Monday, February 28, 2011

PNAS: Reassortment Of H1N1 And H9N2 Avian viruses



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We’ve a study published today in PNAS that is shedding new light on the possibility of seeing a biologically `fit’ and virulent novel virus emerge from a reassortment between the H9N2 avian flu and the (former) pandemic H1N1 swine flu.


Researchers in China – using reverse genetics – created 127 hybrid viruses in the laboratory and tested them on mice for compatibility, replication ability, and virulence.


They found that half of the hybrid viruses were biologically `fit’ as far as replication goes, and 8 hybrids were significantly more pathogenic than either of their parental viruses.


A link to the study, followed by excerpt from the abstract, and then I’ll return with more.


High genetic compatibility and increased pathogenicity of reassortants derived from avian H9N2 and pandemic H1N1/2009 influenza viruses

Yipeng Sun,Kun Qin, Jingjing Wang, Juan Pu, Qingdong Tang, Yanxin Hu, Yuhai Bi,Xueli Zhao, Hanchun Yang, Yuelong Shu, and Jinhua Liu


H9N2 influenza viruses have been circulating worldwide in multiple avian species and repeatedly infecting mammals, including pigs and humans, posing a significant threat to public health. The coexistence of H9N2 and pandemic influenza H1N1/2009 viruses in pigs and humans provides an opportunity for these viruses to reassort.


Our results indicate that some avian H9-pandemic reassortants could emerge with a potentially higher threat for humans and also highlight the importance of monitoring the H9-pandemic reassortant viruses that may arise, especially those that possess the PA gene of H1N1/2009 origin.



When it comes to pathogenicity of flu viruses, mice are reasonably good test subjects  . . . but are not necessarily the best physiological surrogates for humans.


The authors of this study are quoted in the media as saying their next step is to repeat these experiments with ferrets and guinea pigs, lab animals that have more human-like respiratory systems.


We’ve discussed reassortment many times before, so those familiar with the concept may wish to skip ahead.


Shift, or reassortment, happens when two different influenza viruses co-infect the same host swap genetic material.


Influenza A viruses have 8 gene segments (PB2, PB1, PA, HA, NP, NA, M1, M2, NS1, NS2).


Which means that any two compatible influenza viruses could conceivably – and under the right conditions – generate more than 250 different combinations by swapping one or more of their 8 (potentially) interchangeable gene segments.


The key words being “under the right conditions”.


If it were easy, or a common occurrence, we’d be up to our hip boots in new, reassorted viruses all the time.


But it happens often enough that we recognize it as a real threat.   Shift is how new pandemic strains are born, and it was precisely the mechanism that created the 2009 `swine’ flu strain.



While the novel H1N1 `swine flu’ virus needs no introduction, the H9N2 avian virus is less well known. It is endemic in poultry across Asia, and while rare, we have seen a handful human infections. 


How often humans are really infected is unknown, since surveillance and testing among poultry farmers in China is practically non-existent.



A few notable H9N2 stories from the past include:


  • In December 2008 I ran a blog featuring an interview in which world famous Hong Kong virologist Malik Peiris cautioned that the H9N2 virus may be circulating far more commonly than we believe. Revisiting A Malik Peiris Interview On H9N2

  • A little over a year ago, in H9N2: The Other Bird Flu Threat, I wrote about the World Health Organization  recommending the creation of a candidate vaccine virus for H9N2. According to the latest vaccine update from the WHO, work continues on that candidate vaccine virus.


Today’s PNAS study, like many others before it  . . .


EID Journal: H1N1 Reassortment Possibilities

mBio: A/H1N1 Potential For Mutation

PNAS: H3N2 And H5N1 Reassortment)


. . .  point out the potential for nature’s laboratory to come up with new, and potentially devastating, flu strains through genetic reassortment. Granted, less virulent hybrid flu strains are also a possibility.


While we may not be able to stop the next pandemic from happening - knowing which dangerous hybrids to look for, and conducting aggressive global surveillance - may help us detect the next outbreak at the earliest possible moment.

And a few extra week’s warning could make all the difference between having a vaccine in time to mitigate the pandemic’s peak, or having it arrive after the worst had passed.

Bushmeat,`Wild Flavor’ & EIDs




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During the opening years of the first decade of the 21st century, `wild flavor’ restaurants flourished in many parts of China, but most particularly in Guangzhou Province.


There you could partake in all sorts of exotic dishes – often slaughtered and cooked in front of you - including dog, cat, civit, muskrat, ferret, monkey, along with a variety of snakes, reptiles, and birds.


What are commonly referred to as `bushmeat’.


For a horrific description of the conditions in these restaurants, I would direct you to an essay by Karl Taro Greenfeld called Wild Flavor which appeared in the Paris Review in 2005.


Greenfeld, you may recall, is the author of The China Syndrome: The True Story of the 21st Century's First Great Epidemic.  Perhaps the most authoritative (and absolutely riveting) account of the SARS outbreak of 2003, and how it was directly linked to the practice of consuming bushmeat in China.


In the wake of the SARS outbreak China – at least for a time – cracked down on many of these `wild flavor’ establishments, although they reportedly still flourish in some parts of China.


Yesterday, the British papers were filled with stories on the importation and sale of illegal bushmeat in the UK, including reports of chimpanzee meat being sold in some restaurants. 


A couple of links to articles include:


Meat from chimpanzees 'is on sale in Britain' in lucrative black market

Chimp meat discovered on menu in Midlands restaurants



The slaughtering of these intelligent (and often endangered) primates for food (but mostly profit) is sufficiently disturbing in its own right, but the dangers inherent in such practices are hardly trivial.


The killing, butchering, and even consumption of bushmeat have the very real potential of introducing zoonotic pathogens to humans. We saw that happen in 2003 with SARS, and it believed that this was how HIV was introduced into the human population as well.


While most people think of bushmeat hunting as something that a few indigenous tribes in Africa might do to feed their protein-starved communities, the reality is that hundreds of tons of bushmeat are butchered and exported (usually smuggled) to Europe, Asia, and North America every year.


In the summer of 2010 headlines were made when a study – published in the journal Conservation Letters  looked at the amount of smuggled bushmeat that was coming into Paris's Charles de Gaulle airport over a 17 day period on flights from west and central Africa.


An Associated Press article provides the details (link & excerpt below)



Tons of Bushmeat Smuggled Into Paris, Study Finds


By MARIA CHENG and CHRISTINA OKELLO Associated Press Writers

PARIS June 17, 2010 (AP)


Experts found 11 types of bushmeat including monkeys, large rats, crocodiles, small antelopes and pangolins, or anteaters. Almost 40 percent were listed on the Convention on International Trade in Endangered Species.


Based on what officials seized — 414 pounds (188 kilos) of bushmeat — the researchers estimated that about five tons of bushmeat gets into Paris each week.

(Continue . . . )


In 2005, the CDC’s EID Journal carried a perspective article on the dangers of bushmeat hunting by Nathan D. Wolfe, Peter Daszak, A. Marm Kilpatrick, and Donald S. Burke.


Bushmeat Hunting, Deforestation, and Prediction of Zoonotic Disease


It’s an interesting article, and it describes how it may take numerous transmissions of a zoonotic pathogen to man – over a period of years or decades – before it adapts well enough to human physiology to support human-to-human transmission.


Bushmeat hunting is a common intersection between man and reservoirs of zoonotic viruses, with a strong potential for an infection to occur.


One of those zoonotic diseases of concern is monkeypox.


In recent years we’ve seen an increase in the number of outbreaks of in central and western Africa, and even a rare outbreak in the United States in 2003 when an animal distributor imported hundreds of small animals from Ghana, which in turn infected prairie dogs that were subsequently sold to the public (see MMWR  Update On Monkeypox 2003)



(Photo Credit CDC PHIL)


While dubbed `monkeypox’, this less lethal cousin to smallpox is probably more commonly found in rodents than in monkeys.  Both of which are often targets of bushmeat hunters.


No vaccine is available for monkeypox, but the smallpox vaccination is said to reduce the risk of infection.


Just a few of the other viruses of concern include Hendra, Nipah, Ebola, many variations of SIV (Simian immunodeficiency virus), and of course . . .  Virus X.   


The one we don’t know about.  Yet.


For more on this we turn again to Nathan Wolfe, `The Virus Hunter’  and founder of Global Viral Forecasting Initiative (GVFI), who spends half his time in the wilds of Cameroon testing bushmeat – and hunters – looking for virus X.


I’ve written about Nathan Wolf several times over the years, including:


Nathan Wolfe And The Doomsday Strain
Nathan Wolfe: Virus Hunter


I can also highly recommend an absolutely fascinating TED Talk by Dr. Wolfe.


TED stands for Technology, Entertainment, Design.  Each year they hold a 4 day long event at Long Beach, California where 50 people are urged to give the 18-minute talk of their lives.


And believe me, this is one talk you don’t want to miss.

Video Link


While many people are understandably outraged or disgusted by the notion of bushmeat hunting, for virologists, the impact is much broader. 


Three quarters of human diseases originated in other animal species, and there are undoubtedly many more out there, waiting for an opportunity to jump to a new host.


Sadly, the role of `wild flavor’ cuisine in SARS epidemic in China and the introduction of HIV to humans via the hunting of bushmeat in Africa, it would appear, are lessons we have yet to fully embrace.

Arkansas Earthquake Swarm: 4.7 Magnitude Overnight



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Nine days ago I wrote about the ongoing swarm of earthquakes occurring in and around Guy, Arkansas in a blog called USGS: The Arkansas Earthquake Swarm. Since then the temblors have continued, with the latest being a 4.7 and a 3.8 magnitude quake overnight.



Note: The two latest shocks (depicted by the blue boxes) are obscuring an additional 52 smaller quakes in the past 7 days in this graphic.



While a bit unnerving for local residents, based on the USGS produced shake map for last night’s shallow 4.7 magnitude event, the quake was likely to be only moderately felt north of Little Rock, and damage – if any – should be `very light’.




Arkansas is no stranger to seismic events, although the main quake dangers are focused more in the northeast corner of the state, and associated with the New Madrid fault line.




Strong – even damaging quakes – have occurred outside of the New Madrid region in Arkansas over recorded history.  On the University of Arkansas’s (Little Rock) earthquake history page you’ll find descriptions of a number of quakes over the past 200 years.


One of the largest in recent memory occurred on New Year’s Day, 1969, and is briefly described:


On January 1, 1969, a tremor centered about 19 miles northwest of Little Rock and caused much commotion in the area. In Little Rock, plaster cracked, and furniture was moved about in some homes; and trees and utility wires swayed and shook throughout a wide area. The shock was also noted by residents in southern Missouri and western Tennessee.



In 1982 and again in 2001 a prolonged series of temblors struck very near the same region as we are seeing activity today, in what was called the Enola Earthquake Swarms


Enola is located only 20 miles or so to the south-east of this current area of activity. The Arkansas Geological Survey website gives a nice accounting of this swarm. 


A small excerpt follows:


The Enola swarm was initiated by a magnitude 1.2 earthquake recorded on January 12, 1982 near the town of Enola in Faulkner County, Arkansas. Since then, over 40,000 seismic events have been recorded in the Enola area. Most of the recorded seismic events are microquakes, but at least 93 earthquakes have been felt in the local area by at least one person during the first year of seismic activity. Earthquake magnitudes have not exceeded a 4.5, which occurred on Jan. 21, 1982. No structural damage has ever occurred, although there have been reports of broken china.



As far as whether these latest shocks are a harbinger of bigger things to come?   The USGS has this to say about earthquake swarms east of the Rockies.


Earthquake swarms are common east of the Rocky Mountains; although none of the others have involved so many small earthquakes as the central Arkansas swarms. Scientists don't know why swarms start, why they stop, or how long to expect them to last.

The possibility of a larger earthquake cannot be discounted but none of the other swarms have given us any reason to expect an earthquake large enough to cause significant damage in central Arkansas in the near future.

Most of North America east of the Rocky Mountains has infrequent earthquakes that can strike anywhere at irregular intervals. The causes of earthquakes are not understood well enough for us to predict earthquakes reliably.


Since earthquakes are unpredictable, the only rational response if you live in a seismically active area is to be prepared to deal with one if it happens.


In Because It Can Happen Here, I provided a long list of preparedness links, which I would encourage you to follow.


FEMA, READY.GOV and the American Red Cross all strongly encourage you to be prepared to deal with a wide range of emergencies, including earthquakes, fires, tornadoes, floods, or hurricanes.


They know that during a major crisis, they may not be able to provide assistance to everyone during the first crucial 72 hours.  


You and your family need to be capable of fending for yourselves, and hopefully helping your neighbors, until help can arrive and services are restored.


As reminds us:


Do it today.

Saturday, February 26, 2011

BFIC: Two Indonesian Bird Flu Reports



Note:  I’ll be away from my desk for the next 36 hours, so updates to this blog are unlikely until Sunday Evening or Monday morning.    

For the latest news from Flublogia you may wish to visit Crofsblog, Arkanoid Legent, Chen Qi, FluTrackers, the Flu Wiki or any of the other links in my sidebar.



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Overnight Ida at the Bird Flu Information Corner - a joint project of Kobe University in Japan and the Institute of Tropical Disease, Airlangga University, Indonesia – has posted translations of a couple of news items revolving around the recent outbreak of bird flu in Garut, Indonesia.


As you may recall, yesterday in A Friday Round Up Of Bird Flu Reports I mentioned that a number of people were being observed for signs of illness after a large outbreak of H5N1 in poultry in Garut, and that at least one person was suspected of being infected.


This morning, that number has climbed to two, with the hospitalization and isolation of a 7 month old baby.


Garut, West Java ::: Baby is suspected to contract bird flu

Posted by Ida on February 26, 2011

Garut – A 7-month-old baby named Lena, rushed to dr Slamet in Kabupaten Garut, West Java, on early Saturday (26/2) and treated in bird flu isolation unit.


The baby developed coughing, fever and breathing difficulty.


Hundreds of chickens had suddenly died of bird flu H5N1 in patient’s neighborhood, Kampung Cangkuang, Desa Bagendit, Kecamatan Banyuresmi. She is reported to have contact with the diseased chickens.


Head of Livestock Division of Kecamatan Banyuresmi, Nenok Kusmiati, is being treated in the same hospital as bird flu suspect patient.


They both are receiving intensive medical care. Nose and throat swab samples have been sent to Ministry of Health Laboratory in Jakarta.



Ida has a another story on this event, with more details on the 49 year-old agricultural agent suspected of being infected. 


Garut, West Java ::: H5N1 outbreaks, 5000 people at risk.

Posted by Ida on February 26, 2011



Despite the symptoms, the close proximity of infected poultry, and the response by health officials: these cases are still unconfirmed. Test results are awaited, and as we’ve seen in the past, they can take some time to be revealed.


In the meantime, you’ll find that Ida at BFIC and the newshounds at FluTrackers are keeping a very close eye on things in Indonesia right now.

That Was The Year That Was


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An interesting map has been produced by the Munich RE Group – a major international Insurance and Re-Insurance company – showing 960 natural disasters occurring around the globe in 2010.


The two page PDF file includes both the map, and a listing of the top 50 natural disasters, and is available on the Relief Web Site.


First the link, then I’ll return with a little discussion.



World Map of Natural Catastrophes 2010

Map of 'World%20Map%20of%20Natural%20Catastrophes%202010'

  • Date: 24 Feb 2011
  • Type: Natural Disaster
  • Keyword(s): Natural Disaster; Reference
  • Format:

    PDF *, 1847 Kb

  • Source(s):
    - Munich Re Group



While the format of this blog isn’t well suited for such detailed graphics (download the file for a closer look), the snapshot below gives you some idea of the scope of disasters around the world.





As one might expect, areas of highest population density (United States, Europe, Southeast Asia) saw the greatest number of events. As the map blow-up below illustrates, you don’t have to live in a developing country to be impacted by a natural disaster.




In 2010 FEMA handled a record number (81) federally declared disasters across the United States.


Good enough reason to follow the advice of, FEMA, the American Red Cross, and others and make preparations now to be ready should a disaster – or personal emergency – impact you or your family.


Some resources to get you started on the road to `all threats’ preparedness include:






And a few of my (many) preparedness essays include:

An Appropriate Level Of Preparedness
Inside My Bug Out Bag
Red Cross Unveils `Do More Than Cross Your Fingers’ Campaign
The Gift Of Preparedness


You can search this blog for more preparedness information by clicking this link.

North American Flu Surveillance: Week 7



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Influenza activity in the United States remains elevated, while in Canada – where levels had been declining for several weeks -  the number of new influenza cases is on the rise again.


A few excerpts from week 7’s data (ending Feb 19th) -pulled from the latest CDC’s FluView and PHAC’s  FluWatch  surveillance reports.


In Canada:


Summary of FluWatch Findings for the Week ending February 19, 2011

  • In week 07, there was an increase in overall influenza activity level, with 62.5% (35/56) of regions reporting localized influenza activity. There was a substantial increase in the number of outbreaks reported this week. The proportion of positive influenza detections overall decreased slightly, though the ILI consultation rate remained similar to the previous week.
  • Since the beginning of the season, 86.3% of the subtyped positive influenza A specimens have been influenza A/H3N2. In week 07, pandemic H1N1 2009 detections increased to 8% of positive influenza detections while the proportion of influenza B detections remained stable at 10%.


Overall Influenza Summary – Week 7 (February 13 to February 19, 2011)

In week 07, 35 regions reported localized activity (in all provinces except PE), 15 regions reported sporadic activity (in all provinces and territories except YK) and 6 regions presented no activity (see Activity level Map).

Compared to the previous week (week 06), 15 regions reported an increased level of influenza activity, 5 regions reported decreased activity, and 33 regions maintained a stable level of influenza activity (sporadic or higher).

Fifty-one new ILI/influenza outbreaks were reported: 26 in long-term care facilities (LTCF) in BC(2), SK (5), ON(4), QC(7), NB (2) and NS(6); 20 school outbreaks in AB(2), NB(15), NS(1) and NL(2); 1 hospital outbreak in ON; and 4 outbreaks in other facilities in SK(1), ON(2) and NL(1).



From the CDC, a few excerpts from this week’s FluView report.



2010-2011 Influenza Season Week 7 ending February 19, 2011



During week 7 (February 13-19, 2011), influenza activity in the United States remained elevated.

  • Of the 9,154 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, 2,866 (31.3%) were positive for influenza.
  • The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold for the fourth consecutive week.
  • Six influenza-associated pediatric deaths were reported bringing to season total to 41. Three of these deaths were associated with an influenza B virus, one was associated with an influenza A (H3) virus, one was associated with a 2009 influenza A (H1N1) virus, and one was associated with an influenza A virus for which the subtype was not determined.
  • The proportion of outpatient visits for influenza-like illness (ILI) was 4.9%, which is above the national baseline of 2.5%. All 10 regions reported ILI above region-specific baseline levels. Twenty-one states experienced high ILI activity; six states experienced moderate ILI activity; New York City and 16 states experienced low ILI activity; seven states experienced minimal ILI activity, and the District of Columbia had insufficient data.
  • The geographic spread of influenza in 44 states was reported as widespread; four states reported regional influenza activity; the District of Columbia reported local influenza activity; Puerto Rico, the U.S. Virgin Islands, and two states reported sporadic influenza activity, and Guam 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.


Pneumonia and Influenza (P&I) Mortality Surveillance

During week 7, 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 8.0% for week 7 and is the fourth consecutive week in which P&I has been above the epidemic threshold.

Pneumonia And Influenza Mortality

Influenza-Associated Pediatric Mortality

Six influenza-associated pediatric deaths were reported to CDC during week 7. Three of these deaths were associated with an influenza B virus, one was associated with an influenza A (H3) virus, one was associated with a 2009 influenza A (H1N1) virus, and one was associated with an influenza A virus for which the subtype was not determined. Forty-one deaths from 21 states (Arizona, Colorado, Florida, Georgia, Illinois, Indiana, Louisiana, Michigan, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Pennsylvania, Texas, Utah, Virginia, West Virginia, and Wisconsin) and New York City have been reported during this influenza season.

Sixteen of the 41 deaths reported were associated with influenza B viruses, 10 deaths reported were associated with influenza A (H3) viruses, eight were associated with 2009 influenza A (H1N1) viruses, and seven were associated with an influenza A virus for which the subtype was not determined.

Influenza-Associated Pediatric Mortality

Friday, February 25, 2011

WHO Update On Cambodian H5N1 Fatalities



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The World Health Organization’s Global Alert and Response (GAR) site has just posted their official statement on the recent H5N1 cases in Cambodia.


This update fills in some details on the fatalities reported here, and in the media, on Wednesday of this week (see Cambodia Reports Two Bird Flu Fatalities).

The good news is, no other cases have been detected.


And since both victims had multiple contacts with sick or dead poultry prior to falling ill, and both became symptomatic at roughly the same time (Feb 5th), human-to-human transmission at this time does not appear to be likely.


These are the 2nd & 3rd H5N1 fatalities reported in Cambodia in 2011.





Avian influenza – situation in Cambodia - update

25 February 2011 - The Ministry of Health of Cambodia has announced 2 new confirmed cases of human infection with avian influenza A (H5N1) virus.


A 19-year-old female, from Takong village, Ta Kong commune, Malay district, Banteay Meanchey Province, developed symptoms on early hours of 5 February, was admitted to a private clinic on 9 February, referred to a hospital on 12 February, and died on 12 February without avian influenza being considered as a diagnosis. She had travelled from her home with her husband, her 11-month old son, her mother in law and her sister in law to Rokar Chor village, Bantey Chakrey commune, Prash Sdach district, Prey Veng Province on 3 January. She had multiple exposures to sick and dead poultry between the second half of January and early February. A blood specimen collected at hospital on 12 February was transferred to Institut Pasteur du Cambodge on 22 February and tested positive by (polymerase chain reaction) PCR.


The 11-month-old son developed symptoms on 5 February, was admitted to hospital 15 February and died on 17 February. He also had multiple exposures to sick and dead poultry in the same time frame. The presence of H5N1 virus in nasopharyngeal specimens was confirmed by Institut Pasteur du Cambodge, the National Influenza Centre on 20 February.


The Ministry of Health has been coordinating the response with assistance from WHO. To date no other symptomatic contacts have been found.


Of the 13 cases of human H5N1 virus infection confirmed since 2005 in Cambodia, 11 have been fatal.

A Friday Round Up Of Bird Flu Reports



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My opinion of (mostly machine-translated) foreign media reports on disease outbreaks is essentially the same as what I’ve held about American television programs over the years;


I’m not particularly thrilled by their quality, but I tend to watch them all the same.


Disease surveillance and reporting – particularly in places like Indonesia and China – tend to be less than optimal, and so media outlets are usually our first (and sometimes only) source of outbreak information.


Unfortunately translations can produce vague, ambiguous, or sometimes misleading results.  Other times stories are simply wrong, or blown out of proportion.


So I tend to approach all reports – even official ones – with a fair amount of skepticism.


But, as I say, I do watch them.  And on occasion I highlight them here in this blog. 


This week we are seeing poultry & wild bird outbreaks of bird flu in a host of countries, and in at least two (Indonesia & Cambodia), a number of potentially exposed people are said to be `under observation’.  

It isn’t at all clear that any of these `suspect’ cases actually have the H5N1 virus.


So, with the appropriate caveats out of the way, a round up of a few H5N1 reports from around the globe.



On Monday, Ida at BFIC reported on a die-off of poultry in Garut, Indonesia and Dutchy started a thread Flutrackers which you can follow HERE.


In quick succession we saw stories posted by other newshounds indicating that the Indonesian government was sending more Tamiflu into the region, and that poultry deaths had been reported in 5 local villages over the previous 3 weeks, and that villagers were resisting government attempts to cull their flocks.


On Monday it was reported that 5 citizens with contact with infected poultry were under observation for `flu-like’ symptoms.  


By Tuesday, that number had increased to 14.  A typical report, posted by Treyfish, reads:


H5N1 raged in Garut, 600 Chicken Dead, 14 Citizens Influenza

By admin-February 22, 2011

At least 600 chickens died suddenly due to mengganasnya Avian Influenza (AI/H5N1), Sukaratu Village, and Village Banyuresmi Sukasari Banyuresmi Garut district, even up to now there are about 14 local residents suffering from severe influenza.

(Continue . . . )



By Thursday, the headlines became a bit more concerning, although the large number of people under `observation’ appear to be so out of an abundance of caution.


This report was posted by Dutchy123 on FluTrackers.


163 Garut residents feared H5N1 Transmission

Thursday, February 24, 2011,

Officers destroy bird flu infected poultry

REPUBLIKA.CO.ID, GARUT - Public Health Service, Garut regency, West Java, to supervise the 163 people who live in District Banyuresmi, because it was feared H5N1 virus or bird flu after the discovery of hundreds of chickens died suddenly fell ill from the virus.


Head of Communicable Diseases Eradication (P2M), Public Health Service, Garut regency, Dede Rohmansyah told reporters on Thursday, said the monitoring of citizens because otherwise have been in contact with dead or sick poultry.

(Continue . . . )



It isn’t all all clear that any of these people under observation are genuinely suspected of having the virus. Today, however, we are seeing a report about at least one suspected human infection.


This, again, from Treyfish on FluTrackers.


Animal Husbandry Department Officers Suspected Bird Flu Virus Infected

Friday, February 25, 2011 | 16:16 pm
TEMPO Interactive, Garut - Head of Technical Services Unit Banyuresmi District Livestock Office, Garut regency, West Java, the initials EK, 49 years suspected of contracting the H5N1 virus or bird flu from poultry. "His condition began to improve, but still suspect bird flu," said Executive Responsible Garut Hospital Isolation Room, Asep Roni Aryanto, Friday (25 / 2).


Residents Cempaka Perum Bumi Indah, Lebak Jaya Village, District Karangpawitan, have not been allowed to go home. The hospital is still in intensive care in isolation rooms. EK admitted to hospital on Friday afternoon at around 12.00 pm.

(Continue . . . )


For now, all we really have is a large outbreak of poultry deaths due to the H5N1 virus, a number of local villagers with `flu-like’ symptoms, and a lot of Tamiflu being passed out as a  precaution.


Events that, quite frankly, we’ve seen before in Indonesia. But the newshounds will keep close watch on the situation, and I’ll post an update if more comes of it.





From Xinhua News, we learn that five new provinces in Vietnam are reporting outbreaks of H5N1. 


Vietnam reports more cases of bird flu

HANOI, Feb. 25 (Xinhua) -- Bird flu has been discovered in five more provinces in Vietnam, the Vietnam News Agency reported Friday.


According to the report, the cases were found in northern Thai Nguyen, Vinh Phuc, Lang Son, Nam Dinh provinces and Central Highland Kon Tum province.


Meanwhile, foot-and-mouth disease has been discovered in 19 provinces across the nation since the end of January. A total of about 700 buffaloes, cows and pigs were reported to be affected.


South Korea


The last OIE report, submitted on February 18th, listed 48 separate outbreaks since December.  This, again from Xinhua News. 



S Korea confirms additional case of bird flu

SEOUL, Feb. 25 (Xinhua) -- South Korea on Friday confirmed an additional case of bird flu at a farm near Seoul.


The Ministry for Food, Agriculture, Forestry and Fisheries said the new case of the H5N1 virus was confirmed at the chicken farm in Yeoju, about 100 kilometers southeast of Seoul.


About 30,000 chickens on the farm have been culled to prevent the spread of the disease, the ministry said.


The spread of the disease has shown signs of slowing down in February with only five confirmed cases, including the latest one.


A record 5.5 million birds have been put to death due to the disease, which began in December last year.



While not necessarily making big headlines, Bangladesh continues to struggle with large numbers of H5N1 outbreaks in poultry.  In an OIE Report submitted on Feb 24th, they list 22 new outbreaks so far in February.



Follow up Report #29




Mizoram India is nestled between Bangladesh, Tripura, and Myanmar; nearly surrounded by bird flu endemic regions.  As this New Kerala article tells us - the alert is on to prevent the introduction of H5N1 into their region.


Tripura, Mizoram on bird flu alert

Aizawl/Agartala, Feb 25 : Mizoram Friday sounded a bird flu alert following the outbreak of the avian influenza in neighbouring Tripura and also in Myanmar and Bangladesh, which border the state.

The authorities in Tripura, after the fresh cases of bird flu, have culled more than 6,000 ducks and poultry birds and are now busy with mopping, cleaning and disinfecting.

(Continue . . . )



And to the above stories we could easily add ongoing reports out of Egypt, Cambodia, and Japan.



While none of these outbreaks appear unusual or particularly alarming, they do serve to remind us that the bird flu threat has not abated.  The virus continues to circulate in wild & migratory birds, and poultry flocks, across large areas of the globe.


Despite the obvious concerns over human exposure to bird flu, the H5N1 virus remains primarily adapted to avian physiology. Humans have only rarely contracted the virus, usually after direct exposure to infected birds.

Thursday, February 24, 2011

Gimme Shelter: There’s An App For That



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I’ve just downloaded and installed the new American Red Cross Shelters app – released on Feb 17th – onto my beloved iPod Touch.     




This is a free application that will allow the user to find open Red Cross shelters anywhere in the country, along with accessing the latest news from Red Cross website.  All you need is a wireless connection.



Operation is simple, and quick.  You can choose either map or list (by state) views of open shelters.  This is a very small (.2 MB) app, and well worth adding to your device.



For those without an iPhone/iPad but who have access to the Internet, you can retrieve much of the same information from the Red Cross Shelters website.




Kudos to the Red Cross for making this data, and the application, easily available online.


Highly recommended.

Dr. Paul Offit: The Dangers Of The Anti-Vaccine Movement




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As a child of the 1950s I well remember a time when American kids by the tens of thousands were still being crippled – and sometimes killed – by polio. In the 1950s, the fear of polio was palpable across the nation.


There were hospital wards filled with polio-paralyzed children trapped in iron lungs (a grim technology many younger adults have no memory of), which were used to keep them alive.


The following short film clip may be hard for some to look at, but is a reminder of how things were . . . not so very long ago.



In 1954, the year I was born, the first major field trials of the Salk vaccine took place, and the following year – after review of the data - a national vaccination campaign was launched.


By 1957, after two years of vaccination - the number of new polio cases in the United States dropped from over 35,000 to under 6,000.  And by 1964, that number had dropped to just 121 cases.


An incredible feat, in less than a decade. 


Another vaccine victory is illustrated by the following chart showing the number of Pertussis cases (whooping cough) in California over the past 60 years.



The dramatic drop in Pertussis - which began in the early 1950s – closely follows the introduction of the first whole-cell pertussis vaccine combined with diphtheria and tetanus toxoids (DTP) was introduced in the mid-1940s.


Nationwide, in the 1940s, about 160,000 cases of Pertussis were recorded, and the illness claimed about 5,000 lives.


By 1976 the number of reported cases reached a record-low of 1,010 cases, a decrease of 99%.  But over the past decade the number of cases has steadily risen, and last year 21,000 cases were reported.


This rise in Pertussis cases, in part, can be traced to a decreasing number of parents getting their kids vaccinated, and a general lapsing of adult booster vaccinations.


Which brings us to an interview with Dr. Paul Offit – the vaccine research scientist and pediatrician that anti-vaccine activists love to hate – which appears in today’s Time Magazine.


The Dangers of the Anti-Vaccine Movement

By Meredith Melnick Thursday, Feb. 24, 2011

Childhood inoculations protect us against deadly infectious diseases like measles, whooping cough and polio. But they are also the source of near constant conflict — most recently in the Feb. 22 Supreme Court decision which ruled in favor of a vaccine manufacturer over the family of a disabled girl.


In recent years, some parents have begun to refuse vaccination for their children, influenced by fringe activists who believe it causes autism, brain damage and other ailments. Dr. Paul Offit, Chief of the Division of Infectious Diseases and the Director of the Vaccine Education Center at the Children's Hospital of Philadelphia, has seen the consequences: preventable childhood deaths, community outbreaks of outdated diseases and misinformed, angry parents.

(Continue . . . )



Admittedly, vaccines are neither 100% safe nor are they 100% effective.  I know of no medicine that can meet both (or even one) of those standards.


But vaccines have an excellent safety record, and while not perfect, have done a remarkable job reducing (and in some cases eliminating) infectious diseases from our communities.

Despite the tremendous good vaccines have done over the years, anti-vaccination forces continue to use fear tactics to push their agenda.  In The Monsters Are Due On Vaccine Street I wrote:


Practically every day I see articles on the internet purporting to tell the `truth’ about vaccines, and in nearly every case it is about as far removed from the truth as you can get and still remain on this planet.


Their techniques are simple, but effective.


First, they use  biased and inflammatory language, filled with incendiary adjectives like `deadly’, `useless’, `dangerous’, or `untested’ practically anytime the word `vaccine’ is used.


Second, they build a straw man, by claiming that vaccines are supposed to be 100% safe and effective (which no one in medicine claims), and then proceed to knock that down with some story about a purported bad reaction or side effect.


And third . . . and used with great effect online . . . they cherry pick a news article that somehow bolsters their claims, without acknowledging any evidence to the contrary.



Extremely effective tactics – particularly on the internet - that in recent years have encouraged a growing number of parents to file  personal belief exemptions to avoid vaccinating their children.


A worrisome trend that, should it escalate, could endanger the progress our communities have made against a number of infectious childhood diseases.

Wednesday, February 23, 2011

Cambodia Reports Two Bird Flu Fatalities




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For the past two days the newshounds on FluTrackers  have been following a story regarding two suspected H5N1 fatalities in Cambodia, a 21 year-old mother on February 12th and her infant son a few days later.



In the past hour, the Bangkok Post has reported that the World Health Organization, along with local Cambodian Health officials, have confirmed that these two cases tested positive for the H5N1 virus.



Cambodian mother, son die of bird flu

Published: 23/02/2011 at 08:07 PM

Bird flu has claimed three lives in Cambodia this month, with a mother and her 11-month-old son becoming the latest victims of the virus, officials said Wednesday.


The 19-year-old woman died on February 12 while her baby died five days later, the Cambodian health ministry and the World Health Organization said in a joint statement. Tests confirmed both had contracted H5N1 avian influenza.


Earlier this month Cambodia reported its first bird flu fatality in nearly a year when a five-year-old girl in the capital died from the virus.


The new victims, from northwestern Banteay Meanchey province, were admitted to hospital with high fever and coughing days after "eating sick poultry'' while visiting relatives in southeastern Prey Veng province, the statement said.

(Continue . . . )


These latest cases died in Banteay Meachey province, but reportedly ate the diseased birds in Prey Veng province, which is fairly close to where the first Cambodian H5N1 death was reported two weeks ago.




We’ll obviously be watching for any follow up reports on these cases, or on any other potential victims in the region, with interest.

JAMA: Cell Phone Use Stimulates Brain Activity




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Concerns over the potential health ramifications of long-term & frequent cell phone use continues despite a number of studies that have yielded inconsistent results.


In May of 2010, the International Agency for Research on Cancer (IARC) released their long-delayed INTERPHONE report, which was unable to establish a link between cell phone use and brain tumors  (see The IARC Cell Phone Report)


Of course, it can sometimes take years – or even decades – of research before the full effect of a new technology like cellular communications can be adequately established.


Today we’ve a new study that looks at how cell phone radiation affects brain activity, which is published in the February 23rd issue of JAMA.


The short version is: Prolonged exposure to cell phone radiation has now been shown to increase brain activity, but the clinical significance (if any) of such increases are unknown.


First a link and some excerpts from the abstract, followed by links to a video, press release, after which I will return.



Effects of Cell Phone Radiofrequency Signal Exposure on Brain Glucose Metabolism

Nora D. Volkow, MD; Dardo Tomasi, PhD; Gene-Jack Wang, MD; Paul Vaska, PhD; Joanna S. Fowler, PhD; Frank Telang, MD; Dave Alexoff, BSE; Jean Logan, PhD; Christopher Wong, MS


Objective To evaluate if acute cell phone exposure affects brain glucose metabolism, a marker of brain activity

Conclusions In healthy participants and compared with no exposure, 50-minute cell phone exposure was associated with increased brain glucose metabolism in the region closest to the antenna. This finding is of unknown clinical significance.

The link to the press release, embargoed until yesterday afternoon, follows:


Cell Phone Use May Have Effect on Brain Activity, But Health Consequences Unknown


Media Advisory: To contact Nora D. Volkow, M.D., call the NIH press office at 301-496-5787 or email

To contact editorial co-author Lennart Hardell, M.D., Ph.D., email

Cell Phone Use May Have Effect on Brain Activity, But Health Consequences Unknown

CHICAGO – In a preliminary study, researchers found that 50-minute cell phone use was associated with increased brain glucose metabolism (a marker of brain activity) in the region closest to the phone antenna, but the finding is of unknown clinical significance, according to a study in the February 23 issue of JAMA.


“The dramatic worldwide increase in use of cellular telephones has prompted concerns regarding potential harmful effects of exposure to radiofrequency-modulated electromagnetic fields (RF-EMFs). Of particular concern has been the potential carcinogenic effects from the RF-EMF emissions of cell phones. However, epidemiologic studies of the association between cell phone use and prevalence of brain tumors have been inconsistent (some, but not all, studies showed increased risk), and the issue remains unresolved,” according to background information in the article. The authors add that studies performed in humans to investigate the effects of RF-EMF exposures from cell phones have yielded variable results, highlighting the need for studies to document whether RF-EMFs from cell phone use affects brain function in humans.


(Continue . . . )



This study basically used PET scans (Positron emission tomography) to chart the brain’s activity via it’s uptake of F-FDG, a radioactive pharmaceutical used for imaging the heart, lungs, and brain.


Participants underwent PET Scans with cell phones placed on their left and right ears; once with the right cell phone `on’ (with sound muted) for 50 minutes and once with both cell phones `off’.


Areas of the brain in close proximity to the antennas of the activated cell phones demonstrated increased glucose uptake, indicating increased localized brain activity in response to the RF (radio frequency) emissions.


This study indicates that the prolonged use of a cell phone does affect brain activity. What all this might mean in regards to human health is unknown for now.


In an accompanying editorial, Cell Phone Radiofrequency Radiation Exposure and Brain Glucose Metabolism, Henry Lai, PhD & Lennart Hardell, MD, PhD write:


“Although the biological significance, if any, of increased glucose metabolism from acute cell phone exposure is unknown, the results warrant further investigation. An important question is whether glucose metabolism in the brain would be chronically increased from regular use of a wireless phone with higher radiofrequency energy than those used in the current study. Potential acute and chronic health effects need to be clarified. Much has to be done to further investigate and understand these effects.”


These authors also question whether the changes to brain function detected in this study could adversely affect other physiological functions of the body.


Admittedly, not many answers from this study. 

But it raises a lot of questions.

Tuesday, February 22, 2011

Japan Reports Peramivir Resistant Virus




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In 1940, even before penicillin could be rolled out for clinical use, a penicillin-resistant organism was detected by researchers in a sample of Gram-negative E. coli.


Ever since then, man has been in a ongoing battle to create new antibiotics and antivirals faster than nature can find ways to circumvent them.


One of the newest entries onto the antiviral stage has been peramivir (Rapiacta) introduced in Japan in 2010, and used under an EUA (Emergency Use Authorization) here in the United States during the pandemic.


Peramivir is an IV neuraminidase inhibitor, developed by BioCryst, and has been viewed as a potential successor to Tamiflu – particularly for severe cases of influenza.


Today we are hearing of what appears to be a single spontaneous mutation of the new H1N1 virus in a child receiving the IV peramivir therapy.


Spontaneous mutations of this sort, while notable, are not unexpected and are far less serious than a resistant mutation detected in a biologically fit (and circulating) flu strain.


The story from Kyodo News, and then I’ll return with more.


New flu virus resistant to antiflu drug Rapiacta detected in patient

TOKYO, Feb. 22, Kyodo

A genetic mutation of the H1N1 influenza virus resistant to the Rapiacta anti-influenza drug has been detected in a 5-year-old patient, according to the National Institute of Infectious Diseases.

(Continue . . . )


The child has reportedly recovered and has been discharged from the hospital. There are no indications that the mutated virus was transmitted further.


In March of 2010 we learned of another case of peramivir resistance (see NIH: Rapid Development Of Antiviral Resistance In Two Cases) during the fall 2009 pandemic wave.


Our arsenal of antivirals is limited, and some of the new ones in the pipeline are refinements of older drugs, which may prove vulnerable to some of the same forms of resistance.


Overuse of Amantadine, particularly its inclusion into chicken feed during the 1990s to combat bird flu in Asia – has been credited with a dramatic rise in influenza’s resistance to the drug by 2005.


Tamiflu (oseltamivir), released in 1999 proved extremely effective against influenza until 2008, when a resistant version of the old seasonal H1N1 appeared and quickly spread around the world.


Seasonal H3N2 remained susceptible to the drug.


The old H1N1 virus has been replaced by novel H1N1, which fortunately still remains largely sensitive to the drug.  


Scientists do worry that over time, the new H1N1 virus could pick up resistance to Tamiflu. And as we’ve seen in these two isolated cases, even newer generations of neuraminidase inhibitors are not immune to resistant spontaneous mutations.


The takeaway message from these reports isn’t that peramivir has already been rendered useless (it hasn’t), but that resistance can develop quickly in rare instances in some people while receiving these medications.  


Which is another good reason why getting a flu shot every year is an exceedingly good idea.


It is almost always better to try to prevent an illness, than to have to treat one.

Because It Can Happen Here


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For constant readers, I apologize for sounding a bit like a broken record on the need for individual, family, and community preparedness.  But events such as we’ve witnessed overnight in Christchurch are a reminder that yes . . . it can happen here.


At least, in most areas of North America, and for that matter, much of the world.  We live on a seismically active planet where earthquakes, volcanoes and tsunamis occur with some regularity.



1. Based on observations since 1900. 2. Based on observations since 1990. NOTE: The NEIC estimates that several million earthquakes occur in the world each year. Many go undetected because they hit remote areas or have very small magnitudes.

Source: National Earthquake Information Center, USGS 


Seismically active areas of the world

While I grew up in hurricane country, for about 10 years I lived in the orange ring of the bullseye (New Madrid fault) in the center of our country.  


In 1811 and 1812, that fault produced four of the largest quakes ever felt in the United States (8.1-8.3), so I have a keen appreciation of the hazards.




Earthquakes, like Hurricanes, Tornados, Floods, and yes . . . even pandemics . . .  are hazards everyone should be aware of, and prepared to deal with.  A prime focus of this blog has always been preparedness.



If you’ve already taken my preparedness sermons to heart - feel free to skip the rest of this blog.  I’ll be back later today, I’m sure, on another subject.


But for those who may be new to this blog, or for those who haven’t as yet taken the essential steps to prepare for an earthquake, tornado, flood, hurricane or any other major disaster, the following is a short list of a few of the preparedness essays I’ve written.


Planning To Survive



Resolve To Be Ready In 2011 Toolkit



FEMA: Preparedness Gift Suggestions 
The Gift Of Preparedness: 2010 
The Gift Of Preparedness (2009)

Cold Weather Car Bag



Thanksgiving Is Family History Day


NPM10: FEMA Asks, "Are You Earthquake Prepared?”


NPM10: An Appropriate Level Of Preparedness


Inside My Bug Out Bag


Red Cross Unveils `Do More Than Cross Your Fingers’ Campaign



And last, and perhaps most important:


In An Emergency, Who Has Your Back?


FEMA, READY.GOV and the American Red Cross all strongly encourage you to be prepared to deal with a wide range of emergencies. 


They know that during a major disaster, they may not be able to provide assistance to everyone during the first crucial 72 hours.  


You and your family need to be capable of fending for yourselves, and hopefully helping your neighbors, until help can arrive and services are restored.


As reminds us:


Do it today.

NZ: Aftershocks, Rescue Attempts, Casualties, And The Mounting Toll



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Damage reports continue to come in from quake stricken Christchurch overnight as rescuers sift through pancaked buildings looking for survivors. 


The news is grim, with reports of scores still trapped, and dozens of fatalities.  Cold temperatures and rain are not only making residents – many unable or unwilling to stay indoors – miserable, but are also complicating rescue and cleanup activities.


The NZ Herald has extensive coverage, including:


Christchurch Earthquake: Workers trapped in crushed buildings

10:03 PM Tuesday Feb 22, 2011One of the buildings damaged by the 6.3 earthquake. Photo / Mark Mitchell

One of the buildings damaged by the 6.3 earthquake. Photo / Mark Mitchell

Up to 35 workers are trapped in two prominent Christchurch buildings, hard hit in today's 6.3 magnitude quake.

Thirty people are believed trapped in the Pyne Gould financial services building on Cambridge Terrace, with another five trapped in the Christchurch Press building.

(Continue . . . )



Despite their smaller size, the city has been damaged far more heavily by this latest quake, and the numerous ongoing aftershocks, that it was during the September 7.1 magnitude quake. 


These temblors are both closer in to the center of the city (10 km) and shallower (3 km).


With winter approaching, and a number of homes destroyed (and many of those still habitable likely to have sustained additional chimney damage), residents will find many new challenges ahead.


The physical damage of an earthquake can take years to recover from.   The emotional damage – for some – can last a lifetime.


Many Christchurch residents had spent the last few months working to put their houses, businesses, and lives back in order after the September quake, only to find their efforts undone in a matter of seconds by last night’s temblor.


And the numerous aftershocks (several dozen over 3.5 magnitude in the first 10 hours) are an abrupt and ongoing reminder that the earth remains violent and uncertain beneath their feet.


While not approaching the impact of last year’s Haitian earthquake, the misery, heartache, and economic toll of last night’s quake are quite substantial and serve as another reminder that disasters can strike anywhere, and at any time.


I’ll return in my next blog with a long list of earthquake and disaster preparedness information.