Bird flu update meta-post

It’s been about a week since my last “bird flu” post–and I know that many people, including myself, tend to get burned out on the same ol’ thing, but there’s some interesting news out that I wanted to share. First, two posts from Effect Measure. Here, Revere discusses the newest reports of H5N1 spread: swans in Austria, Germany, and Iran. Revere also discusses one of GrrlScientist’s favorite topics, spread of the virus caused by wild birds vs. domestic poultry. I agree with his conclusion (and not just because he linked my “small world” post):

Another (and in our view more likely) possibility is that both explanations [that the virus spreads by wild birds *and* domestic poultry] are correct. The virus makes the occasional long jump via migratory birds but primarily spreads locally via the poultry trade.

Since the virus itself does get a lot of attention, I’m also highlighting another of Revere’s posts, , trying to get people to go beyond individual strategies–or public health strategies–and think about community measures that will help in responding to a disaster.

But if we are going to get through this with minimum pain we will, above all, need to help each other. The more prepared we are as communities the more likely we will see neighbor helping neighbor instead of neighbor fleeing neighbor. In essence this is a task at community mobilization and the closer a pandemic seems, the easier it will be to mobilize the community. So we should be thinking about it and doing it, even if in the past it was hard to get attention. Perceptions change and with them, willingness to take action.

We are not just talking about public health measures. In a way, they will more likely take care of themselves because that seems to be the only thing state and local governments are thinking about. The big issues will be those loosely called social services: how to care for the many people who will need care despite no money, family or social support; how to ration scarce resources of all kinds; how to cope with a prolonged 30% to 40% absenteeism that can cripple essential services like food supply, pharmacies, water, power; how to provide for the dead and comfort their survivors. All of these things can be done by schools, businesses and agencies thinking ahead and putting in place some rudimentary planning.

Wise advice.

Finally, one new research finding just out today in Nature:

Antibodies to H5N1 found in village dogs and cats.

Large numbers of domestic dogs and cats in Thailand may be infected with the H5N1 strain of avian flu, Nature has learned. Experts are struggling to work out whether such carnivores might be spreading the disease.

In an unpublished study carried out last year by the National Institute of Animal Health in Bangkok, researchers led by virologist Sudarat Damrongwatanapokin tested 629 village dogs and 111 cats in the Suphan Buri district of central Thailand. Out of these, 160 dogs and 8 cats had antibodies to H5N1, indicating that they were infected with the virus or had been infected in the past. “That’s a lot,” says Albert Osterhaus, a virologist at the Erasmus University in Rotterdam, the Netherlands. “This is definitely something to look into.” So far, researchers at Bangkok’s Chulalongkorn University have isolated the virus from at least one of the dogs.

Wild cats, including tigers, are known to be susceptible to the virus, but this is the first scientific study to find it in dogs, suggesting that infection could be widespread. Osterhaus is pressing officials at the UN Food and Agricultural Organization (FAO) and the World Organisation for Animal Health to monitor dogs, cats and other carnivores for H5N1. “It’s a gap in our surveillance,” he says. “Basically all carnivores seem susceptible.”

Again, this is one thing that makes H5N1 so scary–it’s just such a strange influenza virus. Cats and dogs normally aren’t infected by influenza virus (though of course, a new “dog flu” was announced last year.) This just adds another layer of surveillance that we don’t have–infections we’re likely missing.

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Comments

  1. #1 Dave S.
    February 15, 2006

    Sudarat Damrongwatanapokin

    Now that’s a name and a half!

  2. #2 cpurrin1
    February 15, 2006

    Hi Tara,

    I think the dog/cat antibody results are fascinating. I’ve been wondering whether WHO et al. and local authorities ever test victims’ _pets_ for antibodies. Dogs, in particular, are known for their slobber, and it seems a possibility that pets might facilitate transmission of H5N1 to humans. Or even if they don’t now, it might be a route to pay attention to as the strains evolve.

  3. #3 Hank Barnes
    February 15, 2006

    I’m not worried about this exotic bird flu. It’s mostly hype. Go read Fumento on this.

    Its the same scare-mongering we saw in SARS, which was/is bogus, too. Not one person in USA died of SARS.

  4. #4 Tara
    February 15, 2006

    Hi Hank–

    I don’t suggest “worrying,” but I disgree it’s only “hype.” I’ve written extensively on this issue previously (including comparisons to SARS); the link to the collected influenza posts is here. Older posts can be found by searcing “influenza” here.

    Colin–

    As far as I know, they’d not done pet testing previously (or if they had, it was only on occasion). There’s been antecdotal evidence of dead or ill cats in areas where birds were culled, but again, I don’t know how much follow-up testing was actually done.

  5. #5 Hank Barnes
    February 15, 2006

    It’s total hype, Tara.

    I predict there will be no change in the deaths due to flu in the U.S. (35,000/year) anytime soon.

    Also, How do we know that H5N1 isn’t a mere passenger virus? Are we radomly sampling blood of healthy people in the U.S.

    Barnes, Hank

  6. #6 Tara
    February 15, 2006

    Hank,

    I predict there will be no change in the deaths due to flu in the U.S. (35,000/year) anytime soon.

    And pretty much everyone in public health would agree with you. Does that mean we should ignore what’s happening around the world?

    Also, How do we know that H5N1 isn’t a mere passenger virus? Are we radomly sampling blood of healthy people in the U.S.

    Actually, yes, they are. Our center, in fact, has been working on a number of projects looking at serosurveillance for a variety of “animal” influenza viruses. We’ve not found any H5 antibodies–mostly H1, 2, and 3 as would be expected. I wrote a bit about a recently published study from our group here.

  7. #7 Hank Barnes
    February 15, 2006

    Our center, in fact, has been working on a number of projects looking at serosurveillance for a variety of “animal” influenza viruses.

    Well, keep up the good work!

    We’ve not found any H5 antibodies–mostly H1, 2, and 3 as would be expected.

    Why shoot for antibodies, rather than culturable virus? I guess the question is moot, in light of the absence of antibodies, but I still don’t understand why y’all don’t try to detect actual virus.

    Barnes

  8. #8 Dave S.
    February 15, 2006

    Aren’t antibody tests more general and much simpler to administer than trying to find a specific pathogen? Makes sense to me to first find if the body is reacting to something, before trying to find that something.

    Sort of like running the metal-detector over the haystack first to see if its worthwhile to then look for a needle.

  9. #9 Hank Barnes
    February 15, 2006

    Dave S.

    Problem: Historically, antibodies were thought to represent past illness, not future illness.

    Example: I had chicken pox when I was 14. No test, no “anti-virals”, no doctors — just 8 days of hell. Then, I developed anti-bodies to the virus, and got better.

    So, if you test me, you might find anti-bodies to the Varicella-Zoster virus. This absolutely doesn’t mean I’m at risk from developing chicken pox — it means the opposite.

    Barnes

  10. #10 Joseph O'Donnell
    February 15, 2006

    It’s also worth noting that growing a virus like influenza takes considerable time and patience. In this case the virus has to be grown in chicken eggs, which isn’t the most inexpensive method of doing things and depending on what you’re looking at the virus might not grow at all anyway. Antibody tests are cheap and sufficiently accurate, especially if you are merely wanting to check to see if a specific serotype is appearing in humans at all.

  11. #11 mgr
    February 15, 2006

    In this discussion, it seems the focus is on the US, and that our experience is the paradigm.

    Let’s see, what did SARS do in Toronto? Wasn’t there a quarantine? Would it have reached the US in larger numbers if preventative measures were not in place (imagine a pre 9/11 situation)?

    The elephant in the room is AIDS. I find it interesting that with all the concern about scaremongering, it is not mentioned, and employed to provide some perspective. After all it is the exotic disease that could. It’s just that it hits those repulsive homosexuals (although what is going on in Africa is a bit against the model), and causes death in a few months or years, unlike the black death

    To my thinking AIDS’ recent history puts to shame explanations why we should not be concerned with avian influenza, given the known progress in antibiotic and antiviral resistence by infections agents. It’s just whistling past the graveyard if one is more concerned with public hysteria than an outbreak, particularly if the predictive capacity of epidemiology is in its infancy. I think the approach to SARS was measured, and successful–all silliness aside.

    Mike

  12. #12 Hank Barnes
    February 15, 2006

    Joseph,

    Antibody tests are cheap and sufficiently accurate, especially if you are merely wanting to check to see if a specific serotype is appearing in humans at all.

    I agree with the former (cheap), not the latter (sufficiently accurate).

    You’re not trying to detect antibodies out of idle curiousity. You’re trying to establish the risk of future illness, by establishing a connection to the presence of antibodies.

    If antibodies have no connection to future illness, but rather demonstrate healthy immune function, then what’s the point?

  13. #13 Joseph O'Donnell
    February 15, 2006

    In this particular case the goal isn’t so much as to find infections, it’s to determine the spread of an organism. With an emerging pathogen like influenza, it could be expected that a lot of new cases are not likely to result in disease and will be subclinical. The immune system just handles it and things progress all nicely.

    The problem is that such movements are critical to monitor, because more exposure to people with H5N1 viruses means more of a chance of genetic shift occuring (picking up new gene segments from already human transmissable influenza). If H5N1 can be detected at all, that is enough of a worry because that means it is circulating within humans. More time spent in people is the key thing as far as influenza goes in getting to the next step to begin an epidemic (followed potentially by a pandemic).

    Tracing who got infected, where they are and what other influenza viruses they have can be just as important as determining illness.

  14. #14 Hank Barnes
    February 15, 2006

    J’OD,

    Nothing you say is unreasonable.

    But, I differ with you on this:

    Tracing who got infected, where they are and what other influenza viruses they have can be just as important as determining illness.

    This smacks of a microscopic wild-goose chase. If the various flu viruses are clinically irrelevant, meaning they are neutralized by normal functioning immune systems, why bother?

    I had the flu this week. I’m sure if you took a blood sample, you’d find all sorts of viruses — even mutated versions as well as various antibodies.

    But, so what? I’m back on my feet.

  15. #15 john
    February 16, 2006

    When Tara said, “I know that many people, including myself, tend to get burned out on the same ol’ thing”… I think she means me. But I AM interested. At the same time, I agree, mostly, with Hank. Chances are it’s a hyped up news story. As I pointed out earlier, screaming scare headlines on the front page about the newest country to find H5N1 in birds is just ridiculous in my opinion.

    The history of our planet and even our short history as a species called Homo sapiens is that disaster is right around the corner – in GEOLOGICAL TIME, that is, not H. sapiens time.

    Will a meteor the size of Vermont slam into the earth? You bet. Will a “Super Volcano” erupt in Yellowstone or some other location? It will. Are we going to have catostrophic climate changes? Uh huh. Will we destroy vast chunks of H. sapiens culture with nuclear (or other) tecnological means? Unfortunately. Is a disease, or diseases, going to come along and decimate the population? It’s coming.

    For all of these reasons, Tara, I’M INTERESTED! But, the reality of it is, probably not a single one of these things will happen in our own, our children’s or our grand-children’s lifetimes. I hate to make this ananolgy, but we are still much like the cliche character from a thousand years ago running around yelling, “Repent, the end is near”!!! And, it could be. In fact, IS if you consider that “near” is within the next 3 million years. (Personally, I consider that to be “near”. After all, our planet has been here for over 4 BILLION years). But if you look at the history of catastrophic events, it’s probably about 1 in 20,000 or so of it happening in anyone’s lifetime on our planet.

    But, it’s still fascinating to speculate on. And even more so to try to combat a needless, avoidable trajedy, even if one on a much smaller scale. If H5N1 were to mutate into a disease that was easily communicable from person to person, I would guess that 10s of millions would likely perish in 3rd world countries. So that alone makes it more than worth being in the news, and for folks like Tara to be actively studying it. I do think though, that it would be taken more seriously by folks like Hank and myself (Filthy SCEPTICS!) if it were presented more in the terms that I just did, rather than seeing a front page picture of a wild goose, with large, bold type underneath crying out, “BIRD FLU ARRIVES IN ALASKA” (or wherever).

  16. #16 Dave S.
    February 16, 2006

    John,

    In the human time scale, these events have happened and continue to happen. People have died in earthquakes, they have died due to volcanoes erupting and they certainly have died due to nasty pathenogens of one sort or another (although AFAIK no-one has yet died due to bolide impact, still best keep an eye out). Many steps that could be taken to understand and minimize the risk of bird flu apply not only to that particular bug, but to many other potential micro-nasties. That such things inevitably happen doesn’t mean we need throw up our hands and wait for them. While risk can’t be eliminated, it can be limited.

    I do agree however that we have to be careful not to get too carried away and run around like a chicken (pardon the pun) with our head cut off whenever a new H5N1 infected duck crops up in another country (today’s country is Slovenia…maybe yours is next!). It’s quite possible an effective H2H infection vector may never evolve for this strain. But it’s also possible that in the next strain it will.

    Perspective is a difficult thing to maintain.

  17. #17 john
    February 16, 2006

    Hi Dave;

    I absolutely agree. I have an annoying habit (especially at AETIOLOGY, I’m afraid) of sounding like I’m arguing a point I’m NOT! LOL! I’m all for vigilance, even if what we are guarding against is not an “end times” scenario. I hoped to make that clear back in the last paragraph of that post.

    AND… I could be totally wrong about it not happening in our lifetimes – see this: http://www.msnbc.msn.com/id/11385475/

  18. #18 Cayte
    February 16, 2006

    >>But if you look at the history of catastrophic events, it’s probably about 1 in 20,000 or so of it happening in anyone’s lifetime on our planet.

    But modern civilisation is putting a stress on the planet. Global warming, peak oil, loss of biodiversity, antibiotic resistance, etc.

    Ewald did some work on evolution of virulence. Wonder if modern farming practice of crowding animals together, crowded slums with malnourished people and loss of biodiversity has anything to do with these weird new diseases?

  19. #19 john
    February 16, 2006

    True enough, Cayte. The exponential growth of technology could go hand in hand with an increased expectancy of a catosrophic event. 100 years ago, the very idea of a nuclear bomb was purest science fiction. Not only do we have them now, but many other weapons that could have worldwide catastrophic implications. And that’s JUST weapons. Our “peaceful” technologies had not advanced enough, and been so heavily implemented worldwide, as they are now. So creating global weather changes may not have been possible that short time ago, while now it certainly is possible – if not actually happening.

  20. #20 Tara
    February 16, 2006

    Hi all–

    Been out all day today (kids’ school was cancelled), so I’m short on time and catching up. Just a few comments.

    First, why we’re looking for flu antibodies versus incident infection. Actually, we’re doing both. Our initial studies (including the manuscript I linked) were looking for evidence of prior infection with swine influenza viruses in people who worked with swine and swine products–farmers, CAFO (confined animal feeding operation) workers, veterinarians, meat packers. These were pilot studies. Once we showed evidence of prior infection, we then went forward to do some prospective studies with a larger group, getting both blood and nasal swabs when they have an ILI (influenza-like illness). The antibodies often tell a much better story, however, since the window of time when influenza virus can be obtained is so small, we’re likely to miss lots of cases if we only focus on getting live virus–hence the bloodwork. Additionally, since we have archived sera from the subjects, if the antibody titers rise, we know they’ve had a recent infection. ]

    Additionally, Hank said:

    So, if you test me, you might find anti-bodies to the Varicella-Zoster virus. This absolutely doesn’t mean I’m at risk from developing chicken pox — it means the opposite.

    Right, but influenza virus is highly mutable, and just because you have antibodies to one strain doesn’t mean you’re protected from others.

    Hank goes on,

    You’re not trying to detect antibodies out of idle curiousity. You’re trying to establish the risk of future illness, by establishing a connection to the presence of antibodies.

    If antibodies have no connection to future illness, but rather demonstrate healthy immune function, then what’s the point?

    Indeed, we’re trying to establish the risk of future illness–in a cohort of people. So by showing that agricultural workers have previously been infected with swine influenza viruses (or avian influenza viruses, in our other study), our argument is that these people should be considered in pandemic preparedness plans. Additionally, they should have better access to personal protective equipment, such as latex gloves, and be better versed in other simple protections, such as handwashing and not smoking on breaks (or at least washing hands carefully before doing so). Our objective isn’t to go back to the people we find are antibody positive and tell them they’ve been previously infected–it’s to show that their occupation puts them (and others who share that occupation) at risk.

    John,

    I agree with the screaming headlines, and that’s one reason I wrote up my pandemic flu series (see left sidebar at the bottom)–because it’s sometimes hard to get to the science and find what is the real risk, and reasons that those of us in microbiology and public health are concerned. Screaming headlines sell papers, but it’s often times at the expense of getting the real science across. That’s why Revere and others started the flu wiki–to get the info out there without the sensationalism.

    And that’s at the heart of why I write about this stuff. It’s not with the intent to worry anyone–indeed, in part 5 of my series I specifically discussed the whole worry issue. I simply think knowledge is power. I mean, I’ve dedicated the last decade of my life to learning about all kinds of infectious diseasea nd other medical conditions, and the more you know, the less this stuff tends to scare you.

  21. #21 Tara
    February 16, 2006

    Oh, and regarding SARS–yes, there were quarantines put in place, and it’s a real testament to the public health in Toronto that it didn’t spread farther than it did. (Of course, that’s the Catch-22 about public health: when it’s working well, it’s invisible). Additionally, SARS, being a coronavirus, isn’t nearly as mutable as influenza, and it was also found to be much more difficult to transmit human-to-human than an ordinary influenza virus. So using SARS as a comparison isn’t really accurate.

  22. #22 john
    February 18, 2006

    Tara; I doubt you had this story in Ohio this morning, since the by-line is for writers who actually work for the L.A. Times. Anyway, I’ll give you the beginning of it and anyone who is interested in the full text can use the link I’ll provide, although you MIGHT have to register for the Times (free), I’m not sure.

    Anyway, this is what I’m talking about. I don’t blame science for this. I blame newswriters. It’s exactly because of those screaming headlines that we discussed earlier. Anyway, I’ll let the story do the talking:

    ‘Bird Flu Psychosis’ Is Catching
    Despite efforts of health officials, anxiety is spreading with the virus in Western Europe.

    By Livia Borghese and Jia-Rui Chong, Special to The Times

    Western Europe has been preparing for months for the arrival of bird flu, with health officials urging calm in the face of the spreading virus.

    Apparently, some people weren’t listening very well.

    “The feathered death ? it has landed,” blared a headline from the Berlin tabloid BZ.

    “Bird flu psychosis,” was how Italian television channel Rai News 24 described the national mood.

    The lethal bird flu, known as H5N1, crossed into Western Europe this week for the first time with the discovery of infected birds in Italy, Greece, Germany and Austria. On Friday, France reported it had a probable case of bird flu in a dead duck.

    ———————————————————–

    I should have been a copy editor and I would have changed the first line of the last paragraph to read: “The deadly H5N1 virus, known commonly as bird flu”…

    But I pick nits. Here’s the link if anyone wants the whole story. It’s pretty interesting, including 3 deaths that have nothing to do with flu – just panic over it.

    http://www.latimes.com/news/nationworld/world/la-sci-birdflu18feb18,0,2607943.story?coll=la-headlines-world

  23. #23 Mary
    February 22, 2006

    Tara, this is probably way off subject, but why doesn’t Asian Scrub Typhus spread in the same manner as bird flu-and could it’s similar symptoms falsely inflate the number of bird flu cases reported? I know it is a flea (mite?) borne vector, but couldn’t it confuse the picture?
    The European countries seem to be a lot more open and progressive in their infectious disease studies, we are a global community, and it is only a matter of time before the bird flu ‘flies’ to our shores.

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