06/23 | Daily BF: Spread of bird flu ‘likely’ by personal contact

Link to yesterday's thread: http://www.timebomb2000.com/vb/showthread.php?t=201564

Here is an important link...
Johns Hopkins on influenza: http://www.iom.edu/Object.File/Master/33/450/Rashid Chotani.pdf

MARGIE MASON, Jakarta June 23 2006

The World Health Organisation concluded that human-to-human transmission probably occurred among seven relatives infected with bird flu on Sumatra island in Indonesia, while an expert said the disease was more widespread in poultry than previously thought.

WHO experts reported that first case in the cluster was probably infected by sick birds and spread the disease to six family members living in a remote village. One of those cases, a boy, then probably infected his father, it said.

The UN agency stressed the virus had not mutated in any important way and that no cases were detected beyond members of the family, six of whom died last month.

"Six confirmed H5N1 cases likely acquired [the] H5N1 virus through human-to-human transmission from the index case . . . during close prolonged contact with her during the late stages of her illness," the report said.

It was distributed at a closed meeting in Jakarta attended by top bird flu experts. The three-day session was convened after Indonesia asked for international help. The country has recorded the highest number of human bird flu cases this year, and 39 of those infected died.

More outbreaks are also occurring in poultry than previously thought, said Jeff Mariner, an animal health expert working with the UN Food and Agriculture Organisation in Jakarta.

He is co-ordinating a project that involves local surveillance teams conducting field interviews to track backyard poultry that have rapidly died. The teams then use bird flu test kits to identify outbreaks.

In the 12 pilot districts on Java island, 78 poultry outbreaks were detected from January to May. Birds discovered in those outbreaks were slaughtered to limit the spread of infection.

"We thought there was dramatic under-reporting, but we never imagined that it would be so pervasive," Mariner said. "These numbers of outbreaks only represent, say, one-third of the coverage in the district."

The experts were expected to discuss Sumatra's family cluster. A remaining mystery is why only blood relatives, not spouses, became infected.

The WHO report theorises the family shared a common genetic predisposition to infection with H5N1 virus "with severe and fatal outcomes". However, there is no evidence to support that.

Malik Peiris, the Hong Kong University professor who discovered the Sars virus, said scientists must closely monitor all clusters to ensure they are not behaving differently. He said both family clusters and human-to-human transmission occurred in some of the first H5N1 cases discovered in Hong Kong in 1997.

"It's very important that they be investigated because they could be the first signal of an emerging pandemic," he said.

Peiris said he had not detected any mutations in the virus that would move it closer to being able to pass easily among people.

Bird flu has killed at least 130 people worldwide since it began ravaging Asian poultry stocks in late 2003.

Experts fear the virus will mutate into a form that spreads easily among people, potentially starting a pandemic.

So far, it remains hard for people to catch, and most human cases have been traced to contact with infected birds.-AP

http://www.theherald.co.uk/news/64615-print.shtml

WHO: Bird Flu Virus Mutated in Indonesia​

http://www.washingtonpost.com/wp-dyn/content/article/2006/06/23/AR2006062300224.html

By MARGIE MASON
The Associated Press
Friday, June 23, 2006; 5:41 AM

JAKARTA, Indonesia -- A World Health Organization investigation showed that the H5N1 virus mutated slightly in an Indonesian family cluster on Sumatra island, but bird flu experts insisted Friday it did not increase the possibility of a human pandemic.

The virus that infected eight members of a family last month _ killing seven of them _ appears to have slightly mutated in a 10-year-old boy, who is then suspected of passing the virus to his father, the report said.

It is the first evidence of possible human-to-human-to-human transmission of the H5N1 virus, said Tim Uyeki, an epidemiologist from the U.S. Centers for Disease Control and Prevention, adding that the virus did not pass outside the cluster and died with the father.

"Then it stopped. It was dead end at that point," he said, stressing that viruses are always slightly changing and there was no reason to raise alarm bells.

"Analysis of the viruses suggest that there is nothing remarkable about these viruses compared to other human H5N1 viruses or animal H5N1 viruses," he said.

The findings appeared in an investigation report obtained by The Associated Press.

Residents refuse bird flu testing​

http://www.thejakartapost.com/detailnational.asp?fileid=20060623.H04&irec=7

JAKARTA: Health Minister Siti Fadillah Supari is gravely concerned about some North Sumatra villagers' refusal to have their blood tested for the avian flu virus after a bird flu outbreak killed seven people in the Tanah Karo regency.

"Maybe, the residents there have yet to receive proper information about bird flu," she said before attending a Cabinet meeting.

Tanah Karo residents are also refusing to let officials check their chickens for the flu, insisting there is no incidence of the disease in their area.

The government plans to cull all chickens in a one-kilometer radius in all areas testing positive for the virus. -- JP

Expert: Bird flu more widespread than thought in poultry​

http://www.thejakartapost.com/detaillbus.asp?fileid=20060623170049&irec=1

JAKARTA (AP): Bird flu is more widespread among Indonesia's poultry stocks than previously thought, and will only get worse if more action isn't taken soon in the country with the world's highest number of human deaths this year, an expert said.

"We thought there was dramatic underreporting, but we never imagined that it would be so pervasive," said Tufts University's Jeff Mariner, who is working with the U.N. Food and Agriculture Organization in Jakarta.

He spoke on the sidelines of a three-day meeting that wraps up Friday in the nation's capital attended by some of the world's top bird flu experts.

Mariner is coordinating an FAO program that trains local surveillance teams to conduct field interviews with farmers to track backyard poultry that have suddenly died. The teams then use bird flu test kits to identify whether bird flu is to blame.

In the 12 pilot districts on Java Island, the teams detected 78 poultry outbreaks from January to May - roughly one in every 10 interviews resulted in bird flu, Mariner said. He added those numbers cover only about a third of each district due to a lackof manpower needed to conduct the interviews.

"Leaders are now realizing, 'Boy, this is just the tip of the iceberg,"' he said Thursday. "Whereas before, district leaders were saying, 'Well, we don't really think we have it."'

There are plans to expand the project to Bali and Sumatra islands, but Mariner said the virus will continue to spread unless Indonesia can devise a coordinated approach for local governments to work together to control the disease. Slaughteringand vaccination are now currently sporadic at best and often outbreaks in poultry are not reported until a human case is discovered.

"It's gonna be a long struggle," Mariner said. "It's 300 million poultry ... and it's a rapid turnover in the population.Essentially, you get an entirely new population after six months."

Earlier this week, FAO animal health expert Peter Roeder said Indonesia needed US$50 million over three years to lay the groundwork for tackling bird flu in poultry. But he said money has been slow to come. He's hoping the World Bank will release a US$10 million grant soon

Bird Flu Cases May Be Harder to Detect in China, Indonesia​

http://www.bloomberg.com/apps/news?pid=10000080&sid=aLCzn8r7pcOI&refer=asia



June 23 (Bloomberg) -- Human bird flu cases may be harder to detect in China and Indonesia because vaccination programs mask the virus in poultry.

The potential impact on human health of poorly implemented bird inoculations and experimental poultry vaccines needs to be carefully considered, according to a report prepared by the influenza team at the European Centre for Disease Surveillance and Control in Stockholm. A drop in the number of human cases in countries where fowl are vaccinated should ``be interpreted cautiously,'' the report said.

``Surveillance for H5N1 cases in humans is becoming harder where poultry immunization is widely but imperfectly implemented because the marker of local poultry deaths for human case detection is being lost,'' according to the report published yesterday in Eurosurveillance, an online journal of peer-reviewed information on communicable diseases.

China and Indonesia, which immunize poultry to control outbreaks of the H5N1 avian influenza strain, account for more than half the 84 human cases reported this year. Infection in birds and humans creates opportunity for the H5N1 virus to mutate into a pandemic form that may kill millions of people.

Indonesia's struggle to arrest the spread of avian flu in poultry and prevent human infection is attracting international attention. The virus has killed a person every six days this year in the world's fourth-most-populous nation.

``Indonesia is failing to control outbreaks due to a poorly implemented veterinary control strategy, including poorly implemented vaccination,'' the report said.

The World Health Organization has highlighted the risk to human health of poorly implemented avian vaccine programs and the use of poor quality vaccines, said Roy Wadia, a spokesman with the United Nations agency in Beijing.

No Warning

``If you don't see poultry dying when they are infected, then from a public health point of view, you can't be extra vigilant and warn people that they could be at risk,'' he said.

China has reported one outbreak of H5N1 in poultry to the World Organization for Animal Health in the past four months. In the same period, seven human cases were reported across five provinces. The world's most-populous nation has reported a total of 19 human cases of H5N1, of which 12 were fatal.

Wadia said 18 of those cases weren't forewarned by poultry outbreaks.

While the use of appropriate vaccines in poultry will reduce the amount of circulating virus, even without 100 percent coverage, it is vital to further clarify and address the specific risk factors for human H5N1 infection in order to reduce exposure, he said.

`Mask Infections'

``Vaccination can mask infections in birds,'' Wadia said. ``Thus, poultry vaccination shouldn't be taken as a sign that human surveillance can be in some way eased.''

China made progress in strengthening its response to infectious diseases after a 2003 outbreak of severe acute respiratory syndrome, or SARS.

``But major planning and logistical problems in controlling H5N1 in birds remain,'' the report in Eurosurveillance said. ``Poultry immunization is used widely but is a challenging task, with billions of birds needing to be immunized annually.''

Poultry vaccines have also been used to help control H5N1 outbreaks in Egypt, Kazakhstan, Russia, Iraq, Jordan, Pakistan and Vietnam, the Food and Agriculture Organization of the United Nations said in a June 19 report.

In Vietnam, no poultry outbreaks have been officially reported for almost six months after a nationwide vaccination campaign in 2005 in which 118 million birds were vaccinated, the Rome-based agency said.

Another milestone: WHO has concluded that virus has mutated

WHO says H5N1 virus mutated slightly in Indonesian family​

MARGIE MASON

Associated Press

JAKARTA — A World Health Organization investigation showed that the H5N1 virus mutated slightly in an Indonesian family cluster on Sumatra island, but bird flu experts insisted Friday it did not increase the possibility of a human pandemic.

The virus that infected eight members of a family last month — killing seven of them — appears to have slightly mutated in a 10-year-old boy, who is then suspected of passing the virus to his father, the WHO investigative report said.

It is the first evidence of possible human-to-human-to-human transmission of the H5N1 virus, said Tim Uyeki, an epidemiologist from the U.S. Centers for Disease Control and Prevention, adding that the virus died with the father and did not pass outside the family.

“It stopped. It was dead end at that point,” he said, stressing that viruses are always slightly changing and there was no reason to raise alarm bells.

The findings appeared in a report obtained by The Associated Press that was distributed at a closed meeting in Jakarta attended by some of the world's top bird flu experts.

The three-day session that wraps up Friday was convened after Indonesia — which is on pace to become the world's hardest hit nation with 39 human bird flu deaths — asked for international help.

Experts fear the virus will mutate into a form that spreads easily among people, potentially sparking a pandemic. So far, it remains hard for people to catch, and most human cases have been traced to contact with infected birds.

WHO concluded in its report that human-to-human transmission likely occurred among seven relatives infected with the H5N1 virus in a remote farming village on Sumatra island. An eighth family member who was buried before specimens could be taken is believed to have been infected by poultry, a WHO report said.

Despite the virus' slight mutation in the father and son, Mr. Uyeki insisted that an analysis suggested there was “nothing remarkable about these viruses” compared to other human or animal H5N1 viruses.

Bird flu has killed at least 130 people worldwide since it began ravaging Asian poultry stocks in late 2003. Indonesia trails on Vietnam, where 42 people have died, in human bird flu deaths.

http://www.theglobeandmail.com/servlet/story/RTGAM.20060623.windoflu0623/BNStory/International/home

Genetic Evidence of Human Transmission of H5N1 in Indonesia​

http://www.recombinomics.com/News/06230601/H5N1_H2H_Genetic_Karo.html

Recombinomics Commentary
June 23, 2006

Genetic sequencing of a virus sample taken from a 10-year-old boy who died from the H5N1 avian influenza strain showed a minute change that was also found in a virus sample taken from his father who later died from the virus, said Dick Thompson, a spokesman for the United Nations health agency in Geneva.

``We have seen a genetic change that confirms in a laboratory that the virus has moved from one human to another,'' Thompson said in an interview. The change in the virus ``doesn't seem to have any significance in terms of the pathology of the disease or how easily it's transmitted,'' he said.

Human-to-human transmission had previously been suspected as the cause of infection in seven members of the Indonesian family from the island of Sumatra. The cases attracted international attention because they represent the largest reported instance in which avian flu may is likely to have spread among people. They also provide the first evidence of a three-person chain of infection.

The above comments include the first reported genetic link supporting human-to-human transmission of H5N1 bird flu. In the past, the evidence was largely limited to disease onset dates. However, the gaps between the onset date of the index case and other family members has been present in the vast majority of clusters, dating back to the 2003 cluster in the Hong Kong family that had visited Fujian Province.

These data add to the accumulation of evidence for human-to-human transmission within families and between families in Turkey. These clusters have involved several versions of H5N1 including clade 1 and clade 2 and are common.

However, the cases in Karo created the largest and deadliest reported cluster in Indonesia, which highlights minor changes in the H5N1 genes. These changes are not public because the human sequences have been withheld and are sequestered in a private WHO database. Although Indonesia has indicated that the data could be released, only HA and NA sequences from the first confirmed case in Indonesia have been released.

These sequences should be released immediately.

MEDIA-INDONESIA:
Reporters Get the Bird Flu Jitters​

http://www.ipsnews.net/news.asp?idnews=33733

Sonny Inbaraj

MEDAN, North Sumatra, Jun 23 (IPS) - ''I really feel strongly that the issue of health and safety of reporters covering avian flu must be addressed by the management of news organizations,'' said Daenk Haryono of the North Sumatra-based ‘Harian Global' daily.

''Many times I've seen my colleagues go out to the field, not aware that they should be at least wearing face masks and gloves,'' he added. ''It seems like the editors just want our stories and couldn't give a damn about our safety,''

Haryono has every reason to worry. Two reporters have so far been admitted to hospital, suspected to be suffering from avian influenza or bird flu. The latest victim from the popular ‘Tempo' daily was rushed to hospital last week when he developed high fever after covering the mass culling of chickens and the funeral of a bird flu victim in West Java.

Indonesia, the world's fourth most populous country has reported the world's highest number of human deaths from bird flu this year, with 51 cases to date and 39 deaths. The world total is 228 cases with 130 deaths. The lethal H5N1 virus is already endemic in birds in Indonesia.

In North Sumatra, the spectre of a deadly global flu pandemic was raised early this month when the World Health Organisation (WHO) admitted it was having difficulty identifying the source of bird flu infection in a case where seven people in the same family died.

It is Indonesia's largest cluster to date and has raised fears of human-to-human transmission of the H5N1 virus.

‘'Good reporting is essential to educate the public about the risk of outbreaks in their poultry and how to protect themselves in the eventuality of a human pandemic,'' said David Swayana of the ‘Harian Waspada' daily.

‘'But news organizations should make preparations to protect their reporters in the field before they are sent out to report stories on the illness,'' added the journalist at a training seminar for news reporters organized by the U.S.-based media development agency Internews and the United Nations Children's Fund (UNICEF).

The Brussels-based International News Safety Institute has the following guidelines for news media staff covering stories on bird flu:

- Avoid direct contact with poultry that has no apparent symptoms, as well as with sick or dead poultry and any surfaces that may have been contaminated by poultry or their faeces or secretions;

- Wash your hands thoroughly and as frequently as possible and definitely after any potential contact. You should use soap and water where possible, or waterless alcohol based hand rubs when soap is not available and hands are not visibly soiled;

- You may want to use personal protective equipment like gloves, masks, overshoes;

- You must monitor your health for 10 days after your last exposure. If you become unwell with a fever, develop a cough or have difficulty breathing you must seek medical help immediately.

But to be fair, a few large media organizations in Indonesia do have guidelines for their reporters.

‘'It is compulsory for all members of the news crew when they're out reporting in the field to wear masks and gloves,'' said Fitrianti Megantara of the Jakarta-based Trans TV. ‘'It's written down in black and white for us to follow,'' she said.

Trans TV cameramen, too, according to Megantara, have been instructed by their management to keep their distance from victims and are excused from filming in houses where there have been deaths.

She said her TV station's journalists are also subject to a compulsory blood test for the H5N1 virus if they had been reporting in the field for a week or more.

While face masks are deemed as standard protection gear, many journalists complained that villagers often didn't want to talk to them if they wore one.

‘'It's really difficult getting interviews if I were to wear a face mask,'' said Iir Sairoh of the West Java-based ‘Radio Cindelaras'. ‘'I seem to scare off people with it,'' she added.

But the radio journalist revealed that not wearing a face mask, each time she conducted an interview has a traumatizing effect on her.

‘'It's okay when I'm doing the interview, with the adrenalin flowing to beat the deadline. But after I've filed my piece that's when I become scared,'' she told the seminar.

‘'That's when I realise that I haven't had any protection and it just plays on and on in my head that I'm going to get sick and die,'' said Sairoh, while sharing her experiences with her colleagues.

Sairoh revealed that once she had a fever after returning from a village where there was a bird flu outbreak.

‘'That was very scary and I told myself that if the fever persisted for another day I would go to the nearest hospital. Fortunately it did not,'' she said. ‘'Maybe I'm just a hypochondriac,'' added Sairoh, laughing it off.

Prof. Luhur Suroso, the avian influenza team head in Medan's Adam Malik hospital, had this advice for journalists at the seminar. ‘'Though human-to-human transmission of avian flu still has not been confirmed scientifically, you need to take precautions while covering the issue in the field,'' he reminded them.

‘'There are basic measures you can take to reduce your chances of catching and spreading the disease,'' said the chest specialist. ‘'Wearing face masks and gloves should be compulsory for reporters.'' (END/2006)

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<B><font size=+1 color=brown><center>Giant Eagle Preparing for Bird Flu </font>

<A href="http://www.progressivegrocer.com/progressivegrocer/headlines/article_display.jsp?vnu_content_id=1002727129">www.progressivegrocer.com</a></center>
JUNE 23, 2006 -- PITTSBURGH -- Giant Eagle here shared details of its pandemic flu preparation plan as one of several key participants at a forum on the avian flu and pandemic preparedness this week.

John Saunders, Giant Eagle's director of computer services and IT procurement, said Giant Eagle will aim to minimize person-to-person contact in its stores by encouraging the use of self-service checkout lines, drive-up pharmacy windows and debit or credit cards rather than cash.</b>

The forum, sponsored by the University of Pittsburgh Medical Center, drew a gathering of about 200 business leaders focusing on steps to prepare for a public health emergency.

In the event of a pandemic threat, the Giant Eagle official said the chain is considering the feasibility of creating an online grocery store that would ship purchased goods to homes via mail or a commercial shipping service. Because a typical Giant Eagle store stocks about 40,000 different items, Saunders said the company also is trying to determine which core items it would need to stockpile during a pandemic.

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<B><center>Friday, 23 June 2006, 12:50 GMT 13:50 UK

<font size=+1 color=green>Family vector for Sumatra bird flu </font>

By Lucy Williamson
BBC News, Jakarta
<A href="http://news.bbc.co.uk/1/hi/world/asia-pacific/5110084.stm">LINK</a></center>
Indonesia is facing a growing bird flu problem </b>

The World Health Organisation has said it believes limited human-to-human transmission of the bird flu virus did occur in an Indonesian family in May.

But it said that the incident did not signal a major change in the spread of the disease.

The WHO made its announcement at the end of a three-day bird flu conference in the Indonesian capital, Jakarta.

The case of seven family members who died from bird flu has drawn attention to Indonesia's growing problem.

Ending the closed-door conference, the WHO said its investigation suggested the virus had been passed between the family members in Sumatra.

The WHO also found that the virus had mutated in one case, but not in a way that made it more easily transmissable between people.

Nevertheless, according to both the WHO and Indonesian government, the virus is widespread among poultry in the country and the focus should now be on implementing Indonesia's national strategy to contain bird flu.

To do that, they said, the country would need funding.

Indonesia has asked for $900m (£495m) over the next three years to tackle the virus.

Thirty-nine people are now known to have died from the disease in Indonesia.

The virus cannot yet pass easily from one person to another. But experts fear it could mutate and in its new form trigger a flu pandemic, potentially putting millions of human lives at risk.

China bird-flu research raises questions​

http://www.upi.com/NewsTrack/view.php?StoryID=20060623-125406-6406r

BEIJING, June 23 (UPI) -- A new China study predates the country's claim of its first human bird-flu case by two years, raising questions about the spread of the disease, a report says.

The new findings were outlined by eight Chinese scientists in a letter to the New England Journal of Medicine, the Wall Street Journal said. The letter said a 24-year-old man who died in late 2003 was a victim of a particular strain of the bird flu and not of SARS, or severe acute respiratory syndrome, as earlier believed.

Prior to this, the Journal said, China had claimed it discovered its first human case late last year. The report said international health officials have long suspected the actual death toll from bird flu in China might be higher than claimed.

The Journal said one of scientists had sought to withdraw the letter, but a spokesman for the medical publication told the newspaper, "We returned {the e-mails} with a message from the editors telling them that it was too late to withdraw since the issue had already been printed. We asked them for an explanation, and we asked them if they would like to retract the letter. We have not yet received a response."

H5N1 Transparency and Openness Pledge in Indonesia​

http://www.recombinomics.com/News/06230602/H5N1_Karo_Openness.html

Recombinomics Commentary
June 23, 2006

``Detection of human clusters is a priority,'' they said in a joint statement today. A report of the investigation of the Sumatran cases will be made as soon as possible to boost ``transparency and openness.''

A 37-year-old Sumatran woman suspected of being the first family member to die was buried before samples were taken, so her cause of death can't be determined.

The woman, who sold fruit and vegetables in a local market, owned eight chickens, including three egg-laying hens that were reported to have died about two to seven days before she became ill on April 24, the summary said. She mixed fowl manure with soil with her bare hands to fertilize her garden, it said.

The woman's 10-year-old nephew, 18-month-old niece, 19-year- old son, 18-year-old son and 29-year-old sister became sick between May 2 and 4, and subsequently died, after having close and prolonged contact with the woman during her illness, the summary said. A brother, 25, was also infected and survived.

Chain of Infection

A seventh patient, the father of the 10-year-old boy, contracted his fatal infection from close and unprotected contact with his son during the boy's hospitalization. The 37-year-old woman is the only one for whom exposure to sick or dead chickens or other animals was ascertained, the summary said.

The above comments on transparency and openness should lead to the release of the human H5N1 sequences from the Karo cluster, as well as the other human sequences from Indonesia.

Although the number of confirmed H5N1 human cases in Indonesia has now exceeded 50, only one set of sequences (HA and NA) from the first confirmed case in Indonesia has been released. The other six gene segments from that patient has been withheld, as have sequences all subsequent isolates including the Sumatra cluster.

The latest media reports indicate there is a change that was specific for the father and his 10 year old son, providing genetic evidence for human-to-human transmission. However, these isolates are also Amantadine resistant and have a wild type cleavage site, which differs from the vast majority of earlier isolates from Indonesia.

When Malik Pieris was asked about these changes in the above cluster, he indicated he could not comment because the sequencing was done under contract with the WHO. WHO said hat release of the data was up to the Indonesian government, and the Indonesian government indicated the sequences could be released.

However, the sequences remain password protected at the Los Alamos site, and simple removal of the protection would allow public access. These sequences can be accessed by 15 WHO affiliated consulting labs, but they are not available to other scientists.

The analysis of the sequences is extremely limited. WHO updates focus on reassortment, although there are no examples of H5N1 reassortment with human or swine genes and little indication that such reassortment will be significant. Prior mixing experiments using human and H5N1 genes did not identify significant human / avian combinations.

Changes in polymorphisms are largely focused in positions 226 and 228 in the receptor binding domain. However, H5N1 bird flu is constantly drifty and forming new branches and tries. In depth analysis of this evolution requires a robust and current database, which is made available to a small group that does a limited amount of analysis.

Link to tomorrows (6/24) Bird Flu thread: http://www.timebomb2000.com/vb/showthread.php?t=201818