Pandemic Flu

[mugwump]

If you can plow through it, this report from Henry Niman summarizes the history of clusters, the genetic changes found in the clusters, and the game the WHO are playing with the pandemic alert levels.

Henry Niman is the gadfly (a spooky-smart gadfly) who has been riding the WHO for over 18 months. He's qoted extensively in the NY Times article cited in a post above. Niman is an 'outsider' whose theories and positions have initially met almost universal scorn and are now almost universally acknowleged to be correct (although verrry grudgingly acknowleged; he's rubbed a lot of people's noses in the chicken poop).

mugwump

[Peregrino]

Originally Posted by mugwump

Henry Niman is the gadfly (a spooky-smart gadfly) who has been riding the WHO for over 18 months. He's qoted extensively in the NY Times article cited in a post above. Niman is an 'outsider' whose theories and positions have initially met almost universal scorn and are now almost universally acknowleged to be correct (although verrry grudgingly acknowleged; he's rubbed a lot of people's noses in the chicken poop).

mugwump

I like him already, especially since the stuff he's rubbing their noses in is what they keep trying to package and sell to the world as chicken salad. Keep it coming, it's fascinating reading. And it ties in well with the hurricane preparedness plan (great excuse to prep for a lot of contingencies). Peregrino

[mugwump]

Originally Posted by Peregrino

I like him already, especially since the stuff he's rubbing their noses in is what they keep trying to package and sell to the world as chicken salad. Keep it coming, it's fascinating reading. And it ties in well with the hurricane preparedness plan (great excuse to prep for a lot of contingencies). Peregrino

Will do.

One thing you should know about is his predilection for referring to 'cleavage sites.' He never really explains it, but this is referring to a spot on the hemagglutinin (HA) molecule that is used by the virus as the docking grapple for attaching to the cell. If sequences are published (and through Niman's tireless goading, they are starting to trickle into GenBank) the HA and NA portions usually arrive first, because they are critical mutation sites for a final breakout. Cleavage sites are good ways to compare strains of H5N1.

There isn't a lot of actual significance to the cleavage site, except it allows you to differentiate between what Niman considers 'bird' H5N1 and 'mammal' H5N1. Niman has been saying for a while now that human-to-human transmission is much more efficient than bird-to-human. When you think about it, there are scores of thousands of contacts between infected birds and humans, with very few infections. But once a human becomes infected, there is a much greater change for H2H transmission -- like in Sumatra.

Niman doesn't believe that the current crop of cases are coming initially from birds but from a mammal reservoir -- possibly pig or cat. This is ominous. If the initial vector is birds, as the WHO desperately tries to ascribe to every case, then there is very little selective pressure for the virus to adapt to mammals and humans. (Why would the virus gain any advantage by adapting to a mammalian body temp of 96F when a bird's temp is 105F?) Any breakout would depend on a fluke mutation in birds, which in a similar fluke would be passed to a human. But, if the virus is coming from a mammal, then there is significant selective pressure for the virus to adapt to mammalian receptors, body temperature, defense systems, etc.

There are data going back to 2001 which show H5N1 is pandemic in Indonesian pigs.

This is the first time in history we've watched a potential pandemic develop -- everything has been historical up to now. Nobody knows what is going to happen. That said, Niman has an uncomfortable track record of being right.

mugwump

[mugwump]

http://www.who.int/csr/don/2006_06_06/en/index.html
6 June 2006

For the past four days, Indonesian health authorities and WHO have been monitoring cases of influenza-like illness in four nurses who were involved in the care of confirmed H5N1 patients.

Test results have now convincingly ruled out H5N1 infection in all four nurses.

Two of the nurses cared for siblings, a 10-year-old girl and her 18-year-old brother, who were hospitalized in Bandung, West Java, on 22 May and died the following day. Test results for both nurses are negative for H5N1 infection. One nurse was shown to be infected with a seasonal influenza A (H1N1) virus, which is now circulating widely throughout Indonesia. The second nurse experienced only mild and transient symptoms, but was tested urgently as a precautionary measure. Her test results were also negative for H5N1 infection.

The two additional nurses, who work at a hospital in Medan, North Sumatra, were involved in the care of confirmed H5N1 cases among members of an extended family from the village of Kubu Simbelang in Karo District. One of the nurses, a 34-year-old woman, experienced only mild symptoms and has subsequently tested negative for H5N1 infection. The second nurse, a 42-year-old woman, developed influenza-like illness on 1 June. Test results received today are also negative for H5N1 infection.

The speed and thoroughness with which influenza-like illness in these nurses was investigated are indicative of the heightened concern among Indonesian health authorities. The negative test results for all four nurses provide reassuring evidence that the virus is not spreading efficiently or sustainably among humans at present.

[mugwump]

The other view:

http://www.recombinomics.com/News/06...donesia_4.html

[mugwump]

Include cases up to 06Jun06. They still don't include 12 confirmed cases in Turkey because the onset dates can't be nailed down. Weak.

Cumulative_WW_jun_6.jpg

Monthly_WW_June_6.jpg

WHO_GRAPHS_June_6.jpg

[Pete]

Something funny in graph # 2.

Around Sep 04 it looks like 100% death rate and much lower around Apr 05. The rest of the time it looks like around 50/60%.

Could it be that the flu is more wide spread but just making a number of people slightly sick? With the focus on people at deaths door is the flu spreading under the radar?

Pete

[mugwump]

Originally Posted by Pete

Something funny in graph # 2.

Around Sep 04 it looks like 100% death rate and much lower around Apr 05. The rest of the time it looks like around 50/60%.

Could it be that the flu is more wide spread but just making a number of people slightly sick? With the focus on people at deaths door is the flu spreading under the radar?

Pete

You're looking at outcomes from 3 separate clades, or strains rolled into a single graph. The 2004 strain -- the original southeast Asian strain -- was extremely nasty. A second strain is in the middle east in Egypt, Turkey and Azerbaijan and had a 30% to 40% CFR in December 05 - January 06. The third strain is the one in Indonesia now, which is actually three variations of the same strain: one nearly identical to the flu infecting birds in the area and two others from Sumatra and East Java which many are now assuming are coming from some mammal reservoir (probably pigs and cats). The CFR bounces from nearly 100% to 40% to 75% in six weeks: April - May 06. Small sample size has a lot to do with the large variation.

You are absolutely correct: there could be more mild cases that aren't being reported. There could also be more clusters with serious cases and deaths than are being reported as well. Surveillance and reporting are so crappy in China, Indo, Burma, Africa, etc. that no one knows.

It goes beyond simple ignorance. There are reports of whistle-blowers in China being beaten, jailed, and even killed for reporting human H5N1 infections (one example here)

[mugwump]

I attended a congressional briefing by Dr. Robert Webster (St. Jude Children's Research Hospital, Memphis, TN) on the Risks of Avian Influenza sponsored by the Joint Steering Committee for Public Policy. Dr. Webster has studied avian influenza for over 30 years and is a source of great information on avian influenza (H5N1). He confirmed a bit of good news that I have heard as rumor in the scientific community: this year's seasonal influenza vaccine might provide limited protection against some strains of H5N1. That is great news if true. This doesn't mean the seasonal flu shot will save the world, but if there was an influenza pandemic sooner rather than later, the seasonal vaccination could "buy us some time" until a vaccine is developed for the circulating H5N1 strain(s). -- Mote Dai

http://www.dailykos.com/story/2006/6/8/20401/71732

[jasonglh]

Mugwump you were talking about geese once:

Geese blamed for Lake Tahoe pollution


Spencer said the bottom of Lake Tahoe is covered by up to two inches of goose feces in some areas. A 10-pound Canada goose can produce four pounds of nitrate- and phosphate-rich feces every day.

It went on to say they were going to trap 400 and innoculate them for disease but not which.

[mugwump]

I haven't been posting panflu reports as in the past, mostly because I'm deathly sick and tired of the whole topic. There have been additional deaths, additional H2H clusters, and recurring idiocy from all governments and agencies involved. Coverups are increasing in scope. Long story short, the recent pattern continues.

The virus appears to be marching toward a breakout and there is a growing sense of inevitability, even among former pandemic sceptics and agnostics.

The following two articles summarize fairly well the situation in China and Indonesia. I've separated the two countries and precede the articles with some analysis.

============
China:

There is growing concern that there is widespread human H5N1 in the Chinese countryside. It is speculated that the virus is being spread in a "more efficient" manner, but still not so efficiently as to cause the big breakout.

The chickens have come home to roost. The Chinese have been using 'poorly formulated' (crappy) H5N1 poultry vaccines for 2 years now. The concern has always been that these vaccines would be effective enough to keep the inoculated chickens alive but not effective enough to keep them from becoming infected. This now appears to be the case. Official reports state that up to 1% of all marketed poultry are infected with H5N1 while appearing to be healthy. Back channel reports state this figure could be as high as 15%. This is why Hong Kong has prohibited importation of poultry from the mainland.

There is a whiff of official panic coming from Hong Kong.

http://usinfo.state.gov/usinfo/Archi...16-316446.html

Washington – Chinese and international health officials have verified another human case of avian influenza, and the mystery of how the 31-year-old truck driver was exposed to the disease is causing some concern in Guangdon province and Hong Kong.

Chinese health authorities confirmed the case June 16, saying the ailing man still is alive, although in critical condition. In investigating the possible route of his infection, it has been confirmed that prior to his infection, he had visited a local market where live poultry were being sold. Thus far, there is no confirmation that he had direct exposure to ailing birds.

Inability to make that direct link to an animal carrier of the H5N1 virus that has been plaguing East Asia for more than two years is causing some genuine concern in Hong Kong.

Health Secretary York Chow of the special administrative region of Hong Kong told Radio-TV Hong Kong that he is concerned about this case for several reasons. The sick man has no apparent history of contact with sick animals; rather, he comes from the city and not from the countryside where the virus has been more common. Chow also is concerned that the case is occurring in the hot summer; most of China’s avian flu cases have occurred in winter.

“So we have a suspicion -- and we cannot confirm it yet -- that the virus might be more virulent and more widespread than we expected,” Chow said in the interview. “We need to monitor the situation closely to see if there is continuity of this pattern.”

===================
Indonesia:

All information coming from the Indonesian health services is being totally ignored by the public health community. It used to be that the term "local confirmation", as in "the tests were confirmed locally" was code for results coming from the US NAMRU2 facility. This is now not always the case. Indonesian official press releases are now sometimes citing an Indonesian lab that is highly suspect.

Numerous nurses (4-9, reports vary) who treated H5N1 patients have come down with the flu -- officially, the seasonal flu. They were all given high-dose Tamiflu/amantadine combined treatment at the first sign of symptoms and all have recovered. Despite official assurances that they were not infected with H5N1, many suspect otherwise.

I won't include any of the NYT article cited below, it's pretty complete. I'll only add that the single death reported on 14 June is actually part of an apparent H2H cluster; two siblings died previously but were buried before samples were taken.


http://www.iht.com/articles/2006/06/16/news/flu.php

[InTheBlack]

>>>
this year's seasonal influenza vaccine might provide limited protection against some strains of H5N1.
>>>

Are you referring to the 2005/2006 vaccine, or the 2006/2007 vaccine? I presume the 2005/2006 is the only one available at the moment, if there is any left ???

When I checked a couple weeks ago I couldn't find any online sources that had _any_ antivirals in stock, not even Amantadine or Relenza (zanamivir).

[mugwump]

Originally Posted by InTheBlack

>>>
this year's seasonal influenza vaccine might provide limited protection against some strains of H5N1.
>>>

Are you referring to the 2005/2006 vaccine, or the 2006/2007 vaccine? I presume the 2005/2006 is the only one available at the moment, if there is any left ???

When I checked a couple weeks ago I couldn't find any online sources that had _any_ antivirals in stock, not even Amantadine or Relenza (zanamivir).

ITB: Post an introduction and fill in your profile, please.

The 2006-2007 vaccine is the one which confers partial immunity. Make sure your kids are immunized -- they still stupidly give priority to the elderly (wrong strategy, even w/ seasonal flu).

Immunizations will start in August.

The antivirals are gone.

[InTheBlack]

Profile etc done right after-check now.

Which component is the 'active ingredient?'

http://www.cdc.gov/flu/professionals...sition0607.htm
>>>
The panel recommended that vaccines to be used in the 2006-07 season in the U.S. contain the following:

an A/New Caledonia/20/99 (H1N1)-like virus;
an A/Wisconsin/67/2005 (H3N2)-like virus (A/Wisconsin/67/2005 and A/Hiroshima/52/2005 strains);
a B/Malaysia/2506/2004-like virus (B/Malaysia/2506/2004 and B/Ohio/1/2005 strains)
The influenza vaccine composition to be used in the 2006-07 season in the U.S. is identical to that recommended by the World Health Organization on February 15, 2006.
>>>

[mugwump]

Originally Posted by InTheBlack

Profile etc done right after-check now.

Which component is the 'active ingredient?'

No idea. I'd say the H1N1 component but that is just a guess based on the matching neuraminidase subtype. I was taking Webster's word on it.

There's a new vaccine that protects ferrets against the Vietnamese H5N1 -- not even in Phase I yet though.