HEALTH 8/7/08- 8/15/08 Weekly Bird Flu Thread:Suspect H5N1 Cluster In Sumatra Indonesia

Link to last weeks thread:

8/1/08- 8/7/08 Weekly Bird Flu Threadelayed H5N1 Confirmation In Indonesia

http://www.timebomb2000.com/vb/showthread.php?t=296333


Johns Hopkins on influenza:

http://www.iom.edu/Object.File/Master/33/450/Rashid Chotani.pdf

National Avian Influenza Surveillance Information:

http://wildlifedisease.nbii.gov/ai/

CDC

http://www.cdc.gov/flu/avian/index.htm

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

CIDRAP

http://www.cidrap.umn.edu/

Official U.S. Government Web site

http://www.pandemicflu.gov/

FAO

http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html

Public Health Agency of Canada

http://www.phac-aspc.gc.ca/influenza/avian_qa_e.html

European Union

http://ec.europa.eu/dgs/health_consumer/dyna/influenza/country_en.htm

The World Bank

http://web.worldbank.org/WBSITE/EXT...68427~piPK:64168435~theSitePK:1793593,00.html
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Suspect H5N1 Cluster In Sumatra Indonesia Raises Concerns​

http://www.recombinomics.com/News/08060801/H5N1_Sumatra_Suspect.html

Three people have died and 13 have been admitted to hospital with symptoms of bird flu in Indonesia, a nurse treating the patients said Wednesday.

Officials and residents in Asahan district of North Sumatra province said villagers began showing symptoms of avian flu after a large number of chickens died suddenly last week.

The nurse at Asahan district's Kisaran hospital said three people had died after suffering bird flu-like symptoms in Air Batu village.

On Wednesday at dawn struck their 02,00 arrived. The two patients consisted of a male child and the woman, said public relations of RSUP Adam Malik of the Ginting rays, on Wednesday (6/8) when being encountered by the reporter.

The official of the Intensive Care Unit (UGD) RSUD Abdul Manan, Ana, said, eleven other patients on behalf of RAPPING (5), IP (6), Spr (33), DY (5), the US (39), M. (32), D (32) Sdr (39), RM (8), and D (2).

The "patient D was the last patient who entered this morning (on Wednesday 6/8)," said Ana.

The above comments and translation describes three suspect fatal H5N1 infected patients as well as 13 more who are hospitalized at the Adam Malik hospital in Medan in North Sumatra.

This large number of suspect patients is cause for concern. The largest confirmed H5N1 outbreak in Indonesia was also in North Sumatra. Most of the members of the Karo cluster were also treated at Adam Malik. The large number of adults in the above list suggests the cases represent multiple families.

The H5N1 status in Indonesia has been cloudy because of reporting failures by the Indonesian government, WHO, or both. Although Indonesia has acknowledged two lab confirmed cases in Tangerang last month, WHO has yet to publish updates on these patients. Similarly, the reporting of the cases preceding the cases last week would reported weeks after confirmation in violation of IHR regulations. The earlier cases were members of clusters, which Indonesia failed to confirm and WHO failed to acknowledge.

WHO’s continuing failure to report these clusters in Indonesia remains a cause for concern.

Details on this large cluster and an explanation from WHO on its glaring oversight failures would be useful.

Birds slaughtered as suspected flu breaks out​

http://www.news.com.au/story/0,23599,24148410-401,00.html

From correspondents in Jakarta

August 08, 2008 05:05pm

HUNDREDS of chickens and ducks have been slaughtered to contain a suspected bird flu outbreak in Indonesia as 13 people with flu-like symptoms await laboratory results.

Thirteen people were hospitalised earlier this week with fevers and respiratory problems after a large number of chickens died suddenly in their village in North Sumatra province.

Two of them, a baby boy and a seven-year-old girl, have been put in a bird flu isolation unit at a hospital in the provincial capital Medan.

"We have taken measures since Tuesday when we found strong indications of bird flu virus in some 100 chickens and ducks in several places in Air Batu village," said local husbandary office chief Oktoni Eryanto.

At least 400 birds have been slaughtered and burned, and officials were continuing to spray backyard coops with disinfectant, he said.

"We don't need to send samples from the poultry to a laboratory because it's pretty clear that the cause is the bird flu virus," he said.

"Preventive action is more important to control it."

A nurse at a local hospital said this week that three people had died in the village with flu-like symptoms, but health ministry officials have not been able to confirm any suspect deaths.

The ministry, which has not confirmed the latest suspected outbreak, has stopped providing regular public updates on human bird flu deaths even though Indonesia is the country most affected with 112 confirmed cases.

The deadly H5N1 strain of bird flu has killed more than 240 people worldwide since late 2003.

The virus typically spreads from bird to human through direct contact, but experts fear it could mutate into a form easily transmissible between humans, with the potential to kill millions in a pandemic.

Farmer charged in bird flu case ​

http://news.bbc.co.uk/2/hi/uk_news/england/suffolk/7549042.stm

A Suffolk farmer whose business was at the centre of a bird flu outbreak has been charged with breaching regulations intended to limit its spread.

Geoffrey Buchanan, a director of Gressingham Foods, in Debach, Suffolk, is accused of breaching carcass disposal regulations.

Suffolk County Council said the charges follow the outbreak of the deadly H5N1 strain of the virus in November 2007.

The 38-year-old is due appear at Bury St Edmunds Magistrates' Court later.

Poultry deaths from bird flu on the rise​

http://www.thejakartapost.com/node/176989

Thu, 08/07/2008 10:08 AM | The Archipelago

PURBALINGGA, C. Java: The number of poultry, mostly chickens, that died of bird flu in Purbalingga regency in the first half of 2008 has surpassed the 2007 total, the head of the local development planning agency said Wednesday.

"Some 58,000 poultry died of bird flu in 2007, while more than 60,000 died during the first six month of this year," Heni Ruslanto said.

"The poultry were confirmed to have died of bird flu."

Heni added people in the region had limited information about preventive health measures and how to handle bird flu cases.

"Therefore, we are calling related institutes to pay attention to this problem," he said. -- JP

From Wednesday, some details

Thirteen more bird flu suspects detected in North Sumatra​

http://www.thejakartapost.com/news/...bird-flu-suspects-detected-north-sumatra.html

The Jakarta Post , Jakarta | Wed, 08/06/2008 8:22 PM | National

Thirteen people from Air Batu village, Air Batu subdistrict, Asahan regency in North Sumatra, were taken to Asahan's Abdul Manan hospital early Wednesday after showing symptoms of avian influenza, more commonly known as bird flu.

Two patients were later admitted to Medan's Adam Malik Hospital for further treatment, while the other 11 were still undergoing treatment at Abdul Manan hospital.

"Two patients from Abdul Manan hospital, a seven-year-old girl and an eight-month-old baby boy, arrived here at 2 a.m.," Adam Malik Hospital spokesman Sinar Ginting told Kompas.com on Wednesday.

Sinar said the two patients were in a "critical" condition, with a high fever, serious respiratory problems and a cough.

The two patients, he said, had no history of direct contact with chickens but a week earlier chickens around their neighborhood had died suddenly.

"Officials from the local health agency have examined the chickens and found they were positively infected with H5N1 virus," Ginting said.

Ginting said a team of doctors led by Dr Luhur Soeroso had provided all appropriate treatment to the patients, who are being held for further tests even though they are only suspected of having the disease.

Indonesian villagers test negative to bird flu​

http://www.radioaustralia.net.au/news/stories/200808/s2329928.htm?tab=latest

Thirteen people in Indonesia suspected of having bird flu have tested negative.

A health ministry official says all thirteen from Air Batu village in North Sumatra have recovered.

Officials feared a possible outbreak after villagers began to show symptoms of avian flu following the sudden death of a large number of chickens and three villagers.

The local husbandry office has taken preventive action this week by slaughtering and burning some 400 chickens and ducks.

The deadly H5N1 strain of bird flu has killed 112 Indonesians since late 2003.

Contact With Birds Not Required to Contract Bird Flu Infection ​

http://www.naturalnews.com/023815.html

(NaturalNews) The World Health Organization (WHO) has warned that it may be possible to contract the avian flu without coming into direct contact with infected poultry.

In a report published in the New England Journal of Medicine, WHO researchers examined all 350 known cases of infection with the H5N1 strain of influenza, known popularly as "bird flu." Approximately three-quarters of these cases could be attributed to close contact with infected birds, often by poultry workers. A very few cases of human-to-human transmission are suspected, always between family members who came into close contact with each other. But the rest of the cases were more ambiguous.

"In one quarter or more of patients with influenza A (H5N1) virus infection, the source of exposure is unclear, and environment-to-human transmission remains possible," the researchers wrote. Some of the unclear cases occurred in people whose only contact with birds was walking through live poultry markets.

The authors speculated that the virus may remain active in fertilizer made from bird feces, or in certain fluids that stick to surfaces eventually touched by humans. The question has also been raised as to whether the virus needs to enter the nose or can infect humans by merely being eaten.

"It is unknown whether influenza A (H5N1) virus infection can begin in the human gastrointestinal tract," the researchers wrote. "In several patients, diarrheal disease preceded respiratory symptoms, and virus has been detected in feces."

The report confirmed government reassurances that well-cooked food is not a source of the disease, but cautioned that non-potable water might be: "Drinking potable water and eating properly cooked foods are not considered to be risk factors, but ingestion of virus-contaminated products or swimming or bathing in virus-contaminated water might pose a risk."

Bird flu is a highly lethal strain of the influenza virus, killing 61 percent of the people that it has infected. Scientists fear that it might mutate into a variety that passes easily to and between humans, with catastrophic public health consequences.

New bird flu strain detected in Nigeria​

http://www.fao.org/newsroom/en/news/2008/1000909/index.html

FAO calls for increased surveillance
11 August 2008, Rome - A strain of Highly Pathogenic Avian Influenza previously not recorded in sub-Saharan Africa has been detected in Nigeria for the first time, FAO said today. Nigeria has recently reported two new Highly Pathogenic Avian Influenza outbreaks in the states of Katsina and Kano.

Laboratory results from Nigeria and an FAO reference laboratory in Italy show that the newly discovered virus strain is genetically different from the strains that circulated in Nigeria during earlier outbreaks in 2006 and 2007. The new strain has never been reported before in Africa; it is more similar to strains previously identified in Europe (Italy), Asia (Afghanistan) and the Middle East (Iran) in 2007.

“The detection of a new avian influenza virus strain in Africa raises serious concerns as it remains unknown how this strain has been introduced to the continent,” warned Scott Newman, International Wildlife Coordinator of FAO’s Animal Health Service.

“It seems to be unlikely that wild birds have carried the strain to Africa, since the last migration of wild birds from Europe and Central Asia to Africa occurred in September 2007 and this year’s southerly migration into Africa has not really started yet,” Newman said. “It could well be that there are other channels for virus introduction: international trade, for example, or illegal and unreported movement of poultry. This increases the risk of avian influenza spread to other countries in Western Africa.”

Swift reporting

“Uncertainty about virus spread and transmission is a major challenge for control campaigns. Increased surveillance is key to monitor the situation and keep track of virus spread,” said FAO Chief Veterinary Officer Joseph Domenech. “FAO greatly appreciates Nigeria’s swift reporting and sharing of the relevant information about this new virus strain.”

Since the avian influenza epidemic caused by the H5N1 strain started five years ago in Asia, the disease has affected over 60 countries; the vast majority of countries have succeeded to eliminate the virus from poultry. In Nigeria, the virus was first confirmed in February 2006 and infected poultry in 25 states before being contained.

FAO supports affected countries and countries at risk to detect bird flu outbreaks at a very early stage. FAO has also contributed to an efficient global response to HPAI.

In Nigeria, FAO has a team of animal health experts and veterinary epidemiologists working with the government and its veterinary services. FAO has assisted the government with disease surveillance and outbreak investigations, as well as establishing a stockpile of veterinary drugs both at central and state levels. FAO and the Federal Government of Nigeria have identified priority areas where animal health and transboundary animal disease prevention measures need to be improved.

“Many countries have succeeded in getting the virus under control; but as long as avian influenza remains endemic in some countries, the international community needs to be on alert. Both, at risk and affected countries have to keep a high level of surveillance,” Domenech said.

Bird flu alert​

http://www.thejakartapost.com/node/177355

Mon, 08/11/2008 10:33 AM | Headlines

Indonesia has been the worst hit by the bird flu epidemic, with more than 110 people dead. The virus has struck again, with at least 11 people hospitalized in North Sumatra. What's wrong with the government program handling the problem? Send your thoughts by SMS to +62 811 187 2772. Please include your name and city.

Indonesian Denials of H5N1 Cases In Sumatra Raise Concerns​

http://www.recombinomics.com/News/08110801/H5N1_Sumatra_Denial.html

A senior health official says 13 villagers hospitalized with bird flu-like symptoms in western Indonesia have tested negative for the disease.

Nyoman Kandun said the test results came back negative on Saturday and the patients' conditions are improving.

He says dozens of chickens started dying last week from the H5N1 bird flu virus in Air Batu, a village on Sumatra Island, sending panicked residents rushing to a nearby hospital.

The above comments provide an update on the situation in northern Sumatra, but it is not convincing. H5N1 is endemic in poultry in Indonesia, and the fully extent is unclear because Indonesia has not filed an OIE report since 2006. Although their reporting requirement is every six months, since they declared H5N1 endemic, they have not met the six month requirement.

Similarly, they have not released any sequence data on human H5N1 isolates since early 2007, and have only sent samples from a handful of patients who have died in the past 18 months. Their recent announcement that they will limit reports on human cases, and the absence of WHO confirmation of the patients who were confirmed in July, continues to raise concerns due to lack of transparency.

These changes happened while clusters were obvious, even though Indonesia denied their existence. One of the clusters was specifically denied by Kandun, who stated that the brother of an H5N1 fatal case died of dengue fever.

This is of concern, because now media reports are stating that the patients who are being hospitalized with bird flu symptoms are being diagnosed with dengue fever. The association of H5N1 positive poultry, patients with bird flu symptoms, including fatal cases, and a diagnosis of dengue fever, are cause for concern.

Clarification of the situation by the WHO team on the ground in northern Sumatra would be useful.

Dengue Fever Diagnosis In Sumatra Raises Concerns​

http://www.recombinomics.com/News/08110802/H5N1_Sumatra_Dengue.html

August 11, 2008

The concerned atmosphere was mixed with panic covered casualties's family from the Asahan Regency, they expected his two children terjangkit bird flu because by chance their area was found by casualties suspect bird flu. “Melihat our child's fever did not descend-descended we concerned was mixed with panic, we suspected our child of being affected by bird flu because in our area was found by bird flu casualties but after being brought by us to this hospital and results were stated positive DBD not flu burung” clear Zuhaina the mother Fitra and Aiman to the reporter.

the Team of the doctor suspected the patient of being suspected of by bird flu having the initials F (7) was attacked by dengue fever dengue fever or DBD. the Content trombosit in the F body was below normal.

We were not sure the dengue fever attack happened from here (Medan), said public relations of RSUP Adam Malik Medan Sinar Ginting, on Sunday (10/8).

The volunteer furthermore was assigned to monitor 5 to 10 families that suffered the sign of bird flu.

The above translation describes the hospitalization of more patients with bird flu symptoms. These comments suggest multiple members from the same family are being hospitalized, and some reports have piu the number of patients seeking treatment above 70. The above translation indicates some patients being hospitalized in Medan are being diagnosed with dengue fever.

Fatal dengue fever cases are being reported in other cities in the area, which raises additional concerns. In the past, H5N1 patients have been misdiagnosed as dengue fever because symptoms are similar, especially for the more serious dengue hemorrhagic fever. However, the dengue fever diagnosis for a family member of a confirmed H5N1 case raised serious questions about an increased reliance of a dengue fever diagnosis to reduce the number of confirmed H5N1 cases. This diagnosis was of particular concern because it was repeated by the Director General at the Ministry of Health, Nyoman Kandun, who has also indicated the the dramatic increase in hospitalized patients is due to villager concern over the H5N1 poultry. However, H5N1 positive poultry is common in Indonesia, where it has been declared endemic.

Recently, WHO has dispatched a team to North Sumatra in the absence of any confirmed H5N1 cases, raising concerns that the public denials of cases is inconsistent with the situation on the ground. Similarly, Japan agreed to supply an additional 500,000 courses of Tamiflu to southeast Asian countries, raising additional concerns regarding the situation in Indonesia. The earlier shipment of 500,000 courses of Tamiflu was stored in Singapore, which is adjacent to North Sumatra.

More information on the patients with bird flu symptoms and those being diagnosed with dengue fever would be useful.

Flu "the worst threat to Britain"​

http://www.managementinpractice.com...ritain"&page=article.display&article.id=12876

Monday 11th August 2008
Flu virus

Pandemic flu has ranked as the biggest risk to the British public, according to a national threat assessment.

Such an incident would be the most damaging, claiming up to 750,000 lives.

The Cabinet Office's National Risk Register, part of Prime Minister Gordon Brown's overhaul of homeland security strategy, considers the likely dangers posed by threats including terrorism, climate change, extreme weather and pandemic disease.

It said the government has stockpiled enough doses of the antiviral drug oseltamivir, known as Tamiflu, to treat a quarter of the population.

"This should be sufficient to treat all those who fall ill in a pandemic of similar proportions to those that occurred in the 20th century," it said.

"The government is collaborating actively with international partners on prevention, detection and research, and is taking every practical step to ensure that the UK is prepared to limit the internal spread of a pandemic and to minimise health, economic and social harm as far as possible."

But a pandemic is only the fifth most likely type of risk, and is ranked as slightly less likely than a severe weather incident. Another targeted attack on the country's transport network, such as the July 7 incident, ranked as the number one threat.

ProMED Halts Reports Of Suspect H5N1 Cases in Indonesia​

http://www.recombinomics.com/News/08110803/H5N1_Sumatra_ProMED.html

August 11, 2008

Until further notice, ProMED-mail will not report suspected human cases of avian influenza in Indonesia until they have been confirmed by the Indonesian Ministry of Health.

The above statement by ProMED is unfortunate. It is in response to Indonesia's failure to confirm H5N1 in the 13 hospitalized patients in North Sumatra. Indonesia's track record on confirming H5N1 patients has been poor. In addition to having the largest number of confirmed H5N1 cases and confirmed H5N1 deaths, it also has the highest case fatality rate, raising questions about its ability to detect non-fatal cases of H5N1.
'
Although Indonesia has failed to recently confirm H5N1 in patients in North Sumatra, H5N1 has been confirmed in poultry and three patients recently died with H5N1 symptoms. However, these patients were not tested for H5N1, which is still not uncommon in Indonesia.

The number of hospitalized patients continues to rise, and some are being diagnosed with dengue fever. However, Indonesia's record on diagnosing H5N1 patients as dengue fever cases has also raised concerns, especially when the dengue fever diagnosis is confirmed by the Minister of Health even when the sister of the dengue fever patient tested positive for H5N1.

The presence of a WHO team investigating the three fatal cases is unusual, especially since no H5N1 cases in humans has been reported.

ProMED's reliance on confirmation by the Indonesian Ministry of Health is unfortunate. The Ministry of Health has yet to issue a report the lab confirmed cases from July, and they have stated that they will report cases on a delayed basis.

ProMED's aiding and abetting of this diminished transparency in Indonesia, the country with the highest number of confirmed H5N1 cases in the world, should not stand.

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

As of 19 June 2008

http://www.who.int/csr/disease/avian_influenza/country/cases_table_2008_06_19/en/index.html

U.S. Cities Would be Locked Down, Quarantined
Under Pandemic Flu Response Plan ​

http://www.naturalnews.com/023823.html

NaturalNews) The federal government would need to quarantine infected households and ban public gatherings to contain pandemic flu, according to a computer simulation study conducted by researchers from Virginia Tech and published in the Proceedings of the National Academy of Sciences.

"You wouldn't go out to the movies. You wouldn't congregate with people," said researcher Stephen Eubank. "You'd pretty much be staying home with the doors and windows battened down."

The consensus among health experts is that a pandemic, or global epidemic, of influenza is inevitable. The last such pandemic, in 1918, killed between 40 and 100 million people.

Because of the belief that a pandemic cannot be avoided, researchers are instead looking into ways to limit its effects. In the current study, researchers used a computer to model the hypothetical spread of flu pandemic in the city of Chicago under various containment scenarios. They found that a vigorous early response could reduce the infection rate by 80 percent.

"Depending on how fast it is spreading, it seems as though you really need to throw everything you can at it," Eubank said.

Under the containment scenario, people infected with or exposed to the disease would be confined to their homes, and schools and day-care centers would be shut down, as would places of public gathering like bars, restaurants and theaters. Offices and factories would remain open but would operate at reduced capacity due to quarantines.

The extreme measures would need to continue for months, until a vaccine was developed.

"We are not talking about simply shutting things down for a day or two like a snow day," Eubank said. "It's a sustained period for weeks or months."

The computer model assumed widespread compliance with the response plan, but Eubank says he doesn't anticipate that as a problem.

"In the context of a very infectious disease that is killing a large number of the people, I think large fractions of the population won't have a problem with these recommendations," he said.

Bird flu outbreak reported in southern Vietnamese province ​

http://news.xinhuanet.com/english/2008-08/12/content_9203628.htm

HANOI, Aug. 12 (Xinhua) -- Specimens from 570 ducks raised by two households in Vietnam's southern Ben Tre province have been recently tested positive to bird flu virus strain H5N1, according to local newspaper Youth on Tuesday.

The bird flu test has been conducted by Vietnam's 6th Regional Animal Health Center, the newspaper quoted the provincial Veterinary Bureau as reporting. The bureau has disinfected and isolated the affected areas in Ben Tre's Ba Tri district.

The Department of Animal Health under the Vietnamese Ministry of Agriculture and Rural Development has yet to confirm the bird flu outbreak in Ben Tre. Now, only central Quang Ngai province andsouthern Dong Thap and Kien Giang provinces are being hit by the disease, the department said.

Bird flu outbreaks in Vietnam, starting in December 2003, have killed and led to the forced culling of dozens of millions of fowls in the country.

N. Sumatra remains alert against bird flu outbreak​

http://www.thejakartapost.com/node/177445

The North Sumatra Health Office remains on "extraordinary occurrence" (KLB) alert status following the deaths of three people and the hospitalization of 13 others believed to have contracted bird flu.

Office head Chandra Syafei Monday said his office had imposed KLB status because it had so far not received autopsy reports to determine the causes of deaths from the Health Ministry, including results on blood samples and bodily fluid from the patients from Air Batu district in Asahan regency.

Chandra said he personally learned that the patients' blood tests were negative for bird flu from the ministry's website, but remained wary due to the lack of an official report from the ministry.

"So far there has yet to be any report specifying whether the three victims in Asahan were positively or negatively infected with the bird flu virus. If the results are positive, we will have to monitor the area longer," Syafei told The Jakarta Post in Medan on Monday.

Chandra said a number of health workers were still in Asahan to monitor the situation.

"We are on full alert to monitor developments of a bird flu outbreak in Asahan. A team from the World Health Organization is still there to investigate the case," said Chandra.

He added that health officials were focusing on the three fatalities and the 13 current patients showing symptoms consistent with bird flu.

Chandra said so far those involved in the investigation could not determine the causes of death of the three victims and the 13 currently hospitalized.

"The three people died following the discovery of dead poultry, but we don't know whether or not it was the cause," Chandra added.

Chandra said authorities had disposed of 276 infected birds in Asahan and would continue to slay birds believed to be infected with virus.

Nearby Labuhan Ratu regency has killed 1,126 birds after seeing hundreds suddenly die in the past week.

Labuhan Batu Vice Regent Sudarwanto said the virus had affected the poultry population in six subdistricts of North Rantau: Padang Bulan, Cendana, Lobusona, Sirandorung, Ujung Bandar and Padang Matinggi.

Sudarwanto said his office had taken several measures to prevent the spread of the disease, such as disposing of birds, conducting public awareness campaigns and using rapid testing. It has also set up posts in bird flu-prone areas.

"We have so far carried out various anticipatory measures to curb the virus spread, and we urge people to remain alert," Sudarwanto said.

New bird flu threat could be H9N2, researchers say​

http://uk.reuters.com/article/healthNews/idUKN1252379220080813

WASHINGTON (Reuters) - Countries around the world may be preparing for a possible H5N1 bird flu pandemic, but another strain called H9N2 also poses a threat to humanity, researchers reported on Tuesday.

Tests on the H9N2 strain of the virus show it is capable of infecting and spreading with very few changes, a team from the University of Maryland, St. Jude's Children's Research Hospital in Memphis, and elsewhere reported.

"Our results suggest that the establishment and prevalence of H9N2 viruses in poultry pose a significant threat for humans," the researchers wrote in the Public Library of Science journal PLoS ONE.

Most influenza experts agree that a pandemic -- a deadly global epidemic -- of some kind of flu is inevitable.

No one can predict what kind but the chief suspect is the H5N1 bird flu virus, which has infected 385 people and killed 243 of them since 2003. It is entrenched in birds now in some areas and has killed or forced the slaughter of 300 million.

Just a few mutations could turn it into a virus that people catch and transmit easily. But flu experts caution H5N1 is not the only virus with this potential.

H9N2, a virus seen mostly in birds, has infected at least four children in Hong Kong, causing mild illness, and is found in birds, pigs and other animals in Europe and Asia.

Maryland's Daniel Perez and colleagues tinkered with the virus and tested it in ferrets, animals whose biology is very close to humans when it comes to flu.

A single mutation made H9N2 more virulent and pathogenic, and also helped it transmit more easily from one ferret to another, they reported in their study, available on the Internet here

They also mixed H9N2 with an H3N2 virus, a type of influenza virus that causes seasonal flu in people. Scientists believe that if a human or animal is infected with two strains of flu at the same time, this "reassortment" can happen in nature.

The reassorted virus was easier for the ferrets to catch and transmit.

One reassuring finding -- neither of the lab-engineered viruses could be transmitted in the air, via aerosol. This might make them somewhat less transmissible, although people pick up flu from surfaces touched by an infected person.

"Although no aerosol transmission was observed, the virus replicated in multiple respiratory tissues and induced clinical signs similar to those observed with the ... human H3N2 virus," the researchers wrote.

There are hundreds of strains of avian influenza viruses, but only four -- H5N1, H7N3, H7N7, and H9N2 -- are known to have caused human infections, according to the World Health Organization.

State to test dead ducks found in Lowell for avian flu​

http://www.tradingmarkets.com/.site/news/Stock News/1821607/

Aug 12, 2008 (The Sun - McClatchy-Tribune News Service via COMTEX) -- ZZHKU | Quote | Chart | News | PowerRating -- Aug. 12--LOWELL -- The death of more than two dozen ducks along the Riverwalk in downtown Lowell has drawn the attention of the Massachusetts Division of Fisheries and Wildlife, which is hoping to conduct tests on a recently deceased duck.

Lisa Capone, spokesman for the Executive Office of Energy and Environmental Affairs, of which Fisheries and Wildlife is a division, said Lowell Health Director Frank Singleton had notified state authorities, who now want to test a bird to rule out avian influenza as a cause of the deaths.

Though avian flu is typically associated with fears of a potential global health crisis, Capone stressed that the tests are routine when large numbers of birds die.

She said a Lowell National Historical Park ranger's diagnosis that the likely cause of the deaths is avian botulism, which poses no threat to humans, appears to be correct.

"I believe all signs seem to be pointing to avian botulism," Capone said.

Capone said state officials have yet to get a specimen to test, but that they do intend to do so.

She said officials would also check to make sure West Nile Virus is not involved.

Avian botulism is a bacteria than can grow in the water and poison ducks, which then suffer paralysis and drown when they cannot move their necks to keep their heads above water, according to the U.S. Geological Survey.

Singleton has said recent hot weather and heavy rains have likely created a fertile environment for the bacteria by

warming the water and washing nutrients into the river that create an oxygen-free environment in which the bacteria can thrive.

Such outbreaks are natural and occur commonly between July and September across the country.

David Redding, chief ranger at the National Historical Park, recognized what was happening when a witness described the death of a duck, and the symptoms matched those seen three or four years ago when about 30 ducks died from avian botulism.

Neighbors had earlier feared adolescents may have been harming the birds.

Bird flu ID 'must be speeded up'​

http://news.netdoctor.co.uk/news_detail.php?id=18731377

Health officials have been urged to do more to speed up the identification of bird flu cases in humans.

Research conducted in Indonesia has shown the benefit of improved diagnostic methods and improved case management to diagnose patients with H5N1 influenza.

And UK experts are recommending the advice be taken on board now, rather than in 'the teeth of a pandemic'.

H5N1 can be fatal to humans, with Indonesia having one of the highest bird flu mortality rates.

Research published in health journal the Lancet hails the combined effect of antiviral drugs - oseltamivir - and better case management.

Dr Toni Wandra of the Indonesian ministry of health and colleagues analysed the factors associated with bird flu fatality in the south-east Asian country.

Between June 2005 and February 2008, 127 confirmed bird flu infections were recorded.

Investigation teams were deployed to investigate and manage each confirmed case; they obtained epidemiological and clinical data from case-investigation reports when possible and through interviews with patients, family members and key individuals.

The researchers found that 81 per cent of infected patients died, with patients taking an average of six days to be taken to hospital.

On reaching hospital the vast majority had a fever and nine in ten had breathing problems.

However, for the first two days after onset, most patients had non-specific symptoms; only 31 had both fever and cough, and nine had fever and breathing problems.

The average time taken from the beginning of treatment with the antiviral drug oseltamivir was seven days; treatment started within two days for one patient, who survived.

One third of patients receiving treatment within six days survived compared to one fifth for treatment after seven days.

Starting treatment within two days was associated with significantly lower mortality than was starting treatment at days five to six or later.

'Early case identification and treatment with oseltamivir is key to addressing the high case-fatality rate in Indonesian cases. There is a clear need to identify definite causes for high-case fatality,' the authors write.

Professor Sheila Bird from the Medical Research Council and Oxford University professor of tropical medicine Jeremy Farrar said: 'Consideration needs to be given now - not in the teeth of a pandemic, and not deflected by either proprietary defensiveness or opportunistic profiteering - to gauging the comprehensiveness of national surveillance for human H5N1 cases.

'The world also needs to find a more equitable way to ensure that all share in the benefits of such important research. Indonesia could give the lead here.'

Other bird flu virus may cause pandemic ​

http://www.iol.co.za/index.php?set_id=1&click_id=31&art_id=nw20080814090305778C611155

Washington - US scientists on Wednesday raised fears that a different strain of the bird flu virus could mutate to become more easily transmissible among humans and trigger a pandemic.

"Since their introduction into land-based birds in 1988, H9N2 avian influenza A viruses have caused multiple human infections and become endemic in domestic poultry in Eurasia," said the study published in the journal of the Public Library of Science.

"This particular influenza subtype has been evolving and acquiring characteristics that raise concerns that it may become more transmissible among humans."

The team from the University of Maryland studied the transmission of this type of bird flu virus, known as H9N2, among ferrets to see how it spreads.

Examining five types of H9N2 viruses isolated from five types of poultry from 1988 to 2003, they discovered the virus seems not to spread in the air.

Instead an amino acid known as Leu226, found on the surface of the virus, was found to be important to the spread of the disease. They also found that ferrets were more susceptible to H9N2 viruses which had already infected humans.

"Although no aerosol transmission was observed, the virus replicated in multiple respiratory tissues and induced clinical signs similar to those observed with the parental human H3N2 virus," the report said.

"Our results suggest that the establishment and prevalence of H9N2 viruses in poultry pose a significant threat for humans."

The H5N1 strain of bird flu has killed more than 230 people worldwide since late 2003 through contact with infected birds, with about half of the cases in Indonesia.

Health experts fear the strain could mutate into a form easily transmitted from person to person, leading to a pandemic.

Nigeria: Ghana, Togo, Benin Parley over Bird Flu​

http://www.thisdayonline.com/nview.php?id=119659

Ghana's Veterinary Services Directorate, alarmed at the resurgence of avian influenza (bird flu) in Nigeria, is seeking a meeting with its eastern neighbours, Togo and Benin Republic to discuss common measures to prevent it from spreading to their countries.

Dr Enoch Koney, Acting Director, said a similar cross border meeting had been planned with Cote d'Ivoire to the west and Burkina Faso to the north.
Nigeria is sited to the east of Ghana. Ghana declared itself free from the disease about two years ago after culling and other measures.

Speaking on Tuesday in Kumasi at a day's simulation exercise on avian influenza, he said all regional directors of agriculture as well as veterinary officers had been informed about the new case in Nigeria.

Koney said this was to strengthen surveillance in all avian influenza risk-prone areas and asked them not to be complacent in their prevention and control measures.

He urged them to have a constant check at all live bird markets and monitor the staging posts of migratory wild birds at wetlands while they strictly enforced import permits for poultry and poultry products.

The UN Food and Agriculture Organisation (FAO) has warned that a new strain of avian influenza never before reported in Africa has been identified in Nigeria.

It said tests conducted by Nigeria and by the FAO showed that the new virus strain which was similar to strains identified last year in Italy, Afghanistan and Iran was genetically distinct from other forms detected in Nigeria in 2006 and 2007.

It pointed to other avenues the virus could have taken to Nigeria, such as international trade or illegal and unreported movement of poultry. "This increases the risk of an avian influenza spread to other countries in Western Africa,"

Real-time bird flu detector developed​

http://www.hospitalhealthcare.com/d...veloped&page=article.display&article.id=12966

A machine which can identify different types of bird flu and is portable enough to be used anywhere in a hospital is being developed by British scientists.

The team at Nottingham Trent University say the machine will be able to identify different types of bird flu - including the potentially fatal H5N1 strain - within two hours. This is much quicker than the current tests and would significantly help hospital managers to identify and isolate a potential outbreak.

The technology works by recognising molecules from a swab of human saliva or animal tissue, before identifying if it is infected with bird flu and if so which strain is present.

The university says the technology will mean officials can set up exclusion zones and cull infected birds far quicker.

Dr Alan McNally, a former avian flu researcher for the Government who is working on the project, said: "The key thing about this is that the process will be fully automated so there is no requirement for a skilled person to use the technology.

"At present, tests have to be sent to a lab where you need fully trained personnel and that's where the hold-up occurs."

He added: "There's a large train of thought that one of the best ways of dealing with avian influenza is by detection and containment."

The £2.3 million project, known as Portfastflu, is being funded by the European Union.

More than 80 pct of Indonesia bird flu cases die​

http://www.reuters.com/article/americasCrisis/idUSN13258075

WASHINGTON, Aug 13 (Reuters) - Late diagnosis and treatment means that more than 80 percent of people infected with H5N1 avian influenza in Indonesia have died, researchers reported on Wednesday.

An analysis of outbreaks in Indonesia, the country hardest hit by bird flu, affirms that quick treatment with antiviral drugs can save lives. But local health care workers are not properly trained in diagnosing bird flu and often do not have the needed drugs to treat it.

Indonesia has had one-third of the world's known cases of human infection with H5N1 avian influenza. It rarely infects people but globally has killed 243 out of 385 sickened since 2003. In Indonesia, 135 people have been infected and 110 have died, according to the World Health Organization.

Dr. Toni Wandra of the Ministry of Health in Jakarta and colleagues analyzed the known cases as of February and found it took on average six days for patients to be admitted to a hospital.

By the time they were admitted, 99 percent had a fever, 88 percent were coughing and 84 percent had breathing problems, they reported in the Lancet medical journal.

But for the first two days they were ill, most patients had hard-to-identify symptoms -- only 31 had both fever and cough, and nine had fever and breathing problems.

On average it took seven days to get oseltamivir -- Roche AG (ROG.VX: Quote, Profile, Research, Stock Buzz) and Gilead Sciences Inc's (GILD.O: Quote, Profile, Research, Stock Buzz) Tamiflu.

More than a third of patients who got Tamiflu within six days survived, compared to 19 percent treated at seven days or later survived.

This confirms other research that shows treatment with flu drugs such as Tamiflu needs to start right away to be effective, they said.

"There is a clear need to identify definite causes for high-case fatality," Wandra's team wrote.

"Poultry surveillance is being stepped up, and active human case finding by local health centers and village officials is being instituted in areas of poultry deaths."

Workers need to be trained in getting information about whether patients with flu-like symptoms were around sick poultry, they added.

"Finally, all health-care workers should be trained in case management of early H5N1 influenza, and should be equipped with oseltamivir to enable timely administration."

H5N1 currently infects mostly birds and has killed or forced the destruction of 300 million in Asia, Europe, the Middle East and Africa.

It rarely infects humans and almost all cases have been infected by sick birds. Doctors fear it could change into a form that easily infects people, in which case it could sweep the world, killing millions of people in months.

Tamiflu and GlaxoSmithKline's (GSK.L: Quote, Profile, Research, Stock Buzz) and Biota's (BTA.AX: Quote, Profile, Research, Stock Buzz) Relenza can treat the infection, but are in short supply, and a vaccine would take months or years to manufacture and deliver. (Reporting by Maggie Fox, editing by Will Dunham)

Uvs Lake H5N1 Migration Into Nigeria​

http://www.recombinomics.com/News/08140801/H5N1_Nigeria_Uvs.html

Tests conducted at the laboratory confirmed that the virus from Gombe closely resembles the virus isolated from wild birds in Central Europe (Romania and the Czech Republic ) in 2007.

The above comments clarify the clade 2.2.3 H5N1 recently reported for Nigeria. The FAO press release compared the recent isolates to the sequences from 2006/2007 clade 2.2.3 isolates from Italy, Afghanistan, and Iran. Since these earlier isolates were all clade 2.2.3 it seemed likely that the isolates would be the Uvs Lake strain which flew into Kuwait in early 2007 and spread throughout central Europe (Czech Republic, Germany, and France) in the summer of 2007, followed by more locations in Europe and the Middle East in late 2007 / early 2008. The above mentioned isolates in the Czech Republic represent Uvs Lake isolates in the summer, while Romania represents Uvs Lake in the fall.

Thus, the spread of Uvs Lake to eastern Africa was not unexpected, and the comparison top 2006 sequences is curious. The FAO press release once again tried to link the outbreak to trade and ignore the fact that the sequences were commonly found in wild birds. The sequences were first identified in a massive wild bird outbreak in the summer of 2006 and involved wild birds at Uvs Lake, the largest lake in Mongolia, as well as wild birds in Tyve, Siberia, which is just north of the lake.

The press release was yet another example of FAO’s denial of the role of wild birds in the transport and transmission of H5N1 clade 2.2 into more than 50 countries west of China, include those in south Asia, Europe, the Middle East, and Africa. All isolates reported to date are clade 2.2 including the 2.2.3 sub-clade in Nigeria. The Uvs Lake strain is within the 2.2.3 sub-clade, and is readily distinguished by the isolates in the FAO press release. The curious use of these earlier isolates in the FAO press release is yet another example of the FAO’s state of denial, since the clade 2.2,3 identified in Nigeria is firmly linked to outbreaks tied to wild birds in Asia and Europe.

In the FAO press release, the lack of association with the upcoming migration is the same argument that was used when there was an outbreak in Europe in the summer of 2007, when there was little long range migration. However, the H5N1 in wild birds in the Czech Republic, Germany, and France indicated the surveillance had missed the earlier arrival of clade 2.2.3, which was repeated in Africa this year.

The clade 2.2.3 in Nigeria was recently detected, but the earlier arrival was missed because of poor surveillance, which is far less robust in Nigeria than western Europe, which also failed to detected the Uvs Lake strain prior to the outbreak in wild birds a year ago.

Alarms sounding over bird flu in wake of Olympics
By ALYSSA NOEL, SUN MEDIA
Thu, August 14, 2008

Medical officials will be extra vigilant monitoring patients for symptoms of the bird flu in the weeks following the Beijing Olympics.

Although the predicted pandemic has waned from public consciousness in recent years, Dr. Louis Francescutti warns the threat is still real.

“We know the flu originates in the far east, so if there is a strain that’s implicated with any pandemic the likelihood of people who are visiting increases the odds of something happening,” Francescutti, a University of Alberta professor and emergency room doctor, said.

“There are people who are far smarter than I who haven’t raised alarm bells. There are others who have said we’ve got to do some monitoring.”

Health officials around the world sounded the alarm when the flu first spread around several Asian countries in 2004. Media coverage exploded shortly after, warning the public to be prepared for an outbreak that could kill an upwards of 50,000 Canadians. But years later, with no immediate danger in sight, both the media and public have lost interest, Francescutti said. However, he added, people need to be prepared for any type of emergency that could arise.

“Right now being in tornado and (storm) season, you’re more likely to have to deal with that disaster or emergency than a pandemic. The preparation is the same for one or the other,” he said.

Everyone should have enough water, cash, food and other necessities for their family to last at least three days, he recommended. [Wow, 3 days, that will get it done...]

Francescutti’s warning comes after up to 100 dead and disoriented ducks were discovered at The Forks, a popular Winnipeg downtown destination where the Assinboine and Red Rivers meet.

Conservation officials there have linked the deaths to avian botulism, which isn’t a threat to humans, but the sight of bird carcasses has been unsettling for many residents.

According to Environment Canada, type C botulism toxin originates in bird or animal carcasses. It’s usually transferred to birds when they eat maggots or other invertebrates that feed on the decaying carcasses. Poisoning causes progressive paralysis.

http://www.edmontonsun.com/News/Edmonton/2008/08/14/6454186.html

Link to next weeks thread:

HEALTH 8/16/08- 8/23/08 Weekly Bird Flu Thread:H9N2 bird flu threat understated in humans

http://www.timebomb2000.com/vb/showthread.php?p=2964082#post2964082