bird flu
revere | July 13, 2007The bird flu stories from Indonesia have a sameness to them so it is sometimes hard to remember these are real people. Someone's little girl or boy, sister, brother, father, cousin, best friend. They are just another "6-year-old boy died of bird flu at the weekend, a health official said on Thursday." I'm not blaming anyone of heartlessness. This is a normal way to react. It is also normal to think you know how the disease is transmitted and if you see a circumstance remotely like your pre-conceived notion, you stop searching for other causes. But in the case of the 6 year old just mentioned…
revere | July 11, 2007If you aren't worried about bird flu you probably aren't in the poultry business. The pandemic that has yet to materialize for humans is already here for birds, where it is called a panzootic. And it is taking a toll. When highly pathogenic H5N1 surfaced again in Germany and France in the heart of western Europe Japan banned imports of German poultry while Egypt banned French and German poultry. Egypt already has more bird flu than any country outside of Asia, so they are just trying to prevent a bad situation from getting worse.
Meanwhile West Virginia's annual poultry festival was canceled…
revere | July 10, 2007CDC recommends (MMWR Recomm Rep. 2005 Jul 29;54(RR-8):1-40) hospitalized patients with influenza A be placed under standard and droplet isolation precautions for 5 days after the onset of their symptoms. This is based on studies of volunteers who received live attenuated flu vaccine drops in their noses. After 7 days only 1 of 18 were shedding virus. One might wonder if attenuated flu vaccine in healthy volunteers is the best way to estimate the length of viral shedding. A new paper of viral shedding in hospitalized elderly patients at the Mayo Clinic suggests it isn't. Sensitive methods for…
revere | July 9, 2007CIDRAP had an interesting story about some Stanford undergraduates who designed a local pandemic flu hotline staffed by home-based volunteers. The idea emerged from a course in innovation and "entrepreneurship." The course was designed to teach students the rudiments of taking an idea of social utility and getting it implemented and they are fairly common. They give students a perspective on the many steps and obstacles between a good idea and a good product in the real world. But I sometimes wonder if they teach the right things.
First the idea:
The classes aim to teach students methods of…
revere | July 7, 2007Prepping for bird flu isn't a very good excuse. Excuse for what? Being a racist pig:
A former British National Party member from Lancashire accused of plotting to make bombs from chemicals he bought on the internet has claimed the substances were for cleaning his false teeth and unblocking drains.
Robert Cottage, 49, of Colne, told Manchester Crown Court he thought some of the other chemicals could be used to protect him from bird flu and purify water if supplies were cut off during civil unrest - two of his greatest fears. (Pendleton Today)
I know. Some of you might be saying, "Hey, I'm…
revere | July 6, 2007France, Germany, the Czech Republic and possibly Austria are the latest EU countries to have a recurrence of H5N1 (bird flu) in wild birds or domestic poultry. Last year also saw many EU countries afflicted, but until the UK turkey outbreak in February (see here, here, here and here) some hoped it wouldn't come back. Now it is spreading again. No surprise, really. Wherever and however it finds a place in birds it seems very hard, if not impossible, to eradicate permanently.
That, of course, is the problem. Let's forget about the argument as to whether a pandemic is "inevitable" because…
revere | July 5, 2007There was a story about prepping for a pandemic in the Washington Post a couple of weeks ago I made note of but didn't get to commenting on. Now's my chance.
When Alexandrians opened their June FYI newsletter, out slipped a slick brochure with a photo of a stern-faced crowd staring out from the cover. "Be Ready, Alexandria!" the boldface type warned, "For a Pandemic Flu Outbreak."
[snip]
"We must take this risk very seriously," Mayor William D. Euille said in an interview. "If a pandemic were to occur, we are going to have a lot of people infected. People are going to die. Some people are…
revere | July 3, 2007Influenza is primarily a disease of birds but other animals, including mammals, can be infected. Humans are mammals, of course, and we know humans get flu. But there are 144 different subtypes of influenza A and mostly they infect birds. When H5N1 jumped from birds to humans in Hong Kong in 1997 it was a surprise. It was thought the bird viruses needed to acquire human specificity by mixing bird and human viruses in a suitable animal (usually thought to be the pig). Pigs are very lucky. They can be infected by both human and bird viruses. That seemed to be what happened in the 1957 and 1968…
revere | July 2, 2007The New Scientist has a story this week asking whether flu vaccines really protects the elderly. It's not a new question. Careful epidemiological analyses of national mortality data has seemed to show no change in mortality amongst the elderly when vaccination for seasonal influenza ramped up starting in 1980. On the other hand, careful randomized clinical trials in specific populations seemed to show substantial protection.
The problem is more technically difficult than appears at first sight. On the one hand in a clinical trial you are making individual level measurements of both exposure (…
revere | June 30, 2007The British Medical Journal is an odd thing. I was very impressed when they went Open Access a few years ago, only to be disappointed when they stopped, even though their new editor, Fiona Godlee, came over from the world's leading Open Access publisher of medical journals, BioMed Central. Recently they have been publishing pieces that seem to challenge conventional wisdom. This has the odor of "catch up to The Lancet" about it, but maybe not. In any event, conventional wisdom isn't always wrong. In fact it is mainly conventional because it is wise thinking. Not always, but usually. So it's…
revere | June 29, 2007Emerging infectious diseases don't appear out of thin air. Mostly (75%), they come from animals. In the language of science, they are zoonoses. So veterinary pathologists see themselves on the front line of early warning against emerging disease and runaway pandemic disease. Consider bird flu:
So is the threat real? "Whether the bird flu virus will spread to North America is unpredictable at this time," says Corrie Brown, Diplomate of the American College of Veterinary Pathologists (ACVP) and a University of Georgia professor of veterinary medicine. "Although the likelihood of this mutation…
revere | June 28, 2007You can't look at the bird flu news without seeing a new outbreak somewhere, whether it's in Bangladesh, Ghana, Togo, the Czech Republic, or Germany, or of course the old standbys, Vietnam, Indonesia and Eqypt. Lots of it around and I didn't give anywhere near the whole list. So it's curious to find this headline, "UN finds progress in tackling bird flu" in an AP story in the Houston Chronicle by Marta Falconi (same story and headline in Washington Post):
Scientists and officials gathering in Rome for a three-day technical meeting on bird flu said that in most cases the virus is rapidly…
revere | June 26, 2007The Department of Homeland Security (DHS) may be the most incompetent and dysfunctional in the federal government (Katrina is one example; but only one). DHS also has a very expansive view of its role. Almost everything is a matter of homeland security. That includes epidemic disease, where there remains uncertainty as to who will do what to whom in the event of a pandemic. According to the Government Accountability Office (GAO), they also want to give the US Department of Agriculture (USDA) the bird:
In an effort to prepare for H5N1, the USDA rolled out a series of measures including…
revere | June 25, 2007For a long time I (and many others) were of the opinion that the reported deaths from H5N1 and the extraordinaraily high Case Fatality Ratio (CFR; proportion of all infections that end fatally) was an over estimate due to underascertainment of infections that were mild, inapparent or just undiagnosed because they weren't severe enough to come to the attention of the medical care system. The reason for thinking this was that this is the pattern for most other infectious diseasesk, even serious ones like TB and cholera. Most of the infections are asymptomatic or at least undiagnosed. It is…
revere | June 24, 2007There's been a bit of a buzz about a paper by Australian researcher Jennifer McKimm-Breschkin at the Toronto flu meetings last week. McKimm-Breschkin told the gathering of 1500 flu obsessed scientists just what they didn't want to hear: that she and her colleagues had evidence from the laboratory that clade 2 H5N1 avian influenza virus isolated from birds in Indonesia were becoming resistant to the only oral antiviral effective against the virus, oseltamivir (Tamiflu). In comparison to clade 1 (southeast asian) virus from a few years back, the sensitivity was 20 to 30 times less.
We'll have…
revere | June 22, 2007This site has a Creative Commons license on it. Essentially this means anyone can copy, distribute or transmit my blog posts for whatever purpose they want -- even commercial purposes. The only restriction is that this unrestrictive license travels with the post. If you use something from us you must permit anyone else to take the same post from your site without asking permission; and to attribute it to us at Effect Measure (i.e., give us credit, ideally including a link back to this blog).
We think this is a good model for influenza viruses, too. Because without it we are headed for…
revere | June 21, 2007The prospect of a influenza pandemic has concentrated the minds of vaccine makers. There has been a lot of new research and development on newer, faster and cheaper ways to make flu vaccines. The antiviral field hasn't been quite as active, although now things seem to be picking up. Until now the antivirals (all four of them!) have been in two main classes, the old M2 inhibitors (adamantanes) and the newer neuraminidase inhibitors (oseltamivir, zanamivir; and waiting in the wings, peramivir). Now we are hearing about new drug targets:
One of the promising things about the work is that the…
revere | June 20, 2007Many people have the impression the bird flu menace has receded. Much of this is based on its lack of media visibility. I don't blame the media. There is a lot happening in the world, editors get bird flu fatigue just as the rest of us do, and there doesn't seem to be a lot to say that hasn't been said before. Whichy of course is the problem. Things haven't changed.
Consider Africa:
Some African nations are experiencing a rapid spread of the H5N1 virus in poultry while a lack of equipped public health labs, customs surrounding chickens and poor surveillance hamper pandemic plans, a…
revere | June 14, 2007One of the big issues over sharing of viral isolates from Indonesia was the contention, probably well justified, that the poor nations would be last in lie for any vaccine that might be available in the event of a pandemic. While a well matched vaccine has to await the emergence of a pandemic strain, there are good reasons to think vaccines made from pre-pandemic strains would provide some cross-protection, and such vaccines are already in production, although in small quantities.
The choke point is the clearly inadequate global production capacity for influenza vaccine. Even if there were a…
revere | June 13, 2007Bird flu news tends to be episodic. For long stretches there seems to be little news (unless you deliberately go looking for it; then you find it). Then there are these little spurts as bird flu pops up here and there in the news. Human cases in places where they haven't been for a while tend to be more noticeable. Or suspicion there are cases where they haven't been before. So we have Malaysia quarantines five with suspected bird flu (possible new country for human cases; but suspect cases of febrile illness around poultry outbreaks often turn out "negative," either because they are one of…