05/29 | Daily Bird Flu Thread: WHO to rewrite pandemic staging descriptions

Link to yesterday's thread: http://www.timebomb2000.com/vb/showthread.php?t=198864

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO:

http://www.who.int/csr/disease/avian_influenza/country/cases_table_2006_05_12/en/index.html

May 28, 2006

WHO to rewrite pandemic staging descriptions in wake of Indonesian cluster​

By HELEN BRANSWELL

(CP) - The World Health Organization plans to redraft the descriptions of its pandemic phases, a task triggered by the confusion provoked by the recent large cluster of human cases of H5N1 avian flu in Indonesia.

The acting head of the WHO's global influenza program says the rewrite will spell out more clearly how the agency thinks a novel influenza virus would behave during the different phases leading up to a pandemic.

The redraft should also help people understand why the WHO doesn't believe the Indonesian cluster - which killed seven of eight infected members of a family in at least three waves of illness - signifies a change in the level of pandemic risk.

"What we're hoping to do is clarify what are the differences between phases and make it more easily understood by everyone what we're actually looking for," Dr. Keiji Fukuda said in an interview with The Canadian Press.

"There's clearly so much confusion both about what is Phase X or what is Phase Y, how do we go from it, what is the role of the pandemic task force and what is the process for deciding whether there should be a phase change.

"And so I think that what we will try to do is address those issues specifically and get it posted on the web," said Fukuda, noting he hopes the work will be completed in the next week or two.

The worrisome Indonesian cluster - the largest to date and the first time person-to-person-to-person spread of the virus is believed to have taken place - has provoked calls from some quarters to change the global pandemic alert level to Phase 4 from the current Phase 3.

Before it could consider making that change, the WHO would have to convene a panel of experts - the task force Fukuda mentioned - to comb through the accumulated scientific data looking for evidence H5N1 viruses are becoming more transmissible to and among people and therefore pose a greater pandemic risk.

The task force would advise the WHO. But the final decision rests with the Geneva-based global health agency.

The current pandemic phasing document is a six-step ladder going from no known pandemic threat (Phase 1) to a full-blown pandemic (Phase 6). Many experts admit it's hard to see the difference between Phase 3 (no human-to-human spread or rare instances where a person has had close contact with an infected person), Phase 4 (small clusters of limited and localized person-to-person spread) and Phase 5 (larger but still localized clusters of human-to-human spread).

Fukuda agrees the descriptions of the phases are ambiguous, acknowledging that "it drives people crazy because we can't say precisely: 'Look for three of these or 10 of those or 13 minutes of this."'

The revised version will likely key in on the type of activity that allowed the virus to jump from one person to another - prolonged close contact with a sick individual or more fleeting or incidental exposure.

It's been known since the first H5N1 outbreak in 1997 that the former could trigger human-to-human spread. The latter, though, would be a signal of a significant shift in the virus's transmissibility - and would likely prompt serious consideration of a phase change.

"That's a little bit hard to describe for people. It's easier to say we're looking for 10 people or 15 people," Fukuda said. "But in truth, what we're really looking for is what's the kind of contact between the source of infection and the people who become infected."

Redrafting the language may pose challenges. After all, the emergence of a pandemic flu virus is an uncharted process, one which science has never had the capacity to watch.

"No one has a black-white answer because we've never done it before," said Lance Jennings, a virologist and epidemiologist at Christchurch Hospital in New Zealand who helped draft the current pandemic phasing document.

Exacerbating the situation is the fact that determining whether human-to-human spread has taken place is an inexact science. Most clusters to date have occurred in families, where cases almost invariably share experiences and exposures.

Unless the genetic blueprint of the virus takes on some signature changes, in many such cases it's almost impossible to say with certainty that the source of infection was another person, not an infected bird.

Still, infectious disease experts believe the scientific world will be able to tell when the pattern of transmission has sufficiently changed - though how quickly the change will be noted is anybody's guess.

"I think we'll know it when we see it," said Dr. Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, reaching for the famous phrase coined to describe pornography - "I can't define it, but I can tell you when I see it."

But that phrase, often cited by experts attempting to describe the next phases in the pandemic alert scale, highlights how challenging it may be to put into words a clearer picture of what the stages of an emerging pandemic might look like.

A lot rides on the process. Pandemic planning by governments and multinational companies is geared to the level of the global pandemic alert. An upward shift in the level kicks pandemic preparedness activity into higher gear.

"There are major multi-national companies in this world that are prepared to evacuate expats out of certain areas of the world if the staging goes from 3 to 4," noted Osterholm, who cautioned major U.S. business leaders in New York last week against tying responses too closely to the WHO pandemic staging document.

"To try to distil down the current status of where we're at is like trying to give the world economy a one number grade," he said, but added the phases are useful "to help us organize our thinking."

Fukuda agreed that changing the alert level would likely have a domino effect on international trade, travel and economies.

"It would be perceived as countries as a signal that something significant had changed," he said. "I think it's quite likely that we would see an increase of action in all areas. Certainly an increase in concern. Certainly there would be a lot of media attention. Certainly countries would probably really look at their pandemic planning . . . and try to identify what gaps that they might fill. It's highly conceivable that it would have a big effect on travel."

-

(CP) - The World Health Organization's current pandemic phase scale is divided into six stages. They are:

Phase 1 - No new influenza virus subtypes detected in humans. An influenza virus subtype that has caused human infection may be present in animals, but risk of human infection considered low.

Phase 2 - No new influenza virus subtypes detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease.

Phase 3 - Human infection(s) with a new subtype occur, but no human-to-human spread, or at most rare instances of spread to a close contact.

Phase 4 - Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting the virus is not well adapted to humans.

Phase 5 - Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible.

Phase 6 - Pandemic: increased and sustained transmission in general population.

http://cnews.canoe.ca/CNEWS/World/2006/05/28/1602743-cp.html

Current phase of alert in the WHO global influenza preparedness plan

November 2005

Current phase of alert in the WHO global influenza preparedness plan

Experts at WHO and elsewhere believe that the world is now closer to another influenza pandemic than at any time since 1968, when the last of the previous century's three pandemics occurred. WHO uses a series of six phases of pandemic alert as a system for informing the world of the seriousness of the threat and of the need to launch progressively more intense preparedness activities.

The designation of phases, including decisions on when to move from one phase to another, is made by the Director-General of WHO.

Each phase of alert coincides with a series of recommended activities to be undertaken by WHO, the international community, governments, and industry. Changes from one phase to another are triggered by several factors, which include the epidemiological behaviour of the disease and the characteristics of circulating viruses.

The world is presently in phase 3: a new influenza virus subtype is causing disease in humans, but is not yet spreading efficiently and sustainably among humans.

http://www.who.int/csr/disease/avian_influenza/phase/en/index.html

UPDATED: 07:51, May 29, 2006

Romania reports more than 88 bird flu outbreaks ​

The number of outbreaks among birds of avian flu in Romania has reached 88, with a further 23 suspected outbreak locations, as of noon Sunday, the Romanian news agency Rompres said.

A month after the strain was said to have been eradicated in the Black Sea state, most of the current cases have been reported in the central region of Transylvania.

The latest outbreaks originated from a poultry farm in the county of Brasov, some 170 km north of Bucharest,

Last Friday, the Agriculture Ministry confirmed in a statement that the bird flu virus had been found "in 75 localities from 13 counties."

"There are also 35 suspect locations. The national institute for animal health is further testing suspect deaths in fowl," the statement said.

Reports here said three districts in the capital Bucharest are among those affected and among the 13 counties, Brasov was at the top with 28 outbreaks.

Over the past 12 days alone, authorities have culled 500,000 birds to prevent the spread of the virus, which a World Health Organisation expert says "has broken out very rapidly."

The Romanians have culled one million fowl and dealt with 60 outbreaks of bird flu since the first case was detected in the Danube delta last year, officials say.

To date the country has not reported any cases of bird flu in people.

Source: Xinhua

http://english.peopledaily.com.cn/200605/29/eng20060529_269247.html

So instead of going to a level 4 they redid the chart to make a level 4 a level 3?

HeyU said:

So instead of going to a level 4 they redid the chart to make a level 4 a level 3?

Click to expand...

Close...

Post #2 said:

The World Health Organization plans to redraft the descriptions of its pandemic phases, a task triggered by the confusion provoked by the recent large cluster of human cases of H5N1 avian flu in Indonesia.

Click to expand...

It appears that WHO is very concerned about the economic effects of changing the alert level.

Post #2 said:

Fukuda agreed that changing the alert level would likely have a domino effect on international trade, travel and economies.

Click to expand...

So, it appears their solution will be to redefine the alert system.

That's why for posterity, I posted "post #3"... the 'current alert system'.

Indonesia

Tests confirm bird flu death in Indonesia​

Last Updated 29/05/2006, 11:08:09 Select text size:


It has been confirmed that a 10-year-old Indonesian girl who died last week in the city of Bandung was infected with the H5N1 bird flu virus.

This comes after tests at a World Health Organisation accredited laboratory in Hong Kong.

The girl's 18-year-old brother, who also died last Tuesday, tested positive locally for the H5N1 strain of bird flu this week.

However, the Hong Kong laboratory has not confirmed that he died from the lethal strain of the virus.

The death toll in Indonesia from bird flu now stands at 34, and the worldwide total stands at 125.

http://www.radioaustralia.net.au/news/stories/s1649601.htm?Indonesia

Interesting, Thanks!

Indonesia


May 29 2006 at 05:05AM

Jakarta - The World Health Organisation (WHO) on Sunday confirmed the 35th human bird flu fatality in Indonesia - a 29-year-old man who died 10 days ago in the capital Jakarta.

WHO spokesperson Dick Thompson told AFP that tests carried out at a WHO-affiliated laboratory had confirmed local results showing the man had died of the virus.

WHO tests also confirmed that two more Indonesians - an 18-year-old man from Surabaya, the capital of East Java province, and a 43-year-old Jakarta man - had contracted bird flu and were recovering in hospital.

More than 120 people have died of bird flu around the world since late 2003, the vast majority of them in Asia. - Sapa-AFP

http://www.iol.co.za/index.php?set_id=1&click_id=31&art_id=qw114885666111B216

You read my mind PCV...this is a level 4...the economic implications globally would prove devastating should they declare this alert level, so to dull the impact for a little while longer, revamp the system...this is like putting a bandaid on a nuke plant meltdown. I myself find it deceitful and fully unethical to bang a lid on a situation where getting the word out may save lives, instead they're hedging their bets that Joe sixpack won't go about his way and potentially be exposed to a potential BF victim....a totally irresponsible stance if they choose to revamp the level system for their convienence. JMHO.

PCViking said:

Close...



It appears that WHO is very concerned about the economic effects of changing the alert level.



So, it appears their solution will be to redefine the alert system.

That's why for posterity, I posted "post #3"... the 'current alert system'.

Click to expand...

changing the definition for economic reasons? Can't help but wonder if they would also try to minimize the increasing signs of a looming pandemic for the same reason too..

so who is playing the fiddle while the city burns this go round???

okie medicvet said:

changing the definition for economic reasons? Can't help but wonder if they would also try to minimize the increasing signs of a looming pandemic for the same reason too..

so who is playing the fiddle while the city burns this go round???

Click to expand...

Politicians.

Indonesia

UPDATED: 17:53, May 29, 2006

WHO confirms new human death of bird flu in Indonesia​

World Health Organization (WHO) has confirmed a new human bird flu fatality in Indonesia, said local health authorities on Monday.

Source: Xinhua

http://english.peopledaily.com.cn/200605/29/eng20060529_269468.html

Posts #7, #9 & #13 illustrate how confusing the news coming out of Indonesia are...

I'm going to assume blips like Post #13, will become more of the norm with reporting from hot-spots.

"seventh case of family members, or clusters, hit by the disease in Indonesia"

Indonesia's human bird flu deaths hit 37​

29/05/2006 - 13:03:29

Indonesia’s human bird flu death toll climbed to 37 today after the World Health Organisation confirmed that an 18-year-old boy died from the H5N1 virus, a senior health ministry official said.

Tests for the boy, whose sister also died from bird flu, came back positive from a WHO-sanctioned laboratory in Hong Kong, Nyoman Kandun said.

Both died on May 23 in the city of Bandung, becoming the seventh case of family members, or clusters, hit by the disease in Indonesia, he said.

The laboratory also confirmed that a 14-year-old girl from Solok, West Sumatra, had been hit by the virus, Kandun said. Indonesia’s total number of confirmed cases now is 50, of which 37 were fatal, he said.

Worldwide, bird flu has now killed at least 125 people since it began ravaging Asian poultry stocks in late 2003.

Kandun said all of the victims in the seven clusters were blood relatives, not spouses or in-laws, supporting an unproved theory that some people may have a genetic susceptibility to bird flu.

The two most recent siblings had a history of contact with dead birds, Kandun said.

A day after they died, animal health officials in the province found four chickens with the virus and culled up to 500 poultry within one kilometre (half a mile) of the victims’ house, he said.

Neighbours also reported that a number of chickens had suddenly died days before the victims were hospitalised.

Most human cases of bird flu have been traced to contact with infected poultry.

Experts are puzzled why six of seven Indonesians from a family in a North Sumatra village died from the H5N1 virus. An eighth was buried before tests could be done, but she is believed to have also been infected.

No links to sick birds could be found, raising the possibility of human-to-human infection. However, no other cases have been reported and the virus has not mutated, officials said.

Health officials fear that the bird flu virus could mutate into a form that is easily transmissible between humans and possibly trigger a global pandemic.

http://www.eecho.ie/news/bstory.asp?j=184220816&p=y84zzy5zz&n=184221576

Bulgaria Sooths Bird Flu Fears, Romania Cases Exceed 100​

Politics: 29 May 2006, Monday.

There is no imminent threat for poultry consumers in Bulgaria, as local veterinary authorities are struggling to explain.

Right at this moment it is impossible, or rather unlikely, for the wave of the lethal bird flu to cross the Danube and spread here, National Veterinary Service's Director Zheko Baychev said.

Last Friday Bulgaria imposed a ban on poultry products from Romania as part of the tightened precautionary measures with its northern neighbour.

Meanwhile Romania has been reporting more and more locations of the ravaging deadly virus. Currently the fowl disease is located at 115 places, a spokesman of the agriculture ministry announced.

All vehicles crossing the Bulgarian-Romanian border are subject to thorough disinfection. Large bulks of food stuff carried by passengers coming from Romania are being confiscated by customs authorities.

The ranks of veterinary officers were strengthened at border checkpoints, particularly at Vidin and Russe where the main gates to Romania are located.

http://www.novinite.com/view_news.php?id=64197

http://www.sptimes.com/2006/05/28/Worldandnation/Who_lives_Flu_crisis_.shtml


Who lives? Flu crisis may make us pick

Experts are divided on who gets the limited vaccine in case of a pandemic.

By LISA GREENE, Times Staff Writer
Published May 28, 2006


Imagine the worst: A deadly new strain of flu speeds across the globe, and as it approaches the United States, the reality is grim.
There isn’t enough vaccine to prevent people from getting the virus. Not enough medicine, hospital beds or even ventilators to treat the sick.

Whom do you save?

What was once an abstract philosophical dilemma has become an urgent health policy question. The most immediate danger, Asia’s killer bird flu, hasn’t turned into a worldwide epidemic because it hasn’t yet developed the ability to spread easily from person to person.

But public health officials must prepare for the threat of a disease that could spread with explosive speed. A global epidemic could kill nearly 2-million people and hospitalize nearly 10-million just in the United States. If a pandemic hits any time soon, scientists estimate that there may be only enough vaccine for about 10 percent of the population during the first year of the illness.

“In a situation like that, we will have to choose,’’ said Dr. Greg Poland, director of the Mayo Clinic Vaccine Research Group and a member of the advisory committee on vaccines for the federal Centers for Disease Control and Prevention. “We’re not used to that. We want everyone to get on the lifeboat.’’

But in this instance, most people won’t fit. And already, some of the nation’s top ethicists and flu experts disagree about who should go first.

“I’m not a fan of the rules as they’ve been presented,’’ said prominent bioethicist Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania. “I’m not sure they’ve explained why they’re doing what they’re doing.’’

The priority vaccinations

The guidelines now listed in the federal pandemic flu plan call for health care workers and vaccine producers to be vaccinated first. Few argue with that; without them, there will be nobody to care for the sick.

“If you have doctors and nurses that don’t come to work, you have nobody taking care of flu patients,’’ said Dr. Bruce Gellin, director of the National Vaccine Program Office for the federal Department of Health and Human Services.

After that, the guidelines call for certain vulnerable groups to be vaccinated, such as pregnant women, and then people older than 65. Healthy children would come last, along with other healthy people ages 2 to 64.

It’s more than an abstract policy for LeeAnne Cochran.

The 27-year-old Tampa resident was watching her three kids make their way to a park play gym one afternoon last week. She had a quick reaction to who should get the first vaccine: “The kids, I think.’’

But her youngest child, 6-year-old Chelsey, was listening.

“No, you should get it first,’’ she told her mother.

“But I don’t want my kids to die,’’ Cochran said.

“We don’t want you to die!’’ Chelsey said.

“But you have a whole life ahead of you.’’

Is it that easy? Should Chelsey, Marissa and Devin get vaccine before, say, the elderly? Before their grandmother?

“I don’t know,’’ Cochran said. “It’s a hard decision. Yeah. I’d have to say the kids. It’s kind of selfish. But I have three kids.’’

That question has been a key point of contention for scientists as well.

“There was substantial discussion of priority for children,” Gellin said. “It’s not as if they were ignored … healthy children have been at low risk in prior pandemics.’’

Does age matter?

It’s the age question that has incited the most debate. In setting the guidelines, the federal group assumed that this pandemic would be similar to earlier ones in 1957 and 1968, and that the elderly would be among the most at-risk for severe illness and death.

But others question whether that’s true. In the worst flu pandemic, the 1918 Spanish flu that killed more than 40-million people around the globe, the most deaths occurred among healthy young adults.

What would really save the most lives?

“Government policies have been, the people most likely to get sick, the people most likely to be in danger,’’ Caplan said. “But you could argue that in real scarcity, it makes sense to take into account the best chance of surviving. Instead of the 85-year-old with pneumonia, you could say you’re going to treat the 30-year-old.’’

Caplan and colleagues recently put together a group, the Ethics of Vaccines Project, to discuss such questions.Protecting children makes medical sense, Poland said. Some studies show that vaccinating children for regular flu decreases the spread of flu in the whole community. Children gather together in school, swapping homework, hugs and germs at a rapid rate.

“Children tend to be super-spreaders,’’ Poland said. “So in reality, if I give it to a 2-year-old, I’m protecting the 2-year-old, the parents, the sibling, the grandparents. If I give it to an 80-year-old, I’m probably not going to protect the same number.’’That depends on the nature of the pandemic, Gellin said. Who gets vaccinated could change depending on who gets sickest.

“All this is shaped by how a pandemic looks,’’ he said. “You need to have a process that would allow that kind of flexibility — to have some understanding of how it’s playing out.’’

Also, studies that show vaccinating children provides a protective effect on the community reflect situations when enough vaccine was available to cover all the children, Gellin said. In a pandemic, that might not happen.

Underlying the medical questions are more philosophical choices. Whom do you want to save? How do you decide which lives have the most value? Dr. Ezekiel J. Emanuel, chair of the Department of Clinical Bioethics at the National Institutes of Health, recently upped the debate with a provocative essay in Science magazine.

Federal guidelines suggest saving the most lives, rather than giving people a chance to live more years or their natural lifespan, wrote Emanuel and a co-author, expressing their personal opinions, not federal policy.

The two propose giving younger people higher priority based on that idea, then combining it with what they call an “investment refinement.” They would give a higher priority to 13-year-olds than 2-year-olds, balancing the teenagers’ “more developed interests, hopes and plans” that have not yet come to fruition.

The federal guidelines follow the same philosophical principles as vaccination for a normal flu season, Emanuel said.

“It’s a completely different situation,’’ he said. “The potential for mortality is high. The potential for social chaos is completely different … the principles underlying pandemic flu (vaccination) need to be realigned too.’’
Some say protect children

Others also argue for protecting children as a philosophical choice.

“The thing that would make the most sense to me, is not to prevent deaths, but to preserve as many quality years of life as possible,’’ said Dr. John Sinnott, clinical director of the Signature Program in Allergy, Immunology and Infectious Disease at the University of South Florida College of Medicine.

How choices are made is an essential part of the equation, too, Caplan said. Although there have been some government-sponsored forums on the topic, Caplan said there hasn’t been nearly enough public debate.

“The person who’s more informed is more likely to comply,’’ he said. “Part of the reason to have a discussion of the rules is so people will follow them. It’s all the glue you’ve got.’’

Other hard decisions would have to be made as flu spread. Who would get flu medicine, such as Tamiflu? Ventilators? Beds in hospitals’ intensive care units?

Some of those decisions would be similar to those made with vaccine, doctors said. Health care workers, once again, would be high priorities for getting Tamiflu, an antiviral medicine that could reduce the severity of the flu. But other decisions might mean uncomfortable choices: giving beds to the extremely sick — but not the frailest of all.

“When you’re really overwhelmed, you start to ration by triage,’’ Caplan said. “Let go of the people so injured and sick that you don’t know if you can help them. Like on a military field … we do it a lot in war.’’

And that, doctors say, is what a true pandemic would be.

http://english.people.com.cn/200605/29/eng20060529_269360.html


Indonesia gets tough on bird flu, announcing epidemic law
font size ZoomIn ZoomOut

The Indonesian government Friday reactivated the 1984 epidemic law in its latest effort to fight against bird flu, which so far has killed 36 people.

Under the law, those convicted of blocking government's way to eradicating the disease are punishable by one-year jail term.

Coordinating Minister for People's Welfare Aburizal Bakrie said the government would reactive the law following Indonesia's biggest cluster case in North Sumatra, in which seven family members died of bird flu.

There has been no evidence that the fatalities were resulted from human-to-human virus transmission, he said at a meeting with other related officials at his office here.

The government will establish rapid-response teams in areas considered to be most vulnerable to the disease, he said, adding that President Susilo Bambang Yudhoyono has agreed to disburse a considerable amount of fund to finance the program.

Not sure if this is a dupe or not.....


http://abcnews.go.com/International/print?id=2015991


Indonesian Villagers Blame Magic, Not Flu
Villagers Blame Black Magic, Not Bird Flu, for Deaths in Indonesian Family
By MARGIE MASON
The Associated Press

KUBU SIMBELANG, Indonesia - The three brick-and-clapboard houses stand along the village's muddy dirt road, empty and forlorn. A naked light bulb hangs from a wire over one door, still burning. A white pet bird cries for food from its cage. But no one dares to go near.

Health experts have focused on the houses since an extended family started dying from bird flu and no links to sick birds could be established. They suspect limited human-to-human transmission, but say there is no need to panic because no one else in this mountain farming village has fallen ill and the virus has not mutated.

Some neighbors insist, however, that bird flu is not to blame. They are convinced black magic is at work, that ghosts now haunt their quiet Christian community of about 1,500 people.

Many are too scared to even pass by the family's houses, and some who live nearby are awakened by nightmares that they will be the next to die.

"We are so afraid just to step into that house," said a 37-year-old woman who identified herself only as Sembining. "We can't tell what we're afraid of we're just afraid."

She lived near the victims and said the first woman who died was like a daughter to her. She recalled feeding and caring for her friend as she lay burning with fever before bird flu was ever suspected. Sembining can't understand why she, too, didn't fall ill.

"I think the family was cursed," she said. "It must be, because if it's bird flu, why only their family? Their blood?"

This is the largest cluster in a handful of cases involving bird flu passing from human to human, but scientists think it has always done so between blood relatives not spouses. That has led some to theorize there may be a genetic susceptibility to the disease, but there is no evidence yet to support that.

Tests found no trace of the H5N1 virus in the village's poultry, and dozens of hens, roosters and chicks run freely in backyards. Pigs, cows, buffalo, dogs and barefoot children roam along the rutted road and across fields of chilies, oranges and limes.

Whatever the source of the infection, six of seven family members who tested positive for H5N1 have died. An eighth was buried before samples could be taken, but the World Health Organization considers her part of the cluster.

As their neighbors started dying, confusion and mistrust prompted villagers to stop cooperating with officials. Many refused to give blood samples, fearing they would later fall ill and suffer the fate of their neighbors.

The case has been a powerful lesson for WHO officials in understanding the importance of early communication and education.

"We're seeing what problems we're going to run into on the ground," WHO spokesman Dick Thompson said. "We're learning with every step."

Jules Pieters, manager of WHO's rapid response and containment group in Geneva, said it is clear that people familiar with the culture, language and customs of this area should have been involved earlier to help villagers understand what was happening, how to protect themselves and the importance of allowing treatment if they develop symptoms.

Instead, many people who were never scared of doctors before are now terrified of them.

"We are afraid to be sent to an isolation room. You know an isolation room is a slaughtering room a room for the people who want to die," said villager Caranta Perangin-Angin. "Therefore we are afraid of (letting doctors) take blood. Taking the blood, for me, symbolizes going to die."

Indonesian officials reported that at least one patient had fled the hospital to seek traditional medicine and was later caught and returned. In the event H5N1 should mutate into a form easily passed among humans, such behavior would likely spread the illness further a serious worry for experts who fear the possibility of a bird flu pandemic.

"In these situations, we need to first earn the trust of the people most directly at risk," Thompson said. "I think one of the lessons we're learning from this outbreak is that you can't just drive truckloads of Tamiflu into this area and expect that the problem is solved."

He said some villagers began associating Tamiflu, the chief drug to treat bird flu, with death because members of the infected family most of whom were given the medicine too late to help were dying after taking the pills.

Not everyone in the village is spooked.

Parked on a bench outside his tiny shop and strumming a guitar, Bapak Karunia Sembiring smiled when asked about bird flu. "If the doctors said it's bird flu, then so be it."

He said he is happy officials are monitoring the villagers' health and spraying disinfectant. But the 60-year-old fears his village will be shunned.

"I'm a little bit worried about what will happen in the future to the village," he said. "The worst is that the world will hate us, will judge us."

Tuesday, May 30th: Rerun of Oprah's special on Bird Flu from January with Dr. Osterholm....a very good overall presentation and worth watching.....


http://www2.oprah.com/tows/pastshows/200601/tows_past_20060124.jhtml

SUN; a role model for other high tech employers....

Tech firm hopes flexibility will pay in pandemic​

Mon May 29, 2006 4:02 PM ET

By Maggie Fox, Health and Science Correspondent

WASHINGTON (Reuters) - Surveys show that few companies have coherent plans for a possible bird flu pandemic, but one California high-tech firm hopes its flexible employment practices may pay off in such an emergency.

Santa Clara-based computer-maker Sun Microsystems <SUNW.O> hopes both its technology and its popular telecommuting options will help keep its 38,000 employees working safely in case of a pandemic or any other emergency.

"We think we are a little further down the path than most companies are and I think that gives us a little advantage," Bill MacGowan, Chief Human Resources Officer and Executive Vice President of People and Places at Sun, said in a telephone interview.

The H5N1 avian influenza virus rarely infects people, with just 224 confirmed cases, but some recent clusters of family cases in Indonesia have renewed concern that it could evolve into a form that people could pass to others easily.

That could cause a pandemic that would sweep the world in months and kill millions, with up to 30 percent of the population infected in the first wave of sickness.

Even with just a few percent seriously ill, 40 percent of the work force would be out for weeks at a time, either themselves ill, caring for sick relatives, watching children kept home when schools close, or simply out of fear.

The World Health Organization has been urging companies and governments to plan for such an outcome, but a survey earlier this year by employment experts Watson Wyatt Worldwide showed only 15 percent of large U.S. companies have any bird flu plan.

MacGowan believes Sun is more prepared than most.

"Forty to 50 percent of our employees work in a flexible environment, such as from home," he said.

DROP-IN CENTERS

"We have drop-in centers instead of regular large offices that people can use. Some of these arrangements would work to our advantage if we are ever in a pandemic situation."

Doctors advise keeping employees at least three feet (one meter) apart during flu epidemics, because the virus is carried about that far in particles.

They also recommend wiping down shared surfaces and equipment with bleach-based or other antiviral cleaners.

Sun has stocked up on antimicrobial soaps, face masks, and has started educating employees about hygiene.

Telecommuters or those using satellite offices could avoid crowds by working in the off-hours, MacGowan said. His company, unlike others trying to gear up, has rehearsed the system.

"A lot of our employees are used to working from home," he said. "It allows you to retain key employees you would otherwise lose and it can attract others," he said.

The company's technology can help, too, he said.

For instance, its Sun Ray product lets workers carry the equivalent of their own workstation from workplace to workplace, allowing them to keep sessions active and secure without have to log in again and again.

Much depends on the Internet -- a weakness, MacGowan agreed. Some models have predicted that the Internet and telecommunications in general could slow down or even crash if tens of millions of people all of a sudden try to access it.

"As a high-tech company we would be challenged if the Internet and electricity didn't work," MacGowan said.

Scott Kriens, Chairman and Chief Executive Officer of computer network equipment maker Juniper Networks, Inc., pointed this out to a hearing of the House Government Reform Committee earlier this week.

"Emergency communications systems that rely on satellite communications may be required," Kriens told the hearing on telework. "Data flow is the essential requirement, and whether it moves through wires, fiber, or the air, it will have to be robust enough to function through a crisis."

http://today.reuters.com/business/n...7397_RTRIDST_0_BUSINESSPRO-BIRDFLU-SUN-DC.XML

I myself am looking at a genetic predisposition to being either able to fight off birdflu or not...I'm not a rocket scientist, but I'm recalling what I was told as a child and what I've learned as a healthcare professional.

Who lives? Flu crisis may make us pick

Experts are divided on who gets the limited vaccine in case of a pandemic.


That's easy

1) The Pres, his family and friends
2) Everyone else on capital Hill, friends, family
3) Medical personal to take care of above
4) Caretakers and guards of the shelters that the above are in
5) State Gov employees
6) The experts

That should about do it.

New Freedom said:

Not sure if this is a dupe or not.....


http://abcnews.go.com/International/print?id=2015991


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This is the largest cluster in a handful of cases involving bird flu passing from human to human, but scientists think it has always done so between blood relatives not spouses. That has led some to theorize there may be a genetic susceptibility to the disease, but there is no evidence yet to support that.

Click to expand...

Didn't I read here somewhere that China was trying to develop bioweapons that infect everyone except themselves?

WHO Revisions of Pandemic Phases
​

http://www.recombinomics.com/News/05290602/WHO_Phase_Revisions.html

Recombinomics Commentary
May 29, 2006

The difference between stages three and four hinges on how easily the virus can be passed between humans -- a subjective call that in some cases may prove very difficult to make.

Examples of close contact include "staying close to the ill persons for hours or holding, touching, wiping the face, or kissing or speaking with the ill person at a close distance," according to Paul R. Gully, a senior advisor at the WHO in Geneva. "By contrast, casual contact refers to a lesser degree of contact between the infected person and others -- for example, being [within] a few to several feet away for shorter periods of time, but long enough for common respiratory infections such as regular flu or colds to be passed on through coughing or sneezing."

New guidelines that distinguish between close contact and casual contact may eliminate some of the confusion over pandemic phases, but there are several sources of confusion. WHO comments used the subtle approach to distinguish the types of transmission by introducing the word "easily" into human-to-human transmissions (H2H) descriptions. Thus, comments indicted that H5N1 was not EASILY transmitted to humans. However, this subtle change was not widely noticed and was left out of many media reports, However, even when included, readers would not necessarily notice the subtle change.

Several months ago, when the public profile of bird flu increased, the difference of transmission was linked to the failure to identify examples of H2H2H transmission, as opposed to just H2H. However, the recent cluster in Sumatra appeared to be H2H2H or H2H2H2H, so the failure to increase the phase from 3 to 4 caused additional confusion.

However, this confusion was due to the failure of WHO to be more transparent on prior H2H clusters. WHO knows that the key to distinguishing H2H from a common source is the disease onset dates. The WHO and CDC wrote a paper on the first 15 clusters, which were largely clusters that has a 5-10 day gap between disease onset dates of the index case and additional family members. These frequent gaps left little doubt that the vast majority of familial clusters were H2H or longer chains. As noted above, there are many types of transmission due to close contact and these types of close contact would be common among family members. Although possible, common source transmission by two or more independent events would be highly unlikely because H5N1 transmission from birds to humans is extremely rare. In contrast, familial clusters are increasingly common, especially in Indonesia.

The majority of cases in Indonesia is linked to family clusters and are examples of H2H. Thus, the extended chain in Sumatra was the largest and most deadly reported cluster in Indonesia, but it was only incrementally greater than the large number of earlier cases.

Moreover, WHO officials know that most cases in West Java have a novel cleavage site that has not been reported in bird sources in the area. The lack of an avian source for the human infections raised the question of H2H in Indonesia as soon as the first sequences was generated in July of 2005. The cleavage site RESRRRKKR was not in any public sequence and as the number of bird and human sequences in Indonesia increased, the difference between the human cases and bird cases remained. Only one human case in the West Java area had the wild type H5N1 sequence, RERRRKKR, although the cases in Sumatra probably change the number of human sequences with the wild type sequence. However, this new data clearly demonstrates that two distinct sequences are circulating in Indonesia that can cause H2H transmissions.

H5N1 has been evolving incrementally via recombination. In many instances single nucleotide changes are acquired. However, even a single nucleotide change like S227N in HA or E627K in PB2, can cause a dramatic change in transmission or virulence. The only viable human Indonesia sequence of HA and NA has a large number of polymorphisms found in a wide range of H5N1 sequences in Asia, indicating recombination is frequent and involves many hosts, including mammals.

Therefore changes in key areas such as the receptor binding domain can be sudden, and changes in transmission, even if limited to close contact can be instructive and offer intervention targets.

Once H5N1 is easily transmitted by casual contact, the time between that change and phase six may be hours or days.

Therefore the small changes may provide more useful intervention opportunities than a declaration that transmission has become easy, because at that time options may be very limited.

Confirmed H5N1 Bird Flu Cases Increase Across Indonesia​

http://www.recombinomics.com/News/05290601/H5N1_Indonesia_Widespread.html

Recombinomics Commentary
May 29, 2006

One of them was an 18-year-old man from Bandung on Java island who had tested negative earlier in Hong Kong. The latest result classified him as a H5N1 case, said I Nyoman Kandun, director-general of communicable disease control.

He was the brother of a 10-year-old girl, who was tested positive for H5N1 by the Hong Kong laboratory last week. Both died last Tuesday.
Kandun said a 15-year-old girl from Solok in western Sumatra, who is fighting for her life, also tested positive, according to results from the Hong Kong laboratory.

The above comments add to the WHO list of confirmed H5N1 bird flu cases in Indonesia. In addition to the large cluster on North Sumatra and another case in Bekasi, which have been described in updates. Seven more confirmed cases have been announced in media reports in the past few days. Two siblings in Bandung in Western Java have been confirmed in addition to three cases in nearby Jakarta. There has also been confirmation in East Java as well as western Sumatra.

These new cases cover large geographical regions in Indonesia and involve at least two different versions of H5N1. The cases in West Java have a novel cleavage site RESRRKKR, which has not been reported in poultry, raising concerns of Mammalian reservoir. In contrast the large cluster in Sumatra appears to be related to the wild type H5N1 cleavage site sound in birds in Indonesia, RERRRKKR, which has bee found throughout Asia.

The analysis of changes in these two versions has been hampered because they are sequestered in a private WHO database and not publicly available. The recently reporting of new cases in Indonesia has led to the deployment of Tamiflu by the United States and warning to Tamiflu maker Roche. In addition, WHO has announced a revision in the definition of pandemic phases, with a distinction between human-to-human transmission within families and more casual transmission.

The increase in the number of cases is cause for concern, and the sequences should be released immediately.

H5N1 Transmission in Clusters Is Not Limited to Blood Relatives​

http://www.recombinomics.com/News/05290603/H5N1_Blood_Relatives.html

Recombinomics Commentary
May 29, 2006

So far, scientists think, all such case have involved passing the virus between blood relatives. Some experts theorize that may mean some people have a genetic susceptibility to the disease, but there is no evidence to support that.

The above comments, indicating that all H5N1 bird flu transmissions in clustwers are between blood relatives, are false. There are several examples of H5N1 confirmation in cluster members that are not blood relatives. In 2005 the largest familial cluster was in a family of five in Haiphong. All five family members were hospitalized on the same day and all were H5N1 confirmed. The family consisted of a mother, father, and three daughters, so transmission was not limited to blood relatives.

Similarly, in 2005 there was a cluster involving a pair of siblings and the nurse of the index case. The nurse was not a blood relative and had no exposure to poultry.

More recently there was a large cluster in Azerbaijain involving siblings and a close friend who was also not a blood relative.

Since most family members are blood relatives, most infected in familial clusters will be blood relatives, but these are the people who are in close contact with infected family members. The close contact is a major driver of these infections, which are largely limited to family members.

In the Azerbaijan cluster, all confirmed cases were siblings. There was no reported transmission to either parent. Similarly the large cluster of confirmed cases in Turkey also involved siblings. There was no confirmed transmission to either parent. Thus, even though both parents were blood relatives to the siblings, none were confirmed to have been infected.

Although most family members are blood relatives and all members of the Sumatra cluster were blood relatives, the exceptions cited above weaken evidence to support a genetic susceptibility as a major driver of familial clusters.
.

First vaccine to fight bird flu is here
http://timesofindia.indiatimes.com/articleshow/1585483.cms

NEW DELHI: A single vaccine can now protect poultry against two of the deadliest killers - bird flu and Newcastle disease.

A team of American biologists have found that inserting a bird flu gene into a popular vaccine that protects poultry against Newcastle disease, leads to resistance against both these viruses within the bird's body. There currently is no vaccine for avian flu.

Developed by Peter Palese, chair, department of microbiology, Mount Sinai School of Medicine in New York City, this new vaccine could, for the first time, offer an alternative to the mass slaughtering that has cost the world's poultry industry millions in lost sales, and also an effective and inexpensive way to vaccinate poultry against bird flu.

Scientists added the gene H5 - one of 16 subtypes of hemagglutinin, a protein that binds the avian influenza virus to the cells it infects, to a commercially available Newcastle vaccine.

When they exposed chicken to lethal doses of the avian influenza virus and the Newcastle virus, birds inoculated with the recombinant vaccine produced antibodies against both viruses, offering protection against both diseases.

The researchers are now negotiating with drug companies about mass production of the vaccine. They say the Newcastle disease virus vaccine that is now in use, costs less than a penny per bird, and the genetically-engineered version to protect against avian flu should not cost much more.



Speaking to TOI, Palese said, "This is a major breakthrough in terms of protecting chicken. First we grafted a flu virus, using genetic engineering onto a vaccine that exists against Newcastle Disease.

The reverse technology needed for making these viruses took 10 years to develop. Then the vaccine was tried on 80 chicken and nearly 100% effectiveness was seen. We have the strains with us and are negotiating with companies to make the vaccine.

Our entire research was financed by the National Institutes of Health. This will be a very cheap vaccine that can be added to water or even sprayed. The vaccine can also be altered to carry genes from any of the hemagglutinin subtypes."

Nearly 115 people have died of bird flu and all the victims had been in close contact with infected birds. However according to experts, "You probably would have to vaccinate the birds more than once, because you only get partial protection the first time.

The reason for the partial response is that the immune systems of young birds carry antibodies from their mothers that reduce the response to the vaccine."

Meanwhile, delegates at World Health Assembly, including those from India, agreed to begin implementing parts of the International Health Regulations relating directly to avian influenza immediately.

Link to tomorrows (5/30) Bird Flu thread: http://www.timebomb2000.com/vb/showthread.php?t=199132