11/30 A New Dread/ H5N1 Cases In Asia/While US Stockpiles Flu Vaccines

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<B><font size=+1 color=red><center>Indonesia confirms new human death from bird flu</font>
(AP)

30 November 2005
<A href="http://www.khaleejtimes.com/DisplayArticle.asp?xfile=data/theworld/2005/November/theworld_November791.xml&section=theworld&col=">Khaleej Times Online</a></center>

JAKARTA - Indonesian tests have confirmed that a 25-year-woman who died overnight in a Jakarta hospital had the bird flu virus, a hospital official said on Wednesday.</b>

However, Dr. Ilham Patu said the results had yet to be confirmed in a Hong Kong laboratory. If they come back positive, her death would bring to eight the number of human victims in the country, he said.

Indonesian tests are generally reliable, but the World Health Organization does not recognize cases unless they are confirmed in one of its accredited laboratories in Hong Kong.

Patu also said that two younger brothers of a 16-year-boy currently being treated in hospital for bird flu died several days before he fell ill showing symptoms of the virus.

The 16-year-old is a confirmed case of bird flu.

Patu said the two died before doctors had taken samples from them, so “it couldn’t be proved” whether they had contracted the virus or whether it had been transmitted directly between the brothers.

Health experts are closely watching possible “clusters” of cases within families or neighborhoods for signs that the virus is being passed between humans.

So far, most human cases of the disease have been traced to contact with infected birds. But experts fear a human flu pandemic if the deadly H5N1 bird flu virus mutates into a form that passes easily between people.

At least 68 people have died from the H5N1 bird flu virus since it emerged in Asia in 2003.

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<B><font size=+1 color=brown><center>Anger over slow response on bird flu </font>

Abdul Khalik,
<A href="http://www.thejakartapost.com/detailcity.asp?fileid=20051130.G01&irec=0">The Jakarta Post</a></center>

Jakarta
Already concerned by news reports of bird flu in Greater Jakarta, the first thing Nana did when dozens of chickens and other birds began dying in Kampung Gardu, Buaran village, Tangerang, was contact the local animal husbandry office.</b>

"What really terrified me was that children in my neighborhood began coming down with fevers at the same time. I am afraid that bird flu has arrived in my neighborhood. The really frustrating thing is that officials from the animal husbandry agency did not respond to my calls," she told The Jakarta Post recently.

After calling the agency several times but failing to get a response, she gave up and now just hopes for the best.

"I just wanted them to check if the chickens and birds in the neighborhood were infected with avian influenza, nothing else," she told the Post.

Nana is just one of numerous residents in Greater Jakarta who have accused health officials of ignoring reports from the public of suspected bird flu cases.

A senior official at the Jakarta Animal Husbandry, Fisheries, and Maritime Affairs Agency, Adnan Ahmad, said it was impossible to respond immediately to every report because local animal husbandry agencies had only three to four veterinarians to cover an entire regency.

"Tangerang, for instance, has only three veterinarians at its animal husbandry agency. With the bird flu outbreak, they cannot cope with all the reports being filed by residents," he told the Post.

He did acknowledge, however, that several officials at local animal husbandry agencies in Greater Jakarta had failed to make bird flu their top priority since the national campaign to eradicate the disease was launched by President Susilo Bambang Yudhoyono in September.

Ahmad said the central government should push local administrations to prioritize the campaign against bird flu, and help to improve coordination among the different administrations.

In addition to a lack of veterinarians, many agencies also complain about conflicting policies issued by the central government and local administrations regarding the disbursement of funds to tackle bird flu.

The head of the animal husbandry agency in West Jakarta, Riana Faiza, said his office had not received any funds from the central government or any additional funds from the Jakarta administration.

"We have heard the government has been allocating money to local administrations to deal with bird flu for the last several months, but we have not received any money. Now we are expected to do more work on the same budget," she said.

Riana said her office was working to prevent the spread of bird flu through information campaigns, the spraying of disinfectant and selectively culling chickens and other birds.

She said her office had culled dozens of infected birds and chickens in several districts, but had been unable to compensate the owners because of budget constraints.

Adnan said his office had found infected birds in every municipality in Jakarta and had culled hundreds of fowl.

The World Health Organization-sanctioned laboratory in Hong Kong has confirmed 12 cases of bird flu in humans in Indonesia, which have resulted in seven deaths.

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<B><font size=+1 color=green><center>U.S. Builds Stockpile of Vaccine for Flu Pandemic</font>

By Justin Gillis
<A href="http://www.washingtonpost.com/wp-dyn/content/article/2005/11/29/AR2005112901849.html?nav=rss_business">Washington Post</a> Staff Writer</center>
Wednesday, November 30, 2005; Page A01

The government expects to stockpile nearly 8 million doses of an experimental vaccine against pandemic influenza by February, and studies are underway that could stretch that supply to cover more than a third of the population, federal health experts said yesterday.</b>

Two manufacturers are already making doses of the experimental vaccine under contract, and most of them will be delivered to government stockpiles by late December, according to presentations made to an advisory panel of the Department of Health and Human Services.


That unusually rapid clip reflects the high priority the Bush administration has placed recently on preparing the nation for a catastrophic flu outbreak. The immediate plan is a start toward building a stockpile that eventually could reach tens of millions of doses, assuming that Congress appropriates enough money.

In the worst case, scientists said, the vaccine being manufactured now would immunize only 4 million people, each of whom would need two shots a month apart. That means the vaccine would probably be restricted to critically needed personnel who would keep the government and public-safety services running during a pandemic. About a quarter of the vaccine is destined for a stockpile controlled by the Pentagon.

A pandemic would be expected to confine millions of people to their homes for weeks or months, shutting down much of the economy.

Techniques to dilute the vaccine while preserving a strong immune response are under study. In the most optimistic scenario, the stockpile due by February might be diluted to cover 120 million people out of a U.S. population of 298 million. Some preliminary research suggests that dilution will work, but scientists said larger studies are needed. How well the vaccine, diluted or not, would prevent influenza in a pandemic remains uncertain.

"I didn't realize there was so much going on," said Charles M. Helms, a University of Iowa doctor and chairman of the National Vaccine Advisory Committee, which heard reports on the government's efforts at a meeting in Washington yesterday. "It's incredible."

William Hall, a spokesman for the Health and Human Services Department, said the government has made it a point not to claim that vaccine dilution would produce a huge stockpile in the short run, since the studies needed to prove that are still underway. "We're trying to stretch the supply of vaccine, but to be perfectly honest, if a pandemic occurs tomorrow, we can cover 4 million people," he said.

A fast-spreading form of influenza that sickens mostly birds but can also kill people has provoked worldwide alarm.

So far the virus cannot jump readily from person to person. But scores of people, mostly in Asia, have caught it from birds, and it has killed half of them. Authorities fear that the virus will evolve to the point that it can spread readily in the human population.

The influenza pandemic of 1918 killed perhaps 50 million people worldwide in months. President Bush announced a plan Nov. 1 to prepare the nation for a pandemic, and Congress is considering his request for more than $7 billion in emergency funds.

There is no licensed human vaccine today, and standard vaccine against annual flu would offer little protection. Several countries, including the United States, are rushing to develop and stockpile a vaccine. The government also is stockpiling Tamiflu, a drug that might be used to treat infected people, but for prevention, a vaccine is the preferred approach.

The effort is fraught with uncertainties, however. The experimental vaccine is designed to immunize people against the viral strain circulating in birds, but it is unclear how much protection it would provide if the virus evolved to spread readily among humans.

Multiple human tests are underway, and Linda C. Lambert, chief of respiratory diseases at the National Institute of Allergy and Infectious Diseases, said researchers would offer some results soon. But scientists do not expect hard data on the number of deaths the vaccine could prevent to be available until a pandemic outbreak.

Sanofi Pasteur SA of Lyon, France, and Chiron Corp. of Emeryville, Calif., are making the experimental vaccine under government contract. Several companies are working on more advanced vaccines that might offer strong protection with one shot, but those are years away.

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<B><font size=+1 color=blue><center>Vietnam reports new suspected huamn bird flu case</font>

<A href="http://news.xinhuanet.com/english/2005-11/30/content_3856504.htm">www.chinaview.cn </a>
2005-11-30 11:21:43 </center>

HANOI, Nov. 30 (Xinhuanet) -- A 51-year-old man from Vietnam's northern Thanh Hoa province has been hospitalized after exhibiting bird flu symptoms, local newspaper Vietnam Agriculture reported on Wednesday. </b>

The man named Le Truong Hong is under treatment at the Thanh Hoa General Hospital, the hospital's director Hoang Sy Binh said, adding that he still had high fever and breathing difficulties on Tuesday afternoon.

The patient's specimens are being tested for bird flu viruses, Binh said, adding the man bought two ducks, slaughtered and ate them before he fell ill several days ago.

Vietnam's Health Ministry on Tuesday announced that the country has detected 66 human cases of H5N1 infections, including 22 fatalities, in 25 cities and provinces since December 2004, bringing the total infection cases and death tolls since December 2003 to 93 and 42 respectively.

A total of 22 localities nationwide have detected poultry deaths since Oct. 1. However, recent tests have showed that fowls in central provinces of Quang Nam and Quang Ngai, and southern Dong Thap province have not been infected with bird flu virus. Meanwhile, capital Hanoi and southern Bac Lieu province have met criteria for announcing an end to bird flu outbreaks (detecting nonew affected spot for at least three weeks). Therefore, the current number of bird flu-hit localities, is only 17, according to the Department of Animal Health under the Ministry of Agriculture and Rural Development.

Since early last month, Vietnam has culled over 1.7 million poultry, including both infected ones and healthy ones. Hanoi, Ho Chi Minh City and central Da Nang city have decided to stop raising poultry in their inner areas this month. Enditem

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<B><font size=+1 color=purple><center>Indonesia Bird Flu Case Had Two Deaths in Family - WHO </font>

SWITZERLAND: November 30, 2005
<A href="http://www.planetark.com/dailynewsstory.cfm/newsid/33723/story.htm">Planet Ark: Indonesia</a> </center>

GENEVA - A 16-year-old boy confirmed as Indonesia's 12th human case of bird flu had two brothers who died from similar symptoms days before he was taken to hospital, the World Health Organisation (WHO) said on Tuesday. </b>


The brothers died on Nov. 11 after being diagnosed with typhoid fever, but they were never tested for the deadly H5N1 bird flu virus, leaving questions hanging over the cause of death, WHO spokeswoman Maria Chang said.
"They had similar symptoms, fever and respiratory distress, but we don't have samples. We'll probably never have a definite diagnosis," Chang said, adding that the possibility of human-to-human transmission of bird flu could not be ruled out.

Family chickens had died shortly before the deaths of the brothers, aged 7 and 20, Chang said.

The West Java boy, whom Indonesian officials said on Saturday had tested positive for the H5N1 virus, remains in stable condition, she said.

The avian virus remains hard for people to catch but the fear is that it could mutate into a form that could be passed easily from person to person, sparking a global pandemic in which millions could die.

Asked about possible human-to-human transmission in the West Java family, Chang replied: "In theory, it could fit, but we won't have an opportunity to get samples from the brothers. No one else in the wider community is sick and that is reassuring."

A team of WHO and Indonesian health ministry investigators have gone to the village to trace contacts of the surviving brother, who entered hospital on Nov 16, according to Chang.

"We could not exclude it (human-to-human transmission), but an investigative team has gone house-to-house to 80 households and hasn't found any symptoms in the wider community," she said.

"There is no reason to think there could be any clusters."

Indonesia has had seven confirmed deaths from bird flu and the 16-year-old boy is among five known cases in the world's fourth most populous nation to survive the disease.

Bird flu has claimed 68 lives in five countries in Asia since 2003 -- Vietnam (42), Thailand (13), Indonesia (7), Cambodia (4) and China (2) -- according to the WHO.

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<B><font size=+1 color=red><center>WHO says one more human case of bird flu confirmed in Indonesia</font>

November 30 2005
<A href="http://english.peopledaily.com.cn/200511/30/eng20051130_224571.html">People's Daily Online</a></center>

A further case of human infection with the H5N1 bird flu virus has been confirmed in Indonesia, the World Health Organization (WHO) said Tuesday. </b>

The case is a 16-year-old boy from West Java Province. He developed symptoms of fever and cough on Nov. 6, followed by breathing difficulties a few days later. He was hospitalized on Nov.16 and remains in stable condition.

WHO said a field investigation of this case determined that two siblings had died 5 days before his hospitalization.

"His two brothers, aged 7 and 20 years, had onset of illness on Nov. 3 and died on Nov. 11, following symptoms of fever and breathing difficulty. The presumptive diagnosis was typhoid fever. No samples were taken before burial, which precludes definitive diagnosis," WHO said, adding that it reports laboratory-confirmed cases only.

No other cases of influenza-like illness were detected in the 80 households of the village.

The field investigation found that chickens in the family household had died during the two weeks preceding onset of illness in the deceased brothers. Samples from animals have been collected for testing and the investigation continues, according to WHO.

The newly confirmed case brings the total number in Indonesia to 12. Of these cases, 7 were fatal.

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<center>

I may as well bump it before
I go try and find it on the board</center>

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<B><center>HLT-UK-BIRD FLU-MUTATION

<font size=+1 color=blue>Bird flu mutation "could happen at any time" -- expert</font>

<A href="http://www.kuna.net.kw/Home/Story.aspx?Language=en&DSNO=792376">www.kuna.net</a></center>

LONDON, Nov 30 (KUNA) -- The mutation of bird flu into a form of the disease dangerous to humans could happen "at any time", the chief executive of the British Medical Research Council (MRC) warned Wednesday.</b>

But Professor Colin Blakemore said he was hopeful that the disease would not cross over into the human population this winter, and said there was no cause for panic at this stage.

Professor Blakemore was part of a delegation of MRC experts who have just returned from a visit to speak to scientists in China, where some people have already fallen prey to the illness.

He is today addressing MPs at the House of Commons Science and Technology Committee on the scale of the threat.

Professor Blakemore told BBC domestic radio "The situation certainly hasn't gone away. Infection amongst birds is certainly spreading with migration of birds as expected this year, as it has to some extent in previous years".

"Mutation could happen at any time and anywhere there are infected birds. We know that the virus can transmit to human beings if a mutation were to happen, or if the virus were to be recombined with a conventional seasonal flu virus".

"There's always a possibility of transition into pandemic form", he said.

Asked when avian influenza could be expected to cross over into the human population, he replied "As Liam Donaldson, the Chief Medical Officer, has said, it is probably not a matter of if but when".

"We are hoping very much that the transformation of this virus which would make it particularly dangerous to human beings, with a potential pandemic, won't happen this season. We might have a respite".

"Concern is probably the right word, rather than panic. We all need to be vigilant and aware, but there is absolutely no reason at the moment for panic".

Professor Blakemore said the MRC delegation had found their discussions with their Chinese counterparts very helpful.

"What we saw in China and Vietnam made us confident that the authorities there are well aware of the problems and the threat to them and are anxious to collaborate and be involved in research projects", he said.

A recommendation is going to the MRC council for the commitment of a further 10 million pounds to research into vaccines and treatments for flu. (end) he.

bs

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<B><font size=+1 color=purple><center>Indonesia Marks 8th Human Death From Bird Flu </font>

Chinese Government: Some Health Workers 'Not Very Competent'

10:27 am EST November 30, 2005
<A href="http://www.wyff4.com/health/5434428/detail.html">WYFF4.com</a></center>

Indonesian officials have confirmed another human fatality from bird flu, a 25-year-old woman who died overnight in Jakarta.</b>

It marks the eighth human death in the nation, and the 69th worldwide, according to the World Health Organization.

They're also looking into the possibility that several members of one family were infected. A 16-year-old boy is hospitalized with it, and his two younger brothers recently died from it. They died before doctors got samples, so it's not clear if they caught it from birds or from him.

The concern is that the virus could mutate into a form that could be passed among people.


In China, there's concern that medical workers in poor, rural areas are not detecting bird flu cases as quickly as they should. The government said Wednesday that health workers in some areas are "not very competent."

Meanwhile, Vietnam said it plans to continue a containment effort that includes poisoning wild pigeons. The U.N.'s health agency said governments should concentrate on poultry.

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<B><font size=+1 color=purple><center>Warning over bird flu 'black holes'</font>

13:59 - 30 November 2005
<A href="http://www.suttonobserver.co.uk/displayNode.jsp?nodeId=185916&command=displayContent&sourceNode=186002&contentPK=13595732">Medical Researcher</a></center>

Medical researchers have issued a warning that there are "black holes" in the international network for monitoring the spread of bird flu.</b>

Dr Alan Hay, the director of the World Health Organisation (WHO) influenza reference centre based in London, said some countries lacked adequate systems while others were reluctant to share their information.

Giving evidence to the Commons Science and Technology Committee, he backed an estimate by Chief Medical Officer Sir Liam Donaldson that the death toll in the UK could be 50,000 if the virus mutated into a human form of the disease.

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<B><font size=+1 color=red><center>Bird flu: a new dread - PTI</font>

November 30 2005
<A href="http://www.greaterkashmir.com/Full_Story.asp?Cat=12&ItemID=12456">www.GreaterKashmir.com</a></center>

Bird flu is in news making a common health conscious human so concerned about what he should or he should not do, Mehnaaz Sultan Khuroo explains in detail all about the diseases, preventions and the reality behind</b>

Recently there has been an extensive western media coverage of avian influenza (bird flu) and its potential to threaten the human race through an impending pandemic.

The flu also known in medical terms as influenza is caused by a virus which infects respiratory tract. Flu symptoms include a high fever, chills, and dry cough, sore throat, and muscle aches. Complications can occur because body immune system may be run down by the virus, allowing secondary bacterial infections to cause illnesses such as bacterial pneumonia. The flu once infects patients with diabetes, heart failure, and asthma is particularly disastrous. Young children and the elderly are particularly susceptible to flu and resulting complications. Influenza can be transmitted through the air by coughing and sneezing. It can also be caught through touch. If one touches the droplets from a sneeze or a cough that have landed on a table or a telephone and then the person touches eyes, mouth, or nose, he may get the flu virus. It is important to note that you can pass the virus on to someone else before you actually start to feel any flu symptoms. Seasonal human flu typically affects 10-15% of the population each winter and leads to hundreds to thousands of deaths. Although minor antigenic drift in the human influenza virus A occurs continuously, a major shift in its surface protein antigens H or N can trigger a worldwide influenza pandemic because of absence of population immunity.

Fortunately, this happens only rarely. “Spanish” flu pandemic in 1918-19 (H1N1 virus) caused an estimated 50 million deaths (3 times the casualties of the First World War). Other recorded major influenza pandemics occurred namely “Asian” flu in 1957-8 (H2N2), and “Hong Kong” flu in 1968-9 (H3N2). Many scientists believe that another pandemic is overdue. A vaccine for influenza can prevent the infection and due to its continuous mutation, a new batch of vaccine is introduced in late autumn based on presumptive mutation for that year.


What is then bird flu?
Bird flu (also known as avian influenza, avian flu) is a type of influenza virus that is hosted by birds. H5N1 is a highly pathogenic strain of bird flu. Normally, avian flu viruses are transported worldwide in the intestines of wild birds, and are non-lethal. Infected birds pass on H5N1 through their saliva, nasal secretions, and feces. Other birds may pick up the virus through direct contact with these excretions or when they have contact with surfaces contaminated with this material. Because migratory birds are among the carriers of the H5N1 virus it may spread to all parts of the world. We used to be primarily concerned with losing valuable birds that were providing eggs or meat to poultry farmers.

These viruses evolve in two ways, through drift and shift. Drift refers to inexact replication, such that newer viruses are further from the original genetic material, but share enough DNA that they are still only spread amongst a single species. When a virus shifts, it means that the genes of one virus mix, or breed, with a different virus, usually inside a carrier. Due to shift, bird flu mixed with a human kind of flu, and was thus able to infect humans through direct contact with birds.

In these conditions a virus can mutate into a form that more easily infects humans. For more than a century, bird flu has circulated among birds, particularly domesticated fowl, but recent attention has been called to avian influenza since some strains infected humans. No longer is bird flu relegated to pigs and birds, as the virus has strengthened and mutated, resulting in a contagion that can move from bird to human. Human cases of bird flu have caused infections and death across the globe as scientists struggle to identify the dangerous strains and prevent a fatal pandemic.

Human cases of bird flu are incredibly alarming, and raised the concern of virologists and government agencies in China, Hong Kong, Vietnam, Canada, and other countries. Conservative modelling from UK suggests that in case of a pandemic a quarter of the UK population (over 14 million people) would become ill, with 50 000 excess deaths, during successive pandemic waves. These data once extrapolated to world population gives alarming figures. This imminent pandemic could only be controlled by the vast slaughter of millions of fowl to contain the virus that spreads by air, water, and soil. The bird flu is especially dangerous because our immune systems don’t have any antibodies to handle something that used to be relegated to animals. Thus, it takes hold with unprecedented force, settles in the lungs, and resists anti-viral and anti-bacterial medication.

Most health experts researching and fighting the incidence of human bird flu do not have an optimistic outlook. They point out that the pathogen has not appeared to evolve such that human-to-human contact is contagious, yet it remains that people working with fowl, swimming in infected rivers, playing in an area where carcasses were buried, or breathing air near a poultry processing plant, can lead to infection.

Thus far, doctors have been able to diagnose bird flu, identify the specific strain, and target the proper disposal of infected birds. Yet they are ineffective at treating the resultant respiratory infection, leading to fatalities. They note that flu epidemics and pandemics appear to be inevitable given the history of contagious disease over the last few centuries.

The occurrence of human influenza A (H5N1) in Southeast Asia has paralleled large outbreaks of avian influenza A (H5N1), although the avian epidemics in 2004 and 2005 have only rarely led to disease in humans. The largest number of cases has occurred in Vietnam, particularly during the third, ongoing wave, and the first human death was recently reported in Indonesia. The frequencies of human infection have not been determined, and seroprevalence studies are urgently needed. The expanding geographic distribution of avian influenza A (H5N1) infections, with recent outbreaks in Kazakhstan, Mongolia, and Russia, indicates that more human populations are at risk.

For human influenza A (H5N1) infections, evidence is consistent with bird-to-human, possibly environment-to-human, and limited, nonsustained human-to-human transmission to date. In 1997, exposure to live poultry within a week before the onset of illness was associated with disease in humans, whereas there was no significant risk related to eating or preparing poultry products or exposure to persons with influenza A (H5N1) disease. Exposure to ill poultry and butchering of birds were associated with seropositivity for influenza A (H5N1). Recently, most patients have had a history of direct contact with poultry although not those who were involved in mass culling of poultry. Plucking and preparing of diseased birds; handling fighting cocks; playing with poultry, particularly asymptomatic infected ducks; and consumption of duck’s blood or possibly undercooked poultry have all been implicated. Transmission to felids has been observed by feeding raw infected chickens to tigers and leopards in zoos in Thailand and to domestic cats under experimental conditions. Transmission between felids has been found under such conditions. Some infections may be initiated by pharyngeal or gastrointestinal inoculation of virus.

(Author is MD, Department of Pathology, Shree Ramachandran Medical College and Research Institute, Porur, Chennai, India.)

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<B><font size=+1 color=brown><center>Bird flu: a new dread - II</font>

November 30 2005
<A href="http://www.greaterkashmir.com/full_story.asp?ItemID=12506&cat=12">www.GreaterKashmir.com</a></center>

Bird flu is in news making a common health conscious human so concerned about what he should or he should not do, Mehnaaz Sultan Khuroo explains in detail all about the diseases, preventions and the reality behind
Human-to-human transmission of influenza A (H5N1) has been suggested in several household clusters and in one case of apparent child-to-mother transmission. Intimate contact without the use of precautions was implicated, and so far no case of human-to-human transmission by small-particle aerosols has been identified. </b>

In 1997, human-to-human transmission did not apparently occur through social contact, and serologic studies of exposed health care workers indicated that transmission was inefficient. Serologic surveys in Vietnam and Thailand have not found evidence of asymptomatic infections among contacts. Recently, intensified surveillance of contacts of patients by reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay has led to the detection of mild cases, more infections in older adults, and an increased number and duration of clusters in families in northern Vietnam, findings suggesting that the local virus strains may be adapting to humans. However, epidemiologic and virologic studies are needed to confirm these findings. To date, the risk of nosocomial transmission to health care workers has been low, even when appropriate isolation measures were not used. However, one case of severe illness was reported in a nurse exposed to an infected patient in Vietnam.

Given the survival of influenza A (H5N1) in the environment, several other modes of transmission are theoretically possible. Oral ingestion of contaminated water during swimming and direct intranasal or conjunctival inoculation during exposure to water are other potential modes, as is contamination of hands from infected fomites and subsequent self-inoculation. The widespread use of untreated poultry feces as fertilizer is another possible risk factor.

Clinical Features
The clinical spectrum of influenza A (H5N1) in humans is based on descriptions of hospitalized patients. The frequencies of milder illnesses, subclinical infections, and atypical presentations (e.g., encephalopathy and gastroenteritis) have not been determined, but case reports indicate that each occurs. Most patients have been previously healthy young children or adults.

The incubation period of avian influenza A (H5N1) may be longer than for other known human influenza. In 1997, most cases occurred within two to four days after exposure; recent reports indicate similar intervals but with ranges of up to eight days. The case-to-case intervals in household clusters have generally been 2 to 5 days, but the upper limit has been 8 to 17 days, possibly owing to unrecognized exposure to infected animals or environmental sources.

Most patients have initial symptoms of high fever (typically a temperature of more than 38°C) and an influenza-like illness with lower respiratory tract symptoms. Upper respiratory tract symptoms are present only sometimes. Unlike patients with infections caused by avian influenza A (H7) viruses, patients with avian influenza A (H5N1) rarely have conjunctivitis. Diarrhea, vomiting, abdominal pain, pleuritic pain, and bleeding from the nose and gums have also been reported early in the course of illness in some patients. Watery diarrhea without blood or inflammatory changes appears to be more common than in influenza due to human viruses and may precede respiratory manifestations by up to one week. One report described two patients who presented with an encephalopathic illness and diarrhea without apparent respiratory symptoms.

Lower respiratory tract manifestations develop early in the course of illness and are usually found at presentation. In one series, dyspnea developed a median of 5 days after the onset of illness (range, 1 to 16). Respiratory distress, tachypnea, and inspiratory crackles are common. Sputum production is variable and sometimes bloody. Almost all patients have clinically apparent pneumonia; radiographic changes include diffuse, multifocal, or patchy infiltrates; interstitial infiltrates; and segmental or lobular consolidation with air bronchograms. Radiographic abnormalities were present a median of 7 days after the onset of fever in one study (range, 3 to 17). In Ho Chi Minh City, Vietnam, multifocal consolidation involving at least two zones was the most common abnormality among patients at the time of admission. Pleural effusions are uncommon. Limited microbiologic data indicate that this process is a primary viral pneumonia, usually without bacterial suprainfection at the time of hospitalization.

Progression to respiratory failure has been associated with diffuse, bilateral, ground-glass infiltrates and manifestations of the acute respiratory distress syndrome (ARDS). In Thailand, the median time from the onset of illness to ARDS was 6 days (range, 4 to 13). Multiorgan failure with signs of renal dysfunction and sometimes cardiac compromise, including cardiac dilatation and supraventricular tachyarrhythmias, has been common. Other complications have included ventilator-associated pneumonia, pulmonary hemorrhage, pneumothorax, pancytopenia, Reye’s syndrome, and sepsis syndrome without documented bacteremia.

Mortality
The fatality rate among hospitalized patients has been high, although the overall rate is probably much lower. In contrast to 1997, when most deaths occurred among patients older than 13 years of age, recent avian influenza A (H5N1) infections have caused high rates of death among infants and young children. The case fatality rate was 89 percent among those younger than 15 years of age in Thailand. Death has occurred an average of 9 or 10 days after the onset of illness (range, 6 to 30), and most patients have died of progressive respiratory failure.

Diagnosis
Common laboratory findings have been leukopenia, particularly lymphopenia; mild-to-moderate thrombocytopenia; and slightly or moderately elevated aminotransferase levels. Marked hyperglycemia, perhaps related to corticosteroid use, and elevated creatinine levels also occur. In Thailand, an increased risk of death was associated with decreased leukocyte, platelet, and particularly, lymphocyte counts at the time of admission.
Antemortem diagnosis of influenza A (H5N1) has been confirmed by viral isolation, the detection of H5-specific RNA, or both methods. Unlike human influenza A infection, avian influenza A (H5N1) infection may be associated with a higher frequency of virus detection and higher viral RNA levels in pharyngeal than in nasal samples.

In Vietnam, the interval from the onset of illness to the detection of viral RNA in throat-swab samples ranged from 2 to 15 days (median, 5.5), and the viral loads in pharyngeal swabs 4 to 8 days after the onset of illness were at least 10 times as high among patients with influenza A (H5N1) as among those with influenza A (H3N2) or (H1N1). Earlier studies in Hong Kong also found low viral loads in nasopharyngeal samples. Commercial rapid antigen tests are less sensitive in detecting influenza A (H5N1) infections than are RT-PCR assays. In Thailand, the results of rapid antigen testing were positive in only 4 of 11 patients with culture-positive influenza A (H5N1) (36 percent) 4 to 18 days after the onset of illness.

The possibility of influenza A (H5N1) should be considered in all patients with severe acute respiratory illness in countries or territories with animal influenza A (H5N1), particularly in patients who have been exposed to poultry. However, some outbreaks in poultry were recognized only after sentinel cases occurred in humans. Early recognition of cases is confounded by the nonspecificity of the initial clinical manifestations and high background rates of acute respiratory illnesses from other causes. In addition, the possibility of influenza A (H5N1) warrants consideration in patients presenting with serious unexplained illness (e.g., encephalopathy or diarrhea) in areas with known influenza A (H5N1) activity in humans or animals.

The diagnostic yield of different types of samples and virologic assays is not well defined. In contrast to infections with human influenza virus, throat samples may have better yields than nasal samples. Rapid antigen assays may help provide support for a diagnosis of influenza A infection, but they have poor negative predictive value and lack specificity for influenza A (H5N1). The detection of viral RNA in respiratory samples appears to offer the greatest sensitivity for early identification, but the sensitivity depends heavily on the primers and assay method used. Laboratory confirmation of influenza A (H5N1) requires one or more of the following: a positive viral culture, a positive PCR assay for influenza A (H5N1) RNA, a positive immunofluorescence test for antigen with the use of monoclonal antibody against H5, and at least a fourfold rise in H5-specific antibody titer in paired serum samples.

--To be concluded

(Author is MD, Department of Pathology, Shree Ramachandran Medical College and Research Institute, Porur, Chennai, India.)

Thanks for the ongoing work, Shakey. Indonesia seems to be the current flashpoint for bird flu. Now we have to worry about a mutated H2H form sneaking in the back door through North Africa or southwest Asia, someplace where communications and medical care haven't kept up with poverty and population growth and famine. The possibilities -- and the probabilities -- just keep growing.

Are you still predicting a general outbreak within the next few months?

CW

Thanks, Shakey, for the continuing updates!! Please, keep it up.

squeeks

bump

HLTH - 11/30 A New Dread/ H5N1 Cases In Asia/While US Stockpiles Flu Vaccines

Click to expand...

cause and effect implied?

Thanks for the updates.... appreciate it!!!!

To comment on the current situation. within the last 3 days we have had China admit several deaths and several new outbreaks; we have also had Indonesia start, repeat, start to admit that the bird flu is out of control in Jakarta. We are dealing with third world cesspools here, in terms of medical competency and the corrupt government trying to keep things quiet.

THE SITUATION IS MUCH, MUCH WORSE THAN IT IS BEING REPORTED IN THE MEDIA.
PBS had a special last night where the army admited it had recreated live 1918 flu virus in October of 2005. Gee what a coincidence.

We are looking at an out of control situation now in Asia. they have had their chance and they have blown it
Society will not collapse, but the social order will be radically changed and new attitudes towards authority will surface.

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What interests me a bit more D.D.; is all the *Not talked about* planning, exercises and seminars which have been hurriedly called up by the local, state and fed.gov.

When they are acting - and doing so as if there is an impending emergency. There usually is something which has TPTB in a dither....




<B><font size=+1 color=red><center>State officials talk flu preparedness</font>

KEVIN FREKING
November 30 2005
<A href="http://www.kentucky.com/mld/kentucky/news/breaking_news/13294687.htm">Associated Press</a></center>

WASHINGTON - The Bush administration is taking its concerns about a potential flu pandemic on the road over the next few months to try to motivate cities and towns to start planning.</b>

Minnesota, Arkansas and Arizona will be the first stops, Health and Human Services Secretary Mike Leavitt said in an interview Wednesday. In addition, the administration has asked governors to send representatives to the capital on Monday to talk about flu.

"The public health people get this and have been advocating preparation for some time," Leavitt said. "What's now necessary is for the political leadership at the county, city, school and business level to understand it so they can prepare in the ways unique to them."

In early November, the administration released its strategy for combating a super-flu outbreak. Health officials say there is increased risk of such an outbreak should bird flu mutate into a form that is easily transmittable from person to person. The odds of such a mutation are low, officials say, but cannot be dismissed.

The last century saw outbreaks in 1918, 1957 and 1968. The 1918 pandemic, caused by a bird flu that jumped to humans, killed at least 40 million people; the later outbreaks killed far fewer, but still caused widespread disruption.

Bush asked Congress to spend $7.1 billion for steps such as a larger stockpile of medicine and greater surveillance of poultry markets and migratory bird flyways.

But the federal government can only do so much, Leavitt said, adding that local communities will be at the forefront of any effort to prevent or diminish a pandemic.

Dr. George Hardy, executive director of the Association of State and Territorial Health Officials, said states have separate plans for dealing with a pandemic, but look to Washington for guidance. Hardy said he expected the cost - and who will pay for it - to be raised at Monday's meeting.

The administration's plan calls for the federal government to pick up most of the tab for antiviral drugs, with states asked to spend $500 million.

An additional concern is a lack of clear guidelines on who should get first crack at medicine in the event of a pandemic. The federal government leaves that decision to the states.

"A lot will be left for the states to decide. There certainly is some merit to that," Hardy said. "But I think citizens of the country sort of expect they won't be treated differently if they live in Alabama rather than Massachusetts."

Congress has yet to approve the $7.1 billion that Bush requested. Many lawmakers have urged spending cuts in other programs so that the pandemic preparation does not add to the national debt.

"I'm sensitive to the fact readiness requires investment," Leavitt said. "We'll be as responsive as we're able to based on our request to Congress, but I'll also make clear that pandemic readiness is a fundamental obligation of state and local governments, as well as the national government."

Leavitt said that if a pandemic were to occur, the public would not be satisfied with the explanation that Congress did not provide enough money.

"Public health is a local function. It always has been," Leavitt said.

Leavitt said the federal government would continue to offer recommendations on what populations in a state should get the first chance to take a vaccine or antiviral drug.

"Every state will be different, and the best decisions won't be made in Washington on that subject," he said.

In Monday's meeting, the administration expects that states will send their senior health and emergency services directors. Leavitt described the meeting as a "foreword" in a book. He said he expects that events designed to enhance pandemic preparation will take place in all 50 states in the subsequent four months.

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<B><font size=+1 color=brown><center>U.N. battles bird flu</font>
By Lauren Mack
Nov 30, 2005, 20:02 GMT
<A href="http://news.monstersandcritics.com/health/article_1065705.php/U.N._battles_bird_flu">monstersandcritics.com</a></center>

UNITED NATIONS, United States (UPI) -- As bird flu continues to spread, the United Nations and member states are scrambling to avert a potentially lethal pandemic.</b>

Since the first human case of the latest avian influenza outbreak was reported in January of last year, U.N. agencies have been working with health organizations and government agencies to curb the spread of the deadly disease.

Last week, the World Health Organization joined a mission by the Chinese Health Ministry to investigate exposure to the virus, which in a worst-case scenario can mutate into a human pandemic that could kill millions.

U.N. health officials have said in the past that the virus could evolve into a human pandemic if it mutates into a form that could transmit easily between people.

Avian flu is an infectious bird disease caused by type A strains of the influenza virus.

The U.N. Food and Agriculture Organization has warned the H5N1 strain of avian influenza that has hit several Asian countries is likely to be passed on to other regions including the Middle East, Europe, South Asia and Africa. The virus can be fatal in both poultry and people.

U.N. health officials have said a human flu pandemic is inevitable.

'It is only a matter of time before an avian flu virus -- most likely H5N1 -- acquires the ability to be transmitted from human to human, sparking the outbreak of human pandemic influenza,' said Lee Jong-wook, WHO director-general at a conference of experts earlier this month. 'We don`t know when this will happen. But we do know that it will happen.'

There have been 132 reported human H5N1 cases, 68 of them fatal, all in Southeast and East Asia, according to the U.N. health agency. Vietnam has registered 93 human cases, the largest number of cases in Asia. Some 42 of those were fatal. Thailand follows with 21 cases resulting in 13 fatalities. Indonesia, Cambodia, and China have also reported cases.

The Rome-based FAO, along with Geneva-based WHO and the inter-governmental World Organization for Animal Health, has recommend a series of measures to fight the virus, including improved veterinary services, emergency preparedness plans and control campaigns such as culling infected animals, vaccination and compensation for farmers to encourage them to report outbreaks.

'Controlling the virus in poultry is the most effective way by which the likelihood of the bird flu virus acquiring human-to-human transmissibility can be reduced,' said Juan Lubroth, FAO senior officer responsible for infectious animal diseases.

Some 150 million domestic birds have died or been culled in an effort to curb spread of the current outbreak, according to the WHO.

Avian influenza was first identified 100 years ago during an outbreak in Italy and it has cropped up several times since. The first documented cases involving humans infected with bird flu occurred in Hong Kong in 1997 and 1998. Hong Kong`s entire poultry population, estimated at around 1.5 million birds, was destroyed in three days which probably averted a pandemic, said WHO.

The Spanish flu pandemic killed an estimated 20 to 40 million people worldwide between 1918 and 1920, said WHO.

There are 15 subtypes of the influenza virus known to infect birds. All birds are susceptible to infection but some species are more resistant to infection than others.

Migratory waterfowl, like wild ducks, are a natural reservoir of the virus. They are the most resistant to infection. Domestic poultry, including chickens and turkeys, are particularly susceptible, according to WHO.

The disease is contagious and spread by excrement from migratory birds and from human interaction with infected animals. The strain H5N1 is a particular concern because it mutates rapidly, said WHO. Since influenza viruses tend to undergo frequent changes, the global influenza situation must regularly be monitored and adjustments made to influenza vaccines, said WHO.

The FAO says eating poultry is safe and the probability of humans being infected is low. Symptoms in humans include fever, sore throat, and cough and, in some cases, severe respiratory distress.

The origin of the latest outbreak is unknown but the dramatic increase in domestic poultry in Asia may be to blame.

There are an estimated 6 billion birds in Eastern and Southeastern parts of Asia. More than half of the poultry population is under strict containment measures in medium and large size holdings but a sizeable portion remain with 200 million small farmers, said WHO. The scavenging birds living in open pens are exposed to viruses carried by wild and migratory birds, said WHO. These vulnerable living conditions provide a favorable environment for the disease to spread.

Hygienic precautions such as proper hand washing and cleaning of clothes, cages and other items that come in contact with the birds help prevent spread of the disease, said WHO.

Killing infected birds as well as poultry which may have been exposed to the disease is common in the battle against avian flu.

The FAO warned Tuesday against destroying wild birds as a precautionary measure in countries affected by bird flu, saying this might distract attention from the campaign to contain the disease among poultry.

'There are other, much more important measures to be considered that deserve priority attention. Fighting the disease in poultry must remain the main focus of attention,' said the FAO`s Lubroth. 'Wild bird species found in and around cities are different from the wetland waterfowl that have been identified as carriers of the avian influenza virus.'

The virus has proven resilient in some places.

China has reported a recurrence of poultry influenza outbreaks in several parts of the country since mid-October, said WHO.

There is no cure for the virus.

Drugs exist to help fight the disease in humans and lessen its affect. There are vaccines for poultry and for humans which may prevent contracting the disease but as viruses are constantly changing, so must the vaccines. The WHO estimates it would take four months to produce a new vaccine in significant quantities to protect against a new virus subtype.

U.N. agencies are not only working on eradicating the current outbreak but they are investigating ways to prevent future outbreaks which are inevitable.

The U.N.`s Environmental Program is supporting work by environmental organizations on an avian flu early warning system to alert countries and communities of the arrival of potentially infected wild birds. Special maps will be made for individual countries pinpointing the precise locations of lakes, marshes and other wetland areas where the birds are likely to go. The system is expected to take up to two years to complete.

'But we know that it is needed and we know that the issue of avian flu and similar infections is likely to be a long-term one,' said Robert Hepworth, executive secretary of UNEP`s Convention on Migratory Species. 'So such a system should be useful not only over the short but over the long term, too.'

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<center>

Since on one else would;
I'll bump this for the late
night member to read.</center>

Further research shows with relative certainty that there will be no effective vaccine for 6-8 months after a strain of H5N1 goes pandemic - and even then it will be in short supply - perhaps enough for politicians and soldiers. We do not have the manufacturing capacity to protect even close to everyone in this country in any kind of timely fashion.

Things change rapidly with this situation, and I would suggest people try to keep up on a daily basis and not fool themselves into thinking they know what is going on based on news that is days old.