Penumbra Pandemia

"Public reminded to be vigilant against influenza-like illness
Tuesday, 26 June 2007
The Centre for Health Protection (CHP)
The Centre for Health Protection (CHP) of the Department of Health today (June 26) called on members of the public and management of institutions to maintain strict personal and environmental hygiene to prevent influenza-like illness.
The appeal was made following CHP's investigation into an outbreak of influenza-like illness affecting 29 students in a kindergarten in Tseung Kwan O.
The affected, comprising 18 boys and 11 girls aged from 4 to 7, developed influenza-like illness, including fever, cough, runny nose and sore throat between June 9 and 25.
Of them, 20 consulted general practitioners or out-patient clinics. Three others were admitted to Tseung Kwan O Hospital , Queen Elizabeth Hospital and Prince Wales Hospital respectively and had been discharged.
Preliminary laboratory results showed two samples taken from the patients¡¦ respiratory tracts yielded positive results for influenza A and Influenza B respectively.
---
To prevent influenza and upper respiratory tract infection, the public are advised to adopt the following measures:
* To build up good body immunity by having a proper diet, regular exercise and adequate rest, reducing stress and avoiding smoking;
* To maintain good personal hygiene, and wash hands after sneezing, coughing and wear a mask when developing symptoms of respiratory infections;
* To maintain good ventilation; and
* To avoid visiting crowded places with poor ventilation, especially during peak influenza season.
Members of the public, particularly children, elderly people and those with chronic diseases, should wear face masks and consult their doctors for medical advice promptly [i.e. immediately] if they develop symptoms of respiratory tract infection.
For more information on the disease, members of the public may visit the CHP's website (http://www.chp.gov.hk)."

Undiagnosed disease, porcine - China (13): Guangdong
Archive Number 20070628.2081
Published Date 28-JUN-2007
Subject PRO/AH> Undiagnosed disease, porcine - China (13): Guangdong
Mon 25 Jun 2007
Source: Food QS.com [in Chinese, translated by Rappt.DS, edited] via
ProMED-mail post
"Recently, there have been outbreaks of pig disease in some parts of China.
The enthusiasm of breeders has taken another hit, weakening breeder demand
for soymeal in the short term. Sources say that pig disease is
comparatively serious in the Guangdong region. Local industry insiders say
that, in addition to highly pathogenic blue ear disease, there is also an
outbreak(s) of a not well-known [alternatively, "unknown"] disease for
which vaccines are not so effective, [creating] a rather substantial new
assault on local breeders.
--
communicated by:
ProMED-mail rapporteur Dan Silver
--
[Experience has shown that apparently non-significant, poorly detailed, indirect media reports on animal health issues, when originating from regions such as Guandong, should not be ignored. Additional information, confirmatory (with more details) or otherwise, would be welcomed. - Mod.AS"

"Possibility of Bird Flu in Taxila escalating
Wednesday June 20, 2007 (1340 PST)
TAXILA
---
possibility of Bird Flu is on rise in Taxila and adjoining areas after supply of sick chickens that later died in the shops.
Further, it has been told that shop keepers are purchasing ailing chickens on decreased rates and later selling them on higher rates thus looting masses with both hands. --"

Bird flu found in second German state
Archive Number 20070626.2064
Published Date 26-JUN-2007
Subject PRO/AH/EDR> Avian influenza (112): Germany (Saxony), wild birds
---
Source: DPA via expatica.com [edited] ---
A summer outbreak of bird flu in Germany was confirmed on Tuesday [26 Jun 2007] to have spread to a second state, with 3 swans killed by the deadly form of avian influenza in a small town close to Leipzig. At the end of last week, 6 swans killed by the virus were found in a turgid urban pond in Nuremberg in the state of Bavaria.
The health ministry in Saxony state in Germany's east said 3 dead swans
were found in the Frohburg district, south of Leipzig, and a quick test
established they were infected with the dangerous H5N1 virus. Saxony state
had to exterminate a flock of farm birds last year after they caught H5N1.
More tissue tests are being done at Germany's federal animal-disease
laboratory on the Baltic Sea island of Riems.
In Nuremberg, a municipal spokeswoman said none of the other [how many?
since when? - Mod.AS] dead birds in the city apart from the 6 swans had H5N1.
Scientists on Riems are trying to establish if the virus is connected to
outbreaks of avian influenza at a Czech poultry farm and in Hungary. The
disease has not been detected in Germany between August 2006 and its
appearance late last week in Nuremberg.
--
communicated by:
ProMED-mail rapporteur Mary Marshall
[The distance between Leipzig and Nurnberg exceeds 200 km [124 miles].
Confirmation from the OIE reference laboratory in Riems is anticipated, as
well as molecular data on the interrelationship between the recent isolates
from Germany, Czech Republic, Hungary, England (as well as the recent
Siberian isolates from wild duck?!). - Mod.AS]

Multi-focal Detection of Qinghai H5N1 in Western Europe
Recombinomics Commentary
June 26, 2007
Germany identified three more cases of the lethal H5N1 strain of bird flu in swans on Tuesday, bringing the total number of wild birds infected to nine, but authorities said they had not changed their risk assessment.
The Friedrich Loeffler animal disease institute said the three swans were found near Leipzig in the eastern state of Saxony. Nine wild birds -- eight swans and a Canada goose -- had now been confirmed as H5N1 cases, it added.
'The new cases from Saxony do not change anything yet in our risk assessment,' Thomas Mettenleiter, president of the institute, said in a statement.
The above comments increase the number of confirmed H5N1 infections near Leipez and highlight the multi-focal nature of the H5N1 outbreaks in Germany and The Czech Republic. A map of the confirmed cases in OIE reports from the Czech Republic and Germany is here. These confirmed cases, along with the three cases described above, form a triangle in the heart of Western Europe. Additional wild bird deaths in the Czech Republc are under investigation.
The multi-focal appearance of H5N1 in western Europe in June is consistant the widespread outbreaks in western Europe in February, 2006. In both time periods, wild bird migration was minimal, and the vast majority of cases were in non-migratory birds. These data support an endemic condition, which is sporadically detected by a surveillance program in need of a significant upgrade.
Poor surveillance was clear when all countries in western Europe failed to detect H5N1 migration into the region in the fall of 2005. H5N1 was reported in the Volga Delta, the Danube Delta, and western Turkey in 2005. It was also present in the Nile Delta in December, 2005, but was not reported until the fall of 2006 because low levels blunted initial sequencing attempts. Moreover, the sequence in the healthy teal in Egypt matched sequences subsequently found in Austria, further supporting an earlier introduction into western Europe.
In addition to failing to detect H5N1 in the fall of 2005, detection of H5N1 between June of 2006 and June of 2007 has been minimal. Although it is not clear why H5N1 is now being detected, the continued presence of H5N1 in the region is clear.
Sequence data on the new isolates will be useful."

"Germany confirms second bird flu outbreak
26/06/07 20h08 GMT+1
AFP
German health officials on Tuesday confirmed that the potentially lethal H5N1 strain of bird flu had been found in wild swans in the east of the country, the second such incident here in a week.
The three birds were found dead in the area around Frohburg, near Liepzig, second incidence of the feared virus in a week, the Friedrich Loeffler Institute reported.
The discovery followed the confirmation on Sunday of six cases of H5N1 in wild birds found dead near Nuremberg, 200 kilometres (120 miles) further south.
In Frohburg, a three-kilometre security cordon has been set up around the area where the swans were found. All poultry within this area must be kept indoors and dogs and cats are being kept on leads.
The Frohburg case was the second case of the flu strain found in Germany this year, and the third in Europe. ---"

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
Kyoko Sawabe*, Keita Hoshino, Haruhiko Isawa, Toshinori Sasaki, Toshihiko Hayashi, Yoshio Tsuda, Hiromu Kurahashi, Kiyoshi Tanabayashi, Akitoyo Hotta, Takehiko Saito, Akio Yamada, Mutsuo Kobayashi
Am. J. Trop. Med. Hyg., 75(2), 2006, pp. 327-332
Department of Medical Entomology, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan; Department of Veterinary Science, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan; Department of Virology III, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan
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. "

"Lintuinfluenssaa löytyi Saksasta
Julkaistu 24.06.2007, klo 16.32 (päivitetty 24.06.2007, klo 17.31)
Reuters/YLE
--- Saksassa on löydetty ihmisille vaarallista H5N1-lintuinfluenssavirusta, kertoo EU-komissio.
[Linnut] löydettiin kuluneella viikolla kuolleena Nürnbergistä Baijerista ja niille tehdyt testit osoittavat, että linnut oli surmannut H5N1-viruksen aiheuttama lintuinfluenssa.
--- parhaillaan tutkitaan viittä muuta kuollutta lintua, joiden epäillään menehtyneen H5N1-virukseen.
Lintuinfluenssaepidemia piinasi Saksaa vuonna 2005, jolloin se levisi myös nisäkkäisiin.
---
H5N1-virusta löydettiin viime viikolla myös tshekkiläiseltä siipikarjatilalta ---"

"New bird flu fears in southern Germany
Sunday 24 June 2007 13:41
jurnalo.com
Scientists were Sunday [24.6.07] examining the remains of eight birds feared to have contracted avian influenza in the Bavarian city of Nuremberg.
Officials set up a four-kilometres exclusion zone around two lakes where the wild swans, geese and ducks were found over the past few days, local health officials said.
Veterinary experts at the Friedrich Loeffler Institute on the island of Riems were examining the animals
---
In the meantime, officials ordered that all poultry farmers in the exclusion zone keep their animals indoors. Pet owners were warned not to let their dogs or cats roam free in the affected area.
Nuremberg is located 120 kilometres from the border with the Czech Republic, where an outbreak of bird flu at a poultry farm was confirmed on Thursday.
The disease was discovered after nearly one-third of the 6,000 turkeys perished at the farm in the village of Tisova in the country's east. ---"

"Mystery killer strikes seabirds
Florida Today
Wednesday, June 20, 2007
BREVARD COUNTY - Hundreds of dead seabirds washed ashore this week on beaches spanning almost the entire Florida East Coast, and dozens more were found dying.
---
Frantic beachcombers dropped off about 130 greater shearwaters -- gull-like birds that prefer the open ocean -- to Brevard County rescue centers in the past three days. The die-off of birds ranged about 300 miles, from Hobe Sound in Martin County to South Ponte Vedra Beach in St. Johns County.
Scientists suspect recent winds and currents disrupted the birds' bait fish supply. But they also plan tests to rule out algae toxins, bird flu, parasites, metals and other common causes of seabird deaths."

"Tshekissä ensimmäinen lintuinfluenssatapaus
YLE Uutiset
20.06.2007, klo 21.51 (päivitetty 20.06.2007, klo 21.53)
Tshekkiläisestä siipikarjasta on ensimmäistä kertaa löydetty lintuinfluenssaa. Tshekin eläinlääkintäviranomaiset vahvistivat tautitapauksen keskiviikkona.
Viranomaisten mukaan vasta torstaina selviää, onko kyseessä ihmiselle vaarallinen H5N1-tautityyppi. Virus löydettiin pohjoistshekkiläiseltä kalkkunatilalta.
Aiemmin pelättyä virusta on löydetty Tshekissä vain villeistä linnuista, lähinnä joutsenistä."
*****
Suomessa H5-vasta-aineita löydettiin ensimmäisenä tilalinnuista, mikä käytännössä tarkoittaa, että Suomessa ei ole ajoissa eikä tarpeeksi tutkittu villilintuja; yleensä H5N1 tulee maahan ensimmäisenä nimenomaan villilintujen mukana.

Via crofsblog: a good The Onion article that finely sums up the H5N1 vaccine situation of the world:


Hip hooray... ;)

Viral infection under control in Kerala
THIRUVANANTHAPURAM
UNI
Friday June 15 2007 00:00 IST
Preventive measures against the dreaded viral fever in Kerala continued for the fifth day on Thursday
---
though there was a decrease in chikungunya cases in the state, Kottayam district showed a slight increase in the number of cases.
---
The defence medical teams, which are aiding the state health officials in containing the spread of epidemic, continued with their medical camps, vector control and sanitation measures in Thiruvananthapuram, Pathanamthitta, Kottayam and Idukki districts.
The week long sanitation campaign, which got underway on Tuesday, to check the spread of the viral fever, was going on a war footing in almost all the districts in the state.
The state government had on Wednesday decided to provide Rs 1 crore each to Kottayam and Pathanamthita districts for vector control activities and sanitary measures. Kottayam and Pathanamthitta were the worst effected by the viral fever epidemic. The other effected districts would be getting Rs 50 lakh each he said.
Meanwhile, opposition leader in the Kerala Assembly Oommen Chandy appealed to the state government to take immediate steps to open more medical camps for the effective management of the situation in the viral fever affected areas.
Talking to newspersons after making an on the spot study at the viral fever affected areas in Kottayam, he alleged that the situation was very serious.
Even though the doctors and other para medical staff members were rendering meritorious service, the state government had failed in giving proper coordination, he charged."
*****
The population of Kerala was 31,838,619 in year 2001.

Undiagnosed illness - India (Kerala): Request for information
Archive Number 20070614.1951
Published Date 14-JUN-2007
Subject PRO/EDR> Febrile disease - India (Kerala): RFI
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Date: 13 Jun 2007
Source: Malayala Manorama [trans. and summarized by T. Jacob John, edited]
The number of fever cases this season [2007] has gone up to 550 000.
This is an undeclared emergency, and the help of the Army has been obtained by the state government.
---
Hundreds of deaths have been reported, but there is no official confirmation or count or an organized way of collecting authentic data. There was a disease surveillance system in place, but it was
scrapped in 2003 upon declaring Kerala as the healthiest place in
India.
---
The government health system has been overwhelmed by the number of persons entering hospitals, and that has resulted in panic
and the army's assistance.
The mosquito-borne fevers chikungunya and dengue cannot spread to such a large population in such a short time, especially as
chikungunya infected a number of people last year [2006], and they are, therefore, immune; dengue has been endemic for 2 decades, and, again, a large proportion should be immune.
Communicated by:
Dr T Jacob John
Retired Prof & Head, Dept of Clinical Virolgy,
Christian Medical College,
Vellore
[Dr. John's interpretation is that a contagious infection is present.
By contagious he means person-to-person transmitted, not via a vehicle or vector. He goes on to say that 'Respiratory transmitted fevers are very few, and influenza is a number one possibility. Most of the deaths are in persons over 60 years old, according to newspaper reports. That too fits with an influenza diagnosis.
Epidemic influenza is not readily suspected because of the wide age range involved, the severe systemic symptoms, the lack of
familiarity, and the lack of laboratory testing. Sometimes the most obvious is the easiest to miss.'
ProMED thanks Dr. John for this report. This large number of febrile infection exceeds the number of recent chikungunya virus infections
in Kerala. In October 2006, some 100 000 suspected cases (reported by
MedIndia.com) with at least 70 deaths (reported by BBC News) in Kerala due to chikungunya virus infection were reported in the popular press. It will be important for samples from a significant number of the febrile patients to be tested in the laboratory to establish the etiology or etiologies of these illnesses. ProMED
requests further information about the laboratory results and about the epidemic, indicating how long it has been going on, specific locations of the cases, and the sex/age breakdown of those affected. A map of Kerala, India can be accessed at:
http://mapsofindia.com/maps/kerala/kerala.htm. - Mod.TY]
*****
The population of Kerala was 31,838,619 in year 2001. So about 32 million persons. 550,000 persons out of 32 million is a little under 2 %. That's not a lot of people to fall ill during an influenza season, unless that is the number of the people needing hospital ward care.

New global rules to fight health threats come into force
Thursday 14 June 2007
GENEVA (AFP)
Revised International Health Regulations (IHR) enter into force on Friday, aiming to boost the world's capacity to deal with the growing threat that infectious diseases such as bird flu can spread globally.
The rules will ensure 'faster and better detection and evaluation of health emergencies with an international scope, those that have the potential to cross frontiers,' said Guenael Rodier, the World Health Organisation's IHR coordination director.
---
'SARS was a wake-up call for all of us. It spread faster than we had predicted and was only contained through intensive cooperation between countries which prevented this new disease from gaining a foothold,' said WHO Director General Margaret Chan.
'Today, the greatest threat to international public health security would be an influenza pandemic.'
'The threat of a pandemic has not receded, but implementation of the regulations will help the world to be better prepared for the possibility of a pandemic,' she added.
The rules bolstering international cooperation to stifle health emergencies were agreed by the World Health Organisation's 192 member states in 2005.
Countries will have an obligation to alert the WHO about health threats that might have international implications, ranging from disease to contaminated food, chemical agents or radioactive material, the WHO said.
It also lays out action like quarantines, surveillance of travellers and a requirement for a 24 hour, seven day a week alert system.
The revision was partly motivated by fears that easier global air travel can help spread infections far and wide in short space of time.
SARS reached seven countries on three continents within the space of weeks in 2002 and 2003, and eventually blossomed to 8,096 cases in 29 countries before it petered out, according to the WHO.
The previous regulations last updated 1969 in were limited in scope to four named diseases -- cholera, plague, yellow fever and smallpox -- while the revised ones are open-ended and place individual countries under greater pressure to provide transparent information.
'The world is such now that these events cannot be obscured,' said Michael Ryan, the WHO's director of epidemic alert and response.
'I'm sure we'll have many bumps on the way,' he told journalists.
---
'We must move away from the idea that there's a global band aid that can make up for the deficiencies of national systems,' Ryan underlined.
The WHO estimates that about two-thirds of countries need to make major progress to be able to cope with the new requirements.
David Heymann, WHO assistant director-general for communicable diseases, said in Malaysia that the agency will help poorer nations which lack basic health facilities.
'It will be a very great challenge for countries to develop their core capacities, especially the low income countries,' he said.
Heymann said the regulations will also cover Taiwan, which has been repeatedly denied membership by WHO members.
'Taiwan is actually not excluded from the International Health Regulations. We work with the government of China to be sure Taiwan has the representation it needs and also the support from WHO that it needs,' he said.
---"

Memorial Hospital death under investigation
Posted By: Bea Karnes
Updated: 6/9/2007 9:48:26 PM
A death at Memorial Hospital has raised some measured concern in the medical community. The hospital reported the death to the El Paso County Department of Health & Environment after suspicion the patient may have had a communicable disease. The health department is now running tests to determine the cause of death.
Hospital officials say the adult was brought to Memorial Hospital on Friday and died the same day. The health department said test results will not be available until next week.
The death has alarmed some people because of a recent tuberculosis scare.
Dr. Chris Nevin-Woods of the state board of health said there are many types of communicable diseases. 'West Nile Virus, infections, influenza, H5N1 strain of influenza, and salmonella,' she said.
The hospital will not release any information about the patient, or even say what symptoms the patient showed. A hospital spokeswoman said staff and family wore protective gear as a precaution.
*****
Although there are vast number of differebt deadly communicable diseases in the world, there have been quite a lot of plague reported in Colorado lately.

H5N1 may be transmitted via human waste
17:07' 08/06/2007 (GMT+7)
VietNamNet Bridge via crofsblogs
With the assistance of experts from the US’ Offox University, doctors at Hanoi-based Bach Mai Hospital discovered H5N1 virus in not only the throat and gastric juices but also in the stool of the type A/H5N1 patient from the northern province of Vinh Phuc.
This information was released by Dr. Nguyen Quoc Tuan, Head of the General Planning Department of the Bach Mai hospital, on June 7.
Dr. Tuan warned that H5N1 could completely spread through human waste, which is very dangerous if this disease attacks rural areas where many families don’t have standard toilets.
According to Dr. Tuan, as doctors can determine the quantity of H5N1 virus in an individual, they can follow the disease in each phase of development to apply suitable treatment methods. In addition, thanks to continuous blood filtering methods, the patient from Vinh Phuc has quickly regained his health.
Dr. Tuan said that these were new methods and useful for type A/H5N1 patients in general. They have been proven through the recovery of the patient from Vinh Phuc, the first Vietnamese type A/H5N1 patient since November 2005.
Those discoveries will be shared with experts of the Japan International Health Centre early next week at a video conference, Dr. Tuan said.
(Source: CAND)"
*****
Blood filtering methods? Might that refer to hemodialysis and blood transfusions?

2007/06/10
Two more hospitalized for suspected bird flu
nstonline
BERNAMA
KUALA LUMPUR
A teenager in Terengganu and a 31-year-old man in Selangor were warded yesterday for showing bird flu-like symptoms.
Health Minister Datuk Seri Dr Chua Soi Lek said the 16-year-old youth was now being treated at the Kuala Terengganu Hospital after he had fever and coughing.
'The teenager is believed to have been exposed to the reared chickens and ducks which had died in Seberang Takir, Kuala Terengganu,' he said in a statement issued here today on the current status of monitoring of avian influenza.
He said specimens for laboratory examination for the bird flu virus (H5N1) had been sent to the research institute here.
He added that the Terengganu Veterinary Services Department was also checking on reared fowls and had taken specimens for tests at the Veterinary Research Institute in Ipoh. The results would be known in a day.
Meanwhile, the 31-year-old man who works at the Universiti Malaya Medical Centre had been referred to the Sungai Buloh Hospital after he was down with fever, coughing and sore throat.

The man lives in the Subang Suria apartment, which is within a 300-metre radius from where an outbreak of avian flu occurred among the reared fowls in Kampung Paya Jaras Hilir, Sungai Buloh, near here.
However, he was reported to be in stable condition, said Dr Chua.
He said five of the seven cases being isolated for treatment at the Sungai Buloh Hospital, had been discharged while the other two were transferred to the normal ward as they were suspected of having dengue fever.
One more patient at the Melaka Hospital and another at the Alor Star Hospital were also allowed to return home after being tested negative for the bird flu virus.
Dr Chua said detection of cases was no longer actively carried out in Selangor as all households within the 300-metre radius from the outbreak area had been checked and interviewed.
He said daily monitoring and inspection were now focused on 30 villagers in Kampung Paya Jaras Hilir and all of them were found to be free of the virus. The activity would go on for a week."
*****
So the 31-year-old man working in the university medical centre got the H5N1 from a patient?

The new epidemic - the viral fever in Kerala can create havoc in India - Army rushes to help
The India Daily
Jun. 9, 2007
Kerala government has sought the army medical teams' assistance to cope with the spread of a viral fever to many parts of the state that has claimed at least 36 lives.
Defence medical teams from Secunderabad and Chennai are expected to arrive in the state on Sunday on a request by the state government as fever-affected patients continued to pour into hospitals, especially in Kottayam and Pathanamthitta districts.
After an all-party meet convened to discuss the situation, Chief Minister V S Achuthanandan said information from the two worst-hit districts, including media reports, put the casualty at 36.
According to official sources, Defence Minister A K Antony has offered to make available the Army's help to tackle the situation based on a request from state Health Minister P K Sreemathi.
A state-wide cleanliness campaign with the co-operation of political parties, medical fraternity NGOs and defence personnel would be launched from June 12. The campaign would focus on mosquito-control, removal of wastes and curb on use of plastics.
The government offered to release more funds for hospitals to purchase medicines and step up facilities to deal with the fever. One month's free ration would be provided to people in affected areas.
Pledging their support to efforts to bring the situation under control, leaders of political parties asked their rank and file to join the cleanliness campaign.
The defence team of medical and paramedics would be sent to Pathanamthitta and Kottayam districts where they would help the state medical personnel.
The Health Department had on Friday confirmed 7,000 chikungunya cases with isolated cases of dengue and malaria.
Efforts would be made to control the situation before the monsoon gains strength as the rainy season in the state often posed severe health challenges.
While patients continued to arrive in hospitals in the affected districts, mostly in the Central Travancore region, fresh cases were reported from some of the northern districts also."

Developing global climate anomalies suggest potential disease risks for 2006-2007.
Anyamba A, Chretien JP, Small J, Tucker CJ, Linthicum KJ.
BACKGROUND: El Niño/Southern Oscillation (ENSO) related climate anomalies have been shown to have an impact on infectious disease outbreaks. The Climate Prediction Center of the National Oceanic and Atmospheric Administration (NOAA/CPC) has recently issued an unscheduled El Niño advisory, indicating that warmer than normal sea surface temperatures across the equatorial eastern Pacific may have pronounced impacts on global tropical precipitation patterns extending into the northern hemisphere particularly over North America. Building evidence of the links between ENSO driven climate anomalies and infectious diseases, particularly those transmitted by insects, can allow us to provide improved long range forecasts of an epidemic or epizootic. We describe developing climate anomalies that suggest potential disease risks using satellite generated data.
RESULTS: Sea surface temperatures (SSTs) in the equatorial east Pacific ocean have anomalously increased significantly during July - October 2006 indicating the typical development of El Niño conditions. The persistence of these conditions will lead to extremes in global-scale climate anomalies as has been observed during similar conditions in the past.
Positive Outgoing Longwave Radiation (OLR) anomalies, indicative of severe drought conditions, have been observed across all of Indonesia, Malaysia and most of the Philippines, which are usually the first areas to experience ENSO-related impacts. This dryness can be expected to continue, on average, for the remainder of 2006 continuing into the early part of 2007. During the period November 2006 - January 2007 climate forecasts indicate that there is a high probability for above normal rainfall in the central and eastern equatorial Pacific Islands, the Korean Peninsula, the U.S. Gulf Coast and Florida, northern South America and equatorial east Africa. Taking into consideration current observations and climate forecast information, indications are that the following regions are at increased risk for disease outbreaks: Indonesia, Malaysia, Thailand and most of the southeast Asia Islands for increased dengue fever transmission and increased respiratory illness; Coastal Peru, Ecuador, Venezuela, and Colombia for increased risk of malaria; Bangladesh and coastal India for elevated risk of cholera; East Africa for increased risk of a Rift Valley fever outbreak and elevated malaria; southwest USA for increased risk for hantavirus pulmonary syndrome and plague; southern California for increased West Nile virus transmission; and northeast Brazil for increased dengue fever and respiratory illness.
CONCLUSION: The current development of El Niño conditions has significant implications for global public health. Extremes in climate events with above normal rainfall and flooding in some regions and extended drought periods in other regions will occur. Forecasting disease is critical for timely and efficient planning of operational control programs. In this paper we describe developing global climate anomalies that suggest potential disease risks that will give decision makers additional tools to make rational judgments concerning implementation of disease prevention and mitigation strategies.
PMID: 17194307 [PubMed - indexed for MEDLINE]"

Malaria surveillance - United States, 2005.
Thwing J, Skarbinski J, Newman RD, Barber AM, Mali S, Roberts JM, Slutsker L, Arguin PM; Centers for Disease Control and Prevention.
MMWR Surveill Summ. 2007 Jun 8;56(6):23-38.
This report summarizes cases in persons with onset of illness in 2005 and summarizes trends during previous years. ---
CDC received reports of 1,528 cases of malaria, including seven fatal cases, with an onset of symptoms in 2005 among persons in the United States or one of its territories. This number represents an increase of 15.4% from the 1,324 cases reported for 2004. --- Twelve patients (0.8% of total) were infected by two or more species. The infecting species was unreported or undetermined in 22.6% of cases.
Compared with 2004, the largest increases in cases came from the Americas (23.1%; n = 213) and Asia and the Middle East (18.6%; n = 204). On the basis of estimated volume of travel, the highest estimated case rates of malaria among travelers occurred among those returning from West Africa.
---
The 15.4% increase in malaria cases in 2005, compared with 2004, resulted primarily from increases in the number of cases reported from Asia and the Middle East and from the Americas. This increase might in part reflect more complete reporting and in part increased travel to malarious areas. No change was noted in proportions of cases from other areas of the world, or in species responsible for the infection. --- U.S. civilians who traveled to West Africa had the highest estimated relative case rate.
---
Any person who has been to a malarious area and who subsequently has a fever or influenza-like symptoms should seek medical care immediately and report their travel history to the clinician; investigation should include at least one blood-film test for malaria. Malaria infections can be fatal if not diagnosed and treated promptly ---"

Clinical overlap between malaria and severe pneumonia in Africa children in hospital.
English M, Punt J, Mwangi I, McHugh K, Marsh K.
Clinical Research Centre, KEMRI Kilifi Unit, Kenya.
Trans R Soc Trop Med Hyg. 1996 Nov-Dec;90(6):658-62.
PMID: 9015508 [PubMed - indexed for MEDLINE]
Data collected from 200 children admitted to a hospital on the Kenyan coast who met a broad definition of severe acute respiratory infection (ARI) indicated that simple clinical signs alone are unable absolutely to distinguish severe ARI and severe malaria.
However, laboratory data showed that marked differences exist in the pathophysiology of unequivocal malaria and unequivocal ARI. Children in the former group had a higher mean oxygen saturation (97 vs. 94, P < 0.001), mean blood urea level (5.3 vs. 1.9 mmol/L, P < 0.001) and geometric mean lactate level (4.5 vs. 2.1 mmol/L, P < 0.001), and lower mean haemoglobin level (5.3 vs. 9.0 g/dL, P < 0.001) and base excess (-9.4 vs. -2.6, P < 0.001) than those in the latter group.
Using these discriminatory variables it was estimated that up to 45% of children admitted with respiratory signs indicative of severe ARI probably had malaria as the primary diagnosis. Radiological examination supported this conclusion, indicating that pneumonia characterized by consolidation was uncommon in children with respiratory signs and a high malarial parasitaemia (> or = 10,000/microliters). There is no specific radiological sign of severe malaria. In practice, all children with respiratory signs warranting hospital admission in a malaria endemic area should be treated for both malaria and ARI unless blood film examination excludes malaria. In those with malaria and clinical evidence of acidosis, but no crackles, antibodies may be withheld while appropriate treatment for dehydration and anaemia is given. However, if clinical improvement is not rapid, antibiotics should be started.

There have been already five H5N1 wild bird flock cases in USA in May 2007. After August last year 2006 there have been total of 22 known cases of wild bird H5N1 in USA.
The latest five cases were in Kent and Sussex counties in Delaware.
*****
It doesn't matter whether the H5N1 is low path or high path to birds. Essential is the pathogenicity of H5N1 to humans. Which seems to be something between 60-80%.

"Aussie bird flu would kill 48,000
Ben Packham
news.com.au
June 09, 2007 01:00am
A MAJOR exercise has identified gaps in Australia's preparations for a deadly bird flu pandemic.
The nation's medical facilities, communications systems and health workforce were all found wanting in the $4 million test run.
A report on the exercise came amid warnings yesterday that 48,000 Australians could be killed and 150 000 put in hospital in a bird flu pandemic. ---"
*****
If there would be only 48 000 deaths in Australia due to H5N1 pandemic, there would be only 144 000 infected if counted by the present H5N1 case fatality rate (CFR). The population of Australia is about 21 million. During the usual seasonal influenza about 30 % of the world population is estimated to be infected.
If the H5N1 went pandemic with 30 % infection rate, there would be about seven million H5N1 patients in Australia. If the CFR remained the same as now, about 3,5 million Aussie's would die of H5N1.
The estimation of 48 000 H5N1 pandemic deaths is grossly underestimated.

Malaysia reports five suspected human cases of bird flu
People's Daily Online
Source: Xinhua
"Four men and a woman were hospitalized in Malaysia for bird flu-like symptoms, according to the Malaysian Health Ministry on Friday.
The five, aged between 11 months and 35 years old, were living within the 300m radius of the area, where chickens were tested positive for deadly H5N1 bird flu virus.
'They went to the hospital to get treatment and have been isolated because of the symptoms,' the ministry said in a statement,
---
Malaysian officials Wednesday confirmed that H5N1 strain of bird flu virus had been detected in a village of Selangor State near here."

Five ill Malaysians hospitalized on bird flu fears
June 8, 2007 at 4:43 a.m. EDT,
KUALA LUMPUR, Malaysia
"Five Malaysians with flu-like symptoms were in a hospital isolation ward Friday as a precaution for bird flu, the health minister said, after the country's first reported outbreak of H5N1 among birds in more than a year.
The four males and one female, ages 11 months to 35 years, were in stable condition and under observation after coming to Sungai Buloh Hospital on their own accord to seek treatment, said a statement from Health Minister Chua Soi Lek.
---
Veterinary officials said Tuesday that concerns about bird flu emerged after tests on 60 birds that died last week in Sungai Buloh, near Malaysia's commercial capital, Kuala Lumpur, confirmed they had the H5N1 bird flu virus.
Since then, health authorities have visited 4,556 villagers in 742 homes in the area to look for anyone suffering symptoms such as fever, cough, sore throat or breathing difficulties, Chua said.
However, he said 17 people with mild fevers have been ordered to remain at home until health officials, who will check on them periodically, give them clearance to leave.
---"
*****
Usually the sentence "in stable condition" in the context of the Asian countries reporting human H5N1 cases has practically meant "in coma" or "sedated in respirator".
Let's hope that the 17 people with fevers don't have either H5N1 nor seasonal influenza.

Bird flu 'climate of fear' could hit Asia economies
Michael Perry
Reuters
SYDNEY, June 8 (Reuters) - Asia-Pacific health ministers said on Friday that a 'climate of fear' that accompanies the outbreak of infectious diseases such as bird flu could have a devastating impact on Asia's economies.
---
'The climate of fear that disease outbreaks such as avian influenza bring can rapidly sap the confidence and enterprise that underpins the economic dynamism of our region,' Australian Health Minister Tony Abbott told the conference.
The health ministers endorsed a plan called 'APEC Functioning Economies in Times of Pandemic Guidelines' which aims to assist in managing economies during a pandemic. The guidelines cover communications, essential services, financial systems and movement between and within countries.
'We recognise that healthy populations contribute to economic growth and development. Conversely, any threat to the health of a population can have a devastating effect on prosperity,' the ministers from the 21-member Asia-Pacific Economic Cooperation forum said in a statement.
The ministers said that the Asia-Pacific needed to replicate the co-operation seen during the SARS respiratory crisis in 2003 to combat the threat of a bird flu pandemic.
---
'WE MUST REMAIN VIGILANT'
The H5N1 strain of bird flu was mutating unpredictably and at a rapid pace, a senior WHO official told the health ministers.
'The virus is already entrenched, embedded in this part of the world and...it has been very, very unstable and changeable,' said Dr Shigeru Omi, WHO Regional Director for the Western Pacific.
'If we put (these two points) together, it's a very clear indication that we have to remain vigilant.'
Indonesia said on Wednesday the H5N1 virus might have undergone a mutation that allows it to jump more easily from poultry to humans, but stressed the findings were preliminary.
---
Indonesia said last month it had resumed sharing samples with the WHO after a five-month hiatus. Along with other developing nations, Indonesia has been demanding guarantees that they will have access to affordable vaccines in the event of a pandemic."

Indonesia: avian influenza situation - WHO update 9
Archive Number 20070606.1832
Published Date 06-JUN-2007
A ProMED-mail post
Date: Wed 6 Jun 2007
Source: WHO Epidemic and Pandemic Alert and Response (EPR) disease outbreak news [edited]
"As of Wed 6 Jun 2007, the Ministry of Health of Indonesia has announced a
new case of human infection of H5N1 avian influenza. A 16 year old female
from Kendal district, Central Java province developed symptoms on 21 May
[2007], was hospitalized on 25 May [2007], and died in hospital on 29 May
[2007]. ---
Of the 99 cases confirmed to date in Indonesia, 79 have been fatal.
--
communicated by:
ProMED-mail rapporteur Marianne Hopp"

Indonesia worries over latest bird flu virus samples
By Adhityani Arga
Wed 6 Jun 2007, 10:49 GMT
Reuters
"--- A microbiologist at the bird flu commission said the suspicions were based on preliminary findings of molecular genetic tests conducted at laboratories in Indonesia.
'Virus samples from poultry cases have increasingly shown a similarity in their amino acid structure to virus samples extracted from humans,' Wayan Teguh Wibawan told Reuters.
'This makes it easier for the virus to attach to human receptors,' he said, referring to receptor cells lining the human throat and lungs.
---
Lo Wing-lok, an infectious disease expert in Hong Kong, said changes such as these demonstrated how important it was for Jakarta to share virus samples.
'Are they going to share these samples with overseas labs? These must be confirmed and the world must be forewarned if there has been such an important change,' Lo told Reuters in Hong Kong.
'If there is such a change, it would not only mean that the virus can jump more easily from bird to man, but from human to human, too.'"
*****
"Dr Wibawan added the cover-up could be due to political reasons. Pressure on regional governments over alleged cover-ups continued yesterday as the European Union warned its ban on imports of Thai chickens would not necessarily be lifted once the epidemic was over."

Indonesia worries over latest bird flu virus samples
Wed 6 Jun 2007, 10:49 GMT
By Adhityani Arga
JAKARTA, June 6 (Reuters)
The H5N1 bird flu virus in Indonesia may have undergone a mutation that allows it to jump more easily from poultry to humans, the head of the country's commission on bird flu control said on Wednesday.
---
'In the past it took exposure of high intensity and density to the virus to get infected. There are now suspicions, early indications that this has become easier,' Bayu Krisnamurthi [chief executive officer of Indonesia's committee on avian and pandemic flu] told reporters.
---
'Virus samples from poultry cases have increasingly shown a similarity in their amino acid structure to virus samples extracted from humans,' Wayan Teguh Wibawan told Reuters.
'This makes it easier for the virus to attach to human receptors,' he said, referring to receptor cells lining the human throat and lungs.
---
Wayan said he had spotted 'gradual changes' in the virus sample he receives every month. He did not give details on these gradual changes.
Lo Wing-lok, an infectious disease expert in Hong Kong, said changes such as these demonstrated how important it was for Jakarta to share virus samples.
'Are they going to share these samples with overseas labs? These must be confirmed and the world must be forewarned if there has been such an important change," Lo told Reuters in Hong Kong.
'If there is such a change, it would not only mean that the virus can jump more easily from bird to man, but from human to human, too.'
---
Indonesia said last month it had resumed sharing samples with the WHO after a five-month hiatus. Along with other developing nations, Indonesia has been demanding guarantees that they will have access to affordable vaccines in the event of a pandemic.
(Additional reporting by Tan Ee Lyn in Hong Kong)"

UNDIAGNOSED DISEASE, PORCINE - CHINA (09)
A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases
Date: Tue 5 Jun 2007
Source: People's Daily online, Xinhua News Agency report [edited]

"--- During the recent months, contradictory information on the incidence and distribution of the disease [initially (2006) denominated by the Chinese as 'swine high fever disease' (SHFD; a multifactorial syndrome)] in China and on its etiology, has been published by official and unofficial sources. According to one of them, (Guangxi News -- Modern Life Daily, 12 May 2007, translated from Chinese, and posted in ProMED-mail 20070514.1533), SHFD had already been discovered in vast areas of the Guangxi Autonomous Region, while during the previous months, it had been reported 'in Anhui, Hunan, Guangdong, Shandong, Liaoning, Jilin, and other provinces', causing the deaths of 'more than 20 million pigs, with extremely heavy economic losses'. A look at a map of China will show that, if the above information is accurate, the disease has spread across eastern China, from Jilin in the north east, to Guangdong and Guangxi in the south east and south, a distance exceeding 3000 km (1864 mi) within the pig-breeding provinces of China.
The blurred picture has already bred suspicions on the possible involvement of various disease agents, in addition to PRRSV, including FMD, avian influenza, classical swine fever, and even African swine fever; to (hopefully) exclude them and to enable a realistic assessment of the situation, an official OIE (Office International des Epizooties; World Organization for Animal Health) update is anticipated. - Mod.AS]"

Chinese Soldier Infected with Bird Flu Virus in Critical Condition
By Feng Yiran
Epoch Times International
May 31, 2007
China's Ministry of Health confirmed a 19-year-old People's Liberation Army(PLA) soldier has been infected [died on 3 June 2007] with H5N1 bird flu virus, but did not disclose where or how the patient got infected since the patient is military personnel.
The infected soldier is from the PLA number 31 Troop Group station, which is listed as one of the top ten Troop Groups in the PLA.
According to state-owned media, the patient, surnamed Cheng, started to show symptoms of fever and coughing on May 9, and was admitted into the army hospital on May 14. He was finally confirmed to be infected with Bird Flu virus 10 days later on May 24.
According to the Hong Kong-based newspaper The Sun , the infected soldier is from a troop station in Nanan city, Fujian province. He is still in No.180 PLA Hospital in Quanzhou city
Nanan City Center for Disease Control and Prevention (CDC) staff confirmed with The Sun that the soldier was from a troop station in one of Nana's small surrounding towns, Guanqiao, and said, 'The Military has its own system, so we don't know the detailed situation.'
Currently, Nanan and its neighboring cities are taking measures such as checking patients with fever, inspecting poultry farms, and killing suspected poultry to prevent further outbreak of the virus.
The Sun also reported that the incident has alarmed the State Council and Central Military Commission of the Chinese communist regime. Vice Minister of Agriculture Yi Chengjie made a special trip to where the solider is currently hospitalized to coordinate the prevention measures.
Villagers from Guanqiao town said that large numbers of police and health department officials have recently come into the village to kill all poultry and they did a complete sanitization. Local villagers are now very scared of being infected by the disease. To date the village has already gone through the sanitization process twice.
*****
It took two whole weeks to get the soldier H5N1 confirmed. It's not bad, the situation is quite the same in many of the more developed countries. But the situation definitely could and should be better.
In those two weeks, how many of the soldiers comrades and health care workers might have got infected? How come the village has gone through the sanitization process twice already Quite a big problem there, I guess. And this was the first disease case. Lucky villagers!

"Further wait for bird flu test results
By Matthew Colledge
GOVERNMENT officials are testing for bird flu after a sick chicken at a smallholding near Chard showed telltale symptoms of the disease.
Vets from the Department for Environment, Food and Rural Affairs, took away blood, faeces and saliva samples from 12 hens at Stony Knaps, Winsham, on Wednesday.
The birds are being tested for bird flu and Newcastle disease - which is lethal to poultry but harmless to humans.
advertisement
The results were due yesterday, (Thursday, May 31) but are now expected on Monday.
---
A DEFRA spokesman said until the test results were available no restrictions would be placed on the movement of people or animals to and from Mrs Johnson's property - a farmhouse and half an acre of land on the outskirts of the village. ---"
*****
Influenza subtype quick tests are fast. The result should be known by now. Supposedly the quick test was positive, because if it would have been negative, the officials would have told. Presumably they are now making the PCR tests to be sure.

'In the dark' over bird flu outbreak
By Adam Johson
NATIONAL departments working to contain the bird flu outbreak have come under fire for keeping politicians out of the loop, as the disease reached Denbighshire's main hospital.
North Wales AM Brynle Williams claimed this week that politicians were kept in the dark over the location and strain of Wales' first bird flu outbreak.
His concerns follow the identification of 221 people who may have had contact with the H7 flu virus.
Twelve people are identified as having flu like symptoms or conjunctivitis.
They have been tested for the Influenza A viruses, including the H7 subtype that has been isolated from the affected poultry. Two tests have been reported as positive for H7 subtype.
Ysbyty Glan Clwyd staff are the latest to be offered tamiflu as officials try to stay one step ahead of the virus.
---
Mr Williams told the Free Press he faced a 'blackout' from all departments handling the information on the initial bird flu outbreak
'I think the way it's been handled by the ministry has been absolutely appalling. I would have thought they would tell AMs because it's a matter of importance. I do not like finding out things like this from the national media.
There are 10 birds dead before anybody has done anything. When I phoned the ministry they said we can't tell you where it is. I am just appalled at the way it was handled. I eventually found out where it was and that was down to the police. Dread to think if this was a full blown epidemic how fast our veterinary services would be stirring into action!'
Mr Williams added: 'I am very disappointed in the way that this has been handled from the onset. I will not be letting this rest. I will be writing to and contacting the ministry, and Dr Christianne Glossop. I don't think the people have moved satisfactorily enough but I know it takes time to trace where this came from.
'For four years I have been questioning the bio-security in Wales and the UK, and the last outbreak with Bernard Matthews, I said from the onset this has come off the back of a wagon, and I was proved right. ---"