bird flu
revere | January 25, 2008You'd think finding that there were some bird flu infections that went undetected would be bad news but it is actually good news. Not tremendous good news but better than no news, and that's unusual in the bird flu world. For some time the absence of mild or inapparent infections has been worrying. It means that the current case fatality ratio of over 60% is the real CFR, not one based on just the most serious cases coming to the attention of the surveillance system. Now scientists gathered in Bangkok at one of the many gatherings of those studying the disease have heard some new data…
revere | January 24, 2008Predictable as clockwork, no sooner does the Director General of the World Organization for Animal Health (OIE), M. Bernard Vallat tell us that things are looking up for bird flu then we have a massive outbreak threatening to devastate the poultry industry of India. So the poultry problem is neither stable nor under control, whatever M. Vallat says (and I daresay he probably regrets saying it). The Indian problem is a big deal, with reports of villagers eating birds that died of the virus and violent resistance to culling efforts. Clearly India was unprepared for this poultry outbreak,…
revere | January 23, 2008In 2006 there were 115 confirmed cases (WHO case count) of H5N1 in humans with 79 deaths. In 2007 the figures are 86 cases and 59 deaths. Some have taken this as evidence H5N1 is less of a problem (latest data here). That's not how I read it, however. Seasonal flu numbers bounce around from year to year, too, and if this year is better than last year it isn't because flu is disappearing. Still, let's take a look at the numbers a little more closely and see where the differences are. Here's the WHO Table:
21 January 2008
Country
2003
2004
2005
2006
2007
2008
Total
cases
deaths…
revere | January 21, 2008A report late last night by Helen Branswell alerted me to a tabulation from a new tracking system WHO is putting into place to answer demands from a number of member states in the developing world that there be more transparency in how isolates of avian influenza (bird flu) submitted to WHO are used and by whom. About a third of confirmed cases have been registered in Indonesia, although that country has provided less than a quarter of the isolates, a reflection of the refusal by the country's health minister, Dr. Siti Fadilah Supari, to provide any more specimens until matters of vaccine…
revere | January 21, 2008We've complained enough about the unwise words of M. Vallat, Director General of the World Organization for Animal Health (OIE; see here and here). Nor was it the first time (May 2007).
What I didn't say was that whenever I hear an official like M. Vallat assure us that everything is stable, a chill runs down my spine. Invariably shortly afterward things start to come apart. These folks have an uncanny sense of timing. So now we have bird flu in Iran again for the first time since 2006 and the virus is marching relentlessly across India (things have gotten messy with culling teams attacked…
revere | January 19, 2008I saw a small news article about what seems to me a fairly silly piece in a bulletin called Communicable Diseases Intelligence:
Never mind the Tamiflu, authorities should be stockpiling thermometers in preparation for an influenza pandemic, public health specialists say.
The much-rehearsed public health measures to contain an outbreak of influenza may fail because they falsely assume that most households have thermometers to allow self monitoring of suspected fever, they write in the bulletin Communicable Diseases Intelligence.
For containment to be effective, health workers are expected to…
revere | January 18, 2008In 2005 the world's bird flu doctors got together and pooled their meager knowledge about the epidemiology and clinical features of this zoonotic disase that has so far infected 350 people and killed 217 of them (latest "official" figures via WHO). In March of 2007 they got together again in Turkey and the New England Journal of Medicine (January 17, 2008 issue) has just published a joint report summarizing their discussion. Helen Branswell sets the stage:
The article, a review of data compiled on human cases to date, answers some questions about how the virus affects people. But it also…
revere | January 17, 2008When we complained the other day about World Organization for Animal Health (OIE) Director General Bernard Vallat's ill-considered remarks about how stable H5N1 was and that earlier fears were "overblown" we were not alone. Mike Osterholm at CIDRAP issued a similar remonstrance and the latter was publicized by the folks at Avian Flu Trackers on a press release that was picked up by a number of papers. Now DG Vallat is busy trying to extricate his foot from his mouth (or wherever he lodged it):
At an informal meeting with the press on 10/1/08 , the Director General of the OIE, Dr Bernard…
revere | January 16, 2008The host range of H5N1 is impressive: birds, of course; but also many mammals, including dogs, cats, stone martens, ferrets, mice, rats, humans. There are undoubtedly others. Cats are probably infected when they eat infected birds. Dogs? Not clear. Humans? Birds, other people on rare occasions. What else? In fact we know incredibly little about how various hosts are infected. Do cats spread it from cat to cat and dogs, dog to dog? How about cats spreading it to dogs and vice versa? Of course dogs to humans or cats to humans is an important topic. So it's good to see some studies looking at…
revere | January 15, 2008Most of us read the Federal Government pandemic flu plan as having two components: the first is procurement of vaccines and antivirals for stockpiles and sale to states at a discount; the second is to leave everything to the locals. The American Civil Liberties Union (ACLU) sees it differently and they may well be right. They see the federal pandemic flu plan as containing a covert but not subtle command and control law enforcement core. Whatever you think of the ACLU (and I confess to be ambivalent because they caved in to McCarthyite enemies of civil liberties in the 1950s; they have since…
revere | January 13, 2008I'm not sure who Professor David Alexander, the Robert Gordon University in Aberdeen, Scotland is (he's identified as an adviser to NAOA and the UK Government on pandemic flu) but I think he's got it right:
The public would put themselves at risk because they would not trust politicians to tell the truth if the country was hit by a major outbreak of bird flu, a world expert on disaster management has claimed.
Professor David Alexander, of the Robert Gordon University in Aberdeen, has been appointed as an adviser to both Nato and the UK Government on the issue of pandemic flu.
Alexander says…
revere | January 11, 2008An AP report in The Daily Star (Egypt) says the head of the World Organization for Animal Health (OIE) is complaining that fears of a flu pandemic caused by H5N1 are overblown. He's talking to the press so presumably he understands that he has to be careful how he says things. So we also have to assume that when Bernard Vallat said that he meant to send a message. But what is the message?
Vallat said the H5N1 virus has proved extremely stable, despite concerns that it could mutate into a form that could spread easily among humans.
"We have never seen such a stable strain," Vallat said.
He…
revere | January 10, 2008Whenever confirmed human cases of bird flu appear in an area there usually follows heightened sensitivity to new cases of severe pneumonia. Are they bird flu too? Severe pneumonia is pretty common, so you can't automatically assume that "if it quacks like a duck and walks like a duck it must be a duck." It turns out there are a lot of birds that look like ducks that aren't ducks, at least when it comes to influenza-like illnesses. On the other hand, "testing negative" with PCR, which on its own is a pretty sensitive and specific test is also not foolproof. "On its own" means under the best…
revere | January 9, 2008Every year "flu season" comes during which there is a marked uptick in influenza-like illnesses (ILIs) in the community. An ILI is defined to be cough or sore throat together with a fever of over 100 degrees F. (37.8 degrees C.) or self-reported fever and chills as well as no other obvious cause (e.g., strep throat). But are all ILIs influenza? No. They are ILIs. In the absence of lab work (and since most are thought to be of viral origin, only non-specific symptomatic and supportive therapy is recommended and no diagnostic lab work is usually done), an ILI could be from influenza virus or…
revere | January 8, 2008A new study from a glycobiology laboratory at MIT is creating a buzz in the flu community (see the MIT Press Release here). A great deal of molecular biology and virology studies what happens when the virus gets into a cell to use the cell's own machinery to make copies of itself. Glycobiology is a relatively new area, concentrating on the straight and branched chains of sugar units that make up a great deal of the "stuff" one finds outside of a cell. What do these sugars have to do with influenza?
In earlier posts (see here and here and links therein) we showed how the influenza virus…
revere | January 7, 2008Hospitals are dangerous places, but sometimes you have to be there. If you are a child in the developing world sick with pneumonia, the World Health Organization (WHO) thinks that's one of the times. Pneumonia is the big killer of children globally, so WHO guidelines call for children with severe pneumonia to be treated with intravenous antibiotics in the hospital. Now a landmark clinical trial from a team at the Boston University School of Public Health and published this week in The Lancet (January 4 issue), says these seriously ill children will do just as well at home on antibiotic syrup…
revere | January 6, 2008The big newswires and health agencies are relatively quiet, but word keeps leaking out of Egypt that there are a lot of suspect bird flu cases:
CAIRO: Hospitals nationwide reportedly quarantined more human cases suspected of being infected with the H5N1 bird flu virus.
According to Al-Masry Al-Youm newspaper, Damietta -- where the latest Bird Flu victim Hanem Atwa Ibrahim, 50, died late on Monday Dec. 31 in a Cairo hospital -- hosts the largest number of cases with five people suspected of carrying the virus, while the Upper Egyptian city of Qena came next, with two cases, followed by El-…
revere | January 4, 2008With the turn of the calendar there is always both hope and anxiety about the year ahead. This is nice because it gives pundits and bloggers something to write about. Just before Christmas The Times of London published\ a "leading article" (unsigned), Black Swans and Bird Flu, which was about the anxiety part, assessing the threats, and planning for them in advance:
Living at risk, it has been said, is akin to jumping off the cliff and building your wings on the way down. Not everyone would be content with such a strategy. Some would not venture close to the edge, even if that meant missing a…
revere | January 3, 2008The back and forth about WHO over the weekend generated plenty of comment. I am still of the mind that WHO is an important part of the pandemic flu picture and we should try to help it do better. After defending them on Friday of last week I turned around and slammed them for poor risk communication on Sunday. A commenter observed that this may have been bad reporting, and while I allowed the possibility, I thought it too similar to past examples to accept this as the first explanation. However yesterday I received the following email from Mr. John Rainford, the WHO spokesman I took to task…
revere | January 2, 2008Egypt continues to be the country outside of Asia with the highest case total of H5N1 disease. Last year there were 23 cases, 18 the year before. A year ago there were 3 confirmed cases each in December and January, with the big month being later, March (7 cases). Flu season (including bird flu) is starting again there with four deaths at the end of December, the first since July. The flu sites newshounds are doing their usually diligent job and they report an additional confirmed but still living case. In addition there are the usual spate of "suspect" cases, a fluctuating number that can…