bird flu
revere | August 17, 2007I'm not sure which is worse. Pandemic flu preparation which puts most of its eggs (pathogen-free, of course) in the vaccine basket or the one that plans to distribute the non-existent vaccine in a way that it misses the most needy and vulnerable. I guess it's obvious that if the first is bad, the second is very bad so it's worse, but it also a warning that other kinds of preparation may also be seriously flawed from the equity point of view. I know many of you don't care about these folks -- undocumented immigrants, substance users, the homeless, homebound elderly, and minorities. Many…
revere | August 16, 2007A new paper in the Annals of Internal Medicine underlines a point we have tried to make multiple times (e.g., see here, here and here). Naive and unthought out therapeutic responses to the idea that bird flu kills via a "cytokine storm" is a bad idea. Cytokine storm is also a common feature of sepsis, which accompanies some pneumonia and other infections and has a high case fatality ratio. I haven't read the original paper because I am at the beach where the Annals of Internal Medicine isn't carried at the local convenience store and my internet connection is barely adequate for email, but I…
revere | August 14, 2007We write so much here about influenza A virus that you might get the idea it is an especially clever virus, always changing genetically in ways that allow it to perform new and nastier tricks. But other viruses are capable of doing the same thing, and one of them West Nile Virus (WNV), is currently becoming a a more persistent and serious public health hazard, all because of a clever little genetic trick it learned in the last decade or so.
WNV has been around longer than that, although we didn't have a problem with it in North America until 1999, when this mosquito-borne disease showed up,…
revere | August 13, 2007Bird flu in Indonesia and elsewhere keeps simmering away. Little stuff, here and there. Constant noise, so much so you wonder if you will hear the signal, if and when it sounds. Will it suddenly become so loud it is unmistakable? Or will it be there, growing louder and louder until everyone can hear it and in retrospect, see that it was there before we recognized it? I don't know the answer. Lots of worrisome sounding things I ignore and wait for a couple of days more information to sort them out. That's my inclination for the latest Indon case on the resort island of Bali:
Bali has recorded…
revere | August 12, 2007Another press release on a vaccine breakthrough from NIH. This one allegedly predicts the mutations that will result in enhanced transmissibility. Just published as a paper in the journal Science, the focus was on mutations of the HA protein (the "H" part of H5N1) that are related to binding to human cells versus bird cells. We have discussed this pretty often here (for the science background see the posts here):
The research group compared the structural proteins on the surface of bird-adapted H5N1 influenza virus with those on the surface of the human-adapted strain that caused the 1918…
revere | August 10, 2007The turkeys were doomed anyway, so the discovery they had a "mild strain of bird flu" didn't seal their fate, which had already been hermetically sealed. The birds showed no sign of illness. The evidence for infection came from finding the presence of antibodies to the low pathogenic strain prior to being sent to slaughter. The US Department of Agriculture reassured everyone: no human has ever caught bird flu after eating properly cooked poultry or eggs. So who cares? It turns out lots of people in the poultry industry elsewhere care a great deal:
But officials in Japan, Russia, Turkey, the…
revere | August 9, 2007We've written here frequently about the ineffectiveness of quarantine for stopping the spread of influenza, but now a piece comes out in the Journal of the American Medical Association (JAMA) that claims quarantine was an effective mitigation method for influenza in 1918. Time Magazine, for example, had an article with the headline: "Study: Quarantines Work Against Pandemics":
To plan for the future, researchers in Michigan went straight to the past. Led by Dr. Howard Markel, director of the University of Michigan Medical School's Center for the History of Medicine, a team of public-health…
revere | August 7, 2007Dr. John Agwunobe is the federal official in charge of the US Public Health SErvie Commission Corps and of coordinating the nation's response to pandemic influenza. At least he will be until the end of this month.
Announcement from Department of Health and Human Services:
For Immediate Release Contact: HHS Press Office
August 7, 2007 202/690-6343
STATEMENT FROM HHS SECRETARY MIKE LEAVITT ON THE RESIGNATION OF ASSISTANT SECRETARY FOR HEALTH DR. JOHN…
revere | August 6, 2007A long story in The York Dispatch discusses personal preparation for a pandemic. Taking personal responsibility is a good thing, although it means different things to different people. I have reserved my energy for community activities. I don't have a stash of Tamiflu or water or canned goods, despite the fact we have written (often) here about the possibilities of supply chain and infrastructure. With the understanding I am not against personal prepping, I would still like to urge both some caution and perspective.
Here's some of the news story that attracted my attention, with some of my…
revere | August 3, 2007Stories about experimental vaccines that "work in animals" are a dime a dozen these days. That's not bad. It means there is a lot of activity on the innovative technologies front. But there is a huge distance between "works in mice" and "works in humans." So news that one of these technologies is entering human trials, even small scale Phase I trials, is rarer. Recently we posted on the proposed start of Phase I clinical trials for a "universal flu vaccine" that works across subtypes (H5N1, H1N1, H3N2, etc.) as well as across drift variations within subtypes (the genetic differences seen from…
revere | August 1, 2007The intellectual property issues surrounding H5N1 and pandemic influenza in general continue to deepen and ramify into uncharted territory. Currently the usual suspects are meeting in Singapore to try to resolve issues that have arisen when some developing countries, led by Indonesia, have upset the international flu applecart by refusing to provide viral isolates to the WHO laboratory network, asserting that the practice of supplying "their" isolates to pharmaceutical companies who then make vaccines the originating country can't afford was inequitable and intolerable. I have waded into…
revere | July 31, 2007One reason Helen Branswell is such a good flu reporter is she has the best contacts. Of course this is a chicken-and-egg proposition, because she has the best contacts because she is the best flu reporter. She gets it right and she explains it the way it was told to her. [By the way, I am not on her payroll. In fact she is uncomfortable about being praised. But I don't do it for her sake. She doesn't need it anyway. My motive is to show other reporters what good flu reporting is and encourage them to do the same. And there are a number of other excellent reporters, which I try to acknowledge…
revere | July 29, 2007There is an apocryphal story of a politician during the Revolution of 1848 desperately running after a crowd in Paris's Jardin du Luxembourg. "I'm their leader," he cried. "I must follow them!" A couple of years ago most national pandemic planners were occupied with procuring stockpiles of antivirals, worrying about the lack of a vaccine and reassuring people that they had the matter under control if a pandemic were to strike. No one believed them and they knew they were whistling past the graveyard, but the poverty of vision was amazing. There has been much progress since then. Now there is…
revere | July 25, 2007Small steps but steps in the right direction. It's taking time, but there is progress:
Every household in Fairfax County [Virginia] should receive a pamphlet from the county's health department by the end of the month about protecting against a flu pandemic.
Health department staff began mailing the guide to 440,000 households in the county on July 16, and will also be available from the health department in different languages. It is part of the county's endeavor to prepare residents to cope with pandemic influenza, according to Gloria Addo-Ayensu, the county's health director
"Management…
revere | July 22, 2007Cuba has announced it has established a monitoring system for bird flu. I don't know any of the details except that they have trained personnel for the purpose and they say they have invested millions of dollars and are following what goes on elsewhere closely. The US can say the same thing and has health indices not unlike Cuba's. So is there any reason to think Cuban citizens will be any better off than Americans if a pandemic strikes? Yes.
Because Cuba has universal health care and an efficient public health system that accomplishes a great deal despite a cruel embargo imposed by a…
revere | July 20, 2007If you work for Tyson foods, one of the US's largest poultry producers, you probably aren't very worried about bird flu. That's because you are too busy worrying about not getting cut to pieces, electrocuted, maimed from a fall or burned to death. As part of a strategy of increased attention to workplaces with higher than usual worker injury rates the US Occupational Health and Safety Administration (OSHA) inspected the Tyson poultry processing plant in Noel, Missouri, and found "serious, willful, and repeat" health and safety violations. The plant was fined almost $350,000 as a result.…
revere | July 20, 2007The first of the putative "universal" vaccines against influenza A is entering Phase I (small scale safety and efficacy) testing. Manufactured by UK vaccine company Acambis, the vaccine is designed to protect against a wide range of influenza A viruses of many subtypes and many strains. Here's the idea. The immune system mainly "sees" viral proteins on the outside of the virus. The most visible of these is the hamagglutinin (HA) protein which gives its initial letter to the H-subtypes like H5N1 and H3N2, etc. The other visible protein is the neuraminidase (NA) protein, the initial letter of…
revere | July 18, 2007A "cytokine storm" as the lethal element in H5N1 infection is back, not with a bang but a whimper. Maybe. Here's the gist, from the ever reliable Helen Branswell:
New research suggests successful treatment of the H5N1 avian flu virus requires targeting the virus, not the overwhelming immune response it triggers.
The study, done in mice genetically engineered to lack critical immune system chemicals called cytokines, found these mice were as likely to die from H5N1 infection as mice armed with an intact immune system.
That suggests the activity of the virus, not the immune response it induces…
revere | July 17, 2007In the world of opera a diva is a prima donna, often problematic in behavior, but in the world of bird flu, DIVA stands for differentiating infected from vaccinated animals (DIVA). The bird flu DIVA relates to a problematic behavior of vaccinating poultry: after you've artificially induced them to produce antibodies against bird flu, you are faced with the trying to tell if a bird with antibodies against bird flu got it artificially or naturally. Since antibody detection is the main screening method for poultry infection with avian influenza virus most countries won't accept imports of…
revere | July 16, 2007So now we can all rest easy because we know where the 6 year old girl (not a boy as the Indon Ministry of Health previously reported) who died recently of H5N1 infection acquired the virus. The source of all H5N1 infections: birds. How do we know? Because an official of the Indonesian bird flu centre says so:
"She had indirect contact with dead chickens near her school," Joko Suyono, an official at the ministry's bird flu centre, said by telephone. The victim, from the city of Cilegon in Banten province, had initially been identified as a six-year-old boy, but Suyono said this was due to a…