Penumbra Pandemia

Congo-Kinshasa: Food Shortages for 80,600 IDPs
Bunia
July 31, 2006
Food aid is running short for about 80,600 people displaced by insecurity in the northeastern Democratic Republic of Congo (DRC), a local official of the UN World Food Programme in Ituri District said on Friday.
'We have only 40 to 60 tonnes in stock for the displaced in camps, and with 40 tonnes we can only serve pregnant women, nursing mothers and children,' said François Djissou, the WFP official in charge of the agency's Ituri office in Bunia.
The agency does not yet know when food aid might resume, Djissou added. It is seeking donor assistance for its programme in Ituri.
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As a result, Djissou said, humanitarian NGOs were overwhelmed. The mobile hospital in Gety run by Médecins Sans Frontières Switzerland was overcrowded with malnourished and sick children. In addition, the 120-bed therapeutic nutritional centre run by the Italian NGO COOPI is now caring for 169 severely malnourished children.
'Infections will get worse since diseases are always related to food,' Djissou said.
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"Moscow doctors testing bird-flu vaccine on humans
Izvestia
31/ 05/ 2006
Doctors have started testing the first Russian bird flu vaccine on humans, in the hope of finding out by August whether it can counteract the lethal H5N1 strain.
---
Science and Production Association Mikrogen, a state-owned enterprise that produces bacterial preparations, developed this vaccine in conjunction with a flu research institute at the Russian Academy of Sciences, based on the H5N1 strain from Vietnam that is recommended for use in vaccines by the World Health Organization. The new vaccine was first tested on rats, and prevented bird flu in 95% of cases. Mikrogen director Anton Katlinsky said he was cautiously optimistic about the new vaccine after the rat tests.
Pyotr Deryabin, deputy head of research at the Russian Academy of Sciences' Ivanovsky Virology Institute, said it was pointless to test the new vaccine on humans.
"Such tests would make sense if there was an ongoing epidemic of a specific virus strain, but no one can yet say for sure whether the H5N1 strain will be the one to cause a pandemic," Deryabin told the paper. He said it normally takes at least three to four years to launch clinical tests of any new medication.
But Mikrogen representatives said that streamlined production of an H5N1 vaccine would make it easy to create a vaccine against a pandemic virus.
"If necessary, it would take us about 45 days to produce the first batch of the new anti-viral vaccine," said Katlinsky. Production could start as soon as a mutation of the virus began to pass from human to human.
WHO officials have denied reports of possible human-to-human transmission between members of an Indonesian family, while experts have said they could not accurately predict the rate at which bird flu might spread globally in the next month and a half.
Doctors still have no plans to vaccinate the entire Russian population.
"There is no need for this, because we are not involved in the vaccine business. The trade and sanitation inspectorate will choose specific territories for vaccination in case of possible human-to-human transmission," said Oleg Kiselyov, director of the Russian Academy of Sciences' Influenza Institute."
*****
See also the post Russians did it again? :)

"To the Editor: A 24-year-old man had pneumonia and respiratory distress in November 2003 and died four days after being hospitalized. Because the clinical manifestations were consistent with those of the severe acute respiratory syndrome (SARS) and occurred when sporadic cases of SARS were described in southern China,1 serum and lung tissue from the patient, as well as fluid aspirated from his chest, were examined for SARS coronavirus with the use of indirect fluorescence antibody tests and the reverse-transcriptase polymerase chain reaction (RT-PCR). All tests were negative for SARS.
A virus was isolated from the lung tissue in Vero-cell cultures and was characteristic of influenza A virus on electron microscopy. A serum sample collected on day 8 of the patient's illness was positive for IgM antibody against the isolated virus. Fragments of both the influenza A virus matrix gene (M) and the H5-subtype hemagglutinin gene (HA) were amplified from the infected Vero cells with the use of RT-PCR assay.2,3 The nucleotide sequences of the fragments were identical to those amplified from the stored specimens of the patient's serum, chest fluid, and lung tissue.
The genomic sequence of the virus (A/Beijing/01/2003) was determined, and its eight segments were genetically related most closely to corresponding sequences of influenza A (H5N1) viruses that had been isolated from chickens in various regions of China in 2004. The segments of the polymerase basic protein 1 gene (PB) and the nonstructural gene (NS) were most closely related to those from Guangdong Province (in southeastern China), with 99 percent identity. The segments of the polymerase basic protein 2 gene (PB2) and HA gene were closest to those from Jilin Province (in northeastern China), with 99 percent and 97 percent identity, respectively. The segments of the neuraminidase gene (NA), nucleoprotein gene (NP), and M gene were closest to those from Hubei Province (in mideastern China), with 98 percent, 98 percent, and 99 percent identity, respectively, and the polymerase acidic protein gene (PA) segment was closest to that from Japan, with 99 percent identity.
These findings suggest that influenza A/Beijing/01/2003 may be a mixed virus. Phylogenetic analyses of the HA and NA genes of the representative influenza A (H5N1) strains have revealed that the viruses isolated from patients in Thailand and Vietnam in 2004 and 2005 belong to the same clade, and those obtained from patients in Hong Kong in 1997 and 1998 are from another clade (Figure 1 in the Supplementary Appendix, available with the full text of this letter at www.nejm.org). A sample of virus obtained from a patient in Hong Kong in 2003 seems to represent a transitional genotype, of which the HA gene sequence was close to the cluster from southeastern Asia (Figure 1A in the Supplementary Appendix), whereas the NA gene sequence was close to that of the cluster from Hong Kong in 1997 and 1998 (Figure 1B in the Supplementary Appendix). Phylogenetic analyses of the HA or NA gene indicated that the influenza A/Beijing/01/2003 strain was genetically distant from viruses previously isolated from humans, although it appears to have originated from a lineage similar to the influenza A/goose/Guangdong/1/96 (Gs/GD) lineage.4
These findings have important implications for selecting viruses for the development of vaccines to prevent infection in humans. The genetic distance between the isolate reported and the strain currently proposed for vaccine development (A/Vietnam/1203/2004)5 implies that viruses from different regions may need to be considered in the development of an effective vaccine against influenza A virus.

Qing-Yu Zhu, M.D.
State Key Laboratory of Pathogens and Biosecurity
Beijing 100071, China

E-De Qin, M.D.
Beijing Institute of Microbiology and Epidemiology
Beijing 100071, China

Wei Wang, M.D.
309th Hospital of the People's Liberation Army
Beijing 100091, China

Jun Yu, Ph.D.
Beijing Genomics Institute
Beijing 101300, China

Bo-Hua Liu, Ph.D.
State Key Laboratory of Pathogens and Biosecurity
Beijing 100071, China

Yi Hu, Ph.D.
Beijing Institute of Microbiology and Epidemiology
Beijing 100071, China

Jian-Fei Hu, Ph.D.
Beijing Genomics Institute
Beijing 101300, China

Wu-Chun Cao, M.D., Ph.D.
State Key Laboratory of Pathogens and Biosecurity
Beijing 100071, China
caowc@nic.bmi.ac.cn
Supported by grants from the National Task Force of China (2004BA519A62 and 2004BA519A71) and the 973 High-Tech Projects Plan (2005CB52300015).
References
1. Liang G, Chen Q, Xu J, et al. Laboratory diagnosis of four recent sporadic cases of community-acquired SARS, Guangdong Province, China. Emerg Infect Dis 2004;10:1774-1781. [ISI][Medline]
2. Poddar SK. Influenza virus types and subtypes detection by single step single tube multiplex reverse transcription-polymerase chain reaction (RT-PCR) and agarose gel electrophoresis. J Virol Methods 2002;99:63-70. [CrossRef][ISI][Medline]
3. Lee MS, Chang PC, Shien JH, Cheng MC, Shieh HK. Identification and subtyping of avian influenza viruses by reverse transcription-PCR. J Virol Methods 2001;97:13-22. [CrossRef][ISI][Medline]
4. Chen H, Smith GJD, Li KS, et al. Establishment of multiple sublineages of H5N1 influenza virus in Asia: implications for pandemic control. Proc Natl Acad Sci U S A 2006;103:2845-2850. [Abstract/Full Text]
5. Treanor JJ, Campbell JD, Zangwill KM, Rowe T, Wolff M. Safety and immunogenicity of an inactivated subvirion influenza A (H5N1) vaccine. N Engl J Med 2006;354:1343-1351. [Abstract/Full Text]
This article has been cited by other articles:
* Parry, J. (2006). Chinese man died three years ago of avian flu, not SARS. BMJ 333: 7-7 [Full Text]"

Here is a report from the Thai Ministry of Public Health.

"Thailand: Ministry of Public Health on the Phichit case
---
'H.E.Pinit said that the registered new avian influenza patient was 17 years old male, resident of 132/1 moo 11 Tambon Thap Khlo, Thap Khlo district, Pichit province, died from avian influenza plus symptoms of dengue iinfection, on July 24, 2006.
His onset was on July 15, 2006 with fever, cough and headache. He had an injection at the private clinic, and later on, admitted into the Thap Khlo hospital at 01.00 pm. on July 18, 2006. He had a history of contacting 10 dead chickens while burying the carcasses, 7 days before the onset.
The ministry team had registered the patient into the avian influenza suspect screening system. The influenza rapid test and blood sample sent to the Medical Science Center Pitsanuloke revealed negative results. His chest X-ray was normal and had moderate fever.
The blood sample had been subsequently, drawn 3 times on July 20, 21, 22, 2006 respectively and the tests revealed high hematocrit, lower platelet count of which are suspect signs of hemorrhagic fever, those are rampaging in Pichit areas. The dengue control operation is undertaken, hence the treatment for dengue was prescribed.
Though, the avian influenza virus infection was not ruled out, therefore, when the patient died, the phlegm had been sent to the Medical Science Department on July 24, 2006. The positive result was disclosed at 06.00 am. (July 26, 2006). So, it is likely that the patient had been infected with both avian influenza and dengue viruses, which is the first case ever in Thailand and the world.'
Update: Here's a story from the Mass Communication Organization of Thailand on dengue and H5N1. Many of the symptoms of dengue and flu are similar (and Spanish flu was often misdiagnosed as dengue). And while Vietnam has been reported free of human H5N1, the country has also seen an outbreak of dengue in recent months."

Seven areas of Thailand on red alert

"The Nation
27.7.2006
Seven provinces have been labelled as bird-flu red zones where surveillance is being increased for the highly contagious disease.
They are Phichit, Sukhothai, Phitsanulok, Kamphaeng Phet, Uttaradit, Nakhon Sawan and Nakhon Pathom.
Currently, 44 patients are under close supervision after developing symptoms similar to avian flu. Laboratory tests are ongoing to determine whether they have the lethal H5N1 virus, which killed a 17-year-old boy in Phichit on Monday.
The boy was first diagnosed with dengue fever and initial tests for bird flu were negative. After he died, a further test showed he was infected with the bird-flu virus.
Caretaker Public Health Minister Pinij Charusombat yesterday called on doctors across the country to carefully check patients with fever, especially those who had come into close contact with fowls.
The bird-flu victim's father said yesterday he doubted whether his son died from the virus, given the fact that the teenager's contact with a dead chicken took place last month.
Medical Sciences Department director-general Paijit Warachit said the victim's blood sample was undergoing another test to double-check whether he had dengue fever. The result should be available next week.
According to caretaker Agriculture Minister Sudarat Keyuraphan, the government paid out several billion baht last week as compensation for fowls exterminated last year as the country tried to curtail the spread of avian flu.
'If we take preventative measures at the beginning, we will be able to prevent outbreaks,' she said.
She told authorities to immediately cull fowl suspected of having bird flu and to disinfect their areas."

"Laidback Al
Senior Member:
INDONESIA - WHO reportedly raises Indonesian pandemic warning to level 4

Here is an email response I received from WHO in Indonesia this morning.
'From: Tallis, Graham [mailto:TallisG@who.or.id]
Sent: Wednesday, July 26, 2006 10:35 PM
Subject: Pandemic Phase
I refer to your request to Dr Petersen, WHO Representative to Indonesia, regarding whether it is correct that WHO has raised the pandemic level to 4 for Indonesia in mid July. Dr Petersen has asked me to respond to your query on his behalf.
It is NOT correct that the pandemic phase has been changed. Please note that the WHO Pandemic Phase is applied to the entire world, and not to individual countries. The world remains in WHO pandemic alert phase 3, which means that the new influenza virus (H5N1) causes primarily animal infection but also some human infections. The world will go to WHO pandemic alert phase 4 only if there is sustained human-to-human transmission contained in a local area. Limited human-to-human transmission that is not sustained, as may have occurred in Indonesia as well as other parts of the world, is NOT a reason to go to phase 4.
I trust this information clarifies the current situation for you.
Dr Graham Tallis
Medical Epidemiologist
CSR Team - Influenza
WHO Jakarta
tel +62 21 520 4349
fax +62 21 520 1164
hp +62 811 102 466'

"H5N1 H9N2 Bird Flu Reassortant Identified In Israel
Recombinomics Commentary
July 26, 2006
The H5N1 bird flu NS sequence from a turkey in Israel, A/turkey/Israel/345/06(H5N1) has been released. Although the other seven gene segments have not been released, the H5N1 sequence is clearly the Qinghai strain. It has several Qinghai specific polymorphisms as well as a 15 BP deletion that is one of the markers that defines in the Z genotype and is linked to increased virulence.---
One of these 2006 sequences, A/turkey/Israel/446/06(H9N2), was an exact match of the H5N1 Israeli turkey sequence, indicating the H9N2 isolate was a reassortant formed via a dual infection between H5N1 and H9N2.
Such a dual infection had been predicted in October 22, 2005 and a warning that such a dual infection could lead to the acquisition of HA S227N because H9N2 in the Middle East had appropriate donor sequences. In early 2006, S227N was reported in two of the four human H5N1 sequences from Turkey, including the isolate from the index case A/Turkey/12/06(H5N1), who was linked to a very large cluster involving multiple families of cousins.
The H5N1/H9N2 reassortant in Israel is cause for concern and human infections may be under-reported. Israel had reported a suspect case with confirmed antibodies to H5N1, but re-confirmation attempts failed. The sharing of H5N1 polymorphisms with the first Qinghai H5N1 isolated in the area (western Turkey in 2005), suggest H5N1 had been in Israel long before its first reported case in poultry in 2006."

"Eleven more suspected bird flu cases in Phichit
PHICHIT, July 27 (TNA)
Eleven more suspected bird flu cases were reported in Thailand's lower northern province of Phichit on Thursday.
Dr. Prajak Wattanakul, head of the Phichit provincial public health office, said that the 11 patients, mostly children aged between 4-14, are suspected of being infected with avian influenza virus and were admitted to five different hospitals in the province on Thursday.
Some of them had contacted with dead poultry and others live in areas where a large number of fowls died of unknown causes.
All the 11 patients were quarantined and samples of their blood and phlegm were sent for laboratory tests in the medical science centre in Nakhon Sawan, expected to be able to release the test results Friday, the doctor said. (TNA)-E009"

"H5N1 Bird Flu Recombinant in Ivory Coast
Recombinomics Commentary
July 25, 2006
The HA sequence from an H5N1 bird flu sequence from the Ivory Coast, A/chicken/Ivory Coast/1787/2006(H5N1), shares a number of polymorphisms with other Qinghai isolates. However, the haplotype containing these polymorphisms indicate the Ivory Coast isolate is a recombinant and was independently introduced into the area. It has little in common with the three different sets of sequences from Nigeria, or the sequences from Niger. These data indicate migrating birds have brought in multiple versions of the Qinghai strain into western Africa. The Ivory Coast lies within the East Atlantic Flyway, which connects western Africa with western Europe and northeast Canada.---
The recombinants in the Ivory Coast will increase the genetic diversity in the Qunbghai isolate in western Africa. ---"

"Tuva and Mongolia H5N1 Bird Flu Sequences Are Similar
Recombinomics Commentary
July 26, 2006
The widespread detection of the Qinghai strain raises surveillance issues. Wild life conservation groups failed to find H5N1 in Africa and few countries have detected H5N1 in live wild birds, although detection in dead birds has been widespread.
These recent sequences demonstrate an expanded geographical reach and added genetic complexity generated by recombination. The Qinghai stain of H5N1 will soon be mixing with the H5 found to be widespread in Canada in 2005. The first published sequence has acquired swine sequences, indicating the swine can serve as reservoirs and create new H5N1 sequences worldwide, ---"

Qinghai-like H5N1 from Domestic Cats, Northern Iraq

"Yingst SL, Saad MD, Felt SA. Qinghai-like H5N1 from domestic cats, northern Iraq [letter]. Emerg Infect Dis [serial on the Internet]. 2006 Aug [date cited]. Available from http://www.cdc.gov/ncidod/EID/vol12no08/06-0264.htm
*US Naval Medical Research Unit No. 3, Cairo, Egypt

To the Editor: Natural infection of several cat species with highly pathogenic avian influenza (HPAI) H5N1 viruses in Thailand (1–4) and experimental infection of domestic cats with similar viruses have been reported (5,6). Thus, literature describing HPAI H5N1 infection of cats is limited to descriptions of infections with a subset of clade I viruses. HPAI H5N1 viruses, highly similar to viruses isolated from Qinghai Lake in western People's Republic of China in spring 2005, are now rapidly disseminating throughout Eurasia and Africa. To our knowledge, this is the first report of a Qinghai-like virus detected in domestic cats. This finding is noteworthy because the host range of influenza viruses is determined by the antigenic characteristics of the hemagglutinin and neuraminidase molecules; clade II viruses are antigenically distinct from clade I viruses, and Qinghai-like viruses are genetically distinct from other clade II viruses.
Personal communications in January 2006 from field veterinarians noted deaths of domestic cats that were associated with suspected (eventually confirmed) H5N1 outbreaks in eastern Turkey (2 villages) and Kurdish northern Iraq (Sarcapcarn in Sulymaniyah Governorate and Grd Jotyar in Erbil Governorate). The clinical conditions of the birds did not suggest HPAI to villagers or consulting veterinarians. In both scenarios in Iraq, results of rapid antigen detection tests with the Anigen kit (Suwon, Republic of Korea), while positive for influenza A, were negative for H5, so the outbreaks were not thought to be caused by HPAI, but concern about the unusual deaths in cats remained. Because the regions are remote and veterinary services limited, such anecdotal reports have rarely been followed up.
After H5N1 influenza was diagnosed in a person in Sarcapcarn, Kurdish northern Iraq, the government of Iraq requested a World Health Organization investigation, which was supported in part by Naval Medical Research Unit No. 3 veterinarians. While investigating the situation in Erbil Governorate, the team was informed of suspicious deaths in cats associated with the death of all 51 chickens in a household in Grd Jotyar (≈10 km north of Erbil City) From February 3 to February 5, 2006, five cats reportedly died; 2 of these were available for examination on February 8. A sick goose from an adjacent household was killed and underwent necropsy with the cats. Gross pathologic changes in cats were similar to those previously reported, except that severe hemorrhagic pancreatitis was observed (5,6). Tissues from these animals and archived tissues from 1 of the 51 chickens were conveyed to Cairo for virologic examination.
An influenza A H5 virus was present in multiple organs in all species from the outbreak site in Grd Jotyar (Table). cDNA for sequencing was amplified directly from RNA extracts from pathologic materials without virus isolation. On the basis of sequence analysis of the full HA1 gene and 219 amino acids of the HA2 gene, the viruses from the goose and 1 cat from Grd Jotyar and from the person who died from Sarcapcarn (sequence derived from PCR amplification from first-passage egg material) are >99% identical at the nucleotide and amino acid levels (GenBank nos. DQ435200–02). Thus, no indication of virus adaptation to cats was found. The viruses from Iraq are most closely related to currently circulating Qinghai-like viruses, but when compared with A/bar-headed goose/Qinghai/65/2005 (H5N1) (GenBank no. DQ095622), they share only 97.4% identity at the nucleic acid level with 3 amino acid substitutions of unknown significance. On the other hand, the virus from the cat is only 93.4% identical to A/tiger/Thailand/CU-T4/2004(H5N1) (GenBank no. AY972539). These results are not surprising, given that these strains are representative of different clades (8,9). Sequencing of 1,349 bp of the N gene from cat 1 and the goose (to be submitted to GenBank) show identity at the amino acid level, and that the N genes of viruses infecting the cat and goose are >99% identical to that of A/bar-headed goose/Qinghai/65/2005(H5N1). These findings support the notion that cats may be broadly susceptible to circulating H5N1 viruses and thus may play a role in reassortment, antigenic drift, and transmission.
The route of infection in these cats cannot be determined definitively. How cats behave when eating birds makes both oral and respiratory infection possible. However, the source of infection seems clear in that an identical H5N1 virus was detected in samples from a goose from the same dwelling, and an H5 virus was detected from archived samples from 1 of 51 chickens that died over the course of a few days. The potential for horizontal spread cannot be ruled out since we detected viral RNA in gut, stool, and trachea; clinical signs developed in all cats, and all died from the acute illness 2–4 days after the chicken deaths began; therefore, simultaneous exposure seems likely. Death in cats, spatially and temporally associated with unusual deaths in poultry, especially when the cats show positive results of a rapid antigen detection test for influenza A, should be considered to indicate a presumptive diagnosis of HPAI, and appropriate response should ensue. ---"

"WHO urges quick action on emerging infectious diseases
People's Daily Online
July 21, 2006
Infectious disease specialists meeting at World Health Organization's Western Pacific Regional Office held in Manila, capital of the Philippines, on Friday proposed to take specific steps to ensure a faster and more comprehensive response to the emerging infectious diseases, including avian influenza.
Their recommendations emerged during a three-day meeting of WHO 's nine-person Technical Advisory Group on emerging diseases.
'Our starting point was the Asia Pacific Strategy for Emerging Diseases,' said Dr Takeshi Kasai, WHO's Regional Adviser in Communicable Disease Surveillance and Response, referring to a joint approach the WHO's Western Pacific and South-East Asia Regional Offices developed to strengthen the response to emerging infectious diseases.
'This week we focused on a work plan that will allow us to help countries in the Region build the capacity they need to detect and quickly respond to the emerging diseases, including avian and pandemic influenza,' Kasai said.
The Asia Pacific Strategy on the Emerging Diseases and the work plan hammered out this week were developed, in part, to meet the requirements of the recently revised International Health Regulations.
Known as IHR (2005), the regulations call on all WHO members to improve surveillance and to rapidly report and respond to any outbreak of infectious disease or other public health emergency of international concern.
The Technical Advisory Group recommended aspects of the work plan related to avian influenza be implemented on a priority basis throughout Asia and the Pacific. The advisory group members also urged each country to quickly develop national plans to rapidly implement the emerging diseases strategy and to ensure that they are meeting the core capacity requirements of IHR (2005).
The experts also called on national leaders to make the political and financial commitments to ensure that these disease- control strategies are implemented and sustained.
Since December 2003, highly pathogenic A(H5N1) avian influenza viruses have swept through poultry populations across Asia and parts of Europe. The outbreaks are historically unprecedented in scale and geographical spread. Their economic impact on the agricultural sector of the affected countries has been severe.
Source: Xinhua"

According to Niman at 4.00 on 23 July 2006:
"Neurovirulence in Mice of H5N1 Influenza Virus Genotypes Isolated from Hong Kong Poultry in 2001
The MB variants, designated Ck/HK/YU822.2/01-MB, Ph/HK/FY155/01-MB, Ck/HK/FY150/01-MB, and Ck/HK/NT873.3/01-MB, were markedly more virulent than the original viruses (Table 2). These variants had MLD50 values similar to their EID50 values, which indicates that these viruses are highly pathogenic for mice.
The MB variants fell into one of two groups according to their organ tropism. The first group included the highly pathogenic variants of genotypes A and C, which replicated systemically and infected brain and internal organs (Table 2). High infective doses of these MB variants resulted in death within 3 to 5 days; lower doses killed the mice 6 to 11 days after inoculation. Inoculation with doses of 102.5 to 100.5 EID50 of either virus caused neurologic signs such as hind-leg paralysis, tremor, and paresis. Viral titers of the MB variants of genotypes A and C in liver, spleen, kidney, and heart were at least 3.5 to 2.0 log10 lower than those in lungs and brain (Fig. 4), where these variants replicated efficiently; this result suggests that these MB variants were pneumotropic and neurotropic.
Amino acid sequence variations between the original viruses and their MB variants were compared to those found between mouse phenotypes of human H5N1/97 isolates of high and low pathogenicity (Tables 3 to 5). There were amino acid changes in the highly pathogenic variants in all gene products except for PB1, NP, and NS1 proteins. Most of these changes distinguished the original viruses from the MB variants, as well as from other viruses of high and low pathogenicity, and were not unique. The random nature of these differences suggested that the viruses were heterogeneous and indicated that rapid selection of highly pathogenic variants was possible (Tables 3 to 5). This suggestion was confirmed by the heterogeneity of the original sequences (shown by electrophoretograms) of the PB2 and PA genes, especially in genotypes A, C, and D (data not shown)."

"Ukraine exchanges bird flu with loss of cattle
www.for-ua.com
2 November 2005 | 10:10
The ictus of unknown disease cased the mass loss of cattle in Rivno, Khmelnitsk, Volyn and Zhitomyr regions of Ukraine.
The hundreds cows were killed in Trubitsy village of Rivno region because of the infection. The chief of Kostopol Veterinary Department Victor Vetrov says it is the first case in his eighteen-year practice.
The causes of the loss are being investigating. The vets suppose it may infection or poison in local pound. The herbicide version is included."

Singapore investigates possibility of mutated flu virus
Sheralyn Tay
18 July 2006
Singapore News
---
Singapore investigates possibility of mutated flu virus
Tests are underway to determine if the recent increase in flu cases is due to a mutation of the influenza virus, says Director of Medical Services at the Ministry of Health, Professor K Satku.
'When something like this (an increase in flu patients) happens, one can speculate that --- some kind of mutation has taken place, - he said at a briefing yesterday.
But he added that it would take months for tests to be completed, and the results to be confirmed by the World Health Organisation (WHO). The latter will then design new flu vaccines to deal with the new strain.
'Flu vaccines are for people who are more susceptible to infection, that is, the elderly and some children. Generally, a healthy person would not require a flu vaccine. If we restrict it to this group of people we will not encounter a shortage,' he said.
In Singapore, flu causes some 600 deaths annually, mostly in those over 65 years old. This is because it often leads on to serious infections such as pneumonia, which is the third most common cause of death here.
More at http://tinyurl.com/gzal4"

"WHO prepares instructions to prevent human-to-human bird flu spread in Azerbaijan
18 Jul. 2006 17:44
The World Health Organization’s experts are preparing instructions to prevent communicable diseases, especially human-to-human bird flu, which is supposed to break out in autumn in Azerbaijan.
The WHO Office in Azerbaijan told the APA that the instructions on inflection in hospitals are being prepared by the WHO’s proposals and recommendations. These instructions are for health servants and will be published in several thousand of copies at the initial stage. Health servants will get these instructions free of charge./APA/"

"Transverse Myelitis: Symptoms, Causes and Diagnosis
Joanne Lynn, M.D.

Transverse myelitis (TM) is a neurologic syndrome caused by inflammation of the spinal cord. TM is uncommon but not rare. Conservative estimates of incidence per year vary from 1 to 5 per million population (Jeffery, et.al., 1993). The term myelitis is a nonspecific term for inflammation of the spinal cord; transverse refers to involvement across one level of the spinal cord. It occurs in both adults and children. You may also hear the term myelopathy, which is a more general term for any disorder of the spinal cord.

Clinical Symptoms
TM symptoms develop rapidly over several hours to several weeks. Approximately 45% of patients worsen maximally within 24 hours (Ibid.). The spinal cord carries motor nerve fibers to the limbs and trunk and sensory fibers from the body back to the brain. Inflammation within the spinal cord interrupts these pathways and causes the common presenting symptoms of TM which include limb weakness, sensory disturbance, bowel and bladder dysfunction, back pain and radicular pain (pain in the distribution of a single spinal nerve).
Almost all patients will develop leg weakness of varying degrees of severity. The arms are involved in a minority of cases and this is dependent upon the level of spinal cord involvement. Sensation is diminished below the level of spinal cord involvement in the majority of patients. Some experience tingling or numbness in the legs. Pain (ascertained as appreciation of pinprick by the neurologist) and temperature sensation are diminished in the majority of patients. Appreciation of vibration (as caused by a tuning fork) and joint position sense may also be decreased or spared. Bladder and bowel sphincter control are disturbed in the majority of patients. Many patients with TM report a tight banding or girdle-like sensation around the trunk and that area may be very sensitive to touch.
Recovery may be absent, partial or complete and generally begins within 1 to 3 months. Significant recovery is unlikely, if no improvement occurs by 3 months (Feldman, et. al., 1981). Most patients with TM show good to fair recovery. TM is generally a monophasic illness (one-time occurrence); however, a small percentage of patients may suffer a recurrence, especially if there is a predisposing underlying illness.

Causes of Transverse Myelopathy and Myelitis
Transverse myelitis may occur in isolation or in the setting of another illness. When it occurs without apparent underlying cause, it is referred to as idiopathic. Idiopathic transverse myelitis is assumed to be a result of abnormal activation of the immune system against the spinal cord. A list of illnesses associated with TM includes:

Table: Diseases Associated with Transverse Myelitis
* Parainfectious (occurring at the time of and in association with an acute infection or an episode of infection).
- Viral: herpes simplex, herpes zoster, cytomegalovirus, Epstein-Barr virus, enteroviruses (poliomyelitis, Coxsackie virus, echovirus), human T-cell, leukemia virus, human immunodeficiency virus, influenza, rabies
- Bacterial: Mycoplasma pneumoniae, Lyme borreliosis, syphilis, tuberculosis
- Postvaccinal (rabies, cowpox)
* Systemic autoimmune disease
- Systemic lupus erythematosis
- Sjogren's syndrome
- Sarcoidosis
* Multiple Sclerosis
* Paraneoplastic syndrome
* Vascular
- Thrombosis of spinal arteries
- Vasculitis secondary to heroin abuse
- Spinal arterio-venous malformation

The cause of idiopathic transverse myelitis is unknown, but most evidence supports an autoimmune process. This means that the patient's own immune system is abnormally stimulated to attack the spinal cord and cause inflammation and tissue damage. Examples of autoimmune diseases which are more common include rheumatoid arthritis, in which the immune system attacks the joints, and multiple sclerosis, in which myelin, the insulating material for nerve cells in the brain, is the target of autoimmune attack.
TM often develops in the setting of viral and bacterial infections, especially those which may be associated with a rash (e.g., rubeola, varicella, variola, rubella, influenza, and mumps). Approximately one third of patients with TM report a febrile illness (flu-like illness with fever) in close temporal relationship to the onset of neurologic symptoms. In some cases, there is evidence that there is a direct invasion and injury to the cord by the infectious agent itself (especially poliomyelitis, herpes zoster, and AIDS). A bacterial abscess can also develop around the spinal cord and injure the cord through compression, bacterial invasion and inflammation.
However, experts believe that in many cases infection causes a derangement of the immune system which leads to an indirect autoimmune attack on the spinal cord, rather than a direct attack by the organism. One theory to explain this abnormal activation of the immune system toward human tissue is termed "molecular mimicry." This theory postulates that an infectious agent may share a molecule which resembles or "mimics" a molecule in the spinal cord. When the body mounts an immune response to the invading virus or bacterium, it also responds to the spinal cord molecule with which it shares structural characteristics. This leads to inflammation and injury within the spinal cord.
Vaccination is well known to carry a risk of the development of acute disseminated encephalomyelitis (ADEM) which is an acute inflammation of the brain and spinal cord. This was particularly common with the older antirabies vaccine which was grown in animal spinal cord cultures; the use of the newer antirabies vaccine grown in human tissue culture has almost eradicated this complication. This is also thought to occur as an immune system response.---

References
1. Jeffery DR, Mandler RN, Davis LE. "Transverse myelitis: retrospective analysis of 33 cases, with differentiation of cases associated with multiple sclerosis and parainfectious events." Arch Neurol, 1993; 50:532."

"Bird flu has returned, suspects senator
By Phoojadkarn Daily 17 July 2006 02:11
Outgoing Ubon Ratchathani senator Nirand Pitakwatchara said at the weekend that he believes bird flu has resurfaced in Thailand, but that state authorities have concealed the matter for political reasons.
Nirand, a former chairman of the senate committee on social development and human security, said it was most likely that the Agriculture Ministry, under Khunying Sudarat Keyuraphan, who was responsible for dealing with avian flu when she was Public Health Minister, has teamed up with the Public Health Ministry to cover up the reappearance of the disease to protect the Thai Rak Thai government.
'If bird flu has really come back, it means that all the government’s measures to prevent the disease have failed miserably,' said Nirand.
'It seems to me that the government’s previous actions were only meant to build up its image and gain political popularity,' he added.
The senator’s comments coincided with the disclosure by a livestock official who told a Phoojadkarn Daily reporter that bird flu has returned in Phichit and Phitsanulok provinces, killing poultry there in recent months.
Livestock officials have been told to keep their mouths shut as the news may affect the government’s stability and lead to a worsening of political and economic conditions, said the source, who asked not to be named."

"Doctors find infection in brain of bird flu cluster survivor
14 Jul 2006
bbj.hu
Jones Ginting, the 25-year-old man suffered from headaches and fatigue a month after receiving care for bird flu, said Luhur Soeroso, head of Adam Malik hospital in the North Sumatra city of Medan, where he's staying. 'We found abscesses in several parts of his brain,' Soeroso said in Jakarta on July 13. Treatment for the H5N1 strain of avian influenza may have weakened Ginting's immune system, although there's no direct link to show the H5N1 virus caused the illness, Soeroso said. Ginting and his relatives who died of the disease in May attracted international attention because they represent the largest reported instance in which H5N1 may have been spread among people and the first evidence of a three-person chain of infection. Human cases provide an opportunity for the virus to mutate into a pandemic form that may kill millions of people. Ginting, a farmer from the village of Kubu Sembelang in Sumatra, is one of the few human cases of avian influenza in which disease of the central nervous system has been observed.
---
In most cases, severe respiratory disease is the main symptom. Ginting has responded to treatments and the abscesses in the brain have gradually reduced, Soeroso said. 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. Ginting's 37-year-old sister is suspected of being the first family member to die from the disease. She was buried before samples were taken. The woman's two sons, a sister, another brother, a nephew and a niece died from the virus between May 4 and May 22. To make the 'restless' man, who tried to escape from the hospital, 'comfortable,' the hospital gave him a 14-inch television in his room, Nur Rasyid Lubis, deputy director of the Adam Malik Hospital, said. (Bloomberg)"
Print

"RIA Novosti, 16/ 07/ 2006
STRELNA, July 16 (RIA Novosti) - Bird flu vaccine for humans will be created in Russia by September, the health minister said Sunday.
'We expect reports on all the clinical trials to be submitted to the ministry by September 10,' Mikhail Zurabov said.
The minister said that 156 volunteers in St. Petersburg and 200 in Moscow were taking part in the trials.
'The results show a satisfactory tolerance toward the vaccine and a lack of side effects,' Zurabov said.
He said 50-60 million doses would be produced and stored in September and in the event of a sudden outbreak Russia could produce 500 million doses quickly.
Leaders of the Group of Eight leading industrialized nations gave their support at the current summit in St. Petersburg to Russia's initiative to build within its territory a World Health Organization center for the fight against bird flu in Eurasia and Central Asia."
*****
See also the post Russian vaccination

"Goose Parts From Bird Flu-Ridden China Lost in U.S. (Update1)
July 14 Bloomberg
U.S. inspectors are probing the disappearance of four boxes of goose intestines smuggled from China, where bird flu is spreading.
The Department of Agriculture had tagged about 100 pounds of goose guts, a delicacy used in some Chinese recipes, for destruction before they disappeared last week from a Troy, Michigan, warehouse, officials said today. Agency inspectors previously found about 2,000 pounds of frozen poultry shipped illegally from China at the same warehouse.
Smuggling of poultry products poses a risk for avian influenza, which has infected 230 people in 10 countries in Asia and the Middle East, killing 132. Frozen products pose less risk because they aren't likely to spread virus to other birds, said Joseph Domenech, chief veterinary officer for the United Nations' Food and Agriculture Organization, based in Rome.
``Nothing can be sure and everything can happen,'' Domenech said in a telephone interview late yesterday. ``This is smuggling and it's totally uncontrolled.''
People can be infected with H5N1 through close contact with infected live birds or by eating them, according to the World Health Organization in Geneva. Proper cooking kills the virus, and no cases of transmission from cooked food have been recorded, the health agency's Web site said.
``We have no evidence to lead us to believe this is of concern to consumers,'' said Lisa Wallenda-Picard, a spokesman for the Agriculture Department, in a telephone interview today. ``We have no reason to believe this was infected by avian influenza, and we have no reason to think this is on the average American's dinner plate.

`Small Amount'
``We're talking about a small amount of product in question,'' Wallenda-Picard said.
None of the seized meat was tested to see whether it was contaminated with H5N1, said Karen Eggert, a spokeswoman for USDA's Animal and Plant Health Inspection Service, in a telephone interview today.
Michigan health and safety officials are now conducting a sweep of about 65 food import warehouses in the southeast part of the state to look for more smuggled imports.
The discovery of the smuggled birds has prompted a debate over testing. Brad Deacon, emergency management coordinator for the Michigan Department of Health, said that if more Chinese bird parts are found, they should be tested for bird flu. Eggert said the agency is not convinced testing is necessary.

`Know There's Disease'
``Our purpose in testing would be to determine whether or not there was disease in that country,'' Eggert said. ``We know there's disease in that country, and we've placed restrictions on that country.''
The USDA seized and destroyed more than 326,000 pounds of illegally shipped meat last year, Eggert said.
``That would require a lot of testing on each individual piece that we receive,'' she said. ``Unless there's some sort of scientific trigger to believe this meat needs to be tested for a reason, and that's rare, we're not going to test it.''
Thousands of domesticated birds, including chickens, ducks and geese, are shipped illegally in airports in Europe every year, and health officials have said they are also concerned about H5N1 bird flu in smuggled poultry in Africa, Domenech said. Restrictions and surveillance in the U.S. probably keep the risk lower, he said.
The Michigan warehouse case shows why health officials say arrival of the virus in the U.S. is inevitable, said Steve Brozak, an analyst with WBB Securities Inc. in New Jersey. He previously worked as a military liaison to the United Nations.

`Troubling Trend'
``It's a troubling trend when you're looking at the smuggling of any kind of livestock that might be vulnerable to H5N1,'' he said in a telephone interview today. ``This verifies that the arrival of H5N1 in America is a certainty. It's just a matter of time.''
Since 2003, H5N1 has spread in birds from Asia to Africa, the Middle East and Europe. Millions of birds in China have died of H5N1 or been culled to prevent its spread. Scientists also have found infected wild, migratory geese that may have carried the infection to other parts of Asia.
Health officials are concerned about H5N1 because avian influenza strains have been known to gain the ability to spread quickly in people. A pandemic that killed as many as 50 million people worldwide in 1918 and 1919 is thought to have started spreading in birds.

2,000 Pounds
The Michigan warehouse was targeted by an U.S. probe that on June 5 found almost 2,000 pounds of uncooked, frozen poultry that appeared, based on the markings on the boxes, to have been shipped from China, said the USDA's Wallenda-Picard. The U.S. bans importing uncooked poultry from China, and the meat was incinerated on June 9.
USDA and Michigan health officials returned to the warehouse June 27 and found five boxes containing 150 pounds of smuggled goose intestines, and pieces of suckling pig. The boxes were bagged and tagged for destruction, Wallenda-Picard said. When they returned to the warehouse July 5, they found that the goose intestines had been replaced with chicken parts, she said.
Michigan health officials are following up with at least 35 restaurants and other customers whose names were found in paperwork at the Tin Way warehouse to see if they bought smuggled meat, said Deacon, from the state's health department.
Health officials are concerned about H5N1 because avian influenza strains have been known to gain the ability to spread quickly in people. A pandemic that killed as many as 50 million people worldwide in 1918 and 1919 is thought to have started spreading in birds.

To contact the reporter on this story:
John Lauerman in Boston at jlauerman@bloomberg.net.
Last Updated: July 14, 2006 11:10 EDT"

"Influenza A virus (H5N1) infection in cats causes systemic disease with potential novel routes of virus spread within and between hosts.
Am J Pathol. 2006 Jan;168(1):176-83; quiz 364.
Rimmelzwaan GF, van Riel D, Baars M, Bestebroer TM, van Amerongen G, Fouchier RA, Osterhaus AD, Kuiken T.
Department of Virology, Erasmus MC, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.

The ongoing outbreak of avian influenza A virus (subtype H5N1) infection in Asia is of great concern because of the high human case fatality rate and the threat of a new influenza pandemic. Case reports in humans and felids suggest that this virus may have a different tissue tropism from other influenza viruses, which are normally restricted to the respiratory tract in mammals. To study its pathogenesis in a mammalian host, domestic cats were inoculated with H5N1 virus intratracheally (n = 3), by feeding on virus-infected chicks (n = 3), or by horizontal transmission (n = 2) and examined by virological and pathological assays. In all cats, virus replicated not only in the respiratory tract but also in multiple extra-respiratory tissues. Virus antigen expression in these tissues was associated with severe necrosis and inflammation 7 days after inoculation. In cats fed on virus-infected chicks only, virus-associated ganglioneuritis also occurred in the submucosal and myenteric plexi of the small intestine, suggesting direct infection from the intestinal lumen. All cats excreted virus not only via the respiratory tract but also via the digestive tract. This study in cats demonstrates that H5N1 virus infection causes systemic disease and spreads by potentially novel routes within and between mammalian hosts."

"A Single Amino Acid Substitution in 1918 Influenza Virus
Hemagglutinin Changes Receptor Binding Specificity
J Virol. 2005 Sep;79(17):11533-6.
Glaser L, Stevens J, Zamarin D, Wilson IA, Garcia-Sastre A, Tumpey TM, Basler CF, Taubenberger JK, Palese P.
Department of Microbiology, Mount Sinai School of Medicine, New York, NY 10029, USA.

The receptor binding specificity of influenza viruses may be important for host restriction of human and avian viruses. Here, we show that the hemagglutinin (HA) of the virus that caused the 1918 influenza pandemic has strain-specific differences in its receptor binding specificity. The A/South Carolina/1/18 HA preferentially binds the 2,6 sialic acid (human) cellular receptor, whereas the A/New York/1/18 HA, which differs by only one amino acid, binds both the 2,6 and the 2,3 sialic acid (avian) cellular receptors. Compared to the conserved consensus sequence in the receptor binding site of avian HAs, only a single amino acid at position 190 was changed in the A/New York/1/18 HA. Mutation of this single amino acid back to the avian consensus resulted in a preference for the avian receptor."

Could be.

"Mystery rise in bird-flu reports
Laboratory tests on three patients suspected to have caught the bird-flu virus in the northern province of Phichit confirmed that they did not have the disease, the Public Health Ministry said yesterday.
Two children, aged 7 and 12, from Thab Khlo district, and a 32-year-old woman showed no signs of the lethal H5N1 virus, said Dr Pratch Boonyawongwiroj, the ministry's deputy permanent secretary.
All had reportedly fallen sick with similar symptoms of high fever, coughing and muscular pain after being in contact with home-raised chickens that died of unexplainable causes, said the doctor.
The ministry warned the public against cooking poultry that had died of irregular symptoms.
Whether it was because of mounting concerns among health workers or the number of cases was rising, the reported number of patients listed as suspected cases of bird flu had surged from a few to about 20 per day, said Dr Kumnuan Ungchusak, director of the ministry's bureau of epidemiology.
Dr Phaijit Warachit, head of the Department of Medical Science responsible for testing the virus, said there had still been no sign of the virus being significantly mutated or developing drug resistance."

Evira, answer us, please! Is the situation like this in Finland?

"Eating Chinese chicken in Detroit
The Effect Measure Blog
July 13, 2006 7:12 AM, by revere
If you are worried you'd have to go all the way to China to eat chicken from a bird flu endemic area, worry not. You can just go to Detroit.

The U.S. Department of Agriculture worked with the Michigan Department of Agriculture on a raid at a Troy warehouse. Investigators found chicken, goose and pork products from areas in China affected by bird flu, Local 4 reported.
USDA investigators seized more than 1,600 pounds of illegally imported poultry and pork products, the station reported. Most of the products were mislabeled and put in boxes that read frozen tilapia, according to the report.
'This is absolutely a public health issue. Food safety and public health are our number one concerns,' said Brad Deacon, emergency management coordinator for the state Agriculture Department.
[snip]
'The public should know that health departments in the state are out looking in warehouses and backrooms and freezers to make sure this material is not out there,' said Deacon.
The warehouse has provided investigators with a list of about 300 restaurants and food stores it delivers to, and investigators will follow up with those businesses to locate all of the illegal meat, Local 4 reported.
Doctors said that cooking meat to its proper temperature should eliminate any risk of infection to humans.(ClickOnDetroit)

What's interesting about this is the mixed (up) message. "'This is absolutely a public health issue. Food safety and public health are our number one concerns.' But then the disclaimer: properly cooked chicken is not a health hazard.
So let me get this straight. If bird flu comes to this country, it is not a health hazard because properly cooked chicken is safe:

Eating properly handled and cooked poultry is safe. If highly pathogenic H5N1 were detected in the U.S., the chance of infected poultry entering the human food chain would be extremely low. Even if it did, proper cooking kills this virus just as it does many other disease organisms and parasites. (US Department of Agriculture)

But if the chicken comes from China, it is 'absolutely a public health issue.' I get it. Sort of."

It would be interesting to know the sequences of these FMD strains. And interesting to know how was made sure that it is FMD really in case...
*****
"China reports new outbreak of foot-and-mouth disease
China on Tuesday [11 Jul 2006] reported a fresh outbreak of foot-and-mouth
disease [FMD] affecting 51 head of cattle in the nation's northwestern
Qinghai province.
Cattle at 3 farms in Qinghai's Henan county began showing symptoms of the
illness on 1 Jul 2006. The cattle were diagnosed with FMD on 7 Jul 2006,
the agriculture ministry said on its website.
A total of 212 head of cattle were culled following the outbreak, while
local agriculture officials quarantined and disinfected the farms and the
surrounding area, the ministry said.
The case is the 3rd in Qinghai this year [2006] and brings to 9 the total
number of FMD outbreaks to strike China so far in 2006, according to the
ministry's website.
FMD is a severe, highly contagious viral disease affecting cattle, pigs,
sheep and other cloven-hoofed livestock. It is not usually fatal but causes
losses in the production of meat and milk.
--
Pablo Nart"

"Preparing for the flu
Business Standard / New Delhi July 11, 2006
The dreaded bird flu, which struck the country in February, may have been controlled and contained in the Navapur and Jalgaon belts, but that does not guarantee that it will not make its appearance again. In fact, the chances of the pathogenic H5N1 virus being brought back by migratory birds during their fresh influx in the coming winter are even greater as the infection still exists in over a score of countries. The time to take preventive action through vaccination is, therefore, now.
---
Considering Indian conditions, where poultry is not confined to organised farms and bio-safety measures are almost impossible to adopt, prevention is almost certainly better than cure. China, in a more or less similar situation, has opted for 100 per cent compulsory vaccination of poultry birds.
---
while the first outbreak of the H5N1 virus in 2003 was on the East Asia-Australia flyway of migratory birds—and, thus, kept India safe—the latest one is on the East Africa-West Asia flyway, which passes through India. Navapur is very close to this pathway. This, even while heightening the danger of the re-emergence of the bird flu, provides a chance to keep the affliction under check through pre-emptive action in a narrow belt along this route, and thus spare the rest of the country.
---
Besides, there is also merit in the plea for adopting a “zoning” policy so that the entire country is not deemed flu-hit, should the virus reappear. As for poultry exports, although these account for less than 1 per cent of total production, they can be sustained from disease-free zones. But the government must act fast, because the winter is not far away."

"World Bank outlines economic effects of bird flu
By Ahmed ElAmin
12/07/2006
A World Bank report outlines the dire economic effects avian influenza is having on Europe’s poultry flocks and consumers’ falling purchases of the meat.
---
Worldwide, governments are starting to step up their precautionary measures against the disease as more scientific evidence points to coming pandemic.
---
In most economies the impact has been relatively limited so far, mainly because the poultry sector is a relatively small part of the world economy, stated Milan Brahmbhatt, the bank's lead economist for East Asia.
There are direct production costs because of losses of poultry, due to the disease and to control measures such as culling birds, with impacts extending not only to farmers but also to upstream and downstream sectors such as poultry traders, feed mills, and breeding farms.
---
There are also secondary or indirect impacts related to sharp shifts in market demand which result primarily from spontaneous efforts by consumers to reduce their perceived probability of becoming infected from eating the meat.
In Romania, for example, which has suffered about 100 outbreaks of the disease in poultry over recent months, domestic sales have fallen by 80 per cent, Brahmbhatt stated.
Many Romanian producers are on the verge of bankruptcy. In Iraq only 10 per cent of semi-commercial farms remain operational, and there have also been large losses in Turkey.
In France, Europe's leading poultry producer, producers hit by sharply lower demand reportedly lost 40 per cent of their income in the first quarter of 2006, he stated.
The poultry feed sector in Europe, which accounts for a turnover of $42bn, has been hit with a 40 per cent reduction in demand for poultry feed in some EU countries.
---
“Thus even in Brazil, which has not experienced an outbreak of the disease, weakening world demand and lower prices have induced the main suppliers to reduce production by 15 per cent this year,” Brahmbhatt stated.
---
The number of human infections and deaths reported to WHO has accelerated in the past six months. There were 41 deaths in all of 2005, but 54 in only the first half of 2006, more than twice the pace of last year."

"H5N1 Bird Flu in Djibouti Simlar to Isolates from Egypt
Recombinomics Commentary
July 11, 2006
The H5N1 HA sequences from a human case in Djibouti, A/Djibouti/5691NAMRU3/2006(H5N1) has been released. As expected, te sequence was a Qinghai sequence which had acquired a series of new polymorphisms. These polymorphisms demonstrate the evolution of H5N1 ad allow the isolates to be grouped and analyzed. The partial 1311 BP sequence has 14 such changes and 11 of them are also found in a chicken and human isolate from nearby Egypt, A/chicken/Egypt/960N3-004/2006 and A/Egypt/2782-NAMRU3/2006, respectively, demonstrating significant evolution from the H5N1 sequences from Qinghai Lake in China and Novosibirsk in Russia. Six or seven of the 11 changes are also found in isolates from Italy, A/mallard/italy/332/2006 and A/Cygnus olor/Czech Republic/5170/2006.
These relationships indicate the H5N1 sequences are acquiring new polymorphisms via recombination with other Qinghai sequences in the area.
---
The phylogenetic trees and newly emerging sequence data clearly show rapid diversification of Qinghai sequences throughout Europe, the Middle East, and Africa, raising concerns over cross-reactivity of pandemic vaccines and new problems in the fall after more recombination in wintering sites southern Siberia and northern Mongolia."

UN Warns Bird Flu Spreading More Rapidly
"By Lisa Schlein
Geneva
10 July 2006
Avian influenza experts say bird flu is traveling across the globe at much greater speed. They warn against complacency, and urge countries to implement pandemic preparedness plans without delay. Lisa Schlein reports for VOA from Geneva, where experts are meeting to assess how prepared the world is to cope with a possible pandemic.
The senior U.N. System Coordinator for Avian and Human Influenza, David Nabarro, says between 2003 and 2006, the deadly H5N1 strain of the bird flu virus was detected in 16 countries. He says that number has doubled in just six months.
'I would say it is certainly moving into more and more countries, with a speed that is, for me, and for my colleagues, a continuing and serious cause of concern,' he said.
Another cause of concern is the high mortality rate. WHO Assistant Director General Margaret Chan says 228 human cases of bird flu have been reported in 10 countries, and 130 of them were fatal.
'Now this is, in terms of avian influenza, a very devastating disease,' he said. "We have never seen, what we call, such a high case-fatality rate. That means more than…50 percent of people affected by the infection eventually succumb to the disease."
WHO says avian flu is still primarily an animal disease. Humans have become ill after direct contact with a sick bird. In recent months, there have been some limited cases of human-to-human transmission, most notably in Indonesia.
Although the risk for humans remains minimal, WHO acknowledges the H5N1 virus could mutate into a form that could spread easily among humans, causing a pandemic that could potentially kill millions.
The deputy director general of the U.N. Food and Agriculture Organization, David Harcharik, says, many countries in Asia, the Middle East and Europe have successfully stopped the spread of bird flu. They have done so by employing methods, such as the culling of sick poultry, disinfecting and vaccinating birds. Harcharik says, once H5N1 is stopped in poultry, human cases also stop.
'Of special concern is Africa, where there is a real risk of avian influenza becoming endemic in several countries, at least in the short term,' he said. 'One reason is that, it is very difficult to enforce appropriate control measures in the African context. Culling, compensation to farmers and effective checks on animal movements, which have worked well in Europe and East Asia are much harder to achieve in Africa.'
Harcharik says another worry is the illegal poultry trade in Africa. He says the movement of poultry and poultry products across borders is one of the main vehicles for spreading the virus. He warns the risk will remain until effective control is achieved.
http://www.voanews.com/english/2006-07-10-voa38.cfm"

Dr. Bala Mohammed is the secretary general of the Nigerian Veterinary Association.
"There has been some kind of a resurgence in Taraba and Lagos. And except for some few people who believe bird flu had gone, but for those on the job, the heat is on. We have new cases in Lagos and Taraba," Mohammed says.
---
Experts warn that, unless the Nigerian outbreak is effectively dealt with immediately, there is now a real chance that the virus could become transmissible among humans, leading to the possibility of a pandemic.
Food and Agriculture Organization representative in Nigeria Helder Muteia says surveillance is being stepped up to get a clearer picture of the current outbreak.
"We have designed an active surveillance program, because we have to know. Until this moment, we had a very passive surveillance strategy," Muteia says. "So, let us have an active surveillance.
---
"A whole lot of problems that I feel will have to be sorted out. Until the issue of surveillance, compensation, decontamination ... until things are done properly, until regulatory agencies collaborate, until we get either remotely or actively get the farmers to report cases, we would not get out of the problem," Mohammed says.

"Jul. 8, 2006. 01:00 AM
RITA DALY
The Toronto Star
The threat of a flu pandemic — dubbed nature's terrorist attack — has led G-8 leaders to put it at the top of their agenda when they gather in St. Petersburg next week. It's the latest in a world that has become increasingly focused on the need for all nations and all cities to get ready for a global outbreak of infectious disease.
---
The WHO has long recognized Canada as a leader in pandemic preparedness and one of the few countries in the world to have a domestic contract to produce a pandemic flu vaccine. As a member of the Group of Eight wealthy nations, Canada has lent expertise to poorer nations to help control spread of the H5N1 bird flu and is willing to sign on to further commitments to global pandemic planning at next week's summit.
---
It sounds surprising today, but prior to SARS there were no emergency stockpiles for infectious diseases. Ontario municipalities weren't required to have emergency plans until the end of 2004, and there was no overall strategy to deal with a major disease outbreak.
---
in the early days of SARS, public health authorities fed conflicting information on protective measures hospital staff ought to take. First they were handed gowns to wear, then gloves, and then masks. Then plastic barriers were brought in.
'Eventually you saw the spacesuits.---'
---
About two months ago, Toronto's public health department mailed out letters to every licensed physician in the city, about 8,000 in total, asking for updated contact information in the event of an emergency. At the same time it asked doctors if they'd be willing to help out at pandemic treatment centres.
'Last time I checked we had a 20 per cent response rate. Not bad, I suppose, for doctors,' Yaffe laughs, then soberly adds: 'This will be an issue. There will be a shortage of staff.'
Toronto has, however, made progress in its mass vaccination plan. The public health department recently obtained permission from the city's two school boards to use approximately 30 schools as vaccination clinics in a pandemic, said Yaffe.
---
The Ontario government recently angered doctors and nurses when it introduced Bill 56, sweeping new emergency powers that could force health workers into service in a pandemic. While most have a natural inclination to work, they fear being conscripted to work in unsafe situations or face fines and jail terms. The government says no one will be forced to work.
Marilyn Reddick, vice-president of human resources for Sunnybrook Health Sciences Centre, said it's expected some staff will remain home if they're sick or caring for family members. The right to refuse to work, however, is another issue and 'we'd have to go through a negotiating process,' she says.
---
'This will be a living hell like SARS. But we have an attitude that we're professionals and we'll deal with it,' she says."

"Ireland On-Line
07/07/2006 - 11:45:42
European Union experts today said a global influenza pandemic that could kill millions remains inevitable, although the immediate threat to human health from bird flu in Europe remained low.
“It’s when and not if,” Robert Madelin, director general of the EU’s Health and Consumer Protection department, said in Brussels.
---
However, he warned forecasting was very difficult and current predictions could be “wildly wrong”.
---"

"Recombinomics Commentary
July 7, 2006
SPANISH state radio said today the country's first case of H5N1 bird flu had been confirmed in a great crested grebe in the city of Vitoria…….
A great crested grebe is a migratory waterbird.
Spanish national radio said the dead bird had been found about six weeks ago near the northern city of Vitoria.
The above comments indicate that the enhanced surveillance in Europe has a major political component. The delay of six weeks in the confirmation of the H5N1 raises serious transparency issues. This report follows yesterday's Nature report on distinct H5N1 strains in Lagos, Nigeria, which is in the East Atlantic Flyway (EAF).
The city of Victoria is in the EAF, as is Denmark, which also reported H5N1 on a farm yesterday. The EAF includes northeastern Canada, which then links to the East Americas Flyway, which includes Prince Edward Island. H5 was confirmed in a dead goose on PEI last month, but the sample had degraded sometime between the death of the goose on June 5 and shipment to Winnipeg almost two weeks later.
H5N1 bird flu is in migratory birds and spreading along well established flyways.
Transparent and timely reporting by surveillance sites along these pathways remain areas of concern.
H5N1 does not read press releases."

Regnum
5.7.2006
"Ornithologists establish a reduction in the number of number it is specific the birds, that dwell in by Krasnoyarsk edge, reported on 5 July to correspondent IA rEGNUM-KNews the leader of the center of ornithological monitoring KrasGU Aleksandr Savchenko. According to him, it is assumed that epizootic disease of bird influenza is the basic reason for this. ---"

Regnum
5.7.2006
"Ornithologists establish a reduction in the number it is specific the birds, that dwell in by Krasnoyarsk edge, reported on 5 July to correspondent IA rEGNUM-KNews the leader of the center of ornithological monitoring KrasGU Aleksandr Savchenko. According to him, it is assumed that epizootic disease of bird influenza is the basic reason for this. ---"

Regnum
5.7.2006
"Ornithologists establish a reduction in the number it is specific the birds, that dwell in by Krasnoyarsk edge, reported on 5 July to correspondent IA rEGNUM-KNews the leader of the center of ornithological monitoring KrasGU Aleksandr Savchenko. According to him, it is assumed that epizootic disease of bird influenza is the basic reason for this. ---"

"Indonesian H5N1 Swine and Bird Sequences Are Similar
Recombinomics Commentary
July 4, 2006
--- the remaining human cases formed a separate branch, located at the bottom of the tree. The only non-human isolate on this branch is an H5N1 isolate from a cat, feline/IDN.CDC1/06. Like the other isolates on the branch, it had a novel cleavage site, RESRRKKR.
The presence of the novel cleavage site in human and cat isolates raised the possibility that the source of the human infections was mammalian rather than human. This first human isolate in Indonesia was in Banten in July 2005. At the time H5N1 was found in swine in Banten and a recent presentation included two H5N1 swine isolates from Banten, as well as 19 chicken isolates from locations throughout Indonesia.
These are listed in a phologenetic tree and show that the swine sequences are similar to bird sequences in Indonesia. Moreover, the swine sequences have the common HA cleavage site RERRRKKR, which is in all but two 2003 isolates on the phylogenetic tree. Similarly, most of the Indonesian bird isolates in Indonesia are RERRKKR.
These data indicate the H5N1 in the swine in Banten are not the source of the H5N1 in humans in and around the Jakarta area. In the past year, the human isolates continue to point away from an avian source.
---
other than the Karo cluster and the second human isolate in Indonesia, all other human isolates form a separate branch on the tree and virtually all have an RESRRKKR cleavage site. ---"

"Indonesian H5N1 Bird and Human Sequences Do Not Match
Recombinomics Commentary
July 3, 2006
---
The cases include isolates in and around Jakarta as well as a case in East Java. Thus; although the human cases have been isolated for almost a year and throughout the island of Java, none of the human isolates match a bird isolate.
A recent phylogenetic tree has 19 bird and two swine H5N1 isolates from isolates across Indonesia. Thus, the number of non-human isolates in Indonesia now exceeds fifty and only the cat isolate falls on the human branch which has 20 H5N1's isolated in Hong Kong (in addition to corresponding isolates by the CDC).
The failure of the twenty human isolates to match the 50 avian isolates suggests birds are not the source of H5N1 in most of the human cases in Indonesia. In spite of this failure to match, WHO updates continue to cite bird deaths in some sort of association with the human cases. However, H5N1 is widespread in birds in Indonesia, and the sequences indicate that the correlation between human and avian H5N1 does not exist, based on the sequences described in the Jakarta meeting and released in the form of phylogenetic trees.---

Näin Suomessa ihmisiä neuvotaan toimimaan, jos löytää kuolleita lintuja... Ei ihme, jos meiltä ei löydy H5N1:stä:

"Kirjoittanut: 'terveisiä keski-suomesta'
28.6.2006 klo 21.28
Eilen oli parvekkeen alla 3 kuollutta pulua pienellä alueella, kaikki olisivat sopineet yhden neliön alalle. Soittelin sitten huoltoyhtiöön että pitäisikö tuosta ilmoittaa johonkin ja sain niiltä pandemianeuvontapuhelinnumeron jotta voi kysyä haluaako joku instannsi tutkia tarkemmin raatoja.
Eipä olisi voinut juuri vähempää kiinnostaa kun oli vain 3 kappaletta, ei muuta kuin vippaat vaan sekajätteisiin. Viisi olisi ollut joukkokuolema ja sillä olisi syntynyt vipinää.
Täältä löytyy toimintaohjetta:
http://www.ttl.fi/NR/rdonlyres/2332A151-9CCF-48D1-9158- 0D110A5B3C5C/0/suoja_uloste.pdf
Jos on alle 5 lintua niin ne on suhteellisen vaaratonta maallikonkin poimia vaikka muovipussiin mutta jos niitä on viisi muutuu tilanne oleellisesti, täytyy ilmoittaa eläinlääkärille eikä saa mennä lähelle eikä myöskään koskea.
Olisikohan pitänyt tutkia aluetta tarkemmin, ehkä jostain pensaan alta olisi löytynyt pari lisää? Paremmissa voimissa olleethan ovat voineet raahautua hieman sivummalle ja sitten naapuri löytää vaikka neljä eikä sekään ole olevinaan vaarallista, jää siis raporttien ulkopuolelle. Kuolleisuustiheus oli minusta kuitenkin aika korkea jo tässä kolmen tapauksessa 3 pulua/m2"
***
And briefly in finglish:
"Yesterday there were 3 dead pigeons under our balcony in a small area, all of them in an area of about one square meter.
I called to the building caretaker company to ask if I should inform some instance about the pigeons. They gave me a phone number to the official pandemic information phone service so that I could ask if some authority wanted to test these carcasses.
Well, I guess they couldn't have been less interested in my case, because there were only three of the pigeons. Just throw them to the garbage. Five would have been mass death and that would have caused reaction.
Here you can find instruction how to act:
http://www.ttl.fi/NR/rdonlyres/2332A151-9CCF-48D1-9158- 0D110A5B3C5C/0/suoja_uloste.pdf
If there are under 5 birds, they are relatively safe for anyone to collect in a plastic bag. But if there are five birds, the situation changes essentially, you need to inform the veterinarian, you shall not go near or touch the birds.
I wonder should I have searched the area better, maybe there would have been a couple more under the bushes? Other birds in better condition could have been able to drag themselves a little bit aside, and then our neighbour could have found e.g. 4 and even that wouldn't have been officially dangerous, it would have been left outside the official reports.
Anyway, in my opinion the death rate density was quite high already in this case of three birds in one square meter."