Penumbra Pandemia

"Britanniassa löydetty ihmiselle vaarallista lintuinfluessaa
YLE Uutiset
Julkaistu 29.02.2008, klo 18.10
Kuolleesta kanadanhanhesta on löytynyt ihmiselle vaarallista H5N1-virustyyppiä Etelä-Englannissa Dorsetissa. Britannian maatalousministeriön mukaan samalta alueelta on löydetty alkuvuonna kymmeneltä kyhmyjoutsenelta samaa virustyyppiä.
Ministeriö totesi lausunnossaan, että löytö ei ole yllättävä. Ministeriö pohtii parhaillaan pitäisikö alueelle asettaa rajoituksia.
Ympäri maailmaa on tapettu miljoonia lintuja lintuinfluenssan leviämisen estämiseksi. Ihmiselle vaarallinen virustyyppi on surmannut yli 200 ihmistä eri puolilla maailmaa."

4th avian flu death suspected in Guangdong Province
By Donald Greenlees
The International Herald Tribune
Hong Kong
February 25, 2008
"Health authorities tightened surveillance measures against avian influenza here Monday following the fourth death in mainland China suspected to have been caused by the virus since late last year.
Hospitals will be required to step up monitoring and reporting of patients with symptoms of pneumonia over a four-week period from Tuesday amid concerns of a renewed outbreak of the deadly H5N1 virus.
A 44-year-old woman died Monday in the southern Chinese province of Guangdong from an infection suspected to have been bird flu, Chinese and Hong Kong health officials said. A test by the Center for Disease Prevention and Control in Guangdong found the woman to have been infected with the virus, but the result had yet to be confirmed by the Health Ministry in Beijing.
Her death follows several confirmed cases of bird flu infection since December. A 24-year-old man from the eastern province of Jiangsu died on Dec. 2. He passed the virus to his 52-year-old father, who later recovered. In the latest cases, a 22-year-old man from central Hunan Province died on Jan. 24, and a 41-year-old man from the southern region of Guangxi died on Feb. 20.
Hans Troedsson, the World Health Organization representative in China, said there was only a 'preliminary' report on the Guangdong case.
But since mid-December, health and agriculture authorities in Hong Kong have been on heightened alert for cases of bird flu in humans and poultry. They have advised airlines and the travel industry to distribute information to travelers going to and from Jiangsu.
In a statement announcing additional measures Monday, the health authorities said they had alerted 'frontline staff of hospitals and clinics to step up all infection control measures and maintain vigilance.'
Evidence of a resurgence of the bird flu virus causes jitters in Hong Kong, where the economy was battered several years ago by an epidemic of Severe Acute Respiratory Syndrome, or SARS.
Since late 2003, the H5N1 virus strain has been widespread in poultry populations in Asia and parts of Europe and has led to the culling of tens of millions of birds. China has the biggest domestic poultry population in the world, with many of the birds kept by households.
The World Health Organization has reported 232 deaths worldwide in the past four years, 29 of them in China.
Almost all the reported cases have been as a result of close contact between humans and infected birds. But there are fears that as the number of cases in people increases, so will the risk of the virus mutating into a form that is easily transmissible.
Health officials in Hong Kong said the Guangdong woman who died Monday appeared to have contracted the illness from poultry she kept near her home.
'This lady kept some chickens in her backyard, and they became sick and died during the incubation period of her illness. She also ate some of the chickens herself,' Thomas Tsang, the controller of Hong Kong's Center for Health Protection, told Reuters.
Tsang said anyone in Hong Kong who has 'signs of pneumonia and has visited Guangdong in the past six months' will be tested for the virus."

"Poultry to be Kept Inside during Spring Bird Migration
www.yle.fi via Crofsblogs
Published 21.02.2008, 19.11
Poultry farms will have to keep their birds inside again this year during the spring migration of birds. The requirement is a precaution against the possible spread of bird flu.
The ministry of Agriculture and Forestry says that poultry must not be kept out of doors between March 15th and the end of May.
No cases of bird flu have been diagnosed in Finland yet.
YLE"
**************
The News Agency reporter seems to have forgot this case, where antibodies against bird flu were found in geese of a farm in central Finland, near Jyväskylä.

"H5N1 Fatal Case in Guangxi China
Recombinomics Commentary 18:05
February 21, 2008
A man from China's southern Guangxi autonomous region has died of the H5N1 bird flu virus, the third death from the disease since late last year, the Health Ministry said on Thursday.
The man fell ill on February 12, was admitted to hospital two days later and died on February 20, the ministry said on its Web site (www.moh.gov.cn).
A 22-year-old man from the central Chinese province of Hunan died in late January of the H5N1 strain. Between Jan 18 and Feb 14 it also killed three men in north Vietnam, which borders Guangxi.

The above comments describe another fatal H5N1 case in southern China. As noted above, Guangxi is just north of Vietnam, where there have been three recently confirmed fatal H5N1 cases (see satellite map). These infections are likely linked to clade 2.3 (Fujian strain).
In addition, northern Vietnam has reported multiple suspect hospitalized cases, in addition to a suspect fatal case in the south. The human outbreaks have been associated with reports of new outbreaks in poultry in the region.
More information on the sequence of H5N1 linked to the human and poultry cases would be useful."

AVIAN INFLUENZA (36): THAILAND, MOSQUITOES
Archive Number 20080219.0676
Published Date 19-FEB-2008
ProMED-mail is a program of the International Society for Infectious Diseases
"Date: Fri 1 Feb 2008
Source: Vector Borne Zoonotic Dis. 2008 Feb;8(1):105-110 [edited]

Avian influenza H5N1 virus in mosquitoes collected from Thai poultry farm
The abstract reproduced below is from a paper published in the
current issue of Vector-borne and Zoonotic Diseases. The paper is titled: 'Detection of H5N1 Avian Influenza Virus from Mosquitoes Collected in an Infected Poultry Farm in Thailand'. The authors are
Barbazan P, Thitithanyanont A, Misse D, Dubot A, Bosc P, Luangsri N, Gonzalez JP, Kittayapong P.; at the Center of Excellence for Vectors and Vector-Borne Diseases, Faculty of Science, Mahidol University at
Salaya, Nakhonpathom, Thailand, and Institut de Recherche pour le
Developpement, IRD-UR 178, Paris, France.

'Blood-engorged mosquitoes were collected at poultry farms during an
outbreak of highly pathogenic avian influenza in Central Thailand
during October 2005. These mosquitoes tested positive for H5N1 virus
by reverse transcription-polymerase chain reaction (RT-PCR). Results
were confirmed by limited sequencing of the H5 and N1 segments.
Infection and replication of this virus in the C6/36 mosquito cell line was confirmed by quantitative real-time PCR. However,
transmission by mosquitoes was not evaluated, and further research is
needed. Collecting and testing mosquitoes engorged with the blood of
domestic or wild animals could be a valuable tool for veterinary and
public health authorities who conduct surveillance for H5N1 virus spread.'
--
Communicated by:
Shamsudeen Fagbo
oloungbo@yahoo.com

[The relevance of this paper is difficult to evaluate as arthropod
vectors have not previously been implicated in the epidemiology and
transmission of seasonal or avian influenza viruses. This research
demonstrates that avian H5N1 influenza virus can be taken up by blood-feeding mosquitoes in a form retaining infectivity long enough
to infect susceptible C6/36 mosquito cell cultures. The experiments
leave open the question whether the virus surviving in the insect
vector will be competent in vertebrate cells and in a form that may
be infectious on transmission to live susceptible poultry and/or mammals.
There is no clear precedent for involvement of mosquitoes in the
transmission of influenza, but recently Sawabe et al. (Am J Trop Med Hyg. 2006 Aug;75(2):327-32); ), demonstrated
that 2 species of blow flies (_Calliphora nigribarbis_ and _ Aldrichina grahami_) collected within a radius of 2.5 km (1.55 miles) from an infected poultry farm in Japan had H5N1 virus in gut, intestinal organs and crop that was infectious for embryonated chicken eggs. They concluded that blow flies might play a role as mechanical transmitter of H5N1 virus.
These experiments, while far from conclusive, deserve to be pursued. - Mod.CP]
arn/cp/ejp/mpp"

"More Symptoms in Hospitalized Calcutta Cullers
Recombinomics Commentary 22:36
February 4, 2008
The South 24-Parganas district health administration on Monday collected the blood samples of one more culling team member, who is suffering from fever, cough and joint aches. Aminuddin is now admitted to Muchisha Block Hospital and is under surveillance. The district health authorities do not know whether Aminuddin had taken the dose of Tamiflu that was prescribed to him before he went for culling.

The above comments describe symptoms of another culler hospitalized near Calcutta (see satellite map here and here). It is not clear if there are two or three cullers hospitalized, but the above symptoms are similar to those of the first culler, and the issue of complete courses of oseltamivir is still open.
The repeated references to blood samples for testing also remain confusing. Virus is typically detected in throat swabs, so it remains unclear if throat swabs are being collected from the suspect patients. India has never reported H5N1 in a wild bird or patient, and testing conditions and procedures may be a factor. H5N1 is rarely isolated from blood samples, and is more commonly found in throat swabs or lung fluid collections if there are lower respiratory symptoms.
Earlier, patients were called influenza patients, but it s not clear that any of the patients has been positive in influenza tests.
More detail om testing procedures and results would be useful."
************************
It is strange if there's no wide knowledge of the preferability of the H5N1 throat swabs over blood samples in India, where is claimed to be even serious research work in the medical sciences.
Maybe not saying if the H5N1 tests have been done or not is a political decision? Probably the quick tests have been done, because if they hadn't, wouldn't it be more probable that the hospitals would have done the tests, not district health administration as above mentioned. Usually, in western countries, the district administration comes to take tests only after the hospitals' own tests have been taken.

Pakistan: Isolation wards set up in major hospitals of Peshawar for treatment of bird flu patients
Associated Press of Pakistan
PESHAWAR
Feb 3, 2008
"After confirmation of bird flu virus in some areas of the country, emergency has been declared in major hospitals of NWFP and Isolation Wards have been set up to treat any patient infected with the deadly disease.
'We have set up an Isolation Ward with the capacity of treating 100 patients affected by the disease,' informed Dr. Saib Gul, Director Emergency Lady Reading Hospital Peshawar.
Talking with APP here on Sunday, Dr. Sahib Gul said all precautionary measures have been taken by hospital administration for treatment of bird flu patients and officials have been directed to be very vigilant and efficient.
All the staff members have been informed about the protective measures from being infected with the deadly virus in case of admission of any patient in the hospital, he added.
He said presently no such patient has arrived from any part of the province.
About the protective equipments for medical staff, he said hospital administration has already made arrangements in this regard.
Meanwhile, a spokesman of Khyber Teaching Hospital (KTH) informed APP that Isolation Ward has also been set up in the hospital.
He said Isolation ward already exist in the hospital where patients with severe viral infections are treated.
In this ward, he continued, 16 separate rooms are made available which have the capacity of providing treatment to 32 patients. However, in case of increase in number of patients, the capacity of the ward can be extended in accordance with the need, he informed.
He said all the equipment in the Isolation Ward are in accordance with the standard of WHO and hospital administration is fully alert for treatment of bird flu patients."
****************************
One may wonder, why all these South East Asian countries are, all in the sudden, preparing their hospitals for hundreds of H5N1 patients. What happened?

Bird flu scare raises food prices in UAE

Lyhyesti suomeksi: Peruselintarvikkeiden hinnat nousseet Arabiemiraateissa 50 % viimeaikaisten H5N1-tapausten takia. Kotimainen kananmunantuotanto riittää tällä hetkellä kattamaan vain 45 % kysynnästä, ja tuonti nostaa osuuden vain 55 %:iin. Myös riisin hinta on noussut voimakkaasti, koska suuri osa Arabiemiraattien riisistä tuodaan Intiasta, jossa myös on H5N1-tapauksia, ja intialaiset joutuvat keskittämään tuotantoaan omaan maahansa. Arvion mukaan riisin hinnat ovat nousemassa seuraavan kuukauden aikana ainakin 30 %.

"Mudassir Rizwan on Sun
IANS
Dubai
02/03/2008 - 10:34
Fears of a fresh bird flu outbreak have sent prices of basic goods in the United Arab Emirates (UAE) soaring by up to 50 percent.
Suppliers of basic goods have called upon the country's ministry of economy to go for price regulation, according to local media reports.
'Our prices have been the same for the past two months. We are not the ones who increase prices. It's the markets that increase them and that's because no one regulates them or controls them. They blame it on us,' Mahmoud Fawaz, general manager of Dana Poultry Farm, a major supplier of eggs, told the Gulf News newspaper.
A tray of 30 eggs, which cost 13 dirhams ($3.5) in December last year, now costs 18 dirhams (almost $5). For imported eggs, the price has gone up from 17 dirhams in December to 27 dirhams Jan 31.
Local eggs meet only 45 percent of the country's demand and a ban on import of eggs from India and Saudi Arabia has led to a shortage of 55 percent in the retail market.
However, the authorities here have ruled out price regulation as of now.
'We are not going to regulate prices. We only interfere if the item has a monopoly in the market or if there is an unjustified increase,' the newspaper quoted Undersecretary of the Ministry of Economy Abdullah Al Salah as saying.
With India concentrating on meeting domestic demand, prices of rice have also shot up drastically.
'Indian production is not sufficient for the Indian population, let alone other countries. Most of the UAE's rice comes from India. We have rice in stock but the prices just keep rising,' rice-purchasing manager of KM Trading Abdul Hakeem told the Gulf News.
Prices of Egyptian rice have also rocketed since that country banned exports of rice Jan 19 to control its price within the country.
However, according to the newspaper, the ministry of economy still believes that there is no need to control prices of Egyptian rice.
KM Trading's Hakeem said prices of rice would definitely rise by at least another 30 percent this month."

Problems force shutdown at disease lab
Marty Schladen
The Galveston County Daily News
GALVESTON
January 25, 2008
A laboratory used by researchers to study highly infectious organisms is being shut down at the University of Texas Medical Branch after an internal door failed twice.
That door was in a lab containing mice that had been exposed to the virus that causes bird flu. It was between a chemical shower scientists must walk through before entering the lab, and the lab itself.
Both diseases are highly deadly in humans, but no people were in the two rooms connected by the door when it failed, said university spokeswoman Chris Comer.
In addition, the disease-causing bugs were behind barriers of their own within the lab, so none escaped, Comer said.
'It’s containment within containment within containment and negative air pressure throughout,' Comer said.
Even so, the Robert E. Shope lab is being shut down as a precaution, Comer said.
In addition to the experiments connected by the failed door, there are six other ongoing experiments being conducted in the laboratory.
All will be wrapped up today and the entire laboratory will be fumigated Saturday, Comer said.
Any further experiments will be delayed until the cause of the internal door’s failure is discovered and corrected. Comer said representatives of its manufacturer are being flown in from Germany to investigate. Medical branch engineers believe a defective switching device was responsible for the problem, Comer said.
The door opened twice: at 3 a.m. and again at 2 p.m. Wednesday. Nobody had been in either of the labs it connected since 5 p.m. Tuesday, Comer said.
The Shope lab is a Biolevel Safety Containment 4 laboratory. Scientists study highly infectious organisms in the secure labs.
The organisms under study in the labs separated by the failed door are both potentially extremely dangerous.
In one, about 10 mice had been infected with the H5N1 influenza virus. The bug, which initially attacks the respiratory system, has killed multitudes of birds, pigs and other animals, primarily in the Far East. It also has killed hundreds of humans, but it doesn’t pass easily between them.
Public health officials are very worried that the virus will change genetically so that it is easily communicable between humans and cause a flu pandemic like the one in 1918. That outbreak is estimated to have killed between 50 and 100 million people worldwide.
Comer, of the medical branch, emphasized that neither pathogen escaped its containment. The medical branch plans to post details of that containment and its safety procedures on the Web today."
*********************
"Nobody had been in either of the labs it connected since 5 p.m. Tuesday"
I wonder how did they find out that the door had opened. Had it been open all night long, the air switching between the hemorrhagic fever lab and the H5N1 lab? Was the door open when the scientists came into the labs?

By the way, the Omsk Hemorrhagic fever doesn't sound "extremely dangerous":
http://www.phac-aspc.gc.ca/msds-ftss/msds113e.html :

Omsk Hemorrhagig fever "Not directly transmitted from person-to-person", "estimated case fatalities are 1-10%; previous infection leads to immunity".
Who said it wasn't ebola? Why would they study Omsk hemorrhagic virus in a level 4 lab (level 4 is the most safe that can be built)?

"NAME: Omsk hemorrhagic fever virus
SYNONYM OR CROSS REFERENCE: Omsk hemorrhagic fever, tick-borne encephalitis (far eastern subtype)
CHARACTERISTICS: Flaviviridae; spherical, enveloped virions about 45 nm in diameter, single-stranded, positive sense RNA genome
SECTION II - HEALTH HAZARD
PATHOGENICITY: Sudden onset of fever, chills, headache, pain in lower and upper extremities and severe prostration; a papulovesicular rash on the soft palate, cervical lymphadenopathy and conjunctival suffusion are usually present; central nervous system abnormalities develop after one to two weeks; severe cases present with haemorrhages - no cutaneous rash; leukopenia and thrombocyopenia are marked; estimated case fatalities are 1-10%; previous infection leads to immunity
EPIDEMIOLOGY: Principally in the western Siberia regions of Omsk, Novosibirsk, Kurgan and Tjumen; occurring mostly in muskrat trappers; 2-41 cases reported between 1989-1998; all ages and both genders are susceptible; seasonal occurrence in each area coincides with vector activity
HOST RANGE: Humans, rodents, muskrat and possibly ticks
INFECTIOUS DOSE: Not known
MODE OF TRANSMISSION: By the bite of an infective tick (Dermacentor reticulatus and D. marginatus, Ixodes persulcatus); data suggests direct transmission from both muskrat to humans and virus contaminated water to humans
INCUBATION PERIOD: Usually 3-8 days
COMMUNICABILITY: Not directly transmitted from person-to-person; ticks remain infective for life"

"Culling man under flu watch
The Telegraph
Saturday , February 2 , 2008
Feb. 1: Culling operations will come to an end in the 13 bird flu districts on Sunday, animal resource development minister Anisur Rahman said today.
He said 27,26,840 chickens had been culled till yesterday. 'We have revised the target to a little over 29 lakh.'
Subhas Barui, who was part of a culling team in Rampurhat, Birbhum, was admitted to the isolation ward of the Tamluk District Hospital yesterday with symptoms of influenza. A resident of Janka village in East Midnapore’s Khejuri, he was engaged in culling between January 22 and 28. He returned home on January 30.
Barui’s blood and mucus samples have been sent to the Indian Council of Medical Research (ICMR), Calcutta. 'If there is a preliminary confirmation of bird flu, we will send the samples to the National Institute of Virology, Pune, or ICMR Delhi,' said health service director Sanchita Bakshi.
The government today issued a directive asking officials to ensure that culling team members were quarantined for at least seven days before returning home.
Health officials said 26 culling team members have been under observation. Eighteen of them have already tested negative for bird flu.

Private culling
In Falakata, Alipurduar, 2,000 chickens were culled at a farm last night after 1,000 birds allegedly died within an hour.
Swapan Kar, who owns the farm, said: 'We immediately contacted Sagun, the company that had supplied the poultry birds. Its officials culled 2,000 chickens to finish the stock.'
The culled birds were buried at the farm. Poultry samples have been sent for tests."
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So, they send for confirmatory tests only those samples that quick test positive. Even though the patients that quick-test negative had influenza-like illness (ILI) after attending culling of H5N1 birds. The quick tests are well-known for that they show false negatives in almost 20 % of real H5N1 cases.

"'Govt failed to look after safety of culling teams'
Saugar Sengupta
Kolkata, India
Saturday, February 02, 2008
Even as a thousand children showed bird flu-like symptoms in Chahol block of Malda district and one member of a culling team was admitted to a East Midnapore hospital awaiting results of his blood test, the Bengal Government on Friday admitted that it should have been more cautious while dealing with the teams engaged in culling about 30 lakh chickens across the State.
'The officials should have been a bit cautious about allowing these people to go back to their families without getting their blood tested,' State Animal Resources Development Minister Anisur Rahaman said, adding 'directives have been issued that culling team members must be quarantined for seven days to prevent contracting the H5N1 virus.'
When asked about the conditions of those showing avian flu-like symptoms similar to people from Indonesia and even Hong Kong reportedly had caught the disease the Minister said there was no threat to humans 'till now.'"