CurEvents - Some interesting threads on the latest papers about Bird Flu:

H5N1 May Infect Via Aerosol Transmission and May Stay Airborne For A Long Time

Ordinary flu shots may help fight bird flu, mouse study suggests

Revere's Analysis of latest Nature Paper

Scientists uncover why Spanish flu was so deadly (partly new)

Revere | September 27

Effect Measure - ... crashing through half the world's poultry flocks, flicking off various other mammalian host species and the occasional human (251 at last count). We know much more about the virus than we did two years ago, but some of what we have learned is that what we thought we knew was wrong. That's progress, but of a peculiar sort. Still no effective vaccine in production and no likelihood of significant quantities for several years, if then. Uncertain quantities of antivirals on hand and with uncertain efficacy. And public health systems still tottering on the edge, with social service systems weakened as well. These are gross failures of government, and those government failures are traceable to gross failures in leadership.

Washington | September 10

AP - When bird flu infects people, the virus is more concentrated in the throat than the nose, the opposite of human flu, according to a new study. This finding may help doctors more quickly diagnose the bird flu in people.

...It is also important that physicians can detect the virus in diarrhea and other rectal secretions. This is one more way the disease can spread and shows the need for infection-control measures.

..."Our observations suggest that H5N1 virus replicates to very high levels — higher than common human flu — in the respiratory system and that these high levels of virus ignite an overwhelming intense inflammatory response"

Dr. Revere | September 9

Effect Measure - It's just early September and already the number of confirmed cases of bird flu in humans has equalled that of all last year. And we are just entering flu season. Since the resurgence of the disease in late 2003 (four cases that year), there has been a steady escalation, with 46 cases in 2004, doubling to 97 in 2005 and as of today already 97 this year And it's only September. WHO now has recorded 244 cases since 2003, with 143 deaths (WHO).

Revere | September 1

Effect Measure - WHO has just issued case definitions for H5N1 infections. Case definitions are criteria that must be satisfied to designate a person as being "a case" of H5N1 infection. Case definitions are not clinical tools but epidemiological ones. Epidemiological measures pertain to populations and require the ability to count cases and at risk populations. For example, a case fatality ratio (sometimes incorrectly called a case fatality rate) is the percentage of people infected with H5N1 that die from the disease. A case definition is necessary to determine the denominator, those infected with H5N1. Case definitions should not be used to guide treatment, which requires clinical judgment. But they are necessary elements for understanding what is going on epidemiologically, especially monitoring and following the evolution of the disease over time and in various areas and in investigating outbreaks.

Betsy McKay | September 5

WSJ - Three of the most important global public-health jobs are up for grabs this fall. How these leadership positions are filled will help determine the world's strategy for confronting health threats ranging from AIDS to pandemic flu for years to come.

The United Nations' World Health Organization is preparing to elect a new director-general following the unexpected death in May of its former chief, Lee Jong Wook, of a stroke. Nominations for the job are due today. The Global Fund to Fight AIDS, Tuberculosis and Malaria is interviewing applicants to fill its top post, succeeding Richard Feachem, who will step down as executive director in January after more than four years on the job. And the World Bank has a search under way for a new senior vice president for its human-development network, who will oversee its health programs, following the retirement of the incumbent this past July.

Washington | August 14

AP - Scientists have discovered the possible presence of bird flu in wild mute swans in Michigan _ but it does not appear to be the worrisome, highly pathogenic strain, the White House announced Monday.

"They believe it is a strain of low pathogenicity, similar to strains that have been seen before in North America," White House spokesman Tony Snow said.

Testing is still being done to confirm the presence of the virus and its type, officials said.

Scientists had feared that the deadly H5N1 strain of bird flu would reach North America sometime this year. Just last week, the U.S. expanded monitoring of wild migratory birds throughout the nation, to check for early warning signs.

Revere | August 4

Effect Measure - Update on bird flu issues in Germany, Laos, Thailand, and Vietnam.

Helen Branswell | August 5

CP - The World Health Organization on Friday welcomed the announcement that the Indonesian government had agreed to share with the global scientific community the genetic blueprints of the H5N1 avian flu viruses retrieved from human cases in that country.

A WHO official said the Geneva-based organization has instructed the WHO reference laboratories that sequenced the viruses for Indonesia to deposit their blueprints into Genbank, a databank which places no restrictions on who can study the genetic information it contains.

"What we will do is ensure that the labs — i.e. CDC and Hong Kong — that would have specimens from Indonesia are aware of the announcement from Indonesia . . . that there is permission," said Dr. Paul Gully, a former top official of the Public Health Agency of Canada who was seconded to the WHO’s global influenza program earlier this year.

Jia-Rui Chong | August 1

LAT - An experiment combining bird flu with a common human strain failed to create a pandemic virus, suggesting that it may be more difficult for bird flu to mutate into a form that is easily transmissible among humans, federal scientists said Monday.

Researchers in a high-security lab infected ferrets with genetically engineered versions of H5N1 avian influenza and found that the animals did not infect other ferrets caged nearby. The hybrid flu versions also appeared less virulent than their parent strains.

Sabin Russell, Chronicle Medical Writer | July 23

San Francisco Chronicle - Swiss drugmaker Hoffmann-La Roche has launched a campaign urging businesses to stockpile its antiviral pill Tamiflu, despite a backlog of orders from world governments building emergency caches for the public as a hedge against a deadly flu pandemic.

With only a fraction of the doses needed for a U.S. government stockpile on hand, the prospect that private companies could jump the queue to build their own reserves of Tamiflu has upset some American disaster planners who believe the public interest should come first.

"I think it is socially irresponsible. Frankly, I think it is unconscionable," said Dr. Brian Johnston, a Los Angeles emergency room physician and a trustee of the California Medical Association who works on disaster preparedness.

David Adam & James Meikle | June 26

The Guardian - · Four Azeris died after plucking swan feathers
· Virus spread by humans in Indonesia, WHO confirms

Four people have died after catching avian flu from infected swans, in the first confirmed cases of the disease being passed from wild birds, scientists have revealed.

The victims, from a village in Azerbaijan, are believed to have caught the lethal H5N1 virus earlier this year when they plucked the feathers from dead birds to sell for pillows. Three other people were infected by the swans but survived.

Andreas Gilsdorf, an epidemiologist at the Robert Koch Institute in Berlin, who led the team that made the discovery, said: "As far as we know this is the first transmission from a wild bird, but it was a very intensive contact. We know that the virus is carried by swans and we know that you can catch the virus if you have close contact, so it doesn't change anything, it's just the first time it has been reported."

Stephanie Nebehay & Fitri Wulandari | Geneva/Jakarta | June 23

Reuters - The H5N1 bird flu virus mutated somewhat among Indonesians in the largest known human cluster, but did not evolve into a more transmissible form, the World Health Organisation (WHO) said on Friday.

A spokeswoman for the U.N. agency, Maria Cheng, said the result had come from its investigation into a cluster of cases in northern Sumatra, where seven members of a single family were killed in May.

"There was a mutation found, it was in a report recently given to the (Indonesian) government. It was the summary of the investigation into the northern Sumatra case," she told Reuters in Geneva, in response to a query.

"But it did not mutate into a form that is more transmissible because it didn't seem to go beyond the cluster," she added.

Hong Kong | June 16

BBC - China's latest human bird flu case is worrying because it may show the virus is becoming as active in summer as in winter, a Hong Kong minister said.

China confirmed on Thursday that a 31 year-old man in the southern city of Shenzhen had the H5N1 virus.

Some experts believe the virus is more of a threat in cooler, winter months.

"We are concerned whether the virus has mutated so that the infection rate has become equally high all year around," Health Minister York Chow said.

"Is it because the summer and winter seasons make no difference to it? Or is it that it is active in summer, but gets even stronger in winter?" Mr Chow said.

En-Lai Yeoh | Bantul, Indonesia | June 5

AP/Canadian Press - Many of the nearly 650,000 displaced by Indonesia's earthquake are living with deteriorating sanitary conditions, forced to wash with dirty water that infects wounds and spreads skin disease, doctors said Sunday.

Another peril loomed from a nearby volcano, which spewed lava and hot gases dozens of times on Sunday. There was also concern about bird flu in the quake zone, as the number of Indonesia's human deaths from the virus mounted. Some of the homeless have taken shelter in chicken coops that aid workers fear could contain the disease.

Despite the hardships of day-to-day survival, farmers in the quake zone were returning to their fields to pick food, under pressure to earn money for rebuilding their shattered homes. Farming communities were among the hardest hit by the quake.

Earlier threads here and here.

Setphanie Nebehay | Geneva | May 30

Reuters - The World Health Organisation (WHO) issued a step-by-step plan on Tuesday, including the rapid mass use of the antiviral Tamiflu, for containing a birdflu outbreak if the virus starts to spread rapidly among humans.

The "rapid response and containment strategy" has a chance of quashing the deadly H5N1 virus only if people in the zone at risk receive massive doses of the drug within three weeks of a confirmed outbreak, it said.

"The success of a strategy for containing an emerging pandemic virus is strictly time dependent," the WHO said in its latest containment report, based on recommendations by 70 international experts who held closed-door talks in March.

Miriam Falco | Indonesia | May 29

CNN - Six more human cases of the H5N1 strain of avian flu have occurred in Indonesia, the World Health Organization has said, citing Indonesia's Ministry of Health.

Three of the cases were fatal.

May 24 Update (Originally posted May 18)


Bird Flu is confusing the experts. The highly lethal virus, in Indonesia, may have already mutated into a form easily spread among people, indicating a pandemic is on the way. On the other hand, it may not have mutated, and bird flu may even burn itself out. The spread to pigs in Indonesia, however, makes human transmission more likely.

Updates:
Reuters - Indonesian pigs have bird flu virus, making it easier to transmit to humans.
Nature - Evidence that Chinese were breeding wild birds near Quinghai Lake adds confusion to the role of migratory birds in the spread of H5N1.
CP - Exposure, rather than genetics, explains why H5N1 doesn't jump from birds to humans more often?

Alan Sipress | Jakarta | May 18

WaPo - An international team of health investigators arrived on Indonesia's Sumatra island Thursday to determine whether an unusually large cluster of human bird flu cases indicates that the highly lethal virus has mutated into a form easily spread among people.

James Sturcke | May 17

The Guardian - The World Health Organisation today confirmed five more bird flu deaths in Indonesia and that the disease has spread to the Horn of Africa.

Four of the Indonesian deaths were members of one family in North Sumatra and one was in the country's second largest city, Surabaya, in East Java, a WHO spokeswoman said.

In North Sumatra, eight members of a single family were infected and six of them have since died. Health authorities are awaiting conclusive test results on the sixth death.

Epidemiologists are now studying "cluster" cases of the disease for signs that H5N1 may have mutated into a form easily passed between people - a scenario that many fear could trigger a global human pandemic. The latest deaths mean that 30 of the 38 human cases of bird flu in Indonesia have proved fatal.

Also see: H5N1 spread among people not ruled out in Indonesia

Elisabeth Rosenthal | Rome | May 11

IHT - The flocks of migratory birds that winged their way south to Africa last autumn and then back over Europe in recent weeks did not carry the H5N1 flu virus or spread it during their annual journey, scientists have concluded, defying health officials' dire predictions.

International health officials had feared that the disease was likely to spread to Africa during the winter migration and return to Europe with a vengeance during the reverse migration this spring. That has not happened - a significant finding for Europe, because it is far easier to monitor a virus that exists domestically on farms, but not in nature.

"It is quiet now in terms of cases, which is contrary to what many people had expected," said Ward Hagemeijer, an avian influenza specialist with Wetlands International, an environmental group based in the Netherlands that studies migratory birds.

In thousands of samples collected in Africa this winter, H5N1 was not detected in a single wild bird, officials and scientists said. In Europe, there have been only a handful of cases detected in wild birds since April 1, at the height of the northward migration.

Well this is guaranteed to cause a twist in some knickers, and it does highlight how very little is really known about the virus. ~ candy

James Gerstenzang | Washington | May 4

LA Times - A government report(warning large PDF) says an outbreak could kill 2 million people and lead to quarantines, travel restrictions and an economic downturn.

The White House on Wednesday unveiled a foreboding report on the nation's lack of preparedness for a bird flu pandemic, warning that such an outbreak could kill as many as 2 million people and deal a war-like blow to the country's economic and social fabric. It urged state and local governments to make their own preparations beyond the federal efforts.

In the government's first detailed look at the potential effects on public health and U.S. society as a whole, the report said a full-blown pandemic could lead to travel restrictions, mandatory quarantines, massive absenteeism, an economic slowdown "and civil disturbances and breakdowns in public order."

It warned that the healthcare system — including doctors, nurses and suppliers of pharmaceuticals — was inadequate to meet the country's needs in a flu pandemic. "In the event of multiple simultaneous outbreaks, there may be insufficient medical resources or personnel to augment local capabilities," the report warned

Nedra Pickler | Washington | May 2

AP - Employers should have plans to keep workers at least three feet apart, colleges should consider which dormitories could be used to quarantine the sick, and flight crews should have surgical masks to put on coughing travelers under a draft of the government's pandemic flu plan obtained by The Associated Press.

The Bush administration forecasts massive disruptions if bird flu or some other super-strain of influenza arises in the United States. A response plan scheduled to be released at the White House on Wednesday warns employers that as much as 40 percent of the work force could be off the job and says every segment of society must prepare.

Alan Sipress | Jakarta | April 30

WaPo - Here at the heart of the epidemic, where bird flu continues to rip through poultry flocks and more people now succumb to the virus than anyplace else on Earth, the lunchtime crowd at the Ayam Goreng Suharti restaurant can't get enough of the chicken.

The ravenous and the merely peckish cram nearly every one of the two dozen tables. They hunch over their plates, tearing off chunks of the succulent meat with their hands, licking their greasy fingers. While international health experts continue to sound the alarm about the prospect of pandemic and U.S. officials warn ominously that the disease could appear in American birds by fall, the overriding concerns at this Jakarta eatery turn on whether to order the chicken fried or grilled, with chili or spices; to have half a bird or to splurge on a whole one.

Indonesians have learned after two years to live with bird flu. Their now-sober response offers a lesson in levelheadedness to those abroad who are panicked or might soon be.

Abidjan | April 26

Reuters - Ivory Coast has reported its first outbreaks of the H5N1 strain of bird flu in two populous neighbourhoods of its main city Abidjan, the World Organisation for Animal Health (OIE) said on Wednesday

Related:

* UK confirms bird flu in dead chickens
* Computers Predict Bird Flu Pandemic's Course
* Ducks slaughtered on Indonesia's Bali after bird flu found
* 57 suspected human cases test negative for bird flu - Pakistan