Liens pour les nouvelles. (CLIQUEZ ICI)

Juillet 2006

7/29/06      Bird-flu patient numbers soar Pinij Charusombat asked a special medical committee to report on the prescription of anti-viral oseltamivir, after an escalation in the number of people exhibiting symptoms similar to those caused by bird flu.

7/28/06      The big news today is that there are 11 more suspected human cases in Phichit, Thailand, where there has already been one death. Obviously, this is a big group, and if confirmed, people will be looking for clusters. Warning: with the death, panic and fear could be a possible cause. India is preparing to declare itself bird flu free.

India is also declaring that Asia needs $500M more to fight the bird flu.

Asian countries have signed the "Delhi Declaration." This will outline the regional cooperation envisioned to fight the bird flu.

UN confirms bird flu on Laotian farm.

Interesting article. Claims that recent scientific research says that the real killer of the 1918 flu might have been undetected tuberculosis.

Link to the direct report.

International Medical Corps' Director of Evidence-Based Research, is traveling to Mongolia, China, Thailand, and the surrounding Mekong countries to meet with various UNICEF country teams focusing on Avian Influenza research and behavioral change plans.

Wildlife monitoring will be taking place in Chattanooga.

Effect Measure comments on a report that the Indonesians are nearly bragging (my perception) about having bird flu isolates and keeping them for their own research. By the way, their own secret research says there is no human adaptability going on.

Amador County, CA, will hold a pandemic exercise.

Hempstead County, AR, is doing bird flu planning.

CIDRAP reports on the duck hunter study from earlier in the week.

This local story says there are actually 22 suspected cases. It also says the Thai government is afraid that Tamiflu will be overused and a resistant strain will emerge.

CIDRAP on Thailand and Laos. Says there are reports of 44 suspected cases.

ProMed on Thailand and Laos.

Recombinomics on Thailand.

7/21/06    Animal updates:1)  Bulgaria finds avian flu in domestic birds there  are very few details but it appears to be in 3 different backyard flocks.  This would suggest that it is less likely to be from commercially traded/illegally smuggled birds and more likely to be from migratory spread.  There is no way to know for sure.  Bulgaria is right next to Turkey which has seen wild outbreaks in the past year.  It is very difficult to truly sterilize an area and there can be sporadic reoccurrences.  Typically there is a animal reservoir that keeps the virus alive.  The virus was detected at a local lab and needs confirmation studies at an EU lab.

7/21/06  Preparedness reminder:  Coping with a flu pandemic- the Washington Times has a nice Op/Ed piece on Avian Flu prep.  Check it out.  It is very straight forward and matter of fact without being inflammatory.

2) Questionable Bird Flu Remedies Uncovered there are always opportunists who want to take advantage of others.   I would strongly advise to avoid all "herbal remedies"- at least to say I would not depend on them to do any good.  Tamiflu is the best studied and that is still not well studied for avian flu.  You probably need to take it within the first 48 hours of symptoms.  The best thing to do is have great hygiene, and stay away from anyone who is sick, and if things are really bad, stay home!  That means to be prepared to do any/all of the above. 

7/20/06    Human updates:1)  International test confirms 42nd bird flu human death- this is to be expected.  "The man was confirmed to have bird flu by the Hong Kong laboratory. There were dead chickens around him, but chickens around his neighborhood tested negative for bird flu," I Nyoman Kandun, director-general of communicable disease control at the Health Ministry, told Reuters.  This comment is a bit obscure.  Did the chickens at his house/work have H5N1?  That is not specifically answered.  Generally, the tests are done on live animals and it is a bit harder but not impossible to find out the status of dead animals.    In contrast to Vietnam, which has the same number of total deaths, Indonesia shows no sign of decreasing events.  Quite the contrary, they continue to have events in a time where there should be relative quiet as this is not influenza season there.  

7/20/06    Political updates:1)  States hesitant to buy bird flu drugs- each state has the right to buy a certain amount at a guaranteed price by a certain date.  Each state has made different choices to date.  "Less than two weeks before a federal deadline for states to announce their plans, at least 16 say they're undecided how much Tamiflu and Relenza they'll buy. Thirteen others — including California, the biggest state — say they plan to buy their full allotments."  This means that if/when an outbreak happens, each state will be in a different position of readiness.  Sad but true.   Apparently they can change orders through till the end of the year.  I think each state would be wise to obtain a reasonable volume of Tamiflu.  In an outbreak, all bets are off, and the ability to get more supplies will likely disappear.

7/19/06    Political updates:1)  Get powers ready for bird flu, U.S. governors told-

Absolutely so!  There will always be those who argue that this unnecessary and it is an infringement on people's individual right to go where they want to, when they want to, and no on is going to tell them otherwise.  Well, this situation requires special rules.  Clearly, these rules need to have a certain trigger...and this should be defined in the law... but the laws are necessary none the less.  People's lives are at stake.  We do not say that anyone has the right to shoot whomever they want to with no consequences do we?  Of course not.  But with avian flu, the results of running around with the flu, giving it to others is no less dangerous.  The mortality rate in Indonesia is running over 75%.  Now admittedly, the fatality rates are supposed to go down in a pandemic but we do not currently know what that rate will be.  All of the current estimates are based on past experience. Look at investing in mutual funds.  We know that past experience does not always predict future experience real well.   Hence we need to have some rules in place "just in case".

Here is a link to the entire 32 page National Governor's Association Pandemic Preparedness article if you are so inclined.  The article encourages everyone to have a week's worth of food per person stored at home.  As a physician, I would encourage you to make sure you have at least that much of any critical medications at home.  Longer if these medications are of particular importance (heart medications, asthma, insulin and the like)

7/18/06    Animal updates:1) Chicken sole bird flu source: Indonesian expert. "

"Longtime veterinarian and physician Mangku Sitepoe said although veterinarians had found H5N1 in wild fowls, pigs, flies, birds and water, the source of all human infections in the country thus far had been chickens. "After compiling and studying research done by veterinarians throughout the country, it is only sick chickens that have been able to transmit the virus to humans so far," he said."  It would appear that the vast majority of cases in Indonesia are related to sick birds.  That is both the good news and the bad news.  Despite the presence in a variety of different species, spread to humans has only been documented to come from poultry there (at least according to his comments).  The bad news is that there appears to be a lot of sick poultry out there.  Control of this vector has been recommended for a long time but the Indonesian government has not shown the effort or will to pursue that vigorously.  

7/17/06    Political updates:1) Bird flu vaccine (results) for humans to be ready in Russia by September  The vaccine has been administered and the results will be available in Sept.  This is good news but does not indicate to which strain the vaccine is geared, the effectiveness of the vaccine, and how it is to be produced.  If all these issues look good, then the next issue will be actual production capacity and distribution.  Hopefully, as more countries develop vaccines there will be the ability to produce some for the countries that do not have internal production capacity/expertise.

2) Indian lab develops local bird flu vaccine- this report is similar to the one above but involves an poultry vaccine.  Same issues apply but the benefit is for chickens, and thus less directly for humans.  I should note, the biggest issue for animal vaccines is that they are helpful only in the animals they are given to.  Russia developing a chicken vaccine is helpful to them, but only marginally so to the rest of the world.  They have not been the major source of avian cases.  Indonesia has, and probably Africa is having problems, but we just do not have enough reporting out of there.    As long as there are countries in the world that are not able to handle their own outbreaks, the rest of the world is at risk as those birds contact humans and there is the potential for mutation.  Once there is a stable mutation that allows rapid human to human transmission, the animal vaccines become dramatically less important for the current outbreak. They do have some role in the future for long term poultry and thus human health.

7/15/06    Human updates:1) Local tests show Indonesian man died of bird flu- "Like so many other bird flu cases, the man had contact with a dead chicken in his neighbourhood. He died on July 12 and we are now waiting for the confirmation," I Nyoman Kandun, director general of communicable disease control at the Health Ministry, told Reuters. This is the 42nd death in Indonesia from H5N1 and we can expect to see confirmation in the next week or so from WHO.   Notably, the article says that Indonesia is seeing an increase in the poultry death rate.  Details are unknown but this is indicative of the poor effect of Indonesian control plans and efforts.  Vaccination there is not working like it has in Viet Nam or China.  It is not clear if this is related to using a different vaccine or if this is from inadequate vaccination rates.  In the past, Indonesia has seen people siphoning off funds and using improper vaccines.  

2) Mystery rise in bird-flu reports (Thailand)- "Whether it was because of mounting concerns among health workers or the number of cases was rising, the reported number of patients listed as suspected cases of bird flu had surged from a few to about 20 per day, said Dr Kumnuan Ungchusak, director of the ministry's bureau of epidemiology."  So far, testing has come up negative.  Still, the etiology for this apparent rash of human cases is not known and they have had exposure to sick/dying chickens.  This outbreak bears careful watching.  It would be wise to make sure alternative forms of testing are employed.  Avian flu is notorious for

7/14/06    Human updates:1) Tests confirm Indonesian child died of bird flu- this child had been reported by the Indonesian authorities on 7/7/06 but is confirmed by WHO testing.  There is report of sick chicken exposure.  There "was one dead chicken in the backyard".  This confirmation is no surprise.  "Runizar Ruesin, the head of the health ministry's Bird Flu Information Centre, said the ministry planned to launch a pilot project in August for the prevention and control of avian influenza."  The nature and details of this program are not described.  Hopefully the program will include culling around birds that are found to be sick (like the WHO has been recommending for quite some time). 

7/14/06    Political updates:1) New York City Avian Flu Plan- I would strongly encourage local municipalities to review what NYC has already set up.  To be sure, they do not have all the answers.  No one does.  At least there is a plan that has a fair amount of details in it and a local community can use this as a framework to build off of.  Thanks to NYC for being so kind as to share it with the world.  There truly is not a need for everyone to re-invent the wheel.  It is already commonplace for communities to follow the lead of larger, better funded areas and adopt the same general standards of operation.  This is a perfect opportunity to lean on the expertise of others, and save lots of time, money and labor.  In addition, if a large part of the US adopts the same standards, then as new learning takes place, there will be a better idea as to what to change and how to implement these changes.  

2) Rand Corporation report on "Organizing State and Local Health Departments for Public Health Preparedness" Here is a link to the summary of the study... in essence it is important to determine "who is responsible for what"...  There is no magic answer but there is a major need for groups to get together and communicate about their efforts.  Local authorities, please check it out!

7/13/06    Virology updates:1) Report: H5N1 mutated rapidly in Indonesian cluster "Genetic studies show that the H5N1 avian influenza virus mutated multiple times as it spread through an Indonesia family in May, but the significance of the changes is uncertain, according to a news report today in Nature."  There are two significant aspects to this report, one scientific and one political/ethical.  The science is that the virus clearly shows the capability to change at amazingly fast rates.  32 documented changes in the matter of weeks.  Even though they did not go anywhere, clearly this is evidence that the basic H5N1 is not a stable constant sequence.  The changes keep happening, and the more infected animals there are, and the longer time goes on, the higher the risk of mutation that is easily transmissible between humans.  This is the most striking public data that I have seen to point out the concern.  Prior writers who claimed that the H5N1 has been in the animal kingdom for decades and not changing are clearly uninformed.

The second major issue is the way the WHO has handled it.  They have put the emphasis on short term damage control but at the expense of long term credibility.  I had questions about the changes at the time of the outbreak but they firmly denied them, and then later changed it to "there were a few slight changes".  Clearly there was a lot more than met the eye.  Sure, some of it may have been related to a lack of enough testing but the WHO needs to be in the forefront and transparent about what is or is not happening.  Honesty and credibility are crucial even if it is not the news we want to hear.  At some point, when a pandemic really does occur, people have to have confidence in what authorities say.  Look at China... their arrest and conviction of a avian flu case whistle blower really makes us all feel they are still covering up.  Now, whatever is said, is viewed with suspicion and doubt.  Local authorities should keep this in mind...  Your reputation in hard to build and quite easy to be lost!

7/12/06    Political updates:1) Early detection best to control bird flu -report "From the results of the mathematical model of avian influenza spread, we can say that the best methods, ranked by importance, are a) immediate culling of infected flocks...b) early detection of the disease in a flock," said Dr Arnaud Le Menach of the University Pierre and Marie Curie in Paris. He added that increasing the radius in which surrounding farms are culled would also help in controlling the disease along with improved surveillance."  The best comment I have to this article is "No Kidding".   Essentially, "snuff out the fire while it is small, and  if you spray the surrounding area with water then you are less likely to have spread."  Common sense would show this to be the case.  The political issue here is that people are not pursuing this course of action.  

2) US CDC releases $225 million for bird flu- these funds were already allocated and are now being released to the states.  The goal is to help states plan and implement public health level activity.  Setting up schools, vaccination planning and the like. These funds are apparently not for directly buying medications and supplies.  The Federal government is saying that the states have to be ready to be self-sufficient.  These funds are to help get things started.  Unfortunately, most local areas are saying they don't have the funds either.  I would encourage you to talk with your local representatives and have them prioritize preparatory funding.  

3)  Chinese bird flu whistle-blower jailed: state media- this is pretty sad.  The Chinese government is way too controlling and needs to be more honest in their operations.  While it may be that the individual could have tried to threaten/blackmail authorities, given their track record, many people suspect the government is simply using their powers to squelch information they do not want released.   That seems to be the repetitive pattern.   Old habits die hard!

7/12/06    Animal updates:1) Nigeria continues to have new animal cases reported- despite the lack of showing up in popular American news sites, the spread of H5N1 continues in Nigeria.  Under reporting there is a huge issue.  

2) Indonesia vets urge uniform approach on bird flu - the lack of a standard plan, or leasttt following through on it makes adequate control very difficult.  This same concept needs to be understood here in the US as we plan.  If your plans are great but the city right next door is not properly planning, then you will be affected as people are so mobile.  Truly it is not necessary for everyone to invent the wheel.  A relative standard plan of action would minimize confusion and improve outcomes. 

7/11/06    Political updates:1) Complacency over bird flu leaves UN short of funds- Despite the continued increase in cases, the actual amount of funds being committed to combating avian flu is limited.  Of that 1.9 billion pledged, only 1.15 billion has been legally committed, and only $331 million received.  This makes efforts very difficult.  Even the full 1.9 billion is not considered to be enough for the effort.  I was just talking with a friend who came back from doing volunteer work in Ghana.  The hospital staff and doctors at the largest hospital there have been on strike for the last few weeks because they have not been paid at all for 8 month.  Doctors were having to spend their own money to buy instruments for the operating room.  This is so different from developed countries.  We can hardly comprehend what it is like.  How well will they deal with potential illnesses when they can't even really deal with the sick and dying right now?  Developed countries need to at least spend the dollars they say they will give.