Skip to comments.Avian Flu Surveillance Project
Posted on 05/09/2005 10:18:08 AM PDT by Dog Gone
Some folks suggested that we begin a thread similar to the Marsburg Surveillance Project for monitoring developments regarding Avian Flu.
The purpose is to have an extended thread where those interested can post articles and comments as this story unfolds.
If we're lucky, the story and this thread will fade away.
A couple of 'grabs' from Drudge:
Mammals at greater risk as BF mutates:
....and a few questions about the side effects of Tamiflu:
Saudi Arabia Hosts Int'l Conf. on Bird Flu
Saudi fears intensify with the approach of Hajj season.
By Fawaz Mohammad, IOL Correspondent
RIYADH, November 14, 2005 (IslamOnline.net) Saudi Arabia is planning to host an international conference on November 21-22 to discuss ways of preventing an outbreak of the bird flu during the Muslim hajj.
"The conference will discuss means of vaccination against the approaching danger of the avian flu," said Zayad bin Ahmed Memish, director of the Gulf Center for anti-bodies Saturday, November 12.
The two-day conference will bring together more than 300 health experts and specialists from around the globe in addition to Saudi officials to discuss means of protection against the deadly virus.
"The conference will also probe ways to gain more information about the nature of the virus as well as means of diagnosis and protection," added Memish, who is also head of the conference's organizing committee.
Executive director of the National Guards' health affairs department Dr. Abdullah bin Abdul Aziz highlighted importance of the conference in fighting the avian flu.
"It comes at a time world countries are racing time to gain more information about the deadly virus to prevent its outbreak."
Fears of bird Flu coming to the Arab world were highlighted when the Paris-based World Organization for Animal Health said 3,673 wild waterfowl had died in Iran.
Saudi fears intensify with the approach of Hajj season, where millions of Muslims from the four corners of the globe head for the Kingdom for the annual spiritual journey.
Official figures put the total number of pilgrims performing last year's Hajj at 1,892,710, with 1,419,706 from abroad and 473,004 Saudis and other Muslim residents of the kingdom.
Every able-bodied adult Muslim who can financially afford the trip must perform hajj, one of the five pillars of Islam, once in their lifetime.
Hajj consists of several ceremonies, meant to symbolize the essential concepts of the Islamic faith, and to commemorate the trials of Prophet Abraham and his family.
Fears of a bird flu outbreak have been high in Saudi Arabia since reports that chickens perished in a farm in the Kingdom.
Fears of a bird flu outbreak have been high in the oil-rich kingdom since reports on November 6, that chickens perished in a farm in southeastern Saudi Arabia.
The owner of the farm in Surat Obaida, south of Khamis Mushayt in the Asir region said he had told the Saudi authorities that the poultry started to cough, faint and then die within three days.
But Saudi officials denied an outbreak of the avian virus in the region, saying tests on the perished birds showed no sign of the flu.
Saudi Arabia has stepped up measures to prevent any outbreak of virus in the country.
On Saturday, Saudi Arabia said that it was banning all bird imports from neighboring countries amid heightened regional concerns about bird flu, according to Agence France Presse (AFP).
"A royal decree was sent to the customs and all entry points forbidding the entry of all bird species coming from countries bordering the kingdom," the official SPA agency said.
The decision comes a day after Kuwait announced a bird stricken with avian flu in the country carried the deadly H5N1 strain, in the first case of its kind in the Gulf region.
Another bird was found to have the milder H5N2 strain.
On October 25, the kingdom banned live bird imports from Asian countries, Romania and Turkey where the deadly strain of H5N1 avian flu has been detected.
Scientists fear if the bird flu virus, which originated in Asia, were to pass on any large scale from birds to humans it could mutate into a variety that could spread between humans. In a virulent form, they say, this could kill millions worldwide.
Anti-bird Flu Drug
In a related development, China said Sunday it has developed what it calls the equivalent of the anti-bird flu drug Tamiflu in preparation for a feared pandemic if the virus begins spreading among humans.
Zhong Nanshan, director of the Guangzhou Institute of Respiratory Diseases, was quoted in the Information Times newspaper as saying the drug would be effective in treating the virus, Reuters said.
The Information Times report did not say when the drug might be available or say how it compared with the antiviral Tamiflu, made by Swiss drug giant Roche Holding AG.
In the absence of a vaccine for bird flu, the World Health Organization recommends that governments stockpile Tamiflu, which does not cure the disease but can reduce its severity and might slow the spread of a pandemic.
China has reported a total of eight outbreaks of the deadly H5N1 strain of bird flu in poultry since the start of October.
The latest outbreak occurred in Jingshan county in Hubei province. Local authorities have culled more than 31,000 poultry within a radius of 3 km (2 miles).
The H5N1 strain first emerged in Hong Kong in 1997, when it caused the death or destruction of 1.5 million birds. Eighteen people fell ill, of whom six died.
It re-emerged in 2003 in South Korea and has spread to China, Vietnam, Thailand, Laos and Indonesia. H5N1 has infected 117 people in four countries and killed 60, according to the WHO.
Bird flu 'mutated into more dangerous form'
09:40am 14th November 2005
Study shows bird flu is mutating
Bird flu has mutated into a more dangerous form which could breed in humans, according to scientists.
The Vietnamese research has shown the bug is adapting to infect humans in the biggest study of its kind.
The respected Ho Chi Minh Pasteur Institute in Vietnam said it had decoded 24 samples of the H5N1 virus taken from poultry and humans.
Look here too...
Skip gossip links to more articles
Bird flu virus: What you need to know
Article: 'Don't let bird flu stop free range', campaigners urge
News: British GPs briefed on bird flu
Revealed: Bird flu 'as serious a threat as terrorism'
Article: Fears over global bird flu threat
Don't miss today
Report: Coping with asthma
Support: Talk about cancer here
Factfile: Bird flu latest
Join our diet centre
Sign up to our health newsletter
Have your say
Are you having a flu jab this winter?
Yes, I'd rather be safe than sorry
No, I'd rather use my own immunities
More polls »
Boards & chat
Have you been abroad for dental treatment?
Join the debate » The results showed a significant variation of antigen - any foreign substance that stimulates the body's immune system to produce antibodies.
"The H5N1 type that infected people and waterfowl in early 2005 has several mutations focusing in the important functional parts of the surface proteins," the institute said on its website.
"There has been a mutation allowing the virus to breed effectively on mammal tissue and become highly virulent," it said.
Virus could breed in humans
The study also found a mutation of the PB2 gene in a virus sample from a patient who died in the southern Dong Thap province earlier this year.
Small changes in this gene can make it much easier for the virus to breed in humans making it more deadly.
An Agriculture Ministry report said the H5N1 virus had now hit 10 of Vietnam's 64 provinces since returning in early October. Vietnam's death toll since the virus first arrived in late 2003 is 42.
The latest affected area is the northern port of Haiphong where 1,000 ducks and chickens died in four farms last week.
Bui Quang Anh, head of the ministry's animal health department, has warned provincial authorities that improper quarantine of infected poultry was helping the disease to spread.
Poultry rearing to be banned in Vietnam
Vietnam is gearing up its battle against bird flu with Hanoi and Ho Chi Minh City officials spreading the word about a November 15 deadline from when poultry raising will be banned in those cities.
The Hanoi's People Committee said live poultry will be destroyed from Thursday if found in the capital.
Last week, Agriculture Minister Cao Duc Phat said police and soldiers would be used to quarantine farms, destroy sick poultry and man checkpoints to control poultry transportation better.
Bird flu has killed at least 64 people in Asia since it arrived in 2003 and became endemic in several countries.
Thirteen people are known to have died of bird flu in Thailand, five in Indonesia and four in Cambodia.
I imagine that you have been very busy as of late.
Are you working on the flu currently?
This MUST have already been posted on FR somewhere:
Over 50 birds die in British quarantine from bird flu
In a related development, China said Sunday it has developed what it calls the equivalent of the anti-bird flu drug Tamiflu in preparation for a feared pandemic if the virus begins spreading among humans.
Sadly for western animal lovers, it's made from Panda testicles.
Thanks for posting.
My guess is that we will miss the main event this flu season. But it is so widespread in birds, and in pigs as well (though not as widespread), that it seems certain we will see something major in the 2006/07 flu season.
If so, I certainly hope someone comes up with something REALLY innovative in the next 12 months...
Are you working on the flu currently?"
Yes very busy and yes it is my sole role the field of influenza. I work as part of the sentinel system
U.K. Says Flu Failed to Spread From Infected Birds (Update2)
Nov. 15 (Bloomberg) -- The strain of avian influenza capable of infecting people didn't spread between species in a quarantine center in the U.K. after killing as many as 53 birds from Taiwan, government scientists said...
Taiwan responded to the U.K. report by saying there is a ``good possibility that profit-driven traders smuggled mesias from China to Taiwan, using our avian flu-free country as a front from which they laundered these birds to the UK and other countries,'' the British Broadcasting Corp. reported. Taiwan has asked if it can send a team to the U.K. to discuss the findings with British officials, BBC said.
Ping to post # 2,110.
Here's a new one from TCS. http://www.techcentralstation.com/111705C.html
The Flu the Next Time
Duane D. Freese
President Bush's plan to combat the threat of avian flu is borne of fears that the H5N1 viral strain closely resembles the 1918 flu strain that had leapt from birds to humans, killing 500,000 Americans and 20 million people worldwide. A report by the Department of Health and Human Services after the unveiling of Bush's plan warned that as many as 1.9 million Americans could be killed in a new pandemic with a third of the population becoming infected.
As protection, the administration's plan proposes spending $1.2 billion to vaccinate 20 million Americans with the current strain of avian flu. The idea is to give key emergency personnel some limited immunity to a mutated pandemic strain while a vaccine is prepared for the actual strain. To increase the ability to create enough of that kind of vaccine, the Bush plan would invest $2.8 billion in research and development of a cell-based (versus egg-based) vaccine, making it possible to inoculate everyone within six months of an outbreak.
That new technology, though, won't be ready until 2010 at the earliest. In the interim, and even after it's available, the first line of defense will be antivirals for most people. Antivirals given within 48 hours of onset of flu symptoms can in many cases relieve the worst of those symptoms, which in the case of the avian flu means it can prevent a lot of deaths.
The Bush plan calls for buying enough to treat about 44 million Americans, about 15% of the population, and expects states and local governments to kick in and buy enough to cover another 10% or so.
What antiviral to buy? The primary one, though not the only one needed, would be Tamiflu. This drug from California-based inventor Gilead Sciences is licensed for production by the Swiss pharmaceutical firm Hoffmann-La Roche. Tamiflu has been shown to reduce mortality in the avian flu strain that is of concern, at least in mouse models; and it can be made in a form that is easy to take and has a long shelf live.
Roche began expanding its supply chain after contacts with the Department of Health and Human Services in 2003, and the Food and Drug Administration recently approved a new U.S. manufacturing site.
That said, Roche doesn't have the capacity and won't have the capacity to produce enough to meet the administration's goals for some time.
New York Sen. Charles Schumer recently criticized President Bush's pandemic plan flu for failing to provide antiviral medicine for enough Americans soon enough. Schumer wants the country to follow the lead of some European countries that are seeking to acquire enough to cover 40% of their populations, a level that health experts believe would be safer yet.
All indications are that if you want to really keep a pandemic from getting out of hand and killing hundreds of thousands of people, you're going to need a lot of antiviral at the ready. That's because pandemics run in waves. They can come in two or three over several months. And antivirals only work as long as your taking them, unlike vaccines that offer longer range immunity.
Further, Tamiflu is a rather complicated formula to make, according to Roche. It requires a 10-step production process that can take six to eight months to complete once all materials are on hand. And one key ingredient, shikimic acid, from the star anise plant, is in limited supply.
So, it isn't like you can simply churn out enough additional antiviral really quickly to meet the needs of a nation of 300 million. You have to have it on hand so people can take the full regimen when they need it. If you take less than the prescribed full course, as with anything with drugs, you can encourage mutation into resistant strains.
While Sen. Schumer's concerns are understandable, he proposed the wrong solution to resolve the problem. He threatened Roche with legislation requiring compulsory licensing -- essentially breaking their patent rights. He drew back from that threat when Roche then met with a key New York state generic drugmaker, Barr, to discuss licensing production of Tamiflu here.
With numerous generic drug makers' offices and facilities in his state, Schumer's actions are nothing unexpected - it's a typical political sop to constituents at the expense of others. He made the same threat of legislation against the German pharmaceutical giant Bayer over the anti-anthrax drug Cipro at the height of the post 9/11 anthrax scare. And the Bush administration went along, too. It threatened Bayer until Bayer agreed to cut a deal for cut-rate prices.
The Cipro episode created a field day for anti-pharmaceutical industry zealots, such as Jamie Love of the Consumer Project on Technology, a Naderite group, who told the San Francisco Chronicle: "The Cipro thing was timely. When the US did not like the price of a medicine, we were very fast to say we might override patent rights."
In the current imbroglio with Roche, Love is beating the drums again: "I think it is pretty clear that Roche intends to suppress generic production as much as it can get away with. A failure to issue compulsory licenses liberally will result in a slower response by the generic industry to the capacity and supply problem, and much higher prices, and smaller stockpiles. The private market is likely to be particularly important for those who cannot realistically depend upon governments to protect them." There is nothing Love and the others would like more than to break the current reluctance of developed nations to force licensing of patented medicines to generics manufacturers.
But a failure by the Bush administration and the wealthy western countries to protect property rights for life-saving medicines would be disastrous.
As Bill Gates, whose foundation is providing billions for health programs worldwide, recently noted: "When you think about developing world health, the price of drugs is not the key issue. It's the drugs that aren't being invented, and part of the reason they aren't being invented is that [if] the pharmaceutical companies work in these areas, then they're expected to give the drugs away."
In a new study Avian Flu: What Should Be Done, economist Tyler Cowen argues that respect for property rights and paying fair prices for drugs are especially important if new drugs are to be available for future pandemics, whether the long lasting AIDS pandemic or of the shorter duration but equally kind an avian flu pandemic might pose.
"Confiscating property rights would reduce the incentive for innovation the next time around," Cowen argues. "Moralizing aside," he goes on, "the future supply of antivirals and other drugs still will depend on expected profits. If we eliminate or reduce such profits, we can expect less innovation in the future."
So, Sen. Schumer's reaching immediately for the compulsory licensing threat was not good -- not for the United States or for defeating the pandemic.
The good news, though, is that Roche has agreed to work with the administration to meet its stockpile needs, and has settled its dispute with Gilead, which can now become one of the partners it needs in an appropriate expansion of the production of the drug.
But governments must make sure appropriate incentives are in place so that will happen. As Cowen points out, stockpiles of any particular anti-viral is no solution to a pandemic. It is more important to decentralize supplies and provide timely distribution of any drugs that might be helpful in battling the disease. In short, don't count on any drug being a silver bullet. It is ridiculous that governments worldwide focused so much attention on getting cheap drugs that they failed to promote the invention, development and distribution of those medicines needed to meet a deadly outbreak of avian flu.
Either way, the tough Love approach of whipping drug makers into releasing one drug, and in the process discouraging the production of better ones -- or drugs for the next potential pandemic, whatever it may be -- is no solution.
Yes I have been aware of these incidents, it's too early to say what has happened. 12 cases is not really enough of a study group, there needs to be a report based on a wider and more inclusive sample group
Interesting. Let us know if the "bug" makes the jump.
Check this out:
China: Avian Flu Death Count Uncovered... 310 Dead (5,554 in Quarantine)
Posted on 11/18/2005 6:43:39 AM PST by TigerLikesRooster
China: Avian Flu Death Count Uncovered.... 310 Dead (5,554 in Quarantine)
/begin my translation
Avian Flu Death Count Uncovered.... 310 Dead
| 2005·11·18 10:14 |
Avian Flu Statistic Published by Boxun (boxun.com)
Statistic on Avian Flu, which is spreading in many parts of China, including the actual number of the infected and the dead, were published on Nov. 14 at Boxun.com, a China-related news site.
According to their expose, the number of fatalities in this year up to Nov 12, totals 310 from 13 different provinces, and the number of the quarantined people is 5,554 in total, contrary to the official announcement from Chinese authorities.
Moreover, the numbers in the statistics are lower than the actual ones. These numbers were 'approved' by the Cabinet. The data were provided by an high-level official of Chinese Health Ministry, and it was not revealed the manner in which they came to receive this statistic.
According to the source, since 2004, deadly epidemics are breaking out in many parts of China, including Avian Flu. Since 2005, military was put in charge of epidemic control, leading to tightened information blackout. This kept the accurate report on epidemic situation from coming out to the international community.
The source also said that, the announcement by Chinese Health Ministry is also masking the real situation by resorting to 'technical treatment' or 'unique academic modification and interpretation.' Even when they allow foreign experts or international organizations into China for inspection, they can do it only under Chinese authorities' supervision, which made it almost impossible to uncover the real truth.
Right now, the spread of Avian Flu has become the serious situation in many places of China, and each provincial government is given clear instruction on handling the crisis and keeping out the information.
Currently, Chinese Cabinet and Supreme Military Command issued an instruction, "Anyone suspected to be infected by Avian Flu, or really infected ones should be all confined to designated medical facilities and its report be made to higher government immediately. It is strictly prohibited to reveal information on (Avian Flu) infection without approval of the Cabinet. Any violators will be disciplined and fired or held accountable by further means."
The source also mentioned another authorities' instruction, which says, "If a patient dies (of Avian Flu), you cannot record Avian Flu or H5N1 as a cause of death. A patient suffering infectious respiratory disease, but who did not get treatment at designated medical facilities will not receive assistance such as health insurance. The medical facility which treated this patient will also receive stiff sanction.
/end my translation
Ping to the above post. Thanks for the line little jeremiah!
Thanks to Tiger - longtime freeper, and translator! We appreciate your work.
I believe Boxun.
This is shocking, except that knowing China, it isn't.
Thanks, Tiger, lj, red...
2ndrecon, see post 2116...
If possible, it would be nice to get total deaths or total infections as a sequence as a function of time. I.e. number of cumulative deaths (or infections, either will do just fine) for several different dates. That way I can calculate the growth rate.
I don't particularly care whether the data are accurate, per se. What is important, is that if they are biased (i.e. undereported), they are consistently biased.
I can't read Chineese, and I cannot decipher what the infection/death rate is. The post only provided the net total now.
British Columbia bird with H5 infection but neuramanidase type not yet determined.
Main Entry: neur·amin·i·dase
Pronunciation: "n(y)ur-&-'min-&-"dAs, -"dAz
: a hydrolytic enzyme that occurs on the surface of the pneumococcus, the orthomyxoviruses, and some paramyxoviruses and that cleaves terminal acetylated neuraminic acids from sugar residues (as in glycoproteins and mucoproteins)
Influenza A viruses are divided into subtypes based on two proteins on the surface of the virus: the hemagglutinin (H) and the neuraminidase (N). There are 15 different hemagglutinin subtypes and 9 different neuraminidase subtypes, all of which have been found among influenza A viruses in wild birds. Wild birds are the primary natural reservoir for all subtypes of influenza A viruses and are thought to be the source of influenza A viruses in all other animals. Most influenza viruses cause asymptomatic or mild infection in birds; however, the range of symptoms in birds varies greatly depending on the strain of virus. Infection with certain avian influenza A viruses (for example, some strains of H5 and H7 viruses) can cause widespread disease and death among some species of wild and especially domestic birds such as chickens and turkeys.
(paragraph above from http://www.cdc.gov/flu/about/fluviruses.htm)
VANCOUVER, British Columbia (Reuters) - Avian influenza has been found in a duck on a farm in southwestern British Columbia, but the bird appeared to pose little risk to public health, officials said on Friday.
Officials were alerted to the duck on Thursday, and said initial testing indicated it was an H5-type avian influenza virus, but more testing was needed to identify the specific strain, said Dr. Jim Clark of the Canadian Food Inspection Agency.
Health officials around the world have been on the watch for the H5N1 strain of the virus that experts fear may mutate just enough to allow it to be easily transmitted among humans. There are nine known N strains of H5 virus.
Officials said the virus was discovered in routine tests after the bird was sent to them for unrelated reasons by a commercial packing house.
"We do know that the flock that this bird was taken from appears to be healthy, and is for all intensive purposes well," Clark told reporters.
The farm in Abbotsford in the Fraser Valley east of Vancouver has been quarantined and animal health inspectors were visiting farms within a 3-mile (5-km) area, a move officials said was standard procedure after such a discovery.
Officials said the farm where the duck was raised had allowed its birds to be outside of barns, which meant the animal might have come in contact with wild waterfowl that are known to carry the disease.
"The finding of avian influenza in a domestic duck flock is not surprising. Birds are known carriers of the virus that are commonly raised under conditions that they may be exposed to avian influenza viruses carried by wild birds," Clark said.
A sampling program of birds in a different area of British Columbia over the summer found 24 percent tested positive for H5 bird flu, although none of those birds showed signs of being ill and none was carrying the H5N1 strain.
That program was begun because of an outbreak of an H7 type of bird flu in the Fraser Valley last year. That virus spread quickly among farms and eventually caused officials to cull 16 million poultry in the area.
"In this particular incidence, we have no reason to believe that there is a virus that is going to cause any significant risk on this particular farm itself or farms nearby," said Ron Lewis, British Columbia's chief veterinarian.
The Hong Kong University says each sick person will infect another 1,024 within one month. It is predicted that there will be one million victims in Hong Kong alone. Meanwhile, China has acknowledged a second death.
Beijing (AsiaNews/Scmp) - Each Sars patient was responsible for infecting 27 people in 30 days. Every bird flu infection will cause 1,024 others in a month.
That's 38 times as fast a spread of disease. It is one of the frightening assumptions underlying a disease model that experts hope will help prepare for a H5N1 pandemic. With a worst-case scenario as gloomy as that - it is based on the Spanish flu of 1918, which killed 50 million people - the experts say, not surprisingly, that the first two weeks will be key to containing a bird flu outbreak.
The Centre for Health Protection's disease modelling committee is assuming the first wave of a bird flu pandemic will last three to four months.
Under its worst-case scenario, the disease-modelling team from the University of Hong Kong assumes each flu patient will infect two others every three days. "According to this formula, each index patient will infect 1,024 people in 30 days," said the committee's chairman Gabriel Leung, HKU associate professor of community medicine.
In 2003, Sars infected 1,755 people in Hong Kong, of whom 299 died. Dr Leung said based on the current bird flu outbreak in Southeast Asia, in which more than half the 120-plus people infected have died, the first two to three weeks would be crucial to putting a lid on the spread of the virus.
Dr Leung said his team would work with the Centre for Health Protection around the clock if there is a pandemic.
"We will update the situation in our modelling to get a real-time projection of the number of infected, hospital admissions and mortality rate. The projection will give us an idea when and how to act - for example, the right time to quarantine the infected or distribute [antiviral drug] Tamiflu to the health-care workers."
Dr Leung said the government had to weigh the costs and benefits of the measures it took.
"For example, quarantine and contact tracing are standard procedures, but when we have tens of thousands of cases, are there enough holiday camps to quarantine so many people? And do we have manpower for so much contact tracing?" The centre estimates a flu pandemic would attack a million people in Hong Kong.
China. The mainland last night reported its second human death from bird flu. The 35-year-old woman, a farmer from Anhui province, died on Tuesday after developing a fever and pneumonia following contact with sick and dead poultry, the Ministry of Health said.
November 24, 2005
A resident of northern Israel may have contracted bird flu, the Health Ministry has reported. The man underwent a blood test, after a previous test indicated "further tests" were necessary to clarify his condition.
The man has recovered from the illness he was suffering from and released to his home, but preliminary tests reveal he may still be suffering from bird flu.
The above comments suggest that the patient has tested positive for H5N1 bird flu. These results are cause for concern. Although prior boxun reports suggeste the H5N1 wild bird flu at Qinghai Lake could cause human cases and fatalities, human cases were not reported in Russia. Kazakhstan, Mongolia, or European countries reporting H5N1 wild bird flu.
However recently China has confirmed H5N1 in patients in Anhui and Hunan and a case in Liaoning is under investigation. Moreover, recent boxun reports cite 77 H5N1 human fatalities in Liaoning.
The Middle East is of considerable concern because of the large number of migratory birds that pass through the Middle East when migrating from Europe to Africa. Although Israel has not report confirmed cases of H5N1, they have reported Newcastle Disease, as have many other countries in the Middle East and Europe. In the past, reports of Newcastle Disease have preceeded H5N1 reports in many counries in Asia. There have been many reports of bird deaths in the Middle East and Europe (see map) The Middle East is also of concern because of indiginous H9N2. Those isolates contain doner sequences for the HA polymorphism S227N which could be formed via recombination with H5N1 wild bird flu and H9N2 found in Israel. There details on the possible Israeli case would be of interest, including the HA sequence of H5N1 in the region.
However, they got their own math wrong (they don't understand exponential growth).
Under their assumptions, 1 index patient does not turn into 1024 patients at the end of 30 days, rather, 1 index patient turns into 59,049 patients. The e-folding time is 2.73 days.
Assuming that everyone on the planet could possibly catch this bug in one form or another, then we reach a 100% infection rate (assuming 7 billion people), in 62 days!!!! That, of course, is a ridiculous number. What would happen in reality is what is known as non-linear saturation, which is a fancy term to mean that the linear relationship would no longer hold and the exponential would also no longer hold. But what we do learn from this, is that if these numbers are correct, this thing will hit the world essentially instantaneously.
The prior models have assumed multiple waves over 1 to 2 years. Assuming these data are correct (I cannot emphasize that enough), we learn that this thing will essentially hit the world instantaneously.
Make sure you are prepared. You won't have much warning. Assuming these data are correct.
The Council on Foreign Relations had another Bird Flu meeting this month, with five different forums. The transcripts are posted on the CFR site, and they are a VERY scary read.
council on foreign relations - many transcripts to wade thru....
bitt, I can't thank you enough. I asked you to do this so I could take the lately extraordinary step of notifying everyone of this series of CFR articles linked in your post
This is a very long read, but the information is excellent. If anyone recalls, the CFR had an excellent article last summer on avian flu, as well.
Thanks for the ping.
REALLY scary stuff.
I wish we could get permission somehow, to print the series here. I just read a comment by Dr. Osterholm in the second article that brought up something I hadn't cosidered before.
Most countries are concerned about the virus mutating to the point where there is efficient human to human spread. Let's just remember how fast SARS got spread from China to Toronto--one man on one flight--and it wrecked Toronto health care and their economy for months. SARS is a virus that doesn't transmit efficiently, but influenza spreads BEFORE symptoms show--you can't screen for it at the border, any border.
Which means, according to Dr. Osterholm, that the first country that announces that it has found efficient human-to-human spread of H5N1 is signing its own death warrant--it becomes a place that the rest of the world will not trade with, enter, or allow citizens to leave.
There are two things that jump out here:
1. Nobody wants to be that country. What lengths would a country go to, to prevent that identification?
2. That COULD be the country that makes our US health care workers' masks, gloves and gowns. Or hypodermics. Or whatever.
And it raises another question: How long does it take a country to confirm that it has efficient H2H transmission of avian flu. At LEAST a week. Can we all do the math ourselves?
Here's a link to some excerpts of the CFR transcripts, I just had to read a couple and copied some bits I thought people might want to read, now I'm not sure why I copied it onto this particular thread... Who knows if the parts I copied actually make sense, it's too late for me to be up:
Expert says bird flu has killed 300 people in China
Two things concerned me about the conference. One was my overall impression of the meeting. It appeared to me as a layman that most of the participants were really not up to speed about the H5N1 virus. Some of the questions appeared to be totally inane or off the wall.
The second thing that concerned me is the open admission about human transmission of the avian flu. The experts leading the conference admitted H5N1 has been transmitted from person to person. But they chose to focus on the issue of "sustained transmissibilty."
The fact remains the U.N./WHO has not been permitted into avian flu hot spots in China. Military quarantine has been ordered in some regions by Beijing. Which means the experts are debating medical issues in a vacuum.
The experts appear to be discussing using antivirals on both birds and humans. They were switching back and forth at times. I found it most disconcerting. A brief excerpt from the conference transcript:
In the bird population, we've had resistance to the virus by using [antiviral medication] indiscriminately in that case. Oseltamivir ["Tamiflu"}and the other neuraminidase inhibitors basically prevent the virus from being released from the cell. So basically you want to use it in a situation where you want to reduce the potential for spread and reduce the disease. [My comment: In HUMANS !]. It has been shown to reduce severity of symptoms by a day, half a day in terms of treatment, but more importantly, it's really shown that it's been a protective effect -- (inaudible) -- have actually been exposed to the virus.So it appears to me that the experts are saying that Tamiflu will not help someone who has been infected with H5N1. But it may help to protect other family members or persons in close contact with infected persons. In other words, it may help protect medical personnel.
SUAREZ: Is there a scenario where you can actually make things work by self-prescribing and self-medicating with preparations like that?
WOLINSKY: Absolutely. When we have family clusters, if the -- if one member of the family is actually infected, and we have a number of family members that we want to protect against infection, we don't want to give the drug to the person who's actually infected, believe it or not. We give it to the other family members. If we give it to the person who's infected, it has a high amount of virus replication, and a lot of virus is being put out by -- through respiratory secretions. The chance of getting resistance in that person is very high, and then we lose the protective effect in the other family members.
This is very strange. Because Tamiflu is intended to be used by persons after they have been exposed to the flu. I concluded from my reading, that if you are exposed and begin to show symptoms, taking Tamiflu is useless. I also concluded that medical staff may be required to eat Tamiflu tablets like candy.
No a very hopeful picture being presented at all.
The thing that jumped out to me were the moderater's opening comments:
1. He put everyone on notice that this was going to be in the public record, and comments could be used against the participants. In other words, be very careful what you say, and think about how it will be reported in the news.
2. He defined the framework for discussion right after reminding everyone that this would be in the media: This was to be treated as the classic "insurance" problem. How much should be spent on protection against an unlikely event that will nevertheless be catastrophic if it occurs.
In other words, the official line for public consumption was to be that this is unlikely, regardless of what it might mean if it occurs.
As readers of this thread know, the odds of H5N1 making the jump to easy human to human transmission are actually pretty good. The odds are not 100%, but they are a lot higher than 50/50.
The real questions are WHEN?, and will the easily transmissible version be milder than the versions we are seeing now.
Thank you for the clarification 2ndreconmarine. It is greatly appreciated.
Thanks for the info/links on those chilling CFR transcripts.
And thank you for yours, too...
HALIFAX (CP) - Thirty-six healthy, wild ducks from the Maritime provinces have tested positive for H5 and H7 strains of avian influenza viruses.
Researchers are quick to point out that these results do not indicate any increased threat to human health or commercial poultry flocks. Of 710 birds tested as part of a national wild bird surveillance program, 35 in the Maritime provinces were found to be carrying H5 viruses and one carried an H7 viruses.
Most of the birds were taken from an area along the border between Nova Scotia and New Brunswick.
Additional testing needs to be done to identify which strains of H5 viruses were found.
But health officials say it is unlikely the viruses are the same as the virulent H5N1 strain causing widespread outbreaks among birds in southeast Asia. That strain has been blamed for at least 68 human deaths.
The H5 and H7 viruses were the first officials looked for because some viruses of these subtypes are highly pathogenic and can trigger economically devastating outbreaks in domestic poultry. Smaller numbers of birds infected with H5 and H7 viruses have been found in British Columbia, Manitoba and Quebec as part of the surveillance program.
The Maritime samples have been sent to the National Centre for Foreign Animal Disease in Winnipeg to confirm preliminary results and to determine the subtypes of the viruses.
Bird flu outbreaks have continued to spread in Vietnam, while a man suspected of being infected with the virus fled a hospital quarantine unit, state-controlled media reported today.
The southern Mekong Delta province of Long An became the newest area to report bird flu outbreaks among poultry, the Department of Animal Health said on its website.
Outbreaks have been reported in 19 other provinces throughout the country since October, killing or forcing the slaughter of more than 1 million birds, it said.
Meanwhile, a man was admitted yesterday to the General Hospital in southern Tien Giang province with a high fever and difficulty breathing, the Tuoi Tre (Youth) newspaper said. He was transferred to an isolation ward, left to buy personal items and never returned, it said.
The man told doctors he slaughtered his sick chickens a week before falling ill, the newspaper said. Officials in his home province of Ben Tre have been trying to persuade the man to return to the hospital, it said.
In addition, todays Pioneer newspaper reported that the Ministries of Agriculture and Finance have jointly asked Prime Minister Phan Van Khai to provide financial assistance for farmers in unaffected areas who raise more than 500 poultry to try to lessen their losses.
The proposal comes as more and more people shy away from poultry, making it increasingly difficult for farmers to sell their products.
The ministries also requested rescheduling debts for poultry farmers for one year, it said.
At least 67 people have died from bird flu in Asia since 2003, the bulk of them in Vietnam.
Health experts fear the virus could mutate into a contagious form that spreads easily from person to person. So far, most human cases have been traced to contact with birds.
Bird flu has been detected throughout the Indonesian capital, Jakarta, with the country's Agriculture Minister Anton Apriyantono admitting: "It's very serious. Based on our research, the virus has spread all over the city."
Saturday, November 26, 2005
Bird flu has been detected throughout the Indonesian capital, Jakarta, with the country's Agriculture Minister Anton Apriyantono admitting: "It's very serious. Based on our research, the virus has spread all over the city."
Excerpted due to copyright (AP)
November 25, 2005
The Health Ministry announced Thursday that contrary to an earlier announcement it is possible that an Israeli man hospitalized Saturday at Rebecca Sieff Hospital in Safed may have contracted a virulent strain of the bird flu virus. The man's blood will be further tested both in Israel and England, the ministry said.
On Tuesday the Health Ministry reported that it was examining suspicions that a 57-year-old Galilee resident, hospitalized since the weekend, had contracted bird flu. The man was employed at the Lake Hula nature reserve and his job was to feed the birds there. A test on saliva taken from his pharynx showed that he did not carry the virus, but on Thursday it was revealed that his blood tests raised suspicions that he had the disease, and had probably contracted a virulent strain of the virus.
The above comments suggest that the 57 year old patient has contracted H5N1. A positive H5 antibody at this early date is an indication of significant antibody. If the titer increases four fold, the data will represent confirmation of H5, which would be the first confirmed H5N1 human case outside of Asia.
Although Israel has not reported H5N1 in birds, H5N1 has been reported in OIE reports from Turkey, Romania, and Croatia. Although there have been many reports of dying birds in the Middle east, media reports indicate only Kuwait has confirmed H5N1 in a wild bird (see map).
H5N1 is expected in Israel. H5N1 in wild birds was widely detected in Siberia over the summer. The positive birds were in migratory flight paths that go from Siberia to the Caspian and Black seas in the fall and then to Africa for the winter. During the migration from Europe to Africa, 500 million wild birds fly over Israel and adjacent countries.
H5N1 infections in Isael are of particular concern because H9N2 isolates in Israel contain donor sequences to create S227N in HA. This polymorphism increases HA affinity for human receptors, which would be associated with more efficient transmission to humans. Moreover, all H5N1 wild bird sequences of PB2 contain E627K, which has been associated with increased virulence in mammals as well as the ability to grow the 34 C. The ability of H5N1 to grow at the lower temperature would also increase the efficiency of transmission to the upper respiratory tract.
Thus, it would be useful to test contacts of the patient to identify additional positives and isolate the H5N1 for sequencing. Detection of HA S227N would represent a serious increase in the efficiency of H5N1 to infect humans.
Official Chinese bird flu deaths could be 'tip of iceberg'
Updated 12:31 25 November 2005
Bird flu special report, New Scientist
A respected Japanese scientist, who works with the World Health Organization, has told New Scientist he fears that Chinas official tally of laboratory-confirmed human bird flu fatalities just three is only the tip of the iceberg.
Masato Tashiro, head of virology at Tokyos National Institute of Infectious Disease a WHO-collaborating centre for bird flu showed a slide at a meeting of virologists in Marburg, Germany, on 19 November listing several dozen outbreaks in people, 300 deaths, 3000 people placed in isolation, and seven human-to-human transmissions. The meeting was reported in the German newspaper Frankfurter Allgemeine Zeitung.
Tashiro has now told New Scientist that the figures were examples of the unauthorised information circulating in China, where he was recently helping investigate the outbreak in Hunan for the WHO.
Earlier reports suggested that Tashiro believed 300 to be the true death toll from bird flu in China. I do not know whether the numbers were based on any evidence, he says.
But the message is that we do not know how many cases actually occurred in China, due to poor disease surveillance. If surveillance is done more extensively, more cases may be detected. He says the international community should assist China with monitoring. He describes the situation as an "iceberg phenomenon" with most cases unreported.
China has reported only three confirmed cases of H5N1 in people: a boy in Hunan province who recovered, and two women in Anhui province who died, the latest of which was announced on Thursday. There was another probable case in Hunan.
The potential problem of underreporting may not only be technical. There are also claims that Chinese medical personnel have been arrested for trying to report cases. China enforced severe restrictions on the investigation and reporting of suspected cases of bird flu in June 2005.
But the WHO says it does not believe China is deliberately hiding cases as it did during the SARS outbreak in 2003. "There are many countries where surveillance is weak and needs to be strengthened, I think that's true in certain parts of China as well," says Roy Wadia, a WHO spokesman based in Beijing. "We're getting lots of information in a timely way about the outbreaks and we're asked to be part of the ongoing investigations. I think that speaks for itself."
Virologists consider the relative absence of human cases of bird flu in China unusual, given its widespread infection in birds. China has reported 22 poultry outbreaks in 10 provinces all across the country since mid-October 2005, the latest being on Friday.
The WHO told the official Chinese news agency Xinhua last week that the virus that caused the outbreak in Hunan is the same as the H5N1 flu in Vietnam and Thailand, where it has caused 113 confirmed human cases and 55 deaths so far.
Now, for China's version:
BEIJING, Nov. 25 (Xinhuanet) -- China's Ministry of Health (MOH) on Friday refuted a rumor on the Internet spread by a Japanese virologist saying China has had several hundred human deaths from bird flu.
"The rumor is absolutely groundless," MOH spokesman Mao Qun'an told Xinhua in an interview.
"MOH has confirmed from the World Health Organization (WHO) Beijing office that there was no Japanese expert in WHO's mission in Hunan Province early this month," said Mao.
All the reports quoting this so-called Japanese expert said that China has had several hundred human fatalities from bird flu were unreasonable and without foundation, he stressed.
China so far reported three confirmed human cases of bird flu, including two deaths in east China's Anhui Province and one recovered case in central province of Hunan.
In the areas where bird flu outbreaks occurred, health authorities have put all the people who closely contacted with sick and dead poultry under strict medical observation. Surveillance, reporting and separate treatment of fever and respiratory cases have also been strengthened, said Mao.
MOH has made timely report to WHO, Hong Kong, Macao, Taiwan and some countries on each confirmed case and has immediately released the information to the public as well, he said.
The cooperation between the Chinese government and WHO on bird flu control has been going smoothly, a spokesman at WHO headquarters was quoted by Mao as saying.
China is not covering any human cases of bird flu and the Japanese expert has never visited China on a WHO mission, the WHO spokesman confirmed, according to Mao.
The Japanese expert named Masato Tashiro said last week that in Germany that bird flu has killed 300 people in China, including seven cases caused by human-to-human transmission, according to reports on the Internet portals including "news scientist" and "WorldNet daily".
This is potentially major news. Let's hope Israel handles this correctly. The stakes are VERY high.
Thanks. I will read every word. The Indonesian man at the CRF meetings used the same phrase - that the nine documented H5N1 patients are but the "tip of the iceberg", that no one really has any idea of how many humans have gotten it. And he's the expert, so if he doesn't know, no one knows.
Unknown quantity: bird flu in Cambodia
24 November 2005
When people think of bird flu in Asia, Cambodia rarely springs to mind. It is usually either the massive culling of birds in China or new outbreaks in Indonesia or Vietnam that grab the headlines.
Yet the H5N1 bird flu virus is widespread in Cambodia's poultry and wild bird populations alike. And with the country's limited health care capacity, inadequate surveillance and poor public health awareness, any investigation into bird flu here is a journey into the unknown.
To read more go to: http://www.scidev.net/gateways/index.cfm?fuseaction=readitem&rgwid=3&item=Features&itemid=481&language=1
Why am I not surprised?
Scientists, producers slam proposal to force poultry indoors
Last Updated Nov 25 2005 02:23 PM CST
Chicken producers and scientists have been quick to criticize the province for considering a move to force all birds to be raised indoors.
The move comes after several wild birds in the province tested positive for the H5N1 virus. While this is not the strain blamed for human deaths in Asia, provincial officials would rather be safe than sorry, so they are considering among other possible risk-limiting measures a move to have all poultry raised indoors to limit the risk of wild birds passing on the avian flu virus to domestic birds.
In the previous pandemic of 1918, that is what happened. there were cases world wide reported within days of each other. That is part of the problem of finding how it spread. When in the same week there are outbreaks in Jakarta, New Deli, and Boston, finding the source is very difficult.
We won't have much warning. Days probably if we are lucky.
Ex, a respectable amount of evidence exists to the contrary. Lives have been saved by Tamiflu recently, after exposure, infection, and influenza symptomatology (H5N1). Spend some time on the influenza forums and you will see. Many people, including "professionals" have been mistaking antibiotic-type genetic resistance for the H5N1 situation, where resistance is seen due to the incredibly prolific replication ability of the virus. In other words, it overwhelms a normal dose and course of Tamiflu. Better results have been seen with a double or triple dose, for twice the time of the normal course. Hence my PM question about probenecid, which increases the level and duration of Tamiflu in the body.
I'm not about to bet my family's lives solely on Tamiflu, but one of the best anti-virals out there definitely seems like a good start, even if imperfect. Comments welcomed.