.

 

WHO spokesman Paul Garwood says U.N. agencies and the Haitian government will conduct a campaign next week to immunize hundreds of thousands of children under age five against measles, tetanus and diphtheria.

 

He says WHO and other aid agencies will be taking additional measures to try to prevent epidemics from breaking out.


(Continue . . .)

Indonesia: Residents Worry Over Poultry Deaths

 

 

 

# 4307

 

 

In recent days we’ve been watching a spike in media reports out of Indonesia on their bird flu situation, something which is typical for this time of the year. These reports include suspected human cases, as well as infected poultry. 

 

Reports Out Of Indonesia Continue
Indonesia: A Tale Of Two Cities
Suspected Bird Flu Fatality In Indonesia
The Indonesian Beat Goes On

 

Today the Jakarta Post has a report out of South Lampung, on the southern tip of Sumatra, concerning the sudden deaths of thousands of chickens at a large poultry operation.

 


image

 

While the Indonesian government rarely releases information regarding their bird flu problem, based on the media reports we keep seeing, the problem has not diminished.

 

 

Residents worry as chickens die en masse

 

Oyos Saroso H.N. ,  The Jakarta Post ,  South Lampung   |  Sat, 01/30/2010 12:53 PM  |  The Archipelago

Residents in South Lampung are panicking following the sudden deaths of thousands of chickens owned by poultry company PT Central Avian Pertiwi, despite the birds having been previously cleared of avian flu.

 

However, after samples were re-tested at the Lampung Livestock and Animal Husbandry Agency lab, they were tested positive for H5N1.

 

The egg-laying hens, totaling more than 12,000, have currently been culled and tens of thousands of others have been isolated.

 

"Residents are afraid they will be infected by the bird flu virus. The poultry company has taken several measures, such as isolating the healthy chickens, destroying the sick and those showing signs of being infected," said South Lampung Livestock Agency head Ahmad Khandrie on Friday.

 

The poultry farm is now under the supervision of the Tanjungkarang Veterinary Agency, Lampung Husbandry Office and South Lampung Livestock Agency.

 

A resident in Merakbelantung village, Kalianda, South Lampung, Sobirin, 38, whose house is near the poultry farm, said the chickens had died suddenly over the past four days.

 

"Thousands of chickens are dying daily. We are obviously worried, especially after being informed that the chickens died after being infected by the bird flu virus," he said.

 

"The smell from the burning dead chickens has also disturbed residents. Some were forced to stay at their relatives in Bandarlampung out of fear."

 

A virologist at the veterinary agency, Sri Marfiatiningsih, said besides being infected by H5N1, another factor in the chickens' mass deaths in Lampung was the changing weather. She said abrupt deaths of chickens mostly occurred between January to February, with a likely decline in March.

(Continue . . . )

Friday, January 29, 2010

CDC: FluView 2010 Week 3

 

 

# 4306

 

 

The key indicators for influenza activity around the country remained roughly the same in the latest reporting period as they were in week 2

 

Once again the P&I (pneumonia & influenza) Mortality levels remain above the epidemic threshold for this time of year.   Not all  P&I deaths can be attributed to influenza, however.

 

Overall, US flu activity continues to be considerably below the levels we saw last October and well below normal for this time of year.

 

Below you’ll find some excerpts from the CDC’s weekly FluView  report. Follow the link to read it in its entirety.

 

 

2009-2010 Influenza Season Week 3 ending January 23, 2010

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

Synopsis:

During week 3 (January 17-23, 2010), influenza activity remained at approximately the same levels this week in the U.S.

  • 164 (4.6%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza.
  • All subtyped influenza A viruses reported to CDC were 2009 influenza A (H1N1) viruses.
  • The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
  • Five influenza-associated pediatric deaths were reported. Four deaths were associated with 2009 influenza A (H1N1) virus infection and one was associated with an influenza A virus for which the subtype was undetermined.
  • The proportion of outpatient visits for influenza-like illness (ILI) was 1.7% which is below the national baseline of 2.3%. Two of the 10 regions (Regions 4 and 9) reported ILI equal to their region-specific baseline.
  • No states reported widespread influenza activity, five states reported regional influenza activity, Puerto Rico and nine states reported local influenza activity, the District of Columbia, Guam, and 33 states reported sporadic influenza activity, and the U.S. Virgin Islands and three states reported no influenza activity.

U.S. Virologic Surveillance:

WHO and NREVSS collaborating laboratories located in all 50 states and Washington D.C., report to CDC the number of respiratory specimens tested for influenza and the number positive by influenza type and subtype. The results of tests performed during the current week are summarized in the table below.

image

Pneumonia and Influenza (P&I) Mortality Surveillance

During week 3, 8.3% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 7.7% for week 3, and is the second consecutive week that the percentage of P&I deaths has been above the epidemic threshold.

Pneumonia And Influenza Mortality

Influenza-Associated Pediatric Mortality

Five influenza-associated pediatric deaths were reported to CDC during week 3 (New York [4] and Wisconsin). Four deaths were associated with 2009 influenza A (H1N1) virus infection and one was associated with an influenza A virus for which the subtype was undetermined. The deaths reported during week 3 occurred between November 8, 2009 and January 2, 2010.

Influenza-Associated Pediatric Mortality

Reports Out Of Indonesia Continue

 

 


# 4205

 

 

For readers who may not have followed bird flu outbreaks and reports of human infections in the past, the next few months may seem like a bit of a roller coaster ride.  January through April is traditionally the height of the bird flu season, and reports often come in a staccato fashion.

 

Some of these reports will turn out not to be H5N1, while others may simply never be officially verified by their host countries.   Reporting and surveillance still leaves much to be desired, and there are political elements involved as well.

 

Today we’ve a series of reports out of Indonesia, including a report of two neighbor children in Riau suspected of having the H5N1 virus. These reports come via the considerable efforts of Ida at The Bird Flu Information Corner.

 

 

Pekanbaru, Riau ::: Two babies suspected of having bird flu

January 29, 2010

Pekanbaru – Arifin Achmad regional hospital in Pekanbaru received two more bird flu (H5N1) suspect patients from Kabupaten Indragiri Hulu, Riau Province.

Those patients were AN, six months old, and YL, three years and six months old. They both referred to Arifin Achmad hospital on Thursday afternoon and evening.

Both patients were neighbors, resided in Kecamatan Kelayang, Indragiri Hulu. They had contact history with dead chickens.

Patients are now under intensive treatment.

 

(Continue . . . )

 

This article goes on to relate some details of two other bird flu cases that Arifin Achmad hospital has treated in the past month.  One recovered, while the other died.

 

Two more reports from BFIC include:

 

Purbalingga, Central Java ::: Thousands of layer chicken positively die of bird flu infection

January 29, 2010

Purbalingga – Avian Influenza (AI) or bird flu killed thousands of layer chickens in Desa Tegalpingen and Tumanggal, Kecamatan Pengadegan, Purbalingga, Central Java. It had been two weeks where people were found to burying and burning bird flu infected birds.

 

Total number of culled chickens within these 2 weeks had reached 5,500 layer chickens within the productive age, 16-18 months. “Each day I burn about 50-60 dead layer chickens,” admitted a local of Desa Tegalpingen who had lost about 500 chickens within these couple of weeks.

 

Depopulation was done by burning the dead chicken to prevent possible transmission to other farms because Pengadegan is one of layer chicken central.

 

(Continue . . .)

 

 

Indramayu, West Java ::: Bird flu attacks chickens and birds

January 29, 2010

Indramayu – Hundreds of chicken and birds suddenly died in Desa Pasekan and Brondong, Kecamatan Pasekan, Kabupaten Indramayu. Died chickens showed discharge from nose and bluish carcass. One of the farmers testified that he found his chickens had died in the morning whereas they appeared healthy on the previous day.

 

Officials have done control measures by burying dead chickens and spraying disinfection to chicken’s houses.

(Continue . . .)

 

 

Meanwhile on FluTrackers, Shiloh and Dutchy (about as good a newshound tag-team as exists anywhere) have picked up on an article from Poskota, a Jakarta based newspaper, that warns of the dangers of buying or illegally transporting `uncertified’ chickens which may harbor the H5N1 virus.

 

In a bit of a cautionary tale, the bottom of the story carries a description of a suspected H5N1 death in Jakarta on the 26th of January, supposedly after the victim bought and slaughtered uncertified chickens.

 

This is an excellent example of how the newshounds work together and build on each other’s contributions.  For the full translation of the entire article, and analysis, you can visit the FluTrackers thread HERE.   

WHO Updates Egypt’s H5N1 Case Count

 


# 4304

 

 

The World Health Organization has updated their H5N1 case count, adding the four cases which we’ve discussed here, and on the flu forums, over the past several weeks. 

 

Thus far, Egypt is the only country to officially report human infection with the H5N1 virus in 2010, although Indonesia and Vietnam have both had `suspected’ cases mentioned in their local press.

 

Curiously, the Arabic press reported the first victim – the 20-year-old female from Baniswief governorate – as having died more than a week ago.   We’ll have to wait to see if there is a clarification forthcoming on this case. 

 

 

Avian influenza - situation in Egypt - update 27

 

28 January 2010 -- The Ministry of Health of Egypt has announced four new cases of human H5N1 avian influenza infection. The cases are not linked epidemiologically.

 

The first case is a 20-year-old female from Baniswief governorate. She developed symptoms on 6 January and was hospitalized on 11 January, where she received oseltamivir treatment.

 

The second case is a 1-year-old male from Dakahalya governorate. He developed symptoms on 7 January and was hospitalized on 12 January, where he received oseltamivir treatment.

 

The third case is a 3-year-old male from Assuit governorate. He developed symptoms on 19 January and was hospitalized on 21 January, where he received oseltamivir treatment.

 

The fourth case is a 45-year-old male from Shargea governorate. He developed symptoms on 12 January and was hospitalized on 19 January, where he received oseltamivir treatment.

 

All four are currently in a stable condition in hospital. Investigations into the source of infection indicated that all four cases had exposure to sick and dead poultry.

 

The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network (GISN).

 

Of the 94 laboratory confirmed cases of Avian influenza A(H5N1) reported in Egypt, 27 have been fatal.

 

 

The WHO has also updated their global case count table. As it is now too large to display properly in this blog, I’ve edited out the years 2003-2006.  

 

whocount

Edited Table (click to view in entirety)

Thursday, January 28, 2010

Singapore To Stockpile Bird Flu Vaccine

 

 

 

# 4303

 

 

image

 



While the H5N1 bird flu virus has thus far not managed to adapt to humans well enough to spread among them easily, there are scientists and governments around the world who believe that may still happen.   

 

With a CFR (Case Fatality Ratio) that has run 50% or greater in some countries, an outbreak would be far worse than anything the H1N1 virus has produced.  

 

Although the probability of this happening is unknown, having a vaccine on hand would greatly reduce the impact of an outbreak.

 

Singapore, with a population of roughly 5 million and neighbor to bird flu endemic Indonesia, is looking to stockpile roughly 1 million doses of H5N1 vaccine.

 

This is a bit of a gamble, of course, since vaccines have a limited shelf life; generally 18 months to 2 years.  

 

This from the Singapore Times.

 

 

Jan 29, 2010

1m doses of bird flu vaccine

 

By Jessica Jaganathan

THE Health Ministry will be buying about one million doses of H5N1 avian flu pre-pandemic vaccine soon.

 

Health Minister Khaw Boon Wan revealed yesterday that his ministry is evaluating a tender to stock up on the vaccine.

 

'It's one of those insurance policies that we have to buy and we will stock it up and hope never to have to use it,' he said.

 

'The virus is still out there and it may flare up, so we cannot afford not to do anything.'

 

The World Health Organisation's director-general, Dr Margaret Chan, had recently said that countries remain ill-prepared for mass outbreaks of the bird flu virus, which affects humans in contact with sick birds.

 

It has a mortality rate of more than 60 per cent, leading to fears that a pandemic with this strain of virus could prove lethal. Scientists also fear that it could achieve efficient human-to-human transmission at any time and trigger a pandemic.

Updating CIDRAP’s Promising Practices

 

 

# 4302

 

It’s been nearly 2 months since I last highlighted CIDRAP’s Promising Practices Website, and since that time they’ve added a number of locally created preparedness programs that can serve as an outline for other communities to learn from or follow.  

 

If you are interested in starting a community preparedness program, rather than re-invent the wheel, a visit to this website makes a lot of sense.  

 

image

 

Some of the newest entries on the site include:

 

· H1N1 Vaccine Clinics for Medically Fragile Children (RI) describes a process for holding H1N1 vaccination clinics for children with severe neurological illnesses or other severe, chronic medical conditions. View Practice

 

· Resource Manual Ensures Smooth Clinic Operations (SC) details how public health officials created a manual with all of the materials and protocols necessary to ensure consistent vaccination clinic operations throughout the region. View Practice

 

· Mass Vaccination Clinic Held at Baseball Stadium (IL) describes how Illinois used a baseball stadium, a team mascot, and a Santa Claus to provide a comfortable environment in a mass vaccination clinic for children. View Practice

 

· Tracking H1N1 Trends Through Electronic Prescription Records (RI) describes how the health department uses electronic prescription records to identify outbreaks or inappropriate use of antivirals. View Practice

 

· Faith-Based Collaboration Provides Outreach in Multiple Languages (CT) details how establishing communication channels with community organizations can make important information available to hard-to-reach populations. View Practice

 

· Training for Community Agencies to Plan for H1N1 and People with Special Needs (RI) describes a three-day seminar to train community leaders in responding to H1N1 issues among their clientele. View Practice

 

 

These are but a few of the more than 220 practices available.   If you’ve never visited their site, or haven’t been there in awhile, point your browser in their direction.  

 

But you’d better pack a lunch.

 

There’s a lot to be gleaned there.

Referral: Effect Measure On The COE Hearings

 

 


# 4301

 

 

A couple of weeks ago I referred to the overwrought charges being levied against the WHO (World Health Organization) over their declaration and handling of the pandemic as a `witch hunt’  (see WHO To Review Their Pandemic Response).

 

Since then, the political grandstanding has reached bizarre (and dangerous) heights, culminating with the Council of Europe hearings earlier this week  (see CIDRAP Summary Of The Council Of Europe Hearings).

 

Today the Reveres of Effect Measure have a scathing assessment of the leader of the inquisition, Wolfgang Wodarg.

 

While rated PG for language, this is the `must read’ of the day.

 

 

Fire in the hole: Wolfgang Wodarg and WHO

Indonesia: A Tale Of Two Cities

 

 

# 4300

 

 

As if my last blog on Vietnam’s H5N1 woes wasn’t enough this morning, we’ve more news coming out of Indonesia on their recent outbreak of bird flu in Central Java  (previous reports here and here).

 

image

Map by Ida at BFIC.

 

 

On January 20th, a 22 year-old man from Cirebon died in a Karanganyar hospital, after contracting what is suspected to have been H5N1 in his home town.  He is the second suspected H5N1 case from Cirebon in the past week, and we’ve reports of poultry deaths spreading through four villages there.

 

Ida at The Bird Flu Information Corner has several items this morning from the local media, including:

 

 

Karanganyar, Central Java ::: Officials collect bird samples from deceased bird flu suspect’s  neighborhood

January 28, 2010

Karanganyar – Livestock and Fishery Service of Kabupaten Karanganyar conducted investigation to chicken samples such as cloacal and throat swab of birds in Desa Wonorejo, Jatiyoso, regarding to the death of bird flu suspect patient named WD, 22 years old.

 

Head of Animal Health Division, Saptawan Hadiputra mentioned officials had collected about 25 chicken samples to be subjected for laboratory test, since they did not find any bird flu evidence by field investigation.

 

Victim is a meatball seller (meatball is bakso in Bahasa Indonesia. Typically, sellers are circulating with their cart to get costumers. -adm-), and suggested to have caught infection around his place in Cirebon.  For this evidence, Livestock and Fishery Service of Kabupaten Karanganyar, Central Java, had contacted its counterpart in Kabupaten Cirebon, West Java for more investigation.

 

Wd, resident of Desa Wonorejo, Jatiyoso, possibly died of bird flu infection on Wednesday (20/1). Patient finally died after refused to be transferred from Wonogiri regional hospital to Dr Moewardi regional hospital to get medical treatment.

 

Source: Indonesia local newspaper, Solo Pos.

 

 

Cirebon, West Java; Rembang, Central Java ::: H5N1 outbreak in birds

January 28, 2010

Outbreak report from Cirebon, West Java. H5N1 seems to surge in Cirebon. Officials linked this incident with two suspected human cases, a 41-year-old and deceased 22-year-old.

 

Other report mentioned H5N1 in Kabupaten Rembang, also in birds.-adm-

 

Paliaman – Animal Health Center in Kaliwedi, Kabupaten Cirebon found bird flu H5N1 had been spreading to four villages in three sub-districts, Desa Ciawi, Kecamatan Paliaman, Desa Danawinangun and Desa Pekantingan, Kecamatan Klangenan and Desa Kedungsana, Kecamatan Plumbon.

 

Head of Animal Health Center Kaliwedi, Suharto said the virus currently transmitted among animals. Until now, no positive case in human found from those three sub-districts.

 

Meanwhile, Head of Health Service, Rinny R. Sechan confirmed that a resident of Keluarahan Tukmudal, Kecamatan Sumber, named Duramham Suherman (DS) had been treated in isolation unit of Gunung Jati regional hospital because of suspected of contracting bird flu (H5N1) infection.

 

DS had fever after contact with suddenly dead chickens before been admitted to hospital. Until now officials are still waiting blood test result for bird flu confirmation of DS.

 

 

Since it has been more than a week since the unfortunate death of this young man, presumably someone at the Indonesian Ministry of Health knows the test results.

 

As we’ve seen over the past couple of years, however, the MOH is often very slow to release such information. 

Watching Vietnam

 

 

# 4299

 

  Ha Tinh Province

image

 

 

When it comes to news of infectious diseases outbreaks it is practically axiomatic that early reports, particularly from remote areas of the world, are often wrong or misleading.  

 

It is for that reason that I try not to jump in with both feet every time some dire sounding report crosses the wires.  I’m an old man, and don’t jump that easily.  Besides, quite often, they end up being less than first advertised.

 

Still, a major outbreak of a disease would probably first appear as a small but disturbing news blip somewhere.  Which is why we comb media sources from around the world, looking for anything out of the ordinary.


Today we’ve one such report, that may well turn out to be nothing.  But it is notable enough to warrant mention, and following to see where this leads.

 

As you are probably aware, H5N1 bird flu has resurfaced in several provinces in Vietnam over the past few weeks (see An Outbreak Of Reports From Vietnam).  Thus far, most of the reports have been of sick or dying birds, but we are now starting to hear of suspected human cases as well. 

 

In particular, this morning there are reports of `dozens’ of suspected bird flu infections in Ha Tinh province.

 

It should be immediately noted that we have no laboratory confirmation of H5N1 infection, and that these people are hospitalized because they have been exposed to sick or dead birds and because they are showing symptoms consistent with H5N1.

 

Symptoms `consistent with H5N1’ could cover a lot of disease territory, including Dengue, Chikungunya, seasonal influenza, and pandemic H1N1.  

 

For now, this is just an interesting news report.   We’ll have to wait and see if it becomes anything more.

 

A big hat tip to Dutchy on FluTrackers for posting this translation from  VTC News.

 

Dozens of people hospitalized for suspected influenza A/H5N1 infection


January 28, 2010 8:17


A/H5N1. (VTC News) - There were dozens of people exposed to sick poultry in Ha Tinh province were hospitalized with symptoms typical of influenza A/H5N1. Many patients have been isolated track.

 

Avian influenza outbreak is in the Thach Quy - hesitance Tinh, Cam Binh, Cam Thach Cam Xuyen. The process of exposure to bird flu, many people in the provinces was hospitalized.

 

Specific to this time, the whole Cam Binh has 1450 people exposed to birds as food for poultry, slaughtering; including 859 who had direct contact with poultry were H5N1.

image 

HPAI is threatening the region's progress


Worrying thing is just less than a week but the outbreak in the commune had 38 cases with suspected symptoms of influenza A/H5N1 infection. These patients after exposure to poultry high fever, headaches. Some people have expressed serious was isolated tracking station in the treatment room and isolated from communities for monitoring and treatment at home.

 

Doctor Nguyen Van Dinh-station chief clinics Cam Binh, Cam Xuyen said, this time the number of people in treatment or health monitoring yey for more than 30% increase compared to normal.

 

Meanwhile in hesitance Tinh, he Trinh Van Thuan, the owner of the Ward Forum duck sick You also have to Thach hospital treatment for symptoms typical of influenza A/H5N1.

 

At the same time infectious Sciences - General Hospital province has also conducted treating a patient in isolation Song Loc commune Can Loc district for suspected influenza A/H5N1 infection.

Wednesday, January 27, 2010

Egyptian Media Reports 93rd & 94th Bird Flu Cases

 

 

# 4298

 

 

Not exactly `breaking news’,  but ProMed Mail tonight has translated media reports of three H5N1 cases out of Egypt. The two latest cases were picked up by Commonground and posted on FluTrackers several days ago; here and here.

 

Somehow these reports got past me, otherwise I’d have posted them sooner. 

 

Of course I’m not the only one a little behind in the reporting.

 

The last update to the WHO (World Health Organization) was on December 21st, listing Egypt’s 90th bird flu case.  Admittedly, the WHO can’t update their page until they’ve been officially notified by the member nation.

 

Egypt’s Bird Flu page, which bills itself as `All You Need To Know About Bird Flu’, is even further behind. The screenshot below was taken this afternoon, and it shows the latest update being from  September of last year, announcing Egypt’s 87th H5N1 infection.

 

image

 

Since the last WHO update, on January 14th we learned of Egypt’s 91st bird flu victim - and then 2 days later - about the 92nd.

 

Egypt Reports 91st H5N1 Infection
Egyptian Media Reports 92nd H5N1 Infection

 

On January 21st, Arabic media carried reports that victim #91 had died (see Egyptian Media Reports 28th H5N1 Fatality).

 

Tonight ProMed Mail has the translated news accounts of the last three H5N1 victims.  The first one (#92) is one we’ve already covered.  But here are the details on the other two.

 

Here is the link, and some excerpts from the ProMed Mail report.

 

AVIAN INFLUENZA, HUMAN (05): EGYPT, 92ND - 94TH CASES
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[1] Ad Daqahliyah: 92nd case
[2] Assiut: 93rd case
[3] Ash Sharqiyah: 94th case

2] Assiut: 93rd case


Date: Wed 20 Jan 2010
Source:
" target=_blank>" target=_blank>" target=_blank>" target=_blank>" target=_blank>youm7.com [in Arabic, machine trans., edited]
 

A 3-year old male patient in Assiut Governorate was confirmed as the 93rd human case of H5N1 infection in Egypt. The boy presented high fever, cough, runny nose and he was admitted to the Al-Ghanaem Hospital. Exposure to HPAI-infected birds is suspected.

 

[3] Ash Sharqiyah: 94th case


Date: Sat 23 Jan 2010
Source:
youm7.com [in Arabic, machine trans., edited]
 

The Ministry of Health [MOH] and national sources reported the 94th confirmed human avian influenza (AI) case in a 45-year-old Ash Sharqiyah man. Additionally, 8 suspect human AI cases were recorded between 20 and 23 Jan 2010.

 

The new confirmed AI case has been hospitalized at the Fakous Fever Hospital [in Ash Sharqiyah] since 19 Jan 2010. He reportedly presented with high fever, cough, breathing difficulties, and joint pain on 12 Jan 2010. The patient allegedly came into contact with birds believed to be infected with AI. He was given Tamiflu upon suspicion of his infection with AI and his health situation is reportedly stable.

 

On 23 Jan 2010, one new suspect human AI case was recorded in As Suways, Dumyat, Al Qalyubiyah, and Ash Sharqiyah, respectively.

 

Follow the link to read the entire listing, and ProMed Mail’s commentary.

The Law Of Unintended Consequences

 


 

# 4297

 


From IRIN (Integrated Regional Information Networks), which was founded in 1995 and is part of the UN Office for the Coordination of Humanitarian Affairs, we get updated on the fallout from the massive culling of pigs in Egypt last May.

 

For years, Egyptian Health officials had looked for an opportunity to eliminate pigs from their country.  With the emergence of a new strain of swine flu, and concerns that pigs could be vectors, the decision was quickly reached to eradicate hundreds of thousands of swine.  

 

The unintended consequence – beyond the hardship placed on pig farmers by the destruction of their herds – is that cities are now overrun with the garbage that the pigs used to eat.

 

 

 

 

 

EGYPT: Pig-cull induced street rubbish a “national scandal”

 


Photo:
Amr Emam/IRIN

Piles of garbage being burned in Cairo's streets put residents in danger of contracting respiratory diseases

CAIRO, 26 January 2010 (IRIN) - The Egyptian government’s decision to cull all of the country’s 300,000 pigs in May 2009 is increasingly being viewed by experts and officials as a gross mistake as piles of organic waste the pigs once ate accumulate in Cairo’s streets, posing serious health hazards.

 

The month-long cull was ostensibly to stem the spread of H1N1 influenza, but the government later said it was simply a general health measure.

 

The cull hit the livelihoods of 70,000 former pig farmers and unofficial rubbish collectors and their families in the Cairo area, according to local NGO Association for the Protection of the Environment.

 

During a recent stormy session of parliament, Cairo Governor Abdelazeem Wazeer called the decision to cull the pigs a “mistake” and legislator Hamdy el-Sayed, chairman of the Doctors’ Association, called it a “national scandal”.

''The decision to kill the pigs was wrong and hasty. There could’ve been better alternatives. The pigs could’ve been moved from their farms in the cities to the desert.''

 

“Our streets are overcome by waste. This is catastrophic,” he said.

 

“The decision to kill the pigs was wrong and hasty,” Fahti Shabana, an Egyptian medical expert, told IRIN. “There could’ve been better alternatives. The pigs could’ve been moved from their farms in the cities to the desert.”

 

(Continue . . . )

OIE Report: H5N1 In Israeli Poultry

 

 

# 4296

 

 

Last night there were a pair of news briefs out of Israel regarding a `bird flu’ outbreak discovered in that country.  These early reports mostly sought to reassure and provided scant details.

 

Both come from Arutz Sheva, an Israeli news media. 

 

Bird Flu Discovered at Kibbutz

Reported: 22:45 PM - Jan/26/10

(IsraelNN.com)

An outbreak of bird flu was discovered Tuesday night at a henhouse in Kibbutz Ein Shemer. The disease was found in a henhouse containing about 43,000 hens. Agriculture Ministry workers began Tuesday night marking off the birds to be culled. All agricultural production in the area has been shut down until further notice.

 

This report was followed by a statement from the Health Ministry.

 

Health Ministry: No Danger to Humans from Bird Flu

Reported: 23:45 PM - Jan/26/10

(IsraelNN.com)

The Health Ministry said Tuesday that the strain of bird flu discovered earlier would not infect humans. The Ministry said that it had taken steps to protect workers dealing with culling the infected birds, and that in previous incidents of bird flu no humans had been affected.

 

This muddle of a second statement seeks to reassure that the virus detected posed no danger to humans, but stressed the protective measures workers were taking to prevent infection.   

 

Not necessarily a contradiction, of course.  Protective measures are taken even when dealing with a LPAI (Low Pathogenic Avian Influenza).

 

Today we learn from the required OIE filing that the virus is not some LPAI as the initial reports might suggest, but that it is HPAI (Highly Pathogenic) H5N1.

 

A hat tip to Ironorehopper who posted a summary of  this OIE Report on FluTrackers overnight. 

 

The link below is to the FT summation.

 

 

Highly pathogenic avian influenza, Israel


Information received on 26/01/2010 from Dr Moshe Chaimovitz, Director , Veterinary Services and Animal Health, Ministry of Agriculture and Rural Developement, BEIT DAGAN, Israel

  • Summary
    • Report type Immediate notification
    • Start date 24/01/2010
    • Date of first confirmation of the event 26/01/2010
    • Report date 26/01/2010
    • Date submitted to OIE 26/01/2010
    • Reason for notification Reoccurrence of a listed disease
    • Date of previous occurrence 04/01/2008
    • Manifestation of disease Clinical disease
    • Causal agent Highly pathogenic avian influenza virus
    • Serotype H5N1
    • Nature of diagnosis Suspicion, Clinical, Laboratory (basic), Laboratory (advanced), Necropsy
    • This event pertains to the whole country
  • New outbreaks
    • Summary of outbreaks
      • Total outbreaks: 1
      • Location(s) - HAIFA (EN SHEMER, HADERA)
        • Total animals affected: Species - Susceptible - Cases - Deaths - Destroyed - Slaughtered
          • Birds - 43000 - 700 - 100 - 0 - 0
  • Outbreak statistics
    • Species - Apparent morbidity rate - Apparent mortality rate - Apparent case fatality rate - Proportion susceptible animals lost*
      • Birds - 1.63% - 0.23% - 14.29% - 0.23%
      • * Removed from the susceptible population through death, destruction and/or slaughter
  • Epidemiology
    • Source of the outbreak(s) or origin of infection
      • Unknown or inconclusive
  • Epidemiological comments
    • The epidemiological investigation is in process.

 

 

Israel saw their first outbreaks of H5N1 in 2006, with a return in 2008.  Their last OIE report was filed in August 2008.

 

The reassurance from the Health Ministry that `the strain of bird flu discovered earlier would not infect humans’, now rings hollow given the OIE report above.  

 

While the danger to humans may be low, it certainly isn’t zero.  Which makes this less than a sterling example of good risk communication.

 

The two big concerns right now, however, are whether this virus has spread to other farms, and exactly how did it happen to re-emerge in Israel after an absence of 17 months.

 

The question of why the virus continues to be reintroduced into an area months or even years after eradication is one that remains largely unanswered.

 

Migratory birds?  Illicit Poultry Trade?   An unknown host reservoir?  

 

It may well be that all three have been responsible at one time or another.  Or perhaps some other mechanism we are unaware of.

 

While in the global scheme of things this outbreak may prove to be more of a nuisance than a danger to Israel, it illustrates that the bird flu problem hasn’t gone away.  

 

Even in countries where the virus isn’t considered endemic.

Tuesday, January 26, 2010

CIDRAP Summary Of The Council Of Europe Hearings

 

 

# 4295

 

CIDRAP news tonight has in depth coverage of the Council of Europe hearing into the WHO’s (World Health Organization’s) handling of the H1N1 pandemic.   

Lisa Schnirring, who was up way before I was this morning, monitored the proceedings.

 

Lisa not only brings us the details of that hearing, she draws on the considerable expertise of two of the best risk communication experts in the world for some analysis of how the WHO might have handled things differently.

 

 

Dr. Peter Sandman along with his wife and colleague  Dr. Jody Lanard, M.D.  are risk communications consultants who have produced a wealth of invaluable risk management advice on their website:

Peter Sandman Website logo

I’ve highlighted their work on numerous occasions, including:

Peter Sandman: Swine Flu For Grownups
Experts: `Mild’ Is A Misleading Term For This Pandemic
Peter Sandman On Pandemic Risk Communication

 

 

Lisa does her usual terrific job of reporting here, so follow the links to read the article in its entirety.

 

European hearing airs WHO pandemic response, critics' charges

 

Lisa Schnirring * Staff Writer

Jan 26, 2010 (CIDRAP News) – Officials from the World Health Organization (WHO) and a vaccine-maker trade group at a public hearing today defended themselves against allegations from some European politicians that they exaggerated the H1N1 pandemic threat to benefit drug companies.

 

The hearing was conducted by the Council of Europe's Committee on Social, Health and Family Affairs on the second day of the group's parliamentary assembly. Yesterday the council rejected a request that the committee's former leader made to schedule a debate on the theme "False pandemics: a threat to health." Dr Wolfgang Wodarg, a German physician and epidemiologist, is no longer a council member, because he lost his race in Germany's September federal election. However, he has been serving as an advisor.

 

The theme of today's hearing was transparency issues that arise in a pandemic setting. The Council of Europe, a separate entity from the European Union, is known for working on broad issues such as civil rights, economics, and democracy. The group was established after World War II and is made up of elected officials from 47 nations.

 

(Continue . . .)

Suspected Bird Flu Fatality In Indonesia

 


# 4294

 

 

Via The Bird Flu Information Corner tonight we get this translation of an article from solopos.com which provides details on the death of a 22 year-old who is suspected to have contracted H5N1.   

 

This death appears to have occurred on Thursday of last week. 

 

The victim, who died in a hospital in Kranganyar, had recently traveled from Cirebon, where it is assumed he contracted the virus.

 

Yesterday, BFIC had a report of another resident of Cirebon, a 40 year-old agricultural extension worker – who is hospitalized with suspected bird flu symptoms.  There is no word at this time of any other links between these two cases.



Ida, at BFIC has posted a map showing the two cities. 

 

Karanganyar, Central Java ::: Patient presumably dies of bird flu

Karanganyar – A resident of RT 03/ RW XVI Dukuh Josari Desa Wonorejo Jatiyoso, Wardi, 22 years old, presumably died of bird flu or avian influenza (AI) infection on Thursday (21/1).

 

Investigation of local newspaper Espos mentioned victim had high fever and lung infection. Head of Disease Control and Environment Health, Health Service of Kabupaten Karanganyar, Fatkhul Munir, confirmed the information above.

 

Fatkhul assumed victim had contracted bird flu virus in Cirebon. He had been sick when he returned back to Karanganyar, and finally died after had been admitted to hospital.

 

“Report mentioned victim had high fever and lung damage. Wardi also had contact history with birds,” said Fatkhul.

 

A US Report Card On Bioterrorism Readiness

 

 

 

# 4293

 

 

In the wake of the 9/11 Commission report - Congress set up a Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism - which is chaired by former Florida Senator Bob Graham and former Missouri Senator Jim Talent.

 

Last year the commission produced their first major report, The World At Risk, where they warned that a bio-terrorism attack on the US was likely by 2013.

 

Today, we get a new report from the commission – a report card, really – on how the  US is responding to the terror threat.  

 

And in the view of this commission, the marks aren’t very good. In fact, in some areas, they give the US a failing grade.

 

Admittedly this report is geared primarily towards the prevention and/or containment of an intentional biological or radiological attack, not a pandemic or a disease outbreak. 

 

Regardless of how seriously you view the threat of an intentional biological release,  it can certainly be argued that many of the skills and resources needed to deal with that contingency would prove equally important in a serious pandemic.

 

Here then is the press release from the Commission.  You can download the full report here.

 

 

Report Card: Government Failing to Protect America from Grave Threats of WMD Proliferation and Terrorism

 

Washington, D.C.—Former Senator Bob Graham (D-FL) and former Senator Jim Talent (R-MO), chair and vice chair of the bipartisan Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism, today released a report card indicating that the U.S. government is not taking the necessary steps to protect the country from the threats posed by WMD and terrorism.

 

Of 17 grades, the report card includes three failing “F” grades on rapid and effective response to bioterrorism; Congressional oversight of homeland security and intelligence; and national security workforce recruitment.  Fortunately, all three grades could be substantially improved by committed leadership in Congress and the Administration.

 

“Nearly a decade after September 11, 2001, one year after our original report, and one month after the Christmas Day bombing attempt, the United States is failing to address several urgent threats, especially bioterrorism,” said Senator Graham.  “Each of the last three Administrations has been slow to recognize and respond to the biothreat. But we no longer have the luxury of a slow learning curve, when we know al Qaeda is interested in bioweapons.”

 

“We are also enormously frustrated about the failure of Congress to reform homeland security oversight,” said Senator Talent.  “The Department can’t do its job, if it is responding to more than 80 congressional committees and sub-committees.  This fragmentation guarantees that much of what Congress does is duplicative and disjointed.”

 

The Report Card also includes “A” grades for achieving specific actions related to a review of domestic programs to secure dangerous pathogens, for finalizing and approving an Interagency Bioforensics Strategy, and for conducting recommended reorganization inside the National Security Council.

 

In December 2008, the Commission released its World at Risk report with a unanimous threat assessment: Unless the world community acts decisively and with great urgency, it is more likely than not that a weapon of mass destruction will be used in a terrorist attack somewhere in the world by the end of 2013.  That weapon is more likely to be biological than nuclear.  The Commission identified a series of recommendations and specific actions that Congress and the Administration should take to change the trajectory of risk.  Today’s report card evaluates steps taken to implement these recommendations and to protect the United States from the threats of WMD proliferation and terrorism.

 

The threat assessment was based on multiple factors.  There is direct evidence that terrorists are trying to acquire weapons of mass destruction and acquiring WMD fits the tactical profile of terrorists. Terrorists also have global reach and the organizational sophistication to obtain and use WMD. Finally, the opportunity to acquire and use such weapons is growing exponentially because of the global proliferation of nuclear material and biological technologies.

 

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Australia: Pregnancy And Flu

 

 

# 4292

 


From almost the start of the pandemic of 2009, it was apparent that pregnant women were at particularly high risk of complications from this virus.   

 

That is something that has been seen in pandemics past, although it isn’t considered as much of a factor with seasonal flu.

 

In a Perspective, written by 3 CDC physicians (Sonja A. Rasmussen,  Denise J. Jamieson, Joseph S. Bresee) and published in the CDC Journal of EID article, Pandemic Influenza and Pregnant Women in February of 2008, we get this assessment of the historic impact of influenza on pregnant women.

 

Although appropriate nonpregnant control groups were generally not available, mortality rates among pregnant women in the pandemics of 1918 and 1957 appeared to be abnormally high (5,7). Among 1,350 reported cases of influenza among pregnant women during the pandemic of 1918, the proportion of deaths was reported to be 27% (5).

 

Similarly, among a small case series of 86 pregnant women hospitalized in Chicago for influenza in 1918, 45% died (6). Among pregnancy-associated deaths in Minnesota during the 1957 pandemic, influenza was the leading cause of death, accounting for nearly 20% of deaths associated with pregnancy during the pandemic period; half of women of reproductive age who died were pregnant

 

Additionally, these authors write:

 

Associations between maternal influenza infection and childhood leukemia (23), schizophrenia (24), and Parkinson disease (25) have been suggested by some studies. Even if the influenza virus does not have a direct effect on the fetus, fever that often accompanies influenza infection could have adverse effects.

 

Today, with the approach of a new flu season women in Australia are being reminded of the dangers of the H1N1 influenza virus, and urged to get vaccinated against it.   


The article below refers to an eMJA study I covered back in November in a blog entitled Australian Study: H1N1 Hospitalized Patients.

 

 

Pregnant women warned over swine flu

JULIA MEDEW
January 27, 2010

PREGNANT women are being warned to protect themselves against a second wave of swine flu expected in coming months after research confirmed they were more prone to serious illness compared with other healthy people.

 

The first major review of 112 people admitted to seven Melbourne hospitals with the virus last year found that 13 per cent of the patients were pregnant or had just given birth.

 

The research published in the Medical Journal of Australia also found that two patients had suffered rare complications of influenza including Guillain-Barre syndrome, a debilitating form of paralysis, and rhabdomyolysis, a muscle-melting condition.

 

Justin Denholm, a research fellow at the Royal Melbourne Hospital who worked on the project, said both conditions could be seen in people with seasonal flu, but were very rare.

 

(Continue . . . )

 

 

The evidence thus far has supported the idea that the flu shot is safe and beneficial for pregnant women and their unborn children.  

 

A few blogs on that include:

 

Hong Kong: No Increase In Fetal Death Among Vaccine Recipients
NEJM: Pregnancy and Postpartum Risks Of Novel H1N1 Infection
UK: DOH Urges Doctors To Reassure Pregnant Women About Vaccine
IDSA: Studies Show Flu Vaccine Benefits For Pregnant Women

UF: Emerging Pathogens Institute

 


# 4291

 

 

A story from practically out of my own backyard.  Only about an hour away.

 

The University of Florida in Gainesville opened their new EPI  (Emerging Pathogens Institute) facility yesterday.   The EPI  is now poised to become one of the top bio-level 3 (and lower) research facilities in the country.

 

A nice profile of this institute appears Monday’s Gainesville Sun.

 

 

UF's EPI poised to fight tomorrow's diseases

By Diane Chun
Staff writer

Published: Monday, January 25, 2010 at 6:57 p.m.
 

 

Within these walls, researchers are preparing to do battle with the next wave of infectious diseases that could plague our times.

 

The Emerging Pathogens Institute on the University of Florida campus will be dedicated today. The $60 million facility provides a one-of-a-kind defense system against the dangerous microorganisms that arrive and thrive in Florida's semi-tropical climate.

 

"We are a tourist center with a constant influx of people from throughout the world, bringing with them all sorts of microorganisms, some of which can create problems," says Dr. Glenn Morris, director of the institute. "If you live in Maine, you don't have to worry about this stuff."

 

"This stuff" can include malaria, swine flu, Salmonella or E. coli contamination of our food; citrus cancer, blight or greening that could destroy one of Florida's key crops; or animal diseases that can spread to humans, such as West Nile virus.

 

"Florida is a magnet for pathogens that pose a threat not only to people but also to agricultural mainstays and to our native ecosystem," UF Vice President of Research Win Phillips said. "We've already seen the consequences. The Emerging Pathogens Institute will help us understand and contain future threats."

 

(Continue . . . )

 

 

Emerging Pathogens Institute at a glance

• Focuses on new infectious diseases of humans, plants and animals.
• Built at a cost of about $60 million.
• 28 biological safety labs, levels 2 and 3.
• 3 biosafety level 3 greenhouses.
• Research collaborations in 32 countries.
• On the Web at www.epi.ufl.edu


Emerging pathogens:
• Infectious diseases include cholera, malaria, tuberculosis, swine flu, Salmonella or anti-microbial drug resistance, E. coli contamination of food.
• Plant diseases include citrus canker, blight and greening, sudden oak death, soybean rust, Pierce's disease of grapes.
• Animal diseases that can affect humans include avian influenza (bird flu), bovine spongiform encephalitis (mad cow disease), Rift Valley fever, Nipah virus and West Nile virus.

 

 

 

I’ll put the EPI link in my sidebar today.  You’ll find the EPI web site below.

 

 

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