In December some people were wondering what had happened to bird flu. In January it came back, but there was hope it wouldn't be as bad as last year and that some of the control measures were working. Now February is behind us and we are seeing resignation in some quarters that we haven't made as much progress as we'd hoped:
Bird flu is on the march again across Asia as winter ends, but the battle against the killer virus is being hobbled by stark differences between the region's diverse countries, health experts warn.While Vietnam and Thailand have been hailed as poster adverts in the fight against avian influenza, new cases in hotspot Indonesia and population giant China have highlighted concerns the disease will be hard to stamp out.
Many Asian nations have learned much since the H5N1 strain erupted here in 2003, spreading as far as Europe and Africa last year, but gaps remain and the threat of a pandemic remains real, epidemiologists say.
New human infections in China and Laos and recent animal cases in Myanmar, Pakistan, Afghanistan and Hong Kong are reminders that the virus "is still entrenched," said World Health Organization (WHO) spokesman Peter Cordingley.
"If you take a broad look at the region, I would say it's pretty much the same as last year, when we saw bird flu move all the way to Africa.
"We're seeing signs of that already. We're seeing human cases in Egypt, and inside Asia the virus is obviously becoming quite active." (Agence France Presse via China Post)
The flu season is in full swing now, perhaps just a bit later than last year. Even countries with extensive resources and technical know-how have suffered, Japan and South Korea being notable examples. Then there are those that have made almost no progress, including the world's bird flu hotspot, Indonesia. And while Vietnam and Thailand are often held up as models, they have continued to have outbreaks in poultry and their close neighbors Laos, Cambodia and China have, too, including human cases in Laos and China. More and more legal and illegal poultry trade movements are being implicated in the spread of the virus, so the presence of infection nearby should be a deep cause for concern in both Vietnam and Thailand.
But we also wonder exactly how well these "model" countries are really doing, Vietnam in particular, where the major control measure is mass vaccination of poultry. If this allows birds to remain infected without showing signs of illness and the birds continue to shed virus, albeit at a lower level, might we not be missing both bird and human infections? Many diseases, such as usual seasonal influenza and Dengue fever, mimic the symptoms of bird flu and sporadic human H5N1 cases might easily be lost in the background noise of the huge number of those other diseases, most of which never receive diagnostic work-ups, much less the specialized diagnostic techniques need to diagnose H5N1 infection.
A large and systematic seroprevalence survey (i.e., looking for blood antibody evidence of past infection) in Vietnam might answer some of these questions. Results showing little or no evidence of undiagnosed past infection might not settle all the questions, but it would lessen some of the nagging doubt that all is well in Vietnam. Comparison with Thailand where mass culling has been the main control technique and in Laos and Cambodia where little effective control of any kind exists would be instructive.
It is hard to understand why more of this kind of work has not been done, or if it has, why we haven't heard the results. More resources need to be devoted to the basic descriptive epidemiology of this disease. It's not rocket science, as the saying goes. But it does require some deft and strong leadership and WHO would seem to be the natural agent.
Dr. Chan?
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"It is hard to understand why more of this kind of work has not been done, or if it has, why we haven't heard the results. More resources need to be devoted to the basic descriptive epidemiology of this disease. It's not rocket science, as the saying goes. But it does require some deft and strong leadership and WHO would seem to be the natural agent.Dr. Chan?"
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why not invest in malaria-research or AIDS-research instead ?
Or research to defeat a new, still unknown bakterium or how
to defend against Aliens ?
I mean, how can someone who has not the foggiest idea
about the likelyhood of a pandemic require that we should
invest more money in defeating it ?
anon: Of course invest in those diseases. Also invest in lupus, although I don't know how much lupus there is in the world. I'd like to know, so I advocate research to find out. If there are things you don't know, then you try to develop evidence that will help you to know. I didn't think it was that hard to understand, although your comment suggestions I was wrong about that.
I do know that a sero-surveillance study was planned for Indonesia through NAMRU-2, focusing on a few hotspots such as Tangerang and West Java. It took about 18 months to develop the protocols and there was a lot of politics. It had the support of NIH / NIAID and Dr Gregory Gray, an influenza expert at the University of Iowa but got cancelled at the 11th hour by the Indonesian health department as it involved sending samples overseas.
(Gregory C. Gray (PI; Prospective Studies of Avian Influenza Transmission in Asia NIH / NIAID-1 R01 AI068803-01} I think NAMRU2 are trying to still run the project through other Asian countries now.
These studies are necessary and some leadership is required to make them happen. I fully endorse Revere's comments. Lets just say in Indonesia there is a void.
Dr. Jeremijenko, do you know if they are doing any seroprevalence follow-up studies on the large numbers of people who have been given Tamiflu in Indonesia?
Pixie,
I do not know. I would guess the answer would be no.
Dr. Jeremijenko, do you know if there any seroprevalence follow-up studies on large numbers of people who have been administered Tamiflu in any country other than Indonesia in which H5N1 has appeared, like Turkey or Egypt?
Do you know of plans to conduct such a study in Malaysia, where the virus apparently is, as they have said they've be vaccinating their poultry, and we know that Eastern Kalimantan, to the west of Sulawesi has had at least one poultry outbreak?
Andrew: Thanks for the info. I'll check CRISP for other stuff. Hope all is well with you. Your email to me last time got bounced by the University spam filter for reasons I don't understand. Glad you are still hanging in there! If you get a chance, try email again and let me know what and how you are doing.
..."got cancelled at the 11th hour by the Indonesian health department"...
(Could they have finished it themselves?)
Thank you for all you do, Dr.Jeremijenko, and good luck to you!
Help, Reveres & Dr. Jeremijenko, please....
(I posted an earlier version of this on the latest cat page)
I am trying to figure out HOW they test H5N1 survivors for prior exposure to the virus. I suppose this applies to cats, too.
I was looking into PCR testing, which is meant to be the grand model (but which falsely indicated a pertusis epidemic at Dartmouth last year when there was none).
Given all the debate about "seropositivism," with naysayers like Michael Fumento playing up the vague & unconfirmed Vietnamese study, I was surprised to find that extensive googling doesn't get me much on the specific testing alternatives and their pros and cons.
For instance, what test would NAMRU-2 conduct in Indonesia to determine how many seropositives are wandering around the archipelago? What test was used in Cambodia?
Are better tests expected to materialize?
This might make a good post topic.
Thanks in advance!
Gratefully as ever,
DA