Public health preparedness

Trust 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…
We'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…
My children are no longer young. In fact they are old enough to have children of their own and when my daughter asked me if I thought her then 6 month old should get a flu shot I didn't hesitate: Absolutely, I said. And he did. Two of them, the required number. That was just before the flu season, which he has so far weathered just fine. Sadly that's not true for all children. The two most vulnerable groups for dying from influenza are children under 5 and the elderly (me). I got flu shots, too, although the evidence it will help me is not as good as the evidence my little grandson will be…
While 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…
I 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…
The 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…
Last week The US Department of Health and Human Services (HHS) released a comprehensive pandemic flu guidance document for states, accompanying it with a web presentation, the first of three. I haven't seen the Web Seminar and only quickly perused the document, so I am commenting on the basis of a description in CIDRAP News, a reliable source. You can find the Web presentation and document at pandemicflu.gov. It is always best to see the original, so this is my take from a second hand source. Even so, I don't think our take is likely to be wildly off kilter (assuming you don't think we are…
There are all sorts of ways to prepare for an emergency. One is to simulate it inside a computer (a computer model). But you don't have to simulate inside a computer. You can also do it in "meatspace" (aka, the real world). Dungeons and Dragons using books is one example of this. Another is to do a pandemic version of D&D. It's called a table top exercise, although the size of the table can be pretty big. Recently our wiki partner, DemFromCT (if you can call someone a partner who does all the work), observed a CDC exercise which he has described in detail over at the FluWiki Forum (here,…
The headline seemed to say it all: "Funding Issues Stymie Pandemic Preparation." Right, I thought. All the money is going in to procurement, too little into shoring up a failing public health system. Little did I know: The fear of bioterrorism and avian flu are driving a healthy new interest by biotech firms in developing products in the field of infectious diseases. "Even though we were developing a smallpox vaccine in 2000, there is no doubt that 9/11 was the moment that biodefense suddenly came up the funding ladder in the U.S.," said Clement Lewin, Ph.D., vp of marketing policy and…
I'm an advocate of using computer models to help us think about what might or could happen during various pandemic flu scenarios, but it is a technique with drawbacks. For one, it can suggest that some things might be possible that are either very difficult to do or aren't feasible. This happened in 2005 when some models were published in Science and Nature that suggested a pandemic could be nipped in the bud before it started. Most people thought that what was required was unrealistic but it put WHO in a bind. They had to marshal their resources to show they were willing to try or go down…
Here's what a flu pandemic might look like: "In four weeks, we went from a ho-hum flu season to ridiculous overcrowding," said Dr. Maurice Ramirez, an emergency physician who works in several institutions in north Florida. "We have had so many people that we have them, not in beds in the hallway, but in chairs with a number taped to the wall over their heads." "We've seen a tremendous amount of flu--from an anecdotal standpoint, a much busier season than in recent years," agreed Dr. Peter A. Lipson, a private practice internist in southern Michigan who also sees patients at a walk-in clinic.…
There are a lot of open questions about the influenza antiviral drug oseltamivir ("Tamiflu"), among them whether it works at all for bird flu (highly pathogenic influenza A/H5N1), and if it does, whether resistance will develop making it ineffective. But all the questions have a common assumption: that the patient is actually taking Tamiflu. How would you know if you were or not? Because the bottle says so? Not necessarily. In December 2005 U.S. Customs and Border Protection (CBP) Officers seized 51 shipments they said were counterfeit Tamiflu pills at their air mail facility in San Francisco…
If you look at the bar chart below you will see that this year's bird flu season is shaping up to look pretty much like last year. In the first two months of the year there are a few more cases but essentially the picture looks much the same. If that is indeed true, then also expect a spike of cases this month (March) since you can also see that is the past pattern. Already cases are being reported in Egypt, and of course, Indonesia. The countries involved this season have been Vietnam, China, Egypt and Indonesia, just like last year. Whether you consider that reassuring or worrying probably…
Press releases are the way a lot of scientific information is released today. Straight to the public, no peer review. This has advantages and disadvantages. The advantages are speed and directness. No filtering through reviewers, journal editors, colleagues. And of course that's the disadvantage, too, especially when the news comes from an interested party as it usually does in a press release. This is part of the interpretation of data these days. All that being said, the maker of Tamiflu, Hoffman - La Roche, has released data they have gathered from physicians treating cases of H5N1 in…
The Indonesian virus sharing impasse is said to be over, and with the dénouement comes some fascinating new information. Many will remember the row started when an Australian vaccine maker took an Indonesian viral isolate and made an experimental vaccine from it (see many posts among those here). At the time it was said the Indonesian Health Minister objected that her country would never be able to afford the vaccine and she therefore stopped making the virus available to WHO. WHO was the source of the seed strain used by the Australian company to make a prototype vaccine. It turns out,…
All I can say is that it's a good thing Canadian Press's Helen Branswell isn't a blogger or she'd put all the rest of us flu bloggers out of business. She is the professional flu reporter's professional (one of the best of the flu reporters once described a story of hers to me as "annoyingly good"). Being in Canada she also has more of an international perspective, as in a recent story about differences between seasonal flu in the US and Canada this year, a story that would have escaped the notice of US based reporters (hat tip to crof): Maps generated by the Public Health Agency of Canada…
Indonesia is providing bird flu specimens to WHO again. And Indonesian Health Minister Dr Siti Fadilah Supari has just published a book declaring the 50 year plus history of global influenza surveillance is part of a conspiracy by the developed world to control the rest of the world: "Developed countries become richer because they have the capability to develop the vaccine and control the world," she writes. Dr Supari also expresses alarm at WHO laboratories sharing bird flu virus data with the United States National Laboratory in Los Alamos, New Mexico, where nuclear weapons are developed. "…
CDC has just issued a report on the state of US readiness for a health crisis. Its assessment is upbeat: In the first report of its kind, US health officials said the nation's cities and states made a strong effort to prepare for a flu pandemic, bioterrorism, or other emergency health crises, but big challenges remain. "I think in terms of effort and progress, an 'A,' " Dr. Richard Besser of the Centers for Disease Control and Prevention said when asked to assign a letter grade. "In terms of amount of work to be done, I would say that's absolutely enormous." (AP) Let's see if we can interpret…
There's bird flu in poultry all over Bangladesh and new human cases reported in China, Vietnam and Indonesia. Is this the sound of the other shoe dropping? Or is it just this: This barchart is from February 5 so it doesn't include all the new cases. But it clearly shows that when we get to flu season we also get to bird flu season. How will we know if something different is happening? It's a good question and I don't have an easy answer. Here are four signals and what I would make of them. Sudden increase in number of cases that are not connected or are connected by a common source (as…
When my colleagues announced early afternoon on Friday he was headed home because he was sick, I knew the flu had finally arrived on my doorstep. It was already here, of course. The emergency rooms are jammed, clinics have long waits and hospital admissions for flu are up -- way up. The flu situation was the page one column eight story in Saturday's Boston Globe: The flu virus is rampaging across New England, spawning waves of coughs and fevers, causing patients to flood doctors' offices, and raising questions about the effectiveness of flu shots given to tens of millions of Americans. During…