Pandemic Flu [Archive] - Page 2 - Professional Soldiers ®

mugwump

07-26-2006, 22:10

YES!
Unless you know what you are taking, WHY you are taking it, and the drug's contraindications then you should not be playing emergency doctor... Anything you give someone; you better have to capability on hand to manage any complications or allergic reactions that result from that medication.

Sacamuelas is of course correct--knowledge is critical. I know he wasn't busting my chops and I'm responding in the same spirit.

I'm also a big proponent of "first, do no harm" and I'm pretty opinionated about the over-use of antibiotics. That said, I was talking above in the context of post-H5N1 therapy. If a pandemic hits there will be no antibiotics and no medical care for most. None. Leavitt has been informing all 50 governors of this fact over the last 6 months. Those without the knowledge and supplies to render emergency care are going to be feeling pretty helpless. (Augmentin was made in Spain and India when I used to know about those things).

Augmentin is about as safe as mother's milk if you don't have a beta-lactam allergy (penicillin/cephalosporin): liver effects in 1:4,000,000 courses of treatment and the same risk of serious gut effects as any antibiotic. If you bring a kid to the doc-in-a-box around here I challenge you to leave without a script for Augmentin, whether you need one or not. :)

I consider Hib vaccination, a flu shot, fever-reducers (acetaminophen 500-650mg every 6 hours PLUS ibuprofen 500mg every 4 hours), oral rehydration mix (previously discussed), antibiotics for post-flu bacterial pneumonia, a statin, an ACE blocker or inhibitor AND THE KNOWLEDGE TO USE THEM to be minimal preps. (Note that statins are already over-the-counter in the EU and ACE inhibitors aren't far behind. )

You MUST check the warnings and apply them to your circumstances. But short-term administration (10-12 days) for an acute condition? The benefit:risk ratio is firmly on your side, in my opinion (especially when death by ARDS is the alternative <shudder>). You'll need a dosage plan for each person in the family (it will differ by age and underlying conditions) and you'll have to keep good records. Assume you'll be tired, scared, and maybe ill yourself as you take care of your loved ones. You'll mess up your dosing plan if you don't write things down.

Personally, I'd get all of this stuff before firearms or a generator (both of which will also bite you on the ass if you don't know how to use them safely).

mugwump

PS -- None of this stuff is as risky as the adjuvants in the vaccine you'll be fighting for.

InTheBlack

07-27-2006, 01:16

Mugwump-Throughout these 18 pages you have given lots of good info but on some points I'm still trying to understand the details so I have everything in a tidy list which I also understand.

WRT statins & ACE blockers:
Is there any best guess as to which particular drug might work best, and what sort of dosage & dosage schedule one would use?

& I don't recall if these are theorized to augment anti-virals or are just to mitigate ARDS.

And for those with allergies to penicillan, what would a good alternative be? I'm thinking of gram positive vs negative bacteria. Why not stockpile some of the powerful broad spectrum antibiotics instead of the "plain" ones?

Big B

07-27-2006, 07:47

Ah, confirmation. Confirmed by whom? The Thai government, which has a proven track record of lying through their teeth? The WHO? The CDC? I understand your desire for corroboration, but credibility from "official" sources is a bit thin on the ground right now.

The Bangkok Post reported avian H5N1 in Pichit province starting about three weeks ago, all of which was hotly denied by the Thai government. The govt initiated increased surveillance in what they called "potential hot zones", which by great coincidence coincided with the areas where outbreaks reportedly occurred.

That said, the Thai government reported the recent death and the WHO has included it in its official statistics. Three cases are currently under official review (and I have Charter House Rule reports of others):

Thailand confirms 15th bird flu death (http://www.iht.com/articles/2006/07/26/news/thai.php)...Health officials also were closely monitoring three other suspected cases in Phichit Province, Public Health Minister Pinij Jarusombat said in a statement...

Watch what they do, not what they say.

mugwump

I fully understand your reluctance to believe the W.H.O. and news reports but what do you base your reference to the CDC?

mugwump

07-27-2006, 08:40

Between you and me, InTheBlack, I think we've driven home the point Sacamuelas was making. I will now officially say the better part of valor would have been to keep my mouth shut. :) I'll dig the hole deeper one more time and then let's drop the subject and I'll go back to keeping my ear to the ground. I don't want to create an ethical dilemma for the moderators or the board.

RE: other antibiotics. If you or yours have beta-lactam/penicillin allergy there are clear alternatives which you'll have to scrape up on your own. More powerful antibiotics (gorillacillin) generally = more side effects. I have additional antibiotics on hand but I was the director of antibiotic development for a big pharma in a previous life and I'm clear on the risks/benefits. I mentioned Augmentin because it's still effective, off patent (cheap) and it's relatively safe.

It's been said that the flu virus doesn't kill, it directs your body to commit suicide. An exaggerated immune response, the "cytokine storm", is what does the damage. This immune response is a very complicated process but it has a strong inflammatory component which causes leaking blood vessels (the cause of the shock and bleeding from the nose, eyes, gut seen in H5N1).

Statins (Lipitor, Zocor, etc.) are currently used for lowering cholesterol but they are turning out to be like aspirin; they have a multitude of positive effects--among them is their anti-inflammatory effect. They also appear to stabilize the lining of the blood vessels. I'm in a rush now but I cited in the thread some journal articles about their use in toxic shock, which is a kissin' cousin to ARDS (if not the same thing under different circumstances). Statins appear to tamp down the inflammatory component in ARDS. The dose I've settled on is based upon this research and is dependent upon the drug I've chosen - Zocor. The therapeutic dose of these things varies widely depending on the molecule; Zocor has a very different dose than Lipitor even for cholesterol lowering. Statins have few side effects and except in exceedingly rare cases these appear after extended use. A 12-day course would be safe in my personal estimation. YMMV. Bottom line with statins: look up the research and base your dose on what you can get. (In the EU that would be Zocor -- it's sold over the counter like aspirin.) Do a Google News search on statins and avian flu, it hit the MSP about 6 weeks after my first reference to it here.

A molecule called angiotensin is being implicated in the lung effects caused by cytokine storm/ARDS that H5N1 causes. This is preliminary research but it looks solid. There is a class of drugs called ACE (Angiotensin-Converting Enzyme) inhibitors and another called ACE blockers that are widely used to lower high blood pressure. There is debate over which class is better. It is speculated (some positive research is trickling in) that these will moderate the lung effects of ARDS. These drugs are also relatively safe (ironically the biggest side effect of ACE inhibitors is they cause a harmless cough in about 20%, but this is usually after weeks of use).

I will try to find another site which discusses these issues in greater detail and I'll direct you there. This will be my last post on this. I'll continue to cite new research on these topics as they appear but I won't talk specific drugs or dosages unless they are OTC.

mugwump

mugwump

07-27-2006, 08:53

mugwump

07-27-2006, 08:59

I fully understand your reluctance to believe the W.H.O. and news reports but what do you base your reference to the CDC?

I wasn't clear--not unusual. I generally trust local news sources the most. It requires running the articles through machine translators, but they are consistently the best sources. The MSP is generally of exceedingly poor quality with the financial media (Bloomberg, WSJ) often the exception because the financial stakes are astronomical.

The CDC is very complicated. Outstanding people in a very political environment. I'll cover this when I get the time.

Leavitt in Homeland is aces. He actually says what he thinks and lets the chips fall where they may.

The Reaper

07-27-2006, 09:04

This will be my last post on this. I'll continue to cite new research on these topics as they appear but I won't talk specific drugs or dosages unless they are OTC.

mugwump

I think that this would be a loss for everyone.

Anyone goofy enough to order meds for which they have no scrip and to take them without conventional (and common sense) regards to dosage, frequency, etc., without keeping an eye out for adverse reactions is a Darwinian Award winner waiting for any opportunity to harm themselves.

Any of you wannabe Dr. Welby's out there, reread Saca's post very thoroughly.

Keep up the fire, mw. It is appreciated.

TR

x SF med

07-27-2006, 10:29

mugwump

07-27-2006, 10:38

I have heard through the grapevine that the hospital overload speculated in yeterday's 27Jul06 16:01 post is due to not enough regular beds, which sounds rather ominous. There are confirmed reports of bird flu in Laos (high path vs. low path H5 is being tested) and unconfirmed reports of human illness in Laos and Southern China as well.

It is reasonable to suspect the source of this latest outbreak is China, IMO, but that's pure speculation.

6549

Eleven more suspected bird flu cases in Phichit (http://etna.mcot.net/query.php?nid=23654)

PHICHIT, July 27 (TNA) - Eleven more suspected bird flu cases were reported in Thailand's lower northern province of Phichit on Thursday.

Dr. Prajak Wattanakul, head of the Phichit provincial public health office, said that the 11 patients, mostly children aged between 4-14, are suspected of being infected with avian influenza virus and were admitted to five different hospitals in the province on Thursday.

Some of them had contacted with dead poultry and others live in areas where a large number of fowls died of unknown causes.

All the 11 patients were quarantined and samples of their blood and phlegm were sent for laboratory tests in the medical science centre in Nakhon Sawan, expected to be able to release the test results Friday, the doctor said. (TNA)-E009

mugwump

07-27-2006, 11:07

Mug-
just to clear up a few questions I have (simplified so that others don't get lost):

Due to the vector, mutability and cross-species contamination potential, a pandemic is not only possible but highly probable.

Primary prophylaxis through "flu shots" is key. If available. The GSK vaccine is being fast-tracked but who knows when it will be available in quantity. If the virus mutates its 80% effectiveness will drop but it will still be worth someting.

The PCN (Augmentin or Amoxicillin) regimen is for prophylactic Tx of 2* bacterial inection, since H5N1 is a virus, and viral infections do not respond well, or at all to PCN (or even gorillacillin) Tx, based on the inherent immunodeficiency seen in previous cases of H5N1/ARDS infection. Yes. Antibiotics only treat bacterial infection not H5N1. I'm still looking into whether I'll administer as prophylactic Tx or if I'll wait for pneumonia syptoms. I'm leaning toward prophylactic, i.e. administering before symptoms develop as up to 1/3 died in 1918 from secondary bacterial infection.

Statins and ACE are for stabilization of blood vessel walls and the 2* anti-inflammatory properties. Yes

Normal fluid / antipyretic / anti-inflammatory therapy is in the course of symptomatic Tx for a viral infection. Yes. There is speculation that the H5N1 virus replicates better at higher temps so keeping the temp down is thought to be important. In many viral infections doctors are leaning toward leaving fever alone as it helps fight off the disease. Not so in H5N1.

Is this a fair, if somewhat basic synopsis of the Tx plan you've described? Yes, good summary.

Plus, the regular seasonal flu shot may have some merit and can't hurt. Also, the H. influenzae vaccine Pneumovax II (Pneumococcal)may help prevent pneumococcal pneumonia, one of the most common types of secondary bacterial infection -- it also can't hurt.

mugwump

MW - Sorry, had to change the color for readability. Peregrino

x SF med

07-27-2006, 13:28

[/B]

Plus, the regular seasonal flu shot may have some merit and can't hurt. Also, the H. influenzae vaccine Pneumovax II (Pneumococcal)may help prevent pneumococcal pneumonia, one of the most common types of secondary bacterial infection -- it also can't hurt.

mugwump

[/COLOR]

P. influenzae or H. influenzae for Pneumovax? you cite both, although indirectly to the P. inf.

Jack Moroney (RIP)

07-27-2006, 13:38

I think it was COL Moroney (?) who speculated on this first. Turns out he's right.

Avian Influenza among Waterfowl Hunters and Wildlife Professionals (http://www.cdc.gov/ncidod/EID/vol12no08/06-0492.htm)

I sorta had a little more insight than I let on to. I have a couple of degrees in Wildlife Management-and I often stay at Holiday Inn Express:D

mugwump

07-27-2006, 14:23

P. influenzae or H. influenzae for Pneumovax? you cite both, although indirectly to the P. inf.

Sorry, I'm very unclear, I threw them both into the same sentence. Thanks for catching this.

Let me start over.

Hib® and Pneumovax® (adult) or Prevenar® (children) are combined around here but that might not be the case where you are. These things tend to be driven by your state's school vaccination requirements.

Haemophilus Influenzae Type b (Hib) Vaccine (http://www.cdc.gov/nip/publications/VIS/vis-hib.pdf) is for H. influenzae and was developed to prevent bacterial meningitis (infection of brain membrane). H. influenzae is also a common cause of middle ear infections and pneumonia as well. If you have a kid who gets frequent middle ear infections this vaccine has been known to stop that nonsense. Nowadays this vaccine is generally given to babies and repeats are not necessary. If you have older kids check their immunization records. I'm guessing that if you have relatively recent military immunization you've gotten this as meningitis is traditionally a disease of troops/students, ie. those in barracks/dormitory facilities, but I stress that this is just a guess.

Pneumovax® (or Prevenar® for children) is for S. pneumoniae. S. pneu is another very common cause of community-acquired pneumonia. Pneumovax®/Prevenar® vaccines are primarily given to prevent pneumonia.

You will be thought to be a slack-jawed idiot if you mention that you want these for H5N1. They have nothing directly to do with the flu. These vaccines prevent bacterial infections and don't have any effect on viral influenza. Most medical folk are not aware of the huge numbers who died in 1918-1919 from secondary bacterial pneumonia (even though flu+bacterial pneumonia is a significant cause of death every year).

Sorry for the confusion.

mugwump

mugwump

07-27-2006, 14:46

Five new patients suspected of having caught deadly H5N1 (http://www.bangkokpost.com/News/28Jul2006_news04.php)

Hmmm...44 suspected cases? None confirmed, though. We live in interesting times, eh?

Five new patients in Phitsanulok and Phichit, the provinces declared bird flu red zones, are suspected to have caught the H5N1 virus, doctors said yesterday. The Public Health Ministry said the new cases pushed the number of suspected cases to 44 nationwide, all awaiting bird flu laboratory test results.

Bunchai Theerakan, acting chief of Phitsanulok Public Health Office, said three new patients in the province were admitted on Wednesday at Noen Maprang, Wang Thong and Ruam Phaet hospitals.

They showed symptoms similar to influenza, and all had had direct contact with chicken in areas where mass chicken deaths were reported. The hospitals were waiting for blood test results.

mugwump

07-27-2006, 14:49

I'm out of town for an indeterminate time and they took away my cell phone last time. Watch Thailand. And Indonesia. And Laos, China, Burma...

x SF med

07-27-2006, 14:58

Gotcha mug!

So the Pneumococcal Influnzae strains aren't caught by these vaccinations ( I wouldn't think so, because it's essentially viral pneumonia, and there aren't any really good vaccinations for it because of the quick mutation cycle - or that was the story back when I had to really know it).

Now that brings us to the really heavy kick in the ass - 2* viral infections, exacerbated by the already impaired immune system. Since antivirals are not the most accurate of meds, and may or may not work on multiple infections, how do we treat this. It's going to be a very big issue at some point especially in areas endemically prone to M. pneumoniae, or Rickettsial virus strains, and the re-emergence of P. myeletius and other un-vaccinated viruses. (Jeez, I sound like the Andomeda Strain here don't I?). We can't use attenuated viruses as tx, or prophylactically either, post infection.

What do you suggest as the best course of action - besides the common sense quarrantine of patients - for both public health and personal health reasons?

Sacamuelas

07-27-2006, 19:33

I will try to find another site which discusses these issues in greater detail and I'll direct you there. This will be my last post on this. I'll continue to cite new research on these topics as they appear but I won't talk specific drugs or dosages unless they are OTC.

mugwump

MW-

As you know from our PM's last night. I was not directing my uneasiness towards you or your information. I just wanted to put out the general disclaimer 'again' on the site that reminds everyone reading these posts of the fact that he/she should know something about what you are talking about before taking action. I view your posts to be factually correct, educational and interesting. You obviously don't need my warning.... some on here might have need reminding. Better safe than sorry.

I am with the Reaper... keep posting. You are a valuable source on this pandemic issue. :cool:

Back to topic....

InTheBlack

07-28-2006, 02:23

Non-medical folks are limited in their ability to do the kind of research necessary. And to understand what we find even if we stumble across it. I've got a biology degree so I'm not totally lost.

But even Doctors won't have a protocol for using Statins under the circumstances we are talking about.

So the best we bunkered-down individuals might do is have a copy of any published articles having the most reputable speculation regarding dosage & regimen.

WRT antibiotics, what sort of bacteria is most likely to be involved? Match that to a list of which antibiotics are best against what types of bacteria, and attempt to stockpile appropriate materials.

And its all for naught if your water supply isn't secure...

mugwump

07-28-2006, 06:44

MW-

As you know from our PM's last night. I was not directing my uneasiness towards you or your information. I just wanted to put out the general disclaimer 'again' on the site that reminds everyone reading these posts of the fact that he/she should know something about what you are talking about before taking action. I view your posts to be factually correct, educational and interesting. You obviously don't need my warning.... some on here might have need reminding. Better safe than sorry.

I am with the Reaper... keep posting. You are a valuable source on this pandemic issue. :cool:

Back to topic....

Sacamuelas,

You were "spot on" with your observations. I saw the wisdom, so much so that I felt guilty about my posts. I'll keep it up if you'll jump in when I leave off a disclaimer or a warning.

Your post and TR's "read and heed" a coupla posts later will be cited in all future medication posts.

mugwump

mugwump

07-28-2006, 07:04

The following is scuttlebutt, pure and simple. It's scuttlebutt from a gal who's often right, but... If I knew I was going to be able to post over the next few days it would normally be the type of thing I would wait for some add'l corroboration before passing on.

There are rumbles that Thailand is pressing the WHO for release of the "firebreak" Tamiflu which Leavitt prepositioned in an undisclosed Asian location a while back. The Thai govt has already changed their ROE for administration of their own limited Tamiflu stocks to "administer if H5N1 is suspected" (this part is fact).

If the emergency stock is actually released, it will be extremely significant. It will indicate that there are at least several "more efficient" H2H clusters OR the genetic analysis shows the infecting virus has picked up a significant mutation. Because they didn't release it for the latest worrying Indonesian outbreak (which even the WHO now admit was a very, very close thing) it will also imply that the situation in Thailand is worse than that in Indonesia.

If they release the Tamiflu, ignore the calming words that are sure to accompany it. Don't wait for a change of pandemic phase. It is generally conceded that the WHO will never go to Phase 4 or 5 until a virus is spreading like wildfire. Finalize your preps and pray this burns out like it did in Indonesia.

mugwump

x SF med

07-28-2006, 07:53

mug, Sac-
I jumped in late on this thread, and have tried to keep my comments general. I agree with all of the disclaimers - they're just common sense anyway, if you aren't a doctor, or a trained medical provider, go to one for treatment.
Thanks for being the voices of reason, and educational at the same time.
Primum non nocere.

The Reaper

07-28-2006, 08:42

mugwump

07-31-2006, 09:47

mug:

I understand that the Augmentin dosage is the standard dose prescribed for normal infections.

Any feedback on what the statin dosages are to gain the protection required? Is it the normal dose for someone on it to lower cholesterol, or is there a lesser dosage threshold which will provide the desired effects?

TR

The guys at Ben Gurion University found the protective effect in patients who had been receiving normal statin therapy for high cholesterol. They did not administer statins in a controlled double-blind study. They speculated that statins would protect people from ARDS and sepsis based on its reported anti-inflammatory effects. They compared people with severe infections who were on normal statins therapy vs. those who weren't and found a striking beneficial effect.

Mouse models at U of Chicago show the same thing. Additional human studies are showing the same. See the WSJ article in this thread.

I am planning on giving the standard dose used to lower cholesterol; this varies depending on the statin you can get hold of. It is speculated that you must administer at the first hint of infection. If someone in my house comes down with the pandemic flu I am going to begin administering statins to all.

Statins are very expensive in the States. If you can, find an Internet source for Zocor at an EU pharmacy -- it's over the counter there. Zocor went off patent here and cheaper generics should be hitting the market soon/now.

mugwump

07-31-2006, 10:19

Thailand update.

I'm still away and have lost my email contacts in agencies. Press reports from the northern provinces are nonsensical, with numbers of suspected cases bouncing from 44 to 132 to 18. I am told Thailand lacks the capacity for rapid determination of H5N1 infection, so they can't be quickly ruling out suspected cases. There appears to be a severe outbreak of normal seasonal flu plus great fear over H5N1 which may be leading to the large number of suspected cases.

There are no deaths being reported, though, which is really good news. There may or may not be health care workers suspected of having H5N1 (one nurse was reported to be infected, attributed to attending cock-fighting, then changed to "killed chicken with mouth open" (ISYN) then reported not sick at all and then back to "presumptive H5N1."

Hundreds of thousands of chickens are being culled and dumped in rivers--incredibly stupid.

mugwump

mugwump

08-02-2006, 15:41

There's a new suspected cluster in Indonesia in the same region as the 8-person h2h cluster earlier in the year:

http://asia.news.yahoo.com/060802/kyodo/d8j845jg0.html

There's another confirmed H5N1 case in Thailand. Those cases under observation I posted yesterday are apparently those showing symptoms of flu who also were exposed to sick poultry -- there is no confirmation of H5N1. The best I can figure there are 244 under observation.

http://nationmultimedia.com/2006/08/03/national/national_30010244.php

So far no evidence of a breakout.

mugwump

Monsoon65

08-02-2006, 17:22

Thailand update.

Hundreds of thousands of chickens are being culled and dumped in rivers--incredibly stupid.

mugwump

Culling suspected H5N1 exposed chickens: Good idea.

Dumping chickens in the river: Bad idea.

Thanks for all the great info on this thread!

mugwump

08-15-2006, 14:07

Well, if you've been following the mainstream media you know that there have been two additional confirmed H5N1 deaths in Indonesia. There have also been several more unconfirmed ones -- relatives of the confirmed cases who were dead and buried before being tested. The most recent confirmed H5N1 patient in Java was released against medical advice and is in the community under the care of a witch doctor/shaman -- he's not expected to live. It is widely speculated that there must be many additional unreported cases in Java and Sumatra.

Indonesia finally released the genetic sequences from many H5N1 samples and there is a definite difference between the H5N1 strains infecting birds and the ones infecting humans. Protests by the government and the WHO aside, it appears that most Indonesians are getting the flu from a vector other than infected poultry. Cats? Dogs? Pigs? Cats are the closest match, although we both may be getting the flu from an undiscovered source -- I'll update you when the verdict is in.

Avian flu has once again exploded across Laos, Thailand, Cambodia and probably Viet Nam. Remember Thailand, the shining success story that the WHO held up (along with Viet Nam) as the exemplar of a country that had eradicated bird flu? Well, humans are dieing again and the WHO now has this to say:

"The World Health Organisation (WHO) on August 9 warned the government to urgently review measures taken to control the H5N1 bird flu virus, both in poultry and humans, to tackle the spread of the disease in the country. Somchai Peerapakorn, the WHO Thailand office medical officer, said with the current outbreak still at an alarming scale, it was necessary for the authorities to rethink measures taken over the past three years to stop the virus spreading to people. "(From Bangkok Post, Thailand - Aug 9, 2006 -- sorry their web site is down and I can't get the link.)

Reports vary on the number of suspected H5N1 cases still under isolation in Thailand, but 40-50 seems to approach the consensus figure. I am told (Charter House) that there has been a 5% mortality rate among the 6,000 pneumonia patients reported in Thailand since the "red zone" provincial warnings were issued several weeks ago. This is an extremely high death rate for hospitalized pneumonia patients and there is strong suspicion that many of these cases are actually H5N1. It is interesting to note that a 5% CFR represents the best current thinking on the overall CFR in the 1918/1919 "Spanish Flu" pandemic.

(So, you are thinking, why don't we know for sure if someone has H5N1? There is growing suspicion that there may be many false negatives among samples taken from extremely sick patients and during post mortem exams.)

There is one additional confirmed death in Western China and several more suspected.

There are at least four genetically distinct versions of H5N1 that have caused human fatalities and are currently circulating: Clade 1 in Southeast Asia, Fujian in China and southeast Asia, Indonesian in Indonesia, and Quinghai worldwide. On the vaccine front, this is...problematic.

Bottom line: Things are cooking but there is still no evidence of a breakout. It's going to be an interesting autumn/winter.

Jack Moroney (RIP)

08-15-2006, 18:56

They have also found a couple of swans in Lake Eire with a strain of bird flu, however not the same strain as in Indonesia. Tick, tick, tick ....

mugwump

08-16-2006, 12:38

I am getting additional second-hand reports (local doctors/WHO grunts on the ground in Thailand --> "connected" colleague --> me) which raise troubling questions. Local hospitals in the "red zone" northern and center-north provinces of Thailand are reporting large numbers of patients showing up "sick as dogs" and quickly dieing of a virulent pneumonia. Local doctors are convinced that the presentation is consistent with H5N1 but swab testing is coming up negative.

I am told that the number of cases of pneumonia being seen is extraordinary for summertime, whether it's H5N1 or not. There is concern that the nasal/throat swabs are falsely negative for H5N1 either because of improper technique or the virus has mutated to such an extent that the test is ineffective. (Note that the test uses antibodies to identify H5N1 and a mutation of the virus could render it useless. Note also that getting accurate results is difficult even under the best conditions; the CDC in Atlanta recently judged samples from one dead patient in Indonesia as negative, then positive, then negative, then positive, positive, positive. The sample sources and their handling can be key to the outcome.)

Complicating factors are a dengue outbreak and common seasonal flu. But, again, I am told that the number of cases of pneumonia and the high death rate are far higher than expected when compared with season averages.

My take? I've heard this type of report in the past (India), but this one is worrying because of confirmed H5N1 deaths, the explosive re-emergence of the disease after a relatively long lull, and the fact that the use of partially effective poultry vaccines have led to a high proportion of infected birds in the coutryside. I am now nearly convinced that bird-to-human transmission is NOT occurring in most cases of human H5N1, but it makes sense to me that infected birds lead to infected cats, dogs, and pigs. One of these animal, or some other undiscovered vector, is the likely culprit.

Watch this one, folks.

mugwump

08-16-2006, 13:47

In addition to the pneumonia death reports I also received an email describing feverish construction of isolation facilities on the outskirts of Thai regional centers. That smelled a little fishy so I decided to do a little digging before posting. I found enough corroboration from the Thai Ministry of Public Health to pass it on. Note that the link below describes wards in existing hospitals and the structures reported to me were free-standing and away from existing hospitals.

mugwump

Thailand builds isolation wards for H5N1 victims (http://eng.moph.go.th/ContentDetails.php?intContentID=14171&strOrgID=001002002)

mugwump

08-17-2006, 09:48

In addition to the two confirmed new cases in Jakarta, Niman is reporting that the outbreak in West Java has grown to a cluster of eight with five fatalities. Recombinomics is a good place to visit occasionally -- Niman is usually well ahead of the curve.

http://www.recombinomics.com/News/08170603/H5N1_Garut_8.html

Edited to add: http://news.yahoo.com/s/afp/20060817/wl_asia_afp/healthfluindonesia

mugwump

mugwump

08-18-2006, 08:17

Reports vary on the size of the latest Indo cluster in Garut (centered about 90 miles from Jakarta) but it seems to be widening, with some reports indicating up to 11 deaths through 18Aug06 and many others currently sick. Several of these deaths will never be confirmed as they occurred before testing could be done (already in the ground). It is reported that the "official" dead patients presented to the hospital on death's door and passed away within hours. I speculate that shaman/witch doctor treatment is the norm in the area.

A concern with the Garut cluster is the apparent lack of a common point of infection. In the previous cluster in Barung (where H2H was confirmed) there was a family gathering/party which was the original starting point. At FluTrackers they are speculating that later Garut victims may have picked the virus up H2H after attending a wake/funeral for one of the earlier victims. This would be mildly encouraging as it may indicate hugging/contact is still required to pass H2H.

You know they're taking things seriously when there are isolation suits in the sticks:

Poor little guy (http://www.pikiran-rakyat.com/cetak/2006/082006/18/02a.htm)

6618

mugwump

mugwump

08-18-2006, 08:32

I stated previously that 1/3 of the US deaths in the 1918/1919 Spanish Flu pandemic were due to secondary bacterial infection. I've been told by one of the epidemiologists who study this that the figure is closer to 2/3.

Apparently, all type A influenza -- and in particular new avian flu viruses which break into the human population -- can be so efficient at infecting the cells lining the respiratory tract that all of these cells are killed. This leaves a "raw" respiratory tract that must re-line itself with cells in order to heal. Until that happens, it's fertile ground for bacterial infection.

Note that in Indonesia and Thailand, deaths are occurring from primary viral infection/cytokine storm/ARDS and not secondary bacterial infection. Doesn't change the fact that if a breakout occurs you should be prepared to administer antibiotics to those who survive the initial attack and that up to 2 weeks of bed rest and isolation from the community after apparent "recovery" from the initial flu should be mandatory for loved ones.

mugwump

Team Sergeant

08-18-2006, 09:30

mugwump

08-18-2006, 10:45

Mugwump,

A couple of points to ponder;

If you’ve never been to Asia many Asians idea of "take home" is a live chicken. This can be witnessed just about anywhere in Asia. You see kids/women on tuk-tuks carrying live chickens home for dinner. My point is that many average Asians handle live poultry on a daily basis.

Two, many Asians (and Latinos) enjoy cock fights. When your cock is bloodied in battle and has blood running out of its nose and mouth (but still alive and fighting) many Asians (and Latinos) will literally "suck" the mucus and blood out of the birds nasal system so the bird can breath and possibility win the fight. My point is that we are not going to stop the bird to human transmission anytime soon and that I’m not surprised that the virus might take hold first in Asia. (possibly South America, southern US next).

TS

Scary. Maybe 10% of those birds you describe are infected with H5N1. In some areas it approaches 100%.

Thailand, Viet Nam, India, Mayalasia, etc. all have been partially vaccinating flocks against BF. These poorly-developed vaccines will keep the birds alive but don't prevent infection. Released today in Nature:

By University of Edinburgh, Incomplete vaccination of poultry flocks could make the spread of deadly strains of avian flu such as H5N1 worse, scientists at the Universities of Edinburgh and Warwick have found. The research shows that even though the available vaccines are effective on individual birds, the disease is likely to spread unless almost all of a flock has been protected. The study, published in Nature journal, is the first to quantify how incomplete vaccination of flocks can contribute to the undetected spread of the disease.

Add in that poultry are often the most significant source of wealth to the poorest of the world and compensation for culling is ten cents on the dollar, poultry are often eaten (rare to medium rare, yum yum) at the first sign of their illness or after they actually die of disease, and that birds are held in high esteem (ROK to me: "Why do you call cowards 'chicken'? They are the bravest of animals"). Finally add in a weak/nonexistent central govt in Indonesia.

People tell me that Thailand is busting hump to eradicate BF before the start of the tourist high season in six weeks. Those on the ground in Indo echo your position: fuggedaboudit.

That said, smarter people than me have been saying for many months that birds are no longer the source of human BF. It's criminally negligent that no one is doing broad species sampling in SE Asia.

I'm told that NAMRU-2 is effectively gone from Indo; their "unofficial" official testing won't be available. Sometimes I think we deserve whatever we get.

mugwump

mugwump

08-18-2006, 11:02

Unsettling news: H5N1 virus now harder to detect in humans (http://nationmultimedia.com/2006/08/18/national/national_30011374.php)

There's massive use of Tamiflu in Thailand. (There's back-channel speculation about where it's all coming from but nothing solid. Has the "firebreak" stock of Tamiflu prepositioned by the US been released? Not officially, at least.) Some also fear that a very recent mutation has rendered the swab test less effective.

"Goldilocks testing" refers to the timing of tests. In most cases patients are showing up at the hospital when they are quite ill: too late to be positive in the swab test (which is only effective early in the disease), too early to be positive in the serum antibody test (which is only effective 2-3 weeks after the start of the disease), but "just right" to be a false negative.

Bottom line? This may be the reason that more of those 5% pneumonia deaths are not being attributed to H5N1.

I'm just Suzy Sunshine today, eh? The only positive spin I can put on all of this is, if we make it through the winter without a breakout, it may be that the species barriers in this virus are so formidable that this is not the one we have to worry about. Fingers crossed.

mugwump

mugwump

08-18-2006, 11:20

PHNOM PENH, Aug 18 (Reuters) - Bird flu outbreaks have hit two districts in eastern Cambodia, killing thousands of ducks, after a man smuggled infected birds to the region bordering Vietnam, officials said on Friday.

Two people were admitted to local hospital suspected of having contracted the virus, Ku Chanthan, a veterinary official in the province told Reuters. He said the results of tests on the two would be released in coming days.
Two more bird flu outbreaks hit ducks in Cambodia (http://www.alertnet.org/thenews/newsdesk/BKK298001.htm)

I think it's safe to say AF is exploding across SE Asia. I suspect reports coming out of China will be next. I'm going to shut up after this report as I expect there'll be many add'l reports coming out over the next week.

I'll let you know if I hear about Tamiflu stocks being released or back-channel chatter about a breakout.

mugwump

mugwump

08-20-2006, 09:17

True to form, there are dueling press releases in Indonesia: there is/isn't a cluster in Garut. It's pretty apparent that there is, and it appears to cover a 25 square mile area around the village of Cikelet. I am told that Tamiflu is being distributed "like Smarties" (Brit speak for "Like M&Ms") for free. As in Thailand, I wonder where all this Tamiflu is coming from.

Indonesian woman died of bird flu, cluster probed
Sun 20 Aug 2006 2:32 AM ET

JAKARTA, Aug 20 (Reuters) - A 35-year-old woman who died last week in an Indonesian village described as rife with bird flu was infected with the virus, according to two local tests, and a possible new cluster case is being probed, the health minister said on Sunday. The woman from the West Javan village of Cikelet -- which has seen a series of confirmed and suspected cases of bird flu in humans -- died on Aug. 17 after being treated for symptoms of the H5N1 virus.

"Euis Lina was positive, we suspect there is a possibility of cluster," health minister Siti Fadilah Supari told Reuters by telephone.

Fears that the virus had mutated into a form that could pass easily between humans heightened in May when seven people from an extended family died of the disease in Indonesia's North Sumatra.

mugwump

08-20-2006, 15:32

I met a mucky-muck from Booz Allen last night (cute, but afflicted with Hillary cankles) who was a participant at the January 2006 Influenza Pandemic Simulation (http://www.boozallen.com/media/file/Influenza_Pandemic_Simulation.pdf) in Switzerland and was a co-author of the report (she brought it up after I said I was in medical research -- I don't initiate conversations about flu, as surprising as that may seem).

I said I'd read the report and that it was fairly grim. She said that wasn't the half of it. They toned it down because they were afraid if they reported what they really thought that people would be so spooked that they'd "lock up" and do nothing. (Did you know that only 20% of the machining capacity required to make and repair our manufacturing facilities is here in the CONUS? Or the percentage of airplane and transport ship servicing that's done outside our borders?)

Her parting shot was "Read the last paragraph again." Which I just did:

"Participants urged all sectors to develop contingency plans today that go beyond the typical disaster response to focus on how to respond when the entire fabric of society and the economy falls apart."

Well, it should read "...the entire fabric of society and the economy fall apart" but I guess I won't hold that against her.

My contingency plan is to drink bourbon.

She also said anyone within 100 miles of a major city was fooked. I was sorta thinking anyone more than 33.6 miles away would be OK. Oh well.

mugwump

mugwump

08-20-2006, 15:42

These guys were at the forefront of the SARS response in Hong Kong.

Reducing the Impact of the Next Influenza Pandemic Using Household-Based Public Health Interventions (http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030361)

...the combination of household-based quarantine, isolation of cases outside the household, and targeted prophylactic use of anti-virals will be highly effective and likely feasible across a range of plausible transmission scenarios. For example, ...this combination could reduce the infection (symptomatic) attack rate from 74% (49%) to 40% (27%), requiring peak quarantine and isolation levels of 6.2% and 0.8% of the population, respectively, and an overall anti-viral stockpile of 3.9 doses per member of the population.

mugwump

InTheBlack

08-20-2006, 19:52

Does the US possess 3.9 doses per person?

But are they ignoring the real-world dosage requirement?

Per their Protocol S1 document:
"4. After a delay of 1 day, all compliant non-symptomatic household members took 1 dose of prophylactic antivirals per day when antiviral policies were in effect (QA,QIA,QIAC). Symptomatic household members took 2 doses of anitvirals per day."

***

They are examining reducing the Infection Attack Rate (IAR) by modifying the population behavior component- the Basic Reproductive Number.

With a public health plan that quarantines 6.2% of the population, "only" 40% get overtly sick.

But the paper seems to be totally ignoring the actual observed mortality rate:

"a basic reproductive number of 1.8 [2] with a 50% case attack rate [24], and observations from deliberate infections of humans with H1N1 [25]. We assumed that 6.0% of symptomatic infections resulted in hospitalization and 17.2% of these resulted in death (nonpandemic data for community-acquired pneumonia extracted from the Hospital Authority Integrated Patient Administrative System, Hospital Authority, Hong Kong Special Administrative Region, 2002)"

and

"Based on an influenza-associated mortality rate of 0.5% (as has been estimated for New York City in the 1918–1919 pandemic)"

Note that 6% x 17.2% = 1% death rate. They seem to presume that only hospitalized cases will die, which in turn must presume that the case load is not greater than the capacity of the hospital system? This does not sound like the definition of "pandemic."

Mugwump, what can you say about their choice of 1.8 for the Basic Reproductive Number -- reasonable?

***

" large countries will suffer importation of infectious individuals in all regions, and pandemic strains will spread rapidly between large cities. Therefore, it is unlikely that geographical heterogeneities will last longer than 1 or 2 wk in large countries such as the United States"

Which means that once it appears here in any location, it will be everywhere in about 14 days.

That's the period of time that is available for all levels of Government to invent and "sell" a plan for infection-reducing behavior changes.

mugwump

08-20-2006, 20:58

Does the US possess 3.9 doses per person?

But are they ignoring the real-world dosage requirement?

Per their Protocol S1 document:
"4. After a delay of 1 day, all compliant non-symptomatic household members took 1 dose of prophylactic antivirals per day when antiviral policies were in effect (QA,QIA,QIAC). Symptomatic household members took 2 doses of anitvirals per day."

"All models are wrong, but some models are useful."
statistician George Box

Ha, I wondered who'd be the first to see that little Tamiflu problem. The apple doesn't fall far from the tree. ;)

Last I heard (end of 2005) we had 2 million treatment courses (20 million actual pills) of Tamiflu for 300M people. To put that in perspective, Australia had 2.5 million courses for 20M people and France was reported to have a course for every citizen.

According to the last I publicly heard from Roche, individual states have ordered 28 million treatment courses and the federal government ordered 18 million. They were hoping to have that in place by the end of 2006 calendar year but I have no idea how close they are to meeting that goal. By the time we got around to ordering there were a lot of others ahead of us in the queue.

So, 3.9 doses per person would be 1,170M pills or 117M treatment courses (ten day course) required for the protocol in this paper. We are hoping to have 46M treatment courses, so there's an obvious disconnect.

Also note they used the unofficial Tamiflu dose for those who are symptomatic: 2 pills per day (two courses per patient).

As far as the Ro goes, 1.8 seems reasonable (pretty cheeky of me to pass judgement, sorta like me passing judgement on TS's pistol handling). Flu tends to have a lowish Ro but a very short generation cycle. But the bottom line is if this thing hits, the Ro is the sort of thing people will be figuring out afterwards.

RE: the 40% overtly sick. The way I read it 40% are infected but only 27% are overtly sick -- down from 74% infected and 49% overtly sick without public health interventions. Considering deaths are a percentage of the symptomatic population, that reduction from 49% to 27% could have a huge impact.

From what I've heard and read recently, those 1918/1919 death statistics of 0.5/0.7% are absurdly low. It varied hugely by locale, though. Philadelphia and Boston were hammered -- I don't know about New York. The West Coast got off relatively easy. Local army camps were catastrophic. Pregnant women had a 50% CFR, old people much less.

The take home bullet point is that this is the third model that shows isolation works. Ironically, that could be very bad news for the supply chain, power grid, water supply, etc. if everyone takes it to heart.

mugwump

mugwump

08-20-2006, 21:01

" large countries will suffer importation of infectious individuals in all regions, and pandemic strains will spread rapidly between large cities. Therefore, it is unlikely that geographical heterogeneities will last longer than 1 or 2 wk in large countries such as the United States"

Which means that once it appears here in any location, it will be everywhere in about 14 days.

I think all those 33.7 miles outside of major metropolitan areas will be safe. :p

InTheBlack

08-20-2006, 21:25

Damn! I just looked at the map... you couldn't revise that to 33.65mi could you? :O

I wonder how much Ro could be reduced if everyone wore a P95 mask in public. Or even a placebo paper mask just to reduce hand-to-face contact.

mugwump

08-22-2006, 07:33

I thought I'd give a status update on Indonesia and Thailand.

I'm always a bit concerned that something might be cooking away in the weeds, out of sight. But that said, the two high profile outbreaks in Thailand and Indonesia look pretty stable to me. Additional cases are being reported daily in both places, but my take on this thing is that the Ro, the number of new infections produced by each existing illness, is currently 1 or less. This means that I think these outbreaks are going to stabilize and burn out.

Note that Tamiflu "blankets" are in place in both regions: daily double doses administered to symptomatic patients and daily single doses to those without symptoms.

You don't talk about Ro unless you have human-to-human transmission. I am firmly convinced that is the case in both Thai and Indo. It's not very efficient, but it's H2H.

The WHO and the Indonesian government are going to absurd lengths to redefine "cluster" so the Indo cases don't fit. They say it can't be a cluster because the infections are occurring over too wide an area, are not limited to family members, and are too spread out time-wise. Well, earth to Indo, epidemics follow lines of social contact and not just family and geography, and a gap between infection 1 and 2 is an argument for H2H and a cluster, not against.

On the more disquieting end of the stick, cluster size keeps growing: the Indo one now looks to be about 20 folks and the previous one was what, 8? I don't know what this means. There is speculation that the virus is becoming more adapted to mammals in some yet-to-be-discovered animal that is passing it on to humans.

On to China. China recently pitched a world-class hissy fit at the WHO and Thailand over statements that the strain of virus in Northern Thailand came from China. This was simply a statement of fact -- it was the Qinghai strain which originated in China (well, they all originated in China, but this one more recently). After furious behind-the-scenes attacks by China, much apologizing, retracting, and kowtowing ensued. I am told that the Chinese are extremely afraid of drops in foreign investment and potential effects on their Olympic showcase efforts if the words "China" and "bird flu" become linked in people's minds. Doesn't bode well for transparency in China.

mugwump

mugwump

08-23-2006, 06:23

Someone sent me this link and I don't know what to make of it. I think the Thais are doing pretty much everything they can, but 800,000 people? What would the US govt have to know to get a similar proportion of the population working on combating AF?

800,000 'bird flu busters' set for door-to-door campaigns
SUPHAN BURI, Aug 23 (TNA) - Launching a door-to-door campaign against bird flu, Thailand's Ministry of Public Health is set to send over 800,000 health volunteers to educate people at home on how to prevent the deadly virus, according to Caretaker Public Health Minister Pinij Jarusombat on Wednesday.
...<snip>...
Public Health Ministry permanent secretary Prat Boonyawongwirot said that in the 24 hours from 6am on August 22, some 79 patients with flu-like symptoms were hospitalised in 22 provinces, quarantined and
monitored for possible bird flu, awaiting laboratory tests to indicate whether they carried the deadly virus or not.

800,000 'bird flu busters' set for door-to-door campaigns (http://etna.mcot.net/query.php?nid=24293)

mugwump

mugwump

08-31-2006, 10:56

No problems, just a weekly update.

Indonesia keeps...simmering is a good word. There are three hot spots currently active and all three look like low-Ro clusters: West Java, North Sumatra and Sulawesi.

The West Java one (reported here under Cikelet (village cluster) and Garut (region) is a bit worrying because it has survived a full-court-press tamiflu blanket and several sloppy poultry culls and two door-to-door, look-under-the-bed detailed poultry culls. They even started compensating the locals $1.90 per "tail", as they call it, during culls. This is more than local market value (chicken ain't so popular right now) so there's little incentive to hide flocks. Still, there are more cases daily. The good news is there are no more deaths. That Tamiflu is looking better and better.

When are they going to start looking for a different vector? The gene sequences in poultry viruses and people viruses are different in the region.

Al Reuters: Four treated in Indonesia for H5N1 symptoms (http://www.alertnet.org/thenews/newsdesk/JAK299676.htm)

Thailand is doing a great job, at least that's what I've been hearing. They also employed a brilliant strategy of over-estimating the problem: they have some 3,000 people under observation for bird flu. The vast majority come up negative, approaching 100%, so they look good. Great PR in my book.

China: who knows?

mugwump

mugwump

09-04-2006, 11:04

Remember: All models are wrong, some models are useful.

I've been shown an update of the Los Alamos Scenario of Human Spread of H5N1 infection model that I cited here (http://www.professionalsoldiers.com/forums/showpost.php?p=114279&postcount=22). I am not authorized to release the sim at this time, but will do so as soon as I can.

Bottom Line: the new sim has EVERY air hub city infected within 92 hours of the first efficient H2H H5N1 case entering the country. There is no real change to the endpoint of the whole country turning red, it just happens much faster.

I'm still trying to find all of the changes to the inputs of the original model, but I'm told two of the changes were: 1) they assumed improved transmission vectors via airport hubs as seen in the recent Midwestern mumps outbreak; and, 2) dramatically increased Ro (number of new cases caused by a single index case) found in long-haul airline passengers (think Asia-N Am intercontinental flights) who are cooped up for more than eight hours with a symptomatic or asymptomatic flu patient.

Doesn't really change anything except the time you'll have to prepare if you were assuming you were in, or close to, a city that wouldn't be an entry point. Basically every city with a major or regional airport is now a simultaneous entry point.

mugwump

Team Sergeant

09-04-2006, 12:20

jatx

09-04-2006, 12:55

Remember: All models are wrong, some models are useful.

Or as my former prof Dr. Richard Zeckhauser used to say, "The great art of modeling is appropriate simplification." :D

mugwump

09-04-2006, 17:32

There was a good article in the March 2005; Scientific American concerning "EpiSims".

"EpiSims unleashes virtual plagues in real cities to see how social networks spread disease. That knowledge might help stop epidemics"

It also discussed the airport hubs and the model showed just how fast the virus might spread..... good reading.

TS

Thanks for this TS, I'll check out the article. From what I've found so far, Episims may be what is being used in the H5N1 models.

http://episims.lanl.gov/

mugwump

mugwump

09-07-2006, 08:26

Team Sergeant

09-07-2006, 10:12

The University of Michigan Medical School Center for the History of Medicine has just put up a web synopsis (http://www.med.umich.edu/medschool/chm/influenza/) of a report it prepared for the Defense Threat Reduction Agency (full report here (http://www.med.umich.edu/medschool/chm/influenza/assets/dtra_final_influenza_report.pdf)--pretty interesting)

Their mandate was to identify and characterize communities that experienced extremely low infection/death rates during the 1918-1920 "Spanish Flu" pandemic. Check out Bryn Mawr College -- target-rich environment (prime death age group), very close to Philadelphia (one of the hardest hit cities) yet no deaths.

Bottom line, if you're not interested in the whole nine yards: button up.

Executive Summary Conclusions:

(1) Protective sequestration (the shielding of a defined and still healthy group of people from the risk of infection from outsiders), if enacted early enough in the pandemic, crafted so as to encourage the compliance of the population involved without draconian enforcement measures, and continued for the lengthy period of time at which the area is at risk, stands the best chance of protection against infection. When implemented successfully, protective sequestration also involves quarantine of any outsider who seeks entry, self-sufficiency in the supplies necessary for daily living, enforcement of regulations when necessary (including fining and jailing), and the ability of those sequestered to entertain themselves and maintain some semblance of a normal life.

(2) Available data from the second wave of the 1918-1920 influenza pandemic fail to show that any other NPI [edit - non-pharmaceutical interventions] (apart from protective sequestration) was, or was not, effective in helping to contain the spread of the virus. American communities engaged in virtually the same menu of measures, including: 1) the isolation of ill persons; 2) the quarantine of those suspected of having direct contact with the ill; 3) social distancing measures, such as the cancellation of schools and mass gatherings; 4) reducing an individual’s risk for infection, (e.g., face masks, hand washing, respiratory etiquette); and 5) public health information campaigns and risk communications to the public. Despite these measures, most communities sustained significant illness and death; whether these NPI lessened what might have been even higher rates had these measures not been in place is impossible to say on the basis of available historical data. Moreover, we could not locate any consistent, reliable data that would support the conclusion that face masks, as available and as worn during the 1918-1920 influenza pandemic, conferred any protection to the populations that wore them.

mugwump

I've got a couple of problems with these conclusions;

First the population of the US in 1918 was 103 million. (About a third of what it is today)

IMO while "Protective sequestration" might have worked in 1918 it will not work today.

In 1918 a person could not travel 3-6 thousand miles in one day. In 1918 not everyone had a car, a TV, the internet, (instant means of communications) telephone or access to a worldwide airline capable of handling millions of passengers per day. Let's not forget the high speed interstate system and SUV's very capable of off-road travel (in the US one out of eight owns an SUV).

I would predict as news of the virus spreading hits the media, and the media in turn places their "spin" on it a large portion of the current population of a "target city" will be on the move. Personally I would not want to be in a city of millions when this virus strikes due to the catastrophic social breakdown that might/will occur.

IMO when the virus strikes a city of one-half million and up all hell is going to break loose. (see New Orleans during Katrina) As soon as the virus victims overwhelm the local emergency services, fill the hospitals, exhaust the medical supplies and personnel, chaos will ensue.

We need not worry about the use of "draconian enforcement" either; the entire US military could not contain one city the size of Los Angles. Does anyone actually think the military could contain every city in the US with a population over half a million? We cannot even control movement in our border areas and we’re only dealing with a few thousand a day there (and they're mostly on foot). IMO protective sequestration only works in hollywood movies.

My conclusion if and when this virus strikes and it turns out to be a very deadly virus, we are going to see what true anarchy really looks like, especially in the big cities and densely populated areas around the country. We are no longer considered "the Greatest Generation" and I do not see most of the citizens (and illegals) of the United States waiting patiently in their homes while the effects of the virus fade.
My .02

mugwump

09-07-2006, 11:24

<snip>

My conclusion if and when this virus strikes and it turns out to be a very deadly virus, we are going to see what true anarchy really looks like, especially in the big cities and densely populated areas around the country. We are no longer considered "the Greatest Generation" and I do not see most of the citizens (and illegals) of the United States waiting patiently in their homes while the effects of the virus fade.
My .02

You're not alone in your assessment. The more carefully this potential scenario is thought through, the more horrific the consequences become. A high Case Fatality Ratio (I've been chastised by a flu-weenie for incorrectly using "rate") would be catastrophic -- "civilization buster" and "viral Chicxulub" have been tossed around in conferences I've attended.

I'm not totally pessimistic. It hasn't broken out yet in spite of us humans doing just about everything wrong. It may be this virus's species barriers are just too high a hurdle. If we make it until next May I'll feel much better. As things stand now with recent reappearances in Egypt, Sub-Saharan Africa, Azerbaijan, Cambodia, VietNam, etc. I think this winter will be a real test.

The best-case scenario is no pandemic and this whole brouhaha wakes people up to the possibilities, and we get better surveillance and vaccine infrastructure out of the exercise.

If it does break, I still believe that "protective sequestration" or SIP ("shelter in place" in Homeland Security-speak) is the only viable option for a single home. It will work if scrupulously applied and preparations are made for food, water, medicine, shelter, entertainment, etc. Clearly, security/anarchy is the wild card even for those who are prepared to hunker down. Personally, I'm not optimistic about the chances of three well-armed civilians, in a frame house with no cover, vs. a determined mob.

RE: the military -- You probably wouldn't be surprised if you saw the hand-wringing that goes on in discussions I've sat in on WRT the use of the military/martial law/posse comitatus. It all revolves around leftie paranoid fantasies of Republicans not lifting martial law when the pandemic is over. There is never any doubt that the military could restore order nation wide if "let off the leash." Sheesh.

In my mind the key is keeping the grid up. I don't think that will happen.

mugwump

mugwump

09-08-2006, 08:49

No, not those bin Laden and Mohammed Atta (are these names the Anglo equivs of Smith and Jones?). More suspected Egyptian H5N1 cases -- up to four now. Last para seems to indicate extensive spread among birds in other provinces.

Now that migrating birds are moving back south, things are going to heat up in Africa and Southwest Asia.

Machine translation:

The Directorate of Health became seizure of bin Laden, Mohamed Atta - five years - and his mother, an evening full Qasim Sawamah east of the village center Akhmim in hospital on suspicion of haemorrhagic disease caught the avian flu. Also been sent samples of bin Laden, an evening for analysis at the Ministry of Health.

The National Committee to face bird flu headed by Dr. Hatem Al-Gabali, Minister of Health that it had to take measures to isolate and execution of poultry suspected of carrying the virus after an outbreak among domestic birds last week in the revival of the rain and Kobba and the eighth district in Cairo.

It also emerged in the cases of Giza and Dakahlia, Damietta, Qena, Qalubia and Beni Suef.

mugwump

[Edit - Looks like bin Laden/Mohammed Atta are the same 5 y.o. boy - the mom doesn't rate a name in the report.]

Peregrino

09-08-2006, 10:02

mugwump

09-08-2006, 10:25

Interesting cultural tidbit that a 5 y.o. Egyptian boy should be named bin Laden/Mohammed Atta. Nothing like naming your kids after the "Islamic hero/martyr du jour". Makes you wonder how his parents/family/culture really feel about "The Great Satan". Any recent conspiracy reports in the Islamic presses blaming us for the virus (again)? :munchin Peregrino

I wouldn't be surprised, but no, I haven't seen/heard any recent reports from the ummat al-mu'minin. An acquaintance did tell me her NGO pulled out of India because of Maoists whipping up the peasantry with tales of US plans for poultry hegemony. Two total equipment wipeouts by bandits and one beating were enough for her.

mugwump

The Reaper

09-08-2006, 11:47

And people say that the commies have no sense of humor!:D

TR

mugwump

09-08-2006, 12:15

And people say that the commies have no sense of humor!:D

TR

Proletarian poultry of the world, unite!

InTheBlack

09-08-2006, 14:03

http://www.alertnet.org/thenews/newsdesk/HKG147715.htm

HONG KONG - China, which has not shared bird flu virus samples with foreign experts since 2004, has blamed a U.S. laboratory for the long delay, saying it had not put in place import procedures, Chinese media said on Friday. Citing the Ministry of Agriculture, the official China Daily newspaper said China had already prepared 20 samples for a laboratory at the U.S. Centres for Disease Control and Prevention (CDC), which is accredited by the World Health Organisation. "But the U.S. lab has not yet completed import procedures, causing an indefinite delay in the shipment of the virus," a ministry spokesman was quoted as saying. China said this week it had not provided international health agencies with samples of bird flu viruses found in the country since late 2004, but was putting in place procedures to do so.

SNIP

***
I found the above on the California Dept of Food & Agriculture site; it seems to be an actively updated source of information:

http://www.cdfa.ca.gov/exec/pa/birdflu/

They have a nice flyway map "centered" on Asia, showing the paths of the flyways going worldwide.

Mug-- what software do you use for language translation? Babelfish just sucks for me.

InTheBlack

09-08-2006, 15:06

Mug- You said before that this year's flu vaccine might have some utility against H5N1. Is there any adjuvant we could obtain that might boost its efficiency? Or does the current vaccine already have their best-guess at potential effectiveness _deliberately_ included ?

I am shocked to learn that the EU standard for a flu vaccine only requires it to work at all in 40% of the recipients. What is the USA standard?
>>>
the criteria of the European CPMP that are required for the annual registration of interpandemic influenza vaccines in the European Union. The CPMP criteria are: seroconversion by more than 40% of participants...
>>>

The author's previous study (ref. #5) added "MF59" as an adjuvent and discovered that it made the vaccine effective. This study shows that it also made single-dose re-vaccination at 16 months (against the 2nd wave) effective.

HOWEVER - the Ref #5 study used 2 doses taken three weeks apart to gain initial protection. Is there any potential benefit to taking the current flu shot twice?

LINK TO HTML CONVERSION OF PDF:
http://scholar.google.com/scholar?hl=en&lr=&client=safari&q=cache:iSMBVUZC3nwJ:202.127.20.16:8080/DC/UserData/Upload/UploadFile1135749703812_0.pdf+author:%22Stephenson %22+intitle:%22Boosting+immunity+to+influenza+H5N1 +with+MF59-adjuvanted+...%22+

LINK TO PDF
http://202.127.20.16:8080/DC/UserData/Upload/UploadFile1135749703812_0.pdf#search=%22H5N3%20ver sus%20H5N1%22

***

Boosting immunity to influenza H5N1 with MF59-adjuvanted H5N3
A/Duck/Singapore/97 vaccine in a primed human population
Iain Stephenson ...(et al)

Vaccine 21 (2003) 1687â€“1693
7 October 2002
Abstract
In 1997, influenza A/Hong Kong/97 (H5N1) emerged as a potential human threat. In 1999, a randomised study comparing two doses of MF59-adjuvanted and non-adjuvanted influenza A/Duck/Singapore/97 (H5N3) surface-antigen vaccine found non-adjuvanted vaccine was poorly immunogenic. Addition of MF59 significantly boosted antibody to H5N1 to levels associated with protection. At 16 months, we undertook a follow-up study to assess the effect of H5N3 revaccination.
SNIP
protective antibody titres
did not exist at 16 months after two-dose priming. Twenty-one days after revaccination, there was significant boosting of antibody compared to GMTs achieved 21 days after two-dose priming in the original study...

mugwump

09-08-2006, 17:30

"But the U.S. lab has not yet completed import procedures, causing an indefinite delay in the shipment of the virus," a ministry spokesman was quoted as saying. China said this week it had not provided international health agencies with samples of bird flu viruses found in the country since late 2004, but was putting in place procedures to do so.

Pure, unadulterated bullshit. They are attempting to preserve their current strategic advantage in having an effective flu vaccine. "Swingen oil, Wu vaccine. Swingen, Wu like this:"
67236722

RE: Text translation:

Babelfish is reasonable for some languages but doesn't do Indo at all or Arabic very well. I don't do this any more, who's got time. People send translations to me or I find it on the web. When I did look for articles I started at alltheweb.com:

http://www.alltheweb.com/?cat=news&cs=utf8&q=&rys=0&itag=crv&_sb_lang=pref

For Indonesia, for example, Enter "flu burung" and choose results in any language.

Choose a likely candidate and put the Indonesian text into toggletext:

http://www.toggletext.com

For Arabic enter بأنفلونزا الطيور which is 'by the bird flu' and translate via:

http://translate.sakhr.com/sakhr/elogin_ET.asp

Google also has a Beta Arabic-English machine translator:

http://www.google.com/language_tools?hl=en

mugwump

mugwump

09-08-2006, 17:41

Mug- You said before that this year's flu vaccine might have some utility against H5N1...

ITB,

Yes, 40% response is considered "success." That's what the Sanofi vaccine achieves. I peripherally work on the Glaxo vaccine and I don't know what's been publicly released so you'll have to find the rate yourself (but it's higher). Even when it works, with all flu vaccines you can still get the flu -- it's just less severe if you've had a decent response to the vaccine.

A consistent outcome of all H5N1vaccine trials is the demonstration that one conventional 15µg hemagglutinin dose (the typical flu vaccine configuration -- the "H5" part of the virus) of vaccine does not work. Much larger single doses or two lower doses are needed to induce satisfactory immunity. H5 vaccines are particularly poor immunogens and all need an adjuvant to kick-start the immune system.

RE: can you take an adjuvant? Adjuvants are injected with the immunogenic molecule, and are particularly nasty buggers. Scientists have told me they are convinced that the (untested) adjuvants used in pre-deployment immunizations are responsible for Gulf War Syndrome. Do not mess with this.

Glaxo and Sanofi use the H5 portion of the virus and the Chinese version uses whole killed virus. The Sanofi vaccine is crap; it needs two 30-micro gram (µg) doses four weeks apart. The Chinese version needs two 10µg doses and the Glaxo version needs two 3.8µg doses. Dose size is important because current world production capacity is 900 million 15µg doses (standard seasonal flu dose). So, w/ Sanofi you get 450M doses divided by 2 doses needed = 40% protection for 225MM people. The Chinese get 1.35 billion doses or 675M people protected. Glaxo gets 3.55 billion doses or 1.78 billion people protected.

Note that it will take 6-9 months to get those doses produced, there will be a mixture of vaccines manufactured (i.e. all facilities will not be making the Glaxo version), and distribution networks will be...problematic. Now add to the mix that these vaccines all use old H5N1 strains that may match poorly to the actual circulating strain.

Also, Glaxo will not sell their vaccines in the US -- they think we're too litigious, imagine that. I'll be my bottom dollar that China will be taking care of their middle class, Iran and Venezuela in that order (and they may tell their own middle-class to go fish). We get to pound sand.

RE: Will seasonal flu vaccine protect against H5N1. Webster at St. Jude's thinks it might help a little and that's good enough for me. The rest of the world doesn't subscribe to the US's silly "only old people" strategy anyway, so go for it. (The best strategy from a population perspective is flu shots for little kids. We all know what snot machines the little buggers are.)

RE: two seasonal shots? Makes sense that 2 is better than one, but I have no idea. I'd make sure I had my Pneumovax II first.

mugwump

InTheBlack

09-09-2006, 01:11

So how can you tell if you have seroconverted your flu shot or not, and to what extent?

For future reference- Is (Glaxo) flu vaccine over the counter in Europe or anywhere else? Does it need special shipping (ie temperature regulation)?

mugwump

09-09-2006, 07:34

So how can you tell if you have seroconverted your flu shot or not, and to what extent?

You can't without a specialized immunoassay. You rolls the dice and you takes your chances.

For future reference- Is (Glaxo) flu vaccine over the counter in Europe or anywhere else? Does it need special shipping (ie temperature regulation)?

It isn't even released yet. Hopefully by the time it is, Congress will sufficiently indemnify Glaxo, et. al. I know Glaxo is lobbying for it.

I believe it requires refrigeration for shipment and storage but it's not sensitive about a couple of days at room temp.

mugwump

The Reaper

09-12-2006, 08:13

Wash Post printed an article which pretty clearly links air travel and the spread of influenza.

http://www.washtimes.com/national/20060911-103340-7169r.htm

TR

mugwump

09-12-2006, 10:49

Purely anecdotal, but on Fluwikie someone is reporting that their ROTC son has been recruited by the Ohio National Guard for a red team. He is to act as part of a rioting mob during "avian flu" training (taunting and throwing tennis balls at the Guard members). The Guard is reportedly training to secure grocery stores, hospitals, clinics, vaccine distribution points, etc.

If true, it's interesting, as stretched as the Guard is nowadays.

mugwump

stone

09-12-2006, 13:54

A recent article in Slate called "How to Survive the Avian Flu..."

http://www.slate.com/id/2148772/entry/2148778/

Nothing in depth but a possible introduction for those new to the subject.

Also, there's a link in the article to an interesting piece in Live Science called "The Odds of Dying."

http://www.livescience.com/forcesofnature/050106_odds_of_dying.html

mugwump

09-13-2006, 09:14

This actually goes somewhere, trust me.

I've known a guy for almost 20 years who works in the re-insurance business. Re-insurers are the guys who insure the insurance companies. It's a huge business - hundreds of billions of dollars are in play. When Allstate gets hammered in a Florida hurricane, much of the liability is actually footed by their insurance company, the re-insurer. Who knew, eh?

Anyway, this guy worked for Kemper, which was sold to GE Financial, which was sold last year to Swiss Re. I ask him how traumatic the transition was, and he said "Fine, except their risk assessment strategy is radically different from GE. Before, we were really worried about hurricanes and earthquakes but Swiss Re is most worried about business continuity exposure right now." A little digging reveals we are really talking about pandemic flu and its effect on their clients' exposure from "loss of business" policies. They are apparently raising their risk assessment for flu starting October 1 (actual quote was "We're going to bump it up a notch in the fourth quarter.")

I've stated before that I think the upcoming flu season presents a significant risk of a panflu breakout and, at least anecdotally, it sounds like a major re-insurer concurs.

NOTE: I suspect that they are moving their stance from a 'moderate' risk (1%-10% chance) to 'high' risk (10%-20% chance).

I found the following when searching for some info on Swiss Re and panflu. I guess it's nothing really new and represents what I think the likely outcome of a high CFR event would be, but it's rather chilling to have your assessment mirrored by Merril Lynch, Swiss Re and Wharton.

Here's the panflu overview from the report, followed by the link.

A World Economic Forum Report,
in collaboration with
MMC (Marsh & McLennan Companies, Inc.)
Merrill Lynch and
Swiss Re
and in association with the Risk Management
and Decision Processes Center at the
Wharton School of the University of Pennsylvania

A conflation scenario for H5N1

New pandemics such as SARS (before its emergence) and human variants of avian flu lie on the continuum between unknown (u) and unknowable (U) risks. Unlike human flu or animal foot and mouth disease – where it is known that outbreaks will reoccur and past experience provides a reasonably accurate guide as to their impact – new viral diseases evolve and cause death and secondary economic damage in unpredictable ways. Global interconnectivity has vastly increased the opportunities for the emergence and rapid transmission of disease and the myriad linkages in the global economy enable systemic economic, social and political contagion as well.

The following is a brief sketch of the possible conflationary impacts of a major human outbreak.

Several cities in East Asia suffer major outbreaks of human-to-human transmission. International travel is severely affected, pandemic-specific vaccine supplies are secured and security authorities prepare for external contingencies and domestic insurgency. Emergency supply chain management is instituted, based on the possibility that 50% of those infected die. Commodities and services needed to survive for one to three years are identified. Non-critical industries reduce output or close. Even with full-scale vaccine production in nine countries with 12% of the global population, fewer than 500 million people (14% of the world’s population) can be vaccinated in a year.

An outbreak of H5N1 human-to-human transmission could have devastating impacts globally across all social and economic sectors, disrupting efficient processes, severely degrading response capabilities and exacerbating the effects of known weaknesses in different systems. These impacts might include: the disruption of supply chains and trade flows; an exacerbation of financial imbalances and the transformation of intellectual property regimes for pharmaceutical products; rioting to gain access to scarce supplies of antivirals and vaccines; a collapse of public order; partial de-urbanization as people flee population centres; the extinction of trust in governments; decimation of specific human skill sets; and forced, large-scale migration, associated with the further collapse of already weak states.

In such a scenario, the impact on society might be as profound as that which followed the Black Death in Europe in 1348. That plague caused a fundamental transformation of socio-economic relations in Europe. The deaths of an estimated one third of the European population of the time created a shortage of labour, undermining an economy based on serfdom, and effecting a shift in the relative values of capital and labour. Scarcity of labour resources brought about a wage-based economy in which the value of
skills was efficiently priced.

http://www.weforum.org/pdf/CSI/Global_Risk_Report.pdf

mugwump

09-13-2006, 09:21

Follow up to above. I asked the guy if he thought we should prepare in any way (I don't tell anyone I've prepped) and he said "Huh, never thought of that. Maybe."

People are funny.

mugwump

InTheBlack

09-13-2006, 16:36

InTheBlack

09-13-2006, 17:02

BTW regarding this year's flu vaccine - does the US supply all come from one company, or more specifically is it all made using same 'formula' ?

What seroconversion rate did it actually achieve?

mugwump

09-13-2006, 17:08

Of course, we need to consider how much this is also a bit of a propaganda document to be used to support the rise in premiums. Sure they are worried, but presenting the worst case helps cover their ass. It would be good to know their 5 year profit history & how long its been since premiums were increased etc.

True, but it's a competitive business. If the price goes too high their clients find someone else or "go bare" like I do. If the risk gets too high the re-insurers stop underwriting completely. If I'm right about their assessment of a 10-20% risk in the short term, I bet that's exactly what they will do. Try to get a hurricane policy at any price in some parts of Florida -- many insurers have pulled out completely.

And note Merrill Lynch, MMC, and the Wharton Business School as authors of the risk document. I think Swiss Re were included because they have some of the best risk assessment teams in the world.

I certainly hope they're all wrong.

mugwump

mugwump

09-15-2006, 07:27

Maybe kimchee is the H5N1 secret weapon? This makes nine S. Koreans who have seroconverted, that is, developed antibodies to H5N1. None had symptoms -- I'm trying to get an explanation. Several other studies from Cambodia, VN and Indo are showing few or no asymptomatic infections. A puzzle. Gotta be the kimchee...

SEOUL (AFP) - Five South Koreans were infected by the H5N1 bird flu virus two years ago while helping slaughter birds that had contracted the disease, health officials have said.
ADVERTISEMENT

The five were exposed to the virus between late 2003 and early 2004 but have shown no symptoms, said the health ministry's Center for Disease Control and Prevention.

They make up only the second known incident of human infection in
South Korea, which slaughtered 5.3 million poultry during a bird flu epidemic two years ago.

mugwump

09-15-2006, 07:37

I've seen it in print so I can talk: the Glaxo vaccine was 82% effective ("strong antibody response") with lesser but still partially effective protection in the remaining 18%. This was after two 3.8 microgram doses.

mugwump

09-18-2006, 06:39

Maybe this is why Swiss Re is reassessing their risk status:

Bird-Flu Pandemic Could Cost $2 Trillion

September 18, 2006 -- A severe bird-flu pandemic among humans could cost the global economy up to $2 trillion, the World Bank warns, sharply raising earlier estimates.

The comments on September 17 came as a senior World Health Organization official said the threat from the H5N1 avian-flu virus was just as real today as it was six months ago.

http://www.rferl.org/featuresarticle/2006/09/a846048f-7441-4627-a56c-5fcd28993071.html

mugwump

09-18-2006, 19:35

See the speculation that vitamin D suppresses flu (but note that the highest death rate in 1918-1919 was in rural India -- they get a bit of sun there). Makes some sense though - the observation about short days and illness...

"Why does flu break out as the nights draw in? Scientists have seen the light - we don't get enough of it."

http://news.independent.co.uk/uk/health_medical/article1525348.ece

mugwump

09-27-2006, 10:10

Well, it's about time for an update...

Since the last update, bird infections have returned to Viet Nam, Malaysia, Egypt, Sudan, Sub-Saharan Africa and Azerbaijan. It's not unexpected, given the endemic nature of the infection in SE Asia and the start of the migratory return of birds to Africa and the marshes in SW Asia.

Nigeria/Uganda/Sudan etc. are major worries for the ID community due to the extreme poverty (massive opposition to culling), the lack of surveillance, and densely-packed urban centers.

There's a bit of excitement about several deaths this summer in Thailand. Some patients received up to nine H5N1 tests before they died -- all of which came back negative. More exhaustive post mortem tests performed by the WHO (and rumors say NAMRU-2, which doesn't officially exist any more) have revealed they died of H5N1. Not what Thailand wants to hear at the start of the high tourist season. Note that several apparently died of opportunistic bacterial infection after surviving the initial H5N1 attack. An example is here: Nine tests failed to detect H5N1, doctors reveal (http://nationmultimedia.com/2006/09/27/national/national_30014707.php). Note that this is just one example -- more similar cases will be reported in the next couple of days. Or then again maybe not, depending on the new government.

China has rammed through more draconian laws restricting journalism in the country, one of which makes it theoretically illegal for CNN to report on American TV any civil disturbance or disease outbreak that occurs in-country. What a bunch of clowns. All of the official press organs have been predicting a human H5N1 outbreak this winter/spring. Xinhua, Peoples Daily, etc. had a run over several days where they pressed home the story. An example is here: Avian flu "may strike" in winter (http://news.xinhuanet.com/english/2006-09/23/content_5127119.htm). Given the current state of affairs, these reports have to be considered official government pronouncements.

Indonesia remains a smouldering potential nightmare. While only two "official" deaths have occurred in the last two weeks (two male youths, numbers 50 and 51) up to ten new H5N1 deaths are known to have occurred -- many in small H2H clusters. An example report is here: Indonesia confirms bird flu in possible cluster (http://news.yahoo.com/s/afp/20060927/wl_afp/healthfluindonesia). Indonesia continues to bury respiratory disease deaths without obtaining samples, so the situation has to be considered potentially worse than official reports suggest. There are reports of H5N1 infections in pigs and dogs throughout the country.

I did my little informal poll among my contacts: Whatsup? The gist after weeding out the noise and "go away's": a growing consensus on a 20%-30% chance for a major outbreak this winter/spring. I take comfort that this means a 70%-80% chance it won't hit.

mugwump

09-27-2006, 10:22

I forgot to mention that Swiss Re, the reinsurance giant, is apparently issueing "catastrophe bonds" for an avian influenza pandemic. Cat bonds are issued in an attempt to shift the risk to individual investers when a company feels it is overexposed to a costly potential risk. Investers can get a good return if the disaster doesn't hit.

It looks like hurricane cat bond investers will make out like a bandit this season, touch wood. If you think panflu is all a bunch of hooey, you can now vote with your wallet.

Edit - found a cite: Moody's: Catastrophe Bond Market Expands (http://www.chron.com/disp/story.mpl/ap/fn/4215074.html)

mugwump

09-29-2006, 09:12

There's a very interesting new article in Nature, arguably the premier science journal in the world (Genomic analysis of increased host immune and cell death responses induced by 1918 influenza virus). Unfortunately it's a subscription site and they are getting cranky about posting more than the first paragraph. So, not to get PS.com in hot water I'll summarize the results.

The researchers compared four viruses. One virus was the 1918 strain that caused the Spanish flu pandemic and the other three were standard flu strains which were genetically altered to contain bits and pieces of the DNA from the 1918 strain. They caused infections in mice by introducing the viruses via the nose. They then compared infection rate, severity, etc. and performed sophisticated DNA analysis to determine the way each virus killed its hosts.

The 1918 strain was by far the worst, causing lung lesions and ARDS in a fashion similar to the currently circulating H5N1 strains. The altered viruses, even the one that had five-eights of the 1918 virus's DNA inserted, were far less deadly.

The upshot? The 1918 strain was deadly due to a combination of actions by all of the genes in the virus, not just this piece or that piece. Severe cytokine storm was found as well -- the inflammatory response I talked about earlier, the one potentially tamped down by statins (Lipitor, Zocor, etc.). Also, the genes that control "programmed cell death" (apoptosis) were switched on in the lungs of the 1918 infection. Programmed-cell-death genes are a normal part of cell DNA and are used during growth when organs are reshaping themselves (used as a sort of internal organ "eminent domain" when space is needed for new structures). It is definitely unusual to have these genes switched on in such a fashion during infection. Bad juju.

They don't know if it's chicken or egg, whether the inflammatory response is turning on the cell suicide or vice versa.

The 1918 viral gene segment that appears to turn on the programmed cell death is shared by three of the four H5N1 strains currently circulating. Also bad juju.

mugwump

09-29-2006, 09:38

Privately, Indonesia is coming under intense criticism for public pronouncements of "not a cluster", "all cases of bird flu are coming from chickens", and "there is no evidence of human to human transmission." The economy is beginning to take a big hit and the $1 billion they hoped to get from the international community has not appeared, so it's circle the wagons time. So, new criteria for declaring H2H:

Health Minister Siti Fadillah Supari said any conclusion on human-to-human spread could not be based on small cases. "You cannot just declare there is human-to-human (transmission) from a doctor's examination. It may need thousands of cases first."

Cincinnatus

09-29-2006, 10:14

I saw the following on another board and thought it might be of interest. I profess to being somewhat skeptical of most herbal cures, and have not researched this further, that said this looks like elderberry based remedies may be effective against various influenza strains. (There's long been anecdotal evidence that tincture of elderberry was effective against flu.)

"Study shows Israeli elderberry extract effective against avian flu
By Nicky Blackburn January 29, 2006

At first glance, world-renowned Israeli virologist Dr. Madeleine Mumcuoglu does not seem like the sort of person you expect to come up with what could turn out to be a cure for one of humanity's biggest threats today - the avian flu.

She seems comfortable and grandmotherly, not the type you usually associate with the frontline of research into a potential pandemic. On the other hand, however, Mumcuoglu is clearly a very determined woman who has turned a lifetime of research into the health benefits of elderberry, an old folk remedy for influenza, into a clinically proven treatment for regular flu. Now, new in-vitro tests have proved that her remedy, the elderberry-based Sambucol, also appears to be effective against avian flu.

Last week, Retroscreen Virology, a leading British medical research institute associated to Queen Mary College, University of London, announced that Sambucol was at least 99% effective against the avian flu virus, H5N1, and in cell cultures significantly neutralized the infectivity of the virus.

"I think that Sambucol has a great role to play - it really can save lives," Mumcuoglu told ISRAEL21c. "To my knowledge, it's the only product that can cut the flu in half, before complications have a chance of setting in. If we do have a cure for chicken flu, this is a really positive thing for Israel."

Mumcuoglu (pronounced mum-shu-glu) was born in Algeria and immigrated to Israel in 1974. She holds a Doctorate in Virology, and studied bird flu during her Ph.D. In the 1980s, Mumcuoglu began studying the natural healing elements of the elderberry from the black elder tree (Sambucus nigra). Her interest in the plant was piqued because it had been used in medicine for many centuries. It was first referred to as a healer in the 5th century BC and received mentions in the writings of Hippocrates, Dioscurides and Plinius.

Elderberry wine was traditionally used for influenza and the ill effects of the chills, and the juice of the black elderberry has historically been an invaluable remedy. The elder has often been called the 'medicine chest" of the country people.

During Mumcuoglu's research she discovered the key active ingredient in elderberry and when she tested it against the flu virus, she found it effective. On her arrival in Israel, Mumcuoglu joined the Hebrew University Hadassah Medical Center in Jerusalem, and continued her research.

The result was Sambucol, a patented natural formula which contains a potent antiviral compound, AntiVirin, isolated from the black elderberry, and three flavonoids - naturally occurring plant antioxidants. In 1992, Mumcuoglu decided to commercialize her elderberry supplement, and founded Razei Bar Industries to do so.

Mumcuoglu, who is president of Razei Bar, first tested her research on patients in the Southern Israel flu epidemic of 1992/3. The results were extremely encouraging. Within 24 hours, 20% of those patients taking Sambucol had dramatic improvements in symptoms like fever, muscle aches and pains and coughing. By the second day, 73% were improved and by day three, 90%. In the untreated group, only 16% felt better after two days. The majority of that group took almost a week to begin feeling better.

In 1995, laboratory studies were carried out at Hadassah, which showed that Sambucol was effective against human, swine and avian influenza strains.

Shortly afterwards, a further randomized, double blind, placebo-controlled study was conducted in Norway, where Sambucol was shown to significantly reduce the duration of flu by approximately four days. The use of rescue medication (pain relievers, etc.) was significantly less in the group receiving Sambucol than in the placebo group. The study concluded that Sambucol stimulates the healthy immune system by increasing production of inflammatory cytokines.

Today Razei Bar sells a number of different liquid anti-viral treatments including Sambucol Black Elderberry Extract, Sambucol Black Elderberry Syrup, Sambucol Immune System, and Sambucol for Kids. The company also has a number of elderberry flu remedies designed for diabetics.

At the end of last year, Retroscreen Virology in London began laboratory tests on Sambucol to discover whether the natural remedy could also be used to combat the deadly H5N1 strain of bird flu in dog kidney cells. And their findings last week are an encouraging sign.

While it is too soon to know if Sambucol can cure avian flu in humans, the Retroscreen Virology trial does hold out hope that it may be a possible solution if more studies support the findings. Mumcuoglu admits that clinical research into H5N1 is impossible at this stage, because there have only been 140 or so cases around the world, and the mortality rate is over 50%. Instead, the company is preparing to begin in vivo studies to look at the effect of Sambucol against the disease caused by the avian influenza virus.

If Sambucol does prove effective against H5N1, it will be a major breakthrough. Unlike many of the other remedies being touted as possible treatments to bird flu, this is a tried and tested product, already on sale in 17 countries around the world, including the US, Canada, Britain, Holland, Belgium, Norway, Israel, South Korea, and Singapore.

In the US, Sambucol has been well received and now controls about 80% of the elderberry remedy market. The liquid food supplement is distributed by Nature's Way Products and sold in most health food stores across the country.

A SPINS survey revealed that in the US three of Sambucol's products are among the top 10 out of 662 herbal formulas available for adults, while the children's remedy, Sambucol for Kids, is at the top of the list as the number one formula for kids out of 192 products in different categories.

Another advantage of Sambucol, says Mumcuoglu is that unlike the anti-viral drug Tamiflu, which is the only treatment for bird flu now available that is thought to reduce the length and severity of flu symptoms, Sambucol has no side effects. It can also be given safely to children. Tamiflu, in contrast, cannot be given to children under 12.

Recently there has also been doubt cast on the effectiveness of Tamiflu as two Vietnamese patients, including a 13-year-old girl, developed resistance to the anti-viral drug and died. A report on this was published in the New England Journal of Medicine. Commenting on the report in the journal, Prof. Anne Moscona of Cornell University in New York said Tamiflu-resistant H5N1 "is now a reality".

"This frightening report should inspire us to device pandemic strategies that do not favor the development of Tamiflu-resistant strains."

The US, like many nations around the world, has stockpiled supplies of Tamiflu.

Another advantage of Sambucol is that it can treat every type of flu virus.

"Our research has shown that the antiviral effect of Sambucol is not strain-specific," says Mumcuoglu. "It was effective against all influenza viruses tested. The original formulation of Sambucol is the product we have tested in all cases - both in the laboratory and in clinical studies for the common flu. It is what was also used in the recent experiments in London against avian influenza virus thus any Sambucol already on the shelves is the same as any we would produce now."

Traditional vaccines given to prevent flu from developing are often created through guesswork, with scientists simply speculating which strain of flu is likely to hit that year. The three most likely strains are combined into a vaccine, but by the time the flu season arrives, these strains may have undergone changes, or new strains may have emerged. Despite this, Mamcuoglu insists that those at risk continue to take their flu jabs.

Mamcuoglu insists that use of Sambucol against traditional flu viruses will help reduce the annual death rate. "If you stop the flu virus at the beginning then you stop it going to the lungs, or from creating the additional complications that are normally the cause of death," she explains.

Currently about 30,000 people die of regular flu every year in the US, a figure that could rise alarmingly if avian flu becomes the pandemic experts are predicting. If Sambucol proves effective against bird flu, however, Mamcuoglu believes that figure will be much lower.

The next round of trials into Sambucol's efficacy as a treatment for bird flu are likely to be completed during the year. Mumcuoglu is ready for any upsurge in sales that are likely if the results are positive. "We have additional production facilities on standby," she says.

The company also has another interesting product in the pipeline, called ArteryCare 40 Plus. This is an antioxidant formula containing strong antioxidants from the elderberry, the pomegranate and the persimmon. It helps avoid the formation of plaque in the arteries by preventing the oxidation of LDL (the bad cholesterol), and is thought to also have anti-aging properties."

Link from article:

http://www.israel21c.com/bin/en.jsp?enScript=PrintVersion.jsp&enDispWho=Article s^l1209

mugwump

09-29-2006, 17:24

Webster's gone public on the seasonal flu vaccination study I told you about earlier:

SAN FRANCISCO (AP) - A leading flu expert says an encouraging but small study in mice gives more reason to hope that ordinary flu shots might help protect people if bird flu starts spreading among humans and causes a pandemic.

http://www.canada.com/topics/news/world/story.html?id=6211fc34-64a7-4f92-afdd-89a78959b56f&k=14658

InTheBlack

10-03-2006, 10:44

CDC shortages info says:
http://www.cdc.gov/nip/news/shortages/default.htm
>>>
Hib vaccine currently is not available from Wyeth. Updates on their supply of this product are not available.
>>>

Currently trying to figure out what to say to the local health dept to get them to give it to us (adults). They are keyed on its administration to toddlers. Our general practitioner doesn't stock it.

Mug previously recommended:
>>>
If, God forbid, this pandemic breaks out and you or yours catch it, you will of course fight it off. What you now are at risk for in your weakened state is catching bacterial pneumonia. The H flu vaccine can prevent some of those infections (those caused by Hemophilus influenzae type B)
>>>

And they say the seasonal flu vaccine won't be here till near November.

InTheBlack

10-03-2006, 13:36

mugwump

10-03-2006, 14:13

This HiB vaccine is hard to obtain. Local Health Dept only gives to kids, family GP won't order it since it comes in multi-dose vials, local international travel shots place doesn't have it either.

Only option to get a scrip & order thru pharmacy.

Then focus on the Pneumovax II and the seasonal flu shot as 25m targets. The HiB would be nice to have, but as you relate it's really hard to get as an adult. My kids have HiB and Pneumovax II (23 strain polyvalent, they are young adults) and the wife and I the PV II only. Seasonal flu shots are scheduled for the end of October.

It's an open question whether an older immunization like my kids have will still stand up in adults -- it's designed to protect kids in their first 5 years.

HiB prevents infection w/ Haemophilus influenzae, which under normal circumstances infects only children under the age of 5 and those with compromised immune systems (HIV, chemo, etc.). Avian flu viruses are masters at denuding the trachea and lungs of their cell lining, which leaves you open for attack by H. flu.

See below, from http://textbookofbacteriology.net/haemophilus.html

Haemophilus influenzae is widespread in its distribution among the human population. It was first isolated by Pfeiffer during the influenza pandemic of 1890. It was mistakenly thought to be the cause of the disease influenza, and it was named accordingly. Probably, H. influenzae was an important secondary invader to the influenza virus in the 1890 pandemic, as it has been during many subsequent influenza epidemics.

InTheBlack

10-03-2006, 22:17

That article says 2-3 doses provide 90% plus protection in children, so buying a vial of 10 doses isn't a waste for 2-3 people.

Maybe the single HiB vaccine has been replaced by the DPT combinations; but getting the Tetanus at the same time would not be a bad thing.

>>>
one specific type of common bacterial pneumonia
>>>
Did you mean a bacterium other than the H. Influenzae bacterium itself?

mugwump

10-04-2006, 09:29

The potential of statin therapy in H5N1 treatment has hit the MSM:

Cholesterol drugs could combat flu pandemics

Statins, the cholesterol-lowering drugs prescribed to two million people in Britain each year, could play a pivotal role in combating a flu pandemic, scientists believe.

Early evidence suggests that the cheap, readily available drugs are a potential treatment for virulent influenza strains such as H5N1, which has killed 148 people in Asia...

http://www.timesonline.co.uk/article...387803,00.html

[Note: vets/AD should look into getting the following stuff via the VA, it's all in the formulary (including Tamiflu as of 6 weeks ago) and it's obviously much cheaper by that route. ]

I know a person who has obtained without prescription 100 tablets of generic Zocor/simvastatin from Europe (much cheaper than in the US, where no generics currently are marketed) via the online pharmacy GoldPharma (http://goldpharma.com/index.php?show=item&item=home) (There's another good European pharmacy I've recommended via PM, but this is the one with a spotless track record among the last 3 folks using them.)

zocor FORTE 40mg 100 Tbl. N3 100 Tablets € 185.55 40.00 mg Simvastatin (Dieckmann Arzneimittel GmbH, Germany)

Note that purchasing 100 tablets x 40mg is significantly cheaper that 200 tablets x 20mg. This person I know is planning on using a drugstore pill splitter to create 200 half-tablets of 20mg each. The daily dose of 20mg in the morning and 20mg in the evening would be administered to anyone showing the first hint of illness. When the first family member showed symptoms, young asymptomatic adults would get 20mg once daily for 10 days if they remain asymptomatic (they are the most susceptible to ARDS but you can't eat up the whole supply treating prophylactically) with another another 20mg added if they developed any symptoms.

Be aware that ex-US purchase of prescription drugs is a legal grey area. That said, many state .gov websites have links to reliable Canadian pharmacies (which all require a script--something GoldPharma doesn't).

GoldPharma also have Tamiflu and antibiotics. The last three shipments that I know of have arrived successfully, but you bear the risk of financial loss if a shipment is intercepted by customs.

Previously-discussed big-boy rules are obviously in play. Do research into contraindications and side effects and make up your own mind. Note that while statin therapy data suggest that it's effective in short-circuiting ARDS, the data are not conclusive. Also note that Tamiflu resistance is cropping up in Indo (it may be ineffective when flu hits locally) and the dose being used is twice the one recommended on the labeling (they are using two tablets per day, not one). You will obviously have to assess your own situation and determine if the money is better spent elsewhere.

Personally, I'd go for statins and a good broad-spectrum antibiotic (Augmentin, azithromycin, or moxifloxacin) before Tamiflu. And I'd get my oral re-hydration supplies, fever and diarrhea OTC meds, seasonal flu shot and Pneumovax II shot before anything.

mugwump

10-04-2006, 10:00

This next tidbit is third-hand info, but I pass it on because it seems credible and I haven't heard it anywhere else. It comes via my one lonely employee in Singapore, who heard it from a friend in Jakarta. (In other words, this is not Charter House Rule gouge from the vaccine community.)

There is talk in Indo of many less-critical human avian-flu cases. The word is that many of these are being treated by traditional "medics"/shamans and only some of the worst cases end up in the hospital. Hospitals and Tamiflu are associated with fatal outcomes and are being avoided like, well, the plague. This flu they report is characterized by a distinctive sounding cough (it is being called "clucking flu" in a play on its avian origin and the funny-sounding cough), shortness of breath, stubborn high temperature with severe chills, widely distributed bruising and splinter hemorrhages on the fingernails. These all sound credible, given the hemorrhagic nature of this flu.

I don't know what his means. I think everyone who follows this topic believes there are more cases in Indo than are being reported. The rumor that people are recovering from this flu is good news but this may herald the drop in mortality that many expect prior to a major breakout. Who knows, just another piece of the puzzle.

mugwump

10-04-2006, 10:11

Checking for corroboration for the previous post: Niman reports recovering patients in the report below (from today). Note the new patients haven't been established to be H5N1:

H5N1 Suspect Cluster in Makassar South Sulawesi Grows
Recombinomics Commentary
October 4, 2006

As Many As eight citizens who lived in Street Perintis Breakingprep Kemerdekaan, Makassar, were taken the sample of his blood because of experiencing the sign that was similar to the bird flu sufferer.

Two among them, the older brother was siblings, Dion (7) and Mustarisa (4), underwent the intensive maintenance in the Public Hospital (RSU) Wahidin Sudirohusodo, on Tuesday (3/10).

The official also combed the patient's neighbour.Two citizens, Nurwan (30) and Hidayati (21), kedapatan experienced the similar sign.The neighbour Dion that lived in Street Perintis Breakingprep Kemerdekaan KM 8 No 8 this took part in being taken the sample of his blood and was recommended to RS Wahidin to undergo the intensive maintenance.

Six patients suspect this was their respective, Dion R (7), Mustarisa (4), Nur Asiah (11), Apriliyani, Paturungi, and Salsabil.

From six patients tesrebut, four among them, Dion, Mustarisa, Nurasiah, and Salsabil entered on the same day, on Monday (2/10).

The above translation indicates the number of hospitalized suspect H5N1 bird flu victims continues to increase in Makassar in South Sulawesi. In June a confirmed H5N1 case died in Makassar and recently the number of additional hospitalized patiens began to increase dramatically. Some of the earlier cases are recovering, so the recent cases could be seasonal flu, or H5N1 responding to Tamiflu treatment.

The clustering in the same neighborhood, however, remains a cause for concern.

mugwump

10-09-2006, 08:09

Excellent article: Deception Dominates World Health Organization's Bird Flu Releases (http://www.crimelibrary.com/news/original/0706/1402_who_looking.html)

InTheBlack

10-10-2006, 17:03

Seasonal Flu Vaccines:

Since a shot is so very cheap to get, it might be a useful strategy to get two shots with different brands of vaccine.

There are currently 5 brands licensed in the US. Still looking for the names of the other three. Two were "fast tracked:"

http://www.fda.gov/bbs/topics/NEWS/2006/NEW01478.html

FluLaval- by ID Biomedical Corporation of Quebec, Canada, a subsidiary of GlaxoSmithKline Biologics
GlaxoSmithKline's Fluarix received approval in 2005.
***

This patent description for a Glaxo nasal vaccine contains a good review of the nature of vaccines:

http://www.freshpatents.com/Intranasal-influenza-virus-vaccine-dt20050915ptan20050201946.php

Vaccines can use either inactivated or live attenuated virus. Inactivated can contain "whole," "split," or "purified" viral portions.

Protection can be measured either systemically or in the nasal mucosa. Inhaled (vs injected) vaccines give lower odds of systemic but higher odds of mucosal protection:

"Mucosal immunity constitutes the first line of defence for the host and is a major component of the immune response in the nasal passages and in the airways of the lower respiratory tract. Although the presently used injectable influenza vaccines stimulate serum HA-specific IgG in the majority of healthy individuals, a significant rise in HA-specific nasal IgA antibody occurs in only a minority of vaccinated subjects."
***

I'm still looking for the actual submitted efficiency on the 5 vaccines, and for the US standards.

Which of the three strains in the seasonal vaccine is the one that might help vs H5N1? We would want our seasonal shot brand to be the one with the best protection against that particular portion of the "trivalent."

"Theoretically, to meet the European Union requirements, an influenza vaccine has to meet only one of the criteria in the table, for all strains of influenza included in the vaccine. However in practice, at least two or all three of the criteria will need to be met for all strains, particularly for a new vaccine such as a new intranasal vaccine. Under some circumstances two criteria may be sufficient. For example, it may be acceptable for two of the three criteria to be met by all strains while the third criterion is met by some but not all strains (e.g. two out of three strains). The requirements are different for adult populations (18-60 years) and elderly populations (>60 years).
TABLE 1
18-60 years >60 years
Seroconversion rate* >40% >30%
Conversion factor** >2.5 >2.0
Protection rate*** >70% >60%
*Seroconversion rate is defined as the percentage of vaccinees who have at least a 4-fold increase in serum haemagglutinin inhibition (HI) titres after vaccination, for each vaccine strain.
**Conversion factor is defined as the fold increase in serum HI geometric mean titres (GMTs) after vaccination, for each vaccine strain.
***Protection rate is defined as the percentage of vaccinees with a serum HI titre equal to or greater than 1:40 after vaccination (for each vaccine strain) and is normally accepted as indicating protection. "

*****
Here's the March 2006 FDA draft criteria for licensing a Pandemic Flu Vaccine:

http://www.fda.gov/ohrms/dockets/98fr/06d-0088-gdl0001.pdf

Here are comments on that document by the National Institutes of Allergy and Infectious Diseases (NIAID) within the NIH:

http://www.fda.gov/OHRMS/DOCKETS/DOCKETS/06d0088/06d-0088-emc0001-03.pdf

"With regard to the criteria on rates of seroconversion, NIAID’s recent experience with the FDA has included an additional parameter where a four-fold rise was considered seroconversion as long as the titer was greater than or equal to 1:40."

InTheBlack

10-10-2006, 23:53

Researchers have infected mice with the completely reconstructed 1918 virus:

http://www3.niaid.nih.gov/news/newsreleases/2006/1918mouse.htm

>>>
Modern analyses of 1918 flu victim autopsy samples show extreme and extensive damage to lung tissues. This observation gave rise to the hypothesis that the 1918 flu virus infection provoked an uncontrolled inflammatory response leading to rapid lung failure and death.

To test this idea, Dr. Tumpey infected mice
SNIP
In particular, genes involved in promoting inflammation were strongly and immediately activated following infection by the reconstructed 1918 virus. “We clearly see a dramatic and uncontrolled immune response in the mouse lungs as early as one day following infection with the reconstructed 1918 virus,” he says. A complete understanding of the host’s response to the 1918 flu virus, adds Dr. Katze, requires use of a fully reconstructed virus.
>>>

In the people infected with H5N1, have they done careful analysis to distinguish inflammation from a secondary infection vs that caused by the virus itself?

mugwump

10-11-2006, 07:14

In the people infected with H5N1, have they done careful analysis to distinguish inflammation from a secondary infection vs that caused by the virus itself?

Yes and no. There are six(?) postmortems total AFAIK -- in Christian children (many of the VN and Indo folk who are nominally Christian or Muslim are basically still animist at the core -- the Bandug cluster in Indo was in Christians -- but only the Christians allow pm's.). They revealed the lesions described, and also kidney, gut and brain involvement. These are the hallmarks of disseminated hemorrhagic infection.

When you hear about someone in Indo going into the hospital, going on vent support, and dieing -- that's primary infection and the inflammatory response/cytokine storm is likely to blame. If they improve, come off vent support and then worsen and die -- that's secondary infection.

Ventilator support is always bad; it often causes as many problems as it solves. Secondary infection is common even if the vent was used for a non-infectious cause.

If a pandemic hits, there will most likely be people who just get a bad case of the flu (recovery likely if no 2' bacterial pneumonia) and those who get the inflammatory response (survival possible but unlikely). The proportion between the two is unknowable at this stage.

InTheBlack

10-12-2006, 00:07

Mug- I talked the people at my HMO into giving the HiB vaccine except that they don't know the adult dose or number of repeats. The package insert doesn't mention it; they left it up to me to find the documentation for them. Do you happen to know where to find it?

Searching the web for "HiB" brings up only Hep B, and any use of the word "influenza" drowns the results in seasonal flu noise.

& this thread is so long and the Search function so restricted... looking for the post documenting who in Indonesia is using twice the normal Tamiflu dose. Do you recall what month that was?

InTheBlack

10-12-2006, 22:14

FYI: ZOCOR product insert at Canadian Merke site:
http://www.merckfrosst.ca/mfcl/en/corporate/products/zocor.html

mugwump

10-20-2006, 07:25

I haven't posted an update here for a while, so I guess it's time.

Avian flu (in birds) has returned to Africa and SW Asia with the migrating waterfowl. There's been one confirmed human case in Egypt and several suspected ones in northern Nigeria (dead and buried). There are strong suspicions of avian infections in Iran (confirmed infections in neighboring states).

Expect a resurgence of human cases in Africa and SW Asia. Remember that the closest we've come to a breakout was Turkey in Dec '05 -- Jan '06. (It was a bigger cluster than Karo, Indonesia. The WHO still had some credibility then -- people believed them when they said there was no H2H. We now know from the DNA sequences that they were wrong or lying.)

Indonesia is moving from a high simmer to a slow boil. The government is reeling under increasing criticism for the way they've mishandled the whole affair and they're getting increasingly defensive. There have been numerous, widely distributed deaths over the last weeks with the tempo of infections apparently increasing (three deaths in three days last week, different locales).

Journal articles have confirmed H5N1 infections in Indonesian pigs, dogs and cats. The DNA sequences from cat and human infections are nearly identical with big differences from bird viruses. They are working on the dog sequences now and I wouldn't be surprised if they matched as well. I've passed on the concerns of others that the direct poultry-human link was weak, and this seems to indicate another vector is possible, even likely.

Nearly every MSM article you read will say "every/nearly every case of human bird flu is linked to close contact with dead or dying birds." This mantra has replaced the now defunct "there have been no cases of human-to-human transmission." They are both bullshit. Clearly, birds are sick and dieing but many, many smart people think direct bird to human transmission is of minor importance now.

NAMRU-2, the US Navy research facility in Jakarta, is apparently back up after publicly announcing they'd left the country a while back. Who knows the politics behind all that.

The latest worry: Bird Flu Suspected in Nine More Indonesians on Sulawesi Island (http://www.bloomberg.com/apps/news?pid=20601203&sid=arR6u4Gv9tRE&refer=insurance)

InTheBlack

10-20-2006, 07:56

WRT giving HiB vaccine to adults:

Sanofi says to refer to CDC guidance in the MMWR of April 9, 1993 which says to give a standard (child) dose to adults with altered immuno competency (which seems to be the only adult use envisioned). This is for their "ActHIB" vaccine (Haemophilus b Conjugate Vaccine).

***
What are the chances that pandemic control measures in the US will include large scale or local zone euthanising of pet dogs & cats?

***
My wife just got over a sinus to bronchial infection lasting 5-6 weeks. After about 10 days of being sick myself, hindsight says I must have the common cold.

How the heck are you supposed to recognize Influenza within 48 hours to utilize the Tamiflu strategy? What are the key symptoms (or absent symptoms) ? Everything I have read about Flu, Strep Throat, and Common Cold indicates that the early symptoms are variable and make differentiation a crap shoot without lab tests.

At least now I have one course & a bottle of antibiotics on the shelf.

mugwump

10-20-2006, 11:10

What are the chances that pandemic control measures in the US will include large scale or local zone euthanising of pet dogs & cats?

Not a chance in the world. And it's a good thing -- they'll be the only food available to many. Tastes like chicken.

My wife just got over a sinus to bronchial infection lasting 5-6 weeks. After about 10 days of being sick myself, hindsight says I must have the common cold.

How the heck are you supposed to recognize Influenza within 48 hours to utilize the Tamiflu strategy? What are the key symptoms (or absent symptoms) ? Everything I have read about Flu, Strep Throat, and Common Cold indicates that the early symptoms are variable and make differentiation a crap shoot without lab tests.

Fever over 99F and headache usually mean flu. Currently 30% in Indonesia get diarrhea -- not found in colds. It's a tough call, you're right. Differential Diagnosis: Cold vs. Flu (http://www.medscape.com/viewarticle/408402_6)

The Reaper

10-22-2006, 10:26

http://haaretz.com/hasen/spages/777902.html

Last update - 18:11 22/10/2006

Four people die after receiving flu vaccinations in 2 separate clinics

By Ron Reznik, Haaretz Correspondent and Haaretz Service

Four people have died after receiving flu vaccinations, it was announced Sunday. The Leumi health maintenance organization informed the Health Ministry of three victims among its subscribers, and the Meuhedet HMO announced that one of its subscribers had also died.

In response, the Health Ministry has instructed health facilities to immediately stop providing the vaccinations.

Army Radio reported that the first three victims were all vaccinated last week at the same branch in Kiryat Gat. The injections were all performed from the same vaccine pool.

Three of the victims, ages 75, 70 and 52, had been vaccinated in previous years against the flu, and none showed abnormal reactions.

An initial investigation conducted by the Health Ministry discovered that all four had suffered from various illnesses, including diabetes, high blood pressure and heart problems.

The first three people died of cardiac arrest - one of them a day after receiving the vaccination, another three days after and the last six days after. The fourth victim, a 67-year-old male from Petah Tikva, died several hours after receiving the immunization.

Ashkelon District physicians are investigating the deaths. The Health Ministry has contacted the manufacturer of the vaccine, Aventis of France, whose products are used all over the world, and requested that it perform extensive examinations of its laboratories.

It is still unclear whether there is a connection between the vaccinations and the fatalities, or the nature of such a connection if it exists.

It is also unclear whether there were complications in the administration of the vaccine, whether related to the method of injection or the vaccine itself.

mugwump

10-23-2006, 07:45

http://haaretz.com/hasen/spages/777902.html

Last update - 18:11 22/10/2006

Four people die after receiving flu vaccinations in 2 separate clinics

While there's no reason why a flu vaccine would cause cardiac deaths, I'm sure this situation is causing an all-out fire drill at Aventis. Heart patients, diabetics, etc. are often the first to be immunized and some deaths in the recently-immunized are likely. That said, I'm sure no one is taking this lightly.

This is the nighmare scenario for vaccine developers and not for financial reasons (although this type of thing can wipe out a company). I'm sure after the fire drill is over quite a few companies will be asking "Is this worth it?"

InTheBlack

10-24-2006, 08:51

http://www.cdc.gov/flu/professionals/bulletin/2006-07/bulletin3_100206.htm#12

Although overall influenza supply should be very good, CDC anticipates providers may have difficulty in obtaining sufficient vaccine to vaccinate all three-year-old children. Sanofi pasteur is the only supplier of vaccine that can be administered to these children and all of this vaccine was pre-booked in January 2006, prior to ACIP’s February 2006 recommendation to routinely vaccinate all children aged 24 to 59 months. If a provider has insufficient vaccine for this age group, CDC recommends that children 6 to 23 months of age be prioritized as they are at increased risk for hospitalization.

Pete

10-31-2006, 12:13

mugwump

10-31-2006, 13:04

I think as mugwump had REed this before.

I realy hate to try and find stories in the on line edition of the Fayetteville Observer. Anyway on page 3A of the Tuesday October 31, 2006 edition is a Randolph E. Schmid story, The Associated Press, on "Resistant strain of bird flu found."

Reports on a new strain that sidesteps the current vaccines. Infecting people as well as poultry. The new variant has become the primary version in several provinces of China and has spread to Hing Kong, Laos, Malaysia and Thailand.

Dr Perdue, WHO, says the new variant doesn't indicate any increased risk to people "other than the fact it seems to be pretty widespread."

I don't know what to make of this report -- to me it's old news. This Fujian strain has been around for quite a while; it's the one that infected some people in Thailand late this summer. When the Thai gov't said at that time (correctly) that the source of the virus was Southern China, Beijing went ballistic and demanded a retraction, which they got.

All sorts of weirdness going on, with legitimate press sources drying up in Indonesia and the iron grip on the Chinese media being tightened. And now this, with official Chinese media publishing stories about the Fujian strain coming out of China and how the Chinese poultry vaccination program apparently applied the selective pressure which brought this strain to the fore. Weird, not China's style at all.

It doesn't really change anything, there's still a fairly significant risk of a breakout this winter (4:1 against a pandemic, which is still pretty scary in my book). It could be this strain, or one of the other 3 -- or none of them (I hope).

mugwump

10-31-2006, 21:02

I asked the Smart People about this "new strain" and here's the assessment:

I was wrong (well, only partially right) about Thailand and this "new" strain. The original Fujian strain infected the folks in Thailand this summer. This "new" strain the MSM have jumped all over is the original Fujian strain (which originated in Fujian Province in Southern China) that has mutated just enough so that the poultry vaccines which the Chinese developed against it are now useless. It's the same old story with flu viruses: they mutate all the time, which is why you have to get a new flu shot each year.

This means: 1) the Chinese have pissed away great wads of money vaccinating 2 billion fowl -- don't gloat, we want them to be successful 2) new waves of mass poultry die-offs and culls are likely 3) new pockets of poultry-human infections are possible 4) it's a bad omen for the human H5-based vaccines under development (like the one I worked on).

All that aside, this virus is no more dangerous than the original strain it evolved from, and it shows no more adaptations toward easy transmission among humans.

mugwump

11-02-2006, 20:08

I've gotten a couple of PMs asking for prescription drug recommendations in case of panflu. The two folks who asked have access to a sympathetic physician.

[B]I'M NOT A DOCTOR. If you get and use this stuff without careful consideration, you are fishing for a Darwin Award. FOR EXAMPLE, PROMETHAZINE CAN KILL YOUNG CHILDREN. You must get some instruction on how and when to use this stuff, and how to modify the dosage strength for children.

The best book I've found that pulls the influenza treatment information together is The Bird Flu Manual by Grattan Woodson, MD. The book details best practices for home care of a flu patient, including the use of both non-prescription and prescription meds. He also details how to calculate doses for children, make up suppositories for those who can't take meds by mouth, etc. I recommend it highly. You can find it here (http://www.amazon.com/gp/product/1419641522/002-0043940-3843218). Woodson is a good guy and is big on fluwikie.com. Get his free pamphlet on home care here (ftp://wikimember:wiki123@singtomeohmuse.com/Good%20Home%20Treatment%20of%20Influenza%2010pt.pd f). (It's also excellent, but limited by the removal of the prescription drug section). Get the book.

The following are for ONE PERSON. The number of pills is after the '#'. Ramp it up by however many people you are planning for. The stuff with the stars is the most critical.

Prescription items:

--**Tamiflu 75mg #20 (oseltamivir, a neuraminidase inhibitor): doesn't prevent or stop the flu, but limits viral release from cells and thereby slows the infection. The current H5N1 strains are showing some Tamiflu resistance already, but it's still worth getting and using (the resistance pattern could change at any point). Comes in packs of 10 x 75 mg, which is 10 days at the daily dose. The current protocol is to double that dose, so for each person you'll need 2 packs -- note that this dosage level is twice what the packaging says. This must be taken at the first sign of infection to work effectively.

--Promethazine 25 mg # 60 tablets (Phenergan) -- for nausea, vomiting, cramping

--Hydrocodone 5 mg #60 tablets: for pain and coughing -- you'll be splitting these as 2.5 mg doses -- you need a pill splitter

--diazepam 5mg #60: for anxiety, muscle aches, insomnia

--**azithromycin 250mg 20# (twice daily for 10 days) OR **moxifloxacin 400 mg x 10# tablets (400 mgs once daily for 10 days) for community-acquired bacterial pneumonia
AND
--**augmentin 500mg #20 tablets for community-acquired bacterial pneumonia

--**Zocor 40mg #20 tablets for prevention of ARDS (acute respiratory distress syndrome AKA "cytokine storm") Your doc probably hasn't heard of this unless s/he's following things very closely. Search on "ZOCOR" in this thread -- I cite some journal articles (Ben Gurion hosp and U of Chi, I believe). Get a pill splitter from the drugstore and split your 40 in half - take half in the morning and half in the evening. If you are taking care of a sick loved one, you should also start taking the Zocor on the same schedule.

Non-Prescription items: (no stars here, get it all)

--ibuprofen 200 mg #100 tablets

--diphenhydramine 25mg #100 (Benadryl)

--Robitussin DM 12oz or generic equiv.

--acetaminophen 500mg #100 tablets

Oral Rehydration Solution (ORS)

Most who pass as a consequence of flu die from: 1) primary effects (ARDS, cytokine storm); 2) dehydration; 3) post flu bacterial pneumonia. The antibiotics may help w/ the pneumonia. Much of your nursing efforts will center on keeping the patient hydrated. I assume everyone has had the experience of having the flu, staggering to the pot after a bout of the bone-shaking chills and peeing dark, dark yellow. Well, that level of non-care will kill you if you catch this flu. Keep your patient hydrated. This is the solution you should use:

Expedient Oral Rehydration Solution (based upon WHO formula, revised 2004)

This formula is based upon the readily available "Morton Lite Salt Mixture" found in blue 11 oz. containers. The container should say "Half the Sodium of Table Salt" and the first two ingredients should be salt and potassium chloride.

Morton Lite Salt 1 tsp.
Baking Soda 1/3 tsp.
Table Sugar 2 tablespoons
Potable Water 1 Liter (= 1 Qt. + 2 tablespoons)

Chill if possible. This tastes quite salty to someone who isn't dehydrated. You can mix it with sugar-free Kool-Aid or Crystal Lite or whatever as long as it is sugar-free. Add the minimum flavoring to make it palatable. Avoid products with sugar or the artificial sweetener Splenda (sucralose) which will change the osmolality of the solution and possible worsen diarrhea. If the patient will drink it plain so much the better.

Have small children start with 1 tsp. every 5 - 10 minutes, which is usually quite well tolerated. The amount can be increased every 30 - 60 minutes (2 tsp, 3 tsp, 2 tablespoons, etc. every 5 - 10 minutes).

Adults can go on the same increasing schedule but start with a tablespoon.

If the patient is moderately to severely dehydrated (skin "tenting" is present - when pinched skin does not return to the original flat shape; compare with your own skin) and unresponsive you can still use an eye dropper to introduce small amounts of solution into the mouth - I'm talking drop-by-drop over time, not pumping whole droppers full repeatedly into the mouth. Over several hours you can administer a significant amount of solution - tedious but potentially life-saving.

x SF med

11-02-2006, 21:26

Cincinnatus

11-02-2006, 23:06

Don't know if there is something specific to flu so that taking acetaminephine and ibuprofen is contraindicated, but in both my EMT course (SOLO) and a class by Dr. Keith Brown (RESQDOC) taking them together was encouraged as they have a synergistic effect. Naproxin sodium in the place of acetaminephine was also recommended. HTH.

InTheBlack

11-02-2006, 23:58

Some people get nauseous from codeine. What about Hydrocodone?

My pharmacist said I could indeed take both Acetaminophen and Ibuprofin at the same time, and that I should since they work on different pain pathways. Along with Darvocet, for a root canal.

It puzzles me that the "standard" narcotic pain pill is combined with Acetaminophen, since the acetaminophen does not reduce inflammation.

mugwump

11-03-2006, 08:52

It puzzles me that the "standard" narcotic pain pill is combined with Acetaminophen, since the acetaminophen does not reduce inflammation.

It's an abuse disincentive; the thinking is that you can't get high without blowing out your liver from a tylenol overdose. In reality, the solubility of acetaminophen and oxycodone are so different that all the junkies use "cold water separation" to get the codeine out while leaving the Tylenol behind.

mugwump

11-03-2006, 09:08

Mug-
The only issue I have with the pharma list is in the OTCs - both Ibuprofen and Acetominophen? I thought it was contraindicated to take both within a 48 hr period due to the renal implications ( the compounding effect of the renal activators in both) - am I mistaken?

That was the message when ibuprofen went OTC in the mid-80s -- they've changed the recommendations with further research. Now it's recommended to combine the two to lower temperature and relieve aches and pains:

* ibuprofen 2-4 tablets (400-800mg) every 4 hours
plus
* acetaminophen 2 tablets (500mg) every 6 hours

The combination increases the benefits but not risk of side effects.

I can't say enough how important it is for all of us untrained folk to get the book, or at least look into home care further. For instance record keeping during care is critical. You'll be tired, scared, and maybe sick yourself. With every pill on a different administration schedule you'll screw it up without records. Make sure you have a battery powered clock.

I have to admit that the Pt will be pretty 'comfortable' with the phenergan, valium and hydrocodone ...

Gratten is very conservative with the meds in the book, and has specific circumstances/trigger points when they should be administered or avoided.

mugwump

11-03-2006, 09:14

And BTW the list is mostly Grattan's. I amended the antibiotics (now that I do know something about), added the Zocor, and swapped in a better ORS formula (Grattan's has no potassium, this one is better).

Cincinnatus

11-03-2006, 09:17

FWIW, I've found that when I've taken oxycodone w/ acetaminephine it both takes effect more quickly and seems to be just a little more effective against pain than pure oxycodone.

I've found hydrocodone and codeine to be about equally effective against pain, but hydrocodone to feel "cleaner" (i.e., I feel less sluggish, don't get as constipated, don't have a hungover feeling when the effect wears off.) YMMV

My understanding of the logic in taking acetaminephine (or naproxin sodium [Aleve]) is that the former is primarily an antiimflammatory with some analgesic effect and the latter are analgesics with some antiimflammatory effects, hence the synergistic benefit.

Ooops, cross posted with mugwump.

x SF med

11-03-2006, 09:36

Mug-
With the recent (last 18 mos) findings on the more extensive renal implications of either high or extended dose acetominophen, esp. in cases of extreme fever and dehydration (already reduced renal function) - do you see the protocol changing? Ibuprofen does have renal implications, although less severe than acetominophen, without the puritic catalysation. With the multiple levels of nephrotic compromise (puritic, dehydration, and chemical) could this protocol be ammended to a single OTC - probably ibuprofen, for the anti inflamatory, antipuritic, and analgesic properties. Yes, I know that ibuprofen has a much lower efficacy as an antipuritic, but isn't that offset by the increased anti-inflamatory properties and slightly lower renal implications? I do tend to be a little more conservative in pharma therapy - start at a lower level and work up.

Would short term low dose steroid therapy be indicated (in addition to, or in place of the NSAIDs), if access to doctors was available - or would the initial (switch-over) natural immunodeficiencies in steroid contraindicate this approach?

Slap me if I'm going too far with this, or if my assumptions are way off base.

mugwump

11-03-2006, 11:59

x_sf_med --

Sheesh, you know more about this than I do. All I know is that the panflu protocols I've seen recommend the acetaminophen/ibuprofen therapy (US, New Zealand, UK, and Woodson et al.)

Your observations may be partly behind the urgent recommendations for keeping the patient well hydrated. That, plus the elevated fluid loss from high body temperature and the fact that this flu is causing serious inflammation, with associated "leaky" capillaries.

If H5N1 breaks out and the pattern seen in Indonesia is repeated, we'll see very high body temperatures (over 105 F) with the risk of brain damage. Following the 1918 pandemic there were 1 million people who came down with a disabling Parkinson’s-like disease labeled “encephalitis lethargica.” (This was the subject of the book and Robin Williams movie Awakenings.) There is broad speculation that this disease was caused by direct viral effects from the flu or the sustained high temperatures caused by the disease. Keeping temperature below 101F is judged to be very important.

High dose prednisolone (steroid) therapy is indeed being discussed. I don't know enough about it to make a recommendation. Statins are over-the-counter in the EU and will be here as well, fairly soon. Those I have no problem recommending. Steroids are a different kettle of fish. Search on "cytokine dysregulation" and "steroids" in Google -- you'll get a lot to chew on.

The Reaper

11-03-2006, 12:12

Every physician we have had, to include pediatricians have recommended that Acetominophen and Ibuprofen be taken concurrently for maximum effect.

If you read the referenced work, Dr. Woodson recommends that approach as well and explains the logic.

TR

x SF med

11-03-2006, 12:43

Thanks TR - Woodson reccomends in peds cases starting with acetominophen, then trying ibuprofen, then the combo; and seems to suggest the same for adults, saying both taken together are well tolerated.

It seems it's a six of one, half dozen of the other approach - as long as hydration is kept up - that's his biggest point throughout.

mugwump

11-03-2006, 16:18

What's this? The WHO spank the Chinese and acknowledge the elephant in the parlor, all in the same week.

...in the new report, the WHO says if the virus becomes easily transmissible between people as a result of mutation,".. then the present high lethality could be maintained during a pandemic."

The report also raises concern about vaccine. It says, "Efforts to develop a vaccine that confers adequate protection have been greatly complicated by the emergence of ... diverse viruses..."

The report adds ".. Decisions about which vaccines to stockpile may be premature."

Infectious Disease expert Dr. Michael Osterholm says, "We have no evidence that these vaccines will protect, and on top of it, we just don't have the production capability." So even if an effective vaccine is created, it most likely can't be manufactured fast enough to be distributed to all those who would need it.

http://www.kare11.com/news/news_article.aspx?storyid=138212

Edited: Better article. (http://www.cbc.ca/cp/health/061102/x110236.html)

New Zealand, Australia, and Singapore assume in their pandemic plans a 30% fatality rate with 40% of the population showing symptoms. In the US we assume a 0.25% to 2% fatality rate (with layered responses) with 30% showing symptoms. I'm guessing that Australia's preparations for 30% CFR with a 0.25% actual CFR would be the optimal scenario.

InTheBlack

11-03-2006, 16:37

mugwump

11-03-2006, 17:15

What about using a non steroid like Albuterol to keep the lungs open?

And it might be convenient to add chemical cold packs to the emergency supplies. I forget what the chemical is, but we did it in high school chemistry class. Might be cheap to just buy from a chemical supplier.

You should really check out Fluwikie.com. There are some physicians there and albuteral, albuterol and ipratropium combo, inhaled steroids, yada yada have been discussed backwards and forwards. You can find anything over there (they'll even interpret your dreams) but the signal-to-noise ratio is getting lower and lower. Check out the Nepal thread if you don't want to sleep tonight.

It's ammonium nitrate. Don't buy in volume.

InTheBlack

11-04-2006, 03:49

I can't figure out how to do an effective search in the Wiki organizational paradigm. Results don't have dates attached.

I did find this when looking for a copy of the actual Los Alamos computer model, as opposed to articles _about_ it(Mug, why was your updated info confidential? ):

http://www.lanl.gov/news/index.php/fuseaction/home.story/story_id/9178

Los Alamos licenses avian flu modeling and simulation software
Contact: Hildi T. Kelsey, hkelsey@lanl.gov, (505) 665-8040

LOS ALAMOS, N.M., October 12, 2006 -- Company to run flu impact models for government, public, and private organizations

Santa Fe-based CIVA (The Company for Information Visualization and Analysis) signed an agreement to license Los Alamos National Laboratory's epidemiological modeling and simulation system, called EpiCast. Developed by Los Alamos scientists Tim Germann, Kai Kadau, and Catherine Macken, EpiCast was designed to help epidemiologists understand the spread and impact of an Avian Influenza (H5N1) pandemic. SNIP

I found the online report of the first Los Alamos study here, although the print version might differ:

http://www.pnas.org/cgi/reprint/103/15/5935?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=pandemic+flu&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

mugwump

11-14-2006, 16:53

Surf n Turf

11-14-2006, 21:30

I'm hearing corporate scuttlebutt that contracts for security at the Sanofi facility (http://www.sanofipasteur.com/sanofi-pasteur/front/templates/vaccinations-travel-health-vaccine-aventis-pasteur.jsp?&lang=EN&codeRubrique=13&codePage=PR_15092005) in Sweetwater, PA and the GlaxoSmithKline site in Marietta, PA have been handed out to Blackwater by DHS. I'm hearing that the $100M DHHS contract w/ Sanofi is for sufficient vaccine to cover all military personnel (4 million doses = 2 million people covered).

Does this rumor pass the smell test?

Mugwump

The Sanofi Pasteur Facility is on Discovery Drive in Swiftwater, PA.
The are doing a massive build / renovation to the facility, that includes metal (but no razor wire) fencing.
We drove by on Sunday, and all that security we could see was a “rent a cop” at the gate, and one security truck parked by the entrance building, ---- but we were not looking for extra secutity.

From outward appearances, it does not look like the place is a secure facility.
I have some friends that work there, and will check out any increase in security.
They did make an announcement on October 18, 2006 that they had a H5N1 pre-pandemic vaccine That neutralizes additional circulating H5N1 virus. See the pdf file

http://www.sanofipasteur.com/sanofi-pasteur/front/pages/vaccination-immunology-vaccines-aventis-pasteur.jsp

BTW, this is the facility that two years ago, “suddenly” discovered 200 million doses of flu vaccine in one of their freezer vaults. Their inventory was screwed up as they are switching to a new (SAP) computer system.

SnT

Edited for clarification

mugwump

11-15-2006, 07:58

Thanks, Surf n Turf. Security at big pharmas has always seemed akin to that currently at airports: intrusive/annoying and only marginally effective for folks walking in the front door; non-existent for commercial cargo and guys walking across the back 40. No offence meant to guys running airport security, I know it's better in some places and it's nearly impossible to accomplish.

I suspect that even if the rumor is true there wouldn't be any extraordinary security presence during normal times.

According to open sources, Sanofi is supposed to be through with their DHSS run -- the vaccine is in inventory.

mugwump

11-26-2006, 09:26

Just an update, there's no change in pandemic status...

Bird-to-bird (B2B) transmission has reemerged or developed in China, S. Korea, Sudan, Nigeria, Egypt and Ivory Coast (and is most likely pandemic throughout Africa at this stage).

Small human clusters (H2H transmission status unknown) have emerged in Egypt and continue to be reported in the local Indonesian media. None of these reports are breaking into the MSM, and it's debatable whether they deserve to. The bottom line on human cases: no change in status over what's been seen over the last several months. It's worrying that the latest human cases have appeared in Africa, given its high incidence of AIDS, but its not reason to batten down the hatches.

Charter House reports say that Indo is mounting a full-court press to keep BF out of the news (both carrots and sticks: payments to reporters for "cooperation" and threats/harassment for "unpatriotic reporting"). China is aggressively publicizing every report of avian or human H5N1 in Indo in an increasingly desperate attempt to de-link "H5N1" and "China" in the public consciousness. Recent open attacks on China by the WHO have rattled cages.

News which won't surprise most who follow this issue: a recent study (http://www.nytimes.com/2006/11/26/health/26flu.html?_r=1&oref=slogin) demonstrates that the two rapid tests for human H5N1 don't work and produce false negatives.

Finally, a really good journal article which summarizes the current status of H5N1: H5N1 Influenza — Continuing Evolution and Spread
Robert G. Webster, Ph.D., and Elena A. Govorkova, M.D., Ph.D. (http://content.nejm.org/cgi/content/full/355/21/2174). Highly recommended.

From the above, a map showing the spread of the existing viral sub-types. You can see why vaccine developers are worried; each color represents the need for a different vaccine. The current vaccines are for the clade that's spread into Korea/Japan.

6969

The Reaper

11-26-2006, 09:44

Good leading article from the front page of the Raleigh paper today on BF and how the state of NC is preparing.

Scary stuff. At least here in NC, the state is preparing and one in three victims would have a ventilator available. Nationwide, the number seems to be more like one in seven.

http://www.newsobserver.com/102/story/514902.html

Good secondary report also on the front page on shortages of resources and how triage works.

http://www.newsobserver.com/102/story/514895.html

THis may energize some of the locals to make some hurricane-like initial preparations. Probably not enough to get the politicians to dedicate more resources to it, especially when there are more pressing causes, like bridges to nowhere.

Well taken point made that the standard US disaster response of bringing in resouces from unaffected regions to help will not work with pandemic flu.

Mug, if you think the entire articles are worth posting, let me know so that I can cut and paste before it is taken down.

TR

mugwump

11-26-2006, 14:36

TR --

Great articles, both of them, but especially the first. Jim Nesbitt did an exceptional job. It certainly doesn't sugar-coat the issue. It's impressive that he used the projection for a 1918 pandemic when presenting ventilator requirements.

Along with the state of Washington, NC is generally considered in the top tier for preparedness. But, considering they have only prepared for a pandemic as severe as that in 1968 (the mildest in the last 200 years and not even noticed by the general population) that fact only highlights how weak most state plans are. It's probably unreasonable to try to prepare for a 1918-level pandemic; plans for 1957 intensity are probably the sweet spot.

I've heard that NC will sequester power and water workers if a pandemic hits -- which is the key to limiting collateral damage in my opinion -- but I don't know what plans have been made for their families. The fact that all of the military will most likely be vaccinated should help enormously. [The vaccine will most likely be for the 'wrong' H5N1 clade, so it won't prevent infection, but studies show it will most likely prevent death.]

The longer this holds out the better, obviously. If we make it through this winter without going up in flames then the tissue-culture production of vaccine will start coming on-line in time to hopefully protect HCWs, police and infrastructure workers.

mugwump

11-26-2006, 15:15

Man, the News & Observer is going after the flu, hammer and tongs. A good historical report of the Spanish Flu in NC: http://www.newsobserver.com/105/story/514837.html

InTheBlack

11-27-2006, 11:03

You need to wear the respirator everywhere you go. Unless you trust that the quarantine on travel will really prevent anyone who is infected from getting there.

Hospitals may stop functioning. You need to be prepared to be on your own - this thread has a lot of info on doing that.

InTheBlack

11-28-2006, 07:50

Don't get all Howard Hughes on us!

Pathogenic organisms are generally degraded by sunlight and by other microscopic organisms present in soil. When someone sneezes, the stuff dries out on whatever surface it landed on. It stays there unless mechanically agitated. Even if someone was sneezing directly into the roof air intake of a building, its unlikely that enough particles would make it to one person's lungs to infect them.

It would be interesting if Mug knows the minimum number of virus particles needed to infect a person with seasonal flu, and if any extrapolations have been made to H5N1. And how sensitive the flu virus is to environmental degradation.

Masks generally do less to prevent inhalation (esp the paper masks that really leak all over the poor 'seal' against your face) than to remind you not to put your hands on your face/eyes/nose/mouth, because your hands pick up stuff off of surfaces.

In a recognized public health emergency, society won't stand for people sneezing in public; they should be sneezing into their own mask and then go home.

mugwump

12-15-2006, 14:30

Don't get all Howard Hughes on us!

It would be interesting if Mug knows the minimum number of virus particles needed to infect a person with seasonal flu, and if any extrapolations have been made to H5N1. And how sensitive the flu virus is to environmental degradation.

Masks generally do less to prevent inhalation (esp the paper masks that really leak all over the poor 'seal' against your face) than to remind you not to put your hands on your face/eyes/nose/mouth, because your hands pick up stuff off of surfaces.

In a recognized public health emergency, society won't stand for people sneezing in public; they should be sneezing into their own mask and then go home.

Catching up...

There are disputes about flu transmission. Some say surface transmission only, some say aerosols, some say both. I'm in the "both" camp. There's enough anecdotal evidence from airline passenger infections to support aerosols spreading disease.

Minimum viral load for flu infection hasn't been established. We know very little about flu, actually. It's "just flu" after all. People are scrambling to gather this data now.

You're right about mask leakage and the "don't touch face" reminder, but N95 masks have been shown to work. Don't laugh, but there are recommendations to pull a nylon stocking section over your head/mask to snug the mask to the face and prevent peripheral air leaks, sort of like a "Haines Sheer Taupe" Ranger band. I think it works by making you so embarrassed to be seen that you stay home.

mugwump

12-15-2006, 14:50

Things are blissfully quiet on the Panflu front. Korea and Africa are hot with avian H5N1 but few to no human reports. It is assumed that avian infections continue unreported in China (Korea states their current infections are a new strain from "Mid-Western China" wherever that is.)

I was recently in Singapore and no one trusts any report coming from Indo or China, or not coming from Indo/China. Their attitude is healthy in my opinion: get ready and then forget about it -- nothing else to do.

Avian H5N1 is considered pandemic in Africa now with the odd human case in Egypt bubbling to the surface. Things were much worse last year at this time in SW Asia/N Africa.

Folks I work with are puzzled about the current lack of human cases but are obviously very pleased. That said, no one is letting their guard down.

Finally, make plans to pull home any loved ones at the first sign of trouble in the US. Federal pandemic planning leans heavily on travel restrictions and quarantine and a new study seems to back this up: The effect of travel restrictions on the spread of a moderately contagious disease (http://www.biomedcentral.com/1741-7015/4/32/abstract)

Results

We find that a ban on journeys longer than 50 km drastically reduces the speed and the geographical spread of outbreaks, even when compliance is less than 100%. The result is found to be robust for different rates of inter-municipality transmission intensities.

Conclusions

The study supports travel restrictions as an effective way to mitigate the effect of a future outbreak.

Probably the same total number of infections will occur with or without travel restrictions. So why even try? Because you flatten the curve of the rate of infections. By that I mean you decrease the number of people infected at the peak at the expense of making the infection cycle last longer. Right now people are worried about collapse of the medical systems and infrastructure as much as the disease itself (correctly). In a mild to moderate pandemic, flattening the peak might keep the grid and financial systems up.

mugwump

12-16-2006, 09:57

The Institute of Medicine/National Academy of Science released a letter report (http://www.nap.edu/catalog/11800.html) on H5N1 pandemic modeling that highlights some of the questions asked here.

Basic inputs into any pandemic model are the infectivity rate (how many catch it), the attack rate (how many who are infected get sick), the mode of infection (aerosols, surface contamination, food, etc), mean time between cases (elapsed time between on infection and the ones produced by it), and mean transmission rate (related to infectivity rate: how often will an infection be passed on).

Please note I'm going quickly here and these terms have nuanced definitions that sometimes escape me, but the gist is this: we don't know much of anything about these critical inputs when it comes to flu in general and H5N1 in particular.

"All models lie, some models are useful." So are the models useless? Well, are mortars useful? It's an apt analogy. By plugging in a range of assumptions, these guys can bracket the problem with best case and worst case. As more data come in, they correct the model and fire another round. The time lapse between corrections can be frustrating, but at least the models help clarify what we don't know (questions are sometimes more important than answers).

On first reading, some of the models support quarantine, masks, respiratory etiquette, etc. as useful in "flattening the curve", the current mantra in public health circles.

I do know for a fact that a couple of these guys have prepped for 3 months of total isolation. ("Food: check; water: check, pocket protectors: check...")

jasonglh

12-17-2006, 10:10

Interesting first person account from one of the survivors of the 1918 Flu pandemic:

Link (http://news.yahoo.com/s/ap/20061217/ap_on_he_me/pandemic_remembering1918)

The city began shutting down. The federal government staggered its hours to limit crowding on the streets and on streetcars. Commissioners overseeing the district closed schools in early October, along with playgrounds, theaters, vaudeville houses and "all places of amusement." Dances and other social gatherings were banned.

The commissioners asked clergy to cancel church services because the pandemic was threatening the "machinery of the federal government," The Washington Star newspaper reported at the time. Pastors protested.

I wonder how America would react to such restrictions in 2007?

The Reaper

12-17-2006, 12:23

Interesting first person account from one of the survivors of the 1918 Flu pandemic:

Link (http://news.yahoo.com/s/ap/20061217/ap_on_he_me/pandemic_remembering1918)

I wonder how America would react to such restrictions in 2007?

Natural selection.

Those who ignore it can die, and then traffic should be much easier for the rest of us.

TR

jasonglh

12-20-2006, 09:51

From the tail end of this article (http://news.yahoo.com/s/ap/20061219/ap_on_go_pr_wh/bush_bill_signings)

The president also signed a bill to create a new agency within the Health and Human Services Department to oversee the development of medicine and equipment to respond to a bird flu pandemic or a bioterrorism attack.

"It will increase our preparedness and response capabilities for public health emergencies by increasing our medical surge capacity, strengthening our public health infrastructure, and clarifying the responsibilities of federal officials," Sen. Edward Kennedy

A bit of what the bill does is here:

Linky (http://govhealthit.com/article97058-12-11-06-Web&RSS=yes)

I love the last bit:

The bill does not identify any likely technology candidates for the new disease outbreak network, but critics call current HHS disease surveillance systems under management of the Centers for Disease Control and Prevention a “money pit.” They say the systems lag behind CNN news reports in real-time monitoring of disease outbreaks.

Sounds like the Brits have their act together on this already. (http://govhealthit.com/article96727-11-13-06-Print) The bill gives the Department of Health and Human Services two years to build a network that would detect catastrophic disease outbreaks. I hope we have 2 years. :blink:

InTheBlack

12-20-2006, 23:15

Came across a "family pack" of N95 mask & stuff that includes goggles.

Kinda makes sense; your tear ducts allow entry to your nose...

InTheBlack

12-22-2006, 22:33

I think the article has serious flaws in its premise. Its no surprise that the rich have a lower chance of dying, from any cause. To say that overall death rates will be lower because income is higher is just wrong. The disparity between high and low income is probably greater in 2006 than it was in 1918, which means that the lower end will have relatively LESS access to scarce medical resources than in 1918.

The H5N1 pandemic might cause economic collapse by breaking the "just in time" supply chain.

Deaths occurring from the social upheaval need to be counted as well as direct infection fatalities.

Sorry I don't have the URL:
>>>
World Death Toll Of a Flu Pandemic Would Be 62 Million
Study Examined 1918-19 Outbreak

By David Brown
Washington Post Staff Writer
Friday, December 22, 2006; A03

snip

The extra deaths ranged from 0.2 percent of the population in Denmark to 7.8 percent in the Central Provinces and Berar region of India -- a 39-fold difference.
snip

If a modern Spanish flu killed all its victims in one year, it would more than double global mortality. About 59 million people now die each year.

snip

Murray and his colleagues analyzed the death patterns and deduced that about half the variation from region to region was explained by differences in per capita income. For every 10 percent increase in income, a person's risk of dying during the pandemic fell 10 percent.

Why the poor were so vulnerable is unknown. It could have been that many were already ill with parasites or other illnesses or lacked micronutrients such as Vitamin A and zinc that are essential to immunity.

To estimate the effects of a modern Spanish flu, the researchers applied the 1918-1920 death rates to the current world population broken down by income, sex and age. They came up with a range of 51 million to 81 million deaths, with a median of 62 million.

Even though the world's population is three times what it was during the Spanish flu pandemic, the estimated mortality of a modern Spanish flu isn't three times what it was in 1918. That is mainly because per capita income is higher now -- and the higher the income, the lower the risk of dying of influenza.

The illness caused by the 1918 virus was largely untreatable. There were no antiviral drugs, no mechanical ventilators to help people breathe and no antibiotics to treat bacterial pneumonias that often set in after the viral infection. All are available now and would reduce the death toll, though some interventions would be in sort supply during a pandemic.

mugwump

12-23-2006, 11:20

I think the article has serious flaws in its premise...

Well, it is what it is, a statistical analysis of death rates from three periods: 1) the three years prior to the 1918-1919 pandemic years, 2) 1918 and 1919, and 3) the three years after the pandemic. The report is good at analyzing the inputs it uses -- my problem is with the inputs and the context, the "smell test."

Let's just look what the report says. If a pandemic hit and the outcome was as predicted in the article, it would be no walk in the park. Doubling the excess death rate over two years (as the paper predicts) glosses over the fact that the excess deaths would occur in waves, with each wave producing eight time to ten times the normal death rate in a region. It might average out as a 200% increase, but a 1000% increase in each of three 4-week spans would be devastating economically and psychologically.

That most deaths would occur in the third world and southern latitudes is no surprise. We don't need statistical predictions, the history of the 1918 pandemic tells us that. At the very beginning of this thread I cited reports from India that indicate up to a 10% excess death rate -- staggering.

The smell test: The paper tries to present what might happen to the world if a "Spanish Flu" pandemic hit us now, and they come up with 51 to 81 million excess deaths. In 1918 there were 12 cities with a population of 1 million and today there are over 500. Over a billion people now live in cities and are classed by the UN as living below the poverty line. The total world population is over 3 times higher now.

So, some facts: 1) the consensus figure for excess deaths from flu in 1918-19 was 100 million deaths 2) population has tripled since then 3) the vast majority of that population growth is in the demographic group the paper cites as the most at risk: southern latitudes and living below the poverty line 4) much of this increased population lives packed together in high-density cities. Given all this, how do they predict 51M to 81M deaths?

Assuming no antivirals, primary medical care, or vaccine for the vast majority of the world's population (a safe bet) my back-of-the-envelope calculations come up with 300M deaths, assuming no change in mortality from 1918 (not a safe bet) and no massive die-off in AIDS patients (not a safe bet).

Now throw in social/infrastructure effects.

I think the best course is to just not have a pandemic.

jasonglh

12-23-2006, 12:06

In ICU we have a cross training relationship with ER so back in early Nov I spent the better part of a day working the triage desk of our ER. I would wager 50% of the patients that came in wrote flu like symptoms on the triage slip. Now non of these idiots actually had the flu but they wanted to get something to fix it none the less. I remember thinking that day that if there were a pandemic or the deadly avian flu we would need the riot police to maintain order outside the ER. Can you imagine the ignorant masses lined up outside scared to death by the media demanding the Tami flu we probably wont have? Maybe I just have little faith in the general public but I am having visions of the villagers with torches banging on the gates of Dr Frankensteins castle.

mugwump

12-23-2006, 15:08

We had a knifing at the local Best Buy over the last Playstation 3 when it was first launched. I don't know what it'll be like when they believe their lives are on the line, but it can't be good.

The Reaper

12-28-2006, 18:37

Promising, if we avoid the pandemic till it is ready.

TR

http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=425227&in_page_id=1774

The vaccine to cure every strain of flu
by FIONA MacRAE

Last updated at 22:20pm on 28th December 2006

Join the debate » British scientists are on the verge of producing a revolutionary flu vaccine that works against all major types of the disease.

Described as the 'holy grail' of flu vaccines, it would protect against all strains of influenza A - the virus behind both bird flu and the nastiest outbreaks of winter flu.

Just a couple of injections could give long-lasting immunity - unlike the current vaccine which has to be given every year.

The brainchild of scientists at Cambridge biotech firm Acambis, working with Belgian researchers, the vaccine will be tested on humans for the first time in the next few months.

A similar universal flu vaccine, being developed by Swiss vaccine firm Cytos Biotechnology, could also be tested on people in 2007 - and the vaccines on the market in around five years.

Importantly, the vaccines would also be quicker and easier to make than the traditional jabs, meaning vast quantities could be stockpiled against a global outbreak of bird flu.

Martin Bachmann, of Cytos, said: "You could really stockpile it. In the case of a pandemic, that would be a huge advantage.

"If you were to start making a traditional vaccine at the start of a pandemic, there is no way there would be enough."

The Government believes a bird flu pandemic is inevitable, killing 50,000 people in Britain alone.

However, it acknowledges that the bug could be much more lethal - infecting one in two people and claiming more than 700,000 lives.

Normal winter flu can also kill, claiming up to 12,000 lives a year in the UK.

Although a vaccine exists, constant changes in the virus's appearance have until now made it impossible to create just one flu vaccine. Instead a new vaccine is put together each year to protect against the particular strains circulating at that time.

In addition, the virus used in the jab is grown in hen's eggs - a time-consuming process that yields just one shot of vaccine per egg.

The new jabs would be grown in huge vats of bacterial 'soup', with just two pints of liquid providing 10,000 doses of vaccine.

Current flu vaccines focus on two proteins on the surface of the virus. However, these constantly mutate in a bid to fool the immune system, making it impossible for vaccine manufacturers to keep up with the creation of each new strain.

The universal vaccines focus on a different protein called M2, which has barely changed during the last 100 years.

The protein is found in all types of Influenza A, including the current bird flu and the virus that caused the 1918 Spanish flu pandemic which killed up to 50 million across the globe.

Normally, such vaccines would have to go through at least five years of human tests before going on the market. However, if a bird flu pandemic occurs before that, they could be made more quickly available.

Zurich-based Cytos, which is also developing anti-smoking and obesity vaccines, has showed that its version of the jab stops mice dying from a dose of flu strong enough to kill them four-times over.

The vaccinated animals were also spared the fever that normally goes along with flu.

Although it is too early to say what the effect would be in humans, an initial course of two or three shots could provide long-lasting immunity, topped up with booster shots given every five to ten years.

Dr Ashley Birkett, of Acambis, said: "It wouldn't be that one shot protects for life but you would need fewer doses over your lifetime."

In addition, the jabs could be produced in vast quantities and stockpiled ahead of a flu pandemic - or even given to people in advance.

In contrast, a traditionally-produced vaccine, matched to the specific strain of flu, would not be available until around six months after the start of the pandemic.

The new vaccines only protect against influenza A - the version of the bug responsible for pandemic flu and the most severe cases of winter flu.

However, it may also be possible to create a similar jab against influenza B, which causes a milder form of winter flu.

Professor John Oxford, Britain's leading flu expert, said the development of a universal vaccine was the "holy grail" of flu research.

He added: "If you get a M2 vaccine which protects against the whole caboodle in the same vaccine, the possibilities are huge."

But, others cautioned that there is no guarantee that the jabs would be as effective in humans as it has been in animals.

Virologist Professor Ian Jones, of the University of Reading, said: "It is an encouraging technique which may have a role to play but it is too soon to assume that it will translate into a universal vaccine in the human population."

Dr Jim Robertson, a vaccine expert from the government-funded National Institute for Biological Standards and Control, said the main advantage of a universal jab would be lasting immunity.

"If it works, it will be lovely," he said. "The best result would be that it would last for a long, long time."

Dr Ron Cutler, an infectious diseases expert from the University of East London, said: "Continual protection would be a tremendous advantage against flu."

He cautioned however, that there is no guarantee that the M2 protein will not mutate in the future - meaning the jab will have to be regularly reformulated.

mugwump

01-08-2007, 13:14

Things are still chugging along -- heavy avian activity and several human clusters in SE Asia and N Africa -- but still no truly alarming trends.

There's a suspected six-patient cluster of family members plus neighbors in Indonesia. The index case is the 14 year-old boy reported in the MSM. The following is Toggletexted from an local source (cite) (http://www.liputan6.com/view/3,135460.html):

Six patients are currently treated in the Friendship Hospital, Jakarta East, till Monday (8/1).

They experienced the sign of the deadly illness.

The six patients generally still have relatives's relations.

Ramli was treated three days set after being stated positive contracted bird flu.

Followed by the mother, the brother, as well as his three neighbours, this morning.They lived in the Rawabebek region, Angke, Jakarta North.

Avian H5N1 is exploding across flocks in southern Viet Nam and there are additional reports coming out of Egypt and Nigeria. South Korea has gotten close to eradicating avian flu after truly draconian culls of poultry, swine and dogs, but still no cigar.

The report we were discussing here around 20ish of December that predicted 20-100 million deaths has been pretty roundly slagged as wildly optimistic. This (http://news.yahoo.com/s/nm/20070108/ts_nm/pandemic_united_states_deaths_dc) is fairly representative:

The number of people that could die in a flu pandemic that matches the 1918-20 outbreak will be "very scary" and far higher than the 62 million deaths forecast by a recent study, an adviser to the White House said on Monday.

"I think that number is a very optimistic number if we are talking about a 1918-wide pandemic today," Rajeev Venkayya, Special Assistant for Biodefense to President Bush

There were two small clusters late in December in S Viet Nam and Egypt which are widely believed to have been falsely declared negative. NAMRU-3 is reportedly developing a new diagnostic test to detect mutated strains in Egypt.

mugwump

01-09-2007, 07:47

This is no more than was reported here yesterday, but it's interesting that the NYT appears to be Toggletext'ing local reports, or grazing through blogs and forums to get their news. [cite] (http://www.nytimes.com/2007/01/09/world/asia/09briefs-birdflu.html?_r=1&oref=slogin)

A new human cluster of avian flu cases could be emerging in a suburb of the capital, Jakarta, according to Indonesian news reports. One case of H5N1 flu, the country’s 75th, was confirmed by the Health Ministry over the weekend; it was in a 14-year-old boy who had reportedly buried a flock of backyard ducks that died suddenly. He was alive but using a respirator to breathe. A local radio station and news outlets said six other people from the same town — at least three of them related to him — were hospitalized with flu symptoms in Jakarta, being treated with Tamiflu and awaiting test results. Indonesia has failed to get its poultry epidemic under control since it emerged in 2005.

mugwump

01-12-2007, 08:09

It looks like Japan has poultry H5N1 for the first time in three years. Korea still can't stamp out its infections. Avian H5N1 has exploded across the Mekong delta in VN and the first human infection has been reported there. More than 70% of all tested chickens in China have asymptomatic H5N1 (due to shoddy vaccine use). I heard from a guy who knows a guy in Nigeria who says hundreds of flocks in southern Nigeria are having die-offs, although only one flock is officially reported. Not really news, but the take-home is that this virus is endemic throughout Asia and Africa and will never be eradicated.

On the human front there are reports of three clusters around Jakarta, with six teens admitted with severe respiratory distress and bloody sputum, but no test confirmation, today. NAMRU-3 released the sequences for the Nile delta cluster in Dec '06 and there are mutations considered "disquieting." The Qinghai isolates there appear to have "fixed" another mutation needed for the virus to go pandemic in humans (maybe, maybe not, see next paragraph) and have picked up another mutation that makes it more similar to H3 and type B influenzas, both highly transmissable in humans.

A new paper in Nature casts doubt on the whole alpha-2 / alpha-6 sialic acid receptor theory. That's the one where they say birds have receptors in their guts and humans scattered only deeply in the lungs, which is why H5N1 is poorly transmitted in humans. Turns out that's all crap, humans have oodles of receptors high in the respiratory tract (nose, throat) for H5N1 and massive quantities of viruses are shed from there in human infections. Something else is going on to prevent efficient transmission. Turns out we don't know very much about this virus at all.

The bad news from the Nature article is the implication that all aerosols, including the largest, would be infective if the final mutations are picked up. The bet 'til now was that only the tiniest aerosols could make it deep into the lung where the receptors were thought to be. It's still thought that that flu viruses are expelled most efficiently in those larger droplets you've seen in the famous "sneeze" photographs. Those droplets tend to get caught in the nose, where we now know we have many H5N1 receptors. Bad juju.

Note to self: buy more masks.

ETA the Nature cite: Tropism of avian influenza A (H5N1) in the upper and lower respiratory tract (http://www.nature.com/nm/journal/vaop/ncurrent/abs/nm1529.html)

mugwump

01-12-2007, 10:11

Niman's web site is reporting 20 suspect cases in and around Jakarta, discusses the NAMRU-3 findings in the Nile delta cluster viruses, and apparently corroborates the Nigeria avian flu explosion rumor.

http://www.recombinomics.com/News/01120701/H5N1_Jakarta_3.html

http://www.recombinomics.com/News/01120702/H5N1_Nigeria_Spread.html

Take everything (including my posts) with a grain of salt -- Niman once declared the pandemic had started in 2005 -- but he's generally ahead of the curve. He peruses the blogs and local news sources and posts useful summaries. He's a very good scientist as well -- you can tell by how many people he pisses off when he's right. ;)

mugwump

01-13-2007, 13:24

Something has changed in the situation in Indonesia.

There are currently over 30 suspect human H5N1 cases per local media reports and there have been two additional deaths since 00:00 13Jan2007 local time. Clusters of up to seven family members are reported. So far the old pattern of family clusters appear to be holding and there is no evidence of human-to-human transmission up to this point. There are reports of symptoms suggestive of cytokine storm (ARDS, profuse hemorrhaging, bloody vomitus, death) along with unusually shortened incubation period and relatively short time from initial symptoms to death.

Possible explanations for the sudden spike in cases are a large increase in poultry infections (meaning more opportunities for bird-to-human contact and B2H transmission) or a mutation in the virus that makes B2H transmission more efficient. This is pure speculation on my part, by I'd vote for the mutation. There has been no culling in Indo and no effective controls have been put in place to mitigate poultry infections, so my thinking is that every "tail of poultry" (as they call them in Indo) that can be infected, already was by the beginning of 2006.

The point of concern here is not the current number of B2H (if that's truly the mode of infection) infections per se, but the opportunity that each human infection presents for this virus to further mutate in a way to allow efficient H2H transmission. Each human case is a mixing vessel that can allow recombination with other flu types the patient might be co-infected with.

Although there is a health care worker currently suspected of having H5N1, he is part of a 7-member family cluster and is not currently suspected of having contracted the infection via H2H (although he is the index case in the cluster, apparently, so who knows). There are no reports other HCWs infected, nor of social disruption typical in ongoing pandemics (refusal to transport patients to hospital, shunning of families of patients, etc.) and the infections, as I said earlier, seem to be confined to smallish clusters among family members.

No one knows where this will lead, and it's still entirely possible that there is some species barrier in this virus that will prevent it from breaking out. That said, NAMRU-3 in Egypt has recently seen some scary mutations in human cases there, and I wouldn't rule out NAMRU-2 in Jakarta reporting something similar as well.

Given the recent simulations that suggest "sheltering-in-place" (voluntary complete quarantine) and strict travel controls could flatten the curve of infection rate, I think it would be prudent to review your plans for pulling family members home just in case. I suspect the feds might quickly impose some fairly draconian travel restrictions if things break out.

mugwump

01-14-2007, 09:52

I bring this up because yesterday I said there was no evidence of H2H in the recent Indo cases and that now appears to be wrong.

The cases discussed in the top of the linked article are now presumed to show H2H transmission.

Bird Flu Infects Indonesian Teenager, Creating New H5N1 Cluster
(http://www.bloomberg.com/apps/news?pid=20601202&sid=aypDR4isWC24&refer=healthcare)

There are two ways to determine human-to-human transmission: 1) via genetic markers, where small mutations found in the virus from the index case are also found in the virus from later cases 2) epidemiologically, a more "common-sense" approach where start of case 1, plus a reasonable incubation period, equals the start of case 2. The cases described here fall into the epidemiological pattern. Typically, the WHO don't confirm H2H until months after everyone in the chain is dead or recovered because they consider genetic markers the gold standard.

mugwump

01-14-2007, 09:55

I've all of a sudden discovered a scheduling conflict that prevents me from going to Singapore next week. ;)

mugwump

01-15-2007, 09:19

I don't know what this means -- it could be panic or not enough respirators -- but it caught my attention:

Jakarta bird flu hospital overwhelmed with patients (http://today.reuters.co.uk/news/CrisesArticle.aspx?storyId=JAK234534)

The father in the latest Indonesian cluster cam back negative (unclear whether from local or NAMRU-2). This is positive news. Up until now, clusters are in blood relatives of the mother, strongly suggesting a genetic susceptibility in some people. If the father had been pos it would have suggested a fairly serious change in the virus. So far the cluster pattern is holding.

[Note: false negatives are a serious problem, so I discount any test=negative when there are symptoms/death. I'm watching for the outcome of the father.]

mugwump

01-15-2007, 10:58

I've heard from a woman with contacts in Jakarta (Charter House, but the contact is in a health agency) and she's given me some perspective on the recent cases.

Random observations:

The human H5N1 outbreak in Indonesia is legit but does not seem out of control at this time.

The recent outbreaks are in relatively prosperous neighborhoods and the folks there are more likely to seek medical care in hospitals.

Several, but not all, of the cases being reported negative after testing are most likely positive. The press reports of negative findings are from local PCR testing (polymerase chain reaction, a type of test looking for DNA markers) and not NAMRU-2 results. So, they should be taken with a grain of salt.

This is flu season in Indonesia and there's a lot of seasonal type A/B going around, and bronchitis as well.

The level of awareness is going up as bird outbreaks in Viet Nam, Korea and Japan take some of the pressure off the Indo govt. and more local reporting is encouraged ("See, we're not the only ones!" A page out of China's book; check out Xinhua trumpeting every H5N1 case outside of China.)

So, seasonal flu + fear + publicity + legit H5N1 cases = you do the math. Who knows.

Bottom line for now: those on the ground are concerned but this latest spate of cases appears to be more of the same with a worrying increase in volume of cases.

InTheBlack

01-16-2007, 13:31

And the CDC merely summarizes WHO, who don't report anything WRT mode of transmission:

CDC Clinician Communication Updates - January 8-16, 2007

Avian Influenza – Situation in Indonesia – Update 3 - January 15
The Ministry of Health of Indonesia has confirmed the death of a 22-year-old woman from Tangerang City, Banten Province. The woman, whose infection was announced on January 12th, died later that day. The Ministry of Health has also confirmed two additional cases of human infection of H5N1 avian influenza.

<http://www.who.int/csr/don/2007_01_15/en/index.html>http://www.who.int/csr/don/2007_01_15/en/index.html

"of the 79 cases confirmed to date in Indonesia, 61 have been fatal."

mugwump

01-16-2007, 15:47

Yeah, the CDC has taken themselves out of the game -- hard to understand. Thank God for the Navy, though. The various NAMRUs are doing yeoman's work.

mugwump

01-16-2007, 16:05

I heard yesterday that three more hospitals in Jakarta were being dedicated to bird flu cases but the report came fourth-hand from my guy in Singapore (his cleaning lady's nephew is a doctor in Jakarta :) ). The following seems to corroborate the report: Indonesia is preparing more hospitals to deal with bird flu cases.
(http://www.radioaustralia.net.au/news/stories/s1828182.htm)
I don't know if these are contingency plans or are handling actual overflow cases.

crofrog

01-18-2007, 11:57

http://www.icelandreview.com/icelandreview/daily_news/?cat_id=16539&ew_0_a_id=257558

Cod enzyme kills H5N1 virus
An Icelandic cod enzyme might be the cure for bird flu, a recent experiment, which the Icelandic company Ensímtaekni hf. took part in, indicates. In five minutes, the isolated fish enzyme killed 99 percent of H5N1 viruses.

The killer enzyme, called penzim, was extracted from the intestines of cod by Ensímtaekni and is currently being developed for beauty products and various types of medicine. The experiment on the H5N1 virus was conducted in London. Fréttabladid reports.

CEO of Ensímtaekni and biochemist Jón Bragi Bjarnason said he is very excited about the results of the bird flu experiment.

“People have feared that the bird flu virus will change into a human flu virus and now we have a likely cure in case that happens,” Bjarnason told Fréttabladid.

Bjarnason also believes that penzim might prove a cure for common flu and cold, eczema in children and arthritis.

This is also my first post here, I've been following this thread with great intrest. You guys have a really good house here.

Chris

Team Sergeant

01-18-2007, 12:05

You guys have a really good house here.

Chris

Chris,

That's because our members read the rules and comply else we disembowel and feed them to the fishes.

http://www.professionalsoldiers.com/forums/showthread.php?p=38798#post38798

That was a subtle hint to "read the rules".;)

Team Sergeant

spectre919

01-18-2007, 12:42

During mass casualty exercises here in ___ state, most health care providers are often caught off-guard buy an "exercise" patient describing H5N1 symptoms; even after knowing they are participating in an Mass Prophylaxis exercise.

AAR after AAR shows the same systemic failures in Mass Prophylaxis during an epidemic; or CBRNE contamination after a terrorist event. Most of the failures are based around poor communication between response personnel and the hospital (for CBRNE); and self check-in patients (pandemic). Most of their SOP's tell them what to do once it has been identified; but nothing about maintaining day-to-day readiness and implementing safeguards to prevent initial contact contamination.

I have often wondered what the probability of success would be when they have NO prior knowledge. I don't think it would be real appealing and maybe some public education is in order.

Pete

01-18-2007, 14:16

I just knew Lutefisk was good for something other than as wallpaper glue.:D

UffffDaaa.

Pete

mugwump

01-18-2007, 17:02

I just knew Lutefisk was good for something other than as wallpaper glue.:D

UffffDaaa.

Pete

7090

The Reaper

01-18-2007, 19:06

http://www.foxnews.com/story/0,2933,244234,00.html

1918 Flu That Killed Millions Hijacked Victims' Immune Systems
Wednesday, January 17, 2007

WASHINGTON — Monkeys infected with a resurrected virus that was responsible for history's deadliest epidemic have given scientists a better idea of how the 1918 Spanish flu attacked so quickly and relentlessly: by turning victims' bodies against them.

The research, which found that an over-stimulated immune system killed even as it tried to fight the flu, helps explain why many of the 50 million people who died in the epidemic were healthy young adults. Conventional flu usually claims mostly the very young and very old.

This new look at an old killer gives doctors ideas on how to fight the current bird flu if it develops the ability to spreads from human-to-human, as many scientists fear it will.

The 1918 virus, which was reconstructed with reverse genetics, exists today only in two labs where scientists are studying it.

Scientists said they were struck by how suddenly and overwhelmingly the 1918 flu struck seven macaques that were tested in a high-level biosafety lab in Winnipeg, Manitoba.

The virus spread faster than a normal flu bug and triggered a "storm" response in the animal's immune systems.

Their bodies' defenses went haywire, not knowing when to stop, researchers said. The lungs became inflamed and filled with blood and other fluids.

The scientists believe the virus had the same effect on humans.

"Essentially people are drowned by themselves," said University of Wisconsin virology professor Yoshihiro Kawaoka, lead author of a study published Thursday in the journal Nature.

The experiment was supposed to last 21 days, but after eight days the monkeys were so sick — feverish, in pain and having difficulty breathing — that ethical guidelines forced the researchers to euthanize them.

"There was some surprise that it was that nasty," University of Washington virologist and study co-author Michael Katze said. "It was the robustness of the immune system that helped victimize them."

The virus was simply overwhelming, researchers said.

"It's a very good replicating virus and therefore it can affect more of the immune system and thereby triggers what one refers to as a cytokine storm," said Peter Palese, chairman of the microbiology department at Mount Sinai School of Medicine in New York, who wasn't part of the study but has worked on the resurrected virus before.

Cytokines transmit messages among cells in the immune system.

No other flu virus is deadly to monkeys, and the speed in its spread and the overwhelming immune system response is only similar to those in the H5N1 bird flu, Kawaoka said.

The bird flu has spread around the world intermittently, but has yet to develop the ability to transmit person-to-person. If it does, scientists believe understanding the 1918 flu may give them clues about how to protect people from it.

The new work "gives us another tool," said Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, who was not part of the research.

Fauci praised the study and said what it found in the effects on the body are stunning: "There aren't a lot of things that can induce that robust of an inflammatory response that quickly."

The 1918 flu research suggests that those fighting the bird flu in the future could try using drugs that reduce inflammation and control the body's immune response, Katze said.

In the Winnipeg research, the first-of-its-kind controlled introduction of the 1918 flu to primates, the monkeys were given extra high doses of the flu virus by nose, mouth, eye, and direct injection into the trachea to ensure infection.

The virus had been tested before on mice, but macaques provide better models of how viruses work on humans, the scientists said.

The virus was reconstructed from tissues of victims from 1918. Besides the Public Health Agency of Canada's lab in Winnipeg, it exists only at the Centers for Disease Control in Atlanta.

The fate of the monkeys was sealed within hours of their infections, Katze theorized.

In normal flu, the immune system response wanes, but in the 1918 flu "the innate response stayed up and didn't go down," Katze said. "There was an uncontrolled or aberrant response."

Adolfo Garcia-Sastre, a Mount Sinai microbiology professor who conducted some of the earlier mouse work, said it may be a mistake to focus so heavily on immune system response.

The 1918 flu virus "induces an overwhelming and probably damaging immune response system" but it is largely because the virus grows so much, he said.

In mice, when the overactive immune response was eliminated, mice died because of high viral levels.

"It's like a vicious circle — you get more viruses, you get more immune response and this results in damage," Garcia-Sastre said.

InTheBlack

01-18-2007, 21:02

Same sort of results the CDC got from their mouse experiment. I guess you can't use monkeys in the US anymore.

Maybe the Canadians can try it again and administer statins & ACE inhibitors to see if they actually do any good.

***
This cod enzyme apparently is already in a product sold by blueoceanind. Whether it would be more effective than other anti-viral hand cleansers remains to be seen. They claim the fish-derived trypsin is much more active than trypsin from mammalian sources, which has been studied for many years for various skin disorders.

Called Penzim:

"Penzim is a natural product containing the active ingredient we call penzyme,which is the digestive protease trypsin from the North Atlantic Cod...

Penzyme degrades numerous proteins associated with inflammation,pain,arthritis,psoriasis,ezema,rashes ,sores etc.

Penzyme, meaning penetrating enzyme, is absolutely new and unique in its action."

***

OK, here's the science info from the consortium of Icelandic scientists studying fish enzymes. This reads like a patent application.

http://www.zymetech.is/?id=5&tegund=z

"The present technology provides the use of cod derived trypsins or other related trypsins or serine proteinases such as chymotrypsins derived from animals, in particular aquatic animals such as fish including cod, in a variety of medical and cosmetic contexts..."

mugwump

01-18-2007, 22:20

Maybe the Canadians can try it again and administer statins & ACE inhibitors to see if they actually do any good...

It would be nice if someone did...

mugwump

01-19-2007, 08:24

Chinese press is great at reporting this stuff when it's elsewhere. And there's nothing right over the border in southern China, where this all started...Riiight.

The Thais are really good at being safe rather than sorry. They had 400 people under observation this summer and only a nadful were positive.

26 suspected human bird-flu cases detected in northern Thailand

http://english.peopledaily.com.cn/200701/19/eng20070119_342951.html

A total of 26 suspected human bird- flu cases were being closely watched in Thailand's northern province of Phitsanulok since they fell sick after contacting with dead birds, the chief public health officer of the province said Friday.

Thawatchai Kamoltham, chief Phitsanulok public health officer, said 15 of the 26 people whose symptoms are similar to those of the deadly H5N1 bird flu virus were officials taking part in culling infected fowls.

The rest were villagers from three districts of Muang, Wat Bote and Bang Rakam, Thawatchai was quoted by Thai news group The Nation as saying.

However, only three of the 26 have been admitted to hospitals while the rest were being closely monitored at their home, the report said.

Local health authorities had declared a duck farm in Tortae sub- district of Phitsanulok off-limits for two weeks as a precaution. About 600 ducks in the farm have been slaughtered. It is also reported that there are also about 30 pigs in the province which may have contracted bird flu.

pegasus

01-21-2007, 13:00

I've read this thread for some time and thought about asking a question to those that study this daily.

I have had many discussions with equine vets about the 1918 flu and some of the vets have done their own research on the possible equine connection. There are numerous times in history where one can correlate human outbreaks with equine outbreaks.

In 1918, during and post WW1, there was an influx in the consumption of horse meat.
By April 1918, civilian and military horses un Europe were affected by horse flu or strangles.

Fast forward to today. The USA exports equine for consumption to predominantly Asian countries. Horses are not bred, especially in western countries, with the intent of human consumption. There are drugs and vaccinations given to horses that are illegal for animals bred for slaughter.

Equine flu jumped species to dogs in 2003 in FL (link (http://www.sciencedaily.com/releases/2004/04/040429055247.htm).

Then there is Equine Encephalitis which can spread from birds to mosquitos to horses to humans. New epidemic in FL started in 2006 (link (http://www.thehorse.com/viewarticle.aspx?ID=6664)) (link (http://www.ncsu.edu/news/press_releases/03_08/207.htm)).

I understand the theory of bird to human, but could it be the consumption of horse meat makes this jump more possible? It has been suggested, and it is a theory with no proof that I am aware of, that the jump from horses to dogs occurred in greyhounds that were fed bad horse meat.

Just wondering.

.02

InTheBlack

01-22-2007, 16:22

http://www.who.int/csr/don/2007_01_18/en/index.html

Avian influenza - situation in Egypt - update

18 January 2007

Viruses with a genetic mutation, linked in laboratory testing to moderately reduced susceptibility to oseltamivir, have been discovered in two persons previously reported with H5N1 infections in Egypt.

snip

Current laboratory testing suggests that the level of reduced susceptibility is moderate. This mutation has previously been identified in Viet Nam in one case in 2005. Moreover, these mutations are not associated with any known change in the transmissibility of the virus between humans.
snip

mugwump

01-31-2007, 09:41

This is where things could get a bit sporty: Four suspected bird flu deaths in Nigeria (http://www.msnbc.msn.com/id/16901897/)

LAGOS, Nigeria - Four Nigerians are suspected to have died from H5N1 bird flu, but tests on three of the victims were inconclusive and the virus was confirmed scientifically in only one case, a senior health official said on Wednesday.

Abdulsalam Nasidi, a bird flu expert at the health ministry, said the three inconclusive cases were the mother of the confirmed case in Lagos, a poultry worker in northeastern Taraba state and one person in far northeastern Borno state.

It doesn't say so here, but the timing of the infection onsets in the mother-daughter deaths suggest H2H. Same pattern as Indo, clusters in family members with care-givers falling ill after close contact. Other family members are ill and are being tested. I expect the results to come back "inconclusive."

I suspect that if they could isolate a virus, it would reveal the Tamiflu resistance that NAMRU-3 reported in the Egyptian cases (and will soon report in the recent Azerbaijan death, from what I hear).

H5N1 is now firmly entrenched in poultry flocks in sub-equitorial Africa, which is also the AIDS belt. Ironically, many scientists think that the impaired immune system in AIDS patients will allow them to weather the cytokine storm. The worry is that this will make these people the perfect mixing vessel for recombination with H3 flu.

I am told there is huge and growing resentment towards WHO inside many NGOs and UN alphabets working in Africa. They feel that millions are dieing each year from diseases that can/must be controlled (measles, infant diarrhea, AIDS, malaria) and that all a county's resources tend to be thrown at BF because of the fianancial exposure by the ruling elite (they own/control the tourist sites, poultry processing, etc.). There is great pressure being exerted to mute the messages coming out of Africa. A countervailing influence is sure to be the local politicos' desire to lay their hands on some nice juicy international aid money.

The Reaper

01-31-2007, 10:02

I am told there is huge and growing resentment towards WHO inside many NGOs and UN alphabets working in Africa. They feel that millions are dieing each year from diseases that can/must be controlled (measles, infant diarrhea, AIDS, malaria) and that all a county's resources tend to be thrown at BF because of the fianancial exposure by the ruling elite (they own/control the tourist sites, poultry processing, etc.). There is great pressure being exerted to mute the messages coming out of Africa. A countervailing influence is sure to be the local politicos' desire to lay their hands on some nice juicy international aid money.

We could save millions every year, were the enviroNazis not so bend on banning pesticides.

DDT, used properly in Africa, could cut the malaria deaths by more than half.

I guess the anti-pesticide concept is worth more to them than the cost in human lives.

TR

InTheBlack

01-31-2007, 19:15

DDT is in fact being used again vs malaria in South Africa & probably other nations by now.

The Reaper

02-02-2007, 09:30

I see the NYT is finally on board.

Still reading, trying to find where they blame the POTUS for this. They did take a dig at the war in Iraq at the end.

TR

http://www.nytimes.com/2007/02/01/health/01cnd-flu.html?ei=5065&en=cdb820c97dd329e6&ex=1170997200&partner=MYWAY&pagewanted=print

February 1, 2007

U.S. Issues Guidelines in Case of Flu Pandemic

By DONALD G. McNEIL Jr.

ATLANTA, Feb. 1 — Cities should close schools for up to three months in the event of a severe flu outbreak, ball games and movies should be canceled and working hours staggered so subways and buses are less crowded, the federal government advised today in issuing new pandemic flu guidelines to states and cities.

Health officials acknowledged that such measures would hugely disrupt public life, but they argued that these measure would buy the time needed to produce vaccines and would save lives because flu viruses attack in waves lasting about two months.

“We have to be prepared for a Category 5 pandemic,” said Dr. Martin Cetron, director of global migration and quarantine for the Centers for Disease Control and Prevention, in releasing the guidelines. “It’s not easy. The only thing that’s harder is facing the consequences. That will be intolerable.”

In an innovation, the new guidelines are modeled on the five levels of hurricanes, but ranked by lethality instead of wind speed. Category 1, which assumes 90,000 Americans would die, is equivalent to a bad year for seasonal flu, Glen Nowak, a C.D.C. spokesman, said. (About 36,000 Americans die of flu in an average year.) Category 5, which assumes 1.8 million dead, is the equivalent of the 1918 Spanish flu pandemic. (That flu killed about 2 percent of those infected; the H5N1 flu now circulating in Asia has killed more than 50 percent but is not easily transmitted.)

The new guidelines also advocate having sick people and all their families even apparently healthy members stay home for 7 to 10 days.

They advise against closing state borders or airports because crucial deliveries, including food, would stop. They did not offer guidance on wearing masks, but Dr. Cetron said the C.D.C. would issue advice on this soon.

The guidelines are only advisory, since authority for measures like closing schools rests with state and city officials; but many local officials had asked for guidance, Dr. Cetron said.

The federal government has taken primary responsibility for developing and stockpiling vaccines and antiviral drugs, as well as masks and some other supplies.

Today’s guidelines are partly based on a recent study of how 44 cities fared in the 1918 epidemic conducted jointly by the C.D.C. and the University of Michigan’s medical school. Historians and epidemiologists pored over hospital records and newspaper clippings, trying to determine what factors partly spared some cities and doomed others.

While a few tiny towns escaped the epidemic entirely by cutting off all contact with outside, most cities took less drastic measures. These included isolating the sick and quarantining homes and rooming houses, closing schools, churches, bars and other gathering places, canceling parades, ball games, theaters and other public events, staggering factory hours, barring door-to-door sales, discouraging the use of public transport and encouraging the use of face masks.

The most effective measure seemed to be moving early and quickly. For example, said Dr. Howard Markel, a medical historian and one of the study’s leaders, Philadelphia, the worst-hit city, had nearly three times as many sick and dead per capita as St. Louis, which had was hit weeks later by the virus moving inland from the Eastern Seaboard and had time to react as soon as flu cases rose above averages.

“No matter how you set up the model,” Dr. Markel said, “the cities that acted earlier and with more layered protective measures fared better.”

Any pandemic is expected to move faster than a new vaccine can be produced; current experimental vaccines against H5N1 avian flu are in short supply and based on strains isolated in 2004 or 2005. Although the government is creating a $4 billion stockpile of the antiviral drug Tamiflu, it is only useful when taken within the first 48 hours, and Tamiflu-resistant flu strains have already been found in Vietnam and Egypt.

“No one’s arguing that by closing all the schools, you’re going to prevent the spread,” Dr. Markel added. “But if you can cut cases by 10 or 20 or 30 percent and it’s your family that’s spared, that’s a big deal.”

School closures can be very controversial, and picking the right moment is hard, because it must be done before cases soar.

Jeffrey Levi, executive director of the Trust for America’s Health, a health policy organization, noted that in poor city neighborhoods, 30 to 60 percent of all children get breakfasts or lunches crucial to their nutrition at school.

“What are you going to do about that?” he asked.

Dr. Markel said it might be possible to keep the cafeterias open and transport food to points where parents could pick it up, a move that would also keep cafeteria workers and bus drivers employed.

Several public health experts praised the C.D.C. guidelines, although there were some quibbles with aspects of them.

Dr. Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, said he saw no point in fretting over exactly when to close schools, because his experience in meningitis outbreaks convinced him that terrified parents would keep their children at home anyway.

“I don’t think we’ll have to pull that trigger,” he said. “The hard part is going to be unpulling it. How do the principals know when schools should open again?”

Other experts pointed out that children out of school often behave in ways that are nearly as contagious. Youngsters are sent to day care centers, and teenagers gather in malls or at each others’ houses.

“We’ll be facing the same problem, but without the teaching,” said Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health. “They might as well be in class.”

Also, he noted, many employed people cannot afford to stay at home and the financial stress from not working could increase domestic violence. And he said most states and cities lacked the money to carry out the suggested guidelines or to stage drills of them.

Dr. Cetron argued that caring for children in groups of six or fewer cut transmission risks. He also argued that parents would keep many children from gathering.

“My kids aren’t going to be going to the mall,” he said.

The historian John Barry, author of “The Great Influenza,” a history of the 1918 flu, questioned an idea underpinning the study’s conclusions. There is evidence, he said, that some cities with low sickness and death rates in 1918, including St. Louis and Cincinnati, were hit by a milder spring wave of the virus. That would have, in effect, inoculated their citizens against the more severe fall wave and might have been more important than their public health measures.

The guidelines did not suggest using the military to enforce quarantines, as President Bush said he might do when he first mentioned avian flu in 2005.

Dr. Levi said that using the National Guard to set up temporary clinics or move pharmaceutical supplies might make sense.

“But they’re not there,” he said. “The people who know how to run field hospitals are in Iraq.”

InTheBlack

02-03-2007, 05:49

What they said about the NG medical units being deployed seems to be just the truth.

Looks like the guideline document intro page is here:
http://www.pandemicflu.gov/plan/community/mitigation.html

PDF downloadable as:
http://www.pandemicflu.gov/plan/community/community_mitigation.pdf

***

Who the hell writes this stuff anyway? I love the punchline at the end.

Appendix 9 at the end are a few pages intended for distribution to individuals:

This Pandemic Influenza Community Mitigation Interim Planning Guide for Individuals and Families provides guidance describing how individuals and families might prepare for and respond to an influenza pandemic. At the onset of an influenza pandemic, public health officials will determine the severity of the pandemic and recommend actions to protect the community’s health. People who become severely ill may need to be cared for in a hospital.
However, most people with influenza will be safely cared for at home.

mugwump

02-03-2007, 09:47

Who the hell writes this stuff anyway? ...

I actually think they have moved in the right direction, but are handcuffed by the social and political environment and the realities of a serious pandemic. The reality is that most cases of flu will be treated at home if a pandemic strikes. If it's a less-virulent strain like that in 1968, most won't require hospital care. If it's a nightmare scenario, you'll have to treat at home because the medical system will have collapsed. So, saying that most cases won't require hospital care is a lie or realpolitik, depending upon your perspective.

The hurricane rating scale of pandemic categories 1-5, if it's used correctly, is also a good idea, and takes a lot of pressure off of local authorities (Katrina analogies notwithstanding). The implications of a category 4 or 5 are clear to anyone who can think for themselves (and also has a dictionary -- recrudescent: from the ancient Aramaic -- re repeating, crud crap and mud, scent an odor, i.e. recurring crap smell, or recurring shit hitting fan).

It is recommended for planning purposes that communities be prepared to maintain interventions for up to 12 weeks, especially in the case of Category 4 or Category 5 pandemics, where recrudescent epidemics may have significant impact.

It's like the pandemic guidance that's gone out to to all DoS employees and embassies: 12 weeks of food and water vs. the two weeks recommended for US citizens. If you say three months, do you hand out vouchers to public aid recipients so they can stock up? Imagine the Dems and the field day they'd have with that -- "So, the rich live and the poor die! Katrina all over again!"

jasonglh

02-03-2007, 12:36

EU confirms H5N1 bird flu virus on poultry farm in Britain (http://www.usatoday.com/news/health/2007-02-03-avianflu-britain_x.htm?csp=34)

"It's not just a national problem; people across in Holland, France, and Germany will all be rather quaking in their shoes as well," Oxford told British Broadcasting Corp. television.

I first misread that as quacking. :o

Will be interesting to see how the British handle this and hopefully our govt is paying attention to not repeat any mistakes they make.

mugwump

02-03-2007, 14:35

They've hopefully already made all their mistakes during the hoof and mouth debacle. I was in the UK often then. It was a positively medieval scene; smoke from dozens of carcass pyres as they burned thousand of sheep at one time.

I expect the'll be pretty draconian in their culls.

The Reaper

02-03-2007, 14:52

mugwump

02-03-2007, 15:18

I would have thought the same during their Mad Cow/K-J debacle, and they botched that too, as I recall.

TR

Well, there is that. :) I was living there during that time (late 80s) and ate a lot of their crappy pub grub (shepherd's pie, etc.) and their crappy beef until I discovered the wonders of Indian food. Can't donate blood as a result.

Regarding the UK situation:

The 2007 Global Risk Assessment authored by Wharton/Swiss Re/Marsh et al coins the term Infodemic, which anticipates the 24-hour news cycle's unrelenting coverage of any future disease outbreak. They discuss a future minor epidemic (1M deaths worldwide) that has profound economic and social impact because of the fear/uncertainty/doubt produced by the MSM's "information epidemic".

Google News has over 600 news items in 18 hours >

7162

This is only turkeys. Imagine if FOX/CNN show an unending video loop of a biohazard team removing bodies from a first-world house, or mass funeral pyres in Nigeria. Instantaneous, mass freakout.

InTheBlack

02-03-2007, 15:59

Is GB's poultry industry conducted indoors like ours, or are there innumerable small outdoor flocks?

And I think the USA will lag behind in any Infodemic because I don't see why the MSM would do any less censorship on the graphic details of a pandemic than they normally do for genocide & terrorist acts.

mugwump

02-03-2007, 16:25

Is GB's poultry industry conducted indoors like ours, or are there innumerable small outdoor flocks?

Indoor factories, like us. Small hobby flocks are common outdoors, but they don't take pride in mass, free-range poultry operations like the French do. (The chicken is the national symbol of the French - well, the cockerel anyway. Trés amusing, n'est-ce pas?) It'll be interesting to see if the French bring their flocks indoors.

Almost all EU operations (outside of the Phrench) are factory farms, except run to fanatical levels of cleanliness. I was at a Danish chicken operation once. (I was on a pharma industry task force, the EU was trying to get us to stop using antibiotics in our poultry feed. The fact I was extremely junior shows how interested the company was in the idea -- we made and sold antibiotics.;) )They steam sterilize the coops between brood "crops" and you had to get into a full containment suit before entering a coop. The place smelled like chickens, but not the nauseating, nostril-hair shriveling, eye-stinging ammonia stench that comes from a US operation. Kinda makes you wonder how the H5N1 got into the UK operation.

The Reaper

02-03-2007, 17:05

Kinda makes you wonder how the H5N1 got into the UK operation.

Migratory wildfowl.

TR

The Reaper

02-07-2007, 10:03

Looks like a few are taking this more seriously.

TR

http://today.reuters.com/news/articlenews.aspx?type=businessNews&storyid=2007-02-07T012416Z_01_N06268695_RTRUKOC_0_US-BIRDFLU-COMPANIES.xml&src=rss&rpc=23

U.S. companies prepare for bird flu pandemic
Tue Feb 6, 2007 8:24pm ET

By Maggie Fox, Health and Science Editor

ORLANDO, Florida (Reuters) - Exxon plans to keep some refinery workers living in the plants to keep them going. A small Southern grocery chain is thinking about drive-through pickup of soup and bread.

The U.S. Labor Department's Occupational Safety and Health Administration urged employers to develop plans to cope with a possible flu pandemic on Tuesday, suggesting letting employees work from home and encouraging sick workers to stay home without reprisals.

But a few international companies and small regional firms were already making bird flu planning a full-time job, and said on Tuesday they have had to prepare for the unthinkable.

Jay Schwartz, vice president of information systems at North Carolina-based Alex Lee Inc., is worried about what will happen when food supplies begin to get scarce as people become ill, stay home to care for children when schools close or tend to ill relatives.

"Security is a huge issue," Schwartz, whose company owns a chain of grocery stores and an institutional food supplier, told a conference in Orlando.

Big food trucks may be targeted by bandits. "Maybe we'll have someone riding shotgun for added security," Schwartz told the Business Preparedness for Pandemic Influenza summit, sponsored by the Center for Infectious Disease Research and Policy at the University of Minnesota.

Experts almost universally agree that the world is ripe for a pandemic of some infectious disease. The H5N1 avian influenza virus is considered the leading candidate to cause one.

It can sometimes infect people and has sickened at least 271, killing 166 of them, according to the latest World Health Organization count.

If the virus mutated in just the right way, it could easily begin spreading like common respiratory infections -- only with much more deadly effect. WHO predicts the outcome would be devastating.

"During a pandemic, workplaces can likely experience high absenteeism -- probably as much as 40 percent of the workforce," OSHA official Amanda Edens told reporters.

"What we are trying to find are the few who have those critical first-step plans that are going to help others," said Mike Osterholm, a University of Minnesota infectious disease expert who arranged the conference.

One big concern -- how to keep employees on the job if schools close and people begin to fear big gatherings. In a pandemic, the biggest danger may be the person next to you.

"We don't have the option of shutting facilities down. We have the obligation of providing energy," said James McEnery, deputy vice-president for human resources at Exxon Mobil Corp.

"We are going to ask some employees to come in and live in the facility," McEnery told the conference.

Food suppliers also feel an obligation, Schwartz said.

His stores may switch to products that people can stock, such as canned stew. They may arrange for drive-through pickup to avoid person-to-person contact. But this presents its own problems.

"What do you do if a guy pulls up in a pickup truck and wants to buy all the soup?" Schwartz asked.

Other companies feel well set up to make use of teleworkers.

"Everybody has got a laptop," said James Wall, global managing director of human resources for Deloitte Touche Tohmatsu. "Our plans assume that people would have to shelter in place and stay where they are."

Some companies plan to offer moral support, too.

"We employ approximately 200 chaplains of many faiths," said Ken Kimbro, a vice president at Tyson Foods Inc. "We rely very heavily upon this group in times of stress."

(With additional reporting by Will Dunham in Washington)

© Reuters 2007. All Rights Reserved

mugwump

02-10-2007, 09:13

If you're an "in for a penny, in for a pound" kind of person, and especially if you've gone to the trouble to acquire Tamiflu, amantadine and rimantadine are now recommended for co-administration.

Combination Of Drugs Should Be Stockpiled To Fight Flu Pandemic, Say Experts (http://www.sciencedaily.com/releases/2007/02/070209074203.htm)

Both are off patent and relatively cheap. I don't have a source; the feds have given the usual European sources so much heat that they are refusing to ship to the US.

InTheBlack

02-10-2007, 09:40

mugwump

02-10-2007, 10:19

The article doesn't say it increases individual patients _survival_:

>>>
In laboratory tests, the combination of ion channel and neuraminidase inhibitors reduced the emergence of resistance and even prevented the emergence of resistant strains of the highly pathogenic avian influenza H5N1 virus.
>>>

True true, but it can be assumed (I know, I know) that it will help and "herd" effects are critical in a pandemic.

Tamiflu resistance has two flavors: 1) innate, where the virus you catch is already resistant; 2) acquired, where during the process where your body produces viral copies a resistant mutant appears. It's the second flavor that this dual-drug approach appears to stop.

This is not just academic. The fatal Indonesian cases have shown evidence of patients holding their own while on high-dose Tamiflu and then going rapidly downhill when the susceptible viruses develop Tamiflu resistance during the course of the infection.

Note that this multi-drug regimen doesn't affect flavor #2, innate resistance, which NAMRU-3 in Cairo has found in viruses isolated from recent Egyptian fatalities. If you catch a resistant strain then the drugs flat out won't work.

mugwump

02-10-2007, 10:25

I would have thought the same during their Mad Cow/K-J debacle, and they botched that too, as I recall.

TR

You're right again.

BRITAIN'S food safety watchdog is urgently investigating whether meat infected with the deadly avian flu virus has entered the food chain after an outbreak of the disease on a farm run by Europe's largest poultry producer.

mugwump

02-11-2007, 09:04

From Helen Branswell, one of the best science scribes: Analysis suggests immunity to bird flu in people over age 35 (http://www.canada.com/vancouversun/news/story.html?id=197e432d-13a6-4c60-a278-1ca75bb455fb&k=75727)

Nearly 90 per cent of the people who’ve been diagnosed so far with H5N1 avian flu were under age 40, a new analysis from the World Health Organization shows.

And two British scientists suggest that as yet unexplained phenomenon could be a clue that widespread immunity to infection with this virus may exist in people aged 35 and older.

Pete

02-11-2007, 10:51

InTheBlack

02-11-2007, 11:42

InTheBlack

02-11-2007, 12:32

OK I think I found the WHO article here:
http://www.who.int/wer/2006/wer8126/en/index.html

30 June 2006, vol. 81, 26 (pp 249–260)

249 Epidemiology of WHO-confirmed human cases of avian influenza A(H5N1) infection

Which leads me to think that Branswell did not express herself very well. The WHO article notes the age differences, but does not assert anything. I guess that we will need to see if the "two British scientists" are just mouthing off or if they have some kind of data to contradict what the WHO article says about it:

"The highest proportion of cases occurred among those
aged 10–29 years. Since most of these cases occurred in
countries with a young population (for example, in 2005,
34% of the population in Egypt and 28% in Indonesia were aged <15 years), this might primarily reflect the age distribution
within the countries affected, although age-related
behaviours that increase risk of exposure are clearly
important. The increased number of cases among females
aged 10–29 years could indicate higher risk-exposure
patterns (for example, by taking part in culling, defeathering
or food preparation practices that are often
carried out by specific population groups, such as young
females). However, the incomplete nature of the data on
exposure make it difficult to infer a link between age and
exposure, and further studies are needed, especially to
assess whether younger people or other groups (such as
pregnant women) have an increased risk of contracting the
infection.
A statistical difference was found in case-fatality rates
across the age groups. These rates were highest among
those aged 10–39 years, lowest among those aged >50 years
and intermediate among children <10 years. This age profile
differs from that for seasonal influenza, where the highest
mortality rates are found among the very old age. The
differences in the age-related case-fatality distribution
among H5N1 cases are reminiscent of those observed during
previous influenza pandemics, particularly in 1918,
where case-fatality rates were higher among young adults."

InTheBlack

02-11-2007, 12:40

Here's what the two Brits have to say:
http://www.cdc.gov/eid/content/13/3/06-0849.htm

in a CDC published 'journal.'

They don't have any data different from the WHO report, they just raise the question without giving any reasons to substantiate it.

InTheBlack

02-11-2007, 13:36

CoLawman

02-11-2007, 14:24

mugwump

02-11-2007, 15:21

Is there an end game with bird flu? Does it have to morph, allowing for a vaccine before it can be dealt with. From what I have been able to understand, there is no endgame.

Isolation, quarantine, and burning the infected fowls seems to be the strategy. However, this effort seems dubious when certain countries are more interested in preventing disclosure of occurrence, rather than preventing the spread.

If there is no endgame then reason tells me that eventually it will become the pandemic we all fear.

There is no endgame; your reasoning is correct. H5N1 is endemic in birds and cannot be stamped out at this point. There are probably mammal reservoirs as well. There is strong circumstantial evidence that poultry are not the vector for many human infections. Cats are known to harbor H5N1, and the viral genetics are a closer match in some cat-human vs. poultry-human comparisons.

That said, it's possible that H5N1 will not be the strain that goes pandemic, although some strain surely will eventually. I know some very knowledgeable people who think H7 and H9 are more likely candidates. It's like living in California -- you know a quake will come eventually, but when, and how strong?

This is a wake-up call and people are responding. Vaccine technology is advancing rapidly...

mugwump

02-11-2007, 15:28

Of more interest is an article in the same issue on observation of 197 cats in a shelter who were exposed to a H5N1 infected bird in the same shelter. Only I think 2 got infected, and then when they isolated the cats, only a couple more from cat to cat transmission. But the infection was asymptomatic.

http://www.cdc.gov/eid/content/13/2/243.htm

Found another article where a lab infected cats by feeding them infected meat and they developed infections intestinally & excreted live virus.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16400021

In a recent report out of Indo, 20% of feral cats trapped around a poultry "wet market" harbored H5N1 (N=500, I=100 if I recall correctly) It led to this warning from the US embassy: U.S. warns citizens in Indonesia on threat from cats (http://today.reuters.com/news/articlenews.aspx?type=worldNews&storyid=2007-02-07T071349Z_01_JAK156138_RTRUKOC_0_US-INDONESIA-BIRDFLU-CATS.xml).

mugwump

02-11-2007, 15:36

So is this "age" effect actually a "vigorous immune system" effect? Or were people born before a certain year exposed to some immunizing factor?

I have a hard time believing its not just because x percent of the Indonesian etc population is under 40.

One very likely possibility is that old people (and if you're over 40 in many of these 3rd world countries, you're old) drop dead from respiratory disease every day. Over 100,000 a year die from resp. disease in Indo alone. Young people gasping unto death is worrying and unusual, and might warrant testing. Old Uncle Pangi gasping his last breath doesn't raise any suspicion -- it's almost expected. This is a very difficult virus to detect even when the clinical presentation raises all sorts of suspicions. What you don't look for you can't find.

mugwump

02-12-2007, 09:19

This is going to run nation wide as a priority public service announcement.

http://video.pandemicflu.gov/?&fr_story=4f1ccbd849c89f30b3abe85d940a78fc81070378&autoplay=true&skin=oneclip&rf=FRONT_PAGE

mugwump

02-12-2007, 15:26

I would have thought the same during their Mad Cow/K-J debacle, and they botched that too, as I recall.

TR

Meat from bird-flu farm ‘was sent abroad’ (http://www.timesonline.co.uk/tol/news/uk/health/article1368959.ece)

An investigation was under way last night after claims that poultry meat was exported from the Suffolk farm at the centre of the bird flu outbreak after the disease was identified.

Despite the imposition of quarantine rules, six trucks of poultry products from the farm owned by Bernard Matthews were said to have arrived in Hungary on Thursday.

Six lorryloads of turkey meat sent to Hungary last week from the Bernard Matthews plant at the centre of the avian flu outbreak were raw and may have returned the H5N1 virus to Central Europe.

The revelation immediately sparked a political and diplomatic row between London and Budapest. Miklos Suth, the Hungarian chief vet, said that he was outraged by the consignment of raw meat from an infected zone.

Poultry industry chiefs and farmers were incensed by the move and believed that it would lead to a collapse of consumer confidence in all turkey and chicken, especially as the route of the infection from Hungary to Suffolk has still not been established.

mugwump

02-15-2007, 10:42

CIDRAP has posted a summary explanation of the population dynamics studies, i.e. selective attack in those under 40. It's certainly easier to read than the original reports.

WHO cites more evidence of H5N1's bias toward young (http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/feb1407epi.html)

Roycroft201

02-28-2007, 02:47

Infected birds in Kuwait:

http://www.kuwaittimes.net/

InTheBlack

02-28-2007, 21:09

I can't find anything on the FDA site about this.

A NY Times News Service newswire report says the FDA has "endorsed" an "experimental" Sanofi-Pasteur vaccine as a stopgap.

It requires 2 doses at 12x the typical antigen level and was 45% effective out of the 91 people it was tested upon.

The Fed gov wants enough to protect 20 million health care workers.

It won't be sold to the public & is based on a 3 year old Vietnam strain.

jasonglh

03-02-2007, 15:01

While I would welcome some measure of protection I hope they can improve the performance before they expect me to go volunteering my arm.

InTheBlack

03-02-2007, 20:40

What interests me most is that if the stuff costs, say, $20 a dose then we are talking about close to a billion dollars. That's real money. I wonder what the contract will pay.

Martin

03-07-2007, 03:58

Bird Flu Buster: New Vaccine Protects against Multiple Viral Strains (http://www.sciam.com/article.cfm?chanID=sa003&articleID=29C319E4-E7F2-99DF-30ED8A0878193075)

M

mugwump

03-16-2007, 16:52

What interests me most is that if the stuff costs, say, $20 a dose then we are talking about close to a billion dollars. That's real money. I wonder what the contract will pay.

Prices I've heard bandied about run around $8 per dose, the usual for flu vaccine.

One billion is not big bucks to a pharma. A drug I worked on was sold off because it only made $450M/year, not worth the effort.

The pot o' gold is with worldwide orders, say a billion doses.

mugwump

03-16-2007, 16:54

http://www.bangkokpost.com/News/17Mar2007_news18.php

The newspaper [Asian Wall Street Journal] said that during the executive board meeting of the WHO in January, Dr Suwit, who is also special adviser to the public health minister, declared that if an influenza pandemic hit, he would advise Bangkok to hold Western tourists hostage until those countries gave Thailand the necessary vaccines.

The US government has lodged a formal protest letter and requested an apology. Dr Suwit's comments ''appear to contravene the spirit and provisions of the revised International Health Regulations'', US Health and Human Services Secretary Michael Leavitt wrote in the letter dated March 7, referring to the WHO's rules on how countries cooperate to curb the international spread of diseases. ''Voicing support for these counter-productive policies at a multilateral, intergovernmental meeting ... can impair global influenza preparedness efforts,'' the Journal quoted Mr Leavitt as saying.

mugwump

03-16-2007, 17:20

I'm losing steam on this issue, not because the risk has decreased but because I'm as ready as I can be without moving house and I'm sick of thinking about it. My development work has moved away from H5N1 vaccines (although I'm on the periphery of some interesting cytokine work) and my clients are pumping away in the political realm now more than the scientific one. Wonder why the GlaxoSmithKline vaccine (the one that's much, much better than the one we bought from Sanofi-Pasteur, costs less and uses a lower dose) is still offshore? Liability and lack of indemnification. Our tort process will be the end of us yet. They won't risk a 20 billion liability for a billion dollar payout. Can't blame 'em.

As far as the flu goes, the MSM is pretty on top of things. Egypt's the new big mess, Indo's still the old big mess, Laos, Thailand, Burma (won't use that other name), VN and China are all sporting new human cases. Sub-equatorial Africa is quiet, but is a black hole.

Subjectively, lots of chatter in the last 3 days, which is what prompted this tardy update. Means nothing, but my NGO/WHO/expert sources are all twitchy. The discussion lately is about when "it" happens (they really say "it"--it's like a cancer treatment center, where you'll never hear the 'C' word), will we see a serious breakout, high death rate in a limited geographic area (like Java, say), and then a fadeout without full global pandemic? This is the sucker-punch scenario, and what happened in France in 1917, the year before "it" went global the last time.

Well, on that happy note I'll close. Adios, y'all. Stay safe.

InTheBlack

03-18-2007, 23:49

>>>
he would advise Bangkok to hold Western tourists hostage until those countries gave Thailand the necessary vaccines.
>>>

Given the kind of tourism they are famous for, I don't see why we would want them back...

So Mug, are you still going to post a Warning Order if the situation warrants?

mugwump

03-19-2007, 07:30

So Mug, are you still going to post a Warning Order if the situation warrants?

Yeah, of course, as soon as any qualitative change occurs. But for various reasons when I travel I sometimes can't post, so don't count on me.

I suspect Wall Street will let everyone know most rikki tik.

I've been quiet on this lately because while there is a slow, steady drumbeat from SE Asia and Egypt, it's more of the same from where I sit. I don't like the fact that there are more dice being thrown in more places, but they still keep coming up snake eyes at about the same rate as before. Keep fingers crossed.

Huh, "rikki tik" is in my spell-check.

Sacamuelas

03-19-2007, 18:58

MW-

Please post whenever you discover something that elevates itself beyond the normal daily chatter in your circle. I am sure I am not the only one on this site that comes HERE to gain insight into the potential of this threat as well as to gain information on the new findings,etc. After reading your prior posts, I have gained trust in your insight on the issue over my own interpreting of the normal media reports.

Whenever you get time to post, that works for me as I am sure it takes a lot of time. Just stay with us on this issue if/when you can. :cool:
-Saca

mugwump

03-20-2007, 14:02

Well, I don't know if this changes anything, and it is just an extension of the Germann, et al, pandemic models that I referenced long ago, but...

There is growing consensus in the public health community that the spread of any pandemic with a Ro of 1.9 or greater will be nearly instantaneous (Ro = number of new cases each sick person creates, so 1.9 mean each sick person infects a little less than two others). See a recent and well-received paper that models a H5N1 pandemic starting in Viet Nam here (http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040013#toclink1). It assumes unlimited supplies of antivirals.

The paper concludes that the genie is out of the bottle at the point when only 84 Vietnamese are infected (1 out of every 1,000,000 population, it's my assumption of 84M population). At that early stage of the infection (upper map, below), they project that the disease will have spread to China, S Korea, Laos and Thailand and will have already resulted in secondary infections in those countries (so it has spread to those countries and is actively being passed on). When it gets to the point where 840 Vietnamese are infected (lower map), it will have spread to Japan, Russia, France, UK, India, etc.

Unless the Ro is extremely low (note that the assumption used in the model of 1.9 is very reasonable) and the initial outbreak occurs in a urban area with good journalists and a free, alert press (Ha!), the take home message is that by the time I hear about it and pass on my pitiful little warning:( , it will likely be in your country and maybe in your town. (It might take as little as 6 days to go from 84 to more than 840 VN cases, so 6 days from Hanoi to London and Paris and Dubai. In another 6 days it would be everywhere.)

Think of this as a tornado...that's how much warning you'll get. You will not get a chance to dig a storm cellar--what you've got on hand will be what you'll have for quite a while. Look into the recent Canadian rail strike's effect on propane supplies in the Northeastern US, or the recent study that showed 40% of British workers would stay home on the report of a pandemic or impending terrorist attack (doesn't even take into account any staying home due to illness or to nurse a family member). Assume instantaneous and widespread infrastructure disruption and panic.

7352

Edited to add: The above "tornado" warning assumes a Ro of 1.9, similar to the 1918 experience. The paper cited also looks at lower Ro scenarios that have much less dire outcomes. Plan for the worst, hope for the best.

The Reaper

03-21-2007, 09:08

This seems imprudent to me....:rolleyes:

TR

http://www.foxnews.com/printer_friendly_story/0,3566,259975,00.html

Government Wastes Millions of Flu Shots
Tuesday , March 20, 2007

Millions of doses of flu vaccine will expire at midnight June 30, unsold during this year's mild flu season and written off as trash. Still perfectly good, and possibly useful for a few more years, it will wind up being destroyed.

This annual ritual is supposed to ensure that Americans get the most up-to-date vaccine, but the leftovers -- more than 10 million of a record 110 million doses produced -- will be destroyed before a new supply is guaranteed.

An Associated Press examination of this long-standing practice raises questions about its consequences. For years, policymakers have talked about letting doctors keep unused vaccine until new doses are in hand, donating leftover supplies to poor countries, or pushing back the expiration date. Wasted vaccine means lost money for drug companies and one stopped making flu shots because of it -- setting the stage for a flu shot shortage in 2004.

Having no vaccine in the summer deprives travelers of the chance to get a shot before they visit places where flu is in season. It also prevents summer vaccinations for children, who need two doses the first time around.

"All of those issues have come up in the past," but there is a strong reluctance to change policy, said Dr. William Schaffner of Vanderbilt University, a government vaccine adviser. "These ideas clearly have merit and at the very least ought to be discussed."

The June 30 expiration date is set by the federal Food and Drug Administration and has less to do with the vaccine's shelf life than with the desire to tweak the recipe each year to include the three strains causing the most cases.

Manufacturers test throughout a flu season to ensure the vaccine stays potent, but they don't test beyond June 30 because it's assumed that new vaccine will be made, said Len Lavenda, spokesman for Sanofi-Aventis SA, which supplies most of the nation's flu shots.

However, vaccine degrades very slowly and not into anything harmful, said Dr. Peter Patriarca, a scientist who formerly worked for vaccine maker MedImmune Inc. and once headed the FDA's vaccine division. Patriarca says most vaccines would be stable for another year or two years, some as long as three or four.

The June 30 date is mostly to ensure that all old vaccine is gone before new doses come out.

"What they don't want to have happen is people inadvertently getting vaccinated with last year's vaccine," because it will not be as effective since it targets older strains, he said.

"There is some benefit to a system where unused vaccine is discarded even if it hasn't really lost that much potency," said Dr. John Treanor, a vaccine expert at the University of Rochester in New York.

Old vaccine could be a tough sell if one of the strains is not well-matched to what's expected to circulate. "You'd have to tell people next year that the vaccine they got could be inferior," said Dr. Walter Orenstein, a vaccine expert at Emory University.

One more argument for the current system: Straying from a set expiration date for an entire season's vaccine would probably cause a huge headache for those trying to manage vaccine supplies, and for manufacturers trying to calculate the following season's demand, added Dr. Carolyn Bridges of the federal Centers for Disease Control and Prevention.

But there also is risk in destroying old before new is available -- the first shipments are usually by early fall.

After the 2002-03 season, Wyeth Pharmaceuticals had to destroy a third of the 20 million doses it produced because of low sales. The company lost about $35 million and then dropped out of the flu shot business. A national shortage followed in October 2004, when Chiron Corp. lost a manufacturing license that deprived the nation of half of its flu shot supply during the height of vaccination season.

Although there are more suppliers now than then, brewing vaccine takes six months at best and remains vulnerable to the vagaries of millions of chicken eggs and a fragile production system.

Stockpiling leftover vaccine until new vaccine is available "doesn't sound like an unreasonable thing to be doing," said another vaccine scientist, Dr. Robert Belshe at St. Louis University. After all, usually only one of the three vaccine strains changes -- often, only slightly. Twice in the last decade, the recipe didn't change at all, said Alexander Klimov, a CDC flu strain expert.

And three times in the last decade, the vaccine strains recommended for the United States in one winter were identical to what was recommended for the Southern hemisphere the following summer, he said.

Also, several recent studies showed that even poorly matched vaccine can still be highly effective -- something to consider amid worries about bird flu and efforts to stockpile vaccine to protect in a pandemic.

Dr. Stuart Brown, Georgia's director of public health, suggested a second wave of flu shots every spring and availability of one season's shot into the following summer.

"That would allow us to purchase just as much vaccine as we need and maybe a little more," he said, without worrying as much about losing money and tossing vaccine if deliveries don't arrive until November or later.

Georgia got less than half of its flu shot orders by Nov. 1 last year, and expects to have thousands of doses left this spring.

Despite a big 'Flu Shots Available' banner outside his Atlanta pharmacy, Ira Katz says few customers are interested this time of year and he's left with about 40 doses. "We're not at all hurting for vaccine, that's for sure," he said.

"This past year, the demand definitely was down," said Jean Ellis of the Visiting Nurse Associations of America. Many late-season orders were canceled, and lots of vaccine remains on shelves. Doctors and VNA clinics will get a refund of taxes paid but will still lose about $10 per dose. Losses of up to $20,000 a season have caused some clinics to quit offering shots.

As long as public demand falls short of supply and manufacturers can make enough fresh vaccine, "there doesn't appear to be any reason to hang on to it," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Even better, Fauci said, would be a universal, permanent flu vaccine effective for all strains of the virus, something his office has been researching.

Peregrino

03-21-2007, 15:21

Even better, Fauci said, would be a universal, permanent flu vaccine effective for all strains of the virus, something his office has been researching.

Sounds like a conflict of interest. In fact, the entire issue sounds questionable to me. I don't think the policy passes the common sense test - why destroy the 80% solution and leave a gap (or deny protection entirely to potential recipients among disadvantaged peoples/countries) while we wait for the 85% solution that won't be available until Nov? Peregrino

Ret10Echo

03-22-2007, 04:50

[QUOTE=mugwump]Well, I don't know if this changes anything, and it is just an extension of the Germann, et al, pandemic models that I referenced long ago, but...

There is growing consensus in the public health community that the spread of any pandemic with a Ro of 1.9 or greater will be nearly instantaneous (Ro = number of new cases each sick person creates, so 1.9 mean each sick person infects a little less than two others).

the recent study that showed 40% of British workers would stay home on the report of a pandemic or impending terrorist attack (doesn't even take into account any staying home due to illness or to nurse a family member). Assume instantaneous and widespread infrastructure disruption and panic.

[.[/QUOTE

From a continuity of operations viewpoint, most of the charting and response is far too uniform. Much like the British study, I think that the delta will be tremendous. Things will go from say a phase 1 to phase 4 or 5 in one step. People will hear of an outbreak and shut down. There will not be time to come up with a solution

mugwump

03-22-2007, 09:05

...Things will go from say a phase 1 to phase 4 or 5 in one step. People will hear of an outbreak and shut down. There will not be time to come up with a solution

Agreed. I fervently hope we never find out. Imagine cable news.

I'm OCONUS for 1-2 weeks and off the air...

Dub

04-04-2007, 14:51

One thing I have not heard mentioned in this thread is the term Original Antigenic Sin. Which is one of the main reasons we cannot fight off H5N1 before it kills us.

We have immunological memory, which normally serves us well. We 'see' an antigen we have 'seen' before and direct the far majority of our antibody production at that 'remembered' antigen. This allows us to quickly kill pathogens we have been previously exposed to.

The problem with H5N1 is that almost all the population has been exposed to the common H1N1 virus. And therefore has memory B cells dedicated to the H1 and N1 molecules.

When exposed to the H5N1 virus the body recognizes the N1 molecule and cranks out antibodies against it. PROBLEM is that N1 antibodies do not effectively neutralize the virus, and it can still bind to our cells via H5.... so by the time your body changes tactics and H5 antibodies are being made at an effective level you are dead or dying.

P.S.
Does anyone have the major preparations for an avian flu pandemic, which have been suggested in this thread written down in one place? If so please post it :) or pm it to me.

The Reaper

04-04-2007, 15:06

Does anyone have the major preparations for an avian flu pandemic, which have been suggested in this thread written down in one place? If so please post it :) or pm it to me.

Dub:

I know that it seems like a lot of work to you, but since the info is all here, you could just read the entire thread.

TR

Sionnach

04-04-2007, 17:40

P.S.
Does anyone have the major preparations for an avian flu pandemic, which have been suggested in this thread written down in one place? If so please post it :) or pm it to me.

Check out TR's Be Prepared (http://professionalsoldiers.com/forums/showthread.php?t=10819) thread. It covers all sorts of SHTF scenarios, and is an excellent source of information for preparing for H51N, Acts of God, Acts of Idiots, etc.

Dub

04-04-2007, 19:35

I know, I will get to all that good stuff eventually myself, I had to try though. :D

InTheBlack

04-18-2007, 07:22

April 17, 2007

Avian Influenza Vaccine

FDA Approves First U.S. Vaccine for Humans Against the Avian Influenza Virus H5N1
The U.S. Food and Drug Administration (FDA) today announced the first approval in the United States of a vaccine for humans against the H5N1 influenza virus, commonly known as avian or bird flu. The manufacturer, sanofi pasteur Inc., will not sell the vaccine commercially. Instead, the vaccine has been purchased by the federal government for inclusion within the U.S. Strategic National Stockpile for distribution by public health officials if needed. Please go to the following FDA link for more information:

http://www.fda.gov/bbs/topics/NEWS/2007/NEW01611.html

Pete

04-18-2007, 08:51

...Avian Influenza Vaccine....

Hmm, 45% effective. But they hope it helps the other 55%.

Well, I'd take one if they offered it.

Pete

Lanyard

04-30-2007, 21:46

http://today.reuters.co.uk/news/CrisesArticle.aspx?rpc=401&storyId=N27259685

US health agency stages bird flu war game
Fri 27 Apr 2007 22:33:31 BST
By Matthew Bigg

ATLANTA, April 27 (Reuters) - A leading U.S. health agency staged a war game this week to test its response to one of the worst health emergencies it could imagine -- an outbreak of avian flu on American soil.

The exercise, which ended on Friday, was designed to simulate how the Centers for Disease Control and Prevention would marshal its resources, coordinate with other branches of government and, crucially, reassure the public while preparing it for a possible pandemic.

"If we were at the beginning of a pandemic this is exactly what it would look like," said CDC Director Julie Gerberding at a news conference early in the 48-hour drill, which involved hundreds of officials.

If things turn out wrong it could lead to a "catastrophe beyond our planning," she said.

In the script, a student infected with a new strain of H5N1 virus returns from Indonesia where a bird flu outbreak is under way. He dies but not before infecting others including members of a swimming team.

On Day One, 12 people contract the disease in four states and 25 percent die, a rate that shows the virus to be particularly lethal.

By Day Two, there are 25 cases and CDC is forced to consider whether to recommend ordering schools to close, banning flights from Indonesia or even shutting U.S. borders.

They decide against these measures but send experts to Indonesia, release a quarter of the U.S. stockpile of flu vaccines and force all international flights to land at just 10 airports to screen passengers and limit the disease's spread.

Health experts say that in real life it's just a matter of time before a global flu pandemic strikes. The 1918 pandemic killed up to 100 million people -- 650,000 in the United States -- and there have been two subsequent less-severe pandemics.

"24"

In some ways the war game resembled the hit U.S. TV show "24," with health officials battling in real time to save the United States from imminent disaster, though of course minus the violence.

Like the Counter Terrorism Unit at the heart of "24," the CDC used its Director's Emergency Operations Center, a high-tech command post at which scores of doctors and public health experts assist decision makers who in turn brief government leaders.

Behind the scenes, planners draw on a wealth of research.

In calculating whether to close the border, for example, there are hundreds of studies on the movement of pathogens, the impact of public health decisions on the economy and the potential social and political repercussions.

"What we do (in the exercise) is tailor our thoughts over the last few years to the specific scenario that is playing out. These are the facts on the ground: do our theoretical constructs hold," said Martin Cetron, CDC director of the division of global migration and quarantine.

Another consideration was whether to adopt a "containment" model, by trying to stop the virus' spread, or a "mitigation" model, by taking steps such as closing schools to lessen its impact once it can pass freely from person to person, he said.

If they overreact, it could stifle the economy and cause a host of unintended consequences. If they do too little they could fail to impede the spread of the disease.

So will the United States be safer? The exercise is part of a long-term plan involving multiple layers of government to prepare for public emergencies. The game, set up by a team of former military planners, is followed by an extensive effort to analyze mistakes.

"Doctrine number one is that we are learning, so we expect to make mistakes ... We expect to own the mistakes that we make .... We are a great agency but we are not perfect," Gerberding told a staff briefing at the outset of the drill.

But in an ominous note, the next stage of the exercise to be held over the summer will start with the assumption that the bird flu outbreak has become a full blown pandemic.

CDC Flu Drill Part 1 (FEB 2007)
http://www.washingtonpost.com/wp-dyn/content/article/2007/02/03/AR2007020301120.html

mugwump

05-10-2007, 15:10

I've been watching the pig die-off in Guangdong for the last week. http://www.msnbc.msn.com/id/18597469/site/newsweek/?from=rss The hemorrhagic nature of the disease (gushing bleeds from eyes, nose, lungs, gut) is disquieting, and reminiscent of 1918 pandemic flu in humans. This report says 300 pigs are dead but I've heard that in reality that figure may be far higher (thousands to tens of thousands), and that rivers are choked with rafts of corpses.

The Chinese are calling this porcine respiratory and reproductive syndrome (PRRS), but the symptoms don't fit. I'm hearing that WHO/OIE are sending teams and isolation gear. There are fears that this pig disease is H5N1.
In the classic flu evolution theory, the virus adapts to birds, then pigs, then humans.

Poultry H5N1 is all over equatorial Africa and major outbreaks are active in Bangladesh and India. SE Asia is still a mess.

On the human front: It was a bit interesting at times over the last month, with small clusters of deaths in Indo, Egypt and Nigeria (Nigeria is unreported by the media but I know lab guys in London who received samples from there). These followed the old pattern of infection within the immediate family. The rate of infection has markedly slowed (or at least the reports of infection) in the last week, so we may be over the winter hump. The most recent deaths in Indo and China are notable because the governments and WHO state that there was no known contact with poultry.

My take? It's still a crap shoot. If the pigs have the flu I'd probably take the day off when I heard the confirmation and top up the preps.

In other words: the sky ain't falling, but skies aren't exactly clear, either.

ETA: The China situation is notable because the Commies are reported to be strictly enforcing their draconian law that makes it illegal to report on any disease or civil disturbance. The MSNBC picture is the first I've seen on this, and contrary to the usual bullshit being report about China cooperating, they are actually stonewalling. How shocking.

InTheBlack

05-14-2007, 19:23

Department of Defense Releases Pandemic Influenza Implementation Plan - DoD News Release - May 9

The Defense Department is teaming with other federal agencies to prepare the nation to deal with a potential pandemic outbreak of influenza.

<http://www.defenselink.mil/news/newsarticle.aspx?id=45950>http://www.defenselink.mil/news/newsarticle.aspx?id=45950

Press release implies that the DoD will take the lead in "containment" of an outbreak by culling bird farms.

Questions and Answers on Pandemic Influenza Vaccine - May 9

<http://www.who.int/immunization/newsroom/PI_QAs/en/index.html>http://www.who.int/immunization/newsroom/PI_QAs/en/index.html

FDA Clears First Respirators for Use in Public Health Medical Emergencies - May 8

The U.S. Food and Drug Administration (FDA) cleared for marketing the first respirators that can help reduce the user's exposure to airborne germs during a public health medical emergency, such as an influenza pandemic. These two filtering facepiece respirators, manufactured by St. Paul, Minn.-based 3M Company (and called the 3M Respirator 8612F and 8670F), will be available to the general public without a prescription.

<http://www.fda.gov/bbs/topics/NEWS/2007/NEW01630.html>http://www.fda.gov/bbs/topics/NEWS/2007/NEW01630.html

Sounds like a marketing ploy by 3M so they can sell to goverment stockpiles by creating a fear of liability with "uncertified" P95 respirators.

"These two filtering facepiece respirators, manufactured by St. Paul, Minn.-based 3M Company (and called the 3M Respirator 8612F and 8670F), will be available to the general public without a prescription.

The devices are also certified as N95 filtering facepiece respirators by the National Institute for Occupational Safety and Health (NIOSH).
snip
FDA is requiring those who want to market respirators for use during public health medical emergencies to assure that they are certified by NIOSH to provide adequate filtration without hampering people's ability to breathe. In addition, companies must conduct fit assessment testing, conduct biocompatibility testing to reduce the chance for allergic skin reaction, and provide instructions that will enable wearers to achieve a protective fit and use the devices properly.

3M evaluated fit characteristics...While individual results varied, all participants tested achieved some reduction in exposure to airborne test particles.
snip
FDA will soon issue a guidance document outlining its regulatory approach to this new type of device.

mugwump

05-26-2007, 16:16

As the world watches H5N1 and waits, H7N2 sneaks in a sucker punch: More people showing signs of illness from mild strain of bird flu, British authorities say
(http://www.iht.com/articles/ap/2007/05/26/europe/EU-GEN-Britain-Bird-Flu.php)

As I believe I mentioned near the beginning of this thread, I have a colleague who always considered H7 and H9 variants more likely candidates for the next pandemic. He now worries about a recombinant that merges H7's infectivity in humans and H5's breathtaking mortality rate. Given Britain's demonstration of piss poor biosecurity with the recent H5N1 poultry outbreak, I hope they can keep their flocks from simultaneous infection with H5N1 and H7N2. Bad juju.

Not that H7 is a day at the beach. It is quite efficiently transmitted H2H (lots of conjunctivitis -- interesting) and in its most recent outbreak had a case fatality rate of over 1%, which is a pretty nasty number even if it's obviously better than H5's 50-65%.

On the H5N1 front, new human deaths in Indo, the first in Viet Nam since 2005, a new death in China, Bangladesh is a seething mess on the poultry front, and Sub-Saharan Africa continues to smoulder. Same old, same old.

mugwump

05-26-2007, 16:27

Sorry, rushed the last and forgot to add this: China reports bird flu infection in military (http://www.hindustantimes.com/StoryPage/StoryPage.aspx?id=81748ded-f52f-4d2d-8b95-de442b5dfb2e&MatchID1=4465&TeamID1=10&TeamID2=6&MatchType1=1&SeriesID1=1109&MatchID2=4467&TeamID3=2&TeamID4=4&MatchType2=1&SeriesID2=1110&PrimaryID=4465&Headline=China+reports+bird+flu+infection+in+milit ary)

H5N1 in a barracks environment is not the best of things.

China's Health Ministry on Saturday confirmed a case of H5N1 infection known as bird flu in a 19-year-old soldier.

The ministry identified the man by his surname, Cheng, and said he was under treatment at a People's Liberation Army hospital.

But it did not specify his unit or say which region he came from, maintaining the government's customary secrecy for military affairs.

Cheng developed symptoms of fever, coughing and pneumonia on May 9 and was admitted to hospital on May 14, the ministry said.

Tests on May 18 suggested that he was infected with H5N1 bird flu, and national government and military health officials confirmed the results Wednesday.

The health ministry had reported the case to the World Health Organization and regional health authorities, it said.

The new case brings the total number of human infections with bird flu reported in China to 25 since 2003 of which 15 were fatal.

Experts have long warned that the virus might be more widespread in China, where dozens of outbreaks of H5N1 have been reported in poultry, the most recent one last weekend in the central province of Hunan.
H5N1 bird flu had infected 307 people, including 186 who died, in 12 mainly Asian and African nations by May 24, according to WHO statistics.

.

mugwump

06-06-2007, 06:11

I don't know anything about this other than what I read. It does appear that human infections are reappearing during a normally slow time of the year. I've stopped counting in Indo but there have been several deaths since the last update, Viet Nam has two official human infections (first since 2005 and up to eight more unconfirmed but judged "probable/likely"), the soldier in China who recently died was another case where there was no hx of poultry contact.

I'm wondering what the politics of this announcement are? More $$$ being sought to funnel to numbered accounts in Switzerland?

Indonesia worries over latest bird flu virus samples (http://africa.reuters.com/commodities/news/usnJAK214520.html?rpc=401&)

JAKARTA, June 6 (Reuters) - The H5N1 bird flu virus in Indonesia may have undergone a mutation that allows it to jump more easily from poultry to humans, the head of the country's commission on bird flu control said on Wednesday.

Indonesia has recorded 79 human deaths from bird flu, the highest in the world, and the country has been struggling to contain the disease because millions of backyard chickens live in close proximity to humans across the archipelago.

"In the past it took exposure of high intensity and density to the virus to get infected. There are now suspicions, early indications that this has become easier," Bayu Krisnamurthi told reporters....

<snip>

Virus samples from poultry cases have increasingly shown a similarity in their amino acid structure to virus samples extracted from humans," Wayan Teguh Wibawan told Reuters.

"This makes it easier for the virus to attach to human receptors," he said, referring to receptor cells lining the human throat and lungs.

mugwump

06-06-2007, 06:19

There's an explanation here (http://scienceblogs.com/effectmeasure/2007/06/not_all_in_our_genes_the_seque.php#more) of a recent Hah-vud paper looking at the question of whether a genetic predisposition to H5N1 lies behind family clusters.

Short answer: not necessarily. The distribution in clusters is just as likely down to chance and not blood.

Edited to add: Little Evidence for Genetic Susceptibility to Influenza A (H5N1) from Family Clustering Data (http://www.cdc.gov/eid/content/13/7/pdfs/06-1538.pdf)

The Reaper

07-18-2007, 09:28

Back in the news.

TR

http://www.nytimes.com/2007/07/18/health/18flu.html?ei=5065&en=12c28f28e37ca54e&ex=1185422400&partner=MYWAY&pagewanted=print

NYT

July 18, 2007
Limited Capacity Is Seen in Flu Defenses
By GARDINER HARRIS

WASHINGTON, July 17 — More than a year after President Bush unveiled a plan for coping with a pandemic flu outbreak, the federal government still has limited capacity to detect a disease outbreak and track its progress across the country.

The government has also decided that it will not close the borders if a pandemic flu outbreak occurs somewhere in the world.

“The reality is that there are tremendous challenges to sealing our borders to begin with,” said Dr. Rajeev Venkayya, special assistant to the president for biodefense. “Secondly, we believe that if a pandemic virus emerges anywhere in the globe, it is inevitable that it will arrive here in the U.S. irrespective of the actions we take at the borders.”

The government will try to limit the number of arriving people who might be infected with the virus and detain those suspected of harboring the virus, Dr. Venkayya said. But it will also try to allow the flow of goods and people across the border to continue, he said.

In the coming weeks, officials will release the government’s priority list detailing who will get the first lots of flu vaccines in the event of an outbreak. Plans to coordinate with state and local governments about when to close schools are also still in the works, they said.

These updates were delivered Tuesday in a White House briefing on the government’s progress in preparing the nation for an outbreak of a deadly infectious disease. Top officials emphasized that significant planning and investment decisions had already been made, including a $1 billion investment in finding new ways to manufacture flu vaccines.

But, Dr. Venkayya said, “there is much work that remains to be done.”

Also Tuesday, the Department of Health and Human Services announced that it had released $897 million to states for emergency preparedness efforts. The money includes $175 million for pandemic flu preparedness.

A nationwide surveillance system to track the progress of an outbreak as it moves around the world and across the country still needs considerable work, officials said.

“Just to be brutally honest, we have a lot of trouble determining when we have an outbreak of disease in a community here in the U.S.,” Dr. Venkayya said. “We need to have uniform biosurveillance capability to prepare not only for a pandemic, but any outbreak of infectious disease.”

The nation also has little extra capacity in its hospitals and other health care facilities to deal with a huge surge in need that would accompany a mass disease outbreak, Dr. Venkayya said. And the government has little ability to ensure that during an outbreak, when many workers would stay home, limited Internet capacity would go to essential work and not to children playing video games, officials said.

Eighty-six percent of the tasks that were to be completed this year under the president’s flu plan have been finished, officials said. The remaining 14 percent of those should be done by the end of the year, Dr. Venkayya said.

A significant remaining challenge, officials said, is that the country has grown tired of pandemic flu warnings. They emphasized that the planning would help prepare for any disease outbreak, whether from natural causes or a terrorist attack.

Jeff Levi, executive director of Trust for America’s Health, a nonprofit organization dedicated to disease prevention, praised the administration’s flu preparations.

“This report demonstrates that the federal government has made major strides in preparedness for a pandemic,” Mr. Levi said. “But as the administration also recognizes, there is still a long way to go before all levels of government and all sectors of society are fully prepared.”

82ndtrooper

07-18-2007, 09:35

Here, the greater Cincy Area, the networks have been airing an "Dooms Day" scenario type commercial.

This seems to be resurfacing just after Chirtoff has been giving warnings against a more strengthy AQ.

Ret10Echo

08-07-2007, 08:10

BERLIN (AFP) - More wild birds have been found dead of the H5N1 bird flu virus in Germany, where domestic poultry were infected last month, authorities in Bavaria said Saturday.

Police in the southern state said restrictions on movement had been put in place around the Speichersee lake, east of Munich, after two out of three ducks found dead there were confirmed to have been carrying the virus.

Press reports said around 14 other birds had also been found dead in the area, but it was not known if they were infected with the virus, which is potentially deadly to humans.

More than 150 wild birds have died of H5N1 in southern and eastern Germany in the past few weeks, and a month ago the disease spread to a smallholding in the eastern state of Thueringen.

http://news.yahoo.com/s/afp/20070804/hl_afp/healthflugermany_070804173337;_ylt=Am.AJ1Rl0_izk2L peHj9XEyJOrgF

mugwump

09-02-2007, 17:54

The chair is NOT against the wall. I am NOT saying that the following represents a panflu event. Nobody knows at this stage.

For a look at what I suspect the first reports of pandemic flu will look like, see the following report and note the poultry/pig/human infection chain, medical staff dieing, the hemorrhagic nature of the disease, and the H2H spread:

Mystery DR Congo fever kills 100 (http://news.bbc.co.uk/1/hi/world/africa/6973013.stm)

I haven't updated this thread in a long while, so here goes (this will be rushed):

- Poultry infections are once again entrenched in Viet Nam, Laos, Bangladesh, and India with little sign of improvement. Note that Viet Nam was WHO's "shining example" of a country that stamped out H5N1. (They're kinda buggered now that their home-grown chicken vaccine has apparently failed.) H5N1 is endemic in the Caucasus and Africa.

- Western Europe has had major poultry outbreaks and has culled hundreds of Ks, mostly in Germany. The disease appears endemic in the wild bird population there. Last winter's statements that no H5N1 was found in birds migrating through Europe are now thought to be in error, with poor detection the culprit. (All duck flocks carry flu, just like all human flocks carry the common cold. If you don't find benign flu in ducks when you are looking for H5N1, you are doing something wrong).

- On the human front, there are five confirmed cases in Viet Nam since late June (four died) and continuing singleton and cluster infections in Indonesia. Recent news reports focus on Bali, where several small clusters of cases have occurred (and are occurring now). As with the 2006 clusters, the initial cases usually die before diagnosis. The case fatality rate is not dropping from 65% fatalities. Africa is a black hole.

- All the usual characters are playing their parts: China and Indo continue to waffle, lie and obfuscate (how is it there is avian flu all along the Viet Nam-China and Laos-China borders and none in China?), Viet Nam is acting in a stand-up fashion, Africa is a basket case, etc.

- On the vaccine front, good stuff has and is happening. We're still a full year away from initial manufacture of a broad-spectrum vaccine even with a crash program, but at least progress is being made. The Glaxo vaccine was tested with a new adjuvant (immune booster) and even very tiny doses were providing evidence of protection. Supplies of antigen could be greatly stretched. Anyone figured out how to administer it? (The old chestnut about amateurs/pros and tactics/logistics comes to mind)

- Some guys at St. Jude came out with a genetic analysis comparing flu which passes easily from H2H (seasonal flu) and H5N1. They assert that up to 10 more mutations are needed before it passes easily H2H and they doubt it will break out. It's being widely discussed with the brilliant/bullshit ratio even-steven at 50:50. I'll let you know when a consensus develops...it's over my head so I have no opinion.

- A recent international conference in the UK came up with a 5-20% chance of pandemic in the next year. When physicians only were polled, they came up with 3% chance ( these are the straight odds using the historical 3 pandemics every 100 years). Others (the 5-20 per-centers) argue the 3% should be upped in light of existing crappy conditions.

clapdoc

09-02-2007, 21:10

I am very impressed by the detailed data that is shown on this thread. Bird Flu will be a disaster if we get it in the U.S.
We live in the 2nd leading state that raises commercial poultry for consumption.
I can tell you that the poultry companies and state health department take bird flu very seriously and have a plan in place to handle the infection.
If bird flu is discovered, all poultry within a 70 mile radius from the infected site will be destroyed and the chicken houses sprayed with a very strong disinfectant.
What the officials are worried about are the sparrows and pigeons that inhabit feed mills and chicken houses.
We need to do everything possible to keep this disease from reaching our shores.

Clapdoc sends,

mugwump

09-02-2007, 23:18

...What the officials are worried about are the sparrows and pigeons that inhabit feed mills and chicken houses.
We need to do everything possible to keep this disease from reaching our shores....

Yes, the economic consequences are disastrous. This fact drives many public health decisions made about bird flu. Many more Indian, Bangladeshi, and Malaysian farmers have committed suicide after being financially ruined than have died from contracting the disease.

That said, if it mutates for efficient human transmission, those financial damages will appear inconsequential.

I am quite surprised that we haven't seen H5N1 in the States, yet. Current theory states that there should be merged African/European/Asian/North American flocks in Alaska and Siberia, with disease moving down the Atlantic, Mississippi, Central and Pacific flyways.

Lanyard

09-25-2007, 08:51

Chickungunya, a non-lethal disease found primarily in the tropics, has been discovered in Ravenna Province, Italy. The vector is the dreaded Tiger mosquito (which many of you southerners may know of, http://www.cdc.gov/ncidod/dvbid/arbor/albopic_new.htm ) While the Tiger mosquito has been in Italy for at least 10 years they were not concerned because there were no signs of any associated pathogens (Univ of Bologna.) However, this past summer has proved otherwise. While Chikungunya is usually a mild and self limiting disease, the Tiger mosquito is also a known vector for Dengue & Yellow Fever as well as encephalitis. The Bologna Chamber of Commerce is concerned about the possible ramifications on the next tourist season in the Riviera if the mosquitos survive through the winter. ( DW-World.de)

http://sciencenow.sciencemag.org/cgi/content/full/2007/907/1

Italian Virus Outbreak May Portend Global Spread

By Martin Enserink
ScienceNOW Daily News
7 September 2007

Another pathogen has jumped its traditional boundaries to begin what some fear is a march around the globe. This time the invader is a virus that causes chikungunya, a crippling and painful disease until now found only in the tropics. This summer, it sickened more than 160 people in and around two small villages in Italy. Chikungunya is transmitted by the Asian tiger mosquito (Aedes albopictus), a species that is taking the world by storm, and medical entomologists worry that the disease has the potential to follow the insect.
Chikungunya is rarely fatal but can cause severe fevers, headaches, fatigue, nausea, and muscle and joint pains. People started falling sick in Castiglione di Cervia and Castiglione di Ravenna--two small villages separated by a river in the province of Ravenna--in early July, says Antonio Cassone of the Istituto Superiore di Sanità (ISS), a national government lab in Rome. But because symptoms overlap with those of other diseases, such as the Toscana virus, it took a long time to get noticed, he says. Samples reached ISS on 27 August, and the virus was identified the next day.

Epidemiological detective work suggests that the index patient was a man who traveled to one of the villages and fell sick there, after having been infected in India. Isolation and sequencing of the virus is under way to confirm that theory, Cassone says. One patient, an 83-year-old man with severe previous medical problems, has died; more than 30 cases are still awaiting lab confirmation.

Chikungunya caused a massive outbreak at La Réunion, a French island in the Indian Ocean, as well as several nearby islands, in 2005 and 2006. (ScienceNOW, 17 February 2006). India, too, has been hit very hard in recent years. Several European countries had seen "imported" cases of chikungunya lately--that is, people who were infected elsewhere. But local transmission in Europe has never been observed before. "It's fascinating," says entomologist Paul Reiter of the Pasteur Institute in Paris, France.

It's too early to tell whether the virus now has a permanent foothold in Europe. New cases have slowed down to a trickle, says Cassone, in part because the mosquito population is dwindling. But the critical question is whether infected mosquitoes can survive the winter or pass on the virus to their offspring via their eggs, says Reiter. "If they can, we might see a rip-roaring epidemic next year," he says.

There are neither drugs nor vaccines against chikungunya, but the outbreak at La Réunion has triggered renewed interest in an old vaccine candidate developed in the 1980s by a U.S. Army lab in Fort Detrick, Maryland, that was later shelved. Scientists at three French government institutions are currently working on that vaccine, and new clinical trials might begin before the end of 2008, says epidemiologist Antoine Flahault, who chaired a French task force on chikungunya last year.

Related sites

Report about the outbreak in Eurosurveillance
http://www.eurosurveillance.org/ew/2007/070906.asp#1

Chikungunya Fact Sheet
http://www.ecdc.eu.int/Health_topics/Chikungunya_Fever/Disease_facts.html

Map showing Aedes albopictus distribution in the United States
http://www.cdc.gov/ncidod/dvbid/arbor/albopic_97_sm.htm

mugwump

09-25-2007, 15:40

Chickungunya, a non-lethal disease found primarily in the tropics...

While Chikungunya is usually a mild and self limiting disease...

Chik has mutated into a more serious disease in the last year. There were hundreds of official fatalities in India in 2006-2007, and unofficially several thousand. Things were getting panicky there for a while.

Pete

09-25-2007, 15:52

Caught a fleeting story about pig problems in China. Something about large die offs/deaths and China saying "Nothing to see, move along."

Some swine problems out there perking?

mugwump

09-25-2007, 16:54

It is "blue-ear pig", a nasty hemorrhagic viral disease that leads to circulatory collapse and therefore bluish tinge to tongue and ears. First reported in Nebraska(?) in the 1980's I think. It's about 100% fatal in pigs. It has spread from China into Vietnam and Myanmar, and two Vietnamese farmers were reported today to have died from it. The Vietnamese and Burmese are mightily pissed at China.

People are a bit surprised that it jumped into humans.

Last I read, China 'fessed up to a few thousand pig deaths. There were unofficial reports earlier in the year of rafts of pig corpses floating down major rivers in south China. Hundreds of thousands of dead porkers were speculated. Right around that time, new teeth were put into old laws that forbid reporting of disease outbreaks.

mugwump

09-25-2007, 17:08

Those massive poultry culls and millions of pigs dead from blue-ear are a huge economic burden...

"In any other country, a shortage of pigs might be brushed off as a temporary phenomenon, cured by another turn in the perennial “hog cycle” as rising prices prompt higher meat production.

But in China, where pork is the staple meat and food counts for a large part of the household budget, the shortage – and its feared spillover to other parts of the economy – is being treated as something approaching a national emergency.

The spectre of inflation fomenting broader discontent – as it did two decades ago, culminating in the Tiananmen Square protests of 1989 – taps into the deepest existential fears of Chinese rulers about mass disorder and regime survival. In recent weeks, protests by students angry at higher prices and smaller food servings in their canteens have been reported in Anhui and Guangdong provinces. Even in affluent urban centres, including Beijing and Shanghai, the food price rises are causing resentment..."

Piggy bank raid: Beijing acts to quell inflation (http://http://www.ft.com/cms/s/0/e094f842-6b97-11dc-863b-0000779fd2ac.html)

clapdoc

09-25-2007, 17:30

We need to watch the conditions closely in China concerning the amount of calories available for daily intake by the population.
I remember being taught in 91b school that if intake dropped below 1000 calories per day in a society, then anarchy and uprising would start to occur.
We don't need xxx number of Chinese on the march for food.

Clapdoc sends.

mugwump

10-05-2007, 06:52

Bird flu virus mutating into human-unfriendly form (http://news.yahoo.com/s/nm/20071005/wl_nm/birdflu_mutations_dc)

Unstated in the article, but these strains also have moderate-to-near-complete Tamiflu resistance.

NEW YORK (Reuters) - The H5N1 bird flu virus has mutated to infect people more easily, although it still has not transformed into a pandemic strain, researchers said on Thursday.

The changes are worrying, said Dr. Yoshihiro Kawaoka of the University of Wisconsin-Madison.

"We have identified a specific change that could make bird flu grow in the upper respiratory tract of humans," said Kawaoka, who led the study.

"The viruses that are circulating in Africa and Europe are the ones closest to becoming a human virus," Kawaoka said.

Recent samples of virus taken from birds in Africa and Europe all carry the mutation, Kawaoka and colleagues report in the Public Library of Science journal PLoS Pathogens.

"I don't like to scare the public, because they cannot do very much. But at the same time it is important to the scientific community to understand what is happening," Kawaoka said in a telephone interview.

I don't know if there's a line in Vegas, but among the wonks I know the bet for a breakout this coming winter seems to range from 1:20 to 1:4. Big range, I know.

There's disagreement about the European/African clades being closest to a breakout. The Indo H5N1 strains circulating in pigs have picked up several key mutations as well.

InTheBlack

10-09-2007, 14:37

3 doses of this inhaled worked; SubQ didn't work. Mug, can you explain if this vaccine is still available? They also mention an adjuvent being used. This abstract doesn't specify the time between doses.

The time lag between the data and publication is very disturbing -- they did this LAST YEAR!

Cross-protection against H5N1 influenza virus infection is afforded by intranasal inoculation with seasonal trivalent inactivated influenza vaccine - Oct 5
Journal of Infectious Diseases -
<http://www.journals.uchicago.edu/JID/journal/issues/v196n9/38072/brief/38072.abstract.html>http://www.journals.uchicago.edu/JID/journal/issues/v196n9/38072/brief/38072.abstract.html

Methods. BALB/c mice were inoculated 3 times, either intranasally or subcutaneously, with the trivalent inactivated influenza vaccine licensed in Japan for the 2005–2006 season. The vaccine included A/NewCaledonia/20/99 (H1N1), A/NewYork/55/2004 (H3N2), and B/Shanghai/361/2002 viral strains and was administered together with poly(I):poly(C12U) (Ampligen) as an adjuvant. At 14 days after the final inoculation, the inoculated mice were challenged with either the A/HongKong/483/97, the A/Vietnam/1194/04, or the A/Indonesia/6/05 strain of H5N1 influenza virus.

Results. Compared with noninoculated mice, those inoculated intranasally manifested cross-reactivity of mucosal IgA and serum IgG with H5N1 virus, as well as both a reduced H5N1 virus titer in nasal-wash samples and increased survival, after challenge with H5N1 virus. Subcutaneous inoculation did not induce a cross-reactive IgA response and did not afford protection against H5N1 viral infection.

Conclusions. Intranasal inoculation with annual influenza vaccine plus the Toll-like receptor–3 agonist, poly(I):poly(C12U), may overcome the problem of a limited supply of H5N1 virus vaccine by providing cross-protective mucosal immunity against H5N1 viruses with pandemic potential.

Received 25 December 2006; accepted 24 April 2007; electronically published 5 October 2007.

mugwump

10-09-2007, 18:55

I don't know anything about this; first I've heard. Thanks, I'll ask around. (I sure wouldn't trust an adjuvant named poly(I):poly(C12U). "Stick Out Tongue" has no place in a pandemic vaccine.)

My problem with this stuff is I don't know enough about species specificity to make a call on mouse experiments. I do know the ferret is the gold standard of H5N1 animal models. I'm kinda out of the loop lately but I'll see what I can find out. The quality of the paper is probably good; JID is a top journal and the rigorous peer-review process accounts for the publication delay.

If I recall correctly, there have been hints in the past that the neuraminidase component of the H1N1 vaccine fraction -- the N1 bit -- might confer some protection against H5N1.

Anywho, it's a good reminder to get your flu shot. In the likely scenario where H5N1 doesn't hit this winter, you'll still have protected yourself against seasonal flu and contributed to 'herd immunity.' If H5N1 does hit, you won't be wasting any Tamiflu you might have on seasonal flu. Also, remember that you can catch both flu types in one season...you might be strong enough to survive one but not both.

InTheBlack

10-09-2007, 19:50

I think its significant that only the inhaled vaccine had effect -- so is this year's inhaled vaccine H1N1 component "probably similar enough" to the 2005-6 version to be worth taking the inhaled version (which IIRC might be less effective than SubQ versus the Seasonal Flu)? Still have the 3 dose & adjuvent factor, though.

InTheBlack

10-22-2007, 13:12

I don't think this report says much that WE don't already know, but it will be useful to convince people who "don't believe" in the seriousness of the threat. Since this report is by a Pediatric group and focuses on the danger to children, parents might pay it some attention.

The full report is very easy to read and quite comprehensive; everything from vaccines to face masks to social distancing strategies & the problems of keeping kids out of school before requiring adults to stay home, to an explanation of the structure of the flu virus.

Report Finds Major Gaps Exist in U.S. Pediatric Pandemic Preparations - TFAH News Release - PDF file - Oct.17
The American Academy of Pediatrics (AAP) and Trust for America’s Health (TFAH) issued a new report today, Pandemic Influenza: Warning, Children At-Risk, which finds that children and teens between the ages of 0-19 account for nearly 46 percent of all H5N1 “bird” flu deaths. The report also identifies gaps in U.S. preparedness for treating and caring for children during a possible pandemic flu outbreak.

http://healthyamericans.org/newsroom/releases/release101707.pdf

Full report:
http://www.aap.org/new/KidsPandemicFlufnl.pdf

***

Some data I found intersting:

>>>
In January 2007, HHS awarded $103 million
to develop a new influenza antiviral drug,
peramivir, which appears to be effective in
laboratory tests against a number of influenza
strains. Further studies will test whether
this drug can treat seasonal and other lifethreatening
influenza viruses such as
H5N1. The drug is another neuraminidase
inhibitor given by a single injection
into the muscle and is comparable to 5
days of treatment with other existing agents.
It also can be delivered intravenously.
>>>

MUG DO YOU HAVE ANY INFO ON PERAMIVIR RESEARCH?

>>>
in April 2007, FDA approved a
vaccine for the H5N1 “avian flu” virus for
use in adults; however, this vaccine is expected
to primarily protect against one of the
virus strains predicted to have the potential
to cause pandemic flu. It is administered
through 2 intramuscular injections given 1
month apart

SNIP

The newly approved vaccine is manufactured
by sanofi pasteur,32 but will not be sold commercially.
Instead, the vaccine has been purchased
by the U.S. government for the
Strategic National Stockpile for distribution
by public health officials to states when needed.
The federal government expects to have
enough of the pre-pandemic vaccine for an
estimated 20 million of the nation’s 300 million
people. The government currently has
12 million doses, or enough for 6 million people,
assuming that 2 doses will be required...

>>>

the federal government and
the states have been buying antiviral drugs,
mostly Tamiflu, with the goal of stockpiling
enough treatment courses (81 million) for 25
percent of the U.S. population, a figure that
includes children.

HHS plans to buy 50 million treatment
courses to distribute to states based on their
population; the remaining 31 million will be
purchased directly by the states, partially subsidized
by the federal government.

HHS has
purchased or has on hand approximately 36
million antiviral treatment courses. Almost all
of the states have taken advantage of a federal
discount plan and, to date, have purchased
more than 12 million treatment courses.

>>>
healthy children over 5 years of age usually fall near
the bottom of vaccine priority lists -- despite
some studies that point to the value of mass
immunization of schoolchildren in reducing
community-level infection.

SNIP

Otherwise healthy individuals
ages 2-64 years - - an estimated 179.3 million
people -- are at the bottom of the initial priority lists
>>>

>>>
Some key gaps identified in the report include:

• There are currently only 100,000 courses of antivirals for children in the Strategic
National Stockpile. There are currently 73.6 million children in the U.S. A severe
pandemic outbreak could result in 25 percent of the U.S. population becoming ill.
Children are known to often be disproportionately impacted by contagious respiratory
illnesses.
>>>

“Right now, we are behind the curve in
finding ways to limit the spread of a pandemic in children even though they are among those most at-risk.”
>>>

Experts predict a severe pandemic flu outbreak could result in up to 1.9 million deaths in the U.S., approximately 9.9 million Americans needing to be hospitalized, and an economic recession with losses over $680 billion to the U.S. Gross Domestic Product.

>>>

"THE REAL ISSUE IS THAT THE CURRENTLY LICENSED
H5N1 VACCINE IS ONLY MODESTLY IMMUNOGENIC, REGARDLESS OF AGE, AND, OF
COURSE, WE HAVE NO EFFICACY DATA. REGARDLESS, IN AN ACTUAL PANDEMIC, MODEST IMMUNOGENICITY BEATS NO IMMUNOGENICITY AT ALL."
>>>

A trial is currently underway
in Southeast Asia studying the efficacy of different
doses of Tamiflu among hospitalized
children and adults diagnosed with either
severe seasonal flu or avian flu. No preliminary
data on this trial are yet available.

>>>
CDC has
recommended against using amantadine and rimantadine for the treatment or prevention of seasonal flu because influenza A viruses are becoming increasingly resistant to both drugs.
SNIP

CDC has urged that these 2 drugs not be used again until circulating influenza A
viruses once again become susceptible to them
>>>

WE COULD
TAKE A PLACE LIKE KANSAS CITY, AND DIVIDE IT INTO GRIDS, THEN ASSIGN GRIDS AMONG THE TOTAL NUMBER OF PEDIATRICIANS’ OFFICES. WE’D HAVE TO MAKE HOUSE CALLS WEARING MASKS, AND PEOPLE WOULD HAVE TO BE TAUGHT HOW TO PROVIDE INTRAVENOUS FLUIDS AT HOME. IT WOULD REQUIRE A DIFFERENT HEALTH SYSTEM THAN THE ONE WE ARE FAMILIAR WITH NOW.

>>>