Skip to comments.Avian Flu Surveillance Project
Posted on 05/09/2005 10:18:08 AM PDT by Dog Gone
click here to read article
A UK doctor writing in the British Medical Journal has warned that governments around the world must stop burying their heads in the sand over the growing threat of a global epidemic of avian flu. Dr. Nigel Higson writes that disasters like the Asian Tsunami will "pale into insignificance" when compared to the human cost of an influenza pandemic which has the potential to wipe out "hundreds of millions" of lives.
Higson says the catalyst for government action should have been the discovery earlier in the year that avian flu (known as strain H5N1) is now spreading via human to human transmission. "Development of vaccines against H5N1 needs government pump priming, as will the stockpiling of euraminidase inhibitors, which should be effective against avian flu," writes Higson. "It is many years since a pandemic struck, and people have become complacent in that time. For governments to bury their heads in the sand may have some benefits in many political areas but it will be disastrous in terms of pandemic planning."
Now that human to transmission has been confirmed, Higson believes that doctors should prepare themselves for the practicalities of treating epidemic or pandemic influenza as well as encouraging increased pharmaceutical company capacity.
Thanks starting the thread.
Thanks for taking on this project.
A friend of ours was diagnosed with a type of avian influenza some years ago. While it did not prove fatal, it has left him permanently impaired with decreased lung function because of it. When I speak with his wife tonight I will ask if they remember exactly what the "name" of the diagnosis was.
At the time of his diagnosis that was the least of their concerns because it was discovered while he was being treated for tuberculosis. However there was some speculation at the time that it may have been present in his system for many years from exposure while he was a medic in Viet Nam, but only surfaced when his system became impaired due to the TB.
Good idea...we have a ping list for it?
If so..put me on both...
I'm not going to post the full article because it's reasonably lengthy and somewhat over my head, but here's a snip:
TORONTO (CP) - A diagnostic test designed by Canadian researchers and used in Vietnam to detect H5N1 avian flu is out of date, scientists from the National Microbiology Laboratory admit - raising the possibility some human cases may have been dismissed in error.
The test was designed at the Winnipeg lab using genetic sequencing information from samples of the virus that circulated in the first quarter of 2004. But the virus has changed enough since then that questions have surfaced about the test's sensitivity.
Tracking the virus's forays into and among humans is critical, given fears that H5N1 may acquire the ability to easily transmit from person to person, sparking an influenza pandemic.
"Well, you have to be concerned," says Dr. Earl Brown, a virologist at the University of Ottawa who specializes in influenza evolution. Brown was not involved in the design of the test.
"You want to have a good idea of how much infection is going on out there. And if you're starting calling certain people with pneumonia or whatever infections negative when they're not, then you're not recognizing the full situation."
This is not the first suggestion that labs in Vietnam may have underestimated the number of positive cases there.
Earlier this year, Japanese scientists retested a number of specimens that technicians at a lab in Ho Chi Minh had determined were negative. The re-analysis found several of the rejected cases were actually positive.
Full story is here.
Just that snip makes it more imperative that I find out just what it was my friend was diagnosed with.
I sure hope the vaccine makers are working overtime to produce enough effective vaccine. With this strain being so lethal, I'd think just about everyone in the country would want to get vaccinated.
Please add me to the avian flu watch ping.
I agree with you.........and that would include even me, who avoids shots when at all possible.
Dog, I'm going to ping the list here in a moment. Then I'll pass a copy to you for maintenance, is that okay?
Ping to you all to the new surveillance thread for avian flu. If you want on or off the list, please FReepmail me or Dog Gone.
My reasoning is that most people interested in the Marburg surveillance thread would likely be interested in the avian flu thread.
Please excuse the ping, and notify me or Dog Gone if you want on or off.
Sure, that'd be fine.
please add me to the ping list.
brazzaville, you're already on. ;-D
KSApplePie_Two, you're added. ;-D
It's a good thing that two of us are keeping a list. I'm not always where I have access to mine...;-D
Judith Anne, I suggest setting up a "Biothreats" thread-to embrace naturally-occurring and deliberate events.
Great job! This new thread is a very good move.
I'd rather not do that, for the reason that Marburg is a pretty discrete topic, with lots of information pertaining to Marburg alone, and so is the one on Avian flu.
A separate whole forum for Biothreats, with various discrete disease topics would be the only way to encompass all the various biothreats, but frankly, I don't think that's too likely to happen.
What I DO see is where you're coming from and why, but at this point, I've got all I can do to keep up.
There is a lot of interest in, and news on, avian flu. Looking like it may get here in the US this fall (maybe).
Thanks for the ping. I want to stay informed.
I read, and I often understand, but I'm not sufficiently knowledgable to post on either this or the Marburg thread. Thank you to those FReepers with expertise in associated fields who keep the rest of us up to date.
Does anyone here know how far along researchers are in developing a vaccine for avian flu? Perhaps Kelly_2000 can help us here? Are sufficient resources being allocated, or is this something about which our government reps need to be better informed?
Since this thread is new today, perhaps some posted background basics -- why the worry, what's being done, etc. -- would be appropriate for later referral. Or maybe a post with collected links to earlier flu threads, like was done for Marburg.
Just suggestions from a layman.
On the contrary, your suggestions about background information and articles being posted here are excellent. It certainly slipped my mind.
I'm not sure who has a list of background articles, or if anyone does...
I'll go look up a couple, probably from WHO and the CDC and post links here shortly.
Here's a link to an article from the New England Journal of Medicine, entitled "Preparing for the Next Pandemic" dated May 5, 2005:
This is a really excellent overview of the situation, in my opinion.
Beyond research and development, we need a public health approach that includes far more than drafting of general plans, as several countries and states have done. We need a detailed operational blueprint of the best way to get through 12 to 24 months of a pandemic.
What if the next pandemic were to start tonight? If it were determined that several cities in Vietnam had major outbreaks of H5N1 infection associated with high mortality, there would be a scramble to stop the virus from entering other countries by greatly reducing or even prohibiting foreign travel and trade. The global economy would come to a halt, and since we could not expect appropriate vaccines to be available for many months and we have very limited stockpiles of antiviral drugs, we would be facing a 1918-like scenario.
Production of a vaccine would take a minimum of six months after isolation of the circulating strain, and given the capacity of all the current international vaccine manufacturers, supplies during those next six months would be limited to fewer than a billion monovalent doses. Since two doses may be required for protection, we could vaccinate fewer than 500 million people approximately 14 percent of the world's population. And owing to our global "just-in-time delivery" economy, we would have no surge capacity for health care, food supplies, and many other products and services. For example, in the United States today, we have only 105,000 mechanical ventilators, 75,000 to 80,000 of which are in use at any given time for everyday medical care; during a garden-variety influenza season, more than 100,000 are required. In a pandemic, most patients with influenza who needed ventilation would not have access to it
Good Deal (bump)
I want on this ping list too, please.
I haven't seen a single story about how the vaccine companies are addressing this situation and what their capabilities will be.
If a pandemic is probable or even possible, what exactly are we doing about it? I don't think it's an unreasonable question.
According to my copy of the list from Dog Gone, you're on it. Did you get pinged, earlier?
Well, DG, the problem is we don't know enough about the virus to make a vaccine yet. In fact, the test for the current group of avian flu cases depends on identification from the virus circulating in fall, of 2004.
It's thought that the virus has changed enough that there are false negatives, leading to a whole host of difficulties. In fact, it's fairly certain that there are an unknown number of false negatives, and that we cannot currently identify avian flu from the tests we presently have.
I'll post a commentary from Recombinomics here in a second.
Pandemic Flu False Negatives in Vietnam and Korea
May 8, 2005
>>Genetic sequences from more recent versions of H5N1 are needed to produce more up-to-date test components, called primers.
Primers are tiny strands of synthetic nucleic acid used in PCR or polymerase chain reaction testing. If they are a perfect match for the influenza strain, primers used in flu tests should bind to the RNA of the virus.
Kobasa and lab technician Laura Hart spent several weeks at the National Institute for Hygiene and Epidemiology in Hanoi, sharing diagnostic expertise and helping Vietnamese scientists assess their testing proficiency.
That is when the problem with the primers came to light.
"There've been enough changes in the viruses between last year and this year that we found some of our PCR primers did not work that well," says Kobasa, a researcher in the division of respiratory viruses.
The comments above offer some explanation for the false negatives in southern Vietnam. Earlier this year, tests from the National Institute for Infectious Diseases (NIID) in Tokyo found that several samples that tested negative at the Pasteur Institute in Ho Chi Minh City tested positive in Tokyo. The number of false negatives was initially reported as 7 of 30. The number was raised to 11 of 30 in follow-up NY Times report.
These numbers indicated that approximately 80% of the H5N1 positive cases in southern Vietnam were being missed. Recent reports indicated a missing amino acid has been detected in isolates in northern Vietnam, suggesting those isolates were recombinants between isolates from Vietnam and isolates from China. It seems likely that there have been primer problems in northern Vietnam also, which may explain why northern Vietnam sent 1000 samples to CDC for testing.
The lowered sensitivity for tests in the south may be do in part to an evolving H5N1, which continues to recombine with the many versions of the virus in Vietnam and new versions brought into the area by migratory birds. This primer related sensitivity problem may also explain why Thailand failed to identify any human cases this season when H5N1 was detected throughout the country in a wide variety of domestic and wild birds. Human Influenza A cases were testing negative for H5N1. The testing was almost certainly also based on the 2004 sequences, which had changed in 2005.
For Vietnam and Thailand, new probes relied in part on new sequences. However, primer issues may have also played a role in the WHO's failure to find WSN/33 sequences in swine in Korea. However, for the Korean sequences, the 2004 sequences were known in 2004 and had been deposited at GenBank in 2004. However animal quarantine in Korea as well as consultants to the WHO failed to confirm the data. In 2005 they did find H1N2 sequences in Korean swine, but these sequences had been reported previously in swine from the United States and Korea. They were quite different from the human WSN/33 sequences, or the original WSN/33 sequences or the closely related sequences found in swine.
The WHO had written up a release that described these 27 isolates from 2 farms in Korea. Although a draft was distributed to media, it remains unclear if the release ever went out to a larger audience. A small number of these isolates were sequenced and no WSN/33 was found in the limited number of sequences generated. However, it remains unclear if the primers used to generate the H1N2 sequences would have detected WSN/33 sequences.
Thus, the lack of primer specificity may have generated false negatives in Vietnam and Korea. The inability of the WHO to monitor H5N1 and WSN/33 seriously impacts any intervention strategy. The results from the 1000 samples from northern Vietnam have not been released. It remains unclear as to how much sample collection has been done from patients with flu-like symptoms. In northern Vietnam the case fatality rate has fallen to 20%. Many of the recovered patients are H5N1 positive, but have a relatively short hospital stay, which suggests a large number of milder cases may not be seen by physicians or hospitals.
Similarly, it is not clear where the WSN/33 sequences are in Korea, or how the 1933 human lab virus made its way into swine in Korea. Since Korea imports pigs from the United States and H1N2 was detected in the United States prior to being detected in Korea, the H1N2 and WSN/33 infections could date back to 2001 or earlier.
Strategies based on control of H5N1 bird flu or WSN/33 pandemic flu dependent on early detection have limited chance of success if the presence of the virus is largely unknown.
Then we're screwed. I'm not willing to accept that yet without an admission from the pharmaceutical companies.
If it takes six months to manufacture and distribute a vaccine, and if they don't have one already in the works for avian flu, the earliest we could see one is in November if they start tomorrow, and that's too late.
The only hope we'd have then is that it somehow doesn't spread very fast in Asia and doesn't hop continents.
"If we're lucky, the story and this thread will fade away."
And if we're not the peregrines will fly it intercontinent.
The threat matrix threads have been incorporating all bio hazard info along with chem and nuclear as it appears on the net.
I think I did. I'm running two ping lists, and am currently overwhelmed!
That's all right, idle mind/devil's workshop and all that.
I posted this on the Marburg thread but was told this is a good place to post it also.
To those that wish to form a Bird Flu surveillance project thread...This story should scare you.....Marburg is scary but at the moment it pales to what is going on in Asia.
HONG KONG: More than 10,000 people, mostly children, have been suffereing from flu symptoms during an outbreak in southern China during the weeklong Labor Day holiday according to media reports.
The victims had symptoms including runny noses, cough and fever.
More than half of the 10,000 people who contracted the virus were children, the report said, adding that a hospital in the city of Shenzhen had to set up temporary beds to accommodate nearly 700 children admitted daily during last week's holiday.
A man surnamed Shen who answered the phone at Shenzhen's health department said he didn't have information on the outbreak.
Asian countries are vigilant about flu outbreaks amid warnings that bird flu could mutate and become easily transmissible among humans, sparking a pandemic that could kill millions.
Bird flu has killed 52 people in Vietnam, Thailand and Cambodia since it began ravaging poultry farms across Asia in late 2003, but there have been no signs of human-to-human transmission so far.
I like the last paragraph the best. When have you heard of 10,000 people getting the flu in the same week? The case for human-to-human transmission is made in this article and the MSM ignore the facts and just report what the government says. Just proves that reporters are among the dumbest people on the earth.
and a second post..
The above is dated 05-08-05 but if that isn't enough look at this posted 04-11-05.
Hospitals in Ho Chi Minh City have been filled with thousands of children who have caught respiratory and digestive illnesses due to the hot weather.
Pediatric Hospital I reported that it had examined nearly 4,000 children patients a day with some 85 per cent of them suffering from respiratory problems, said a hospital doctor.
Meanwhile, more than 3,000 children were brought into Pediatric Hospital II on Monday. One-third of the children had respiratory problems and 300 others had digestive problems.
Besides, many children have been hospitalized for brain diseases caused by the entero virus.
The major reason behind the illnesses is that children are sleeping all night with fans on due to the hot weather in recent days.
April and May are probably the hottest months of the year in the South of Vietnam.
Thus, the children have lost a lot of water from their skins and are easily immune to respiratory illnesses, said Dr. Nguyen Duy Tien from Pediatric Hospital I.
But you know mass infections of thousands of children happen every day. Right? There is no human-to-human transmission of a flu strain that humans have no immunity going through South Asia like wildfire is there? So the question is this, Do you trust the media and government to tell you the truth and facts? If you do I have a bridge you maybe interested in buying....they would rather you know about the runaway bride or Jackson
One final note. What do you think would happen to this Economy if tens of thousands of people could not go to work at the same time in the same city. If parents had to call off to stay with sick kids. If schools were canceled to prevent spreading of infection. In this just in time inventory system that America runs on it could be a nightmare. p.s. I can just imagine the law suits being filed if an infected person died in a gym because there wasn't enough beds in the hospital.
I wonder why he is promoting protein inhibitors over and above vaccination? protein inhibitors such as this are only effective if taken prior to the onset of symptoms, they also retard the replication of the virus not relieve symptoms, in the case of influenza high risk groups are still at risk of succumbing to symptoms that impair and impact the respiratory system (ARDS chiefly). The most effective proactive measures against a pandemic of this nature would be timely and relevant vaccination as well as symptomatic relief for infected high risk groups. The majority of the mortality statistic is made up from the elderly (65+), infants under 2 years old, people with weakened immune systems, caregivers and people with chronic conditions such as asthma, diabetes, heart or lung disease. If this is undertaken then most patients will recover, remember that influenza for instance is not attributed with a high mortality statistic it kills the high risk in the main, even in pandemic years.
the government only becomes aware of the danger of pandemic when it is too late, once the filed reports are coming in, there is not much that can be achieved only reactionary measures. It is far more likely that a proactive strategy will result in less fatalities globally.
Nice thread Judith well done :-)
Thank you for this and please put me ON the ping list svp.
Judith Anne I posted this story separately but since I dont know how to 'link' to other articles here I'm going to repost the news story here since it may be relevant to your point...hope that is ok.
Experts mull possibility of vaccine protection against pandemic flu strains
CP ^ | 24/04/2005 3:48:00 PM | Canadian Press
Posted on 04/27/2005 11:53:34 AM EDT by FYREDEUS
TORONTO (CP) - When the next influenza pandemic hits, vaccine will be the key defence for countries that can afford it. But there will be inevitable if agonizing months between the emergence of a pandemic strain and the point when vaccine is ready to be plunged into arms.
Some influenza experts, though, have started to debate whether it's really necessary to wait for a pandemic to ignite before moving to protect people against virus subtypes on flu watchers' Most Feared list.
Wracked by concerns the world might be watching the unfolding of a pandemic, they are searching for out-of-the-box solutions to reduce the devastation to human health and the global economy that one would wreak.
Dr. Jesse Goodman is among those mulling over the notion of trying to create some population immunity to threatening flu strains during interpandemic times.
The idea is still "very exploratory," admits Goodman, director of the Food and Drug Administration's centre for biologics evaluation and research, which regulates vaccine production and sales in the United States.
"I think there is an opportunity to think about: Can we prepare and provide some protection not in a crisis mode, but more ahead of time? Ahead-of-the-curve kind of mode," he suggested in a recent interview from Washington.
"I think this is a strategy worth considerable thought and discussion. . . . (But) it's not something one would just do without a lot of thought and evaluation."
The idea would most likely entail adding a fourth component to the annual flu shot, which currently protects against the three flu strains - two influenza A and one influenza B - experts predict will be dominant in the coming flu season.
Adding a fourth strain could awaken or prime the immune system to viruses it's never seen before. Like the H5N1 strain smouldering in Southeast Asia. Or the H7N3 strain behind British Columbia's 2004 avian flu outbreak. Or H2N2, the 1957 pandemic strain recently sent in unlabelled vials to more than 5,000 labs around the world.
(While the flu world fears H5N1's lethality, some experts argue H2N2 is the top contender for the next pandemic strain because of its proven ability to infect and spread among humans.)
It is widely believed people would need at least two shots - a primer and one or two boosters - to get good protection against a flu strain their immune systems has never battled.
This idea would see a generic primer to H5N1 or H2N2 delivered well in advance of need. Once a pandemic starts and a vaccine targeting the specific strain is produced, the booster or boosters would be administered. If a large segment of the population was pre-primed, vaccine production time could be cut dramatically.
University of Ottawa flu expert Dr. Earl Brown says the approach could give pre-vaccinated people "a leg up."
"It has some merit in that you should have some (protective) advantage," Brown says, adding that even without the booster shot, people who'd been primed might have some protection. "Maybe some people wouldn't get as severely diseased."
The head of the World Health Organization's global influenza program also sees the theoretical appeal of the notion.
"Logistically, it could make sense that during ... peace times like now you vaccine everybody and then when it comes to mass vaccination needs . . . you'd only need to apply one dose," says Dr. Klaus Stohr.
But Stohr is also quick to point out what might be the single biggest impediment to the idea - the issue of liability. While flu shots are considered to be among the safest medical interventions available to public health, no vaccine or drug is risk-free.
The flu community knows that too well, having learned the lesson the hard way during from the swine flu debacle. In the spring of 1976, four U.S. Army recruits fell ill with what was discovered to be a swine flu similar to the 1918 strain that caused the worst infectious disease outbreak in recorded history, the pandemic know as the Spanish Flu.
Fearing the 1918 virus was readying itself for a new assault, the U.S. government mounted a mass vaccination campaign aimed at protecting every American.
Swine flu never took off, but another health threat did - Guillain-Barre syndrome.
A small but significant number of people who got the swine flu shot developed the potentially fatal neurological condition, resulting in major lawsuits. To this day, the rare syndrome remains linked to influenza vaccination, though only one study has shown an association and then only at the rate of one case per million people vaccinated.
Still, swine flu instantly comes to mind when the flu community starts discussing the ethics and liability concerns raised by the notion of vaccinating people against a theoretical risk.
"The bar does rise," Brown admits.
"If you vaccinate your whole country, you've got to be concerned that everybody for the next two or three months is going to blame whatever bad happens on the vaccine."
Vaccine expert Dr. John Treanor sees other problems as well. Treanor thinks pre-priming might actually work, though it would need to be proved through testing.
But he says with current flu vaccine production limitations - old technology, capacity to make vaccine for only a fraction of the world's populace - "it's probably not going to fly.
"It's been quite difficult just to make the regular vaccine. Add another component, it just makes it that much harder. It might make it so hard it couldn't be done," says Treanor, director of the vaccine treatment and evaluation unit at the University of Rochester, one of three centres testing an experimental H5N1 vaccine for the U.S. government.
Stohr points out another issue. Pre-priming, if it worked, is only really an option for affluent countries.
"We must also not forget that we are talking about a privileged part of the population. Those who can already afford the seasonal vaccine would have access to it. And the others would again draw the short straw."
Goodman knows all these arguments, but feels the notion is still worth exploring.
"It needs a careful discussion" he says.
"But in the long run, if you really do think about it more optimistically, what you realize is that with good surveillance systems we do have the possibility of knowing what are potential pandemic threats and thinking about these kinds of strategies."
Add me to the ping list.
S.Korea Suspects North's Bird Flu Outbreak Extensive
Mar 29, 2005
Good article thanks
Glad you liked it...I would have pinged you to it back then but dont know how to do that either...the Help article here isnt entirely helpful with how to do such things, unless perhaps its a 'do it in HTML' thing. I'm even less [read that UN]skilled at HTML than typing...and you know how sloooow I am with that lol.
Visit Dave's Site! Scroll down to find the links that are relevant to your need. :-)
Merci Beaucoup :-)
/offcolor humor attempt on
Then again, there was that funny looking chunk of hairy meteorite we passed amongst office co-workers about a week ago...
/offcolor humor attempt between coughing episodes off
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