Penumbra Pandemia

"H5N1 Cluster in Gharbiya Egypt Cause Concern
Recombinomics Commentary
December 30, 2006
--- WHO update suggest sequence data on the Gharbiya cluster will be public soon. US NAMRU-3 submitted the HA`sequence, A/Egypt/12374-NAMRU3/2006(H5N1) from the first Egyptian H5N1 case for this season on October 13, two days after confirmation. The HA sequence was cause for concern because it included M230I, a change that extended the identity with influenza B to positions 226-230 (QSGRI). This region of identity is cause for concern because influenza B is efficiently transmitted human-to-human and increased efficiency of transfer generates clusters such as the one described above, which is the largest reported to date in Egypt. Moreover, these cases are much earlier than last season, when the first reported case in Egypt was in February.
Large clusters involving the Qinghai strain are cause for concern because there were several clusters in Turkey, Azerbaijan, and Iraq last season. Changes in the receptor binding domain were found in each cluster. In Turkey, clusters had S227N. In Azerbaijan, clusters had N186K. In Iraq, clusters had N186S and Q196R. All of these changes were in the Qinghai strain, which can readily transport and transmit changes over long distances because the strain is found in long range migratory birds.
Additional receptor binding domain changes have been found in other H5N1 strains, In China, Shanxi isolates has as many as five changes in or near the receptor binding domain (A188E, A189T, T192I, L194I, R220K, K222Q). Hunan isolates had four changes (D187N, A189E, T192I, L194I). Shantou isolates had three changes (K222R, V223I, S227R). One of these changes (V223I) was in a Qinghai isolate from Mongolia, A/bar-headed goose/Mongolia/1/05. Sequence from this isolate have already been traced from Mongolia to Egypt, so these changes could fly into the Middle East and generate additional combinations of receptor binding domain changes via recombination. ---"

"Six month radiological and physiological outcomes in severe acute respiratory syndrome (SARS) survivors.
Ng CK, Chan JW, Kwan TL, To TS, Chan YH, Ng FY, Mok TY.
Department of Medicine, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong. nckz01@netvigator.com
Thorax. 2004 Oct;59(10):889-91.
BACKGROUND: The long term physiological and radiological outcomes of SARS survivors and their possible determinants are uncertain. METHODS: SARS survivors in a follow up clinic in a regional hospital underwent high resolution computed tomography (HRCT) of the thorax and lung function tests 6 months after admission to hospital. The associations between the clinical and demographic data of the patients and the physiological and radiological outcomes were examined. RESULTS: Fifty seven patients took part in the study. Lung function abnormalities were detected in 43 patients (75.4%), with restrictive defects (n = 16) being most common (28.1%). Radiological abnormalities of any degree were detected in 43 patients (75.4%). Only the use of pulse corticosteroids was associated with the presence of CT abnormalities (p = 0.043, OR 6.65, 95% CI 1.06 to 41.73). CONCLUSIONS: Physiological and radiological abnormalities are still present in a considerable proportion of SARS survivors at 6 months.
PMID: 15454656 [PubMed - indexed for MEDLINE]"
*****
Why not such studies done of H5N1 survivors?

Harvinaisia siivekkäitä lintulaudoilla
Julkaistu 25.12.2006, klo 17.20 (päivitetty 25.12.2006, klo 20.21)
Leuto alkutalvi on saanut lintumaailman aikataulut pahoin sekaisin. Joulupäivänä tehtiin harvinaisia joukkohavaintoja useista lajeista.
Espoossa tavattiin päivällä punakylkirastas, Turussa nokkavarpunen ja Himangalla, Keski-Pohjanmaalla mustapääkerttu.
Myös sulapaikoilla ja vesillä on nähty tähän vuodenaikaan harvinaisia lajeja.
Lintuharrastajat saivat kiikareihinsa joulupäivänä muun muassa jalohaikaran Raahessa, pikkujoutsenen Äetsässä, Varsinais-Suomessa, kanadanhanhen Helsingissä ja silkkiuikun Valkeakoskella.
Pirkanmaalla, Vammalan Liekovedellä oli päivällä yli kolme sataa laulujoutsenta ja 70 kanadanhanhea. Jyväskylän lähellä Säynätsalossa nähtiin yli 200 laulujoutsenta.
Normaalisti syys-lokakuussa muuttavia nokikanoja löytyi toista sataa Tammisaaren Stadsfjärdenissä ja Kristiinakaupungin edustalla nähtiin 90 tavallisesti lauhkeilla vyöhykkeillä talvehtivaa mustalintua. Raahessa sinnitteli yksinäinen jalohaikara.
Vääksyn ostoskeskuksen pensaissa Asikkalassa ruokaili kolmisen sataa viherpeippoa. ---"

UNDIAGNOSED DISEASE, FATAL - CHINA (HONG KONG): REQUEST FOR INFORMATION
"Archive Number 20061229.3649
Published Date 29-DEC-2006
Subject PRO/EDR> Undiagnosed respiratory disease, fatal - China (Hong Kong): RFI ---
Date: Thu 28 Dec 2006
From: Dan Silver
Source: Health & Community, news gov hk online
Thu 28 Dec 2006 [edited]
The Centre for Health Protection is investigating the death of 2
local pig farmers who succumbed to a pneumonic illness in the past 6
months. Laboratory tests have not identified a specific bacteria or
virus causing the pneumonia. Further investigations are needed to
ascertain the nature of a possible infectious illness and any
relation it may have with pigs.
A 44-year-old Sheung Shui man came down with fever and cough on 7 Dec
2006. He was admitted to North District Hospital on 11 Dec 2006 and
died of a pneumonia-like illness on 13 Dec 2006. He visited Dongguan
about 20 days before the onset of symptoms, but an association
between this travel and his illness cannot be established yet.
Another case involved a 62-year-old Tsuen Wan man who developed a
similar illness and was admitted to Yan Chai Hospital at the end of
May. He died on 4 Jun 2006. The Centre is following up on his travel history.
Five family members of the 44-year-old patient and a worker at his
farm have no symptoms. Family members of the 62-year-old patient will
be tested. The Centre has also followed up on a pig farmer
acquaintance of the 44-year-old whom he had visited in Queen
Elizabeth Hospital in early December. This acquaintance had a
pre-existing lung disease and kidney problems and had been
hospitalised since the end of October. His clinical presentation was
different from the victims.
The Centre's Consultant Dr Thomas Tsang appealed to pig farmers who
have suffered from pneumonia-like illnesses and required
hospitalisation since 1 Jun 2006 to call 2125 1133 for follow-up advice.
The Centre has been liaising with Mainland health authorities, and
the Agriculture, Fisheries & Conservation Department has reminded
local farmers to report any pig disease outbreak and abnormal pig
death. So far there has been no unusual increase in the mortality
rate of pigs in local farms. There have also been no unusual pig
diseases found. ---"

"More Nigerian states hit by bird flu infection
Sunday, December 24, 2006 14:39:30 Vietnam (GMT+07)
Source: Reuters
via The Thanhnien News
The deadly H5N1 bird flu virus has spread in the last few weeks to two new states in Nigeria and reappeared in two others where it was believed to have been contained, officials said Friday.
Nigeria is one of three countries regarded by experts as the weakest areas in the global attempt to stem infections among birds and head off a potentially devastating human flu pandemic.
The disease was first discovered in the northwest state of Kaduna in February and it spread rapidly in the early weeks to 12 other states and the Federal Capital Territory, despite culling and quarantine measures.
---
'We have never really been free of bird flu. The disease keeps recurring. There were two new cases in Borno and Kwara states in November and we immediately cleaned them up,' Junaidu Maina, head of Nigeria's livestock department told Reuters.
'There were also fresh cases in Kano and Ogun, but these are states that had already been positive,' Maina said by telephone from the capital, Abuja.
Officials say disaffection with the government's compensation system discourages farmers from reporting bird deaths, making it more difficult to detect the spread of the virus.

Movement of livestock
Maina said the new infections may have been triggered by the movement of livestock across the West African country, adding that things could get worse when migratory birds begin to arrive from other infected areas.
---
Nigeria was the first African country to be hit by the highly pathogenic virus, but it has not reported any human cases of the disease although experts warn that surveillance may not be completely effective and cases may have gone undetected.
---
Thousands of poultry have died or become infected in Nigeria since the H5N1 virus was first detected, hitting farmers badly.
Many Nigerians live on less than a dollar a day and are too poor to afford the luxury of rejecting infected or dead chickens, raising concern among experts on bird flu that Nigeria is at risk of becoming a permanent host to the virus.
The risk is elevated with Christmas and the Muslim Eid festivals only days away because consumption rises."

Central Vietnam facing imminent bird flu threat
Source: Tuoi Tre, Thanh Nien – Translated by Tuong Nhi
Thanhnien News
Saturday, December 30, 2006 11:48:09 Vietnam (GMT+07)
About 73 percent of poultry samples came back positive for H5N1 virus in the central province of Quang Nam, reported an official from the Ministry of Agriculture and Rural Development on Friday.
Hoang Van Nam, deputy head of the ministry’s Animal Health Department said the result had put the central region on red alert for bird flu outbreaks.
The seasonal migration of birds and cool weather create a ripe environment for the virus to spread, especially as H5N1 has already been found in poultry, Nam warned.
To date the disease has spread to 10 communes in six districts in three Mekong Delta provinces namely Bac Lieu, Ca Mau and Hau Giang.
Hau Giang’s animal health department said they had quarantined and sterilized infected sites to isolate the outbreak.
Within the last several days in Bac Lieu, relevant agencies had slaughtered thousands of poultry and inoculated another 170,000 fowl.
In Ca Mau and Soc Trang, six people were isolated with bird flu symptoms after eating chicken, and local health centers had taken their samples for tests.

China crisis
Ho Chi Minh City’s market control bureau said illegal poultry trade and transport had increased considerably with 106 cases, more than three-fold those from last week.
In the northern province of Lang Son, poultry trafficking from China was exploding with hundreds of tons of fowl illegally transported into Vietnam daily, which local authorities could not fully control.
Officials said poultry smuggling flared up because domestic fowl prices were rising while smuggled fowl from China was much cheaper.
They added smugglers could benefit substantially from their business, especially in months ahead of the Lunar New Year holiday when fowl demand peaks.
Prime Minister Nguyen Tan Dung assigned 11 relevant ministers to be heads of bird flu control task forces in regions nationwide.
Tran Thi Trung Chien, Health Minister launched Friday a nationwide campaign for January, urging people to sanitize the environment, especially in poultry breeding farms to control the outbreak.
Under the campaign, localities were guided to keep surveillance on poultry trade and transport, especially at border check points.
Local health centers were ordered to prepare medicines for the fight against avian influenza in humans in the event of an outbreak and increase food hygiene inspections.
Since the virus first arrived in Vietnam in late 2003, it has killed 42 of the 93 people infected, second only to Indonesia's 57, according to the World Health Organization (WHO).
WHO said the influenza had killed more than 150 people worldwide since late 2003, and prompted the slaughter of tens of millions of poultry.

"Vietnam reports suspected bird flu cases
The Times of India
30 Dec, 2006 1232hrs ISTAP
HANOI: Four members of a family in southern Vietnam have been admitted to a hospital with symptoms of bird flu, a doctor said on Saturday.
A 36-year-old woman and her three children aged three to 13 were admitted to Namcan hospital in Camau province between Monday to Thursday with fever, coughing, decreased blood white cells and damaged lungs, said Ho Van, a doctor at the hospital.
The family had four chickens and five ducks, he said, adding that they ate one of the chickens, which had fallen sick and died, on December 23.
Swab samples from the four patents have been sent to the Pasteur institute in Ho Chi Minh city to test for the deadly h5n1 strain of bird flu, van said. ---"

South Korea slaughters thousands of pigs to stem spread of bird flu
The Associated Press
Published: December 23, 2006
SEOUL, South Korea
South Korean quarantine workers slaughtered thousands of pigs on Sunday, as the country struggles to stem the spread of bird flu, an official said.
Nearly 4,200 pigs were killed at a farm in Asan, about 90 kilometers (55 miles) south of Seoul, where a case of bird flu — South Korea's fourth in less than a month — broke out last week, said Yoon Chang-hee, an official at the South Chungcheong provincial government.
Yoon declined to give a reason for the measure, only saying there was an Agriculture Ministry instruction to cull all pigs within 500 meters (547 yards) of the outbreak site.
Ministry officials were not immediately available for comment, but Yonhap news agency said pigs are vulnerable to respiratory diseases and could spread viruses.
In the first two bird flu outbreaks last month, South Korea slaughtered pigs, dogs and 14 unspecified animals within a 3-kilometer (1.9 miles) radius of the outbreak sites in Iksan, about 250 kilometers (155 miles) south of Seoul. ---"

"Egypt faces grim bird flu situation
www.chinaview.cn 2006-12-29 06:25:45
CAIRO, Dec. 28 (Xinhua) -- Egypt witnessed three human bird flu death cases in only four days, the death toll of the human bird flu cases in the country rose to 10 and aroused some worries about spreading of the deadly disease.
Reda Abdel Halim Farid, a 26-year-old man from a big family living in the Egyptian Delta governorate of Gharbiya, some 90 km north of Cairo, died of the deadly H5N1 virus on Wednesday, became the third casualty in a week after another two members of the family, a 30-year-old woman and a 15-year-old girl, who died on Sunday and Monday respectively.
On the current bird flu situation in Egypt, Egyptian Health Ministry spokesman Abdel Rahman Shahine told Xinhua that the situation seems to be dangerous but it is under control, specially as people start to recognize how dangerous the virus is and directly inform the authorities of any suspected cases.
---
For his part, Egyptian Ministry of Environment senior official Ahmed el-Emary said that there would be serious problems during next March, the birds immigration season, when hundreds of birds come from the EU through Egypt on their way to Africa.
---
The first bird flu case in Egypt was found in dead poultry on Feb. 17, 2006 and then the virus spread to 20 of the country's 26 governorates, with the first human bird flu case in the Arab country reported on March 18, 2006.
Since then, a total of 18 reported human bird flu cases have been reported, among which 8 persons were cured."

"UNDIAGNOSED DEATHS - INDONESIA (JAKARTA): REQUEST FOR INFORMATION
Archive Number 20061228.3637
Published Date 28-DEC-2006
Subject PRO/EDR> Undiagnosed deaths - Indonesia (Jakarta): RFI
****************************************************
A ProMED-mail post
International Society for Infectious Diseases
Date: Thu 28 Dec 2006
From: Dan Silver
Source: The Jakarta Post, Associated Press report, Thu 28 Dec 2006 [edited]

Indonesian health officials are investigating the deaths of 22 people
in the capital Jakarta over a 2-month period from an unidentified
illness characterized by high fever. Samples from the patients - all
of whom died days after being admitted to St. Carolus hospital -
have been sent to the U.S.Naval Medical Research Unit 2 [NAMRU2] in
Jakarta, but the cause of death remains a mystery, said Nyoman
Kandun, a senior health ministry official.
'We have not been able to conclude if this is or is not a new
emerging disease,' Nyoman told the Associated Press on Wed [27 Dec
2006]. 'But after experiencing both bird flu and SARS (Severe Acute
Respiratory Syndrome) we do not want to take any chances."'
Samples were also sent to the U.S.-based Centers for Disease Control
& Prevention (CDC), another health official said on condition he not
be named because he is not authorized to speak to the media. Tests
there were also inconclusive.
Nyoman said the patients may have been poisoned, but for the time
being the cause of death was listed as from a 'high fever of unknown
origin.' Most of the victims were over 40 and from middle-class
residential areas near St. Carolus in central Jakarta. The hospital
started reporting the deaths in October and the last death was
reported on 27 Nov 2006, he said. Surveillance teams have visited the
homes of the patients but found no additional cases, and
investigators also concluded that they did not get their infections
from fellow patients at the hospital, Kandun said. There are 2 other
hospitals in the neighborhood, but they have not reported similar
mysterious deaths, he said."
*****
The report from Jakarta provides insufficient information to allow
speculation. Anyways, if it was malaria, dengue fever, MRSA, VRE, tuberculosis or chikungunya, the tests would have shown it already.

"Third H5N1 Fatality in Gharbiya Cluster in Nile Delta
Recombinomics Commentary
December 27, 2006
--- the case fatality rate in Egypt's Gharbiyah governate remains at 100%. There have been four confirmed cases, who lived within 12 miles of each other, and all four have died. The first case was hospitalized on September 30
---
the isolate had M230I, which is found in all three human influenza strains, H1N1, H3N2, and influenza B. The acquisition creates a region of identity in the receptor binding domain of influenza, QSGRI (positions 226-230). This identity match with influenza B indicates that H5N1 need not change positions 226 and 228 to generate a receptor binding domain match with a human influenza strain that is efficiently transmitted human-to-human, since influenza B has that property with Q (glutamine) and G (glycine) at positions 226 and 228, respectively. ---"
*****
One can just imagine what is happening in those war-torn, famished, HIV and tuberculosis plagued sub-Saharan countries where even pure water is an utopistic luxus for the most of the population.

Egypt: 26-year-old man is 10th avian influenza fatality
Date: Wed 27 Dec 2006
From: Mary Marshall
Source: Reuters Foundation Alertnet [edited]
"A 26-year-old Egyptian man died of bird flu on Wednesday [27 Dec
2006] after 10 days in hospital, an official of the World Health
Organization (WHO) told Reuters. He was the 3rd member of an extended
family in the Nile Delta province of Gharbia to die of the disease,
said Hassan el-Bushra, WHO regional adviser for communicable diseases
surveillance. It was the 10th death from bird flu in Egypt since an
outbreak of the deadly virus started in February [2006]."

Health Minister Talks About SARS in China
via China Info Travel
22 Dec 2006 (The story wasn't dated)
"--- From the beginning of 2003 when atypical pneumonia was found to March 31, a total number of 1,190 cases were reported. ---
According to the epidemiological and clinical analysis, this epidemic has the following characteristics:
1. The period of onset is winter and spring when people are more susceptible to respiratory diseases.
2. Clinical symptoms of the cases are sustained fever and dry cough. A few cases have breathing difficulties. The symptoms, signs and lab testing results of the cases are different from those of typical pneumonia.
3. It is mainly transmitted by air droplet with close distance.
4. Atypical pneumonia can be prevented and cured.
The majority of the cases have recovered and been discharged from hospital. The central committee of the CPC and the State Council are very concerned about it and have paid close attention to this epidemic. Instructions have been given many times to take effective measures to control the spread of the disease.
---
The number of fatalities has been reduced and the epidemic has been put under control. --- People live and work normally. Society is stable and travel is safe. ---"
*****
But, if 4) Atypical pneumonia can be prevented and cured, why there are so many fatalities? And what is the cause of the pneumonia? Virus? Bacteria? If, by definition, the atypical pneumonia is curable, then should we be watching for a "typical pneumonia" to find H5N1 cases? At least in this text the writer doesn't speak anything about any laboratory tests. Are the diseases diagnosed only by clinical ey, without any lab tests?

Atypical Pneumonia Kills 34 on China's Mainland
via China Info Travel
22 Dec 2006 (The story wasn't dated)
"The death toll on Chinese mainland from an atypical pneumonia outbreak reached at least 34 from November to February, mostly in South China's Guangdong Province, health officials clarified Wednesday.
Previously, only seven deaths were reported in Guangdong. By late February, 680 cases of atypical pneumonia had been diagnosed in Guangzhou and 24 patients had died, said a spokesman with the Health Bureau of Guangdong. Beijing municipal health bureau also revealed Wednesday that three patients had died in the capital.
Despite the deaths, notable progress has been made in controlling and treating the disease, the Guangdong health bureau spokesman said. Seventy-five percent of patients suffering from atypical pneumonia had recovered and been discharged from hospital thanks to effective medical treatment, he said.
The first case of atypical pneumonia in Guangdong occurred in Foshan on November 16. After that more cases were found in the cities of Heyuan, Zhongshan, Jiangmen, Shenzhen and Zhaoqing. Altogether 112 people reportedly contracted the potentially fatal respiratory disease in the six cities. Of the total, seven died. 'The epidemic has been brought under full control in the six cities and no fresh cases have been reported in those areas since February 15,' said the spokesman.
In Guangzhou, the provincial capital, the first cases of atypical pneumonia were reported in late January and the infection rate reached its peak in early February. But the number of fresh cases has dropped drastically this month, he noted.
Meanwhile, health authorities in Beijing said they have managed to contain the atypical pneumonia outbreak.
Among the eight who have been hospitalized this month, seven were from the northern province of Shanxi and one was infected in Hong Kong and returned to Beijing for treatment, a health bureau spokesman in the Chinese capital said. One had recovered and been discharged from hospital.
The city has set up an epidemic monitoring network, and is capable of dealing with emergencies and ensuring public health, he said. In a related development, the World Health Organization (WHO) for the first time has linked the pneumonia outbreak on the Chinese mainland to a mystery flu-like illness that has hit other countries on three continents. World health officials said the symptoms of the illness in China and the way it had spread seemed the same as severe acute respiratory syndrome, which has brought illness to nearly 500 and killed 19 worldwide."

"Bird flu hits Indonesia's tsunami-battered Aceh
JAKARTA, Dec 21, 2006 (Xinhua via COMTEX)
Avian Influenza has infected tens of thousands of fowls in Aceh province, which was devastated by tsunami in December 2004, an Indonesian Health Ministry official said here Thursday.
After infecting scores of chickens in one district in North Aceh regency at the end of December last year, the highly pathogenic H5N1 virus now has contracted tens of thousands of chickens in seven districts of the regency, said Suyono, a member of the investigation team of the ministry for combating avian flu, who has just returned from the province.
---
The Indonesian health ministry has ordered to slaughter all poultry in radius of one kilometer and to vaccinate all of them in radius of three kilometers.
The official said two out of the seven districts were hit by the tsunami in 2004, the Senedon district and Santa Lira Bayu district.
On Dec. 26, the Aceh province is to commemorate the second anniversary of the tsunami."
*****
Indonesia: Many still homeless, two years on
Source: Muslim Aid
Date: 21 Dec 2006
'But so much more needs to be done,' said Hamid Azad, head of overseas programmes at Muslim Aid. 'At least 70,000 people are still living in temporary barracks, and 25,000 poor and landless families in Aceh have yet to be re-housed, even though the tsunami was so long ago.'
---
Hamid Azad pointed out that in Sri Lanka at least half of the survivors were still waiting for houses.
'This earthquake caused so much devastation that it will take many years to recover from it,' said Hamid Azad, who has recently returned from a visit to Banda Aceh. ---
Muslim Aid responded by spending about £18 million to help rebuild the lives of those affected in Banda Aceh, Sri Lanka, India and Somalia.
---
'In Somalia, 600 people were made homeless as a result of the tsunami," Hamid Azad observed. "We have only been able to address 10 per cent of the needs in this country, which is the forgotten victim of this terrible natural disaster.'"

"S. Korea confirms fourth case of pathogenic bird flu
SEOUL, Dec. 21 (Yonhap)
South Korean officials said Thursday they discovered a new case of a highly pathogenic strain of avian influenza at a duck farm in the southwestern part of the country.
'The cause of collective deaths at a duck farm reported on Dec. 11 in Asan, about 90 kilometers south of Seoul, has been finally confirmed as a highly pathogenic form of avian influenza,' the agriculture ministry said. ---"
*****
It's already ten days ago.

Businesses cannot exist in a bubble
The following letter from Robert Davies, IBLF's (International Business Leaders Forum) Chief Executive Officer, was published in the Financial Times today:
- 'Sir, Your report "Companies 'failing to prepare for pandemic' " (December 18) quotes an insurance industry study criticising companies for complacency in relying on uncertain insurance protection against significant losses to business continuity from potential pandemics, rather than taking action at supply chain and workforce level to minimise risk. While the avian flu pandemic risk failed to materialise this year, along with the $1,000bn-$2,000bn worst-case estimates of loss made by global health authorities, representing a 3.1 per cent to 4.8 per cent loss of global gross domestic product, risks will remain and intensify while globalisation speeds business engagement in poor countries with high health risks.
A business model to improve risk avoidance and promote corporate citizenship advocated by the International Business Leaders Forum (IBLF), with the encouragement of the UN System Influenza Co-ordinator and the World Health Organisation, has been proposed in Indonesia and advanced more widely. With the high cost of inaction in mind, this proposes a practical framework to engage business, not just at the workplace and in the value chain, but through collective action to build health system capacity, community outreach and social marketing of simple messages - such as the vital importance of hand-washing.
The emerging lessons about increasing pandemic risks are that business just cannot rely on insurance or creating a bubble around its operations, but must engage as responsible corporations in business models that integrate prevention with multi-stakeholder partnerships to mobilise business skills and resources to improve local health system effectiveness.'
*****
Nopeasti suomeksi:

Herra bisnesmies, et elä kuplassa.
Financial Times -sanomalehdessä julkaistiin tänään (20.12.06) Robert Daviesin, IBLF:n (International Business Leaders Forum) toiminnanjohtajan kirjoitus:
"--- Vaikka H5N1-pandemian riski ei tänä vuonna vielä toteutunutkaan, riskit ovat yhä olemassa ja pahenevat jatkuvasti sitä mukaa, kuin globalisaatio nopeuttaa yritysten toimintojen siirtymistä köyhiin maihin, joissa on suuria terveysriskejä. Maailman johtavien epidemia-asiantuntijoiden laskelmien mukaan tänä vuonna pahimman pandemiatilanteen menetykset olisivat olleet 1-2 miljardia dollaria, mikä vastaa noin 3,1-4,8 % koko maailmanlaajuisesta tuotannosta.
IBFL, YK ja WHO ovat kehittäneet mallin yritysten riskien pienentämiseksi ja jotta järjestöt pystyisivät kantamaan kansalaisvastuunsa. Kyseistä mallia on suositeltu käytettäväksi Indonesiassa sekä levitettäväksi laajempaan käyttöön.
Valmistautumattomuuden tiedetään olevan erittäin kallista. Nyt kehitetty malli tarjoaa käytännönläheiset puitteet saada yritykset mukaan - ei ainoastaan yrityksen ja tuotantoketjun sisäisesti - vaan myös yhteisöllisen toiminnan kautta kasvattamaan sairaanhoitojärjestelmän kapasiteettia, yhteisön tavoitettavuutta ja yksinkertaisten viestien, kuten käsien pesun elintärkeän merkityksen, sosiaalista markkinointia.
Pandemiariskin kasvaessa on alettu ymmärtää, että yritykset eivät kerta kaikkiaan voi nojautua pelkkiin vakuutusjärjestelyihin tai siihen, että ne rakentaisivat jonkinlaisen kuplan toimintojensa ympärille. Yritysten kannattaa vastuullisina järjestöinä sitoutua toimintamalleihin, joissa yhdistetään ehkäisytoimet monikeskisiin kumppanuuksiin, jotta voitaisiin saada yritysten taidot ja resurssit parantamaan paikallisten sairaanhoitojärjestelmien toimivuutta."

"http://www.thestatesman.net
Straits Times/ANN
SINGAPORE, Dec. 13
A fast-spreading version of the H5N1 bird flu virus able to jump from human to human could already exist, one expert believes.
But he insists there is no cause for panic yet .
Speaking at the annual scientific Keystone Symposia at the Raffles City Convention Centre yesterday, Dr Ron Fouchier of the Erasmus University of Rotterdam said the sheer number of mutations in the virus could have created - by chance - a strain that can pass between humans.
This mutation, the precursor to a possible pandemic, is a 'statistical probability', Dr Fouchier told delegates.
However, it is likely to stay tucked away in the bird population, at least for now.
Dr Fouchier explained that influenza is one of the fastest mutating viruses known to man.
---
Each strain can further mutate to have slightly different properties.
Mutations - or changes in the virus’ genetic make-up - may give it new properties, like the ability to reproduce more quickly in humans.
For example, studies have shown that just two changes in the protein sequence will allow the H5N1 virus to replicate almost seven times more quickly in animal tissue.
Dr Fouchier estimated that just 10 mutations in the viral genome would be enough to turn the virus from one that infects mostly birds to one that efficiently infects humans as well."

Old news, but still as significant as ever:

Fears grow over felines carrying H5N1 virus.
Nature 440, 135 (9 March 2006) | doi:10.1038/440135a
Felines are fast becoming a new focus for fears over avian flu, as cats infected with the deadly H5N1 strain are reported in Austria, Germany, Thailand and Indonesia. So could they spread the virus? The World Health Organization (WHO) has played down the danger based on current knowledge, but experts warn that the science is moving rapidly.
The Austrian authorities announced on 6 March that three domestic cats had tested positive for H5N1 in the southern town of Graz, the scene of a recent outbreak in birds. That followed detection of the virus in a dead cat on the northern island of Rügen, Germany, on 28 February, and news that 8 of 111 apparently healthy cats tested close to bird flu outbreaks in central Thailand carried antibodies to the virus (see Nature 439, 773; 2006).

Cats infected with H5N1 may shed the virus extensively.
In a statement last week, the WHO maintained a careful but reassuring tone: 'There is no present evidence that domestic cats play a role in the transmission cycle of H5N1 viruses. To date, no human case has been linked to exposure to a diseased cat.'
That is all true, for now. In February 2004, the WHO reported the first outbreak in domestic cats. H5N1 was found in two of three cats tested from a household of 15 cats (of which 14 died) in Nakornpathom, Indonesia. At the time the WHO argued that cats are not naturally susceptible to flu, and that even if infected they would not shed large quantities of virus.
But with bird flu it may be different. Later in 2004, Albert Osterhaus's team from Erasmus University in Rotterdam showed experimentally that domestic cats do die from H5N1 and do transmit it to other cats (T. Kuiken et al. Science 306, 241; 2004). And in January this year, the virus was found not only in sputum but also in faeces of experimentally infected cats, suggesting that infected animals may shed the virus extensively (G. F. Rimmelzwaan et al. Am. J. Pathol. 168, 176–183; 2006).
It is unclear how these findings relate to cats in their natural environment. But in next month's issue of Emerging Infectious Diseases, Thai researchers describe a cat that died of H5N1 after eating a pigeon carcass. It showed similar pathology to cats experimentally infected with the virus.
Meanwhile, Andrew Jeremijenko, head of influenza surveillance at the US Naval Medical Research Unit 2 in Jakarta, Indonesia, detected H5N1 in a kitten he found near a poultry outbreak in Cipedang, West Java, and tested out of curiosity on 22 January. The virus from the kitten is closely related to recent H5N1 strains isolated from humans in Indonesia: it shares genetic changes found in human strains that are not present in samples from birds.
But scientists may just be learning what is already common knowledge among Indonesian villagers. Peter Roeder, a consultant for the UN Food and Agriculture Organization, says locals have an onomatopoeic name for bird flu 'that sounds like 'plop', the sound of a chicken hitting the ground when it falls out of a tree. They also have a name for the cat form of avian flu — 'aaargh plop' — because cats make a screaming noise before they fall out of the tree.'"

"Suomeen perustetaan zoonoosikeskus
Anna Niemelä 15.12.2006, 11:40
Mediuutiset
Suomeen perustetaan zoonoosikeskus. Sen tehtävänä on parantaa zoonoosien eli ihmisen ja eläinten välillä tarttuvien tautien torjuntaa ja seurantaa Suomessa.
Zoonoosikeskuksesta tulee Elintarviketurvallisuusviraston ja Kansanterveyslaitoksen välinen yhteistyöelin. Keskuksen työ kattaa väestön, elintarvikkeet, eläimet ja rehut.
Uuden viranomaisen tehtäviin kuuluvat zoonoositilanteen seuranta ja siitä tiedottaminen, valvonta- ja seurantaohjelmien ja tutkimusten suunnittelu. Keskus ohjaa kansallisella tasolla ruokamyrkytysepidemioiden ja muiden zoonooseihin liittyvien terveysvaaratilanteiden selvitystä.
Aluksi keskuksen palveluksessa toimii asiantuntijoita noin 20 henkilötyövuoden verran. Keskusta varten perustetaan päätoiminen johtajan virka, joka sijoitetaan Elintarviketurvallisuusvirastoon. ---
Zoonoosit ovat kansanterveydellisesti ja -taloudellisesti merkittävä tartuntatautiryhmä. Ne voivat tarttua eläimistä ihmiseen suoraan tai välillisesti esimerkiksi elintarvikkeiden, talousveden tai ympäristön kautta.
Suomessa tärkeimpiä elintarvikevälitteisiä zoonoosien aiheuttajia ovat salmonella, kampylobakteeri ja yersinia-bakteerit. Suoraan eläimistä tarttuvia zoonooseja ovat esimerkiksi myyräkuume, borrelioosi ja rabies. Kansainvälisesti verrattuna Suomen zoonoositilanne on hyvä."
*****
Shortly in English:
The National Public Health Institute and the Finnish Food Safety Authority are going to establish a new national zoonosis centre.
In Finland the most important zoonosis are salmonella, campylo and yersinia. Compared to the international zoonosis situation, the authorities view the situation good in Finland.

"South Korea says 3rd bird flu case confirmed
Date: Mon 11 Dec 2006
From: Mary Marshall
Source: Reuters Alertnet [edited]
via ProMed-mail
--------------------------------------------
South Korea's agriculture ministry said on Monday [11 Dec 2006] it had
found a 3rd case [I think this means "incident" or "outbreak". - Mod.SH] of
highly pathogenic bird flu in North Cholla province south of Seoul.
Last month [November 2006], South Korea confirmed its 1st 2 outbreaks of
the H5N1 strain in about 3 years, saying the virus had been found at 2
poultry farms close to each other in North Cholla province.
The 3rd case was discovered at a quail farm in the same province about 170
km (100 miles) south from Seoul, some 18 km from the original outbreak,
according to the ministry. "The case has been confirmed as the H5N1 strain
of avian influenza," the ministry said in a statement, adding thousands of
birds at the farm had died over the past 4 days.
The fresh case emerged after South Korea had completed culling all 760 000 poultry near the 2 farms already discovered to have been infected with H5N1. ---"

"China urges vigilance against SARS, bird flu
Tue 14 Nov 2006 3:02:55 GMT
Reuters
BEIJING, Nov 14 (Reuters) - China's Ministry of Health has urged local governments to be on alert for SARS and human cases of bird flu and to strengthen prevention against epidemics as winter approaches.
Severe Acute Respiratory Syndrome first emerged in China's southern Guangdong province, and the country is at the centre of the fight against the H5N1 bird flu virus, with dozens of animal outbreaks and 21 human cases since 2003.
'Experts believe that currently China has already entered the high season for respiratory disease,' the ministry said in a statement on its Web site (www.moh.gov.cn) on Tuesday.
'The health ministry demands that all localities strengthen supervision and reporting of cases of pneumonia where the cause is unclear, human cases of bird flu, ordinary influenza cases and SARS,' it said.
Local authorities must 'immediately report outbreaks and adopt measures to prevent and control epidemics,' the statement said.
China was widely criticised for its initial coverup of a SARS outbreak, which contributed to its spread around the world.
Experts say management of outbreaks has improved, but the government has acknowledged a lack of administrative capacity and a willingness among local officials to disclose information."
*****
Would be interesting to know approximations about how many diseased, how many deaths. And in what parts of China. What might be the pracautions and preparations in e.g. Helsinki-Vantaa airport, which accepts non-stop flights straight from some main far east airports.

BRITAIN 'CLOSED OFF' IN KILLER FLU PLANS
By Vincent Moss Political Editor
SundayMirror.co.uk
3 December 2006
"Thousands of people will take part in a giant exercise next month to prepare Britain for a lethal bird flu outbreak - with parts of the country sealed off and patrolled by police.
Operation 'Winter Willow' will involve all the emergency services, town hall officials and government ministers including Health Secretary Patricia Hewitt and Environment Secretary David Miliband.
Police will stop people entering the exclusion zones and emergency centres will be set up. Ministers are also considering allowing TV cameras to film the exercise to ease public fears.
--- The exercise will take place in two stages, starting on January 30 and then February 19 and 20.
Government experts fear up to seven million Britons could die in a major outbreak. A senior minister said: 'That is a worst case scenario. But we are overdue for a flu pandemic and when it arrives as many as one in four people could be affected.'
Precautions could include closing public transport and masks being issued to millions of people. There have been 250 cases of bird flu in humans in Asia since 2003, plus suspected human cases in Somalia and South Korea."
*****
Possible post-pandemic situations would also be useful to think through. How to manage without an infrastructure and what to do with the bodies and the collective sorrow and fear.
Read more:
Part two
Part three

Old attitudes will not work: Ignoring flu won't protect you
Pensacola News Journal
Published - December, 1, 2006
Apparently, people in this area have the same attitude about preparing for flu season that used to be prevalent about hurricanes: It won't happen to me.
Our advice: It might, and if it does, you'll be sorry. Go get a flu shot, especially if 'spring chicken' is what people used to call you.
The flu is not only no fun -- it can be deadly. At best it is an unpleasant experience. More importantly, it is contagious. If you get the flu, odds are someone else will, too.
It could be someone whose responsibility is to take care of you if you get sick, such as a family member or a health-care professional.
You can also lay waste to your office, classroom or friends by circulating during the flu's early stages.
Last year at this time, officials say almost twice as many Pensacola Bay Area residents had gotten their flu shots. For some reason, people are just not responding this year -- even though cases of the flu have been showing up in this area since October.
Last year, the flu season peaked in February, and it takes about two weeks for a shot to become fully effective. Officials say a flu shot taken now should protect you through the spring, when the flu has generally run its course (in large part because people are not cooped up inside together so much).
The shots being given now do not protect you against the bird flu, the epidemic-in-waiting that so many health officials fear. But preventing more ordinary cases of flu can help manage a bird flu crisis if it comes.
People weakened by the regular flu can be more susceptible to bird flu. And trying to manage two flu epidemics at one time would be a strain on everyone, from health care systems to families.
Older people are particularly vulnerable to the flu, so it's a good idea for them to get vaccinated. Fortunately, Medicare pays for flu shots.
Don't wait. Much like a hurricane, by the time you feel the flu coming on, you know you have waited too long."

Bird Flu Outbreak Plagues Korea
By Tom Pauken II
The Seoul Times
Sunday, December 3, 2006
The bird flu has spread to the Korean Peninsula --- The Korean Central News Agency (KCNA) reported that authorities culled over 100,000 fowl in Hadang farm in Pyongyang, North Korea's capital city. Yet, neither countries reported cases of human infections.
The South and North Korean governments have taken dramatic steps to stem the spread of the bird flu, called the avian influenza by scientists. Nonetheless, the South Korean Agriculture Ministry announced on Saturday November, 25th that the chicken killed by the Avian Flu were infected by the H5N1 virus.
This illness is highly virulent and pathogenic with a mortality rate of 90-100% for fowl. H5N1 virus spreads mostly through chickens but humans can be infected with the possibility of being contagious.
Alarm bells have been ringing throughout the world. But some high-level South Korean government authorities expressed more concern for the financial welfare of poultry farmers than for the public at large.
---
The scenes of men in white lab suits going to slaughter chickens are heart-rending for those farmers who dedicated their lives to raising them. They're forced to watch anonymous individuals hidden behind masks take away their means of financial support. It's as if one is watching a nightmare plot from a science-fiction film. But if the poultry were not culled then the results would be the same and worse.
H5N1 virus is highly virulent and would kill all of their chickens then spread throughout the land. So, culling is a difficult decision by the government but the right one.
Nonetheless, the South Korean government shouldn't promote chicken consumption until after the bird flu crisis ends. Not to do so is foolish and dangerous. It's quite possible that a pandemic might start just because the South Korean prime minister ate a bowl of chicken soup."
*****
Any government in the world shouldn't promote chicken consumption until after the bird flu crisis end. How can this necessity be actualized?

Jason Irwing from New Orleans was helping individual humans and working as a health care provider after the hurricane Katrina during Aug 2005. He literally lived through Katrina disaster as a health care worker. In the Avian Flu Symposium on Nov 22nd 2006 he asked about H5N1 planning:
"The number of employees that you were expecting to come to work - granted over this long period of rumours spreading 'how do I catch this?', misconceptions,... In our area, we had a lot of folks from the outside of the area that wanted to come in.
But the folks that were locals had a lot of other problems: they didn't know if their house was still standing, they didn't know where their family members were and things like that.
In those first initial days, when the drama was really great, we had a lot of folks coming in that were locals and able to provide their care. But as those days progressed, they started worrying about their own family members, did we see those numbers decline, and we had that spread [away], until the cavalry actually came and helped us out.
When I [now] looked at your numbers [of health care employees estimated to be at work] I thought: 'What was your thinking behind that, so to assume that so many people would want to return to work under these dire conditions?'"

What actually is our thinking behind the numbers of employees planned to come to work under extreme dire conditions of a probable highly pathogenic pandemic in a society where the infrastructure probably at least partly collapses?

International bird flu news searches
by: Theresa42
Sat Dec 02, 2006 at 00:25:05 AM EST
"--- some tips for searching for bf news stories from non-Western sources (mainly newspapers, but also governmental sites) -- it's basically a compilation of links to international news sources, online machine-translators, a 'bf word-list', etc. ---"
***
And very good list it is.

Darwin Meets His Match - From Stuffy Nose to Pandemic (video)
www.scribemedia.org
November 22nd, 2006

It will be awful, horrible and you will probably not get help from any authorities. It will be a nightmare that we just will have to bear on our own. We are going to have to help ourselves.

Found the link to the video from H5N1/crofsblogs

A Finnish authority talking on one of the videos, in the panel discussion part 1, and said that the H5N1 pandemic preparedness is on very high level. But how can that be when for example doctors, nurses and institutions, health centres haven't be preparing nor prepared to work during an i.e. eight week or longer outbreak? Maybe the plans are good on the tables of Kansanterveyslaitos (Public Health Institute), but the knowledge hasn't been spread efficiently nor enough outside, to the medical workers. How to maintain functions during a chronic disaster without evidently not proper large scale, real life preparations.

The bottom line: When have the authorities planned the serious educating for doctors about chronic H5N1 disaster to be started? It should have began already, significantly, large scale. Real life.