Penumbra Pandemia

"Novel H5N1 Cleavage Site in Duck Raises Pandemic Concerns
Recombinomics Commentary
August 31, 2006
The release of recent H5N1 bird sequences in Indonesia have identified a duck from that has the novel cleavage site, RESRRKKR. This sequence has been detected in almost all human H5N1 isolates in West Java, including the Jakarta area
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Although the duck listed below is the first reported bird isolate with the novel cleavage site, the sequence contains an additional change in the cleavage site that is present in a small subset of the human cases. This change indicates the sequence in the duck is not the source of the majority of the human cases with the novel cleavage site, and suggests the duck H5N1 bird flu came FROM the human subset, which were isolated in 2005. The source of the majority of the human sequences has not been identified. The only non-human sequence to date is a cat sequence from Jakarta.
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Wild birds were transmitting and transporting H5 sequences long before the Qinghai Lake reports, and continue to be a source of dual infections and recombination. This evolution is clearly represented in the newly acquired polymorphisms, and Qinghai sequences have been found in earlier isolates as well as the duck described above.
The finding of the novel cleavage site in a duck indicates these sequences are being transported by birds locally in Indonesia. The novel cleavage site has not been reported outside of Indonesia, and both bird and human isolates contain polymorphisms which are found in most or all Indonesian isolates.
The presence of these sequences in birds raises pandemic concern, but has yet to identify the reservoir for most of the human sequences from Java. ---"

"Costello outlines bird flu risks
www.theaustralian.news.com.au
August 30, 2006
A regional outbreak of bird flu would be traumatic economically, Treasurer Peter Costello has said.
'If there were an outbreak of bird flu that would be probably the most severe economic shock that the region could have,' Mr Costello said on ABC Radio.
His comments come ahead of an Asia-Pacific Economic Co-operation (APEC) meeting of finance ministers in Vietnam next week.
'If there was an outbreak then you'd have to close borders, you'd have close cross border trade, you'd have to close movement of people, you would have obviously a lot of companies that would have to stop production,' Mr Costello said.
'It would be recessionary, if not worse, so the economic impacts of avian flu are enormous and that's one of the reasons why we spend as much money as we do, and we do spend quite a lot of money, preparing for such an eventuality.'"
*****
Kuinka paljon rahaa Suomessa käytetään H5N1-sairaustapausten ehkäisemiseen ja pandemian varalta valmistautumiseen?

"Dog contracts bird flu: doctor
www.nationmultimedia.com
Wed, August 30, 2006
A dog in Suphan Buri has been found contracting the bird flu after eating infected ducks, a doctor said Wedneday.
Professor Dr Yong Pooworawan, a lecturer at the Chulalongkorn University's Faculty of Medicine, disclosed the findings at a seminar yesterday.
According to him, a researcher at the Kasetsart University's Kamphaengsaen Campus found the bird-flu infection in a dog and the findings will be published in a foreign journal - Emerging of Infectious Diseases - soon.
Yong refused to elaborate further on the findings."

Avian flu: Is your practice ready?
"Whether the bird flu scare is real or just so much hype, it doesn't hurt to have a commonsense game plan.
Jul 21, 2006
By: Robert Lowes
Medical Economics
--- There's also skepticism about the nation's wherewithal to cope with a real pandemic, especially since it's a struggle just to vaccinate patients against seasonal influenza. Over three months during last year's flu season, 30 percent of physicians received none of the vaccines they ordered, according to the AMA. Only one in four received more than 80 percent of their order. The blame for such snafus falls on reduced vaccine production, as well as skewed distribution. Pharmacies and grocery stores, it's said, have an easier time getting their supplies than doctors do. ---"

"Agriculture Minister Alexei Gordeyev on customs tariff regulation of poultry imports to Russia:
August 21, 2006
Bocharov Ruchei, Sochi
at www.kremlin.ru
As you know, the United States is the biggest supplier of poultry imports on the Russian market with an import quota of around 75-80 percent.
Rounding the figures off, they have a quota of around 800,000 tons. We have an import quota of 1.15 million tons of chicken in total, and 800,000 tons of this is the American quota. This is a considerable preference that has been accorded to our American colleagues, but this was tied to Russia’s becoming a member of the World Trade Organisation, so that we could act on an equal footing with our partners, including the European Union countries, where there are sizeable subsidies both for production and exports. Now, though, we are in a situation where the accession negotiations are dragging on and it is not expedient to continue maintaining such a high quota for American producers. They are earning around $1 billion on the Russian market. Given that the negotiations are dragging on, it would make sense to revise this quota. Clearly, we will raise this question with our American colleagues now.
PRESIDENT VLADIMIR PUTIN: So, you propose redistributing the quota among other exporters?
ALEXEI GORDEYEV: Yes, among other countries. Brazil, in particular, has been actively bringing up this issue. They say that they have genuine potential that they are currently developing, but that they cannot enter the Russian market on competitive conditions because of our country-based quotas."
*****
One could think of many reasons why the USA might want to belittle the threat of the Michigan H5N1. One being the exports of poultry.

"Azerbaijan H5N1 Sequences Fly Into Indonesia
Recombinomics Commentary
August 28, 2006
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Most of the human H5N1’s isolated in Indonesia do not match avian sequences from domestic poultry. The presence of Qinghai polymorphisms in Indonesian isolates suggest wild birds are bring in new sequences. The sequences may also be present in a mammalian reservoir, because many of the novel polymorphisms are also not found in wild bird sequences.
The increasing detection of Qinghai sand other novel sequences in the Indonesian sequence database indicates a more aggressive program should be launched to increase the H5N1 survellance in additional hosts including humans without poultry exposure, other mammals, and wild bird birds."

"Illegal egg imports 'pose no bird flu threat'
August 24 2006
Investigations into illegal imports of water-fowl eggs should not spark fears of a bird flu outbreak, Gauteng's agriculture department said on Thursday.
The probe is being carried out on a farm in the province and as well as one in neighbouring North West. Both properties have been placed under quarantine.
'South Africa is determined to maintain its avian influenza-free status and does not allow the importation of any live birds, poultry or poultry products from any country that has not been free for at least the past three months,' said provincial spokesperson Steve Galane.
Galane said people should be assured that chicken and ostrich products on supermarket shelves in South Africa remained safe for human consumption. - Sapa"
*****
What would be enough testing in cases like this?

"Suspect H5N1 Bird Flu Cluster in South-East Sulawesi Indonesia
Recombinomics Commentary
August 24, 2006
---
three siblings with H5N1 bird flu symptoms. In addition to common symptoms, at least one sibling had 'spots' on her skin, suggesting petechiae, another bird flu symptom. In addition, poultry in the area have died recently. Moreover, there appear to be two additional patients who are already hospitalized.
This South Sulawesi cluster is far from the current cluster in Garut in Western Java as well as suspect cases in northern and southern Sumatra. Thus far the recent confirmed cases have been limited to three cases in Garut and one in Bekasi, but these positive patients are linked to a large number of suspect cases, including six who have died with bird flu symptoms, but no samples were collected.
The simultaneous outbreaks of suspect H5N1 cases at five distinct locations in Indonesia are cause for concern. As noted above, many highly suspect fatal cases are never tested. Others test negative, but are highly suspect because of clinical symptoms coupled with contact with H5N1 positive patients. Some of these patients may test negative because of prior treatment with Tamiflu.
The steady rise in confirmed and suspect cases remains a cause for concern."

- Poorer nations balk at commercial use of their work and high prices
By DONALD MCNEIL
New York Times
via chron.com
Aug. 23, 2006
In an effort to speed flu research and set an example for other nations, the U.S. announced this week that it had placed the genetic sequences of about 650 flu viruses in a public database.
However, the sequences did not include any highly pathogenic A(H5N1) flu — the strain that has killed 140 people in 10 countries and is threatening to turn into a pandemic — because it has not been found inside the U.S. Instead, the sequences are of seasonal human flu and animal flu viruses isolated here.
The agency is trying to put pressure on Indonesia, Thailand, Vietnam and China, where the avian flu has infected humans and is mutating rapidly, to release sequences found inside their borders.
'We hope these initiatives will set the stage for other countries to adopt similar approaches,' said Dr. Nancy Cox, director of the influenza division at the Centers for Disease Control and Prevention.
Researchers, laboratories, health agencies and various national governments have been at loggerheads over the issue for months.
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Resentment over cost
In March, an Italian veterinarian who sequenced genes from birds infected in Africa and Europe refused to put her data there, released it publicly and urged others to do the same.
Also at issue is the anger of poor nations like Indonesia and Thailand, which release data and then see it used by private companies to make vaccines for sale at prices they cannot afford.
At the gathering of the world's health ministers in Geneva in May, the Thai delegation tried to pass a resolution preventing any commercial use of their data, said Edward Hammond, the American director of the Sunshine Project, an organization based in Texas and Germany that opposes the creation of biological weapons.
'They're saying, 'We want to play ball, but we resent this coming back to us in the form of a business deal,' ' he said.
In Thailand, the flu epidemic is largely under control, but it is out of control in Indonesia, where 46 people have died, more than any nation.
After months of pressure, Indonesia recently agreed to release avian and human sequences found there.
The CDC praised that decision in releasing its own data.
One Indonesian cluster now being investigated, in Cikelet village in the Garut district of West Java province, appears to consist of up to 20 suspect cases, according to Indonesian news reports. Only three have been confirmed by laboratory tests. A local health official said antiviral tablets have been given to 2,400 residents as a preventive measure."
*****
See also here.

Täällä keskustelua aiheesta, kuinka varautua yhteisötasolla yhteiskuntarakenteita horjuttavaan ja kaatavaan pandemiaan.
*****
Ja tässä AnnieB:n teksti Fluwikissa:
AnnieB – at 02:39
"To save you having to ‘think of everything’ by yourselves, have you looked at plans etc from other countries? As these plans were recently praised internationally, here is a link (http://tinyurl.com/onplm) to the NZ Civil Defence and Emergency Management Guide to the National Plan (link for that on the same page). It covers off emergency services, utilities, food, communication, welfare etc etc.
If your ‘locals’ don’t give you a comfort level that they are ready then perhaps these links could be offered to them also. There are many such links on the main fluwiki site for other countries."

Fluwiki
News Reports for Aug 23
Hodge Podge – at 01:06
23rd Aug, 2006
"At my local grocery store in Morgantown WV, at every checkout line, the cashiers were putting fliers in people’s bags: 'Are You Ready? Be Aware… Be Prepared… Have a Plan!'
It answers questions such as ‘What is Influenza Pandemic?’ and ‘What Can I Do to Prepare?’ Phone numbers and websites offer further info. It’s put out by the county health department and the office of emergency management
FINALLY!!"
*****
And what is the response in our country?

Here's the Red Cross home care card for the pandemic flu.
It's a nice two page pdf for general info.

H5N1 Cikelet Cluster in Garut Grows to 20
Recombinomics Commentary
August 23, 2006
"'a patient will come back was reconciled the Cikelat Community Health Centre to RS Doctor Selamet. The patient was Herman, 21 years.
Herman will be reconciled to RS Handsome Sadikin, Bandung, West Java. Because, although having one room for two patients, was not possible for Herman to be united with Gilang.
At this time the Cikelat Community Health Centre also it was reported treated a patient suspect bird flu was named the Dervish'
The above translation indicates more bird flu patients from Cikelet are being hospitalized, but there is a shortage of space at Sadikin in Bandung. The Garut cluster continues to grow. Reports from yesterday included 18 patients. Five had died prior to sample collection. Two of the three who tested positive for H5N1 bird flu also died, while 10 additional patients had been hospitalized. The two patients described above would raise the total to 20.
A Tamiflu blanket has been placed over four hamlets in Cikelet, covering over 2000 people. This treatment may impact the detection of H5N1 in these patients. It is not clear if samples were collected from the two patients above prior to treatment with Tamiflu.
The steady increase in admitted patients, as well as discharge of patients prior to clear of virus is cause for concern."
*****
An example of the World Health Organization (WHO) definition of the pandemic phase 4:
"One or more clusters involving a small number of human cases, e.g. a cluster of <25 cases lasting <2 weeks."

An example of the World Health Organization (WHO) definition of the pandemic phase 5:
"Ongoing cluster-related transmission, but total number of cases is not rapidly increasing, e.g. a cluster of 25–50 cases and lasting from 2 to 4 weeks."

www.iol.co.za
August 23, 2006
Heinz de Boer
"Durban hospitals are implementing stringent infection control measures to counter a possible bird flu pandemic despite the government's assurances that South Africa is not yet home to the deadly H5N1 virus.
Nursing sisters in most of the country's private hospitals have embarked on an intensive educational campaign, while certain wards in many healthcare facilities have been earmarked as areas where bird flu victims could be treated.
Contingency plans being implemented by healthcare giant Netcare include the purchase of special protective clothing for nursing staff dealing with potential patients, the stockpiling of drugs and staff vaccination plans. Although procedures may vary from hospital to hospital, it is understood that specifically trained nurses will work two-hour shifts in isolation wards under layers of protective gloves and gowns.
Netcare 911 medical director Dr Glenn Staples said bird flu posed a 'real threat' to the country. He confirmed that Netcare would soon release a modelling plan detailing exactly what implications a pandemic would carry. The model will predict the number of infected people hospitals may be called on to deal with.
'The difficulty with making meaningful plans for a group of our size is the lack of clarity as to what the impact of a possible pandemic will be,' said Staples.
'Netcare is represented on the department of health's flu pandemic committee and will tailor its plans to integrate with those of the Department of Health as and when they are finalised. It's impossible to predict whether or not a pandemic is 'imminent' due to the fact that it represents a random occurrence. We do believe that it is a real threat for the country and as such are making specific plans to deal with it,' he said.
Director of the National Institute of Communicable Diseases Barry Schoub confirmed that scientists had yet to locally find the H5N1 strain in humans, wild or domestic birds in South Africa.
He said an ongoing monitoring programme had been implemented by the government in the light of bird flu cases reported in central Africa, Asia and specifically Indonesia.
In 2004, South African authorities were able to contain the H5N2 strain detected at ostrich farms in the Eastern Cape.
'It is by no means inevitable that South Africa will see the H5N1 strain. It is a risk and there is the fear that we may yet encounter cases but there are no definites,' said Schoub."

CDC and APHL Make Influenza Virus Sequence Data Publicly Accessible
- Collaboration with public health labs will foster greater research and openness
August 22 , 2006
CDC Media Relations
Phone: (404) 639-3286
Scientists at the Centers for Disease Control and Prevention (CDC) have released genetic blueprints for over 650 genes of influenza viruses into a database accessible to researchers worldwide. The action marks the beginning of a collaboration between the CDC and the Association of Public Health Laboratories (APHL) that will allow for greater access to data on a variety of influenza virus samples obtained from patients in the United States, including avian influenza H5N1 if it should arrive here.
Through the new collaboration, CDC expects to provide genetic information for several hundred influenza viruses per year as a way to encourage more research on influenza. The sequence data will be available in nearly real time through Genbank, a public-access library for virus sequences managed by the National Institutes of Health, and through an influenza database housed at Los Alamos National Laboratories (LANL). The information added will include viruses from the annual flu season in the United States, any animal influenza viruses that infect humans and any novel strains that may emerge such as avian influenza H5N1. The new agreement will only apply to viruses isolated in the United States.
'CDC has long supported the timely and open sharing of influenza virus information to foster new research on influenza. We’re excited that this historic collaboration with APHL provides a way to make international exchange of this information possible,' said Dr. Nancy Cox, director of the CDC’s Influenza Division. 'With more information, the world’s influenza experts can advance our understanding of the viruses circulating, potentially create new prevention strategies and treatments, and ultimately help us better protect the health of people around the world.'
The sequence information, which is like a DNA fingerprint of each virus, allows researchers to determine more about a virus’s origin and to compare it to other influenza viruses. This will help scientist determine whether the virus is susceptible to antiviral drugs and, in the case of avian influenza currently circulating in much of the world, to assess whether it’s changing in a way that might make the virus more easily transmissible among people – a key property the virus would need to acquire to spark a pandemic. In addition, the sequences can be used to better identify the strains that should be included in the yearly flu vaccine.
Previously, the influenza sequences were available to a small number of influenza researchers who work together with WHO to recommend which influenza viruses should be included in influenza vaccines around the world. The sequence data will now be available through GenBank to anyone with Internet access.
APHL, the national association representing public health laboratories, collaborated with its members to gain approval from all 50 state laboratories to make sequence data from influenza viruses tested in these labs publicly available. APHL promotes effective programs and public policy to strengthen laboratory capacity to protect the health of US residents and to prevent and control disease globally.
'State health department laboratories analyze and subtype thousands of influenza viruses each year. If a novel virus is out there, we will likely be the first to detect it. This is why public health labs are a critical part of our country’s early warning system for pandemic influenza, and why this collaboration with CDC is so important,' said APHL President Dr. Jane Getchell.
State public health laboratories participate in national influenza surveillance efforts by subtyping viruses and routinely submitting some influenza viruses to CDC for more in-depth characterization. CDC asks public health labs to submit samples of influenza viruses from the beginning, peak and end of each flu season, as well as any samples that are unusual. Under the new agreement, if a novel strain is identified at CDC, the state laboratory which submitted it would be notified prior to the posting in Genbank or LANL databases.
CDC has been actively working with the World Health Organization to encourage sharing of viruses from countries with avian flu activity. After the Indonesian government recently agreed to make available the sequences for viruses from Indonesian bird flu patients, CDC placed total genome sequences for over 40 H5N1 viruses into a public-access database.
'We hope these initiatives will set the stage for other countries to adopt similar approaches to the release of Influenza virus sequence data that they manage' Dr. Cox said."
*****
See also here.

"Best Syndication
Nicole Wilson
August 22, 2006
According reports from Sinar Harapan newspaper in Indonesia, authorities have located 17 individuals in West Javanese that are believed to have become infected with bird flu virus. This raises concern that the bird flu may have become more transmittable and may be a cluster case. At this time it has not been officially claimed to be a cluster by any agency.
Government officials have been culling chickens within a radius of 1 km of any human cases. The government is reimbursing the villagers for the cost of the chicken. There have been at least 2,505 chickens killed in this culling."

"Bird flu 'may mutate too fast for us to track.'
The Nation
Aug 23, 2006
Arthit Khwankhom
A leading microbiologist expressed concern yesterday that the killer bird-flu virus could mutate faster than experts could track it.
Identification of H5N1 mutation warning signs was taking too long and the next human-flu pandemic could be upon us before we knew, the expert said.
Assoc Prof Prasert Auewarakul monitors the H5N1 virus and viral pathogenesis in humans at Siriraj Hospital medical school.
He said detecting changes in the highly pathogenic virus and heading off a global pandemic had to be achieved in days, not weeks.
'We should be able to do it in days, not weeks,' he said adding that in a worst-case scenario the disease could change so suddenly it could be too late.
In some cases the incomplete collection of virus samples had made mutation detection more difficult.
Not all confirmed human cases of flu were analysed for mutations, he said, and this meant it remained inconclusive if the disease had changed to an 'alarming level' or not.
'So far, as far as we've seen, there has not been any significant changes.' However, he warned there were 'some changes in the virus which we're closely monitoring.' These changes were in the virus receptor binding sites.
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'The strain is not an issue. How to get a vaccine produced in sufficient volume is,' he said.
At present Thailand was capable of producing a bird-flu vaccine in limited amounts at the lab level.In a related development, the Cabinet was told yesterday that human flu was spreading rapidly. Ministers say people should protect themselves with flu shots."

At Crofsblog's H5N1 there's a good CIDRAP based resource: A PDF with hypertext links to different countries' governmental avian-flu and public-health sites around the world. Here is a link to it:
http://crofsblogs.typepad.com/h5n1/files/countryinfo082106.pdf

"Evidence of Human H5N1 Transmission in Garut Cluster
Recombinomics Commentary
August 22, 2006
---
five Cikelet patients with bird flu symptoms died prior to collection of samples. These five deaths provide the evidence for human-to-human transmission of H5N1 bird flu. The latest WHO update acknowledges that there were deaths in late July and early August and the deaths included family members. Four of the five fatalities have been identified in local media reports, and three of the four identified are related to patients who tested positive.
This relationship, coupled with the disease onset dates, indicates there was human-to-human transmission in the Garut cluster. As the WHO noted in their prior commentary, the identical disease onset dates of two cousins made it unlikely that the two cousins infected each other. However, the sister of one of the cousins in among the patients that died prior to collection of samples, suggesting she may have infected her brother and cousin. Similarly, the daughter of another confirmed case was among the early cases who died before samples could be collected.
Thus, the gap in disease onset dates indicates the patients who died earlier infected the patients who tested positive later. Although the disease onset dates may not be available, the early dates for the deaths would also indicate there was human-to-human transmission.
The 10 additional suspect cases may not test positive because of Tamiflu treatment, The treatment can reduce H5N1 to levels that are not detected, creating false negatives. However, these patients may develop H5N1 antibodies, but those levels may not peak until 2-4 weeks after disease onset dates.
Thus, although the number of confirmed positives remains at three, the 5 earlier fatalities, coupled with 10 additional suspects cases, many of whom are related to the confirmed cases, provide evidence of human-to-human transmission in the Garut cluster."

NZ, Australia win praise for bird flu planning
Wednesday August 23, 2006
Reuters via The New Zealand Herald
New Zealand's preparedness for an influenza pandemic has been praised by medical researchers who raised fears about other countries in the Asia-Pacific region.
In an article published in The Lancet medical journal yesterday, Richard Coker and Sandra Mounier-Jack, of the London School of Hygiene and Tropical Medicine, wrote that New Zealand, with Australia and Hong Kong, had taken a 'strategic approach aimed mainly at harnessing available resources or preparing for the deployment of resources'.
'The plans of Hong Kong, Australia and New Zealand compared favourably with the best European plans.' But the public health experts called on wealthier nations to share scarce antiviral drugs and vaccines with poorer countries in Asia.
They warned that poorer nations may refuse to share vital information and to co-operate with the rest of the world without an equitable distribution of antiviral drugs.
'If this [equitable drug distribution] were to prove unattainable, some have warned of a potential risk that poor countries in the region would be reluctant to co-operate with the international community, eg. by providing information to assist with disease surveillance, or isolates of the virus to facilitate vaccine development and production,' the experts wrote.
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authors suggested that these plans be complemented with operational guides giving details about implementation and management of available resources.
'A pandemic might not wait until capacity is developed. These operational guides would need to be modified as capacity grows,' they said.
Contingency plans in Europe and Asia had the same failings.
'Most plans did not adequately address operational responsibility at the local level; logistical aspects of vaccination and antiviral stockpiling, distribution and delivery; or the maintenance of essential services,' they said."

"Tamiflu Blanket Placed Over Four Cikelet Villages
Recombinomics Commentary
August 22, 2006
---
Tamiflu blanket is being placed over four hamlets in Cikelet covering 2000 people. The WHO update describes prophylactic use of 'close contacts'. Clearly WHO is playing fast and loose with definitions of 'close contacts', as well as 'evidence' of human-to-human transmission.
Although failure to collect samples from the early deaths of family members destroys the 'evidence', the more efficient transmission of H5N1 to humans is clear.
H5N1 does not read press releases."

"17 suspected bird flu cases found in Indonesia's Garut
People's Daily Online
Xinhua
August 22, 2006
Indonesian authorities have found 17 suspected bird flu cases in the West Javanese town of Garut, raising fears that a cluster case has occurred, an evening newspaper reported Tuesday.
Three sufferers have been tested positive of bird flu by local laboratory and two of them died last week as the government began to cull all chickens within the radius of 1 km from any case found in Garut, some 200 km southeast of Jakarta.
Health officials have been deployed to the area to distribute bird flu medicine and take blood samples form villagers, reported Sinar Harapan newspaper.
I Nyoman Kandun, a senior official with the Ministry of Health, said cases of chicken died allegedly from bird flu had been found in all villages in Garut over the last three months, prompting authorities to order mass cull in the area.
At least 2,505 chickens were culled during the government operations.
The government promised a compensation payment of 12,500 rupiah (1.37 U.S. dollars) for any chicken killed in the cull program.
Cikelet district was the worst hit area in which nine villages have reported bird flu case in human.
The latest casualties in Garut have raised bird flu death in the country to 46, considered to be the highest in the world."

"H5N1 Transmission in Cikelet Patients in Garut Cluster
Recombinomics Commentary
August 20, 2006---
The number of confirmed and suspect cases in the small region around Cikelet, indicates the transmission to humans is more efficient than has been seen previously.
The report of bird flu in the region in June, coupled with the collection of birds for feeding to dogs, raises the possibility that the H5N1 in the region has acquired additional mammalian polymorphisms via recombination, and is therefore more adapted to infections in humans. In the Jakarta area, almost all human isolates have a novel cleavage site which has not been reported in bird isolates, raising the possibility of a mammalian reservoir. Media reports indicated the sequences from the current cluster do not match Karo or Bekasi, suggesting a third sub-clade of Indonesian H5N1 is circulating.
---"

Cikelet,
Garut, Indonesia - Summary
mamypoko
22nd Aug, 2006 at 04:46
Fluwiki Discussion Board
Thread: Possible Cluster in Cikelet Indonesia 4
Village Uncertain:
* Sardi 4M, died 7/31, no tests done
Rancamareme Village:
* Rubiyah 13F, died 8/1, no tests done
* Risman 5M, brother of Rubiyah & Misbah, 8/19 in Slamet Hospital
Rancasalak Village:
* Misbah 20F, sister of Rubiyah & Risman, symptoms 7/26, died 8/5, no tests done
* Umar Aup 17M, cousin of Misbah, symptoms 7/26, Slamet Hospital → home treatment, recovering, tested POSITIVE for H5N1 (WHO confirmed)
* Yana 50, 8/19 in Slamet Hospital
Jojok or Jojoh Tipar Village:
* Ai Siti Amanah 9F, symptoms 8/1, died 8/15, tested POSITIVE for H5N1 (WHO confirmed)
* Ismawati 5F, cousin of Ai Siti Amanah, 8/16 in Hasan Sadikin Bandung Hospital, locally tested NEGATIVE for H5N1
* Santi 6F, 8/17 in Hasan Sadikin Bandung Hospital, locally tested NEGATIVE for H5N1
* Dea 9F, daughter of Euis Lina, died at home 8/16, no tests done
* Euis Lina 35F, died 8/17 in Slamet Hospital, tested POSITIVE for H5N1 (WHO confirmed)
* Ai Rohimah 10F, 8/19 in local health center
Sawah Bera Village:
* Kuraesin 35F, 3.5mths(14wks) pregnant, 8/18 in Hasan Sadikin Bandung Hospital, recovering, tests pending
* Osin 36M, husband of Kuraesin, 8/21 Hasan Sadikin Bandung Hospital
Pasir Meja Village:
* Risma 4F, ill since 8/16, 8/19 in Slamet Hospital, 8/20 left hospital, recovering
Gunung Sula Village, Desa Cigadog:
* Gilang 14M, 8/21 Pameungpeuk health centre, 8/22 transferred to Slamet hospital, seems to be recovering
Cibeunteur Village:
* Memen 60M, 8/19 in Hasan Sadikin Bandung Hospital
Cinangka Village, Desa Cijambe:
* Tosim 61M, 8/18 chickens died, 8/20 onset of symptoms, 8/22 transferred from Slamet Hospital to Hasan Sadikin Hospital

Background knowledge can be found i.e. from Fluwiki's text Disease Transmission Primer.
Brian and Cecilia had a two years old daughter, Angela. They lived in Kansas City, in a quite nice neighbourhood. Every day Angela was taken to a kinderkarten, because mom Cecilia went to work in a bank in Topeka and dad Brian traveled by car all the way to Des Moines for work.
The flu season came, like it comes every year, and first fell ill little Angela - she was in kinderkarten after all, and that's where the families get many of their infections. Angela was coughing, sneezing like almost every other kid in those days. Finally Angela went down in the bed, fever went up and Angela got also otitis media. Mom had to stay home with her for a couple of days.
Then mom fell ill in the same way. Only not otitis media, and she was well enough to go to work for two days before the first symptoms. Still it wasn't good, because her coworker - Daniela, who was from Wichita - fell ill too and gave the disease to her two sons, Earl and Frank who also had to go to kindergarten in Wichita like Angela did in Kansas City.
In the same time Angela's dad Brian fell ill, too. But he had a very important project to finish at work, and the company needed him at least during this week. So, Brian took the maximium doses of Tylenol and drove to Des Moines. Even though sneezing and coughing quite a lot, he went to have a business lunch as usually in his favourite high end restaurant. It was convenient also because the restaurant situated quite near the airport; it was easy to arrange business meetings there. Anyways, the restaurant cook Gina wasn't very happy three days later, when she fell ill and had to stay at home in Cedar Rapids. She was a single mother, so her kids Hannah and Irwin had to stay home with her, because she was so ill that she couldn't even get up do the household work let alone to drive a car. Gina was worrying about the work situation, because their best waitress Janet had also felt ill two days after Gina, and there was a large scale political meeting coming up in a couple of days, and their restaurant had a contract to take care of the meals for participants of the meeting. Janet had traveled to Rochester to her parents Ruth's and Sandy's house, because Janet hadn't seen them for a long time and now that she was ill she could as well be ill at her parents'.
But well, Gina's life became easier three days later when her mom Kelly could fly to Cedar Rapids from Chicago where she had moved to after she became a single pensioner. Kelly had always liked Chicago. But now she was on her way to a bridge contest in St Louis, so she had a possibility to drop by to Cedar Falls for a couple of days to take care of Earl and Frank before attending her bridge weekend. Bridge was her favourite hobby, and she and her bridge pair Lara, who lived all the way in Indianapolis most of the year, had been very successful pair in pensioners' bridge contests this year.
But no one had got any second thoughts about the illness before Earl's classmate Maria fell so ill that her mother Nina took her to a hospital where Maria was diagnosed to have a pneumonia. First Maria was in a four patients room. But after having been two days in the hospital, the results of the virus tests came. Maria was immediately isolated, and Nina got a call from the doctor: Maria had H5N1. Her condition had also deteriored in the same day and she had to be moved to a special care unit.
What more sad, Maria's patient room mates Olivia from Tulsa and Patricia from Oklahoma had got the disease, too, as well as nurse Quentin, who had been travelling to work daily from Madison.
*****
So, these cases of illness in Kansas City, Topeka, Des Moines, Wichita, Cedar Rapids, Rochester, Indianapolis, Tulsa, Oklahoma, Madison and soon to be in other towns, are they a cluster according to for example Indonesian authorities' defnitions?

Archive Number 20060820.2339
Mod.MPP, ProMed Mail
20-AUG-2006
"Undiagnosed deaths - Nepal (Nuwakot): request for information
---
Given the paucity of symptoms provided in the 2 very similar
newswires above, it would be very hazardous to venture a differential
diagnosis at this time. That being said, it is important to mention
that we were 1st alerted to this outbreak by a subscriber (who,
though known to us, did not wish that identifying information be
given), who mentioned that chat rooms/blogs were speculating that
this might be due to H5N1, given the history of poultry and dogs
(although dogs have not been routinely identified as being affected
by H5N1). It seems that in today's environment, any mention of an
animal death preceding undiagnosed human deaths results in a "knee
jerk" response on the part of bloggers to attribute deaths to H5N1
immediately, even if the symptoms are not clearly those associated
with human H5N1 deaths as seen in the majority of cases confirmed and
officially reported.
This moderator did use the Global infectious disease epidemiology
network (GIDEON ) and ran the above
given information complex (fatal outcome, hemorrhagic illness, fever,
contact with birds (no choice of poultry was given) and dogs in
Nepal, and came up with: "No known infectious diseases fit this complex."
Eliminating exposure to birds, the most likely infectious disease
mentioned was leptospirosis, known to be endemic in Nepal. Another
febrile hemorrhagic disease reported in the literature to occur in
Nepal is old world hantavirus (from Mod.MPP discussion in ProMED-mail
posting Undiagnosed deaths - Nepal (Udyapur): RFI 20050824.2493:
"There is an article in the Japanese literature (abstract in English)
which identified an
overall seropositivity rate of 8.7 percent of 322 specimens from
patients attending outpatient clinics at the Tribhuvan University
Teaching Hospital in Kathmandu. Of note, a higher positivity rate of
12 percent was seen in those living outside of the Kathmandu valley
(5.1 percent), suggesting hantavirus infection was more prevalent in
rural areas.").
As one can see from the see also list below, ProMED-mail reports of
undiagnosed illnesses and deaths in Nepal have not been rare.
Unfortunately, what has been rare is for ProMED-mail to receive
information from knowledgeable sources in Nepal on results of
epidemiologic and laboratory investigations into these reported
outbreaks and clusters. We are still awaiting information on an
outbreak reported last month (July 2006), for which this moderator
postulated that the most likely diagnosis might be typhoid fever.
Once again, we are requesting that knowledgeable sources (either
Nepal-based or organizations that have knowledgeable sources based in
Nepal) shed light into what may be the etiology of the above
mentioned fatal febrile illness with hemorrhagic phenomena occurring
in the Nuwakot district of Nepal.
see also:
Undiagnosed deaths - Nepal (Sankhuwasabha)(03): RFI 20060806.2194
Undiagnosed deaths - Nepal (Sankhuwasabha)(02): RFI 20060730.2108
Undiagnosed deaths - Nepal (Sankhuwasabha): RFI 20060728.2088
2005
Undiagnosed deaths - Nepal (Udyapur): RFI 20050824.2493
Undiagnosed deaths - Nepal: RFI 20050617.1709
2003
Unexplained deaths - Nepal (Bajura): RFI 20030212.0377
1999
Unidentified disease - Nepal 19990308.0345
1996
Fever, fatal - Nepal (5) 19960422.0760
Fever, fatal - Nepal (3): Current status 19960418.0749
Mystery fever in Nepal. 19960416.0728
Fever, fatal - Nepal (2): ?possible diagnoses 19960411.0687
Fever, fatal - Nepal (press report) 19960409.0673]"
*****
But what happened to the chickens then?
But what makes the arm chair diagnosis of a ProMed Mail specialist better than an armchair diagnosis of the medical and veterinarian specialist bloggers?

Posted by: kyangadac
in response to
'Increasing genetic diversity in H5N1'
at the Effect Measure blog
August 21, 2006 10:30 AM
"Speaking as someone who lives a mere 4 hours by plane from the latest clusters, the words "don't panic" spring to mind. The current Java cluster is a good thing if it's H2H because it has given the authorities in Indonesia and Australia a chance to beef up there preparedness being isolated at least in Indo terms. The odds are pretty good that the Indo army has shut down the roads to Cicelet until they can sort it out.
The Australian Foreign Minister, Alexander Downer reiterated the 'high' threat level to travellers to Indonesia on Saturday night TV news, apropos of nothing in particular. All returnees from anywhere in SE Asia are already routinely quizzed at the airport about contacts etc.
I'm not saying that any of this will do any good but I suspect that somebody in ASIO or JIO in Canberra has sat down with Cabinet and told them what to expect and as soon as HTH transmissions confirmed in Indonesia I'm pretty sure plan A will be an immediate no-exceptions closure of the border. This will, of course, strand lots of aussies who will write songs about in years to come.
Not that it will work, of course. Since it will only take a customs officer to catch it off an Indonesian fisherman being into custody at Darwin or Broome.
But it's not going to happen tomorrow, next month, maybe, end of the year probably. Anyhow, I read somewhere yesterday that the wholesale supply of P95 masks has gone from being instant to 3 month wait. So I went and bought one from the hardware store this morning just in case the 40 million that the Oz governemt claims to have in stockpile doesn't make it out of the store room."

Pigs die of mysterious disease in eastern Nepal
english.eastday.com
5/3/2006 12:25
Over 2,000 pigs have died of an unidentified disease in some villages of Morang district in eastern Nepal in the past two months, an official said Sunday.
The disease, first seen in Dangihat and Karanari village of Morang district, some 300 km east of Kathmandu, claimed the lives of over 1,000 pigs in Letang village alone, Shambhu Yadav, an official of the District Livestock Services Office (DLSO), said, adding that eight boars and four buffaloes also died of the disease.
'The disease is believed to be air borne but we have not launched any investigation into it,' Yadav noted.
Earlier, it was suspected that swine fever was the cause of the deaths but outbreak of avian flu in India has terrified the farmers of Morang district located close to India.
Farmers have been disposing the carcass of diseased animals in the nearby forest and the environment has been polluted there, according to Yadav.
Fever, dysentery, yawning and lack of appetite are the symptoms of the disease, Yadav added.
Xinhua news"

Unidentified disease kills 14 in central Nepal
Xinhua
Aug 19, 2006
Unprecedented epidemic of an unidentified disease has killed at least 14 people, including seven children, in central Nepal in the past two weeks, The Kathmandu Post reported on Saturday.
According to the newspaper, the disease, which was first detected in dogs and chicken in the last week of June, had started spreading to humans in Netini, a far eastern village of Nuwakot district, some 50 km northwest of Kathmandu.
Major symptoms of the disease are high fever together with bleeding from nose and mouth at the time of death."


*****
I think of Pakistan also. How are earthquaked people getting along there?

Lyhyesti suomeksi:
"Tunnistamaton sairaus on tappanut vähintään neljätoista ihmistä, joista seitsemän lapsia, Keski-Nepalissa kahden viime viikon aikana, raportoi sanomalehti The Kathmandu Post lauantaina.
Lehden mukaan sairaus, jota ensin oli koirissa ja kanoissa kesäkuun viimeisellä viikolla, oli alkanut levitä ihmisiin Netinissä, joka on Nuwakotin alueen itäreunalla oleva kylä. Sen etäisyys Katmandusta on noin 50 km. Alueella ei ole aiemmin tavattu tällaista sairautta.
Sairauden pääasialliset oireet ovat korkea kuume ja verenvuoto nenästä ja suusta kuoleman hetkellä."

"14 People Die of Illness Located in Bird Flu Stricken Region
The symptoms of the disease are high fever along with bleeding from nose and mouth at the time of death, which is similar to that of the bird flu virus.
PRWEB
August 19, 2006
There is a lot of nervous talk circulating on an online discussion forum, Avian Flu Talk, concerning a mystery disease that has killed 14 people in the last two weeks located in the Nuwakot District of South Asia. This disease was first detected in dogs and chickens in the last week of June and had started spreading to humans in Netini. The symptoms of the disease are high fever along with bleeding from nose and mouth at the time of death, which is similar to that of the bird flu virus.
The bird flu virus was previously suspected in Nuwakot District on February 24, 2006 in which thousands of chickens began to die. With the developments regarding a lethal disease now spreading in that area, alarm bells are sure to ring among the local residents.
For up to the minute developments on this quickly unfolding story, there is an online discussion forum in which people from all around the world are discussing this latest event. For all of those who are interested in following this story and to see what others are saying, we would strongly encourage you to visit this website located at www.Avianflutalk.com.
Contact:
Media One
Jim Henry
2465 Orangethorpe Ave.
Fullerton, CA 92831
Phone number 714.965.5945"

"Indonesia Expands Probe of Human Bird Flu Cases in Java Region
Aug. 18 2006
Bloomberg
Jason Gale
Indonesia expanded an investigation of human cases of bird flu in a remote village on Java island, including testing more people for the virus, as health officials check whether the disease may have spread from human to human.
The Ministry of Health confirmed yesterday that the H5N1 avian influenza strain killed a 9-year-old girl in a neighboring area in West Java where a 17-year-old man caught the virus days earlier. A cousin of the teenager, who lived nearby in one of three hamlets being studied, may have had H5N1 when he died on Aug. 5, the World Health Organization said.
'Teams from local health authorities, the Ministry of Health and WHO are currently in the three hamlets investigating these cases and assessing the overall situation,' the Geneva- based agency said in a statement yesterday. `Rumors of additional deaths from respiratory disease in the hamlets in late July and early August are also being investigated.'
World health officials are tracking H5N1 infections for signs the virus is being spread from human to human, which could indicate the start of a lethal influenza pandemic.
---
The H5N1 strain is known to have infected 239 people, killing 140 of them since 2003, mostly in Asia. It may kill millions should it mutate into a pandemic form.
---
The latest human infections take the number of confirmed H5N1 cases in the southeast Asian nation to 58. Of those, 45 were fatal. Indonesia, the world's fourth-most-populous country, surpassed Vietnam last week as the country with the most avian flu deaths.

International Attention
Indonesia attracted international attention in May when seven members of a family from the island of Sumatra contracted the virus, six of them fatally. The cases represented the largest reported cluster of infections and the first laboratory-proven instance of human-to-human transmission.
Clusters of cases may signal the virus is becoming more adept at infecting humans, not just birds.
The 9-year-old girl, Indonesia's latest avian flu fatality, developed symptoms on Aug. 1, was hospitalized Aug. 14 and died the next day, the WHO said. The 17-year-old developed symptoms on July 26 and is now recovering, it said. His elder cousin died of severe respiratory disease on Aug. 5.
No samples were taken from the 20-year-old for testing and the cause of his illness is uncertain, the WHO said. `Based on epidemiological and clinical findings, however, infection with the H5N1 virus is strongly suspected,' the agency said.

Human Source Unlikely
As both men developed symptoms on the same day, epidemiologists assume that they acquired their infection from a shared environmental source, the WHO said.
`The currently recognized incubation period for H5N1 infection of 2 to 8 days makes human-human transmission between the two highly improbable,' it said.
Recent deaths of poultry are known to have occurred in the village and all three cases involved exposure to diseased chickens, the agency said.
Heightened awareness in the hamlets of avian flu and the presence of medical and animal health teams has prompted more villagers to be screened for the illness. Specimens have been taken and tests are being conducted, the WHO said."
*****
But the genetic link between bird h5n1 and human h5n1 hasn't been found. Based on scientific research, the most likely way of transmission would be cat-human or human-human.

"Indonesia girl dies from bird flu virus in afflicted village
2006/8/18
JAKARTA, Reuters
A nine-year-old Indonesian girl who died this week had bird flu according to two local tests and the village where she lived is rife with the disease, the health ministry said on Thursday.
The girl died on Tuesday in a hospital in West Java's Cikelet village where there are many sick and dead chickens, said Runizar Ruesin, the head of the health ministry's bird flu information centre.
Her death takes Indonesia's toll from the disease to 45, the highest of any country.
'Bird flu is rife in Cikelet. You can always find dead or sick chickens there,' Ruesin told Reuters.
A 17-year-old-boy in the same village has also tested positive for bird flu, but has stayed at home and refused to be treated at the main hospital in Bandung, the provincial capital to the south of Jakarta.
The boy's condition was improving and he was being constantly monitored by health officials, said health ministry spokeswoman Lily Sulistyawati.
'He is a survivor and he is doing very well,' she said."

Posted by: M. Randolph Kruger
August 16, 2006 11:23 AM
On Effect Measure blog site
"My friend Dr. Hideki is getting info in from Thailand daily and he said that its becoming really difficult to get a confirmation of the H5N1 in people that they fully believe that have it. He said IHO that the testing is either not being done correctly or the virus has changed again and the test is inadequate. Also he said that IHO that to have that many cases of "pneumonia" its an epidemic in itself in the summertime. His other big concern is that these people are reporting to HCF's sick as dogs and certainly some of them likely have H5. They are being placed in to ward situations and dual rooms with no isolation protection because there is nothing that says they are H5 positive. ---"

Nopea suomennos:
"Ystäväni tri Hideki on saanut tietoja Thaimaasta päivittäin, ja hän sanoo, että on alkanut olla hyvin vaikeaa saada varmistusta, onko sellaisilla sairastuneilla H5N1, joiden täysin uskotaan sairastuneen H5N1:een. Hän sanoi mielipiteenään, että joko testausta ei tehdä oikein tai sitten virus on muuntautunut taas kerran, eikä käytetty testausmenetelmä tunnista sitä. Lisäksi hän sanoi mielipiteenään, että näin monta "pneumoniatapausta" on jo kesäaikana epidemia itsessään. Hänen huolenaiheensa on myös se, että nämä ihmiset ovat raportoineet hoitohenkilökunnan olevan sairaita kuin koirat, ja todennäköisesti osalla näistä on H5N1. Sairastuneita sijoitetaan normaaleille osastoille ja kahden hengen huoneisiin vailla eristysmahdollisuutta, koska ei ole voitu osoittaa, että he sairastaisivat H5N1:sta. ---"

"Sequence Analysis of H5N1 Bird Flu in Michigan
Recombinomics Commentary
August 14, 2006
---
Last year young ducks were tested as part of an expanded banding program across southern Canada. Four H5 sero-types (H5N1, H5N2, H5N3, H5N9) were identified. H5N1 was in Manitoba, while H5N2 and H5N9 were in British Columbia. In Manitoba, an alarmingly 24% were H5 positive. In the testing in southern Michigan, 2 of the 20 tested birds were H5N1 positive, so the percentage in certain regions of the United States may also be alarmingly high.
The high frequency6 of H5 in wild birds is a concern because H5 can become highly pathogenic, and can acquire mammalian polymorphism. Moreover, it can most easily recombine with H5N1 from Asia because of regions of genetic identity.
There is already evidence for both processes. Although a large number of H5 virus was identified last year, only one sequence has been made public. However, that sequence has polymorphisms shared by swine in Canada as well as H5N1 in Russia.
The tandem polymorphism from H1N1 Canadian swine were describe earlier. Today 2006 HA sequences Russia were released. A new polymorphism found in three recent isolates from Russia, A/cat/Dagestan/87/06(H5N1), A/chickem/Krasnodar/199/06(H5N1), A/chicken/Adygea/203/06(H5N1), was also present in the H5 in British Columbia.
Analysis of the H5N1 sequence from Michigan can be used to determine of the evolution in the 2006 isolate and can be used to evaluate new polymorphism present in new Qinghai isolates.
Full sequences of the Michigan swans should be made public as soon as possible."

"Pointe Mouillee swans checked for bird flu strain
monroenews.com
story updated August 14. 2006 12:04PM

Two mute swans found in Monroe County have a virus related to the bird flu that has swept parts of Asia
---
The birds were two among 20 that were sampled at the Pointe Mouillee State Game Area last week. Further testing is under way, but the virus found is believed to be a low pathogenic strain 'and not known to produce any illness in people,' said Dr. Ron DeHaven, a United States Department of Agriculture administrator.
'This is not the virus found in Asia or other parts of the world - that we can say for certain,' Dr. DeHaven said.
A highly pathogenic version of the H5N1 strain resulted in the deaths of millions of birds and hundreds of people in parts of China and Asia.
Dr. DeHaven also said the strain carried by the Pointe Mouillee swans is believed to be that found in the United States in 1975 and in Manitoba, Canada, last year and is not known to produce illness in people.
Federal and state officials have stepped up their waterfowl monitoring programs since the Asian bird flu scare in hopes of finding early evidence of the disease if it migrates to this country. They discussed the Pointe Mouillee swan discovery during a press conference this morning because the H5 strains can mutate rapidly.
But Dr. DeHaven said there's no evidence yet that the virus found is a threat to poultry.
'The finding of this virus in wild birds should be no basis for any country imposing trade restrictions,' he said.
He said the virus was found in genetic tests on birds taken during a thinning of the mute swan population at Pointe Mouillee. It was pinpointed at a screening lab at Michigan State University, and the swans with the virus now are undergoing more tests at the National Veterinary Services Laboratory in Ames, Iowa.
The plan there is to inoculate eight chicks with the swan virus. If six or more die within 10 days, the strain might be categorized as a high pathogenic virus. The results might be known in two weeks.
---
Pointe Mouillee, in Berlin Township on the Lake Erie shore, is a 3,000-acre marsh that's part of the migratory path for waterfowl, birds of prey, songbirds and about 75,000 shorebirds."

"DETECTION AND ISOLATION OF HIGHLY PATHOGENIC H5N1 AVIAN INFLUENZA A VIRUSES FROM BLOW FLIES COLLECTED IN THE VICINITY OF AN INFECTED POULTRY FARM IN KYOTO, JAPAN, 2004.
Sawabe K, Hoshino K, Isawa H, Sasaki T, Hayashi T, Tsuda Y, Kurahashi H, Tanabayashi K, Hotta A, Saito T, Yamada A, Kobayashi M.
Am J Trop Med Hyg. 2006 Aug;75(2):327-332.

During the outbreak of highly pathogenic avian influenza that occurred in Tamba Town, Kyoto Prefecture in 2004, a total of 926 flies were collected from six sites within a radius of 2.3 km from the poultry farm. The H5 influenza A virus genes were detected from the intestinal organs, crop, and gut of the two blow fly species, Calliphora nigribarbis and Aldrichina grahami, by reverse transcription-polymerase chain reaction for the matrix protein (M) and hemagglutinin (HA) genes. The HA gene encoding multiple basic amino acids at the HA cleavage site indicated that this virus is a highly pathogenic strain. Based on the full-length sequences of the M, HA, and neuraminidase (NA) segments of virus isolates through embryonated chicken eggs, the virus from C. nigribarbis (A/blow fly/Kyoto/93/2004) was characterized as H5N1 subtype influenza A virus and shown to have > 99.9% identities in all three RNA segments to a strain from chickens (A/chicken/Kyoto/3/2004) and crows (A/crows/Kyoto/53/2004) derived during this outbreak period in Kyoto in 2004. Our results suggest it is possible that blow flies could become a mechanical transmitter of H5N1 influenza virus."

"H5N1 suspected in Rotterdam zoo
Sat Aug 12, 2006 11:55
AMSTERDAM (Reuters) - Two young owls which died in a zoo in Rotterdam are suspected of having the H5N1 bird flu virus, the Dutch farm ministry said late on Saturday.
The Netherlands, Europe's second biggest poultry producer after France, has never reported a case of the highly pathogenic avian flu strain which is endemic in parts of Asia and has spread to birds in a number of European Union countries.
A ministry spokeswoman said further tests were being conducted, but it was suspected that the birds died of a highly pathogenic strain of the virus. Final test results are due in the coming days.
---
No other dead birds have been found, and authorities are currently testing other birds in the zoological garden, most of which were vaccinated, the spokeswoman said.
The Netherlands found a low-pathogenic H7 bird flu strain at a farm earlier this month, prompting five countries to ban imports of Dutch poultry.
The Dutch suffered a devastating outbreak of an H7N7 avian flu strain in 2003 that led to the culling of about a third of the poultry flock, some 30 million birds."
*****
So, 1) were the owls vaccinated, too, but the vaccination didn't work in their case or 2) were they not vaccinated at all or 3) were they zoo birds or visitor wild birds?
Apparently the vets took the rapid tests already?

"Doctors warn of worst flu in years
- Healthy eating habits, vitamins and bed rest advised
June 16, 2006 Edition 1
Bhavna Sookha
General practitioners and pharmacists are saying they have been inundated with patients requiring medical attention and medication to treat what they are calling the 'worse case of flu' in years. Umlazi GP Dr Dumisani Mkize said his practice had seen a 40% increase in patients being treated for the flu. 'This year's flu is especially bad and very virulent. Patients need combination antibiotics for treatment,' he said. 'We are seeing more than 40 viral strains right now and the usual vaccines we get cover about three of those strains.'
Pharmacists have also reported an influx of people coming through for 'over the counter' flu medication.Musthaq Patel, a pharmacist at the Chatsworth Sparkport Pharmacy, said: 'Patients are suffering from fevers, diarrhoea, pain and colds. Patients are also suffering from severe acute effects and the flu is taking at least three weeks to be totally cured.'
For people wanting to take the flu injection now, Patel advised against it, saying that it was too late in the year.'People now need to take preventative measures by taking vitamins and immune system boosters,' said Patel.

Contact
'They also need to maintain healthy eating habits and not get into close contact with people who have contracted the flu,' he said.
Another pharmacist, in Pietermaritzburg, said that this year's flu was so bad that some patients were getting viral pneumonia and needed nebulising.
South African Medical Association councillor Dr Mohamed Bayat, from Mooi River, agreed that the situation has been 'much worse than previous years'.
'The best thing you can do is get into bed for two to three days until you feel better,' he said.
---
Leon Mbangwa, spokesman for the KwaZulu-Natal Department of Health advised the public not to panic as there was always an expected escalation in the number of flu cases around this time of the year. 'This is why we are now seeing an increase in the number of people visiting our hospitals and clinics with flu symptoms. Children, the elderly and people who have a compromised immune system are at a higher risk,' he said."

"Bird flu warning raised in northern Iran
Tehran
Aug. 12 2006
Xinhua (editor: Yan Zhonghua)
An Iranian medical university raised warning status for regional bird flu contamination in northern Iran, the Fars news agency reported on Saturday.
People should refrain from selling and buying living birds, Gilan Medical Sciences University said in a statement, urging the public to observe rules of hygiene and take necessary precautions.
The statement asked the public to avoid direct contact with domestic and wild birds and inform health authorities of any suspicious cases.
The first case of bird flu was reported in Iran in February, when tests confirmed 135 swans died of the virus in marshes near Bandar Anzali in northwestern Iran."

During a pandemic one could envision circumstances where field expedient medical techniques might be very useful for doctors who are separated from the tools of their trade.
To start off-
* Super glue is a good field expedient substitute for sutures.
* Honey is a powerful anti-infective agent for wounds and burns.
* It is better under field conditions to dress a fresh wound in it’s own blood and leave it than to make frequent dressing changes.
* Fly larvae, (maggots) are effective debriders of dead tissue. Sterile maggots are still used for this purpose today.

More tips here .
(According to LMWatBullRun – at 19:22 on 12th August 2006)

"H5N1 Match Failures in Indonesia Raise Pandemic Concerns
Recombinomics Commentary
August 11, 2006
The decision of the government of Indonesia to release the H5N1 sequences at the WHO repository has yielded dramatic changes in the genetic analysis of the H5N1 in Indonesia. The announcement last Thursday was followed by the removal of the password protection on over 500 Indonesian sequences in the database. These new sequences provided additional data indicating the human H5N1 cases in Indonesia are linked to an animal reservoir that has yet to be identified.
---
There were a modest number of avian sequences available from Indonesia and most were from 2003 and 2004. However, new sequences were made public earlier this year and although the new sequences had several isolates from 2005, there was still no sequence that matched the cleavage site. Word then began to leak out of Indonesia indicating that a cat sequence had the cleavage site and matched the human sequence. Phylogenetic trees showed that the growing number of human sequences formed a separate branch which contained no avian sequences.
In July the WHO held a meeting in Jakarta on H5N1 in Indonesia. In that meeting for sequence data was presented showing that virtually all of the human sequence had the novel cleavage site and additional changes in HA that created the separate branch. One sequence was on another branch with avian sequences and the Karo cluster was on another branch with avian sequences, but all of the other sequences formed a separate branch that include the cat sequences. The separate branch was markedly larger and was diverging further from the avian sequences. Other than the one sequence from August of 2005, all human sequences from Java, which included the Jakarta area isolates, were on the separate branch.
---
Testing for H5N1 in patients in Indonesia is still tightly linked to exposure to dead or dying poultry. The lack of a match with H5N1 from poultry suggests more patients with bird flu symptoms should be tested for H5N1. Moreover, the large number of H1N1 seasonal flu suggests sequence analysis of those isolates is needed. Similarly, more testing of wild birds and mammals is required. H5N1 positive swine are frequently discussed, but no H5N1 sequences have been made public. Presentations at scientific meetings indicates that sequences from earlier isolates have H5N1 which does not have the novel HA cleavage site, but more testing, especially on more recent isolates is required. Similarly, testing of domestic mammals such as dogs and cats is necessary.
The release of the sequences was a good start. That data indicates that a much more aggressive screening is required to identify the source of the human infections. This aggressive surveillance in Indonesia should begin immediately."

Date: Tue 8 Aug 2006
From: ProMED-mail
Source: Thanh Nien News via Saigon Giai Phong [trans. Minh Phat, edited]
Viet Nam braces for fresh foot-and-mouth epidemic
Signs of a fresh outbreak of foot-and-mouth disease [FMD] have
emerged in Viet Nam's Mekong Delta region, with more and more animals
being infected in the last 10 days.
The deadly disease, which erupted nationwide in 2005, has now
reappeared in Vinh Long, Hau Giang, and Bac Lieu provinces. Some
areas in the northern and central regions are also reported to face
high risk of an epidemic.
In Vinh Long, 261 pigs and cows have fallen victim, the provincial animal health department reported. In Hau Giang, 15 pigs had been infected in the last few days, taking
the toll since May 2006 to 100, authorities said. Bac Lieu province's Ngan Dua town reported widespread infection among cattle.
Authorities in these areas are now tightening control over transport
and trade of cattle, disinfecting affected areas, and vaccinating
animals.
The Vietnamese government has provided the provinces with tens of
thousands of doses of FMD vaccine. It plans to import 2 million doses
worth VND 36 billion [USD 2.3 million] from France and the
Netherlands for the national reserve.
Last year, 17 363 cattle and 18 232 pigs were reported to be
infected. Of them, 247 cattle and 12 072 pigs died of the disease or
were culled.
FMD is a highly infectious viral disease infecting animals with
cloven hooves, such as cattle, swine, sheep, goats, and deer."

"Experts predict more Chinese bird flu cases
James Sturcke
Tuesday August 8, 2006
Guardian Unlimited
China's admission today that bird flu killed a soldier in 2003 - two years earlier than previously acknowledged - is unlikely to surprise scientists studying the emergence of the virus in Asia.
Many have questioned why China, where so many people live in close proximity to wildfowl, has recorded only 19 cases of the disease, 12 of which have proved fatal.
Last October, as British attention turned to the spread of H5N1 cases to European countries, scientists travelled to Asia - at least in part to urge more openness on bird flu from the Chinese authorities.
'We would like to know precisely how the Chinese are responding to such a widespread infection of their chickens, how they are looking at their birds, how they are looking at their human beings for having potentially been infected,' Sir John Skehel, the director of the National Institute of Medical Research at the Medical Research Council, said at the time.
'That information is not available at the moment.'
Today, Neil Ferguson, of Imperial College, London, who has been modelling the predicted spread of bird flu for the British government, said it was possible that more cases would come to light.
'It would have been a surprise had there not been more cases from China, because it is in the epicentre of the bird flu outbreak,' he said. 'I am certainly not surprised about this one.'
Prof Ferguson said it was difficult to judge whether the Chinese authorities had deliberately tried to cover up bird flu outbreaks or whether the delay in identifying the disease had been due to poor surveillance and communication systems.
'I think a lot has happened since the severe acute respiratory syndrome [Sars] outbreak, and it is a more open country now,' he added.
In 2002-2003, the Chinese authorities were accused of being secretive about Sars, which killed 774 people worldwide.
The death of the soldier - known only by his surname, Shi - was admitted after eight Chinese researchers wrote a letter to the New England Journal of Medicine to say they had found bird flu genes in samples from him.
It was originally thought he had died of Sars, which has similar symptoms, but later tests on his lung tissue yielded fragments of a bird flu virus.
Genetic sequencing revealed it to be a mixed virus, with genes similar to those found in types of bird flu seen in northern and southern China.
The World Health Organisation questioned the long gap in confirming the soldier's cause of death.
'It's good that this case came to light,' Roy Wadia, a WHO spokesman in Beijing, said. 'It shows that the internal communication mechanism needs further improvement, further strengthening.'
Shi's case showed 'H5N1 human infections on the Chinese mainland are not something new', Mr Wadia said.
'There well may be sporadic H5N1 infections in humans which may not be found because surveillance systems are weak and because it's a difficult disease to pinpoint,' he added.
However, Prof Ferguson said he was more concerned about the continued spread of bird flu in Indonesia, particularly in sub-Saharan Africa, where it continues to infect people without being properly monitored.
Today, Indonesian officials reported tests indicating two more bird flu deaths which, if confirmed, would bring the country's bird flu toll to 44, surpassing Vietnam as the place to have suffered the most fatalities.
Vietnam has confirmed 42 deaths, but has not reported any this year.
The rapidly mounting human death toll from bird flu in Indonesia is concerning experts, who fear the virus will continue infecting people until its spread in poultry flocks is halted. It has accounted for almost one-third of the world's fatalities in the past 12 months.
The latest local tests concluded that a boy and a girl, both aged 16 and living in the outskirts of Jakarta, died from the H5N1 virus this week. Samples have been sent to WHO labs for further tests.
'Indonesia is one of the more worrying areas of the world,' Prof Ferguson said. "The education of the population is not high.
'Along with sub-Saharan Africa, it is one of the areas of the world to be worried about ... much more so than the occasional case in Europe. Here, we will deal with any outbreak effectively. In Africa, there is almost no control, and there is no monitoring.'
Last month, the United Nations Food and Agriculture Organisation warned that bird flu was likely to become endemic in several African nations."

Hematological and biochemical factors predicting SARS fatality in Taiwan.
Chang HL, Chen KT, Lai SK, Kuo HW, Su IJ, Lin RS, Sung FC.
The Center for Disease Control, Department of Health, Taiwan.
J Formos Med Assoc. 2006 Jun;105(6):439-50.
BACKGROUND/PURPOSE: Severe acute respiratory syndrome (SARS) has a high fatality rate worldwide. We examined the epidemiologic and clinical factors associated with death for all laboratory-confirmed SARS patients in Taiwan. METHODS: Using initial data in medical records reported by hospitals to the Center for Disease Control in Taiwan, we analyzed whether hematological, biochemical and arterial blood gas measures could predict fatality in 346 SARS patients. RESULTS: Both fatalities (n = 73; 21.1%) and survivors had elevated plasma concentration of initial C-reactive protein (CRP), but the mean CRP concentration was higher in fatalities (47.7 +/- 43.3 mg/L) than in survivors (24.6 +/- 28.2 mg/L). Initial lymphocyte counts were low in both fatalities (814 +/- 378/microL) and survivors (1019 +/- 480/microL). After controlling for age and sex, multiple logistic regression analysis showed that hematological factors significantly associated with fatality included initial neutrophil count > 7000/microL (odds ratio [OR] = 6.4), initial CRP concentration > 47.5 mg/L (OR = 5.8) and lactic acid dehydrogenase (LDH) > 593.5 IU/L (OR = 4.2). Factors significantly associated with initial CRP concentration > 47.5 mg/L included dyspnea (OR = 4.3), red blood cell count < 4.1 x 106/microL (OR = 4.3) and serum aspartate aminotransferase > 57 IU/L (OR = 3.1). CONCLUSION: Initial neutrophil count, CRP and LDH levels are important predictors of mortality from SARS.
PMID: 16801031 [PubMed - indexed for MEDLINE]

"SARS: Death rate higher than thought
May 7, 2003
Britain - In the first major epidemiologic study of the SARS epidemic completed after the Chinese government health officials allowed researchers access to examine all known and suspected cases of SARS, the findings indicate that the infection rate of SARS may be much higher than previously believed - up to 55% in persons 60 and older and 13.2% in persons younger. These findings come from analysis of 1,425 patients suspected of having SARS admitted to Hong Kong hospitals from February 20 to April 15, 2003. The mortality rate was estimated at 19.9%, which is near 20 times higher than the influenza pandemic of 1918 which had a mortality rate of 1% or less. This would make SARS among the most lethal of infectious diseases, even higher than HIV, known to man at this time. At the moment there is no definitive diagnostic test for SARS which makes studying the statistics of the disease a difficult challenge. It could be that once such a test is in place many more people thought not to have SARS will test positive for it. It is thought that some people can be infected with the virus, not become ill with it, or become very mildly ill, carry it and infect others who might go on to become fatally ill. As with most viruses, the health of the immune system of the person who contracts the virus is crucial to that person's survival.
Meanwhile in China, 8 new deaths from SARS has been reported and Chinese Premier Wen Jiabao comments that the situation in Beijing "remains grave", with a total fatality count now up to 214 persons. People in the region continue to wear respiratory masks and observe good public hygiene such as washing hands after touching surfaces, or even wearing rubber gloves.
The study was completed by researchers from the Imperial College of London, the University of Hong Kong, and the Hong Kong Health Department and were reported by the British medical journal, The Lancet, on their website, www.lancet.com."

"SARS Death Rate Doubles In Polluted Cities
Source: University Of California - Los Angeles
November 20, 2003
A new study led by researchers at the UCLA School of Public Health associates air pollution with an increased risk of dying from Severe Acute Respiratory Syndrome, or SARS.
Published this week in the peer-reviewed journal Environmental Health: A Global Access Science Source, the study shows that patients with SARS are more than twice as likely to die from the disease if they come from areas of high pollution.
'Long-term and short-term exposure to air pollution has been associated with a variety of adverse health effects including acute respiratory inflammation, asthma and chronic obstructive pulmonary disease -- and now SARS,' said Dr. Zuo-Feng Zhang, a professor of epidemiology at the UCLA School of Public Health and a leading scientist of the study. 'Our findings suggest that caregivers need to pay close attention to exposure to pollutants in the living and working environments of SARS patients. These factors and others related to exposure to airborne toxins could leave some individuals at greater risk of death from the illness than others.'
Since November of 2002, 5,327 cases of SARS have been diagnosed in mainland China, and so far 349 patients have died from the disease. SARS death rates vary between regions of the country, with higher rates in the north of China.
A team of researchers from the UCLA School of Public Health, the Jiangsu Provincial Center for Disease Control and Prevention, and Fudan University School of Public Health investigated whether these differences could be explained by differences in air pollution levels.
Using publicly available SARS data, the researchers assessed the death rates of patients with SARS in five different regions of China. They used data published by the Chinese National Environmental Protection Agency to assess the air pollution levels in these different regions between April and May 2003, when the majority of SARS cases were diagnosed.
The researchers categorized the regions according to their level of air pollution. Guangdong, with an air pollution index of 75, was said to have a low level of pollution; Tianjin, with an air pollution index of more than 100, a high level of pollution; and Shanxi, Hebei and Beijing, moderate pollution levels.
Mortality rates of patients with SARS increased as pollution levels increased. In regions with low air pollution, the death rate was 4.08 percent, whereas in areas with moderate or high air pollution levels, the death rates were 7.49 percent and 8.9 percent, respectively.
The researchers were unable to examine the socioeconomic status or the smoking habits of the SARS patients, nor did they consider the treatment that the patients were given. All of these may have contributed to the patients' outcome.
However, the two regions with the highest case fatality rates were Beijing and Tianjin. The researchers suspect that patients would probably have received better clinical support in these areas. If this is the case, then air pollution may play an even greater role in increasing death rates than their data suggests.
Other researchers involved in the study included Yan Cui and Roger Detels of the epidemiology department at the UCLA School of Public Health; John Froines of the Southern California Particle Center and Supersite, and UCLA School of Public Health; Jinkou Zhao and Hua Wang of the Jiangsu Provincial Center for Disease Control and Prevention in Nanjing, China; and Shun-Zhang Yu of the School of Public Health at Fudan University in Shanghai, China.
###
The UCLA School of Public Health is dedicated to enhancing the public's health by conducting innovative research, training future leaders and health professionals, translating research into policy and practice, and serving local, national and international communities. Detailed information about the school is available online at http://www.ph.ucla.edu."

"Bird Flu Spreads to Tula Village
www.kommersant.com
8.8.2006
The actions of unprecedented safety have been taken in Yandovka following the disclosure that the bird flue might have reached that village of Tula Region and approached Moscow. Yandovka villagers, where over 300 chickens, ducks and geese died in the seven private farms over a few days, have been offered to sell all poultry at 100 ruble per unit. The authorities have blocked all access roads and introduced the quarantine.
The tissue samples from Yandovka's dead poultry were forwarded for bird flue virus tests to Moscow and Vladimir Region. The main symptoms are joints’ induration, heads thrown back and higher temperature, i.e. the bird flue (virus H5N1), which outbreak was registered in Siberia in summer, might have approached that village, carried, perhaps, by wild ducks. The test results are expected by late this week.
No cases of people with some strange diseases have been reported so far, said Lidiya Shishkina, chief sanitary physician of the Tula Region. Preventive vaccination against the ordinary flue is currently underway there, Yandovka residents are vaccinated urgently and free of charge, with all costs referred to the municipal budget, local physicians pointed out."

When was the last time we heard H5N1 news about Pakistan striken by a powerful earthquake in 2005?

"Angola Press Agency (Luanda)
August 3, 2006
Posted to the web August 3, 2006
Sumbe
A total of 6000 people died during the first semester of this year at the 17 de Setembro Hospital, in Sumbe city, central Kwanza Sul Province, victims of malaria.
According to the clinic director, Madalena Gouveia, during the referred period were admitted in the institution at least 19,000 patients, among them 90 percent were children under five years old.
The source added that the number of deaths reflects the late appearance of the patients in Hospital.
The official appealed the population to use insecticide treated mosquito-nets, with a view to reducing the rate of malaria.
Madalena Gouveia advanced that the hospital has sufficient medicines to assist the patients who come in a serious condition.
The 17 de Setembro Hospital has the capacity to hospitalise 200 patients. The Works are guaranteed by 26 doctors, among Angolans and foreigners, 154 nurses and 51 technicians of diagnostics and therapy."

A brief calculation: In a half year, if all the doctors are at work all the time, there are dying nine patients per week per doctor of malaria.

"Recombinomics Commentary
August 4, 2006
Yesterday Indonesia pledged to release the H5N1 human sequence sequestered in the WHO private database. Today the password protection on the sequences was removed and the sequences became publicly available. Analysis of the sequences can help determine origins and predict targets for vaccines. Orgins can be traced by monitoring informative polymorphisms.
Below is one such series, showing the similarity between the various human isolates and relationship to other H5N1 bird flu sequences at Genbank or Los Alamos.
---"

"Chinese Start Another Mass Dog Slaughter
By CHRISTOPHER BODEEN, Associated Press Writer
4 Aug 2006
SHANGHAI, China - A second Chinese city plans a mass dog slaughter to control a rabies outbreak, state media said Friday, days after a similar cull in which dogs were beaten to death prompted a torrent of criticism.
Officials in the eastern city of Jining said Thursday they would kill all dogs within three miles of areas where rabies had been found, the official Xinhua News Agency said.
The measure came in response to the deaths of 16 people from rabies in Jining in the last eight months, Xinhua said. It didn't say when the cull would begin or how the animals would be killed. It said the city had about 500,000 dogs.
Rabies cases are on the rise in China, with more than 2,000 people dying from the disease each year. Only 3 percent of the country's dogs are vaccinated against rabies.
Last week, a county in southwestern Yunnan province killed 50,000 dogs after three people died of rabies. The massacre provoked unusually pointed criticism in state media, while the activist group People For the Ethical Treatment of Animals called for a boycott of Chinese products.
Other slaughters have been reported elsewhere in China this year, although the government says it has no standard policy of destroying dogs.
'I think this is completely insane,' Zhang Luping, founder of the Beijing Human and Animal Environmental Education Center, said Friday in response to Jining's announcement.
'What's more, this really damages our national image and sets a really bad example to show how lazy and inconsiderate those local government officials are,' Zhang said.
Zhang said there were no laws under which citizens could stop the killings, but said she and other animal protection activists were reaching out through the media to try to change policy.
'I think this brutal and cold-blooded campaign should stop as soon as possible,' Zhang said.
People answering phones at Jining's city government and epidemic control center refused to comment or said they weren't authorized to release information to media.
The World Health Organization has not directly criticized the slaughters, but WHO experts have said they underscore a lack of coordination and other problems with China's health care system.
The killings have prompted widespread commentary in state media and online forums, with opinions strong divided.
Rabies attacks the nervous system. In humans, it normally results in death within a week after symptoms develop."
*****
Why would the officials slaughter only dogs when rabies infects all mammals? Why not also the cats, cows, goats and so on including wild animals? It must be cheaper just to drop vaccination baits from an airplane all over the countryside for animals to eat than hire quite a bunch of people to hammer down the neighbourhood dogs (500 000?) by hand in the middle of the night.

You are now encouraged and have received an invitation to nominate candidates eligible for the Capua Prize for publishing sequence data on H5N1 strains in GenBank, the public database of genetic sequences.
The candidates eligible for the Capua Prize of scientific community are those nominated by persons concerned about the imminent pandemic (like you) who have received an invitation from the Capua Prize Committee to submit names for consideration. No one can nominate himself or herself.
The names can be submitted into this thread. The deadline for submission is the start of the next pandemic. Prize winners are chosen by the Capua Assembly which chooses the Prize Winners through a majority vote. The Assembly consists of people that survived the pandemic. The decision is final and without appeal. The names of the Prize Winners are announced after the third pandemic wave.
The Prize Award Ceremony takes place on the first post-pandemic anniversary of the day when the WHO announced the phase six. The Prize Ceremony takes place in the capital of the country of the first phase six outbreak. The Prize Winners then receive the Capua Prize consisting of a medal, diploma, and a document confirming the prize amount of gold.
Let the nomination process begin!

On behalf of the Capua Prize Committee,
Thinlina of the Penumbra of Pandemia
4.8.2006

Japan team to use monkeys for bird flu tests
Sat Jul 29
9:11 AM ET
TOKYO (AFP) - A team of Japanese reseachers plans to use monkeys for testing the effectiveness of a vaccine against the H5N1 strain of the bird flu virus.
Researchers from Hokkaido University and the Shiga University of Medical Science will carry out the tests on long-tailed macaques, also known as crab-eating monkeys, Kyodo News reported Saturday. The results are expected within about six months.
The experiment could shed light on aspects of the infection mechanism of the viral strain that remain a mystery, and pave the way for a human vaccine, the researchers said.
'The highly virulent H5N1 strain virus could kill mice and chickens when they were infected with it but it remains unknown what exactly would happen for monkeys,' Kazumasa Ogasawara, a Shiga professor, told Kyodo.
'Monkeys have immune system cells akin to those of humans, so the research should also be useful in devising measures against infection in humans,' he said.
The researchers had so far given the vaccine to seven monkeys, and six of them have developed a type of antibody that appears to have removed the virus from their bodies, Kyodo said.
In the planned test, the researchers will infect those six as well as three non-vaccinated monkeys to check what symptoms appear."

"Wed 2 Aug 2006
ProMED-mail
NewsRoom Finland, Virtual Finland, Wed 2 Aug 2006 [edited]
Health authorities in the Tampere region of Finland reported on Wed [2 Aug
2006] that at least 300 people have fallen victim to the food poisoning
epidemic that struck the region late last week [see: Food poisoning, salad
- Finland (W Finland) 20060731.2116]. The culprit appears most likely to be
a norovirus, present in all patient samples.
The food poisoning was contracted from a salad eaten at 9 different
workplace canteens in Tampere and 3 in Valkeakoski. Although the canteens
belong to more than one chain, the salad ingredients originated from the
same source.
--
ProMED-mail
[The number of people in the Tampere region of Finland affected by food
poisoning has doubled since the initial report of the outbreak on Mon 31
Jul 2006. The number may yet increase, since the cause of the outbreak has
been attributed now to norovirus contamination of a salad distributed to
several canteens from a common source. Noroviruses are highly infectious
ubiquitous enteric viruses which can be transmitted either from
environmentally contaminated food and water or directly from an infected
individual. Therefore, there may be some secondary spread of infection from
those suffering the effects of food poisoning. It remains to be determined
whether the infection was associated with a particular ingredient of the
salad or whether the infection originated from an infected food handler
preparing the salad prior to its distribution. Further information is awaited.
A map of Finland showing Tampere in the Province of Western Finland in
south west Finland can be found at: http://www.mapsofworld.com/finland/maps/finland-political-map.jpg. - Mod.CP]"
*****
This might be a good sociographic and timeline simulation of easily spreadable pandemic starting from only one person.

Global Corporations Struggle to Plan for Pandemic
July 10, 2006
Consumers Affairs
A significant majority of global corporations currently have either a detailed avian flu pandemic readiness plan in place or are in the process of developing a plan, according to a report released by The Conference Board.
Nearly three-fourths of the 553 responding global companies either have a plan or are well into developing one, and 85 percent of the survey participants began their planning efforts within the last 12 months.
'As concern about the possibility of an avian flu pandemic becomes increasingly widespread across the globe, a large number of companies are taking steps toward adopting a risk mitigation strategy,' says Amy Kao, co-author of the report from The Conference Board with David J. Vidal, Research Director, Global Corporate Citizenship, The Conference Board.
'The effectiveness of business plans and the quality of relationships necessary for their successful implementation in times of extreme public, private and social stress remains open to question,' Vidal added.
Of the one quarter or so responding companies without a specific avian flu pandemic preparedness strategy, about half of them simply do not see such planning as a current business priority; while 20 percent feel that their existing business continuity plan is adequate to manage the threat.
'Small and privately held companies represent the majority of those without an avian flu plan and are therefore the organizations most vulnerable to the risks of a pandemic,' say Kao and Vidal.
Large and publicly held companies appear to be the most advanced in their preparations for a possible avian flu pandemic. Approximately 95 percent of companies with more than $5 billion in sales either have an up-to-date preparedness plan or are in the process of planning. But, 65 percent of companies with less than $100 million do not yet have any plans specifically in place addressing the impact of an influenza pandemic.
---
No Coordination
According to The Conference Board report, the most significant disadvantage in not conducting formal pandemic preparedness planning may be the virtually total absence of coordination with the public sector.
An overwhelming 94 percent of participating companies report that they have not had discussions with any level of government officials about their organization's ability to provide essential services or access to facilities, equipment, or staff during a pandemic.
In addition, the gap in readiness efforts is significantly felt between those companies in critical industries and non-critical industries. A critical industry is defined as those designated by government as vital to national economic continuity in a crisis. Companies in the healthcare, energy/utilities, chemical manufacturing, and computer/technology manufacturing industries ranked at the top for either having a plan in place or being in the process of planning.
Health care and computer/technology manufacturing industries are farther along in their planning efforts, with 30% of those in both industries having a complete plan ready in the event of a pandemic.
---
Identifying critical positions within an organization constitutes a basic first step toward minimizing business disruptions. A third of companies have completed the task; just under half are in the process of identifying critical positions, and the remaining 20 percent have not yet begun the process but plan to do so in the future.
---
'While telecommuting may alleviate some business disruption, the downstream effects stemming from supply chain disruption will likely remain significant," says Kao. "In fact, about half of survey participants predict that impact from delivery and supply chain disruptions will be very serious or extremely serious.'
---
There doesn't seem to be a strong consensus on any specific criterion that would activate an organization's pandemic preparedness plan. Close to one-third of the survey participants report that their plan will be activated when the World Health Organization (WHO) declares Alert Level 4 (increased human-to-human transmission)."

"Robert Roos
Feb 14, 2006
CIDRAP News
---
Careful risk assessment urged
Attorney Cheryl Falvey advised business leaders to carefully assess the risks a flu pandemic would pose and then take documented steps to limit them. Falvey is a partner with Akin Gump Strauss Hauer and Field LLP in Washington, DC.
She said the pandemic threat poses a dilemma for preparedness advocates in business. 'Pre-pandemic we can sound alarmist, yet post-pandemic we can look as if we didn't do enough,' she said.
The foreseeable consequences of a pandemic, she said, include economic losses, supply-chain disruptions, employee absenteeism, quarantines and travel restrictions, an increase in demand for health care, and a decline in tourism.
Falvey invited business people to imagine what kind of lawsuit they could face in the aftermath of a pandemic.
'You need to develop a record to show that management has met its obligations to its various constituencies,' such as customers, employees, shareholders, subsidiaries, and the community, she said.
Most juries in liability suits understand that accidents happen and human errors occur, Falvey said. 'What juries don't forgive is a failure to assess, a failure to act, to commit money and resources to deal with a problem,' and to involve top management in that effort, she said.
'Jurors want to know that there was an adequate planning process and that all possibilities were considered, and they were balanced,' she said.
For example, Falvey said she represented a refinery operator in Belize that worked for years to prevent an explosion. The company had a computerized alarm system, and officials worked with neighborhood groups and local doctors to prepare them to respond.
Despite the precautions, the feared explosion finally occurred—and the computerized alarm system failed in the event, she said.
When the company landed in court, Falvey reported, 'What happened was that the jurors respected the process of planning and due diligence. . . . They didn't penalize the company for a failed alarm system, because there was a documented record of monthly tests. That kind of evidence of planning and proactive efforts at mitigation and relief helps limit your liability.'
Echoing a point made by Cooper, Falvey urged businesses to make sure they have sick leave and medical policies that don't discourage workers from staying home when sick.
She also advised the audience to educate their employees on pandemic-related risks and on company policies.
'I think it comes down to the concepts in the law of foreseeability and reasonable response to foreseeable risks,' she concluded.
In a question period later, Falvey was asked how aware the business world is about the pandemic threat. 'I don't think everyone is getting it, but companies that provide pandemic-related products and services are,' she said. 'There's lots of movement at the highest levels in America to plan for this.'
Osterholm was asked if he would advise people to stockpile oseltamivir. In reply, he admitted that he has stockpiled some himself, as have colleagues who have been known to counsel the opposite. But he also said it's essential to make sure there are adequate supplies of antivirals and other medical products for healthcare workers and first responders."

"7 tested for virus from same village
Seven Indonesians from the same village in North Sumatra have been hospitalized and are being tested for bird flu, an official said yesterday, raising fears of new cluster cases in the country.
The group comes from Karo district in North Sumatra province where bird flu killed as many as seven people in an extended family in May, triggering fears the H5N1 bird flu virus had mutated into a form that could spread easily between people.
'Whether it is a new cluster or not, that must be scientifically proved,' said Runizar Ruesin, head of the bird flu information centre at Indonesia's health ministry.
He said the seven were admitted to the local Kaban Jahe hospital, with three referred to a state-run hospital.
The latter three are children two siblings aged 10 and six and their 18-month-old neighbour.
'I am still waiting for the result of the tests,' Ruesin said.
Another official said chickens in the area where they lived had died and tested positive for bird flu. Sick poultry is the usual mode of transmission of the disease, endemic in birds in about two-thirds of the country's provinces.
Health Minister Siti Fadilah Supari, Agriculture Minister Anton Apriyantono and Welfare Minister Aburizal Bakrie travelled to Karo yesterday to assess the situation, but were jostled by villagers angry about a planned bird culling.
The seven being tested are from the village of Sumber Mufakat, in the same district as the case in May.
Source: China Daily

Briefly in english:

"Finland preparing for pandemics
Finnish hospitals are preparing for pandemics, even though the bird flu hasn't arrived in Finland yet. The migrating birds of autumn that fly over Finland are not from the bird flu hot zones. So the risk to catch influenza is small.
Hospital districts were promised altogether 2,5 Me for preparing for pandemics. The money is meant for the rest of this year.
The Public Health Organization of Finland (Kansanterveyslaitos) received also funding to organize a 24/7 H5N1 laboratory service.
The Finnish researchers anticipate a pandemic to arrive in Finland, but don't know when."
*****
So: The researchers are anticipating a pandemic to arrive in Finland, not only bird flu.
But why wouldn't the migrating birds come from H5N1 hot zones? Many of them are after all from Russia, in where H5N1 has been found - especially in Siberia.

"Suomessa varaudutaan pandemioihin
Suomen sairaaloissa valmistaudutaan pandemioiden varalta, vaikka lintuinfluenssa ei ole vielä Suomeen kulkeutunut.
Syksyllä Suomeen lentävät muuttolinnut eivät ole lähtöoisin tautialueelta, joten influenssariski on pieni.
Sairaanhoitopiirit saivat pandemiatyöhön loppuvuodeksi 2,5 Me. Kansanterveyslaitoksen saamalla tuella puolestaan järjestetään ympärivuorokautinen päivystys.
Suomalaistutkijat odottavat pandemiaa Suomeen, mutta ajankohdasta ei ole tietoa."
*****
Eli Suomeen odotetaan siis pandemiaa, ei vain lintuinfluenssaa.
Mutta miten niin syksyllä Suomeen lentävät muuttolinnut eivät olisi lähtöisin tautialueilta? Niistähän iso osa tulee Venäjältä, missä lintuinfluenssaa on löydetty monilta alueilta, varsinkin Siperiasta.

Blackout' threat to bird-flu analysis
02 August 2006
By DAN EATON
Indonesia is failing to send bird flu samples to official laboratories, creating a 'data blackout' that could have serious implications for New Zealand as it seeks to ward off a pandemic.
Experts said submitting samples for testing at United Nations-approved facilities was key to global surveillance of the virus, which it is feared will mutate into a form easily passed between people.
They also warned new research unveiled this week in the United States, in which scientists failed to combine the deadly H5N1 strain with common flu in a way that could cause a pandemic, was not as encouraging as it might seem.
'I think the situation in Indonesia is worrying for the rest of the world, and it is rapidly catching up, in terms of the number of outbreaks in poultry species, with Vietnam,' said Lance Jennings, a Christchurch virologist.
Jennings, who works as a consultant for the UN's World Health Organisation (WHO), said some samples from indonesia were getting out.
'One of the major issues with a number of countries is that they are putting caveats on those samples; for example, that the information is not allowed to be widely disseminated,' he said.
He said the WHO was working to try to find a resolution. 'The WHO does manage a global influenza surveillance network and it is imperative that countries do contribute openly to this network.'
Experts say some countries have been reluctant to disclose the extent of bird flu infection for fear of sowing panic and damaging tourism.
The weekly scientific journal Nature on July 28 reported that few, if any, avian flu samples from Indonesia had been sent to official laboratories for sequencing over the past year.
It said the data blackout came as surveys of the country were revealing a startling number of previously unrecognised avian flu outbreaks. Peter Roeder, a consultant with the UN Food and Agriculture Organisation in Indonesia, said the first samples since August last year had finally arrived at the World Organisation for Animal Health reference library in Geelong, Australia.
Without proper sequencing of bird flu viruses, it is difficult to tell whether they are mutating or how human cases correspond to those in birds. Seven bird flu deaths in an Indonesian family this year led to fear the virus could spread from one person to another as no nearby avian source could be identified.
'It's not really surprising in countries like Indonesia that there are possibly unrecognised pockets of infection still bubbling away,' said Environmental Science and Research (ESR) health general manager Fiona Thomson-Carter.
'Quite frankly, Indonesia probably doesn't enjoy First World public health services,' she said.
ESR is the New Zealand agency that monitors new organisms and holds the national collection of medical bacteria and viruses.
Thomson-Carter said the failure by US scientists to create a pandemic virus should not get people too excited. 'What nature accomplishes very elegantly, scientists struggle to mimic in a laboratory situation.'
However, it was encouraging to know that should terrorists get hold of the virus they would face significant challenges. 'The notion of the white-coated boffin being able to unleash merry hell on the world doesn't always hold,' she said.
Biosecurity chiefs this year imported a small quantity of the H5N1 virus and are keeping it under tight security at a lab in Upper Hutt. Lab manager Joseph O'Keefe said Kiwi scientists would not be conducting US-style experiments."