Effect Measure

If you were wondering what happened to bird flu, you can ask the people in Vietnam, South Korea and Nigeria. The virus doesn’t care if you know where it is or not. It just keeps going about its business, making copies of itself, using whatever hosts are around whose genetic and protein copy machines it can hijack for its own use. With all the talk about “where’s bird flu?” it is useful to remind ourselves it’s still around. And flu season is just starting:

Nigeria:

Bird flu reached every region of Nigeria, Africa’s most populous nation, after government inspectors found infections in three states.

The H5N1 strain of avian influenza was detected by the National Veterinary Research Institute in samples collected from the southern state of Delta, the western state of Kwara which borders Benin, and the northeastern state of Borno, which borders Chad, Cameroon and Niger, the United Nations said yesterday in an e-mailed report.

[snip]

H5N1 outbreaks have now been reported in 17 of Nigeria’s 36 states as well as the Federal Capital Territory, reaching every part of the country. No human infections have been recorded in Nigeria, on the western edge of a continent ravaged by poverty and HIV/AIDS. Egypt and Djibouti have reported human cases.

Reports from the Federal Departments of Livestock and Pest Control Services showed that outbreaks were reported in three small-scale poultry farms in Borno, the UN report said.

The outbreak in Delta state occurred on a farm in Ughelli North, the report said. Details of the outbreaks aren’t yet known, the UN said.

The disease was first reported on a farm in Kwara state’s Galladima village on Nov. 27, according to the report. More than 5,000 fowl died or were culled because of infection, the UN said. (Bloomberg)

South Korea:

A fourth case of bird flu has been discovered in South Korea after culling of poultry from earlier cases, a government official said on Thursday, raising concerns that quarantine measures had failed to control the outbreak.

South Korea confirmed in November its first case of the H5N1 strain in about three years.

The three initial cases were found in farms in the North Cholla province, around 170 km (100 miles) south of Seoul. The latest case emerged at a duck farm in Asan, South Chungcheong province, about 100 km further north.

“We confirmed that a case at a duck farm in Asan was highly pathogenic,” an official at the agriculture ministry said. (Reuters)

Vietnam:

Vietnam’s first outbreak of bird flu since August has spread to four more areas in the Mekong Delta, where nearly 8,300 birds have been killed by the virus or slaughtered to hold it back, the Agriculture Ministry said.

Three outbreaks spotted between Dec. 11 and Dec. 20 in Ca Mau province killed over 2,500 chickens and ducks, while one in neighbouring Bac Lieu province killed dozens of ducks, the ministry’s Animal Health Department said in a report on Thursday.

The outbreaks of the H5N1 virus were the first in Vietnam since August. The initial eruptions killed around 6,000 newly hatched chickens and ducklings that were not vaccinated against bird flu.

Farmers have since thrown dead birds into water channels or let ducks roam on rice fields, helping spread the virus that first arrived in the Delta in late 2003 and has since killed 42 of the 93 people infected in Vietnam.

[snip]

The Mekong Delta outbreaks caused health officials in nearby Ho Chi Minh City, Vietnam’s largest city, to tighten inspection of poultry and step up monitoring of breeding farms, state media reported on Thursday. (Reuters Alertnet)

Then there is the “good” news from Indonesia, the world leader in confirmed deaths (57) and second in confirmed cases (74):

Human bird flu deaths in Indonesia have slowed markedly over the last three months, a drop local officials attributed Thursday to a more aggressive fight against the virus.

But the World Health Organization cautioned that the fall — a rare piece of good news in the country worst hit by the H5N1 virus — did not indicate a trend and refused to speculate on possible reasons for it.

Health Minister Siti Fadillah said the success was due to a more forceful vaccination and culling policy which led the government to recently declare 14 of its 33 provinces free of the virus in poultry stocks.

She also cited an ongoing public education campaign.

“The drop in cases is because of the success of the government … which is now unified and moving quickly,” she told The Associated Press on Thursday. “If the birds are free of the virus, so are humans.” (International Herald Tribune)

Right. And we’re The Andrews Sisters.

Comments

  1. #1 Path Forward
    December 22, 2006

    Loved the quote from the Indon Health Minister: “The drop in cases is because of the success of the government … which is now unified and moving quickly.”

    So if the situation there worsens, we can expect her to say, “The increase in cases is because of the failure of the government,” right?

    No…. It will be someone ELSE’s fault if AI cases increase in Indonesia.

    I haven’t heard anyone else in Indonesia say that its fractured decentralized disempowered government is “unified.” That was certainly a pleasant surprise…

  2. #2 The-Best-Bird-Flu-Blogs-team.
    December 22, 2006

    I would like to point out to you, the “One Flu Over the Cuckoo?s Nest” post, from the- ProudToBeCanadian Blog -on our site.

    Your comments on this post would be greatly appreciated.

    JM Tom

    The-Best-Bird-Flu-Blogs-team.

  3. #3 DeadAhead
    December 22, 2006

    Hi all –
    Re the cuckoo analysis, which of course prefers the inconsequential pandemic stats to the scary ones that better suit a virus that covers more than half the earth’s landmass and kills more than half of those who catch it, I found this excellent response at Flu Trackers, from Florida1. I’ll dispense with quotes, as they would very confusing here. All follows, no alterations (best, DA):

    Free Enterprise Action Fund

    From Wikipedia, the free encyclopedia

    The Free Enterprise Action Fund is a mutual fund operated by Steven Milloy and Tom Borelli, with the aim of counterbalancing the activities ethical investment funds. Whereas ‘ethical’ funds avoid investments in firms that are accused of damaging the environment, or other unethical behaviour, the Free Enterprise Action Fund seeks out such investments, relying on Milloy;s arguments that such criticisms are typically based on political bias or junk science.

    Controversy

    The Free Enterprise Action Fund has been criticised for taking ideological stances at the expense of its investors’ interests . Daniel Gross, in Slate wrote that

    FEAF’s managers also don’t appear to be very interested in making money. Assembling a portfolio of 392 teeny positions (111 shares of Federal Express, 60 shares of Tiffany, etc.) is an incredibly inefficient and costly way of trying to mimic the S&P 500. Asset managers get paid based on the assets they manage. At FEAF, the Adviser (Milloy plus Borelli) receives a fee equal to 1.25 percent of assets. Five million dollars in assets throws off about $62,000 in fees annually, which is nowhere near enough to pay the salary of a professional money manager.

    Page 17 of the annual report shows that the fund incurred total expenses of $302,117, a whopping 6 percent of assets. But the prospectus promises that fees won’t eat up more than 2 percent of total assets each year. And so in 2005, the adviser (i.e., Borelli and Milloy) waived his entire $44,727 management fee. What’s more, the adviser reimbursed some $185,616 in trading, administrative, and legal expenses to the fund. If the fund’s assets rise sharply in the next few years, the adviser can theoretically recoup these waived payments and reimbursements. But in the short term, it looks like Borelli and Milloy are essentially paying the fund for the privilege of using it as a platform to broadcast their views on corporate governance, global warming, and a host of other issues.[1]
    http://en.wikipedia.org/wiki/Free_En…se_Action_Fund

    “Thank You for Investing

    A very curious right-wing mutual fund.”

    By Daniel Gross
    Posted Thursday, May 4, 2006, at 1:07 PM ET
    Are you a right-wing, free-market type who believes that Fortune 500 CEOs have devolved into a gaggle of eco-friendly squishes? Do you like paying high expenses for stock market returns that lag the S&P 500? Would you trust a former tobacco executive and a critic of junk science to manage your money? Then have I got a mutual fund for you! The Free Enterprise Action Fund…..

    http://www.slate.com/id/2140997/

  4. #4 K
    December 22, 2006

    Comments on one Flu Over – the authors say “And let’s not forget that during 1918-1920, much of the world was still recovering from the strains of World War I. Poverty, hunger, unsanitary living conditions and stress likely made much of the global population ripe for a killer flu pandemic.”

    Do they realize that 1/2 the people in the world live on $2 a day or less. Do they realize that the density of humans is more than 3 times what it was in 1918? Do they realize the increase in the amount and speed of trade and travel from 1918? Do they realize that first world hospitals are dependant on just on time supplies from the far east where H2H is likely to hit first.

    On the other hand, as the author notes, strengthening our public health measures to handle current diseases would likely have a bigger payoff in a pandemic than excessive investment in antivirals and vaccines. The payoff would come in a healtier populace at the start of a pandemic and the local resources to handle one.

    Making people aware of how vulnerable a 6+ billion globalized world is to a (however unlikely) pandemic should be done, but not in a way that panics folks, enriches big Pharma but rather in a way that helps us see that we are all in this together. The fact that 1/2 of the world lives on $2 a day endangers us all – the density and poverty these people live in give germs an ideal place to take hold and engulf us all. And of course people get tired of living on $2 a day when others are living on $50 a day and up. When such people feel their is nothing to loose sometimes they say “hell no, I won’t take it any more”.

    http://www.prb.org/Content/NavigationMenu/PRB/Journalists/PressReleases/More_Than_Half_the_World_Lives_on_Less_Than_$2_a_Day_(August_2005).htm
    *

    More than one-half of the world’s people live below the internationally defined poverty line of less than U.S. $2 a day—including 97 percent in Uganda, 80 percent in Nicaragua, 66 percent in Pakistan, and 47 percent in China, according to data from the World Bank.
    *

    Nearly one-third of rural residents worldwide lack access to safe drinking water.
    *

    The use of modern contraceptives is more common among wealthy women than poor women in nearly all countries, and the gap is particularly pronounced in the poorest countries, in places as diverse as Uganda and Nepal
    *

    Africa’s infant mortality rate is nearly 15 times that of the developed world.
    *

    The more developed world uses over 5 times the energy per capita used by the less developed world. North America uses over 8 times as much energy per person as does Latin America.

  5. #5 Henry Niman
    December 23, 2006

    Family cluster in Nile Delta. Two cousins confirmed (hospitalized 3 days apart). Sister hospitalized with symptoms. Two more hospialized in same area. Earlier case in same area had M230I.

    http://www.recombinomics.com/News/12230602/H5N1_Egypt_Cluster.html

  6. #6 tony m
    December 24, 2006

    I like Milloy’s accuracy that: “a great proportion of the deaths in 1918 was probably due to secondary bacterial infections that followed the initial viral infections. Today, antibiotics would be used to treat bacterial infections”.

  7. #7 caia
    December 24, 2006

    Accuracy? Hardly.

    1. Most of the deaths were “probably” due to secondary bacterial infections? According to whom? On the basis of what evidence?

    We simply do not know what proportion of deaths were due to secondary bacterial infections. “Some” is probably accurate, but we don’t know if that’s 1%, 10%… or 0.000002%. “Most” is a hopeful guess.

    Do people turn blue when dying of bacterial pneumonia? I honestly don’t know, but they did with the 1918 flu.

    2. Antibiotics might be used. If we don’t run out of them. If there’s anybody available to prescribe and dispense them. If a patient can get the diagnostic tests necessary to suggest they’re suffering from a bacterial pneumonia rather than cytokine storm or viral pneumonia. If a patient can even get admitted to the hospital.

    I must agree with Crawford Killian on this matter: I find it alarming the degree to which “flu skeptics” must rely on baseless supposition, cherry-picked facts, pure fabrication, and wishful thinking. I would be open to them making sound, scientifically-based arguments. It’s unnerving that they can’t.

  8. #8 tony m
    December 24, 2006

    Caio:
    Not true.

    1. Most medical accounts of 1918 during and after speak of bacterial pneumonia as doing the killing.

    2. Turning blue is not just reserved for 1918 or viral pneumonia. It is from a lack of oxygen saturation in the blood and can be bacterial as well. Ever hear of ARDS?

    3. Go to the recent NEJM article entitled “Three Indonesian Clusters of H5N1 Virus Infection in 2005″ (New England Journal of Medicine: Vol355:2186-2194 no 21 November 23, 2006). There see that out of a small patient population to begin with, besided antivirals, 6 patients received antibiotics “to treat possible bacterial coinfection” although “no invasive bacterial infections were identified”. When faced with life and death, that’s the way it’s done caio, either here or in Indonesia. One 8-year-old girl in the study was placed, at different times, of 6 antibiotics: ceftiraxone, meropenem, ciprofloxacin, vancomycin, gentamycin, amikacin….granted, although not mentioned, that some of these were off of culture and sensitivities.

    4. “Cytokine storm” or cascade is also not the sole domain of viruses and their are certain bacteria which are pretty good at it, so clinicians don’t go through the emergency room or wards discussing it as a hallmark of viral infection alone.

  9. #9 revere
    December 24, 2006

    tony:

    1. In 1918 alll specimens had bacteria. They though it was a bacterium that caused flu.

    2. ARDS. The mortality from ARDS, even in an ICU (and there will be no ICU beds available) is still around 50%

    3. Individually applied medical measures have not had much success in affecting epidemics or even the general death rate. There is much data on this, going back to the 1970s with McKeown’s work on the rise of world population. Those medical advances are not even blips on US death rates which are mainly affected by measures like sanitation that affect the whole community at once.

    4. We have very little idea what the main pathogenetic mechanism will be for this virus if and when it becomes more easily transmissible. It could be only mildly virulent or even easily treatable. But to hope for that is folly and there is no indication either will happen.

    Public health is about prevention and prudence, not hoping for the best.

    Steve Milloy is another lawyer in the pay of the ultra right. He has made a career (with his buddy Fumento) of inveighing against “junk science,” by which he means science that is inconvenient to his sponsors. I won’t ask you to check out his junk science page because I’m sure you are very familiar with it, but others may wish to do so. This non-scientist does nothing but attack some of the country’s best scientists because they dare to write that a diet rich in fatty meat might not be so good for you. BTW, I am not a target on his page nor do I do nutritional epidemiology. But I know many of the scientists he attacks and they are ten times smarter and have infinitely more integrity than he does.

  10. #10 tony m
    December 24, 2006

    revere,

    Thanking you for your clarification of the matter.

  11. #11 tony m
    December 24, 2006

    http://www.cdc.gov/flu/professionals/diagnosis/labrole.htm

    And a little note from the CDC:

    “Appropriate treatment of patients with respiratory illness depends on accurate and timely diagnosis. Early diagnosis of influenza can reduce the inappropriate use of antibiotics and provide the option of using antiviral therapy. However, because certain bacterial infections can produce symptoms similar to influenza, bacterial infections should be considered and appropriately treated, if suspected. In addition, bacterial infections can occur as a complication of influenza.”

  12. #12 tony m
    December 24, 2006

    http://www.who.int/csr/don/2005_09_29/en/index.html

    The question of course being how “timely” before reaching a WHO reference laboratory. WHO states regarding anything short of this:

    “Laboratory testing to confirm human infection with H5N1 avian influenza is technically difficult; some tests produce inconclusive or unreliable results.”

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