06/06 | Daily BF: Source of Human H5N1 Bird Flu In Indonesia Unclear

Link to yesterday's thread: http://www.timebomb2000.com/vb/showthread.php?t=199703

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

Source of Human H5N1 Bird Flu In Indonesia Unclear​

Recombinomics Commentary
June 5, 2006

for the source of the spread, 23 percent of the bird flu sufferer had direct contact with with the chicken or the poultry that died, 25 percent contact indirectly (the chicken or the poultry around the sufferer's positive house H5N1), 2 percent contact with fertiliser that came from the waste of the animal and totalling 17 percent was not yet known by the source of his spread.

The "case of bird flu in Indonesia most happened to the man compared to the woman." This illness not only attacked the adult, but also children. Twenty-two percent of the case of bird flu happened to children, twenty percent to the student, eight percent happened to the worker in livestock breeding, four percent happened to the worker in the traditional market, said Steven.

The above translation on human H5N1 bird flu infections in Indonesia raises additional questions about the source of the infections. As noted above, the majority of confirmed cases are not directly linked to poultry. Poultry outbreaks are widespread in Indonesia (see map below), and don't always coincide with human cases (see map below).

The amount of sequence information from H5N1 human cases in Indonesia is limited to two sequences (HA and NA) from one isolate, A/Indonesia/5/2005 (deposited at Los Alamos on August 1, 2005). WHO updates have descriptions of that isolate as well as the isolate from the second confirmed case, and recent isolates from the north Sumatra cluster. Additional information in an Effect Measure report, as well as Declan Butler's report in association with a Nature news story suggests there are three distinct H5N1's isolated from human cases and none match the public poultry sequences from Indonesia.

The most common sequence is public. It has a novel cleavage site as well as a novel glycosylation site. Although it is closely related to a subset of Indonesian poultry isolates, the cleavage site is not found in any other public H5N1 sequence. However, it does match most of the human H5N1 in the West Java region and was also present in a cat isolate from the area. The absence of this sequence from the public H5N1 poultry sequences raises questions about the origin of the human infections.
The second human H5N1 isolate described in the WHO update appeared to be more closely related to bird isolates. It had a wild-type cleavage sie and was sensitive to both classes of anti-virals. However, it had PB2 E627K, which allowed H5N1 to grow at lower temperatures and be more virulent, Most humans infected with H5N1 with PB2 E627K died, as did the 2nd confirmed patient. E627K was not found in bird H5N1 until it was isolated from infected birds at Qinghai Lake. However, the Qinghai strain was easily distinguished from the Indonesian strain of H5N1. Thus, the E627K could have been acquired via reassortment, random mutation, or recombination.

The most recent description of human H5N1 from Indonesia is from the large cluster in North Sumatra. Those isolates also had a wild type cleavage site, but were amantadine resistant. Moreover the patients were said t have higher levels of H5N1 in their nose and throat, suggesting they had E627K, which could make H5N1 more easily transmissible, which would be consistent with the large number of cases (eight) coupled with the high fatality rate, 87%.

Thus, there at least three distinct versions of H5N1 in humans in Indonesia. The genetic relationship of these isolates with Indonesia birds is not public. Only two of the eight gene segments have been released for the isolate from the index case, and no sequences have been released from the other isolates, which remain sequestered in WHO's private database.

Release of the sequences would allow for more detailed analysis of the origins of these isolates and their relationship to local birds. More isolates from both domestic and wild birds in Indonesia would expand the H5N1 database and make more accurate determination of the source of the human cases in Indonesia. More detailed analysis would also allow for more accurate predicts of new sequences and better vaccine targets.

The growing number of clusters in Indonesia dictates a more aggressive screening program and release of the existing data being hoarded by WHO. Recent statements by representatives of the Indonesian government indicated that these sequences could be released, which should be done immediately.

http://www.recombinomics.com/News/06050602/H5N1_Indonesia_Source.html

Last update: June 04, 2006 – 1:39 PM



Right now, the H5N1 virus is beautifully adapted to chickens. Researchers want to know more about the process by which it might become adapted to humans.
Wendy Orent

There's a lot of bird flu virus out there. Despite encouraging news from Vietnam and Thailand, neither of which has reported any bird or human cases of the lethal H5N1 strain this year, the situation in Indonesia continues to worsen. Eight members of a family contracted the disease, and seven of them died last month. The timing suggests person-to-person transmission. Although not the first instance of such transmission, it's the single largest cluster that has been seen, according to virologist Earl Brown of the University of Ottawa. Indonesia appears to lack the resources to combat the disease.

The virus is also active in Egypt and has spread to Israel, Jordan and the territories where Palestinians live. Africa has a wide belt of infection. With the disease spread over so much of the world, more people in contact with sick birds means more opportunities for humans to catch the virus. This appears to be how human influenza pandemics have begun -- through human contact with sick birds.

But the factors that set off a pandemic remain unknown. No one has ever tracked the evolution of a new pandemic. All we have seen -- in 1918, 1957 and 1968 -- is the aftermath of that evolution. Still, we are told that all it would take for H5N1 to become a pandemic would be for the virus to mutate so it could spread in a sustained way from person to person. This is known as "mutation to transmissibility."

This phrase has appeared countless times in news reports. It's a warning. It's also boilerplate. What does it really mean?

Part of the problem is that "mutate to transmissibility" means different things to different people. To Peter Palese, chairman of the department of microbiology at Mount Sinai School of Medicine, who has studied influenza viruses for 35 years, the phrase makes sense. "These mutations [to make the disease transmissible from human to human] could happen in a chicken. It's not likely, but it cannot be excluded."

Palese recognizes that many mutations would be necessary for a virus to switch from a chicken virus to a human one. But, he adds, the genetics of transmission are "one of the black boxes of human influenza research."

The H5N1 virus faces several barriers in jumping to and transmitting among humans. The most important is its ability to replicate in and adapt to human tissues, specifically the upper respiratory tract (not in deep lung tissue, where it now seems to grow). In the windpipe, the virus would be more likely to spread in a cough or sneeze, infecting other humans.

Palese thinks that bird flu mutations are sitting in the evolutionary driver's seat -- that a combination of the right host switches in this most mutable of viruses could set things off. Still, that's a long way from a single mutational switch -- say, from chicken to human -- triggering a pandemic. But things may be more complicated.

To Brown, H5N1 mutations are not enough. They have to occur in the right context. "It's hard to get infected with this virus," he said. "You need a large dose of it to ensure the presence of some mutant strains suitable for growing in mammals." According to Brown, several different mutations on different genes seem to be involved in a virus moving from one host to another. Bird flu strains he's passed through laboratory mice have changed in ways similar to what has been seen in certain cases of the human H5N1 virus, suggesting that the changes may be significant for the strain's adaptation to mammals.

Some mutant strains have appeared repeatedly and independently in different humans infected with the bird flu virus. In one patient in Turkey, about half the H5N1 strains detected appeared to be viruses that had adapted to humans. But, as Brown points out, the changes were a dead end -- the victim died without passing on the disease.

It won't happen overnight

Brown recognizes what seems to elude most people who worry about pandemic outbreaks: What's necessary to produce a human-adapted virus is humans -- a series of person-to-person infections. Without that chain of transmission, any human adaptation of H5N1 is difficult to imagine.

Here is where communication between those who fear an overnight pandemic and those who believe the process will be longer, slower and more controllable breaks down. If we think H5N1 mutations alone drive escalation to a human-adapted virus, all that's necessary for a pandemic is for the right combination of genes to line up in a sort of viral slot machine.

In a casino, the house usually wins, but occasionally someone hits the jackpot. It's the law of large numbers -- given enough time and enough opportunity, viral mutation will toss up a deadly combination. No one wants to win the bird flu slot-machine game. If the genes happen to line up and a vulnerable human happens to be the host in the right place, the disease takes off and a pandemic explodes. Given how mutable the H5N1 virus is, the thinking goes, at some point this is inevitable.

But as Brown knows, evolution doesn't work this way. Gene mutation isn't in the driver's seat. Rather, it's Darwin's charioteer -- natural selection -- that drives evolution. Mutations are the raw material of evolutionary change. They don't determine which direction the chariot will go.

Any successful H5N1 mutation must interact with other viral genes in a human host to improve its ability to infect the host. This is an adaptive process -- and it is true whether the new virus arises directly through mutation or even through recombination with a common flu strain. H5N1 is beautifully, tragically adapted to chickens and has proved a monstrous predator. It evolved this way by preying on chickens packed into huge commercial chicken farms in Asia.

It's only just begun

The bird flu virus is still at the starting gate when it comes to humans. But should any strain of H5N1 manage to survive many sequential transmissions, Darwin's charioteer may drive off. The best transmitters will be favored by selection, as evolutionary biologist Paul W. Ewald of the University of Louisville contends. The process will continue, human by human, until a fully human-adapted, explosive strain emerges.

This process of adaptation is probably how pandemics begin. The World Health Organization recently proposed a plan to move experts and resources to any area afflicted with clusters of viral infection -- a plan that, given this evolutionary logic, makes eminent sense. At the beginning, viral adaptation to a host is slow. A disease just beginning to transmit is controllable. Surveillance, flexibility, willingness to impose or undergo quarantines, along with international cooperation, will be necessary to stop pandemic flu -- or any other disease moving from animals to humans -- before Darwin's driver gets ahead of us and nothing can be done.


Wendy Orent is the author of "Plague: The Mysterious Past and Terrifying Future of the World's Most Dangerous Disease." She wrote this article for the Los Angeles Times.

http://www.startribune.com/562/story/470467.html

Hey PCV, I thought you went to bed at this time... Yep, I know, the findings are indeed worrisome, but I'm keeping my yap shut right now, better to know more facts than to interject without the background of facts.

Now we can see if the little red specks on the map(human H5N1) start to spread around the clusters.
Thanks, PCV
I am seeing a lot of good science and , IMHO, duplicitious politics.
Do you have any graphs showing trends?

Source of Human H5N1 Bird Flu In Indonesia Unclear​

http://www.recombinomics.com/News/06050602/H5N1_Indonesia_Source.html

Recombinomics Commentary
June 5, 2006

for the source of the spread, 23 percent of the bird flu sufferer had direct contact with with the chicken or the poultry that died, 25 percent contact indirectly (the chicken or the poultry around the sufferer's positive house H5N1), 2 percent contact with fertiliser that came from the waste of the animal and totalling 17 percent was not yet known by the source of his spread.

The "case of bird flu in Indonesia most happened to the man compared to the woman." This illness not only attacked the adult, but also children. Twenty-two percent of the case of bird flu happened to children, twenty percent to the student, eight percent happened to the worker in livestock breeding, four percent happened to the worker in the traditional market, said Steven.

The above translation on human H5N1 bird flu infections in Indonesia raises additional questions about the source of the infections. As noted above, the majority of confirmed cases are not directly linked to poultry. Poultry outbreaks are widespread in Indonesia (see map), and don't always coincide with human cases (see map).

The amount of sequence information from H5N1 human cases in Indonesia is limited to two sequences (HA and NA) from one isolate, A/Indonesia/5/2005 (deposited at Los Alamos on August 1, 2005). WHO updates have descriptions of that isolate as well as the isolate from the second confirmed case, and recent isolates from the north Sumatra cluster. Additional information in an Effect Measure report, as well as Declan Butler's report in association with a Nature news story suggests there are three distinct H5N1's isolated from human cases and none match the public poultry sequences from Indonesia.

The most common sequence is public. It has a novel cleavage site as well as a novel glycosylation site. Although it is closely related to a subset of Indonesian poultry isolates, the cleavage site is not found in any other public H5N1 sequence. However, it does match most of the human H5N1 in the West Java region and was also present in a cat isolate from the area. The absence of this sequence from the public H5N1 poultry sequences raises questions about the origin of the human infections.
The second human H5N1 isolate described in the WHO update appeared to be more closely related to bird isolates. It had a wild-type cleavage sie and was sensitive to both classes of anti-virals. However, it had PB2 E627K, which allowed H5N1 to grow at lower temperatures and be more virulent, Most humans infected with H5N1 with PB2 E627K died, as did the 2nd confirmed patient. E627K was not found in bird H5N1 until it was isolated from infected birds at Qinghai Lake. However, the Qinghai strain was easily distinguished from the Indonesian strain of H5N1. Thus, the E627K could have been acquired via reassortment, random mutation, or recombination.

The most recent description of human H5N1 from Indonesia is from the large cluster in North Sumatra. Those isolates also had a wild type cleavage site, but were amantadine resistant. Moreover the patients were said t have higher levels of H5N1 in their nose and throat, suggesting they had E627K, which could make H5N1 more easily transmissible, which would be consistent with the large number of cases (eight) coupled with the high fatality rate, 87%.

Thus, there at least three distinct versions of H5N1 in humans in Indonesia. The genetic relationship of these isolates with Indonesia birds is not public. Only two of the eight gene segments have been released for the isolate from the index case, and no sequences have been released from the other isolates, which remain sequestered in WHO's private database.

Release of the sequences would allow for more detailed analysis of the origins of these isolates and their relationship to local birds. More isolates from both domestic and wild birds in Indonesia would expand the H5N1 database and make more accurate determination of the source of the human cases in Indonesia. More detailed analysis would also allow for more accurate predicts of new sequences and better vaccine targets.

The growing number of clusters in Indonesia dictates a more aggressive screening program and release of the existing data being hoarded by WHO. Recent statements by representatives of the Indonesian government indicated that these sequences could be released, which should be done immediately.

Bird flu patient in Indonesia released​

http://english.people.com.cn/200606/06/eng20060606_271533.html

A patient who had been infected with bird flu was released on Tuesday by a hospital in the East Java provincial capital Surabaya, the second largest city in Indonesia.

The patient had been treated at Dr. Soetomo state hospital since mid-May, after being treated at another hospital in his hometown Kediri, Antara news agency quoted Urip Murtedjo, a hospital spokesman, as saying.

"Medically, he is declared free from the disease," Urip said.

The patient was admitted to a hospital in Kediri with high fever, respiratory problems and cough -- all symptoms of bird flu.

The patient's father said his son frequently collected chicken feathers for his handicrafts before he was infected with the H5N1 bird flu virus.

There was an average of one bird flu death in the country every 2.5 days last month, bringing Indonesia's death toll to 37, following Vietnam's 43 deaths. The World Health Organization confirmed the latest death in the country Sunday, a 15-year-old boy, Indonesian health officials said.

Source: Xinhua

Bird flu in India was made in China​

http://www.hindustantimes.com/news/5922_1714196,0015002100000000.htm

SRAVANI Sarkar
Bhopal, June 5, 2006

TILL A couple of months ago, it was the most asked question: who brought bird flu to India and from where? The High Security Animal Disease Laboratory (HSADL) is ready with the answer and many more interesting revelations.

Scientists at the Bhopal lab say migratory birds carried the deadly virus from China -- after a detour of Europe and West Asia. After detailed research work for two-and-a-half months, they found the origin and source of the virus and the method of its introduction into India.

A study of the gene sequences (HA1 and HA2) of the virus, isolated from the Navapur and Jalgaon outbreaks, concluded that the viruses originated from -- Qinghai (central China) and Jiangxi (south China).

HSADL joint director in-charge H.K. Pradhan says the findings shatter a common belief: that the outbreaks at Navapur and Jalgaon (140 km away) in Maharashtra were related.

He says genetic analysis revealed that the viruses from Navapur and Jalgaon were not identical (they showed 3.5 per cent divergence). This points to the fact that the two outbreaks were independent from each other and were caused by different sources.

Study is on to identify the other country, says Pradhan. Another interesting finding. Jalgaon was the first to be hit and not Navapur — as widely believed.

Though the outbreak at Jalgaon was reported 12 days after Navapur (February 18), its virus had evolved earlier, says Pradhan.

Since the Jalgaon outbreak was in backyard poultry (involving scattered deaths), it was reported later than the Navapur outbreak in which a large number of birds in organised poultry farms died.

That was also the reason why it took more time in Jalgaon to control the disease, as it had spread far and wide. Pradhan says probably the Navapur virus was responsible for the outbreak in Uchhal in Gujarat, and the Jalgaon virus for the Burhanpur outbreak in Madhya Pradesh.

Scientists are working on this theory. For now, the lab says bird flu — that led to culling of millions of poultry birds and a scare — has been tamed in the country. It has not detected any fresh positive cases in the last two months. Animal husbandry secretary H.M.A. Hakeem on Monday said he was yet to get the details of the lab’s findings. “ I don’t know about it.

As far as I know, the department of animal husbandry hasn’t been informed,” he said. Animal husbandry commissioner S.K. Bandhopadhyay said blaming the outbreak on just migratory birds would mean ruling out other sources. “Other options such like smuggled infected birds, contaminated feed and bird products cannot be ruled out.

For example, in Africa, the FAO has ruled out migratory birds as a source of infection and are examining other sources,” he said.
(With Delhi inputs)

Chinese scientist urges improvement of bird flu control methods​

http://english.peopledaily.com.cn/200606/06/eng20060606_271327.html

The Chinese government should review the strategies and effects of the bird flu control efforts of the past two years and improve them to cope with the epidemic which is still a serious threat, said a Chinese scientist in Beijing on Monday.

"When, and to what extent, the current avian influenza virus could evolve into a human pandemic is unpredictable. We should do our best to reduce the risk of a human pandemic influenza breaking out and make necessary preparations before such a risk becomes reality," said Chinese bird flu control expert Liu Xiufan.

Liu, a member of the Chinese Academy of Engineering (CAE), said at a national conference of the CAE members that controlling the H5N1 virus in poultry at its source is the best way to reduce or even eliminate the risk of a human pandemic virus.

He said the full range of control measures should include enforced biosecurity of poultry farms and restriction on the movement of poultry and products, culling of infected poultry, quarantine, disinfection, and prudent use of vaccines.

Some changes in the H5N1 virus have taken place recently. The virus has increased virulence to ducks, and the currently available vaccines are not effective for protecting poultry, said Liu.

The H5N1 viruses isolated during the 2004-2006 period have increased their ability to replicate in mammalian cell culture. The transmission mode of the viruses is changing from fecal-oral to aerosol, said the scientist, adding that the viruses have increased resistance to the environment, especially to temperature.

He noted that it is a big challenge for China to eradicate the H5N1 viruses because the viruses have been circulating in poultry in China for some time.

The outbreaks of bird flu have affected vast areas of China. The extensive presence of waterfowls and vaccinated birds as the carriers of the H5N1 virus has increased the difficulty of effective control and eradication, Liu said.

China produces 3.7 billion waterfowls each year, more than 75 percent of the world's total.

Huge numbers of small poultry holders scattered all over China increase the difficulty of disease prevention and control, Liu added.

The government should sponsor a review of the strategy and its implementation and to evaluate the effectiveness of the prevention and control of bird flu in the last two years, Liu said.

Because bird flu infection has become endemic in some areas in China and cannot be stamped out in a short time, the government should draw up a short-term plan of prevention and control and a long-term program of eradication, Liu added.

More than 80 outbreaks of bird flu have been reported in China since February 2004, affecting 24 provinces, municipalities and autonomous regions. Eighteen confirmed human cases with 12 fatalities have been reported since last September.

Source: Xinhua

Countries need better plans for handling of mass corpses caused by disasters​

http://www.cbc.ca/cp/health/060605/x060538.html

TORONTO (CP) - Corpse management should be a fundamental part of national emergency response plans, a study of the way Thailand, Indonesia and Sri Lanka handled human remains after the disastrous South Asian tsunami of late 2004 suggests.

The authors of the work said efforts to rapidly dispose of large numbers of bodies after natural disasters actually can exacerbate the trauma of people who survive but who have lost loved ones.

"Emergency response should not add to the distress of the affected communities by inappropriately disposing of the victims," they said in their paper, published in the June issue of the journal Public Library of Science Medicine.

Lead author Oliver Morgan said authorities often attempt to deal quickly with large numbers of dead bodies, believing that in doing so they are sending a strong and reassuring signal to traumatized survivors that someone is in control. They often buttress the decision to bury bodies in mass graves, for instance, by claiming - erroneously - that the corpses are a source of contagion for survivors.

Corpses aren't a health risk, so long as they are kept out of drinking water sources, he and others argue. But depriving people of the ability to find and bury their loved ones is.

"They use the argument that the dead bodies cause epidemics. That is not true. It's a health argument for bad management," said Dr. Ciro Urgarte, regional adviser for emergency preparedness and disaster relief for the Pan American Health Organization, the World Health Organization's regional body for the Americas.

PAHO, as it is known, has taken a lead on research into corpse management in disaster settings. In April the Washington-based agency issued a field manual on retrieving, identifying and managing human remains for first responders to disasters.

Despite devastating recent examples of how challenging corpse management can be in disaster settings, little work has been done internationally to set standards or to incorporate lessons learned from previous incidents, Morgan, a researcher with the health policy unit of the London School of Hygiene and Tropical Medicine, said from London

"Very few countries have put any resources into doing that. Even Western countries."

Each disaster is different and poses its own challenges. No single formula will work in developing and developed countries, urban and rural settings. But some factors hold true across the board, said Morgan.

"Really the main lesson from the natural disasters is that rapid and unplanned disposal of human remains shouldn't be promoted as a public health measure, which is often the case," he said.

"And that where possible, every effort should be made to at least in an organized way gather and bury the bodies."

The study suggested marked graves where bodies are buried in a single layer offer better opportunities for exhumation and forensic investigation later.

"My experience is regardless of what the culture or religion the community has which has been affected, the individual response is that people want to find their relatives, identify their relatives and either bury or cremate them, give them the rites that they would normally give them. And I've seen that in all cultures," Morgan said.

"For the individuals affected, that's the overriding desire."

While the study looked at deaths caused by a natural disaster, it offers lessons for emergency planners preparing for a possible flu pandemic, said infectious diseases expert Dr. Michael Osterholm.

Reports from the 1918 Spanish Flu suggest the handling of bodies became an enormous psychological burden on communities. Osterholm, a leading advocate for pandemic preparedness, has warned that the just-in-time economic model used by suppliers of most goods means supplies of coffins will be quickly exhausted when the next pandemic hits.

"Dealing with mass casualties and the timely and respective handling of the dead is similarly relevant regardless of whether it's tsunami, earthquake, hurricane or pandemic influenza," he said.

"We spend far too much time worrying about contagion and not nearly enough time about the psychological impact on the living. The real job we have to do is not to protect the living from some invisible infectious agent.

"What we need to do is support them in their sense of grief and control of the situation. And when you handle the dead in a disrespectful and less than timely manner, it pushes all of our psychological buttons that tell us we're out of control and we cannot deal with the situation."

-

On the Net:

The study, in PLoS Medicine: http://dx.doi.org/10.1371/journal.pmed.0030195

Indonesia fights uphill battle against bird flu​

http://today.reuters.com/News/CrisesArticle.aspx?storyId=PEK200630

Tue 6 Jun 2006 4:53 AM ET

By Tan Ee Lyn

JAKARTA, June 6 (Reuters) - Chickens roam free just a couple of minutes' walk from Jakarta's central business district and elsewhere in Indonesia it is common to see poultry workers handling dead birds, mucus dripping from beaks, with bare hands.

Despite a steady rise in the number of human infections and outbreaks in poultry, government campaigns to stop the H5N1 bird flu virus and protect flocks and people have not reached the masses in the vast archipelago of 17,000 islands.

After its first known outbreak in chickens in Indonesia in October 2003, H5N1 is now endemic in almost all 33 provinces and has infected 48 people, killing 37 of them -- the second highest total in the world after Vietnam.

Officials readily admit to lapses in handling the problem in a country which stretches 5,000 km from east to west and where more than half its 220 million population live on less than $2 a day.

"There are sporadic outbreaks but they are hard to monitor. Some are far from the centre where there are no veterinary services," said Abdul Adjid, of Indonesia's Veterinary Research Institute, the country's top facility for testing animal samples.

"Public awareness is low and (messages) don't reach the remote areas."

Such words will do little to reassure the medical community, which has warned repeatedly that the more entrenched the virus is in poultry and humans, the more opportunities it will have to mutate.

If it adapts to humans and spreads easily among people, experts fear it could trigger a pandemic, killing millions.

HOLES IN COMBAT PLAN

Jakarta argues that it has not been remiss. Since 2004, it says it has vaccinated 70 percent of its estimated one billion chickens -- but backyard poultry, believed to have been the source for many human infections, are the problem.

"Chickens surround us," said I Nyoman Kandun, a leading health ministry official for communicable diseases. "They are wandering about."

Bayu Krisnamurthi, who works with a national anti-bird flu taskforce, agreed backyard chickens were a liability.

"If you just walk around, you will realise the problem we face."

The government has carried out only limited culling, saying it can't afford the compensation.

"We can afford to pay only 10,000 rupiah ($1) a chicken," said Krisnamurthi.

A full-grown chicken costs 35,000 rupiah in Jakarta, prompting some poor villagers to keep quiet and eat dead birds rather then give them up for culling.

What is most worrying is how human cases are often shrouded in mystery with officials unable to say whether the virus is in the environment or how widely it has spread -- which means H5N1 outbreaks in poultry essentially go uncontrolled.

In a cluster in north Sumatra where H5N1 killed as many as seven members of a family in May, local researchers found H5 antibodies in poultry in a nearby village but they were unable to proceed with N1 tests because of a lack of reference materials.

Neither are they equipped to find out the age of the antibodies, a test that is done in more advanced laboratories. Such a procedure would enable scientists to estimate when the animals were infected.

But officials are adamant that more must be done to identify where the disease has spread from.

"To control human infections, we have to deal with the source of infection first," said Kandun. ($1=9,270 rupiah)

The article below is from the WHO website. I find it very coincidental that these nurses, who took care of the patients who died, came down with just 'ordinary' flu shortly thereafter...........something smells fishy to me.....maybe there are even more hospital workers that are sick that they ARE NOT reporting till they get a negative testing from...........



http://www.who.int/csr/don/2006_06_06/en/index.html


Avian influenza – situation in Indonesia – update 17

6 June 2006

For the past four days, Indonesian health authorities and WHO have been monitoring cases of influenza-like illness in four nurses who were involved in the care of confirmed H5N1 patients.

Test results have now convincingly ruled out H5N1 infection in all four nurses.

Two of the nurses cared for siblings, a 10-year-old girl and her 18-year-old brother, who were hospitalized in Bandung, West Java, on 22 May and died the following day. Test results for both nurses are negative for H5N1 infection. One nurse was shown to be infected with a seasonal influenza A (H1N1) virus, which is now circulating widely throughout Indonesia. The second nurse experienced only mild and transient symptoms, but was tested urgently as a precautionary measure. Her test results were also negative for H5N1 infection.

The two additional nurses, who work at a hospital in Medan, North Sumatra, were involved in the care of confirmed H5N1 cases among members of an extended family from the village of Kubu Simbelang in Karo District. One of the nurses, a 34-year-old woman, experienced only mild symptoms and has subsequently tested negative for H5N1 infection. The second nurse, a 42-year-old woman, developed influenza-like illness on 1 June. Test results received today are also negative for H5N1 infection.

The speed and thoroughness with which influenza-like illness in these nurses was investigated are indicative of the heightened concern among Indonesian health authorities. The negative test results for all four nurses provide reassuring evidence that the virus is not spreading efficiently or sustainably among humans at present.

http://www.recombinomics.com/News/06060601/HCW_Flu_Indonesia_4.html


Commentary

4 Indonesian Health Care Workers with Flu-like Symptoms

Recombinomics Commentary
June 6, 2006

Test results have now convincingly ruled out H5N1 infection in all four nurses.

Two of the nurses cared for siblings, a 10-year-old girl and her 18-year-old brother, who were hospitalized in Bandung, West Java, on 22 May and died the following day. Test results for both nurses are negative for H5N1 infection. One nurse was shown to be infected with a seasonal influenza A (H1N1) virus, which is now circulating widely throughout Indonesia. The second nurse experienced only mild and transient symptoms, but was tested urgently as a precautionary measure. Her test results were also negative for H5N1 infection.

The two additional nurses, who work at a hospital in Medan, North Sumatra, were involved in the care of confirmed H5N1 cases among members of an extended family from the village of Kubu Simbelang in Karo District. One of the nurses, a 34-year-old woman, experienced only mild symptoms and has subsequently tested negative for H5N1 infection. The second nurse, a 42-year-old woman, developed influenza-like illness on 1 June. Test results received today are also negative for H5N1 infection.

The above comments in today's WHO update are cause for concern. Although WHO comments indicate the health care workers are "convincingly" negative, convincing tests would require collection of serum 3-4 weeks after disease onset dates. Since at least two of the health care workers developed symptoms in the past week, appropriate samples would not be ready for antibody testing for another two - three weeks.

Moreover, the identification of seasonal H1N1 is an additional cause for concern. All human H1 isolates to date, including the 1918 pandemic strain have PB2 E627K. Dual infections with H5N1 and H1N1 could lead to acquisition of E627K via recombination. Therefore, determining the H5 antibody level in convalescing serum is important, even though the health care workers had mild cases.

The optimistic report by the WHO is clearly premature, and is cause for concern.

The tendency to focus on optimistic results is a concern and endangering lives. One of the most telling examples is the status of anti-viral resistance markers in the Medan H5N1 isolates, which are amantadine resistant. Instead of disclosing the resistance, the WHO update indicated the isolates were oseltamivir sensitive, and withheld the amantadine resistances. Moreover, when asked about the changes, WHO consulting sequencer Malik Peiris declined comment.

The withholding of important sequences changes, couple with withholding of human H5N1bird flu sequences in Indonesia is cause for concern.

http://www.vnagency.com.vn/NewsA.asp?LANGUAGE_ID=2&CATEGORY_ID=33&NEWS_ID=202234


Malaysian hospitals urged to be alert for bird flu
06/06/2006 -- 17:23(GMT+7)


Kuala Lumpur (VNA) - Malaysian hospitals and clinics have been alerted to inform the Health Ministry if they are treating an excessive number of people with flu and cough.

This follows a notice from the World Health Organisation (WHO) warning that the bird flu situation in Indonesia could get out of control.

"The notification is a reminder of the danger of bird flu as well as to keep a close watch on the current situation here," Health Ministry director-general Dr. Ismail Merican has said.

"We are also monitoring the situation with the Veterinary Services Department. Our medical personnel have been put on standby and are ready to be mobilised should an outbreak occur," he was quoted by the Star newspaper as saying.

He added that the ministry was prepared to handle the situation. "We have the capability and machinery to handle the situation. We have prepared our medical staff to meet any eventuality," he said.-Enditem

I find this strange......considering what is going on in Indonesia......very strange.....

http://en.ce.cn/World/Asia-Pacific/200605/31/t20060531_7165495.shtml


US defense secretary to visit Indonesia next week
Last Updated(Beijing Time):2006-05-31 16:11

U.S. Defense Secretary Donald H. Rumsfeld will pay a one-day visit to Jakarta next week to enhance military cooperation between the two countries, a defense official said.



Rumsfeld will visit Jakarta on June 6 on his way home from attending a defense meeting in Singapore, the Jakarta Post daily Wednesday quoted the official as saying.



Indonesian Defense Ministry spokesman Brig. Gen. Edy Butar Butar said Rumsfeld's visit to discuss military cooperation with Defense Minister Juwono Sudarsono had been confirmed.



A credible source at the Defense Ministry said that the meeting would focus on three topics, namely, details of U.S. military assistance to Indonesia, the war on terrorism and the Iranian nuclear dispute.

from post #9 above:

<b><font size=5> <font color=green>"The H5N1 viruses isolated during the 2004-2006 period have increased their ability to replicate in mammalian cell culture. The transmission mode of the viruses is changing from fecal-oral to <u>aerosol</u>, said the scientist, adding that the viruses have <u>increased resistance to the environment, especially to temperature</u>."</b> </font> </font>

More confirmation the virus is changing to infect humans more easily, quickly.
The bad news keeps accumulating and increasing every day.

EU states abandon proposal for stockpile of flu vaccines​

06 June 2006


European Union health ministers have failed to come to an agreement on the constitution of a stock of antiviral treatments in preparation for a possible flu pandemic, the European Commission said in a statement on Friday.

The European commissioner for health, Markos Kyprianou said that EU Health Ministers had failed to agree to proceed with the creation of a European strategic stockpile of antivirals against influenza.

The possibility of creating a stockpile had been discussed on the initiative of France which had asked that such a stockpile be established. After months of discussion with health experts from the Member States on this issue, the Commission put forward a concept paper which set out the basic purpose and principles of the stockpile.

However, the lack of agreement on the part of the health ministers' meeting on Friday at the Council in Luxembourg, appears to have set a seal on the fate of this proposal.

The aim was to have a supplementary source of antivirals at European level, in addition to the national stockpiles composed by each Member State, Kyprianou explained. He said: ‘The responsibility now lies fully with national authorities to ensure that there are sufficient resources, at the very least for the most vulnerable, in the case of a pandemic.’

The World Health Organisation (WHO) has a stockpile of three million oseltamivir treatments from a donation from Roche.



Source: AMP Health Europe

http://www.manufacturing-chemist.info/story.asp?sectionCode=109&storyCode=40930

" .... The World Health Organisation (WHO) has a stockpile of three million oseltamivir treatments from a donation from Roche ... "

Yes, but it was the USA who emergency shipped Tamiflu to "asia," ie Indonesia, where clusters are spreading and growing. The WHO is worthless.

All the WHO can do is hoard vital scientific info, dither, give wrong advice, and fiddle changing semantics and definitions to cover up what's happening.

Plan for bird flu, retailers warned​

http://www.thestar.com/NASApp/cs/Co...573&call_pageid=968350072197&col=969048863851

Jun. 6, 2006. 01:00 AM
DANA FLAVELLE
BUSINESS REPORTER

Few Canadian retailers are prepared for a pandemic, such as the avian flu, despite growing evidence that the deadly virus poses a serious threat, a retail-conference audience has heard.

"When I travel across the country, the sense I get is, `Gosh, we haven't done much about this,'" said Derek Nighbor, the Retail Council of Canada's vice-president of national affairs. "This is not the average seasonal flu, where a few people may be off for a few days," Nighbor said at the council's annual conference in Toronto yesterday. "This is a serious illness that will spread rapidly."

So far, the so-called bird flu has been transmitted only in Asia and eastern Europe, and when a human comes into contact with an infected bird. But it may be only a matter of time for new locations and a jump from human to human.

Some task forces studying this issue have predicted that as many as third of employees would not report to work once the flu struck. They might be home ill, or caring for sick family members or afraid to go out in public for fear of contracting the illness, said Kirsten Lopes, a lawyer with Ogilvey Renault.

Employers need to have contingency plans that include everything from cross-training key personnel to teaching them better hygiene, Lopes said. That can include such things as showing employees how to cough into handkerchiefs and then safely dispose of them, she said.

"Over the past few years, more companies have been putting into place emergency policies and training their staff. But a lot more work remains to be done," Lopes said.

Dawn Dickinson, manager of corporate risk for Hudson's Bay Co., said few insurance policies cover what's considered a foreseeable loss of this type.

Unlike a flood, fire or terrorist attack, she added, a pandemic attacks your workforce.

Ag Secretary Says Bird Flu Easily Found​

http://news.moneycentral.msn.com/provider/providerarticle.asp?feed=AP&Date=20060606&ID=5774951

WASHINGTON (AP) - Scientists have a new test that can tell within four hours if a bird is possibly infected with bird flu -- but it still will take about a week to know if that suspect case is really sick with the deadly Asian strain, Agriculture Secretary Mike Johanns said Tuesday.

Bird flu hasn't yet reached North America, but testing of migrating wild birds has begun in an attempt to catch it early if it does. There have been no worrisome discoveries yet, Johanns told The Associated Press.

Four hours also is how long it takes to get preliminary results in people infected with the H5N1 virus, Health and Human Services Secretary Mike Leavitt said in the joint interview. But if bird flu ever begins spreading easily among people, that's too long, he warned.

"If it occurs anywhere in the world, it's just a matter of weeks until it appears in the United States," Leavitt said, stressing U.S. preparations that include research into faster human tests for the disease as well as vaccines and treatments. Previously, officials have said that tests allowed them to tell within a day of testing whether a bird was possibly infected with bird flu.

Bird flu has killed at least 127 people worldwide since it began spreading in Asia in late 2003, and tens of millions of poultry and other birds have died of it or been destroyed to stem outbreaks. It is difficult for people to catch -- most infections so far have been linked to close contact with infected birds or their droppings.

But experts fear the virus could mutate into a form easily spread between people, potentially sparking a worldwide outbreak.

It's considered likely that an infected bird eventually will wing its way to North America, perhaps mingling with native birds on breeding grounds in Alaska who then could bring H5N1 south to infect other birds.

An infected bird isn't a threat to the average American: "That will not be a crisis," Leavitt stressed.

Instead, Ag officials will work closely with farmers to protect poultry from getting sick, destroying entire flocks if the disease appears, quarantining farms and ensuring a disease-free perimeter of about six miles, Johanns said.

Indeed, the world got a scare last month when an Indonesian family apparently spread the virus to one another, killing at least six relatives and probably a seventh and sickening one more. There have been a handful of such in-family cases before, but this was the largest familial cluster ever counted. Genetic testing showed the virus hasn't mutated, and it didn't spread beyond blood relatives.

But Johanns and Leavitt said the situation illustrates the cultural difficulties in battling bird flu: how to educate impoverished families that the backyard chickens responsible for their livelihoods could sicken, even kill them.

In Cambodia, Leavitt said, a health minister told him it was "difficult to get farmers to think a few dead chickens are a serious problem" when 14,000 people there die of rabies in a given year.

Given such stark realities, what's the chance that health workers could contain a bird flu pandemic in its country of origin?

"We'll do all we can to help other nations," he said. But, "the chance of actually being there when the spark happens so you control it is very low."

Medan Customs and Excise Impounds WHO Equipment​

http://www.tempointeractive.com/hg/nasional/2006/06/05/brk,20060605-78423,uk.html

Monday, 05 June, 2006 | 15:36 WIB

TEMPO Interactive, Medan: Equipment for eradicating bird flu, belonging to the World Health Organization (WHO), has been impounded at Polonia Airport, Medan.

The equipment, which is to be sent to Kubu Simbelang village, Karo regency, arrived from Singapore on May 30 and more on June 4.

The equipment from WHO comprises four packages weighing 265 kilograms, containing spraying tools, boots, masks, medicine and other health equipment.

According to WHO's liaison officer in Medan, Elia Ginting, the four packages are labeled 'protective equipment bio packaging' and were sent via Singapore.

“The equipment was sent after the WHO's laboratory recommendation about bird flu transmission in Karo was issued. It was sent in special stages for bird flu eradication personnel in Karo,” she said.

However, she acknowledged that the import documentation for the packages was not yet completed by WHO at the time of shipment from Singapore.

Meanwhile, according to Jontara Siburian, Head of the Customs Section of the Customs and Excise office at Polonia Airport, told Tempo that Customs and Excise was not going to release all of WHO's goods because it has not received the import documents until now.

“Although hey are for emergency purposes, Customs will not release the equipment yet,” he said.

Leavitt: States will ration bird flu vaccine​

http://www.cnn.com/2006/HEALTH/conditions/06/06/bird.flu.test.ap/

Local authorities should set priorities, health secretary says

Tuesday, June 6, 2006; Posted: 5:05 p.m. EDT (21:05 GMT)

WASHINGTON (AP) -- States will get to decide how to ration scarce vaccine if bird flu triggers a worldwide epidemic, the nation's health secretary said Tuesday -- a decision that means where someone lives could determine his or her protection.

"Let's acknowledge the fact that for the first six months of any pandemic, we're not going to have a vaccine," Health and Human Services Secretary Mike Leavitt told The Associated Press.

Once doses start being produced, "this is a battle that'll be fought in thousands of communities simultaneously. What's working in one community may not work as well in another," Leavitt said in a joint interview with Agriculture Secretary Mike Johanns.

The United States is girding against the deadly H5N1 strain of bird influenza on two fronts: what to do if this virus one day mutates into a form easily spread among people and makes its way here via ill travelers -- and, more immediately, what to do if it gets here in a migrating wild bird.

Testing of wild birds, a total of 100,000 by year's end, has begun in an attempt to catch the virus early if it does arrive that way -- with some labs beginning to use a new test that can tell within just four hours if a bird is possibly infected, Johanns said.

The first announced test results could generate false alarms: Influenza is a common infection in birds, and Johanns cautioned that it still will take about a week to confirm whether a suspect bird really has the deadly Asian strain, so-called "highly pathogenic" H5N1 flu.

Johanns said there have been no worrisome discoveries in the testing to date. But it is considered likely that an infected bird could fly to North America as early as this year, perhaps mingling with native birds on breeding grounds in Alaska who in turn bring H5N1 south and infect other birds.

Even if that happens, an infected bird isn't a threat to the average American, but a signal to protect poultry in the area from infection.

"That will not be a crisis," stressed HHS' Leavitt.

For people, the bigger concern is watching H5N1 for signs that it's mutating to become more easily spread. Today, H5N1 is very difficult for people to catch: It has killed at least 127 people worldwide since it began spreading in Asia in late 2003, and on to Africa and Europe in the past year. At the same time, it is blamed for the death or slaughter of 200 million birds.

The vast majority of the human casualties involved close contact with infected birds or their droppings. Only in a handful of cases have people apparently spread it to each other while caring for sick relatives, the latest an Indonesian family last month that sparked international concern because it was the largest cluster to date.

In case a human pandemic happens, the government is stockpiling both antiflu medication and a small amount of vaccine that might give some protection until inoculations that are a direct genetic match to the illness could be brewed. That will take six months -- even longer to produce enough for everyone, Leavitt warned.

Who gets first doses? Vaccine factory employees and front-line health workers head the Bush administration's list. But scientists are fiercely debating who's next: school-age children who are flu's prime spreaders? The frail elderly who may be at highest risk of death? Police, firefighters, utility workers who would have to keep order and essential services running?

Leavitt said supplies will be divided among the states according to their population. It will be up to the states to decide who is first in line.

"You could make a case for many different segments of the community being a priority," Leavitt said Tuesday. "You could also see different situations in each state that would warrant those decisions being different."

"The federal government has a very important role, and we'll play it," in developing and stockpiling vaccines and drugs, he added. But, "when it comes down to managing the public health in a pandemic situation, it will be up to local public health authorities."

More sobering, Leavitt said there's only a very low chance that doctors could contain a human bird-flu outbreak and thus stop a pandemic at its source.

Asia is considered the likely hot zone, largely because there are so many impoverished families who live in close quarters with chickens -- not just the back yard but sometimes inside the house -- that they need to survive, and thus they won't willingly slaughter infected flocks.

Leavitt recalled how a health minister in Cambodia told him it was "difficult to get farmers in rural areas to think a few dead chickens are a serious problem" when 14,000 people there died of rabies last year.

The stark reality: "We'll do all we can to help other nations," Leavitt said. But if a bird flu outbreak "occurs anywhere in the world, it's just a matter of weeks before it will be in the United States."

Link to tomorrows (6/7) Bird Flu thread: http://www.timebomb2000.com/vb/showthread.php?t=199970

Thanks ...

PC ... thanks for keeping these threads going ... they're full of valuable info ...