Avian flu updates page 17

[Martin]

avian flu page 16 at
http://www.timebomb2000.com/vb/showthread.php?p=1576159#post1576159

Reports of Tamiflu resistance to avian flu based on old data, not new proof

Helen Branswell
Canadian Press


Friday, October 07, 2005


TORONTO (CP) - It appears a misunderstanding, not a mutation, is behind recent reports suggesting the H5N1 avian flu strain is developing resistance to the drug Tamiflu.

The professor of pharmacology from Hong Kong University quoted as warning of an emerging resistant strain of the virus says he was citing old data, not new evidence, when he gave an interview last week.

He was trying to urge GlaxoSmithKline to reintroduce an injectable form of their rival flu drug, Relenza. The resulting report suggested Tamiflu was becoming less useful - a claim that was widely repeated.

"My point is to emphasize on the introduction of injectable drugs. But they use a headline 'Resistant H5N1 appears in Vietnam,' " Dr. William Chui, who is also chief of the pharmacy service of Hong Kong's Queen Mary Hospital, said in an interview.

"I'm not the right channel to say that."

Chui says he was citing medical literature, including a recent New England Journal of Medicine review article on human cases of avian influenza that made reference to an H5N1 isolate from Vietnam shown to be partially resistant to oseltamivir, Tamiflu's generic name.

That discovery was made public in mid-May in the report of a meeting of experts the World Health Organization convened in Manila to determine whether the pandemic risk from H5N1 had risen.

When the reports quoting Chui started to circulate, flu experts around the world sent out urgent e-mails trying to find out who had found new evidence of resistance. The flu community keeps close tabs on the efficacy of these important drugs, known as neuraminidase inhibitors.

They came up with a puzzling blank.

Except for that one partially resistant H5N1 isolate from Vietnam, no researchers have reported new discoveries of Tamiflu-resistant viruses isolated from human cases of H5N1, both the WHO and Tamiflu's manufacturer, Hoffman-La Roche confirm.

"There is a network of laboratories that has been set up to follow antiviral resistance among influenza strains," says Michael Perdue, a scientist in the WHO's global influenza program.

"One of the first things they look at (when they get new viral isolates) is the antiviral sensitivity and resistance. And the papers that have been published thus far have shown all the strains to be sensitive."

That doesn't mean there might not be evidence of resistance out there, being kept under wraps by researchers pushing them through the publication pipeline of medical journals.

Still, Perdue thinks word might have gotten around.

"There's no hard and fast rule. But generally people let WHO know information like that. And we have not heard."

Neither has Roche, which has stewed while reports have questioned the value of their drug.

Oseltamivir is one of only two drugs thought to be effective against H5N1; Relenza is the other. Governments around the world have been rushing to stockpile the easier-to-administer Tamiflu as a hedge against a possible pandemic. (Tamiflu is sold in pills; Relenza is inhaled like an asthma drug.)

"We don't have additional (resistance) data so when we see articles like this, we're as perplexed as everyone else," says Paul Brown, a vice-president of Roche Canada and until recently global team leader for Tamiflu.

However, everyone, including Roche, expects some resistance to the drug to develop if it becomes widely used. In fact, studies have shown just that in Japan, the only market to date which has embraced Tamiflu in a serious way for seasonal influenza.

Antiviral researcher Dr. Frederick Hayden of the University of Virginia says a recent study of Japanese children showed about 16 per cent developed resistance to the drug.

"That's one in six. So I would anticipate that in H5N1-infected persons that the frequency would certainly be no less," says Hayden, co-chair of an international network of scientists who monitor for resistance to neuraminidase inhibitors.

But even when resistance develops, evidence suggests it may not spread easily. In the lab, viruses that develop resistance to oseltamivir pay a price; they are less fit than non-resistant viruses.

That suggests it might be difficult for a resistant strain of the virus to emerge and claim dominance over non-resistance strains.

So far the evidence that resistance strains are less fit has been shown only with human flu strains, Hayden says. But studies could and should be done to see if the same holds true with H5N1 viruses, he insists.



http://www.canada.com/components/printstory/printstory4.aspx?id=81201e24-9e91-4287-833b-9da02ff083ac

 

[garnetgirl]

Thank you

Martin,

Just a quick thank you and note of appreciation for keeping up with this thread.

garnetgirl

 

[Martin]

Talk of Bird Flu Pandemic Revives Interest in Passed-Over Drugs

By ANDREW POLLACK
New York Times
October 07. 2005 6:03AM





Three years ago BioCryst Pharmaceuticals gave up on a drug it was developing to treat influenza.

The drug, peramivir, had failed in clinical trials, in part because not enough of it got into the bloodstream when taken orally. Johnson & Johnson pulled out of a partnership with BioCryst in 2001 when it saw that other flu drugs were not selling well.

But now, amid growing fears of a global bird flu pandemic, peramivir may be resurrected. Scientists using government funds are already testing the drug in animals, this time in a form that is given intravenously or injected.

"We never even thought of the prospect of resurrecting it until avian flu came along," said Charles E. Bugg, chief executive of BioCryst, which is based in Birmingham, Ala. Although the drug is nowhere near formal approval by the Food and Drug Administration, Mr. Bugg said peramivir could be quickly manufactured on an emergency basis for government stockpiles.

But experts say that previous inattention to flu drugs has the world facing a potential shortage that could leave millions of people dead if avian flu were to break out in the next year or two.

After years of lackluster sales - and, as a result, limited production - two flu drugs on the market, Tamiflu from Roche and Relenza from GlaxoSmithKline, are in intense demand by governments building stockpiles against a possible bird flu pandemic. Neither company is now in a position to come close to meeting the global demand for their drugs.

A Japanese company, Sankyo, has developed an advanced version of Relenza that did not go beyond early clinical trials but that now, in part with money from Washington, is being studied as a possible avian flu treatment.

"You have to play catch-up in development," said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases.

The strain of avian flu that has killed birds in Asia has already resulted in the deaths of at least 60 people, most of whom were thought to have had direct contact with infected poultry. But experts theorize that the strain, known as H5N1, could kill millions if it mutated into a form easily passed from person to person.

Such fears were heightened by the finding announced by scientists this week that the 1918 influenza virus that killed as many as 50 million people worldwide was a bird flu that jumped to human beings.

Tamiflu and Relenza failed to sell well as conventional flu treatments because patients and their doctors tend to rely on preventing influenza through yearly vaccines rather than waiting to use drugs to treat the illness. But it could take years before there is an adequate supply of vaccine against bird flu, and so health authorities are counting on antiviral drugs like Tamiflu as the first line of defense after someone has become ill or been exposed to the disease.

The slow sales had prompted Roche and Glaxo to scale back their efforts in promoting and producing Tamiflu and Relenza. And other drugs in development were put on the back burner.

"It's basically the corporate model working," said Arnold Monto, a flu expert at the University of Michigan. "You put your money where the blockbusters are."

Jeremy Carver, chief executive of the International Consortium on Antivirals, a group of scientists based mainly in Canada, said he had identified five drugs that showed some effectiveness against conventional flu in academic laboratories but never advanced because of a lack of commercial interest. He said his group was trying to raise $60 million from governments to move the drugs forward, though it would take years for any of them to reach the market.

And because even now, an avian flu epidemic is still only hypothetical, companies have been reluctant to invest for that alone.

The smaller companies that originally developed Tamiflu and Relenza, and receive royalties on their sales, have accused Roche and Glaxo of neglecting the drugs, contributing to the current shortage.

Tamiflu's inventor, Gilead Sciences, a California biotechnology company, told Roche in June that it wanted to take back the rights to the drug, accusing Roche of a "consistent record of inactivity and neglect" since the medicine was approved by the F.D.A. in 1999.

A Roche spokesman, Terence J. Hurley, said the company had fulfilled all its obligations to Gilead to promote and manufacture the drug and the dispute was in arbitration.

Mr. Hurley said Roche had quadrupled manufacturing capacity in the last two years and would expand it further next year. While the drug is now produced in factories in Europe, Roche is about to add capacity in the United States; American officials have been concerned that a flu outbreak on a wide scale might cause other nations to restrict exports of the drug.

But the Tamiflu production process takes 10 to 12 months. So the company cannot immediately supply the millions of doses being ordered by 40 countries for use in case of a flu pandemic. Mr. Hurley said Roche would make enough Tamiflu this year to treat tens of millions of people, but would not be more specific.

Sales of Tamiflu soared to about $450 million in the first six months of 2005, more than four times those in the period a year earlier.

The United States government has acquired enough Tamiflu to treat 2.3 million people - each person would take 10 capsules over five days - and it plans to buy enough to treat two million more people this year.

The government's current goal is to stockpile enough to treat 20 million, and that goal is expected to be raised. Neither Roche nor government officials, though, would say how soon such quantities could be supplied.

With Tamiflu, also known as oseltamivir, in short supply, some attention is turning toward Relenza, which is also known as zanamivir. Approved the same year as Tamiflu, Relenza has been a distant also-ran.

Unlike Tamiflu, which is taken orally, Relenza requires an inhaler. Within months of Relenza's approval, there were instances of respiratory problems and fatalities in users who had asthma or other pulmonary diseases. But some experts say that the inconvenience of an inhaler and the risk of side effects were minor considerations compared with the dangers from flu on a wide scale.

The federal government recently purchased 84,300 treatment courses of Relenza for $2.8 million. Germany recently ordered 1.7 million units. The German order alone exceeded the total amount of Relenza sold worldwide in the last four years, said Peter Molloy, chief executive of Biota, the company that invented Relenza and licensed it to Glaxo.

Biota, which is based in Australia, filed a lawsuit there against Glaxo last year, saying it did not adequately try to market Relenza. After the drug's first year on sale, "essentially all promotion was stopped," Mr. Molloy said.

Biota is seeking about $300 million in royalties it says it would have earned if Glaxo had done an adequate job. (Biota has now teamed up with Sankyo to move Sankyo's version of Relenza forward under a $5.6 million grant from the National Institutes of Health in the United States.) Glaxo denies Biota's accusations in the case, which is headed toward arbitration later this year.

"We lost a lot of money, quite frankly, promoting it, and the demand wasn't there," said David Stout, Glaxo's president for pharmaceutical operations. Mr. Stout said Glaxo was now getting calls from many governments asking about the drug and was stepping up its production capacity. But, he said, "This is not something you can just turn on the faucet and something comes out."

A spokeswoman for Glaxo, declining to cite specific figures, said all the company's supply for 2005 and 2006 was already committed to health authorities. She said Glaxo planned to apply this year for approval in the United States and Europe to use Relenza both to prevent flu and to treat it. Tamiflu is approved for both uses.

How well the flu drugs would work in the event of a pandemic is still open to question. Experts say that with conventional flu, Tamiflu has been shown to significantly reduce hospitalizations and serious complications like pneumonia, which could lower the death rate if it worked the same way for avian flu. "This is not just a treatment that reduces symptoms," said Frederick Hayden, a flu expert at the University of Virginia.

The drugs might also be taken to prevent flu in those who think they have been exposed to the virus or are likely to be exposed. But such prophylactic use usually requires more of the drug than does treatment for the disease.

Animal and test-tube studies have shown both Tamiflu and Relenza to work against the H5N1 strain of bird flu. Tamiflu has also been used to treat people infected with H5N1 in Asia, with only mixed success - though in some cases, treatment might have been started too late.

BioCryst's drug, peramivir, has also shown effectiveness against some strains of avian flu in mice. When peramivir, Tamiflu and Relenza are all given by injection, "peramivir is definitely better," said Robert W. Sidwell, a professor of virology at Utah State who is testing various avian flu drugs for the National Institutes of Health. Dr. Sidwell has been a consultant to BioCryst.

Concerns about avian flu have helped BioCryst's stock, which closed yesterday at $10.26, more than double in the last three months.

Dr. Bugg, BioCryst's chief executive, said the N.I.H. was expected to begin safety tests of peramivir in people this winter and could test its effectiveness next year in Southeast Asia.

Johnson & Johnson and BioCryst had decided that an injected drug would never be able to compete with Tamiflu as a treatment for conventional flu. But in a pandemic, people might not mind getting a shot. And an injected drug gets into the bloodstream more quickly than a pill.

Dr. Bugg said peramivir would also be far easier and cheaper to produce than Tamiflu. He said a contract manufacturer in Switzerland could quickly make enough of it for eight million people, using precursors that Johnson & Johnson had made before it abandoned the drug.

It would take $10 million and six to nine months, he said, for the manufacturer to scale up to make 10 million treatments a month - which is thought to be more than Roche can make of Tamiflu. Because of the limited commercial prospects for the drug, Dr. Bugg said he hoped that governments would come up with that $10 million.

"It's kind of hard to have our investors step up to the plate," he said, "when it's still not clear what the commercial potential is."


http://www.tuscaloosanews.com/apps/pbcs.dll/article?AID=/20051007/ZNYT01/510070382

 

[Martin]

Italians given assurances over eating chicken despite avian flu threat

www.chinaview.cn 2005-10-08 04:23:14

ROME, Oct. 7 (Xinhuanet) -- Italian Agriculture Minister Gianni Alemanno assured Italians on Friday that they ran no risk of catching avian flu by eating chicken in their own country, according to Italian News Agency ANSA.

"The emergency exists but it's not connected with the eating of poultry or eggs," Alemanno said.

"Avian flu is transmitted in other ways, certainly not by eating cooked meat from Italian chickens."

"We have done everything necessary," Alemanno said, adding that blanket checks were under way in a bid to ensure the disease is kept out of Italy.

The Italian government has also temporarily increased the number of vets available in public health facilities and boost personnel at NAS, the food and health control division of the Carabiniere police.

Italian Health Minister Francesco Storace has said in recent weeks that the government has struck accords with three major pharmaceuticals companies to receive 35 million doses of vaccine against the H5N1 avian influenza virus.

Avian flu has killed about 60 people in southeast Asia since 2003.

Most of the victims caught the virus from infected birds but scientists fear the flu could soon become transmittable between humans, sparking a lethal pandemic.

The Food and Agriculture Organization (FAO) said here in September that the H5N1 virus, which spread to Russia and Kazakhstan this summer, could spread with the next wave of mass bird migrations.

It stressed that the areas most at risk were southeast Europe, east and north Africa and the Middle East.

According to European experts, up to 16 million people could be affected by a bird flu epidemic in Italy with some two million requiring hospitalization. Enditem

http://news.xinhuanet.com/english/2005-10/08/content_3591590.htm

 

[Martin]

Sunday, October 9, 2005

World waited too long to pay attention to avian flu

MARCELA SANCHEZ

WASHINGTON -- World health officials put it bluntly -- that the world faces a influenza pandemic is not a question of if but when. Whether the pandemic kills 2 million or 7.4 million will hinge largely on how affected nations prepare and coordinate a response.

Health ministers from the Americas meeting here discussed their regional response to such a threat. The Pan American Health Organization is urging all governments to adopt immediate preparedness plans following global guidelines meant to prompt early action and containment. Most countries in the region have no such plans in place.

The predicted pandemic will undoubtedly originate as an avian flu virus. It likely will erupt the day the deadly H5N1 influenza virus, found first in commercially produced chickens in Southeast Asia and more recently in Russia and Kazakhstan, becomes capable of jumping the species barrier and begins to spread among humans.

So as the world prepares for what looks already unavoidable, it is easy to lose sight of one basic fact: Highly virulent avian flu is easily preventable. The United States produces about 8 billion chickens every year, but those infected are in the mere thousands and only with a low pathogenic virus. That's because, says David Suarez, at the U.S. Department of Agriculture's Southeast Poultry Research Laboratory, "we do a good job in preventing avian influenza."

In February 2004, Delaware discovered a flock was infected with H7 avian influenza. While the strain wasn't threatening to humans, immediate measures were taken to control it. About 72,000 chickens were killed and quarantines were imposed around the affected farms. Within months, the 23 countries that had banned imports of some or all U.S. poultry had lifted them.

But that is the United States. Things get much murkier where industrial chicken operations are growing exponentially thanks to the resettlement of large agribusinesses in search of lower operational costs. Last year in Latin America and the Caribbean, there were over 2.5 billion chickens, nearly 1 billion more than 10 years ago, according to the United Nations' Food and Agriculture Organization. In 2004, according to Worldwatch Institute, Brazil became the world's second-largest poultry producer, just behind the United States.

Such expansion of industrial farming in less developed countries usually is accompanied by poor surveillance and control. In 1992, an epidemic of a low pathogenic avian influenza began in Mexico and remained uncontrolled for three years, allowing the virus to transform into a highly fatal form.

Poor hygienic conditions in confined animal feeding operations, or factory farms, and their relative proximity to large concentrations of people compound the problem. Factory farms account for more than 40 percent of world meat production, up from 30 percent in 1990, according to the Worldwatch Institute's report, "Happier Meals: Rethinking the Global Meat Industry." Located near urban centers in countries with weak public health, occupational, and environmental standards, those farms "create the perfect environment for the spread of diseases, including outbreaks of avian flu," the institute said.

Richard Webby, an influenza expert at St. Jude Children's Research Hospital in Memphis, agrees that "the increased density of poultry is a big factor" in the development of highly pathogenic strands of the influenza virus. The "more hosts in close confinements," the easier it becomes for the virus to mutate to the point of becoming capable to jump species and begin spreading easily among humans, he added.

That is exactly what happened in Hong Kong in 1997, when the deadly H5N1 avian influenza virus killed six of 18 people infected. It was then that the world should have started paying attention, said Danielle Nierenberg, author of the Worldwatch report. Last week, Bush administration officials were rushing to prepare the first comprehensive plan to deal with a pandemic, with reportedly a request to Congress for an estimated $6 billion to $10 billion to stockpile vaccines and antiviral medications.

With an influenza pandemic looming, such actions are clearly warranted and necessary. But they are the equivalent of "closing the barn door after the horses have gotten out," said Nierenberg. Unfortunately, just as in the case of famines developing because of a failure to deal with world hunger, the world seems now reduced to prepare for the deadly consequences of having neglected avian flu's chronic warning signals.


http://seattlepi.nwsource.com/opinion/243797_sanchez09.html

 

[Kim99]

Witness to 1918 flu: 'Death was there all the time'

--------------------------------------------------------------------------------

Witness to 1918 flu: 'Death was there all the time'
98-year-old man recalls pandemic that killed millions
By Kelley Colihan
CNN


FRAMINGHAM, Massachusetts (CNN) -- Kenneth Carotty was 11 years old when the "great flu" hit his neighborhood in Framingham, outside Boston.

"It was scary, because every morning when you got up, you asked, 'Who died during the night?' You know death was there all the time."

The 1918 pandemic is thought to have killed anywhere from 20 million to 100 million people around the world. Researchers recently re-created the virus to study it for clues on how to fight the current strain of bird flu, which threatens to become the next great flu pandemic.

As an altar boy, Carotty said he served in more than 30 Masses for the dead, some for flu victims some for those who died on the battlefields of World War I, which was in its final weeks.

"They'd have those monstrous big candles on the first six aisles on the body that was drawn down, and I remember the heartbreak I felt when I saw that person lugged down the center aisle, down the steps packed into a small truck," he said.

At 98, Carotty resides in a nursing home in his hometown in Massachusetts. In 1918, he lived there with his parents and four sisters.

He didn't get sick, but two of his sisters came down with the flu. His mother kept him downstairs, while his ill sisters stayed upstairs until they were well enough to move about.

Five neighbors on his street of about 20 houses died during the season of death, he recalled.

"People were very leery of each other. And when we went out, we wore a mask over our noses and mouths," he said.

Carotty said people also covered their shirts with holy medals to "ward off the evil of this terrible disease."

Historian John Barry, author of "The Great Influenza," said the disease "killed more people in 24 weeks than AIDS has killed in 24 years."

The worst-hit U.S. cities were Philadelphia, New York and Boston.

Barry said vigilantes patrolled the streets of Albuquerque, New Mexico, making people wear their masks.

President Woodrow Wilson continued sending troop ships to Europe, something Barry describes as "floating coffins."

Treatment was limited in 1918 -- Carotty said people tried folk medicine, prayer, anything.

"There were no antibiotics, there was just hope that you'd get through, that fate was kind enough that it wouldn't hit you or yours," he said.

Bayer aspirin was just hitting the market. But because it was a German company, and Germany was a foe in World War I, many Americans distrusted it and even believed the new product was a form of germ warfare.

A theory, Barry notes, that was even suggested by U.S. government officials. He said the pandemic caused the United States largely to "grind to a stop."

"Fear drove everybody inside," he said. Across the United States, "60 percent absentee rates" and empty city streets were common, Barry said.

He said the climate of fear was brought on by a mistrust of government officials and the press.

"People could see while they were being told on the one hand that it's ordinary influenza, on the other hand they are seeing their spouse die in 24 hours or less, bleeding from their eyes, ears, nose and mouth, turning so dark that people thought it was the black death," Barry says said. "People knew that they were being lied to; they knew that this was not ordinary influenza."

Nearly as quickly as it struck, the 1918 flu seemed to disappear.

Did it mutate? Or did people on Earth now have antibodies?

Leading scientists say both likely happened. Scientists say weakened strains of the 1918 virus have shown up since then. And as people are exposed to flu strains, they develop resistance to them.


Find this article at:
http://www.cnn.com/2005/HEALTH/cond...ness/index.html

 

[Kim99]

A $3.9-billion first strike

The Senate has earmarked funds in response to fears of a killer-flu pandemic. Now Washington just has to get its spending priorities straight.

By Laurie Garrett, LAURIE GARRETT is a Pulitzer Prize-winning writer and senior fellow for global health at the Council on Foreign Relations.

PANDEMIC INFLUENZA anxieties have reached fever pitch in Washington amid growing concern that the H5N1 avian flu virus now circulating in Jakarta, Indonesia, may mutate into a human-to-human transmitter that could claim hundreds of millions of lives. After years of relegating flu preparedness to one small office inside the Department of Health and Human Services, the government, from the president on down, seems suddenly in a mad flurry to do something — anything — to prepare for disaster. Perhaps the hurricanes have taught them a lesson.

"The people of the country ought to rest assured that we're doing everything we can…. And we are," President Bush said in a news conference Tuesday. But racing around like a chicken with its head cut off (pun intended) won't put the United States any closer to safety than we were before flu anxiety hit.

For example, on Tuesday, the president suggested we might need to quarantine sections of the nation, adding, "and who best to be able to effect a quarantine? One option is the use of a military that's able to plan and move."

But hold on, Mr. President: Even your own top flu experts at the Department of Health and Human Services and the Centers for Disease Control will tell you that human influenzas are so contagious there is little, if any, evidence that quarantine helps. Further, your top military leaders have told me that there is no Defense Department plan in place for the protection of active-duty personnel, much less one aimed at putting the armed forces in charge of domestic epidemic management.

Last week, the also agitated Senate, by unanimous consent, tagged a $3.9-billion "pandemic influenza preparedness" rider onto the 2006 Defense Department appropriation bill. If the House agrees to it, this would, among other things, guarantee a supply of the potentially lifesaving drug Tamiflu for about half of all Americans.

That's a start, but the White House has threatened to veto the entire bill, saying it considers the flu problem a domestic issue that shouldn't be addressed in defense appropriation legislation. The Bush administration should back down from its veto threat — especially if the president envisions a military epidemic response.



SCIENTISTS have been nervously following developments in Asia with the H5N1 avian influenza virus since it first emerged in 1996, and anxiety is rising. About three weeks ago, H5N1 broke out in Jakarta, population 9 million. About 60 suspected human cases of H5N1 have been placed under treatment there, and seven people have died. Statistics gathered since 2003 indicate that 55% of those who contract H5N1 will die of it. (In chickens, felines, ferrets and mice, H5N1 kills 100% of the time.)

For the moment, the pattern of H5N1 infection does not show that avian flu is easily transmitted from human to human. But viruses evolve quickly. The number of suspected cases in Jakarta increases the concern that H5N1 is spreading and mutating. It doesn't help that scientists studying the virus that caused the 1918 flu pandemic see key similarities between it and H5N1.

Last Friday, the Assn. of Southeast Asian Nations approved a three-year plan that requires its 10 member nations to wage an "all-out coordinated regional effort" to quash the virus in bird populations. Similarly, the Asian-Pacific Economic Cooperation forum is drawing up guidelines for controlling the virus in animals and, should it become a human epidemic, for limiting its effect on populations and economies. Last month, China's president, Hu Jintao, promised an open, scientific exchange with the United States in hopes of stemming a flu tsunami.

But the United States must do more. Sen. Ted Stevens (R-Alaska) suggested last week that "we ought to wait" because avian flu "has not yet become a threat to human beings." But waiting until confirmed human-to-human transmission is underway means dooming millions to die. A human-to-human avian flu eruption would spread around our globalized world in a matter of weeks, perhaps days. The lessons of the hurricane season are clear: It costs less in lives and dollars to invest in adequate defenses than to react once disaster strikes.

Does the Senate rider do enough? The overall appropriation, $3.9 billion, may be about right, but the devil is in the details. The Senate plan sets aside 80% of that money primarily for buying Tamiflu. The other 20% would be used for global flu surveillance, bolstering local preparedness and improving flu vaccine production. The ratio isn't correct.

Tamiflu can suppress H5N1 at the beginning of infection, but it isn't a cure. It must be taken at the right time or it's ineffective. It also has not been approved for use in children. And in some adults, it may only partly suppress the virus, leaving them ambulatory carriers of infection. On top of that, the latest scientific studies indicate that some H5N1 viruses may already be resistant to the drug.

That means that instead of spending most of the appropriation on Tamiflu, we should demand that the pharmaceutical industry rev up flu vaccine production and then use some of the $3.9 billion to pull genuine innovations out of the lab and into quick mass production. Further, a hefty percentage of that money should be spent on helping Los Angeles and other cities and states prepare: Where will they put all the patients? The bodies? How will they feed house-bound millions? How can they keep the economies and machineries of their jurisdictions running while a deadly pandemic holds them in its grip for more than a year?

Still, the Senate plan is a step in responding to an urgent need. The House should fine-tune it, and the president should sign it into law. As Sen. Tom Harkin (D-Iowa) said Thursday: "It's the midnight hour. We have to get moving … now, not next year, not after some study group in the White House bangs this thing around for another three months." He's absolutely right.

vhttp://www.latimes.com/news/opinion/commentary/la-oe-garrett7oct07,0,7080637.story?coll=la-news-comment-opinions

 

[Kim99]

http://www.effectmeasure.blogspot.com/

Saturday, October 08, 2005
Annas on Bush quarantine

Professor George Annas, Chairman of the Department of Health Law, Bioethics and Human Rights at Boston University School of Public Health, has a superb Op Ed in the Boston Globe this morning. Here it is:

Boston Globe: Bush's risky flu pandemic plan

By George J. Annas | October 8, 2005


WHENEVER THE world is not to his liking, President Bush has a tendency to turn to the military to make it better. The most prominent example is the country's response to 9/11, complete with wars in Afghanistan and Iraq. After Hurricane Katrina, Bush belatedly called on the military to assist in securing New Orleans, and has since suggested that Congress should consider empowering the military to be the ''first responders" in any national disaster.

On Tuesday, the president suggested that the United States should confront the risk of a bird flu pandemic by giving him the power to use the US military to quarantine ''part of the country" experiencing an ''outbreak." So we have moved quickly in the past month, at least metaphorically, from the global war on terror to a proposed war on hurricanes, to a proposed war on the bird flu.

Of all these proposals, the use of the military to attempt to contain a flu pandemic on US soil is the most dangerous. Bush says he got the idea by reading John Barry's excellent account of the 1918 Spanish flu pandemic, ''The Great Influenza." Although quarantine was used successfully in that pandemic, on the island of American Samoa, Barry in his afterword suggests (sensibly) that we need a national plan to deal with a future influenza pandemic. He said last week that his other suggestions were the only ones he hoped public health officials and ethicists would consider, but they read like policy recommendations to me and apparently the president. Barry writes, for example, ''if there is any chance to limit the geographical spread of the disease, officials must have in place the legal power to take extreme quarantine measures." This recommendation comes shortly after his praise for countries that ''moved rapidly and ruthlessly to quarantine and isolate anyone with or exposed to" SARS.

Planning makes sense. But planning for ''brutal" or ''extreme" quarantine of large numbers or areas of the United States would create many more problems than it could solve.

First, historically mass quarantines of healthy people who may have been exposed to a pathogen have never worked to control a pandemic, and have almost always done more harm than good because they usually involve vicious discrimination against classes of people (like immigrants or Asians) who are seen as ''diseased" and dangerous.

Second, the notion that ruthless quarantine was responsible for preventing a SARS pandemic is a public health myth. SARS appeared in more than 30 countries; they all reacted differently (some used forced quarantine successfully, others voluntary quarantine, and others no quarantine at all), and all ''succeeded." Quarantine is no magic bullet.

Third, quarantine and isolation are often falsely equated, but the former involves people who are well, the latter people who are sick. Sick people should be treated, but we don't need the military to force treatment. Even in extremes like the anthrax attacks, people seek out and demand treatment. Sending soldiers to quarantine large numbers of people will most likely create panic, and cause people to flee (and spread disease), as it did in China where a rumor during the SARS epidemic that Beijing would be quarantined led to 250,000 people fleeing the city that night.

Not only can't we evacuate Houston, we cannot realistically quarantine its citizens. The real public health challenge will be shortages of health care personnel, hospital beds, and medicine. Plans to militarize quarantine miss the point in a pandemic. The enemy is not sick or exposed Americans -- it is the virus itself. And effective action against any flu virus demands its early identification, and the quick development, manufacture, and distribution of a vaccine and treatment modalities.

In 1918 the Spanish flu was spread around the US primarily by soldiers, and it seems to have incubated primarily on military bases. It is a misreading of history that a lesson from 1918 is to militarize mass quarantine to contain the flu. And neither medicine nor public health are what they were in 1918; having public health rely on mass quarantine today is like having our military rely on trench warfare in Iraq.

What has not changed in the past century, however, is the fact that national flu policy will be determined by national politics. In World War I, as Barry recounts, this policy demanded that there be no public criticism of the federal government.

That policy was a disaster, and did prevent many potentially effective public health actions. Today's presidential substitution of a military quarantine solution for credible public health planning will also be counterproductive and ineffective in the event of a real pandemic. It would leave US citizens sick with the flu to wonder -- like the citizens of New Orleans told to go to the Convention Center and the Superdome for help -- why the federal government had abandoned them.

Public health in the 21st century should be federally directed, but effective public health policy must be based on trust, not fear of the public.

 

[O2BNOK]

http://www.alertnet.org/thenews/newsdesk/L08229465.htm

CHRONOLOGY-Key dates in Asian bird flu outbreak
08 Oct 2005 12:36:42 GMT

Source: Reuters

LONDON, Oct 8 (Reuters) - Romania reported three cases of avian flu in a village in the Danube delta on Saturday and started to cull hundreds of birds to prevent the disease from spreading, chief veterinarian Ion Agafitei said. Tests were being carried out to determine which strain of the virus was involved.

A total of 65 people have died from the disease in Asia since late 2003, 44 in Vietnam, 12 in Thailand, five in Indonesia, four in Cambodia.

Here is a brief chronology of the spread of Asian bird flu:

Dec 15, 2003 - South Korea confirms a highly contagious type of bird flu at a chicken farm near Seoul and begins a mass cull of poultry when the virus rapidly spreads across the country.

Dec 31 - Taiwan reports its first case and later destroys thousands of chickens with a milder form of avian flu.

Jan 8, 2004 - Vietnam says bird flu has been found on many of its poultry farms.

Jan 13 - The World Health Organisation confirms the deaths of three people in Vietnam are linked to bird flu.

Jan 25 - Indonesia discovers an outbreak among chickens.

Jan 26 - Thailand confirms the death of a six-year-old boy, its first human death from bird flu.

Feb 12 - The World Health Organisation confirms tests show no evidence bird flu is passing from person to person.

March 16 - China declares it has stamped out the disease in all 49 hotbeds and has had no reports among poultry for 29 days.

May 26 - Thailand reports a fresh case of bird flu is found in several dead chickens on a university research farm in the northern city of Chiang Mai.

Aug 19 - Malaysia says a strain of bird flu has been found in two chickens that died in a northern village near the Thai border in the country's first bird flu outbreak.

Sept 27 - Thailand says it has found its first known probable case of a human being infecting another with bird flu. It said this was an isolated incident that posed little risk to the greater population.

Dec 15 - Taiwan says it has discovered two strains of avian flu in migratory birds in the northern part of the island, the milder H5N2 strain and also the H5N6 strain.

April 5, 2005 - The UN says that the H7 strain of bird flu previously undetected in Asia has been found in North Korea.

July 8 - The Philippines says it has suffered its first case of bird flu, in ducks. It later says it is free from any highly pathogenic strain of bird flu.

July 20 - Indonesia confirms its first deaths from bird flu.

July 26 - Japan says a fresh outbreak of bird flu has been discovered on a chicken farm in eastern Japan. All outbreaks in the Ibaraki prefecture since late June have been confirmed as the weak H5N2 strain.

Aug 9 - Vietnam reports one new human death from bird flu, taking its death toll to 43. The H5N1 virus has also killed 12 people in Thailand, four in Cambodia and three in Indonesia.

Aug 10 - The bird flu virus has been found in Tibet, the world animal health body OIE says.

Aug 15 - Russia reports an outbreak of bird flu in the Urals region of Chelyabinsk, the sixth region to be affected.

Aug 23 - In Kazakhstan a bird flu outbreak of the H5N1 strain in seven northern villages is confirmed as dangerous to humans.

Aug 26 - Finland says it has found a possible case of bird flu in a seagull in the northern town of Oulu.

Sept 1 - Vietnam reports one new human death from bird flu, taking its total to 44.

Sept 15 - United States says it has promised Vietnam $2.5 million over 5 years to improve its collection of information on bird flu. Vietnam says it is vaccinating poultry to prevent new outbreaks.

Sept 16 - Indonesia confirms fourth human death from bird flu.

Sept 26 - Indonesia confirms fifth human death from H5N1 strain of bird flu, says disease has spread to 22 of its 33 provinces.

Oct 8 - Romania reports avian flu cases in a Danube delta village, culls hundreds of domestic birds to prevent the disease from spreading, unclear which strain is involved.

 

[O2BNOK]

http://www.alertnet.org/thenews/newsdesk/L0865537.htm

Facts about bird flu
08 Oct 2005 12:39:09 GMT

Source: Reuters

Updates death toll)

Oct 8 (Reuters) - Romania reported three cases of avian flu in a village in the Danube delta on Saturday and culled hundreds of domestic birds to prevent the disease from spreading, chief veterinarian Ion Agafitei said. Tests were being carried out to determine which strain of the virus was involved.

The H5N1 avian flu virus has killed 65 people in Asia since late 2003. It is one of 15 known subtypes of bird disease caused by type-A strains of influenza. Type-A avian influenzas were first identified in Italy more than a century ago.

Here are some facts about H5N1 avian flu:

-- There are dozens of known flu strains, named for two proteins each virus carries. H5N1 refers to an avian flu strain that emerged in Hong Kong in 1997, killing or forcing the destruction of 1.5 million chickens, ducks and geese, infecting 18 people and killing six. The World Health Organization says the quick slaughter of all potentially infected birds may have averted a pandemic.

-- H5N1 avian influenza re-emerged in Korea in 2003. It has now been found in birds in Cambodia, China, Indonesia, Japan, Kazakhstan, Korea, Laos, Malaysia, Mongolia, Philippines, Russia, Taiwan, Thailand and Vietnam.

-- H5N1 is considered the biggest direct disease threat to humanity because it mutates rapidly and can also acquire genes from other viruses, making it a potential human pathogen.

-- Experts estimate that if it acquires the ability to infect people easily and spread from person to person efficiently, it will make more than 25 million people seriously ill and will kill as many as 7 million.

-- Other models show the virus would make 50 percent of people where it is circulating ill, and 5 percent could die.

-- All influenza viruses change quickly, which is why the standard flu vaccine must be changed every year. H5N1 is particularly good at changing. Experts fear it may acquire a key gene from a flu virus that already easily infects humans and become a highly contagious and deadly strain.

-- Birds that survive infection with H5N1 excrete the virus for at least 10 days, orally and in faeces, making it highly likely to spread. Migratory birds, usually wild ducks, are the natural "reservoir" of avian influenza viruses, and usually do not become sick when infected. Domestic poultry, including chickens and turkeys, die quickly when infected.

-- Several companies are working on an H5N1 vaccine, and the furthest along in development is France's Sanofi-Aventis <SASY.PA>. U.S.-based Chiron Corp. <CHIR.O> aims to test its H5N1 vaccine later this year and Britain's GlaxoSmithKline Plc <GSK.L> plans large-scale clinical trials in 2006. The ordinary flu vaccine does not protect against avian flu.

-- Two antiviral drugs can help against the infection and may even prevent it if taken at precisely the right time. These are Tamiflu from Switzerland's Roche Holding AG <ROG.VX>, known generically as oseltamivir, and GlaxoSmithKline's Relenza, or zanamivir.

 

[O2BNOK]

http://www.nytimes.com/2005/10/08/opinion/08sat2.html?hp

Editorial
Bird Flu and the 1918 Pandemic
Published: October 8, 2005

There are both frightening and promising implications in this week's announcement that research teams have deciphered the genetic sequence of the devastating 1918 influenza virus and have synthesized the lethal germ in a high-security laboratory. The feat is a scientific tour de force that should provide important insights on the best way to respond to the avian influenza strain now circulating in Asia. The worrisome news is that the 1918 virus appears to have jumped directly from birds to humans, and that the genetic changes that allowed it to do so are already beginning to appear in the avian strain, known as H5N1, which has killed large numbers of birds and about 60 people in four Asian countries.

The two most recent global pandemics, in 1957 and 1968, were caused by human flu viruses that picked up some bird flu components. Now it turns out that the far more lethal 1918 virus, which killed perhaps 20 to 100 million people, was most likely an avian strain that jumped directly into humans. That gives today's avian strain two routes to wreak havoc among humans. It could either mix some of its genes with human influenza, like the 1957 and 1968 viruses, or it could mutate on its own to become easily transmissible among humans, like the 1918 virus.

So far, the avian virus has rarely jumped from birds to humans and seldom spread from one human to another. But it may be traveling slowly down the same evolutionary path as the 1918 virus. Two top federal health officials said that the H5N1 virus has already acquired five of the 10 genetic sequence changes associated with human-to-human transmission of the 1918 virus.

That does not necessarily mean that catastrophe is imminent. Nobody knows how likely it is that further mutations will occur or how long the process may take. The avian virus has been around for decades without turning into a monster.

The new findings offer promising leads to health officials who are concerned about preparing for a possible pandemic. Scientists should be able to prepare a checklist of the most worrisome genetic changes so they can monitor the evolution of the avian flu virus and rush medical help to any area where it looks as if the virus is becoming more transmissible. They may also be able to develop drugs and vaccines aimed at the most important genetic targets, thus allowing them to treat or even prevent influenza more effectively.

Nobody knows whether the avian strain now under the spotlight will become a big threat to humans. But some day a potential pandemic strain will arrive. The new findings could help develop tools to contain it.

 

[O2BNOK]

http://www.recombinomics.com/News/10070502/H5N1_WBF_Philippines.html

Commentary
.
H5N1 Wild Bird Flu Outbreak In The Philippines?

Recombinomics Commentary
October 7, 2005

Philippine authorities were investigating possible bird flu in the sudden deaths of 50 chickens in a village north of Manila, an official said Friday.

Blood samples have already been taken from at least two of the birds in a village outside Calumpit, about 40 kilometers (25 miles) northwest of Manila, the same town where a low-risk version of bird flu was discovered in a duck farm in July.

The above commentary suggest that H5N1 wild bird flu may have entered the Philippines. There have been reports of H5N2 antibodies in the Philippines, but those birds did not die. There have also been outbreaks of H5N2 antibodies in Japan. However, there were very few birds that died.

In contrasts, the Philippines is reporting dead chickens. Although the deaths could be due to other viruses such as New Castle Disease, the timing of the announcement and proximity to Indonesia and Vietnam make H5N1 a likely candidate.

Wild birds are beginning to migrate from Mongolia, Siberia, and Kazahkstan, as well as Qinghai Lake in China. These birds carry HPAI H5N1 and probably are responsible fro the dead domestic ducks being reported in Romania. Indonesia has suggested that the H5N1 in their Ragunan zoo may be due to wild birds and Thailand has reported deaths in free range poultry, also suggesting wild birds may be responsible.

The distance from the recent outbreak in Kurgen to Romania is similar to the distance from Qinghai Lake to Manila (see map), so the location of the chicken deaths is within the range of migratory birds that are flying to warmer climates.

Results from the Philippine isolates are expected soon, and H5N1 would not be a surprise and would extend H5N1's geographical range.




http://www.recombinomics.com/News/10070504/H5N1_WBF_Romania_Quarantine.html

Commentary
.
Romania Imposes H5N1 Wild Bird Quarantine

Recombinomics Commentary
October 7, 2005

Romanian officials quarantined a Danube delta village of about 30 people Friday after three dead ducks there tested positive for bird flu -- the first such cases reported in the region.

Agriculture Minister Gheorghe Flutur said the virus found in the farm-raised ducks came from migrating birds from Russia.

And while it is difficult for the virus to spread from birds to humans, authorities were taking no chances. They sealed off the village of Ciamurlia and banned hunting and fishing in eight counties in the region.

The above comments strongly suggest that the ducks died from H5N1 wild bird flu. The ducks dying from bird flu in Siberia are testing positive for HPAI H5N1 and sequences have shown the virus to be very closely related to H5N1 from Qinghai Lake in China or Chany Lake in Russia.

This would be the first reported cases of H5N1 in Europe. Although H5N1 was first discovered in a chicken in Scotland in 1959, the H5N1 isolates in Europe in the past have lacked the multi-basic amino acids at the HA cleavage site. However, the cleavage site of the H5N1 from wild birds in Siberia, as well as those from Qinghai Lake in China had the sequence commonly found in H5N1 from Asia in infected birds, cats, pigs, and humans.

The quarantine of people and restrictions on hunting strongly suggests that preliminary tests show that the bird flu is H5N1. This finding raises questions about the lack of reporting of similar cases in Europe, especially in regions near the Caspian and Black Seas. These areas support migratory birds from Siberia and H5N1 was been frequently detected in southern Siberia and Northern Kazakhstan. Now that these birds are migrating to the southwest, moiré European countries should be reporting dead migratory birds. The H5N1 in the wild birds is quite virulent and has left a trail of dead birds on migratory paths.

Extension of the H5N1 geographical range to Europe strongly suggests that H5N1 will be distributed worldwide in the next 12 months. The infected birds can travel long distances and migratory paths cross, so transfer of H5N1 between species leads to rapid spread via a large number of intersecting flyways.

As H5N1 increases its geographical range, the opportunity for more recombination increases. Similar outbreaks may be occurring in the Philippines and Indonesia, which provides additional support for a global spread of H5N1.

The rapid spread demands close surveillance in humans, birds, and other animals. Moreover, more samples need to be collected, sequenced, and shared.

H5N1 is clearly marshalling forces for a major assault and more resources need to be brought to bear of the widening and extremely dangerous situation. The meeting of 80 nations this week in Washington is a good start, but a major commitment of resources is required. H5N1 has the upper hand and its spread is accelerating and efforts to blunt the spread are long overdue.

 

[Martin]

Bird Flu Detected to NW Turkey


Politics: 8 October 2005, Saturday.

Turkish authorities have killed more than 2,000 turkeys in suspicion of having the avian flu strain, CNN Turk reported.

The reported cases were identified in the province Balikesir, to the north-west of Turkey, the district governor Halil Yavuz Kaya was quoted as saying.

Turkey producers in the region of Manyas have been put under quarantine

Balikesir's governor said this is just an isolated case of infection through the migratory birds and that all precautionary measures have been taken.

http://www.timebomb2000.com/vb/newreply.php?do=newreply&noquote=1&p=1577585

 

[Martin]

October 8, 2005 - 16:48

Flu pandemic could kill nearly 2 million Americans: government

WASHINGTON (AP) - A super-flu could kill up to 1.9 million Americans, said a draft of the U.S. government's plan to fight a worldwide epidemic.

Officials are rewriting that plan to designate not just who cares for the sick but who will keep the country running amid the chaos, said an influenza specialist who is advising the government on those decisions.






"How do you provide food, water...basic security for the population?" asked Michael Osterholm of the University of Minnesota, a government adviser who has a copy of the draft plan and described it.

"This is a much more comprehensive view than has previously been detailed," he said in an interview Saturday.

The U.S. administration has spent the last year updating its plan for how to fight the next flu pandemic. While it is impossible to say when one will strike, the fear is avian flu in Asia could trigger one if it mutates to start spreading easily among people.

A recent draft of the plan, first reported Saturday by the New York Times newspaper, models what might happen based on the last century's three pandemics.

In a best-case scenario, about 200,000 people might die.

But if the next pandemic resembles the 1918 Spanish flu, as many as 1.9 million could die, Osterholm said. Millions more would be ill, overwhelming hospitals.

"You plan for the worst-case scenario," he said.

"If it's less than that, thank God."

The government has on hand enough of the anti-flu drug Tamiflu to treat 4.3 million people. Manufacturing of $100 million worth of an avian flu vaccine just began.

The draft makes clear tens of millions more doses of each would be needed. That is far more than the world has the capacity to manufacture quickly.

To finish that draft plan, U.S. health officials for several weeks have been role-playing what would happen if a super-flu struck now - not next year, after more medicines and vaccines have been stockpiled.

The strategy, Osterholm said, is "don't emphasize what you can buy, emphasize what you can get your hands on."

"If it happens tonight, how do you deal with order?"

For example, health workers would need to wear special masks, known as N-95 masks, to prevent infection, while treating patients. Two U.S. companies produce 90 per cent of the world's supply and "we'll run out overnight," Osterholm said.

Also being considered is the possibility Tamiflu will not be powerful enough to treat someone already sick but could protect against illness if given beforehand. So who would receive the 4.3 million doses? Health and Human Services Secretary Mike Leavitt recently met with cabinet secretaries to ask other federal agencies to determine their role in stemming rioting at vaccine clinics; when to close schools; how to keep gasoline, electricity, food and water supplies running and how to manage the economic fallout.

State health officers also are being asked for input, Osterholm said.

"The HHS plan is going to be the foundation of a larger government-wide plan," said Leavitt's spokeswoman, Christina Pearson.

"Beyond health care, there are issues with banks and schools and that states and other place have to have their own plans."

Democrats have criticized the administration for not having a plan. U.S. Senator Tom Harkin, an Iowa Democrat, said in a statement Saturday time for action is short.

"Having a plan on paper does nothing to protect us," Harkin said while urging the administration to work with Congress on implementing protections against a pandemic.

"Next month is too late. The United States is woefully unprepared for this and we must get started immediately."


http://www.macleans.ca/topstories/news/shownews.jsp?content=w100863A#

 

[Kris Gandillon]

1.9 Million is 6/10ths of 1 percent of the current population of the US (latest estimated US population I have seen is 297 million).

While 1.9 million deaths are bad, doesn't sound nearly as bad as I would have expected for H5N1...assuming this is an accurate estimate.

Kris

 

[Martin]

How they come up with these 'estimates' is beyond me. There really is no accurate data concerning the total deaths in the 1918 pandemic. All just guess work. Even if the 2 million were true imagine the chaos in the country as everything would come to a screeching halt and many more deaths from other reasons would occur...

Sorry you can't have that emergency operation...your doctor just died of the flu

 

[Martin]

Myanmar - the world's bird flu black hole?

By Ed Cropley
BANGKOK (Reuters) - With big chunks of its territory in rebel hands and a military government shrouded in riddles, mystery and enigma, Myanmar presents the global fight against bird flu with a unique set of problems.

Officially, the H5N1 avian influenza strain that has killed millions of birds and scores of people across Asia since late 2003 has not landed in the former Burma, even though neighbouring China, Thailand and Laos have all had outbreaks.

However, given the dearth of reliable information that comes out of Yangon, as well as the junta's dubious track record with the truth, many international observers are worried about a cover-up of potentially global significance.

The fear is that the virus will infect birds in Myanmar then -- either through a cover-up or a lack of monitoring in remote or rebel-run areas -- will remain undetected for long enough to mutate, "go human" and unleash a killer flu pandemic on the world.

"Would they admit to it if it was here? That's the big question, since they deny everything left, right and centre," said one Yangon-based diplomat.

Another said some of the ruling generals appeared to have grasped the seriousness of the threat, but given the dire lack of infrastructure -- annual health spending amounts to a few dollars per person -- doubted whether anything could or would be done.

"I think there's an assumption that if it isn't already, then it will be a problem here, but you're lacking capacity and you're lacking will," the second diplomat said.

Myanmar is spurned by most of the international community due to its human rights record and detention of democracy icon Aung San Suu Kyi, but where bird flu is concerned, sanctions, isolation and strong rhetoric are in nobody's interest.

Bringing that problem into focus is this week's "front line" bird flu trip by U.S. Health Secretary Michael Leavitt, who is going to Thailand, Cambodia, Laos and Vietnam -- but not Myanmar, which Washington has branded an "outpost of tyranny".

DRAFT PLANS

Officials at the Food and Agriculture Organisation (FAO) treat Myanmar's assurances it has never had bird flu with a degree of scepticism, especially since it is situated on the path of migratory birds which could be spreading the virus.

"If you consider the flight paths, and the fact the disease is spreading westwards, infection in Myanmar may be likely now or in the future," an FAO spokesman in Bangkok told Reuters.

However, they are loath to accuse the junta of lying, noting among other things that after the Indian Ocean tsunami, Myanmar announced a death toll only in double figures -- an estimate derided at the time but which later turned out to be accurate.

On the ground, the FAO says cooperation with government veterinary officials is good, and that bird flu reports from overseas dissident groups are in all likelihood Newcastle disease, a bird illness which poses no major risk to humans.

"I trust them," said Tang Zhengping, the FAO's representative in Yangon.

Under FAO auspices, Myanmar has been able to test samples for bird flu since April by sending them to Australia for analysis, although Tang said none had been sent either there or elsewhere.

No human or animal testing is available inside the country.

International health experts say the Health Ministry has drawn up a draft bird flu management strategy, including plans to educate Myanmar's 45 million people about it, as well as disease surveillance and victim treatment plans.

It has even identified special "bird flu hospitals", including one at an infectious diseases centre near Yangon which is equipped with isolation wards, said one expert, admitting nevertheless that much concrete action needed to be taken.

"Developing a national plan is already a big step. If the government is building a plan, I see that as a sign of political will," the expert said.

"But obviously, the Minister of Health will need resources in case something happens. Whether he will get those resources -- that's another story."

Even though years of mismanagement have crippled the economy, the expert said Myanmar still had a relatively large number of overseas-qualified doctors, unlike other impoverished nations in the bird flu firing line such as Cambodia.

Health experts said they also expected open cooperation in the event of a human outbreak, since that was the only way to get access to regional stockpiles of treatments such as Tamiflu.

http://thestar.com.my/news/story.as...01_NOOTR_RTRJONC_0_-218759-1&sec=Worldupdates

 

[Martin]

Weekly BlogScan: H5N1 and Avian Flu Fears


http://blogcritics.org/archives/2005/10/08/211900.php

 

[marsh]

Interesting site: http://www.upmc-biosecurity.org/index.html

Clinical presentation of H5N1 flu: http://www.upmc-cbn.org/dmz/index.html?whereto=/

New England Journal of Medicine article:
http://content.nejm.org/cgi/content/full/353/13/1374

Good laymans booklet:
http://fluwikie.com/uploads/Consequences/NewGuideOct5.pdf

Department of Health and Human Services
Pandemic Influenza Response and Preparedness Plan
http://www.hhs.gov/nvpo/pandemicplan/

Here is the CDC's website on the flu http://www.cdc.gov/flu/avian/index.htm

 

[Martin]

Vaccine failure could lead to flu pandemic

Robin McKie, science editor
Sunday October 9, 2005
The Observer


Prospects of providing protection against the expected global outbreak of avian flu have been dashed by US researchers. They have found that only massive doses of vaccine are likely to protect individuals against the disease. As a result, manufacturing plants would strain to make even meagre supplies for a small number of people, doctors have warned.

'There is now a tremendous anxiety among scientists - including me - about this,' said bioprocessing expert Professor Peter Dunnill, chairman of the Advanced Centre for Biochemical Engineering at University College, London. 'Instead of providing protection for up to a billion people across the world, we will be lucky to get enough doses to vaccinate a few dozen million.

'That is not going to halt this virus if it gets into the human population. The problem is that the science of vaccines is great but the technology for their manufacture is lousy.'

At present, millions of chickens and other poultry are known to be infected with a deadly strain of flu virus known as H5N1. People who have picked up the virus from these birds have become seriously ill and in some cases have died. Doctors and scientists now fear a version that could be passed from human to human could soon evolve from avian H5N1. The result would be a deadly flu pandemic, one that would rival the 1918 outbreak of the disease which killed more than 20 million people.

Two medicines have been put forward as key defences against the outbreak. The first, the anti-viral medicine Tamiflu, which blocks the flu virus's growth within the body, could protect key workers - doctors, nurses, transport staff and police - when the disease strikes Britain. Supplies of Tamiflu are limited, however.

Instead, the main line of defence would be to rely on injecting people with a vaccine - based on a crippled version of the H5N1 virus - to boost immune defences in preparation of future infection.

But a new study by the National Institute of Allergy and Infectious Disease in Bethesda, Maryland, has dashed these prospects. Scientists at the institute used a vaccine made to combat the H5N1 avian flu virus and tested various concentrations on 452 healthy adults.

Only those who received the maximum dose - two shots of 90 micrograms of vaccine - were protected. 'This is the worst-case scenario,' James Robertson, of the UK National Institutes for Biological Standards and Control, told Nature. 'You are not going to get far with that.'

At present, the world has the capacity to manufacture about 900 million doses of flu vaccine a year at drug plants round the globe. But these vaccines are designed to target existing flu strains. Only a single dose of 15 micrograms is required for these.

Professor Ian Jones, of Reading University said: 'It is possible we could improve dosage levels but legal disputes over manufacturing rights, problems of scaling up manufacturing, arguments about who owns vaccines made in a given country and many other problems will also affect vaccine manufacture. We will be lucky to get enough vaccine to protect the public against avian flu in the next five years. We should therefore be quite clear: the chances of stopping a flu pandemic before 2010 are going to be extremely slim.'

Scientists do however point out that a human version of H5N1 could still fail to emerge. The virus could remain isolated in bird populations, weakening over the years until it poses no risk to humanity. 'It is a possibility but do we want to do nothing and hope for the best given the stakes?' added Jones.

Instead, scientists are now pressing that more radical solutions be sought. 'The current vaccine system is not going to work,' said Dunnill. 'We need a new approach.'


http://observer.guardian.co.uk/uk_news/story/0,6903,1588106,00.html

 

[Wowser]

Flu Plan Leaves Many Decisions at Local Level

http://www.washingtonpost.com/wp-dyn/content/article/2005/10/08/AR2005100801258.html
washingtonpost.com
Flu Plan Leaves Many Decisions at Local Level
U.S. Preparedness Draft Also Calls for Unprecedented Cooperation, Expert Says

By David Brown and Rick Weiss
Washington Post Staff Writers
Sunday, October 9, 2005; A13

A public health expert familiar with the latest draft of the federal government's pandemic influenza preparedness plan said it predicts that a full-scale disease outbreak might kill as many as 1.9 million Americans and sicken more than half the country's population.

The military probably would be used to help move critical supplies and provide security at places such as vaccination centers, the expert said, but quarantines will play only a small role in a pandemic response. Many crucial decisions on how to manage disruptions and shortages will be made at the local, not national, level.

Michael T. Osterholm, who advised the Department of Health and Human Services from 2000 to 2003 and now heads a medical think tank in Minnesota, made the comments after an article on the government's proposal appeared in the New York Times yesterday. The article described a 381-page version of the plan dated Sept. 30.

"There have been tremendous improvements in the plan even over the last week to 10 days," Osterholm said. In particular, he said, the most recent version emphasizes the likely prolonged effects of a flu pandemic and the need for unprecedented cooperation between the government and the business sector for more than a year.

"It is very much in flux now," he said. "Up until recently, it has been a plan that was handling this [event] much more like an earthquake or a hurricane. But it is not something that occurs over a very short period of time and then we go into the recovery phase. A pandemic will literally unfold, like a slow-moving tsunami, over 12 to 18 months."

Federal officials refused to provide the latest version or to describe it in any detail. Several of the people most involved in the multi-year writing of the plan were traveling to Southeast Asia yesterday with Health and Human Services Secretary Mike Leavitt and were unavailable.

Leavitt will visit at least four countries where influenza A/H5N1 -- also known as "bird flu" -- has killed or led to the culling of 140 million birds, as well as to 116 human cases and 60 deaths. Accompanying him on the 10-day trip are Jong Wook Lee, director general of the World Health Organization, and Margaret F.C. Chan, WHO's chief of pandemic influenza planning.

The trip's purpose, Leavitt said before departing, was to "emphasize the importance of this issue for the United States" and to stress the "need for the world community to be transparent and cooperative" in disease surveillance and reporting.

The final version of the pandemic preparedness plan is unlikely to be released until Leavitt returns. An HHS spokeswoman, Christina Pearson, said, "it's totally premature" to release the document now.

"We're still getting comments on the plan," she said. Speaking generally, she said that "it outlines the public health and health care responses. It describes things communities should be doing now. It has to be a foundation for further efforts."

Osterholm confirmed this view, although he would not give specific details about the plan.

"Basically, cities and states are going to have to shoulder a lot of this burden of response on their own. There is no other choice. When you have all 50 states, every major city, every county and every hospital in crisis -- the federal government can't address all of that," Osterholm said. "Every place is going to need resources and expertise at the same time, and in fact every country in the world is going to need those things."

In describing what Osterholm called "the upper bounds of what a pandemic could look like," the plan describes potential shortages of medicines for non-influenza illnesses, disruptions in the delivery of food and conceivably a lack of caskets and crematorium space.

Among the many critical supplies that hospitals and localities would need to have are masks, gloves and other protective equipment for nurses, physicians and first responders, who would be expected to have exposure month after month to people ill with influenza. They would be expected to be among the first to get access to short supplies of vaccine against a pandemic flu strain, or to prophylactic drugs.

At his news conference last week, President Bush said troops might be called upon to enforce quarantines during a flu pandemic.

Osterholm said yesterday he thinks "the plan is clearly going to address the role of the military for basic logistical operations, such as moving supplies, to possibly corpse management and possibly security." However, he said, "HHS has heard loud and clear from public health experts that quarantine plays a very limited role in stopping or even slowing influenza."

The forced isolation of citizens, he added, would occur only in particular circumstances, such as when an airplane arrives with potentially infected passengers.

Despite the sketchiness of details about it, the plan immediately became a vehicle for some Democratic leaders to criticize the Bush administration.

"The tragedy that unfolded before and after Katrina revealed how ill-prepared the administration was to deal with natural disasters. With the long-overdue release of their draft plan on avian flu, the administration acknowledged it is also woefully unprepared for yet another type of natural disaster," Senate Minority Leader Harry M. Reid (D-Nev.) said yesterday.

"Democrats recognized this problem months ago. That is why we led the fight to secure nearly $4 billion to help this nation prepare for and respond to an avian flu pandemic," Reid said.

Philip K. Russell, a former senior consultant to HHS's Office of Public Health Emergency Preparedness, said yesterday that "considering previous administrations were unable to agree on and produce a plan in spite of trying since about 1990, this is real progress." He added he thinks "the real reason that we are not ready relates to the vaccine industry and the lack of an aggressive vaccine development, domestic manufacturing and deployment capacity. Maybe this will generate the resources to fix the problem."
© 2005 The Washington Post Company

 

[Kim99]

http://www.thejakartapost.com/detaillatestnews.asp?fileid=20051009190917&irec=0

Six patients treated for bird flu to be released on Monday

JAKARTA (Antara): Six of 15 patients being treated for bird flu at the Sulianti Saroso Hospital for infectious disease will be released on Monday after laboratory tests showed negative results, a hospital spokesman said on Sunday.

"Blood samples sent by the hospital to the Ministry of Health's infectious disease laboratory show negative results for both the serology and polymerase chain reaction (PCR) tests," said Ilham Patu.

"We only have the results of six patients as of today."

The identity of the patients was not disclosed.

Indonesia has announced an "extraordinary" outbreak of the disease caused by the H5N1 virus.

"The results show that they do not suffer from bird flu but illnesses such as typhoid and regular flu," said Ilham.

"Negative laboratory test results are one of several considerations before discharging patients.

Another consideration is the absence of secondary bird flu symptoms such as high fever, coughing or spots in lungs visible through X-Ray.

The patients' condition will also determine whether they are going to be discharged or not.

"The decision to discharge the six patients will be taken during a meeting between doctors treating the patients and a team overseeing the disease outbreak," Ilham said. (***)

 

[Martin]

Tourist hub leaves isles vulnerable to bird flu
The state prepares for an unlikely but potentially deadly strain of virus
By Mary Vorsino
mvorsino@starbulletin.com
An avian flu pandemic could spread to the islands with one sick tourist. Everyone on the plane would be exposed, along with those who came in contact with the visitor in a hotel, riding a tour bus or even sharing an elevator.

Dozens, potentially hundreds, of people could get sick and pass the highly contagious virus on to family members, who could pass it on to their co-workers, friends and neighbors. The scale of the outbreak would grow exponentially within days, and, would almost surely cause deaths.

A Trust For America's Health report, issued in June, says as many as 2,400 people could die in Hawaii if the world was gripped by a so-called "mid-level pandemic flu," which they estimated to be about three times more lethal than the most recent flu pandemic in 1968.

Though the possibilities of such a catastrophic pandemic are remote, state health officials are planning and preparing for that kind of doomsday scenario -- especially in light of new fears about avian flu.

Earlier this year, state health officials drafted a pandemic influenza plan. The department declined to release the draft plan until it is approved, which is likely by the end of the year.

Officials at the state's laboratory in Pearl City are also setting up a procedure for testing cultures for avian flu. Within a month, the lab is expected to be ready to provide a preliminary diagnosis for avian flu that is 95 percent accurate.

Definitive results would still have to come from the Centers for Disease Control in Atlanta, which could take days.

There is a sense of urgency in the state's efforts.

In its present form, avian flu is not easily transmitted between humans, which would be required for a pandemic to happen.

But researchers say such a transformation could happen. So far, the flu has sickened more than 100 people worldwide, and killed 60.

Dr. Alan Tice, an infectious-disease specialist and associate professor at the University of Hawaii, said concern over avian flu has gradually increased in recent weeks for two key reasons.

For one, cases of avian flu are being found more often and farther apart. And some preliminary tests show the flu is resistant to antibiotics.

Tice, reached at a conference on infectious diseases in San Francisco on Friday, said the state is as prepared as it can be for a flu pandemic. But, he added, "you can always do more."

He also said it would be difficult -- if not impossible -- to stop a pandemic's deadly influenza strain from spreading to the islands because of the number of flights from Asia that arrive here every day.

"We're in the position in Hawaii where there's a lot of traffic and travel," he said, "and that makes us a little bit more at risk."

EVEN THOUGH a flu outbreak in the islands could spread fast, state health officials contend it could also be contained quickly, primarily with isolation and quarantine.

The sick would be cared for in designated hospital rooms, whose air ducts are not connected to other wards.

Dr. Linda Rosen, state deputy director of health resources, said most major hospitals in the islands could take about one to two sick patients in such rooms. If there were more sick, a whole hospital could be designated for influenza-patients only. Or, field hospitals could be set up.

The state has two tent hospitals, each of which accommodates 100 patients. "We don't have a lot of extra hospital capacity," Rosen said. "So that's (the field hospitals) basically our contingency plan ... if we had a lot more severely ill people at once."

In August, the state Health Department practiced setting up a field hospital in north Kohala on the Big Island.

As part of the exercise, nurses and doctors transported a patient supposedly sick with a highly contagious, deadly flu in an air ambulance from a hospital to the field hospital.

The "patient" was carried on a stretcher in a plastic containment bubble, while nurses and doctors wore protective bio-safety suits.

"There is a whole education curve in learning how to behave in a (infectious disease) emergency," Rosen said.

The sick, though, aren't the only part of a pandemic.

The state must also contend with those who have been exposed to a deadly flu, since they could become sick or pass the disease on even if they don't develop symptoms. That's where quarantine comes in.

Ross said those who have come in contact with a sick person would be asked or required to stay at home until they either show symptoms or are no longer at a threat of getting others sick.

Visitors who are exposed to the flu, Rosen said, would likely be housed on quarantine floors in Waikiki hotels. Whole families and whole neighborhoods could be quarantined in their homes.

And, Rosen said, "if you're going to ask people to stay in their house, you better make sure you get them food and water and health care."

THE STATE has already instituted several early-detection programs in hopes of heading off a pandemic's spread to the islands.

State and federal health officials now screen patients at Honolulu Airport's clinic for flu-like symptoms that could be avian influenza.

Also, "sentinel physicians" in the community have been asked to look for similar illnesses and report them to the state Health Department. The doctors regularly send the state batches of cultures from sick patients, which are tested.

But Rosen agreed that the avian flu could spread easily to Hawaii if it became contagious between humans.

"We certainly do have a lot of visitor travelers," she said. "That does put you at risk at picking up something from everywhere in the world. And we do have concerns" about avian flu.

A Northwestern University study released in May ranked Honolulu in the top 1 percent of world travel hubs, and therefore a place to watch during a contagious disease outbreak.

Other places to monitor included Paris, London and New York.

But officials say Hawaii's centrality for visitors has meant more preparedness in the event of a public health crisis.

Since 1997, when avian flu was first identified, the state Health Department has been watching the influenza strain and its potential for causing a pandemic.

And just two months ago, more than 115 officials from city, state and federal agencies gathered at the Blaisdell Exhibition Hall to discuss how they'd respond to an outbreak of avian influenza at a poultry farm on Oahu.

Under those circumstances, said state veterinarian James Foppoli, a state Agriculture Department employee would be sent out to the farm within hours of a report of dying birds.

Right away, measures would be taken to make sure the flu didn't spread to others, with workers taking showers before they left the premises and washing their shoes.

Once avian flu is definitively confirmed, Foppoli said, the poultry at the farm would be destroyed, a process that could take another week.

A report on the avian flu exercise, which involved the state Health Department, will likely be released next month.

Other agencies, too, have been planning for an avian flu outbreak. In exercises, state Civil Defense has coordinated different departments, including law enforcement.

Reservists and active-duty military are also in the mix.

Maj. Chuck Anthony, spokesman for the Hawaii National Guard, said the governor could request the Guard's assistance in the event of a pandemic.

She could also request the active-duty military's help through the National Response Plan, said Navy Lt. Cmdr. Jason Salata, spokesman for the U.S. Pacific Command in Hawaii.

"Just like if a hurricane hit Hawaii and you have this incredible pool of military here," Salata said.


BACK TO TOP


MAJOR OUTBREAKS OF INFLUENZA
IN HAWAII AND AROUND THE WORLD
1918: The "Spanish" flu pandemic killed 500,000 in the United States and 50 million worldwide.
1945: A flu epidemic on Oahu sickened thousands, including several hundred military personnel stationed here. The outbreak forced officials to close all movie theaters and cancel other gatherings.

1953: Nearly 8,000 people in the islands reported coming down with influenza during a spring outbreak. The number is thought to be as much as double that, since many people did not see a doctor for medications.

1957-58: A flu from China spread across the globe, killing about 70,000 in the United States.

1968-1969: The "Hong Kong flu," the most recent pandemic, affected millions worldwide and disrupted world economies. Some 750,000 people died worldwide, including 34,000 in the United States.

In Hawaii, there were six confirmed reports of Hong Kong flu. Four were military personnel who had just returned from Asia, one was a resident who had also just gotten back from the region and the sixth had been exposed by a visitor from Asia.


Source: World Health Organization and Star-Bulletin news reports

http://starbulletin.com/print/?fr=/2005/10/09/news/story01.html

 

[Martin]

Bird flu tests 'negative'
16:34pm 9th October 2005

What is RSS?

Fears that a deadly strain of bird flu had spread to Romania may be unfounded, the Department for Environment, Food and Rural Affairs (Defra) confirmed.
The deaths of three domestic ducks in the Eastern European country were initially linked to the H5N1 strain of the disease.

Experts have been tracking H5N1 as they fear it will mutate and cause a human flu pandemic.





But today Defra's Chief Veterinary Officer Debby Reynolds said: "The Romanian authorities told us today that initial tests for avian influenza viruses are negative.

"This must be confirmed by further tests which will take several days. Defra is in very close contact with the European Commission and Romanian veterinary services."

H5N1 has so far killed 60 people in Asia, and infected 116. Experts fear these figures could rise dramatically if the virus mutates, passing between people more easily.

The dead birds were first noted in the village of Ceamurlia near the Black Sea in late September. Samples were sent to Bucharest, where scientists initially thought they detected bird flu antibodies.

Dr Reynolds added: "A team of experts from the EU is going to Romania tomorrow to support the authorities there."

She also confirmed that early reports suggested a strain of bird flu may have been discovered in Turkey

http://www.dailymail.co.uk/pages/li...ews.html?in_article_id=364831&in_page_id=1797

 

[Martin]

OCTOBER 9, 2005

NEWS ANALYSIS :TECH
By Catherine Arnst


Avian Flu Under the Microscope


Here's key information about the potentially deadly disease that has governments and scientists on high alert, since it may spread around the globe
Suddenly the news is filled with dire warnings about avian flu, a potentially deadly disease that may -- or may not -- sweep the globe in the next few years. Infectious-disease experts have been warning for years that the virus that has killed tens of millions of chickens and waterfowl in Asia since 1997 could mutate into a form that would infect humans. If that happens, it could produce a devastating flu pandemic such as the Spanish flu of 1918 that killed as many as 50 million people worldwide (see BW Online, 10/6/05, ""Eerie" Discoveries about Flu").

Now Washington is taking the threat seriously: Health officials from 80 countries met with the State Dept. on Oct. 7 to discuss coordinating strategies to address a possible pandemic, and the White House met with vaccine makers the same day to see if production of a potential vaccine could be ramped up.

Here are some facts about avian flu and the risks it poses to humans:

What is avian flu?
In birds, the disease is caused by one branch of a family of microbes called Type A influenza virus. The viral subtype that scientists have been anxiously watching since 1997 is called H5N1, and it originated in water birds, primarily ducks. Ducks can usually withstand this virus, making them ideal carriers -- especially since they're migratory. Chickens have less resistance, and once one is infected it can quickly spread the virus through an entire flock, killing nearly all the birds.

How do humans get avian flu?
So far, virtually all the 100 or so avian-flu cases identified in humans can be traced directly back to contact with live chickens. Infected birds pass the virus through feces, and it affects humans that breathe in the fecal dust. The virus is not passed on in the meat or eggs, so there's no danger from eating cooked chicken.

How deadly is avian flu to humans?
In its current form, very. So far, about 65 people have died from the disease, resulting in a mortality rate near 70%. By comparison, the SARS outbreak of 2003 infected 8,098 people around the globe and killed 774, for a 9.6% death rate.

The disease can kill within a week, destroying the lungs and other organs. If it's anything like the Spanish-flu outbreak, its main victims will be otherwise healthy adults. The World Health Organization has warned that an avian-flu pandemic could kill as many 150 million people worldwide, and the Centers for Disease Control & Prevention estimates that about 25% of the U.S. population would fall ill.

How can the virus mutate into one that can be passed from human to human?
Viruses are notorious shape-shifters, able to constantly rearrange their genes and swap genetic material with different strains. Virologists are watching carefully for evidence that the microbe has begun swapping genetic material with a human virus -- that's when it could turn deadly for people. One worrisome sign: This summer there were reports out of Indonesia that the virus was found in pigs, which often act as incubators for human infections.

Are we sure that avian flu will turn deadly for humans?
No. The virus may never mutate into a form that's harmful to people. Or it could change into a relatively benign bug. Infectious-disease experts fret that the world is overdue for a flu pandemic since for hundreds of years there have been four every century.

In the past 100 years, the world has seen three, of varying deadliness: The Spanish flu of 1918, which killed 500,000 Americans; an outbreak in 1957-1958 that killed 70,000; and the Hong Kong flu outbreak of 1968-1969 that caused 37,000 deaths.

Most experts, however, believe H5N1, if it does end up threatening humans, will probably be quite deadly because of its similarity to the Spanish-flu virus. Also, doctors have noticed that more people are surviving the infection recently than they were when H5N1 was first discovered. That's not necessarily a good thing. It could mean that the virus is mutating into one that is easier to carry -- and spread. Ominously, the Spanish-flu virus, which also started in birds, followed a similar evolutionary path.

If it does turn deadly, when might that happen?
It could be in the next few months, or in the next few years. No one's sure. Once it does turn, the pandemic will likely sweep around the globe over several weeks and last for about a year. Although, again, no one can be sure.

Can anything be done to prevent a pandemic?
Not much. The WHO and other international groups would like to increase surveillance and monitoring in Asia, so that a human outbreak can be quickly identified and contained, with quarantines and aggressive treatment. But Thailand is the only country in Southeast Asia with a comprehensive pandemic plan, so international efforts would have to be put in place rapidly.

Once the virus starts to spread, most likely carried by an international traveler, quarantine will likely do little good. Unlike SARS, which could only be spread by close personal contact, flu is transmitted by sneezing and hand contact, and carriers can be infectious up to a week before they start showing symptoms.

What about a vaccine, or treatment?
No vaccine exists right now, although there was some early success this summer with a potential candidate. The National Institutes of Health is racing to develop one, and the White House is talking to vaccine manufacturers about increasing production capacity. However, if a pandemic does break, it could take six months to produce a vaccine for that particular strain.

As for treatment, Tamiflu, made in Switzerland by Roche Holding's (RHHVF ) Hoffman-La Roche, is the only antidote for flu. However, the U.S. has only stockpiled enough for a few million patients.



http://www.businessweek.com/print/technology/content/oct2005/tc20051010_0869_tc024.htm?chan=tc

 

[Martin]

Israel plans emergency response to avian flu

By Amiram Cohen, Haaretz Correspondent

Should avian flu be discovered in Israel, all the poultry within a radius of three kilometers of the case will be culled. Those within a 10-kilometer radius will be given a special vaccine against avian flu as soon as the first positive case is found.

These are among the preparations being made by officials of the health and agriculture ministries in the event that avian flu reaches Israel.

Israel is on alert lest the avian flu virus be "imported" here from the Far East or Europe. The veterinary services in the Agriculture Ministry, together with Health Ministry officials and other relevant bodies, have set up a special team to deal with this eventuality. Similar teams have been established in other parts of the world.



The Health Ministry has acquired a "vaccine bank" containing serums useful against the H-7 and H-10 strains of the virus. These mildly potent strains are characterized by their ability to turn into virulent mutations.

Special protective kits have also been prepared for the doctors who will have to deal with the virus. They include protective clothing, vaccinations and medications and will be administered at the instruction of the health ministry.

The veterinary services have also set up a special infrastructure to handle the examination of birds that are suspected of carrying the virus. In order to prevent the spread of the disease, it is extremely important to make a swift and early diagnosis.

Cases of avian flu have been reported in Russia, Kazakhstan and Mongolia, and more recently in Romania and the Far East. Romania reported new cases in the Danube delta on the Black Sea over the weekend.

The Danube delta is a major migratory area for wild birds flying from northern Europe to warmer climates in the south. The Romanian strain is being tested to see whether it is the H5N1 strain, which has killed 65 people and millions of birds in Asia over the past two years.

The Romanian government has also dispatched doctors to the area to see whether humans have been infected.

Two strains of the virus are thought to be passed to humans by birds.

Avian flu can have many strains, and so far 15 have been identified. But further strains are likely to develop from those existing. The new mutantions can be especially fatal to the birds.

While it has been proven that avian flu passes from birds to humans, it is not yet clear whether the virus can be transmitted directly from one human to another. It is believed that the great flu pandemic of 1918 that killed 50 million people was caused by a strain of avian flu that mutated and spread among humans.

http://www.haaretzdaily.com/hasen/spages/633563.html

 

[O2BNOK]

AVIAN INFLUENZA - ASIA (39): TURKEY, TURKEYS, H5 CONFIRMED
**********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Sponsored in part by Elsevier, publisher of Tuberculosis
<http://thelancet.url123.com/a5dpp>

[1]
Date: Sun 9 Oct 2005
From: Nati Elkin <nati@poultrymed.com>
Source: AP via CNN, 9 Oct 2005 [edited]
<http://edition.cnn.com/2005/WORLD/europe/10/08/turkey.bird.flu.ap/index.html?
section=cnn_latest>


Turkey confirms bird flu
------------------------
Anatolia, quoting officials, said that on Friday [7 Oct 2005], it was
confirmed that the birds in Turkey died of the H5 type of bird flu.

Turkey's agriculture minister confirmed the country's 1st cases of
bird flu, and officials ordered all winged animals and street dogs in
the village where it was detected destroyed as a precaution against
the disease spreading, the Anatolia news agency said.

Military police have also set up roadblocks at the entrance to the
village near Balikesir in western Turkey and are checking all
vehicles entering and exiting, Anatolia said on Saturday [8 Oct 2005].

[Belikesir is situated in the southwestern, Asian part of Turkey's
northwestern Marmara region (which has also a European part). See map
at
<http://www.plantours.com/regions/marmara.gif>.
For a map of Turkey, showing the location of the Beliksir region, see:
<http://www.hippodromehotel.com/guide/images/turkey_cities_map.gif>].

The birds belonged to a turkey farmer, CNN-Turk reported, saying that
2000 birds died. Anatolia did not cite a number but said that any
animals that did not die of the disease were destroyed.

The outbreak was confirmed by Agriculture Minister Mehdi Eker, who
said that Turkish officials had been communicating with officials in
the European Union and other international organizations about the
outbreak, Anatolia reported. Eker did not specify how many birds died
of the disease.

The outbreak was initially brought to officials' attention on
Wednesday [5 Oct 2005], Anatolia said. On Thursday officials went to
the village and destroyed all the birds on the turkey farm that were
still alive and buried them, then disinfected the area, Anatolia said.

That would suggest the scientists have narrowed it down to an H5 type
virus -- the family of the bird flu virus that experts are watching
-- but have not narrowed it further to determine whether it is the
exact strain H5N1 that health officials are particularly worried
about.

"Unfortunately we met with bird flu," Anatolia quoted Eker as saying.
"But everything is under control, every kind of precaution has been
taken so that it doesn't spread."

Officials from the Health Ministry and the Agriculture Ministry were
sent to investigate, CNN-Turk reported.

They ordered all winged animals in the village destroyed Saturday [8
Oct 2005], saying that farmers would be compensated for their losses,
Anatolia said.

The farmer whose birds carried the disease said he had not been
checked by doctors yet and was scared to go near his wife and
children, Anatolia reported.

Eker said the flu was likely carried by birds migrating from the Ural
Mountains, which divide Europe and Asia, across Turkey and into
Africa.

Cases of bird flu were also confirmed Saturday [8 Oct 2005] in
Romania, which borders Turkey [see ProMED reference below].

--
ProMED-mail
<promed@promedmail.org>

******
[2]
Turkey culls poultry to stem spread of bird flu-TV

Date: 9 Oct 2005 10:19:57 GMT
From:
Source: Reuters
<http://www.alertnet.org/thenews/newsdesk/L09397296.htm>


ANKARA, Oct 9 (Reuters) -
Turkey culled about 1500 chickens and turkeys overnight
to prevent the spread of avian flu after reporting its
first outbreak of the disease on a farm near the Aegean
Sea, NTV private television said on Sunday.

The authorities have also imposed a 3 km (2 miles)
quarantine zone around the affected farm, where nearly
2000 turkeys died of the globally feared disease on
Tuesday and Wednesday, the station said.

Officials were not immediately available to confirm the
reports and it was not clear why the first reports of the
outbreak only surfaced on Saturday evening.

"Last night, some 1500 birds were slaughtered," NTV said.
The authorities have drawn up a national action plan, it
said, but gave no details.

The Anatolian state news agency said veterinary teams had killed 600 turkeys
overnight in one farm alone in the affected area of northwestern Turkey as a
precautionary measure. The birds were buried in lime-drenched pits, it said.
The culling will resume on Sunday evening [9 Oct 2005], the agency said.

[By Gareth Jones]
--
ProMED-mail
<promed@promedmail.org>

[The possible spread of H5N1 (final identification yet to be
confirmed) to the coastlines of the Black Sea area (Tulcea, Romania,
Europe in the west, and southern Marmara, Asia in the southwest)
might be a attributed to transmission by migrating birds. These
locations are situated on a main migratory birds flyway; the annual
southwards migration has began in September 2005. As indicated in the
special report "Wild birds and avian influenza" of FAO's Animal
Production and Health Department:" "... it is plausible that HPAI
H5N1 virus could spread from Siberia to the Caspian and Black Sea
areas in the foreseeable future. Some birds are currently nesting in
the newly HPAI affected areas of Novosibirsk and Altai in Russia and
will migrate to the above-mentioned areas for upcoming winter or land
to rest on their way to Africa and Europe. The exact risk will likely
depend on the identification of specific migratory species that carry
H5 viruses without suffering the disease, and knowledge of their
resting areas and wintering grounds combined with the existing
production poultry systems and husbandry.

Bird migration routes run across southwest Asia and some Mediterranean
countries, where bird flu outbreaks could possibly occur". The report includes
a schematic major-flyways map. See:
<http://www.fao.org/ag/againfo/subjects/en/health/diseases-
cards/avian_HPAIrisk.html>.

Final identification of the Romanian and Turkish isolates, and official
confirmation, including epidemiological data, are anticipated. - Mod.AS]

[From the map referenced above, it seems clear to me that, at least up until
now, the virus has not been spread by migrating birds, since the direction of
spread has been east-west, cutting across several north-south flyways and
following the frontier between Russia and Kazakhstan westwards from the
Mongolian border. Could there be a flourishing trade in poultry along the
border? - Mod.JW]

[see also:
Avian influenza - Asia (38): Russia (Urals) 20051006.2918
Avian influenza - Europe (10): Romania, ducks, susp. 20051007.2928
Avian influenza - Europe (11): Turkey, turkeys, susp. 20051008.2937
Avian influenza - Europe (12): Romania, ducks, susp. 20051008.2939
Avian influenza - worldwide: preventive measures 20050930.2861
Avian influenza - Europe (04): EU, preventive measures 20050824.2498
Avian influenza - Europe (05): EU, preventive measures 20050825.2511
Avian influenza - Asia (23): migratory birds 20050907.2657
Avian influenza - Asia (25): migratory birds 20050909.2675]
....................arn/msp/jw
*##########################################################*
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are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
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[O2BNOK]

http://english.people.com.cn/200510/10/eng20051010_213626.html



Another person infected with bird flu in Indonesia



Another man has been confirmed by the World Health Organization's (WHO) laboratory test in Hong Kong as infected with bird flu, while his nephew, a four-year-old boy was also tested positive by local laboratory as having the virus, an official said here on Monday.

Director General of Disease Control and Environmental Health of the Indonesian Health Ministry I Nyoman Kandun told Xinhua that the case brought the total persons confirmed by the organization of having the H5N1 virus to five in Indonesia. The first four have died in tandem.

The man with initial of H of 21 years old from Lampung Province had been treated in Abdoel Moeluk Hospital in the province. Later, the health officials sent his blood sample to the WHO laboratory in Hong Kong, said Kandun.

"H was confirmed as positive by Hong Kong laboratory test," he said.

"Now, we are waiting for the result of the boy's blood sample from Hong Kong. Normally, if local test said positive, Hong Kong laboratory will say the same. If it is positive, it will add to the list of persons confirmed by the WHO," the director said.

Kandun said that so far over 98 bird flu cases with bird flu symptoms had been found across the country.

Indonesia's health minister has said the country could face a bird flu epidemic if the number of suspected cases of the virus continued to mount.

The highly pathogenic H5N1 strain, which has killed 64 people in four Asian countries since late 2003, has also been found in birds in Russia and Europe.

Source: Xinhua

 

[O2BNOK]

http://www.recombinomics.com/News/10090501/H5N1_Lampung_Cluster_Confirmed.html

Commentary
.
H5N1 Confirmed Familial Cluster in Lampung Indonesia

Recombinomics Commentary
October 9, 2005

The boy, Herdi Setiawan, is from Lampung province on Sumatra, officials said. Initial tests were performed in Jakarta, and blood samples have been sent to Hong Kong for confirmation of the results.

The positive H5N1 lab results on the boy above generates yet another confirmed familial cluster in Indonesia. The boys uncle, Hendriansyah (21M) was admitted on September 25 and also tested positive for H5N1. He is still in the hospital. However, another uncle, Hesiyansyah (5M) tested negative and was release with a diagnosis of "typhus". The two positives however, cast serious doubts on the "negative" test results, since the brother and nephew of the negative case have tested positive for H5N1.

All three family members however, had mild cases. Herdi (4M) no long has a fever, and his admission was likely connected to the fact that his uncle was hospitalized and had tested positive for H5N1. This family cluster raises additional questions about false negatives in Indonesia.

The large number of admissions linked to visits to Ragunan zoo identified several H5N1 positive cases, but all of these cases were also mild.

Mild cases are more difficult to detect, and Indonesia's policy of not collecting samples at the primary hospitals almost certainly leads to a high number of false negatives. By the time the patient is transferred to an infectious disease hospital. The H5N1 has moved from the nose and throat to the lungs. Therefore, swabs from the upper respiratory tract test negative.

The large number of familial clusters in Indonesia suggests that H5N1 is spread relatively easily among family members. The number of zoo visitors with symptoms or positive lab results indicates H5N1 is transmitted by casual contact.

The testing procedures remain scandalously poor, and H5N1 is clearly silently spreading in humans in Indonesia.

 

[O2BNOK]

http://www.recombinomics.com/News/10100501/H5N1_Lampung_Uncle_Confirmed.html

Commentary
.
Hong Kong Confirms H5N1 Positive Uncle in Lampung Indonesia

Recombinomics Commentary
October 10, 2005

The Hong Kongese laboratory again gave the report on a patient from Indonesia positive was infected by birds flu. The patient namely Hendriansyah (21) that currently still is treated in RS Abdul Moeloek, Banda Lampung.

The above machine translation indicates H5N1 has been confirmed in the uncle of the latest case confirmed case in Lampung. Thus, the uncle has now been lab confirmed in Lampung and Hong Kong, while the nephew has been confirmed in Lampung. Results from Hong Kong will likely also confirm.

Both of these cases were mild, as was the 5 year old brother, Hesiyansyah, of the Hong Kong confirmed case. However, the brother was released with a diagnosis of "typhus". Testing of the released brother's serum from antibodies to H5N1 would be useful. False negatives are common, and such negatives can be easily generated.

In the current familial cluster, the uncle had exposure to dying chickens. However, there was no mention of dying chickens in the description of his 4 year old nephew. The nephew developed a fever and the family physician suggested he be admitted to the infectious disease hospital and showing symptoms for 3 days. Testing in Lampung has confirmed H5N1, but the nephew's temperature has already returned to normal and the case appears to be very mild.

Because the case was so mild, it is unlikely that the case would have been admitted had there not been the connection with his hospitalized uncles. It seems likely that there are many more mild cases who are misdiagnosed as human flu. When 115 zoo visitors came to the infectious disease hospital with mild symptoms, they were turned away. It is not clear that samples were collected from any of these patients. Nor is it clear that they were hospitalized or followed.

The mild cases in Jakarta and throughout Indonesia and the world are easily missed. Monitoring of these patients remains scandalously poor. It is unknown how many of the zoo visitors were H5N1 positive, or how many passed H5N1 on to others. The situation in Indonesia demands a serious screening effort, yet it would appear that efforts are being imposed to limit cases.

The latest suspect case, Cahyadi (50M) died 20 minutes after transfer to the infectious disease hospital, Sulianti Saroso, in Jakarta. He had been hospitalized for 3 days at the primary care facility, RS Budhi Asih. The number of cases at the primary facilities who recover and are sent home without testing is unclear.

However, it would appear that casual transmission of H5N1 in Indonesia is common and it is not being properly monitored.

 

[O2BNOK]

AVIAN INFLUENZA, HUMAN - EAST ASIA (143)
****************************************
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International Society for Infectious Diseases
<http://www.isid.org>

Sponsored in part by Elsevier, publisher of
Tuberculosis
<http://thelancet.url123.com/a5dpp>

[1]
Date: Sun 9 Oct 2005
From: ProMED-mail <promed@promedmail.org>
Source: The New York Times, Sun 9 Oct 2005 [edited]
<http://www.nytimes.com/2005/10/09/national/09flu.html?oref=login>


Danger of flu pandemic is clear, if not yet present
---------------------------------------------------
Fear of the bird flu sweeping across Asia has played a major
role in the [United States] government's flurry of
preparations for a worldwide epidemic. That concern prompted
President Bush to meet Friday [7 Oct 2005] with vaccine
makers to try to persuade them to step up production, and it
led Health and Human Services secretary Michael O Leavitt to
depart yesterday [8 Oct 2005] for a 10-day trip to at least
4 Asian nations to discuss planning for a pandemic flu. But
scientists say that although the threat from the current
avian virus is real, it is probably not immediate.

Dr Anthony S Fauci, director of the National Institute of
Allergy and Infectious Diseases, said a bird flu pandemic
was unlikely this year [2005]. "How unlikely, I can't
quantitate it," Dr Fauci said. But, he added, "You must
prepare for the worst-case scenario. To do anything less
would be irresponsible." "I would not say it's imminent or
inevitable," said Dr Jeffery Taubenberger, chief of the
Molecular Pathology Department at the Armed Forces Institute
of Pathology. "I think in the future there will be a
pandemic." But, he said, whether that pandemic will be bird
flu [that is, avian H5N1 influenza] or another type, no one
can say.

The Bush administration is in the final stages of preparing
a plan to deal with pandemic flu. A draft shows that the
country is woefully unprepared, and it warns that a severe
pandemic will kill millions, overwhelm hospitals, and
disrupt much of the nation. What worries scientists about
the current strain of bird flu, known as H5N1, is that it
has shown some ominous traits. Though it does not often
infect humans, it can, and when it does, it seems to be
uncommonly lethal. It has killed 60 people of the 116 known
to have been infected. Alarm [increased] on Thursday when a
scientific team led by Dr Taubenberger reported that the
1918 flu virus, which killed 50 million people worldwide,
was also a bird flu that jumped directly to humans. There is
a crucial difference, however: the 1918 flu was highly
contagious, while today's bird flu has so far shown little
ability to spread from person to person. But a mutation
making the virus more transmissible could set the stage for
a pandemic. Another concern is that H5N1 has become
widespread, killing millions of birds in 11 countries and
widely dispersing as migratory birds carry it even greater
distances. This month [October 2005], it was reported in
Romania [as of 9 Oct 2005 not yet confirmed as caused by
avian H5N1 influenza virus].

Meanwhile, it is spreading widely among birds in Asia. And
it has unusual staying power: it has persisted in different
parts of the world since it emerged in 1997. "Most bird flus
emerge briefly and are relatively localized," said Dr Andrew
T Pavia, chief of the Division of Pediatric Infectious
Diseases at the University of Utah and chairman of the
Pandemic Influenza Task Force of the Infectious Diseases
Society of America. The most worrisome thing about H5N1, Dr
Pavia said, is that it has not gone away.

Some scientists suspect that if H5N1 has not caused a
pandemic by now, then it will not, because it must be
incapable of making the needed changes. But others say there
is no way to tell what the virus will do as time goes on.
And they point out that no one knows how long it took for
the 1918 virus to develop the properties that led to a
pandemic. Meanwhile, H5N1 seems to be finding its way into
more and more species. Once known to infect chickens, ducks
and the occasional person, the virus is now found in a wide
range of birds, and it has infected cats. "It killed tigers
at the Bangkok zoo, which is quite remarkable because flu is
not traditionally a big problem for cats," Dr Pavia said. It
has also infected pigs, which in the past have been a
vehicle to carry viruses from birds to humans. "We should be
worried but not panicked," Dr Pavia concluded.

The timing of the bird flu's emergence also makes scientists
nervous, because many believe that based on history, the
world is overdue for a pandemic. Pandemics occur when a flu
virus changes so markedly from previous strains that people
have no immunity, and vast numbers fall ill. "In the 20th
century there were 3 pandemics, which means an average of
one every 30 years," Dr Fauci said. "The last one was in
1968, so it's 37 years. Just on the basis of evolution, of
how things go, we're overdue."

But not everyone is equally worried about the bird flu. The
fear "is very much overdone, in my opinion," said Dr Edwin
Kilbourne, an emeritus professor of immunology at New York
Medical College, who has treated flu patients since the 1957
pandemic and has studied the 1918 flu. The bird flu, he
said, is distantly related to earlier flu viruses, and
humans have already been exposed to them, providing some
resistance. Scientists also say that the death rate may not
be as high as it appears, because some milder cases may not
have been reported. Dr Kilbourne and other experts also
noted that when viruses become more transmissible, they
almost always become less lethal. Viruses that let their
hosts stay alive and pass the disease on to others, he
explained, have a better chance of spreading than do strains
that kill off their hosts quickly.

Moreover, he said, while much has been made of comparisons
between the current avian flu and the 1918 strain, the
factors that helped increase the flu's virulence in 1918 --
the crowding together of millions of World War I troops in
ships, barracks, trenches and hospitals -- generally do not
exist today for humans. But an essential difference is that
people carrying the flu today can board international
flights and carry the disease around the world in a matter
of hours.

Dr Kilbourne emphasized that medical care had improved
greatly since 1918. Although some flu victims then turned
blue overnight and drowned from blood, with fluid leaking
into their lungs, many more died of what are now believed to
be bacterial infections, which can be treated with
antibiotics. Although the death toll from that flu was high,
the actual death rate was less than 5 per cent. In addition,
more people now live in cities, where they have probably
caught more flus, giving them immunity to later ones. "In
1918, you had a lot of farm boys getting their 1st contact
with city folks who'd had these things," Dr Kilbourne said.

[Byline: Denise Grady; Andrew Pollack and Donald G McNeil jr
contributed reporting for this article]

--
ProMED-mail
<promed@promedmail.org>

[The views of Professor Ed Kilbourne, a scientist with long
experience of influenza viruses and human disease, which are
reported above, deserve some attention if only to moderate
some of the alarmist statements that have gone largely
unchallenged up to the present. - Mod.CP]

******
[2]
Date: Sun 9 Oct 2005
From: ProMED-mail <promed@promedmail.org>
Source: Reuters AlertNet Foundation, Sat 8 Oct 2005 [edited]
<http://www.alertnet.org/thenews/newsdesk/L08229465.htm>


Chronology -- key dates in Asian avian influenza outbreak
---------------------------------------------------------
Romania reported 3 cases of avian influenza in a village in
the Danube delta on Sat 8 Oct 2005 and started to cull
hundreds of birds to prevent the disease from spreading,
chief veterinarian Ion Agafitei said. Tests were being
carried out to determine which strain [serotype] of virus
was involved.

A total of 65 people have died from the disease in Asia
since late 2003, 44 in Viet Nam, 12 in Thailand, 5 [now
revised down to 3] in Indonesia, 4 in Cambodia.

Here is a brief chronology of the spread of Asian bird flu:

15 Dec 2003 -- South Korea confirmed a highly contagious
type of avian influenza at a chicken farm near Seoul and
began a mass cull of poultry when the virus rapidly spreads
across the country.

31 Dec 2003 -- Taiwan reports its 1st case and later
destroys thousands of chickens with a milder form of avian
influenza [LPAI].

8 Jan 2004 -- Viet Nam says bird flu has been found on many
of its poultry farms.

13 Jan 2004 -- The World Health Organization confirms the
deaths of 3 people in Viet Nam are linked to bird flu.

25 Jan 2004 -- Indonesia discovers an outbreak among
chickens.

26 Jan 2004 -- Thailand confirms the death of a 6-year-old
boy, its 1st human death from bird flu.

12 Feb 2004 -- The World Health Organization confirms tests
show no evidence bird flu is passing from person to person.

16 Mar 2004 -- China declares it has stamped out the disease
in all 49 hotbeds and has had no reports among poultry for
29 days.

26 May 2004 -- Thailand reports [detection] of bird flu in
several dead chickens on a university research farm in the
northern city of Chiang Mai.

19 Aug 2004 -- Malaysia says a strain of bird flu has been
found in 2 chickens that died in a northern village near the
Thai border in the country's 1st bird flu outbreak.

27 Sep 2004 - Thailand says it has found its 1st known
probable case of a human being infecting another with bird
flu. It said this was an isolated incident that posed little
risk to the greater population.

15 Dec 2004 -- Taiwan says it has discovered 2 strains of
avian flu in migratory birds in the northern part of the
island, the milder H5N2 strain and also the H5N6 strain.

5 Apr 2005 -- The UN says that the H7 strain of bird flu
previously undetected in Asia has been found in North Korea.

8 Jul 2005 -- The Philippines says it has suffered its 1st
case of bird flu, in ducks. It later says it is free from
any highly pathogenic strain of bird flu.

20 Jul 2005 -- Indonesia confirms its 1st deaths from bird
flu.

26 Jul 2005 -- Japan says a fresh outbreak of bird flu has
been discovered on a chicken farm in eastern Japan. All
outbreaks in the Ibaraki prefecture since late June have
been confirmed as the weaker H5N2 strain.

9 Aug 2005 -- Viet Nam reports one new human death from bird
flu, taking its death toll to 43. The H5N1 virus has also
killed 12 people in Thailand, 4 in Cambodia and 3 in
Indonesia.

10 Aug 2005 -- The bird flu virus has been found in Tibet,
the world animal health body OIE says.

15 Aug 2005 -- Russia reports an outbreak of bird flu in the
Urals region of Chelyabinsk, the 6th region to be affected.

23 Aug 2005 -- In Kazakhstan a bird flu outbreak of the H5N1
strain in 7 northern villages is confirmed as dangerous to
humans.

26 Aug 2005 -- Finland says it has found a possible case of
bird flu in a seagull in the northern town of Oulu. [Not
confirmed as H5N1 virus]

1 Sep 2005 -- Viet Nam reports one new human death from bird
flu, taking its total to 44.

15 Sep 2005 -- United States says it has promised Viet Nam
USD 2.5 million over 5 years to improve its collection of
information on bird flu. Viet Nam says it is vaccinating
poultry to prevent new outbreaks.

16 Sep 2005 -- Indonesia confirms 4th human death from bird
flu.

26 Sep 2005 -- Indonesia confirms 5th human death from H5N1
strain of bird flu, says disease has spread to 22 of its 33
provinces. [Death toll subsequently revised down to 3]

8 Oct 2005 -- Romania reports avian flu cases in a Danube
delta village, culls hundreds of domestic birds to prevent
the disease from spreading, unclear which strain is
involved.

--
ProMED-mail
<promed@promedmail.org>

[This is a highly selective and idiosyncratic chronology,
which nevertheless records some useful milestones. - Mod.CP]

[see also:
Avian influenza, human - East Asia (142): CDC update
20051008.2941
Avian influenza, human - East Asia (138): WHO review
20051003.2892
Avian influenza, human - East Asia (118): CDC trav...
20050813.2372
Avian influenza, human - East Asia (117): WHO Update
20050818.2423
Avian influenza, human - East Asia (105): CDC update
20050724.2144
Avian influenza, human - East Asia (93): CDC advice
20050622.1744
Avian influenza, human - East Asia (79): WHO update
20050519.1376
Avian influenza, human - East Asia (59): CDC guide...
20050328.0892
Avian influenza, human - East Asia (34): CDC Updates
20050220.0558
Avian influenza, human - East Asia (09): CDC update
20050116.0144]

...................cp/msp/sh
*##########################################################*
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using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
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[O2BNOK]

AVIAN INFLUENZA, HUMAN - EAST ASIA (144): INDONESIA
***************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Sponsored in part by Elsevier, publisher of
Tuberculosis
<http://thelancet.url123.com/a5dpp>

Date: Sun 9 Oct 2005
From: ProMED-mail <promed@promedmail.org>
Source: Reuters AlertNet Foundation, Sun 9 Oct 2005 [edited]
<http://www.alertnet.org/thenews/newsdesk/SP265335.htm>


Indonesia: 4 year old boy a suspected avian influenza case
-------------------------------------------
A 4 year old boy has tested positive for avian influenza
virus infection in Indonesia, a case which, if confirmed,
would be the 6th in the world's 4th most populous country,
the health ministry said on Sun 9 Oct 2005. The boy from
Lampung province on Sumatra was found to be infected with
the deadly H5N1 avian influenza virus, director general of
Disease Control and Environmental Health I Nyoman Kandun
told Reuters. "Later, we will confirm the result in Hong
Kong. If the test result there is also positive, he will be
added to the list (of confirmed cases)," Kandun said. The
boy was in the hospital at Lampung. "He's well, only having
a cough," Kandun said.

4 Indonesians are already known to have died since July 2005
from the highly pathogenic H5N1 strain, which has killed 64
people in 4 Asian countries since late 2003 and has been
found in birds in Russia. [Outbreaks of avian influenza in
Romania and Turkey have been reported, but as of 9 Oct 2005,
the identity of the infectious agent has yet to be
confirmed. - Mod.CP]

6 other patients remain in a government-designated hospital
in Jakarta suspected of having avian flu. Indonesia's health
minister has said the country could face a bird flu epidemic
if the number of suspected cases of the virus continued to
mount. The government has put in place emergency measures to
stem the virus, including mandatory hospitalization of
anyone with suspicious symptoms.

--
ProMED-mail
<promed@promedmail.org>

[The number of confirmed cases (i.e. cases confirmed
positive by a WHO-designated reference laboratory in Hong
Kong) has been revised down to 3 fatal cases and 1 non-fatal
case. The Indonesian authorities believe that the above case
and another suspected case will be confirmed as avian H5N1
influenza virus positive, raising the number of confirmed
cases to 6. But another 80 to 90 cases have been identified
as suspected cases by the Indonesian authorities, but none
has been confirmed, and their present status is unknown. -
Mod.CP]

[see also:
Avian influenza, human - East Asia (141): Indonesia
20051006.2912
Avian influenza, human - East Asia (140): Indonesia
20051005.2899
Avian influenza, human - East Asia (139): Indonesia
20051004.2896
Avian influenza, human - East Asia (138): WHO review
20051003.2892
Avian influenza, human - East Asia (137): Indonesia
20050929.2857
Avian influenza, human - East Asia (136): Indonesia
20050928.2852
Avian influenza, human - East Asia (135): Indonesia
20050927.2848
Avian influenza, human - East Asia (134): Indonesia
20050924.2818
Avian influenza, human - East Asia (133): Indonesia
20050922.2804
Avian influenza, human - East Asia (132):
20050922.2794
Avian influenza, human - East Asia (131): Indonesia
20050921.2785
Avian influenza, human - East Asia (130): Indonesia
20050921.2779
Avian influenza, human - East Asia (129): Indonesia
20050919.2769
Avian influenza, human - East Asia (127): Indonesia
20050919.2763
Avian influenza - Asia (27): Indonesia, zoo birds
20050918.2760
Avian influenza, human - East Asia (126): Indonesia
20050918.2758
Avian influenza, human - East Asia (125): Indonesia, conf.
20050916.2736]

.................cp/msp/sh
*##########################################################*
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and its associated service providers shall not be held
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or archived material.
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[O2BNOK]

almost gave this a thread of its' own... Martin, feel free to do so if you think it needs to stand alone...

xoxo

http://biz.yahoo.com/prnews/051010/phm015.html

VIRA 38 Fraction (v38 AMF-1) Inhibits Bird Flu Virus (H5N1) Infections by Blocki

Press Release Source: PRB Pharmaceuticals


VIRA 38 Fraction (v38 AMF-1) Inhibits Bird Flu Virus (H5N1) Infections by Blocking Viral Attachment
Monday October 10, 8:57 am ET


LOS ANGELES, Oct. 10 /PRNewswire/ -- PRB Pharmaceuticals (http://www.prbpharmaceuticals.com) and Lee's Pharmaceuticals (http://www.leespharm.com) announced today the discovery that v38 AMF-1 inhibits H5N1 infection by blocking the ability of the virus to attach to cells. Three fractions of v38 AMF-1 were tested against H5N1, the virus responsible for causing avian influenza (bird flu), and all showed excellent potency and selectivity at inhibiting H5N1 uptake and viral infections.

The results come from the U.S. arm of an ongoing, multi-national, anti- viral project jointly sponsored by PRB Pharmaceuticals and Lee's Pharmaceuticals. In the first arm of the project, researchers led by Dr. John Tam at the Chinese University of Hong Kong found v38 AMF-1 to be effective against a variety of pathogens, including SARS CoV, the virus responsible for causing severe acute respiratory syndrome. It was subsequently shown that v38 AMF-1 inhibits the 3C-like protease (3CLpro), a crucial part of the SARS virus life cycle.

In the second arm of the project, v38 AMF-1 was shown to inhibit H5N1 in chicken embryos. 100% of chicken embryos inoculated with H5N1 and treated with v38 AMF-1 survived while all of those not receiving v38 AMF-1 died within hours.

"The finding that v38 AMF-1 blocks H5N1 virus attachment is extremely important as it demonstrates v38 AMF-1 works much differently than the neuraminidase inhibitors Tamiflu (oseltamivir) and Relenza (zanamivir)," said Dr. Charles Hensley, Chairman and Chief Executive Officer of PRB Pharmaceuticals. "Tamiflu can only work once the virus has already entered and multiplied inside the cells. This drug's mode of action is less than ideal which may explain why Tamiflu is only marginally effective as a treatment for influenza in humans. v38 AMF-1 keeps the virus out of the cells in the first place."

v38 AMF-1 is one component of VIRA 38, PRB Pharmaceuticals' influenza medicine. VIRA 38 is a comprehensive medicine that attacks the virus at multiple points of its life cycle such as viral attachment, uncoating, replication and release. This new paradigm for antiviral medicines generates therapies with greater efficacy and lower incidence of drug resistance.

"When it comes to most viruses, the traditional single molecule - single target approach simply does not work," added Hensley. "Viruses such as H5N1 are not static and they are constantly mutating and changing therapeutic targets. These mutations lead to drug resistance commonly seen with most of the antiviral drugs currently in use. The recent issues with Tamiflu and amantidine resistance illustrates this point."

About VIRA 38

VIRA 38, PRB Pharmaceuticals' broad-spectrum anti-viral medication, is known for its effectiveness in treating and preventing influenza. VIRA 38 first gained notoriety in 2003 when it was selected for use by the Taiwan Presidential staff and doctors at Sungshan Hospital (SARS management facility) during the SARS outbreak of 2003.

About PRB Pharmaceuticals

PRB Pharmaceuticals, Inc. (http://www.prbpharmaceuticals.com) is based in Southern California and Hong Kong (SAR). PRB Pharmaceuticals is a fully integrated biopharmaceutical company focusing on therapies against emerging viruses. PRB's Bio-Security laboratories are located in Cypress, California.

About Lee's Pharmaceuticals

Lee's Pharmaceutical Holdings Ltd (http://www.leespharm.com/EN) (Hong Kong Exchange GEM Stock: 8221) distributes VIRA 38 to the Hong Kong market. Lee's is an integrated research-driven and market-oriented pharmaceutical company engaged in the development, manufacture and sales of quality biopharmaceutical products that focus on combating cardiovascular and viral diseases.


Web sites:

http://www.prbpharmaceuticals.com
http://www.leespharm.com

Contact information:

e-mail: info@prbpharmaceuticals.com

North America:
1 (714) 226-0070
1 (714) 226-0076
1 (714) 226-0094 (Fax)

Asia:
Vivian Fung
+852-2314-1282
+852-2314-1708 (Fax)

This release was issued through eReleases(TM). For more information, visit http://www.ereleases.com.

 

[Nuthatch]

From the BusinessWeek article above:

"How do humans get avian flu?
So far, virtually all the 100 or so avian-flu cases identified in humans can be traced directly back to contact with live chickens. Infected birds pass the virus through feces, and it affects humans that breathe in the fecal dust. The virus is not passed on in the meat or eggs, so there's no danger from eating cooked chicken."


Didn't the Bengal tigers that died in the zoo get it from eating the raw chickens?

 

[Deb Mc]

Nuthatch,

Yep - many died directly from it and the remainder were put down because they were so ill.

Also, people have caught & died from H5N1 from eating duck's blood soup.

 

[O2BNOK]

Didn't the Bengal tigers that died in the zoo get it from eating the raw chickens?

That was my impression as well... and the brothers (or were they uncle/nephew?) supposedly got it by eating a pudding made with raw duck blood.

xoxo

 

[Bill P]

Suspect H5N1 Wild Bird Flu Case Hospitalized in Turkey

http://www.recombinomics.com/News/10100502/H5N1_Turkey_Case_Hospitalized.html



Recombinomics Commentary
October 10, 2005

One person whose name has not been released has been taken to a local hospital on suspicion of having contracted the disease.

The case listed above is the first reported suspect case in Turkey. H5 has been confirmed in Turkey and the large number of poultry deaths strongly implicate H5N1. However, there have been no confirmed human cases associated with the H5N1 wild bird flu in Russia, Kazakhstan, and Mongolia.

However, H5N1 evolves, and the wild bird strain is virulent in a wide range of bird species and the Qingahi Lake versions have the human PB2 polymorphisms, E627K.

More information on the hospitalized case would be useful.