Flu update

As pointed out yesterday, flu blogging has been light this month, even though there have been interesting developments. As such, to catch up a bit, I’m posting an overview of the current Indonesian cluster and some other thoughts below the jump…

As always, I point anyone who wants to keep up-to-date on the latest news over to Effect Measure for excellent analysis of what it all means, or to H5N1 for news from around the world on the topic. Obviously, the biggest news of the moment is the Indonesian family cluster, which appears to not only be an example of human-to-human transmission, but one of three generations of transmission: index case (a 37-year-old woman) to family member #1, who spread it to family member #2, who spread it to family member #3. Overall, 7 members of the family have been infected; 6 have died. It’s worrisome for a number of reasons. First, we don’t know for sure how the index case became infected. Though poultry contact is assumed, no sick animals have been found in the area recently (though the virus has circulated previously in the area). Second, the size of the cluster (and obviously, the incredibly high mortality rate) are both alarming as well. Finally, they’re currently saying that there’s nothing notable about the virus sequence; it doesn’t seem to have mutated, but I think it’s a bit too soon to be able to know that for certain. (CIDRAP also has a nice overview).

Busy the rest of today and I’ll be out over the weekend to spend time with family, but I already have some posts in the works for next week–which will probably include some more on influenza. In the meantime, I’ll point you to some newer research on influenza by colleagues:

Preventing Zoonotic Influenza Virus Infection by Alex Ramirez et al., and The Trojan Chicken Study by Sandy Olson and Greg Gray. Both were recently published in Emerging Infectious Diseases.

Have a good weekend!

Comments

  1. #1 mycotropic
    May 30, 2006

    “There is no evidence of motif changes in the particular areas of the genes that are responsible for how the virus binds to the respiratory tract of people.”

    I wonder if we just saw a “susceptibility cluster” in that family. Also is WHO testing whole areas of Indonesia yet so that we can get some idea of a denominator?

  2. #2 Tara C. Smith
    May 30, 2006

    They are looking into the susceptibility issue, and also into increased surveillance for asymptomatic or mildly symptomatic cases. No data released yet that I know of.

  3. #3 Dan
    May 31, 2006

    Liam Scheff has written an excellent article that brings up a lot of questions about diagnosis and treatment of bird flu.

    [edited–it’s bad netiquette to C&P an entire article. The link is here].

  4. #4 Wilhelm Godschalk
    June 2, 2006

    Did the brilliant idea occur to anybody yet, that when somebody dies in Indonesia, it might NOT be from a bird flu virus?
    Whenever I read about 6 dead and 1 survivor, I look around for headlines such as:
    “Father kills wife and 5 children in a drunken rage.”
    Or:
    “Mother poisons her whole family.”
    But don’t get hung up on these examples either; there are more possibilities.

  5. #5 Tara C. Smith
    June 2, 2006

    Did the brilliant idea occur to anybody yet, that when somebody dies in Indonesia, it might NOT be from a bird flu virus?

    You’re not seriously suggesting that every death in that country is being attributed to H5N1, are you?

  6. #6 Dan
    June 2, 2006

    “You’re not seriously suggesting that every death in that country is being attributed to H5N1, are you?”

    You didn’t seriously get that impression from reading his post, did you?

  7. #7 Tara C. Smith
    June 2, 2006

    I’m honestly not sure what he’s suggesting. Diagnosis of H5N1 takes confirmatory testing, and even while Indonesia is a hotbed of cases right now, it’s not as if every case of pneumonia there is being called H5N1. It seems some people actually think this, though.

  8. #8 Dan
    June 2, 2006

    “Did the brilliant idea occur to anybody yet, that when somebody dies in Indonesia, it might NOT be from a bird flu virus?”

    Wilhelm,
    Indonesia has the misfortune of being the epicenter of the bird flu hysteria. So, I think there’s some truth to your cynical statment about *everybody* whos dying in Indonesia right now will have “bird flu” on their death certificate.

    Might there be a rush to judgement when it comes to bird flu? Do some people get giddy over the prospect of emerging diseases and jump to conclusions…or make the science fit the foregone conclusion? Liam’s article gives the impression that with bird flu (like AIDS) conclusions seem to be reached well ahead of the science. He certainly makes a great case against bird flu as the cause of death for those siblings in Vietnam.

  9. #9 Wilhelm Godschalk
    June 4, 2006

    I’m surprised that my cynical comment was only fully understood by Dan. If you’re determined enough to find something, you’ll find it, even if it’s not there.
    Here’s an illustraton: If a professor in Medical School holds a lecture about a certain disease, and the students go on hospital rounds right after that, they will diagnose that particular disease in every patient they visit. I’m not making this up. It’s the experience of many clinicians I’ve known.
    Don’t get too excited about the confirmatory testing, Tara. It only consists of a hemagglutination test and a test for neuraminidase (an omnipresent enzyme).

  10. #10 Tara C. Smith
    June 5, 2006

    “Only” two tests? That’s not exactly cake. Not to mention sequencing of dozens of viral isolates to date.

  11. #11 Wilhelm Godschalk
    June 6, 2006

    ****”Not to mention sequencing of dozens of viral isolates to date.”****

    Sequencing, yes; isolation, no. Ever since automatic sequencing methods are available, most virologists are sequencing everything they get their hands on, including whatever the cat drags in. The reason for this is that they don’t know how to do anything else.
    But OK, so they have a lot of sequences, straight out of the machine. But sequences of what? They have no basis for calling them flu virus sequences, because they have never isolated these individual virus strains. Consequently, there is no standard to compare their sequences with.
    And investigators operating somewhere in the bush in Indonesia? Do we really have to believe they are equipped to perform isolations, sequencing, and other identification procedures? Let’s just give them credit for the two tests.
    Liam Scheff said it somewhere very poignantly: The WHO goes everywhere [b]scavenging[/b] for cases of bird flu. Do they still hope to scare us?

  12. #12 Chris Noble
    June 6, 2006

    Wilhelm, just out of interest how would you tell the difference between a H3N2 influenza virus and a H5N1 influenza virus let alone influenza B or C?

  13. #13 Tara C. Smith
    June 7, 2006

    But sequences of what? They have no basis for calling them flu virus sequences, because they have never isolated these individual virus strains. Consequently, there is no standard to compare their sequences with.

    Totally false. I just don’t know how else to say it.

    And investigators operating somewhere in the bush in Indonesia? Do we really have to believe they are equipped to perform isolations, sequencing, and other identification procedures? Let’s just give them credit for the two tests.

    In Indonesia, at least, the folks at NAMRU-2 have been doing a lot of the legwork in this area. So yes, they are indeed equipped to perform that.

  14. #14 Wilhelm Godschalk
    June 14, 2006

    Wilhelm, just out of interest how would you tell the difference between a H3N2 influenza virus and a H5N1 influenza virus let alone influenza B or C?

    With a relatively simple hemagglutination test plus a test for neuraminidase. Don’t get the illusion that they are going to the trouble of really isolating these different flu virus strains.

  15. #15 Wilhelm Godschalk
    June 14, 2006

    Tara
    Totally false. I just don’t know how else to say it.

    That’s it? No further details?

    In Indonesia, at least, the folks at NAMRU-2 have been doing a lot of the legwork in this area. So yes, they are indeed equipped to perform that.

    A brother-in-law of mine died while on a trip to Indonesia, a few years ago. They can’t even perform a proper post-mortem there. His widow still doesn’t know what he died from. I only know it wasn’t bird flu.
    The folks at NAMRU-2 ? They are exactly there for the purpose of scavenging for bird flu cases (thanks to Liam Scheff who came up with this appropriate term), and helping to scare the people back home.

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