Effect Measure

The H5N1 crystal ball is cloudy

It seems like just yesterday the UN’s Food and Agriculture Organization was saying that the current resurgence of bird flu is not as bad as last year when it burst out of Asia and extended itself into 40 countries or so. It wasn’t yesterday. It was Monday. Enough time for that judgment to look a wee bit premature.

In fairness, FAO cautioned everyone not to let down their guard. Good advice, especially as the first poultry outbreak in Europe this season has now been confirmed in Hungary and the virus has returned to Japan for the first time in three years. We aren’t even mentioning China and Hong Kong, Thailand, Vietnam, Nigeria, Egypt, and of course, we can’t forget Indonesia, the current epicenter of bird flu. Those are the places we know about. There is undoubtedly virus elsewhere, unreported or undetected.

But it’s hard to make sense out of scattered reports that seem to arrive one on top of the other. I was thinking of this yesterday when my news aggregator, NewsNow (the service I use to alert me to bird flu related articles in the press), presented me with this surprising headline: Vietnam bird flu cases limited so far. Three deaths, seven confirmed, possible human infections. Fortunately I now know enough to check the date, and in this case it was August 16, 2004. Why NewsNow coughs up these old articles I don’t know, but it happens pretty often. In this case it was also instructive.

Vietnam has detected seven confirmed and possible bird flu infections in humans so far, but is concerned about more cases cropping up among its scattered small farms, a health ministry official said on Monday.

Three of the victims in those cases, two children among them, died of bird flu, the government announced last week.

The third, a 25-year-old woman from the southern province of Hau Giang, has been preliminarily identified as infected with H5N1, the same strain of bird flu that killed 24 people in Asia this year, including 16 in Vietnam and eight in Thailand.

[snip]

WHO Vietnam representative Hans Troedsson said the situation did not appear alarming for now. “So far, it’s only a limited number,” he told Reuters. “For the moment it doesn?t look to be the same dimension as in February.”

[snip]

“The characteristics of this disease are difficult to deal with. We have some localities where the disease has not been fully treated, so the virus still exists,” Bui Quang Anh, director of the animal health department of the agriculture ministry, told reporters on Monday.

The latest recurrence was on a smaller scale than the initial outbreak earlier this year, he added. (MSNBC)

No one can accuse the Vietnamese of complacency. They sound appropriately worried. Already they had human cases and flu season has barely started. The Vietnamese were just coming off the first year of the resurgence which started in 2003 when Vietnam had more human cases than any other country (they still are number one, although Indonesia has the most deaths and is rapidly approaching Vietnam on the number of cases, too). At this point they couldn’t see the future. But we know what the future held for them and it wasn’t pretty.

Here is the temporal distribution of case counts up to the point of this article, August 2004. Of the seven confirmed or suspected reported above, five were later counted as confirmed by WHO. The bars are color coded by country and Vietnam is vermillion (I think; I’m color blind):

i-dca255cfce648701896092fb2a05f7a6-flu to Aug.2004.png

Unfortunately the hope that the 2004 – 2005 season in Vietnam would not be as bad as the initial 2003- 2004 season was unfounded. The ensuing months would bring 72 more cases:

i-eedc4d3da67e91db27e07d02e89eb052-flu.all.png

Not all surprises are bad (at least for Vietnam), because here is what happened in the next year (2005 – 2006):

i-826ed8a336b13f7220f3acac6189c886-S1_500x375.shkl.jpg

Vietnam’s color has been replaced by Indonesia (yellow) and a bunch of others.

Knowing what’s going to happen as we head into flu season isn’t easy and I frankly have no idea. Best not to make guesses but instead get ready for whatever it might bring.

I think I’ve said that before.

Comments

  1. #1 Chuck
    January 26, 2007

    Have you ever noticed that when some country or organization announces some bit of good news, they immediately get clobbered with bad news. Example: Weewahootee, FL announces they are offically free from bird flu. The next day there’s an outbreak in Weewahootee.

    I know,I know, I know…not scientific . But, sometimes I just wish governments and experts would just be quiet. And, don’t tell me it’s never crossed your mind .

  2. #2 ZoKun
    January 26, 2007

    KISELYOV RIDES AGAIN !

    Not everybody has been downplaying the H5N1 threat these days.

    PRAVDA is reporting new work by Ole Kiselyov and associates from the Russian Academy of Medical Sciences Influenza Research Institute that millions of birds have succumbed while in flight to a rapidly evolving variant of the deadly H5N1 Bird Flu, saying

    “Doctor Scientist Oleg Kiselyov, the head of the Influenza Research Institute, states in these reports that a nematode parasite belonging to the ‘Superfamily Subuluroidea’ has now become a carrier of a ‘mutated’ H5N1 Bird Flu Virus with ‘sub strains’ never seen before ….

    Doctor Scientist Kiselyov further states that Western scientists are rejecting Russia’s research and are instead reporting to their citizens ‘other causes’ to explain the growing number of mass bird deaths in mid-flight, including Sri Lanka, and which has become yet another of the World’s Nations to report birds falling from sky dead”.

    I hope we can look forward to a follow-up article in THE ONION on this issue …

  3. #3 Ron
    January 26, 2007

    “The characteristics of this disease are difficult to deal with. We have some localities where the disease has not been fully treated, so the virus still exists,” Bui Quang Anh, director of the animal health department of the agriculture ministry, told reporters on Monday.”

    I wonder about the underlying logic here. Bui Quang Anh seems to believe that “full treatment” in a locality will cause the the H5N1 virus to cease to “exist” there.

    Back in the dark ages when I studied epidemiology in our medical anthropology program, I remember that there was a distinction between diseases that are eradicable and those that are not. Eradicable diseases were those that had no non-human reservoirs that would be impossible to control or elimate, among other characteristics. So smallpox and malaria are eradicable, whereas plague and typhus would not be.

    Even from the zoonotic standpoint, its pretty clear that influenza is not eradicable. Every strain of Influenza A, including several variants of H5N1, are present in wild birds, especially aquatic but other species as well, including non-avian species. This reservoir seems to be an endless source of new bouts of the disease in humans, as every year we experience a ‘flu season’. In other words, Influenza A is globally endemic.

    For the most part we have learned to live with Influenza A (because we have no choice), which doesn’t mean that it is not a threatening and nasty disease. However, most variants do not result in 1918-style pandemics or even milder ones.

    Yet much of the approach to H5N1 seems to work on an implicit logic of eradication. When no cases have been detected in Vietnam, say, in X number of months, this is news, as is its eventual reappearance. Yet a disease that has become endemic (ie ever-present in a reservoir that cannot be controlled or eliminated, an endless source of re.infection), its periodic disappearance and reappearance really isn’t news or even a trend. It is just business as usual. Prevention strategies for H5N1 seem to assume that we can isolate poultry or people from contact with the virus indefinitely. So we have the “8 monkeys” image of poultry enclosed in ‘biosecure’ houses, ourselves totally isolated from our animals, etc. Yet given the ecology of Influenza A, it seems virtually inevitable that all poultry and all people will eventually be exposed to this pathogen and that H5N1 will take its place along other strains of Influenza A and become globally endemic.
    That part of the crystal ball doesn’t seem so cloudy to me, yet it seems to be so for those formulating our current policies.

    If global endemism is the inevitable outcome of current processes, we should be paying attention to how we will come to live with H5N1, instead of spending tremendous energy and resources in trying to prevent the inevitable. For example, is it possible that people who live in somewhat closer daily contact with poultry and other farm animals, may have adapted gradually to influenza and be somewhat more prepared immunologically? Is this why younger people (who perhaps grew up in an urban environment) are more susceptible than older people (who may have immigrated from rural areas)? There are a number of such questions one could ask. ‘Learning to live’ with bird flu would imply different strategies, both in terms of poultry production and in terms of public health.

  4. #4 revere
    January 26, 2007

    Ron: I agree completely (although note that the quote from the article is from 2004). We need to be working to manage the consequences. Prevention is not possible.

  5. #5 Greg
    January 26, 2007

    “eradication” and “spending tremendous energy and resources in trying to prevent the inevitable” are concepts pandemic among monotheists.

    Belief in the latter is probably a consequence of futile hopes for the former, which might explain the desperation of some believers to discredit theories of evolution.

  6. #6 The-Best-Bird-Flu-Blogs-Team
    January 26, 2007

    From news.gov.hk (a source of online news, from the Information Services Department of the Government of the Hong Kong Special Administrative Region) here is an interesting news item:

    House crow tested for avian flu.

    Preliminary testing of a dead house crow found in Sham Shui Po has indicated a suspected case of H5 avian influenza, the Agriculture, Fisheries & Conservation Department says, adding it is doing more tests.

    Department staff collected the bird at Yee Kok Court on January 22. The department reminded the public to observe good personal hygiene.

    They should avoid personal contact with wild birds and live poultry and wash their hands thoroughly after coming into contact with them, it said.

    JM

  7. #7 Grace RN
    January 27, 2007

    re: the english pravda article by Oleg Kiselyov; I know you have written about him before (as a procrastinator/downplaying H5N1 in Russia). But re: the 1/26 article’s allegation that this can spread via parasite-any confirmtion, suspicion of this?

    http://english.pravda.ru/science/earth/86777-bird_flu-0

  8. #8 revere
    January 27, 2007

    Grace: I’d have to see what he is saying in a scientific publication. His record isn’t very good and now he’s spinning things in the opposite direction. There is really no way to judge this from a newspaper article. His reliability doesn’t improve because I am more inclined to believe what he says, and this is pretty out of the ordinary. I don’t have any way to believe or disbelieve it but I think the onus is on him to lay out the data.

  9. #9 mary in hawaii
    January 28, 2007

    Ron: I actually posed that same question awhile back…or at least a very similar one. I wondered if perhaps people in countries where the majority of the populace lives in close daily contact with poultry and other birds might actually have some naturally acquired immunity that makes them less susceptible to infection by an avian influenza virus. The few that do get infected are those who have a genetic weakness, compared to the rest of the population, never having acquired that natural immunity. (This would explain the seeming genetic propensity to get H5N1 among blood relatives). However, if that were true, it bodes quite ill for the rest of the world population that does NOT live in close daily contact with poultry and thus has NO such natural immunity. If/when the virus escapes to the western world, it would be akin to when the spanish explorers brought smallpox to the new world. ouch.

  10. #10 Jon Singleton
    January 29, 2007

    Mary, I know it’s kinda hard but try to think ’bout the “recombination paradigm” vis a vis commercially released transgenic DNA — genetically modified DNA which is inherently technically unstable.

    If evil homophobic bigots in the “clever country”, Australia, would just cease their “gangrape” of me — a pissd off gay male in his late 30s — I’d have a go at translating science-speak into plain english…

    C21*S*E*Research — The Politics of Horizontal Gene
    Transfer (How did H2H H5 evolve!?!)

    I suspected genetic engineering was dangerous way back
    in the late 90s when first digesting a tv news item on
    H5N1 contamination in Hong Kong — six people (adults
    and kids) cytokine storm died of this transgenic flu
    during a late 1997 outbreak in Hong Kong’s Special
    Administrative Region.

    Even a major pharma company, Roche, was worried back
    in 1997 bout the global implications — in its Media
    News 16 (May 2006) Roche says:

    “Roche has been in discussions with governments as
    early as 1997 regarding pandemic preparedness…”

    http://www.roche.com/med-cor-2006-05-16

    So how did H5N1 get here?

    H5N1 is a transgenic polymorphic pathogen — a highly
    mutable cross species multi-strained virus probably
    CaMV 35S promoter gene flow originating from genetic
    engineering.

    Since the mid 90s, dietary consumption of GM
    (genetically modified) crops by birds, animals and
    humans (who eat crops, birds and animals) has
    increased dramatically. It is very probable GM crops
    containing CaMV 35S transcription promoter are the
    horizontal gene transfer (HGT) causation vector thru
    which transgenic viral pathogens (eg. H5N1) are
    recombining (homologously) into existence with such
    ease, speed and spread.

    The “homologous recombination” process has, according
    to Recombinomics.com, always been the explanation for
    viral evolution and not “random mutation”. But, the
    thang bout the technology of potpourri tweaking GM
    organisms sees “hyper-acceleration” entering natural
    DNA evolution — thangs move a durn sight faster…

    Recombinomics — Random Mutation Explanation of Flu
    Genetics Is Fatally Flawed (March 30, 2006) @

    http://www.recombinomics.com/News/03300602/Random_Mutation_Flawed.html

    The defence against evolving polymorphic viruses is
    rather simple and has been repeated many times by
    numerous scientists worldwide — cease the corporate
    controlled release of genetically modified organisms
    within the global environment.

    Prior to the end of 2005, efforts in sequence tracking
    the genesis of H5N1 were criminally lackluster — we
    now know transgenic strains are present in birds and
    mammalian populations…

    But still, the question remains unanswered, how did a
    transgenic virus appear out of nowhere?

    The probable (but unproven) cross species vector is
    GM/GE feed fed to domestic fowl from the mid 1990s to
    present, HGT recombining H5N1 (via CaMV 35S promoter)
    into a transgenic polymorphic pathogen, now infecting
    and killing humans…

    So,basically I’m saying gene flow has occurred as a
    consequence of transgenic crops doing a CaMV 35S
    promoter recombination hotspot remix in the bellies
    (and bodies) of all organisms consuming such crops.

    Prof. Joe Cummins was the first to warn against using
    the CaMV 35S promoter or any viral genes in plants
    because it had been shown that such viral transgenes
    in plants could gene flow recombine with naturally
    occurring viruses to generate, in some cases,
    super-infectious viruses.

    Subsequently, the CaMV 35S promoter has been found to
    substitute for the promoter of many plant and animal
    viruses to produce infectious viruses.

    * Remixed excerpt ISIS Press Release 29/11/04 — Fluid
    Genome & Beyond @

    http://www.i-sis.org.uk/Fluidgenomeandbeyond.php

  11. #11 revere
    January 29, 2007

    Jon: The recombination issue for negative sense RNA viruses is controversial and Henry is in a small minority that thinks this is the engine for genetic variation in this case. That doesn’t mean he is wrong, only that it is not generally accepted. He will have a hard time getting acceptance until he publishes his work in the scientific literature, which he hasn’t done. That’s the way it works.

  12. #12 mary in hawaii
    January 30, 2007

    Jon, while your theories re where the mutagenic H5N1 came from are interesting and possible, your commentary misses the mark regarding what I was talking about, so I’m not sure why you addressed it to me. I was bringing up the point that a population (of humans) living in close regular contact with a particular pathogen or family of pathogens (avian influenza viruses) over generations might become naturally resistant to infection by such viruses as a result of natural selection processes. This has nothing to do with the specific nature of the H5N1 virus or any other particular virus, it has to do with the nature of the human population itself. What I was postulating as an “If-then” scenario, was: IF the population of humans in these countries where constant daily contact with poultry and the viruses they carry has led, via natural selection, to a certain level of natural resistance or immunity in that human population, THEN that might explain why the frequency of infection is so low despite the virus being widespread and endemic in the area, and despite recent scientific experiments which have shown it does indeed have the ability to infect humans in the upper respiratory tract.

    My further “If-then” corollary to that is IF the virus were to escape to the western world where people do NOT spend time in bed with their chickens and thus do NOT have this natural immunity, THEN the flu might well take off and be absolutely devastating in those more susceptible populations, as happened when european explorers, resistant to smallpox, brought it to the Americas and decimated the native populations who had no natural immunity whatsoever.

    The 1918 flu actually started in China, where it merely simmered, but where it actually took off like a rocket was in the US heartland. Kansas, I believe.