06/05 | Daily BF: WHO Phasing Out H5N1 Bird Flu Pandemic Phase 4 and 5?

Link to yesterday's thread: http://www.timebomb2000.com/vb/showthread.php?t=199536

Here is an important link... everything you wanted to know about influenza, by Johns Hopkins: http://www.iom.edu/Object.File/Master/33/450/Rashid Chotani.pdf

Here is an article originally posted by New Freedom in this past weekend's BF thread.

It appears that the WHO scale will go directly from 3 to 6?

New Freedom said:

http://www.recombinomics.com/News/06030604/H5N1_Phase_4_5_Out.html



Commentary

Phasing Out H5N1 Bird Flu Pandemic Phase 4 and 5?

Recombinomics Commentary
June 3, 2006

Dr. David Nabarro, chief pandemic flu coordinator for the United Nations, said that even if some unexplained cases were human-to-human, it does not yet mean that the pandemic alert system, now at Level 3, "No or very limited human-human transmission," should be raised to Level 4, "Increased human-human transmission."

Level 4 means the virus has mutated until it moves between some people who have been only in brief contact, as a cold does. Right now, Dr. Nabarro said, any human transmission is "very inefficient."

Level 6, meaning a pandemic has begun, is defined as "efficient and sustained" human transmission.

The above comments from Donald McNeil Jr's New York Times report, "Human Flu Transfers May Exceed Reports," suggests that movement from Level 3 to Level 4 is not necessary because Level 4 and Level 5 are being phased out. Once H5N1 achieves efficient transmission as defined by transmittion by causal contract on a pare with transmission by a cold virus, the final Pandemic level will have been reached.

The current system, which uses six phases, is designed to identify two intermediate phases (4 and 5) which represent increasing efficiencies of transmission. These changes mark progress toward increased efficiency, but at an early stage when intervention may limit progression.

The description of level 4 above, is really the current phase 6, which is efficient and sustained human transmis8sion. Transmission of a cold virus is efficient and sustained, which would also apply to H5N1.

Currently H5N1 can efficiently replicate within humans, but transmission between humans is inefficient. However, these efficiencies have been increasing, as seen in large clusters in Turkey, Azerbaijan, and north Sumatra, Indonesia. The turkey cluster was linked to a change, S227N, in the receptor bindin4g domain, which increases efficiencies and generated the largest and most sustained cluster recorded to date.

Azerbaijan also had a large sustained transmission chain, but the sequence of the H5N1 has not been released. Although these transmission chains are among the largest recorded, the transmission was limited to family members or close contacts. This limited spread was also seen in north Sumatra, and again the sequences have been withheld, so genetic remains unclear.

The increased concentration of H5N1 in the nose and throat may signal a PB2 E627K acquisition, which is another small change associated with increased virulence which may translate into increase transmission because of the preference of E627K for cooler temperatures of 33 C.

The changes in the H5N1 associated with these changes have been small incremental changes, such as those that would be measured by a pandemic phase system the distinguished the incremental steps. Since these incremental steps have been taken previously but not acknowledge, the definition above simply eliminates these intermediate phases.

However, the local response to these small changes has been to flood the region with Tamiflu and treat the outbreak as it would be treated if it were at a higher phase.

Thus, phase 4 and 5 appear to be phased o6ut, and the current status of the pandemic is one step away from the old pandemic level, 6, which is now being called level 4.

Click to expand...

Then also in this wekend's BF thread is this gem from JPD:

JPD said:

As per another thread - http://www.timebomb2000.com/vb/showthread.php?t=199605 and Drudge Reports....

Human Flu Transfers May Exceed Reports​

June 4, 2006

http://www.nytimes.com/2006/06/04/w...&partner=rssuserland&emc=rss&pagewanted=print

The W.H.O. is generally conservative in its announcements and, as a United Nations agency, is sometimes limited by member states in what it is permitted to say about them.

Click to expand...

Hmmm... draw your own conclusions...

Well, I have drawn my own conclusion --- it's a comin'.
With a vengence.

Flu pandemic: It's only a matter of time​

By KRISTIN BUEHNER and JULIE BIRKEDAL, Of The Globe Gazette

Threat of an avian “bird” flu epidemic among humans is unknown, but a future flu pandemic is not a question of if, only a question of when. “A flu pandemic will be like nothing we’ve ever seen before and can even comprehend,” said Ron Osterholm, director of the Cerro Gordo County of Public Health. “Most of us have never experienced this.”

Pandemic influenza refers to a very severe strain of influenza that has the ability to spread across the world. Pan means “all” and demos means “people.”

“Influenza pandemics are like earthquakes, hurricanes and tsunamis — they occur,” said Michael Osterholm of Minneapolis, brother of Ron Osterholm and director of the Center for Infectious Disease Research and Policy (CIDRAP). One of the world’s leading experts on public preparedness, Osterholm’s remarks were included in testimony before the House Committee on International Relations on Dec. 7, 2005.

“I believe an influenza pandemic will be like a 12- to 18-month global blizzard that will ultimately change the world as we know it today,” Michael Osterholm said. “This will occur even if we experience a milder worldwide pandemic of millions of deaths rather than many millions of deaths.”

Osterholm estimated 180 million to 360 million people could die in the next flu pandemic. “This is far and above terrorism or all infectious diseases combined.”

In a Jan. 24, 2006, television interview with Oprah Winfrey, Osterholm said pandemics occur approximately every 20 to 30 years. “It’s going to happen,” he said. “What we don’t know is what strain it will be.”

According to the World Health Organization, about three influenza pandemics occur per century at intervals ranging from 10 to 50 years.

The 20th century witnessed three pandemics: The “Asian” flu of 1957-58, the “Hong Kong” flu of 1968-69, both of which were mild, and the “Spanish” influenza pandemic of 1918-19. The 1918 pandemic killed between 50 million and 100 million people around the world, at least 675,000 in the United States.

In Iowa, more than 29,000 cases were reported in 1918-19, according to a February 2006 report by Mike Leavitt, U.S. Secretary of Health and Human Services.

Today, with a world population of 6.5 billion, more than three times that of 1918, and increased travel, even a mild pandemic could kill many millions of people, Ron Osterholm said.

The current virus strain, H5N1, is spreading very quickly and has been fatal to approximately 56 percent of the people who have been infected by it, he said.

If the H5N1 virus does lead to a pandemic, it could infect up to 30 percent of Americans and kill up to 2 million people, according to the U.S. Department of Health and Human Services. Up to 40 percent of school children could get sick.

Symptoms of the flu include severe respiratory distress, headaches and pneumonia, necessitating the use of ventilators among the seriously ill.

“Obviously, not everyone that gets this flu is going to die from it,” said Karen Crimmings, disease prevention and investigation service manager with the Cerro Gordo County Department of Public Health.

Yet to some extent, a pandemic is expected to affect everyone.

Between 30 percent and 40 percent of the workforce may miss work, Crimmings said.

VACCINE: Currently, there is no vaccine for a flu pandemic because health officials do not know what strain will cause pandemic influenza among humans. After that, it will take at least six months to prepare one, and even then, the quantity will be limited.

According to Michael Osterholm, in a year’s time, only about 300 million doses of vaccine could be manufactured, which would not be nearly enough.

A priority system for the vaccine will be established, with those determined to be most vulnerable to the flu at the top of the list.

But until the virus mutates, no one knows who will be most vulnerable — aside from the first responders, Crimmings said.

Surveillance will have to determine who these people are, Ron Osterholm said.

In the 1918 pandemic, young adults were the chief victims.

The Bush Administration has said workers in vaccine factories and people caring for the ill will get the first doses.

“That makes good sense,” Ron Osterholm said. “You’re going to need health personnel in place to maintain the health system. If frontline responders are not protected, that compromises our whole response system because they’re going to be reluctant to expose themselves by responding.”

Efforts are under way to enhance the world’s flu vaccine-making capabilities.

On May 4, 2006, CIDRAP reported the U.S. government had awarded five contracts to pharmaceutical companies, totaling more than $1 billion to develop cell-based technologies for making flu vaccines. The contracts were to develop an alternative to growing flu vaccines in eggs, a time-consuming method used since the 1950s. The contracts are for five years.

The money is from $3.8 billion Congress appropriated in December 2005 for pandemic preparations by the Department of Health and Human Services.

HOW IT SPREADS: Wild waterfowl and shorebirds are the natural host reservoir of all avian influenza viruses. The avian flu is spread through the feces of migratory birds, can be transmitted to mammals and is continuing to evolve, according to information from the U.S. Department of Health and Human Services.

The H5N1 virus has spread across eastern Asia and into Europe and Africa. The virus has passed from infected poultry to humans and other mammals and has had devastating effects on poultry farming in several nations, according to the U.S. Department of Agriculture.

The change of seasons each year, from winter to spring, sends wild birds from Asia and the continental United States north to Alaska, where they commingle while they nest and molt.

In Alaska, biologists are trapping birds and collecting samples from feces and cells from their digestive tracts for testing for viral influenza. To date, no worrisome cases have been reported.

Scientists say April through September of this year may be a crucial time frame, in terms of knowing whether the disease will spread to the United States via migratory birds.

Iowa, part of the Mississippi Flyway, is visited by a large number of migrating birds each year, making Iowans particularly vulnerable to exposure to avian influenza viruses. About 40 percent of North America’s waterfowl migrate along the Mississippi River, including 11 million ducks and geese per year, according to information from the University of Iowa College of Public Health.

Even if the virus were to appear this year in North American birds, it does not necessarily mean the start of a pandemic or a risk to poultry, Ron Osterholm said.

“It just means there are potential risks for a pandemic to occur,” he said.

As to poultry, poultry growers say that, “because of security in place in the U.S. confined poultry system, there isn’t much chance of wildfowl mixing in with poultry.”

According to the most recent information available from the World Health Organization, updated May 12, 48 countries have reported cases of the avian flu in poultry and wild birds. They include 12 countries in East Asia; 29 (total) in Europe, Siberia and Central Asia; and seven in Africa.

From 2003 to 2006, more than 200 human cases of the H5N1 strain of avian flu have been reported, with a mortality rate of more than 50 percent, according to the World Health Organization as of May 29. Countries in which laboratory-confirmed human cases of avian flu were reported are Azerbaijan, Cambodia, China, Djibouti, Egypt, Indonesia, Iraq, Thailand, Turkey and Vietnam.

HUMAN TO HUMAN: In May, Indonesia averaged one human bird flu death every 2½ days, putting it on pace to soon surpass Vietnam as the world’s hardest-hit country, the World Health Organization reported May 30.

On May 23, a possible case of human-to-human bird flu infection was reported in North Sumatra, Indonesia.

The World Health Organization acknowledged the likelihood that eight members of one family contracted the H5N1 strain of flu. The first was a 38-year-old woman who became ill April 27 and died May 4. Seven members of her family also became ill; six died.

No evidence of a mutation of the virus was found.

“New information changes every day,” Crimmings said. “It is still isolated. From my understanding, the virus has not mutated, but the investigation is continuing.”

For more information:

Web sites of the following organizations offer additional information about avian flu and a potential flu pandemic: Cerro Gordo Department of Public Health, U.S. Government Avian and Pandemic Flu Information Center, University of Minesota Center For Infectious Disease Research and Policy, Centers for Disease Control and Prevention, World Health Organizaiton.

http://www.globegazette.com.cob-web.org:8888/articles/2006/06/04/local/doc448240242a80e836974949.txt

Indonesia

WHO confirms new bird flu death​

Monday, June 5, 2006 Posted: 0540 GMT (1340 HKT)

JAKARTA, Indonesia (Reuters) -- The World Health Organization has confirmed an Indonesian teenager who died last week was infected with bird flu, a Health Ministry official said on Monday, taking the country's total deaths from the virus to 37.

Nyoman Kandun, a director general at the ministry, said the 15-year-old boy from Tasikmalaya in West Java had had contact with poultry.

Indonesia has seen a steady rise in human infections and deaths since its first known outbreak of H5N1 in poultry in late 2003. It has infected 48 Indonesians so far and the country has the second highest total bird flu deaths in the world.

Infected fowl are the usual mode of transmission of the virus, now endemic in poultry in nearly all of Indonesia's 33 provinces.

Last week, workers culled around 1,600 chickens in Tasikmalaya region where the boy died.

Chickens at his home and around the village where he lived had died a few days before he fell ill. The boy's grandfather was a chicken farmer.

Separately, authorities have sent samples from a seven-year-old Indonesian girl who also died last week to a WHO-accredited laboratory in Hong Kong after she tested positive for bird flu locally.

Bird flu remains essentially an animal disease but climbing human deaths have put many countries around the world on alert for fear it may mutate into one that could pass easily among people and trigger a pandemic, killing millions.

Indonesia drew international attention last month when the virus killed as many as seven members of a single family in North Sumatra. Experts said there could have been limited human-to-human transmission in this cluster case.

But they stressed genetic analyses of the virus have not shown all of the traits that are known so far to allow it to spread easily among people.

Indonesia's government has been criticized by some experts for what is perceived as its lack of resolve in stamping out the H5N1 virus.

Unlike neighboring Thailand and Vietnam, which have conducted mass culls to get rid of sources of infection, Indonesia has only carried out selective culling and only in places where there are known outbreaks of H5N1.

The government has cited the huge expense involved in carrying out a mass cull in a sprawling country of 17,000 islands where there are millions of backyard fowl.


Find this article at:
http://edition.cnn.com/2006/WORLD/asiapcf/06/05/indonesia.birdflu.reut/index.html

It is refreshing how Dr Henry Niman holds WHObabble feet to the fire and busts through the murky doublespeak and gets right to the crux of how direly screwed the world is with killer flu gaining more ability to infect humans.

[ Fair Use: For Educational / Research / Discussion Purposes Only ]
http://www.recombinomics.com/News/06050601/H5N1_Phase_Evolution.html

<b>H5N1 Bird Flu Pandemic Phase Evolution</b>

Recombinomics Commentary
June 5, 2006

Dr. Niman contends that the largest human-to-human cluster so far was not in Indonesia, but in Dogubayazit, Turkey, in January. W.H.O. updates recorded 12 infected in three clusters, and quoted the Turkish Health Ministry blaming chickens and ducks. Dr. Niman counted 30 hospitalized with symptoms and said the three clusters were all cousins with the last names of Kocyigit and Ozcan, and that most fell sick after a big family party on Dec. 24 that was attended by a teenager who fell sick on Dec. 18 and died Jan. 1.

A patriarch, Dr. Niman said, told local papers that the two branches had had dinner together six days after the 14-year-old, Mehmet Ali Kocyigit, had shown mild symptoms. He died on Jan. 1, and several other young members of the two families died shortly after, with other relatives showing symptoms until Jan. 16. No scientific study of that outbreak has been released.

Dr. Niman also said clusters were becoming more frequent, especially in Indonesia.

Level 4 means the virus has mutated until it moves between some people who have been only in brief contact, as a cold does. Right now, Dr. Nabarro said, any human transmission is "very inefficient."

Level 6, meaning a pandemic has begun, is defined as "efficient and sustained" human transmission.

Ms. Cheng of the W.H.O. said that even if there were more clusters, the alert would remain at Level 3 as long as the virus dies out by itself.

"A lot of this is subjective, a judgment on how efficiently the virus is infecting people," she said. "If it becomes more common, we'd convene a task force to raise the alert level."

The above comments are from Donald McNeil Jr's article in the New York Times on human-to-human transmission of H5N1 bird flu. Described above is the largest human H5N1 cluster, which was in Turkey and involved three families with confirmed H5N1 and one or two more related families which have hospitalized patients, but tested negative for H5N1. In addition, frequent cluster are being reported in Indonesia, including the large cluster in north Sumatra.

The comments by WHO officials on the phases and change of phases is also include, and those remarks suggest that phase 4 and 5 have been phased out because the requirements for convening a task force are those that define the pandemic phase 6, which is efficient and sustained.

The two phases that are not being discussed are 4 and 5 which are defined by small localized clusters of cases number less than 25 people for phase 4 and over 25 for phase 5. These phases are designed to identify increases in transmission frequencies, that are somewhat controlled.

Although movement to these levels was not formally announced, WHO statements in updates as well as methodology of responses indicate the level has already been raised to four and possibly five.

The most cited cluster of human-to-human transmission was in September of 2004. The index case was staying with her aunt, 100's of miles from her both, an office worker in Bangkok. The mother visited her daughter hospitalized in northern Bangkok. The index case died and the mother and aunt developed symptoms after her death.

The September 28, 2004 WHO update indicated:

While the investigation of this family cluster provides evidence that human-to-human transmission may have occurred, evidence to date indicates that transmission of the virus among humans has been limited to family members and that no wider transmission in the community has occurred.

Thus, WHO indicated limited transmission within the family as defined for phase 3.

The number of clusters increase in northern Vietnam at the beginning of 2005, but it was the second cluster in Indonesia that led to WHO modifying its wording in its updates. The first two confirmed cases in Indonesia were part of clear human-to-human clusters. The first involved a government worker and his two daughters. This cluster produced the only public sequence of human H5N1 from Indonesia. It was related to Indonesian poultry sequences, but had a novel HA cleavage site and glycosylation site and contain bits of genetic information from H5N1 from southeast Asia and China.

The cluster was followed by another cluster, involving an airline worker and her nephew. It was another case of human-to-human transmission and the H5N1 was distinct from the first cluster and had PB2 E627K as well as the wild type HA cleavage site. In the past, E627K was associated with the ability of H5N1 to replicate at lower temperatures and was associated with poor outcomes in humans.

The September 22, 2005 WHO update indicated

In a few instances, limited human-to-human transmission of the virus may have occurred following close contact with a patient during the acute phase of illness. In all known instances, such transmission has been limited and has not led to larger outbreaks in the general community, indicating that the virus does not spread easily among people at this time.

Now the human-to-human spread was being described as not being EASILY transmitted. The number of examples of human-to-human transmission was becoming too large to deny, so the term "easily" was introduced into descriptions of human transmissions. This signal the move to phase 4 which was defined by limited human-to-human transmission.

The limited transmission expanded in Turkey at the beginning of 2006. As noted in the quote above, the clusters were getting significantly larger and disease onset dates indicated that the transmission was now going from cluster to cluster. The clusters involved relatives and close contacts, but the language in the WHO update changed.

The January 12, 2006 WHO update indicated

All available evidence indicates that no sustained human-to-human transmission has occurred

Now the WHO update include the term "sustained" human-to-human transmission. Sustained transmission defines the final phase 6, signaling the pandemic start and inability to contain it. Thus, the update was signaling a move toward phase 5.

The number of cases and clusters was still developing. WHO media reports indicated the initial cases involved two large families. However, WHO failed to indicate that the two large families were related to each other. As the patients were confirmed, WHO updates withheld disease onset dates. In additional, the updates failed to disclose the relationship between the index family, Kocyigit, and cousins from the Ozcan who were together at a family gathering on December 24, 2005. The four Kocyigit siblings were transferred to Van at the end of December. The index case had seen a local doctor when symptoms were mild and was given cough syrup. After the family gathering the condition of the index case and siblings were deteriorating. The three oldest arrived at Van unconscious and all three died. Although they were initial said to be negative for H5N1, H5N1 was detected in the lungs of the three fatalities and H5N1 was isolated from the two oldest siblings. The Ozcans began arriving at Van in early January. 10 Ozcan family members were admitted over several days. Two admitted initial were placed in the ICU and eventually were positive for H5N1. This cluster was followed by infections in Ozcan cousins from another family. The index case for that family died and her bother recovered. Both were H5N1 confirmed.

The H5N1 for the index case for the Kocygit cluster was found to have a genetic alteration, S227N, in the receptor biding domain. This change had been predicted because the H9N2 in poultry in the Middle East had donor sequences which would allow S227N to be formed in the Qinghai strain of H5N1. This was a concern because all bird isolates from the Qinghai strain had PB2 E627K. Although infections in humans by the Qinghai strain had not been confirmed prior to the Turkey cluster, addition of S227N would create two genetic changes which targeted humans.

The WHO update on the H5N1 in Turkey indicated

Virus from one of the patients shows mutations at the receptor-binding site. One of the mutations has been seen previously in viruses isolated from a small outbreak in Hong Kong in 2003 (two cases, one of which was fatal) and from the 2005 outbreak in Viet Nam. Research has indicated that the Hong Kong 2003 viruses bind preferentially to human cell receptors more so than to avian cell receptors. Researchers at the Mill Hill laboratory anticipate that the Turkish virus will also have this characteristic.

Thus, the clusters were growing and the H5N1 was genetically changing. However, as noted in the same report, the H5N1 was susceptible to both classes of anti-virals, neuraminidase inhibitors such as Tamiflu, and M2 ion channel blockers such as the amantadanes.

The Turkey outbreak in January was followed by the Azerbaiian outbreak in February, which also had the characteristic gap in disease onset dates. This outbreak was also due to the Qinghai strain, but the sequence has not been released.

The most recent large cluster was in Indonesia again. The north Sumatra cluster involved 8 family members and 7 died. The WHO update indicated that the H5N1 was sensitive to Tamflu, but failed to indicate that the isolates were amantadine resistant. The description of the H5N1 suggested it had a wild type HA cleavage site. Third party reports indicated the level of H5N1 was elevated in the nose and throat, suggesting the isolates also had PB2 E627K.

As noted above, WHO is now talking about raising the pandemic level when H5N1 is easily transmitted and is sustained, which is the definition of phase 6.

Although WHO has not acknowledge the increases in the clusters which define phase 4 and phase 5, actions have been consistent with the higher levels. Tamiflu ahs been used to flood the area in Turkey, Azerbaijan, and now Indonesia. The United States has begun to deploy its stockpile to a "country in Asia" and Roche, the maker of Tamiflu, as been put on notice to prepare to ship its reserves.

Thus. although WHO has maintained phase 3, their language in updates, and actions signal pandemic evolution well beyond phase 3, and recent comments indicate the level will not be raised until the pandemic has reached the final phase 6.

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<B><center>June 5, 2006

Prepping for flu pandemic:

<font size=+0 color=green>Groups won't wait for feds</font>

<font size=+1 color=purple>Government likely to be swamped, say locals as they brace for worst. </font>

By Ann Wlazelek
Of The Morning Call
<A href="http://www.mcall.com/news/local/all-a1_5pandemicjun05,0,3687381.story?coll=all-newslocal-hed">www.mcall.com</a></center>
A local hospital is considering buying a modular MASH-like unit capable of isolating and treating as many as 100 infected patients.

A Lehigh Valley-based world supplier of medical oxygen is exploring ways to continue production even if a pandemic flu sickens 80 percent of its work force.

And area public health officials have produced a DVD to help individuals and groups prepare for widespread illness.</b>

Regardless of the likelihood that a virus killing birds and some people in Asia will cross the ocean and mutate into the next North American plague, local businesses, health care organizations and public officials are preparing for the worst.

Air Products and Chemicals, Lehigh Valley Hospital and the Allentown and Bethlehem health bureaus are among those taking cues from 9/11, SARS and Hurricane Katrina. They are deciding not to wait for the federal government to swoop in for the rescue, because needs will be immediate and could exceed the feds' capacity.

And those groups are not alone in the region in getting prepared. Sanofi Pasteur, a worldwide vaccinemaker, is making an avian flu vaccine in Swiftwater for national stockpiles. Muhlenberg College is readying its Allentown campus for transformation into a communications command center capable of answering hundreds of hotline calls. And state and regional leaders are testing their plans with drills — the next one for emergency and medical personnel is Tuesday in Bethlehem.

''Everyone is taking a look at their emergency operation plans,'' said Vicky Kistler, an Allentown Bureau of Health manager and regional health and medical task force coordinator. ''Hopefully we are learning from Katrina that we can never be prepared enough.''

No one can predict if the H5N1 strain of virus that kills birds and has killed more than 125 people in 10 countries will affect Americans, said Bill Koch, the ''homeland security chief'' at Air Products and Chemicals in Trexlertown. However, the world is overdue for some type of widespread killer flu, he said.

The 20th century had three, including the Spanish flu of 1918 that killed 20 million to 40 million people. The Asian flu of 1957 and Hong Kong flu of 1968 each killed another 1 million to 4 million people.

''There will be another pandemic,'' Koch said, echoing the warnings of medical scientists around the globe. ''It's just a matter of when.''

For hospitals here and across the country, the buzz word in preparing for a pandemic is ''surge,'' how to expand the number of beds available quickly and for weeks or months at a time without disrupting other patients.

LVH's chief of infectious diseases, Dr. Luther Rhodes, said hospital officials are looking at tractor-trailer-sized modular units that can be driven onto the property off Cedar Crest Boulevard to isolate and treat contagious patients. Such units are sometimes referred to as MASH, or Mobile Army Surgical Hospital, units. Similar units were employed in the rescue and evacuation of residents from Louisiana during Hurricane Katrina, Rhodes said.

While Rhodes has testified before Congress in favor of the National Guard providing such modules in partnership with the hospitals, he said no deal has been struck, so LVH is proceeding on its own ''because we have to.''

St. Luke's Hospital and Health Network plans to convert a patient wing into an isolation unit for contagious patients instead of buying MASH trucks or tents, according to Alan Lynch, director of network safety and security.

Officials for the Fountain Hill-based network also ordered supplies difficult to obtain at high volumes in an emergency, such as surgical masks, respirators and gowns. Equipment alone could cost $250,000, he said.

St. Luke's is evaluating ways to immunize staff in rapid fashion for the coming influenza season in the fall and to arrange for food, shelter and peace of mind for employees who might have to stay at the hospital during a pandemic.

Plans are being made for families and pets, said Dr. Jeffrey Jahre, chief of medicine and infectious diseases at St. Luke's. ''If an employee's mind is at home, he or she won't be able to stay here.''

Jahre said St. Luke's is following national guidelines and not stockpiling Tamiflu, an anti-viral medicine that might or might not work against a pandemic flu.

''We always have enough on hand for patients and staff who would become infected, but are not collecting it…for weeks at a time,'' he explained. ''If all hospitals did that, there wouldn't be any Tamiflu.''

Sacred Heart Hospital in Allentown hopes tents purchased in 2003 with state grant money will suffice for temporary decontamination or isolation of the sick. The staff conducts a drill each year.

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<font size=+1 color=brown><center><b>Bird flu could catch firms cold</font>

Silicon Valley/San Jose Business Journal
June 2, 2006
by Lynn Graebner
<A href="http://sanjose.bizjournals.com/sanjose/stories/2006/06/05/story3.html">sanjose.biz</a></center>
Print this Article Email this Article Reprints RSS Feeds Most Viewed Most Emailed
The federal government is spending $3.8 billion to prepare for a potential avian flu pandemic which could kill up to 2 million Americans, but many local companies either have not started preparing emergency plans for avian flu or are relying on general plans that are not specific to a flu pandemic.

But what would they do if the worst case scenario hit and 40 percent of their employees didn't show up for work? </b>



Intel Corp. is taking that threat seriously. The Santa Clara company not only has a plan in place but has been conducting drills. Last week, the tech giant played out a scenario in which a group of its employees ate at a restaurant in Shanghai. They all went back to their sites in Arizona and Santa Clara and people started getting sick.

Employees started looking at what would happen next if whole plants had to be shut down. How would work be shifted to other sites? How many people could telecommute? How would the phone system need to be reinforced to handle the increased calls? Are there gaps in the company's health plan globally? How can employees coordinating travel plans across the world help keep people informed of what food to avoid and how to recognize symptoms, says Gary Niekerk, in charge of corporate responsibility for Intel.

The company went so far as to consider purchasing infrared thermal scanning devices to detect elevated body temperatures in employees as they enter a building. But that's where precautions can start getting out of hand. What if an employee runs across a parking lot to make a meeting?

"All of a sudden we have to do something with them," Mr. Nierkerk chuckles. And there are privacy issues too, he adds.

On top of actual flu victims is the fear of flu. Intel had one employee fall sick with Severe Acute Respiratory Syndrome (SARS), a disease which killed 774 people several years ago. The employee recovered, but Intel learned a lot from that experience.

"That was a wake up call," Mr. Niekerk says. Employees were leery of working in the same area as the employee.

"There's the actual avian flu and then there's the fear of the flu," he says. On average, 30,000 people a year die from the plain old flu; SARS deaths were a fraction of that. "It's the perception."

And the perception of avian flu can be scary, based on a more than 50 percent death rate. As of May 19, the World Health Organization reported 217 human cases and 123 deaths. Vietnam has been hit hardest by far with 93 cases followed by Indonesia with 41, Thailand with 22 and China with 18.

Intel has reason to be concerned with avian flu. The company recently announced plans to open a new site in Vietnam. It's "the bird flu capital of the world," Mr. Niekerk says.

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<B><font size=+1 color=green><center>Activists plead for humane culling of birds </font>

By Jill Serjeant
06/05/06
<A href="http://news.yahoo.com/s/nm/20060605/lf_nm/birdflu_animalrights_dc;_ylt=A0SOwkr0NoREdEYBiRIPLBIF;_ylu=X3oDMTA0cDJlYmhvBHNlYwM-">news.yahoo.com</a></center>
LOS ANGELES (Reuters) - Horrified by reports from Asia of chickens being set on fire or buried alive in plastic bags, U.S. animal welfare groups are gearing up with trepidation for the arrival of bird flu and the probability of mass killings to contain it.

Animal rights activists have campaigned for years against the cramped conditions for billions of chickens, turkeys and ducks on U.S. factory farms.</b>

Now, as experts suspect the deadly H5N1 virus could find its way from Asia to Alaska this summer, they are lobbying the food industry and U.S. state veterinarians to conduct the expected slaughter of millions of poultry humanely.

Americans who keep small backyard flocks are also desperate to ensure their chickens and ducks will not be swept away in the general hysteria.

"Suffocation, starvation, bludgeoning, bleeding and poisoning should be explicitly prohibited in your planning documents," says a letter being sent by PETA (People for the Ethical Treatment of Animals) to officials in all 50 states.

"We urge you to dictate in writing that only humane methods of killing are used," the PETA letter adds.

Some 200 million birds have been culled in Asia, Europe, Africa and the Middle East since 2003 to limit the spread of the H5N1 avian virus which has killed more than 125 people.

FIRE FIGHTING FOAM

Although preventive vaccination has been used in some countries, notably the Netherlands, the National Chicken Council says it is impractical for the United States.

National Chicken Council spokesman Richard Lobb said broiler birds live for only six weeks and two courses of vaccine are needed.

The first course could be given when chickens are hatched "but the second dose would have to be applied on the farm where you can have 20,000 birds running around loose in a grow-out house and that would be quite a job," Lobb said.

Mass euthanasia and disposal training programs are being carried out around the United States. One method demonstrated in central California last month used fire-fighting foam that can smother thousands of birds in a few minutes, said Kim Sturla, who runs an animal sanctuary nearby.

Although reluctant to sanction slaughter at all, PETA and other welfare groups are urging the "controlled atmosphere killing" method, which uses a mixture of carbon dioxide and nitrogen or argon.

PETA has been in contact with the government's Animal and Plant Health Inspection Service, which has pledged to act humanely.

"We expect receptivity to the message to be high. But implementation will be the dicier proposition in the heat of the moment, which is why we want to insist that humane protocols are communicated in advance," said Bruce Friedrich of

PETA.

Other animal rights campaigners are not so sure. "You are looking at all kinds of resistance. The industry doesn't want to do anything that is going to cost a penny more than the cheapest method," said Karen Davis, president of United Poultry Concerns.

Davis said some groups are debating whether to push for a legislative package in the U.S. Congress on bird flu and animal welfare, including culling methods.

FEARS FOR BACKYARD CHICKENS

Teri Barnato, director of the Association of Veterinarians for Animal Rights, said mass slaughter was "a tragic method of dealing with disease."

"I think it is unfortunate that we have all grown accustomed to (the food industry) telling the public that this is how you deal with these outbreaks," she said.

Lobb of the National Chicken Council said animal activists opposed to culls had "no place in this discussion."

"They are not serious about the management of animals. We are going to do whatever we need to do. The only way to manage this type of situation is to destroy the infected flock. It's not appropriate to suggest you can get by without destroying some animals if there is an outbreak," Lobb said.

Barnato, who keeps chickens, ducks and geese at her California animal sanctuary, is worried about the possibility of being ordered to kill her own "companion birds."

"I am concerned that people will panic and target wild birds and companion birds out of fear for their safety when the chances of someone becoming infected is very remote.

"Someone would have to kill me first before I did that to any of my companion birds," Barnato said.

Kim Sturla, who runs the Animal Place sanctuary in northern California, was more sanguine. She said animal activists saw bird flu as an opportunity to raise awareness about the evils of factory farming.

"If avian influenza comes and they are killing millions of birds, gassing them or foaming them or whatever they are going to do is no worse than what's done every single day to birds who are grabbed out of barns, taken to the slaughter line, shackled upside down and have their throats slit.

Mass culls "may make a grisly story but at least their miserable lives are cut short," Sturla said.

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<B><font size=+1 color=blue><center>Pandemic flu preparations taking shape at area hospitals</font>

Business First of Louisville
June 2, 2006by
Ed GreenFrom Business First of Louisville
<A href="http://louisville.bizjournals.com/louisville/stories/2006/06/05/story3.html">louisville.bizjournals.com</a></center>
With concerns growing across the globe that the Avian Flu might lead to a widespread, and possibly deadly, influenza pandemic, local hospital officials are working to prepare for what could be the worst outbreak of disease in the United States since the Hong Kong Flu killed 34,000 Americans in 1968 and 1969.

According to local hospital executives, preparations for a potential pandemic flu have been under way for months. Such a flu could stem from either a mutation of a viral strain currently circulating here or from a mutation to the Avian flu that allows it to be transmitted easily among humans. </b>

Hospital officials agree that although an outbreak as widespread as earlier flu pandemics might never occur, they are following local and national directives to have a plan ready in case a mutation to a current virus circulating in the United States is detected or strains of the Avian flu, also known as the bird flu, travel to this country.

Some health care workers 'very concerned'

So far, the Avian strain -- scientifically known as H5N1 virus -- has been found in Asia, Africa and parts of eastern Europe. The virus spreads primarily from birds and poultry to humans, and only a few cases have been reported involving human-to-human transmission.

As of May 23, 218 cases had been reported worldwide during the past four years, and 124 deaths have resulted from the disease, according to information from the World Health Organization. Of those, 74 cases were reported this year, with 48 deaths.

The Avian flu virus "still has some components of it that make us very concerned," said Dr. Dan Varga, chief medical officer for Norton Healthcare Inc.

"It is highly contagious among birds, and there clearly are many cases already that have shown bird to human transmitability. ... That is why we are not going to just sit back and hope this thing never transmits easily from human to human."

According to a draft preparedness and response plan created by the Kentucky Cabinet for Health and Human Services, experts believe it would take only one to six months from the time a human-transmitted form of the virus is detected in the United States for it to spread across the country, leaving a short window for hospitals to make preparations.

Both Varga and Cheryl Stout, nursing director for Baptist Hospital East, said their organizations are updating and preparing disaster plans to deal with a possible pandemic flu based on a worst-case scenario.

Jeff Polson, director of public relations and advertising for Jewish Hospital & St. Mary's HealthCare Inc., said the company's health care facilities also are updating their disaster plan, but officials could not be reached to provide additional details about the company's plan prior to Business First's press deadline.

Potential loss of infrastructure adds to concerns about flu outbreak
Varga said disasters such as the Sept. 11, 2001, terrorist attacks and Hurricane Katrina have served as lessons about how health care organizations are affected by widespread disasters that extend beyond typical health care crises.

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<B><center>June 5, 2006
<A href="http://www.floridatoday.com/apps/pbcs.dll/article?AID=/20060605/OPINION/606050308/1004">www.floridatoday.com</a>

<font size=+1 color=red>Our view: Pandemic prep</font></center>
Local governments can't count on the feds for flu pandemic prevention

Brevard County residents are used to being on high alert for hurricanes this time of year, but there's another possible emergency county officials are also preparing for:

Flu pandemic.

So far there's little evidence the avian flu that since 2003 has spread from Asia to Europe and Africa -- and may have reached Alaska -- will mutate into a deadly virus easily transmitted between people.</b>

But bird flu has caused more than 100 confirmed deaths worldwide.

And experts say the threat of a pandemic is real.

A federal plan updated in May offers a worst-case scenario of 2 million deaths and 90 million persons infected in the U.S. if a strain emerges that can jump from human to human.

Florida's Department of Health estimates up to 10 million Floridians could become infected should a flu pandemic strike, with up to 18,000 deaths statewide.

Federal officials have also warned communities who fail to prepare not to expect Washington to rescue them.

That message doesn't surprise us, after the Katrina debacle, but it does drive home the seriousness of local and state preparation efforts.

Brevard officials, to their credit, are getting ready.

The county held a drill Wednesday to gauge its flu-pandemic readiness, a computerized exercise that followed on previous planning meetings, says Tom O'Bryant, Public Health Preparations Coordinator for the Brevard County Health Department.

Wednesday's drill was part of Brevard's broader collaboration with the state health department, Centers for Disease Control and Prevention, and a regional preparedness team to get ready for possible outbreak.

Hospitals, animal control services, and private groups such as Publix Super Markets and Wal-Mart are participating in strategy sessions.

Here's some of what's been done so far:


Area hospitals are gearing up to rapidly identify and isolate infected patients to help prevent spread of the disease.


The county has secured access to a regional stockpile of medications that may help fight the disease.


Plans have been developed, and successfully tested, to make sure CDC requirements that vaccines and antivirals be available at dispensation sites around the county within 48 hours can be met, according to O'Bryant.

But, as Brevard health director Heidar Heshmati points out, flu pandemics are worldwide events far beyond the control of one county, state or nation.

Scientists say it will take six months or more to develop and distribute a vaccine.

And no clear set of priorities as to who should get flu shots first has yet been established on the national level .

Federal guidelines to help businesses and families prepare for a possible outbreak also have received little publicity.

While no good is served by panic, there's much planning and work to be done at the local level so that a potential flu outbreak causes as little damage -- and loss of life -- as possible.

No one ever regretted being prepared.

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<B><font size=+1 color=brown><center>Migrating wild birds play a key role in transporting
highly pathogenic avian influenza </font>

Disease/Infection News
Published: Monday, 5-Jun-2006
<A href="http://www.news-medical.net/?id=18237">www.news-medical.net</a></center>
Migrating wild birds have played and will likely continue to play a role in transporting highly pathogenic avian influenza (HPAI) virus, or bird flu, over long distances.
This was among the main conclusions of a two-day international scientific conference called by the UN Food and Agriculture Organization and the World Organisation for Animal Health (OIE).

But the conference, attended by over 300 scientists from more than 100 countries also recognized that the virus was mainly spread through poultry trade, both legal and illegal. </b>

"Several presentations at the Conference, some supported by recent publications in peer-reviewed scientific journals, implicated wild birds in the introduction of HPAI H5N1 virus at considerable geographical distance from known H5N1 outbreaks in poultry," the meeting said in a concluding document.

But the participants admitted they could not resolve another of the key issues at the conference, which was the role of wild birds in the spread of HPAI to more than 50 countries on three continents, and whether wild birds should now be considered a permanent reservoir of the virus.

If they are such a reservoir, there is a strong likelihood they will carry the virus with them in subsequent migrations. Alternately H5N1 may subside naturally as infected animals die off, or it may mutate to a less aggressive form.

"This was one of the main gaps identified in our present scientific knowledge," said Joseph Domenech, FAO's chief veterinary officer. "We must therefore intensify our investigations."

The conference noted that the current outbreaks of H5N1 virus in eight African countries appeared to be poultry-related and chiefly based on trade in poultry for human consumption, including illegal trade. However, it called for further analysis for a more complete understanding of how the virus was introduced.

"There is a need to mobilize the international donor community to invest in the improvement of veterinary services in developing countries, especially in Africa and Asia," Dr Gideon K. Bruckner, Head of OIE's Scientific and Technical Department, said.

Wise investments here will promote early detection in wild birds and rapid response to disease outbreaks, Dr Bruckner added.

H5N1 disease management would need to be based on improved biosecurity and hygiene at the production level, and in all poultry sectors, including minimizing the possibility of contact between domestic and wild birds, the conference advocated.

It called for the establishment of a global tracking and monitoring facility involving all relevant institutions across the world, including scientific centers and farmers' organizations, hunters, bird watchers, and wetland and wildlife conservation societies.

The participants rejected any suggestion of trying to stop the spread of HPAI by killing wild birds. "Destruction of wild bird habitats or indiscriminate hunting of wildlife is scientifically and ethically unjustified as a response," one of the conference recommendations said.

It urged continuing research to adopt an inter-disciplinary approach, and called for investment to incorporate telemetry/satellite technology to improve understanding of wild bird migration patterns (see related article "Free as a bird -- or under surveillance").

http://www.fao.org/

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<B><font size=+1 color=green><center>First results of bird flu vaccine trials expected in 2 weeks </font>

12:01 | 05/ 06/ 2006
<A href="http://en.rian.ru/russia/20060605/49039203.html">en.rian.ru</a></center>
ST. PETERSBURG, June 5 (RIA Novosti) - Provisional results of bird flu vaccine trials on human volunteers will be available in two weeks, one of the doctors leading the tests said Monday.

Oleg Kiselyov, the director of the St. Petersburg-based Influenza Research Institute, said the trials were focusing on establishing a precise vaccine dose.</b>

"The phrase 'vaccine tests' is not entirely appropriate," he said. "We are conducting trials to calculate the dosage."

Kiselyov said the vaccine presented no danger to the 52 volunteers who had received it intravenously.

Kiselyov said the volunteers would be revaccinated in 28 days from the date of the first vaccination to calculate the vaccine titers used to determine the highest dilution that still contained detectable amounts of antibody.

"The threshold limit [to prevent serious form of a disease] is 1/64, with the optimum level at 1/256," he said.

But he cautioned the vaccine had been created on the basis of a non-pandemic H5N1 bird flu strain and could not stop a pandemic of avian influenza.

"The substance is a reserve vaccine and will not become a panacea in the event of a bird flu pandemic," he said.

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<B><font size=+1 color=blue><center>56-day clinical trial of highly pathogenic bird flu
vaccine begins in St. Petersburg </font>

05.06.2006, 10.51
<A href="http://www.itar-tass.com/eng/level2.html?NewsID=9497094&PageNum=0">www.itar=tass.com</a></center>
ST. PETERSBURG, June 5 (Itar-Tass) - A 56-day clinical trial of a candidate vaccine against the highly pathogenic bird flu virus H5N1 begins in St. Petersburg on Monday.

The chief of the health planning department of the Institute of Influenza, Yelena Doroshenko, told ITAR-TASS that 40 volunteers, mostly men of ages from 18, had been enrolled for the first-stage trial. </b>

The vaccine has been obtained at the institute “with an inverse genetic method from a Vietnamese strain of the H5N1 virus that was provided by a British national centre.

The second vaccine injection will be delivered to the volunteers in two weeks.

The study is expected to yield initial results of the vaccine’s potential effectiveness.

Each volunteer will be paid a 4,000-rouble bonus.

If the trial proves successful, the “St. Petersburg vaccine will be a reserve of Russia’s chief sanitary physician for a case of an emergency”, Doroshenko said.

Bird Flu Fighters Need Money to Help Contain Virus​

http://www.bloomberg.com/apps/news?pid=10000101&sid=a4U1iJ0UpSDM&refer=japan



June 5 (Bloomberg) -- The bird flu fight being waged across Africa, Asia and Europe is draining the cash and human resources of international agencies, which may have to abandon some programs unless donor countries honor their funding promises.

The World Organization for Animal Health and United Nations agencies, including the Food and Agriculture and World Health Organizations, said they have received less than half the $1.9 billion pledged by donors at a conference in Beijing in January. Since then, the H5N1 avian influenza virus has infected animals in 36 new countries, resulting in human cases in four nations.

The lack of funding may derail efforts to control H5N1, which has the potential to set off a deadly outbreak in people. Africa alone needs about $500 million, said Bernard Vallat, director general of the animal health organization, which will join FAO and African officials in Vienna this week to ask for the money.

``The present shortage of funds means the global response is bound to be patchy,'' David Nabarro, the UN's senior coordinator for bird flu and pandemic influenza, said in a June 1 interview. ``It means that national governments can't rely on getting help when they need it from a strong and well prepared UN system.''

Governments are under pressure to stem poultry outbreaks, which create opportunity for human infection and increase the risk that H5N1 will mutate into a pandemic form. The virus has infected a new person every other day this year, killing almost two thirds of them.

Vienna Meeting

In Denmark, fowl at a hatchery with more than 20,000 ducklings were culled after an outbreak of a low-pathogenic form of the H5 bird flu virus. All susceptible birds were destroyed, according to a report released today by the animal health organization in Paris.

The challenges for governments in monitoring, managing and eradicating the virus, and preparing for any pandemic it may spawn, will be discussed at the Influenza Partners' Senior Officials Meeting in Vienna on June 6 and 7. The meeting is being hosted by the European Union, the U.S. and China.

A pandemic similar to the one that killed 50 million people in 1918 may take more than 142 million lives and cause the world's economy to shrink by an eighth, a February report by the Lowy Institute and Australian National University found.

``The relatively small amount of cash being sought by the UN would empower the organizations in this global system to function as the backbone of the international response,'' Nabarro said.

$77 Million Promise

The funding crisis is particularly acute for the WHO, which is assisting governments in responding to human H5N1 cases and upgrading hospitals and laboratories to manage them, he said.

``The WHO, and to a lesser extent FAO, are so strapped for cash that it's going to be very difficult for them to maintain the current level of response to urgent calls for help from countries trying to control H5N1,'' Nabarro said.

Donor countries promised in January to give the health agency $77 million. About $20 million has been received to date. In the past three months, the WHO has dispatched teams of medical experts to Azerbaijan, Egypt, Iraq, Djibouti and Indonesia.

The three-week, six-person mission to Azerbaijan, in western Asia, cost $80,000, according to Maria Cheng, a WHO spokeswoman. An extra $100,000, which came from the Asian Development Bank, was needed to support the response with antiviral medicines, personal protective equipment and assistance in upgrading hospital and laboratory equipment.

``The ability to maintain that level of response with that sophistication, with that number of experts is going to continue to be a challenge,'' said Paul Gully, a senior adviser with the WHO in Geneva.

Indonesia

In Indonesia, bird flu killed a 15-year-old boy in West Java province last week, Sari Setiogi, a WHO spokeswoman in Jakarta, said today. Tests are pending on a 7-year-old girl who died last week in Jakarta. Some homeless survivors from last month's earthquake are at greater risk of catching bird flu as they use poultry sheds for shelter, said Merlin, a U.K.-based aid agency.

Only Vietnam, with 42 avian-flu deaths, has reported more fatalities from H5N1 than Indonesia. At least 127 of the 224 people known to be infected with the bird flu have died, according to the WHO.

The animal health organization, also known as the OIE, will be forced to reduce the scale of its activities, including training fewer government officials, without more funding, Vallat said.

``We'd reduce our ambitions,'' Vallat said in a June 1 interview. That may mean ``the disease risks becoming endemic in some countries,'' he said, and ultimately cost more money and require more veterinarians to eradicate.

Africa

In Africa, where H5N1 was first reported in Nigeria in February, the virus has spread to Niger, Egypt, Cameroon, Burkina Faso, Ivory Coast and Djibouti. Without better surveillance, culling programs, education and training, there is a risk that ``eventually the whole continent will be infected,'' Vallat said.

At the Vienna meeting, the OIE, FAO and a group representing African nations will seek $500 million to raise the continent's veterinary and animal health standards over the next three years, he said.

After assessing the needs in Africa, the FAO requires $308.5 million for three years, according to the Rome-based agency. About $45 million has been received to date.

The money shortage means the $28 million needed to set up an avian flu crisis management center isn't there, said Samuel Jutzi, FAO's director of animal production and health.

``The global coordination, which would thereby be much improved'' means it's important to fund the crisis center, Jutzi said in a June 1 interview. It would act as a sentinel for outbreaks, coordinate the dispatch of response teams within 48 hours of an outbreak, and work with governments in improving veterinary systems.

Link to tomorrows (6/6) Bird Flu thread: http://www.timebomb2000.com/vb/showthread.php?t=199851

Experimental bird flu vaccine...I'm gonna wait to see these results. I'm curious how they came up with this since they were in the quandry how to develop a vaccine in light that they can't develop it in bird eggs....