H5N1: An Impending Pandemic 5/24/05

The Flying Dutchman · May 24, 2005

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<center>May 24th - Day 1 news take</center>

<center>AVIAN INFLUENZA, GEESE - CHINA (02)
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A ProMED-mail post
<A href="http://www.promedmail.org">(LINK)</A>
ProMED-mail is a program of the
International Society for Infectious Diseases
<A href="http://www.isid.org">(LINK)</A>

[1]
Date: Mon 23 May 2005
From: Christian Griot <A href="christian.griot@ivi.admin.ch">(LINK)</A>
Source: Reuters alert 23 May 2005 [edited]
<A href="http://news.yahoo.com/news?tmpl=story&u=/nm/20050523/wl_nm/birdflu_china_dc_1">(LINK)</A>

China rushes in vaccine after deadly bird flu found
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</center>
China has rushed more than 3 million doses of bird flu vaccine to a remote western province, after migratory birds were found dead from the H5N1 strain, which can be fatal to humans, state media said on Monday [23 May 2005].

Poultry across Qinghai province, neighboring Tibet and Xinjiang, had become the "target of a compulsory vaccination campaign," the China Daily newspaper said.

Scientists had proved that the virus killed scores of geese in Qinghai in early May 2005, media said this weekend, the 1st report of H5N1 detected in China since last year [2004].

There had been no reports of the virus spreading to humans or domestic fowl in Qinghai, the Beijing News said. The area where the dead geese were found had been sealed off for 10 days. But experts said domestic poultry could also be at risk.

"There is a significant possibility of that, given the fact that wild birds quite often use the same water sources and feeding sources as domestic ducks or domestic geese," said Malik Peiris, a microbiologist at the University of Hong Kong. "One has to take this risk seriously."

China has been on high alert against bird flu after outbreaks in North Korea and Southeast Asia, which prompted it to tighten quarantine controls at its borders. But Qinghai is far from either border, and there was no immediate explanation as to how wild geese there became infected.

"I think it's sensible to take this outbreak in wild birds quite seriously and enhance surveillance in domestic poultry," Peiris said. "Clearly it shows this virus is still causing problems in this region."

--
Christian Griot
<A href="christian.griot@ivi.admin.ch">(LINK)</A>

[Details on the selected vaccine will be appreciated. Reportedly, the recently developed reverse genetics AI vaccine will render satisfactory protection to ducks and geese (see 20050207.0415, 20050307.0680). - Mod.AS]

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[2]
Date: Mon 23 May 2005
From: David Melville <david.melville@xtra.co.nz>

<center>Bar-headed Geese and H5N1
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178 geese were reported dead between 4 and 8 May 2005. The species of goose was not reported, however it is very likely to be Bar-headed Goose _Anser indicus_, which breeds on Bird Island in Qinghai Hu (Koko Nur).

Bar-headed Geese breed in Central Asia (mainly China and Mongolia), and most of the population winters in India, with smaller numbers in Pakistan, Nepal, Bangladesh, northern Myanmar and southwest China.

Waterfowl populations can be broadly separated into "flyways." These indicate the migration route used during migration and the breeding and wintering areas that the route connects.

Bar-headed Geese which have been banded/ringed at Niao Dao subsequently have been recorded in India (as far west as Karnataka) in the Central Asian Flyway; Cao Hai, Guizhou Province, China in the East Asian Flyway; and Bangladesh, which is in an area where the 2 flyways overlap. There could be potential for future spread of virus between waterfowl populations through mixing on the wintering grounds, thereby facilitating a natural north/west spread of virus through the Central Asian Flyway.

Chinese agriculture officials are quoted as saying that migratory birds may have brought the virus from South East Asia, however it is unclear from the media reports whether the identity of the Qinghai virus has been determined. It is important not to jump to conclusions; c.f. the late 2004
report of H5N1 in a Mallard (_Anas platyrhynchos_) in Siberia [see
20041130.3201].

--
David Melville, Ornithologist
Nelson
New Zealand <david.melville@xtra.co.nz>

******
[3]
Date: Mon 23 May 2005
From: OIE, Animal Health Information Department <A href="information.dept@oie.int">(LINK)</A> Source: OIE Alert message 050523CHN, 23 May 2005 [edited]

Highly pathogenic avian influenza in the People's Republic of China, virus type H5N1 in wild birds
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(Date of previous outbreak of highly pathogenic avian influenza in the People's Republic of China reported to the OIE: June 2004 [in poultry]).

Information received on 21 May 2005 from Mr. Jia Youling, Director General, Veterinary Bureau, Ministry of Agriculture, Beijing:

Report date: 21 May 2005.

Nature of diagnosis: clinical and laboratory.

Date of initial detection of animal health incident: 4 May 2005.

Estimated date of primary infection: 15 Apr 2005.

Date of laboratory tests: 18 May 2005.

Location of the outbreak: Niannaisuoma village, Quanji town, Gangcha county, Qinqhai province (in the central part of the country). The place is an important rendezvous of migratory birds on one of their Asia-Europe routes.

Description of affected population: migratory birds found dead, including bar-headed goose (_Anser indicus_), great black-headed gull (_Larus ichthyaetus_), brown-headed gull (_Larus brunnicephalus_), ruddy shelduck
(_Tadorna ferruginea_) and great cormorant (_Phalacrocorax carbo_).

Total number of birds found dead: 519.

Laboratory where diagnosis was made: National Avian Influenza Reference Laboratory (Harbin Veterinary Research Institute, Chinese Academy of Agricultural Sciences).

--
OIE Animal Health Information Department
<A href="information.dept@oie.int">(LINK)</A>

[The expedient notification by PR China on this outbreak is a most welcome manifestation of transparency, which deserves to be warmly welcomed.

Clearly, the avian influenza A H5N1 virus strain has been demonstrated (how?) in the affected birds. However, it is rather exceptional of avian influenza causing acute mass mortality involving 5 different species of wild birds simultaneously. Other factors, infectious or otherwise, might be involved and should be ruled out prior to final incrimination of the demonstrated virus strain as the sole causative agent. - Mod.AS]

The Flying Dutchman · May 24, 2005

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<center>Vietnamese dies of avian flu; China has cases in wild geese
May 23, 2005 (CIDRAP News) – As Vietnam reported another fatal human case of avian influenza today, Chinese authorities began mobilizing for a massive poultry vaccination campaign following news that a wild goose die-off was due to the H5N1 virus.</center>
A 46-year-old man from northern Vietnam's Hung Yen province died of avian flu May 19 at Bach Mai Hospital in Hanoi, the Associated Press (AP) reported today. He had been admitted May 16 with the high fever, coughing, and breathing problems that often signal avian flu, said Phan Tien Son, director of the provincial preventive medicine center.

The man had tested positive for the H5N1 virus May 18, Son said.

Epidemiologists are investigating how the man contracted avian flu, the AP reported. Officials took samples from 15 family members and other contacts, Son said. Investigators also took samples from the family's ducks, since ducks have been implicated as "silent carriers" of the H5N1 virus.

If the man's illness is the result of contact with poultry, ducks may be the culprit. He had not traveled recently, and no poultry outbreaks of avian flu had been reported in his village, the AP said. The man hadn't eaten any duck, and the family flock appeared healthy.

On the basis of World Health Organization reports, the latest fatality brings the number of avian flu deaths in Asia since late 2003 to 54. Vietnam has had 38 deaths in that time, including 18 in the latest wave of cases, which began in December 2004.

The AP said today that avian flu has re-emerged in China for the first time since July 2004. Authorities were preparing to vaccinate millions of poultry after the H5N1 virus was found in samples from migratory geese in a province of western China bordering on Tibet and Sichuan.

The 178 bar-headed geese found dead between May 4 and 8 on a nature reserve in Qinghai province died of H5N1 flu, Reuters news service reported. Now all nature reserves in China have been sealed off.
Authorities have not found any domestic poultry outbreaks or human illnesses, Reuters said. The Chinese government ordered the vaccination of all domestic ducks, geese, and other poultry in Qinghai Province for avian flu. Three million doses of vaccine were being sent to the province. In addition, farmers along bird migration routes in other provinces were ordered to vaccinate their flocks.

The World Health Organization (WHO) urged China to increase its surveillance, Reuters reported.

"In terms of the evolution of the pandemic [threat] if it spreads over a larger area—and this does seem like a new area—then it is going to be harder to prise the virus out of the environment," said Dick Thompson, a WHO spokesman in Geneva. "This doesn't change the risk assessment, but it's still at a high level."

Malaysia responded to China's outbreak by banning all imports of chicken and chicken products from China, the AP reported today.

China has successfully managed H5N1 outbreaks in the past, Reuters said. A combination of vaccinations, culling, and surveillance, including the burning of about 145,000 birds, brought an outbreak under control last year.
<A href="http://www.cidrap.umn.edu/cidrap/co...y2305avflu.html">(LINK)</A>

The Flying Dutchman · May 24, 2005

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<center>Tuesday, May 24, 2005
Experts wait for the big bird flu jump 
Bejing, May 23 Bird flu has once again raised its deadly head in mainland China. The Chinese Ministry of Agriculture has confirmed that the deaths of 178 migratory birds in the country’s Northwest Qinghai province, have been caused by the avian influenza known as H5N1. </center>
For health experts, this is further confirmation that the virus is now endemic in Asia and many say that it’s not a question of if, but when, the H5N1 mutates into a form that would enable it to spread between humans.

Despite fervent measures to contain the virus since it first appeared in late 2003, including the slaughtering of tens of millions of birds and vaccinating many more, bird flu has continued to spread in Asia. The prospects of eliminating the virus within the next few years now appear to be virtually nil.

‘‘Elimination is a strategy we are no longer looking at,’’ say Maria Cheng, spokesperson for the World Health Organisation (WHO) in Beijing. ‘‘The flu is now established in the region so that eliminating it is not a good possibility.’’ Health experts are trying instead to focus on containment, including the monitoring and vaccination of animals.

Bird flu has affected 11 countries in the region from Japan to Indonesia and WHO says the outbreak is without precedent.

Avian influenza already fulfills 2 out of the 3 conditions for causing a human flu pandemic: the emergence of a new virus to which humans have little or no immunity and the ability of this virus to replicate in humans. The third condition, that the virus must be transmittable from one human to another, is the one standing between the current situation, where the flu is by and large limited to poultry and a possible world wide human flu pandemic of staggering proportions.

Currently, H5N1 is only known to spread between birds and, more rarely, from birds to humans. But as the virus continues to spread there is a distinct possibility that it will mutate in time, enabling human to human transmission.

Says Cheung, ‘‘We have a situation at the moment where both the human influenza virus and avian flu virus are circulating in a region simultaneously.’’

If H5N1 infects a human who is also carrying a human flu virus, the chances of the two strains of virus combining to mutate into a new form are high. Another worry for health officials is the potential for the avian virus to combine with a human flu virus in an intermediary sources like a pig. Already pigs in Java, Indonesia, have tested positive for H5N1.

Last month influenza experts noted a potentially menacing changes in the avian flu virus in Vietnam. Human cases of bird flu in northern Vietnam were found to show an epidemiological pattern and virological features different from those seen in the 2004 cases. They also differed from those currently seen in human cases in southern Vietnam and other Asian countries. These differences could indicate that the virus might already have been transmitted from human-to-human, though this is not proven as yet.
<A href="http://www.indianexpress.com/print.php?content_id=70922">(LINK)</A>

The Flying Dutchman · May 24, 2005

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<center>Frantic race to curb bird flu 
May 24, 2005
With bird flu endemic among birds in the Asian countryside, the disease could pose a threat to humans for years.</center>
REUTERS
Behind high gray double doors in Hanoi Professor Nguyen Thu Van, a simply dressed woman with black hair held back by a hairslide, has been laboring tirelessly with her team of researchers in a race to avert a pandemic.

Her white-coated co-workers scurried about one recent day in their small, second-floor laboratory in an elegant French colonial building in the Vietnamese capital. Engaged in a drive to perfect a human vaccine against avian influenza, Van, 50, has produced an experimental version and conducted successful tests on monkeys. She and her researchers have volunteered to be the first subjects in human trials, which she hopes will begin this summer despite warnings from the World Health Organization.

Van is at the forefront of a campaign in Southeast Asia to halt the progress of bird flu. International health specialists fear the virus could undergo genetic changes suddenly and become the most deadly disease to strike humanity in modern times. Almost 200 million chickens, ducks and other birds throughout Southeast Asia have died from the virus or been slaughtered to contain it in the last two years.

So far, bird flu has killed 54 people, mostly as a result of close contact with infected poultry. But international health experts say they suspect the virus has also begun to spread among humans.

With bird flu endemic among birds in the Asian countryside, the disease could pose a threat to humans for years. And in an age of global travel, health experts predict that an easily transmitted human strain could move beyond Asia in a matter of weeks and infect tens of millions of people worldwide.

When bird flu began spreading in Southeast Asia, governments in the region initially denied its presence. But a Thai doctor, Prasert Thongcharoen, sounded the alarm, issuing blunt declarations that forced Thailand to acknowledge early last year that the disease was decimating bird populations and beginning to infect people.

In Indonesia, the government has campaigned to vaccinate poultry across the vast archipelago, but tens of thousands of doses sit unused in government refrigerators while farmers leave their birds unprotected. A veterinarian named Suparno patrols the country's most populous island in an ambitious endeavor to prevent the virus from spreading.

Van's eyes gleamed with enthusiasm as she predicted Vietnam could become the first country to develop a human vaccine against the lethal H5N1 bird flu strain endemic among poultry in Southeast Asia. But WHO officials say Van's team has flouted international guidelines, saying that material used to develop the vaccine is potentially contaminated and the planned human tests involve imprudent shortcuts.

``We cannot wait,'' Van responded.

Prasert, 71, one of his country's most eminent virologists, literally wrote the book on influenza in Thailand, published seven years ago. He was a physician fresh out of school when the 1957 Asian influenza pandemic swept through Thailand, flooding his hospital with patients. Later, when an outbreak of Hong Kong flu reached Bangkok in 1968, Prasert was already emerging as a leading researcher.

In the fall of 2003, he learned that tens of thousands of chickens had begun dying in Thailand. The government was insisting the birds had contracted fowl cholera, a common affliction. As the world's fourth-largest poultry exporter, Thailand would suffer an economic blow if other countries learned its flocks were infected with bird flu.

Prasert decided to obtain more information. He visited a Bangkok market, where farmers confided they believed it was something worse.

``They said it wasn't like fowl cholera,'' Prasert recounted. ``If they have chickens that are sick with that, they give them tetracycline and they get better. But these chickens, by the next morning, they're all dead.''

Prasert's suspicions mounted in early December when friends who usually took him six or a dozen eggs after visiting their farm east of Bangkok came back empty-handed.

``They told me the farm is usually full of chickens,'' he recalled, ``but the chickens all died.''

In mid-December, researchers privately showed Prasert results of tests done on chickens revealing they had influenza. Prasert warned officials that urgent action was needed.

``I told them it is a public health concern and I would not close my mouth. I will talk even louder,'' Prasert said.

Senior ministers continued to deny the presence of bird flu throughout much of January 2004, according to Thai and international officials.

But in the first week of January, a six-year-old boy from a province west of the capital developed a high fever, followed a week later by symptoms of severe pneumonia. The boy was admitted to Prasert's hospital, and tests on January 22 came back positive for bird flu. He died three days later.

Prasert told the Health Ministry it was too late for a cover-up, he recounted with an ironic smile and narrowed eyes. The strain had reached humans.

On January 23, the health and agriculture ministers announced that bird flu had arrived in Thailand.

Suparno, the Indonesian government veterinarian, crouched in the cramped backyard of a farmhouse in a central Java village, clad in a tan uniform. He slowly drew the bird flu vaccine from a plastic container into a syringe. Then his fellow animal health officers brought five black hens, one by one, from a barn. Suparno inoculated each one.

There were 20 more chickens running around the farm, but they escaped the needle.

``Too hard to catch,'' Suparno explained before driving off. But by leaving most of the flock unprotected, the exercise was pointless. The remaining chickens could catch avian flu and sick birds, in turn, could infect even those that had been immunized. Vaccinated birds can still become carriers of the disease and transmit it to humans.

Tri Satya Putri Naipospos, Indo-nesia's national director of animal health, said Indonesia turned to vaccination because it was too costly to carry out widespread culling of flocks as Vietnam and Thailand were doing. By the time Indonesian officials acknowledged the presence of the virus, it had already infected much of Java, Bali and the Sumatra islands.

``The announcement of the government came very late,'' Naipospos admitted. ``Our laboratory people knew it already.''

She said senior Indonesian officials delayed acknowledging the disease after the outbreak in August 2003 because of intense pressure from the poultry industry, which was afraid it would hurt sales.

In the neighboring Sragen district, Sri Harjono, a farmer who runs a cooperative that has 23,000 broiler chickens, said he lost more than half of his flock after the initial bird flu outbreak in 2003. He restocked and began vaccinating in October, he recalled.

But no longer. ``It's too much hassle,'' he said, stroking a baby chick. ``You have to go one by one. Can you imagine vaccinating 23,000 chickens over and over?''

Educated partly in the Soviet Union, Van, the Hanoi scientist, later trained at the Centers for Disease Control in Atlanta, where she developed an interest in working on hepatitis. Her efforts to develop a hepatitis B vaccine in Vietnam helped her win appointment as general director of Vietnam's Vaccine and Biological Production Company No1.

As the number of human cases in Vietnam grew last year, a senior colleague suggested that Van try to reprise her success with hepatitis B by developing an avian influenza vaccine.

``It was difficult at the beginning because we did not have the experience,'' she said, but added that Vietnam could not afford to wait for vaccines being developed in the West, which she also feared would be exorbitantly expensive.

Vietnam publicly acknowledged the presence of the disease in January 2004, although Trinh Quan Huan, director general of preventive medicine, said the Health Ministry knew of it five months earlier.

Hospitals in the Hanoi area had already admitted 13 children and an adult with symptoms associated with bird flu, according to WHO. Twelve people had died.

Vietnam's current strategy of poul-try control measures has not tamed the outbreak. The government recently extended a ban on hatching ducks and other waterfowl, but enforcement has been erratic. The raising of all poultry in cities was recently prohibited.

After a study last month discovered that more than 70 percent of ducks and geese sampled in the Mekong Delta tested positive for influenza, the government ordered the slaughter of 1.5 million waterfowl, according to state media.

But experts with the United Nations Food and Agriculture Organization predicted that as long as farmers were offered only a fraction of the birds' value in compensation, they would refuse to cooperate.

Last year, Van's researchers developed the virus strain for the vaccine. The self-administered clinical tests are due to begin as early as August. If they are successful, Van says, she hopes Vietnam can produce about half a million doses by January.

WHO experts visited Hanoi earlier this year and warned that the material used to grow the virus strain in Van's laboratory was not approved by international health agencies. It was grown in cancer cells and could be contaminated, according to Michael Perdue, a WHO influenza expert. Perdue's team also told the Vietnamese that testing the vaccine on researchers rather than on true volunteers would be unethical.

Van's worry is that by the time the vaccine is ready, it will no longer be effective against an influenza virus that easily mutates. If the vaccine cannot be updated, she cautioned, Vietnam would be left vulnerable in the face of a mass killer.

``I'm confident it will work,'' she said, adding, ``I'm 80 percent confident we will succeed.''
<A href="http://www.thestandard.com.hk/stdn/std/Focus/GE24Dh01.html">(LINK)</A>

The Flying Dutchman · May 24, 2005

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<center>New federal bioterrorism funds tied to specific goals
May 23, 2005 (CIDRAP News) – The Department of Health and Human Services (HHS) recently announced that $1.33 billion will be available in this year's round of funding to states to improve preparedness for terrorism and other public health emergencies.</center>
The total includes $862.8 million in funds administered by the Centers for Disease Control and Prevention (CDC) to boost preparedness for bioterrorism, infectious disease outbreaks, and public health emergencies. Another $471 million will be passed out by the Health Resources and Services Administration (HRSA) to improve hospitals' ability to cope with events that cause large numbers of casualties.

The total amount is down about $14 million from last year's total, which included $849.6 million in CDC grants and $498 million in HRSA grants. The money goes to states, territories, and four metropolitan areas: Los Angeles County, Chicago, New York City, and Washington, DC.

The package is the fourth in a series of large federal allocations for public health preparedness that began in 2002, following the terrorist attacks and anthrax mailings of 2001.

HHS said the funds will be used to upgrade infectious disease surveillance and investigation, prepare the healthcare system to deal with mass casualties, expand public health laboratory and communications capacities, and improve disease-reporting communication between hospitals and city, local, and state health departments.

Setting specific objectives
One important new wrinkle in the process this year is that the CDC is making an earnest attempt to define preparedness in terms of specific goals and performance capabilities.

The CDC released a document May 13 to guide jurisdictions through the application process. The document includes a lengthy set of goals, under the headings Prevent, Detect/Report, Investigate, Control, Recover, and Improve. The guidelines spell out particular outcomes, tasks, and measures of performance under each goal.

"The preparedness goals or measurements—that is a new piece to the cooperative agreement," CDC spokesman Von Roebuck told CIDRAP News. "They have not been in there before. They do build a bit up on the past recommendations as far as key points that we wanted to have covered. They actually are a work in progress. . . . We'll listen to what states have to say, and they'll be modified in some way if necessary."

Last year the CDC guidelines were framed in terms of focus areas or activities, such as planning, epidemiology and surveillance, biological laboratory, risk communication, and training, according to Aggie Leitheiser, assistant commissioner for the Health Protection Bureau in the Minnesota Department of Health.

"It was focused much more on tasks," Leitheiser told CIDRAP News. "This year they've switched to identifying the goals that we're trying to achieve with this work. They've identified nine, and in that, I believe, are over a hundred critical tasks or subtasks."

The goals and tasks have performance measures linked to them. For example, the prevention goal includes planning for all kinds of public health emergencies. For one of the performance measures in that category, Leitheiser said, "We are to measure the time it takes to get our initial wave of personnel to a staging area to staff emergency operations, and the target is 90 minutes."

For another example, the "investigate" goal calls for speeding up the identification of causes, risk factors, and appropriate interventions for those affected by threats to public health. One of the related performance measures is to be able to start an epidemiologic investigation within 3 hours after an unusual pattern of disease cases is detected.

Another goal is to speed up the detection and reporting of dangerous agents in tissue, food, or environmental samples. One of several associated performance measures is the ability to send a sample potentially containing an infectious agent to a reference laboratory within 60 minutes after collecting it.

"We're very pleased to see the switch" in approaches, Leitheiser said. "Rather than 'How many meetings did you have?' [the CDC is asking], 'Can you show you're able to act effectively?'"

Questions raised about progress
She said many groups, including Congress, the CDC, and state health departments, have been asking how much progress has been made in bioterrorism preparedness with the money that's been spent in recent years. "I think the CDC is moving in a deliberate way to answer those questions," she said.

Not that the new guidance is flawless, Leitheiser said. "Some of them [performance goals] are frankly a little unrealistic. For example, that we be able to handle 1% of the population calling in for information. That would be 50,000 people, which would probably take down the phone system."

She also said that with the new approach, applying for the funds will probably take more work this year. Officials will have to write a description of how they plan to develop the ability to handle each of the critical tasks in the guidance.

"I think it's very good, but change is always hard," she said.

Leitheiser said the guidelines for HRSA funding for hospitals didn't change as much as the CDC guidelines did this year. "The HRSA grant I think has been more focused from the beginning," she said. "They are trying also to be aware of measurement and impact, but they didn't go to the same format that CDC did."

The CDC money includes a base grant of $3.9 million for each jurisdiction, plus an additional amount based on population, according to Roebuck of the CDC. The amounts range from $4.9 million for Wyoming to $61.3 million for California. Thirty-one states and cities are due to get more money this year than they did last year, while 23 will receive less.

The HRSA funds are allocated much the same way as the CDC money, with a base grant plus an amount based on population. David Bowman, a HRSA spokesman in Washington, DC, said the base grant this year is slightly lower than the $1 million used last year. Sums range from about $1.3 million for Wyoming to $39.2 million for California.

Health departments have until Jul 13 to apply for the CDC funds, and the money will be available for spending starting Aug 31, Roebuck said.

Bowman said the deadline for applying for HRSA funds is Jul 1, with the money becoming available after Aug 31.

Program for cities expands
With the CDC funding, HHS is expanding a program to help major cities develop the ability to quickly provide oral drugs to the entire population in a public health emergency. Last year 21 urban areas received funds under the program, called the Cities Readiness Initiative. This year, the CDC is increasing the total funds for those 21 areas by $10 million and is adding another 15 metropolitan areas in 15 states, HHS reported.

Funds for the program this year will total $40.18 million, officials said. The largest sums are slated to go to New York City ($5.1 million) and Los Angeles ($3.44 million).

The CDC is also continuing a program begun last year to strengthen infectious disease surveillance in states bordering on Mexico and Canada. A total of $5.44 million will be available for the Early Warning Infectious Disease Surveillance Program in the border states.

The money is for developing and implementing a program to detect, investigate, and report unusual infectious disease cases in the border regions, HHS said. Twenty states are to receive shares of the money, but most of it will go to Texas (about $2 million) and California ($1.5 million).

The CDC's guidelines also ask states to take steps to prepare for an influenza pandemic. One suggestion is that states use CDC funds to buy supplies of the antiviral drug oseltamivir and store them in hospital-based caches funded by HRSA. Health departments could then use the drug to treat their own staff members if needed in a pandemic, the guidelines say.

<A href="http://www.cidrap.umn.edu/cidrap/content/bt/bioprep/news/may2305grants.html">(LINK)</A>

The Flying Dutchman · May 24, 2005

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<center>519 Bird Flu Deaths in Qinghai China
Recombinomics Commentary
May 23, 2005
> Location of the outbreak: Niannaisuoma village, Quanji town, Gangcha county, Qinqhai province (in the central part of the country). The place is an important rendezvous of migratory birds on one of their Asia-Europe routes.</center>
Description of affected population: migratory birds found dead, including bar-headed goose (Anser indicus), great black-headed gull (Larus ichthyaetus), brown-headed gull (Larus brunnicephalus), ruddy shelduck (Tadorna ferruginea) and great cormorant (Phalacrocorax carbo).

Total number of birds found dead: 519. <<

Initial reports several weeks ago indicated 178 bar headed geese had died at the Qinghai Lake Nature Reserve in early May. The official report from China to the OIE estimates that the outbreak may have begun April 15 and the number of dead birds was 519, including at least 5 species.

The more extensive H5N1 outbreak may explain why 3 million doses of vaccine were rushed to the area. However, at least one of the species does winter in the northern plains of India which are about 1000 miles southwest of the reserve, which can be flown in one day by the bar headed goose.

China has recalled envoy from meeting in Japan with prime minister.
<A href="http://www.recombinomics.com/News/05230503/H5N1_Qinghai_519.html">(LINK)</A>

The Flying Dutchman · May 24, 2005

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<center>Air Travel Study
Tracing Illness Outbreaks 
Tuesday, May 24, 2005

WASHINGTON » Honolulu is in the top 1 percent of the world's most vital air travel hubs -- and therefore one of the key places to watch during a contagious disease outbreak, according to a new study. </center>
The study by Northwestern University researchers lists Paris as the most important global air connection point.

Coming in a surprising second was Anchorage, Alaska, followed by London, Singapore and New York.

Hawaii ranked 24th among the 3,883 communities with airports around the world. The results of the study are being published in today's issue of Proceedings of the National Academy of Science.

The air transportation network is like the Internet, the study concluded, with networks and hubs funneling traffic around the world.

The findings are important in understanding the flow of travelers and in studying the potential movement of new diseases, said lead researcher Luis Amaral.

Though London and Singapore have far more direct flights with other cities, smaller hubs like Honolulu and Anchorage rank with the big boys due to a vital measure called "centrality" -- a rating of the shortest paths connecting any two cities that involve a transfer at a particular city.

Anchorage, for example, has nonstop flights to just 39 other cities, far fewer than the 242 cities connected to London nonstop.

But Anchorage beats London on centrality because the Alaskan capital serves as a conduit between international routes and smaller, local airports.

Likewise, Honolulu ranks 99th on the number of nonstop links to other cities, but is in the top 25 most vital airports partly because it funnels traffic to and from the neighbor islands, boosting its centrality rating.

Amaral said such hubs also are among the first places that authorities should look when trying to arrest the spread of contagious illnesses such as SARS.

"If you want to stop something like that, in what places will you want to be sure to monitor individuals? Honolulu would be one of those places, due to its centrality," Amaral said.

The analysis also could help regulators determine airports where more competition is needed, and could even shed light on the functions of biological networks within the human body, according to Amaral, an associate professor in the Department of Chemical and Biological Engineering.

A traveler can get from any of the cities to any other with an average of 4.4 flights, and more than half the communities are connected with four flights or fewer, the researchers found.

The most difficult air route? Getting from Mount Pleasant in the Falkland Islands to Wasu, Papua-New Guinea, requires 15 separate flights.

Paris and London benefit from their nation's colonial pasts, with many flights from Africa and Asia going to those cities, where travelers transfer to other planes.

Indeed, they are the top cities in the world for nonstop flights to other places. Paris leads, with flights to 250 other cities, followed by London, 242; Frankfurt, 237; Amsterdam, 192 and Moscow, 186.

The two busiest airports in the United States are in Chicago and Atlanta. The study ranked Chicago 13th on the worldwide centrality list and sixth for nonstop flights, with connections to 184 cities. Atlanta ranked 29th for centrality and eighth in connections, with flights to 172 cities.

The study analyzed 531,574 flights operated by 800 airlines worldwide from Nov. 1 to 7, 2000. While the data are four years old, the researchers say the current worldwide airport network is virtually identical to the one at that time.

The research was funded by the National Institutes of Health.

The Associated Press and Star-Bulletin reporter Dan Martin contributed to this story

Proceedings of the National Academy of Sciences
www.pnas.org

<A href="http://starbulletin.com/2005/05/24/news/index1.html">(LINK)</A>

The Flying Dutchman · May 24, 2005

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<center>New York City (almost) gets it 
Revere Commentary

Tuesday, May 24, 2005
Effect Measure

It's nice to see somebody in authority in public health gets it, even if it's a local health department, in this case New York City's.
REVERE</center>

From http://www.nydailynews.com/news/loc...4p-266707c.html

Infectious-disease experts at the Health Department have been meeting every two weeks to prepare a strategy for protecting the city against diseases such as the Asian bird flu, or H5N1, which many scientists believe is just one crucial mutation away from turning into a monster malady.

The written blueprint, which officials expect to complete before the next flu season starts in late fall, spells out how the agency will tackle potentially controversial measures.

The issues addressed include how to handle quarantines, test virus samples for new strains, cope with overcrowded hospitals and ration lifesaving vaccines and other treatments.

Revere
At the moment, the only generally available therapeutic agent is the antiviral, Tamiflu (although an inhaled antiviral, Relenza, should be available to a lesser extent). But the US has only purchased enough for about 1% of the population, while the UK, France and New Zealand have ordered enough for 20% of their populations, Canada 17%. London officials have also independently bought 100,000 doses for use with essential personnel (fire, police, transit workers). This is a sensible plan and one New York and other cities should adopt immediately. Health care workers and nurses should be included. By targeting essential personnel there would be enough Tamiflu to go around, but only if plans and distributions are done now. Neither New York nor any other American city has yet to take this step.

The Daily News article suggests that New York's hesitancy is related to not moving ahead of, and hence upstaging, their federal counterparts, upon whom they might depend in a crisis. Wake up, New York. In a crisis the federal authorities will be even more useless than they are now, since demands will be coming from everywhere. They are paralyzed now. What makes you think they will awake from their coma in time to do you any good?
<A href="http://effectmeasure.blogspot.com/">http://effectmeasure.blogspot.com/</A>

The Flying Dutchman · May 24, 2005

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<center>China rushes in vaccine after deadly bird flu found

Mon May 23,12:34 AM ET

BEIJING (Reuters) - China has rushed more than three million doses of bird flu vaccine to a remote western province after migratory birds were found dead from the H5N1 strain which can be fatal to humans, state media said on Monday.</center>
Poultry across Qinghai province, neighboring Tibet and Xinjiang, had become the "target of a compulsory vaccination campaign," the China Daily newspaper said.

Scientists had proved that the virus killed scores of geese in Qinghai in early May, media said at the weekend, the first report of H5N1 detected in China since last year.

There had been no reports of the virus spreading to humans or domestic fowl in Qinghai, the Beijing News said. The area where the dead geese were found had been sealed off for 10 days.

But experts said domestic poultry could also be at risk.

"There is a significant possibility of that, given the fact that wild birds quite often use the same water sources and feeding sources as domestic ducks or domestic geese," said Malik Peiris, a microbiologist at the University of Hong Kong.

"One has to take this risk seriously."

The H5N1 strain has killed 37 Vietnamese, 12 Thais and four Cambodians since it swept across large parts of Asia in late 2003.

The
World Health Organization said last week the spate of human bird flu cases in Vietnam this year suggested the deadly form of the virus may be mutating in ways that are making it more capable of being passed between humans.

China has been on high alert against bird flu after outbreaks in
North Korea and Southeast Asia, which prompted it to tighten quarantine controls at its borders.

But Qinghai is far from either border and there was no immediate explanation as to how wild geese there became infected.

"I think it's sensible to take this outbreak in wild birds quite seriously and enhance surveillance in domestic poultry," Peiris said.

"Clearly it shows this virus is still causing problems in this region."
<A href="http://news.yahoo.com/news?tmpl=story&u=/nm/20050523/wl_nm/birdflu_china_dc_1">(LINK)</A>

The Flying Dutchman · May 24, 2005

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<center>May 25th - Day2</center>

<center>March 29, 2005
Wait your turn
Canada's pandemic plan has kids last in line
Consider this scenario: news breaks that the widely expected influenza pandemic has erupted somewhere in the world. In Canada, as in many countries, the race begins to produce a vaccine to match the particular strain that's starting to claim lives at an alarming rate. </center>
With luck, three months pass before the first cases are identified here. Perhaps another three months later, with the media din growing by the day, Canada's first doses of vaccine are ready. When those shots are available, public health authorities make sure those people most at risk are at the front of the line -- but that doesn't include the vast majority of kids. Anxious parents are told to be patient for several weeks more. Many will likely keep their kids home from school or daycare, either because they have been told to by public health authorities, or simply out of fear.

This sketch is based on interviews with doctors working with the federal Public Health Agency of Canada on pandemic planning. They stress that there are plenty of big factors still in doubt. For example, how quickly will the vaccine be produced? What segments of the population will be hit hardest, and in which parts of the country? Will one shot or two be needed to inoculate someone? Still, based on their study of past flu epidemics, PHAC has divided the population into five priority groups for vaccinations -- and the place of children in that plan might surprise many.

Health-care workers come first, about 600,000 of them, because they have to take care of those who get sick. Next come a million essential-service providers, including police, firefighters and funeral directors. Children six months to two years old are in a third group of more than 8 million (flu vaccines aren't recommended for babies younger than six months), along with nursing home residents and anyone with a high-risk health problem. The fourth group is made up of 8.7 million healthy adults. And finally, making up the fifth and lowest priority group, come healthy kids older than two -- who will likely have waited weeks, perhaps months, before it's their turn.

<A href="http://www.macleans.ca/topstories/health/article.jsp?content=20050404_103143_103143">(LINK)</A>

The Flying Dutchman · May 25, 2005

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<center>*BUMP*

LOL... I can't find where this thread
landed</center>

Christian for Israel · May 25, 2005

thanks for keeping us updated bro.

squeeksmom · May 25, 2005

Thanks, Shakey, for all the news.

squeeks

RAT · May 25, 2005

Bump...thanks, Shakey!

:chkn:

susan48 · May 25, 2005

Thanks for keeping us updated Mr. Shakey. Looks like this is getting pretty serious!

Susan

Christian for Israel · May 26, 2005

noelle4 · May 26, 2005

Shakey,

Thank you so much, for keeping us informed. Great information!

Noelle

Jumpy Frog · May 26, 2005

BTTT

Christian for Israel · May 26, 2005

darkdakota · May 26, 2005

Bump..this is too important to let fade away...

Thanks Shakey

Dusty Lady · May 26, 2005

Can't help but think of the Nostradamas quatrain.....and now that M. Abbas fella from Palestine is visiting Jorge el Busho.....not to mention the dog virus in New England.

Mabus
Century 2, Quatrain 62
Mabus plus tost alors mourra, viendra,
De gens & bestes vn horrible defaite:
Puis tout à coup la vengeance on verra,
Cent, main, faim quand courra la comete.

Mabus then will soon die, there will come
A horrible undoing of people and animals:
At once vengeance one will see vengeance,
One hundred hands, thirst, famine, when the comet will run.

H5N1: An Impending Pandemic 5/24/05

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