Pandemic preparedness
revere | June 12, 2008Crof, over at H5N1, has an important piece on Indonesia that is worth thinking about. He observes something that lots of us haven't paid attention to: Indonesia hasn't been notifying the UN agency on animal health, the OIE, about bird flu outbreaks in poultry for almost two years:
Here is the very last post from Indonesia: OIE DAILY UPDATE ON AVIAN INFLUENZA SITUATION IN BIRDS. As you will see, the date is September 26, 2006. Since then, Indonesia has told the world nothing about its poultry panzootic.
Look at this map of B2B H5N1 outbreaks. Indonesia looks as clean as Argentina.
Look at this…
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 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 18, 2008If you want to know how far we've come since the early days of discussing community preparations for a possible influenza pandemic, take a look at a story at CIDRAP News about a new guidance document prepared by the Association of State and Territorial Health Officials (ASTHO) and its partners. This is described as the first federal document of its kind prepared outside the federal government (although with a grant from CDC). It's about how to provide necessary resources and services to those who will need it most but who are also the hardest to reach. The 105 page document is aimed at state…
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 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 4, 2008One of the least talked about problems in pandemic preparedness planning is that even if there is flu all around us and the health care system is struggling (and almost certainly failing) to handle the resulting demand of patients, people will still be getting sick from the usual things (heart attacks, strokes, etc.), having accidents, and yes, getting pregnant.
There is pretty good reason to think that getting the flu when pregnant is even worse than getting the flu otherwise. A pregnant woman's immune system reacts differently because of the special circumstance of accommodating the…
revere | April 3, 2008The index case was a 5 year old Miniature Schnauzer with 5 days of nasal discharge and sneezing. The dog recovered but the next case, a 3 year old Cocker Spaniel wasn't so lucky, nor were the 2 Korean hunting dogs (Jindos) or a 3 year old Yorkshire terrier. Then 13 dogs in a shelter started to show signs of nasal discharge, cough and high fever. Antibody studies showed that they had all been suffering from influenza infection, subtype H3N2. These cases happened in the spring and summer of 2007 (NB: this is not flu season). H3N2 is the most common subtype involved in human seasonal influenza.…
revere | April 2, 2008If a worker refused to report for work because it was a demonstrably dangerous workplace they would be within their rights, with a few exceptions. One of the exceptions in some states seems to be health care workers (HCW) who refuse to work during a pandemic. A HCW, like any other worker, might not report for work for a variety of reasons: fear for their own safety, fear for the safety of their families should they bring home an infectious disease like influenza, need to care for their family if one is sick or has not caretaker (say, because the schools are closed). In at least two states,…
revere | March 31, 2008Trust is not transitive, as someone recently pointed out, when reporting on the airline pilot who carried a gun into the cockpit and then accidentally or negligently discharged it and blew a hole in the plane. We had every reason to trust the pilot to be able to fly a 747, but not necessarily to handle a firearm properly. Trust isn't transitive.
There is no doubt that Yi Guan, a professor at the University of Hong Kong, is an expert on H5N1 virus, its genetic lineages and surveillance for the virus in wild birds. He has reportedly screened, via cloacal swabs and fecal specimens, more than…
revere | March 27, 2008Bird flu is a viral disease but its effects go beyond viral infection. An obvious but important fact. Consider Egypt.
The first poultry cases in Egypt were only a little over two years ago, but the virus quickly took root there. The poultry infections were a harbinger of human infections, 18 that year (2006), 25 the next year, 4 so far this yar. Egypt now has more human cases of the disease than any other country outside of Asia (47 cases, 20 deaths). Like other countries with bird flu problems they also have a large population who lives in close contact with birds. Many people keep poultry…
revere | March 25, 2008We've covered the Indonesian refusal to cooperate with international influenza surveillance system to a fare thee well (see posts posts here, here, here, here, here, here, here, here, here, here, here, here, here and links therein), so this is just an update with some additional observations how Indonesia's deplorable behavior isn't that different than the US's deplorable behavior in the Middle East. First, Indonesia. When last we checked in Indonesia had sent off half a dozen flu specimens from the period after the end of January 2007 when it started its boycott. The hope was that the…
revere | March 21, 2008While we are all waiting for the other shoe to drop and a nasty, rip roaring flu pandemic to come rushing down the tracks at us, lots of companies have jumped into the pandemic vaccine sweepstakes. Reuters reports that at least 16 companies are testing flu vaccines and probably even more are involved in some technical aspect of vaccine production. That's good, although whether it will make any significant difference except around the margins remains to be seen. Timing is everything.
Meanwhile, though, work is going forward on many vaccine fronts. The one to hit the PR wires today is a report…
revere | March 20, 2008I rarely report about suspected bird flu cases here, preferring to wait a couple of days to let things sort out. In the early years of this blog I did report about them in the course of time, experience and some reflection we have come to our present position. Besides, it's not necessary. There are plenty of reputable, reliable and thorough places in flublogia to get up to the minute news. Given all that, it isn't surprising we didn't say anything here about a couple of suspect imported cases in Toronto. In fact, like crof, I hadn't heard about them. Now, thanks the the denials streaming out…
revere | March 19, 2008The chief veterinary officer of the UN's Food and Agriculture Organization (FAO) reaffirmed what everyone paying attention already knows: the bird flu situation in Indonesia is critical. The archipelago nation is the fourth most populous country in the world fragmented geographically on 17,000 islands and politically by a disastrously decentralized government. Of its 31 provinces, FAO says 31 have reported infected poultry, and on some of the largest -- Java, Sumatra, Bali and southern Sulawesi -- it is endemic and solidly entrenched. There are an estimated 30 million poultry smallholdings in…