Penumbra Pandemia

"Reuters
Fri Jun 30, 2006 4:34 PM BST169
By Stephanie Nebehay
The risk of bird flu mutating into an form more easily spread between people is still high and there could be an upswing in human infections at the end of the year, the World Health Organisation (WHO) warned on Friday.
In a report analysing more than 200 known bird flu cases, the United Nations agency identified three peaks in human infections since 2003, all concentrated during the winter and spring seasons in the northern hemisphere.
'If this pattern continues, an upsurge in cases could be anticipated starting in late 2006 or early 2007,' the WHO said, adding that further analysis was needed.
'Moreover, the widespread distribution of the H5N1 virus in poultry and the continued exposure of humans suggest that the risk of virus evolving into a more transmissible agent in humans remains high,' it said. ---"

After spending thousands of dollars on cognac at Hooter's to boost thinking what to do after hurricane Katrina, and after paying millions of dollars to USA citizens for e.g. torturing Iraqi civilians in Cuba, the Bush administration has ascended to the intellectual level of the plan described in this article:

"Commentary
Avian influenza – some good news?
A goal should be to not only protect our own population with vaccine, but also to have large quantities of vaccine to export to other countries.
by Theodore C. Eickhoff, MD
IDN Chief Medical Editor
June 2006
--- in May the Homeland Security Council, through the White House, released the National Strategy for Pandemic Influenza Implementation Plan, which provided many of the specific tasks and details of the federal plan that were not spelled out in their initial plan released last November.
---
The perceived shortcomings of the plan were spelled out as well and include, among others, the lack of an aggressive plan for pandemic vaccine development, insufficient funding for many aspects of the plan, more guidance and funding for hospitals, some implausible or even adverse containment strategies, and a clearly articulated plan for preventing and containing avian influenza spread in poultry.

Problems with the plan
There are two problems with the federal plan that merit further discussion. First, hospitals seem to have fared especially poorly in federal thinking, as outlined in the Implementation Plan. Perhaps this should not be surprising, since so few people in the federal government seem to have a deep understanding of hospitals and the problems that they face. Nonetheless, it is a huge oversight considering the central role that health care institutions will be expected to play in the event of a pandemic. Given the marginally sufficient staffing levels, the noteworthy lack of surge capacity, “just-in-time” supply chains, and minimally sufficient ICU-support capability, U.S. hospitals are ill-equipped today to see the country through even a mild pandemic, let alone one of 1918-level severity.
The message to hospitals, to quote again from the Clinicians Biosecurity Network of the University of Pittsburgh Medical Center, is: “you are on your own!” Federal funding for hospital preparedness is not likely to appear anytime soon, if ever, and hospitals will therefore need to make their own preparedness plans and investments. State and local health departments will need to ensure that hospital preparedness plans are in place or at least underway on an individual hospital, community-wide, and regional basis.
Hospital solvency, or rather the lack thereof, will be a real issue in the event of a pandemic; certainly most not-for-profit hospitals are barely breaking even or are losing money; even for-profit chains have little money to invest in pandemic preparedness. In the event of a pandemic, many if not all elective procedures may need to be curtailed, thus cutting off a dependable supply of income, and replacing it with mostly Medicare/Medicaid reimbursement that will not even come close to covering hospital costs. Absent federal help, many hospitals will simply not survive.
A second problem with the federal plan that others and I have addressed before is the lack of truly global thinking, as exemplified in the pandemic vaccine preparation and stockpiling plans. The federal goal seems to be to vaccinate first 20 million, then 60 million, and then every citizen of the United States. (Nothing is being said about immigrants, legal or illegal!) After that goal is met, thinking seems to end abruptly. Only now is planning getting around to employing adjuvants in immunogenicity trials of H5N1 vaccines, and that only after unrealistically high levels of H5 hemagglutinin were required to produce what was believed to be a protective level of HI antibody.

Vaccine needs
A goal more truly befitting the richest country on earth, should be to not only protect our own population, but also to have large quantities of vaccine to export to other countries that have no vaccine production capability. This would need to be done in concert with other North American, European and world influenza vaccine manufacturers with the goal of supplying as much pandemic vaccine as can be delivered to people to prevent a pandemic that could so easily be a global catastrophe.
This point of view has been articulated both in this column, in peer-reviewed journals, and within the federal research establishment by David Fedson, MD, and others, but so far any sense of urgency in the pandemic vaccine plan still seems to be lacking.
On the scientific front, there have been some recent developments that may help in better understanding the transmission patterns and pathogenesis of avian influenza. Space does not permit further discussion of these findings in this column. I will address these in a subsequent issue."

New Russian H5N1 vaccination seems to be safe for use in humans. Hopefully it is as good in provoking the antibody response!

"In NII - SCIENTIFIC RESEARCH INSTITUTE the influenza of Petersburg began the second stage of the tests of vaccine against the bird influenza
28.06.2006, 13.49
ST. PETERSBURG, on 28 June. /Korr. ITAR- TASS Nikolai Krupenik/. in NII - SCIENTIFIC RESEARCH INSTITUTE influenza IS FRAME in Saint Petersburg it began the second stage of clinical tests on volunteers of vaccine against the highly pathogenic virus of the bird influenza H5N1, it reported the responsible executor of project, the doctor of medical sciences Mary Ann Yerofeyeva.
'28 days after the first injection of vaccine it is possible to assert that side effects in man, as shows medical monitoring, it does not produce', she emphasized the representative OF NII - SCIENTIFIC RESEARCH INSTITUTE influenza. According to her, 120 volunteers at the age from 18 to 50 years will pass repeated vaccination, and in sequential 28 days it is possible it will be confidently judge 'the guaranteed safety of innovation vaccine'. 'the vulnerability of organism from the pathogenic virus will be explained as a result of the subsequent analyses of the blood of the tested volunteers', refined Yerofeyeva.---"

Have there been any such testings of wild birds that look healthy in Finland? If so, when and by whom and what were the results?

"H5 Antibodies in Wild Goose in Northwest Russia
Recombinomics Commentary
May 6, 2006
'H5 bird flu antibodies have been found in the blood of a wild goose shot for testing outside Arkhangelsk, Nikolai Yuferev, the chief expert from the Arkhangelsk regional veterinary department, told Interfax.'
The finding of H5 antibodies in northwestern Russia is cause for concern. Although the antibodies could be from low pathogenic avian influenza, the likelihood that it is the Qinghai strain of H5N1 is high. Last year Russia's OIE Mission report described 24 species (wild duck, laughing gull, rook, northern stover, crow, pigeon, sandpiper, oyster catcher, little grebe. black-winged stilt, phalatrope, little tern, pied wagtail, green sandpiper, white headed plover, starling, coot, mallard sparrow hawk, buzzard, turtle dove, garganey, teal) that had H5N1. These birds had also been shot out of the sky by hunters and demonstrated widespread H5N1 in Russia. The report also indicate that testing in sparsely populated regions had been limited, and the H5N1 infections were more common than indicated in the report.---"

Russia drafts anti-bird flu program for G8 summit
15:31
16/06/2006
NOVOSIBIRSK, June 16 (RIA Novosti) - Russia has developed a program of preventive measures against bird flu for the G8 summit starting on July 15, Russia's chief doctor said Friday.
Health care will be one of the prominent themes of the St. Petersburg summit of the Group of Eight industrialized nations this year, as the disease has spread worldwide since it was first spotted in Asia in 2003. Russia has started trials of a vaccine amid fears that the virus could mutate into a form that passes between humans and spark a global pandemic.
'The government adopted a resolution on June 5 to allocate extra funds to the Vektor research center,' Gennady Onishchenko said, adding that the Siberia-based organization was to be turned into an institute for monitoring the spread of influenza, including avian flu.
Although no human lives have been claimed in Russia, figures made public in April indicated that around 1.1 million birds had died of the disease and 300,000 had been culled to control the spread of the virus since the beginning of February.
Onishchenko said the center in Novosibirsk could make use of abundant human resources, as it neighbored a medical university, and would survey both Central Asia and eastern Europe.
The health official said the risk of any infection spreading from Southeast Asia to Siberia was higher than in any other region because of very close human and economic contacts.
He added that the center was also participating in a G8 project to develop an HIV vaccine.
The leaders of Russia, the United States, the United Kingdom, France, Germany, Italy, Canada and Japan will be in St. Petersburg until July 17."

"New bird flu outbreak hits Siberia
17:00 27/ 06/ 2006
NOVOSIBIRSK, June 27 (RIA Novosti) - A new outbreak of bird flu has hit the West Siberian region of Tomsk, the local administration said Tuesday.
A representative said a laboratory analysis of fancy pigeons that died in a village last week revealed the deadly virus.
'All the pigeons and chickens from the courtyard have been culled,' the representative said. 'The owner who had refused to vaccinate poultry will receive no compensation.'
Governor Viktor Kress ordered vaccination as a preventive measure against an epidemic of the disease, which claimed over a million birds in Russia in February-April.
According to the Agriculture Ministry, bird flu was registered in 10 villages in three West Siberian regions in late May."

What are you willing to do to "save your face"? Chinese seem to be ready to do quite a lot :/

"China's shame
June 27, 2006 7:12 AM, by revere
Better not have a 'sudden event' in China. Or rather, you can have one, but don't tell anyone about it.
What's a "sudden event"?
While state media did not offer a definition of 'sudden events,' in the past they have included natural disasters, major accidents, public health or social safety incidents. (New York Times; h/t Easy Hiker)
What will happen to you if you tell?
Chinese media outlets will be fined up to $12,500 each time they report on 'sudden events' without prior authorization from government officials, according to a draft law under review by the Communist Party-controlled legislature.
The law, revealed today in most state-run newspapers, would give government officials a powerful new tool to restrict coverage of mass outbreaks of disease, riots, strikes, accidents and other events that the authorities prefer to keep secret. Officials in charge of propaganda already exercise considerable sway over the Chinese media, but their power tends to be informal, not codified in law.
---
The draft, under consideration by the Standing Committee of the National People's Congress, was described in outline by newspapers today.
It says that newspapers, magazines, news Web sites and television stations should face fines ranging from $6,250 to $12,500 each time they publish information about a sudden event 'without authorization' or publish 'fake news' about such events. (NYT)
So it's OK to have a massive benzene spill, a coal mine accident (not that you could have one in China, of course) or a disease outbreak (SARS? bird flu?) as long as you don't tell anyone it happened. Diagnoses of bird flu in humans are already regarded as 'state secrets.' This proposed law will give a great deal of authority to local officials (often corrupt), who frequently try to cover up poultry outbreaks of avian influenza (see this post). ---"

"MoH says no human-to-human H5N1
11:42' 27/06/2006 (GMT+7)
Soạn: AM 817015 gửi đến 996 để nhận ảnh này
VietNamNet – By June 26, the Ministry of Health (MoH) was still waiting to hear from the World Health Organisation (WHO) on transmission of H5N1 virus from human to human.
Dr. Nguyen Van Binh, Deputy Head of MoH’s Preventive Health Department, said that today, June 27, the agency would meet with WHO specialists.
Mr Binh said that one month ago, the WHO mentioned the issue when a family of eight in north Sumatra, Indonesia, died.
MoH said that there is yet no transmission of H5N1 from human to human in Vietnam, but in some families, two to three members had fallen ill.
Mr Binh told the people to not worry that the virus had undergone sudden mutations because that would not necessarily mean transmission from human to human. (Source: Tien Phong)"

Statin drugs could turn deadly infection into a milder disease, says Fedson
Reuters
June 21, 2006
"---Evidence suggests that statin drugs, designed to lower cholesterol, might help turn a potentially deadly infection into a milder disease, according to Dr. David Fedson, who thinks world health authorities ought to take a harder look at the possibility.
“Generic statins are available in virtually every country,” said Fedson, a retired U.S. physician living in France.
“You’ll be able to take five days of statins in India for less than a dollar,” Fedson, who was also director of medical affairs at Aventis Pasteur (now French drug company Sanofi Aventis), said in a telephone interview.
“We have something that conceivably could save tens of thousands of lives. This research is so important that we cannot afford not to take it.”
---"

"ZAMBIA: Fear of bird flu panics Zambians
LUSAKA, 23 June (IRIN) - The mysterious death of wild birds this week has panicked Zambians, fearing the arrival of avian influenza in a country long-recognised as vulnerable to the deadly H5N1 virus.
Poultry Association of Zambia executive director Mathews Ngosa said a delay by the government in confirming whether Zambia had become the seventh African country to suffer an outbreak has "killed our industry as people are now avoiding eating chickens".
Over 40 wild birds were found dead in Livingstone, southern Zambia, on Wednesday, a major nesting area for migratory birds. Some of the birds were eaten by villagers, but samples were collected and sent for testing in the capital, Lusaka. ---"

"S227N Change in H5N1 Receptor Binding Domains in Turkey
Recombinomics Commentary
June 23, 2006
---
The finding of S227N in a second isolate suggests the acquisition was via recombination, and the change may have been more stable that initially thought. The cluster in Turkey was the largest reported and it involved several related families. There were also outbreaks nearby in Iraq and Azerbaijan. The HA of the Turkey isolates is closely related to HA from bird, cat, and human isolates from Iraq. The nearby Azerbaijan outbreak was also large and extended. Thus, S227N may have contributed to the size of these clusters.
The release of the four sequences add important information on the receptor binding domain change, S227N. The WHO is monitoring adjacent positions, 226 and 228 for additional receptor binding changes. Acquisition of human polymorphism at these positions may greatly increase the affinity of H5N1 for upper respiratory receptors in humans, leading to more efficient transmission, which is the missing condition required for a catastrophic pandemic."

The population of Finland is about 5,2 million people. Yearly there are about 3350 reported infection related deaths.
If the infection death rate in China (population about 1,3 billion) were the same - which it isn't due to health care infrastructure differences between the two countries - there would have been about 830 000 deaths due to infections in China before. After this news that the infection death rate has been doubled in China, there would be at least 1,6 million infection related deaths last year. And this figure is counted based on Finland's reported numbers. In Finland almost everyone has access to antibiotics when needed.

Copied from Effect Measure in hope that this blog isn't banned in China:

"Posted on: June 22, 2006 7:03 AM, by revere
The latest chapter in the Chinese Disease Cover-up Follies involves a just published report in the New England Journal of Medicine by eight Chinese doctors reporting the genetic sequences of an H5N1 case that occurred in November of 2003. Old news. Except China didn't officially report its first case until two years later, November 2005. Just as the first issues of the journal were reaching NEJM's subscribers, were notified that one or more of the authors wished to withdraw the paper. Too bad. Too late.
Meanwhile, the World Health Organization is expressing shock at the reporting lapse and demanding further details.
A spokesperson for the WHO's China office said officials will be seeking answers from the Chinese Ministry of Health about the discrepancy.
'I think it's safe to say that we will be asking for more information on this in the wake of the publication of this letter by the eight scientists,' Roy Wadia said from Beijing.
'We would certainly want much more information as to exactly what happened, who this case was, what the possible source of infection was, where he was infected, the treatment -- all the standard questions.'
'There is information that needs to be shed on this by the Ministry of Health and we will be asking for that.' (Helen Branswell, Canadian Press)

All we need now is Claude Rains, as Captain Renault in Casablanca:
Rick: How can you close me up? On what grounds?
Captain Renault: I'm shocked, shocked to find that gambling is going on in here! [a croupier hands Renault a pile of money]
Croupier: Your winnings, sir.
Captain Renault: [sotto voce] Oh, thank you very much.
[aloud]
Captain Renault: Everybody out at once!

Yes, we are all shocked China has not been completely transparent about the bird flu cases everyone in the world knew they had, but wouldn't admit to:
Influenza experts outside China have long believed the country has hidden or missed human cases of H5N1. To date the country has reported 19 cases to the WHO; 12 of those people have died.
'They were just so noticeable by their absence,' influenza virologist Earl Brown of the University of Ottawa said of China's contention through 2004 and most of 2005 that it had found no human cases of the often fatal disease.
[snip]
The worrisome H5N1 virus was first isolated from a goose in the southern Chinese province of Guangdong in 1996 and is believed to have spread widely throughout the country's vast expanses.
When country after country in Asia reported outbreaks in domestic poultry in late 2003 and early 2004, China maintained an official silence, insisting it was free of the virus.
'I think they were probably part of it (the outbreak) and they didn't look hard or they didn't tell us when they found stuff,' Brown said.
[snip]
Flu watchers aren't surprised that China had cases as early as 2003. In fact, outside China it has been widely assumed, given that three people from Hong Kong became infected with the virus during a visit to Fujian province in February 2003.
But those cases -- only two were confirmed as one died without being tested -- were shoved off the world's radar screens within days. That's because SARS exploded in the intensive care wards of hospitals across Asia and in Toronto.
'It's clear that (H5N1) cases were occurring in China before they were reported and likely have occurred since -- and were not reported,' infectious disease expert Dr. Michael Osterholm said when told of the letter. (Branswell, CP)

This blog's IP has been banned in China so we won't offend the Chinese authorities when we say, "What a bunch of dumb peckerheads." [NB: A peckerhead is not a type of bird.]"

"HEMORRHAGIC PNEUMONIA - BRAZIL (RIO GRANDE DO NORTE)(02): FOLLOW-UP
---
Date: 18 Jun 2006
From: Luiz J. da Silva The cases of hemorrhagic pneumonia, reported from 10 May 2006 onwards in
the northeastern Brazilian State of Rio Grande do Norte, were considered
initially as a distinct, possibly new, disease entity. [See Archive
Hemorrhagic pneumonia - Brazil (RN) 20060604.1561].
Tests were negative for hantavirus, leptospirosis and dengue in the 1st few
cases. The state department of health together with the Ministry of Health
initiated an investigation.
After extensive epidemiological, clinical, laboratory and pathology
work-up, the conclusion was that the hemorrhagic pneumonia was in fact
severe cases of different respiratory diseases. The state was suffering 2
simultaneous outbreaks of respiratory disease, one of respiratory syncytial
virus (RSV) and another of influenza A, as well as outbreaks of dengue and
rotavirus diarrhea. The combination of these outbreaks had the expected
results: persons with risk factors, like malnutrition, pregnancy, sickle
cell anemia and old age, suffered severe, sometimes fatal cases of
pneumonia with hemorrhage.
The hemorrhage was solely in the lungs with no evidence of hemorrhage
elsewhere, except in the dengue cases.
Although the outbreak caused great anxiety in the population and in local
health authorities, the situation is calm at the moment, and, as the RSV
and influenza outbreaks have waned, no more cases of severe pneumonia have
occurred, although surveillance has been enhanced.
--
Luiz J. da Silva
ProMED-PORT Moderator
[We are thankful to Luiz for this follow-up. - Mod.DK]
[see also:
Hemorrhagic pneumonia - Brazil (RN) 20060604.1561]
................dk/msp/dk"

"http://www.recombinomics.com/News/06150602/H5N1_Sumatra_Neuro.html :
---
Neurological involvement of H5N1 has been associated with PB2 E627K. This polymorphism is found in all human isolates that are H1, H2, or H3. PB2 in H5N1 has been associated with neurological problems in mammals. Mice infected with H5N1 have neurological involvement and E627K has been found in brain isolates. Similarly, tigers in Thailand infected with H5N1 have neurological symptoms and E627K. E627K has also been found in H5N1 from cats and dogs. Experimental ferrets infected with H5N1 with E627K have hind leg paralysis.
PB2 E627K is also associated with increased activity at lower temperatures (33 C), which would increase levels in the nose and throat of humans. Declan Butler reported that cases in northern Sumatra had increased levels of H5N1 in their nose and throat, suggesting the H5N1 from these patients had E627K. This change was found in H5N1 (A/Indonesia/6/2005) from the second confirmed case in Indonesia (see phylogenetic tree), suggesting E627K is also in the north Sumatra cases. Isolates from these cases also have an H5N1 wild type cleavage site, RERRRKKR, which was also present in the above examples of neurological involvement.
Neurological involvement of H5N1 is cause for concern. The effectiveness of neuraminidase inhibitors such as Tamiflu is unclear. In addition, the isolates from Sumatra are amantadine resistant, further limiting treatment options. This complication creates additional concerns linked to an H5N1 pandemic, which could significantly impact treatment centers and anti-viral stockpiles."

Soo... This enhances my opinion that it's wise to invest in napkins and hand desinfectant... Hope to get back home before the situation becomes hotter than in Hell's kitchen... :/

http://www.recombinomics.com/News/06160603/H5_Fatal_Symptoms_Canada.html :

"Recombinomics Commentary
June 16, 2006
The owner of the birds, who raised them for personal consumption, told authorities he noticed four of his geese were walking oddly on Sunday. The next day he discovered four had died.
He disposed of three but took one for testing to the Atlantic Veterinary College in Charlottetown. The laboratory there confirmed the presence of an H5 virus.
The goose was part of a small, free-range flock of chickens, geese and ducks. Four of 11 geese in the flock were discovered dead on Monday. None of the other birds fell ill at the time but all have since been destroyed as a precautionary measure.
The above comments increase the likelihood that the geese died of H5N1 bird flu. Geese usually are resistant to low pathogenic avian influenza (LPAI). H5N1 can attack the brain, especially the Qinghai strain since in has PB2 E627K, which is linked to neurotropism. Therefore, geese walking oddly is an indication of H5N1 bird flu infection. Since one of the geese was positive for H5, it is likely that the H5 is H5N1 and all of the dead birds were infected.
The Qinghai strain of H5N1 has never been reported in the Americas. However, prior to the identification of the Qinghai strain in China in May of 2005, none of the countries to the west of China had reported the Asian stain of H5N1. The isolates in Russia, Kazakhtsan, Mongolia, India, Europe, the Middle East, and Africa have reported H5N1 for the first time in the past 12 months.
H5N1 in North America would not be a surprise. North American sequences have previously been identified in Qinghai strains in Astrakhan."

Via Reuters via crofsblog:
"New China case suggests H5N1 now more infectious-HK.
China's latest human bird flu infection is worrying as it indicates that the H5N1 virus may have mutated and become as infectious in warm months as it is in cooler ones, Hong Kong's health minister said on Friday.
The H5N1 virus thrives in lower temperatures and is more infectious in the cooler months between October and March in the northern hemisphere.
But China's confirmation on Thursday that a 31-year-old truck driver in the southern city of Shenzhen had been infected by the disease has brought uneasiness.
'Is this because the virus has changed, so that it can be highly infectious all year round? Or, if it is happening in summer, winter would be even worse?' Health Secretary York Chow told reporters. 'We will have to monitor further.'
'We have a suspicion, but we have not confirmed it yet, that the virus might have become more virulent and more widespread than we have expected. If that is the case, the risk for humans to be infected in future is higher.'
If H5N1 thrives in a sweltering Chinese summer, it can thrive anywhere."

To my understanding this means, that now the virus can survive easier also in the human body temperature, which is warmer than the bird body temperature.

http://www.bloomberg.com/apps/news?pid=10000080&sid=aG2HiPIGxZt4&refer=asia :

"June 16 (Bloomberg) -- Jones Ginting, the only survivor of seven members of an Indonesian family infected with bird flu, is being investigated for rare neurological symptoms associated with the illness.
Magnetic resonance imaging (MRI) scans of Ginting's brain are being checked for signs of infection, said Nur Rasyid Lubis, deputy director of the Adam Malik Hospital. He said the scans were taken late yesterday at the hospital in Medan, the capital of Indonesia's North Sumatra province.
``It's not yet clear whether he's suffering from a brain infection,'' Lubis said in a telephone interview today.
If confirmed, Ginting would be one of few human cases of avian influenza in which disease of the central nervous system has been observed. Doctors are studying the H5N1 avian flu strain to improve treatments and prevent illness. Human H5N1 cases provide opportunity for the virus to mutate into a pandemic form that may kill millions of people.
Avian flu has infected at least 226 people in 10 countries, killing 129 since late 2003, the World Health Organization said yesterday. In most cases, severe respiratory disease was the major symptom.
Diseases involving the central nervous system, including encephalitis, transverse myelitis and Guillain-Barre syndrome, have been associated with influenza in humans, according to Harrison's Principles of Internal Medicine, 13th edition. The cause of the disease isn't established, the medical book said.
---
(Menno) De Jong's team observed 18 H5N1 cases, including that of a 4-year-old boy, who had severe diarrhea, followed by seizures, coma and encephalitis, before he died. H5N1 virus was isolated from his cerebrospinal fluid, de Jong and colleagues wrote in a study published in the New England Medical Journal, Feb. 17, 2005.
The boy's nine-year-old sister died from a similar syndrome two weeks earlier before samples were taken. Neither patient had respiratory symptoms when their illnesses were first observed. The cases suggest that the spectrum of H5N1 avian flu is wider than previously thought, the study said. ---"

http://www.reliefweb.int/rw/RWB.NSF/db900SID/ABES-6QTKRA?OpenDocument :
"BUNIA, 16 June (IRIN) - An outbreak of plague in the northeastern district of Ituri in the Democratic Republic of Congo (DRC) has killed 20 people out of 70 cases identified in the last three weeks, health officials said on Friday.
"The figure is expected to rise as more reports arrive," said Lendunga Wapayer, the medical director of the Centre for Surveillance and Control of Plague in the northeast.
Among those identified since mid-May were 44 cases of pulmonary plague, recorded in the Linga and Rethy health zones, about 120km to 150km northeast of Bunia, the main town in Ituri.
"We have deployed a team to the area for the detection and confirmation of these cases," said Laurent Kambale, an epidemiologist with the United Nations World Health Organization (WHO) in Ituri. Kambale said two isolation units had been set up in Bubba, 135km north of Bunia, and at Kpandroma, 120km north of Bunia, for the treatment of plague patients.
WHO is also handling the preparation and internment of those dying of plague and is in charge of the sick in the isolation sites. Despite these measures, the Centre for Surveillance and Control of Plague is concerned about the possible spread of the disease to other areas.
"We have received news of the disease in Kabasa, Lenge and Vida, but we do not have the figures," said Innocent Umirambe, a laboratory technician at the surveillance centre.
"The problem is that with the [civil] war, the population stays in the bush with the rats that are reservoirs of the disease," Wapayer said. "When they are displaced, they contaminate other places."

Efforts are being made to contain the situation.
"We have in place a team for sensitisation," said Mbitso Ngedza, a government official in Ituri. "We have also requested two vans for the medical teams." The surveillance teams also face logistic problems, as "all the machines, vehicles, motorbikes, etc, were destroyed during the war," he said.
Jean Chrisophe Shako, a microbiologist and director of the referral laboratory in Bunia, said it was impossible to drive to the area "to survey the epidemic," as there were no roads. The laboratory was established in 1953 to deal with epidemiological diseases in the northeastern part of the country.
Ituri is recognised as ground zero for the plague worldwide. "Out of every 2,500 cases identified in the world each year, 1,250 are from Ituri," Wapayer said.
Since the beginning of 2006, 178 cases have been recorded, although insecurity has been a serious handicap in the identification and control of the plague."

http://www.promedmail.org/pls/promed/f?p=2400:1001:4765880987139048749::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,33236:

"PLAGUE, PNEUMONIC - CONGO DR (ITURI)
***************************************
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Wed 14 Jun 2006
From: Marianne Hopp Source: WHO Outbreak Reports [edited]

As of 13 Jun 2006, WHO has received reports of 100 deaths of
suspected pneumonic plague, including 19 deaths in Ituri district,
Oriental province. Suspected cases of bubonic plague have also been
reported, but the total number is not known at this time. Preliminary
results from rapid diagnostic tests in the area confirm pneumonic
plague. Additional laboratory analysis, including tests by culture,
is ongoing on 18 samples.

Ituri is known to be the most active focus of human plague worldwide,
reporting around 1000 cases a year. The 1st cases in this outbreak
occurred in a rural area, in the Zone de Sante of Linga, in mid-May 2006.

A team from Medecins sans Frontieres (Switzerland), WHO and Ministry
of Health has been in the area to assess the situation and provide
support to the local health authorities. Isolation wards have been
established to treat patients; close contacts are being traced and
receiving chemoprophylaxis. However, control measures have been
difficult to implement because of security concerns in the area.

For more information, see the fact sheet on plague at
http://www.who.int/mediacentre/factsheets/fs267/en/.
--
ProMED-mail

[Primary pneumonic plague (one percent of natural plague
presentations) arises as a result of inhalation of plague bacilli in
infectious aerosols, such as would be produced when there are
secondary pneumonic complications in bubonic/septicemic plague.

Primary plague pneumonia has a short incubation period of 1-3 days,
after which there is sudden onset of flu-like symptoms including
fever, chills, headache, generalized body pains, weakness and chest
discomfort. A cough develops with sputum production, which may be
bloody, and increasing chest pain and difficulty in breathing. As the
disease progresses, hypoxia (low oxygen concentration in the blood)
and hemoptysis (coughing up blood) are prominent. The disease is
invariably fatal unless antimicrobial therapy commences within 24
hours of exposure.

Patients with primary pneumonic plague generate large quantities of
infectious aerosols that pose a significant risk to close contacts.
CDC guidelines identify contacts within 2 meters as being at greatest
risk and do not consider the organism likely to be carried through
air ducts or vents. Persons who have been in contact with pneumonic
plague patients or handling potentially infectious body fluids or
tissues without appropriate protection should receive preventive
antimicrobial therapy. The preferred antimicrobial agents for
prophylaxis are tetracyclines, quinolones, or chloramphenicol.

A map of Congo DR showing Oriental province, where Ituri is located,
can be found at:
http://www.lib.utexas.edu/maps/africa/congo_demrep_pol98.jpg. - Mod.LL]

[Of note, this is the same general area where there was a major
outbreak of pneumonic and bubonic plague in 2005 (see prior
ProMED-mail postings listed below. - Mod.MPP]
[see also:
2005
----
Undiagnosed deaths - Congo DR (Maniema) (08): pneumonic plague susp
20050905.2625
Undiagnosed deaths - Congo DR (Maniema): hem fever susp, RFI 20050805.2274
Plague, pneumonic - Congo DR (07): (North East) 20050315.0754
Plague, pneumonic - Congo DR (Ituri) 20050218.0537
2004
----
Plague, fatal - China (Qinghai) 20041101.2948
Plague - Congo DR (Ituri): susp. 20040730.2083
Plague, fatal - Ecuador (Chimborazo) (02) 20040513.1288
Plague, fatal - Ecuador: RFI 20040510.1264
Plague - Uganda (Arua, Nebbi) 20040112.0128
2003
----
Plague - Uganda (Arua, Nebbi) (02): background 20031013.2584
Plague - Uganda (Arua, Nebbi) 20031012.2566
Plague - Algeria (Oran) (04) 20030704.1643
Plague, bubonic - Algeria (Oran) 20030622.1537
Plague - Uganda (Arua) 20030331.0794
2002
----
Plague - Uganda (Nebbi District): RFI 20021218.6090
Plague - Uganda (Arua, Nebbi) 20021130.5938
Plague, bubonic - Malawi (Nsanje) 20020601.4378
Plague, bubonic - Malawi, Mozambique 20020510.4160
Plague - India (Chandigarh) (04): WHO confirmation 20020220.3592
Plague, suspected - India (Chandigarh) 20020215.3567
2001
----
Plague - Uganda (Arua, Nebbi) 20011031.2689
Plague - Uganda (Okoro County) (02) 20011016.2543
Plague, suspected - Congo DR 20011011.2484
Plague - Uganda (Okoro County) 20011009.2459]
........................ll/msp/mpp"

http://www.fluwikie2.com/pmwiki.php?n=Forum.H5N1ScientificForecast2006
http://www.fluwikie2.com/pmwiki.php?n=Forum.H5N1ScientificForecast2006Part2

http://www.alertnet.org/thenews/newsdesk/N14325781.htm :
"---
LABORATORY SHORTCUT
But Govorkova's team recreated the H5N1 virus in their lab, using a strain from Hong Kong. Unlike some other experimental H5N1 viruses, which use bits of its DNA, they made a whole virus.
It protected the ferrets against strains of the same virus.
"To determine the extent of cross-protection induced by (our) vaccine, we challenged vaccinated ferrets with H5N1 viruses that were antigenically and genetically distinct from the vaccine strain," they wrote.
"All 4 unvaccinated ferrets inoculated with (a different H5N1) virus survived but showed signs of disease," they added. These included fever.
Yet the ferrets did not produce large amounts of antibodies, they found. "H5N1 vaccines may stimulate an immune response that is more cross-protective than what might be predicted by (lab tests) and, thus, hold potential for being stockpiled as 'initial' pandemic vaccines," the researchers concluded.
This may be difficult to test, as people cannot be deliberately infected with a virus to see whether a vaccine works. Usually, scientists look at antibodies in the blood to see if their immune systems have been primed by the vaccine.
Making a bird flu vaccine is big business. The International Federation of Pharmaceutical Manufacturers & Associations says 31 pandemic avian influenza vaccines made by 15 companies in Australia, Austria, Canada, France, Germany, Italy, Japan, the Netherlands, Switzerland, Britain and the United States are in human, or clinical, trials."

The ferrets of the world are now saved! :)

Immunization with Reverse-Genetics–Produced H5N1 Influenza Vaccine Protects Ferrets against Homologous and Heterologous Challenge
Elena A. Govorkova,1 Richard J. Webby,1 Jennifer Humberd,1 Jon P. Seiler,1 and Robert G. Webster1,2
1Department of Infectious Diseases, St. Jude Children's Research Hospital, and 2Department of Pathology, University of Tennessee, Memphis

http://www.journals.uchicago.edu/JID/journal/issues/v194n2/35777/35777.html?erFrom=7839297298315857544Guest:

" --- Results. One or 2 doses of vaccine induced a protective antibody response to the vaccine strain. All immunization regimens completely protected ferrets from challenge with homologous wild-type A/HK/213/03 virus: no clinical signs of infection were observed, virus replication was significantly reduced (P < .05) and was restricted to the upper respiratory tract, and spread of virus to the brain was prevented. Importantly, all vaccinated ferrets were protected against lethal challenge with the highly pathogenic strain A/Vietnam/1203/04. The 2-dose schedule induced higher levels of antibodies that were cross-reactive to antigenically distinct H5N1 viruses. ---"

Site to sign a petition to release H5N1 sequences from WHO private repository:
http://www.petitiononline.com/h5n12006/petition.html
Feel free to pass link to interested parties.

täältä.

Links to newspapers here.

Going to New York, the center of the World. Oh, how wonderful :)
So, posting will be every now and then or none.
If you got any ideas where to go in NYC, please email :)

Selection Against Altered Receptor Binding in H5N1 in Indonesia
Recombinomics Commentary
June 9, 2006
CA Nidom in a recent interview indicated he has collected 100 samples from poultry, swine, and people in the Jakarta area. He detected 20 isolates, presumably H5N1 bird flu, and 11 had alpha 2.6 specificity. This finding was alarming because alpha 2.6 linkages are found in the human upper respiratory tract and that specificity would make H5N1 transmission more efficient.
---
The failure to find S227N in the Turkish sibling may have been related to isolation procedures. Since alpha 2.6 has a preference for mammalian receptor, growth in chicken eggs could select against that change. The Hong Kong isolates were grown in a mammalian cell line, MDCK, which is a dog kidney line, and S227N was isolated from both related samples (from a father and son)..
Thus, if Hong Kong and the CDC are growing human H5N1 on chicken cells prior to sequencing, the sequence may reflect the changes during cultivation, which may select against mammalian receptor binding specificities such as S227N (or chnages at positions 226 and/or 228).
If alpha 2,6 specificity, coupled with PB2 E627K are co-circulating widely in the Jakarta area, then increased human-to-human transmission would be expected, which may also be linked to the novel cleavage site found in human isolates in the Jakarta area."

mamypoko – at 00:07
09 June 2006
"---
Translation of Bird Flu ReInfects South-East Sulawesi - Friday 9th June 2006
Liputan6.com, Konawe: Bird flu virus spreads again in South-East Sulawesi after hundreds of chickens belonging to Rawua village, Sampara Subdistrict, Konawe, died suddenly. According to a villager, almost daily hundreds of chickens die in the village. The villager didn’t know how to overcome the bird flu virus and could only burn chickens that died. Up to now, there aren’t isolation procedures or spraying to stop the spread. Meanwhile, Representative of South-East Sulawesi Livestock Breeding, Imam Subagjo said, among hundreds of chickens that died, 40 are bird flu positive. However, results of this bird flu tester is not trusted by the South-East Sulawesi Provincial Government. To be certain, they sent samples of dead chickens to the livestock breeding laboratory in Makassar, South Sulawesi. ---"

Berl Munch Tierarztl Wochenschr. 2006 Mar-Apr;119(3-4):179-85.
[Influenza pandemic planning] - [Article in German]
Scholtissek C.
Division of Virology, Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA.

"--- The third possibility is at the moment the most dangerous situation, if, e.g., a highly neurotropic H5N1 virus from Southeast Asia crosses the species barrier to humans. An infection with such a pandemic virus presumably cannot be treated efficiently by antivirals. In such a situation only a rapid vaccination would be successful.---"

Lyhyesti suomeksi:
--- Kolmas vaihtoehto on tällä hetkellä vaarallisin tilanne, eli se, että erittäin hermostohakuinen Kaakkois-Aasian H5N1-virus ylittäisi lajien välisen rajan ihmisen virukseksi. Kyseisen kaltaisen pandemiaviruksen aiheuttamaa virusta ei oletettavasti voida hoitaa tehokkaasti antiviraalilääkkeillä. Tällaisessa tilanteessa vain nopea rokottaminen olisi menestyksekästä.---"

"Suomenlahden ruokeista ei löytynyt lintuinfluenssaa
STT
6.6.2006 17:56

Itäiseltä Suomenlahdelta tavatuista ja tutkimuksiin toimitetuista kuolleista ruokeista ei ole löydetty merkkejä lintuinfluenssasta. Suomen ympäristökeskus tiedotti asiasta tiistaina, jolloin Elintarviketurvallisuusvirasto Eviran lintuinfluenssatulokset valmistuivat. Lintuinfluenssaa tutkittiin kahdeksasta menehtyneestä merilinnusta. Linnut löydettiin perjantaina Aspskärin merialueelta Pernajasta.

Kuolinsyystä ei tietoa
Suomen ympäristökeskuksen mukaan lintukuolemien syystä ei ole toistaiseksi tietoa. Osa linnuista on lähetetty Eviran Oulun-tutkimusyksikköön tarkemman kuolinsyyn selvittämiseksi.
Linnuista tutkitaan muun muassa bakteerien ja virusten aiheuttamat taudit sekä eräiden ympäristö- ja levämyrkkyjen jäämiä. Nämä tutkimustulokset valmistuvat 2-3 viikon kuluessa.

Miltei 150 kuollutta ruokkia
Itäiseltä Suomenlahdelta on löytynyt tähän mennessä jo lähes puolentoista sataa kuollutta ruokkia. Viimeksi lintulöytöjä tehtiin maanantaina, jolloin asiantuntijat tapasivat Kotkan edustalta 28 menehtynyttä merilintua. Viikonloppuna kuolleita lintuja löydettiin Ruotsinpyhtään kahdesta yhdyskunnasta 12 ja viime perjantaina Aspskärin merialueelta Pernajasta 41. Samalla alueella on jo aiemmin ollut kymmeniä kuolleita ruokkeja."

*******************
Briefly in English:

This far almost 150 dead auks have been found in the Eastern Suomenlahti, latest 28 dead birds being found outside of the city of Kotka on Monday. Last weekend twelve dead birds were found in two bird communities in Ruotsinpyhdäs and last friday fortyone dead birds were found in Pernaja, Aspskär sea district. Tens of dead auks had already been found in the same area before.

According to Suomen ympäristökeskus there's no knowledge about the cause of deaths this far. A part of the birds have been sent to Evira Oulu research unit to discover the cause of death. In Evira's Oulu unit they are going to test birds for bacteria, viruses, some environmental and algae toxins. These test results are going to be ready in two or three weeks.

Eight of the birds found in Aspskär, Pernaja on Friday were immediately tested for H5N1 by Evira. The test results were negative.

J Virol. 1999 July; 73(7): 5903–5911.
A Mouse Model for the Evaluation of Pathogenesis and Immunity to Influenza A (H5N1) Viruses Isolated from Humans
Xiuhua Lu,1 Terrence M. Tumpey,1 Timothy Morken,2 Sherif R. Zaki,2 Nancy J. Cox,1 and Jacqueline M. Katz1*
Influenza Branch1 and Infectious Disease Pathology Activity,2 Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333
*Corresponding author. Mailing address: Influenza Branch, Mailstop G-16, DVRD, NCID, Centers for Disease Control and Prevention, 1600 Clifton Road, N.E., Atlanta, GA 30333. Phone: (404) 639-3591. Fax: (404) 639-2334. E-mail: jmk9@cdc.gov :

"---
A feature of the highly pathogenic HK/483 viruses was the presence of elevated levels of virus in the spleen, liver, and blood at day 4 p.i. Disease progression was associated with the presence of viral antigens in subepithelial tissues in the lungs.
More striking still were substantial titers of virus and viral antigens in the brains of mice infected with HK/483 virus, that increased during the infection and peaked on day 6 just before death. Mice infected with the less pathogenic HK/156 virus had significantly less virus in the brain on day 6 p.i. than did mice infected with HK/483 virus (P < 0.05). Mice infected with HK/486 had no detectable virus in the brain at days 4 and 6.
Taken together these results suggest that the dissemination of virus to organs other than the lungs may depend on the extent of viremia that occurs early in the infection. In addition, the more pathogenic viruses may replicate more efficiently in other organs, including the brain.
In this study, H5N1 group B viruses were highly pathogenic, whereas group A viruses were of intermediate to low pathogenicity. It is not clear from these results whether the additional glycosylation site in HA1, present in group B viruses but not group A viruses, contributes to the pathogenicity of these viruses. Sequence analysis of the HA gene of viruses used in this study confirmed the presence of multiple basic amino acids adjacent to the cleavage site in all viruses, including HK/486 which was substantially less lethal for mice (data not shown). Therefore, further studies are required to determine the molecular basis for the differences in lethality of the H5N1 viruses. ---"

"WHO: Indonesia update 18
WHO has suddenly issued two updates, one about the nurses (see the "nurses" post below) and now one about the 15-year-old who died on May 30: WHO Indonesia update 18.
May 30 seems like a long time ago, so the confirmation is a formality. But the update concludes with this interesting paragraph:
The newly confirmed case is one of several where exposure occurred despite a clear signal of a high-risk situation arising from poultry deaths. Pending better control of the disease in animals, WHO and officials in the Ministry of Health see an urgent need to improve public awareness of this disease, the risk factors for infection, and the behaviours that should be avoided.
At this stage, after 37 confirmed deaths, it's amazing that WHO should feel the need to remind Jakarta about the self-evident. Certainly Antara and the Jakarta Post don't give avian flu much attention. But the regular media, and word of mouth, ought to have spread the news very efficiently.
Here's another mystery: The news that four nurses were under observation has come as a surprise, and a worrisome one. It seems clear that neither WHO nor the Indonesians wanted to cause a scare. (I'm assuming, maybe naively, that WHO was aware of the nurses.) Four sick nurses, announced right after the Ginting family deaths and the Surabaya outbreak, would have scared a lot of us around the world.
It would also have scared a lot of Indonesians, and thereby "improved public awareness." But the authorities must have decided the awareness would come at too high a price. So why would WHO cooperate in suppressing news about the nurses, and then criticize Indonesia for not improving public awareness?
I hope the western media, at least, jump on this issue and get a straight answer out of WHO."

Interesting indeed. Why is that?

Journal of Virology, February 2005
"In ferrets infected with human H5N1/04 viruses, virus was consistently detected in the brain and olfactory bulb at even higher titers than those in the lungs. This finding led us to conclude that these viruses are highly neurotropic, as reported for some H5N1 viruses in a mouse model."

"Blogger News Network
June 3, 2006
Indonesian human-to-human bird flu infection may be false alarm
---
The nurse had been in close contact with two children, brother and sister, who have died. The sister, nine, was confirmed of having died from the virus by local lab tests. The brother was buried before any blood tests could be taken, but showed similar symptoms.
It was reported on Friday that an analysis has shown that the virus has not mutated, and the WHO has said that there was no evidence so far of human to human transmission.
Other members of the same family are currently ill, but all members have received the Tamiflu antiviral drug.
"I think it is a cluster. The local test from the victim in Pamulang is bird flu positive. The symptoms of the virus are very similar to previous clusters we've had. The parents are also suffering from flu, and we are giving them a full dose of Tamiflu now," said Indonesia's Health Minister, Siti Fadilah Supari.
"The characteristics of germ (the boy had) is very similar (to his sister's), and now their mother and father are suffering from flu. They are all in the Pamulang district," added Supari.
The nurse, whose initials are "C.I.," 25, has been put in isolation at Bandung's Hasan Sadikin Hospital, but officials say that her condition is stable and that her case may be the result of human to human transmission due to the fact that she has not had any contact with poultry.
"We could not confirm whether she is positive of having been infected by avian influenza virus or not, although she had earlier have contacts with siblings, 18-year old Ad and 10-year old Ai, who died of bird flu virus recently," said Hadi Yusuf, chief of the Bird Flu team at Sadikin Hospital.
"When she arrived at this hospital last night, her body temperature was very high, namely 39.6 Celsius degrees but now it has decreased to 37 Celsius degrees. After considering her contact with dead bird flu victims, we declared her a suspected bird flu case. But she is still fully conscious, her breathing problems are not too serious and she's not experiencing chest pain," added Yusuf.
The names of the children and the nurse have not been released. The nurse is undergoing treatment and has been administered Tamiflu. She is expected to be released when the required amount of doses are given which officials say could be as early as next week."

"HEMORRHAGIC PNEUMONIA - BRAZIL (RIO GRANDE DO NORTE)
---
Date: 2 Jun 2006
From: ProMED-mail
Source: Diario do Nordeste [translated by Mod.LJS, edited] [Originally reported on Lista de Adversidades em Saude (LISAS) ]
Mysterious disease keeps Health Department on alert
A disease called idiopathic hemorrhagic pneumonia (IHP), of as yet
unknown etiology, has caused the deaths of 7 persons in the state of
Rio Grande do Norte in northeastern Brazil. The State Department of
Health is investigating the etiology of the disease, which affects
the lungs, but they haven't yet determined whether it is viral or
bacterial and how contagion occurs.
Although no case has been reported in the neighboring state of Ceara,
the Ceara State Department of Health is monitoring the situation due
to the proximity of the 2 states.
The most common symptoms in patients with IHP are respiratory
distress, bleeding of the airways and fever. Of 9 suspect patients in
9 different cities of the state, 6 children and a 5-months-pregnant
woman, aged 32, have died. Two children are in critical condition.
The set of symptoms has been named idiopathic hemorrhagic pneumonia
due to its unknown origin. According to the Department of Health, no
epidemiological link was established between the patients, therefore,
there was no transmission between them.
About 78 percent of the patients had a chronic condition, like
asthma, metabolic disorder, epilepsy and sickle cell anemia.
The median age was 3 years, and 56 percent of the patients were male.
The cities where cases have occurred are: Boa Saude, Canguaretama,
Ceara Mirim, Galinhos, Natal, Parnamirim, Sao Goncalo do Amarante,
Sao Tome and Taipu.
The 1st case of IHP was identified on 10 Mar 2006. From this date,
the State Department of Health has identified 24 suspect cases, 15
having been discarded as other diagnosis were confirmed.
Nine cases are still under investigation, the 6 children and the
pregnant woman that died as well as the 2 children still hospitalized.
--
ProMED-mail
[I am at the airport waiting for the plane to take me to Rio Grande
do Norte. Tomorrow, I shall have a meeting with the staff of the
State Health Department. As far as I could understand from data sent
to me, the cases seem to be severe cases of influenza (or maybe
another viral pathogen, but I favor influenza). There is a
respiratory disease epidemic of large proportions ongoing at the
moment. The autopsy reports reveal severe viral pneumonia, some
clearly with bacterial superinfection. The preexisting morbidity of
the deceased patients favors this hypothesis, a pregnant woman, a
child with sickle cell anemia, a child with asthma and another with a
metabolic disorder; I have no idea what this disorder could be. As
soon as I have better data, I'll file a report - Mod.LJS]"

"Human Flu Transfers May Exceed Reports
By DONALD G. McNEIL Jr.
Published: June 4, 2006
The New York Times
--- in a letter published last November in Emerging Infectious Diseases analyzing 15 family clusters from 2003 through mid-2005 in Southeast Asia, scientists from the disease control centers, the W.H.O. and several Asian health ministries noted that four clusters had gaps of more than seven days between the time family members got sick. They questioned conventional wisdom that only one, the Bangkok office worker, was "likely" human-to-human.
In one Vietnam cluster, not only did a young man, his teenage sister and 80-year-old grandfather test positive for A(H5N1) avian flu, but two nurses tending them developed severe pneumonia, and one tested positive.
In another questionable case, the Vietnamese government's assertion that a man developed the flu 16 days after eating raw duck-blood pudding was publicly ridiculed by a prominent flu specialist at Hong Kong University, who said it was more likely that he got it from his sick brother.
---
Dr. Niman says the authors of the Emerging Infectious Diseases article were too conservative: even though the dates in it were fragmentary, it was possible to infer that in about 10 of the 15 cases, there was a gap in onset dates of at least five days, which would fit with the flu's incubation time of two to five days.
And in a study published just last month about a village in Azerbaijan, scientists from the W.H.O. and the United States Navy said human-to-human transmission was possible. That conclusion essentially agreed with what Dr. Niman had been arguing since early March — that it was unlikely that seven infections among six relatives and a neighbor, with onset dates stretching from Feb. 15 to March 4, had all been picked up from dying wild swans that the family had plucked for feathers in a nearby swamp in early February.
While Dr. Niman is an irritant to public health officials, his digging sometimes pushes them to change conclusions, as it did in the recent Indonesia case. The W.H.O. at first said an undercooked pig might have infected the whole family, but Dr. Niman discovered that the hostess of the barbecue was sick two days before the barbecue and the last relative was infected two weeks after it.
His prodding, picked up by journalists, eventually led the W.H.O. to concede that no pig was to blame and that the virus probably had jumped from human to human to human.
The health organization's periodic updates on the number of avian flu cases and the death toll concentrate on cases confirmed by laboratories. The updates use no names and are often cleared by the affected country's health minister.
---
Dr. Niman contends that the largest human-to-human cluster so far was not in Indonesia, but in Dogubayazit, Turkey, in January. W.H.O. updates recorded 12 infected in three clusters, and quoted the Turkish Health Ministry blaming chickens and ducks. Dr. Niman counted 30 hospitalized with symptoms and said the three clusters were all cousins with the last names of Kocyigit and Ozcan, and that most fell sick after a big family party on Dec. 24 that was attended by a teenager who fell sick on Dec. 18 and died Jan. 1.
A patriarch, Dr. Niman said, told local papers that the two branches had had dinner together six days after the 14-year-old, Mehmet Ali Kocyigit, had shown mild symptoms. He died on Jan. 1, and several other young members of the two families died shortly after, with other relatives showing symptoms until Jan. 16. No scientific study of that outbreak has been released.
---"

J Infect Dis. 2006 Jun 15;193(12):1626-9. Epub 2006 May 9.
Distribution of Amantadine-Resistant H5N1 Avian Influenza Variants in Asia.

Cheung CL, Rayner JM, Smith GJ, Wang P, Naipospos TS, Zhang J, Yuen KY, Webster RG, Peiris JS, Guan Y, Chen H.
State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, University of Hong Kong, Pokfulam, Hong Kong SAR, China.

We examined the distribution of genetic mutations associated with resistance to the M2 ion channel-blocking adamantane derivatives, amantadine and rimantadine, among H5N1 viruses isolated in Vietnam, Thailand, Cambodia, Indonesia, Hong Kong, and China. More than 95% of the viruses isolated in Vietnam and Thailand contained resistance mutations, but resistant mutants were less commonly isolated in Indonesia (6.3% of isolates) and China (8.9% of isolates), where human infection was recently reported. The dual mutation motif Leu26Ile-Ser31Asn (leucine-->isoleucine at aa 26 and serine-->asparagine at aa 31) was found almost exclusively in all resistant isolates from Vietnam, Thailand, and Cambodia, suggesting the biological selection of these mutations.
PMID: 16703504 [PubMed - in process]

"Nurse with bird flu-like symptoms hospitalized in Bandung, W Java
Bandung, W Java (ANTARA News) - A 25-year old nurse identified by her initials as `Ci` is currently being treated at the Hasan Sadikin Hospital here for bird flu-like symptoms.
Ci was admitted to the hos[oital which has been treating a number of bird flu patients on Thursday evening (June 1).
"When she arrived at this hospital last night, her body temperature was very high, namely 39.6 Celsius degrees but now it has decreased to 37 Celsius degrees," Hadi Jusuf, head of the bird flu medical treatment unit of the hospital, said here on Friday.
The hospital was planning to send the patient`s blood sample to the laboratory of the Health Development and Research Body in Jakarta on Friday.
The result of the laboratory test is expected to come within the next three days, he said.
"We could not confirm whether she is positive of having been infected by avian influenza virus or not, although she had earlier have contacts with siblings, 18-year old Ad and 10-year old Ai, who died of bird flu virus recently," he said.
The ailing nurse has never had contact with poultry, but she had treated the sibling when being treated at Ujungberung Hospital, where Ci works as a nurse.
If she is confirmed of being infected by bird flu virus, it would be the first case of human-to-human transmission of the virus, he said.
Meanwhile, the UN World Health Organization (WHO) recently announced that international health investigators were finding no evidence that efficient transmission of the highly pathogenic avian influenza virus has emerged from a family cluster of cases in Indonesia`s North Sumatra.
The H5N1 virus has caused 127 deaths in 224 cases worldwide since it was detected in humans in late 2003. In all but a handful of cases, humans have become infected through direct contact with ailing birds, their feces or blood.
Indonesia has detected 48 cases of H5N1, 31 of those appearing since January, and ending in 36 fatalities. (*)
Jun 02 17:38"

Release of H5N1 Sequences Petition
http://www.petitiononline.com/h5n12006/petition.html