Penumbra Pandemia

"EPIZOOTIC HEMORRHAGIC DISEASE, CERVIDS - USA (TEXAS)
A ProMED-mail post
15 Sep 2006
From: Brent Barrett
Source: KXAN.com [edited]
--- a rash of deer deaths in west Central Texas has caught the
attention of wildlife experts. The cause could be epizootic
hemorrhagic disease. ---
Every year, officials expect to see at least some disease in the deer
population. Some years may be worse than others. Some of it has to do
with their close proximity to humans.
'When you have animals that are in high density or in close proximity
to one another, you have an increased opportunity for disease to be
spread from one animal to the next,' Schwausch said.
Experts say there's no health threat to humans. Nonetheless, it is
natural to be cautious.
'Anytime you find an animal carcass or animal found dead, you want to
take precautions. Just not mess with them or handle the animal,
especially if you don't know why it died,' Schwausch said."

Bird flu after 22 months
Posted on: September 27, 2006 7:19 AM, by revere
on The Effect Measure blog
"--- We know much more about the virus than we did two years ago, but some of what we have learned is that what we thought we knew was wrong. That's progress, but of a peculiar sort. Still no effective vaccine in production and no likelihood of significant quantities for several years, if then. Uncertain quantities of antivirals on hand and with uncertain efficacy. And public health systems still tottering on the edge, with social service systems weakened as well. ---"

59-year-old man from Nong Bua Lamphu was yesterday declared the latest victim of bird flu
He was the first person to undergo nine PCR tests, yet the virus was still not detected until an autopsy was conducted on tissue taken from his lungs and faeces, he said.
That PCRs failed to detect the virus could be because of the effects of oseltamivir, which might have prevented the virus from being present in the respiratory-tract areas where swabs were taken for testing, according to Dr Tawee Chotpitayasundond, of the Queen Sirikit National Institute of Child Health.
The above comments describe confirmation of a fatal H5N1 infection in a patient in Thailand who died almost a month after being admitted. Although H5N1 was present during the entire time of hospitalization, it was not detected until autopsy in spite of running 9 PCR tests.
The data raise serious questions about the WHO reliance on PCR test to confirm H5N1bird flu infections, especially on samples collected after Tamiflu treatment has begun. The number of false negatives in Thailand is not known, but the number of such negatives in Indonesia is likely to be high, especially in pandemic regions where Tamiflu blankets are applied.
The recent outbreak in Garut in West Java in Indonesia is an example of such false negatives. Patients linked to three separate clusters where H5N1 confirmed, but initial cases died prior to sample collection and subsequent patients were tested after the Tamiflu blanket was applied. Consequently, only three of the more than 20 hospitalized patients were confirmed.
There are three current clusters being reported in Indonesia. In two of the clusters, H5N1 has been confirmed. However, several patients are` improving after initiation of Tamiflu treatment and have not been reported to be H5N1 positive.
The recovered patients should be tested 3-4 weeks after disease onset to determine if they have neutralizing H5N1 antibodies, signaling a recent H5N1 infection. Without these additional tests, the extent of H5N1 spread among contacts of the index cases will remain unclear and the repeated false negatives will create a significant undercount in the number of cluster and length of transmission chains."

"Suspect Fatal H5N1 Cluster in Medan North Sumatra
Recombinomics Commentary
September 26, 2006
--- The profile of this cluster is similar to many clusters in Indonesia and elsewhere. Because of the large number of clusters and high fatality rate, the use of Tamiflu has become more common. However, the extent of H5N1 infections and transmission in Indonesia is clouded because of the lack of data on convalescent antibody levels in recovered contacts.
This pattern became very clear in the Garut cluster. Although three patients did test positive to H5N1, each was linked to patients who died earlier and were not tested, or patients who were aggressively treated with Tamiflu after they developed symptoms. These patients largely tested negative for H5N1, but there has been no reports on neutralizing antibody levels in recovered patients. The antibody levels typically peak 3-4 weeks after symptoms, so testing of these patients at this time would define the size of the cluster, which involved over 20 hospitalized contacts. ..."

"Canine Link to Suspect Fatal H5N1 Cluster in Bandung Indonesia
Recombinomics Commentary
September 25, 2006
--- In Thailand, the dog, domestic cat, and several wild cat H5N1 isolates have PB2 E627K, which is also in most human isolates from Vietnam and Thailand, but is not found in the Clade 1 H5N1 bird isolates. Moreover, cats and dogs in Thailand have H5N1 antibodies, signaling non-fatal infections. ---"

Summary from Indonesia Outbreak as at 14 September 2006

"New H5N1 Familial Clusters in Sumatra and Sulawesi?
Recombinomics Commentary
September 13, 2006
--- three additional H5N1 confirmed cases in Indonesia which have not been announced. The WHO update of May 29 describes a 15F from West Sumatra who developed symptoms on May 17 and was still hospitalized on May 29. -- suggest that she tested positive and now her 27 year old sister has also tested positive. These two patients would represent a new family cluster in West Sumatra.
Similarly, there has been no report of a recent H5N1 confirmed infection in South Sulawisi. There was a confirmation of a 14F who died on June 24. Her mother and old sister also died with bird flu symptoms prior to the June 24 death, and several additional family members were hospitalized, but media reports suggested that they tested negative and were discharged. --
Although H5N1 bird flu outbreaks in poultry have been reported in North Sumatrra and several locations in Sulawesi, the hospitalized patients were said to have tested negative. The latest comments, coupled with the delayed report of the patient who died June 24 and lack of testing of the relatives who also died in June raise serious questions about H5N1 surveillance and reporting. ---"

Diseased pork sold as healthy roasted pigs in Ho Chi Minh City
Nguoi Lao Dong – Translated by Hoang Bao
Wednesday, August 30, 2006
Thanh Nien News
Diseased pigs are roasted, covered in artificial coloring and strongly scented to mask their spots and rots, and then put on sale as nutritious pork in Ho Chi Minh City.
Nguyen Hong, a resident of District 7 in Ho Chi Minh City, said she recently bought a 10kg roast pig in Nha Be district roasting facility which turned out to be diseased before being cooked.
'On the outside, it looks delicious. After a sacrificial ritual, the pig was brought in to eat. Only then did I discover it was covered in black spots and white grain-like nodules,' she said.
'Almost all pig traders are willing to buy diseased and long-dead pigs', a pork seller in the city told Nguoi Lao Dong newspaper.
At a roasting facility on Phan Van Khoe street near the BaLy Kao bridge in District 6, the newspaper discovered unhealthy, dead or diseased pigs were all accepted here.
The aforesaid area is a hotbed of dodgy roasting facilities, to be avoided by consumers.
Pigs recently dead are immediately 'upgraded' here and put on sale.
Those dead for several hours will be roasted right away if they arrive in early morning when the ovens here are in full swing.
If not at the right time, the pigs will be frozen to wait for early morning.
The newspaper also found that dishonest traders dabbed industrial colorings on the pigs’ bruises or rashes, besides applying a lot of strong spices to drown out the rotten smell.
Instead of colorings, others used malt which will fade away in 5-10 hours, leaving the pork’s spots visible again, Nguyen Thi Nhung, a veteran chef said."

"Vietnam metro to check passengers for bird flu
Thanh Nien News
Source: Agriculture
Tuesday, September 12, 2006
International visitors arriving at Ho Chi Minh City airport will have their body temperatures taken as a precaution after bird flu outbreaks were recently reported in some countries.
Remote temperature-measuring machines using infrared and specialized thermometers are being installed at Tan Son Nhat Airport, ready to operate around the clock.
Those having a temperature of over 38 degrees Celsius would be taken to isolation rooms to test for bird flu.
The task will be carried out jointly by the International Quarantine Center and airport authorities.
The Health Ministry has instructed 14 hospitals in major cities to keep continuous watch to tackle probable outbreaks.
The hospitals and preventive health care centers have been told to ensure the operation of disease surveillance systems around the clock and sufficient supply of facilities for treating bird flu patients.
The government recently instructed state agencies and local administrations to intensify the fight against bird flu, and temporarily ban import of live poultry and poultry products from countries hit by the disease.
Bird flu has killed at least 141 people in 10 countries since December 2003.
Vietnam has registered 42 fatalities, second only to Indonesia where 47 have been killed. No new human cases have been reported since mid-November 2005."

"COA calls for nets to prevent outbreaks of bird flu virus 2006/9/11
http://tinyurl.com/me7tv
TAIPEI, CNA
The Council of Agriculture (COA) called yesterday for chicken and pig farms to set up bird-proofing nets as soon as possible in an attempt to keep wild birds separated from poultry and pigs and prevent outbreaks of avian flu. COA officials said the nets should be set up by the end of this year and warned that farmers who fail to comply will face fines of NT$10,000-NT$50,000.
Migratory birds are considered an avian flu virus-carrying media and Taiwan is a stopover site for various species of migratory birds. The officials said the government will offer subsidies for poultry and pig farmers who set up nets before the end of this year."

"H5N1 replicates more strongly than common flu-study
Hong Kong
Sept 11
Reuters
The H5N1 bird flu virus replicates far more aggressively in people than common human flu viruses, a study of patients in Vietnam has found, offering further insight as to why the virus is so deadly.
The study, in the latest issue of Nature Medicine, also found that the virus had got into the blood stream of many of the human victims it killed, which means the virus could have spread to other parts of the body.
Menno de Jong, a key researcher in the study, explained that the unusually high viral loads triggered intense "cytokine" responses -- an immune system overreaction that can be fatal.
Cytokines are proteins in the immune system that fight off intruders such as bacteria and viruses.
'During H5N1 infection, the (cytokine) response seems to be very, very intense. Cytokines want to get rid of this intruder but if you have very high levels of cytokines, it can also damage the body ... it can be directed against your own cells and organs,' de Jong told Reuters in an interview.
The study involved 18 people infected with H5N1 and 8 with human flu in 2004 and 2005 in Vietnam.
Scientists found far higher viral loads in the nose and throats of those infected with bird flu than human flu.
Thirteen of those infected with H5N1 died and the virus was found in the blood of at least 9 of them, implying it could have been transported out of the respiratory tract.
The virus was also found in the rectums of most of those with H5N1, suggesting it could have spread through the blood stream into the gastrointestinal tract.
Those with common flu had no virus in their blood or rectum. No one died in that group.
'The fatal outcome of H5N1 infections seems to be associated with high levels of replication of the virus and also the detection of the virus in the blood,' said de Jong, of the Oxford University Clinical Research Unit at the Hospital for Tropical Diseases in Ho Chi Minh City in southern Vietnam. ---"

4 Sep 2006
From: Dan Silver
Source: Jiangshan Television [translated by sender, edited]
Recently, the circumstances of pig "high fever illness" have been
relatively severe. In response, Jiangshan is adopting measures to
actively implement prevention and treatment. [Jiangshan -- a common
city name, occurring in several Chinese provinces -- is in this case
a municipality within the larger Quzhou City, situated in the western
part of Zhejiang Province. - CopyEd.PG]
Pig 'high fever illness' is appearing in all areas in our province
[Zhejiang] other than Zhoushan City. There are more than 66 000 ill
pigs and already more than 11 000 have died. Since July, pig "high
fever illness" has appeared in one village after the other in
Jiangshan. Symptoms are elevated body temperature, redness on the
body surface, and cough. Ears turn light blue in a minority of pigs.
The mortality rate among sucklings and weaned pigs is especially
high. To effectively carry out prevention of pig "high fever
illness", the municipal agriculture department strengthens disease
inspection and safe disposal of deceased ill pigs, and guides
pig-raising households to lower temperatures in pigsties, reducing
the occurrence of disease.
On the morning of 4 Sep 2006, Jiangshan held a pig "high fever
illness" prevention meeting. Vice mayor Xu Daqing demanded
heightened attention to pig 'high fever illness' and thorough
implementation of all prevention and control measures, including
sealing off and isolating disease sites, strengthening hygiene and
disinfection, and reducing movement of pigs. At this time, traders
are prohibited from importing breeding pigs from other provinces and
cities to strictly prevent disease from entering Jiangshan and to
ensure the efficacy of disease prevention work.
[Byline: Yu Chunzhou]"

Date: 5 Sep 2006
From: Dan Silver
Source: Suizhou Daily News [translated by sender, edited]
"Yesterday, the provincial government held an urgent, province-wide
videoteleconference [the province in question is Hubei; see URL for
map below] on prevention and control of serious animal diseases,
demanding fast action from all parts of the province, paying special
attention to prevention and control work against the unknown pig high
fever illness, to ensure increased agricultural efficacy and
increased farmer receipts.
Since the middle of July 2006, an unknown pig disease has occurred in
the neighboring provinces of Anhui, Jiangsu, Jiangxi, Hunan and
Henan, and other areas. Already 40 percent of pigs have died from
infection. As of mid-August this disease had already spread to parts
of Hubei. Conditions are relatively serious. According to reports,
the pig disease is characterized by high fever, sudden onset, rapid
transmission, and high mortality rate.
Municipal Government Secretary Yan Xinguo participated in the
conference. He requested all districts of the city to heighten
awareness, formulate vigorous measures, organize with utmost care,
strengthen monitoring, and pay attention to disease trends at all
times. Relevant departments must carry out legal inspections of pig
transports and conscientiously strengthen the intensity of
inspections at border inspection spots. Animal husbandry and other
relevant departments must strengthen market supervision, firmly deal
with disease, and strengthen oversight against disease during
production, slaughter and sale. Once high fever pig illness of
unknown origin is discovered, immediately file reports, quickly
undertake safe disposal, strictly disinfect, work hard against the
sale of dead diseased pigs and pigs that have died of unknown causes,
and ensure the safety of meat on the market. Relevant departments
must suspend purchase of pigs from disease-affected areas to prevent
the spread of pig disease. While prevention and control of unknown
high fever pig disease is being accomplished, strictly watch for
other animal diseases and thoroughly plan prevention and control work
for other serious animal diseases. Organize specialized teams to
supervise disease inspection to ensure substantial progress on
disease prevention in the fall."

"WHO recognises three bird flu cases in Indonesia
08 Sep 2006
Reuters
GENEVA
The World Health Organisation (WHO) said on Friday that it had recognised three more cases of bird flu in Indonesia, one from June and two dating to 2005.
'The retrospectively confirmed cases bring the total in Indonesia to 63. Of these cases, 48 have been fatal,' the WHO said in a statement. The national toll is the highest worldwide. ---"

"H5N1 Garut Cluster Sequences Similar to Western Java
Recombinomics Commentary
September 5, 2006
Sequences from three recent isolates from Indonesia, --- were made public today.
---
One of these sequences appears to be from the second confirmed fatality (35F) of the Garut cluster. Its similarity to recent isolates from the Jakarta / West Java area indicates that the H5N1 in human cases continue to evolve and spread into new areas.
Although there were only three confirmed cases in the Garut cluster, several relatives of the positives died earlier with bird flu symptoms. However, samples were not collected from these contacts, highlighting surveillance failures. This poor surveillance also eliminates clusters, because index cases are not tested. Similarly, the negatives in contacts with symptoms may be false because of the use of a Tamiflu blanket.
Thus, the similarity in the H5N1 in Garut with other human cases on Java suggested that human cases and clusters are far more widespread than indicated by the confirmed cases.
These recent sequences were easily distinguished from the only avian isolate to date with the RESRRKKR cleavage site. Sequence data from birds linked to recent outbreaks in Indonesia would be useful."

Mystery Swine Deaths in Eastern China
Recombinomics Commentary
September 4, 2006
" --- comments on a spreading fatal swine disease in China are alarming on several fronts. There has been little coverage in the press and no diagnosis for the widespread outbreak. The regions affected correspond to locations where the Fujian strain of H5N1 has been reported. H5N1 in swine has also been reported in Fujian province ---
Swine can host swine, avian, and human influenza. Swine are mixing vessels for influenza reassortment and recombination. In Canada, the level of reassortment and recombination in swine has increased in recent years.
Earlier reports to ProMed in 2005 suggested unreported H5N1 bird flu in Fujian, Jiangxi, and Jiangsu was common. The failure to report the large scale swine deaths in the same areas is cause for concern. ---"

"Pig illness in the south, agriculture ministry demands strengthened quarantine
Sun 3 Sep 2006
www.tfol.com
In response to the recent occurrence of pig illness in the south, the
General Office of the Ministry of Agriculture issued a notice yesterday [31
Aug 2006] requiring legally-compliant control and prevention against
transmission or expansion of the disease; requiring increased quarantine
dynamics at sites of production and slaughter; and resolutely implementing
the "four impermissibles, one disposal" for all diseased pigs: no butchery,
no eating, no sale, no transport, and safe onsite disposal.
Since June 2006, a pig disease characterized by rising body temperature,
redness of the skin, and rapid breathing has occurred in portions of Anhui,
Jiangxi, Zhejiang, Hunan, Hubei, Jiangsu, and other provinces. The
Agriculture Ministry's notice requires conscientious implementation of all
control measures: emphasize improvement of disease control and hoghouse
hygiene among small and mid-size breeders (households) and breeding
districts; establish sound disease control systems; strengthen disease
surveillance and epidemiological investigations; promptly find and report
disease; promptly eliminate hidden risks for disease; be strict with
disease handling work; actively undertake appropriate treatment of diseased
pigs; carry out cremation, burial and other safe disposal of dead pigs;
appropriately select vaccines to conduct immunization work; promptly
control and stamp out disease; strengthen supervision over animal hygiene
production, sale and distribution; prohibit pigs that have not passed
quarantine from entering distribution or slaughter; strike hard against
illegal trafficking of diseased pigs and byproducts. ---"

Anchorage Daily News
The Associated Press
September 1, 2006
ANCHORAGE, Alaska (AP) - Hundreds of dead sea birds washed ashore on Unalaska Island over a two-day span and scientists were trying to figure out why.
Several hundred shearwaters died after flying into a crabbing boat early Wednesday morning in Unalaska Bay, said Forrest Bowers, a fisheries biologist for the state Department of Fish and Game in Unalaska.
The boat captain reported a hail of shearwaters struck the vessel for up to 30 minutes, Bowers said. The crew threw the dead and dying birds overboard.
Other boats were in the area and also might have been struck by the birds.
There have been other reports of such occurrences, but not usually in such large numbers, according to Bowers.
Seabird specialist Art Sowls at the Alaska Maritime National Wildlife Refuge in Homer was called in to consult on the deaths. He said shearwaters can be in flocks of more than a million birds. The birds go through a molting process that limits their ability to fly.
'They can fly,' he said, 'but they are somewhat immobile.'
Reid Brewer, a local marine biologist with the University of Alaska Fairbanks, said he counted more than 1,600 bird carcasses on shores near homes in Unalaska and along beaches outside the Aleutian island community.
He said the birds don't look thin and aren't oiled. Some had necks twisted as if they had smashed into something.
Starvation would be a far more likely cause for the deaths than a collision, said David Irons, a seabird authority with the U.S. Fish and Wildlife Service.
'They don't normally run into ships,' he said.
But it is possible, he said, that birds weakened by hunger could have hit boats or that the carcasses washing ashore could be a combination of birds that starved and birds that hit ships.
Irons said he expects that the dead birds will be checked for avian flu but everyone involved with the die-off believes that it is an unlikely cause."