WHO
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 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 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 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 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 | December 30, 2007After spending more time than I wished "defending" WHO against what I considered a particular kind of scurrilous attack (it also seemed to raise the hackles of some unintended as targets, but the dialog with them was at least rational) -- after all that, I now have to turn around and complain about WHO (again). Let me be constructive and offer their spokesperson, John Rainford (or whoever writes the statements he mouths), a little biology lesson. A mutation of a virus is a technical term that describes a replicable change in the sequence of bases that constitute the virus's genetic blueprint…
revere | December 28, 2007Former Pakistani Prime Minister Benazir Bhutto, despite a bevy of bodyguards, was assassinated yesterday. Pakistan is a dangerous place, especially for pro-American politicians or those thought to be pro-Western officials. It's something to think about when you read that WHO and the US reference laboratory NAMRU-3 each sent teams to the politically unstable and hostile-to-the-West northern regions of Pakistan to gather information about the recent cluster of bird flu cases. WHO's team was in Peshawar, north of Islamabad. Here's what Middle East expert Juan Cole said about Peshawar the other…
revere | December 22, 2007WHO [World Health Organization] is now saying that human to human (H2H) transmission has not been ruled out in China or Pakistan:
China:
The World Health Organization said Friday it was impossible to say whether a case of bird flu in China involving a 52- year-old man was due to human-to-human transmission - but, even if it was, it was down to very close contact between the victims.
The Assistant Director-General for Health Security at WHO, Dr David Heymann, said the only proven transmission of this nature so far, in Indonesia and Thailand, had been as a result of very 'close contact' in a '…
revere | December 21, 2007It's been less than a week since the first reports out of Pakistan that cases of bird flu were appearing there. At the time we warned that the coming of flu season meant these kinds of reports were to be expected, but by the weekend concern increased as a family cluster appeared. As common in the early days of an outbreak news reports were contradictory and confusing. We elected to wait. By Sunday, some excellent reporting by Helen Branswell and diligent combing of the news by flusites allowed us to make a preliminary summary. We fully expected more surprises.
The biggest surprise so far is…
revere | December 17, 2007With everyone on tenterhooks over the confusing outbreak of human bird flu cases in Pakistan and the first reported case in Burma (aka Myanmar), WHO is taking the opportunity to give its member nations a pep talk about swift reporting. Since there is evidence the reporting might not have been so terribly swift in that case, one must assume they consider this a "teachable moment" rather than an exemplar:
The World Health Organisation (WHO) on Sunday praised Asian countries for swiftly reporting the latest bird flu cases after Pakistan and Myanmar were hit by a resurgence of the disease.
Asia-…
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 7, 2007This post is about something I've wanted to write about for a while, but never found the time. That's still true, but I've just spent five days as a natural environment for a norovirus or something similar. The good news is I lost 5 pounds. But the bad news -- and there was a lot of it -- is that as I recover I am desperately trying to catch up on too many urgent things that didn't get done. Still, this story is something I want to write about, so I'll do it more briefly now and come back at some later point for more analysis. What's bothering me? Press embargoes:
The World Health…
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 1, 2007Dr. Margaret Chan, a Hong Kong native, has been at the helm of the World Health Organization (WHO) now for almost a year. The Associated Press (no by-line) has an interesting sketch of her, which includes her penchant for using song as an ice-breaking device in contentious settings. We brought you Ed Hammond's report that she burst into "Getting to know you" at a critical point in the recent tense summit over sharing of bird flu virus in Geneva. AP also reports this event, but remember you heard it here first. IN any event, here is some more of their limning of Chan:
Since the karaoke-loving…
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 | June 18, 2007This past weekend was a historic one in international health. The signal event, the coming into force of new International Health Regulations (the first since 1969), was marked by only a few outside WHO. The remarkable thing about them is the new IHR bring the system of international health into line with a new reality of emerging infectious diseases. Unfortunately, it was the new reality of fifty years ago. Events have outrun the new regulations to make them already obsolete.
Many reading this will be surprised that until a few days ago WHO was essentially without ability to release any…
revere | May 22, 2007Sometimes it's good to have a "coordinated message" and sometimes it isn't. The UN agencies dealing with bird flu certainly don't have a coordinated message and that's just fine with me. I don't trust anybody to have the right "message" and we're better served by each agency calling it as they see it. Even if the way the see it seems, well, distinctly odd:
Avian Flu Virus May Be Nearing End as Fewer Birds Die, OIE Says
The avian flu virus that threatens to spark the first pandemic in almost four decades may be nearing the end of its natural cycle after it killed fewer wild and migratory…