Public health preparedness

If avian influenza comes to North America one likely route is through importation or smuggling of infected birds. To protect ourselves, we need good border controls and to do that the US Department of Agriculture needs to know where in the world outbreaks are occurring. A USDA Inspector General's Report says that isn't happening: The USDA should have tested new or revised procedures that relate to pandemic planning, but the agency has not tested 14 of 26 tasks for which it was designated the lead agency, the report states. Though the federal plan does not require the USDA to test the…
A recently published Commentary in the Journal of the American Medical Association (JAMA) raises some interesting and serious questions about conventional efforts for pandemic flu preparedness. The author is John Middaugh of the Florida State Health Department, a long time public health professional. The last I saw him he was in Alaska, so he seems to have put quite a bit of distance between his current and former places of employment. Indeed the question of people distancing themselves from each other is a central theme of the Commentary: Although continuing to invest in diverse aspects of…
We've discussed this already, but now CIDRAP News also has a story (which they got from AP) that this year's flu vaccine is not perfectly matched to the all the circulating viruses (of course we had it first, but hey, who's keeping track?). The data that are used to prepare vaccines for the next flu season come from predictions based on what is seen during the current season as determined by a global surveillance network (the same network at issue in the refusal of Indonesia to share H5N1 isolates, although this mismatch has nothing to do with the Indonesian situation). The circulating…
Blogging can be exhausting. A blogger who wants to be read (not all do) has a hungry mouth, a mouth best fed daily. This one gets fed twice (once on Saturday), seven days a week, 365 days a year. The Reveres have been shoveling stuff into this ravenous maw for over three years. So we sympathize and understand the plight of the excellent flu blogger Sophia Zoe who has been missing of late. She explains where she's been in A Lesson in Real Life (hat tip Avian Flu Diary). Characteristic of her excellent blogging, she also draws a pandemic preparedness lesson from it worth pondering. Here's the…
After our recent rant on the necessity of supporting the public health and social services infrastructure instead of cutting taxes, President Bush has replied. He is cutting the infrastructure: President Bush's $3 trillion budget for next year slashes mental health funding and rural health care and freezes spending on medical research, among the cuts outlined in budget documents obtained by The Associated Press. The budget for the Department of Health and Human Services would be reduced by almost 3 percent under the Bush budget plan to be released Monday. The $2 billion in HHS cuts are about…
The AP's Margie Mason is a pretty good flu reporter and she has a story on the wires today whose title encapsulates the bird flu history of the last four years: Bird flu continues march 4 years later. The number of human deaths is still not large -- a few hundred -- just a day at the office in Iraq. But the virus just keeps extending its geographic range in poultry stocks and wherever it does it there is a risk of human infections. Fourteen countries so far have officially confirmed influenza A/H5N1 cases. The number of birds killed by infection or slaughtered to prevent the spread of…
The number of deaths in Indonesia from bird flu just shot past the 100 mark without even pausing -- 101 was recorded right afterward. Tibet announced an outbreak and the disease continued to march through the Indian subcontinent, although the UN flu czar, Dr. David Nabarro said he thought the Indian/West Bengal outbreak was "coming under control." The use of the progressive tense here ("coming under control") suggests this is a mix of hope and belief and in any case indicates the outbreak is still not under control. Which won't come as a surprise to the residents of Kolkata (neé Calcutta):…
OK, they're not cities, they are states. Or cities in states. Whatever. But when it comes to flu shots they are quite different. First benighted Mississippi: The Mississippi State Department of Health (MSDH) reports 27 laboratory-confirmed influenza cases in counties throughout Mississippi. The presence of influenza was documented by the MSDH Laboratory in the past few weeks. "We are now in the peak season of influenza, which will last for the next couple of months," said State Health Officer Dr. Ed Thompson. "If you haven't gotten your flu shot, it's time to get it now. It's still not too…
Since the antiviral agent oseltamivir (Tamiflu) has been touted as the global savior should a bird flu pandemic materialize the idea has been haunted by the specter of Tamiflu resistance. What if H5N1 becomes resistant to the drug? Is all lost? Now it is being reported in the media that the European Centre for Disease Control and Prevention has found that the predominant circulating seasonal flu virus in Europe this year, H1N1, is showing an unexpectedly high rate of Tamiflu resistance (19/148 isolates tested). This is much more than what has been seen in the past and was from patients not…
There's no vaccine for the influenza subtype, H5N1, of most concern as the agent of the next pandemic but evidence exists that there is some cross-reactivity with existing seasonal vaccines (it's not clear how much if any, but it might not take much) or that previous vaccination with seasonal vaccine produces a much quicker response to an H5N1 vaccine. Moreover there remains a substantial toll in morbidity and mortality from the seasonal influenza which the current vaccines are designed for. So strategies to encourage key populations to get the existing flu vaccine are of interest to public…
Predictable 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,…
In 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…
A 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…
We'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…
Most 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…
I'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…
An 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…
The 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-…
With 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…
Everyone seems to have an opinion about whether bird flu will be the next terrible global pandemic. In current parlance "bird flu" means human infection with the highly pathogenic avian influenza/A subtype H5N1. There is no doubt that this is the 800 pound gorilla in the global health room at the moment, but not because it is more likely to become a pandemic (NB: pandemic by definition is a globally dispersed sudden increase in infection among humans; the same situation for animals is called a panzootic, and it is plausible to say we have an H5N1 panzootic for birds now). On the basis of…