Pandemic Flu

[Pete]

So far.

http://www.breitbart.com/article.php...show_article=1

Tick, Tick, Tick

[mugwump]

New Helen Branswell article.

Looks like Tamiflu is still working, and reinforces the fact that the latest pronouncement from the UN that the virus is "remarkably stable" is utter BS.

[InTheBlack]

This might prove very useful if it can distinguish between seasonal and H5N1 (and profitable).


FDA Clears for Marketing Real-Time Test for Respiratory Viruses* - FDA - Jan.18
The FDA has cleared for marketing a test that simultaneously detects four common respiratory viruses, including the flu, in a patient’s respiratory secretions. The ProFlu+ test provides results in as few as three hours. Other diagnostic tests for respiratory viruses are fast but not as accurate or are accurate but not as rapid. The real-time test employs a multiplex platform that allows several tests to be processed using the same sample to detect influenza A virus, influenza B virus, and respiratory syncytial virus A and B (RSV). These viruses can cause influenza, an infection of the airways called bronchiolitis, and pneumonia. All are among the leading causes of lower respiratory tract infections.**
<http://www.fda.gov/bbs/topics/NEWS/2008/NEW01780.html>http://www.fda.gov/bbs/topics/NEWS/2008/NEW01780.html

[Surf n Turf]

Interesting Article --- If this is fact, do we have H2H contagion ?
Expressindia
http://www.expressindia.com/latest-n...othing/264604/

Kolkata, January 22 About 2,324 cases of people suffering from fever have been reported from the Birbhum district — Ground Zero of the bird flu outbreak in the state — in the last five days.
“The West Bengal Government is failing to understand the gravity of the situation,” said Union Minister of State for Health and Family Welfare P Lakshmi, during a visit to Birbhum on Tuesday.
Lakshmi, who is currently in the state to get a first hand assessment of the culling operations, did not find adequate health infrastructure to combat the bird flu threat. She criticised the state government for acting irresponsibly and lacking seriousness to fight the disease.
“There is no infrastructure, not even qualified doctors. We have sent pills and gear but the required equipment is not in place till date. They do not understand that this is an emergency situation and they should be prepared for it,” she added.
She blamed the state Animal Resource Development department for the spread of the virus to new areas, as it did not carry out culling operations in a swift manner.
The state government, however, maintained that there has been no case of H5N1 virus infecting humans, and tried to play down its own figures of fever cases in Birbhum.
“There is no need to panic. We do not have any reports of humans being infected. Therefore, a few hundred fever cases means nothing,” said Sanchita Bakshi, state director health services.
According to the status report, as many as 707 fever cases were reported from Birbhum district on January 18.
A day later and another 304 people were added to the list.
For January 20, which happened to be a Sunday, the report does not give any figures.
On January 21, 707 more cases were added to the existing figures and today an additional 613 cases of fever were recorded.
The report further stated that that six central rapid response teams are assisting the state government in culling operations.
Five human blood samples taken from South Dinajpur district have tested negative, the report added.

SnT

[mugwump]

Originally Posted by Surf n Turf

Interesting Article --- If this is fact, do we have H2H contagion ?
...
SnT

I don't think there's been extensive h2h in India -- not from what I've heard so far -- but it certainly merits close attention.

A certain amount of human H5N1 is inevitable in W Bengal, although they vehemently deny it currently exists. Conditions on the ground are horrendous. Sick birds are being hidden, poultry is routinely eaten after dieing of H5N1, birds that are culled are being dumped into bodies of water used for drinking water, etc. The full conflation of ignorance, poverty, fear and disease.

There are suspect cases -- many of them -- in Bengal. When the WHO visited the 'isolation wards' where many were being held they found them on sheets on the floor. Not even mattresses, much less masks/gloves/protective gear. The staff were in full panic mode and wouldn't even approach the patients.

The guy is right: fever is as common as dust in India. Dengue, chickungunya, CA pneumonia, seasonal flu, intestinal disease, etc are rampant. That's part of the problem, because documented human H5N1 cases have been initially diagnosed as each of these. This flu can present with gut, CNS, skin and/or respiratory symptoms in humans.

[mugwump]

"MARGRAM (BIRBHUM): Hundreds of goats have died of an unknown disease over the past four days in Birbhum's Rampurhat block II.

Some experts warned that if the H5N1 virus — which causes bird flu — has jumped from birds to mammals, it could be the turn of humans next. "

Cite here.

This is the same locale where the poultry flocks have been wiped out.

Note that there are no deaths reported among the 150 or so suspect cases, which is very good news.

[InTheBlack]

CDC calls it a "small increase" and minimize the figure by including Type B samples, which have never been resistant.

The actual resistance figure is 8.7% for the type which displays resistance, and I'd like to know what change that represents from previous years in order to get a clue as to how fast it's becoming resistant.

Looks like having some Relenza in the fridge would be a good diversification.

Date: Fri, 29 Feb 2008 14:28:41 -0500
From: "Clinician Outreach and Communication Activity (CDC)" <coca@CDC.GOV>
Subject: CDC Clinician Communication: CDC Health Advisory - Influenza Antiviral
Use for Persons at High Risk for Influenza Complications or Who have Severe
Influenza Illness
Sender: CDC's Clinician's Terrorism Update Listserv

For more information, please see the CDC website: <http://www.cdc.gov/flu/professionals/antivirals/>http://www.cdc.gov/flu/professionals/antivirals/


>>>
During this influenza season, a small increase in the number of influenza viruses resistant to oseltamivir has been observed in the United States.

Among the 471 influenza A and B viruses tested during the 2007–08 influenza season to date, 27 (5.7%) have been found to be resistant to oseltamivir, compared with 0.7% during the 2006-07 season.

All of the oseltamivir-resistant viruses have been influenza A viruses of the H1N1 subtype; 8.7% of the 310 H1N1 viruses tested are resistant to oseltamivir.

No resistance to oseltamivir has been observed among the 161 influenza A (H3N2) and influenza B viruses tested to date, and no antiviral resistance to zanamivir has been detected in any subtype.

[InTheBlack]

Tamiflu Label Updated with Neuropsychiatric Warning - FDA - March 4

Roche and FDA informed healthcare professionals of neuropsychiatric events associated with the use of Tamiflu, in patients with influenza. The label has been revised as follows: Influenza can be associated with a variety of neurologic and behavioral symptoms which can include events such as hallucinations, delirium, and abnormal behavior, in some cases resulting in fatal outcomes.

These events may occur in the setting of encephalitis or encephalopathy but can occur without obvious severe disease. There have been postmarketing reports (mostly from Japan) of delirium and abnormal behavior leading to injury, and in some cases resulting in fatal outcomes, in patients with influenza who were receiving Tamiflu.

Because these events were reported voluntarily during clinical practice, estimates of frequency cannot be made but they appear to be uncommon based on Tamiflu usage data. These events were reported primarily among pediatric patients and often had an abrupt onset and rapid resolution.

The contribution of Tamiflu to these events has not been established. Patients with influenza should be closely monitored for signs of abnormal behavior. If neuropsychiatric symptoms occur, the risks and benefits of continuing treatment should be evaluated for each patient.

http://www.fda.gov/medwatch/safety/2...08.htm#Tamiflu <http://www.fda.gov/medwatch/safety/2008/safety08.htm#Tamiflu?s_cid=ccu031008_seasonalinflu enza3_e>

[The Reaper]

http://www.foxbusiness.com/markets/i..._547726_7.html

South Korea Takes Aggressive Steps To Contain Bird Flu

Sue Chang

SAN FRANCISCO -- The South Korean government said late Thursday it will take all necessary steps to contain the spread of the avian flu, including culling 308,000 chickens within 500 meters of the farm where the H5N1 strain of the avian flu was discovered. The Ministry for Food, Agriculture, Forestry and Fisheries has also ordered 3.57 million fowls on 265 farms within 10 kilometers of the farm to be quarantined as well as the destruction of all eggs within a 3-kilometer radius. The ministry is urging all poultry farms in the country to sanitize their facilities and close the farms to outside traffic. "We are doing all we can to prevent the spread of the virus to humans, including vaccinating staff involved in the culling and the sanitation process," said the ministry in a statement.

[Pete]

http://www.timesonline.co.uk/tol/lif...cle3701724.ece

Interesting.

[Moving Target]

Bad news, and unfortunately far enough away that I doubt you'll be seeing this on the nightly broadcasts anytime soon.

[nmap]

I came across this piece about triage planning. Interesting implications.

Article

Doctors know some patients needing lifesaving care won't get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding who to let die.

Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn't be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.

The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.

The proposed guidelines are designed to be a blueprint for hospitals "so that everybody will be thinking in the same way" when pandemic flu or another widespread health care disaster hits, said Dr. Asha Devereaux. She is a critical care specialist in San Diego and lead writer of the task force report.

The idea is to try to make sure that scarce resources — including ventilators, medicine and doctors and nurses — are used in a uniform, objective way, task force members said.

Their recommendations appear in a report appearing Monday in the May edition of Chest, the medical journal of the American College of Chest Physicians.

"If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing," the report states.

To prepare, hospitals should designate a triage team with the Godlike task of deciding who will and who won't get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:

_People older than 85.

_Those with severe trauma, which could include critical injuries from car crashes and shootings.

_Severely burned patients older than 60.

_Those with severe mental impairment, which could include advanced Alzheimer's disease.

_Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

Dr. Kevin Yeskey, director of the preparedness and emergency operations office at the Department of Health and Human Services, was on the task force. He said the report would be among many the agency reviews as part of preparedness efforts.

Public health law expert Lawrence Gostin of Georgetown University called the report an important initiative but also "a political minefield and a legal minefield."

The recommendations would probably violate federal laws against age discrimination and disability discrimination, said Gostin, who was not on the task force.

If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability, he said. While health care rationing will be necessary in a mass disaster, "there are some real ethical concerns here."

James Bentley, a senior vice president at American Hospital Association, said the report will give guidance to hospitals in shaping their own preparedness plans even if they don't follow all the suggestions.

He said the proposals resemble a battlefield approach in which limited health care resources are reserved for those most likely to survive.

Bentley said it's not the first time this type of approach has been recommended for a catastrophic pandemic, but that "this is the most detailed one I have seen from a professional group."

While the notion of rationing health care is unpleasant, the report could help the public understand that it will be necessary, Bentley said.

Devereaux said compiling the list "was emotionally difficult for everyone."

That's partly because members believe it's just a matter of time before such a health care disaster hits, she said.

"You never know," Devereaux said. "SARS took a lot of folks by surprise. We didn't even know it existed."

[frostfire]

Originally Posted by nmap

To prepare, hospitals should designate a triage team with the Godlike task of deciding who will and who won't get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:

_People older than 85.

_Those with severe trauma, which could include critical injuries from car crashes and shootings.

_Severely burned patients older than 60.

_Those with severe mental impairment, which could include advanced Alzheimer's disease.

_Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

sounds about right. Took BDLS course a few months back. The instructor was a big fan of Grossman books. Learnt so very much, and I was the only one who could answer questions thrown about bioterrorism ie. how the Aum sect utilized sarin and HCN, how to make ricin, botulism, and so on

[InTheBlack]

This company might have a novel method of finding and, more importantly, quickly producing quantities of a vaccine. Mug, have you any info on this? A 5 ug effective dose is quite small, right?

Which vaccine has the US Govt ended up contracting for; whats its stockpile situation?

http://www.medicago.com/en/about/overview/

Corporate overview
Medicago is a publicly-traded biotechnology company focused on the development, production and commercialization of protein-based vaccines and biopharmaceuticals using a proprietary manufacturing system developed from its expertise in the genetic engineering of plants.

To face pandemic and seasonal vaccine supply challenges, Medicago has developed a proprietary transient expression system which produces recombinant vaccine antigens in the cells of non-transgenic plants. This technology offers significant advantages of speed and cost over competitive egg-based and cell culture technologies. It can deliver a vaccine for testing in about a month after the identification and reception of genetic sequences from the pandemic strain. This production time frame has the potential to allow vaccination of the population before the first wave of the pandemic strikes and to supply large volumes of vaccine antigens to the world market including developing countries.

The Company is developing its own proprietary pipeline of influenza vaccines.

***

Jun 03, 2008 08:00 ET
Medicago's H5N1 Pandemic Flu Vaccine Effective in Key Ferret Animal Model With Single Dose


QUEBEC CITY, QUEBEC--(Marketwire - June 3, 2008) - Medicago Inc. (TSX VENTURE:MDG) today announced positive results from a preclinical immunogenicity study of the Company's H5N1 Avian Influenza VLP vaccine that was performed in ferrets, the most predictive animal model for the effectiveness of influenza vaccines in humans. Results demonstrated that a single 5-microgram dose of the Company's H5N1 VLP vaccine induced high levels of antibodies in 100% of ferrets and met all required immunogenicity criteria of the European Union Committee for Medicinal Products for Human Use (CHMP).These criteria set by the CHMP for the approval of seasonal flu vaccines in the European Union are widely used to assess immune responses of new pandemic influenza vaccines in humans. In the case of ferrets, these criteria are useful to predict effective doses that should be tested in humans.

SNIP rest of press release

*****

This company is continuing to research a vaccine adjuvant that also seems to make Tamiflu more effective; but I don't know if the blurb about possible cross-protection against H5N1 from a seasonal vaccine is just blue sky hype aimed at investors.

http://www.hemispherx.net/

Recent News:
*
6/2/2008
Hemispherx Biopharma, Inc. Completes Enrollment in Phase II Study of Ampligen® as Seasonal Flu Vaccine Enhancer
Six-month study will also assess potential cross-protection against H5N1 avian influenza

SNIP
Such cross-protection is suggested by animal studies conducted by the Company’s clinical collaborators in Japan at the Japanese National Institutes of Health.

[InTheBlack]

Here's the original press release (2 years ago) WRT boosting Tamiflu effect:

Hemispherx Biopharma's Ampligen Boosts Tamiflu Potency
Peter Kang, 02.16.06, 9:02 AM ET

Hemispherx Biopharma announced today its experimental immune system booster Ampligen can enhance the effects of the avian influenza drug Tamiflu by a factor of up to 100.
SNIP
also reported the potency of Relenza was increased by 500 times in lab experiments.
*****

Given rising Tamflu resistance, the fact that it may also boost Relenza is another optimistic point. If we need to switch to Relenza, maybe this stuff can prevent resistance long enough to fight a pandemic.