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!

More like this

The Editors on Gregg Easterbrook: I was going to do a whole thing about how disingenuous Gregg Easterbrook has been about global warming, but I see that Media Matters has already done a very thorough job. I would like to highlight one rather egregious item they missed, which comes from his dramatic…
This week The New England Journal of Medicine (NEJM) published three articles on the evolving story of the influenza A/H5N1 panzootic that has the potential to become a human pandemic. Two are rather meager case series, one from Turkey and one from Indonesia. It is an extraordinary indication of…
Indonesia registered its 51st official case and 39th death this week, a 13 year Jakarta boy who had helped his grandfather slaughter sick chickens, took sick a week later and was dead less than a week after that. There's more discouraging news from this benighted bird flu hotspot. The Indonesian…
Six days ago when commenting on the first human case in Indonesia for 6 weeks, we noted that flu season was upon us and to expect more. That's seems to be the way it is working. The virus continues to spread in poultry in Vietnam and outbreaks have been confirmed in Nigeria, Japan and South Korea.…

"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?

By mycotropic (not verified) on 30 May 2006 #permalink

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.

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].

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.

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?

"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?

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.

"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.

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).

By Wilhelm Godschalk (not verified) on 04 Jun 2006 #permalink

"Only" two tests? That's not exactly cake. Not to mention sequencing of dozens of viral isolates to date.

****"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?

By Wilhelm Godschalk (not verified) on 06 Jun 2006 #permalink

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?

By Chris Noble (not verified) on 06 Jun 2006 #permalink

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.

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.

By Wilhelm Godschalk (not verified) on 14 Jun 2006 #permalink

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.

By Wilhelm Godschalk (not verified) on 14 Jun 2006 #permalink