WHO: H5N1 Pandemic Threat growing

The Flying Dutchman · May 19, 2005

-

<center>WHO: flu pandemic threat may be growing

May 18, 2005 (CIDRAP News) – The H5N1 avian influenza virus is evolving and poses "a continuing and potentially growing pandemic threat," say experts who were convened recently by the World Health Organization (WHO) to study the pathogen.</center>
Changing patterns of cases, particularly in northern Vietnam, may indicate the virus is becoming more infectious for humans, the WHO said in a report on an international meeting of experts held May 6 and 7 in Manila. In addition, genetic analysis indicates that H5N1 viruses are becoming more antigenically diverse.

The report cites several differences between epidemiologic features of human cases this year in northern Vietnam and those in southern Vietnam this year and overall last year:

* Northern Vietnam has had eight case clusters this year, versus only two in the south.
* Case clusters in northern Vietnam this year have lasted longer than did clusters last year.
* The average age of infected people in northern Vietnam rose from 17 to about 31 years between 2004 and 2005, but it stayed about the same in southern Vietnam (15 to 18 years).
* The case-fatality rate has dropped to 34% this year in the north but is 83% in the south.

In addition, the report says the recent discovery of three asymptomatic cases in Vietnam suggests that milder infections are occurring. A few asymptomatic cases also were found in Japan and Thailand in the past year, and others were discovered in Hong Kong after the H5N1 outbreak in 1997.

The report says the longer duration of recent clusters may signal a growing number of ways in which people contract the virus, including exposure to sick birds, environmental infection, lengthy exposure to asymptomatic birds that are shedding virus, and person-to-person transmission.

The avian virus had already vaulted to the top of the pandemic threat list because it had developed the ability to sicken and kill humans. The virus's inability to cause efficient, ongoing human-to-human transmission is the last barrier to a pandemic. Now experts appear worried that the barrier is crumbling.

"Investigators were not able to prove that human-to-human transmission had occurred. However, they expressed concerns, which were shared by local clinicians, that the pattern of disease appeared to have changed in a manner consistent with this possibility," the assessment states.

At the same time, it says that in places where the disease in poultry has been controlled or eliminated, human cases have stopped. And thus far, the first case in most of the human clusters in Vietnam followed the person's exposure to infected poultry.

For now, "Prevention of H5N1 avian influenza in humans is best achieved by controlling infection in poultry," the document states. "As already recommended by FAO and OIE [the United Nations Food and Agriculture Organization and the World Organization for Animal Health], control strategies for this disease should consider vaccination of poultry, which has been used successfully before."

A team of WHO expert consultants studied Vietnam's outbreak at that country's request from Apr 15 through 25, the report says. That study showed H5N1 could be changing more in the northern region, which prompted a second expert consultation.

This second meeting was held May 6 and 7 at the WHO regional office in Manila. Representatives from Vietnam, Cambodia, and Thailand presented details about the epidemiologic, clinical, and virologic findings regarding H5N1 in people and poultry. Other data were included from the WHO Global Influenza Network and other countries.

The experts make a number of recommendations, including increasing efforts to improve risk assessment, to boost the ability of affected countries to address outbreaks, and to speed the pace of pandemic planning.

The 14 recommendations include the following:

* WHO should convene its Pandemic Task Force to meet regularly, assess the data, and determine the risk for pandemic flu.
* All nations should move as quickly as possible to complete "practical operational pandemic preparedness plans."
* WHO should explore "all possible mechanisms" to make H5N1 vaccine available to the Asian countries affected before a pandemic. It should bring together technical experts, countries, manufacturers and possible donors to find ways to boost global H5N1 vaccine production.
* Coordination of animal and human surveillance and viral information must be improved from the ground level to the national and international level, and data must be exchanged quickly.
* The WHO should complete a handbook on how to investigate possible H5N1 clusters.
* The WHO should explore building a stockpile of antiviral drugs that could be used to respond to early signs of a potential pandemic.
* Countries needing funding and agencies that may provide funding must coordinate their efforts to avoid redundancy and eliminate gaps

As the experts call for greater international effort to address the escalating threat, they also acknowledge the difficulties of preparing for a possible pandemic:

"Evolution of a pandemic strain of virus may be preceded by numerous small steps, none of which is sufficient to signal clearly that a pandemic is about to start. This poses a difficult public health dilemma. If public health authorities move too soon, then unnecessary and costly actions may be taken. However, if action is delayed until there is unmistakable evidence that the virus has become sufficiently transmissible among people to allow a pandemic to develop, then it most likely will be too late to implement effective respondses. . .

<A href="http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/may1805who.html">(LINK)</A>

The Flying Dutchman · May 19, 2005

-

<center>WHO to warn on changing avian flu
By Pallab Ghosh
BBC News science correspondent

Wednesday, 18 May, 2005

A new virus could spread quickly
The WHO is to announce new research showing that the pattern of avian flu in northern Vietnam is consistent with human-to-human infection.
BBC News has obtained an advance copy of the study, which urges governments to bolster public health measures. </center>
The new methods will be needed to protect against a new influenza pandemic, the WHO paper says.

It is thought that at least 92 people have caught the avian influenza virus from handling poultry since late 2003.

But in a handful of cases, there is the suspicion that the virus has mutated and spread from person to person.

Infection clusters

Scientists fear this new infection could form the basis of a new world-wide flu pandemic.

In the first detailed assessment of this possibility, a WHO team says that the infection pattern in northern Vietnam may indicate that the infection is passing from one person to another.

Killer viruses
1918 Spanish flu killed 50m
1957 Asian flu killed about 1m
1968 Hong Kong flu killed 1m
2003 Sars killed 774
2004-5 Avian flu (H5N1) has killed 50 to date

When the infection spreads from poultry, it usually infects a small number of shoppers or meat handlers and is quickly eradicated.

Instead, in northern Vietnam, researchers say they have discovered a higher number of infection clusters, the period of infection is longer and the age range of those infected is much wider.

The scientists have also found that the virus in northern Vietnam is genetically more different to a bird virus than other strains.

However, the WHO stresses that the pattern of infection could also be explained by a more infectious form of bird to human infection
<A href="http://news.bbc.co.uk/2/hi/health/4559309.stm">(LINK)</A>

The Flying Dutchman · May 19, 2005

-

<center>Europe plans bird flu early warning system
By Andrew Jack in Stockholm
Published: May 18 2005 18:03

ImageThe European Union will on Friday take another step towards creating an early warning system to prevent, or at least to limit, an influenza pandemic by the launch of a new continent-wide monitoring system.</center>
Establishing a round- the-clock surveillance network to identify any European outbreaks will be the first task for the newly created European Centre for Disease Prevention and Control (ECDC), which becomes operational in Solna, nearStockholm, on Friday.

Zsuzsanna Jakab, the ECDC's recently appointed director, said pandemic flu was the most important public health challenge her organisation faced.
Her comments came as the death toll among humans who have contracted the H5N1 bird flu strain in Asia has risen to more than 50, and experts have warned of the need for greater efforts to study infections and to prepare for a future pandemic.

So far there are no signs that the virus, which is widespread in birds and some animals, has mutated into a form easily transmissible between humans - the necessary step to trigger a pandemic - but the World Health Organisation (WHO) has warned that the risks are high.

The ECDC, currently recruiting senior scientists and managers to increase its skeleton staff of 10, will tomorrow launch 24-hour monitoring, convene a group of scientists able to offer assistance within Europe and abroad, and begin issuing daily reports.

It will also begin work on building a network of "reference laboratories" across Europe to analyse flu across the continent, and a system to monitor vaccinations against the virus. Thailand yesterday called for international help to create a stockpile of anti-viral drugs to treat a flu pandemic. Speaking at the World Health Assembly in Geneva, Dr Kumnuan Ungchusak from the Thai ministry of health, said developed countries needed to do more to help stem a potential outbreak of flu at its likely source in Asia.

His call came as other countries, including Algeria, warned that current income inequalities would only accentuate differences in deaths and illness from a flu pandemic.
<A href="http://news.ft.com/cms/s/fd74358e-c7bd-11d9-9765-00000e2511c8,dwp_uuid=d4f2ab60-c98e-11d7-81c6-0820abe49a01.html">(LINK)</A>

The Flying Dutchman · May 19, 2005

-

<center>Avian flu virus discovered on eggs from Vietnam

Matthew Lee

May 19, 2005

The deadliest form of the avian influenza virus was found in Guangdong for the first time last month on 45 eggs brought in by air from Vietnam by two passengers.</center>
According to the Guangdong Entry-Exit Inspection and Quarantine Bureau report Wednesday, officials at the Guangdong airport discovered the eggs in the hand luggage of the passengers on separate flights from Vietnam on April 28.

Sniffer dogs detected the eggs, of which five were chicken eggs, five duck eggs, five goose eggs and 30 fertilized duck embryos. The eggs were immediately sent to the provincial and state laboratories for tests as they came from a bird-flu-infected area, the report said.

Most of the duck-embryo shells were cracked and the embryos dead.

The duck and goose eggs tested positive for the highly pathogenic H5N1 bird flu virus.

Scientists from the provincial laboratory said in the report the virus is virulent and can kill the embryos quickly. The death rate for poultry is up to 100 percent.

It was the first bird-flu-infected eggs discovered since several Southeast Asian countries were affected by the outbreak last year.

According to the World Health Organization, Vietnam has reported 68 cases of bird flu in humans since May 4 last year, of whom 36 have died since January this year.

Infectious disease expert Lo Wing-lok said the virus can survive on the surface of an egg for days.

"The Vietnam government stepped up bird flu control measures two weeks ago after studies revealed that 70 percent of waterfowl found in the Mekong River Delta area were carrying the virus,'' Lo said. "The measures include a massive cull of all waterfowls and a ban on hatching duck and goose eggs until February 2006.''

He suggested the measures were one possible reason for the export of the embryos from Vietnam.

"Although it is theoretically possible for the bird flu virus to penetrate the eggshell, so far, viruses like these have only been found outside the shell,'' Lo said.

"The risk of human infection from eating the eggs are relatively low because the eggs, unlike live poultry where the virus can multiply, only carry a fixed amount of the virus,'' he said, adding the virus on the eggshell can be washed away.

A Health, Welfare and Food Bureau statement said the Food and Environmental Hygiene Department has liaised with mainland authorities about the contaminated eggs in Guangdong.

"Imports of table eggs do not require prior approval. Samples are, however, taken at entry, wholesale and retail levels for testing. The results are satisfactory so far. Imported hatching eggs must be, however, be disinfected on arrival at local hatcheries,'' it said.
<A href="http://www.thestandard.com.hk/stdn/std/Metro/GE19Ak02.html">(LINK)</A>

The Flying Dutchman · May 19, 2005

-

<center>Thailand urges world to take on flu pandemic
Posted: 05/18
From: TNA

Thailand has called on the global community to take action to prevent an international pandemic of human and avian influenza, Public Health Minister Suchai Charoenratanakul revealed yesterday.</center>
Dr. Suchai, currently attending the Geneva-based meeting of the World Health Assembly, told TNA reporters that he had suggested to delegates of the 58-member assembly that stocks of anti-viral drugs and influenza vaccines be organized on a regional basis to help in the event of an outbreak of the virus.

"Each country has different policies in stocks of vaccines and the anti-viral tamiflu drug. If each country does this, the most worrying problem is an inevitable shortfall of these medications", Dr. Suchai warned.

Calling for regionally organized stocks, he said that Thailand would be willing to stock vaccines and tamiflu for other countries in the region to purchase and use immediately when an outbreak of influenza emerges.

The public health minister said that he had also proposed that western and Asian scientists work closely and in a systematic manner to develop flu vaccines.

While the United Kingdom and the United States are already acknowledged as global leaders, Thailand hopes to be at the forefront of Asian vaccine development.

Thailand, which has experienced outbreaks of the avian flu virus H5N1, has stored up 200,000 doses of influenza vaccine and 85,000 doses of tamiflu.

It has also prepared a team of 1,030 epidemiologists and has developed its diagnostic laboratories in preparation for the event of an influenza pandemic.

While Vietnam has been struggling to contain its avian flu problem, Thailand has seen no cases of the virus spreading to humans since October last year, a fact for which the kingdom was praised at the World Health Assembly meeting.

The World Health Organization (WHO) has warned of the possibility of a global flu pandemic, possibly caused by the mutation of the avian flu virus.

<A href="http://mathaba.net/x.htm?http://mathaba.net/0_index.shtml?x=216761">(LINK)</A>

The Flying Dutchman · May 19, 2005

-

<center>Threat of Bird Flu Pandemic Dominates World Health Assembly

GENEVA, Switzerland, May 17, 2005 (ENS) - Avian influenza is the most serious known health threat the world is facing, World Health Organization Director-General Lee Jong-wook told opening of the 58th World Health Assembly on Monday. Comparing the possibility to the Spanish flu pandemic in 1918, which killed between 20 and 50 million people, Lee said, "The timing cannot be predicted, but rapid international spread is certain once the pandemic virus appears. This is a grave danger for all people in all countries."</center>
"By good fortune we have had time - and still have time - to prepare for the next global pandemic, because the conditions for it have appeared before the outbreak itself," said Lee. We must do everything in our power to maximize that preparedness. When this event occurs, our response has got to be immediate, comprehensive and effective."

Lee
World Health Organization Director-General Lee Jong-wook addresses delegates from 192 countries at the World Health Assembly. (Photo courtesy WHO)
The most inclusive recent expression of the will of governments around the world is the Millennium Development Goals, and they place health at their center, Lee said. "Yet the translation of those goals into reality is still very far from completion, and progress towards them is not reassuring."

The eight Millenium Development Goals pledge that by 2015 governments of the world will reduce by half the proportion of people living on less than a dollar a day, and reduce by half the proportion of people who suffer from hunger, and reduce by half the proportion of people without sustainable access to safe drinking water. They pledge to reduce by two thirds the mortality rate among children under five, and reduce by three quarters the maternal mortality ratio.

"Unless we succeed in bringing about the major changes we are working for in the very near future, the targets for reducing child mortality will not be achieved by 2015," Lee said. "This is a simple clear fact."

Other Millenium Development Goals are to halt and begin to reverse the spread of HIV/AIDS, malaria and other major diseases, but Lee says the world is not making enough progress towards these goals.

"Although the coverage rates for some health interventions have risen as planned," the WHO chief said. "We have not yet seen the necessary improvement in health indicators," "In some areas death rates have actually risen as a result of extreme poverty and epidemics. The technical and practical know-how exists for achieving what is necessary for global health but we have not yet found the ways to apply it on a large enough scale."

Guest speakers at the World Health Assembly opening were President of the Maldives Maumoon Abdul Gayoom, Bill Gates, co-founder of the Bill and Melinda Gates Foundation, and Ann Veneman of the United States, the new executive director of UNICEF.

Veneman
Speaking at the opening session was Ann Veneman of the United States, the new executive director of UNICEF, who assumed her post two weeks ago after four years as U.S. agriculture secretary. (Photo courtesy UNICEF)
"An integrated approach to child survival designed to deliver a package of lifesaving health services for children in hard to reach communities has shown remarkable results," Veneman said Monday at the World Health Assembly.

The program, called Accelerated Child Survival and Development (ACSD), was initiated in some 100 districts within 11 countries in West Africa beginning in 2002.

After three years of increasing coverage in basic health interventions, UNICEF estimates that child deaths will have dropped by an average of 20 percent across the 16 districts where the program was fully implemented, and by 10 percent where it was partially applied.

“The early results of this initiative are remarkable,” said Veneman. “They have exceeded expectations, and shown us just what can be achieved over a short period of time through sound science using an integrated approach.”

Funded by the Canadian government and initiated by UNICEF, the ACSD model utilizes the expertise and partnership of multiple players on the ground, including governments and health ministries, WHO, the World Bank, numerous non-governmental groups, local community leaders, and others. The model relies on the involvement of everyone who has a role in women’s and children’s health.

Microsoft Chairman Bill Gates, too, expressed concern about the situation of people in developing countries who fall ill. "In my view – and there is no diplomatic way to put this: The world is failing billions of people. Rich governments are not fighting some of the world’s most deadly diseases because rich countries don’t have them. The private sector is not developing vaccines and medicines for these diseases, because developing countries can’t buy them. And many developing countries are not doing nearly enough to improve the health of their own people."

Gates
Bill Gates speaks to the WHO opening plenary. (Photo courtesy WHO)
Gates was invited to speak because the Bill and Melinda Gates Foundation has donated hundreds of millions of dollars to solving some of the toughest health problems in the world today. Monday, he more than doubled that grant from $200 million to $450 million.

"Let’s be frank about this. If these epidemics were raging in the developed world, people with resources would see the suffering and insist that we stop it. But sometimes it seems that the rich world can’t even see the developing world," Gates said. We rarely make eye contact with the people who are suffering – so we act sometimes as if the people don’t exist and the suffering isn’t happening."

"All these factors together have created a tragic inequity between the health of the people in the developed world and the health of those in the rest of the world. I am here today to talk about how the world, working together, can dramatically reduce this inequity," Gates said.

"I am optimistic, Gates said. "I’m convinced that we will see more groundbreaking scientific advances for health in the developing world in the next 10 years than we have seen in the last 50."

"We are on the verge of taking historic steps to reduce diseases in the developing world," he said. "Never before have we had anything close to the tools we have today to both spread awareness of the problems and discover and deliver solutions."

Maldives President Gayoom invited the Assembly to imagine a day when "all of a sudden, and without warning the sea swells to some four meters (13 feet), and crashes through the whole island. Within a matter of minutes, the waters recede as the tsunami rips through the Indian Ocean, In its wake, loved ones go missing, never ever to be seen alive again, the whole island is turned into rubble, and the entire community is left in shock."

Gayoom expressed his gratitude to the international community for its swift response, but said he was concerned that donors have been slow to provide assistance for the cleanup operation and for "the important task of reconstructing the damaged water and sewerage infrastructure."

After the opening plenary U.S. Secretary of Health and Human Services Mike Leavitt convened a ministerial meeting on avian influenza with the health ministers and heads of delegation from both affected countries and donor countries.

"Many of us are particularly worried about H5N1 avian influenza virus, and we’re right to worry," Leavitt told the meeting. "It has infected at least 89 human beings and killed more than half. There is a chance that this virus could cause the next pandemic."

Leavitt
U.S. Secretary of Health and Human Services Mike Leavitt (Photo courtesy HHS)
Leavitt said he is briefed daily on the status of bird flu and that President George W. Bush "understands the gravity of our situation."

"If a flu pandemic starts, public health officials need to be able to react right away across borders - regardless of the relationships among governments - to bring treatment to the victims and protect others from infection," Leavitt said.

"To maximize our preparation, we need to cooperate and communicate, regularly and without surprises," the U.S. health official said. "We need to identify the short- and longer-term barriers to sustainable action on avian influenza. Developed countries need to know where affected countries need the most assistance to address the control and treatment of this virus. We want to work with you."

Leavitt explained that the U.S. National Institutes of Health have this year initiated clinical trials of a vaccine specifically designed against the H5N1 strain that is circulating in Asia. "We have also gone ahead and produced two million doses of this vaccine in bulk," he said.

The U.S. delegation hosts a technical meeting on avian flu today co-chaired by the Kingdom of Thailand and the WHO Secretariat. WHO will also have a technical briefing on avian influenza on Wednesday.

"Pandemic flu is an urgent health challenge, and preparedness is the best defense," Leavitt said. "Transparency, strong surveillance, and communication are essential components of our response to this threat."

<A href="http://www.ens-newswire.com/ens/may2005/2005-05-17-02.asp">(LINK)</A>

The Flying Dutchman · May 19, 2005

-

<center>Swiminization of H5N1 in Asymptomatic Indonesian Pigs

Recombinomics Commentary
May 17, 2005

>> C.A. Nidom, the university researcher who discovered the infection in pigs, said he had found the virus in the blood of 10 pigs out of 20 he checked. A laboratory in Tokyo conducted the tests, he said.</center>
"I found it in the snout to begin with, but I was doubtful whether this meant they were truly infected," he said in a telephone interview.

"So I then proved it by finding a matching strain in the blood."

Nidom said the samples were taken from pigs living 100 yards away from a chicken farm on Java island that was struck by bird flu last year. None of the pigs showed any signs of illnesses, he said. <<

The finding of H5N1 in asymptomatic pigs on a farm in Indonesia is cause for many concerns. Last fall WHO warned about H5N1 in asymptomatic ducks. The H5N1 in that case was isolated from fatal human infections in Vietnam. Since then there has been mounting evidence of H5N1 in asymptomatic ducks and more recently in asymptomatic chickens. By definition these virus are difficult to monitor because the host does not display symptoms. Since the host appears healthy, more virus can be shed for a longer time period and the host offers a provocative target for additional infections. Dual infections lead to the exchange of genetic information via reassortment and recombination, leading to increased genetic instability of more rapid evolution.

The H5N1 bird flu detected throughout eastern Asia has frequently been the Z genotype. Although these viruses have the same constellation of genes, there are regional polymorphisms that distinguish the isolates. There are some that are specific for Vietnam and others specific for Thailand, but a number that are found just in H5N1 isolates from Vietnam and Thailand. However, these polymorphism are present in other serotypes typically found in mammalian isolates, such as swine or humans. This acquisition of mammalian polymorphisms via recombination has been called swimanization and these polymorphisms are associated with the H5N1 that cause fatal infections in humans. Finding Z genotype H5N1 in swine raises the possibility is swimanization in Indonesia, leading to an increased ability of H5N1 to infect humans.

H5N1 infections of swine in Vietnam and Thailand have not been reported. However, testing of asymptomatic swine has not been reported in Vietnam. Similarly, proclamations by Thailand concerning the lack of H5N1 causing illness in pigs do not address H5N1 infections in asymptomatic pigs. Difficulties in detecting H5N1 or other viruses have been described previously. False negatives in PCR tests in both northern and southern Vietnam have been reported.

In addition, South Korea has had difficulty detecting human WSN/33 in swine. Some of these swine are reported infected with three distinct flu viruses, H1N1, WSN/33, H1N2 reassortant similar to the reassortants found in pigs in the United States, and H9N2 containing Korean avian genes.

The failure of government to monitor and report these infections is cause for additional concerns.

<A href="http://www.recombinomics.com/News/05170501/Swimanization_H5N1_Indonesia.html">(LINK)</A>

suzy · May 19, 2005

Not good news Shakey. But thanks for the information and articles.

suzy

The Flying Dutchman · May 19, 2005

-

<center>Bird flu virus mutating, posing bigger threat-WHO

19 May 2005 13:32:12 GMT

Source: Reuters

HONG KONG, May 19 (Reuters) - The spate of human bird flu cases in Vietnam this year suggests the deadly virus may be mutating in ways that are making it more capable of being passed between humans, according to a World Health Organisation report. </center>
The finding points to the greatest fear of health experts that the H5N1 virus could unleash a pandemic and kill millions around the globe if ever it gained the ability to be transmitted among humans efficiently.

While investigators could not prove human-to-human transmission had occurred, the report said that "the pattern of disease appeared to have changed in a manner consistent with this possibility".

"They (findings) demonstrate that the viruses are continuing to evolve and pose a continuing and potentially growing pandemic threat," the report said.

Klaus Stohr, WHO's global influenza programme coordinator, told a news briefing in Geneva: "We don't know whether the pandemic will occur next week or next year...We should continue very intensively with pandemic preparations."

H5N1 made its first known jump to humans in Hong Kong in 1997 and experts have always established that the mode of transmission was through direct contact with birds.

But the virus has mutated since, raising fears among experts that it may one day adapt in humans and become easily passed between them, setting off a pandemic.

In the six-page report, produced after an expert meeting in Manila from May 6-7, the WHO said at least 92 adults and children in Vietnam, Thailand and Cambodia had become ill after being infected with H5N1 since late 2003, and 52 of them had died. Stohr said the toll had risen to 97 cases with 53 deaths.

More clusters of infections involving household members have occurred, opening the possibility that "person-to-person transmission" may have taken place, the WHO said.

Eight such clusters were observed in north Vietnam this year alone, with recent cases spanning over a longer period.

"What we are seeing so far is a slight increase in clusters which could indicate more transmission...," Stohr said.

There was "circumstantial evidence" for such transmission -- which could not be proved -- but based on belief that a person became sick after being exposed only to an infected person and not to a sick chicken or duck, according to the expert.

"Then you can talk about very strong evidence for human to human transmission. That has happened in three clusters, two in Vietnam and one in Thailand...," Stohr added.

REGIONAL VARIATIONS

Recent cases raised the possibility that apart from being exposed to ill birds, the victims might have been infected through prolonged exposure to birds that did not appear sick but which were shedding the virus, or through contact with other sick people.

The report also said that the age range of people infected in Vietnam this year had widened to between less than a year old to 80 years old.

Equally worryingly, human H5N1 viruses isolated from Vietnam were genetically distinct from strains in 2004. Scientists also found that viruses from northern Vietnam and Thailand had begun to form a separate cluster from those isolated from south Vietnam and Cambodia.

"It is possible that the avian H5N1 viruses are becoming more infectious for people, facilitating infection in a greater number or range of people and resulting in more clusters," it said.

"It is possible that avian H5N1 viruses are becoming more capable of human-to-human transmission."
<A href="http://today.reuters.co.uk/News/newsArticle.aspx?type=healthNews&storyID=2005-05-19T133702Z_01_N19687419_RTRIDST_0_HEALTH-BIRDFLU-ASIA-DC.XML">(LINK)</A>

The Flying Dutchman · May 19, 2005

-

<center>Bird flu capable of human-to-human infection

(Agencies)
Updated: 2005-05-19 15:46

GENEVA - A World Health Organisation study in Vietnam has raised the possibility that bird flu is becoming more capable of human-to-human transmission, the WHO said.</center>
The study of bird flu outbreaks in Vietnam until April 2005, presented to a meeting with Asian countries in Manila on May 6, suggested an evolution of infections by the H5N1 virus in Vietnam, according to a report on the meeting.

A bird flu patient lies under a respirator at Hanoi's Institute for Tropical Diseases. A World Health Organisation study in Vietnam has raised the possibility that bird flu is becoming more capable of human-to-human transmission, the WHO said. [AFP]
"The changes in the epidemiological patterns are consistent with the possibility that recently emerging H5N1 viruses may be more infectious for humans," it said.

While that meant a greater number of people might be infected by poultry, there was also evidence that human to human transmission, which has already been found several times since the strain was first detected in Hong Kong in 1997, was strengthening, the UN health agency said.

"It is possible that avian flu viruses are becoming more capable of human-to-human transmission," the report said.

"While the implications of these epidemiological and virological findings are not fully clear, they demonstrate that the viruses are continuing to evolve and pose a continuing and potentially growing pandemic threat," the report said.

Fears of that a new deadlier strain of flu might spread rapidly around the world on a similar scale to pandemics in the last century have been revived with the emergence of the H5N1 bird flu virus among humans in Asia.

Fifty-two people have died in Vietnam, Thailand and Cambodia since late 2003, mainly through infection from poultry.

Concern is now heightened because a pandemic strain may develop through a series of small steps that taken individually might not be enough to signal clearly that an epidemic was about to start, according to the UN health agency.

"It is not sudden event but a complex sequence of events that lead to a pandemic," said WHO official Richard Nesbit.

The pattern of changes observed in north Vietnam included more and larger human clusters of the disease, the increasing mean age of the victims and the lower fatality rate.

Analysis of genes from both avian and human forms of H5N1 from several countries also suggested changes in the virus, the report said.

The report reiterated the health agency's call for "immediate steps" to boost monitoring for possible pandemic influenza in all countries affected by H5N1 in birds.

It also recommended that all countries, including those which were unaffected by the strain, should move ahead with operational plans to tackle a possible global spread of deadlier form of flu.

Other interpretations for the trends observed in Vietnam were raised, including transmission through contaminated water or food or infection from poultry that carried the virus but did not show symptoms, or greater persistence of the virus in the environment.

The experts meting in Manila also considered that the changes seen in north Vietnam could be "inconsequential" but dismissed that assessment as unlikely.

A second human case of bird flu was identified in under a week in Vietnam on Tuesday.

Thirty-six people have died from the disease in Vietnam since late 2003.
<A href="http://www.chinadaily.com.cn/english/doc/2005-05/19/content_444075.htm">(LINK)</A>

The Flying Dutchman · May 19, 2005

-

<center>Bird flu virus showing greater chances of pandemic: WHO
Thu, 19 May 2005

Roland Waite

A World Health Organization (WHO) report from Vietnam has found that the avian flu virus, medically called H5N1 virus, is becoming ‘more capable of human-to human transmission’ and is showing greater potential of causing a pandemic.</center>
A World Health Organization (WHO) report from Vietnam has found that the avian flu virus, medically called H5N1 virus, is becoming ‘more capable of human-to human transmission’ and is showing greater potential of causing a pandemic.

“The changes in the epidemiological patterns are consistent with the possibility that recently emerging H5N1 viruses may be more infectious for humans,” the report said, adding that though the implications of these findings are not ‘fully clear’, they point towards the continual evolution of the virus, thus posing a growing pandemic threat.

“I think it’s fair to say that the report signifies a definite step up in concern. We’re basically worried that that’s what is happening, but we’re also saying that there’s not quite enough information available – not quite enough data and cases and patterns to really solidly say that that is the case,” said Dr Keiji Fukuda, a flu expert from Centers for Disease Control (CDC).

Meanwhile, on Wednesday, the healthcare fraternity, at the annual assembly of the World Health Organization (WHO) in Geneva, expressed its inability to detect and curb the spread of a resistant strain of avian flu virus. “We are working on pandemic preparedness on borrowed time. The objective of pandemic preparedness can only be damage control. There will be death and destruction,” said Klaus Stohr of WHO. He said that estimates show that should a pandemic break out, it could claim 7.4 million lives. “National pandemic response plans are the key,” he said, while accepting that stockpiling antiviral drugs in big amounts might pose a problem due to the cost factor. “The emphasis will have to be on non-pharmaceutical measures to stop spread,” he said.

The warnings are more alarming due to the fact that health officials from developed countries have also expressed doubts about their ability to handle bird flu pandemic. “All countries are grappling with similar questions,” said Bruce Gellin of United States. Officials from Thailand said detection posed a very big problem and detection in the early stages of a pandemic was imperative.

Thailand’s Kumnuan Ungchusak said, “If we detect it at that point, it would be easy to control, but it if we miss it could be bad.” Dutch officials reported facing problems in training medical workers and getting medicines. “The major message in our plans is that we should be aware that there is a shortage. There is a scarcity of everything, operational plans should not hide this,” said Lenie Kootstra, Netherlands’ public health director.

But the threat is the highest for developing nations. “The worst hit countries are going to be poor people, countries that are not prepared, that have poor health systems,” said WHO’s Asamaoah Baah.

Meanwhile, on April 28, health officials in Guangzhou in China found chicken, goose and duck eggs carried by air passengers from Vietnam contained the fatal avian flu virus. So far, the virus has claimed 52 people lives in Vietnam, Thailand and Cambodia.
<A href="http://www.earthtimes.org/articles/show/2849.html">(LINK)</A>

The Flying Dutchman · May 19, 2005

-
I want to state up front - and advise you; that this article is from a *Blogger site*. So far they have been both astute (and what is more important - to me) correct in what they have posted on H5N1 to their site.

The Internet is far too vast for one - or even several persons to adiquately cover; in their efforts to find all the pertenent news articles each and every day.

Sooooooo..........

I hunt news articles - and swap and *cabbage* as much as I can, to find as much of the *event defining* news that I can..

Shakey

<center>Thursday, May 19, 2005
WHO's chilling warning

CIDRAP has a superb rundown on the warning sounded at WHO's World Health Assembly in Geneva. Citing the "WHO Inter-country Consultation: Influenza A/H5N1 in Humans in Asia, Manila, May 6th-7th, 2005" (.pdf) CIDRAP sets out WHO's reasons for believing H5N1 is poised to become a pandemic threat:</center>
The report cites several differences between epidemiologic features of human cases this year in northern Vietnam and those in southern Vietnam this year and overall last year:

* Northern Vietnam has had eight case clusters this year, versus only two in the south.
* Case clusters in northern Vietnam this year have lasted longer than did clusters last year.
* The average age of infected people in northern Vietnam rose from 17 to about 31 years between 2004 and 2005, but it stayed about the same in southern Vietnam (15 to 18 years).
* The case-fatality rate has dropped to 34% this year in the north but is 83% in the south.

In addition, the report says the recent discovery of three asymptomatic cases in Vietnam suggests that milder infections are occurring. A few asymptomatic cases also were found in Japan and Thailand in the past year, and others were discovered in Hong Kong after the H5N1 outbreak in 1997.

The report says the longer duration of recent clusters may signal a growing number of ways in which people contract the virus, including exposure to sick birds, environmental infection, lengthy exposure to asymptomatic birds that are shedding virus, and person-to-person transmission.

[snip]

"Investigators were not able to prove that human-to-human transmission had occurred. However, they expressed concerns, which were shared by local clinicians, that the pattern of disease appeared to have changed in a manner consistent with this possibility," the assessment states.

A number of recommendations are made, including the following:

* WHO should convene its Pandemic Task Force to meet regularly, assess the data, and determine the risk for pandemic flu.
* All nations should move as quickly as possible to complete "practical operational pandemic preparedness plans."
* WHO should explore "all possible mechanisms" to make H5N1 vaccine available to the Asian countries affected before a pandemic. It should bring together technical experts, countries, manufacturers and possible donors to find ways to boost global H5N1 vaccine production.
* Coordination of animal and human surveillance and viral information must be improved from the ground level to the national and international level, and data must be exchanged quickly.
* The WHO should complete a handbook on how to investigate possible H5N1 clusters.
* The WHO should explore building a stockpile of antiviral drugs that could be used to respond to early signs of a potential pandemic.
* Countries needing funding and agencies that may provide funding must coordinate their efforts to avoid redundancy and eliminate gaps

The WHO report concludes in chilling fashion:

"Evolution of a pandemic strain of virus may be preceded by numerous small steps, none of which is sufficient to signal clearly that a pandemic is about to start. This poses a difficult public health dilemma. If public health authorities move too soon, then unnecessary and costly actions may be taken. However, if action is delayed until there is unmistakable evidence that the virus has become sufficiently transmissible among people to allow a pandemic to develop, then it most likely will be too late to implement effective . . . responses."

posted by Revere at 6:28 AM Comment | Trackback
Preparedness is now "damage control"?

Indonesia, an impoverished country with a rudimentary public health system (2002 allocation 0.72% of gross domestic product) has bird flu in poultry and now likely in humans (via Dow Jones Newswires, no link). After pigs were discovered infected with H5N1 on Java island, blood samples from 63 local poultry workers found at least one with evidence of prior infection (antibodies to the virus in his blood). Confirmation of the result is underway, but it is likely there has been much unrecognized infection here and elsewhere.

That is also the message at WHO's annual governance gathering, the World Health Assembly now meeting in Geneva.

Officials in Thailand believe they will not be able to a detect a pandemic virus until it has reached its fourth line of victims, Kumnuan Ungchusak, head of the epidemiology at the Thai health ministry, told the meeting.

"If we detect it at that point, it would be easy to control, but it if we miss it it could be bad," he said. (Dow Jones Newswire)

WHO is now openly admitting that everyone is unprepared.

Health chiefs today warned of major doubts about their ability to detect and tackle a more virulent and deadly strain of the influenza virus before it spreads globally causing millions of deaths.

The warnings came at a meeting to discuss preparations for a looming pandemic, organised on the sidelines of the World Health Organisation's annual assembly in Geneva.

"We are working on pandemic preparedness on borrowed time," the WHO's top influenza official, Klaus Stohr, told the meeting, reiterating that conservative estimates indicated that up to 7.4 million people might die.

"The objective of pandemic preparedness can only be damage control. There will be death and destruction."

"National pandemic response plans are the key," he said.

National pandemic response plan? What's that? In the US we have a Draft Pandemic Influenza Preparedness and Response Plan from last August. It is very general and state health departments have said not very helpful. Moreover CDC has done little to ramp up public concern about the matter, something that is a prerequisite to kick-starting state and local health authorities besieged by urgent competing demands for shrinking funds. Clearly scaring the public is not much of a concern for an Administration that regularly scares them as a matter of policy.

What about a stock of antivirals, the only therapeutic option at the moment? The Wall Street Journal reports the obvious:

Amid growing fears that an outbreak of avian flu could spark the next flu pandemic, wealth has become more of a factor than need in determining who will get an essential drug.

Richer countries facing little immediate avian-flu danger have moved in recent months to stockpile large amounts of the drug, called Tamiflu. The poorer Asian nations at the epicenter of the threat -- the key staging area for fighting the current outbreak and possibly forestalling the pandemic -- have only small-scale donations of the drug at present and scant resources for ordering large amounts.

WHO recommends enough antiviral (Tamiflu) for one quarter of the population. But the drug is expensive ($39 to treat flu if recognized within 48 hours, the only time the drug is effective for treatment) or about $160 for a 6 week course of prophylaxis. Vietnam, the country with the highest case count and millions of infected birds, has 84 million people but only 2000 treatments. Cambodia's population of 14 million has only 300 courses of treatment, mostly donated.

Roche, the only manufacturer of Tamiflu, has an unknown inventory of the drug and most of that has been ordered by developed countries. The drug has a long production cycle -- 12 months -- and thus the newly increased demand can't be met instantly. However Roche, who reportedly doubled its production this year even without advance orders, has also devised a bulk method to facilitate stockpiling:

Roche has already taken unusual steps to try and increase the drug's availability. For instance, it adopted what it calls a "bucket chemistry approach," offering Tamiflu's active ingredient, a white powder known as oseltamavir, in 15-pound barrels and at half the price of the capsule form. The powder can be dissolved in water and consumed. Tests have shown that this form confers the same protection as the capsule and can be stored longer. A small portion of the bucket form has been ordered.

Sweden has ordered enough for half a million and tens of millions more doses have been ordered by Norway, Canada, Australia, New Zealand, Finland and France. The US has only ordered 2.3 million and may increase that to 6 million (enough for only 2% of our population). The UK is more ambitious with plans a $385 million for a quarter of its population. London wants 100,000 for its police fire and transport workers. WHO is trying to establish a "mobile stockpile" of 120,000.

Some public health authorities believe that a pandemic can be substantially slowed (but probably not stopped) by rushing Tamiflu to an initial outbreak and saturating the surrounding area. Whether this would work or not is unknown and some doubt it (see for example Henry Niman at Recombinomics). Even if effective, since the initial frontlines are likely to be in country's with few resources, the Tamiflu would have to be donated by the developed world:

Ensuring that Tamiflu gets to the front lines of an outbreak is so crucial to containing it that some public-health officials recommend that richer nations donate part of whatever stocks of Tamiflu they accumulate to the countries most affected by avian flu.

"Now that we can do something about it, we shouldn't be sitting on our haunches," said John Oxford, a British virologist whose research showed that Tamiflu was effective against the avian-flu strain. He suggests that wealthier countries set aside 10% or so of their Tamiflu stocks for use in Asian countries.

I think this is unlikely. Countries like the US are going to be scrambling desperately with their own "damage control" necessitated by a lack of due diligence. This was all foreseeable. Why we are in this fix now--and as far as I can see still not getting it in gear--is an example of dereliction of duty, incompetence and hardly what we would expect from a President that conned half the country into thinking he was "keeping them safe." In fact he has put them in mortal danger.
<A href="http://effectmeasure.blogspot.com/">(LINK)</A>

Fred's Horseradish · May 19, 2005

I think I shall head for one of my caves here & stay there!
Fred

The Flying Dutchman · May 19, 2005

H5N1-Avian Flu/Asia 5-20-2005

-

<center>Thailand joins Hong Kong in fight against avian flu
Posted: 05/19
From: TNA

Thailand yesterday demonstrated its commitment to spearheading regional efforts to halt the spread of avian flu, announcing that it was joining hands with Hong Kong to set up the world’s first bank of influenza vaccines and anti-viral drugs.</center>
Speaking from Geneva, where he is currently attending the meeting of the World Health Assembly, Public Health Minister Suchai Charoenratanakul said that he had secured the deal during discussions with Hong Kong’s Secretary for Health, Welfare and Food, Dr. York Chow.

The groundbreaking deal forged between two countries which have experienced devastating outbreaks of avian flu covers three main areas.

First, the two countries will establish a joint bank of the anti-viral drug Tamiflu.

While Thailand has a stockpile of 300,000 doses, Hong Kong has managed to store up 3 million.

The bank, which will also store vaccines, will act as a regional resource, to be drawn on by countries across Asia should an outbreak of influenza emerge.

Stressing his desire for the international community to participate in the initiative, Dr. Suchai said: “Both Hong Kong and the US have expressed their absolute agreement.

We will develop this into a regional and global network, allowing us to deal effectively with the virus.

If we have a good network, the virus can’t attack us.

If we stock the medicines but don’t use them, we’ve already won the war”.

The second aspect of the bilateral deal will involve the exchange of experts to control and prevent the spread of avian flu.

While Hong Kong’s expertise lies in laboratory diagnosis, Thailand has considerable expertise in epidemiology.

The experts will draw on the resources of over 800,000 public health volunteers, who will provide vital information to the public.

The final aspect of the deal covers joint research, with the two countries exchanging laboratory samples of viruses.

“This will help ease the burden on the World Health Organization (WHO), and will also help boost the confidence of the global population”, Dr. Suchai noted.
<A href="http://mathaba.net/x.htm?http://mathaba.net/0_index.shtml?x=218043">(LINK)</A>

The Flying Dutchman · May 19, 2005

-

<center>WHO head acknowledges `health gap'

By Melody Chen
STAFF REPORTER , IN GENEVA
Thursday, May 19, 2005,Page 1

Advertising World Health Organization (WHO) Director-General Lee Jong-wook acknowledged yesterday that the health body's lack of Taiwan's health information caused a "gap" in the global framework for infectious disease control.</center>
Lee approached Solomon Chen (³¯§Ó¦¨), a pediatrician working in Taiwan's medical mission to Malawi, trying to explain his efforts to help Taiwan in the World Health Assembly (WHA), the WHO's highest decision-making body, which is meeting in Geneva from Monday to next Wednesday.

Lee asked Chen where he was from after the closure of a committee meeting at the WHA yesterday evening. Chen, due to his medical contribution to Malawi, is now a member of the Malawian delegation to the assembly.

"Lee asked me whether I am from Taipei or Taichung," Chen told Taiwanese reporters.

Lee told Chen as long as Taiwan writes the WHO letters expressing its interest in sending medical and health experts to join the health body's activities, the WHO will definitely respond to the requests.

"But Lee said the WHO cannot guarantee it will let us attend all the conferences and activities, because the health body sometimes turns down even the requests of its member states to join its activities," Chen said.

According to Chen, Lee said although Taiwan can send its requests to the WHO directly, it still has to notify China of its communication with the WHO.

"I told Lee Taiwanese medical experts were barred from a tsunami health conference in Phuket, Thailand last month because of China's pressure," Chen said.

Lee said it happened because at that time, the WHO Secretariat had not yet signed a memorandum of understanding (MOU) with China facilitating technical exchanges between Taiwan and the WHO.

Taiwan dismissed the MOU, signed by China and the WHO Secretariat last Saturday, as "unacceptable" because the memo treated Taiwan as part of China.

Based on the MOU, the WHO can also send experts to Taiwan if it informs China of the decision one month in advance, Lee said. In emergency cases, there can be special arrangements, he added.

Chen took the opportunity to ask Lee whether the WHO will assign Taiwan's Center for Disease Control (CDC) as a national focal point under the International Health Regulations (IHR), the health body's global legal framework for infectious disease control.

Under the IHR, countries will have "focal points" to communicate with each other to share information and control the spread of infectious diseases.

Lee said Taiwan would have to report to China's focal point.

"I told Lee it would be impossible. Only Taiwan's health authority holds the country's health information," Chen said.

"What will the WHO do if Taiwan refuses to report to China?" the doctor asked Lee.

Lee also admitted that the health body's lack of health information in Taiwan is a "gap."

"I told Lee: `So you recognize the gap. It exists,'" Chen said. "Lee did not answer me. He knows Taiwan needs a focal point. He cannot cover the gap," the doctor added.

Seeing Chen's attitude getting sharper during the conversation, Lee told him that he could not spend too much time on him, and walked away, the doctor said.
<A href="http://www.taipeitimes.com/News/front/archives/2005/05/19/2003255698">(LINK)</A>

susan48 · May 20, 2005

Bird flu capable of human-to-human infection

This is the qualifier we've all been dreading.........human to human infection. Well, there it is, how do we prep? Just damn!! Can we get a break or not!! Sure as crap doesn't look like it does it? Am I the only who is just plain worn out and I don't have the damn energy to prep for anything else? I doubt it.

Susan

lynnie · May 20, 2005

shakey, why isn't this main page?

Thanks.

The Flying Dutchman · May 20, 2005

lynnie said:
shakey, why isn't this main page?

Thanks.

No........ But it is my area

:shk:

And sometimes, just sometimes
some one MAY come by and see
the threads/news I find interesting

:lkick:

FWIW.......
Likely I'd be posting here; in any case

:groucho:

So..Why don't you come by
and see me sometime</center>

The Flying Dutchman · May 20, 2005

-

<center>Bird Flu Claims 53rd Victim
ABC News
May 20 2005
HANOI, Vietnam May 20, 2005 -Bird flu has killed another person in Vietnam bringing the regional death toll to 53, the World Health Organization said as it continued to warn of a potential pandemic. </center>
The most recent death was reported to the Ministry of Health on April 17, WHO said Thursday on its Web site, providing no other details. WHO officials in Hanoi typically receive official word of bird flu deaths days after the fact and details are often limited.

The global body said it had asked Vietnamese health officials to provide more individual data on cases.

"Rapid field investigation of new cases, especially when these occur in clusters, remains essential to assess possible changes in transmission patterns that could indicate pandemic potential of the virus," it said.

On Thursday, WHO leaders in Geneva again warned that bird flu poses a great potential threat to humans if it evolves into a virus that can easily spread from person to person. There is no evidence a change has occurred and most cases have been traced back to contact with sick birds.

Separately, authorities in Ho Chi Minh City have advised people to not raise poultry from November this year to February 2006 to reduce the risk of the virus spreading, said Phan Xuan Thao, deputy director of the city's animal health department.

"We have highest risks of the bird flu outbreaks recurring at this period of time," he said, adding that there would be an increase in poultry sales ahead of the Lunar New Year festival which falls in late January, when many people travel to visit their families. Ho Chi Minh City, home to eight million people, has not reported any human cases of bird flu since November of 2004.
<A href="http://abcnews.go.com/Health/wireStory?id=774785">(LINK)</A>

The Flying Dutchman · May 20, 2005

-

<center>Thursday, May 19, 2005
Preparedness is now "damage control"?

Indonesia, an impoverished country with a rudimentary public health system (2002 allocation 0.72% of gross domestic product) has bird flu in poultry and now likely in humans (via Dow Jones Newswires, no link). After pigs were discovered infected with H5N1 on Java island, blood samples from 63 local poultry workers found at least one with evidence of prior infection (antibodies to the virus in his blood). </center>
Confirmation of the result is underway, but it is likely there has been much unrecognized infection here and elsewhere.

That is also the message at WHO's annual governance gathering, the World Health Assembly now meeting in Geneva.

Officials in Thailand believe they will not be able to a detect a pandemic virus until it has reached its fourth line of victims, Kumnuan Ungchusak, head of the epidemiology at the Thai health ministry, told the meeting.

"If we detect it at that point, it would be easy to control, but it if we miss it it could be bad," he said. (Dow Jones Newswire)

WHO is now openly admitting that everyone is unprepared.

Health chiefs today warned of major doubts about their ability to detect and tackle a more virulent and deadly strain of the influenza virus before it spreads globally causing millions of deaths.

The warnings came at a meeting to discuss preparations for a looming pandemic, organised on the sidelines of the World Health Organisation's annual assembly in Geneva.

"We are working on pandemic preparedness on borrowed time," the WHO's top influenza official, Klaus Stohr, told the meeting, reiterating that conservative estimates indicated that up to 7.4 million people might die.

"The objective of pandemic preparedness can only be damage control. There will be death and destruction."

"National pandemic response plans are the key," he said.
National pandemic response plan? What's that? In the US we have a Draft Pandemic Influenza Preparedness and Response Plan from last August. It is very general and state health departments have said not very helpful. Moreover CDC has done little to ramp up public concern about the matter, something that is a prerequisite to kick-starting state and local health authorities besieged by urgent competing demands for shrinking funds. Clearly scaring the public is not much of a concern for an Administration that regularly scares them as a matter of policy.

What about a stock of antivirals, the only therapeutic option at the moment? The Wall Street Journal reports the obvious:

Amid growing fears that an outbreak of avian flu could spark the next flu pandemic, wealth has become more of a factor than need in determining who will get an essential drug.

Richer countries facing little immediate avian-flu danger have moved in recent months to stockpile large amounts of the drug, called Tamiflu. The poorer Asian nations at the epicenter of the threat -- the key staging area for fighting the current outbreak and possibly forestalling the pandemic -- have only small-scale donations of the drug at present and scant resources for ordering large amounts.
WHO recommends enough antiviral (Tamiflu) for one quarter of the population. But the drug is expensive ($39 to treat flu if recognized within 48 hours, the only time the drug is effective for treatment) or about $160 for a 6 week course of prophylaxis. Vietnam, the country with the highest case count and millions of infected birds, has 84 million people but only 2000 treatments. Cambodia's population of 14 million has only 300 courses of treatment, mostly donated.

Roche, the only manufacturer of Tamiflu, has an unknown inventory of the drug and most of that has been ordered by developed countries. The drug has a long production cycle -- 12 months -- and thus the newly increased demand can't be met instantly. However Roche, who reportedly doubled its production this year even without advance orders, has also devised a bulk method to facilitate stockpiling:

Roche has already taken unusual steps to try and increase the drug's availability. For instance, it adopted what it calls a "bucket chemistry approach," offering Tamiflu's active ingredient, a white powder known as oseltamavir, in 15-pound barrels and at half the price of the capsule form. The powder can be dissolved in water and consumed. Tests have shown that this form confers the same protection as the capsule and can be stored longer. A small portion of the bucket form has been ordered.
Sweden has ordered enough for half a million and tens of millions more doses have been ordered by Norway, Canada, Australia, New Zealand, Finland and France. The US has only ordered 2.3 million and may increase that to 6 million (enough for only 2% of our population). The UK is more ambitious with plans a $385 million for a quarter of its population. London wants 100,000 for its police fire and transport workers. WHO is trying to establish a "mobile stockpile" of 120,000.

Some public health authorities believe that a pandemic can be substantially slowed (but probably not stopped) by rushing Tamiflu to an initial outbreak and saturating the surrounding area. Whether this would work or not is unknown and some doubt it (see for example Henry Niman at Recombinomics). Even if effective, since the initial frontlines are likely to be in country's with few resources, the Tamiflu would have to be donated by the developed world:

Ensuring that Tamiflu gets to the front lines of an outbreak is so crucial to containing it that some public-health officials recommend that richer nations donate part of whatever stocks of Tamiflu they accumulate to the countries most affected by avian flu.

"Now that we can do something about it, we shouldn't be sitting on our haunches," said John Oxford, a British virologist whose research showed that Tamiflu was effective against the avian-flu strain. He suggests that wealthier countries set aside 10% or so of their Tamiflu stocks for use in Asian countries.
I think this is unlikely. Countries like the US are going to be scrambling desperately with their own "damage control" necessitated by a lack of due diligence. This was all foreseeable. Why we are in this fix now--and as far as I can see still not getting it in gear--is an example of dereliction of duty, incompetence and hardly what we would expect from a President that conned half the country into thinking he was "keeping them safe." In fact he has put them in mortal danger.
<A href="http://effectmeasure.blogspot.com/2005/05/preparedness-is-now-damage-control.html">(LINK)</A>

The Flying Dutchman · May 20, 2005

-

<center>AVIAN INFLUENZA, HUMAN - EAST ASIA (80): VIET NAM
*************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 19 May 2005
From: ProMED-mail <promed@promedmail.org>
Source: CIDRAP News, Wed 18 May 2005 [edited]
<http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/may1805who.html>

WHO: Influenza Pandemic Threat May Be Increasing
---------------------------------------------</center>
The H5N1 avian influenza virus is evolving and poses "a continuing and
potentially growing pandemic threat," say experts who were convened
recently by the World Health Organization (WHO) to study the pathogen.

Changing patterns of cases, particularly in northern Vietnam, may indicate
the virus is becoming more infectious for humans, the WHO said in a report
on an international meeting of experts held 6 and 7 May 2995 in Manila.
[For additional details, see: ProMED-mail post "Avian influenza, human -
East Asia (77): Viet Nam 20050518.1362", and "WHO Inter-country
Consultation: Influenza A/H5N1 in Humans in Asia, Manila, May 6th-7th,
2005" which can be accessed via:
<http://www.who.int/csr/disease/avian_influenza/H5N1%20Intercountry%20Assessment%20final.pdf>
- Mod.CP].

In addition, genetic analysis indicates that H5N1 viruses are becoming more
antigenically diverse.

The report cites several differences between epidemiologic features of
human cases this year [2005] in northern Vietnam and those in southern
Vietnam this year and overall last year [2004]: (1) Northern Vietnam has
had 8 case clusters this year, versus only 2 in the south. (2) Case
clusters in northern Vietnam this year have lasted longer than did clusters
last year. (3) The average age of infected people in northern Vietnam rose
from 17 to about 31 years between 2004 and 2005, but it stayed about the
same in southern Vietnam (15 to 18 years). (4) The case-fatality rate has
dropped to 34 percent this year in the north but is 83 percent in the south.

In addition, the report says the recent discovery of 3 asymptomatic cases
in Vietnam suggests that milder infections are occurring. A few
asymptomatic cases also were found in Japan and Thailand in the past year,
and others were discovered in Hong Kong after the H5N1 outbreak in 1997.

The report says the longer duration of recent clusters may signal a growing
number of ways in which people contract the virus, including exposure to
sick birds, environmental infection, lengthy exposure to asymptomatic birds
that are shedding virus, and person-to-person transmission.

The avian virus had already vaulted to the top of the pandemic threat list
because it had developed the ability to sicken and kill humans. The virus's
inability to cause efficient, ongoing human-to-human transmission is the
last barrier to a pandemic. Now experts appear worried that the barrier is
crumbling. "Investigators were not able to prove that human-to-human
transmission had occurred. However, they expressed concerns, which were
shared by local clinicians, that the pattern of disease appeared to have
changed in a manner consistent with this possibility," the assessment
states. At the same time, it says that in places where the disease in
poultry has been controlled or eliminated, human cases have stopped. And
thus far, the 1st case in most of the human clusters in Vietnam followed
the person's exposure to infected poultry.

For now, "Prevention of H5N1 avian influenza in humans is best achieved by
controlling infection in poultry," the document states. "As already
recommended by FAO and OIE [the United Nations Food and Agriculture
Organization and the World Organization for Animal Health], control
strategies for this disease should consider vaccination of poultry, which
has been used successfully before."

A team of WHO expert consultants studied Vietnam's outbreak at that
country's request from Apr 15 through 25, the report says. That study
showed H5N1 could be changing more in the northern region, which prompted a
2nd expert consultation. This 2nd meeting was held May 6 and 7 at the WHO
regional office in Manila. Representatives from Vietnam, Cambodia, and
Thailand presented details about the epidemiologic, clinical, and virologic
findings regarding H5N1 in people and poultry. Other data were included
from the WHO Global Influenza Network and other countries. The experts make
a number of recommendations, including increasing efforts to improve risk
assessment, to boost the ability of affected countries to address
outbreaks, and to speed the pace of pandemic planning.

The 14 recommendations include the following: (1) WHO should convene its
Pandemic Task Force to meet regularly, assess the data, and determine the
risk for pandemic flu. (2) All nations should move as quickly as possible
to complete "practical operational pandemic preparedness plans." (3) WHO
should explore "all possible mechanisms" to make H5N1 vaccine available to
the Asian countries affected before a pandemic. It should bring together
technical experts, countries, manufacturers and possible donors to find
ways to boost global H5N1 vaccine production. (4) Coordination of animal
and human surveillance and viral information must be improved from the
ground level to the national and international level, and data must be
exchanged quickly. (5) The WHO should complete a handbook on how to
investigate possible H5N1 clusters. (6) The WHO should explore building a
stockpile of antiviral drugs that could be used to respond to early signs
of a potential pandemic. (7) Countries needing funding and agencies that
may provide funding must coordinate their efforts to avoid redundancy and
eliminate gaps.

As the experts call for greater international effort to address the
escalating threat, they also acknowledge the difficulties of preparing for
a possible pandemic: "Evolution of a pandemic strain of virus may be
preceded by numerous small steps, none of which is sufficient to signal
clearly that a pandemic is about to start. This poses a difficult public
health dilemma. If public health authorities move too soon, then
unnecessary and costly actions may be taken. However, if action is delayed
until there is unmistakable evidence that the virus has become sufficiently
transmissible among people to allow a pandemic to develop, then it most
likely will be too late to implement effective . . . responses."

--
ProMED-mail
<promed@promedmail.org>

The Flying Dutchman · May 20, 2005

-

<center>H5N1 spreading among humans?
May 20, 2005

Epidemiology in Vietnam raises the possibility of human-human spread | By Katherine Schlatter

Avian influenza (H5N1) virus is possibly spreading among humans in Vietnam, the World Health Organization (WHO) said in a document made public on its Web site on Thursday (May 19). </center>
Reporting on an international meeting held in the Philippines last week, WHO officials said worrying changes in the epidemiology of the virus had been seen between January and April this year in the north of Vietnam. "Investigators were not able to prove that human-to-human transmission had occurred, [but] they expressed concerns, which were shared by local clinicians," they said.

The document notes concerns that the latest H5N1 strains could be resistant to the antiviral oseltamivir, previously thought effective in fighting infection. It also discusses changes to the hemagglutinin (HA) protein that have been noted in 2005 H5N1 isolates, but had not been seen in 2004 sequence data. "The changes are consistent with the possibility that recently emerging H5N1 viruses may be more infectious for humans," the document's authors wrote.

"Recent viruses circulating in Northern Vietnam have lost an arginine residue in the mutibasic amino cluster at the proteolytic cleavage site of the HA protein," they warned. "The structure of the cleavage site is typical of highly pathogenic viruses." Epidemiological data also suggest the virus is "behaving" differently.

Kwok Yung Yuen, who heads the University of Hong Kong Microbiology Department—which operates a WHO designated laboratory—said, however, that epidemiological studies support the possibility that the virus pathogenicity has been somewhat reduced. "Fewer people are dying than before, and the disease is affecting a wider age group," he told The Scientist.

According to the WHO document, human bird flu clusters show a lag time between infections. This raises the possibility of incubation periods typical for human to human transmission of flu.

The epidemiology and genetic analysis of viral isolates from Northern Vietnam and other areas in Southeast Asia have been carried out by dozens of international scientists working under WHO auspices. Vietnam has also hosted independent teams, which have jointly investigated H5N1 with Vietnamese scientists, said Hitoshi Oshitani, WHO regional adviser to the Western Pacific Regional Office.

The new 2005 gene sequences are taken from only a handful of isolates. WHO says scientists have had technical problems in trying to derive isolates from the hundreds of serum samples collected in over the past few months in Vietnam.

"CDC has only one isolate and sequence for H5N1 from North Vietnam cases reported in 2005," said Ruben O'Donis, US Centers of Disease Control and Prevention's Chief of the Molecular Genetics Section, Influenza Branch, in an E-mail to The Scientist.

Meanwhile, other scientists outside the WHO network of communicating flu labs await data eagerly. "This time last year, there was a lot more [H5N1 sequence] available on Genbank, [for analysis]," said Henry Niman, founder of Recombinomics, a biotech firm set up to develop vaccine against flu. Niman analyzes data by looking for the possibility that flu viruses are evolving swiftly due to a recombination mechanism.

Niman has analyzed all 610 gene sequences from H5N1 isolates uploaded to Genbank in 2004. He's hopeful sequence data from at least one isolate will likely be made available on Genbank or on Influenza Sequence Database of the Los Alamos National Laboratory in coming weeks.
<A href="http://www.the-scientist.com/news/20050520/01">(LINK)</A>

The Flying Dutchman · May 20, 2005

-

<center>Bird Flu Threat Rises
WHO Expert Panel: World 1 Step Closer to Killer Flu

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

May 20, 2005 -- The world is one step closer to a devastating killer flu pandemic, World Health Organization (WHO) experts suspect.

Two developments in northern Vietnam spur the renewed concern: </center>
Deadly bird flu infections are being seen in larger clusters of people -- with a much wider age range -- than ever before.
The virus is changing in ways that suggest it may be adapting to humans.
Also of concern is the revelation that one virus isolate was partially resistant to TamiFlu, the only effective treatment for human infection with type H5N1 bird flu.
Because of these developments, the WHO urgently convened a panel of experts that met earlier this month in Manila, Philippines. The panel's report, written on May 11, was released yesterday.

"All countries, both those affected and unaffected by avian H5N1 … should move ahead as quickly as possible and develop or finalize practical operational pandemic preparedness plans," the panel advised.

Another Tick of the Pandemic Clock

The WHO lists six stages leading from the detection of a new flu virus in animals to a global human flu pandemic. So far, the H5N1 bird flu has been at stage 4: small, highly localized clusters of human infections. At this stage, the virus cannot spread easily from person to person.

The new evidence suggests -- but does not yet prove -- that bird flu may be moving to stage 5. That would mean the virus is becoming increasingly better at person-to-person spread. When stage 6 is reached, there will be rapid human-to-human flu spread and pandemic flu.

It's only a matter of time, says virologist Klaus Stöhr, PhD, DVM, project leader for the WHO Global Influenza Program.

"We are in a situation where we simply have to deal with uncertainties on when this will happen -- not whether this will happen or not," Stöhr said yesterday in a news conference. "We believe a pandemic will happen, but we don't know when and also [we don't know] the severity of the event."

The last flu pandemic was in 1968. That means that this is the first time the world has had the tools in place to track a flu pandemic as it develops. Guénaël Rodier, MD, MSc, director of the WHO Department of Communicable Disease Surveillance and Response, says it's becoming clear that there are many small steps -- rather than alarming leaps -- that lead to a flu pandemic.

"There is no evidence of a big crisis," Rodier said at the news conference. "But there are enough elements to say there may be something going on. … We have enough data to be concerned. At the same time we don't have enough data to be sure."

"In the last 18 months, we have seen an incremental increase in our concern," Stöhr said. "We do not know if a pandemic can occur next week or next year."
<A href="http://my.webmd.com/content/article/106/108131?src=RSS_PUBLIC">http://my.webmd.com/content/article/106/108131?src=RSS_PUBLIC</A>

The Flying Dutchman · May 20, 2005

-

<center>20 May 2005
Vietnam, Thailand, Cambodia report further human cases; total nears 100

By Charlene Porter
Washington File Staff Writer

Washington – Further confirmation of human cases of bird flu in Vietnam are pushing the total number of cases that have occurred in Asia to almost 100 since the earliest appearance of the disease in December 2003. The World Health Organization (WHO) said May 19 that 97 human cases of the illness have occurred, with 53 deaths. </center>
Three nations have detected human cases of the highly dangerous H5N1 bird flu strain, which has killed more than 140 millions birds in 10 Asian nations, according to the Food and Agriculture Organization of the United Nations. With 76 cases, Vietnam has detected the greatest level of human illness by far. Thailand has discovered 17 cases, and Cambodian medical officials report four.

For months, health officials have expressed grave concerns about this outbreak and warned that a global pandemic of bird flu, with the potential for millions of human deaths, is possible. The H5N1 strain appeared in humans for the first time in the late 1990s, so no human immunity has developed to what has proven to be a fast-moving and highly deadly form of influenza.

H5N1 has not fully adjusted to humans. The human cases detected so far have resulted from an individual’s direct exposure to infected poultry. Epidemiologists say that means H5N1 has not developed the capability to be readily transmitted from person to person -- through a cough or a sneeze, for instance.

If the virus were to mutate in that fashion, then, experts say, the conditions for a global pandemic would be in place.

History also predicts that a flu pandemic is likely soon; Influenza runs in patterns with several major outbreaks occurring per century. By that calculation, experts say, the world is due for development of a deadly flu strain that could sweep the globe.

All these factors have put bird flu on the priority list at the World Health Assembly, meeting in Geneva until May 25. Speaking to delegates from 192 WHO member nations, Director-General Lee Jong Wook called avian influenza the most serious threat to human health today.

"The timing cannot be predicted, but rapid international spread is certain once the susceptible virus appears. This is a grave danger for all people in all countries," he said. "We must do everything in our power to maximize preparedness. When this event occurs, our response has got to be immediate, comprehensive and effective."

U.S. Secretary of Health and Human Services Mike Leavitt also stressed the gravity of the bird flu threat in his remarks to the assembly, and he said U.S. medical agencies have been working to assist affected countries and to improve their technical and research capabilities to respond to disease.

“We have also deployed people from the Centers for Disease Control and Prevention (CDC) into many of the countries, working with them in their laboratories and with their governments,” Leavitt said at a Geneva press briefing. “We have begun to strengthen and expand surveillance work across the globe, especially as I mentioned in East and in South East Asia.”

Detecting flu-like disease, analyzing the strain that’s causing it, tracking the affected individual’s exposure – that’s the kind of disease surveillance that will allow medical officials to monitor H5N1 and determine whether it evolves to become a pathogen that could become a major world killer.

Experts from CDC are supporting regional health officials in that activity, said Director Julie Gerberding at the press briefing.

“[W]e’re taking all the steps now that we can to try to prevent it from evolving, but also to be prepared to contain it if it should emerge and protect people more broadly if that becomes necessary,” she said.

Leavitt said the United States has invested $100 million to provide incentives for pharmaceutical manufacturers to develop drugs and vaccines to respond to a flu pandemic. The United States currently has a vaccine against H5N1 undergoing clinical trials. It can’t be known whether this vaccine would provide protection against a still-unidentified strain that might cause a pandemic, but the officials said the work under way now serves as preparation for responses of the future.

USINFO has more information on bird flu on its special Web page.

(The Washington File is a product of the Bureau of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)
<A href="http://usinfo.state.gov/xarchives/display.html?p=washfile-english&y=2005&m=May&x=20050520152904cmretrop0.9997522&t=livefeeds/wf-latest.html">(LINK)</A>

The Flying Dutchman · May 21, 2005

H5N1 in Asia 5 - 22 - 2005

-

<center>Bird Flu in China Geese That Migrate from India
Recombinomics Commentary
May 21, 2005
>> "The bar-headed goose migrates high over the Himalayas to spend winter on the Indian plains and breeds in Qinghai-Tibet Plateau in May and June," said Wen Bo, Chinese director of Pacific Environment, a US-based non-government organization which has made efforts to support the growth of Chinese environmental groups for years. "Human activities have greatly changed the living environment of wild birds and affected their breeding activity," added Wen. <<</center>
The H5N1 positive bar-headed geese fly from India to Qinghai to breed in May and June. China now has issued an alert for the bird fly-way as well as an alert for Indians coming across the border. Clearly the time for denial has passed. The birds were said to be negative when first announced a few weeks ago. Now, after the two WHO emergency meetings and the finding that Indian poultry workers in the past were H5N1 positive, new precautions are being announced.

The case fatality rate in the Indian meningitis cases is about half of bird flu fatality rates in northern Vietnam. However, H5N1 changes rapidly and sequence data would help identify differences that affect fatality rates.

Sequencing of H5N1 from western China would be useful. The database of H5N1 sequences at GenBank is large, although there are no available H5N1 sequences from 2005. However, many of the deposited sequences should be made available soon.

A comprehensive screening in India, Philippines, and China is long overdue, as is screening in affected countries in the eastern flyways that include Korea, Japan, and southeast Asia.

H5N1 is clearly spreading and there is no comprehnisve screening to show where H5N1 is and is not.

The failure to monitor H5N1 is still a few steps beyond scandalous.
<A href="http://www.recombinomics.com/News/05210503/H5N1_China_India_Geese.html">(LINK)</A>

The Flying Dutchman · May 21, 2005

-

<center>H5N1 in Qinghai China Imported from India?
Recombinomics Commentary
May 21, 2005
>> The birds were found dead on May 4 in Qinghai province's Gangcha city, the official Xinhua News Agency reported, citing the ministry. </center>
The ministry found the birds died of the deadly H5N1 flu strain, but "the disease did not spread to human kind or fowl,'' Xinhua said. It did not say how many birds had died, or where they came from. <<

The acknowledgement that the wild bird die-off in early May was linked to H5N1 is somewhat refreshing, but not reassuring. Initial reports indicated H5N1 had been ruled out, so it is unclear if these earlier statement represented a lack of transparency, or more use of mismatched primers to generate false negatives. The comments could have also indicated the clinical presentation of the wild ducks were unusual.

The details remain somewhat sketchy. The recent report describes fatal H5N1 infections in Gangcha city on May 4 and the earlier report describe bar head geese the began dying May 6 on Bird Island in nearby Qinghai Lake. There were 178 fatalities on the western side of the lake.

Since the dead geese were initially said to be negative for bird flu, it is unclear if other wild birds were tested. The geese however arrive at the Qinghai Lake Nature Reserve in May and June after spending the winter on the plains of India.

India has recently acknowledged H5N1 antibodies in sera from 3 poultry workers collected in 2002. Currently there are fatal infections in India, which have been diagnosed as miningococcemia and meningitis, which are secondary infections of influenza.

Although WHO had announced in Febraury that unexplained deaths would be tested for H5N1, there is little evidence that the mysterious meningococcal-like deaths in the Philippines, or the recent or earlier deaths in India were tested for H5N1.

Thus, while WHO has called two urgent meetings to focus of the human-to-human spread of H5N1 in northern Vietnam, a plan to correct the scandalously poor surveillance remains unclear, even though WHO has acknowledged that the 2005 pandemic may have begun.

There have been no public announcement of results of H5N1 testing of dead patients in the Philippines or India, although WHO has made announcements that the human-to-human transmission in northern Vietnam is of a milder disease and is probable.

Clearly the WHO is not taking the 2005 H5N1 pandemic seriously.

They are simply putting out fires in the most obvious areas and making plans to bury the bodies.
<A href="http://www.recombinomics.com/News/05210501/H5N1_China_India.html">(LINK)</A>

The Flying Dutchman · May 21, 2005

-

<center>China swoops on safety after flu found
06:00 AEST Sun May 22 2005
AAP
AP - China has ordered emergency measures to prevent an outbreak of avian flu after investigators said migratory birds found dead in the country's west this month were killed by the virus.</center>
Nature reserves were closed to the public and local authorities were ordered to watch wild birds for signs of disease and impose quarantines if necessary, the official Xinhua News Agency said. It said poultry farms were ordered to take emergency immunisation measures, while the public was warned to "stop contact with poultry".

The order came hours after the Agriculture Ministry announced that migratory birds found dead on May 4 in the western province of Qinghai were killed by the deadly H5N1 strain of the virus. Xinhua said some came from South-East Asia but it didn't say what species they were.

The ministry "asked the whole country to pay keen attention to the new confirmed cases of migratory birds and to take effective measures to curb possibly spreading the epidemic", Xinhua said.

It said the public "should not be too worried" but said: "Everyone in the country should enhance monitoring for the epidemic and improve their early-warning system."

The dead birds were found in Gangcha, a city in Qinghai province, Xinhua reported.

advertisement
"The disease did not spread to human kind or fowl," Xinhua said. It didn't say how many birds died or give other details.

A report on the website of the newspaper, Life Daily, said 178 birds were found dead on May 4 at Bird Island in the lake, a major research centre for migratory water fowl.

Health experts worry that birds that cross China on migratory routes stretching from Siberia to New Zealand could spread the virus to the country's vast population of ducks, geese and other domestic fowl.

During previous bird flu alerts, China has slaughtered millions of birds and quarantined large areas of farm country to keep the disease from spreading to other animals and possibly humans.

Some experts suggested migratory birds might have been the source of an outbreak of avian flu last year that prompted the slaughter of millions of fowl in 10 Asian countries.

But others say the few wild birds known to have gotten the virus probably contracted it from domestic poultry.

China's most recent known case of bird flu occurred last July in the eastern province of Anhui.
<A href="http://news.ninemsn.com.au/article.aspx?id=50913">(LINK)</A>

The Flying Dutchman · May 21, 2005

-

<center>WHO: Vietnam Bird Flu Variant May Pose Human Flu Pandemic Risk
By John Soltes
May 19, 2005, 20:01

A bird flu variant, which may potentially pose the risk of human flu pandemic, may have developed in northern Vietnam from the influenza A/H5N1 bird flu or avian flu virus that has been plaguing southern Asia since 2003, according to a report released May 11 by the World Health Organization (WHO).</center>
Ever since 2003, over 90 people in southern Asia have suffered from the bird flu caused by a virus known as influenza A/H5N1. The WHO believes that the original bird virus could have mutated over the years, and now a new variant might be spreading from person to person and it could potentially infect millions of people leading to hundreds of thousands of deaths.

"While the implications of these epidemiological and virological findings are not fully clear, they demonstrate that the viruses are continuing to evolve and pose a continuing and potentially growing pandemic threat," according to a WHO press release entitled WHO Inter-country Consultation.

More cases of bird flu have been found in northern Vietnam than in southern Vietnam, eight clusters vs. two, leading researchers to believe that the Northern influenza virus is more infectious, and it possibly spreads from person to person.

In addition to Vietnam, both Cambodia and Thailand have seen cases of bird flu or avian flu. Within these countries the cases have been clustered, meaning that there are similar individuals living near each other that have developed the influenza.

Fatality from the bird flu has been 83.3 percent in southern Vietnam compared to 34 percent in northern Vietnam indicating that the new variant can infect more people than the original H5N1.

The results of genetic tests also indicated that the new bird flu virus found in northern Vietnam is different from the bird flu strains found elsewhere.

All the evidence pointed to a possibility that a less virulent, yet more infectious avian flu virus variant has developed.

A strongly infectious bird flu virus that causes a less than 50% fatality is particularly dangerous and it could potentially lead to human flu pandemic.

Although there is no evidence that the new bird flu variant or variants would definitely lead to human flu pandemic, the WHO is still suggesting precaution throughout southern Asia.

"Immediate steps should be taken to improve the ability to monitor and assess the risk for pandemic influenza more rapidly, continuously and completely in all countries where avian H5N1 viruses are present," stated the WHO press release.
<A href="http://www.foodconsumer.org/777/8/WHO_warns_of_bird_flu_being_transmitted_person_to_person.shtml">(LINK)</A>

The Flying Dutchman · May 22, 2005

-

<center>Bird flu patient dies in Ha Noi

(21-05-2005)

HA NOI — A man admitted to the Institute for Clinical Research into Tropical Diseases with bird flu last Monday has died.</center>
Nguyen Tien Cuu, 46, from Binh Kieu Commune in the Khoai Chau District of Hung Yen Province, about 40km west of Ha Noi, arrived in a very critical condition with lung inflammation and weak kidneys, says the Health Ministry.

He died on Thursday.

Two other patients undergoing treatment at the institute have tested positive for bird flu.

One is from central Thanh Hoa Province and the other from northern Vinh Phuc Province.

Both were suffering from lung inflammation and fever but their condition is now stable.

Khoai Chau District Health Centre director Dr Le Van Luong said Cuu was brought to the hospital after treating himself for several days at home.

"We have investigated and have yet to find the cause of his infection," he said.

Cuu’s family had a small flock of chickens and ducks but all the birds were still very strong.

"We and local animal health workers have destroyed his family flock and cleaned the environment around his house to a radius of 150m."

There were no chickens or ducks with the virus in the district, said Luong.

Blood samples from animals and people who had direct contact with Cuu were taken at the commune yesterday by officials from the Hygiene and Epidemic Prevention centre.

The results are expected soon
<A href="http://discuss.agonist.org/yabbse/index.php?board=6;action=display;threadid=21507">(LINK)</A>

The Flying Dutchman · May 22, 2005

-

<center>New Bird Flu Cases Northern and Central Vietnam

Recombinomics Commentary
May 22, 2005

>> Nguyen Tien Cuu, 46, from Binh Kieu Commune in the Khoai Chau District of Hung Yen Province, about 40km west of Ha Noi, arrived in a very critical condition with lung inflammation and weak kidneys, says the Health Ministry.

He died on Thursday.</center>
Two other patients undergoing treatment at the institute have tested positive for bird flu.

One is from central Thanh Hoa Province and the other from northern Vinh Phuc Province………

Cuu's family had a small flock of chickens and ducks but all the birds were still very strong.

There were no chickens or ducks with the virus in the district, said Luong. <<

The number of new H5N1 confirmed cases in northern or central Vietnam continue to increase. The most recent cases are males between 46-58 years old, which are distinctly different than the fatal cases in southern Vietnam and Cambodia.

These demographic differences correlate with genetic differences, which place isolates from northern Vietnam with 2005 isolates from Thailand and isolates from southern Vietnam with isolates from Cambodia.

An increasing number of cases from northern Vietnam have no clear link to infected birds, and Thailand has yet to report a human case this season. These 2005 cases may be more difficult to detect with primers based on 2004 H5N1 sequences, since there has been several antigenic changes in HA and nucleotide changes have not been reported, but a expected to be significantly higher than antigenic change. Nucleotide changes in regions coding for primers would diminish or abolish binding, which would generate weak positives or false negatives.

Milder cases in northern Vietnam and Thailand could also be missed because the milder cases of H5N1 are similar to more severe cases of H3N2, like those caused by the California/7 strains which swept across the United States in February and March and has now spread worldwide, including southeast Asia and China.

An aggressive screen of patients with flu-like conditions, including secondary infections such as meningitis and meningococcemia is long overdue.

<A href="http://www.recombinomics.com/News/05220501/H5N1_Central_Northern_Vietnam.html">(LINK)</A>

The Flying Dutchman · May 22, 2005

-

<center>Scenic spot closes to visitors due to reported bird flu 

XINING, May 22 (Xinhuanet) -- The bird island in Qinghai Lake, the largest saltwater lake in China, has closed to visitors due to recently reported bird flu cases. </center>
The concerned department of Qinghai Province, northwest China, has established two inspection and quarantine stations on the roadleading to the bird island to prevent entry.

The 0.27-square-kilometer bird island is home to more than 100,000 birds including rare species such as swan, black-necked cranes and brown-headed gull. Large numbers of visitors flock to the bird island to see birds each year.

Death of migratory birds was first reported in Naisuoma Villagein Gangcha County on May 4. By May 8, the number of dead birds reached 178 on the bird island and in nearby areas.

The Ministry of Agriculture announced Saturday that the national bird flu reference laboratory confirmed that the deaths of the migratory birds in Gangcha reported on May 4 was caused by the deadly H5N1 virus.

The disease has not spread to humans and livestock, the ministry said.

The island will reopen after the bird flu is under control, sources said. Enditem

<A href="http://news.xinhuanet.com/english/2005-05/22/content_2988129.htm">(LINK)</A>

The Flying Dutchman · May 22, 2005

-

<center>WHO report charts disturbing changes in avian flu virus, urges preparations

Helen Branswell
Canadian Press

Sunday, May 22, 2005

TORONTO (CP) - The World Health Organization urged countries to make full haste with pandemic influenza preparations Wednesday as it released a report outlining disturbing changes to the H5N1 virus circulating in Asia. </center>
The report raises concerns that molecular and disease pattern evidence may indicate the virus is becoming more adept at infecting people. It also reveals some strains of the H5N1 virus may be developing resistance to oseltamivir, the drug wealthy nations are flocking to stockpile as fears of a pandemic mount.

An influenza expert who helped draft the report said it's meant to convey the message that the level of anxiety regarding the virus has risen.

"I think it's fair to say that the report signifies a definite step up in concern," said Dr. Keiji Fukuda, a flu specialist from the U.S. Centers for Disease Control who is being seconded to WHO's global influenza program.

The report concedes the authors had limited scientific evidence on which to determine whether H5N1 is becoming an even graver risk to mankind.

"We're basically worried that that's what is happening, but we're also saying that there's not quite enough information available - not quite enough data and cases and patterns to really solidly say that that is the case," Fukuda said from Atlanta.

Fukuda was part of a recent three-person WHO mission to Vietnam, where the alarming changes are being observed in the northern part of the country. His team reported last week to a meeting of international experts in Manila; the report was drawn up from their deliberations.

A leading U.S. epidemiologist said the report contains no single smoking gun to suggest H5N1 is becoming a pandemic strain, but the combined evidence paints a compelling picture that cannot be ignored.

"I think it tells us that everything about H5N1 is headed in the direction that none of us would like to see it go," said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

"Do I say that that's going to mean there's an impending pandemic? I don't know that. Does it tell me that ... there's a growing concern about it? Absolutely."

The report of a case where the virus was partially resistant to oseltamivir will give public health officials around the world pause.

Oseltamivir (sold as Tamiflu) is one of only two antiviral drugs known to work against H5N1 and is the first choice for pandemic planners because it is easier to use than the alternative, zanamivir, which is not licensed in Canada.

Dr. Frederick Hayden, an antiviral expert at the University of Virginia, insisted it wasn't necessarily disturbing to find limited resistance to the drug because it has also been documented in a small percentage of infections with human flu strains.

Still, the finding raises the spectre of a resistant strain of the virus becoming dominant and spreading among people, creating a situation where the world has virtually no therapeutic weapons to combat pandemic flu in the months before a vaccine could be produced.

Hayden noted that human flu strains resistant to oseltamivir are generally less fit and don't transmit as well.

But Dr. Earl Brown, an influenza virologist at the University of Ottawa, said oseltamivir is too new a drug for anyone to assume that pattern will persist across all subtypes of influenza.

"The indications from the lab data are that the virus is sort of a wimpier virus when it's resistant to the drug," he said. "So if that's always the case, that's good. But I think given limited experience with the drug, you can't be too categorical at this point."

Fukuda said the authors of the report felt the situation demands close observation.

"It's definitely a warning sign that we need to monitor resistance to oseltamivir," he said. "Clearly, that's what we have to do."

The report also outlined the disturbing changes in infection patterns in northern Vietnam, where this spring there have been more clusters of cases, clusters that lasted for longer periods of time, and a greater age range among human cases.

The changing patterns suggest the virus has altered. Among the possibilities is that the genetic mutations have allowed the virus to be transmitted more easily to people in the first place, or among them after a first case occurs.

At the same time, molecular analysis of the virus shows genetic changes near what's known as the "receptor binding site" - the point where the invading virus attaches to the cell walls of a host.

Flu viruses made entirely of avian influenza genes don't tend to bind well to human receptor binding sites. But these changes may indicate the virus is evolving to be a better fit.

Still, given how little is known about flu, no one can predict with certainty the implications of these changes.

"The information is pretty sketchy," said Dr. Frank Plummer, scientific director of Canada's National Microbiology Laboratory in Winnipeg, which sent a team of three scientists to Hanoi on Wednesday. "And till we know quite a bit more, it's hard to know whether these things are real or not."

The team, led by Dr. Yan Li, chief of the influenza laboratory, will help scientists at Vietnam's National Institute of Hygiene and Epidemiology analyse blood samples from contacts of H5N1 cases to determine if additional undetected infections have occurred.

"It will help a lot in, I think, clarifying the extent of infection," Plummer said.

<A href="http://www.canada.com/health/story.html?id=b0648128-36ff-474a-bbcc-f0f8444b56ca&page=2">(LINK)</A>

The Flying Dutchman · May 22, 2005

-

<center>Sat, May. 21, 2005

China orders emergency bird flu measures

JOE McDONALD
Associated Press

BEIJING - China ordered emergency measures Saturday to prevent an outbreak of avian flu after investigators said migratory birds found dead in a western province this month were killed by the virus.</center>
Nature reserves were closed and local authorities were ordered to watch wild birds for signs of disease and impose quarantines if necessary, the official Xinhua News Agency said. It said farms near migration routes were ordered to immunize their birds, while the public was warned to "stop contact with poultry."

The order came hours after the Agriculture Ministry announced that migratory birds found dead May 4 in the western province of Qinghai were killed by the deadly H5N1 strain of the virus. Xinhua said some came from Southeast Asia but it didn't say what species they were.

The ministry "asked the whole country to pay keen attention to the new confirmed cases of migratory birds and to take effective measures to curb possibly spreading the epidemic," Xinhua said.

The regional death toll in the latest bird flu outbreak rose to 53 this week when another fatality was reported in Vietnam.

The World Health Organization warned Thursday that the virus poses a great potential threat to humans if it develops the ability to spread easily from person to person. There is no evidence so far of such a change and most cases have been traced to contact with sick birds.

China's government is especially sensitive to public health threats following widespread criticism of its slow response to severe acute respiratory syndrome in 2003.

Since the SARS outbreak, it has set up a nationwide disease-warning network and created contingency plans for possible outbreaks.

Health experts worry that birds that cross China on migratory routes stretching from Siberia to New Zealand could spread the virus to the country's vast population of ducks, geese and other domestic fowl.

China's most recent known case of bird flu occurred last July in the eastern province of Anhui.

<A href="http://www.bradenton.com/mld/bradenton/11706457.htm?template=contentModules/printstory.jsp">(LINK)</A>

The Flying Dutchman · May 22, 2005

H5N1/Avian Flu/Asia: 5 - 23rd 2005

-

<center>Poultry gets bird flu vaccine in Qinghai plateau
By Liu Wei (China Daily)
Updated: 2005-05-23 05:05

More than 3 million doses of vaccine against the H5N1 strain of the bird flu virus were dispatched to Northwest China's Qinghai Province immediately after the Ministry of Agriculture confirmed on Saturday the deaths of migratory birds were caused by the fatal virus.</center>
Poultry across the province is the target of a compulsory vaccination campaign launched by the province's animal disease administrative office under the instruction of the MOA.

A worker disinfect a truck entering Gangcha county in Qinghai Province May 21 after bird flu cases were reported there. [Xinhua]
All domesticated birds in the affected area in Niannaisuoma Village in the province's Gangcha County, where the dead birds were found, were labelled a priority and received the vaccine first.

Poultry raised near the migratory route of these birds was also vaccinated as early as possible, on order of the MOA.

The compulsory vaccinations in the two highly sensitive areas were completed by Saturday afternoon, the animal disease office said.

The vaccinations are being carried out starting with the most threatened areas and then spreading to other parts of the province. All vaccinations are to be completed over the coming two days.

The number of doses matched the poultry population in the province, said Dang Chenyan from the animal diseases office.

According to the MOA, there have been no reports of the disease spreading to human beings or fowl so far, thanks to Qinghai's fast emergency response in sealing off the affected area to prevent people and fowl coming to contact with wild birds.

The MOA confirmed the birds carried the H5N1 strain from Southeast Asia, which is a more deadly variety of bird flu and possibly contains a gene that allows for human contraction based on research conducted by the national bird flu reference laboratory.

However, China has a mature bird flu diagnosis, monitoring and prevention system, and people do not need to panic and should be confident that the new cases will be brought under control as effective measures have been taken by the government, said Cui Shangjin, an expert from the national bird flu reference laboratory.

The administration received the bird samples for examination from the Qinghai Lake National Natural Reserve on May 4.

Some 150 bar-headed geese were found dead on the lakeshore from May 4 to 6, said He Yubang from the nature reserve.

Another 28 dead geese were discovered in the following two days, pushing the death toll up to 178 by the morning of May 8, with no further deaths reported after that.

This is the first report of the H5N1 virus being detected in China since the country brought 50 cases of bird flu under control last year.

(China Daily 05/23/2005 page1

<A href="http://www.chinadaily.com.cn/english/doc/2005-05/23/content_444759.htm">(LINK)</A>

The Flying Dutchman · May 22, 2005

-

<center>Pravda:Global human flu pandemic

15:19 2005-05-22
Convinced it`s only a matter of time before a new flu strain capable of killing millions reaches New York, city health officials have started drawing up a crisis plan, the Daily News has learned.</center>
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, reports New York Daily News.

The WHO lists six stages leading from the detection of a new flu virus in animals to a global human flu pandemic. So far, the H5N1 bird flu has been at stage 4: small, highly localized clusters of human infections. At this stage, the virus cannot spread easily from person to person.

The new evidence suggests - but does not yet prove - that bird flu may be moving to stage 5. That would mean the virus is becoming increasingly better at person-to-person spread. When stage 6 is reached, there will be rapid human-to-human flu spread and pandemic flu.

It`s only a matter of time, says virologist Klaus Stöhr, PhD, DVM, project leader for the WHO Global Influenza Program.

The last flu pandemic was in 1968. That means that this is the first time the world has had the tools in place to track a flu pandemic as it develops. Guénaël Rodier, MD, MSc, director of the WHO Department of Communicable Disease Surveillance and Response, says it`s becoming clear that there are many small steps - rather than alarming leaps - that lead to a flu pandemic, publishes FOX News.
NR
<A href="http://newsfromrussia.com/science/2005/05/22/59895.html">(LINK)</A>

The Flying Dutchman · May 22, 2005

-

Radio Australia:

<center>China on high alert against bird flu

23/05/2005, 02:23:45

China has ordered the immediate vaccination of millions of birds -- among other emergency measures after discovering the deadly H5N1 strain of the bird flu virus in migrating flocks.</center>
China's Agriculture Ministry says bird flu has killed migratory birds in the western province of Qinghai, marking the first time the virus has been found in China since last year.

State media reports say authorities have launched the massive vaccination campaign to cover the estimated three million chickens, ducks and other fowl in the province.

The area where the dead birds were found has also been sealed off.

Health experts fear the virus could cause an influenza epidemic among humans if person-to-person transmission occurs.

Klaus Stohr, of the W-H-O's global influenza program, says human-to-human infection may already be happening.

"That has happened in three clusters, two in Vietnam, one in Thailand, where there very strong evidence. As long as it does not change further we will see these small clusters, they will die down after a short period of time, ah but every cluster could be the indication of a change and therefore every single case and cluster has to be investigated very quickly.

<A href="http://www.abc.net.au/ra/news/stories/s1374311.htm">(LINK)</A>

Kimber · May 22, 2005

Poultry gets bird flu vaccine in Qinghai plateau
By Liu Wei (China Daily)
Updated: 2005-05-23 05:05

I've not heard of "China Daily" before. Can you provide a bit of background? Such as, where is it published? Who is the editor? Stupid stuff like that.

David

Fuzzychick · May 22, 2005

What this just shows is that we are oh oh so SCREWED.....start prepping for plenty of sick ones or PLEASE EXIT before hell breaks loose. As a healthcare professional with edu. I say DON'T BREATHE AROUND OTHERS WHEN THE NEWS PICKS IT UP.....OR JUST STAY TUNED HERE!!! OR JUIST EXIT QUIETLY AWAY FROM SOCIETY!!! SERIOUSLY!!!

Reborn · May 22, 2005

No doubt! Read it and weep:

Klaus Stohr, of the W-H-O's global influenza program, says human-to-human infection may already be happening.

Kimber · May 22, 2005

Reborn,

I don't know if you've seen this page, or if not, if you're interested :

http://www.apfn.org/apfn/vaccine.htm

David

Edited (a few time) to add: Spelling, typos and My posts are for entertainment purposes only.

Edited again because of an extra "but." It has since been deleted.

WHO: H5N1 Pandemic Threat growing

Inactive

Inactive

Inactive

Inactive

Inactive

Inactive

Inactive

Membership Revoked

Inactive

Inactive

Inactive

Inactive

Membership Revoked

Inactive

Inactive

Membership Revoked

Membership Revoked

Inactive

Inactive

Inactive

Inactive

Inactive

Inactive

Inactive

Inactive

Inactive

Inactive

Inactive

Inactive

Inactive

Inactive

Inactive

Inactive

Inactive

Inactive

Inactive

Membership Revoked

Membership Revoked

Seeking Aslan's Country

Membership Revoked