AVIAN FLU UPDATE

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NOTE:

Spanish flu research

Main article: Spanish flu research

One theory is that the virus strain originated at Fort Riley, Kansas, by two genetic mechanisms — genetic drift and antigenic shift — in viruses in poultry and swine which the fort bred for local consumption. But evidence from a recent reconstruction of the virus suggests that it jumped directly from birds to humans, without traveling through swine.[30] On October 5, 2005, researchers announced that the genetic sequence of the 1918 flu strain, a subtype of avian strain H1N1, had been reconstructed using historic tissue samples.[31][32][33] On 18 January 2007, Kobasa et al. reported that infected monkeys (Macaca fascicularis) exhibited classic symptoms of the 1918 pandemic and died from a cytokine storm.[34]

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guardian.co.uk, Friday 3 February 2012 10.06 EST

Scientists call for curbs on own research on deadly bird flu virus

Virus experts in the US say outbreak of genetically engineered bird flu could be worst influenza pandemic in history

A group of the leading virus experts in the US has called for new, permanent restrictions on research in the face of a new genetically engineered flu virus that could kill half the population of the world.

Scientists are currently observing a 60-day moratorium on research into the bird flu virus, after two groups found a way to make it infectious through airborne transmission.

An outbreak of this virus could be worse than the 1918 Spanish flu that killed tens of millions of people, warned Michael Osterholm – who has led research into previous dangerous outbreaks – at a public meeting on censorship in science in New York on Thursday night.

"Frankly, I don't want a virus out there that, even if it was 20 times less lethal, would still be the worst influenza pandemic in history," he said.

Professor Osterholm is a member of the US National Science Advisory Board for Biosecurity, which in December asked the journals Science and Nature not to publish the full research on the virus.

Bird flu, or H5N1, has so far infected 583 people according to World Heath Organisation figures, mostly in South East Asia, and killed 344 – though it is believed the proportion of fatalities to infections might be lower, as some may have caught the virus but not been hospitalised.

It can currently only be caught by close exposure to infected birds.

However, the new research demonstrated that the virus could be mutated, through genetic manipulation and other methods, into a form that was transmitted between ferrets in airborne droplets from coughs and sneezes.

Ferrets are considered a good model for human-to-human virus transmission.

The NSABB said this posed a huge risk to the world.

"If this virus were to escape by error or by terror, we must ask whether it would cause a pandemic," said NSABB chair Paul Keim in an interview published in Nature this week.

"The probability is unknown, but it is not zero. There are many scenarios to consider, ranging from mad lone scientists, desperate despots and members of millennial doomsday cults, to nation states wanting mutually assured destruction options, bioterrorists or a single person's random acts of craziness."

Professor Osterholm said he considered the new virus a worse threat than the return of smallpox.

"I wouldn't like to see smallpox get out of the lab, but if it did it wouldn't overly concern me," Osterholm said. "We could contain it. The same thing is true with Sars. But influenza would scare the hell out of me, because it is the most notorious, the 'Lion King' of transmission."

"Once it's out there, it's gone, it's worldwide."

However, he said the research could have positive results, such as finding a better vaccine, or improving virus detection in the early stages of a pandemic if it emerged naturally. He said virus surveillance at the moment was "like a whole lot of broken smoke alarms".

The meeting agreed that restricting research, and access to research data, would have bad consequences for science, because new advances often come from unexpected places.

Several speakers said the publication of redacted data should only be a temporary measure until a better solution was hit upon.

Professor Arturo Casadevall, from the Albert Einstein College of Medicine, who is also on the NSABB board, said he had originally been against restricting research but had been persuaded it was necessary.

"If it is the worst case scenario half the people you know will die, and half the people you don't know will die," he said. "If it is two orders of magnitude (100 times) lower, you are looking at 7 million deaths.

"These viruses were generated in the laboratory … when these things get out and they recombine with existing strains, I think it will be very unpredictable, and this is a risk I think is very high."

However, he said research should continue in a more regulated way.

"Since 1997, we have had sporadic occurrences of this organism," he said. "We did not know it had the potential for mammal to mammal transmission. Now that we know, humanity is under threat and this work needs to go on."

Dr Laurie Garrett, from the Council on Foreign Relations, said any move to control or limit research into influenza would also limit the ability to protect against it if it emerged naturally.

But she added that the more laboratories around the world worked on the virus, the greater the risk it would escape – even in the US, there were hundreds of breaches of quarantine in the highest-level labs.

And she said the spectre of a biological weapon based on the virus was raised "very, very high".

She warned that if scientists agreed a way to move forward among themselves, without consulting more widely, they may discover the issue will "blow up" once the public is made more aware of it.

Alan Ruldolph, from the US Department of Defense's Defense Threat Reduction Agency, said information on the virus was "relatively uncontrollable", and the focus on bird flu should be on how to prepare for and respond to an outbreak.

It is estimated more than 1,000 scientists already know the details of the censored research.

Professor Peter Palese from the Mount Sinai School of Medicine said the moratorium should end and research should continue.

He said the risk of the virus spreading to humans, and the level of danger it posed, had been vastly overestimated.

"All evidence we have now suggests H5N1 isn't easily transmitted to humans, and these experiments don't make it more likely," he said. "When do you stop being afraid?"

Virus experts from around the world are to meet in Geneva this month, at a meeting of the World Health Organisation aimed at assessing the risks, and benefits, of research into the bird flu virus.


www.guardian.co.uk/world/2012/feb/03/bird-flu-virus-scientists-warning?newsfeed=true

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February 07, 2012


Indonesia: Suspected H5N1 death



Via FluTrackers: Indonesia - West Java - Bird Flu Suspect Died In Bandung Hospital. It's a computer translation:

Bandung - SA (37), a resident of Kampung Mengger Girang Village District Pasirluyu Regol suspected suspect bird flu (H5N1) died in the ICU of Hasan Sadikin Hospital at 16:35 GMT, Tuesday (07/02/2012).

Previously, SA with his family had the flu but had recovered. It was told by spokesman Tim RSHS war on bird flu dr Primal Sudjana. "The patient and his family had the flu and got to the clinic, and then recovered. Well two days ago she was cold again and the weight immediately," he told reporters met at RSHS, Pasteur Street.

When brought to RSHS at 11.00 am yesterday, the patient's condition is critical . In fact, according to Sister SA, Juju Komarudin, Monday night that his brother is comatose. "When we come here last night he was in a coma, we were here at 4 pm was dead," he said in the same place.


February 07, 2012 at 07:33 AM in H5N1

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US biosecurity board expert warns against details of H5N1 bird flu getting into wrong hands

Steve Connor Wednesday 08 February 2012

The bioterrorism expert responsible for censoring scientific research which could lead to the creation of a devastating pandemic has admitted the information "is going to get out" eventually.

Professor Paul Keim, chairman of the US National Science Advisory Board for Biosecurity, controversially recommended that researchers be stopped from publishing the precise mutations needed to transform the H5N1 strain of birdflu virus into a human-transmissible version.

In an exclusive interview with The Independent, he argued it had been necessary to limit the release of the scientific details because of fears that terrorists may use the information to create their own H5N1 virus that could be spread easily between people.

Professor Keim said that it was necessary to slow down the release of scientific information because it was clear that the world is not yet prepared for a strain of highly lethal H5N1 influenza that can be transmitted by coughs and sneezes.

“We recognised that, in the long term certainly, the information is going to get out, and maybe even in the mid term. But if we can restrict it in the short term and motivate governments to start getting busy in terms of building up the flu-defence infrastructure, then we’ve succeeded at a certain level,” he said.

“If we can slow down the release of the specific information that would enable somebody to reconstruct this virus and do something nefarious, even for a while, then that was a good thing.”

By withholding key details of the mutations needed to make an airborne strain of H5N1, this would give time for governments to prepare for and prevent a possible pandemic, he added.

“The infrastructure to stop a pandemic in this area is not there. We just don’t have the capabilities. The very first time we knew that the swine flu virus [coming out of Mexico] was there, it was already in 18 countries. I’m not confident at all that we have the surveillance capability to spot an emerging virus in time to stop it,” he said.

“And even if we did spot it early on, I don’t think we have sufficient vaccines. The vaccines aren’t good enough, and the drugs are not good enough to stop this emerging and being a pandemic.”
Although H5N1 spreads rapidly between birds, it has so far affected only about 600 people worldwide who have had direct contact with infected poultry. However, two teams of researchers have shown independently that it only requires five mutations for H5N1 to become an airborne pathogen for laboratory ferrets, the standard animal model for human influenza.

Professor Keim said that the biosecurity board was asked by the US Government to review the two independent studies because they had already been submitted to the journals Science and Nature. The board had to make a recommendation on whether any or all of the information should be published.

Scientists involved in showing how the H5N1 birdflu virus can be transmitted in the air between ferrets have criticised the biosecurity board’s decision to part-censor their research on the grounds that it would hinder the development of new vaccines and drugs.

However, Professor Keim dismissed the criticism as disingenuous. “The argument that we need this information to make better vaccines and better drugs does not ring true,” he said. “There are lots of ways to make drugs against this virus. The very drugs they were using against this virus were the very same ones used against other flu viruses. The drug-invention problem has nothing to do with having this virus to hand,” he added.

Professor Keim revealed that although he is personally in favour of the research that led to the creation of airborne strains of H5N1, some other members of the board were not convinced. “I’m personally in favour of this research but that opinion is not universal on the board. Some people on the board wanted to stop this research and destroy the virus,” he said.

“I don’t think we need this virus to prove that Tamiflu works against it. And we know that the H5 antigen is not a great antigen for vaccines, we don’t need the virus to tell us that. But there are some experiments that can only be done with the live virus and I’m in favour of keeping the virus for those type of experiments.”

www.independent.co.uk/news/science/no-way-of-stopping-leak-of-deadly-new-flu-says-terror-chief-6660997.html

THE POT IS BEING STIRRED

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H5N1 influenza epidemic has returned, says official

VietNamNet Bridge – Vietnam has had only two H5N1 influenza patients in the last two years and both of them are dead. Thus, the H5N1 epidemic has returned, remarked Deputy Minister of Health Nguyen Thanh Long at a meeting on February 7.

On January 10, an 18-year-old man in the southern province of Kien Giang began having symptoms of flu and he bought and took medicines by himself. Four days ago, he was brought to a local hospital when the disease was very serious. The man died two days later.

The second patient, a 26-year-old woman in the Mekong Delta province of Soc Trang died on January 28.

The patient was brought to the local hospital on January 23 after showing fever symptoms. She was then transferred to Bac Lieu Province General Hospital on January 25, with viral pneumonia diagnosis since the illness still persisted. She died in the hospital three days later.

Test conducted by Pasteur Institute in Ho Chi Minh City has showed that both patients were infected with Influenza A virus subtype H5N1, also known as "bird flu."

The first patient was a duck tender, while the second patient slaughtered and ate infected meat.

Dr. Nguyen Van Kinh, Director of the Hanoi-based Hospital of Tropical Diseases, said that the second patient was treated by Tamiflu late so she could not recover.

Kinh recommended doctors to treat patients by Tamiflu early. “We do not lack medicines. It is important to detect the disease early to avoid fatalness,” he added.

Kinh proposed to hold training courses for health workers on diagnosis and treatment of H5N1 influenza because after two years, people now lack vigilance of the fatal flu.

Nguyen Trong Khoa, chief of the Ministry of Health’s Examination and Treatment Management Department, agreed with Kinh. He said that both above patients were only treated with Tamiflu four days after the first symptoms appeared and they were dead 5-6 days later. The second patient was a pregnant woman.

“Vietnam did not have any H5N1 cases in a long time so health workers possibly do not think of H5N1. People should go to hospital immediately when they have flu symptoms and have contact with poultry,” Khoa said.

Dr. Nguyen Tran Hien, Director of the Central Institute of Epidemic Prevention, said that the source of bird flu disease is still around but people forget it because the bird flu epidemic did not happen for a long time.

Deputy Minister of Health Nguyen Thanh Long asked relevant agencies to quickly organize training courses in H5N1 treatment for health workers and remind them to be watchful over the disease.

According to the World Health Organization (WHO), two laboratories in the Netherlands and Japan tested and defined that type A/H5N1 virus can change to spread to mammal animals. However, the tests were only conducted on weasels in laboratories.

english.vietnamnet.vn/en/society/18612/h5n1-influenza-epidemic-has-returned--says-official.html

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Last update 2/10/2012 10:03:00 AM (GMT+7)


New strain of swine flu detected

VietNamNet Bridge – The Heath Ministry has quoted sources from the Ho Chi Minh City Pasteur Institute confirming that a new kind of porcine flu virus, A/H3N1, has appeared, apparently a combination of the pig-related A/H1N1 and A/H3N2 flu viruses.

The medical sector has monitored 10 patients infected with the A/H3N2 virus with porcine origin, and found that three of them had not had direct contact with any diseased pigs.

Therefore, the sector has not ruled out the possibility of a mutation in the A/H3N2 strain which could lead to transmission between humans, instead of strictly from pigs to humans as previously.
However, the situation has not reached an alarming level because the virus has not changed much; it has low toxicity and has shown no sign of drug resistance.

Flu vaccines are able to cope with small changes in this kind of virus, said Le Hoang San, Vice Director of the HCMC Pasteur Institute.

* Bird flu found in two more provinces

The avian flu epidemic has recurred in the southern province of Bac Lieu and the northern province of Ha Nam.

The Bac Lieu Animal Health Department has found hundreds of fowls dead without apparent reason since early February. These fowls included more than 200 ducks in Nha Mat ward, Bac Lieu city, and another 250 ducks in Hong Dan district.

Samples taken from the dead ducks tested positive for the A/H5N1 flu virus.

Given this, the provincial Department of Agriculture and Rural Development allocated one million doses of bird flu vaccine for the local district and city.

The province has taken all necessary preventive measures to head off the epidemic, and not only in the affected areas. The local broadcasting station was asked to instruct local people on how to manage their domestic fowls and to caution them against eating blood pudding or slaughtering sick fowls.

* Meanwhile, on February 9, the Ha Nam provincial People’s Committee declared a state of bird flu epidemic in Nhat Tan commune, Kim Bang district.

The local veterinary department said more than 2,500 ducks have been found dead in a farming area in Nhat Tan commune since February 7. Samples from these ducks also tested positive for the H5N1 virus.

A delegation from the Ministry of Agriculture and Rural Development has been dispatched to the province for supervising efforts to contain the epidemic.

So far this year bird flu outbreaks have been detected in five provinces, namely Ha Nam, Bac Lieu, Thanh Hoa, Soc Trang, and Quang Tri.

VietNamNet/VOV

english.vietnamnet.vn/en/society/18647/new-strain-of-swine-flu-detected.html

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NEWS SCAN: Narrow focus for WHO H5N1 meeting, pandemic impact in Europe, pandemic vaccine safety, vaccine-linked narcolepsy, polio vaccine fears in Japan

Feb 10, 2012

WHO meeting on H5N1 studies to have narrow focus
A meeting planned by the World Health Organization (WHO) next week to discuss two controversial studies on transmissible H5N1 avian influenza viruses will focus narrowly on whether the studies should be published at all and, if so, in full or abridged form, the Canadian Press (CP) reported yesterday. In the studies, Dutch and American teams generated a mutant H5N1 virus and an H5N1-H1N1 reassortant that spread as easily as seasonal flu in ferrets. The US National Science Advisory Board for Biosecurity has recommended that the two journals involved, Science and Nature, withhold the details of the studies out of concern that the data could be exploited by hostile parties. The WHO meeting is unlikely to address the broad question of how to regulate potentially dangerous biological research in the future or—assuming the two studies are not published in full—even how to share the details with those who need to know, WHO officials told the CP. They said they have invited only 22 outside participants to the meeting, scheduled for Feb 16 and 17 in Geneva. The invitees include representatives of the Vietnamese and Indonesian labs that provided the viruses used in the research. The WHO has said it intends to organize a second meeting later with more participants and broader goals.
Feb 9 CP report

Meanwhile, the editors of The Lancet Infectious Diseases called for publishing the full details of the two studies and devising a system to screen future "dual-use" studies before they are carried out. "Now so much is already known by so many, surely the best way to limit the potential harm is to make the full details and the full risks known to as many as possible so that work to address threats can begin," the editorial said. "Moving forward, the international research community and funding organisations must consider how to regulate research with potential for dual use so that the ramifications are considered and addressed long before it is begun; and certainly well before, so to speak, the ferret is out of the bag."
Feb 10 Lancet Infect Dis editorial


European study confirms that kids bore brunt of 2009 pandemic
As measured by medical visits for respiratory illness, the 2009 flu pandemic in Europe was no worse than a seasonal flu epidemic overall, but children bore a disproportionate share of the burden, according to a study in BMC Infectious Diseases. Researchers from the Netherlands and the WHO's European regional office compared the fall wave of the pandemic with the six preceding flu seasons, focusing on the timing of peak activity, geographic spread, and community impact. They measured the impact by examining the total and age-specific rates of consultations for influenza-like illness (ILI) and acute respiratory illness (ARI). The total ILI and ARI rates were no higher than historical rates in 19 of the 28 countries included, they found. However, the consultation rates for 0- to 4-year-olds and/or 5- to 14-year-olds were higher during the pandemic in 11 of 20 countries that had data. The researchers also determined that the pandemic peaked 10.5 weeks earlier than the seasonal flu epidemics and that it spread from west to east in Western Europe.
Feb 9 BMC Infect Dis report


WHO advisors reassured by pandemic vaccine safety reports
The WHO's vaccine safety advisors reviewed data on the 2009 H1N1 pandemic vaccine at their meeting in December and found that its overall safety record is reassuring, according to a report today in the WHO Weekly Epidemiological Record. The group noted no new safety signals, other than a previously reported link between the adjuvanted vaccine and narcolepsy in children in Finland and Sweden. They noted that more epidemiologic studies in Europe and Canada are under way to further explore a possible link, and other research groups are searching for a biological mechanism for the link. Preliminary data from the United States has shown a slightly increased risk of Guillain-Barre syndrome in people who received the 2009 H1N1 vaccine, a finding that has not been reported in other countries. The group noted that if confirmed, the link would be at low levels typical for seasonal flu vaccine. The advisors also reviewed reports of possible links between the vaccine and certain autoimmune and clinical syndromes and found no major safety concerns, though they said the sample size or methodology may not have been adequate for identifying a link. US and Canadian studies of the pandemic vaccine in pregnant women are reassuring, and additional studies in more countries are being completed, the report said. The advisors also reviewed the most recent data on rotavirus vaccines and concluded that the two vaccines on the market, Rotarix and RotaTeq, may be associated with a sixfold increased risk of intussusception after the first dose in some populations, which is substantially less than the risk seen with a previous rotavirus vaccine. They concluded that the benefits greatly exceed the risks and that active intussusception surveillance in African and Asian countries that plan to introduce the vaccine would be useful for future risk-benefit analysis.
Feb 10 WHO Wkly Epidemiol Rec report

Norway to compensate children for narcolepsy tied to pandemic flu shots
A government board in Norway has upheld damage claims for three children who have narcolepsy that was probably triggered by the Pandemrix vaccine, used for pandemic 2009 influenza, according to The Foreigner, an English-language service that provides news of Norway. Another 20 claims of narcolepsy in children possibly related to the vaccine are awaiting processing by the government panel, the story said. About 598,000 Norwegian children and youth from 6 months to 19 years old received Pandemrix during the 2009-10 pandemic vaccination campaign, according to the report. Rolf Gunnar, assistant director of the government board, said compensation will depend on the severity and duration of the children's illness and how much it affects their everyday lives. Pandemrix-related narcolepsy cases in children have also been reported in Sweden and Finland, and compensation programs in both countries were announced last fall.
Feb 10 The Foreigner story
Oct 7, 2011, CIDRAP News item on cases in Sweden

Japanese parents worried about oral polio vaccine
Nearly a third of surveyed parents of young children in Japan want inactivated polio vaccine (IPV) for their children, says a letter in tomorrow's The Lancet from five physicians at Seisa University, Yokohama, and the University of Tokyo. The authors surveyed 260 parents of day care and nursery school children in Kanagawa prefecture. Oral polio vaccine (OPV) was considered dangerous by 50 (19%) respondents, and 81 (31%) wanted IPV for their youngsters. A growing fear of OPV because of the potential for vaccine-associated disease is resulting in decreased inoculation rates in children, point out the authors. The country's health ministry reported a 17.5% drop in OPV coverage from April through June 2011 compared with a year earlier, and some pediatricians are importing IPV for children whose parents can pay the price. The Japan Pediatrics Society recommends OPV until domestically produced IPV becomes available, which is expected no sooner than the end of this year, according to the letter. The authors say that although Japan has been actively involved in the Global Polio Eradication Initiative, "The lack of consistency between its domestic and global health policies is harming its own people."
Feb 11 Lancet letter

www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/feb1012newscan.html

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WHO extends delay of publication of H5N1 research

20-Feb-2012

The World Health Organisation has decided to extend a temporary moratorium on research into laboratory modified versions of the H5N1 ‘bird flu’ virus.

Scientists in the Netherlands and the US have created versions of the H5N1 virus, which could potentially spread more easily among humans.

By using ferrets in a laboratory, the researchers proved it was possible to change H5N1 into an aerosol-transmissable virus that could be spread rapidly through the air.

The Erasmus University study in the Netherlands and the other by scientists at the University of Wisconsin alerted the US National Science Advisory Board for Biosecurity (NSBB), which argued that the research could be used by terrorists to set up a biological attack using the virus.

The researchers were planning to publish their research in the journals Science and Nature, but have now agreed to redact their manuscripts at the request of the NSBB.

A Geneva, Switzerland meeting of 22 scientists and journal representatives agreed that delayed publication of the full research would have more public health benefit than publishing it in part.

‘Given the high death rate associated with this virus – 60% of all humans who have been infected have died – all participants at the meeting emphasised the high level of concern with this flu virus in the scientific community and the need to understand it better with additional research,’ said Dr Keiji Fukuda, assistant director-general of Health Security and Environment for the World Health Organisation.

‘The results of this new research have made it clear that H5N1 viruses have the potential to transmit more easily between people, underscoring the critical importance for continued surveillance and research with this virus.’

Fukuda added: ‘There is a preference from a public health perspective for full disclosure of the information in these two studies. However there are significant public concern issues surrounding this research that should first be addressed.’

The WHO said experts would now look at what information is already in the public domain and how that relates to the contents of these research papers.

A further meeting is likely to take place in a couple of months’ time.

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02:12 | 02/18/2012

All 40 H5N1 Exposed Ferrets Died

NOTE THE VIDEO LINK AT THE BOTTOM OF THE PAGE

Recombinomics Commentary 15:00

February 21, 2012

“What scares me is that this could happen and this could happen so easily”

….air flowed into the next cage. killing all 40 exposed ferrets.

The above comments are from an ABC news video report on the H5N1 transmission experiments by Ron Fouchier in the Netherlands. His quote above highlights his concerns and the second comment highlights the level of lethality seen for the H5N1 that was used to infect one of the ferrets which maintained its high level of lethality after acquiring the full set of 5 changes in 2 genes. This level of lethality was in marked contrast to experiments by Yoshi Kawoaka which also achieved efficient transmission in ferrets but failed to kill at levels higher that H1N1pdm09, which was used as a genetic background for the H5 gene.

Thus, two very different approaches were used to achieve efficient transmission by H5N1 with natural acquisitions, raising serious concerns that such changes could lead to a catastrophic pandemic. However, recent debate has been more focused on H5N1 as a bioweapon, or a true case fatality rate that is orders of magnitude lower than the 60% CFR in confirmed cases.

However, the above ferret studies indicate the H5N1 from Indonesia (Fouchier experiment) is far more lethal than the Vietnam H5N1 H5 reassortant (Kawaoka experiment), and those citing a lower CFR based on serological studies are the same scientists downplayed the ability of H1N1pdm09 with a truncated F2 gene or an acquired receptor binding domain (RBD) change, D225G.

The prediction that the F2 truncation would limit H1N1pdm09 spread was not supported by subsequent events. The virus quickly spread worldwide and then began to appear in additional species (most notably swine and birds), raising concerns for reassortants similar to the virus used in the Kawaoka experiments. Similarly, the claim that D225G would not transmit in humans was based in earlier experiments targeting two RBD changes (E190D and D225G). However, D225G was found in approximately 40% of 1918 sequences, supporting transmission, as well as seasonal H3 sequences from the mid-1990’s, which also was present on H3N2v sequences, including the West Virginia cluster, which included 23 contacts with ILI, again supporting D225G transmission. This transmission is also supported by the Kawaoka and Fouchier experiments, because virtually all H5N1 sequences have D225G.

Thus, the predictions by those citing a low case fatality rate for H5n1 are the same “experts” who discounted the effects of H1N1pdm09, and who cite weak serological data which may be detecting cross-reactive antibodies ro those induced by low path H5.

The death of all 40 ferrets by the Indonesia H5N1 highlights the need for an aggressive H5 vaccination campaign, instead of distractions by unlikely bioterrorism, or claims that H5N1 lethality is largely over-estimated.

VIDEO Bird Flu Pandemic: How the Virus Mutates
Researchers are ready to report new information on the deadly virus.
02:12 | 02/18/2012

abcnews.go.com/WNT/video/bird-flu-pandemic-virus-mutates-researchers-new-information-deadly-health-15745084

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21 February 2012

Bird flu claims third victim this year in Indonesia

Indonesian veterinary workers spray anti-bird flu disinfectant over birds at Medan market in North Sumatra province on January 26. Indonesia's health ministry has said tests on a 19-year-old woman who died last week showed she had contracted the bird flu virus, Indonesia's third human death from the deadly disease this year.

AFP - Tests on a 19-year-old woman who died last week showed she had contracted the bird flu virus, Indonesia's third human death from the deadly disease this year, the health ministry said on Tuesday.

Concerns about avian influenza have risen in the region with China, Cambodia and Vietnam all reporting deaths from the H5N1 virus this year.

The latest Indonesian victim died on February 13, a day after being admitted to a hospital in Tangerang district on the outskirts of the capital Jakarta, the ministry said.

Tests on the victim after she died confirmed she had contracted the virus, but a health ministry team that surveyed her house and neighbourhood was unable to determine its source.

The ministry added the woman had a fever for four days before arriving at the hospital.

Indonesia recorded two fatalities in Jakarta in January. The country has been the hardest-hit by bird flu, with 150 deaths reported between 2003 and 2011, according to the World Health Organization.

Nine Indonesians died from the virus last year, including two children on the resort island of Bali in October, according to authorities.

The virus typically spreads from birds to humans through direct contact, but experts fear it could mutate into a form easily transmissible between humans, with the potential to kill millions in a pandemic.

www.france24.com/en/20120221-bird-flu-claims-third-victim-year-indonesia

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Researchers identify new H5N1 subclade in India

A genetic analysis of H5N1 avian influenza isolates from February 2011 poultry outbreaks in India's Tripura state shows the introduction of a new clade to the area, researchers reported in Public Library of Science (PLoS) One. Until 2009, outbreaks in India and Pakistan were linked to 2.2 clade viruses. The first 2.3.2.1 clade virus was detected in South Asia in 2010 in Nepal; however, investigators found that 2.3.2.1 clade viruses responsible for the Tripura outbreaks are distinct from the ones found earlier in Nepal. When they compared their findings with phylogenetic data from the WHO, they concluded that the new clade circulated in Myanmar, then spread to Bangladesh and India through land-based poultry or migratory birds. The group said it's important to monitor whether the new 2.3.2.1 clade is replacing the previous 2.2 clade in South Asia or is cocirculating with it. They warned that cocirculation of H5N1 subclades in a highly populated area such as South Asia increases the risk of evolving H5N1 strains.

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HEADS UP .... EVERYONE!

'Dangerous' bird flu research available to all

23 February 2012


Two leading scientific journals are likely to publish in full two controversial papers detailing a new version of the bird flu virus that may be transmissible between humans despite a US federal advisory body warning of its potentially "catastrophic" misuse by "malevolent individuals, organisations or governments".

The news followed recommendations of a panel of experts convened last week by the World Health Organisation.

Controversy has surrounded the two papers, by academics based in the US and the Netherlands, since they were accepted for publication - one in Science and one in Nature - last year. They detail the creation of a new version of the H5N1 influenza virus that is transmissible between ferrets - and possibly humans - unlike strains currently found in nature.

In December, the US National Science Advisory Board for Biosecurity recommended that the papers be published only in redacted form, with access to full versions restricted to legitimate researchers. It said deliberate misuse of the research could have "catastrophic" consequences.

But the WHO panel, which included lead researchers on the two studies as well as other flu experts and senior figures from journals and funders, concluded that the necessary mechanism for restricted dissemination did not exist. It also said research into creating more transmissible forms of flu viruses should continue in order to protect public health.


The WHO panel said the papers should be published in full after a pause to allow "significant public concern" to be assuaged. It also recommended the continuation of a voluntary moratorium on H5N1 research to allow a safety review of labs to be conducted.

Philip Campbell, editor-in-chief of Nature, said he would comply with the WHO's recommendations. Bruce Alberts, editor-in-chief of Science, said the journals would await instruction about when to publish the full manuscript.

But he urged the WHO and governments to work out a mechanism for restricted distribution so that "the next time this kind of thing happens, we have a mechanism already established".

[dothedd]

Public release date: 23-Feb-2012

Contact: Garth Hogan

American Society for Microbiology

Opinion: H5N1 flu is just as dangerous as feared, now requires action

The debate about the potential severity of an outbreak of airborne H5N1 influenza in humans needs to move on from speculation and focus instead on how we can safely continue H5N1 research and share the results among researchers, according to a commentary to be published in mBio®, the online open-access journal of the American Society for Microbiology, on Friday, February 24.

H5N1 influenza has been at the center of heated discussions in science and policy circles since the U.S. National Science Advisory Board for Biosecurity (NSABB) asked the authors of two recent H5N1 investigations and the scientific journals that planned to publish the studies to withhold crucial details of the research in the interest of biosecurity.

In the mBio® commentary, Michael Osterholm* and Nicholas Kelley, of the Center for Infectious Disease Research and Policy at the University of Minnesota, present their case that H5N1 is a very dangerous virus, based on their analysis of published studies of the seroepidemiology of H5N1 in humans. H5N1 flu infections have exceedingly high mortality, they say, and current vaccines and antiviral drugs will not pull us out of a global H5N1 pandemic. "We believe that the assertion that the case-fatality rate of H5N1 influenza in humans may be overestimated is based on a flawed data analysis," Osterholm said.

Analysis of reports of H5N1 seroprevalence that include data from the 1997 Hong Kong outbreak as well as data from 2004 to date will give a misleading impression because the 1997 outbreak was a very different "biologic event" that is recognized as such by the WHO, because the 1997 H5N1 virus has a significantly different genotype from that of later H5N1 viruses. This is why the WHO does not include the Hong Kong H5N1 virus data in any analysis of H5N1 transmission, and the 1997 Hong Kong virus is not recommended for inclusion in H5N1 vaccines, Osterholm explained.

Seroepidemiologic studies that have examined the exposure of various groups of people to H5N1 viruses only from 2004 onward indicate that only a small segment of the population has ever been exposed to H5N1, and that among those that have been exposed, many become seriously ill or die.

"The available seroepidemiologic data for human H5N1 infection support the current WHO reported case-fatality rates of 30% to 80%," Osterholm says. In the event of an H5N1 pandemic, they point out, if the virus is even one tenth or one twentieth as virulent as has been documented in these smaller outbreaks, the resulting fatality rate would be worse than in the 1918 pandemic, in which 2% of infected individuals died.

Vaccines will not head off an H5N1 pandemic either, the authors say, since the time required to develop and manufacture an influenza vaccine specific to new outbreak strain has resulted in "too little, too late" vaccine responses for the 1957, 1968, and 2009 influenza pandemics, and not much in the process has changed since 2009.

"The technology behind our current influenza vaccines is simply not sufficient to address the complex challenges associated with an influenza pandemic in the 21st century," Osterholm and Kelley say.

This is the heart of the matter, they say: there has been enough discussion about how severe an H5N1 pandemic might be. Moving forward, the current controversy has provided a valuable opportunity for scientists and public policy experts to discuss influenza research and preparedness and create "a roadmap for the future." The discussion among scientists and policy makers needs to move on from whether H5N1 poses a serious international threat - as it clearly does - and begin discussing how we can prevent these viruses from escaping labs and how scientists can share their flu-related results with those who have a need to know.

There are critical questions that need to be answered, the authors say. For instance, how can scientists conduct virus-transmission studies in mammals safely and how can scientists share research methods and results with those who have a need to know? We also need to come to agreement on how to ensure that strains of H5N1 viruses created in the lab don't escape those controlled environments, the authors say. And new, more effective vaccine technologies are needed that can enable substantially faster production. Resolving these issues could allow H5N1 research and preparedness to serve as a springboard for solving similar problems with existing or emerging pathogens.

###

*Michael Osterholm is a member of the National Science Advisory Board for Biosecurity.

[dothedd]

H5N1 Bioterrorism Media Myth
Recombinomics Commentary 12:00

February 24, 2012

The recommendation to publish flies in the face of pleas for self-censorship from a U.S. government watchdog, the National Science Advisory Board for Biosecurity. The board asked researchers to hold back on releasing crucial “how-to” portions of their work for fear the details would fall into the wrong hands and spark germ warfare on a global scale. Anyone who needs the information for legitimate research, the board reasoned, could make a special request for it.

Not good enough, the WHO committee decided. The new knowledge, every last bit of it, should be freely available. From a public-health perspective, the committee wrote in a statement, full disclosure is the best option.

That conclusion is sending shock waves through the global scientific, epidemiological and counter-terror communities.

The above comments grossly misrepresent the true considerations associated with the release of the full manuscripts at Nature and Science because the media myth ignores the CDC paper published in Virology which provided full details for the creation of an H5 that transmits in ferrets via droplets. Thus, any would be bioterrorist would already have a “recipe” prior to the NSABB request. Moreover, the request also came after Ron Fouchier presented his data at a scientific meeting, which has been widely discussed in the media and on scientific forums. Moreover, recent reports indicate the three changes he introduced onto an H5N1 clade 2,1 isolate from Indonesia, HA Q226S and G228L as well as PB2 E627K, were all included in the CDC publication. Thus, the recipe for transmission (add the above three “mutations” to an Indonesian H5N1 and then passage it in ferrets 10X) was public prior to publication, as was the formula for the Yoshi Kawaoka paper, which used a clade 2.3.4.2 isolate from Vietnam as an H5 source, which was placed on an H1N1pdm09 genetic background.

The detail that the NSABB wanted to censor was unnecessary for the creation of a transmitting H5N1. The two labs involved have published extensively previously, so the materials and methods were public and well known, as were the three “mutations” introduced by the CDC in their published studies, as well as the Fouchier delayed study. It is likely that the H5 used by Kawaoka also had some or all of the same changes. The fact that three different labs used different H5 sequences which were supported by a range of associated flu genes, clearly demonstrates that the public information available today allows for the creation of a transmitting H5N1.

The NSABB request did little to thwart bioterrorism. H5N1 is not a bioweapon of choice because it can’t be control. The NSABB request has elevated this poor choice to a level of importance that will increase the likelihood of a terrorist of rogue state will attempt to create a transmitting H5N1. The NASBB request also exposed the glaring lack of expertise on their board, include gross mismanagement leading to absurd requests that made little sense from a scientific or operational point of view.

The request has led to delays in release of critical information necessary for effective surveillance and analysis of a naturally evolving H5N1, as well as a long list of media myths which will significantly impact the much need understanding of the H5N1 threat, which is now greater than ever.

The NSABB would better serve the public by forming a new board that emphasized the need for a serious vaccination campaign, which would significantly decrease the H5N1 threat, regardless of source.

[dothedd]

Debate on H5N1 death rate and missed cases continues

Lisa Schnirring Staff Writer

Feb 24, 2012 (CIDRAP News) – Two leading voices on the potential threat of lab-modified H5N1 viruses laid out their arguments about the human H5N1 fatality rate and undetected cases today and yesterday, with one group claiming "millions" likely have been infected and the other group saying current World Health Organization (WHO) fatality-rate estimates are about right.

One of the main flashpoints at a live discussion on Feb 3 hosted by the New York Academy of Sciences (NYAS) was a disagreement over how common undetected H5N1 infections are, a key consideration in determining the disease's case-fatality ratio (CFR). If many cases have gone unrecognized, the CFR is lower than the apparent 59%.

Two scientists who clashed over the issue expanded on their arguments: Peter Palese, PhD, a virologist at Mount Sinai School of Medicine in New York City, and colleagues published its analysis in Science yesterday. And today Michael T. Osterholm, PhD, MPH, director of the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP) and a colleague published an analysis in mBio, the online journal of the American Society for Microbiology (ASM).

The two groups came to different conclusions about seroprevalence estimates, which measure antibodies to H5N1 in blood and are the main tool used to detect asymptomatic or subclinical cases.

Palese's team published somewhat higher projections based on separate analyses, including one that factored in studies following Hong Kong's 1997 outbreak, which involved a different strain of H5N1 virus than those seen in the past 8 years. Their overall seroprevalence rate was from 1% to 2%, whereas Osterholm and coauthor Nicholas Kelley, PhD, a research associate at CIDRAP, found a rate of 0.47%. (CIDRAP is the publisher of CIDRAP News.)

When both groups focused on studies that used WHO criteria, however, they came to a similar conclusion of about a 0.5% seropositivity rate.

Palese's group said that, given their findings, there are probably millions of undetected infections, a claim that H5N1 experts contacted by CIDRAP News rejected, saying it goes beyond what the scientific evidence suggests.

All the experts favored a more conservative take on H5N1 seroprevalence rates, with one specifically cautioning against optimism when dealing with H5N1 death rates.

Vagaries of seroprevalence studies
Though research groups have conducted a variety of seroprevalence studies to explore the levels of asymptomatic or mild H5N1 cases, interpreting the findings and comparing results is fraught with uncertainties, such as how long H5N1 antibodies persist and what antibody levels should be used to define a positive case.

Most seroprevalence studies since 2003 in potentially exposed populations, such as poultry workers, healthcare workers, and household and social contacts of confirmed cases, have found few people with antibody levels that suggest unrecognized infections. Some studies found no evidence of infection, and others found extremely low levels, with ranges that were typically less than 3%.

However, researchers have puzzled over higher levels seen in seroprevalence studies that were conducted in Hong Kong shortly after the first human H5N1 outbreak in 1997. Antibody levels ranged from 3% in government workers who responded to outbreaks to 38% in healthcare workers who were exposed to the H5N1 virus. Some experts have suggested the differences in the two patterns might be explained by genetic differences between the 1997 strain and the more recent viruses.

Palese's analysis
At the NYAS discussion and in other outlets, Palese argued that the WHO CFR of 59% is far too high, because only severe infections in hospitalized patients are counted. He cited 10 studies with at least 500 subjects in which subclinical infection rates ranged from 0.2% to 5.6%.

In their analysis for Science today, Palese and his colleagues included 20 seroprevalence studies, which had a total of 12,677 participants. They said their overall analysis suggests that 1% to 2% had evidence of earlier H5N1 infection.

When they grouped all the studies together that used WHO criteria for confirmed cases they found a seropositivity rate of 1.2% (95% confidence interval [CI], 0.6% to 2.1%). A separate analysis of studies that used the researchers' own criteria put the seropositivity rate at 1.9% (95% CI, 0.5% to 3.4%).

A sub-analysis of poultry workers using WHO criteria found a 1.4% seropositive rate overall but a 3.2% rate surrounding the 1997 Hong Kong outbreaks and a 0.5% rate when the 1997 studies were excluded.

The group used a random-effects approach to account for variation between studies. Palese's coauthors are Taia Wang, PhD, associate faculty member in Mount Sinai's department of microbiology, and Michael Parides, PhD, a biostatistician at Mount Sinai.

Taken together, the studies show a subclinical or mild infection rate that isn't accounted for in WHO's H5N1 fatality rate, the group wrote. "Thus, the true fatality rate for H5N1 influenza viruses is likely to be less than the frequently reported rate of more than 50%," according to the report.

Though it's not possible to determine an accurate H5N1 fatality rate based on the studies, the authors estimated that a 1% to 2% infection rate would yield millions of infected people. Palese's group also acknowledged that the number of H5N1 deaths could be underestimated.

They called for further, large-scale, standardized studies to get a better handle on the number of H5N1 infections. "This information is critical for calculation of a real fatality rate that is not solely based on hospitalized patients," the group wrote.

Osterholm's methodology
Meanwhile, Osterholm, who is a member of the federal advisory group that considered the bioterror implications of the lab-modified H5N1 transmission studies, argued at the NYAS discussion that Palese was basing his assessment on a selected number of H5N1 seroprevalence studies, and he contended that 13 studies using the WHO criteria found a rate of 0.469%.

The advisory group, the National Science Advisory Board for Biosecurity (NSABB) has recommended that key details of the studies be withheld from publication.

During the debate, Osterholm downplayed the seroprevalence issue, saying that even if the H5N1 virus was 20 times less virulent than it is now, it would still be more lethal than the 1918 flu virus.

In the analysis for mBio, Osterholm and Kelley identified 24 H5N1 seroprevalence studies, excluding three from the 1997 H5N1 outbreak, because more recent H5N1 viruses are genetically different. They noted that the 1997 infections aren't included in the WHO's global H5N1 case count and the 1997 strain is not recommended for inclusion in H5N1 vaccines.

Osterholm and Kelley's analysis focused on the 13 studies that used WHO screening criteria and were conducted within 4 months of human cases or within 6 months of poultry outbreaks. In the five of these studies that reported the range of serologic titers detected, no participants had evidence of H5N1 infection based on WHO criteria, and only 13 participants had neutralization titers between 1:10 and 1:40.

One of the studies found that most subjects had detectable titers below 1:80, but the researchers who conducted that study reevaluated the dilutions and concluded that the titers did not reflect detectable H5N1 antibodies, according to Osterholm and Kelley.

They said targeted surveillance involving people who were exposed to the virus has not turned up any additional mild H5N1 infections, and though the systems can't identify 100% of cases, data so far suggest the number of missed subclinical infections is likely to be relatively small.

Like the Palese group, Osterholm and Kelley also said it's important to consider the possibility of missed fatal H5N1 infections.

They wrote that the serologic evidence supports the current WHO estimate of a 30% to 80% CFR and emphasized that the CFR was only one of a number of factors the NSABB considered when making its recommendation.

"Given the global population and the current dynamics of population movement around the world, an H5N1 pandemic, even with a relatively low case-fatality rate, would be a truly catastrophic even," Osterholm and Kelley wrote.

Their analysis also took issue with another argument used in the H5N1 study debate: that vaccines and antivirals would play a key role in mitigating an H5N1 pandemic. Experience with the countermeasures during the 2009 H1N1 pandemic showed that the vaccine was produced too late to have a major public health impact and that there were global disparities in the use and availability of antivirals.

Osterholm has been an advocate for better, more effective, and more quickly produced flu vaccines.

Future discussions on the current controversy should answer critical questions, such as how to safely conduct the studies in mammals, how to share critical methods and findings with those who need to know, and how to safeguard the viruses from lab escapes, the article says.

"The current controversy provides a valuable opportunity for scientists and public policy experts to work together in creating this roadmap for the future," it concludes.

Experts respond
Yi Guan, MD, PhD, a virologist at Hong Kong University, told CIDRAP News in an e-mail that he believes H5N1 seroprevalence rates are likely to be lower than what many studies have reported. He said microneutralization assays can generate a lot of false positives, based on his lab experience comparing the method with classical virus neutralization assay.

Conducting serological surveys using microneutralization assays without doing parallel tests to confirm the findings can produce H5N1 seroconversion rates amplified "many, many times or log," he wrote.

Guan said he personally has doubts about whether there are any subclinical H5N1 cases, based on his own experience reviewing unpublished data.

Maria Van Kerkhove, PhD, with the Medical Research Council Centre for Outbreak Analysis and Modelling in the Department of Infectious Disease Epidemiology at Imperial College London, told CIDRAP News in an e-mail that she understands why the Palese and Osterholm groups conducted the analyses, but she strongly cautioned against overinterpreting individual H5N1 seroprevalence studies or reading too much into pooled analyses of studies.

She said pooling H5N1 seroprevalence studies should be viewed with caution, because several factors between studies can vary, such as lab methods used and sera collection timing. Van Kerkhove also noted that scientists have a poor understanding of what a seropositive result means in terms of infection.

Van Kerkhove led a group that published a recent systematic review of H5N1 seroprevalence studies in Public Library of Science (PLoS) One. She said the group, which included scientists from a host of global health organizations including the WHO, had considered doing a pooled analysis, but decided against it, due to the heterogeneity and limited comparability of the studies.

Any analysis of H5N1 seroprevalence studies should account for the strain differences between 1997 and those that circulated after 2002, she said.

She added that Palese's group seems to be overinterpreting the data, with their assumption that a 1% to 2% infection rate in exposed group translates into millions of missed infections.

"While I agree that we are missing both infections and deaths, I do not believe that we are 'missing millions' of infections," Van Kerhkove said. "The data do not support this."

Marc Lipsitch, PhD, professor of epidemiology at the Harvard School of Public Health and director of the Center for Communicable Disease Dynamics, told CIDRAP News that in his view, studies in most high-risk populations show low seroprevalence, and the risk is likely to be even lower for the majority of people in countries where the H5N1 virus circulates in birds.

He said that, given the concerns about the lack of specificity of serologic measurements and the perils of comparing different studies, "I think that really all we can say about the prevalence of H5N1 highly pathogenic virus infections in humans is that it is quite rare, though difficult to say how rare it is."

Lipsitch added that Palese group's contention that millions of people have been infected with the H5N1 virus "goes far beyond the evidence."

Even if the CFR is much lower than 60%, as Palese's group contends, the virus still has the capacity to cause a highly damaging pandemic, he said, adding that the 2009 pandemic was fatal in roughly 1 in 10,000 infected patients, yet caused a major strain on the health system.

"Even if we are missing 100 milder infections for every case we detect of H5N1—and I don't think we are—we would still be talking about a risk of death 60 times or so higher than the most recent pandemic," Lipsitch said.

He cautioned against planning responses to public health threats on best-case scenarios. The possibility that the Palese group's view that the H5N1 threat is overstated is incorrect should move the world to contain the threat, he added.

"In the situation where experts disagree, it is only responsible to plan for the possibility that the optimists are wrong," Lipsitch said.

Osterholm told CIDRAP News, "The article speaks for itself. The discussion now needs to move on from whether H5N1 poses a serious threat as either a Mother Nature–made or a man-made virus—as it clearly does—and move toward how scientists can share their flu-related results with those who need to know and toward how we can prevent these viruses from accidentally escaping labs."

Palese did not respond to a CIDRAP News request for comments.

Wang TT, Parides MK, Palese P. Seroevidence for H5N1 influenza infections in humans: meta-analysis. Science 2012 (published online Feb 23) [Abstract]

Osterholm MT, Kelley NS. Mammalian-transmissible H5N1 influenza: facts and perspective. mBio 2012 Feb 24;3(2):e00045-12 [Full text]

[Aman A.K.A. Ahamburger]

I have a question DOT. So all my kids were sick then I got sick. My wife attended a Bday party on Sat, and all the guest there got sick, no jokes! It all hit us out of nowhere and we were all taking down. Is H5N1 what we are looking at I'm not overly concerned, it's just weird.

[dothedd]

Feb 28, 2012 11:52:11 GMT -5 Aman A.K.A. Ahamburger said:

I have a question DOT. So all my kids were sick then I got sick. My wife attended a Bday party on Sat, and all the guest there got sick, no jokes! It all hit us out of nowhere and we were all taking down. Is H5N1 what we are looking at I'm not overly concerned, it's just weird.

Greetings, Aham...

I know you are not kidding! How long after the B-day party, did the first family member get sick? What were/are their symptoms? Do/did they have a temperature and if so how much? Did you go to a doctor?

As for me, I was out doing errands on Monday the 20th, and awakened on Tues morning with congestion, a runny nose and a low-grade temperature that continued to inch up to 101 over several days. I can't remember the last time I even had a cold ... long story short, I broke down, went to the doctor, and was told I had the flu and was given a Z-PAK and Hydromet for cough and Motrin for body pain. I have begun to see an improvement, and have cut back on the Hydromet because I can't stay awake so I just cough and bear it until bedtime. That said, I have been wearing a facemask much of the time, just in case I have to answer the door.

Today is the first day I have been fully functional and felt like turning on my computer to work or research the local and national flu status. I found your information quickly, but had to go to the weather channel... LOL... to find ANYTHING AT ALL on local outbreaks. All the local links were relative to 2009, and one said it was under construction, so they must be collecting data to post. I'm going to e-mail everyone in my address book to inquire about his or her area flu status.

My answer to your question about H5N1 is NO, because it has not yet mutated to an air borne status, not to mention, as much as 60% of the population infected with H5N1 die.

Below is info, and a link for your area:

Overall Influenza Summary ■Influenza activity has increased in more regions compared to previous weeks
■Seven regions reported localized influenza activity and 17 regions reported sporadic influenza activity
■Eleven outbreaks of influenza were reported this week (7 in LTCFs, 2 in schools and 2 others)
■In week 04, 178 laboratory detections of influenza were reported (65 A/H3, 27 A(H1N1)pdm09, 43 A unsubtyped and 43 B)
■Twenty-two influenza-associated hospitalizations were reported this week (3 pediatric and 19 adult)
■The national ILI consultation rate increased this week compared to the previous two weeks but remains within expected levels for this time of year.
www.phac-aspc.gc.ca/fluwatch/

Aham, if you haven't been following the link you might want to do so. I would also report your experience to your local authorities.

Question: Has your weather been unusually warm? The average temperature in my area has been in the 40's to 70's and the norm for February is 0 to 35 F.

Info for my area in Kentucky:
REGIONAL Outbreaks of either laboratory-confirmed influenza or influenza-like illness are occurring in geographic areas containing less than 50% of the state's population.
www.weather.com/outlook/health/coldandflu/?st=KY&from=flu_state

•Regional influenza activity was reported by 13 states (Illinois, Iowa, Kansas, Kentucky, Michigan, Missouri, Nevada, New York, Oklahoma, South Dakota, Texas, Utah, and Virginia).
www.cdc.gov/flu/weekly/index.htm#ISTE

Most of the links on the above are "dead end" or apply to 2009.
Be well, and keep me updated on your family status.

Later,

dot

[dothedd]

Hope they are right, but I doubt it.


Bird flu cases more common than thought?

Agence France-Presse
Washington, February 27, 2012

Bird flu is believed to be a rare disease that kills more than half of the people it infects, but a US study out recently suggests it may be more common and less lethal than previously thought.

The research could help soothe concerns about the potential for a deadly pandemic that may kill many millions of people, sparked by the recent lab creation of a mutant bird flu that can pass between mammals.

Researchers at Mount Sinai School of Medicine in New York analyzed 20 previous international studies that tested the blood of nearly 13,000 participants worldwide, according to the study in the journal Science.

They found that between one and two percent of those tested showed evidence of a prior H5N1 avian flu infection, meaning millions of people may have been infected around the globe.

The World Health Organization's figures currently show just 573 cases in 15 countries since 2003, with 58.6 percent of those resulting in death.

The researchers said the WHO may be overlooking cases by focusing only on hospitalizations and severe illnesses, and recommended a new approach to calculating the true number of bird flu cases.

The findings could also mean that the death rate from bird flu is underestimated, largely because many of the people who get sick from it live in rural farming areas where medical care may be difficult to come by.

"We suggest that further investigation, on a large scale and by a standardized approach, is warranted to better estimate the total number of H5N1 infections that have occurred in humans," the authors wrote.

Researchers in the Netherlands and the United States have sparked international alarm with lab research that was successful in creating a mutant form of bird flu that was found to be transmissible among ferrets.

US health authorities have urged major science journals to publish only heavily edited forms of the studies in order to prevent the data from falling into terrorists' hands.

However, an international group of experts meeting at WHO headquarters in Geneva last week decided that the studies should eventually be published in full, but that a further risk assessment is needed before that can happen.

[dothedd]

Indonesia reports fourth bird flu death of the year

February 25, 2012 in Diseases, Conditions, Syndromes

A 12-year-old boy on the Indonesian resort island of Bali has died from bird flu, the fourth human death from the virus this year, an official said Saturday.

The boy developed fever on February 11 and was admitted to hospital five days later, the Indonesian health ministry's head of animal-borne infectious disease control, Rita Kusriastuti, told AFP.
"He suffered shortness of breath and eventually died on February 21. Laboratory tests confirmed he died from the H5N1 virus," she added.

Concerns about avian influenza have risen in Asia since China in late December reported its first fatality from the H5N1 virus in 18 months.

Indonesia has been the hardest-hit by bird flu, with 150 deaths reported between 2003 and 2011, according to the World Health Organization.

The health ministry said on its website that 154 people had now died of bird flu in Indonesia since 2005.

The virus typically spreads from birds to humans through direct contact, but experts fear it could mutate into a form that is easily transmissible between humans, with the potential to kill millions in a pandemic.

[dothedd]

Saturday, Feb 25, 2012, Posted at: 15:12(GMT+7)

Vietnam takes urgent measures to tackle bird flu
The National Steering Committee for Bird Flu Prevention held an urgent meeting with local authorities nationwide on February 23 to discuss possible solutions to tackle the re-occurrence of bird flu in the country.

Good Read Continued:

www.saigon-gpdaily.com.vn/Health/2012/2/99992/

[dothedd]

Vietnam creates indigenous bird flu vaccine
Vietnamese scientists at the Company for Vaccine and Biological Production (Vabiotech), under the Ministry of Health, have succeeded in producing a vaccine against bird flu, after eight years of scientific research.


Vabiotech researchers testing bird flu vaccine in the lab (Photo: SGGP)
The vaccine is being considered as one of the 15 important scientific achievements in the medical field in the last 10 years.

Dr. Professor Nguyen Thu Van, director of the vaccine research centre, said her efforts and those of her colleagues’ are going to be rewarded when bird flu vaccine Fluvax will be used effectively to cure people.

Bird flu hit Vietnam in 2003, spreading rapidly throughout the Southeast Asian country, recording 52 deaths. The World Health Organisation warned that bird flu virus could mutate during the pandemic to a more lethal form to cause deadly human flu if there is no effective vaccine found.

Accordingly, Dr. Van and her colleagues started on research to make a vaccine to fight bird flu. The research team decided to develop the vaccine from monkey kidney cells, as they are cheaper and safer than similar vaccines using the culture of embryonic chicken eggs currently being developed by other countries.

The scientists started clinical trials on animals in 2008, and two other trials on hundreds of researchers and staff of the Central Hygiene and Epidemiology Institute and military personnel, with the approval of the Ministry of Health and the Ministry of Defence.

Vabiotech plans the last phase of a clinical trial of the bird flu vaccine on 1,200 volunteers. Like the previous ones, the last trial is being conducted in accordance with strict European safety standards, Van said.

If this last trial succeeds, she said the company would apply for a licence from the Ministry of Health to mass produce the vaccine in 2013 at a cost that will be far lower than the imported vaccine.

The company has spent a substantial amount for purchasing a WHO standard production chain that can make around 5 million doses of vaccine annually.

[Aman A.K.A. Ahamburger]

Thanks for all the info on here DOT. YES it has been warm. We all had a fever at home here, I can't say about guest at the party. The symptoms were all the same though, liquid tummy out of nowhere. I'm glad to hear that it was just most likely a very strong flu. It's just weird how we were all basically fine, maybe a little ill, and it just ravaged everyone. A lot of people have been traveling to Mexico around here in the past two months. I would imagine it has part to do with that.

Thanks again and take care out there with all that crazy weather!

[dothedd]

Aham,

You have mail.

dot

[dothedd]

March 8, 2012

JAKARTA: A 24-year-old woman has died of bird flu on Indonesia’s Sumatra island, the fifth human death from the virus this year, a health ministry official said Wednesday.

“She tested positive for the H5N1 virus by the health ministry’s laboratory. It’s the fifth death here this year,” the ministry’s head of animal-borne infectious diseases, Rita Kusriastuti, told AFP.

Concerns about avian influenza have risen in Asia since China in late December reported its first fatality from the H5N1 virus in 18 months. Since then one more person has died in China, according to the health ministry.

Indonesia has been the nation hardest-hit by bird flu, with 150 deaths reported between 2003 and 2011, according to the World Health Organization.

Nine Indonesians died from the virus last year.

“The woman was living in an area where there are many ducks and chickens. She also had some (poultry) in her house,” Kusriastuti said, adding that she died on March 1 in a hospital in Bengkulu city.
The virus typically spreads from birds to humans through direct contact, but experts fear it could mutate into a form that is easily transmissible between humans, with the potential to kill millions in a pandemic.

Read more: Bird flu claims fifth victim this year - Latest - New Straits Times www.nst.com.my/latest/bird-flu-claims-fifth-victim-this-year-1.57000#ixzz1oU6Vt7Q9

[dothedd]

3 market workers infected with bird flu

Mon, Mar 5th, 2012 9:10 pm BdST


Nurul Islam Hasib
bdnews24.com Senior Correspondent

Dhaka, Mar 5 (bdnews24.com)—Detection of three new human infections with the deadly H5NI strain of bird flu in a week has set alarm bells ringing as scientists have found evidence of the virus in the live-bird market in crowded Dhaka.

The Institute of Epidemiology, Disease Control and Research (IEDCR) confirmed a human case on Feb 26 when a worker of a live-bird market in southern part of the capital was tested H5N1 positive at the IEDCR's surveillance site.

Its director Prof Mahmudur Rahman told bdnews24.com that they had informed the government's Department of Livestock right away and suggested 'immediate' steps to disinfect wet markets.

bdnews24.com saw no cleaning drive but learned the livestock department fixed a technical committee meeting for Wednesday instead of beginning to disinfect the market.

In the meantime, the IEDCR that oversees human infections of bird flu disclosed on Monday that another two cases were confirmed on Sunday night in their lab.

"They are also live-bird market workers," Prof Rahman told bdnews24.com and added that they expected the livestock department to move quickly for the sake of public health safety.

"The virus's presence in live-bird market means it is now even closer to people," he added.

A scientist with the IEDCR told bdnews24.com that they had run into evidence suggesting presence of the H5N1 virus in the live-bird market's garbage, as well.

The virus has the potential to cause severe illness in human with a high fatality rate.

"We are lucky as the strain (clade 2.2) of H5N1 that circulates in Bangladesh is less virulent, but it can change into another class (2.1), which is highly infectious to human," the IEDCR director said.

According to World Health Organisation, across the globe H5N1 killed 349 out of its 592 victims, except the latest two detected in Bangladesh.

Livestock authorities could not be reached immediately.

Chief veterinary officer Mosaddek Hossain, who oversees poultry infections of bird flu, declined comment when bdnews24.com approached him at around 6.30pm.

Prof Nitish C Debnath, FAO expert on avian influenza, told bdnews24.com that the government should launch 'wet market cleaning' drive at this moment.

"All should be vigilant to prevent sick poultries from entering into the market," he warned.

With four strains of flu virus – H5N1, H1N1, H3N2 and H9N2 – circulating in Bangladesh, the Food and Agriculture Organisation in Aug last year warned of a possible major resurgence of bird flu.

It said a mutant strain of the H5N1 virus is spreading in Asia including Bangladesh.

The government has confirmed first case of human infection with H5N1 in 2008, and two cases were reported in 2011.

IEDCR advises people wash egg shells and suggests consuming well-cooked poultry products.

It also urged not to litter giblets and dead birds just anywhere and maintain personal hygiene – cough into the crook of elbow and wash hands with soap often.

The first human infection from H5N1 was detected in 1997 in Hong Kong.

bdnews24.com/details.php?id=219613&cid=2

[dothedd]

Former agriculture minister denies covering up bird flu outbreak

2012/03/06 20:53:18

Taipei, March 6 (CNA) Former Council of Agriculture (COA) Minister Chen Wu-hsiung rebutted the accusation Tuesday that he covered up an outbreak of the highly pathogenic H5N2 avian influenza last December during his term in office.

"The outbreak was classified by our staff as a low pathogenic case back then," Chen said at a press conference held at the council, adding that the COA followed a method established in 2003.

The method is the same as the one used in the United States, he said, questioning if people are saying the U.S. is hiding such diseases as well.

Hiding an outbreak of an epidemic is a very serious matter, Chen said, adding that he does not accept such an accusation.

An egg-laying chicken farm in Changhua reported the disease on Dec. 27, 2011, while infections among chickens at a farm in Tainan were detected on Feb. 7, 2012, according to council officials.

An outbreak of the highly infectious H5N2 avian influenza is recognized only when the daily number of dead chickens is over 0.075 percent for three days in a row, while the figure at the egg-laying chicken farm in Changhua was below the limit, according to Chen.

Since the lab results and the low numbers of dead chickens both indicated it was a "potential case" of the highly pathogenic H5N2 avian influenza, Chen said he chose not to publicize it or report it to the World Organization for Animal Health to avoid causing the public concerns.

In addition, the council not only monitored the situation closely, but also took proper measures to prevent the disease spreading, he said.

Chen, who began serving as COA head in 2008 and was succeeded by the current Agriculture Minister Chen Bao-ji on Feb. 6, 2012, said he will take full responsibility even though he is not in office at present.

Meanwhile, the main opposition Democratic Progressive Party (DPP) criticized the government earlier Tuesday for having been slothful and negligent, and said that the Ma administration was to blame for all of the damage caused by the delayed report.

When the DPP was in power, the government would follow a standard operating procedure, including making a news release and warning surrounding farms if there was an outbreak, the party's spokesman said.
focustaiwan.tw/ShowNews/WebNews_Detail.aspx?Type=aALL&ID=201203060043

[Aman A.K.A. Ahamburger]

I believe if there was an outbreak it would really ravage Asia. It's as dirty there as it was here in 1914 when the Spanish Flu broke out..

[dothedd]

Morning, Aham,

I totally agree, and it's coming!

Have a great weekend.

dot

[dothedd]

Avian influenza – situation in Indonesia – update

1 March 2012 -The IHR National Focal Point in Indonesia has notified WHO of one new case of human infection with avian influenza A (H5N1) virus.

The case was a 12 year-old male from Badung, Bali. He had onset of symptoms on 11 February 2012 and was admitted to a private clinic on 16 February 2012. His condition continued to worsen, resulting in severe difficulty breathing. He was referred to an avian influenza referral hospital on 20 February 2012 where he died on 21 February 2012.

Epidemiological investigation into the source of infection indicated contact with poultry, though no poultry deaths within the household or neighborhood have been reported. The risk factors are still under investigation.

Of the 186 cases confirmed since 2005 in Indonesia, 154 have been fatal.

[Aman A.K.A. Ahamburger]

Mar 10, 2012 9:30:15 GMT -5 dothedd said:

Morning, Aham,

I totally agree, and it's coming!

Have a great weekend.

dot

At least the have US and our meds to help hopefully. We only had GOD on our side!

Keep up the good work!