[AI] Avian Flu Daily Thread 03.08.05
- Thread starter LMonty911
- Start date
http://www.canada.com/saskatoon/starphoenix/news/story.html?id=5d70053f-2003-415f-a55d-8a9dcd4d5cb8
Bird flu pandemic feared
Officials study possible case of human-to-human transmission
Sharon Kirkey and Mark KennedyCanWest News Service
March 8, 2005
OTTAWA -- The first possible human-to-human transmission of bird flu between two unrelated people has raised the spectre the lethal virus could be changing to become more easily spread between humans, a Canadian influenza expert warns.
A 26-year-old male nurse from northern Vietnam who provided bedside care for a 21-year-old bird flu patient now in critical condition has himself tested positive for H5N1 avian influenza, according to media reports from the region.
It was not clear Monday whether the nurse, who carried the patient on a stretcher, caught the virus from the patient or from previous exposure to infected chickens or ducks.
The man reportedly visited his girlfriend, who lives in a village hit by bird flu, in mid-February. While there, they shared several meals, during which he may have been infected. However, the incubation period for H5N1 is believed to last no more than 10 to 14 days -- meaning he probably would have shown symptoms much earlier if infected by poultry.
A spokesperson for the World Health Organization (WHO) said in an interview Monday that the international agency is watching the case closely to determine if it has the potential to spawn a global influenza pandemic.
In a phone interview from the WHO headquarters in Geneva, Dick Thompson said experts have now begun work in Vietnam to confirm that the nurse has the H5N1 strain. As well, Thompson said a comprehensive analysis is being conducted to see if anyone else in the hospital where the nurse worked has had the flu.
Thompson said health officials would clearly be more concerned if it is determined the nurse was infected from another human -- as opposed to from a bird. For months, public health officials have warned of the danger of H5N1 emerging among health-care workers, particularly if it leads to a "cluster" of cases that would then be difficult to control.
There have been at least two probable cases of human-to-human transmission so far in southeast Asia, but both involved members of the same family who likely shared similar genes that could make them susceptible to the killer virus.
If the nurse contracted the virus from his patient, it would be the first known case involving a patient infecting a hospital worker. The case could be a "one-off" event, cautioned University of Ottawa virologist Earl Brown.
"It's unusual for people to get infected (with H5N1) -- period," he said. And it's even more unusual to see humans spreading it to others, he added.
According to the WHO, there have been at least 59 confirmed human cases of avian influenza since the virus began its sweep across southeast Asia in December 2003: 41 in Vietnam, 17 in Thailand and one in Cambodia, resulting in at least 42 deaths. "It seems like all the people who have been infected, and died, had been . . . involved with chickens -- killing and dressing them, and perhaps touching feces that have billions of virus per gram," Brown said. This latest incident, he added, is "a situation we haven't seen before. I always pay attention when doctors and nurses start getting sick."
Brown said it's possible the nurse contracted the virus while doctors were inserting a breathing tube or performing some other invasive procedure that would have exposed him to mucous secretions from the infected lungs.
Bird flu pandemic feared
Officials study possible case of human-to-human transmission
Sharon Kirkey and Mark KennedyCanWest News Service
March 8, 2005
OTTAWA -- The first possible human-to-human transmission of bird flu between two unrelated people has raised the spectre the lethal virus could be changing to become more easily spread between humans, a Canadian influenza expert warns.
A 26-year-old male nurse from northern Vietnam who provided bedside care for a 21-year-old bird flu patient now in critical condition has himself tested positive for H5N1 avian influenza, according to media reports from the region.
It was not clear Monday whether the nurse, who carried the patient on a stretcher, caught the virus from the patient or from previous exposure to infected chickens or ducks.
The man reportedly visited his girlfriend, who lives in a village hit by bird flu, in mid-February. While there, they shared several meals, during which he may have been infected. However, the incubation period for H5N1 is believed to last no more than 10 to 14 days -- meaning he probably would have shown symptoms much earlier if infected by poultry.
A spokesperson for the World Health Organization (WHO) said in an interview Monday that the international agency is watching the case closely to determine if it has the potential to spawn a global influenza pandemic.
In a phone interview from the WHO headquarters in Geneva, Dick Thompson said experts have now begun work in Vietnam to confirm that the nurse has the H5N1 strain. As well, Thompson said a comprehensive analysis is being conducted to see if anyone else in the hospital where the nurse worked has had the flu.
Thompson said health officials would clearly be more concerned if it is determined the nurse was infected from another human -- as opposed to from a bird. For months, public health officials have warned of the danger of H5N1 emerging among health-care workers, particularly if it leads to a "cluster" of cases that would then be difficult to control.
There have been at least two probable cases of human-to-human transmission so far in southeast Asia, but both involved members of the same family who likely shared similar genes that could make them susceptible to the killer virus.
If the nurse contracted the virus from his patient, it would be the first known case involving a patient infecting a hospital worker. The case could be a "one-off" event, cautioned University of Ottawa virologist Earl Brown.
"It's unusual for people to get infected (with H5N1) -- period," he said. And it's even more unusual to see humans spreading it to others, he added.
According to the WHO, there have been at least 59 confirmed human cases of avian influenza since the virus began its sweep across southeast Asia in December 2003: 41 in Vietnam, 17 in Thailand and one in Cambodia, resulting in at least 42 deaths. "It seems like all the people who have been infected, and died, had been . . . involved with chickens -- killing and dressing them, and perhaps touching feces that have billions of virus per gram," Brown said. This latest incident, he added, is "a situation we haven't seen before. I always pay attention when doctors and nurses start getting sick."
Brown said it's possible the nurse contracted the virus while doctors were inserting a breathing tube or performing some other invasive procedure that would have exposed him to mucous secretions from the infected lungs.
What's up Doc? New flu may be spread by bird
By Dr. Jeff Hersh / Daily News Correspondent
Tuesday, March 8, 2005
This week I will conclude my discussion on the "bird flu." Last week I reviewed some general concepts about the influenza virus and discussed how the flu spreads around the world. Although influenza typically starts in birds and then mutates in an intermediate host - such as pigs - before becoming the influenza virus that makes us get sick, direct spread from birds to humans is possible. In the past, direct transmission of influenza from birds directly to humans has been uncommon, but a new strain of influenza A virus may be changing this unwritten rule. There are two major concerns regarding an outbreak of what the press is calling the bird flu. If this new strain of influenza can be easily spread from infected birds directly to humans it may become more widespread and spread faster than the flu usually does. This would minimize the response time we have to vaccinate our population. Our food supply is more commonly being produced in distant places and shipped worldwide. A large outbreak of influenza in chickens from Asia could easily spread from chicken to chicken, causing widespread infections in poultry throughout the world. This infection in poultry would then act as a new reservoir of infection, threatening to spread the disease to our human population. We have seen how hard it is to contain infections that spread from food animal to food animal (and then to humans) in the "mad cow" infections that we keep hearing about. Since any bird may be infected, and of course most birds fly, this infection might spread through the bird population quickly. Those who have followed the spread of West Nile virus through our country may know that what started as several infections in New York several years ago has spread to reported infections in essentially every state in the continental United States. Clearly, birds carrying an infection really does "give it wings" to spread. With the West Nile virus, the mosquito acts as the vector that brings the infection from birds to humans, and this would not be the case with the bird flu. However, flying birds may spread the virus from poultry farm to poultry farm, and some contact with birds other than poultry directly to humans does occur. The second major worry is about how virulent the bird flu strain of virus may be. The pandemic of flu in 1918 that I discussed last week was a very nasty strain of flu. It was highly infectious Á more than a quarter of all Americans were infected Á and it was a very bad infection, eventually killing almost 700,000 Americans. As population density has increased, in the United States and worldwide, human-to-human transmission of infection occurs more easily. The increased population also makes more potential victims of disease. The latest report I could find from the World Health Organization (early February 2005) noted that there have so far been 55 confirmed human cases of what is being called Avian Influenza A/(H5N1), with 42 deaths. It is likely that there have been many more cases of this flu, many of them much milder so they did not come to the attention of health officials. As is often the case when a new disease is identified, the worst cases come to light and cause the investigation. I hope that this disease does not actually kill 42 of every 55 (over 75 percent) people who get it. To prepare for this potential problem our public health officials have already been working hard on a vaccine to prevent people from becoming infected with this new strain of flu. Tests of this vaccine are just about under way. The government is also stockpiling the antibiotic that helps people infected with influenza. There is nothing people here in our country can or should do about this potential threat now, except to support our government's efforts (and worldwide efforts) to prepare for a possible outbreak. Those involved in the poultry farming industry should already be working with government officials to help prevent the spread of this disease in our poultry animals. I gave a lecture this past summer at a scientific conference in New York City titled "The World is Getting Smaller: The Increased Spread of Infectious Diseases" which discussed many of the reasons we seem to be seeing more infectious diseases in our country. We are able to identify infectious diseases better than ever (from improved scientific methods including DNA/RNA testing) and are more vigilant in looking for the spread of infectious diseases (more so with the terrorism concerns that now plague us). The more rapid global mobilization of the world's population due to increased air travel, as well as increased international commerce (especially of food supplies and animals, but also including exotic pets) have contributed to the worldwide spread of infectious diseases. Monkey pox and West Nile virus are just a couple of examples most of us have heard about in recent years. This new concern over bird flu is just another example of this trend. Jeff Hersh, Ph.D., M.D., F.A.A.P., F.A.C.P., F.A.A.E.P., can be reached at DrHersh@juno.com.
http://www.dailynewstribune.com/health/view.bg?articleid=51902&format=text
By Dr. Jeff Hersh / Daily News Correspondent
Tuesday, March 8, 2005
This week I will conclude my discussion on the "bird flu." Last week I reviewed some general concepts about the influenza virus and discussed how the flu spreads around the world. Although influenza typically starts in birds and then mutates in an intermediate host - such as pigs - before becoming the influenza virus that makes us get sick, direct spread from birds to humans is possible. In the past, direct transmission of influenza from birds directly to humans has been uncommon, but a new strain of influenza A virus may be changing this unwritten rule. There are two major concerns regarding an outbreak of what the press is calling the bird flu. If this new strain of influenza can be easily spread from infected birds directly to humans it may become more widespread and spread faster than the flu usually does. This would minimize the response time we have to vaccinate our population. Our food supply is more commonly being produced in distant places and shipped worldwide. A large outbreak of influenza in chickens from Asia could easily spread from chicken to chicken, causing widespread infections in poultry throughout the world. This infection in poultry would then act as a new reservoir of infection, threatening to spread the disease to our human population. We have seen how hard it is to contain infections that spread from food animal to food animal (and then to humans) in the "mad cow" infections that we keep hearing about. Since any bird may be infected, and of course most birds fly, this infection might spread through the bird population quickly. Those who have followed the spread of West Nile virus through our country may know that what started as several infections in New York several years ago has spread to reported infections in essentially every state in the continental United States. Clearly, birds carrying an infection really does "give it wings" to spread. With the West Nile virus, the mosquito acts as the vector that brings the infection from birds to humans, and this would not be the case with the bird flu. However, flying birds may spread the virus from poultry farm to poultry farm, and some contact with birds other than poultry directly to humans does occur. The second major worry is about how virulent the bird flu strain of virus may be. The pandemic of flu in 1918 that I discussed last week was a very nasty strain of flu. It was highly infectious Á more than a quarter of all Americans were infected Á and it was a very bad infection, eventually killing almost 700,000 Americans. As population density has increased, in the United States and worldwide, human-to-human transmission of infection occurs more easily. The increased population also makes more potential victims of disease. The latest report I could find from the World Health Organization (early February 2005) noted that there have so far been 55 confirmed human cases of what is being called Avian Influenza A/(H5N1), with 42 deaths. It is likely that there have been many more cases of this flu, many of them much milder so they did not come to the attention of health officials. As is often the case when a new disease is identified, the worst cases come to light and cause the investigation. I hope that this disease does not actually kill 42 of every 55 (over 75 percent) people who get it. To prepare for this potential problem our public health officials have already been working hard on a vaccine to prevent people from becoming infected with this new strain of flu. Tests of this vaccine are just about under way. The government is also stockpiling the antibiotic that helps people infected with influenza. There is nothing people here in our country can or should do about this potential threat now, except to support our government's efforts (and worldwide efforts) to prepare for a possible outbreak. Those involved in the poultry farming industry should already be working with government officials to help prevent the spread of this disease in our poultry animals. I gave a lecture this past summer at a scientific conference in New York City titled "The World is Getting Smaller: The Increased Spread of Infectious Diseases" which discussed many of the reasons we seem to be seeing more infectious diseases in our country. We are able to identify infectious diseases better than ever (from improved scientific methods including DNA/RNA testing) and are more vigilant in looking for the spread of infectious diseases (more so with the terrorism concerns that now plague us). The more rapid global mobilization of the world's population due to increased air travel, as well as increased international commerce (especially of food supplies and animals, but also including exotic pets) have contributed to the worldwide spread of infectious diseases. Monkey pox and West Nile virus are just a couple of examples most of us have heard about in recent years. This new concern over bird flu is just another example of this trend. Jeff Hersh, Ph.D., M.D., F.A.A.P., F.A.C.P., F.A.A.E.P., can be reached at DrHersh@juno.com.
http://www.dailynewstribune.com/health/view.bg?articleid=51902&format=text
World braces for virulent killer flu outbreak
By Jillian Green & Dominique Herman
Johannesburg: Scientists and doctors the world over are bracing themselves for a possible flu outbreak which could kill millions. Dr Andrew Jamieson, Director of the Netcare Travel Clinic, estimates that an outbreak could spread around the world within a month.
"This is the theoretical risk, but there are warning signs this outbreak could occur," Jamieson said.
The National Institute for Communicable Diseases was planning a meeting to discuss pandemic preparedness because preliminary plans "are not great", said institute medical scientist Terry Besselaar.
"We're in a very difficult situation," she said. "There is no flu vaccine manufacturer in South Africa and, unlike Britain, we are not stockpiling anti-viral drugs or formulating emergency measures.
Besselaar spent five months at the World Health Organisation in Geneva last year and avian flu was among the issues discussed.
"H5N1, the avian flu strain, appears to be becoming more virulent with time, which is scary," she said.
An unexpected finding she learned of was that ducks in China that appeared healthy were excreting the virus in their faeces.
At a conference in Vietnam last month, Western Pacific regional leader of the WHO Shigeru Omi said ducks were thought to be the reservoir of the virus.
"The public health implications of this are very serious," he said.
If the avian flu mutated to a strain that was easily transmitted between humans, it could spread very rapidly.
"We have two big problems if the pandemic comes to South Africa," Jamieson said. "We have a large immune-suppressed population and limited resources to fight it."
Published on the web by Mercury on March 8, 2005.
--------------------------------------------------------------------------------
© Mercury 2005. All rights reserved.
By Jillian Green & Dominique Herman
Johannesburg: Scientists and doctors the world over are bracing themselves for a possible flu outbreak which could kill millions. Dr Andrew Jamieson, Director of the Netcare Travel Clinic, estimates that an outbreak could spread around the world within a month.
"This is the theoretical risk, but there are warning signs this outbreak could occur," Jamieson said.
The National Institute for Communicable Diseases was planning a meeting to discuss pandemic preparedness because preliminary plans "are not great", said institute medical scientist Terry Besselaar.
"We're in a very difficult situation," she said. "There is no flu vaccine manufacturer in South Africa and, unlike Britain, we are not stockpiling anti-viral drugs or formulating emergency measures.
Besselaar spent five months at the World Health Organisation in Geneva last year and avian flu was among the issues discussed.
"H5N1, the avian flu strain, appears to be becoming more virulent with time, which is scary," she said.
An unexpected finding she learned of was that ducks in China that appeared healthy were excreting the virus in their faeces.
At a conference in Vietnam last month, Western Pacific regional leader of the WHO Shigeru Omi said ducks were thought to be the reservoir of the virus.
"The public health implications of this are very serious," he said.
If the avian flu mutated to a strain that was easily transmitted between humans, it could spread very rapidly.
"We have two big problems if the pandemic comes to South Africa," Jamieson said. "We have a large immune-suppressed population and limited resources to fight it."
Published on the web by Mercury on March 8, 2005.
--------------------------------------------------------------------------------
© Mercury 2005. All rights reserved.
this one is one of the first to point out -even if its not clearly-just how a pandemic of this bug might overwhelm the healthcare system. These folks dont have answers-yet. This type of article clearly supports CSues visions of what a pandemic in her country may look like
Worrisome to me- Dr. Preddy states one answer is to mount a mass vaccination campaign-but another article I recently read states Canada may not even try to stockpile flu vaccine...
clearly, theres much confusion at this point even at high levels- and i'd bet the same dynamic is happening all over the world. Canadas recent brush with SARS probalby brought home to them just how difficult a modern pandemic with high mortality rate can be to manage-and at least they seem to be trying some preplanning. I havent heard of muhc liek this going on in the US just yet- and AFAIK it hasnt filtered down to the local level- most of the docs at work seem totally unaware that this is going on- or the details, andhow far along this has gotten. I'd bet that is also being repeated everywhere...
medfolks-anyone seeing any awareness or planning at your local level?
Flu pandemic plans dominate meeting of Canadian city officials
Last Updated Mon, 07 Mar 2005 23:02:52 EST
CBC News
EDMONTON - Representatives from Canada's 16 largest cities meeting in Edmonton on Monday raised some disturbing questions as they discussed what to do when the next flu pandemic hits.
Doctors may have to ration their service during a flu pandemic.
At a breakfast session, doctors and emergency planners imagined a world where millions are dying during a flu pandemic, and discussed how to cope with the extra drain on overcrowded hospitals.
"What worries me most is, in fact, the ignorance of people in the public, who assume that if they get sick there'll be something there for them," said Iris Evans, Alberta's minister of health. "They don't realize the total devastation this could be if they're not taking care of their health today."
After the First World War, as many as 40 million people died in the Spanish flu pandemic. The virus killed 50,000 Canadians, leaving few communities untouched.
Despite advances in medicine, doctors expect as many or perhaps more could die in the next pandemic, triggered by a change in the flu virus that leaves everyone vulnerable.
To limit the spread of the virus, school might be temporarily suspended, said Richard Lessard, medical officer of health for Montreal. "We might even restrain transport," he added.
Medicines, vaccines and even access to doctors will have to be rationed, officials agreed.
"How do you cope when you have 30 per cent of your staff off sick and you have to deal with more sick people?" asked Dr. Gerry Predy, Edmonton's medical officer of health. "You have to mount a mass vaccination campaign."
Conference delegates are keeping an eye on Asia, where the next pandemic is expected to begin.
Avian flu has already killed more than 40 people in Asia. Scientists fear the virus will begin to spread easily from person to person.
There is a scientific debate about whether the H5N1 type of avian flu is truly a pandemic-in-waiting. Canada's Public Health Agency is not convinced, and neither is former Ontario medical officer of health, Dr. Richard Schabas.
"Our science just isn't strong enough for us to know that and it's not strong enough for us to be making these kinds of alarmist predictions that we're hearing from the WHO and others," said Schabas at Toronto's York Central Hospital.
Virologist Dr. Todd Hatchette of Halifax's QEII Health Sciences Centre disagrees. "The virus has gained the ability to infect a large number of hosts," he said. "There's some evidence that it's refining its genes, if you will. I'll suggest that it's pretty good evidence that this will probably be the next one."
Several delegates on the front line of Canada's response admitted they lie awake at night, worrying what a pandemic will mean for the country. They're hoping to leave the meeting on Tuesday knowing what to do.
Copyright ©2005 Canadian Broadcasting Corporation - All Rights Reserved
http://www.cbc.ca/story/science/national/2005/03/07/flu-pandemic050307.html?print
Worrisome to me- Dr. Preddy states one answer is to mount a mass vaccination campaign-but another article I recently read states Canada may not even try to stockpile flu vaccine...
clearly, theres much confusion at this point even at high levels- and i'd bet the same dynamic is happening all over the world. Canadas recent brush with SARS probalby brought home to them just how difficult a modern pandemic with high mortality rate can be to manage-and at least they seem to be trying some preplanning. I havent heard of muhc liek this going on in the US just yet- and AFAIK it hasnt filtered down to the local level- most of the docs at work seem totally unaware that this is going on- or the details, andhow far along this has gotten. I'd bet that is also being repeated everywhere...
medfolks-anyone seeing any awareness or planning at your local level?
Flu pandemic plans dominate meeting of Canadian city officials
Last Updated Mon, 07 Mar 2005 23:02:52 EST
CBC News
EDMONTON - Representatives from Canada's 16 largest cities meeting in Edmonton on Monday raised some disturbing questions as they discussed what to do when the next flu pandemic hits.
Doctors may have to ration their service during a flu pandemic.
At a breakfast session, doctors and emergency planners imagined a world where millions are dying during a flu pandemic, and discussed how to cope with the extra drain on overcrowded hospitals.
"What worries me most is, in fact, the ignorance of people in the public, who assume that if they get sick there'll be something there for them," said Iris Evans, Alberta's minister of health. "They don't realize the total devastation this could be if they're not taking care of their health today."
After the First World War, as many as 40 million people died in the Spanish flu pandemic. The virus killed 50,000 Canadians, leaving few communities untouched.
Despite advances in medicine, doctors expect as many or perhaps more could die in the next pandemic, triggered by a change in the flu virus that leaves everyone vulnerable.
To limit the spread of the virus, school might be temporarily suspended, said Richard Lessard, medical officer of health for Montreal. "We might even restrain transport," he added.
Medicines, vaccines and even access to doctors will have to be rationed, officials agreed.
"How do you cope when you have 30 per cent of your staff off sick and you have to deal with more sick people?" asked Dr. Gerry Predy, Edmonton's medical officer of health. "You have to mount a mass vaccination campaign."
Conference delegates are keeping an eye on Asia, where the next pandemic is expected to begin.
Avian flu has already killed more than 40 people in Asia. Scientists fear the virus will begin to spread easily from person to person.
There is a scientific debate about whether the H5N1 type of avian flu is truly a pandemic-in-waiting. Canada's Public Health Agency is not convinced, and neither is former Ontario medical officer of health, Dr. Richard Schabas.
"Our science just isn't strong enough for us to know that and it's not strong enough for us to be making these kinds of alarmist predictions that we're hearing from the WHO and others," said Schabas at Toronto's York Central Hospital.
Virologist Dr. Todd Hatchette of Halifax's QEII Health Sciences Centre disagrees. "The virus has gained the ability to infect a large number of hosts," he said. "There's some evidence that it's refining its genes, if you will. I'll suggest that it's pretty good evidence that this will probably be the next one."
Several delegates on the front line of Canada's response admitted they lie awake at night, worrying what a pandemic will mean for the country. They're hoping to leave the meeting on Tuesday knowing what to do.
Copyright ©2005 Canadian Broadcasting Corporation - All Rights Reserved
http://www.cbc.ca/story/science/national/2005/03/07/flu-pandemic050307.html?print
Laura
I watched the news report last night that the article you posted expanded on - nice to put names to faces & sometimes visuals are telling...
I saw Iris Evans making that statement about Canadians expecting help to be there. This was NOT a happy, confident, assured Cabinet Minister. This was the face of a lady beginning to hoist aboard some very unpleasant realities.
What I found especially interesting was how the report is beginning to hint at the obvious consequences - rationed health care, shortage of staff, an expectation of help that can't be met, suspension of schools... etc. To be honest it would be all that & more in my opinion. Maybe we all need to hear this in the media - over & over again until we GET IT. Pandemic is anything but buisness as usual or a short lived, low impact blip on our economic/social/etc. horizons.
***Several delegates on the front line of Canada's response admitted they lie awake at night, worrying what a pandemic will mean for the country. They're hoping to leave the meeting on Tuesday knowing what to do.***
That is the most worrying statement of all. What DO you do? In the face of this there are no easy answers. No matter what choices are made, a gut load of pain will walk hand in hand with pandemic. What will politicians decide? Will they give health care a clear mandate & SUPPORT for what will have to happen? I don't think they will until this is literally knocking on their doors. I think pandemic makes its own rules & we all end up 'putting out fires' & trying to deal as best we can.
Now I would dearly locw for our emergency organizations to come out & be blunt & tell people they MUST be prepared to cope as best they can within the confines of their own households, their own social structures. My city isn't ready & no doubt there's at least theoretical planning going on but I've yet to find anything. Man, I'd love to sit on a focus group or ten that discusses this.
I watched the news report last night that the article you posted expanded on - nice to put names to faces & sometimes visuals are telling...
I saw Iris Evans making that statement about Canadians expecting help to be there. This was NOT a happy, confident, assured Cabinet Minister. This was the face of a lady beginning to hoist aboard some very unpleasant realities.
What I found especially interesting was how the report is beginning to hint at the obvious consequences - rationed health care, shortage of staff, an expectation of help that can't be met, suspension of schools... etc. To be honest it would be all that & more in my opinion. Maybe we all need to hear this in the media - over & over again until we GET IT. Pandemic is anything but buisness as usual or a short lived, low impact blip on our economic/social/etc. horizons.
***Several delegates on the front line of Canada's response admitted they lie awake at night, worrying what a pandemic will mean for the country. They're hoping to leave the meeting on Tuesday knowing what to do.***
That is the most worrying statement of all. What DO you do? In the face of this there are no easy answers. No matter what choices are made, a gut load of pain will walk hand in hand with pandemic. What will politicians decide? Will they give health care a clear mandate & SUPPORT for what will have to happen? I don't think they will until this is literally knocking on their doors. I think pandemic makes its own rules & we all end up 'putting out fires' & trying to deal as best we can.
Now I would dearly locw for our emergency organizations to come out & be blunt & tell people they MUST be prepared to cope as best they can within the confines of their own households, their own social structures. My city isn't ready & no doubt there's at least theoretical planning going on but I've yet to find anything. Man, I'd love to sit on a focus group or ten that discusses this.
ainitfunny
Saved, to glorify God.
What could help go a long way towards minimizing the impact of Bird Flu on human populations is reversing the recent social attitudes that deny the filth and disease harbored and transmitted by wild animals, in this case wild ducks and geese.
Misguided and misinformed "animal advocates" have promoted the public policy departure from standards of public hygiene expected and practiced even fifty years ago. We are now compelled by law to submit to cohabiting in HUMAN HABITAT not only with poorly enforced pet control but with vermin, pests, wild animals and birds and all their excreta, disease, nusiance and physical threat.
We have departed so far from normal human ~ wild animal relationships that wild animals no longer fear humans and instead of selecting wild or uninhabited areas
in which to dwell and forage they have taken up residence among us, even in our cities. We, who used to enjoy clean waters and parks and laugh at third worlders who rode the bus with chickens or lived with and endured their "holy cows" pooping all over their city streets now ourselves and our children wade through "holy" goose poop covering our city parks and now swim in parasite infested lakes thanks to a super abundance of ducks and geese permitted to over-load them. "Protected" wild animals and vermin of every sort, from pigeons, and seals so numerous they are called "harbor or rock rats", and deer so numerous they too imperil human life daily, to squirrels , skunks, oppossum, raccoons, rats, snakes, pet pigs,rabbits, hamsters and every other kind of domestic and imported creature that we must now share our human living areas with.
We have come to elevate animals of every sort and description to an inviolable reverence and holiness AT THE SAME TIME WE HAVE COME TO EVEN OFFICIALLY REGARD AND TREAT MANKIND (FROM THE WOMB TO THE AGED AND EVEN THE DEAD) WITH LESS HONOR, RESPECT, DEFERENCE, AND RIGHTS THAN CIVILIZED SOCIETY HAD PROGRESSED TO LONG, LONG BEFORE NOW. Our leaders play word games to enable them to officially reinstate the long ago condemned practice of torturing men. This, at the same time our "Humane shelters" deny dogs to "cruel" people who admit that the dog will sleep outside in a dog house or barn. We wring our hands and weep at the death of a family of wolves destroyed yet, we have come to "ho-hum" accept without even questioning or remorse at the death of an entire family of innocent HUMANS, because they are "fair game" in the free fire war zones we create in other nations. We have come to treat with more regard, compassion, empathy and legal protection an American pet or wild animal, than we accord to HUMAN BEINGS in third world nations. Even our vocabulary has become contemptible- describing the death of innocent people as "collateral damage". Like sex for sex sake, forget the babies, we forbid men to catch fish for food and promote the practice of simply molesting fish for "fun" in our "hook and release" laws. We even consider it "noble" to speak up for, defend and protect a TREE, yet regard a disabled HUMAN with contempt and advocate executing such "vegetables". Our standards are DEVOLVING and our morals are becoming contemptible, not far from becoming an anathema rather than a role model.
Such radical deviance from the ways that God gave us brings with it it's own NATURAL CONSEQUENCES, from which God, by counseling us against such things, hoped to spare us. We defied Him to assert our "right" to premarital sex, against His counsel. We reaped pandemic sexually transmitted disease, unwanted illegitimate children, and unprescedented divorce rates. We denigrated and ignored the Honor, importance, effort required and significance with which God described due motherhood and only succeeded in misguiding and depriving both our mothers and our children of the BEST life they could have had. We defied His counsel to cherish our children in order to assert our right to kill them and continue fornicating for the sake of fornication. We soon reaped a society of old people who had killed off the children God had given them to prosper them and take care of them. We defied God's counsel NOT to mix animals and we shall see how many plagues and diseases we have now enabled to jump from one species to another and to man, who now boasts he has even crossed himself with lower animals. We propose to welcome wild animals to share our human communities without the work and husbandry the farmer that responsibly cares for animals must exert. The examples are endless and these evil fruits are maturing. HARVEST TIME APPROACHES AND MAN HAS SOWN SOME VERY EVIL SEEDS. IT WILL INDEED BE A "GRIM" REAPER WHO MUST REAP WHAT WE HAVE SOWN. May God forgive and help us awaken.
Misguided and misinformed "animal advocates" have promoted the public policy departure from standards of public hygiene expected and practiced even fifty years ago. We are now compelled by law to submit to cohabiting in HUMAN HABITAT not only with poorly enforced pet control but with vermin, pests, wild animals and birds and all their excreta, disease, nusiance and physical threat.
We have departed so far from normal human ~ wild animal relationships that wild animals no longer fear humans and instead of selecting wild or uninhabited areas
in which to dwell and forage they have taken up residence among us, even in our cities. We, who used to enjoy clean waters and parks and laugh at third worlders who rode the bus with chickens or lived with and endured their "holy cows" pooping all over their city streets now ourselves and our children wade through "holy" goose poop covering our city parks and now swim in parasite infested lakes thanks to a super abundance of ducks and geese permitted to over-load them. "Protected" wild animals and vermin of every sort, from pigeons, and seals so numerous they are called "harbor or rock rats", and deer so numerous they too imperil human life daily, to squirrels , skunks, oppossum, raccoons, rats, snakes, pet pigs,rabbits, hamsters and every other kind of domestic and imported creature that we must now share our human living areas with.
We have come to elevate animals of every sort and description to an inviolable reverence and holiness AT THE SAME TIME WE HAVE COME TO EVEN OFFICIALLY REGARD AND TREAT MANKIND (FROM THE WOMB TO THE AGED AND EVEN THE DEAD) WITH LESS HONOR, RESPECT, DEFERENCE, AND RIGHTS THAN CIVILIZED SOCIETY HAD PROGRESSED TO LONG, LONG BEFORE NOW. Our leaders play word games to enable them to officially reinstate the long ago condemned practice of torturing men. This, at the same time our "Humane shelters" deny dogs to "cruel" people who admit that the dog will sleep outside in a dog house or barn. We wring our hands and weep at the death of a family of wolves destroyed yet, we have come to "ho-hum" accept without even questioning or remorse at the death of an entire family of innocent HUMANS, because they are "fair game" in the free fire war zones we create in other nations. We have come to treat with more regard, compassion, empathy and legal protection an American pet or wild animal, than we accord to HUMAN BEINGS in third world nations. Even our vocabulary has become contemptible- describing the death of innocent people as "collateral damage". Like sex for sex sake, forget the babies, we forbid men to catch fish for food and promote the practice of simply molesting fish for "fun" in our "hook and release" laws. We even consider it "noble" to speak up for, defend and protect a TREE, yet regard a disabled HUMAN with contempt and advocate executing such "vegetables". Our standards are DEVOLVING and our morals are becoming contemptible, not far from becoming an anathema rather than a role model.
Such radical deviance from the ways that God gave us brings with it it's own NATURAL CONSEQUENCES, from which God, by counseling us against such things, hoped to spare us. We defied Him to assert our "right" to premarital sex, against His counsel. We reaped pandemic sexually transmitted disease, unwanted illegitimate children, and unprescedented divorce rates. We denigrated and ignored the Honor, importance, effort required and significance with which God described due motherhood and only succeeded in misguiding and depriving both our mothers and our children of the BEST life they could have had. We defied His counsel to cherish our children in order to assert our right to kill them and continue fornicating for the sake of fornication. We soon reaped a society of old people who had killed off the children God had given them to prosper them and take care of them. We defied God's counsel NOT to mix animals and we shall see how many plagues and diseases we have now enabled to jump from one species to another and to man, who now boasts he has even crossed himself with lower animals. We propose to welcome wild animals to share our human communities without the work and husbandry the farmer that responsibly cares for animals must exert. The examples are endless and these evil fruits are maturing. HARVEST TIME APPROACHES AND MAN HAS SOWN SOME VERY EVIL SEEDS. IT WILL INDEED BE A "GRIM" REAPER WHO MUST REAP WHAT WE HAVE SOWN. May God forgive and help us awaken.
Last edited:
Sue-
thanks for the reply. Probably the most perceptive statement Ive seen so far is your comment:
I think pandemic makes its own rules & we all end up 'putting out fires' & trying to deal as best we can.
if this happens, and I believe its most likely down to "when and how bad" not "if"; thats going to be the crux of it.
If it evolves to a form similar to the 1918 bug, that ability to respond to a changing scenario on a personal, family, community, national AND worldwide level will determine much of the outcome. IMHO thats the importance of awareness, education and preparedness...trying to forsee the threats, appropriate responses and actions to mitigate the result.
I hope we dodge the bullet, or it turns out to be a blank. But I'd darn sure like to be prepared in case it isnt.
Back when I was managing OccMed and Emp Health in another HC system, I could make a difference. Here, I'm just staff, and new staff at that...should be interesting. How do I help with awareness and preparation? I'm keeping my eyes open for facilites that post any pandemic plans for a hospital, I'd like to start collecting that info. We may need it to start our own. If anyone sees posted links to HC system plans, please share.
But whatever comes, we may need to rely on folks ability to adapt to rapidly changing situation, that "putting out fires" to help us get through this. Thats why I think its so important to have hard info to help us make decisions from an informed standpoint. Thanks so much for your "Pandemic in My City" series, its helped me think thru what what we may need to consider in advance to mitigate the situation....keeping me more mentally flexible and aware-for me and mine, that may make all the difference.
thanks for the reply. Probably the most perceptive statement Ive seen so far is your comment:
I think pandemic makes its own rules & we all end up 'putting out fires' & trying to deal as best we can.
if this happens, and I believe its most likely down to "when and how bad" not "if"; thats going to be the crux of it.
If it evolves to a form similar to the 1918 bug, that ability to respond to a changing scenario on a personal, family, community, national AND worldwide level will determine much of the outcome. IMHO thats the importance of awareness, education and preparedness...trying to forsee the threats, appropriate responses and actions to mitigate the result.
I hope we dodge the bullet, or it turns out to be a blank. But I'd darn sure like to be prepared in case it isnt.
Back when I was managing OccMed and Emp Health in another HC system, I could make a difference. Here, I'm just staff, and new staff at that...should be interesting. How do I help with awareness and preparation? I'm keeping my eyes open for facilites that post any pandemic plans for a hospital, I'd like to start collecting that info. We may need it to start our own. If anyone sees posted links to HC system plans, please share.
But whatever comes, we may need to rely on folks ability to adapt to rapidly changing situation, that "putting out fires" to help us get through this. Thats why I think its so important to have hard info to help us make decisions from an informed standpoint. Thanks so much for your "Pandemic in My City" series, its helped me think thru what what we may need to consider in advance to mitigate the situation....keeping me more mentally flexible and aware-for me and mine, that may make all the difference.
http://www.thestandard.com.hk
http://www.thestandard.com.hk/stdn/std/others/print.htm=0 cellPadding=0 width=752 align=center border=0>
$254m plan in case bird flu returns
March 9, 2005
The threat of a global flu pandemic has prompted Hong Kong to propose sharply increasing its stockpile of an antiviral drug at a cost of HK$254 million.
The Health, Welfare and Food Bureau wants to boost stocks of Tamiflu from 3.7 million capsules to more than 20 million, in line with World Health Organization (WHO) recommendations, a bureau spokesman said.
Tamiflu is, so far, the only effective drug that can fight the H5N1 bird flu virus.
It has shown some success in protecting against catching the disease, and treating sufferers if caught early enough.
It has been used on bird flu patients in Hong Kong, Thailand and Vietnam.
However, scientists claim that the H5N1 strain is changing rapidly and is becoming resistant to the drug.
Bird flu has killed scores of people in Vietnam and Thailand in the past year, and the WHO has warned of a pandemic which it estimates would kill about 50 million people across the globe.
The WHO fears the H5N1 strain of bird flu will mix with a human virus and trigger a deadly flu pandemic among humans.
According to the WHO, stockpiling of drugs in advance is the only way to ensure sufficient supplies at the start of a pandemic.
The spokesman said it is essential Hong Kong is prepared for a possible pandemic.
``While WHO has repeatedly emphasized the important role of maintaining an antiviral stockpile against pandemic influenza, our target is to ensure adequate supply of antiviral while minimizing wastage as antiviral drugs have a shelf life of three to four years,'' he said.
Hong Kong's Centre for Health Protection recommended a stockpile of at least 20 million capsules of Tamiflu after consulting with scientists in reaction to the recent outbreaks in Vietnam and Thailand.
The bureau is planning to have the new antiviral stocks delivered in phases over the next six to 12 months.
Given that a vaccine is unlikely to be available for the early months of a pandemic, antiviral agents will be one of the only available treatment regimes in the initial stages.
They can be given to workers involved in any mass culling of live poultry to help protect them from catching the disease.
The government will consult with the Legislative Council's health services panel Monday on the Tamiflu plan and will seek the Finance Committee's approval.
Reuters reported last week that Britain is planning to buy stocks of Tamiflu - 7.3 million capsules by next April - to protect against a possible pandemic.
http://www.thestandard.com.hk/stdn/std/others/print.htm=0 cellPadding=0 width=752 align=center border=0>
$254m plan in case bird flu returns
March 9, 2005
The threat of a global flu pandemic has prompted Hong Kong to propose sharply increasing its stockpile of an antiviral drug at a cost of HK$254 million.
The Health, Welfare and Food Bureau wants to boost stocks of Tamiflu from 3.7 million capsules to more than 20 million, in line with World Health Organization (WHO) recommendations, a bureau spokesman said.
Tamiflu is, so far, the only effective drug that can fight the H5N1 bird flu virus.
It has shown some success in protecting against catching the disease, and treating sufferers if caught early enough.
It has been used on bird flu patients in Hong Kong, Thailand and Vietnam.
However, scientists claim that the H5N1 strain is changing rapidly and is becoming resistant to the drug.
Bird flu has killed scores of people in Vietnam and Thailand in the past year, and the WHO has warned of a pandemic which it estimates would kill about 50 million people across the globe.
The WHO fears the H5N1 strain of bird flu will mix with a human virus and trigger a deadly flu pandemic among humans.
According to the WHO, stockpiling of drugs in advance is the only way to ensure sufficient supplies at the start of a pandemic.
The spokesman said it is essential Hong Kong is prepared for a possible pandemic.
``While WHO has repeatedly emphasized the important role of maintaining an antiviral stockpile against pandemic influenza, our target is to ensure adequate supply of antiviral while minimizing wastage as antiviral drugs have a shelf life of three to four years,'' he said.
Hong Kong's Centre for Health Protection recommended a stockpile of at least 20 million capsules of Tamiflu after consulting with scientists in reaction to the recent outbreaks in Vietnam and Thailand.
The bureau is planning to have the new antiviral stocks delivered in phases over the next six to 12 months.
Given that a vaccine is unlikely to be available for the early months of a pandemic, antiviral agents will be one of the only available treatment regimes in the initial stages.
They can be given to workers involved in any mass culling of live poultry to help protect them from catching the disease.
The government will consult with the Legislative Council's health services panel Monday on the Tamiflu plan and will seek the Finance Committee's approval.
Reuters reported last week that Britain is planning to buy stocks of Tamiflu - 7.3 million capsules by next April - to protect against a possible pandemic.
this is the Promed message referenced in Dr Nimans post below:
AVIAN INFLUENZA, HUMAN - EAST ASIA (42): VIET NAM
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
[1]
Date: Mon 7 Mar 2005
From: ayrman <ayrman@pcsia.net>
Source: Agence France Presse report via a correspondent in Viet Nam [edited]
<http://www.news.com.au/story/0,10117,12467629-23109,00.html>
Viet Nam: nurse contracts avian influenza
---------------------------------------------
A 26-year-old Vietnamese man, who worked as a nurse in a hospital with
avian influenza patients in northern Viet Nam, had contracted the deadly
virus, a doctor said today [Mon 7 Mar 2005]. It is still unclear whether
the man contracted the virus from a patient or through contact with sick
poultry, the doctor said. Further investigations would be carried out.
"He is the nurse who took care of a patient confirmed positive for H5N1
virus," a doctor from Hanoi's Institute of Tropical disease told Agence
France Presse. The patient, 21, from northern Thai Binh province, has been
in critical condition for the past 10 days.
--
ayrman
<ayrman@pcsia.net>
******
[2]
Date: Mon 7 Mar 2005
From: A-Lan Banks <A-Lan.Banks@thomson.com>
Source: Reuters News, Mon 7 Mar 2005 [edited]
<http://www.reuters.com/newsArticle.jhtml?type=worldNews&storyID=7821864>
Viet Nam: male nurse contracts avian influenza
-----------------------------------------------
A 26-year-old Vietnamese male nurse, who tended a patient with avian
influenza, has caught the virus that has killed 47 people in Asia, a health
official said on Monday 7 Mar 2005. But it was not yet clear whether the
nurse caught the virus from the patient or by other means, said Tran Khac
Vien, head of a district health care center in the northern province of
Thai Binh, 70 miles southeast of Hanoi. "He looked after and had contact
with an H5N1 patient," Vien told Reuters. "We have been informed that he
was infected by bird flu, but there might be other reasons that could cause
the infection. We have not made any conclusion yet," he said.
Vien said the nurse was in a Hanoi hospital with a high fever, a symptom of
the H5N1 strain that infected his patient, a 21-year-old man from Thai Binh
who caught the virus after drinking raw duck blood last month [February
2005]. The nurse had provided bed care to the man, whose 14-year-old sister
was also infected after coming into contact with sick poultry.
In January [2005], another man in Thai Binh was killed by bird flu after
drinking duck blood, and his 2 brothers had also been infected, but later
recovered. The Thai Binh siblings have raised public concerns about the
possibility of human-to-human transmission of the virus that 1st erupted in
Asia in late 2003, believed to have been brought by migrating birds.
Health Minister Tran Thi Trung Chien said last week [1st week of March
2005], prior to the nurse's case, that all avian influenza cases in Thai
Binh were related to slaughtering or eating poultry. There was no evidence
of human-to-human transmission of the virus, which has killed 13 Vietnamese
since the latest outbreaks in December 2004.
Vietnamese researchers said last week [1st week of March 2005] that initial
tests of a H5N1 vaccine on monkeys were successful, raising hopes in a
country hit hard by the virus that a vaccine may be ready for human tests
later this year. Experts fear that if the versatile and resilient virus
mutates into a form that could easily jump between humans, it would kill
millions in a global pandemic. Almost all the Asian victims -- 34
Vietnamese, 12 Thais and a Cambodian -- have caught it from infected
poultry. Bird flu has killed more than 70 percent of those known to have
been infected, but doctors say victims can be saved if they are diagnosed
early.
--
ProMED-mail
<promed@promedmail.org>
[From the ages of the patients described in the 2 reports, their only
identification, it is probable that the male nurse is a previously
described case whose occupation is now being considered as a relevant
factor in his case history. This is verified by the most recent WHO update
(below) - Mod.CP]
******
[3]
Date: Mon 7 Mar 2005
From: Marianne Hopp <mjhopp12@yahoo.com>
Source: World Health Organization (WHO), CSR, Disease Outbreak News, Mon 7
Mar 2005 [edited]
<http://www.who.int/csr/don/2005_03_07/en/>
Avian influenza - situation in Viet Nam: WHO Update 10
-----------------------------------------------
The Ministry of Health in Viet Nam has confirmed an additional 4 cases of
human infection with H5N1 avian influenza.
Details about these 4 cases are as follows:
A 21-year-old man from Thai Binh Province. He developed symptoms on 14 Feb
2005 and was admitted to the hospital on 20 Feb 2005.
His 14-year-old sister, also from Thai Binh Province. She developed
symptoms on 21 Feb 2005 and was hospitalized the following day.
A 69-year-old man, also from Thai Binh Province. He developed symptoms on
19 Feb 2005, was admitted to the hospital the same day, and died on 23 Feb
2005.
A 35-year-old woman from Hanoi. She developed symptoms on 18 Feb 2005 and
was hospitalized on 24 Feb 2005.
WHO continues to work closely with the Vietnamese Ministry of Health to
further investigate additional cases which may have occurred since 2 Feb
2005. WHO will update its cumulative list of confirmed cases accordingly.
Earlier this year [2005], staff from WHO, Japan's National Institute of
Infectious Diseases in Tokyo, and Centers for Disease Control and
Prevention, Atlanta, Georgia, USA, began working with health authorities in
Viet Nam to improve the sensitivity and reliability of laboratory
diagnostic tests. This activity, which aimed to upgrade laboratory capacity
and included a training component, involved the re-testing in Tokyo of
specimens from several persons initially classified in Viet Nam in January
2005 as negative for H5N1 infection. Re-testing detected H5N1 in specimens
from 7 persons. WHO is awaiting further details about these cases,
including outcomes. Upon receipt of this information, WHO will also include
these cases in the cumulative total for Viet Nam.
One additional case in Viet Nam, dating back to February 2004, has been
identified retrospectively from specimens stored as part of a study of
encephalitis (see the New England Journal of Medicine, 2005, 352:686-691).
H5N1 infection, which was not considered in the diagnosis of this fatal
case, was identified in November 2004, when specimens were submitted to a
battery of tests. Specimens collected from other patients in this study are
now being systematically tested for possible H5N1 infection.
Information on new cases is of greatest concern, and WHO continues to
gather as much data as possible on each new case. Such data are urgently
needed at a time when many countries are intensifying their pandemic
preparedness activities.
AVIAN INFLUENZA, HUMAN - EAST ASIA (42): VIET NAM
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
[1]
Date: Mon 7 Mar 2005
From: ayrman <ayrman@pcsia.net>
Source: Agence France Presse report via a correspondent in Viet Nam [edited]
<http://www.news.com.au/story/0,10117,12467629-23109,00.html>
Viet Nam: nurse contracts avian influenza
---------------------------------------------
A 26-year-old Vietnamese man, who worked as a nurse in a hospital with
avian influenza patients in northern Viet Nam, had contracted the deadly
virus, a doctor said today [Mon 7 Mar 2005]. It is still unclear whether
the man contracted the virus from a patient or through contact with sick
poultry, the doctor said. Further investigations would be carried out.
"He is the nurse who took care of a patient confirmed positive for H5N1
virus," a doctor from Hanoi's Institute of Tropical disease told Agence
France Presse. The patient, 21, from northern Thai Binh province, has been
in critical condition for the past 10 days.
--
ayrman
<ayrman@pcsia.net>
******
[2]
Date: Mon 7 Mar 2005
From: A-Lan Banks <A-Lan.Banks@thomson.com>
Source: Reuters News, Mon 7 Mar 2005 [edited]
<http://www.reuters.com/newsArticle.jhtml?type=worldNews&storyID=7821864>
Viet Nam: male nurse contracts avian influenza
-----------------------------------------------
A 26-year-old Vietnamese male nurse, who tended a patient with avian
influenza, has caught the virus that has killed 47 people in Asia, a health
official said on Monday 7 Mar 2005. But it was not yet clear whether the
nurse caught the virus from the patient or by other means, said Tran Khac
Vien, head of a district health care center in the northern province of
Thai Binh, 70 miles southeast of Hanoi. "He looked after and had contact
with an H5N1 patient," Vien told Reuters. "We have been informed that he
was infected by bird flu, but there might be other reasons that could cause
the infection. We have not made any conclusion yet," he said.
Vien said the nurse was in a Hanoi hospital with a high fever, a symptom of
the H5N1 strain that infected his patient, a 21-year-old man from Thai Binh
who caught the virus after drinking raw duck blood last month [February
2005]. The nurse had provided bed care to the man, whose 14-year-old sister
was also infected after coming into contact with sick poultry.
In January [2005], another man in Thai Binh was killed by bird flu after
drinking duck blood, and his 2 brothers had also been infected, but later
recovered. The Thai Binh siblings have raised public concerns about the
possibility of human-to-human transmission of the virus that 1st erupted in
Asia in late 2003, believed to have been brought by migrating birds.
Health Minister Tran Thi Trung Chien said last week [1st week of March
2005], prior to the nurse's case, that all avian influenza cases in Thai
Binh were related to slaughtering or eating poultry. There was no evidence
of human-to-human transmission of the virus, which has killed 13 Vietnamese
since the latest outbreaks in December 2004.
Vietnamese researchers said last week [1st week of March 2005] that initial
tests of a H5N1 vaccine on monkeys were successful, raising hopes in a
country hit hard by the virus that a vaccine may be ready for human tests
later this year. Experts fear that if the versatile and resilient virus
mutates into a form that could easily jump between humans, it would kill
millions in a global pandemic. Almost all the Asian victims -- 34
Vietnamese, 12 Thais and a Cambodian -- have caught it from infected
poultry. Bird flu has killed more than 70 percent of those known to have
been infected, but doctors say victims can be saved if they are diagnosed
early.
--
ProMED-mail
<promed@promedmail.org>
[From the ages of the patients described in the 2 reports, their only
identification, it is probable that the male nurse is a previously
described case whose occupation is now being considered as a relevant
factor in his case history. This is verified by the most recent WHO update
(below) - Mod.CP]
******
[3]
Date: Mon 7 Mar 2005
From: Marianne Hopp <mjhopp12@yahoo.com>
Source: World Health Organization (WHO), CSR, Disease Outbreak News, Mon 7
Mar 2005 [edited]
<http://www.who.int/csr/don/2005_03_07/en/>
Avian influenza - situation in Viet Nam: WHO Update 10
-----------------------------------------------
The Ministry of Health in Viet Nam has confirmed an additional 4 cases of
human infection with H5N1 avian influenza.
Details about these 4 cases are as follows:
A 21-year-old man from Thai Binh Province. He developed symptoms on 14 Feb
2005 and was admitted to the hospital on 20 Feb 2005.
His 14-year-old sister, also from Thai Binh Province. She developed
symptoms on 21 Feb 2005 and was hospitalized the following day.
A 69-year-old man, also from Thai Binh Province. He developed symptoms on
19 Feb 2005, was admitted to the hospital the same day, and died on 23 Feb
2005.
A 35-year-old woman from Hanoi. She developed symptoms on 18 Feb 2005 and
was hospitalized on 24 Feb 2005.
WHO continues to work closely with the Vietnamese Ministry of Health to
further investigate additional cases which may have occurred since 2 Feb
2005. WHO will update its cumulative list of confirmed cases accordingly.
Earlier this year [2005], staff from WHO, Japan's National Institute of
Infectious Diseases in Tokyo, and Centers for Disease Control and
Prevention, Atlanta, Georgia, USA, began working with health authorities in
Viet Nam to improve the sensitivity and reliability of laboratory
diagnostic tests. This activity, which aimed to upgrade laboratory capacity
and included a training component, involved the re-testing in Tokyo of
specimens from several persons initially classified in Viet Nam in January
2005 as negative for H5N1 infection. Re-testing detected H5N1 in specimens
from 7 persons. WHO is awaiting further details about these cases,
including outcomes. Upon receipt of this information, WHO will also include
these cases in the cumulative total for Viet Nam.
One additional case in Viet Nam, dating back to February 2004, has been
identified retrospectively from specimens stored as part of a study of
encephalitis (see the New England Journal of Medicine, 2005, 352:686-691).
H5N1 infection, which was not considered in the diagnosis of this fatal
case, was identified in November 2004, when specimens were submitted to a
battery of tests. Specimens collected from other patients in this study are
now being systematically tested for possible H5N1 infection.
Information on new cases is of greatest concern, and WHO continues to
gather as much data as possible on each new case. Such data are urgently
needed at a time when many countries are intensifying their pandemic
preparedness activities.
Dr Niman is a virologist-he's the guy that in the early 80's developed the tests we use everyday to identify flu. Cutting edge virology. This man is well worth listening to, IMHO-I give a great deal of weight to his comments that are regulary posted on Recombinomics...
Thai Binh Bird Flu Patients Details
Recombinomics Commentary
March 8, 2005
>> [From the ages of the patients described in the 2 reports, their only
identification, it is probable that the male nurse is a previously
described case whose occupation is now being considered as a relevant
factor in his case history. This is verified by the most recent WHO update
(below) - Mod.CP] <<
Although there are major transparency and testing problems in southeast Asia with regard to bird flu, the details on identities in the Thai Binh cases has been well publicized in media reports.
Although the given name of all of the disclosed Thai Binh cases has been Nguyen, there has not been an overlap on the patient's age or other two names. It is unclear why ProMed considers the 26 year old male nurse, Nguyen Dinh Dan, to be a previous case. The other recent cases from Thai Binh are 36M Nguyen Thanh Chung, 69M Nguyen Khac Teo, as well as the two siblings, 21M Nguyen Sy Tuan and 14F Nguyen Thi Ngoan.
The recent WHO update discussed one of the cases in the New England Journal of Medicine, which was a case that did not present as a respiratory case, and was not initially tested for H5N1. This case was from February 2004, while the nurse is from February 2005. The 2004 case is yet another example of an initial failure to detect H5N1 in a positive patient. Like many of the other 10 bimodal clusters, the index case was not tested as is yet another example of a case that was clearly positive for H5N1, but was not included in the official H5N1 in the past, and will not be added in the WHO update.
The familial clusters represent over one third of the reported H5N1 cases. Although the index case died in all familial clusters, and each cluster includes at least one laboratory confirmed H5N1 family member, many of the cases are excluded because they were never testing.
The lack of testing, combined with false negatives, seriously underestimates the H5N1 cases in Vietnam and Thailand. Similarly, laboratory confirmed cases in Thailand from last year are not included in WHO tallies. The WHO has failed to test meningococcemia cases in the Philippines as well as other patients who have symptoms of dengue fever. Dengue fever was the incorrect diagnosis of the index case in Thailand described as the best example of human-to-human transmission of H5N1. Most of the hemorrhagic dengue fever cases in southeast Asia have also not been tested for H5N1.
The true spread of H5N1 inside and outside of Vietnam and Thailand is largely unknown.
Thai Binh Bird Flu Patients Details
Recombinomics Commentary
March 8, 2005
>> [From the ages of the patients described in the 2 reports, their only
identification, it is probable that the male nurse is a previously
described case whose occupation is now being considered as a relevant
factor in his case history. This is verified by the most recent WHO update
(below) - Mod.CP] <<
Although there are major transparency and testing problems in southeast Asia with regard to bird flu, the details on identities in the Thai Binh cases has been well publicized in media reports.
Although the given name of all of the disclosed Thai Binh cases has been Nguyen, there has not been an overlap on the patient's age or other two names. It is unclear why ProMed considers the 26 year old male nurse, Nguyen Dinh Dan, to be a previous case. The other recent cases from Thai Binh are 36M Nguyen Thanh Chung, 69M Nguyen Khac Teo, as well as the two siblings, 21M Nguyen Sy Tuan and 14F Nguyen Thi Ngoan.
The recent WHO update discussed one of the cases in the New England Journal of Medicine, which was a case that did not present as a respiratory case, and was not initially tested for H5N1. This case was from February 2004, while the nurse is from February 2005. The 2004 case is yet another example of an initial failure to detect H5N1 in a positive patient. Like many of the other 10 bimodal clusters, the index case was not tested as is yet another example of a case that was clearly positive for H5N1, but was not included in the official H5N1 in the past, and will not be added in the WHO update.
The familial clusters represent over one third of the reported H5N1 cases. Although the index case died in all familial clusters, and each cluster includes at least one laboratory confirmed H5N1 family member, many of the cases are excluded because they were never testing.
The lack of testing, combined with false negatives, seriously underestimates the H5N1 cases in Vietnam and Thailand. Similarly, laboratory confirmed cases in Thailand from last year are not included in WHO tallies. The WHO has failed to test meningococcemia cases in the Philippines as well as other patients who have symptoms of dengue fever. Dengue fever was the incorrect diagnosis of the index case in Thailand described as the best example of human-to-human transmission of H5N1. Most of the hemorrhagic dengue fever cases in southeast Asia have also not been tested for H5N1.
The true spread of H5N1 inside and outside of Vietnam and Thailand is largely unknown.
Tamiflu stockpiles are of limited usefulness if influenza becomes crisis, say experts
http://www.newstarget.com/005386.html
Biological and genetic experts warn against over reliance on the existence of stockpiles of antiviral medications such as Tamiflu in the event of a global influenza pandemic, citing the drugs' relative ineffectiveness against some bird flu strains and limited production levels. Even if fully effective, Tamiflu requires a pill to be taken every day, meaning that stockpiles will rapidly dwindle even if limited to only the most critical health care workers.
- Staff writers
News summary:
Source: http://www.recombinomics.com/News/02230505/Antiviral_Myth.html
London Mayor Ken Livingstone announced that £1 million has already been spent on anti-viral drugs to protect up to 100,000 workers in the capital.
The deal for the drug Tamiflu, produced by Roche, aims to secure London's vital services and economy in the event of a pandemic.
Although there has been considerable discussion about governments stockpiling antivirals for use to help control a flu pandemic and keep vital services and health care functional, some analysis of the availability and efficacy is useful.
H5N1 has become endemic to the region, which has accounted for all of the reported human cases for the past year.
The virus has been expanding its host range and tissue tropism.
Two of the drugs, amantadine and rimantadine are ion channel blockers that target the M2 gene product.
However, the H5N1 isolates from Vietnam and Thailand have two mutations in the M2 proteins that make H5N1 resistant to both drugs.
Similarly, WSN/33 and the two H1N1 isolates from swine have a mutation in the gene also that makes the virus resistant.
For the latest H5N1 patients in southern Vietnam, there were no reported discharges, so all died regardless of when they started taking Tamiflu.
Tamiflu targets NA, but is more effective against some subtypes than others.
Tamiflu was used in vivo in an effort to save tigers at a Thailand zoo.
The production rate for Tamiflu has been at about 1.5 million doses per year.
Production is being increased to 4 million doses, so if 3 million doses were available, that would be enough antiviral to protect 100,000 people for a month.
These announcements are much higher than the projected production of Tamiflu, which would protect 100-133,000 people for a month.
http://www.newstarget.com/005386.html
Biological and genetic experts warn against over reliance on the existence of stockpiles of antiviral medications such as Tamiflu in the event of a global influenza pandemic, citing the drugs' relative ineffectiveness against some bird flu strains and limited production levels. Even if fully effective, Tamiflu requires a pill to be taken every day, meaning that stockpiles will rapidly dwindle even if limited to only the most critical health care workers.
- Staff writers
News summary:
Source: http://www.recombinomics.com/News/02230505/Antiviral_Myth.html
London Mayor Ken Livingstone announced that £1 million has already been spent on anti-viral drugs to protect up to 100,000 workers in the capital.
The deal for the drug Tamiflu, produced by Roche, aims to secure London's vital services and economy in the event of a pandemic.
Although there has been considerable discussion about governments stockpiling antivirals for use to help control a flu pandemic and keep vital services and health care functional, some analysis of the availability and efficacy is useful.
H5N1 has become endemic to the region, which has accounted for all of the reported human cases for the past year.
The virus has been expanding its host range and tissue tropism.
Two of the drugs, amantadine and rimantadine are ion channel blockers that target the M2 gene product.
However, the H5N1 isolates from Vietnam and Thailand have two mutations in the M2 proteins that make H5N1 resistant to both drugs.
Similarly, WSN/33 and the two H1N1 isolates from swine have a mutation in the gene also that makes the virus resistant.
For the latest H5N1 patients in southern Vietnam, there were no reported discharges, so all died regardless of when they started taking Tamiflu.
Tamiflu targets NA, but is more effective against some subtypes than others.
Tamiflu was used in vivo in an effort to save tigers at a Thailand zoo.
The production rate for Tamiflu has been at about 1.5 million doses per year.
Production is being increased to 4 million doses, so if 3 million doses were available, that would be enough antiviral to protect 100,000 people for a month.
These announcements are much higher than the projected production of Tamiflu, which would protect 100-133,000 people for a month.
Next story
AVIAN FLUVACCINE TRIALS ON HUMANS
Government decision lauded
APIRADEE TREERUTKUARKUL
A leading academic was upbeat yesterday after the government decided to accept a US proposal to conduct bird flu vaccine trials on humans in Thailand.
Tawee Chotepittayasunont, an avian influenza expert and paediatrician at the Queen Sirikit National Institute of Child Health, yesterday said he fully supported the government's collaboration with the United States National Institute of Health.
``We have to conduct vaccine trials in Thailand as soon as possible. Otherwise, we won't have any protection if and when a flu pandemic happens,'' he said at an annual medical conference at Rajavithi Hospital.
Dr Tawee said it was essential for the government to begin preparing for vaccine production and stockpiling it. It was the only means to protect people from bird flu and an influenza pandemic as well as to curb mutations of the virus, he said.
No human vaccine against bird flu has so far been produced for public use despite warnings of a deadly flu pandemic which could stem from the virulent H5N1 strain of avian influenza.
An index case of probable human-to-human transmission between an 11-year-old girl, Sakuntala Prempasee, and her mother, Pranee Thongchan, which occurred in the northern Thai province of Kamphaeng Phet last year, along with several human cases of bird flu infection in Vietnam and Cambodia, have forced the government's hand in terms of proceeding with the testing of an avian flu vaccine on humans here.
Meanwhile, there is still not enough conventional influenza vaccine to go around for all countries.
Only about 500 million doses of human influenza vaccine are available on the global market, and this would just be sufficient for the populations of the United States and the European Union, he said.
Dr Tawee said conducting vaccine experiments with other developed countries would be a short-cut for Thailand to learn how to develop vaccines itself and it would also be able to stockpile sufficient doses of bird flu and influenza vaccines if the trials proved successful.
Paijit Warachit, Medical Sciences Department director general, said the authority had mapped out a long-term plan to develop a vaccine for commercial use within the next three to five years.
AVIAN FLUVACCINE TRIALS ON HUMANS
Government decision lauded
APIRADEE TREERUTKUARKUL
A leading academic was upbeat yesterday after the government decided to accept a US proposal to conduct bird flu vaccine trials on humans in Thailand.
Tawee Chotepittayasunont, an avian influenza expert and paediatrician at the Queen Sirikit National Institute of Child Health, yesterday said he fully supported the government's collaboration with the United States National Institute of Health.
``We have to conduct vaccine trials in Thailand as soon as possible. Otherwise, we won't have any protection if and when a flu pandemic happens,'' he said at an annual medical conference at Rajavithi Hospital.
Dr Tawee said it was essential for the government to begin preparing for vaccine production and stockpiling it. It was the only means to protect people from bird flu and an influenza pandemic as well as to curb mutations of the virus, he said.
No human vaccine against bird flu has so far been produced for public use despite warnings of a deadly flu pandemic which could stem from the virulent H5N1 strain of avian influenza.
An index case of probable human-to-human transmission between an 11-year-old girl, Sakuntala Prempasee, and her mother, Pranee Thongchan, which occurred in the northern Thai province of Kamphaeng Phet last year, along with several human cases of bird flu infection in Vietnam and Cambodia, have forced the government's hand in terms of proceeding with the testing of an avian flu vaccine on humans here.
Meanwhile, there is still not enough conventional influenza vaccine to go around for all countries.
Only about 500 million doses of human influenza vaccine are available on the global market, and this would just be sufficient for the populations of the United States and the European Union, he said.
Dr Tawee said conducting vaccine experiments with other developed countries would be a short-cut for Thailand to learn how to develop vaccines itself and it would also be able to stockpile sufficient doses of bird flu and influenza vaccines if the trials proved successful.
Paijit Warachit, Medical Sciences Department director general, said the authority had mapped out a long-term plan to develop a vaccine for commercial use within the next three to five years.
Tamiflu as prophylaxis
I got this from the company's website - I'll relocate it & post it. They tested patients in terms of safety for 6 weeks total - 42 days of 1 tablet a day for prophylaxis. There's no longer term testing. So given patients in your hospital that YOU are looking after - do you, (if you have it which I doubt), give those HCW dealing directly with patients Tamiflu for longer than 42 days? I really think that's moot - ain't enough Tamiflu in the world to provide much prophylaxis for anybody.
If a staff member is exposed daily to H5N1 virus & is taking Tamiflu - at what point is the virus going to mutate around it? I'm pretty SURE I saw some journal article about this occuring in vitro in the lab but I'm not certain. In short though, I think any reliance in Tamiflu is a mistake.
Vaccine is simply just NOT going to be available - let's throw that idea out the window. So what will we be left with - prevention measures that literally date back centuries. They can work - if they're rigorously maintained. I submit no one is prpared for that either.
I'm driving myself crazy with my own scenario. Frankly, I can see municipal & higher level governments thrwoing up their collective hands & essentially giving up on any real planning. When pandemic hits, who's got time?
You know, when movies like Outbreak come out, people freak about the more exotic viral diseases - Ebola & such which really pose little risk here. As much as I'm NOT a fan of such scare movies - maybe we need to do one about pandemic flu & show kids & seniors starving to death because responsible adults rarely keep stocked pantries anymore. That's what it's going to come down too. Any plans, no matter how well put together will ciollapse in the face of almost complete lack of INDIVIDUAL preparation.
I'm about 7 posts ahead of what I've put up here in the "My City' thread & I'm at the point where the non-flu toll is about to get supremely ugly because of such considerations. Fruit Loop is right, most will go through a rough time - if they catch flu but survive quite nicely. It will be the speed at which it hits & the effects on ALL of soceity that gets us in the end. The poorest village in Costa Rica might fare far better in percwentgae terms, than New York City, for all its modern conveniences.
I got this from the company's website - I'll relocate it & post it. They tested patients in terms of safety for 6 weeks total - 42 days of 1 tablet a day for prophylaxis. There's no longer term testing. So given patients in your hospital that YOU are looking after - do you, (if you have it which I doubt), give those HCW dealing directly with patients Tamiflu for longer than 42 days? I really think that's moot - ain't enough Tamiflu in the world to provide much prophylaxis for anybody.
If a staff member is exposed daily to H5N1 virus & is taking Tamiflu - at what point is the virus going to mutate around it? I'm pretty SURE I saw some journal article about this occuring in vitro in the lab but I'm not certain. In short though, I think any reliance in Tamiflu is a mistake.
Vaccine is simply just NOT going to be available - let's throw that idea out the window. So what will we be left with - prevention measures that literally date back centuries. They can work - if they're rigorously maintained. I submit no one is prpared for that either.
I'm driving myself crazy with my own scenario. Frankly, I can see municipal & higher level governments thrwoing up their collective hands & essentially giving up on any real planning. When pandemic hits, who's got time?
You know, when movies like Outbreak come out, people freak about the more exotic viral diseases - Ebola & such which really pose little risk here. As much as I'm NOT a fan of such scare movies - maybe we need to do one about pandemic flu & show kids & seniors starving to death because responsible adults rarely keep stocked pantries anymore. That's what it's going to come down too. Any plans, no matter how well put together will ciollapse in the face of almost complete lack of INDIVIDUAL preparation.
I'm about 7 posts ahead of what I've put up here in the "My City' thread & I'm at the point where the non-flu toll is about to get supremely ugly because of such considerations. Fruit Loop is right, most will go through a rough time - if they catch flu but survive quite nicely. It will be the speed at which it hits & the effects on ALL of soceity that gets us in the end. The poorest village in Costa Rica might fare far better in percwentgae terms, than New York City, for all its modern conveniences.
I think I'll nickname Dr Niman the "Paul Revere of Avian Flu". 
While I can collect info from various sites, and collate it-this man knows what it means! and what it may mean to us. His statements are not just "idle speculation from another doomer", as mine might be called; but insight from one of the top experts in the field. If I had a dollar for every time I wished we had a virologist on the board during the SARS crisis, we could all go to lunch. Finding his site is pretty close...
http://www.recombinomics.com/News/03080503/H5N1_Atypical.html
Human Transmission of Bird Flu in Atypical Patients
Recombinomics Commentary
March 8, 2005
>> The seven people, all from southern Vietnam, didn't have clinical or epidemiological factors typical of previous bird-flu cases, the institute official said. One patient had tuberculosis. <<
The seven false negatives were all from southern Vietnam, which may explain while all confirmed H5N1 cases in the south have died. The bird flu test may only detect the most severe cases, raising questions about how many H5N1 cases were missed.
Since the false negatives also did not have clinical or epidemiological factors typical of previous bird flu cases, it seems that they would not have had a history of contact with poultry, increasing the likelihood of undetected human-to-human transmission. As was seen in the familial clusters, even when index cases were from province with dying poultry or had a history of prior H5N1 infections, the patients with clear bird flu symptoms were not tested.
These new cases indicate that many H5N1 patients are either not being tested because they do not have "typical" symptoms, or they are falsely testing negative.
Earlier comments from officials in Vietnam had mentioned complex cases in Vietnam and Cambodia, suggesting a much wider spread of the H5N1 virus. The false negatives in southern Vietnam may explain the failure to detect any human cases this season in Thailand, even in cases that have handled dead chickens, have lung involvement, and are positive for influenza A.
The reports of additional false negatives in non-fatal cases combined with an atypical clinical presentation or epidemiological profile strongly suggests that there has been much more human-to-human transmission of H5N1, and the H5N1 spread has probably gone beyond the borders of Vietnam, Thailand, and Cambodia.
While I can collect info from various sites, and collate it-this man knows what it means! and what it may mean to us. His statements are not just "idle speculation from another doomer", as mine might be called; but insight from one of the top experts in the field. If I had a dollar for every time I wished we had a virologist on the board during the SARS crisis, we could all go to lunch. Finding his site is pretty close...
http://www.recombinomics.com/News/03080503/H5N1_Atypical.html
Human Transmission of Bird Flu in Atypical Patients
Recombinomics Commentary
March 8, 2005
>> The seven people, all from southern Vietnam, didn't have clinical or epidemiological factors typical of previous bird-flu cases, the institute official said. One patient had tuberculosis. <<
The seven false negatives were all from southern Vietnam, which may explain while all confirmed H5N1 cases in the south have died. The bird flu test may only detect the most severe cases, raising questions about how many H5N1 cases were missed.
Since the false negatives also did not have clinical or epidemiological factors typical of previous bird flu cases, it seems that they would not have had a history of contact with poultry, increasing the likelihood of undetected human-to-human transmission. As was seen in the familial clusters, even when index cases were from province with dying poultry or had a history of prior H5N1 infections, the patients with clear bird flu symptoms were not tested.
These new cases indicate that many H5N1 patients are either not being tested because they do not have "typical" symptoms, or they are falsely testing negative.
Earlier comments from officials in Vietnam had mentioned complex cases in Vietnam and Cambodia, suggesting a much wider spread of the H5N1 virus. The false negatives in southern Vietnam may explain the failure to detect any human cases this season in Thailand, even in cases that have handled dead chickens, have lung involvement, and are positive for influenza A.
The reports of additional false negatives in non-fatal cases combined with an atypical clinical presentation or epidemiological profile strongly suggests that there has been much more human-to-human transmission of H5N1, and the H5N1 spread has probably gone beyond the borders of Vietnam, Thailand, and Cambodia.
Sue- honestly- I dont have any idea what they do for Tamiflu. Do you have any idea how many pts with pos flu tests Ive taken care of recently? 12 hours ago, I was getting thrown up on by a woman with pos A flu rapid test who had a nosebleed, and swallowed too much blood...she came in for a nosebleed. No mask, no gloves, it happened too fast- yea i had a flu shot- but it gave me shivers, realizing just how close this could be to a portent...I hope it wasnt A wisconsin, since that wasnt in the shot...
I'm one of many who failed our N95 mask fitting tests. The hospital has TWO, count them, TWO, air flow devices for the racal hoods we get when that happens-for the entire hospital staff.... Theres at least 6 or so staff in the ED alone that would need them...uh, does that give you some idea of how fast unprotected HC workers could go down? It sure gives me the shivers...and I'm really not sure I'm willing to take the risk, Tamiflu or no, since all that i'm reading is that the bug is already showing signs of Tamiflu resistance. Thats why I'm not too much in a hurry to try to get an Rx for it for preps. Personally, I'm having a very hard time deciding- if the facility isnt able to provide me with really effective PPE and/or prophalaxis meds, and this breaks with a high morbidity/ mortality rate, do I take the risk? I guess I'll have to continue to amass info and make that decision that best fits my conscience and my abilities and the reality when the time comes. I hope I make the right one, based on logic and hard info, when the time comes. How many other HC Workers will wrestle with that question soon, and not be prepared mentally to make it? Will panic and disinformation dpelete our medical systems as effectively as the virus?
Failure to prepare at a local facility level may just result in the unintended consequence of HC workers dropping out-either from fear or infection-early on in the epidemic. THAT would add greatly to the chaos, and its a risk we CAN mitigate now with planning and education. So far, it ain't happening AFAICS. I worry about that...
edited to add: for all the comments Ive heard from EC and HC workers in the last few years since 9/11, I wouldnt be the least surprised if we lost at least 1/4-1/3 of our staff, nationally, to fear. The bigest concern I've heard voiced is the fear of bringing it home to loved ones. Beign the cause of your own family catching whatever the biological threat is, and then suffering or dying from it. HC workers are human too-with all the same fears and concerns. I think its darn foolish for any system to assume their current capacity is going to be available- a loss of even 10% of the staff, at once, would result in mass bed closing.
My personal best case scenario drop out rate is about 10%- in the early stages. Thats just from fear-if its got a high attack rate,and we start losing staff to actual infection early on, it could get much worse, very fast...I would not be surpised to see many, many facilities closing their doors completely...and thats one part of Sues scanario I consider very optimistic. In that, the system held. in a 1918 style scenario, I dont think it will hold together everywhere.
I'm one of many who failed our N95 mask fitting tests. The hospital has TWO, count them, TWO, air flow devices for the racal hoods we get when that happens-for the entire hospital staff.... Theres at least 6 or so staff in the ED alone that would need them...uh, does that give you some idea of how fast unprotected HC workers could go down? It sure gives me the shivers...and I'm really not sure I'm willing to take the risk, Tamiflu or no, since all that i'm reading is that the bug is already showing signs of Tamiflu resistance. Thats why I'm not too much in a hurry to try to get an Rx for it for preps. Personally, I'm having a very hard time deciding- if the facility isnt able to provide me with really effective PPE and/or prophalaxis meds, and this breaks with a high morbidity/ mortality rate, do I take the risk? I guess I'll have to continue to amass info and make that decision that best fits my conscience and my abilities and the reality when the time comes. I hope I make the right one, based on logic and hard info, when the time comes. How many other HC Workers will wrestle with that question soon, and not be prepared mentally to make it? Will panic and disinformation dpelete our medical systems as effectively as the virus?
Failure to prepare at a local facility level may just result in the unintended consequence of HC workers dropping out-either from fear or infection-early on in the epidemic. THAT would add greatly to the chaos, and its a risk we CAN mitigate now with planning and education. So far, it ain't happening AFAICS. I worry about that...
edited to add: for all the comments Ive heard from EC and HC workers in the last few years since 9/11, I wouldnt be the least surprised if we lost at least 1/4-1/3 of our staff, nationally, to fear. The bigest concern I've heard voiced is the fear of bringing it home to loved ones. Beign the cause of your own family catching whatever the biological threat is, and then suffering or dying from it. HC workers are human too-with all the same fears and concerns. I think its darn foolish for any system to assume their current capacity is going to be available- a loss of even 10% of the staff, at once, would result in mass bed closing.
My personal best case scenario drop out rate is about 10%- in the early stages. Thats just from fear-if its got a high attack rate,and we start losing staff to actual infection early on, it could get much worse, very fast...I would not be surpised to see many, many facilities closing their doors completely...and thats one part of Sues scanario I consider very optimistic. In that, the system held. in a 1918 style scenario, I dont think it will hold together everywhere.
Last edited:
Comments on the last 2 posts
In light of some comments from Vietnam, I'm not sure I believe the 'false negative' test reports. They may have gambled these patients WOULD make it, so why freak people out reporting yet MORE cases. I may be completely out to lunch... but it's a thought. It would be helpful if ewither Vietnam or the WHO explained just WHAT is meant by 'complex cases'. I hear that & as a former nurse think complex management ICU type cases. Frequent blood tests for liver enzymes, RBC & WBC difs, connstant tweaking of oxygen flow rates & IV solutions, catheterization for accurate urinary output; all that 'fun' stuff.
This obviously doesn't apply in Vietnam oir Thailand - they're lucky when equipment only has 10% of surfaces covered in rust, (I'm not kidding), but what do they mean? Atypical presentations? Be nice if we knew that? An increasing number of systems affected directly by the virus? Are they saying ANYTHING about secondaries???
As to protection of health care workers... I don't have a whole lot of faith in the system. We already have ALL nurses working 12 hour shifts here & they stagger out of hospital. Trying that on with a flu pandemic when the work load will be backbreaking & extremely depressing with load of other concerns as well as work related ones... I suspect a lot will decide it's simply not worth it. How many nurses are sole parents of kids they refuse to put at risk? How well treated are most health care workers in any area at the best of times? For those trying to determine the impact of pandemic flu in their area - look at that issue. Are they always upset with management? If they're not happy now, many will melt away as pandemic begins.
In light of some comments from Vietnam, I'm not sure I believe the 'false negative' test reports. They may have gambled these patients WOULD make it, so why freak people out reporting yet MORE cases. I may be completely out to lunch... but it's a thought. It would be helpful if ewither Vietnam or the WHO explained just WHAT is meant by 'complex cases'. I hear that & as a former nurse think complex management ICU type cases. Frequent blood tests for liver enzymes, RBC & WBC difs, connstant tweaking of oxygen flow rates & IV solutions, catheterization for accurate urinary output; all that 'fun' stuff.
This obviously doesn't apply in Vietnam oir Thailand - they're lucky when equipment only has 10% of surfaces covered in rust, (I'm not kidding), but what do they mean? Atypical presentations? Be nice if we knew that? An increasing number of systems affected directly by the virus? Are they saying ANYTHING about secondaries???
As to protection of health care workers... I don't have a whole lot of faith in the system. We already have ALL nurses working 12 hour shifts here & they stagger out of hospital. Trying that on with a flu pandemic when the work load will be backbreaking & extremely depressing with load of other concerns as well as work related ones... I suspect a lot will decide it's simply not worth it. How many nurses are sole parents of kids they refuse to put at risk? How well treated are most health care workers in any area at the best of times? For those trying to determine the impact of pandemic flu in their area - look at that issue. Are they always upset with management? If they're not happy now, many will melt away as pandemic begins.
Pigs Hold Clues to Man-Made Flu
By Kristen Philipkoski
http://www.wired.com/news/medtech/0,1286,66824,00.html
02:00 AM Mar. 08, 2005 PT
Samples taken from South Korean pigs contain genes from a human flu virus created by scientists in 1933, and one American flu researcher says the sequences could represent a dangerous situation for humans.
The World Health Organization, which monitors the worldwide spread of flu, is remaining mum until researchers finish an investigation of the pig samples.
The presence of a man-made human flu virus in pigs may be worrisome for several reasons. First, a man-made virus has no business in pigs -- did the virus get there naturally, or was it a lab accident? More frighteningly, but less likely, was it bioterrorism? Second, viruses often use pigs as a conduit to humans, who would have little or no immune resistance to this particular strain of flu since no one has been exposed to it.
"In terms of flu, pigs have always represented a danger to humans because these animals act as a mixing vessel for various strains of influenza," said Dick Thompson, a spokesman for the World Health Organization.
But WHO won't be convinced that the data is real -- that the human sequences are not a result of laboratory contamination instead of human virus in a pig -- until more laboratories can verify the samples.
Henry Niman, founder of Recombinomics and a researcher who has sleuthed the spread of bird flu and its changing genetic makeup for two years, says the investigation is moving too slowly. If pigs in Korea are carrying a man-made human flu, authorities should take action immediately to prevent it from spreading.
Sang Heui Seo of Chungnam National University in Daejon, South Korea, entered six genetic sequences from pigs into GenBank in late October. Niman came across the data in late November, and noticed they contained between three and seven genes from the WSN33 virus, which was created in 1933 by a London lab that was researching the 1918 flu pandemic. The London lab found that the virus could infect mice, indicating that it might successfully infect humans, Niman said. He reported the presence of the human WSN33 genes in Seo's samples to WHO officials in early December.
According to a news article in Science, WHO initially dismissed the data as lab contamination based on the fact that a researcher at St. Jude's Children's Hospital in Memphis, Tennessee, said he had shipped samples of WSN33 to Seo's lab. But Seo told Science he never received any WSN33.
St. Jude's declined to comment on the Korean pigs, and Seo did not return e-mails requesting comment.
Seo submitted his pig data to Science for publication, but the journal's editors rejected the research, asking for outside lab testing to verify that the data was valid. Labs in Hong Kong and at the University of Wisconsin-Madison are now verifying the samples. WHO is also waiting for the results to decide whether the pigs might be a danger to humans.
"If there really are WSN33 sequences in pigs -- and probably birds -- on farms in Korea," Niman said, "then there is a very major problem."
Niman says the evidence can likely be explained by one of two possibilities: Either the man-made virus escaped from a lab, or the virus' genes are recombining -- morphing in a way that most flu researchers believe is impossible.
"(WHO doesn't) want to think about the fact that it escaped from some lab, which is most certainly what happened, and they certainly don't want to think about recombination," Niman said.
By Kristen Philipkoski
http://www.wired.com/news/medtech/0,1286,66824,00.html
02:00 AM Mar. 08, 2005 PT
Samples taken from South Korean pigs contain genes from a human flu virus created by scientists in 1933, and one American flu researcher says the sequences could represent a dangerous situation for humans.
The World Health Organization, which monitors the worldwide spread of flu, is remaining mum until researchers finish an investigation of the pig samples.
The presence of a man-made human flu virus in pigs may be worrisome for several reasons. First, a man-made virus has no business in pigs -- did the virus get there naturally, or was it a lab accident? More frighteningly, but less likely, was it bioterrorism? Second, viruses often use pigs as a conduit to humans, who would have little or no immune resistance to this particular strain of flu since no one has been exposed to it.
"In terms of flu, pigs have always represented a danger to humans because these animals act as a mixing vessel for various strains of influenza," said Dick Thompson, a spokesman for the World Health Organization.
But WHO won't be convinced that the data is real -- that the human sequences are not a result of laboratory contamination instead of human virus in a pig -- until more laboratories can verify the samples.
Henry Niman, founder of Recombinomics and a researcher who has sleuthed the spread of bird flu and its changing genetic makeup for two years, says the investigation is moving too slowly. If pigs in Korea are carrying a man-made human flu, authorities should take action immediately to prevent it from spreading.
Sang Heui Seo of Chungnam National University in Daejon, South Korea, entered six genetic sequences from pigs into GenBank in late October. Niman came across the data in late November, and noticed they contained between three and seven genes from the WSN33 virus, which was created in 1933 by a London lab that was researching the 1918 flu pandemic. The London lab found that the virus could infect mice, indicating that it might successfully infect humans, Niman said. He reported the presence of the human WSN33 genes in Seo's samples to WHO officials in early December.
According to a news article in Science, WHO initially dismissed the data as lab contamination based on the fact that a researcher at St. Jude's Children's Hospital in Memphis, Tennessee, said he had shipped samples of WSN33 to Seo's lab. But Seo told Science he never received any WSN33.
St. Jude's declined to comment on the Korean pigs, and Seo did not return e-mails requesting comment.
Seo submitted his pig data to Science for publication, but the journal's editors rejected the research, asking for outside lab testing to verify that the data was valid. Labs in Hong Kong and at the University of Wisconsin-Madison are now verifying the samples. WHO is also waiting for the results to decide whether the pigs might be a danger to humans.
"If there really are WSN33 sequences in pigs -- and probably birds -- on farms in Korea," Niman said, "then there is a very major problem."
Niman says the evidence can likely be explained by one of two possibilities: Either the man-made virus escaped from a lab, or the virus' genes are recombining -- morphing in a way that most flu researchers believe is impossible.
"(WHO doesn't) want to think about the fact that it escaped from some lab, which is most certainly what happened, and they certainly don't want to think about recombination," Niman said.
The Flying Dutchman
Inactive
LMonty911 said:
If anything; this virus worries me more than H5N1 does.. And it surely came along at an particularly *convient* time as well.....
agreed, Shakey, it is a bit odd...we could be looking at a simple contaminant.
Niman doesnt think so.
Somehow, that bug got out in the wild. If its a simple lab error- that doesnt bode well for biosecurity in general.
If it is out there in a substantial number of pigs, it holds a lovely assortment of human to human transmission genes for H5N1 -or any other Highly Pathogenic Avian Influenza-to borrow.
But after thinking bout it, I'm not too on the edge over it. It may well be an error or there may be some other explanation. If not, and it truly is in the wild, there's a good possibility that that particular strain may not tramsmit well, so theres an infintesimal chance of it meeting up with a highly pathogenic H5 anyway.
I might even be committing a little thread drift by including it here, since its so uncertain that it has any bearing on the coming pandemic. But, its an interesting story, and bears watching IMHO.
Niman doesnt think so.
Somehow, that bug got out in the wild. If its a simple lab error- that doesnt bode well for biosecurity in general.
If it is out there in a substantial number of pigs, it holds a lovely assortment of human to human transmission genes for H5N1 -or any other Highly Pathogenic Avian Influenza-to borrow.
But after thinking bout it, I'm not too on the edge over it. It may well be an error or there may be some other explanation. If not, and it truly is in the wild, there's a good possibility that that particular strain may not tramsmit well, so theres an infintesimal chance of it meeting up with a highly pathogenic H5 anyway.
I might even be committing a little thread drift by including it here, since its so uncertain that it has any bearing on the coming pandemic. But, its an interesting story, and bears watching IMHO.
I'm posting this one just so i can use my favorite icons:
U.S. safe from bird flu epidemic
By Ashley Suffle, Contributing Writer
[font=Verdana, Arial, Helvetica, sans-serif]Published: [/font]
Cambodia released information regarding its bird flue epidemic Sunday, sparking concerns that an avian, or bird flu pandemic, might resurface.
Experts express that caution is the best preventative and public concern should not escalate into panic.
"If there was to be a serious problem, the mechanism is in place to do something to handle it very quickly," said Dustan Clark, a poultry health veterinarian and UA professor. Clark is also a member of an avian influenza advisory panel. Domestic poultry, not wild fowl, is the bird that presents a risk to the human population, he said.
In its purist form, even poultry is fairly safe from this "low pathogen" flu; most strains of low pathogenic AI causes few signs of illness in the bird and is non-communicable to humans, he said.
It is when this virus morphs into a "high pathogenic" strain that it becomes extremely fatal, he said.
Humans are not necessarily immune to AI. In 1997, a mutated avian influenza virus, called H5NI, infected some people in Hong Kong, becoming the first reported incident of AI causing severe illness and death within the human population, according to University Relations.
Since then, cases of AI in humans have been relatively few. After a reported 13 cases of AI, Cambodia is using biosecurity, or the policy of exterminating the infected population of animals, border security, and is stockpiling AI vaccinations to assure the health and safety of its people.
So far, epidemiologists have been able to breathe a sigh of relief, becauseof these historical few who have become ill or died because of AI, none have contracted it while being sick with human influenza, according to University Relations. Scientists believe that the risk of a true pandemic lies within the mutability innate to the "flu" virus.
If a human with influenza contracted AI as well, there is a high possibility that the two strains could combine and mutate, forming a highly deadly and contagious variety of AI, according to University Relations.
Experts express that caution is the best preventative and public concern should not escalate into panic.
"If there was to be a serious problem, the mechanism is in place to do something to handle it very quickly," said Dustan Clark, a poultry health veterinarian and UA professor. Clark is also a member of an avian influenza advisory panel. Domestic poultry, not wild fowl, is the bird that presents a risk to the human population, he said.
In its purist form, even poultry is fairly safe from this "low pathogen" flu; most strains of low pathogenic AI causes few signs of illness in the bird and is non-communicable to humans, he said.
It is when this virus morphs into a "high pathogenic" strain that it becomes extremely fatal, he said.
Humans are not necessarily immune to AI. In 1997, a mutated avian influenza virus, called H5NI, infected some people in Hong Kong, becoming the first reported incident of AI causing severe illness and death within the human population, according to University Relations.
Since then, cases of AI in humans have been relatively few. After a reported 13 cases of AI, Cambodia is using biosecurity, or the policy of exterminating the infected population of animals, border security, and is stockpiling AI vaccinations to assure the health and safety of its people.
(a totally misleading statement IMO- good reason why I dread geting my news about this issue-or any important ones- from the MSM. There hanvent been any human AI vaccinations available to stock, in Cambodia and elsewhere, until some very new stuff thats being considered to trial in Thailand. The average news reader wouldnt know that. They must be stocking AI vaccines for poultry-which is controversial, since it *may* allow the virus to exist in a less noticeable form, and prevent the destruction of flocks before people get infected in large numbers. Looks like the virus is evolving into a less pathogenic form in ducks-that species may be developing into silent carriers, the Typhoid Mary's of bird flu)
So far, epidemiologists have been able to breathe a sigh of relief, becauseof these historical few who have become ill or died because of AI, none have contracted it while being sick with human influenza, according to University Relations. Scientists believe that the risk of a true pandemic lies within the mutability innate to the "flu" virus.
If a human with influenza contracted AI as well, there is a high possibility that the two strains could combine and mutate, forming a highly deadly and contagious variety of AI, according to University Relations. ';paragraph[1] = 'Clark stressed that American concern about AI should not get out of hand.
"Most diseases don\'t cross species," Clark said. "In the human population, the best preventative for disease is good sanitation and biosecurity. It\'s a matter of risk assessment. The greater percentage of the population that practices biosecurity, or that receives a human flu vaccine, the less chance we have of avian influenza infecting a person that has human influenza. Thus there is a reduction in the threat of a new influenza mutant developing from a combination of the avian and human types and subsequently developing into a pandemic."
Arkansans have even more cause to worry than most. Tyson Foods, Inc., the leading poultry producer in the world, is based in nearby Springdale and has contracts with over 6,500 poultry providers, many of which are located throughout the state, according to University Relations.
With the large amounts of poultry in Arkansas, the risk for AI increases. However, in conjunction with food safety boards such as the International Food Safety Council, Tyson has taken precautions to insure America\'s protection from AI, according to University Relations.
"If there is any suspicion of avian flu in a poultry flock in this country, the flock would be quickly destroyed," Clark said.
http://www.thetraveleronline.com/news/2005/02/14/News/U.Safe.From.Bird.Flu.Epidemic-862339.shtml?page=2
U.S. safe from bird flu epidemic
By Ashley Suffle, Contributing Writer
[font=Verdana, Arial, Helvetica, sans-serif]Published: [/font]
Cambodia released information regarding its bird flue epidemic Sunday, sparking concerns that an avian, or bird flu pandemic, might resurface.
Experts express that caution is the best preventative and public concern should not escalate into panic.
"If there was to be a serious problem, the mechanism is in place to do something to handle it very quickly," said Dustan Clark, a poultry health veterinarian and UA professor. Clark is also a member of an avian influenza advisory panel. Domestic poultry, not wild fowl, is the bird that presents a risk to the human population, he said.
In its purist form, even poultry is fairly safe from this "low pathogen" flu; most strains of low pathogenic AI causes few signs of illness in the bird and is non-communicable to humans, he said.
It is when this virus morphs into a "high pathogenic" strain that it becomes extremely fatal, he said.
Humans are not necessarily immune to AI. In 1997, a mutated avian influenza virus, called H5NI, infected some people in Hong Kong, becoming the first reported incident of AI causing severe illness and death within the human population, according to University Relations.
Since then, cases of AI in humans have been relatively few. After a reported 13 cases of AI, Cambodia is using biosecurity, or the policy of exterminating the infected population of animals, border security, and is stockpiling AI vaccinations to assure the health and safety of its people.
So far, epidemiologists have been able to breathe a sigh of relief, becauseof these historical few who have become ill or died because of AI, none have contracted it while being sick with human influenza, according to University Relations. Scientists believe that the risk of a true pandemic lies within the mutability innate to the "flu" virus.
If a human with influenza contracted AI as well, there is a high possibility that the two strains could combine and mutate, forming a highly deadly and contagious variety of AI, according to University Relations.
Experts express that caution is the best preventative and public concern should not escalate into panic.
"If there was to be a serious problem, the mechanism is in place to do something to handle it very quickly," said Dustan Clark, a poultry health veterinarian and UA professor. Clark is also a member of an avian influenza advisory panel. Domestic poultry, not wild fowl, is the bird that presents a risk to the human population, he said.
In its purist form, even poultry is fairly safe from this "low pathogen" flu; most strains of low pathogenic AI causes few signs of illness in the bird and is non-communicable to humans, he said.
It is when this virus morphs into a "high pathogenic" strain that it becomes extremely fatal, he said.
Humans are not necessarily immune to AI. In 1997, a mutated avian influenza virus, called H5NI, infected some people in Hong Kong, becoming the first reported incident of AI causing severe illness and death within the human population, according to University Relations.
Since then, cases of AI in humans have been relatively few. After a reported 13 cases of AI, Cambodia is using biosecurity, or the policy of exterminating the infected population of animals, border security, and is stockpiling AI vaccinations to assure the health and safety of its people.
(a totally misleading statement IMO- good reason why I dread geting my news about this issue-or any important ones- from the MSM. There hanvent been any human AI vaccinations available to stock, in Cambodia and elsewhere, until some very new stuff thats being considered to trial in Thailand. The average news reader wouldnt know that. They must be stocking AI vaccines for poultry-which is controversial, since it *may* allow the virus to exist in a less noticeable form, and prevent the destruction of flocks before people get infected in large numbers. Looks like the virus is evolving into a less pathogenic form in ducks-that species may be developing into silent carriers, the Typhoid Mary's of bird flu)
So far, epidemiologists have been able to breathe a sigh of relief, becauseof these historical few who have become ill or died because of AI, none have contracted it while being sick with human influenza, according to University Relations. Scientists believe that the risk of a true pandemic lies within the mutability innate to the "flu" virus.
If a human with influenza contracted AI as well, there is a high possibility that the two strains could combine and mutate, forming a highly deadly and contagious variety of AI, according to University Relations. ';paragraph[1] = 'Clark stressed that American concern about AI should not get out of hand.
"Most diseases don\'t cross species," Clark said. "In the human population, the best preventative for disease is good sanitation and biosecurity. It\'s a matter of risk assessment. The greater percentage of the population that practices biosecurity, or that receives a human flu vaccine, the less chance we have of avian influenza infecting a person that has human influenza. Thus there is a reduction in the threat of a new influenza mutant developing from a combination of the avian and human types and subsequently developing into a pandemic."
Arkansans have even more cause to worry than most. Tyson Foods, Inc., the leading poultry producer in the world, is based in nearby Springdale and has contracts with over 6,500 poultry providers, many of which are located throughout the state, according to University Relations.
With the large amounts of poultry in Arkansas, the risk for AI increases. However, in conjunction with food safety boards such as the International Food Safety Council, Tyson has taken precautions to insure America\'s protection from AI, according to University Relations.
"If there is any suspicion of avian flu in a poultry flock in this country, the flock would be quickly destroyed," Clark said.
http://www.thetraveleronline.com/news/2005/02/14/News/U.Safe.From.Bird.Flu.Epidemic-862339.shtml?page=2
Last edited:
Information About Influenza Pandemics
By Center for Diesease Control and Prevention (CDC)
Mar 8, 2005, 18:13
Email this article
Printer friendly page
Information About Influenza Pandemics
Download PDF version formatted for print (103 KB/2 pages)
Avian Flu
General Information
· Key Facts
· Influenza Viruses
· Avian Influenza Viruses
· Spread of Viruses Among Birds & Poultry
· Transmission Between Animals & People
· Avian Influenza Infection in Humans
· Influenza Pandemics
Outbreaks
Professional Guidance
Related Links
Pandemic: A Worldwide Outbreak of Influenza
An influenza pandemic is a global outbreak of disease that occurs when a new influenza A virus appears or “emerges” in the human population, causes serious illness, and then spreads easily from person to person worldwide. Pandemics are different from seasonal outbreaks or “epidemics” of influenza. Seasonal outbreaks are caused by subtypes of influenza viruses that are already in existence among people, whereas pandemic outbreaks are caused by new subtypes or by subtypes that have never circulated among people or that have not circulated among people for a long time. Past influenza pandemics have led to high levels of illness, death, social disruption, and economic loss.
Appearance (“Emergence”) of Pandemic Influenza Viruses
There are many different subtypes of Influenza or “flu” viruses. The subtypes differ based upon certain proteins on the surface of the virus (the hemagglutinin or “HA” protein and the neuraminidase or the “NA” protein).
Pandemic viruses appear (or “emerge”) as a result of a process called "antigenic shift,” which causes an abrupt or sudden, major change in influenza A viruses. These changes are caused by new combinations of the HA and/or NA proteins on the surface of the virus. This change results in a new influenza A virus subtype. The appearance of a new influenza A virus subtype is the first step toward a pandemic, but the new virus subtype also must spread easily from person to person to cause a pandemic. Once a new pandemic influenza virus emerges and spreads, it normally becomes established among people and moves around or “circulates” for many years as seasonal epidemics of influenza. The U.S. Centers for Disease Control and Prevention and the World Health Organization have large surveillance programs to monitor and “detect” influenza activity around the world, including the emergence of possible pandemic strains of influenza virus.
Influenza Pandemics During the 20th Century
During the 20th century, the emergence of new influenza A virus subtypes caused three pandemics, all of which spread around the world within 1 year of being detected.
1918-19, "Spanish flu," [A (H1N1)], caused the highest number of known influenza deaths: more than 500,000 people died in the United States, and up to 50 million people may have died worldwide. Many people died within the first few days after infection, and others died of complications later. Nearly half of those who died were young, healthy adults. Influenza A (H1N1) viruses still circulate today after being introduced again into the human population in the 1970s.
1957-58, "Asian flu," [A (H2N2)], caused about 70,000 deaths in the United States. First identified in China in late February 1957, the Asian flu spread to the United States by June 1957.
1968-69, " Hong Kong flu," [A (H3N2)], caused about 34,000 deaths in the United States. This virus was first detected in Hong Kong in early 1968 and spread to the United States later that year. Influenza A (H3N2) viruses still circulate today.
Both the 1957-58 and 1968-69 pandemics were caused by viruses containing a combination of genes from a human influenza virus and an avian influenza virus. The origin of the 1918-19 pandemic virus is not clear.
Vaccines to Protect Against Pandemic Influenza Viruses
A vaccine probably would not be available in the early stages of a pandemic. When a new vaccine against an influenza virus is being developed, scientists around the world work together to select the virus strain that will offer the best protection against that virus, and then manufacturers use the selected strain to develop a vaccine. Once a potential pandemic strain of influenza virus is identified, it takes several months before a vaccine will be widely available. If a pandemic occurs, it is expected that the U.S. government will work with many partner groups to make recommendations to guide the early use of vaccine.
Antiviral Medications to Prevent and Treat Pandemic Influenza
Four different influenza antiviral medications (amantadine, rimantadine, oseltamivir, and zanamivir) are approved by the U.S. Food and Drug Administration for the treatment and/or prevention of influenza. All four work against influenza A viruses. However, sometimes influenza virus strains can become resistant to one or more of these drugs, and thus the drugs may not always work. For example, the influenza A (H5N1) viruses identified in human patients in Asia in 2004 and 2005 have been resistant to amantadine and rimantadine. Monitoring of avian viruses for resistance to influenza antiviral medications is continuing.
Preparing for the Next Pandemic
Many scientists believe it is only a matter of time until the next influenza pandemic occurs. The severity of the next pandemic cannot be predicted, but modeling studies suggest that its effect in the United States could be severe. In the absence of any control measures (vaccination or drugs), it has been estimated that in the United States a “medium–level” pandemic could cause 89,000 to 207,000 deaths, between 314,000 and 734,000 hospitalizations, 18 to 42 million outpatient visits, and another 20 to 47 million people being sick. Between 15% and 35% of the U.S. population could be affected by an influenza pandemic, and the economic impact could range between $71.3 and $166.5 billion.
Recent examples of avian influenza outbreaks and infections in Hong Kong in 1997, 1998, and 2002 and the ongoing widespread outbreaks of avian influenza among poultry in Asia, show the importance of preparing for a pandemic. It has been 36 years since the last pandemic.
Influenza pandemics are different from many of the threats for which public health and the health-care system are currently planning:
The pandemic will last much longer than most other emergency events and may include “waves” of influenza activity separated by months (in 20th century pandemics, a second wave of influenza activity occurred 3 to 12 months after the first wave).
The numbers of health-care workers and first responders available to work can be expected to be reduced; they will be at high risk of illness through exposure in the community and in health-care settings, and some may have to miss work to care for ill family members.
Resources in many locations could be limited because of how widespread an influenza pandemic would be.
Because of these differences and the expected size of an influenza pandemic, it is important to have completed planning and preparedness activities to be able to respond promptly and adequately. For this reason, the U.S. Department of Health and Human Services (HHS) supports pandemic influenza activities in the areas of surveillance (“detection”), vaccine development and production, antiviral stockpiling, research, and public health preparedness. In addition, a draft National Pandemic Influenza Preparedness Plan was issued by HHS for public comment in August 2004. To view the draft plan or to obtain more information about pandemic influenza, visit the HHS Web site at http://www.dhhs.gov/nvpo/pandemics/ .
By Center for Diesease Control and Prevention (CDC)
Mar 8, 2005, 18:13
Email this article
Printer friendly page
Information About Influenza Pandemics
Download PDF version formatted for print (103 KB/2 pages)
Avian Flu
General Information
· Key Facts
· Influenza Viruses
· Avian Influenza Viruses
· Spread of Viruses Among Birds & Poultry
· Transmission Between Animals & People
· Avian Influenza Infection in Humans
· Influenza Pandemics
Outbreaks
Professional Guidance
Related Links
Pandemic: A Worldwide Outbreak of Influenza
An influenza pandemic is a global outbreak of disease that occurs when a new influenza A virus appears or “emerges” in the human population, causes serious illness, and then spreads easily from person to person worldwide. Pandemics are different from seasonal outbreaks or “epidemics” of influenza. Seasonal outbreaks are caused by subtypes of influenza viruses that are already in existence among people, whereas pandemic outbreaks are caused by new subtypes or by subtypes that have never circulated among people or that have not circulated among people for a long time. Past influenza pandemics have led to high levels of illness, death, social disruption, and economic loss.
Appearance (“Emergence”) of Pandemic Influenza Viruses
There are many different subtypes of Influenza or “flu” viruses. The subtypes differ based upon certain proteins on the surface of the virus (the hemagglutinin or “HA” protein and the neuraminidase or the “NA” protein).
Pandemic viruses appear (or “emerge”) as a result of a process called "antigenic shift,” which causes an abrupt or sudden, major change in influenza A viruses. These changes are caused by new combinations of the HA and/or NA proteins on the surface of the virus. This change results in a new influenza A virus subtype. The appearance of a new influenza A virus subtype is the first step toward a pandemic, but the new virus subtype also must spread easily from person to person to cause a pandemic. Once a new pandemic influenza virus emerges and spreads, it normally becomes established among people and moves around or “circulates” for many years as seasonal epidemics of influenza. The U.S. Centers for Disease Control and Prevention and the World Health Organization have large surveillance programs to monitor and “detect” influenza activity around the world, including the emergence of possible pandemic strains of influenza virus.
Influenza Pandemics During the 20th Century
During the 20th century, the emergence of new influenza A virus subtypes caused three pandemics, all of which spread around the world within 1 year of being detected.
1918-19, "Spanish flu," [A (H1N1)], caused the highest number of known influenza deaths: more than 500,000 people died in the United States, and up to 50 million people may have died worldwide. Many people died within the first few days after infection, and others died of complications later. Nearly half of those who died were young, healthy adults. Influenza A (H1N1) viruses still circulate today after being introduced again into the human population in the 1970s.
1957-58, "Asian flu," [A (H2N2)], caused about 70,000 deaths in the United States. First identified in China in late February 1957, the Asian flu spread to the United States by June 1957.
1968-69, " Hong Kong flu," [A (H3N2)], caused about 34,000 deaths in the United States. This virus was first detected in Hong Kong in early 1968 and spread to the United States later that year. Influenza A (H3N2) viruses still circulate today.
Both the 1957-58 and 1968-69 pandemics were caused by viruses containing a combination of genes from a human influenza virus and an avian influenza virus. The origin of the 1918-19 pandemic virus is not clear.
Vaccines to Protect Against Pandemic Influenza Viruses
A vaccine probably would not be available in the early stages of a pandemic. When a new vaccine against an influenza virus is being developed, scientists around the world work together to select the virus strain that will offer the best protection against that virus, and then manufacturers use the selected strain to develop a vaccine. Once a potential pandemic strain of influenza virus is identified, it takes several months before a vaccine will be widely available. If a pandemic occurs, it is expected that the U.S. government will work with many partner groups to make recommendations to guide the early use of vaccine.
Antiviral Medications to Prevent and Treat Pandemic Influenza
Four different influenza antiviral medications (amantadine, rimantadine, oseltamivir, and zanamivir) are approved by the U.S. Food and Drug Administration for the treatment and/or prevention of influenza. All four work against influenza A viruses. However, sometimes influenza virus strains can become resistant to one or more of these drugs, and thus the drugs may not always work. For example, the influenza A (H5N1) viruses identified in human patients in Asia in 2004 and 2005 have been resistant to amantadine and rimantadine. Monitoring of avian viruses for resistance to influenza antiviral medications is continuing.
Preparing for the Next Pandemic
Many scientists believe it is only a matter of time until the next influenza pandemic occurs. The severity of the next pandemic cannot be predicted, but modeling studies suggest that its effect in the United States could be severe. In the absence of any control measures (vaccination or drugs), it has been estimated that in the United States a “medium–level” pandemic could cause 89,000 to 207,000 deaths, between 314,000 and 734,000 hospitalizations, 18 to 42 million outpatient visits, and another 20 to 47 million people being sick. Between 15% and 35% of the U.S. population could be affected by an influenza pandemic, and the economic impact could range between $71.3 and $166.5 billion.
Recent examples of avian influenza outbreaks and infections in Hong Kong in 1997, 1998, and 2002 and the ongoing widespread outbreaks of avian influenza among poultry in Asia, show the importance of preparing for a pandemic. It has been 36 years since the last pandemic.
Influenza pandemics are different from many of the threats for which public health and the health-care system are currently planning:
The pandemic will last much longer than most other emergency events and may include “waves” of influenza activity separated by months (in 20th century pandemics, a second wave of influenza activity occurred 3 to 12 months after the first wave).
The numbers of health-care workers and first responders available to work can be expected to be reduced; they will be at high risk of illness through exposure in the community and in health-care settings, and some may have to miss work to care for ill family members.
Resources in many locations could be limited because of how widespread an influenza pandemic would be.
Because of these differences and the expected size of an influenza pandemic, it is important to have completed planning and preparedness activities to be able to respond promptly and adequately. For this reason, the U.S. Department of Health and Human Services (HHS) supports pandemic influenza activities in the areas of surveillance (“detection”), vaccine development and production, antiviral stockpiling, research, and public health preparedness. In addition, a draft National Pandemic Influenza Preparedness Plan was issued by HHS for public comment in August 2004. To view the draft plan or to obtain more information about pandemic influenza, visit the HHS Web site at http://www.dhhs.gov/nvpo/pandemics/ .
new info that supports a lower mortality rate!!! yippee!!
http://www.heraldsun.news.com.au/common/story_page/0,5478,12489662%255E401,00.html
Second opinion turns up bird flu
From correspondents in Hanoi
09mar05
SEVEN Vietnamese patients who had initially tested negative for bird flu had been found to have carried the virus, the World Health Organisation said yesterday after further tests by a laboratory in Tokyo.
All seven had since recovered, officials said.
"The results were positive in Tokyo in a WHO reference laboratory," Hanoi-based WHO epidemiologist Peter Horby said.
Earlier this year, WHO staff at Japan's National Institute of Infectious Diseases in Tokyo and the Centres for Disease Control and Prevention in Atlanta, Georgia, began working with health authorities in Vietnam to improve reliability of laboratory tests.
"Retesting detected H5N1 in specimens from seven persons," WHO said in a statement on its website.
WHO said it was awaiting further details about these cases, including outcomes. Upon receipt of this information, it would also include these cases in Vietnam's cumulative total.
A Vietnamese doctor in Ho Chi Minh City confirmed yesterday "some" samples originally tested negative were found positive in Japan, without saying precisely how many. "There are some differences in the tests between Vietnamese labs and others abroad," the doctor added, asking not to be named.
All the patients had recovered, he said. "WHO has not issued any standards for testing. Therefore, differences are understandable."
Dr Horby said more information was expected in the next few days.
http://www.heraldsun.news.com.au/common/story_page/0,5478,12489662%255E401,00.html
Second opinion turns up bird flu
From correspondents in Hanoi
09mar05
SEVEN Vietnamese patients who had initially tested negative for bird flu had been found to have carried the virus, the World Health Organisation said yesterday after further tests by a laboratory in Tokyo.
All seven had since recovered, officials said.
"The results were positive in Tokyo in a WHO reference laboratory," Hanoi-based WHO epidemiologist Peter Horby said.
Earlier this year, WHO staff at Japan's National Institute of Infectious Diseases in Tokyo and the Centres for Disease Control and Prevention in Atlanta, Georgia, began working with health authorities in Vietnam to improve reliability of laboratory tests.
"Retesting detected H5N1 in specimens from seven persons," WHO said in a statement on its website.
WHO said it was awaiting further details about these cases, including outcomes. Upon receipt of this information, it would also include these cases in Vietnam's cumulative total.
A Vietnamese doctor in Ho Chi Minh City confirmed yesterday "some" samples originally tested negative were found positive in Japan, without saying precisely how many. "There are some differences in the tests between Vietnamese labs and others abroad," the doctor added, asking not to be named.
All the patients had recovered, he said. "WHO has not issued any standards for testing. Therefore, differences are understandable."
Dr Horby said more information was expected in the next few days.
Military intelligence warns that avian flu could be used as weapon: report
Helen Branswell
Canadian Press
March 8, 2005
TORONTO (CP) - The military's intelligence arm has warned the federal government that avian influenza could be used as a weapon of bioterrorism, a heavily censored report suggests.
It also reveals that military planners believe a naturally occurring flu pandemic may be imminent. The report, entitled Recent Human Outbreaks of Avian Influenza and Potential Biological Warfare Implications, was obtained under the Access to Information Act by The Canadian Press.
It was prepared by the J2 Directorate of Strategic Intelligence, a secretive branch of National Defence charged with producing intelligence for the government.
The report outlines in broad terms the methods that could be used to develop a manmade strain of influenza capable of triggering a human flu pandemic.
It notes a method called "passaging," while not entirely predictable, could be a "potentially highly effective" way to push a virus to develop virulence.
"Such forced antigenic shifts could be attempted in a biological weapons program," says the 15-page report, dated Dec. 8, 2004.
Passaging involves the repeated cycling of strains of a virus through generations of a species of animals or through cell culture. The process can be used to either ratchet up or dial down the virulence of a virus, depending on which of the ensuing offspring - the mild or the severe - are selected in each cycle for the next passage.
There is debate in the community of infectious disease experts whether influenza would make a good bioterrorism agent. For one thing, once released, the virus would not discriminate between friend or foe. Terrorists and their supporters would be as likely to fall ill and die as those they hoped to target.
But if the ultimate goal is panic, social disruption and economic losses, influenza would be a good choice, says Dr. Brian Ward, a virologist at McGill University in Montreal.
"To me it's one of the most logical viruses to use. It doesn't have to be a really bad one to throw a huge wrench," Ward said.
"I mean, if you want to hurt the world's economy, that's an awfully good way."
Canada estimates the direct and indirect health-care costs alone of a mild flu pandemic would range from $10 billion to $24 billion. That doesn't start to count societal costs such as lost productivity because of mass illness or the impact on vulnerable industries such as airlines and tourism or the insurance sector that would be hit with business losses and death claims.
But influenza expert Dr. Earl Brown suggests that while flu makes a good theoretical bioterror agent, the reality of these "delicate" viruses is that the task would be harder than it appears.
"Flu is a wimpy virus, which I think is the one knock against it. It doesn't persist in the environment (outside a human) very long," says Brown, a University of Ottawa scientist who specializes in the evolution of influenza viruses.
"You have to infect people sort of straight away, otherwise it's going to die sitting around the environment."
Brown, who has done expensive work on reassorting or mating flu viruses, says any virus bred to spread would have to meet several key criteria: it would need to jump the species barrier and have the ability both to transmit easily and cause severe disease if it did.
"If you want to see chaos and mayhem and you're not concerned about the backlash, then you just have to get to the biology. And right now nobody can do it," Brown says.
"There's a good chance that you'd make something that just would burn out. It just wouldn't spread very well."
The report also raises the spectre of a pandemic strain engineered in a laboratory using reverse genetics. That technically challenging process allows scientists to custom tailor a flu virus, taking genes from a virulent but not highly transmissible strain, for instance, and melding them with genes from a virus that transmits well from person to person.
The report notes this is a technique scientists have been using to try to decipher why the virus that caused the Spanish flu of 1918-1919 was so deadly. That pandemic, which may have claimed upwards of 50 million lives worldwide, was the worst in known history.
"It is feared that this process could be copied . . . to produce a human viral strain similar to the 1918-1919 pandemic," the report says.
It also theorizes that a naturally occurring pandemic may be imminent, unless rigorous measures are taken to contain the spread of the H5N1 avian flu strain that has been responsible for more than 45 deaths in Southeast Asia in the last 14 months.
The report says factors such as the region's inability to eradicate the virus and influenza's propensity to mutate rapidly "raises the possibility that a novel strain capable of efficient human-to-human transmission may arise in the near future, threatening Canadian operations worldwide."
©*The Canadian Press 2005
http://www.canada.com/health/story.html?id=cf20c021-2153-4b60-9924-38655b4d9e1f&page=2
Helen Branswell
Canadian Press
March 8, 2005
TORONTO (CP) - The military's intelligence arm has warned the federal government that avian influenza could be used as a weapon of bioterrorism, a heavily censored report suggests.
It also reveals that military planners believe a naturally occurring flu pandemic may be imminent. The report, entitled Recent Human Outbreaks of Avian Influenza and Potential Biological Warfare Implications, was obtained under the Access to Information Act by The Canadian Press.
It was prepared by the J2 Directorate of Strategic Intelligence, a secretive branch of National Defence charged with producing intelligence for the government.
The report outlines in broad terms the methods that could be used to develop a manmade strain of influenza capable of triggering a human flu pandemic.
It notes a method called "passaging," while not entirely predictable, could be a "potentially highly effective" way to push a virus to develop virulence.
"Such forced antigenic shifts could be attempted in a biological weapons program," says the 15-page report, dated Dec. 8, 2004.
Passaging involves the repeated cycling of strains of a virus through generations of a species of animals or through cell culture. The process can be used to either ratchet up or dial down the virulence of a virus, depending on which of the ensuing offspring - the mild or the severe - are selected in each cycle for the next passage.
There is debate in the community of infectious disease experts whether influenza would make a good bioterrorism agent. For one thing, once released, the virus would not discriminate between friend or foe. Terrorists and their supporters would be as likely to fall ill and die as those they hoped to target.
But if the ultimate goal is panic, social disruption and economic losses, influenza would be a good choice, says Dr. Brian Ward, a virologist at McGill University in Montreal.
"To me it's one of the most logical viruses to use. It doesn't have to be a really bad one to throw a huge wrench," Ward said.
"I mean, if you want to hurt the world's economy, that's an awfully good way."
Canada estimates the direct and indirect health-care costs alone of a mild flu pandemic would range from $10 billion to $24 billion. That doesn't start to count societal costs such as lost productivity because of mass illness or the impact on vulnerable industries such as airlines and tourism or the insurance sector that would be hit with business losses and death claims.
But influenza expert Dr. Earl Brown suggests that while flu makes a good theoretical bioterror agent, the reality of these "delicate" viruses is that the task would be harder than it appears.
"Flu is a wimpy virus, which I think is the one knock against it. It doesn't persist in the environment (outside a human) very long," says Brown, a University of Ottawa scientist who specializes in the evolution of influenza viruses.
"You have to infect people sort of straight away, otherwise it's going to die sitting around the environment."
Brown, who has done expensive work on reassorting or mating flu viruses, says any virus bred to spread would have to meet several key criteria: it would need to jump the species barrier and have the ability both to transmit easily and cause severe disease if it did.
"If you want to see chaos and mayhem and you're not concerned about the backlash, then you just have to get to the biology. And right now nobody can do it," Brown says.
"There's a good chance that you'd make something that just would burn out. It just wouldn't spread very well."
The report also raises the spectre of a pandemic strain engineered in a laboratory using reverse genetics. That technically challenging process allows scientists to custom tailor a flu virus, taking genes from a virulent but not highly transmissible strain, for instance, and melding them with genes from a virus that transmits well from person to person.
The report notes this is a technique scientists have been using to try to decipher why the virus that caused the Spanish flu of 1918-1919 was so deadly. That pandemic, which may have claimed upwards of 50 million lives worldwide, was the worst in known history.
"It is feared that this process could be copied . . . to produce a human viral strain similar to the 1918-1919 pandemic," the report says.
It also theorizes that a naturally occurring pandemic may be imminent, unless rigorous measures are taken to contain the spread of the H5N1 avian flu strain that has been responsible for more than 45 deaths in Southeast Asia in the last 14 months.
The report says factors such as the region's inability to eradicate the virus and influenza's propensity to mutate rapidly "raises the possibility that a novel strain capable of efficient human-to-human transmission may arise in the near future, threatening Canadian operations worldwide."
©*The Canadian Press 2005
http://www.canada.com/health/story.html?id=cf20c021-2153-4b60-9924-38655b4d9e1f&page=2