Avian flu updated

[Martin]

Previous long thread

http://www.timebomb2000.com/vb/showthread.php?t=152300&page=6&pp=40&highlight=avian




H7N2 Bird Flu on Duck Farm in Sullivan New York

Recombinomics Commentary
June 14, 2005

>> South Korea has halted the import of poultry products from New York state after the United States reported a suspicious case of bird flu in the region, the Ministry of Agriculture and Forestry said on Tuesday.

The U.S. Agriculture Department informed the World Organization for Animal Health on June 10 of the outbreak of a low-pathogenic bird flu case on a duck farm in Sullivan, New York, the ministry said.

The virus is known as the H7N2 strain, but it can develop into a high-pathogenic one and infect humans, the ministry said, adding the U.S. farm authorities are conducting further tests. <<

Additional testing of H7N2 in New York will be of interest. The two avian sero-types that have produced reported fatalities in humans are H5N1 and H7N7. Highly pathogenic versions of both sero-types have been isolated with a polybasic cleavage site. H7 appears to be efficiently transmitted human-to-human, but disease is usually mild. The largest outbreak in humans was in 2003 in the Netherlands involving H7N7. H7N7 has also caused equine flu. This season H7 has been detected in North Korea and Indonesia.

Last season H7N2 bird flu was detected in the United States in the Delmarva peninsula. In addition, H7N2 antibodies were detected in a New York resident who was hospitalized for two weeks in November 2003 with fever and cough.

More information on the H7N2 in New York this year would be useful.

http://www.recombinomics.com/News/0...N2_Duck_NY.html



Interesting...
Edited to add this



June 14, 2005 Edition > Section: New York

Fresh and Direct: Live-Poultry Markets Multiply in New York
BY DANIELA GERSON - Staff Reporter of the Sun
June 14, 2005
URL: http://www.nysun.com/article/15372

As a pair of Mexican workers, one with a fleck of chicken flesh on his cap, rolled plastic trash cans brimming with fresh intestines across the wet, feather littered floor, customers waiting for their orders at Delancey Live Poultry barely took a second look. Instead, they remained patiently in line, content to pay a little more to get their meat freshly killed rather than neatly packaged at a supermarket.

Live-poultry markets are booming in New York, thanks to influxes of immigrants accustomed to buying meat from such establishments in their native countries. It's a sea change from 25 years ago, when such markets had all but disappeared. In 1980, the state Department of Agriculture and Markets, the agency that regulates them, counted just six. Today, 80 exist in the five boroughs, concentrated in immigrant neighborhoods.

Much of the jump has occurred in the past decade - the city had only 20 shops in 1996. Today, Brooklyn alone has 28, the same number as Los Angeles, the American city with the second largest number of live-poultry markets.

When she moved to New York from Bangladesh 13 years ago, Wahida Khair recalled, a live-poultry shop was one of the first services she looked for. She ended up trekking from her home in Queens to downtown Manhattan. Nearer to home, she could purchase chicken from a halal butcher, but fresh is always tastier, Ms.Khair, an observant Muslim, said. These days, near her home in Sunnyside, she has a choice of stores where she can pick out a chicken while it's still squawking, or an occasional goat.

At RD's Live Poultry Market in Ozone Park, Queens - which sells chickens, ducks, lamb, and goats - the butcher said that in its 11 years of existence, the business has kept growing and diversifying from its Indian Guyanese roots to serve other immigrant groups. West Indians, "Hispanic customers, a couple of white people, Africans, some Russians, and Jewish people" all shop there now, the butcher, Dhanpaul Ramanand, said.

Across ethnic lines, chicken is the top product, but almost daily Mr. Ramanand sells a goat. He said that "$180 to $200 buys you a nice goat," and within a half-hour, he'll prepare it to the customer's tastes.

"Some people just need the whole thing to be cut up in pieces, some people might need a lamb chop," he said. "We prepare it for the customer how they need it by hand."

The Delancey Street market, which, after 20 years in business, started to make deliveries a few months ago, is particularly adept at catering to its multi-cultural clientele.

On a steamy day last week, the market's pungent smell poured out into the block under the Williamsburg Bridge in Manhattan. Inside, a bearded Yemeni manager was negotiating in Spanish with a regular customer as she picked out hens.

After the customer prodded various hens to check if they were still lively and searched for the reddest beaks - a trick she said she learned from her mother, who raised poultry in her native Dominican Republic - she chose four.

The manager then deftly placed them in an oversize supermarket cart and rolled them over to a Chinese butcher wearing a blood-spattered apron. Standing next to a Spanish-language sign listing prices for delicacies such as chicken feet, with practiced efficiency he tied the claws of two hens with a piece of string to weigh the animals upside down. The hens disappeared rapidly to the back of the store, where the sound of knives being sharpened competed with the chatter of hens, ducks, and chicks in the metal cages.

Working behind the scenes was a Moroccan butcher in rubber work boots. Like most of the city's live-poultry markets, the market offers halal slaughters, where the animal is killed with a special prayer in accordance with Islamic law. In addition, at the Delancey Street market, when needed a rabbi is called in to kill within kosher law, and the Chinese butcher can perform Buddhist ritual slaughters.

For the hens, the next stop was the Mexican workers, who, with the help of a machine, cleaned and plucked them. This, they said, was the only difference from the process in their native Puebla, where the plucking is done slowly by hand.

Within minutes, the hens reappeared through a small window. Now with pimply pink flesh exposed, the birds were wrapped in a plastic bag and ready for dinner.

Uptown, at La Granja, a poultry market at 126th Street and Amsterdam Avenue in Morningside Heights, the walls are similarly lined with rabbits, ducks, and types of chicken that never make it to the supermarket shelf. The mostly Dominican customers there gave similar reasons as those at Delancey Street: Picking dinner out alive provides a better-tasting, healthier meal.

"I don't mind seeing them alive before I eat them - in fact, I prefer it," Norma Garcia, 40, said in Spanish as she waited for three chickens to be slaughtered and plucked. "I can see that they're healthy birds and their meat is much more fresh and tasty, which are both concerns for me because I have children."

A customer waiting next to her, Ramon Silva, said: "The supermarket tells you their chicken is killed no more than two days ago, but, well, that's what they tell you. You don't know. Here you can see it with your eyes."

The spokesman for the trade association for the chicken companies, the National Chicken Council, dismissed any allegations that live is better.

Indeed, Richard Lobb said live chicken shops could pose dangers. The spread of avian flu, he said, is attributed to the transport of mixed birds to and from farms and markets. He noted that the disease, a variation of which devastated the industry in Southeast Asia, broke out last year at farms in Maryland and Pennsylvania. New York has the strictest regulations in the country, and both Mr. Lobb and a spokeswoman for the state, Jessica Chittenden, said the agency is doing an effective job of monitoring the disease, which is pathogenic in birds not humans. Inspectors check stores for cleanliness, conditions of birds, and slaughtering materials on a regular basis.

With no real safety risk to the consumer, Mr. Lobb said personal taste was the only reason he could see to shop for a chicken while it's still alive.

"If you prefer to look your dinner in the eye before you buy it, that's your business, but there is nothing in a chicken that is going to fade off because it's been dead for a few days," he said.

One group that appears reluctant to embrace live markets is the children of their immigrant clients.

A Bangladeshi immigrant, Nasima Begum, who was shopping at the Delancey Street market said her children love her curry chicken, except if they see it live first at the market.

"They don't want to come here," she said. "They said it stinks."

Yet Ms. Begum would never choose a supermarket over a live market. The Moroccan butcher at the Delancey Street shop, Redonan El Gani, said that while the customers choose their purchases along ethnic lines - Chinese customers prefer the rabbits and ducks, while the Hispanic customers go for the big hens - they all shop there for the same reason: "People like to see it fresh."


http://www.nysun.com/pf.php?id=15372

 

[Martin]

Meningitis Update from India Lacks H5N1 Bird Flu Data

Recombinomics Commentary
June 14, 2005

>> As of 8th June, 2005, the cumulative total is now 405 cases with 48 deaths (CFR=11.9 %). 314 cases discharged from hospital.

Control measures are underway including contact tracing, chemoprophylaxis of household contacts, and immunization of high risk groups. Serogroup A has been confirmed by the National Institute of Communicable Diseases (NICD). <<

The latest WHO update on meningitis in India continues to misstate the case fatality rate and provides no data on the H5N1 status of the cases.

The true case fatality rate based on outcomes (48 deaths and 314 discharges) is 13.3% which is virtually the same as the rate in the last update, 13.5% (37 deaths and 248 discharges). The WHO updates have listed CFRs of 11.9% and 10.1% respectively as well as a rate of 7.5% for cases through May 10. All of these calculations are incorrect because they assume that all hospitalized patients will recover, and there is no basis for such an assumption. Indeed, as some of the cases die, the improperly calculated rate rises because the proportion of the patients with an unknown outcome become less relative to the size of the population with know outcomes. Thus the early report significantly understated the true case fatality rate, while the most recent is less than 2% below the actual CFR.

Of more concern is the failure to report any H5N1 testing of these cases. Although an unreported number are positive for sero-type A, bacterial meningitis is a secondary infection of influenza. The initial reported cases were March 29 in New Delhi, which matches the time and location of bar headed geese migration from the northern plains of India to the Qinghai Lake Nature reserve. 150 bar headed geese were found dead on May 4 from H5N1 infections. Since these geese can fly from northern India to Qinghai Lake in 24 hours, it is likely that they were infected in India before arriving at Qinghai Lake.

The number of dead waterfowl, including bar headed geese continued to increase throughout the month of May, as did the number of meningitis cases. Earlier reports described H5N1 antibodies in Indian poultry workers even though India has never reported H5N1 infections in people or birds. The H5N1 in the bar headed geese is genetically similar to the Z genotype found in southeastern China, suggesting H5N1 is widespread in southern and eastern Asia, even though India and Bangladesh have declared themselves H5N1 free.

Clearly more surveillance and testing in India, Bangladesh, and China are necessary, as monitoring of H5N1 in Asia remains scandalously poor.


http://www.recombinomics.com/News/06140502/H5N1_Meningitis_India_4.html

 

[Martin]

More Mild Bird Flu Cases in Northern Vietnam

Recombinomics Commentary
June 14, 2005


>> The Ministry of Health in Viet Nam has confirmed an additional 3 human cases of infection with H5N1 avian influenza. The cases were detected during the last two weeks of May. All three patients are from Hanoi and remain alive. No further data about these cases have been provided. <<

The above comment from the latest WHO update on Vietnam describes three more milder H5N1 cases in northern Vietnam. More geographical or familial relationships were not provided, but the trend in northern Vietnam has been set since the beginning of the year. The clusters are larger and more frequent and the cases are milder. These milder cases are similar to severe cases of human flu and therefore many H5N1 human infections in northern Vietnam may go undetected.

Sequence data from northern Vietnam included an HA cleavage site missing an ARG. This missing basic amino acid matches the cleavage site from 2003 and 2004 isolates in Hong Kong and southeastern China, raising the possibility that mild human H5N1 cases are also in China. The homology with 2005 Thailand isolates also raises the possibility of more human infections there also.

Recent comments on the sequence of H5N1 from bar headed geese at Qinghai Lake also linked bird flu there to H5N1 in southeastern China. The bar headed geese winter in India and Bangladesh and fly over Tibet to nest at Qinghai Lake in May and June. Recently there have been meningitis outbreaks in northern India, which coincide in time and location with the bar headed geese migration.

Interestingly, the crested eagles smuggled into Belgium from Thailand had sequences matching those in Thialand, but the eagles originated in Tibet.

The linkage by time location and sequence of H5N1 cases throughout southern and eastern Asia raise serious questions about H5N1 monitoring of birds and people. The scandalously poor monitoring significantly compromises flu pandemic containment strategies.



http://www.recombinomics.com/News/06140503/H5N1_More_Mild_Northern_Vietnam.html

 

[Martin]

Human trial of H5N1 vaccine prompts concern, Australia touts poultry test
Jun 14, 2005 (CIDRAP News) – Efforts to combat avian flu in both people and poultry are continuing, although some steps have proven controversial.

Vietnam has announced plans to begin human testing this summer on a vaccine for H5N1 avian flu, a move that has evoked concern among some experts.

Vietnam's National Institute for Hygiene and Epidemiology has requested that the Ministry of Trade approve a vaccine trial on 10 to 20 volunteers and on 200 to 300 people living in areas that have had poultry outbreaks, China's news agency, Xinhua, announced today.

The trial would run from August to December, sources told Xinhua. The vaccine has been declared effective on mice, monkeys, and chickens, Xinhua said.

However, an online version of TIME Asia magazine's Jun 20 edition has a story that quotes experts with reservations about the vaccine.

The seed virus used for Vietnam's vaccine was mixed with cancer cells to boost replication, and then grown in monkey kidney cells, a method the article describes as highly unorthodox. It is not the same seed virus as the one approved by the World Health Organization (WHO) for H5N1 vaccine development.

"People could get cancer from the vaccine," according to a TIME quote attributed to Klaus Stohr, head of the WHO's global influenza program.

And although the vaccine's creators say they have followed international protocols to prevent the H5N1 virus from mutating in the course of vaccine production, they "haven't opened all their records or allowed an inspection of their labs," the story says.

TIME describes WHO officials as trying to convince Vietnam's government to call off the human testing and create a new vaccine using the WHO-approved seed strain, but indications are that Vietnam's planned tests will continue.

Vietnam has been Ground Zero in this year's human H5N1 outbreak, which began in mid-December 2004 and continues today. The WHO today updated its avian flu tally to reflect three new human infections diagnosed during the last two weeks of May.

"All three patients are from Hanoi and remain alive. No further data about these cases have been provided," the update noted.

WHO now tallies 55 human cases of H5N1 diagnosed in Vietnam since last December. Eighteen of those patients have died.

In Australia, researchers this week are touting a new test for avian flu that they say will identify 15 subtypes of flu in poultry within 1 day instead of the usual 3 weeks.

The test was created by the Department of Primary Industries in Melbourne, according to a story in today's Sydney Morning Herald.

The test is best used as an early warning system in areas that haven't already identified a particular strain, said Bob Cameron, Victoria's Minister for Agriculture, in the Herald story.

Details of how the test works and what methods have been used to determine its sensitivity and specificity were not available. However, the story noted that the test will be discussed at a biotechnology conference in Philadelphia that begins on Jun 19.


http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/june1405avflu.html

 

[Martin]

Vietnam detects six new bird flu patients - media
Tue Jun 14, 2005 09:50 PM ET

HANOI (Reuters) - Vietnam has recorded six more bird flu victims, taking the number of infections in the country to 61 since December, 18 of whom have died, state media reported on Wednesday.
The six were being treated in a Hanoi hospital, the Tuoi Tre newspaper quoted the National Institute for Clinical Research of Tropical Medicine as saying.

It said one hospital doctor who had been taking samples from carriers of the H5N1 virus had now developed a fever himself and was suspected of being infected.

The hospital was also treating two women found last month to have been infected with H5N1, the newspaper said..

The H5N1 virus has killed 18 Vietnamese since Dec. 16, 2004, when the disease resurfaced, taking the country's toll to 38 since it appeared in late 2003. Twelve Thais and four Cambodians have also died.

Bird flu first emerged in the Mekong Delta in southern Vietnam in late 2003, then spread to the northern region where the virus appears to develop rapidly during the winter.

Scientists fear the avian flu, which is infectious in birds but does not spread easily among humans, could mutate into a form capable of generating a pandemic in which millions of people without immunity could die.



http://www.reuters.com/printerFriendlyPopup.jhtml?type=topNews&storyID=8791936

 

[Martin]

http://www.latimes.com/news/nationw...u,1,6494239.story?coll=sns-ap-world-headlines

Philippines Bolsters Bird Flu Defense
By TERESA CEROJANO
Associated Press Writer

5:35 AM PDT, June 15, 2005

MANILA, Philippines — The Philippines is bolstering its defenses against bird flu to protect a poultry industry enjoying a boom as neighboring countries battle the virus, officials said Wednesday.

Agriculture Secretary Arthur Yap said the precautionary measures -- including strict bans on poultry imports from affected countries -- are of critical importance because the Philippines remains the only country in Asia with a significant poultry industry not affected by bird flu.

"This is a great opportunity for this country right now to export," Yap told reporters. "That is ... why we are stepping up our efforts to ensure that avian influenza does not come to the Philippines."

The Philippines' $2.72 billion poultry industry employs 300,000 people.

Yap said the government would release $1.27 million for the agriculture department to set up facilities to detect and contain avian flu.

A two-mile quarantine zone would be imposed around any area where more than 3 percent of the poultry population has died. If the virus is subsequently confirmed in that area, poultry would be culled and the quarantine zone would be enlarged to more than four miles, Yap added.

Officials are also closely watching 25 areas, mostly swamplands and watering holes of migratory birds which can carry the virus, while imposing an import ban on live or uncooked poultry from at least 11 affected countries.

Yap said if infected migratory birds land in the national wildlife park in southern Davao city, even the endangered Philippine eagle which nests there may have to be stamped out.

"That's how critical it is," Yap said.

The bird virus has swept through poultry populations in large swaths of East and Southeast Asia. Tens of millions of chickens have either died or been slaughtered, while 38 people have died in Vietnam, 12 in Thailand and four from Cambodia since late 2003.

Vietnam has recorded six new cases of bird flu in the past week, state-controlled media and officials said Wednesday.


http://www.latimes.com/news/nationw...oll=sns-ap-world-headlines&ctrack=1&cset=true

 

[Sharon]

Martin: Thanks for creating a new site, the other was getting rather long!

Read and printed out this morning the report about the vaccine that's using cancer cells....makes me want to run out and get one...NOT!!

Now, I'm wondering what "will" be in an improved (by WHO) vaccine when one becomes available...I'm sure they'll be right up front with us...again, NOT.

Anyway, thanks!

 

[Martin]

Human H5N1 Infection in Indonesia Confirmed

Recombinomics Commentary
June 15, 2005

>> The worker from southern Sulawesi island is healthy and currently shows no symptoms of the illness but two tests at a Hong Kong laboratory confirmed that he had been infected by avian influenza, health officials said.

The laboratory results make Indonesia the fourth country to register a human case of bird flu, which international health experts warn could easily undergo genetic change, sparking a global pandemic. <<

The confirmation of a human H5N1bird flu case in Indonesia raises a number of red flags. Although the worker is healthy, H5N1 infections of poultry in Indonesia are widespread are closely related to the H5N1 found throughout Asia.



The H5N1 that was widely detected in poultry in Asia in 2004 was designated as the Z genotype base on the constellation of the eight influenza genes. Each of these constellations had a number of regional specific polymorphisms. Although H5N1 in Vietnam and Thailand had polymorphisms unique to each country, they also had a considerable number of markers that were exclusives to the countries. These markers correlated with human infections, because only Vietnam and Thailand reported human infections and fatalities in 2004.

However, the Z genotype in Vietnam and Thailand were more closely related to H5N1 in other countries such as China, Indonesia, South Korea, and Japan, than and H5N1 isolated from a Hong Kong family in 2003. That constellation was designated Z+ because the NA gene did not have the 20 amino acid deletion found in the Z genotype isolates.

Moreover, the H5N1 human infections in Hong Kong in 1997 involved a constellation of genes that included internal genes found in H6N1 and H9N2 isolates, and was therefore quite different than either Z or Z+ genotypes. Thus, it was clear that a wide range of H5N1 genotypes could infect and kill humans and these was little a priori reason to assume Z genotype H5N1 could not infect humans.

The H5N1 diversity was increased again this season, when a new version appeared in northern Vietnam. Although no 2005 H5N1 sequences are publicly available at GenBank, reports from the Manila meeting last month indicated the isolates from northern Vietnam contained an HA gene that was missing three codons for an arginine reside in the HA cleavage site. This cleavage site would then match H5N1 isolates from 2003 and 2004 in Hong Kong, China, and Japan. Although cases in northern Vietnam are less lethal this season than last, there are still significant numbers of fatal cases and the virus appears to be transmitted from human to human more efficiently. In addition, asymptomatic cases have been reported.

The confirmed case in Indonesia also appears to have been mild and relatively rare. However, the case does show that H5N1 in Indonesia can infect humans and raises the possibility that H5N1 human infections are much more widespread than is being reported. Recently three poultry workers in India also tested positive for H5N1 antibodies in serum collected in 2002. Since these workers had not been out of the country, they were probably infected in India although India has denied any H5N1 infections in poultry.

Recently bar headed geese at Qinghai Lake were found dead from H5N1 infections. Reports indicate that the H5N1 in western China is similar to H5N1 in southeastern China, which is again the Z genotype and includes isolates missing the aginine. Since the bar head geese winter in India and Bangladesh, it seems likely that they were infected prior to the start of their 24 hour migration in early May, suggesting H5N1 is present in India and Bangladesh also.

These latest observations of human H5N1 in Indonesia and India, as well as outbreaks in Qinghai and Xinjiang provinces in China, raise serious concerns about H5N1 monitoring in human and animal populations in Asia.

Failure to monitor the presence of H5N1 in Asia will limit intervention plans to stop or slow the spread of H5N1 worldwide.


http://www.recombinomics.com/News/0..._Confirmed.html

 

[Martin]

Pneumonia Cluster in Tashan Xinjiang China

Recombinomics Commentary
June 15, 2005

>> We have heard from a reliable source about a report of a cluster of pneumonia cases in Tashan Hospital, leading to the isolation of patient(s) and hospital healthcare workers for "viral infection." Tashan is located 600 km from the capital city of Xinjiang Province

The above comments from an RFI report in ProMed are causes for concern. Although the patients are said to be suffering from bacterial pneumonia, the creation of an isolation ward for a cluster of pneumonia cases near the H5N1 bird flu outbreak in geese in Teching Xinjiang is curious. Fever clinics were also set up in the vicinity of Qinghai Lake after an unprecedented die-off of migratory birds infected with H5N1.

Abundant news had reported 121 human deaths linked to the Qinghai Lake outbreak. Although reports of human case have been denied, the 121 deaths and 79 additional infections were never specifically addressed. Those reports, if true, would have signaled phase 6 of the 2005 flu pandemic and further spread such as the pneumonia cluster would have been expected.



WHO has requested an onsite visit to Qinghai Lake to observe how that outbreak was handled. Clearly an expanded trip to include sites in Xinjiang as well as sites in India, where the bar headed geese winter, and an outbreak of meningitis has been described, is warranted.


http://www.recombinomics.com/News/06150503/Pneumonia_Xinjiang.html

 

[Martin]

Hungarian poultry plant pneumonia cases not viral - health official
Jun 15, 2005, 19:40 GMT




Text of report by Hungarian TV on 15 June

[Presenter] The cause of the atypical pneumonia infection caught by 20 employees of the Bekescsaba Poultry Processing Plant [in eastern Hungary] is not viral but bacterial. It means that the cases have nothing to do with the life-threatening Asian bird flu virus. It is possible, however, that the worker's pneumonia was caused by a poultry disease, known as parrot disease.

[Reporter] The first case was reported on 23 May, while the latest was reported on 5 June among the staff of Bekescsaba Poultry Processing Plant. A total of 20 people have been treated for atypical pneumonia; 11 of them have been hospitalized.

ANTSZ [State Public Health Authority] started its investigation at the company after a report by the Lung Care Hospital in Gyula [in eastern Hungary].

[Tibor Varga, executive director of Bekescsaba Poultry Processing Kft] We have ordered a strict inspection. The relevant authorities carried out the same inspection. They have not taken any measures against us which would be different from the usual, otherwise very strict, regulations.

[Reporter] The supervisors have not found any problem at the poultry processing plant. Meanwhile ANTSZ started to examine the patients. We will learn about the exact cause of the pneumonia perhaps three weeks later, the time needed for the blood tests.

[Valeria D. Wagner, Bekes County ANTSZ, head of Epidemiology Department] Among other possible causes, we have been examining the possibility of a bacterial infection which is common among domestic poultry, such as turkey or duck, or perhaps among parrots. The common name for the latter is parrot disease.

[Reporter] Even if this assumption is proven true, the case is not extraordinary. Experts say the diseases which spread from animals to humans may occur in poultry breeding and processing plants, but the infection does not spread from human to human and can be well treated with antibiotics.

Two employees of the Bekescsaba plant remain in hospital.


Source: Hungarian television M2 satellite service, Budapest, in Hungarian 1805 gmt 15 Jun 05

BBC Mon EU1 EuroPol kb




http://news.monstersandcritics.com/...t_pneumonia_cases_not_viral_-_health_official

 

[Martin]

Avian flu controls and pigs

Avian flu controls and pigs
UK - The European Union is proposing to legislate on avian flu controls. Although its proposed directive is targeted mainly at the poultry industry, movement of pigs would also be involved.
National
Pig
Association

THE VOICE OF THE UK PIG INDUSTRY
NPA is active on members' behalf in Brussels & Whitehall, and with processors, supermarkets & caterers - fighting for the growth and pros-perity of the UK pig industry.


"The proposed laboratory tests, and actions following positive findings, appear reasonable and proportionate to the current knowledge and assessment of risk," says NPA policy manager Ann Petersson. Nevertheless she would welcome any feedback from members. See notes from the consultation (below).

The competent authority shall ensure that following an outbreak, laboratory tests are carried out on pigs present on the holding to confirm or exclude the presence of avian influenza. No pigs shall be moved from the holding pending the results of those tests.



Where the laboratory tests confirm positive findings for avian influenza viruses in pigs, the competent authority may authorize the movement of those pigs to other pig holdings or to designated slaughterhouses, provided that subsequent appropriate tests have shown that the risk of spread of avian influenza is negligible.



The competent authority shall ensure that where the laboratory tests confirm a serious health threat, the pigs are killed as soon as possible under official supervision and in such a way as to prevent the spread of avian influenza, in particular during transport, and in accordance with Directive 93/119/EEC.



The competent authority may, following an outbreak or confirmation of a positive finding of avian influenza in pigs on a holding, and based on a risk assessment, apply the measures above to any other animals present on the holding and may extend those measures to contact holdings



Member states shall inform the Commission of the results of the tests and measures applied pursuant to the paragraphs above.

Additional measures to prevent the spread of avian influenza in pigs and other animals, may be adopted in accordance with the procedure referred to in Article 65 (3) (Source: Proposal for a Council Directive on Community measures for the Avian Influenza Brussels. 28.4.2005


http://www.thepigsite.com/LatestNews/Default.asp?AREA=LatestNews&Display=9544

 

[Kim99]

Mysterious Disease Kills 22 in Western Nepal
Recombinomics Commentary

--------------------------------------------------------------------------------

Recombinomics Commentary
June 16, 2005

>> At least 14 people died of diarrhea and eight others died of undiagnosed disease in two different districts of far-western Nepal, the Source reported Wednesday.

"More than 14 people died of diarrhoea in Toleni village of Doti district in the last three weeks," it quoted Hikmat Bahadur Bogati, an official at district health office as telling reporters.

About 80 people in the village are seriously ill and there is no medicine for them, he noted.

"A health worker team has already been dispatched to the epidemic affected area," he added. Xinhua also reported that eight civilians died from an undiagnosed disease in Bajura district in the past one week. <<

Mysterious fatal diseases in Nepal at this time are cause for concern. The H5N1 infected bar headed geese found dead in Qinghai Lake Nature Reserve in May winter on the northern plains of India. Thus, these birds would fly over Nepal when migrating from India to China.

In Vietnam, H5N1 bird flu infections can be found in asymptomatic ducks and geese. These birds excrete large amounts of stable H5N1, causing potential pollution problems. The H5N1 in fatal humans infections in Vietnam can produce these asymptomatic conditions in laboratory ducks.

Thus, it is possible that H5N1 infected geese from India could spread human disease linked to their migratory flight path. After H5N1 was discovered in patients with gastro-intestinal or neurological conditions, WHO had indicated that H5N1 testing of cluster of unexplained deaths would begin.

The 22 deaths described above would clearly meet that definition, but there are no hints of H5N1 testing of these cases or meningitis cases in northern India, which is very close to these two outbreaks in western Nepal.

Although WHO has expressed concerns about delayed reporting of H5N1 cases in Vietnam, surveillance of H5N1 outside of Vietnam also appears to be lacking. A much more aggressive surveillance program is required to understand exactly where H5N1 is and isn't in human and animal populations in Asia.

Media source

http://www.recombinomics.com/News/0...ious_Nepal.html
__________________

 

[Kim99]

No confirmation of reported new human cases of avian flu from Vietnam

Helen Branswell
Canadian Press

Wednesday, June 15, 2005

1 | 2 | NEXT >>
ADVERTISEMENT

(CP) - Vietnamese authorities have not provided the World Health Organization with any information about six reported new human cases of avian influenza in that country, the director of the WHO's flu branch said Wednesday.

And Dr. Klaus Stohr warned that unless the WHO receives case information on a more rapid basis, hopes of trying to extinguish an emerging pandemic at source will be jeopardized.

"We want to use this window of opportunity for early intervention . . . (but) we have to start moving when the window is opening and not when it's closing," Stohr said from Geneva, adding the world would have perhaps 20 to 30 days in which to launch a full-scale response.

"And if we would from the beginning see that the system is not tailored to keeping us within this time schedule, then one has to rethink about the feasibility of the option."

Biostatisticians have been developing mathematical models to try to assess whether it would be feasible to stop an emerging pandemic in Southeast Asia, using a combination of the antiviral drug oseltamivir and strict quarantine.

The models, expected to be published in scientific journals within weeks, suggest it might be possible, Stohr said, calling the need to at least try to avert an emerging pandemic "a moral obligation."

One of the models was produced by Ira Longini, a professor of biostatistics at Emory University in Atlanta.

With his work under consideration by a journal, Longini wouldn't reveal many details of his findings. But he said the work suggests there might be a chance of averting disaster if all the right conditions are met.

Those conditions include a sputtering start in a rural setting, with a virus that doesn't transmit well in the first few generations of cases.

"In a rural area, you could intervene within say three weeks of the first symptomatic case. At that point, containment is still possible," Longini said.

But both he and Stohr stressed the plan could only work if the world moves quickly.

And the recent lengthy delays between the first media reports of human cases of H5N1 influenza and official confirmation from the Vietnamese government do not bode well for an early intervention strategy.

For instance, despite media reports of six "newly detected" human cases being treated in Hanoi hospitals - and word that a doctor treating the patients might also have become infected - authorities in Vietnam were silent Wednesday.

WHO staff in the country attempted to speak with Ministry of Health officials about the reports but were not successful, Stohr said.

"If the objective is to attempt at eliminating the virus at its source, as the models say is possible, then we have to consider the conditions under which that would be feasible," he noted.

"And the conditions would be that one would not only have to reach a relatively large proportion of people in a given area but also to move fast."

The plan also hinges on the emerging pandemic virus remaining susceptible to oseltamivir. That is not a given. Already there has been some worrisome evidence of the emergence of strains of H5N1 flu that are resistant to the drug.

But whether the virus is susceptible or not would be moot if the WHO doesn't learn of cases in time to launch a rapid response.

"If we don't begin with an intervention, moving in antivirals and trying to perhaps eliminate the virus at its source or try and slow it down, we have missed that opportunity. That's why each and every single case needs to be rapidly investigated," Stohr said.

"Because you cannot detect a cluster without an individual case."

http://www.canada.com/health/story....a57e3e0e&page=2
_________________

 

[Kim99]

From the NIH:

http://www.nih.gov/news/pr/jun2005/niaid-14a.htm

______________________________________________________

News Advisory

The Threat of Global Pandemics
Council on Foreign Relations — DC On-The-Record Meeting
Anthony S. Fauci
Director, National Institute of Allergy
and Infectious Diseases
National Institutes of Health

Laurie Garrett
Senior Fellow for Global Health,
Council on Foreign Relations

Michael Osterholm
Director, Center for Infectious Disease Research and Policy, University of Minnesota
Associate Director, National Center for Food Protection, Department of Homeland Security
Professor, University of Minnesota School of Public Health

James F. Hoge, Jr.
Peter G. Peterson Chair, Editor, Foreign Affairs
presiding


International health officials are warning that a deadly avian influenza virus may soon spread rapidly, overwhelming unprepared health systems in rich and poor countries alike. As a call to action, the July/August issue of Foreign Affairs includes a special set of articles on the threat of global pandemics. In collaboration with Nature magazine, Foreign Affairs has provided this coverage to assist the efforts of the Royal Institution World Science Assembly.

Also participating:
Rita Colwell
Chair, Royal Institution World Science Assembly Pandemic Preparedness Project
Former Director, National Science Foundation
Chair, Canon U.S. Life Sciences, Inc.
Distinguished University Professor, the University of Maryland at College Park
and the Johns Hopkins University Bloomberg School of Public Health

Thursday, June 16, 2005
7:30-8:00 a.m. Camera Crew Registration
8:00-8:30 a.m. Press Registration and Breakfast
8:30-9:30 a.m. Meeting**

Council on Foreign Relations
1779 Massachusetts Avenue, N.W.
Washington, D.C. 20036

Note: This event is open to accredited journalists only.
(Please inform if you will be accompanied by a camera crew or if you have special AV needs.)
**RSVP is required**

Email DCpressRSVP@cfr.org
or
Call 202-518-3428

NIAID is a component of the National Institutes of Health, an agency of the U.S. Department of Health and Human Services. NIAID supports basic and applied research to prevent, diagnose and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism. NIAID also supports research on transplantation and immune-related illnesses, including autoimmune disorders, asthma and allergies.

News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — is comprised of 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary Federal agency for conducting and supporting basic, clinical, and translational medical research, and investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.



This meeting was only announced yesterday or the day before, why the rush?

 

[Martin]

Avian flu: 'We're screwed' if it hits soon

A woman in critical condition with a respiratory illness similar to the bird flu in Hanoi, Vietnam

Posted 6/16/05
By Betsy Querna

Health experts and officials shook up a breakfast meeting in Washington this morning with more alarm over what they see is an inevitable avian influenza pandemic and public-health emergency. Also today, World Health Organization officials confirmed the first case of avian flu in a farmworker in the island nation of Indonesia. Known as avian flu because it infects primarily chickens and waterfowl, the officials fear that the virus will mutate and become a human disease. Because this strain has never circulated through the human population, people would have no innate immunity if they were infected. Officials compare the virus to the 1918 pandemic that hit one third of the population and killed between 1 and 5 percent of those infected. This strain, known as H5N1, could be at least that deadly and perhaps more so, especially for young and healthy people who would very likely die from an immune system reaction to the disease, as happened in 1918. Today, if the pandemic hit, the number of dead could be as high as 360 million worldwide.



"You can get rid of the 'if' because it's going to occur," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. It may not occur this year, or next, he said, "but [the threat] is not going to go away." The disease has currently crossed over to humans in Asia, but only among people who have very close contact with chickens or who take care of the sick. It has killed at least 54 people in Asia but is not now communicable in the way that the more common and less lethal human influenza viruses are.

The virus "is due to spin out of this bird population" that it currently infects, said Michael Osterholm, the director of the Center for Infectious Disease Research at the University of Minnesota. When it does, the fast pace of global transportation and trade is sure to carry it around the world in a matter of days if not hours, the officials said. And while most states have plans in place to deal with public-health emergencies, many of those plans have yet to be tested in real or simulated situations. If the pandemic were to hit today, said Osterholm, "I don't know what we could do about it except say, 'We're screwed.'"


http://www.usnews.com/usnews/health/articles/050616/16avian.htm

 

[Martin]

Pandemic could cause food shortages, expert warns
Canadian Press

An influenza pandemic would dramatically disrupt the processing and distribution of food supplies across the world, emptying grocery store shelves and creating crippling shortages for months, an expert warned Thursday.

Dr. Michael Osterholm suggested policy makers must start intensive planning to figure out how to ensure food supplies for their populations during a time when international travel may be grounded or severely cut back, when workers are too sick to process or deliver food and when people will be too fearful of disease to gather in restaurants.

Food and other essential goods like drugs and surgical masks will be available at best in limited supplies, Osterholm cautioned in the July/August issue of Foreign Affairs, which devoted a number of articles to the threat of pandemic influenza.

He saved his most flatly worded warning, however, for a news conference organized by the Council on Foreign Relations, which publishes the respected journal. In an interview from Washington following the briefing, he repeated his blunt message of how dire things would be if a pandemic starts in the short term.

"We're pretty much screwed right now if it happens tonight," said Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

Osterholm said the "just-in-time" delivery model by which modern corporations operate means food distribution networks don't have warehouses brimming with months worth of inventory.

Most grocery store chains have only several days worth of their most popular commodities in warehouses, he explained, with perhaps 30 days worth of stock for less popular items.

He pointed to the short-term shortages that occur when winter storms threaten communities, then suggested people envisage the possibility of those shortages dragging on for somewhere between 18 months and three years as the expected successive waves of pandemic flu buffet the world.

"I think we'll have a very limited food supply," he said in the interview.

"As soon as you shut down both the global travel and trade . . . and (add to it) the very real potential to shut down over-land travel within a country, there are very few areas that will be hit as quickly as will be food, given the perishable nature of it."

Osterholm has been one of the most vocal proponents of the urgent need to prepare for a flu pandemic that could sicken at least a third of the world's population and kill many millions. However, he is not alone in fearing the world may be facing a pandemic, widely viewed as the single most disruptive and deadly infectious disease event known to humankind.

The lingering outbreak of the H5N1 avian flu strain that has decimated poultry stocks in wide swathes of Southeast Asia has influenza experts the world over losing sleep over the possibility the highly virulent virus will mutate or evolve to the point where it can spread to and among humans, starting a pandemic.

According to the official World Health Organization tally, at least 103 people have been infected with H5N1 influenza since December 2003 in Thailand, Vietnam, Cambodia. That count doesn't include a farm worker in Indonesia who was recently confirmed to have been infected with - and recovered from - H5N1.

It also doesn't include six new cases which came to light this week in media reports from Vietnam. While Vietnamese authorities haven't notified WHO of the cases, the agency said in a statement Thursday the reports "appear to be accurate."

Official and unofficial tallies put the human death toll at 54 since December 2003.

Laurie Garrett, a fellow at the council, noted the unprecedented potential of a pandemic to wreak economic and political havoc.

"Frankly no models of social response to such a pandemic have managed to factor in fully the potential effect on human productivity," Garrett, a Pulitzer-prize winning former journalist and author of The Coming Plague, said in an article in the journal.

"It is therefore impossible to reckon accurately the potential global economic impact."

Osterholm said it is incumbent on governments to start identifying essential basic commodities and figuring out supply and delivery for a time when long-distance truckers may balk at travelling to affected communities and armed forces personnel may be too sick to fill in the gaps.



http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/1118969974296_47/?hub=Health

 

[Kim99]

Warnings Grow Dire on Bird Flu Threat

U.S. Officials and Experts Complain of Catastrophic Danger

By Todd Zwillich
WebMD Medical News Reviewed By Michael Smith, MD
on Thursday, June 16, 2005
More From WebMD

Bird Flu May Be More Contagious Than Thought

What There Is to Know About Bird Flu

Get the Day's Top Stories Delivered

June 16, 2005 -- U.S. health officials and infectious disease experts have been sounding the alarm for more than a year on the deadly potential of a widespread pandemic of the bird flu troubling Southeast Asia.

But their warnings have become unmistakably ominous as they struggle to convince the public and policy makers of the need to prepare for the mass casualties, chaos, and devastation that will likely result if the disease spreads across the world.

As of June 14, 103 people have been infected with bird flu in Vietnam, Thailand, and Cambodia, according to the World Health Organization. Officials yesterday also disclosed the first reported case in Indonesia.

Normally, 104 cases of any disease would hardly grab the attention of public health experts. But bird flu is different. More than half of the cases have been fatal, suggesting an unprecedented level of harm for a modern flu. Humans have no natural immunity to the virus causing the disease, known as H5N1, and no vaccine is available.

In congressional hearings and on television, officials have repeatedly advised the public of the potential for millions of casualties if bird flu gains the ability to easily spread from birds to people or between humans themselves.

Bird Flu Warnings Get Stronger

But the warnings have now become decidedly darker as officials warn of a catastrophic economic shutdown and a global political crisis if bird flu strikes an unprepared world.

"This is much larger than a public health threat. The vast majority of the world just doesn't get how vulnerable we are," says Michael Osterholm, MD, associate director of the National Center for Food Protection and Defense in the Department of Homeland Security and a former bioterrorism advisor to the Bush administration.

Federally run tests of an experimental bird flu vaccine are under way and due to yield preliminary results later this summer. Even if it's effective, no one expects manufacturers to be able to quickly make enough to protect the U.S. population.

Osterholm complains that U.S. officials and companies have not planned for the widespread logistical disruptions that would result if bird flu were to spread within the next couple of years. His warnings range from inadequate planning for hospital overcrowding to the fact that the U.S. market has only 2.5-week supply of caskets.

Local and federal agencies have not planned for widespread disruptions to schools and workplaces as the public is told to stay home and gymnasiums are converted to emergency medical facilities, he says. Travel restrictions and a run on vital supplies, such as masks able to filter flu viruses, would "no doubt" lead to an economic shutdown, he adds.

What to Do?

Asked at a Thursday forum hosted by the Council of Foreign Relations what can be done to immediately prepare for a bird flu outbreak, Osterholm says there's probably little we can do at this point.

What can the U.S. do to prevent the continued spread of flu from billions of Asian chickens and ducks? "The bottom line message is: almost nothing," says Osterholm, who is also a professor at the University of Minnesota.

World Community Unprepared

Others offer equally stark warnings that the U.S. has not engaged foreign governments over how nations will react in the event of a global pandemic and economic standstill. Poor and middle-income governments have already begun to complain that they are being left out as industrialized countries make deals to buy stockpiles of antiflu medications, says Laurie Garrett, the council's senior fellow for global health and a former journalist.

"We have no agreed-upon mechanisms of any kind," Garrett says. "This could turn into a big, bloody mess."

Bush administration officials told lawmakers two weeks ago that they are hard at work completing a national flu response plan governing issues such as quarantines, hospital capacity, and distribution of emergency pharmaceuticals.

Anthony Fauci, MD, director of the National Institute for Allergy and Infectious Diseases, acknowledged in an interview that officials' public statements about bird flu have become unusually stark. He attributes the warnings to concerns over bird flu's apparent harm and to the lack of human immunity.

Officials are also trying to galvanize support for new laws that would give pharmaceutical companies incentive to produce large amounts of vaccine against bird flu and other more common types of flu. "That's the thing that we keep trying to drill at," he says.

Fauci says that "the administration is very much up there" in its level of activity in flu planning.

Meanwhile, other experts remain largely unconvinced.

Steven Hoffman, an audience member at the Council forum, rose to say that the experts' stark warnings had convinced him "to get in my car and move to Montana or something."

"It won't help," Garrett told him

http://my.webmd.com/content/Article/107/108562.htm
__________________

 

[Martin]

Vietnamese bird flu doctor has bird flu
17 Jun 2005 02:33:09 GMT

Source: Reuters

HANOI, June 17 (Reuters) - A Vietnamese doctor who treated bird flu patients has contracted the disease himself, a state newspaper reported on Friday.

The male doctor had been taking samples from carriers of the H5N1 virus, the Tuoi Tre (Youth) newspaper said without specifying how he contracted the disease. His condition was stable, it said.

The infection took to 7 the number of bird flu victims revealed this week in Vietnam and the number of infections to 62 since December, 18 of whom have died.

The H5N1 virus has killed 38 people in Vietnam since it appeared in late 2003. Twelve Thais and four Cambodians have also died.

Bird flu first emerged in the Mekong Delta in southern Vietnam in late 2003, then spread to the northern region where the virus appears to develop rapidly during the winter.

Scientists fear the avian flu, which is infectious in birds but does not spread easily among humans, could mutate into a form capable of generating a pandemic in which millions of people without immunity could die


http://www.alertnet.org/thenews/newsdesk/HAN298514.htm

 

[Martin]

How pigs could be launchpad for bird flu pandemic

James Meikle, health correspondent
Saturday June 18, 2005

Guardian

The frustrating search to unravel the bird flu sweeping south-east Asia in the hope of estimating the likelihood of a human global pandemic took another twist yesterday.
A virologist from Hong Kong warned pigs could provide a launchpad, even if birds carrying the virus, which is causing havoc in Vietnam, Cambodia and Thailand, failed to do so.

Malik Peiris warned a conference on animal-to-human diseases in Liverpool that disease could spiral if pigs - already carrying a virus linked directly to human flu - picked up a member of the avian flu family.

The H5N1 virus, one of 15 sub-types of influenza A, originated in waterbirds that never showed symptoms. It became a goose virus and spread to poultry more generally, infesting markets in Hong Kong where birds were slaughtered on the spot. But, after a handful of human deaths and the culling of 1.5m birds, the outbreak was brought under control,

Only about 20% of poultry sold in Hong Kong is raised locally with the rest coming from other parts of China. But because of new controls in the markets the disease was temporarily tamed.

Next time, it was more difficult. The epidemic further south involved backyard flocks, ducks wandering across paddy fields, cock-fighting birds and wild birds. More than 100m birds have been culled.

Though around half of the 100-plus people infected in the last 18 months have died, scientists hoped humans would not pass disease on to others. However there is now some uncertainty. A healthcare professional treating avian flu patients in Hanoi appears to have the disease, for instance.

Viruses are unstable, they mix and match, and their behaviour is unpredictable. Professor Peiris, chief of virology at the Queen Mary hospital, Hong Kong, said: "We have a virus that is inefficiently crossing to humans. But, as with Sars, if you leave this situation to continue for long enough, it is possible that virus may adapt to efficient human to human transmission."

There was another possibility. Pigs are already a mixing vessel for such viruses. Were these to combine and mutate in them before spreading to humans, they could become "reassorted" and either become more or less virulent and more or less likely to transmit between people.

A ready opportunity already existed on farms in Asia. "Pigs in southern China are carrying the human H3N2 virus," Prof Peiris said. "Obviously you have this setting where pigs and poultry are next to each other and you clearly have an opportunity for H5N1 to cross into pigs who might be carrying the H3N2 virus."

Prof Peiris lobbed another grenade into the debate. The British government has claimed that within two years it will have a stockpile of antiviral drugs sufficient to treat 14.6m people- the old, young and chronically sick, about a quarter of the population.

This should buy time, ministers believe, while new vaccines could be developed. But Prof Peiris said a relatively cheap one had to be abandoned in Asia because it has also been used on poultry, and birds developed resistance.

Resistance to the widely used Tamiflu, a weapon also against conventional human flus, had not been widespread. "However the caution would be that we have been looking at normal avian flu.

"There is an immune response already there [in peo ple] and so the antiviral is helping the immune response. In a pandemic situation, it could be much more difficult because you don't have that immune response helping.

More caution was raised yesterday over how governments planned for potential disaster. Marion Koopmans, chair of virology for the National Institute of Public Health and the Environment, the Nether lands, reviewing the Dutch avian flu crisis of two years ago, revealed there had been several hitches in trying to combat the threat posed by another avian virus, H7N7.

A vet died and at least 1,000 people were infected, either through carrying out the 30m chicken cull or picking it up from someone else involved. Safety had been a low priority. Some people forgot to take an tiviral drugs, others stopped too soon and some simply did not have enough.

Privacy laws made it difficult to track down people who might have been exposed; untrained workers carried out the culls. There was also problems informing the public "about the distant risk of reassortment", said Dr Koopmans.



http://www.guardian.co.uk/print/0,3858,5218799-108142,00.html

 

[Martin]

Alarming Increase in Bird Flu Cases in Northern Vietnam

Recombinomics Commentary
June 17, 2005

>> [There are discrepancies between these reports which appear to confuse confirmed and suspected cases. As of 17 Jun 2005, the most recent WHO Update recognizes 4 new human cases of avian influenza, bringing the total of confirmed cases since Dec 2004 to 59 (18 of whom have died).

It is evident from the other reports that there are additional cases under
investigation and that a few people are still contracting avian influenza
in northern Viet Nam. It has been widely reported in the media that one of
the doctors treating avian influenza virus patients in Hanoi has himself
contracted avian influenza. However, the 3rd report above states that a 2nd test has proved negative and it is unlikely that the doctor is suffering
from avian influenza. - Mod.CP] <<

The above comments by one of the moderators at ProMed fails to note the sudden alarming increase in cases from northern and central Vietnam. Although official notifications to WHO are lagging, WHO has indicated that they believe the media reports are accurate. Two separate reports indicated that the total number of confirmed and suspect cases totaled 23. One report broke the cases down into 11 H5N1 confirmed cases, most of which were admitted last week, and an additional 12 suspect cases admitted this week.

Admission of over 20 cases in less than two weeks is cause for concern. There was some detail provided for the confirmed cases. The two that were admitted at the beginning of the month were female and named, Cao Thi Hang from the central province of Nghe An and Dinh Thu Hien from the northern province of Thai Binh. In addition there were two patients from Ha Noi and one each from Vinh Phuc and Hai Duong. In addition there were two more listed from the central provinces of Thanh Hoa and Nghe An. Thus, there would be seven or eight (the two listed in separate reports from Nghe An could be a duplicate of the same patient) in addition to the physician collecting blood from these patients.

The sudden jump in confirmed and suspect patients from at least six separate provinces in northern and central Vietnam in the past two weeks is without precedent.

The characterization of the alarming jump as "a few people" is yet another example of wishful thinking on the part of the ProMed commentator.

The reports do not suggest that the sudden influx of patients has ceased. Indeed it seems that there were two patients in the first week of this month, 9 in the second, and 12 so far in the third. Since the cases are relatively mild, it is likely that the number of unreported cases in these six provinces is large and the jump in cases suggests more efficient human-to-human transmission.

The alarming jump in cases is clearly more than a few, and is cause for concern.

The jump may be signaling progress of the flu pandemic in northern Vietnam into phase 6.


http://www.recombinomics.com/News/06170504/H5N1_Alarm_Northern_Vietnam.html

 

[Martin]

Human to Human Transmission in Northern Vietnam At Phase 6?

Recombinomics Commentary
June 17, 2005

>> LIZ FOSCHIA: The World Health Organisation says news of the infections is being reported locally in Vietnam.

Peter Cordingly is based in the organisation's Asia-Pacific headquarters in Manila.

PETER CORDINGLY: We've seen media reports of six people in a hospital in Hanoi being tested positive for H5N1. In fact we're not quite sure whether it's six patients plus one doctor, or five patients plus one doctor. The media reports are a little bit contradictory, and we don't have any official information from the Vietnamese to work on.

So basically we have to do our best guess work on this one. And this does worry us a little bit. If six people are infected in one hospital, this would be the first time we've seen this. There's no evidence so far, not even in the media reports, or anything we've seen to date, that suggests that there is human-to-human transmission going on in Vietnam.

But this one we will be looking at very carefully........


LIZ FOSCHIA: Is it the fact that it's a group of six people that's concerning?

PETER CORDINGLY: Yes. Clusters always send our blood pressure up. This is the biggest one. The previous one was five, so it's not an enormous jump, but they do catch our attention.

And we need to have very swift information on this, because while we don't know how a pandemic will start, it will almost certainly start through a cluster, so every cluster has to be very closely examined.

I should say that every one that has been closely examined to date has shown that poultry was the source of infection, and that may well be the case here as well. So basically we have to do our best guess work on this one. And this does worry us a little bit. If six people are infected in one hospital, this would be the first time we've seen this. There's no evidence so far, not even in the media reports, or anything we've seen to date, that suggests that there is human-to-human transmission going on in Vietnam.<<
The above comments by WHO are alarming, both because of the comments on prior human-to-human transmissions, as well as the lack of information on the explosion of cases in northern Vietnam.

There has been human-to-human transmission of H5N1 bird flu in Vietnam and Thailand since early 2004. Last season these transmissions were limited to family members and the clusters only involved 2-4 people within a family.

This season the clusters began to expand and transmission extended from patients to health care workers. Although comments on a possible poultry origin were made, there was virtually no evidence to support such a claim. The attempts to use meals at friends houses or blood pudding were embarrassing and did not reflect well on WHO's to objective analyze data.

The above comments are astonishing and demand changes in personnel at WHO.

However, over and above WHO's internal deficiencies on analyzing and reporting data, is their inability to gather current information. As noted above, they are relying on media reports, which can frequently be confusing, and the WHO's ability to analyze such reports are also of concern.

The media reports indicate that there are now 23 cases at the Institute for Tropical Medicine in Hanoi. As noted above, the prior reported record was 5 for a hospital. There appear to be 21 new cases admitted since last week.

Although details of these cases are not known, they are all from northern Vietnam and have been transferred to the same facility. Moreover, a healthcare worker has tested positive for H5N1, providing additional direct evidence of human-to-human transmission. The increase in the size of the clusters has already moved the pandemic in Northern Vietnam to phase 5.

The latest data appears to be moving the pandemic to phase 6. Third party reports from the western provinces of Qinghai and Xinjiang would also indicate the pandemic there has also moved to phase 6, and the H5N1 there may be more virulent than the version in northern Vietnam.

Clearly better monitoring, data analysis, and reporting of data is required by WHO. Their continued comments understanding the human-to-human transmission is well beyond scandalous


http://www.recombinomics.com/News/06170503/H5N1_Northern_Vietnam_Phase_6.html

 

[Martin]

IDSA says US antiviral supply for flu falls far short

Jun 17, 2005 (CIDRAP News) – The Infectious Diseases Society of America (IDSA) is calling the US government's stockpile of antiviral drugs "totally inadequate" in the face of a potential influenza pandemic.

The IDSA says the current stockpile of antivirals for flu is enough for only 2.3 million courses of treatment. IDSA President Walter Stamm, in a Jun 15 letter to Health and Human Services (HHS) Secretary Mike Leavitt, called that amount "totally inadequate and unlikely to provide any meaningful benefit to our population."

"When the next pandemic hits, antivirals will be our only defense for at least the first six to nine months it takes to make a new vaccine," Stamm stated in an IDSA news release. "But right now, if Asia's bird flu or another strain turns into a pandemic, we'll be caught nearly empty-handed."

The IDSA, an organization of about 8,000 physicians and others dealing with infectious diseases, asserts that HHS should have an antiviral stockpile sufficient to treat at least 52 million to 84 million flu patients and to use preventively in at least another 15 million to 40 million essential healthcare workers and emergency responders.

The IDSA statement says government officials are cool to the idea of stockpiling antiviral drugs because they are not convinced the drugs could reduce the death toll in a pandemic.

But the IDSA asserts that research on existing flu strains has shown that antiviral drugs, if used within the first 48 hours of symptoms, can cut the number of hospitalizations in half, reduce complications such as pneumonia, and shorten the illness. They also can prevent flu in the first place, the group says.

The society estimates that an adequate stockpile could cost up to $1 billion. Kathleen Neuzil, MD, a member of IDSA's Pandemic Influenza Task Force, said in the news release, "But we are spending far more than that preparing for smallpox and anthrax attacks. Those are serious threats, but they are unlikely—compared to the serious and very likely threat of a flu pandemic."

Stamm's letter said the government should begin expanding its stockpile now, because it will take several years to build an adequate amount.

Marc Wolfson, a spokesman for the HHS Office of Public Health Emergency Preparedness in Washington, DC, provided information confirming that the HHS has enough oseltamivir (Tamiflu) to treat 2.3 million people. He cited an October 2004 HHS news release stating that by December (2004) the agency expected to have that amount in hand. Oseltamivir is considered the most effective antiviral for H5N1 influenza, the avian flu strain that has infected more than 100 people in Asia.

By e-mail, Wolfson told CIDRAP News, "There are plans to purchase additional antiviral medication for the stockpile, but I have not been given any specific quantities at this point."

A recent report in the British magazine Nature said that Britain has ordered enough oseltamivir for about 25% of its population and Canada has stockpiled enough to cover about 5% of Canadians. The current US stockpile would cover less than 1% of the population.

The World Health Organization has been urging countries to stockpile the drug in advance, the Nature report said. It takes about a year to make a batch of the drug, and the manufacturer, Roche, has no spare production capacity, the magazine reported. The cost of one treatment course is between $10 and $30.

In related news, health experts held a news conference yesterday in Washington, DC, to warn that the world is poorly prepared for a flu pandemic. The event marked the publication by the journal Foreign Affairs of four articles on the threat of pandemics, primarily focusing on the risk of a flu pandemic.

Though they didn't try to predict when a pandemic might erupt, the experts said governments around the world should increase research and preparedness efforts immediately, according to a report in the Minneapolis Star Tribune. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said, "This [threat] is not going to go away. Get rid of the 'if.' This is going to occur."

Michael T. Osterholm, PhD, MPH, said the US government should prepare to deal with a collapse of the global economy if a major pandemic materializes. "I don't know what else to say except, 'We're screwed,'" he was quoted as saying. Osterholm is director of the University of Minnesota Center for Infecctious Disease Research and Policy, publisher of this Web site.



http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/june1705pandemic.html

 

[Martin]

turday, June 18, 2005
Candaba swamp in Pampanga a bird-flu hotspot
By Marna H. Dagumboy

CITY OF SAN FERNANDO -- The Candaba swamp, which has gained international recognition as favorite nesting place of migratory birds, has been included in the list of 20 areas identified as possible breeding grounds for the deadly bird flu.

Officials of the Department of Agriculture (DA) and the Department of Health (DOH) said they have placed under tight watch at least 20 areas in the country that are possible breeding grounds of the avian influenza virus.

Agriculture Secretary Arthur Yap said aside from Candaba swamp, other areas in the list of bird flu "hot spots" include Zamboanga del Norte, Zamboanga del Sur, Zamboanga City, Zamboanga Sibugay, Palawan, Pagudpud in Ilocos Norte, Aparri, Cagayan, Cebu, Negros Occidental, Isabela, Lake Mainit in Agusan del Sur, Agusan del Norte, Surigao del Norte, Surigao del Sur, Roxas City, Sorsogon, General Santos City, Mindoro Oriental and Cotabato.

The areas have an abundance of swamplands and watering holes that are periodically visited by migratory birds, he said.

Yap said the migratory birds are the biggest threat if they are infected with the virus. He said the Philippines is the only country in the Asian region with a significant poultry industry that is avian flu-free.

He said the DA and the DOH will isolate a particular spot where there is a daily death of three percent of the bird population. He said two agencies would isolate the area within a three-kilometer radius quarantine area.

The agriculture secretary added that if findings become positive, the area will be stretched to a seven-kilometer radius and all the birds stamped out. No poultry activities will be allowed, he said.

Health Secretary Francisco Duque said although the risk could not be quantified, the probability of the virus spreading is high.

The most vulnerable people, he said, are those who actually come in contact with the infected birds.

Duque said the avian influenza virus disease has a 70 percent fatality rate for people who are infected.

Yap said even the world-famous Philippine Eagle is in danger of becoming extinct if the National Wild Park Conservation area in Davao, where the national birds are found, becomes part of the three-kilometer quarantine area. (Sun.Star Pampanga/Sunnex)


http://www.sunstar.com.ph/static/net/2005/06/18/candaba.swamp.in.pampanga.a.bird.flu.hotspot.html

 

[Kim99]

This is from the EffectMeasure Blog:

Bird flu sites

The lack of attention to the bird flu problem by the American media is perhaps not surprising (figuring out what's important and then telling us has not been their strong suit), but the similar lack of attention by the blogosphere is. However there are bloggers (besides us, that is) who have paid attention. Judging from the traffic on this site, there is considerable interest out there, so here are the links:

Just a Bump in the Beltway
Similar to this site in some ways, although not concentrating on public health. Melanie has persistently and accurately kept avian influenza in her sights.

Pathogen Alert
The name says it all. Slow server.

Recombinomics
Not exactly a blog, Henry Niman's company site has a wealth of up-to-date information on influenza. Suited to technically confident visitors with a good handle on the existing situation. Part of my daily read.

Center for Infectious Disease Research and Policy (CIDRAP)
Website of the Center at the University of Minnesota run by Mike Osterholm. Full of extremely useful information on infectious diseases and authoritative background information and news about bird flu.

ProMed Mail
Alert service used by many public health professionals that includes reports from everywhere on emerging infectious diseases, including avian flu. Tends to lag a bit behind the other sources.

CDC Avian flu site
Usually a day late and a dollar short, but background information conveniently arrayed.

 

[Martin]

Bird Flu Drug Rendered Useless

Bird Flu Drug Rendered Useless
Chinese Chickens Given Medication Made for Humans

By Alan Sipress
Washington Post Foreign Service
Saturday, June 18, 2005; A01



HONG KONG -- Chinese farmers, acting with the approval and encouragement of government officials, have tried to suppress major bird flu outbreaks among chickens with an antiviral drug meant for humans, animal health experts said. International researchers now conclude that this is why the drug will no longer protect people in case of a worldwide bird flu epidemic.

China's use of the drug amantadine, which violated international livestock guidelines, was widespread years before China acknowledged any infection of its poultry, according to pharmaceutical company executives and veterinarians.

Since January 2004, avian influenza has spread across nine East Asian countries, devastating poultry flocks and killing at least 54 people in Cambodia, Thailand and Vietnam, but none in China. World Health Organization officials warned the virus could easily undergo genetic changes to create a strain capable of killing tens of millions of people worldwide.

Although China did not report an avian influenza outbreak until February 2004, executives at Chinese pharmaceutical companies and veterinarians said farmers were widely using the drug to control the virus in the late 1990s.

The Chinese Agriculture Ministry approved the production and sale of the drug for use in chickens, according to officials from the Chinese pharmaceutical industry and the government, although such use is barred in the United States and many other countries. Local government veterinary stations instructed Chinese farmers on how to use the drug and at times supplied it, animal health experts said.

Amantadine is one of two types of medication for treating human influenza. But researchers determined last year that the H5N1 bird flu strain circulating in Vietnam and Thailand, the two countries hardest hit by the virus, had become resistant, leaving only an alternative drug that is difficult to produce in large amounts and much less affordable, especially for developing countries in Southeast Asia.

"It's definitely an issue if there's a pandemic. Amantadine is off the table," said Richard Webby, an influenza expert at St. Jude Children's Research Hospital in Memphis.

Health experts outside China previously said they suspected the virus's resistance to the medicine was linked to drug use at poultry farms but were unable to confirm the practice inside the country. Influenza researchers at the U.S. Centers for Disease Control and Prevention, in particular, have collected information about amantadine use from Chinese Web sites but have been frustrated in their efforts to learn more on the ground.

China has previously run afoul of international agencies for its response to public and agricultural health crises, notably the SARS epidemic that began in 2002. China's health minister was fired after the government acknowledged it had covered up the extent of the SARS outbreak by preventing state-run media from reporting about the disease for months and by minimizing its seriousness.

In interviews, executives at Chinese pharmaceutical companies confirmed that the drug had been used since the late 1990s, to treat chickens sickened by bird flu and to prevent healthy ones from catching it.

"Amantadine is widely used in the entire country," said Zhang Libin, head of the veterinary medicine division of Northeast General Pharmaceutical Factory in Shenyang. He added, "Many pharmaceutical factories around China produce amantadine, and farmers can buy it easily in veterinary medicine stores."

Zhang and other animal health experts said the drug was used by small, private farms and larger commercial ones. Amantadine sells for about $10 a pound, a fraction of the drug's cost in Europe and the United States, where its price would be prohibitive for all but human consumption.

Two months before China first reported a bird flu outbreak in poultry to the World Animal Health Organization in February 2004, officials had begun a massive campaign to immunize poultry against the virus. They have now used at least 2.6 billion doses of a vaccine.

But researchers in Hong Kong have reported that the H5N1 flu virus has been circulating in mainland China for at least eight years and that Chinese farms suffered major outbreaks in 1997, 2001 and 2003. Scientists have traced the virus that has devastated farms across Southeast Asia in the last two years to a strain isolated from a goose in China's Guangdong province in 1996.

The U.N. Food and Agriculture Organization has long recommended that countries try to eradicate infectious animal diseases by slaughtering infected flocks and increasing safety measures on farms. Last year, the FAO also suggested that countries consider vaccinating their poultry against bird flu. But the guidelines never recommended the use of antiviral drugs such as amantadine, which, unlike vaccination, has been proven to make viruses resistant, officials said.

In 1987, researchers at a U.S. Department of Agriculture laboratory demonstrated that bird flu viruses developed drug resistance within a matter of days when infected chickens received amantadine.

Still, a veterinarian with personal knowledge of livestock practices across China said Chinese farmers responded to the bird flu outbreak by putting the drug into their chickens' drinking water. The veterinarian asked that his name not be published because he feared for his livelihood.

"This would explain why we're seeing such high resistance levels," said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. While various antibiotics have lost their effectiveness because of overuse, he said, the emergence of resistance to amantadine is unprecedented because it is an antiviral.

"This is the first example of an antiviral drug that was used for animal production that has major implications for human health," Osterholm said.

A popular Chinese handbook, titled Medicine Pamphlet for Animals and Poultry, provides farmers and livestock officials with specific prescriptions for amantadine use to treat chickens and ferrets with respiratory viruses. The manual, written by a professor at the People's Liberation Army Agriculture and Husbandry University and issued by a military-owned publishing company, prescribes 0.025 grams of amantadine for each kilogram of chicken body weight.

Farmers also use the drug to prevent healthy chickens from catching bird flu, giving it to their poultry about once a month or more often when the weather is liable to change and chickens are considered susceptible to illness, veterinary experts said. The antiviral is often mixed with Chinese herbs, vitamins and other medicine.

In the United States, amantadine was approved in 1976 by the Food and Drug Administration for treating influenza in adults. Amantadine and it sister drug, rimantadine, known collectively as amantadines, work by preventing a flu virus from reproducing itself. Both are now ineffective against the H5N1 strain.

International health experts stressed that amantadine could have been vital in stanching the spread of the bird flu virus in the early weeks of an epidemic.

Now, the only alternative is oseltamivir and closely related zanamivir, which stop the flu virus from leaving infected cells and attacking new ones. Oseltamivir is easier to use and has far greater sales.

"Amantadine is the cheapest drug against flu," said Malik Peiris, an influenza expert at the University of Hong Kong. "It is much more affordable for many countries of the region. Now, it is clearly no longer an option."

Special correspondents Ling Jin in Beijing and K.C. Ng in Hong Kong contributed to this report.



http://www.washingtonpost.com/wp-dyn/content/article/2005/06/17/AR2005061701214_pf.html

 

[Kim99]

Join Date: Jun 2005
Posts: 3

6,000 chickens die in bird flu outbreak in southern Vietnam

--------------------------------------------------------------------------------

6,000 chickens die in bird flu outbreak in southern Vietnam
(DPA)

18 June 2005



HANOI - After two months with no reports of large bird flu outbreaks, 6,000 birds have been killed by the virus in southern Vietnam, a veterinary official said on Saturday.


“Seven hundred chickens on a farm in An Khanh commune in Ben Tre province were culled last Saturday after 6,000 of them had died within four days,” said Mai Van Hiep, director of the province’s veterinary department.

“Test samples of the fowls were positive for H5 virus,” Hiep said from the province 150 kilometres south of Ho Chi Minh City.

The last reported large outbreak was in mid-April, but smaller outbreaks have been continually occurring since then, a veterinary official said.

“Actually, Vietnam never announces the termination of bird flu,” said Hoang Van Nam, deputy director of the animal health department of the Ministry of Agriculture and Rural Development. “Outbreaks, with large or small quantity of fowl, are still scattered throughout the country.”

On Friday, a senior health official said a number of suspected human-to-human cases of H5N1 had been detected by the National Institute of Hygiene and Epidemiology.

“We have got a number of suspected cases of human-to-human transmission of bird flu, including a doctor from Bach Mai hospital,” Nguyen Tran Hien, the director of the institute, told Deutsche Presse-Agentur dpa. “We will need to do more research before coming to any conclusion.”

The World Health Organization (WHO) has long warned that if the H5N1 virus mutates into a form that is easily spreadable between people, millions could die worldwide in the resulting pandemic.

“Every incident needs to be rapidly and thoroughly investigated, both as to whether human-to-human transmission has occurred and more importantly to confirm whether that transmission was efficient, which might indicate that the risk of the spread of avian influenza in the human population has increased,” said Peter Horby, a WHO epidemiologist working in Vietnam.

Since reports began appearing in late 2003, 38 people have died from the virus in Vietnam.

The first wave of the virus saw it spread to 57 of Vietnam’s 64 provinces and cities. During the second wave from the end of 2004 and April 2005, the virus has affected bird populations in 36 provinces and cities, and 1.6 million birds have died or been culled.

As well as outbreaks in chickens, health experts warned that ducks are a silent carrier of the virus. They can carry the virus without showing any symptoms.

A ban on the raising of waterfowl is routinely flouted and flocks continue to roam in the countryside

 

[Kim99]

Two new bird flu infections confirmed, 5 more suspected
VietNam News ^ | 16-06-2005


HA NOI — Two patients confirmed to be infected with bird flu are receiving treatment at the National Institute for Clinical Research into Tropical Diseases.

The two patients, Cao Thi Hang from Nghe An Province and Dinh Thi Hien from Thai Binh Province, were hospitalised earlier this month, according to a physician at the institute, Nguyen Thi Tuong Van. The patients are reported to be in stable condition.

Five other patients carrying influenza type A were also moved to the institute from Bach Mai Hospital last week, Van said.

The institute has sent samples to them to the Central Institute of Hygiene and Epidemiology for testing to determine if they are also carrying the bird flu virus. Results will be announced next week.

"All seven patients are in fair condition and are not on artificial respiration," said Van


http://vietnamnews.vnagency.com.vn/showarticle.php?num=02HEA160605

 

[Martin]

Mysterious Greater Shearwater Deaths on Carolina Beaches

Recombinomics Commentary
June 18, 2005

>> Wildlife experts are investigating the deaths of more than 250 seabirds that have washed ashore at Carolinas beaches in the past week.

The strandings are particularly unusual because most of the birds were greater shearwaters, which spend their lives at sea, coming ashore only to breed.

This is the time of year when shearwaters migrate north, an arduous journey from their breeding islands off South Africa to the cold waters off New England and Greenland. Once their journeys begin, the birds' first brush with land is off the N.C. coast.

Biologists suspect unusual southeasterly winds in recent days blew exhausted or sick birds toward shore in the Carolinas and Georgia.

But some birds who reached the S.C. coast alive had stumbling, uncoordinated movements <<

Dead or neurologically impaired birds from South Africa are cause for concern. South Africa has been battling avian influenza for most of this year. An OIE report this month indicated ostriches were found to be H5 positive at over 100 farms in South Africa.

H5N1 bird flu can cause death or neurological problems. Last year there were also problems with H5 HPAI in ostriches in South Africa.

Testing of these birds for H5 antibodies would be useful



http://www.recombinomics.com/News/06180503/Shearwater_Carolina.html

 

[Martin]

TOP STORY: Where they'll bury us if bird flu hits Bay
18.06.2005

KATHY WEBB
Burial grounds have been earmarked in Hawke's Bay for a deadly flu epidemic that could kill thousands of the region's people. The nightmare scenario is part of health authorities' planning for an event they say is "a matter of when - not if".

The first suspected case of human-to-human transmission of bird flu was reported in Vietnam two weeks ago. Five more cases of bird flu were reported yesterday. Clinical director of medicine for Hawke's Bay District Health Board Richard Meech said it was just a matter of time before the region had to deal with the deadly consequences of a bird flu outbreak.


"We expect it would be explosive," Dr Meech said.
"We are being told our planning has to be on the basis of when, not if. The omens are not good".

Bird flu, or 'H5N1', has so far been restricted to China and other Asian countries, but scientists say there is every chance it could cause the next worldwide pandemic.

Bird flu has a death rate of 50-75 percent, and it's getting stronger. It has killed 54 who have caught it from chickens and ducks since 1997.

All it would take to set bird flu loose among humans is for someone with a "normal" flu to catch bird flu. The two viruses would mix within that person, change their genetic structures, and gain the ability to pass from person to person.

No one knows how deadly the virus would be if it mutated into a form that could pass easily among people.

World health authorities are planning on the basis that the next global flu pandemic could hit 37 percent of a country's population, but if bird flu causes it, "the infection rate is wide open", Dr Meech says.

On the basis of only 37 percent of people catching the flu, 1.5 million New Zealanders would get sick. Hundreds of thousands could die. In Hawke's bay, 53,000 would get sick and up to 24,000 could die.

More cemeteries would be needed to cope with mass deaths, say the Napier and Hastings councils. Hospital staff plan to use refrigerated containers to store bodies until burial with due ceremony, but others suggest mass graves in hurriedly prepared cemeteries would be the most likely scenario.

Bird flu has killed 38 people in Vietnam, 12 in Thailand and four from Cambodia since the outbreak began.

The five latest cases in Vietnam brought the total of people infected to 11 in the past week, said Tran Quy, director of Bach Mai hospital in Hanoi. The patients, all from northern provinces, were being treated at the hospital and were in stable condition, he said.

Quy said a male doctor at the hospital who took samples from the patients, initially tested positive for the disease, but a second test turned up negative.

http://www.hbtoday.co.nz/storydispl...localnews&thesubsection=&thesecondsubsection=

 

[Sharon]

Martin: With regard to the Shearwater birds, thanks!

I have a google alert on H5N1 and read a lot of the articles that come in, but sure didn't catch this one.

Not good. Please continue to keep us posted, it sure is appeciated.

I'm watching this close, as I'm sure many are, therefore, again, the information you seem to find is appreciated!

 

[Martin]

Amantadine Resistance in Bird Flu Vietnam and Thailand

Recombinomics Commentary
June 18, 2005

>> Zhang and other animal health experts said the drug was used by small, private farms and larger commercial ones. Amantadine sells for about $10 a pound, a fraction of the drug's cost in Europe and the United States, where its price would be prohibitive for all but human consumption.

Su Lijian, vice president of Zhejiang Kangyu Pharmaceutical Co. in southeastern China, said amantadine was introduced into China in the 1970s for human use before being extended to poultry in the 1990s.
Two months before China first reported a bird flu outbreak in poultry to the World Animal Health Organization in February 2004, officials had begun a massive campaign to immunize poultry against the virus. They have now used at least billion doses of a vaccine. 2.6

But researchers in Hong Kong have reported that the H5N1 flu virus has been circulating in mainland China for at least eight years and that Chinese farms suffered major outbreaks in 1997, 2001 and 2003. Scientists have traced the virus that has devastated farms across Southeast Asia in the past two years to a strain isolated from a goose in China's Guangdong province in 1996…….

In the United States, amantadine was approved in 1976 by the Food and Drug Administration for treating influenza in adults. Amantadine and it sister drug, rimantadine, work by preventing a flu virus from reproducing itself. Both are now ineffective against the H5N1 strain.
Even before, these drugs had limitations in treating an ongoing human flu outbreak because of the speed at which the virus would become resistant in humans. But international health experts stressed that amantadine could have been vital in stanching the spread of the bird flu virus in the early weeks of an epidemic.

Now, the only alternative is oseltamivir and closely related zanamivir, which work by hampering the flu virus from leaving infected cells and attacking new ones. Of the two, oseltamivir is easier to use and has far greater sales. <<


The genetic trail of Amantadine resistance is a bit more complicated than many realize. The isolates from Vietnam and Thailand actually have two Amantadine resistance markers in the M2 protein. One, L26I, is found only in the isolates from Vietnam and Thailand. It is not in isolates from China or anywhere else, yet is in all Vietnam and Thailand isolates.

The other M2 mutation, S31N, is much more common, but traces back to lab isolates from the 1930's It is in WSN/33 (also found in swine isolates in South Korea) and PR-8 (used to make vaccines worldwide). These may be related to growing these viruses in tissue culture. The mutation is also in a variety of human isolates (including those from New York last year).

In Asia, the first H5N1 isolates were from Hong Kong in 2002, It is also present in isolates from two patients in 2003 and they presumably were infected in Fujian province. There is also an isolate from Shantou Province and Indonesia. However, most of the isolates from each of these areas do not have the mutation (but ALL 2004 isolates from Vietnam and Thailand do).

Earlier bird isolates can be found in China. The earliest H9N2 isolates were in northern China in 1998 (Shanghai and Beijing).

However, the mutation is also found in swine isolates, and the earliest swine isolates are in the US and Europe. The mutation began appearing in Asian swine in 1999 (in Hong Kong).

Thus, one of the markers is probably traced to treating humans or pigs with Amantadine years ago in the west (US and Europe) and the second mutation may well have arisen in Vietnam or Thailand fairly recently


http://www.recombinomics.com/News/06180501/H5N1_Amantadine_Resistance.html

 

[Martin]

6/27/05
By Mortimer B. Zuckerman
A Nightmare Scenario

Should we sound the alarm for a worldwide epidemic that might not occur? There is no choice with the avian flu emerging from Asia. Last week's disclosure that an Indonesian man tested positive for the bird flu that has already killed more than 50 people in Southeast Asia was just the latest chilling news about the disease. Should it develop certain genetic changes, international health experts warn, bird flu could spark a global pandemic, infecting as much of a quarter of the world's population and killing as many as 180 million to 360 million people--at least seven times the number of AIDS deaths, all within a matter of weeks.

This is utterly different from ordinary flu, which kills between 1 million and 2 million people worldwide in a typical year. In the worst previous catastrophic pandemic, in 1918, more than 20 million died from the Spanish flu. That's more than the number of people who died from the Black Death in the Middle Ages--and more people killed in 24 weeks than AIDS killed in 24 years.

What is a pandemic? There are three elements. First, a virus emerges from the pool of animal life that has never infected human beings and is therefore one to which no person has antibodies. Second, the virus has to make us seriously ill. Third, it must be capable of moving swiftly from human to human through coughing, sneezing, or just a handshake. For avian flu, the first two elements are already with us. Well over half the people who have contracted it have died. The question now is whether the virus will meet the third condition, of mutating so that it can spread rapidly from human to human.

Tipping point. It has already moved from chickens to birds to pigs. The latter often serve as a vessel for mixing human and animal viruses because the receptors on the respiratory cells of pigs are similar to those of humans. This illustrates the dangers we face, because this mixture of bird flu and human flu, in either an animal or a person, could cause the viruses to exchange genetic materials and create an entirely new viral strain capable of sustaining efficient human-to-human transmission. This would be the tipping point to a pandemic.

At this point, nobody knows just how close we might be to such a crisis. Experts are alarmed, however, because we are singularly ill prepared. Worldwide, we currently produce only about 300 million doses of flu vaccine a year to serve over 6 billion people. A pandemic that began in Asia could race around the globe in days or weeks, given the number of airliners crisscrossing the oceans from Tokyo, Vietnam, and Indonesia to New York, Los Angeles, and London.

What should we be doing? A whole lot more. First: We need operational blueprints to get various populations through one to three years of a pandemic. We must coordinate the responses of the medical community, of food providers, of transportation, and of care for first responders from public health, law enforcement, and emergency management at the international, federal, state, and local levels. Second: We must strengthen the World Health Organization so that it can be an accurate clearinghouse of information about the scope and location of the disease, should it begin to spread, and quell false rumors that could lead to global panic. Third: We must track the human cases already documented so as to gain the very earliest warning of any transformation of the disease, and thus of an emerging pandemic. Days would be critical. Fourth: The Bush administration must think of this as terrorism to the nth degree and immediately set up a senior-level emergency task force to develop a strategy. It could serve as a permanent framework for curtailing the spread of future infectious diseases. Fifth: We must prioritize research money to develop a vaccine, expand the production of flu vaccine, and stockpile antiviral medications. It would be irresponsible to begrudge time and money. A pandemic could well bring global, national, and regional economies to an abrupt halt in a world that relies on the speed and distribution of so many products. A pandemic could lead many countries to impose useless but highly destructive quarantines that would disrupt trade, travel, and production--something that has never happened with AIDS, malaria, or tuberculosis. At home, many venues of human contact--schools, movie theaters, transportation hubs, and businesses--would have to be shuttered.


Imagine the chaos. These killer viruses simply can't be isolated in any part of the world. If avian flu were allowed to develop into a pandemic, it would be a direct threat to our health, security, and prosperity.



The word influenza derives from the Latin influentia, reflecting the belief at the time that epidemics were due to the influence of the stars. Today, we have moved far beyond that fantasy, but even so, the world is clearly not ready for an avian-flu pandemic. With the scientific consensus already shifting from if to when the next global outbreak takes place, we have no time to lose.


http://www.usnews.com/usnews/opinion/articles/050627/27edit.htm

 

[Martin]

China ruins best chance of beating bird flu epidemic
By Peter Goff in Beijing
(Filed: 19/06/2005)

China has been trying to suppress a bird flu outbreak by feeding poultry a human antiviral drug, threatening public safety in the event of a global pandemic.



China first reported an avian flu outbreak in February last year. Yet for more than eight years, according to drug company officials in Beijing quoted in the US media, the agriculture ministry has been urging farmers to use the drug, amantadine, on infected birds, in breach of international guidelines.

It explains why scientists discovered late last year that the virus had grown resistant to amantadine, which cannot now be used to fight it in humans.

Over the past 18 months bird flu has spread across East Asia, infecting more than 100 people in Vietnam, Cambodia and Thailand, killing at least 54 people and devastating poultry stocks.

Dick Thompson, a spokesman for the World Health Organisation in Geneva, said last night that the UN body had long suspected China of using amantadine on poultry.

"We will be asking the government in Beijing about it this week," he said.

Mr Thompson said that the drug, which is now ineffective against the H5N1 strain of the virus found in Asia, should have been a key part of the fight against a global outbreak.

"It would have been important in a pandemic and it is a disappointment that it may have been lost to us."

The first human cases of avian flu were recorded in Hong Kong in 1997, when the H5N1 variant mutated into a form lethal to humans, killing six people.

The WHO said the virus could easily mutate further, allowing it to jump from human to human in a lethal strain that could kill millions of people worldwide.

Amantadine is one of two drugs used to treat human influenza. The alternative, oseltamivir, is much more expensive to mass produce.

According to The Washington Post, animal health officials in China said that government bodies approved the production and sale of the drug for use in chickens, even though the practice is banned in many western countries because birds develop immunity.

Chinese farmers and officials from pharmaceutical companies confirmed that the drug had been used since the late 1990s to treat sickly chickens and prevent healthy birds from catching it.

"Amantadine is widely used in the entire country," Zhang Libin, from the Northeast General Pharmaceutical Factory, told the newspaper. "Many pharmaceutical factories around China produce amantadine, and farmers can buy it easily."

A farmer from Hebei province, near Beijing, confirmed that he had been giving his chickens the drug for several years. "Local government vets have always recommended it," he said.

Last week China confirmed an outbreak of bird flu in its northwestern Xinjiang province, where 460 geese died and more than 13,000 birds were slaughtered to try to control its spread.

The outbreak came only a few weeks after more than 1,000 migratory birds died of the virus in neighbouring Qinghai province, the first confirmed outbreak in China in almost 12 months.

Three years ago China was condemned internationally for trying to hide the extent of the SARS outbreak, which ultimately infected 8,000 people and killed about 800.



http://www.telegraph.co.uk/news/mai...lu19.xml&sSheet=/news/2005/06/19/ixworld.html

 

[Kim99]

I sure hope we get some news out of China soon. Who knows what's going on over there .

 

[Martin]

I keep looking... :Look:

 

[dreamseeer]

I'm trying to keep up with all the news on Bird Flu (albeit is depressing) and I haven't noticed if a person gets immunity after getting it and surviving it. I am sure I must have missed this information somewhere.....so,

has anybody read anything about acquired immunity on Bird Flu or can we just keep getting it over and over until we are dead?

 

[freebyrd]

i appreciate all the hard work you do digging up all these news stories, but speaking for someone who has an infant son and very little time to read all this, on a 1 to 10 scale 10 being the worst how concerned should i be?
freebyrd

 

[Martin]

Vietnam reports five more new bird flu cases

HANOI, Vietnam (AP) - Vietnam reported Friday that five more people have contracted the bird flu virus as the country struggles to contain the disease, officials said.

Bird flu has ravaged poultry farms throughout Asia and jumped to humans, killing 54 people in three countries. Vietnam has been the hardest hit with 38 deaths so far.

The five latest cases bring the total of people infected with the virus to 11 over the past week, said Tran Quy, director of Bach Mai hospital in Hanoi.

The patients, all from northern provinces, are being treated at the hospital and are in stable condition, he said.

Quy said separately that a male doctor at the hospital who helped take samples from the patients initially tested positive for the disease, but a second test turned up negative.

Bird flu has killed 38 people in Vietnam, 12 in Thailand and four from Cambodia since the outbreak began in 2003. - AP



http://thestar.com.my/news/story.asp?file=/2005/6/17/latest/20050617135816&sec=Latest

 

[Relic]

freebyrd

If you lived next to a river levee that was SLOWLY leaking during the summer and the next flood season is next SPRING, BUT you've heard rumors of heavy rain up stream? OH yeah, and you can't move.....

 

[Martin]

H5N1 Outside of Vietnam and Thailand is Amantadine Sensitive

Recombinomics Commentary
June 19, 2005

>> China's use of the drug amantadine, which violated international livestock guidelines, was widespread years before China acknowledged any infection of its poultry, according to pharmaceutical company executives and veterinarians.

Since January 2004, avian influenza has spread across nine East Asian countries, devastating poultry flocks and killing at least 54 people in Cambodia, Thailand and Vietnam, but none in China. <<

The media reports on China's widespread use of amantadine has received quite a bit of attention, but the link between amantadine use in China and the H5N1 in Vietnam, Thailand and presumably Cambodia is weak.

There are no 2005 H5N1 sequences available at GenBank, so there are no isolates from Cambodia. However, there are a large number of M2 (the protein targeted by amantadine) sequences from Vietnam and Thailand, as well as other countries affected by the H5N1 spread in Asia in 2004. The resistance markers are almost exclusively in Vietnam and Thailand.

The first H5N1 amantadine resistance markers appeared in Hong Kong in 2002, but these genes were more like those found in H9N2 avian or H3N2 swine sequences. Moreover, these isolates only had the S31N change. There were only four isolates that were more closely related to the 2004 isolates from Vietnam and Thailand. There was one each from Shantou Province in China (A/Dk/ST/4003/2003), Hong Kong (A/Ck/HK/WF157/2003) and Indonesia (A/Ck/Indonesia/2A/2003) in 2003 and one from Guangdong Province (A/chicken/Guangdong/178/04) in 2004.

There were several additional isolates from each region and none of the M2 sequences had the amantadine resistance markers. Similarly, none of the isolates from other provinces in China as well as Japan and South Korea had the markers. In contrast, all M2 sequences from Vietnam and Thailand had the marker. These isolates also had a second marker, L26I, which was not detected in any of the H5N1 isolates (or any other isolates).

Thus, although all isolates from Vietnam and Thailand had two amantadine resistant changes, no other isolate had both, and a very small number had one. Moreover, the isolates that had one and were most closely related to the isolates in Vietnam and Thailand were from 2003 or 2004, even though amantadine had been used in China since the late 1990's.

Thus, amantadine is not useful for treating H5N1 infections in Vietnam and Thailand, but it is effective against the vast majority of H5N1 isolates outside of Vietnam and Thailand (and probably Cambodia).

Third party reports on H5N1 outbreaks in western China have indicated that there have been human infections and media reports indicated the H5N1 isolated from bar headed geese in Qinghai Lake were similar to isolates in southeastern China. Thus, it remains to be see if this version of H5N1 has the amantadine resistant markers. Media reports on human cases in western China, suggest these isolates have the most dangerous combination of efficient human-to-human transmissibility and lethality.

http://www.recombinomics.com/News/06190501/H5N1_Amantadine_Sensitive.html