bird flu
revere | June 6, 2008The Indonesian Health Minister, Siti Fadilah Supari, has figured out how to deal with her country's reputation as being the bird flu capital of the world. She isn't going to announce deaths from the disease as they happen:
A 15-year-old girl died of bird flu last month, becoming Indonesia's 109th victim, but the government decided to keep the news quiet. It is part of a new policy aimed at improving the image of the nation hardest hit by the disease. Health Minister Siti Fadilah Supari said Thursday she will no longer announce deaths immediately after they are confirmed. But she promised to…
revere | June 2, 2008In a typically well informed and thoughtful commentary over at the mega-blog, DailyKos, DemFromCT reminds everyone that just because the media aren't talking about bird flu and pandemics and just because the candidates are arguing about the economy, the war and whose pastor is worse doesn't mean that anything has changed. All the elements that alarmed the public health community as far back as 1997 when the first human cases of H5N1 appeared are still there. In some respects we should be more alarmed because so much of what we thought about flu then we now know isn't the case at all. Learning…
revere | May 28, 2008Stories on the wires this weekend highlight a new study published in the Proceedings of the National Academy of Sciences (PNAS) suggesting that some bird flu viruses are adapting to the human respiratory tract, thought to be a prelude to increased transmissibility and possibly ushering in a pandemic of influenza in humans. We need to sort out a number of things here, beginning with the idea that "avian influenza viruses" are mutating in a way woy to make humans more vulnerable. Let's take it apart.
First, influenza. Influenza can either be a syndrome (a package of clinical symptoms and signs…
revere | May 24, 2008Bangladesh now has its first confirmed human case of avian influenza. That's news. Maybe:
Bangladesh announced its first human case of bird flu on Friday in a 16-month-old baby boy, bringing the number of countries which have recorded human infections to 15. Avian Influenza has already spread through 47 of Bangladesh's 64 districts and concerned Indian authorities say when the disease is so widespread in poultry, it is really a matter of time before humans start getting infected. (Times of India)
Specimens from the case had been sent to CDC in the US and the diagnosis confirmed by WHO. So why…
revere | May 18, 2008Almost all stories in the news about H5N1 (bird flu) have some obligatory line in them, "It is believed that all or almost all human cases come from contact with infected poultry." This is like a mantra of many public health officials and I suspect some reporters have the requisite disclaimer as a cut and paste text they mechanically insert into their stories. But it isn't true. There are an awful lot of human cases for which no poultry source has ever been located and we have yet another example in the latest Indonesia cases:
The city's husbandry, fishery and maritime agency said Friday it…
revere | May 16, 2008At this moment I'm sitting in a Chicago O'Hare airport waiting room reading a news article on MSNBC's website telling me I am in more danger from breathing the air here in the terminal than I would be breathing the air on the airplane when it reaches cruising altitude. This was the conclusion from a just published study done by the National Institute for Occupational Study and Health (NIOSH), the federal research agency on workplace health problems, and two collaborating universities, Harvard and University of Massachusetts. NIOSH has been looking into the environment of the cabin crews, but…
revere | May 15, 2008Last week WHO's flu maven, Keiji Fukuda, said what we and others have been saying for a long time. Flu scientists need to change their research ethics. The world of flu virology has developed a mandarinate that is impeding progress for its own benefit. And their bad behavior is enabled and imitated by some public health agencies, like CDC. Researchers and CDC are sitting on H5N1 genetic and other flu sequences of public health importance. They treat their data as proprietary, to be used for their own benefit in scientific publications.
This isn't unusual. It is the normal way of doing…
revere | May 6, 2008The AP has a story that a task force composed of medical and other experts from academia, professional groups, the military and government executive branches and agencies like the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services has been considering how to ration scarce medical resources in the event of a pandemic. Before I give you their suggested answer I want to consider the underlying problem. This may be too abstract a way for some to think about this, but it is the logical bare bones of the matter.
Suppose…
revere | April 25, 2008For years we have been naming flu viruses in a particular way. Now Declan Butler has a news article in Nature observing that the system is being modified for bird flu to be more "politically correct." What is the system that's being modified (still in use for seasonal flu)?
It starts off with the type of influenza virus, either A, B or C. The type was originally based on a broad class of antibody response but now is related to genetic markers in two of the eleven proteins (matrix M1 or nuceoprotein, NP). The three types have a common ancestor but only types A and B are of public health…
revere | April 24, 2008In the previous two posts (here and here) we laid out some new results that dissect what might be happening at the molecular level when a patient infected with SARS or bird flu descends into Acute Respiratory Distress Syndrome (ARDS) from Acute Lung Injury (ALI) in a just published paper in the journal Cell (Imai et al., "Identification of Oxidative Stress and Toll-like Receptor 4 Signaling as a Key Pathway of Acute Lung Injury", Cell, Vol 133, 235-249, 18 April 2008). We have already discussed their experiments showing that TLR4, a receptor that is part of the innate immune system, was…
revere | April 23, 2008In our previous post we set the stage for discussing the results of a significant new paper by Imai et al. and colleagues on the mechanism of lung damage from diverse pathogens, including SARS, bird flu H5N1, 1918 H1N1 flu, inhalational anthrax and Monkeypox. If this work is verified it is a major step forward in our understanding of how the devastating consequences of Acute Respiratory Distress Syndrome (ARDS) and Acute Lung Injury (ALI) come about and may well provide clues about how to treat what is still an essentially untreatable and catastrophic medical condition.
There are two main…
revere | April 22, 2008The cells of your body don't just sit there, unmindful of what is going on around them. They have to respond to things, even cooperate with other cells to get things done for the common good. Humans do the same thing. We've developed a system of signaling to each other using an intricate vocal system, a complex grammar, ears, eyes and smell detecting systems. It's a very complicated package with a lot of moving parts. It's not so surprising, then, that cells also have complex signaling systems with a lot of parts that they use to respond to their environment. Just as we sometimes make a…
revere | April 17, 2008Peter Doshi has a bone to pick with CDC . His particular idée fixe is that CDC is cooking the books on their estimates of excess mortality attributable to influenza and he aims to set the record straight. He's done it before. Doshi is not the kind of critic CDC is used to. He is a graduate student, not an established public health figure. But he's no shrinking violet and is getting in CDC's face again in the latest issue of the American Journal of Public Health. This time Doshi extends his criticism to imply CDC is pandemic fear mongering, perhaps in collusion with Big Pharma. This has been…
revere | April 15, 2008US Secretary of Health and Human Services, Michael Leavitt, is in Indonesia to discuss matters of mutual interest with the Indonesian government. Topic number one was the Indonesian government's opt out of the international influenza surveillance system which has been in place for almost 60 years and provides vital information on what flu strains to include in the next year's seasonal flu shots. But the system is not limited to seasonal influenza and is an important part of the global surveillance of all influenza viruses that might be of human health concern, chiefly among the non-seasonal…
revere | April 14, 2008I'm a supporter of mathematical modeling as another way to get a handle on what might happen in an influenza pandemic. But a recent paper by the group at London's Imperial College, published in Nature, shows what can happen when modelers allow their work to bear more weight than it can sustain. When a prestigious scientific journal, Nature, publishes such a paper, it also gets attention it wouldn't get if published in a more appropriate place -- meaning a place where its scientific contribution could be judged in the usual way, not under the glare of global publicity. I'm not blaming the wire…
revere | April 13, 2008Since we posted here less than a week ago on a recent paper authored by Chinese and US scientists in The Lancet giving scientific details confirming what most people had already assumed was a person to person transmission of H5N1 between a father and son, it was with considerable surprise we read the headline of a story from wire service Agency France Presse (AFP) claiming that Chinese authorities had "rejected a study which found a probable case of human-to-human bird flu transmission in the country, state media reported." On the one hand we were hesitant to accept this report at face value…
revere | April 11, 2008I have professional colleagues who are dedicated birders but it has never interested me, and their interests are mainly independent of their lives as epidemiologists, toxicologists or whatever else they do at work. But the biosphere is truly interconnected in strange ways and sometimes what seems an unrelated realm intrudes itself front and center in a different context. Bird migration is a good example. How is bird flu spread? Is it human enabled movements of infected poultry or the rare bird trade? Or is it the "natural" movements of wild, migratory birds, the natural reservoir for the…
revere | April 10, 2008First Tamiflu (oseltamivir), now Relenza (zanamivir):
Health officials [in Canada] are investigating whether Relenza - a drug provinces have stockpiled in case of a pandemic flu outbreak - can be linked to fatal reactions or abnormal behaviour in children.
[snip]
The investigation is a response to recently updated safety warnings issued by the U.S. Food and Drug Administration (FDA) or Relenza. In March, pharmaceutical giant GlaxoSmithKline updated Relenza's safety labels after children in Japan were reported to suffer from delirium, hallucinations. Some died after injuring themselves.
A…
revere | April 9, 2008If you pay attention to the latest news about bird flu I will not be telling you anything new that there is a detailed description in The Lancet (a British medical journal) of a case in China of probable person to person transmission of bird flu. You can get details from the incomparable reporting of Helen Branswell (Canadian Press), James Macintyre (The Independent), Deborah MacKenzie (New Scientist) or your favorite wire service. You don't need this blog for the facts, although we also try to provide you with some of those, too. What we try to do is always add some value. Usually it's just…
revere | April 8, 2008We can argue about the cause, but climate is changing. It may be called global warming but the effect most people will see is an increased variability of weather events, with more frequent extreme weather. Little things. Like Hurricane Katrina. WHO is among many warning that it is not only the physical effects that will affect people, but changes in disease patterns as well, with the brunt of climate change linked disease deaths coming from the Asia-Pacific region:
Shigeru Omi, WHO director for the Western Pacific region based in Manila, said "the impact of climate change will be felt more in…