A Brief Hiatus

 

 

 

 

I’ll be out of town and on a 2500 mile road trip for the next few days, and will only be able to blog sporadically (probably not at all Tues-Fri) until I return in about a week from now.  

 

In the meantime, Crof at Crofsblog, Chen Qi, Arkanoid Legent, Mystery Rays, the Virology blog  and Maryn McKenna are all excellent sources of news and information.

 

You may also wish to visit FluTrackers and/or the Flu Wiki to see what the newshounds have come up with.

 

I know I’ll be checking these sites every day.  I hope you will, too.

Disaster Relief Updates From Japan

 

# 5456

 

 

Largely overshadowed in the media coverage by the ongoing nuclear crises at Fukushima, the destruction, loss of life, and human misery from Japan’s earthquake and tsunami truly reaches monumental proportions.

 

Dozens of relief agencies are working to feverishly to reach the injured and isolated, feed and shelter evacuees, and reunite separated families.

 

A couple of relief organization updates this morning, that illustrate some of the work being done, and the progress being made.

 

From SEEDS Asia, out of Kobe, Japan expresses their mandate as: Enhance safety and sustainability of people and communities in the Asia Pacific region to cope with natural disasters and environmental problems.

 

They’ve released their 9th SITREP report, dated March 27th, which gives an excellent overview of the relief efforts going on in northern Japan.

 

 

They summarize the relief situation in the three hardest hit prefectures below.   Follow the link to read the 11-page report in its entirety.

 

 

 

The International Federation of the Red Cross And Red Crescent have released their 5th SITREP on Japan’s triple disaster.

 

 

Follow the link to read the entire 6-page report.

 

While I can’t vouch for all of the organizations that are providing relief efforts in Japan, many reputable relief agencies like the Red Cross/Red Crescent, CARE and SAVE THE CHILDREN (among others) have a reputation for good management and for providing valuable assistance in the wake of disasters around the world.

 

They, and the peoples of Japan, I’m certain would be appreciative of whatever support you can lend.

CDC HAN Advisory: Fukushima Radiation Monitoring

 

 

 

# 5455

 

The CDC’s  Health Alert Network (HAN) is designed to ensure that communities, agencies, health care professionals, and the general public are able to receive timely information on important public health issues.

 

You can sign up for HAN messages, and scores of other CDC and HHS email notifications, by going to the CDC - Quick Subscribe GovDelivery page

 

There are 4 types of HAN releases.

 

Health Alert

Conveys the highest level of importance; warrants immediate action or attention.

Health Advisory

Provides important information for a specific incident or situation; may not require immediate action.

Health Update

Provides updated information regarding an incident or situation; unlikely to require immediate action.

Info Service
Provides general information that is not necessarily considered to be of an emergent nature.

 

Today we have a HAN ADVISORY on the monitoring of radiation from the Fukushima reactors. The `money quote’ reads:

 

At this time, there continues to be no indication for anyone in the United States to take potassium iodine or switch to bottled water on the basis of the events in Japan.

 

But I’ve reproduced the entire HAN message below.  My thanks to Sharon Sanders of FluTrackers for sending this link.

 

 

 

This is an official
CDC HEALTH ADVISORY

Distributed via Health Alert Network
Sunday, March 27, 2011, 0:20 EDT (12:20 PM EDT)
CDCHAN-00320-2011-03-27-ADV-N

This is an official
CDC HAN Info Service Message

 

Monitoring for Increased Levels of Radioactive Material in the US as a Result of the Incident with the Fukushima Nuclear Incident in Japan

Summary

As a result of the incident with the Fukushima nuclear plant in Japan, highly sensitive radiation monitors operated by EPA and others are detecting very low levels of radioactive material in the air in the United States. These levels were expected and consistent with estimated releases from the damaged nuclear reactors and are far below levels of public health concern.

 

Elevated levels of radioactive material in rainwater have also been expected as a result of the nuclear incident after the events in Japan, since radiation is known to travel in the atmosphere. There have been reports received that several states including Pennsylvania and Massachusetts have detected elevated levels of radiation in rainwater following recent precipitation events.

 

Background

The numbers of the elevated levels of radioactive material being reported in Massachusetts are 79 picocuries (pCi) per liter (one picocurie is a trillionth of a curie). The numbers reported in Pennsylvania range from 40-100 picocuries per liter. Although these are levels above the background levels historically reported in these areas, they are still about 25 times below the level that would be of concern for use as a sole source of water over a short period of time, even for infants and pregnant or breastfeeding women, who are the most sensitive to radiation.

 

While short-term elevations such as these do not raise public health concerns – and the levels seen in rainwater are expected to be relatively short in duration – the U.S. EPA has taken steps to increase the level of monitoring of precipitation, drinking water, and other potential exposure routes to continue to verify that.

 

Given the release of radiation in Japan, it was expected that radiation monitors in this country and elsewhere will detect minute quantities of radiation. These monitors are highly sensitive and can detect amounts of radiation in trillionths of a Curie. We expect environmental monitors will continue to detect low levels of radiation in surface waters due to radioactive material in the air. When it rains or snows, the radioactive material is washed to the ground and onto surface waters.

 

What the US Federal Government is Doing

EPA’s Radiation air monitoring network continues to conduct near-real-time air monitoring in networks across the nation. With these recent reports, the US EPA has increased monitoring across the country to ensure that the American people have the most up to date information.

 

What information is available to the public:

The EPA has posted information on its website at http://www.epa.gov/japan2011/

CDC has posted FAQs on our website at http://emergency.cdc.gov/radiation/isotopes/iodine131surfacewater.asp.

USA.gov continues to consolidate federal guidance related to this situation at http://www.usa.gov/Japan2011.shtml.

Recommendations

 

The federal government’s only recommendation to state and local governments at this time is to continue to share their testing results with the appropriate federal authorities. EPA will continue to communicate nationwide sampling results as they come in.

 

At this time, there continues to be no indication for anyone in the United States to take potassium iodine or switch to bottled water on the basis of the events in Japan.

 

The Centers for Disease Control and Prevention (CDC) protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national and international organizations.

DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

RadNet: The EPA’s Radiation Monitoring System

 

 

# 5454

While no harmful levels of radiation are presently expected to reach the United States as a result of the Fukushima reactor crisis, the Environmental Protection Agency’s (EPA) RadNet System has detected very small increases in radiation levels since the March 11th earthquake.

 

The EPA reassures, however:

 

To-date, levels recorded at this monitor have been thousands of times below any conservative level of concern.

 

Still, I know many of my readers possess a good measure of scientific curiosity and would find it of interest to follow radiation monitors around the nation.

 

The EPA, fortunately, has made that information easily available.

 

 

By visiting the RadNet Site you can click on the map (pictured above) and get real-time readout of current and recently detected radiation readings from scores of locations around the nation.

 

The EPA is also posting Daily Summaries on the radiation impact on the United States, along with regular statements.

The latest statement (March 27th) reads:

 

As a result of the incident with the Fukushima nuclear plant in Japan, several EPA air monitors have detected very low levels of radioactive material in the United States consistent with estimates from the damaged nuclear reactors. These detections were expected and the levels detected are far below levels of public-health concern.

 

Elevated levels of radioactive material in rainwater have been expected as a result of the nuclear incident after the events in Japan since radiation is known to travel in the atmosphere. There have been reports received that the states of Pennsylvania and Massachusetts have seen elevated levels of radiation in recent precipitation events. EPA is reviewing this data – however, in both cases these are levels above the normal background levels historically reported in these areas.

 

While short-term elevations such as these do not raise public health concerns – and the levels seen in rainwater are expected to be relatively short in duration – the U.S. EPA has taken steps to increase the level of nationwide monitoring of precipitation, drinking water, and other potential exposure routes to continue to verify that.

 

EPA’s only recommendation to state and local governments is to continue to coordinate closely with EPA, CDC and FDA – EPA will continue to communicate our nationwide sampling results as they come in.

 

Earlier EPA Updates

• March 22, 2011 - Statement on Recent Findings in West Coast States and Hawaii
• March 18, 2011 - JOINT EPA/DOE STATEMENT: Radiation Monitors Confirm That No Radiation Levels of Concern Have Reached the United States
• March 15, 2011 - EPA Statement on Air Monitoring Effort
  • Declaración de EPA (15 de marzo de 2011)

 

You’ll also find an informative FAQ page with information relating to the Fukushima radiation and the EPA’s monitoring network.

 

Frequently Asked Questions

Last updated on Sunday, March 27, 2011 at 2:54:45 PM.

This page provides answers to questions EPA has received about the current nuclear power plant situation in Japan

 

An interesting website, well worth exploring.

Miyagi: Tsunami Advisory After 6.5 Magnitude Aftershock

 

 

 

# 5453

 

 

The strongest aftershock in several days  struck off the east coast of Miyagi Prefecture  at 7:27 JST, on Monday Morning  (1827hrs EST Sunday).

 

While far less powerful than the earthquake of March 11th, a local Tsunami advisory has been issued by Japan’s Meteorological Agency.

 

They anticipate the quake might have generated of a series of waves less than 1 meter in height.

 

A destructive tsunami is not expected.

 

 

Fukushima: Radiation Levels Soar At Reactor # 2 ?

 

 

UPDATED: 0850 Hrs EDT 03/27/11

 

AP is now reporting that TEPCO officials are claiming the radiation readings reported earlier were `a mistake’ and `not credible’.  New measurements will be taken, according to this AP report:

 

Japan: Huge radiation spike at nuke was a mistake

By YURI KAGEYAMA and MARI YAMAGUCHI
Associated Press

 

 

When new, revised radiation readings will be made available wasn’t stated.

 

Stay tuned . . .

 

 

# 5452

 

 

This morning it is being widely reported that the latest readings from inside the reactor buildings, and the land and sea surrounding the Fukushima nuclear plant, continue to show rising levels of radiation.  

 

In one place in particular – in the basement of the turbine building connected to reactor #2, the levels are being characterized as `extreme’; 10-million-times greater than normal.

 

TEPCO officials, however, appear to be disputing some of these readings.  

Details are scant, but at least one Japanese news source  (hat tip Tokyoreporter on Twitter) is carrying a denial of the extreme radiation levels by  a TEPCO Vice President .

 

 

This report from the Voice of America (VOA).

 

Radioactivity Soars at Japan Nuclear Plant

Martyn Williams | Tokyo  March 27, 2011

Japan says levels of radiation contamination in water inside part of the Fukushima nuclear power plant have increased sharply.  Workers at the plant spent the day Sunday on improvements to the water pumping system that is keeping the reactors cool.

 

The level of radioactive Iodine-134 in water in the basement of a turbine building adjoining the plant's Number-2 reactor spiked to more than 10 million times that of normal conditions.

 

At that level it is a thousands times more radioactive than water found in the neighboring Number-1 and -3 reactor buildings. It was in the Number-3 building on Thursday that two workers sustained heavy radiation contamination after standing in water without wearing boots.

 

Government officials and plant operators say they are not sure where the radioactive contamination is coming from.  But there is a possibility it is coming from the reactor core.

(Continue . . . .)

 

A second report from NHK World News provides a few more details:

 

Extreme radiation detected at No.2 reactor

Sunday, March 27, 2011 13:44 +0900 (JST)

Tokyo Electric Power Company says it has detected radioactive materials 10-million-times normal levels in water at the No.2 reactor complex of the Fukushima Daiichi nuclear plant.

<SNIP>


TEPCO says the radioactive materials include 2.9-billion becquerels of iodine-134, 13-million becquerels of iodine-131, and 2.3-million becquerels each for cesium 134 and 137.

(Continue . . . )

 

 

These isotopes vary greatly in their persistence in the environment, with radioactive iodine 134 having a half-life of just 53 minutes,  iodine 131 with a half-life of 8 days, and cesium 137 with a half-life of 30 years.

 

The radioactive Iodines will decay relatively quickly, and should pose only a short-term threat (once the release ends), but isotopes such as cesium 137 decay far more slowly, and can persists for hundreds of years.

 

The measurement of becquerels is a reading of total radioactivity, but doesn’t convert easily to the dose of radiation  (sievert) that one would receive if exposed.

 

Since the `safe’ level of radioactivity in tap water in Japan is set at 300 becquerels per liter, and the water here is being measured in the billions of becquerels per milliliter . . .  suffice to say – if accurate - this is an extremely high level of radiation.

 

 

Meanwhile, NHK World News is reporting that radiation levels roughly 30 km from the stricken plant (outside of the evacuation radius) are rising as well.  These readings, you will notice, were taken last Wednesday.

 

 

(NHK News Video Capture)

High radiation detected 30 km from Fukushima plant

Sunday, March 27, 2011 08:53 +0900 (JST)

Radiation levels 40 percent higher than the yearly limit for the general public has been detected just over 30 kilometers from the Fukushima Daiichi power plant.

 

The Science Ministry says a reading of 1.4 millisieverts was taken on Wednesday morning in Namie Town northwest of the plant.

 

The government has not told residents outside the 30-kilometer radius of the plant to evacuate, or even to stay indoors.

Someone staying outdoors for 24-hours at that location would exceed the annual limit of one millisievert. The limit is based on a recommendation by the International Commission on Radiological Protection.

(Continue . . . )

 

 

And lastly, we have this IAEA update indicating that attempts to remove water from the damaged reactor buildings are either underway, or planned.

 

Fukushima Daiichi Nuclear Accident Update (27 March, 9:00 UTC)

by International Atomic Energy Agency (IAEA) on Sunday, March 27, 2011 at 4:51am

According to the Japanese Prime Minister’s office, TEPCO has begun work to remove water that has accumulated in the turbine buildings at the Fukushima Daiichi nuclear power plant. Workers have started to remove water from the Unit 1 turbine building to its main condenser and are making preparations to do the same at Unit 2. (A main condenser’s function in a nuclear power plant is to condense and recover steam that passes through the turbine.) Work to remove water from the turbine buildings in Units 3 and 4 is currently under consideration.

 

Removal of water from the turbine buildings is an important step to continue power restoration to the plant.

 

The IAEA is seeking further updates from Japanese authorities on the progress of this process and will update as information becomes available.

The IAEA Presentations Channel

 

 

# 5451

 

 

The International Atomic Energy Agency (IAEA) has selected Slideshare to host documentation, slide shows, and other presentations on the Japanese nuclear crisis. 

 

You can access (as of this writing) 26 presentations, and 6 documents at the IAEA Presentations Channel.

 

 

 

Some of these are multi-slide presentations while others are informative single page charts and graphics, like the one below:

 

 

A resource very much worth checking every day or so.

When The Lights Go Out

 

 

 

# 5450

 

 

Some illuminating (and not so illuminating) satellite photos put together by NOAA show us the impact of the March 11th earthquake and tsunami on Japan’s electrical grid.

A side by side comparison of the average nighttime lighting before and after the quake is depicted below:

 

 

You’ll find the article, and high-res (1920 x 1080) photos HERE.

 

Literally millions of people were affected by these power outages, and two weeks after the quake, hundreds of thousands are still without electrical power.

 

While the disaster in Japan was a `worst-case scenario’, large scale, and prolonged, power outages occur with some frequency around the world – particularly in the aftermath of natural disasters.

Residents in Florida, and along the Gulf and Atlantic coast, are well aware that the power can be out for days – or even weeks – in the wake of a major hurricane.

 

The power was still out in parts of New Orleans when I arrived there 6 weeks after Katrina to clean out my brother’s apartment, and it took a couple of weeks to restore power to all of Miami after hurricane Wilma. 

 

Earthquakes, floods, tornadoes, ice storms, and even solar storms (see Solar Storms, CMEs & FEMA) all have the potential to knock the power out in your community for days or even longer.

 

Given our reliance on electricity for practically every aspect of modern living, most families are woefully unprepared to deal with a significant interruption in the grid.   

 

Aside from lighting and powering such `necessities’ as the Internet and cable TV, many homes also heat and cook solely with electricity. 

 

And there are some who rely on oxygen concentrators, or other medical equipment who must have continuous electrical power.

 

Those on wells depend upon electricity to pump water into their homes.

 

Prolonged outages can even affect a municipality’s ability to deliver water, and carry away sewage from your home or business.

 

All of which points out the need for individuals and families to consider how they would cope if the power were to go out for days, or even weeks, where they live.

 

Do you have enough food and water to last at least 72 hours, but preferably 10 to 14 days?

Do you have a source of lighting (other than candles) that will provide sufficient light for a week or longer?

 

If you live in a frigid climate, can you and your family stay warm without electric power?

 

If the power goes out, can you flush toilets?   If not, have you made provisions for sanitation needs?

 

Can you charge cell phones, or run emergency radios, for a week or longer?

 

 

The solution that many immediately consider is to buy a generator, and while a reasonable solution for some families, many will find it impractical.

 

Generators must always be run outdoors, well away from enclosed living spaces, and require large amounts of flammable and difficult to store fuel.

 

They are expensive, noisy, and can attract unwanted attention. And generators require maintenance and occasional repair.

 

FEMA has some useful safety tips on using a generator, for those still considering their use.

 

 

For most people, the better solution is to find workarounds during power outages like LED lighting, chemical toilets, sleeping bags, and camp stoves.

 

In my essay The Gift Of Preparedness: 2010 I highlight a number of small ticket items that would come in very handy during a prolonged power outage, including:

 

 

 

LED lanterns and flashlights can run up to 10 times longer on a set of batteries than with incandescent bulbs.

 

I personally have a solar power setup, to provide (very) limited 110 volt power should the need arise.  You can read about my system, and how you can make one for yourself at Preparedness: Solar Power On A Budget.

 

 

For the price of a solar setup, however, you can buy a lot of alkaline batteries.  As with buying a generator, solar isn’t for everybody.

 

For those living in colder climates, staying warm during a winter power outage may be the biggest challenge.

 

Those with wood, oil, or LP gas heat have an advantage  - although heating a home without electrical blowers can be a bit tricky (and dangerous) - even with these alternative forms of heat.

 

The time to figure out how to do these things safely is now, before a disaster or crisis arrives.

 

One way to do that is to hold a power outage drill.  Pick a weekend to shut off the main breaker to your home for 24 hours, and live without the luxury of the grid.

 

In short order you’ll discover what areas of your family’s emergency plan needs work.

 

While it may sound daunting, I lived successfully `off the grid’ for several years aboard a small sailboat during the 1980s. 

 

It required some adjustments to my lifestyle, but with the proper preparations, it was eminently doable.

Study: Longevity Of Viruses On PPEs

 

 

 

# 5449

 

 

 

PPEs – or personal protective equipment – are items worn by Health Care Workers (HCWs) when examining or caring for potentially contagious patients. They include masks, gloves, and gowns.

 

During the opening months of the 2009 pandemic, it became obvious that our world faced a shortage of PPEs, and so strategies were adopted to maximize their use.  

 

In some cases nurses were issued only one N95 mask to be used for an entire 8 hour shift, and told to don it only when in direct contact with a potentially infected patient. 

 

This, as you might imagine, raised concerns among HCWs that this strategy of reusing masks could expose them, and their patients, to the virus.  That, and the decision to issue surgical masks instead of N95s, sparked protests across the country.

 

Nurses Protest Lack Of PPE’s

Report: Nurses File Complaint Over Lack Of PPE

California Nurses Association Statement On Lack Of PPE

 

Unfortunately, there are differing opinions and gaps in our scientific knowledge regarding the relative effectiveness of N95 vs. surgical masks (something I’ve covered often, including here, here, and here) and on how long a virus may remain viable on inanimate objects (like masks & gloves).

 

Inanimate objects that can transfer infectious agents are called fomites, and the CDC’s  (very) short answer on how long viruses can remain viable on these surfaces reads:

 

How long can human influenza viruses remain viable on inanimate items (such as books and doorknobs)?

Studies have shown that human influenza viruses generally can survive on surfaces for between 2 and 8 hours.

 

Today we’ve a new study that looks specifically at how long viruses may remain viable on PPEs. It appears in the Japanese journal Environmental Health and Preventative Medicine  (Hat tip Tetano on FluTrackers).

 

Essentially, researchers inoculated various fomites (masks, gloves, gowns, wooden and steel desktops) with laboratory grown H1N1, and then tested the surfaces after 1, 8, and 24 hrs for the presence of the virus (HA titer & 50% tissue culture infective dose (TCID₅₀)/mL were measured).

 

Environmental Health and Preventive Medicine

Volume 15, Number 6, 344-349, DOI: 10.1007/s12199-010-0149-y

Maintenance of influenza virus infectivity on the surfaces of personal protective equipment and clothing used in healthcare settings

Hiroko Sakaguchi, Koji Wada, Jitsuo Kajioka, Mayumi Watanabe, Ryuichi Nakano, Tatsuko Hirose, Hiroshi Ohta and Yoshiharu Aizawa

ABSTRACT (Excerpt)

Results 

The HA titer of this influenza A virus did not decrease in any of the materials tested even after 24 h. The infectivity of influenza A virus measured by TCID₅₀ was maintained for 8 h on the surface of all materials, with the exception of the rubber glove for which virus infectivity was maintained for 24 h.

Conclusions 

Our results indicate that the replacement/renewal of personal protective equipment and clothing by healthcare professionals in cases of exposure to secretions and droplets containing viruses spread by patients is an appropriate procedure to prevent cross-infection.

 

TCID₅₀ is the  amount of a pathogenic agent (in this case the H1N1 virus) required to infect 50% of cell cultures inoculated.

 

The results indicate that all surfaces tested harbored viable H1N1 viruses for at least 8 hours, with some surfaces infectious for more than 24 hours.

 

These test results extend the window of infectivity from fomites considerably beyond what has previously been reported.

 

The debate over the proper use of PPEs, and just how protective they really are, is a contentious one.

 

During a highly virulent disease outbreak, getting the science right (and applying it) could save a lot of lives.  We were very lucky that the CFR (case fatality ratio) of the 2009 pandemic was as low as it was. 

 

Last January the IOM (Institute of Medicine) released, through the National Academies Press, an extensive, 200+ page update on the use of PPEs (personal protective equipment) for healthcare workers when facing pandemic influenza and other viral respiratory illnesses.

 

The short version is, we need better science upon which to make decisions regarding the right kind of protection for HCWs.

 

While the entire 200 page pre-publication pdf can be downloaded for free, you can also view an executive summary and an abbreviated list of recommendations.

 

 

While this study from the EHPM won’t close the book on fomite transmission - it does add to our knowledge of the subject – and it shows us just how hearty influenza viruses can be, even outside of a host.

 

For more on the debate over PPEs you may wish to review:

 

Why Size Matters

Study: Aerosolized Transmission Of Influenza

NPI’s and Influenza

NEJM Perspective: Respiratory Protection For HCWs

Follow Up On Juarez Reports

 

 

# 5448

 

 

Two days ago the Mexican media was filled with stories regarding multiple cases of `atypical pneumonia’ in and around Juarez, which has resulted in at least one death (see Some Curious Reports Out Of Juarez).

 

Not too surprisingly, yesterday a number of reports began to emerge stating that these cases were caused by a return of the 2009 H1N1 virus. 

 

Typical of these reports is this one from El Nacional  (hat tip Alert on FluTrackers).

 

Mexico confirms reappearance of H1N1 influenza, which leaves 2 dead

25 Mar 2011 | 09:27 pm

The Ministry of Health of the State of Chihuahua, Ciudad Juárez to which it belongs, confirmed on Friday at a news conference a second death caused by this virus for days after a traffic policeman died and the infection of another person stable.

 
The Mexican health authorities today confirmed the reappearance of H1N1 virus, also called flu, which caused the emergency epidemic two years ago and has already left two dead and one person infected in Ciudad Juarez on the U.S. border.

 

The Ministry of Health of the State of Chihuahua, Ciudad Juárez to which it belongs, confirmed on Friday at a news conference a second death caused by this virus for days after a traffic policeman died and the infection of another person stable.

 

The state Health Secretary Sergio Piña said that clinical studies confirmed the presence of H1N1 virus in all three cases.

(Continue . . . )

 

 

The H1N1 virus, while no longer a pandemic threat, is still capable of mutating or evolving towards increased virulence or transmissibility. 

Given the earlier alarm expressed by local officials and the media over these cases, no doubt some sort of investigation is underway to determine if there is anything about these cases that merits particular concern.

 

FluTrackers has maintained an extensive thread on these reports which you may view here.

WHO: Indonesian H5N1 Update

 

 

 

# 5447

 

 

 

Today the World Health Organization released an update from Indonesia on their latest H5N1 case, that of a 2 year-old girl from Bekasi City, West Java Province.

 

The child was hospitalized on March 9th after a week of illness, but has since recovered.  The child’s mother – age 31 – died on March 1st from H5N1.

 

The child’s mother developed symptoms the 23rd of February, was admitted to a private clinic two days later, and was referred to a hospital on February 28th.  She died the following day.

 

Her death was detailed in the WHO Update of March 14th.

 

The WHO follow up report follows.

 

 

Avian influenza – situation in Indonesia - update 2

 

25 March 2011 - The Ministry of Health of Indonesia has announced a confirmed case of human infection with avian influenza A(H5N1) virus.

 

The case is a 2 year old female from Bekasi City, West Java Province. She developed symptoms on 2 March, was admitted to a health care facility on 3 March and referred to a hospital on 9 March. She has fully recovered from her illness.

 

The case’s mother (see update, 14 March) died of confirmed avian influenza A(H5N1) virus infection one day prior to onset of illness in the new case.

 

The child accompanied her mother to the traditional market where live poultry were sold but investigations into the source of infection are ongoing.

 

Laboratory tests have confirmed infection with avian influenza A(H5N1) virus.

 

Of the 175 cases confirmed to date in Indonesia, 144 have been fatal.

 

The onset date of symptoms of these two cases were 8 days apart, which at least suggests the possibility of human-to-human transmission between mother and child.

 

The incubation period of H5N1 has been described as running anywhere from 2 to 17 days, but has most commonly been on the order of 2 to 4 days.

 

Making a case for h-2-h transmission – even with onset dates a week apart - can be very difficult, since there are so many known and unknown variables at work.

 

We’ll obviously await with interest the results of any epidemiological investigation.

 

USGS: 6.4 Aftershock Rattles Northern Japan

 

# 5446

 

 

 

The strongest aftershock since Wednesday struck northern Japan a short while ago (8:36 pm local time).

 

Local reports have listed the quake as a 6.2, but the USGS is currently showing it as a 6.4.  Magnitude readings are often changed as more data comes in.

 

While strong enough that buildings in Tokyo (nearly 400km to the south) reportedly swayed - no tsunami warning has been issued.

 

 

 

Magnitude 6.4 - NEAR THE EAST COAST OF HONSHU, JAPAN

2011 March 25 11:36:24 UTC

Location 38.763°N, 141.942°E

Depth   39.2 km (24.4 miles)

Region   NEAR THE EAST COAST OF HONSHU, JAPAN

Distances

• 108 km (67 miles) ENE (58°) from Sendai, Honshu, Japan
• 127 km (79 miles) SE (146°) from Morioka, Honshu, Japan
• 172 km (107 miles) NE (48°) from Fukushima, Honshu, Japan
• 395 km (246 miles) NNE (29°) from TOKYO, Japan

Netherlands: H7 Bird Flu Detected

 

 

# 5445

 

 

Due to its high mortality rate, H5N1 gets most of the world’s attention when it comes to bird flu.  While human infections remain rare, among those diagnosed, roughly 60% succumb to the virus.

 

But H5 isn’t the only avian flu strain we worry about.

 

There are other – less deadly strains – including the H7s, H9s and H11s that have demonstrated the potential to jump to humans.

 

Currently, H5s and H7s are both reportable diseases in poultry, due to their ability to mutate from a low pathogenic virus to highly pathogenic virus.

 

Today, we’ve news of an outbreak of bird flu on a poultry farm near Kapelle, in the Netherlands.  The virus has been identified as H7, but the exact subtype has not yet been established.

 

 

 

First a translation of the statement from the Dutch Ministry of Economic Affairs, Agriculture and Innovation, after which I’ll return with more.

 

 

Bird flu in Zeeland

News item | 03/25/2011

In Zeeland Schore, Chapel congregation is a poultry farm with 127,500 laying hens found bird flu. The H7 is a variant.

 

Because a low pathogenic H7 variant can mutate into highly pathogenic (highly contagious and lethal for chickens variant), the company both a low and a highly pathogenic variant in accordance with European regulations are removed. The new Food Safety Authority to carry out culling on March 25. In the afternoon of March 25 is known whether a low or a highly pathogenic variant,.

 

As of March 25, 2011, is 8.00 hours in an area of ​​one kilometer around the company a ban on transporting poultry, eggs, poultry and poultry manure and litter.

 

The infection probably comes from wild birds excrete the virus in their faeces.

 

 

 

Below you’ll find a chart lifted and edited from CIDRAP’s excellent overview Avian Influenza (Bird Flu): Implications for Human Disease  showing non-H5N1 avian flu infections in humans over the past decade.

 

 

Perhaps the most notorious outbreak of H7 in humans occurred in 2003 in the Netherlands.  It  produced (mostly mild) symptoms in at least 89 people, but did cause 1 fatality. 

 

CIDRAP describes it this way:

 

During an outbreak of H7N7 avian influenza in poultry, infection spread to poultry workers and their families in the area (see References: Fouchier 2004, Koopmans 2004, Stegeman 2004). Most patients had conjunctivitis, and several complained of influenza-like illness. The death occurred in a 57-year-old veterinarian. Subsequent serologic testing demonstrated that additional case-patients had asymptomatic infection.

 

In 2006 and 2007 there were a small number of human infections in Great Britain caused by H7N3 (n=1)  and H7N2 (n=4), again producing mild symptoms.

 

Since surveillance is – at best - haphazard (or even non-existent) in many parts of the world,  how often this really happens is unknown.

 

For now, H7 avian influenzas pose only a minor public health threat. 

 

Since the H7 viruses generally produce mild symptoms in humans, you may be wondering why all the fuss over an outbreak of H7?

 

The H7s, like all influenza viruses, are constantly mutating and evolving.  

 

While considered mild today, there are no guarantees that the virus won’t pick up virulence over time, or reassort with another `humanized’ virus and spark a pandemic.

 

Three years ago, we saw a study in PNAS that indicated that the H7 virus might be moving more towards adapting to humans.

 

Contemporary North American influenza H7 viruses possess human receptor specificity: Implications for virus transmissibility

 

You can read more about this in a couple of blogs from 2008, H7's Coming Out Party and H7 Study Available Online At PNAS.

 

For more on pandemic threats beyond H5N1 you may wish to revisit:

 

It Isn’t Just Swine Flu

Nuke Agency: Reactor #3 Containment Function `Likely Damaged’

 

 

 

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Photo credit IAEA

 

Yesterday it was widely reported that 3 nuclear plant workers were exposed to high levels of radiation from water they were wading through in the #3 reactor building (see Fukushima IAEA Updates: March 24th).

 

Today we’ve two follow up reports from NHK World News.

First a report that details the amount of radiation detected in the water in reactor building #3. 

 

TEPCO has measured 3.9 million becquerels of radioactive substances per cubic centimeter, including 2.2 million becquerels of radioactive cerium-144 and 1.2 million becquerels of iodine-131.

 

That’s a level of radioactivity 10,000 times higher than would normally be expected.  

 

High radiation detected in water at plant

Friday, March 25, 2011 08:22 +0900 (JST)

 

Tokyo Electric Power Company says it has detected high levels of radioactive substances in water that 3 workers were exposed to at the troubled Fukushima Daiichi nuclear power plant.

(Continue . . . )

 

 Next a statement to the press by Japan’s Nuclear Safety Agency that suggests that the containment function around reactor #3 is `likely damaged’, leading to the excessive radiation in the report above.

 

 

 

Nuke safety agency: No.3 reactor likely be damaged 

Friday, March 25, 2011 12:48 +0900 (JST)

Japan's nuclear safety agency says it is highly likely that the Number 3 reactor of the troubled Fukushima Daiichi nuclear power plant has been damaged, leading to the leak of high levels of radiation.

(Continue . . . )

Fukushima: Voluntary Evacuation Urged in 20km - 30km Radius Zone

 

 

 

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Voluntary evacuation urged in the red shaded zone.

Graphic NHK World News 

 

 

 

Chief Cabinet Secretary Yukio Edano told reporters today that residents living between 20km and 30km of the damaged Fukushima reactor should consider voluntary evacuation at this time to avoid further hardship.

 

Citing severe living conditions brought on - in part - due to harsh disruptions of essential services and breaks in the local supply/distribution chain, he urged those who have remained in the `stay indoors’ zone for the past two weeks to consider leaving.

 

He also stated that depending upon radiation levels, the government could extend the mandatory evacuation zone in the coming days.

 

 

NHK World News has an article and a video report on this story at:

 

Edano: Voluntary evacuation from 20-30 km advised

Friday, March 25, 2011 13:17 +0900 (JST)

Study: The Role Of Migratory Birds In Spreading Bird Flu

 

 

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One of the more contentious debates in the world of avian influenza is over exactly what role migratory birds play in the spread of highly pathogenic H5N1.  

 

Bird enthusiasts and naturalists tend to point to the poorly regulated and controlled poultry trade as being the main source of the spread of the bird flu virus, while those in the poultry industry tend to blame migratory birds.

 

Over the years we’ve seen study after study that either implicates migratory birds in the spread of the virus, or minimizes their role.

 

 

Last September (see Another Migratory Bird Study) a paper appeared in the British Ecological Society's Journal of Applied Ecology, that claimed that the global spread of the H5N1 virus through migratory birds was possible . . . but unlikely.

 

In a blog from 2009, called  India: The Role Of Migratory Birds In Spreading Bird Flu  I wrote about an article entitled  Scientists rule out spreading of bird flu by migrant birds in India  from Xinhua News.

 

And in January of 2008, Reuters carried a report called:

 

Don't blame wild birds for H5N1 spread: expert

BANGKOK (Reuters) - There is no solid evidence that wild birds are to blame for the apparent spread of the H5N1 virus from Asia to parts of Europe, Africa and the Middle East, an animal disease expert said on Wednesday.

 

There was also no proof that wild birds were a reservoir for the H5N1 virus, Scott Newman, international wildlife coordinator for avian influenza at the U.N.'s Food and Agriculture Organization, said at a bird flu conference in Bangkok.

(Continue . . . )

 

 

Despite these statements to the contrary, there have been plenty of other reports that strongly associate migratory birds with the spread of the virus.

A few include:

 

Korea: Migratory Birds Behind Spread Of H5N1

EID Journal: H5N1 Branching Out

Japan: Hooded Crane Positive For H5N1

Not One Of The Usual Suspects

FAO: On The Trail Of Avian Influenza

 

 

Since I don’t have a bird in this fight, I readily concede that both are probably significant contributing factors in the spread of the virus.

 

I see no reason why they should be mutually exclusive.

 

Which brings us to a study that was recently published in PLoS One  called:

 

 

Wild Bird Migration across the Qinghai-Tibetan Plateau: A Transmission Route for Highly Pathogenic H5N1

Diann J. Prosser, Peng Cui, John Y. Takekawa, Mingjie Tang, Yuansheng Hou, Bridget M. Collins, Baoping Yan, Nichola J. Hill, Tianxian Li, Yongdong Li, Fumin Lei, Shan Guo, Zhi Xing, Yubang He, Yuanchun Zhou, David C. Douglas, William M. Perry, Scott H. Newman

Background

Qinghai Lake in central China has been at the center of debate on whether wild birds play a role in circulation of highly pathogenic avian influenza virus H5N1. In 2005, an unprecedented epizootic at Qinghai Lake killed more than 6000 migratory birds including over 3000 bar-headed geese (Anser indicus). H5N1 subsequently spread to Europe and Africa, and in following years has re-emerged in wild birds along the Central Asia flyway several times.

Methodology/Principal Findings

To better understand the potential involvement of wild birds in the spread of H5N1, we studied the movements of bar-headed geese marked with GPS satellite transmitters at Qinghai Lake in relation to virus outbreaks and disease risk factors.

 

We discovered a previously undocumented migratory pathway between Qinghai Lake and the Lhasa Valley of Tibet where 93% of the 29 marked geese overwintered. From 2003–2009, sixteen outbreaks in poultry or wild birds were confirmed on the Qinghai-Tibet Plateau, and the majority were located within the migratory pathway of the geese. Spatial and temporal concordance between goose movements and three potential H5N1 virus sources (poultry farms, a captive bar-headed goose facility, and H5N1 outbreak locations) indicated ample opportunities existed for virus spillover and infection of migratory geese on the wintering grounds.

 

Their potential as a vector of H5N1 was supported by rapid migration movements of some geese and genetic relatedness of H5N1 virus isolated from geese in Tibet and Qinghai Lake.

Conclusions/Significance

This is the first study to compare phylogenetics of the virus with spatial ecology of its host, and the combined results suggest that wild birds play a role in the spread of H5N1 in this region. However, the strength of the evidence would be improved with additional sequences from both poultry and wild birds on the Qinghai-Tibet Plateau where H5N1 has a clear stronghold.

(Continue . . . )

 

 

 

The USGS has released a press statement on this study, (which was funded by USGS, FAO, National Science Foundation and the Chinese Academy of Sciences) that describes the project and the results.

 

New research suggests wild birds may play a role in the spread of bird flu

LAUREL, Md. -- Wild migratory birds may indeed play a role in the spread of bird flu, also known as highly pathogenic avian influenza H5N1.

 

A study by the U.S. Geological Survey, the United Nations Food and Agriculture Organization and the Chinese Academy of Sciences used satellites, outbreak data and genetics to uncover an unknown link in Tibet among wild birds, poultry and the movement of the often-deadly virus.

 

Researchers attached GPS satellite transmitters to 29 bar-headed geese – a wild species that migrates across most of Asia and that died in the thousands in the 2005 bird flu outbreak in Qinghai Lake, China. GPS data showed that wild geese tagged at Qinghai Lake spend their winters in a region outside of Lhasa, the capitol of Tibet, near farms where H5N1 outbreaks have occurred in domestic geese and chickens.

 

This is the first evidence of a mechanism for transmission between domestic farms and wild birds, said Diann Prosser, a USGS biologist at the USGS Patuxent Wildlife Research Center. "Our research suggests initial outbreaks in poultry in winter, followed by outbreaks in wild birds in spring and in the breeding season. The telemetry data also show that during winter, wild geese use agricultural fields and wetlands near captive bar-headed geese and chicken farms where outbreaks have occurred."

(Continue . . . )

 

 

Like most scientific studies, this one increments our knowledge, rather than completing it.

 

While falling a bit short of finding a smoking gun, it documents a plausible mechanism for the H5N1 virus to be spread from domesticated poultry to wild birds during the winter, and from there relayed primarily by asymptomatic birds along the migratory pathways. 

The authors conclude by stating:

Our study identifies QHL and Lhasa as important linkages between wild and domestic transmission of H5N1 and provides new supporting information regarding the role of wild birds in long distance spread of this virus.

 

Further investigation of wild birds and H5N1 transmission within the Central Asian Flyway will increase our understanding of how wild birds may contribute to virus circulation and the unique pattern of outbreaks in this remote region.

Fukushima IAEA Updates: March 24th

 

 

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The IAEA has posted as series of updates on the Fukushima nuclear reactors on their website and their Facebook Page.

 

 

You can view the most recent updates at:

Fukushima Nuclear Accident Update Log

 

Table: Summary of reactor unit status at of 24 March-0600 UTC

 

 

 

 

Fukushima Daiichi Nuclear Accident Update (24 March, 17:30 UTC)

Japanese Seawater Samples Show Signs of Radioactive Materials

Japanese authorities today provided the IAEA with data on seawater samples they collected on 22 and 23 March, after detecting iodine and cesium in the water near the Fukushima Daiichi nuclear power plant. (See earlier update.)

 

A vessel from the Japan Agency for Marine-Earth Science and Technology (JAMSTEC) collected water samples at several points 30 kilometres from the coastline and found measurable concentrations of iodine-131 and cesium-137.

The iodine concentrations were at or above Japanese regulatory limits, and the cesium levels were well below those limits.

 

The IAEA's Marine Environmental Laboratory in Monaco has received the data for review.

 

Fukushima Daiichi Nuclear Accident Update (24 March 17:25 UTC)

Japanese Workers Treated for Radiation Exposure

Japanese authorities today reported that three workers at the Fukushima Daiichi nuclear power plant were exposed to elevated levels of radiation. The three were working in the turbine building of reactor Unit 3 and have received a radiation dose in the range of 170-180 millisieverts.

Two of the workers have been hospitalized for treatment of severely contaminated feet, which may have suffered radiation burns. The workers had been working for about three hours in contact with contaminated water.

 

Fukushima Daiichi Nuclear Accident Update (24 March 2011, 14:00 UTC)

by International Atomic Energy Agency (IAEA) on Thursday, March 24, 2011 at 10:29am

Spent Fuel Pools at Fukushima Daiichi Nuclear Power Plant - Updated

Spent fuel removed from a nuclear reactor is highly radioactive and generates heat. This irradiated fuel needs to be stored for one to three years in pools that cool the fuel, shield the radioactivity, and keep the fuel in the proper position to avoid fission reactions. If the cooling is lost, the water can boil and fuel rods can be exposed to the air, possibly leading to severe damage and a large release of radioactive materials.

 

Nuclear power plants must replace fuel every one to two years, and the Fukushima Daiichi reactors typically remove about 25 percent of the reactor's fuel -- to be replaced with fresh, or unirradiated, fuel -- during each refuelling outage. The spent fuel, which is hottest immediately after it is removed from the reactor, is placed in the spent fuel pool until it is cool enough to be moved to longer-term storage.

 

The concern about the spent fuel pools at Fukushima Daiichi is that the capability to cool the pools has been compromised. See diagram below for location of the pool in each reactor building.

For more, see...http://www.iaea.org/newscenter/news/tsunamiupdate01.html

 

MMWR: Tuberculosis Trends In The United States

 

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Today’s MMWR from the CDC, released on this World TB Day, contains two reports on the incidence of Tuberculosis in the United States.

 

I’ve pulled some excerpts from each report (and reformatted for readability), but follow the links to read them in their entirety.

 

The first takes a closer look at an unexpected drop in TB cases in two states – Georgia and Pennsylvania – in 2009, and concludes that these reductions were real, and not the result of surveillance artifacts, health-care provider under diagnoses, or underreporting.

 

Assessment of Declines in Reported Tuberculosis Cases --- Georgia and Pennsylvania, 2009

Weekly

March 25, 2011 / 60(11);338-342

What is already known on this topic?

In 2009, tuberculosis (TB) incidence in the United States decreased to 3.8 cases per 100,000 population, the lowest recorded rate since national TB surveillance began in 1953. The 11.4% decrease from 2008 was the greatest single-year decrease ever recorded.

What is added by this report?

Findings from systematic investigations in Georgia and Pennsylvania, two states that experienced unexpectedly large decreases in TB incidence in 2009, indicate that the decline in new TB disease in those states appeared actual and not attributable to surveillance artifact, health-care provider underdiagnosis, or underreporting.

What are the implications for public health practice?

The TB surveillance systems in Georgia and Pennsylvania appear to be functioning appropriately. Current efforts to diagnose, treat, and report TB cases should be vigorously maintained as the United States moves closer to the goal of TB elimination.

 

 

The second report looks at the trends in Tuberculosis in the United States, and finds that while significant reductions in TB have been made, the stated goal back in 1989 of reaching an incidence rate of < 0.1 per 100,000 population by 2010 has not been met.

 

Trends in Tuberculosis --- United States, 2010

Weekly

March 25, 2011 / 60(11);333-337

In 2010, a total of 11,181 tuberculosis (TB) cases were reported in the United States, for a rate of 3.6 cases per 100,000 population, which was a decline of 3.9% from 2009 and the lowest rate recorded since national reporting began in 1953 (1). This report summarizes provisional 2010 data from the National TB Surveillance System and describes trends since 1993.

 

Despite an average decline in TB rates of 3.8% per year during 2000--2008, a record decline of 11.4% in 2009 (2), and the 2010 decline of 3.9%, the national goal of TB elimination (defined as <0.1 case per 100,000 population) by 2010 was not met (3).

 

Although TB cases and rates decreased among foreign-born and U.S.-born persons, foreign-born persons and racial/ethnic minorities were affected disproportionately by TB in the United States. In 2010, the TB rate among foreign-born persons in the United States was 11 times greater than among U.S.-born persons.

 

TB rates among Hispanics, non-Hispanic blacks, and Asians were seven, eight, and 25 times greater, respectively, than among non-Hispanic whites. Among U.S.-born racial and ethnic groups, the greatest racial disparity in TB rates was for non-Hispanic blacks, whose rate was seven times greater than the rate for non-Hispanic whites.

 

Progress toward TB elimination in the United States will require ongoing surveillance and improved TB control and prevention activities to address persistent disparities between U.S.-born and foreign-born persons and between whites and minorities.

FIGURE 1. Rate* of tuberculosis (TB) cases, by state/area --- United States, 2010†

Source: National TB Surveillance System.

* Per 100,000 population.

† Provisional data as of February 26, 2011.

§ 20 states had TB case rates <2.0 (range: 0.61--1.88) per 100,000

What is already known on the topic?

In 1989, the Strategic Plan for Elimination of Tuberculosis in the United States set a target date of 2010 to achieve its goal, defined as an annual tuberculosis (TB) case rate of <0.1 per 100,000 population.

 

What is added by this report?

For 2010, preliminary data show a national TB case rate of 3.6 per 100,000 population, a decrease of 3.9% from 2009, but the goal of eliminating TB in the United States by 2010 was not achieved, and foreign-born persons and racial/ethnic minorities continued to be affected disproportionately.

 

What are the implications for public health practice?

Ongoing surveillance and improved TB control and prevention activities, especially among disproportionately affected populations, are needed to eliminate TB in the United States.