Yesterday's thread is here:
http://www.timebomb2000.com/vb/showthread.php?t=142117
http://www.timebomb2000.com/vb/showthread.php?t=142117
[AI] Avian Influenza Daily Thread 03.09.05
- Thread starter LMonty911
- Start date
Bingo, CSue, we have a winner! Asymptomatic case identified in a family cluster!! I bet Niman will be all over this tomorrow...
Grandfather of two Vietnamese avian flu patients also infected: doctors
Canadian Press
March 8, 2005
HANOI, Vietnam (AP) - The grandfather of two siblings infected with avian flu in Vietnam also has contracted the virus, which has killed 46 people in the region, Vietnamese health officials said Wednesday.
Test results Tuesday at the Vietnamese National Institute of Hygiene and Epidemology in Hanoi showed the 80-year-old man from northern Thai Binh province was infected with the severe H5N1 strain of the flu, said Pham Van Diu, director of the Thai Binh provincial Preventive Medicine Centre.
However, the man has not shown any symptoms of the illness and remains in good health at his home, said Diu.
His 21-year-old grandson and 14-year-old granddaughter are in hospital in Hanoi.
None of the remaining 12 family members has tested positive for the virus, he said.
Health authorities suspect the three may have been infected with the disease after eating a goose the man slaughtered Feb. 8. The family ate chickens and geese several times during the week-long Lunar New Year festival last month, he said.
Vietnam has had a total of 33 deaths from the deadly disease, 13 of them in the latest outbreak which began last December
edited to add I'm having a hard time trying to harvest that link-my 'puter is doing really weird things when I try to copy it. Heres another take on it-
Posted on Tue, Mar. 08, 2005
Vietnam grandfather infected with bird flu
TINI TRAN
Associated Press
HANOI, Vietnam - The grandfather of two siblings infected with the bird flu has also contracted the virus, but has not shown symptoms of the disease that has killed 46 people in the region, Vietnamese health officials said Wednesday.
Test results showed that the 80-year-old man from northern Thai Binh province was infected with the H5N1 strain of the bird flu, said Pham Van Diu, director of the Thai Binh provincial Preventive Medicine Center.
The man, whose 21-year-old grandson and 14-year-old granddaughter are hospitalized in Hanoi, has not shown any bird flu symptoms and remains at home in good health, said Diu.
None of the remaining 12 family members have tested positive for the virus, he said.
Health authorities suspect the three may have been infected with the disease after eating a goose the grandfather slaughtered on Feb. 8. The family ate chickens and geese several times during the week-long Lunar New Year festival last month, he said.
Vietnam has had a total of 33 deaths from the deadly disease, 14 of them in the latest outbreak which began last December.
On Tuesday, the World Health Organization said seven Vietnamese patients who initially tested negative for bird flu were found to be carrying the virus after their samples were retested.
All seven, who were first tested in January, have since recovered, said WHO regional spokesman Peter Cordingley.
"There's no doubt. The WHO accepts that we are missing cases. It's quite possible that some people are falling sick and their symptoms are very light and they don't end up in hospital," he said.
The WHO will wait to receive more details on the seven cases before adding them to the overall tally for Vietnam, Cordingley said.
The seven cases were part of a batch of nearly 90 specimens that had tested negative at Ho Chi Minh City's Pasteur Institute, an official there said on condition of anonymity.
The samples were sent to a laboratory in Japan as part of a move earlier in the year by the WHO, Japan's National Institute of Infectious Diseases and the U.S. Centers for Disease Control and Prevention, to work with health authorities in Vietnam to improve the reliability of diagnostic tests.
The seven people, all from southern Vietnam, did not have clinical or epidemiological factors typical of previous bird flu cases, the institute official said. One patient had tuberculosis.
Last month, the New England Journal of Medicine reported on one case dating back to February 2004 where the victim exhibited none of the classic respiratory symptoms associated with bird flu.
Instead, Oxford University researchers said the 4-year-old boy had suffered from encephalitis, or inflammation of the brain, before slipping into a coma. His case was only discovered months later after researchers found his samples among encephalitis victims.
Those findings suggested that avian influenza may be more widespread than originally believed because the total number of infections may have been underestimated.
http://www.montereyherald.com/mld/montereyherald/news/breaking_news/11084577.htm?template=contentModules/printstory.jsp
Grandfather of two Vietnamese avian flu patients also infected: doctors
Canadian Press
March 8, 2005
HANOI, Vietnam (AP) - The grandfather of two siblings infected with avian flu in Vietnam also has contracted the virus, which has killed 46 people in the region, Vietnamese health officials said Wednesday.
Test results Tuesday at the Vietnamese National Institute of Hygiene and Epidemology in Hanoi showed the 80-year-old man from northern Thai Binh province was infected with the severe H5N1 strain of the flu, said Pham Van Diu, director of the Thai Binh provincial Preventive Medicine Centre.
However, the man has not shown any symptoms of the illness and remains in good health at his home, said Diu.
His 21-year-old grandson and 14-year-old granddaughter are in hospital in Hanoi.
None of the remaining 12 family members has tested positive for the virus, he said.
Health authorities suspect the three may have been infected with the disease after eating a goose the man slaughtered Feb. 8. The family ate chickens and geese several times during the week-long Lunar New Year festival last month, he said.
Vietnam has had a total of 33 deaths from the deadly disease, 13 of them in the latest outbreak which began last December
edited to add I'm having a hard time trying to harvest that link-my 'puter is doing really weird things when I try to copy it. Heres another take on it-
Vietnam grandfather infected with bird flu
TINI TRAN
Associated Press
HANOI, Vietnam - The grandfather of two siblings infected with the bird flu has also contracted the virus, but has not shown symptoms of the disease that has killed 46 people in the region, Vietnamese health officials said Wednesday.
Test results showed that the 80-year-old man from northern Thai Binh province was infected with the H5N1 strain of the bird flu, said Pham Van Diu, director of the Thai Binh provincial Preventive Medicine Center.
The man, whose 21-year-old grandson and 14-year-old granddaughter are hospitalized in Hanoi, has not shown any bird flu symptoms and remains at home in good health, said Diu.
None of the remaining 12 family members have tested positive for the virus, he said.
Health authorities suspect the three may have been infected with the disease after eating a goose the grandfather slaughtered on Feb. 8. The family ate chickens and geese several times during the week-long Lunar New Year festival last month, he said.
Vietnam has had a total of 33 deaths from the deadly disease, 14 of them in the latest outbreak which began last December.
On Tuesday, the World Health Organization said seven Vietnamese patients who initially tested negative for bird flu were found to be carrying the virus after their samples were retested.
All seven, who were first tested in January, have since recovered, said WHO regional spokesman Peter Cordingley.
"There's no doubt. The WHO accepts that we are missing cases. It's quite possible that some people are falling sick and their symptoms are very light and they don't end up in hospital," he said.
The WHO will wait to receive more details on the seven cases before adding them to the overall tally for Vietnam, Cordingley said.
The seven cases were part of a batch of nearly 90 specimens that had tested negative at Ho Chi Minh City's Pasteur Institute, an official there said on condition of anonymity.
The samples were sent to a laboratory in Japan as part of a move earlier in the year by the WHO, Japan's National Institute of Infectious Diseases and the U.S. Centers for Disease Control and Prevention, to work with health authorities in Vietnam to improve the reliability of diagnostic tests.
The seven people, all from southern Vietnam, did not have clinical or epidemiological factors typical of previous bird flu cases, the institute official said. One patient had tuberculosis.
Last month, the New England Journal of Medicine reported on one case dating back to February 2004 where the victim exhibited none of the classic respiratory symptoms associated with bird flu.
Instead, Oxford University researchers said the 4-year-old boy had suffered from encephalitis, or inflammation of the brain, before slipping into a coma. His case was only discovered months later after researchers found his samples among encephalitis victims.
Those findings suggested that avian influenza may be more widespread than originally believed because the total number of infections may have been underestimated.
http://www.montereyherald.com/mld/montereyherald/news/breaking_news/11084577.htm?template=contentModules/printstory.jsp
Last edited:
and another!
http://www.asianews.it/view.php?l=en&art=2732
9 March, 2005
VIETNAM
New, asymptomatic bird flu cases
The disease might be more widespread than thought before.
Hanoi (AsiaNews/Agencies) – The avian or bird flu might strike without patients showing any symptoms—the disease might therefore be more widespread than thought before.
Today Vietnamese health authorities have released information about two such cases. Nguyen Tran Hien, director of the National Institute for Hygiene and Epidemiology, confirmed that lab tests showed that a 61-year-old woman from northern Thai Binh province had contracted the H5N1 virus but was not showing any symptoms.
The woman’s husband died on February 23 from the bird flu but thus far she has not shown any of the disease’s typical symptoms such as respiratory problems and high fever. She remains in good health but has been placed in isolation.
Nguyen Van Thieu, director of the Kien Xuong District Medical Centre in Thai Binh, explained that the “source of infection is still unclear”. The woman’s family raised chickens but none was infected.
Tests conducted at the National Institute for Hygiene and Epidemiology in Hanoi showed that an 80-year-old man had also contracted the virus but he, too, had not fallen ill. By contrast, his 21-year-old grandson and his 14-year-old granddaughter had been hospitalised earlier in Hanoi with the bird flu.
Health officials suspect the three, who are also from Thai Binh province, might have become infected eating an infected duck a month ago.
So far there is no evidence of person-to-person contagion. However, the two latest cases are raising fears that the bird flu might be more widespread than thought before.
“It's quite possible that some people are falling sick and their symptoms are very light and they don't end up in hospital,” Peter Cordingley, regional spokesman for the World Health Organisation, said earlier this week.
Since 2003 the bird flu has killed 46 people in South-East Asia: 33 in Vietnam, 12 in Thailand and 1 in Cambodia. It has also forced the authorities to cull millions of birds.
Copyright © 2003 AsiaNews
All rights reserved
http://www.asianews.it/view.php?l=en&art=2732
9 March, 2005
VIETNAM
New, asymptomatic bird flu cases
The disease might be more widespread than thought before.
Hanoi (AsiaNews/Agencies) – The avian or bird flu might strike without patients showing any symptoms—the disease might therefore be more widespread than thought before.
Today Vietnamese health authorities have released information about two such cases. Nguyen Tran Hien, director of the National Institute for Hygiene and Epidemiology, confirmed that lab tests showed that a 61-year-old woman from northern Thai Binh province had contracted the H5N1 virus but was not showing any symptoms.
The woman’s husband died on February 23 from the bird flu but thus far she has not shown any of the disease’s typical symptoms such as respiratory problems and high fever. She remains in good health but has been placed in isolation.
Nguyen Van Thieu, director of the Kien Xuong District Medical Centre in Thai Binh, explained that the “source of infection is still unclear”. The woman’s family raised chickens but none was infected.
Tests conducted at the National Institute for Hygiene and Epidemiology in Hanoi showed that an 80-year-old man had also contracted the virus but he, too, had not fallen ill. By contrast, his 21-year-old grandson and his 14-year-old granddaughter had been hospitalised earlier in Hanoi with the bird flu.
Health officials suspect the three, who are also from Thai Binh province, might have become infected eating an infected duck a month ago.
So far there is no evidence of person-to-person contagion. However, the two latest cases are raising fears that the bird flu might be more widespread than thought before.
“It's quite possible that some people are falling sick and their symptoms are very light and they don't end up in hospital,” Peter Cordingley, regional spokesman for the World Health Organisation, said earlier this week.
Since 2003 the bird flu has killed 46 people in South-East Asia: 33 in Vietnam, 12 in Thailand and 1 in Cambodia. It has also forced the authorities to cull millions of birds.
Copyright © 2003 AsiaNews
All rights reserved
http://www.knoxstudio.com/shns/story.cfm?pk=BIRDFLU-03-09-05&cat=AN
NATIONAL
Bird flu threat scares experts
By EDIE LAU
Sacramento Bee
March 09, 2005
- The flu this winter is still going around, but the buzz in the public health community is about next season's flu.
Word is, we could have a pandemic.
A pandemic is a disease that strikes many more people than usual in multiple countries. The flu circulates worldwide every year, of course, but a few particularly nasty versions of the virus are brewing in Asia.
The versions are called avian influenza because historically, they've infected birds, not people. Therein lies their danger.
"The (virus variety) will be one that we've never seen circulating in the human population, so we wouldn't have immunity to that," said Nicole Baumgarth, a University of California, Davis, immunologist who studies influenza.
"That's why people get so scared about it."
The fear is based on more than theory. Between Jan. 28, 2004, and Feb. 2 of this year, 42 of 55 people who contracted avian influenza in Asia died, according to a World Health Organization count.
Some individuals may be relatively resistant to the virus' effects: The WHO reported Tuesday it had tentatively identified seven people who were infected without becoming very ill. All the same, the death rate is very high for a flu bug. And the number of cases continues to grow.
Human infections have been detected in three countries: Vietnam, Thailand and Cambodia. With world travel as common as it is today, chances are high that the virus will spread.
"It's definitely going to come," Baumgarth said. "The thing is, how bad will it be?"
By nature, flu viruses are genetically unstable, constantly mutating. That's why the public health system comes out with new vaccines each year that it hopes match the variety of flu that is predicted to hit.
Because of the mutations, the possibility of an avian flu virus changing enough to infect humans is a constant threat, said Dr. Howard Backer, chief of the immunization branch and medical consultant for emergency preparedness at the California Department of Health Services.
But the strains circulating in Asia are of particular concern, Backer said, because:
- Culling chickens in affected areas, an act that contained past human outbreaks of avian flu, has not worked.
- The virus is highly lethal.
- Cats and pigs can become infected, too. The presence in pigs is especially worrisome, because for some reason, pigs are a good "mixing vessel" for flu genes, allowing a genetic shuffling that may produce dramatically new forms of the virus.
The one thing that keeps this flu from causing a pandemic now is that it doesn't spread easily from person to person. Health officials in this country aren't worried about Americans catching it from domestic chickens - assuming our fowl were infected - because livestock are housed much differently here.
Where the avian flu has popped up in humans, the people live in closer contact with their birds; for example, giving chickens the run of the back yard.
But if the virus mutates enough to begin transmitting easily among people, health officials fear the worst.
For those who've weathered many bouts of the flu, it may seem odd to think of the sickness as something that will kill you. Usually it doesn't, except in cases involving very young or very old people, or those with weak immune systems.
That's because most strains of the flu that infect people have been around a long time; at least some among us have developed some resistance to their effects.
Scientists who have examined influenza viruses under microscopes say they basically all look alike.
"In general, they're made out of the same genes and the same proteins," said Frederick Murphy, a University of California, Davis virologist and former director of the Center for Infectious Diseases at the national Centers for Disease Control and Prevention.
"They're about 100 nanometers in diameter," he said, referring to a measurement smaller than one one-millionth of an inch, "and they have an envelope with spikes sticking off the surface."
By themselves, viruses cannot reproduce. They need a "host," a cell of a living organism, to multiply.
The usual way people catch the flu is by inhaling viral particles in the air. The particles settle in the throat. Some of the spikes on the particle's surface, which protrude like upside-down bowling pins, enable it to latch onto and invade a cell.
Then the virus forces the cell to make more viruses.
Other spikes on its surface, which are shaped like mushrooms, enable a new particle to "bud off" from a hijacked cell. It goes on to infect another cell.
That's generally how a flu infection sets in, but how severe the infection will be, or whether the virus manages to infect at all, depends on the bug.
NATIONAL
Bird flu threat scares experts
By EDIE LAU
Sacramento Bee
March 09, 2005
- The flu this winter is still going around, but the buzz in the public health community is about next season's flu.
Word is, we could have a pandemic.
A pandemic is a disease that strikes many more people than usual in multiple countries. The flu circulates worldwide every year, of course, but a few particularly nasty versions of the virus are brewing in Asia.
The versions are called avian influenza because historically, they've infected birds, not people. Therein lies their danger.
"The (virus variety) will be one that we've never seen circulating in the human population, so we wouldn't have immunity to that," said Nicole Baumgarth, a University of California, Davis, immunologist who studies influenza.
"That's why people get so scared about it."
The fear is based on more than theory. Between Jan. 28, 2004, and Feb. 2 of this year, 42 of 55 people who contracted avian influenza in Asia died, according to a World Health Organization count.
Some individuals may be relatively resistant to the virus' effects: The WHO reported Tuesday it had tentatively identified seven people who were infected without becoming very ill. All the same, the death rate is very high for a flu bug. And the number of cases continues to grow.
Human infections have been detected in three countries: Vietnam, Thailand and Cambodia. With world travel as common as it is today, chances are high that the virus will spread.
"It's definitely going to come," Baumgarth said. "The thing is, how bad will it be?"
By nature, flu viruses are genetically unstable, constantly mutating. That's why the public health system comes out with new vaccines each year that it hopes match the variety of flu that is predicted to hit.
Because of the mutations, the possibility of an avian flu virus changing enough to infect humans is a constant threat, said Dr. Howard Backer, chief of the immunization branch and medical consultant for emergency preparedness at the California Department of Health Services.
But the strains circulating in Asia are of particular concern, Backer said, because:
- Culling chickens in affected areas, an act that contained past human outbreaks of avian flu, has not worked.
- The virus is highly lethal.
- Cats and pigs can become infected, too. The presence in pigs is especially worrisome, because for some reason, pigs are a good "mixing vessel" for flu genes, allowing a genetic shuffling that may produce dramatically new forms of the virus.
The one thing that keeps this flu from causing a pandemic now is that it doesn't spread easily from person to person. Health officials in this country aren't worried about Americans catching it from domestic chickens - assuming our fowl were infected - because livestock are housed much differently here.
Where the avian flu has popped up in humans, the people live in closer contact with their birds; for example, giving chickens the run of the back yard.
But if the virus mutates enough to begin transmitting easily among people, health officials fear the worst.
For those who've weathered many bouts of the flu, it may seem odd to think of the sickness as something that will kill you. Usually it doesn't, except in cases involving very young or very old people, or those with weak immune systems.
That's because most strains of the flu that infect people have been around a long time; at least some among us have developed some resistance to their effects.
Scientists who have examined influenza viruses under microscopes say they basically all look alike.
"In general, they're made out of the same genes and the same proteins," said Frederick Murphy, a University of California, Davis virologist and former director of the Center for Infectious Diseases at the national Centers for Disease Control and Prevention.
"They're about 100 nanometers in diameter," he said, referring to a measurement smaller than one one-millionth of an inch, "and they have an envelope with spikes sticking off the surface."
By themselves, viruses cannot reproduce. They need a "host," a cell of a living organism, to multiply.
The usual way people catch the flu is by inhaling viral particles in the air. The particles settle in the throat. Some of the spikes on the particle's surface, which protrude like upside-down bowling pins, enable it to latch onto and invade a cell.
Then the virus forces the cell to make more viruses.
Other spikes on its surface, which are shaped like mushrooms, enable a new particle to "bud off" from a hijacked cell. It goes on to infect another cell.
That's generally how a flu infection sets in, but how severe the infection will be, or whether the virus manages to infect at all, depends on the bug.
I kinda figured Dr. Niman would be all over this today...he's been warning about this for some time. (bolded sections my own empthasis)
Commentary
http://www.recombinomics.com/News/03090503/Thai_Binh_Asymptomatic.html
Three Reported Asymptomatic Thai Binh Bird Flu Patients
Recombinomics Commentary
March 9, 2005
>> Vietnamese health officials said Wednesday the 61-year-old widow of a bird flu victim has also tested positive for the H5N1 virus, but showed no symptoms.
Earlier in the day, officials reported that an 80-year-old man - who had two infected grandchildren - also had the virus but did not fall ill.
The two cases raised concerns that avian influenza may be more widespread than originally believed. <<
The two asymptomatic H5N1 positive patients in Thai Binh raise the number of reported clusters with a reported asymptomatic case to three. The youngest brother of the January familial cluster was also reported to have been positive for H5N1, although he also did not have symptoms.
Detecting H5N1 in three family members of the Thai Binh cluster is clearly cause for concern. Although similar patients have not been reported in the south, the assays at the Pasteur Institute have had sensitivity problems and were creating false negatives in patients who had symptoms but survived. These patients had atypical symptoms and epidemiological histories, strongly suggesting that they too were infected via human-to-human transmission.
The false negatives in atypical cases in the south coupled with asymptomatic family members of confirmed H5N1 fatal cases in the north, indicates that H5N1 can produce a wide range of symptoms in humans and has achieved efficient transmission.
The poor surveillance precludes definitive answers on the extent of the spread, but it is clearly well above previously reported levels and has probably spread beyond the borders of Vietnam and Thailand. The cases in Cambodia have also been described as complex, hinting at further unreported spread.
These reports highlight the poor monitoring of H5N1 and expose the folly of trying to control a virus that is silently spreading throughout the region. A massive screening effort is long overdue and is probably too late to control H5N1 in humans. The virus that was detected in January, 2004 in human-to-human transmissions in Thai Binh has clearly continued to infect additional patients.
The failed monitoring and control of H5N1 in southeast Asia is well beyond scandalous.
Commentary
http://www.recombinomics.com/News/03090503/Thai_Binh_Asymptomatic.html
Three Reported Asymptomatic Thai Binh Bird Flu Patients
Recombinomics Commentary
March 9, 2005
>> Vietnamese health officials said Wednesday the 61-year-old widow of a bird flu victim has also tested positive for the H5N1 virus, but showed no symptoms.
Earlier in the day, officials reported that an 80-year-old man - who had two infected grandchildren - also had the virus but did not fall ill.
The two cases raised concerns that avian influenza may be more widespread than originally believed. <<
The two asymptomatic H5N1 positive patients in Thai Binh raise the number of reported clusters with a reported asymptomatic case to three. The youngest brother of the January familial cluster was also reported to have been positive for H5N1, although he also did not have symptoms.
Detecting H5N1 in three family members of the Thai Binh cluster is clearly cause for concern. Although similar patients have not been reported in the south, the assays at the Pasteur Institute have had sensitivity problems and were creating false negatives in patients who had symptoms but survived. These patients had atypical symptoms and epidemiological histories, strongly suggesting that they too were infected via human-to-human transmission.
The false negatives in atypical cases in the south coupled with asymptomatic family members of confirmed H5N1 fatal cases in the north, indicates that H5N1 can produce a wide range of symptoms in humans and has achieved efficient transmission.
The poor surveillance precludes definitive answers on the extent of the spread, but it is clearly well above previously reported levels and has probably spread beyond the borders of Vietnam and Thailand. The cases in Cambodia have also been described as complex, hinting at further unreported spread.
These reports highlight the poor monitoring of H5N1 and expose the folly of trying to control a virus that is silently spreading throughout the region. A massive screening effort is long overdue and is probably too late to control H5N1 in humans. The virus that was detected in January, 2004 in human-to-human transmissions in Thai Binh has clearly continued to infect additional patients.
The failed monitoring and control of H5N1 in southeast Asia is well beyond scandalous.
this is a very sobering article, and i hope the sheep wake up....
Bird flu shares many traits of devastating 1918 pandemic
Mark Kennedy
CanWest News Service
http://www.canada.com/saskatoon/starphoenix/news/story.html?id=d13c0062-4047-471b-86d1-f81ea8ffcd3d
March 9, 2005
GENEVA -- There are frightening similarities between the bird flu virus raging in Southeast Asia that threatens to spark a global human influenza pandemic and the devastating "Spanish flu" outbreak that killed tens of millions of people in 1918.
That warning comes from the World Health Organization and top virologists who are nervously watching the situation unfold in Thailand and Vietnam, where this week the first possible human-to-human transmission between unrelated people emerged, raising the spectre the lethal virus is changing to become more easily spread among humans.
No one wants to outright predict that the flu virus -- known as H5N1 -- currently causing so much concern will ultimately mutate into a strain as virulent as the one that swept through the world 87 years ago.
Indeed, public health experts at the WHO stress they still don't know how dangerous the next pandemic will be. But they add ominously that while it could be a mild virus that kills as few as two million people, the scenario could be much worse, with fatalities of more than 50 million worldwide.
And in North America, top experts are urging people not to become indifferent to their warnings that a flu pandemic will some day sweep through the world.
"We're not scare-mongering here," said Frank Plummer, scientific director of the Winnipeg-based national microbiology lab, part of the Public Health Agency of Canada.
"We're not crying wolf. There is a wolf. We just don't know when it's coming."
In the meantime, experts are gripped by the eerie parallels with the most devastating public health disaster in history.
"The present situation may resemble that leading up to the 1918 pandemic," the WHO writes in a report which includes a section on the "assessment of the threat."
"Similarities between the H5N1 and 1918 viruses have been suggested in the gradual adaptation of an avian to a human-like virus, the severity of disease, its concentration in young and healthy people, and the occurrence of primary viral pneumonia in addition to secondary bacterial pneumonia."
In an interview with CanWest News Service, Dr. Klaus Stohr, head of the WHO's Global Influenza Program, urged political leaders to immediately start preparing for a pandemic by stockpiling antivirals, conducting research so that the production of life-saving vaccines can be expedited once a pandemic hits, and preparing contingency plans that spell out how countries would respond to a global outbreak -- everything from possible quarantine of infected people to cancellation of public meetings.
Indeed, Stohr's message is blunt: "An influenza pandemic cannot be prevented when the virus has come out. It will spread globally. It's out of the box. What comes afterwards is damage control."
One of the top flu pandemic experts in the U.S. calls the parallels between today's H5N1 virus and the strain in 1918 "frightening."
"It is killing an otherwise healthy group of people in the prime of their life. And it is doing it with an illness that is so reminiscent of 1918 -- respiratory distress syndrome," Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said in an interview.
Osterholm suggests people consider the devastation of the recent tsunamis in South Asia -- how the disaster brought society and commerce to a halt, resulted in tens of thousands of bodies piled up, and left a shattered population in despair.
"Duplicate it in every major urban centre and rural community around the planet simultaneously, add in the paralysing fear and panic of contagion, and we begin to get some sense of the potential of pandemic influenza," he warns.
© The StarPhoenix (Saskatoon) 2005
Bird flu shares many traits of devastating 1918 pandemic
Mark Kennedy
CanWest News Service
http://www.canada.com/saskatoon/starphoenix/news/story.html?id=d13c0062-4047-471b-86d1-f81ea8ffcd3d
March 9, 2005
GENEVA -- There are frightening similarities between the bird flu virus raging in Southeast Asia that threatens to spark a global human influenza pandemic and the devastating "Spanish flu" outbreak that killed tens of millions of people in 1918.
That warning comes from the World Health Organization and top virologists who are nervously watching the situation unfold in Thailand and Vietnam, where this week the first possible human-to-human transmission between unrelated people emerged, raising the spectre the lethal virus is changing to become more easily spread among humans.
No one wants to outright predict that the flu virus -- known as H5N1 -- currently causing so much concern will ultimately mutate into a strain as virulent as the one that swept through the world 87 years ago.
Indeed, public health experts at the WHO stress they still don't know how dangerous the next pandemic will be. But they add ominously that while it could be a mild virus that kills as few as two million people, the scenario could be much worse, with fatalities of more than 50 million worldwide.
And in North America, top experts are urging people not to become indifferent to their warnings that a flu pandemic will some day sweep through the world.
"We're not scare-mongering here," said Frank Plummer, scientific director of the Winnipeg-based national microbiology lab, part of the Public Health Agency of Canada.
"We're not crying wolf. There is a wolf. We just don't know when it's coming."
In the meantime, experts are gripped by the eerie parallels with the most devastating public health disaster in history.
"The present situation may resemble that leading up to the 1918 pandemic," the WHO writes in a report which includes a section on the "assessment of the threat."
"Similarities between the H5N1 and 1918 viruses have been suggested in the gradual adaptation of an avian to a human-like virus, the severity of disease, its concentration in young and healthy people, and the occurrence of primary viral pneumonia in addition to secondary bacterial pneumonia."
In an interview with CanWest News Service, Dr. Klaus Stohr, head of the WHO's Global Influenza Program, urged political leaders to immediately start preparing for a pandemic by stockpiling antivirals, conducting research so that the production of life-saving vaccines can be expedited once a pandemic hits, and preparing contingency plans that spell out how countries would respond to a global outbreak -- everything from possible quarantine of infected people to cancellation of public meetings.
Indeed, Stohr's message is blunt: "An influenza pandemic cannot be prevented when the virus has come out. It will spread globally. It's out of the box. What comes afterwards is damage control."
One of the top flu pandemic experts in the U.S. calls the parallels between today's H5N1 virus and the strain in 1918 "frightening."
"It is killing an otherwise healthy group of people in the prime of their life. And it is doing it with an illness that is so reminiscent of 1918 -- respiratory distress syndrome," Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said in an interview.
Osterholm suggests people consider the devastation of the recent tsunamis in South Asia -- how the disaster brought society and commerce to a halt, resulted in tens of thousands of bodies piled up, and left a shattered population in despair.
"Duplicate it in every major urban centre and rural community around the planet simultaneously, add in the paralysing fear and panic of contagion, and we begin to get some sense of the potential of pandemic influenza," he warns.
© The StarPhoenix (Saskatoon) 2005
Asymptomatic Cases the big flu news of the day
Relatives of avian flu patients have asymptomatic cases
Robert Roos
News Editor
Mar 9, 2005 (CIDRAP News) – Two relatives of avian influenza patients in northern Vietnam have tested positive for the virus without being sick, according to reports from Vietnam today.
The 61-year-old widow of a man who died of avian flu in late February and the 80-year-old grandfather of two patients currently under treatment in a hospital have tested positive, the Associated Press (AP) and other news services reported. Both are apparently healthy.
Both people live in Thai Binh province, where five other avian flu cases have been reported in the past 2 weeks.
The AP said Nguyen Tran Hien, director of the National Institute for Hygiene and Epidemiology in Hanoi, confirmed that the 61-year-old woman had tested positive for the H5N1 virus. The director of a district medical center in Thai Binh, Nguyen Van Thieu, said the woman remained in good health but was isolated at home, the story said.
Her 69-year-old husband fell ill Feb 19 and died Feb 23, Thieu said. He said the family had raised some chickens, but they remained healthy, and the source of the woman's infection was unclear.
The 80-year-old is the grandfather of a 21-year-old man and a 14-year-old girl who have avian flu. The young man has been in critical condition for 2 weeks, while the girl is in good condition though still hospitalized, Agence France-Presse (AFP) reported today.
Testing completed yesterday at the National Institute of Hygiene and Epidemiology showed that the grandfather had the H5N1 virus, the AP reported, quoting Pham Van Diu, director of the province's Preventive Medicine Center. Diu said the man was at home and in good health.
A Reuters report today quoted health officials in the man's village as saying he had drunk raw duck blood during the Lunar New Year festivities in February. But the AFP story said it was unclear whether he had caught the virus from infected poultry or from his grandchildren. None of 12 other relatives tested positive for the virus, the AP reported.
The two new cases are not the first sign that people can contract the H5N1 virus without getting ill or seriously ill. Mild and asymptomatic cases were seen when the virus first jumped to humans in Hong Kong in 1997, Dick Thompson, infectious disease spokesman for the World Health Organization (WHO) in Geneva, told CIDRAP News via e-mail today. (Six of 18 people infected in that outbreak died.)
In addition, a Japanese man was found to have been infected while working at a farm where a poultry outbreak of H5N1 avian flu occurred in February 2003, though he never got sick, according to news reports in December 2004.
The confirmation of asymptomatic cases implies that infections may be more common than previously thought and that the case-fatality rate may be lower. The fatality rate for officially confirmed cases has hovered in the 70% range.
Thompson commented, "The CFR [case-fatality rate] had to be overstated. The cases we were sure of were those which were sick enough to go to a hospital and these extreme cases have very poor outcomes. Surely others were infected and either not getting sick or not getting sick enough to seek treatment at a hospital. Factoring those into the CFR has been impossible. We simply don't know the denominator."
Dr. Arlene King of the Public Health Agency of Canada told CIDRAP News that researchers in Asia have conducted serologic surveys in an effort to find asymptomatic cases, but full results have not been released yet. In a newspaper report yesterday, she said, the WHO's Peter Horby reported that a serologic survey of Asian healthcare workers who had cared for avian flu patients found no evidence of infection among the workers. King is director of the agency's Immunization and Respiratory Infections Division in Ottawa.
King said mild and asymptomatic cases of avian flu could go undetected even if people are tested, depending on test sensitivity. "The sensitivity of tests may be higher in sick patients," she said. "If you're swabbing patients who are less sick, maybe your tests are less sensitive."
If avian flu cases are more common than suspected, it raises the question whether the virus has more opportunities to mix, or "re-assort," with human-adapted flu viruses. Reassortment could lead to a mutated virus that could spread easily from person to person, potentially triggering a flu pandemic in a world population with little or no resistance to the virus.
Thompson said the WHO is assessing the implications of asymptomatic cases for viral reassortment. "We hope to have something soon," he wrote.
King commented, "I think we know so little about the conditions in which that [reassortment] occurs that it's really difficult to speculate on that."
King said it would not surprise her if the two latest cases are found to involve person-to-person transmission, given that some possible cases of human transmission have been seen previously in the past year. "The two settings you're going to see them [cases involving human transmission] in are households and healthcare settings, because that's where infection gets amplified," she said.
Several family clusters of cases have occurred since H5N1 avian flu began spreading in Southeast Asia in late 2003, but human-to-human transmission has been described as probable in only one instance so far. Researchers concluded that the mother and an aunt of an 11-year-old girl probably acquired the virus from her when they cared for her in a hospital in Thailand in September 2004.
Staff writer Amy L. Becker contributed to this report.
See also:
CIDRAP case-count tables
http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/case-count/avflucount.html
Center for Infectious Disease Research & Policy
Relatives of avian flu patients have asymptomatic cases
Robert Roos
Mar 9, 2005 (CIDRAP News) – Two relatives of avian influenza patients in northern Vietnam have tested positive for the virus without being sick, according to reports from Vietnam today.
The 61-year-old widow of a man who died of avian flu in late February and the 80-year-old grandfather of two patients currently under treatment in a hospital have tested positive, the Associated Press (AP) and other news services reported. Both are apparently healthy.
Both people live in Thai Binh province, where five other avian flu cases have been reported in the past 2 weeks.
The AP said Nguyen Tran Hien, director of the National Institute for Hygiene and Epidemiology in Hanoi, confirmed that the 61-year-old woman had tested positive for the H5N1 virus. The director of a district medical center in Thai Binh, Nguyen Van Thieu, said the woman remained in good health but was isolated at home, the story said.
Her 69-year-old husband fell ill Feb 19 and died Feb 23, Thieu said. He said the family had raised some chickens, but they remained healthy, and the source of the woman's infection was unclear.
The 80-year-old is the grandfather of a 21-year-old man and a 14-year-old girl who have avian flu. The young man has been in critical condition for 2 weeks, while the girl is in good condition though still hospitalized, Agence France-Presse (AFP) reported today.
Testing completed yesterday at the National Institute of Hygiene and Epidemiology showed that the grandfather had the H5N1 virus, the AP reported, quoting Pham Van Diu, director of the province's Preventive Medicine Center. Diu said the man was at home and in good health.
A Reuters report today quoted health officials in the man's village as saying he had drunk raw duck blood during the Lunar New Year festivities in February. But the AFP story said it was unclear whether he had caught the virus from infected poultry or from his grandchildren. None of 12 other relatives tested positive for the virus, the AP reported.
The two new cases are not the first sign that people can contract the H5N1 virus without getting ill or seriously ill. Mild and asymptomatic cases were seen when the virus first jumped to humans in Hong Kong in 1997, Dick Thompson, infectious disease spokesman for the World Health Organization (WHO) in Geneva, told CIDRAP News via e-mail today. (Six of 18 people infected in that outbreak died.)
In addition, a Japanese man was found to have been infected while working at a farm where a poultry outbreak of H5N1 avian flu occurred in February 2003, though he never got sick, according to news reports in December 2004.
The confirmation of asymptomatic cases implies that infections may be more common than previously thought and that the case-fatality rate may be lower. The fatality rate for officially confirmed cases has hovered in the 70% range.
Thompson commented, "The CFR [case-fatality rate] had to be overstated. The cases we were sure of were those which were sick enough to go to a hospital and these extreme cases have very poor outcomes. Surely others were infected and either not getting sick or not getting sick enough to seek treatment at a hospital. Factoring those into the CFR has been impossible. We simply don't know the denominator."
Dr. Arlene King of the Public Health Agency of Canada told CIDRAP News that researchers in Asia have conducted serologic surveys in an effort to find asymptomatic cases, but full results have not been released yet. In a newspaper report yesterday, she said, the WHO's Peter Horby reported that a serologic survey of Asian healthcare workers who had cared for avian flu patients found no evidence of infection among the workers. King is director of the agency's Immunization and Respiratory Infections Division in Ottawa.
King said mild and asymptomatic cases of avian flu could go undetected even if people are tested, depending on test sensitivity. "The sensitivity of tests may be higher in sick patients," she said. "If you're swabbing patients who are less sick, maybe your tests are less sensitive."
If avian flu cases are more common than suspected, it raises the question whether the virus has more opportunities to mix, or "re-assort," with human-adapted flu viruses. Reassortment could lead to a mutated virus that could spread easily from person to person, potentially triggering a flu pandemic in a world population with little or no resistance to the virus.
Thompson said the WHO is assessing the implications of asymptomatic cases for viral reassortment. "We hope to have something soon," he wrote.
King commented, "I think we know so little about the conditions in which that [reassortment] occurs that it's really difficult to speculate on that."
King said it would not surprise her if the two latest cases are found to involve person-to-person transmission, given that some possible cases of human transmission have been seen previously in the past year. "The two settings you're going to see them [cases involving human transmission] in are households and healthcare settings, because that's where infection gets amplified," she said.
Several family clusters of cases have occurred since H5N1 avian flu began spreading in Southeast Asia in late 2003, but human-to-human transmission has been described as probable in only one instance so far. Researchers concluded that the mother and an aunt of an 11-year-old girl probably acquired the virus from her when they cared for her in a hospital in Thailand in September 2004.
Staff writer Amy L. Becker contributed to this report.
See also:
CIDRAP case-count tables
http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/case-count/avflucount.html
Center for Infectious Disease Research & Policy
Sue, toddays news had certainly verified many of the assumptions on which you based your "pandemic in My City Thread". I'm glad to see it vindicated so quickly.
I'm assuming the reason the aymptomatic grandmother has been isolated is because they may be concerned about her shedding virus, even without sypmtoms, and therefore infecting others. If so, thats a clear indication they are very concerned that human-to human transmission is occuring in the cluster-or am I reading too much into this? Any other info or ideas on that? What am I missing?
TIA
I'm assuming the reason the aymptomatic grandmother has been isolated is because they may be concerned about her shedding virus, even without sypmtoms, and therefore infecting others. If so, thats a clear indication they are very concerned that human-to human transmission is occuring in the cluster-or am I reading too much into this? Any other info or ideas on that? What am I missing?
TIA
http://www.lnreview.co.uk/news/004931.php
Bird Flu turns symptomless: the threat to Gary Glitter deepens
March 10, 2005
They’re slippery customers, these Type A influenza viruses, what with all the antigenic shifting they get up to. They’re a bit like Dr Who: they keep changing, and with every mutation they tend to get worse.
The latest twist in the run-up to the global avian flu pandemic is a cute one: in northern Vietnam, a pair of elderly villagers – related to people who died of bird flu – tested positive for the virus but didn’t show any actual symptoms of ill health. This might sound like a good thing (symptomless flu? bring it on!) but all it means is that the virus has more chance of spreading unchecked through a population. Like estate agents at the weekend: they take their terrible suits and ties off and blend in. You could be standing next to one at a supermarket checkout and the only clue would be the faint reek of hair gel.*
One of the two symptom-free carriers (along with some of the others who have died) caught bird flu after drinking raw duck blood at the Tet Lunar New Year festival. Now, here’s some free advice. However excited you are to see in the New Year, what with all the firecrackers and men dressed as dragons and whatnot, it’s probably not best to celebrate the event by quaffing raw duck blood in an area rife with an avian flu virus that has a +70% fatality hit rate. In fact, the three easiest ways to avoid catching the H5N1 avian virus are as follows: 1) not drinking raw Vietnamese duck blood; 2) not drinking raw Vietnamese duck blood; and 3) not drinking raw Vietnamese duck blood.
According to the Chinese calendar, 2005 is the year of the rooster (presumably the dead rooster who coughs his final breath straight into the farmer’s face). Raymond Lo, a feng shui “expert” told CNN: "Rooster years are associated with stabbings. Some celebrities may get stabbed or some celebrities might break their back." Oh, and one or two celebrities might get hit by the global flu pandemic which is going to take out about 60 million of us. Doesn’t Gary Glitter live in Thailand? Somewhere like that. And he probably bites the heads off live chickens to pass the time between fiddlings. Glitter’s going to be among the first to drop. Surely.
*Okay, okay, so that's not exactly symptomless, but so far - touch wood - estate agents haven't undergone the necessary DNA mutations to lose all of their telltale traits. But when that day finally comes... God help us all. There'll be riots in the streets. Kangaroo courts. Lynchings.
Bird Flu turns symptomless: the threat to Gary Glitter deepens
March 10, 2005
They’re slippery customers, these Type A influenza viruses, what with all the antigenic shifting they get up to. They’re a bit like Dr Who: they keep changing, and with every mutation they tend to get worse.
The latest twist in the run-up to the global avian flu pandemic is a cute one: in northern Vietnam, a pair of elderly villagers – related to people who died of bird flu – tested positive for the virus but didn’t show any actual symptoms of ill health. This might sound like a good thing (symptomless flu? bring it on!) but all it means is that the virus has more chance of spreading unchecked through a population. Like estate agents at the weekend: they take their terrible suits and ties off and blend in. You could be standing next to one at a supermarket checkout and the only clue would be the faint reek of hair gel.*
One of the two symptom-free carriers (along with some of the others who have died) caught bird flu after drinking raw duck blood at the Tet Lunar New Year festival. Now, here’s some free advice. However excited you are to see in the New Year, what with all the firecrackers and men dressed as dragons and whatnot, it’s probably not best to celebrate the event by quaffing raw duck blood in an area rife with an avian flu virus that has a +70% fatality hit rate. In fact, the three easiest ways to avoid catching the H5N1 avian virus are as follows: 1) not drinking raw Vietnamese duck blood; 2) not drinking raw Vietnamese duck blood; and 3) not drinking raw Vietnamese duck blood.
According to the Chinese calendar, 2005 is the year of the rooster (presumably the dead rooster who coughs his final breath straight into the farmer’s face). Raymond Lo, a feng shui “expert” told CNN: "Rooster years are associated with stabbings. Some celebrities may get stabbed or some celebrities might break their back." Oh, and one or two celebrities might get hit by the global flu pandemic which is going to take out about 60 million of us. Doesn’t Gary Glitter live in Thailand? Somewhere like that. And he probably bites the heads off live chickens to pass the time between fiddlings. Glitter’s going to be among the first to drop. Surely.
*Okay, okay, so that's not exactly symptomless, but so far - touch wood - estate agents haven't undergone the necessary DNA mutations to lose all of their telltale traits. But when that day finally comes... God help us all. There'll be riots in the streets. Kangaroo courts. Lynchings.
Wednesday, March 09, 2005
http://effectmeasure.blogspot.com
Two ways to get it wrong but only one is right
It may be understandable, but it is also unacceptable. The "default assumption" is that a new case of bird flu was contracted from contact with sick poultry, to be ruled out only in the face of overwhelming evidence to the contrary. This is the reverse of the precautionary approach appropriate to such a grave public health threat.
Today Vietnam announced several more cases that were missed because they did not have the typical presentation of bird flu infection. It is significant that in both cases they are family members of confirmed cases, that is, part of familial clusters. One is an 80 year old grandfather of the two confirmed sibling cases (ages 21 and 14) from Thai Binh province reported earlier. AP (via ABC News) is also reporting that the 61 year old widow of a 69 year old man who died of bird flu on February 23 has also tested positive for the infection. Both of these new cases are reported to be in good health but have been isolated in their homes.
In each instance the reports start from the assumption that the disease cluster arose from a common source rather than person to person transmission.
Health authorities suspect that the three family members, from northern Thai Binh province, caught the virus after eating an infected goose slaughtered by the grandfather a month ago, and there was no immediate indication that they had infected one another.
Earlier this week, Vietnam reported that a 26-year-old male nurse who cared for the grandson had also been infected by bird flu but health officials said it was likely he contracted the disease outside the hospital.
Several cases in Vietnam and Thailand have involved family clusters, with several relatives were infected at the same time, though there has been no evidence that the virus has mutated into a form easily transmitted by people. Health officials warn that when that happens, the virus could spark a global pandemic that kills millions. (Irish Examiner)
Unfortunately, wishing won't make it so. The two possibilities here are that a family cluster arose from a common source, such as contact with infected poultry, or from person to person transmission. Contact with poultry in this part of the world is almost ubiquitous, so eliciting a history of such contact by no means rules out person to person transmission. The main indicator would be the timing of onset of the cases, and in each of these instances the assumed common source exposures (eating chicken, duck or goose) around the Tet holiday seems too remote to account for these cases.
Nor is it true there is "no evidence" of person to person transmission in these cases. As Henry Niman has emphasized repeatedly, the bimodal timing of onset and the period from the last known or assumed poultry contacts in a number of the familial clusters points in the opposite direction.
Underneath this is a widespread but unspoken fear among public health authorities that "raising the threat level" (to use contemporary terminology) will "unnecessarily" produce widespread fear and panic. If we are lucky enough for this to be a false alarm, the result would be a loss of credibility.
If you are looking for propositions for which there is "no evidence" I suggest you start right there. If the public trusts its health authorities (and that trust has to be earned by a history of honest communication) they will neither panic nor lose faith in them when a feared possibility doesn't materialize. I know of no evidence to show that sounding a justified alert will result in a damaging loss of needed credibility if the alert turns out to be a false alarm.
Admittedly this is a tough call for public health and there are two ways they can get it wrong: failure to warn when it turns out the warning was justified, or warning when it turns out otherwise. Using a public health precautionary approach it is clear we should be more inclined to accept the latter risk than the former, although national and international officials are tilting in the other direction. If you are going to get it wrong, it is better to err on the side of precaution than the reverse. In the US, the low key posture CDC is taking to bird flu is an unfortunate example of the wrong way to do it.
To use another well-worn cliché of the post 9/11 era, we are talking about a possible failure to "connect the dots." The dots can't get any bigger. The disconnect is at the level of responsible public health leadership.
http://effectmeasure.blogspot.com
Two ways to get it wrong but only one is right
It may be understandable, but it is also unacceptable. The "default assumption" is that a new case of bird flu was contracted from contact with sick poultry, to be ruled out only in the face of overwhelming evidence to the contrary. This is the reverse of the precautionary approach appropriate to such a grave public health threat.
Today Vietnam announced several more cases that were missed because they did not have the typical presentation of bird flu infection. It is significant that in both cases they are family members of confirmed cases, that is, part of familial clusters. One is an 80 year old grandfather of the two confirmed sibling cases (ages 21 and 14) from Thai Binh province reported earlier. AP (via ABC News) is also reporting that the 61 year old widow of a 69 year old man who died of bird flu on February 23 has also tested positive for the infection. Both of these new cases are reported to be in good health but have been isolated in their homes.
In each instance the reports start from the assumption that the disease cluster arose from a common source rather than person to person transmission.
Health authorities suspect that the three family members, from northern Thai Binh province, caught the virus after eating an infected goose slaughtered by the grandfather a month ago, and there was no immediate indication that they had infected one another.
Earlier this week, Vietnam reported that a 26-year-old male nurse who cared for the grandson had also been infected by bird flu but health officials said it was likely he contracted the disease outside the hospital.
Several cases in Vietnam and Thailand have involved family clusters, with several relatives were infected at the same time, though there has been no evidence that the virus has mutated into a form easily transmitted by people. Health officials warn that when that happens, the virus could spark a global pandemic that kills millions. (Irish Examiner)
Unfortunately, wishing won't make it so. The two possibilities here are that a family cluster arose from a common source, such as contact with infected poultry, or from person to person transmission. Contact with poultry in this part of the world is almost ubiquitous, so eliciting a history of such contact by no means rules out person to person transmission. The main indicator would be the timing of onset of the cases, and in each of these instances the assumed common source exposures (eating chicken, duck or goose) around the Tet holiday seems too remote to account for these cases.
Nor is it true there is "no evidence" of person to person transmission in these cases. As Henry Niman has emphasized repeatedly, the bimodal timing of onset and the period from the last known or assumed poultry contacts in a number of the familial clusters points in the opposite direction.
Underneath this is a widespread but unspoken fear among public health authorities that "raising the threat level" (to use contemporary terminology) will "unnecessarily" produce widespread fear and panic. If we are lucky enough for this to be a false alarm, the result would be a loss of credibility.
If you are looking for propositions for which there is "no evidence" I suggest you start right there. If the public trusts its health authorities (and that trust has to be earned by a history of honest communication) they will neither panic nor lose faith in them when a feared possibility doesn't materialize. I know of no evidence to show that sounding a justified alert will result in a damaging loss of needed credibility if the alert turns out to be a false alarm.
Admittedly this is a tough call for public health and there are two ways they can get it wrong: failure to warn when it turns out the warning was justified, or warning when it turns out otherwise. Using a public health precautionary approach it is clear we should be more inclined to accept the latter risk than the former, although national and international officials are tilting in the other direction. If you are going to get it wrong, it is better to err on the side of precaution than the reverse. In the US, the low key posture CDC is taking to bird flu is an unfortunate example of the wrong way to do it.
To use another well-worn cliché of the post 9/11 era, we are talking about a possible failure to "connect the dots." The dots can't get any bigger. The disconnect is at the level of responsible public health leadership.