Effect Measure

No news doesn’t mean good news

We’ve said it here often, but it’s nice to see it in the commercial print media.

Less than a year ago, Americans could barely turn on the television, surf the Internet or pick up a newspaper without finding a doomsday story about deadly avian flu.

By last November, President Bush had asked Congress for $7.1 billion to help develop a vaccine, stockpile antiviral medications and fund state preparations for a possible pandemic.

Now, with the disease still centered in Asia and the failure of migratory birds to spread the illness to Europe and North America, the H5N1 virus has dropped out of the media spotlight. The dearth of coverage has prompted some to think that the threat of a pandemic has passed.

Nothing could be further from the truth, however. (Tony Pugh, McClatchey Newspapers)


What’s different this year? Last year there was a human case every nine days, on average. This year we’re seeing one every four days. All of last year there were 97 cases and 42 deaths. This year there are already 109 cases and 73 deaths (WHO), and we are just getting into flu season.

One thing has decreased, though. News coverage. Such news as there is still comes from far away. The migratory bird scenario for global spread has yet to materialize, possibly because wild birds are a minor part of the geographic spread which is mainly driven by human movements that bring infected birds from place to place.

But that’s not very significant in public health terms (although the poultry industry is glad to hear it). If a pandemic occurs from avian influenza it won’t be spread by birds but by people. As long as this viral stew continues to bubble away in China, southeast asia, the Middle East and Indonesia we face the real possibility it will change character to make human beings an efficient new host for the virus to carry out its only function, make copies of itself.

“We’re as worried now as we ever have been,” said Michael Osterholm, the director of the Center for Infectious Disease Research & Policy at the University of Minnesota.

Well, some of us are.

Comments

  1. #1 lugon
    October 20, 2006

    Revere, you might want to add a graphic to your entry: http://www.google.com/trends?q=pandemic

    Oh, and “pandemic-flu – do not have enough search volume to show graphs.”

  2. #2 cpg
    October 20, 2006

    What more can you say . H5N1 is evolving. Be prepared.

    Henry L Niman latest post states this. Instead of being a concern it now reads.

    ”The predictable evolution of H5N1 is now abundantly clear, and the release of full sequence data is long overdue.”

    Henry may elaborate further.

  3. #3 mary in hawaii
    October 20, 2006

    crof posted last night a breaking story about a potential cluster of 9 bird flu victims on the island of Sulawesi, and today bird flu breaking news has something about a couple of illegal immigrants from India discovered in Greece with bird flu like symptoms. This gives me a shudder. Then I checked the Jakarta Post to see if there was anything about the Sulawesi outbreak in their online paper, and find instead that there is a mass movement of people around the country…mostly it seems city workers and their families who are returning to their home villages to celebrate some Muslim high holy day next Tuesday. They go home, they mix and mingle, exchange various viral strains, then return to their crowded city offices and factories to share these with millions of others. Sounds like a perfect setting for the start of a pandemic, doesn’t it? We better keep an even closer eye on Indonesia now…and start buying those masks and bottles of water. I’m going to finish filling my supplies list this weekend and urge my family members to do the same.

  4. #4 David
    October 20, 2006

    I don’t know about the WHO Pandemic Alert Phase or the Doomsday Clock, but I do know the Sphincter Meter is just about off scale!!!

  5. #5 Andrew S
    October 20, 2006

    Thanks David, I needed a good laugh after reading all the above posts.

  6. #6 Dizzy
    October 20, 2006

    Check the ads on the right-hand side of the page (20/10/06):

    ‘Come to Bali
    Instant discounts of up to 70% off from hundreds of hotels in Bali.’

    Irony at it’s best.

  7. #7 mpb
    October 20, 2006

    Ted Stevens Airport & HPAI

    The Anchorage airport is of obvious interest to those on the edge of the continent, but what are broader implications of its special transshipping status?

  8. #8 mara
    October 21, 2006

    New Zealand is far away but I can assure you that we are as aware of possible danger as you are. If the worst happens,nobody will be OK,whatever the distance.

  9. #9 mary in hawaii
    October 21, 2006

    On the “no news” thing: I can’t find out anything more about the possible new cluster on South Sulawesi island. Only Henry Niman makes mention of it. Following a link in his recent post, one discovers (or rediscovers) that there was another fairly sizable and worrisome possible cluster in So Sulawesi a couple of weeks ago that similarly quickly disappeared from the radar and fell into the black hole of “no news is good news”. Do any of you have any additional information on either of these clusters, or a link to track down what the outcome of the testing and/or illnesses was?

  10. #10 revere
    October 21, 2006

    MiH: It’s been on ProMed. It isn’t clear if these are related inividuals or if it is the (now) usual case of a bunch of people with symptoms compatible with a lot of things (including flu0 being ruled out. We’ll just have to wait and see. Which is why I haven’t posted on it. Premature.

  11. #11 Henry Niman
    October 21, 2006

    I have been limiting comment to cluster that were confirmed or involved a death. The cluster in South Sulawesi included a death, so I did a commentary (also covered by Bloomberg). Of note is how WHO handled the earlier confirmed cluster. That cluster involved three deaths of family members, but only one was tested. Although she died in June, where H5N1 infection was not confirmed until September. The WHO update threw in some hand waving about delays because the testing was routine. If three dead family members is routine, and test results delayed for 6 weeks, there is some cause for concern.

    WHO is still also talking about dead poultry, but the grand total of H5N1 in dead chickens linked to H5N1 in dead patients remains at ZERO, but most testing requires a link to dead or dying poultry.

    Indonesia is blanketing suspect regions with Tamiflu, which may be leading to false negatives on testing (in Thaland a fatal case was tested NINE timkes, but was H5N1 positive only at autopsy.

    I actually came to this thread because of the article quoted which indicated H5N1 spread was via human trade and not wild birds (and wasn’t in Europe!).

    The latest H5N1 sequence data from China (Beijng Genome Institute) not only shows widespread recombination, but shows that the origins of the explosion of H5N1 discosure in 2004 links back to 1997 H5N1 isolates in northern China, which links back to low path avian influenza in Hong Kong in the 1970’s.

    Wild birds have been moving flu sequences around forever, and the latest data from China shows movement from Australia to Alaska, with some major movement of H5N1 information from China to Indonesia.

    Local media in Indonesia indicates expanded testing of wild birds is planned and they have also acknowledged H5N1 in cats (although no additinal cat sequences from Indonesia have been released).

    The sequences from China should move the recombination because it was both obvious and widespread. Now if St Jude and Hong Kong publish FULL sequences on there earlier H5N1 isolates from Hong Kong, China, and Vietnam, the recombination and history of H5N1 movement by wild birds will be even clearer.

  12. #12 Henry Niman
    October 21, 2006

    Revere, Your comment “The migratory bird scenario for global spread has yet to materialize, possibly because wild birds are a minor part of the geographic spread which is mainly driven by human movements that bring infected birds from place to place.” is simply nonsense.

    If you look at OIE reports on H5N1, you will see that prior to July of 2005, H5N1 reports were limited to China and Asian countries to the east and southeast. When the Qinghai strain of H5N1 was found in long range migratory birds, the stage was set for worldwide spread. First reports came out of Russia, Kazakhstan, and Mongolia, all reporting H5N1 for the first time, and all reporting the Qinghai strain (in August, 2005). That was followed by spread to India, Pakistan, Afghanistan, Europe, the Middle East, and Africa. Something like 50 countries reporting H5N1 for the first time, and all reporting various versions of the Qinghai strain.

    I realize sequence analysis is not your area of expertise, but just looking at the location and dates of OIE reports should allow an epidemiologists to conclude that something pretty dramatic happened in the season follwoing the Qinghai outbreak in China. Moreover, there were reports in peer reviewed journals such as Nature indicating that introductions into Nigeria, which conservation groups maintained were due to trade, were in fact independent introductions (as in wild birds). Moroever, the inital positives in Europe were in wild birds, and many countries have found H5N1 ONLY in wild birds (but not on farms), so you don’t have to read teh sequences to know that the “human trade / movement” is utter nonsense.

    I am not sure why you are so hung up on this aspect, but your “analysis” seems to ignore well known facts. I could understand some scepticism about 12 months ago (because you couldn’t read sequences), but to post such nonsense in October, 2006 is disappointing, at best.

  13. #13 revere
    October 22, 2006

    Henry: Thanks for the “lesson.” I, too, realize epidemiology and the spread of disease isn’t your area of expertise, so you can’t be expected to know that the kind of spread you mention (which we have noted here on many occasions) can rather easily be the result of network topologies wherein longer distance jumps via migration or other types of movment need only be minor and relatively uncommon (either scale-free or small world topolgies will do the trick, and probably others as well).

    Eventually we will get this sorted out, but I, too, am disappointed at your lack of open mindedness that brooks no possibility that some of your positions may be incorrect. I didn’t mention you by name and wasn’t thinking of you when I wrote that post. The flu world doesn’t revolve around whether you are right or wrong on any particular position. It has its own discourse, disagreements and logic, among which your claims are only one. You are part of the conversation. You are not the whole conversation.

  14. #14 Patch
    October 23, 2006

    I’m wondering then, Henry, why there aren’t H5N1 birds in the US?

  15. #15 Tom DVM
    October 23, 2006

    Hi Patch. Actually, they found H5N1 in birds in Canada 14 months ago…but it was Low Path H5N1. I think what you probably meant to say was…why isn’t there any High Path H5N1?

  16. #16 M.Randolph Kruger
    October 23, 2006

    Yo Patch,

    Actually they have identified two types of birds today that will likely spread it via migration if it comes in that way. My way of thinking right now is that because H. Niman and a couple of other sequencers out there have identified that this is becoming more of a human bug each and every week that it might come in with a Canadian or someone from Iraq returning home from the front. Kind of like SARS.

    We might be able to slow it but the general consensus is that we would only be able to check it for two or three weeks. And they have it now in Michigan too in Low Path. So we might see a couple of strains and ones that might not give us protection from the others either.

  17. #17 Patch
    October 24, 2006

    Sorry. You are absolutely right, I should have noted that H5N1 has been in North America quite some time (according to Dr. Gary Butcher) but HPAI H5N1 has yet to be found.

    I simply meant that if Reveres comments were “nonsensical”, as Niman suggests that we should be seeing High Path H5N1 passing through Canada and the US right now (as waterfowl migrate).

    What species or “types” of birds are those M Ralph Kruger and who and how did they identify them? I’ve seen nothing in the information I’ve read.

  18. #18 Tom Dvm
    October 24, 2006

    Patch. You are quite right.

    Nature works on its own time…not on our time. We will get our answer eventually…

    …neither you or me…or Dr. Revere or Dr. Niman or Dr. Butcher can define the parameters of ‘eventually’.

  19. #19 kgb
    October 24, 2006

    Stop hijacking other people’s sites, Henry. Why don’t you get your own? Oh wait…

Current ye@r *