bird flu
revere | December 10, 2007The debate about how much wild migratory birds contribute to the spread of highly pathogenic influenza/A H5N1 goes on. According to a sensible Commentary in Nature (Dec. 6) it needn't. We should have taken steps some time ago to answer an answerable question. But we didn't and still haven't initiated those steps:
Two years ago, some believed that H5N1 viruses were poised to spread around the globe on the wings of migrating wild birds. A massive effort was mounted to track their movement but, as of September 2007, very few positive birds have been found in tests of over 300,000 healthy wild…
revere | December 8, 2007Earlier in the week we discussed the unfortunate 24 year old man who died of bird flu in Nanking in Jiangsu province. He had had no known contact with sick poultry. Now the father has bird flu. Did the father get it from the son? Did both get it from the same source? Or two different sources? Those are the open questions at the moment as Chinese health authorities struggle to follow up the health status of the father's 69 suspected contacts:
"The patient, a 52-year-old male surnamed Lu from Nanjing in Jiangsu, is the father of the serious case of bird flu diagnosed on December 2," said the…
revere | December 5, 2007Most people in the developed world think of measles as a pesky but fairly benign childhood disease. For the current generation, who has had the benefit of immunization with measles vaccine, it is also a historical curiosity. Not so for the developing world, where measles has been a major killer of children and infants. Africa has become the poster child for failed public health programs so it is nice to be able to say that when it comes to measles prevention, Africa is a special success story:
Africa, which has long had the most measles deaths, has seen the biggest drop, 91 percent. In many…
revere | December 5, 2007Indonesian Health Minister, Siti Fadilah Supari, has reiterated her refusal to share isolates of H5N1 virus (it's unclear if this is her decision alone or is the considered decision of the Indonesian government). This came at the current inter-minsterial conference on bird flu on underway in Delhi (how many of these conferences are there, anyway? It seems like every week there's another one.) Her demand is that every isolate have a Material Transfer Agreement (MTA) requiring a statement each time the isolate is shared with another laboratory, stating it is only for diagnostic purposes and not…
revere | December 4, 2007China has just registered its 26th known case of bird flu and its 17th death. I emphasize known, because in a country of over 1.3 billion that has not been able to eradicate this virus from its vast poultry population, it would seem the real number is probably quite a bit higher. But what I want to return to about this case is something I have discussed before regarding the Chinese cases (and pertains to most of the other reported cases as well), but is starkest for the Chinese reports. But first, the pertinent part of the case:
China's first human case of bird flu in six months shows that…
revere | December 3, 2007I'm traveling so I'll let other bloggers do the heavy lifting. And I can always count on flu bloggers of note, Crof and SophiaZoe. Both discuss and link to reports of H5N1 in refrigerated turkey meat sold in stores in Poland (I particularly recommend SZ's excellent summary of the safety issues). While I don't have a lot to add to their coverage, I'd like to inject just one more issue related to finding the virus in meat
An ongoing debate is the relative contributions of migratory (wild) birds and domestic poultry to spreading H5N1 geographically. There is evidence for both mechanisms, and…
revere | November 30, 2007Another report, another story: the world is not ready for a pandemic. Before you click away (you've heard it before) I'll be saying something more about it than just reiterating the dire prognosis if we don't shape up. But first the message, from the UN and the World Bank:
The world remains unprepared to cope with a pandemic in humans arising from bird flu, a UN and World Bank report released Thursday found.
"Although a massive global effort to control highly pathogenic Avian Influenza (or severe bird flu) has led to improved responses to outbreaks in poultry in many countries during the last…
revere | November 29, 2007Nonpharmaceutical interventions (NPIs) are in the news again. Yesterday was the dust up over Howard Markel and colleagues' JAMA article from last August that appeared in CIDRAP News calling into question some of the historical data on the effectiveness of isolation and quarantine and now it's an article in British Medical Journal that purports to show that some kinds of physical interventions like masks, gowns and handwashing might be better bets than vaccines and antivirals should a pandemic come our way:
Face masks and regular hand-washing are more likely to halt the spread of a deadly flu…
revere | November 28, 2007A Commentary by John Barry (author of The Great Influenza) in CIDRAP News and accompanying meta-commentary by CIDRAP Director Mike Osterholm highlight an interesting controversy about a JAMA article by Michigan's Howard Markel and colleagues. Markel's article was a detailed compilation of public health responses to the 1918 influenza pandemic in 43 cities in the US with the aim of telling whether any was associated with better community outcomes. The Markel paper bore the following conclusion:
These findings demonstrate a strong association between early, sustained, and layered application of…
revere | November 26, 2007Indonesia's health minister, Siti Fadilah Supari, has answered the question whether the recently concluded Geneva summit on sharing of influenza viruses had produced sufficient agreement to induce that country to begin sharing again. Her answer seems to be "no":
Indonesia's health minister reiterated Sunday that she would not send bird flu specimens to the World Health Organization, saying poor nations needed assurances that any pandemic vaccines developed from the virus would be affordable.
Siti Fadilah Supari made the comments on her return from Geneva, where the WHO held an…
revere | November 24, 2007As you will see from the account below the fold, the flu summit was a contentious and complicated affair. Only time will tell if it was even a qualified success, but there are reasons to be hopeful. Tip of the hat to Ed Hammond, one of the NGO participants, who provided the public health community with his perspective at a time when no one else was talking. This involved late hours for him at the end of long days. We are grateful.
Here's his wrap-up:
Influenza Meeting Ends in Qualified Success
At the end of contentious meetings like the one on policies for sharing flu virus it is tempting to…
revere | November 24, 2007Yesterday was the fourth and final day of the important Geneva summit on sharing flu virus isolates. Like premature news of Mark Twain's death, the Reuters report the meeting had failed was exaggerated. On the contrary, the summit appeared to have moved things forward. We have the latest, below. You can find previous happenings and background here, here, here and here.
Status mid-day, Day 4 (3:26 pm Geneva time, November 23), as reported by Ed Hammond:
Some Things That Happened in the Night Session of Day 3 and Morning Session of Day 4
These sessions were the final negotiations before…
revere | November 23, 2007The critical summit on sharing influenza viruses entered its third day (previous coverage here and links therein). The big media outlets covered the opening but not since. Fortunately, you can read about developments here (Day 2, here). Ed Hammond is there and is keeping us abreast of developments.
A participant's view at the start of Day 3 (5:30 am, Thursday, Geneva time):
Halfway Through and No New Ideas from the US and EU
To be sure, Indonesia has not been the most effective leader for its cause. Its multiple failures at this meeting (if not previous ones) to put forward clear language…
revere | November 22, 2007We have an on-the-ground view of the critical influenza virus sharing summit, provided by Ed Hammond in Geneva. I am promoting his comment thread notes from earlier today and a fuller account from late in the evening on Wednesday (Geneva time) sent me by email. It is clear that the atmosphere is tense and not convivial.
First, if you haven't been following the issue here or elsewhere, here's a bit of background from an excellent piece at Intellectual Property Watch (h/t Agitant):
The politically explosive issue of ensuring everyone benefits from vaccines in the event of an influenza pandemic…
revere | November 21, 2007The first day of the scheduled four day showdown in Geneva over sharing bird flu virus isolates is now over. What seems to have been accomplished is statements of opening positions. How moveable everyone is remains to be seen, as does whether there is an Alexander the Great around to cut the Gordian Knot (you can see the strands of the knot in some of our previous posts, for example (chronologically) here, here, here, here, here, here, here, here, here, here, here, here, here, here and here).
Here is Reuter's version of Day 1:
Indonesia, the nation worst hit by bird flu with 91 human deaths,…
revere | November 20, 2007If a rogue H5N1 virus easiy tansmissible between people is to develop, the most plausible spot for it to happen is Indonesia, the world's fourth most populous with a vast reservoir of infected poultry (and who knows what else) and more human cases (113) and more deaths (91) than any other country. But Indonesia still refuses to share its human H5N1 isolates, contending they get nothing tangible from an arrangement which is likely to lead to vaccines they won't be able to afford. Under the current system, which allows intellectual property rights to cover vaccines developed from WHO supplied…
revere | November 15, 2007If you are in the "older age group" (as those of us in that group prefer to be called) you are at increased risk of dying from seasonal influenza (pandemic strains seem to target the young), but you are also less likely to be helped by a flu shot because you don't mount as fast and effective an immune response. At least that's what we think on the basis of current evidence. Like everything else about flu, it's subject to change.
Like the idea that you have a 48 hour window for the use of antiviral neuraminidase inhibitors like tamiflu. After 48 hours, we believed, they don't do any good.…
revere | November 14, 2007The UK has a bird flu outbreak in turkeys. With any luck the government will do a better job of it than they did last time, although they are slashing funds for control of the problem, which doesn't make much sense. But at least we know about it and how serious it is or it isn't. We don't have to guess or wonder or suspect. Not true for China, also experiencing an outbreak in the southern city of Guangzhou. As usual, China is controlling the news. They are also probably suppressing it:
The outbreak in Guangzhou's Panyu district is the first of the H5N1 bird flu strain since May, but it has…
revere | November 13, 2007WalMart isn't my favorite store but they have shown one effective way to increase awareness about preparing for a pandemic or any other catastrophe that would interrupt supply chains and routine services. The store had a "free flu prep kit" lottery where entry involved filling out a survey about how much they knew about fllu preparing for flu. The winner was among 350 entries and she is frank to admit she didn't now anything about pandemic flu. That's changed:
Heather Farris says she didn't know much about a pandemic flu before, but now with enough flu supplies to stock a small van, she plans…
revere | November 11, 2007Time to return to a theme we have sounded on numerous occasions in the past three years. In a recent post we called for a renewed investment in our public health and social service infrastructure as the best strategy. The object is to harden local communities and make them more resilient to all kinds of shocks, not just a pandemic. We should have added, however, that this means local preparation can't be too local: only looking after ourselves and our families. Of course families should prepare, to the best of their ability, and having some reasonable stockpile will stand them in good stead…