Penumbra Pandemia

Jakarta: Victims' neighborhood H5N1-free
via crofsblogs
May 17, 2008

Via The Jakarta Post: Victims' neighborhood H5N1-free. The story has more information about Istiqomah and her brothers. Excerpt:

The city's husbandry, fishery and maritime agency said Friday it did not find the H5N1 virus in any fowls found in the neighborhood of the latest suspected bird flu victims.
Agency head Edy Setiarto said samples taken from poultry in the Gandaria Utara, South Jakarta, showed negative results.
'We took the samples Thursday and had them examined in our lab in Ragunan, South Jakarta, after scanning an area in the subdistrict with a radius of 100 meters,' he said.
'We found out later that day the tests were negative,' he said.
The agency also culled backyard poultry in the area during the inspection, he said.
'We have finished culling poultry on the subdistrict level,' said Edy.
'The Jakarta husbandry, fishery and maritime agency will continue culling poultry in the whole Kebayoran Baru district.'
The procedure, he said, would be finished by the end of this month.
Edy said the agency is trying to determine where the virus might have come from.
Jakarta Health Agency head Wibowo Sukijat said his agency was testing blood samples taken from people who had contact with the suspects before they died.
'We don't know when the tests will be finished,' he said at City Hall.
Sixteen-year-old Istiqomah died Wednesday after being treated at Persahabatan Hospital, East Jakarta, for having respiratory problems, a cough and a fever.http://www.blogger.com/img/gl.link.gif
Her nails on both her hands and feet had turned blue.
Doctors confirmed Istiqomah died of bird flu, Koran Tempo reported Friday.
On May 4, Istiqomah's brother Ahmad Rizki, 15, died at Prikasih Hospital in Pondok Labu, South Jakarta, after showing similar symptoms.
Doctors at the hospital, however, said Ahmad was suffering from typhoid.
Wibowo said blood samples from Ahmad showed he was not infected by the bird flu virus and thus confirmed the doctors' claim.
A family member of the victims, Alamsyah, 24, is now being treated at Persahabatan Hospital with bird flu-like symptoms.

We still have no confirmation from WHO."
*******************************************

More about the outbreak here.

Avian influenza: two new strains discovered
EL MOUDJAHID via Dutchie at curevents.com
11-05-2008
"A French team of the Centre of International Cooperation in Agricultural Research for Development, CIRAD, announces the identification in Nigeria two new avian influenza viruses.
A highly pathogenic H5N2 strain taken from wild ducks, and a mutant virus H5N1. Both represent potential sources of pandemic.
These findings are the result of a ground survey launched recently by CIRAD in 7 African countries infected in the last two years by bird flu: Burkina Faso, Cameroon, Cote d'Ivoire and Egypt, Niger Nigeria and Sudan."
***********************************************************
"Grippe aviaire : deux nouvelles souches découvertes
EL MOUDJAHID
11-05-2008 à 21:09
Une équipe française du Centre de Coopération internationale en Recherche agronomique pour le Développement, le CIRAD, annonce l’identification au Nigeria de deux nouveaux virus grippaux aviaires. Une souche H5N2 hautement pathogène prélevée sur des canards sauvages, et un virus H5N1 mutant. Tous deux représenteraient des sources potentielles de pandémie.
Ces découvertes sont le résultat d’une enquête de terrain lancée récemment par le CIRAD dans 7 pays africains infectés ces deux dernières années par la grippe aviaire : le Burkina Faso, le Cameroun, la Côte d’Ivoire et l’Egypte, le Niger, le Nigeria et le Soudan."

"Fatal H5N1 Cluster In Jakarta Grows to H2H2H
Recombinomics Commentary 22:38
May 14, 2008
Alamsyah(24), the older brother Istigomah (casualties who diedhttp://www.blogger.com/img/gl.link.gif because of suspect bird flu) took part in being treated in RS Persahabatan, Jakarat Timur. Alamsyah was run off with on Tuesday May 13 2008 yesterday, because of suffering the sign of bird flu

The above translation describes the hospitalization of a third sibling in Jakarta. Two siblings have already died with bird flu symptoms. No sample was collected from the index case, but the second brother was H5N1 confirmed. The hospitalization of the third brothers along with disease onset dates suggests H2H2H transmission, which is among the longest transmission chains reported to date."
*********************************************************
More about the outbreak here.

"H5N1 Clade 2.3 in Japan Signals Global and Genetic Expansion
Recombinomics Commentary 05:21
May 15, 2008
it differs from the virus which in the past is verified in the country, presently has become popular in Indonesia and Vietnam

The above comments on the H5N1 in whooper swans in Japan indicate clade 2.1 or clade 2.3 has moved into long range migratory birds.http://www.blogger.com/img/gl.link.gif Comments from South Korea on similarities between the H5N1 there and H5N1 in Vietnam suggest that H5N1 in both countries is clade 2.3 (Fujian strain). Although movement of H5N1 via migratory birds in eastern Asian is not well defined, an elaborate distribution route in areas west of China has been defined by surveillance and analysis of clade 2.2.
Clade 2.2 was initially reported at Qinghai Lake in central China in May, 2005. The spread outside of China was first reported in outbreaks in Siberia and Mongolia in the summer of 2005. The high concentration of H5N1 in long range migratory birds suggested H5N1 would migrate into Europe, the Middle East, and Africa, where it had never been reported previous. These predictions were confirmed by reports of H5N1 in these regions in late 2005 and early 2006. All isolates were clade 2.2, which was also found in south Asia in India, Afghanistan, and Pakistan.
In the summer of 2006 a new wild bird outbreak was reported at Uvs Lake in Mongolia. This clade 2.2.3 strain subsequently migrated to the east in South Korea and Japan in late 2006 and early 2007. The Uvs Lake strain also migrated to the west, and was reported in Kuwait in early 2007. Although there were few reports of H5N1 in Europe in late 2006 and early 2007, outbreaks were reported in the Czech Republic, Germany, and France in the summer of 2007. All outbreaks were the Uvs Lake strain, which was subsequently widely reported in Europe and Saudi Arabia at then end of 2007.
Although there was considerable heterogeneity in the H5N1 in circulation, all isolates were clade 2.2. The reports of clade 2.3 in whooper swans in Japan and poultry in South Korea raises concerns that the clade 2.3 will follow the paths of clade 2.2 and increase the geographical reach and genetic complexity of H5N1.
The outbreaks in South Korea are at record levels and the locations in Japan are further north than prior outbreaks. The detection of these outbreaks in late spring raises concerns that the H5N1 was brought into the area recently by birds migrating north in the East Asian flyway. Japan and Korea are within intersecting flyways that can move the clade 2.3 into Siberia and Mongolia, while northern movement along the east Asian flyway would move clade 2.3 into North America.
The mixing of clade 2.2 and clade 2.3 in migratory birds could lead to significant recombination and genetic drift, which may then move into new regions as evidenced by the new locations in Japan and the high concentration of H5N1 in South Korea.
Primorie has already reported H5N1 for the first time and its proximity to South Korea and Japan raise concerns that clade 2.3 has already moved into Russia. Details on the sequence of the H5N1 in Russia would be useful.
Enhanced surveillance in Russia and Mongolia, as well as Alaska is warranted by these new movements of H5N1 and the first reports of clade 2.3 in Japan and South Korea."

"H5N1 Clade 2.3.2 in Korea Raises Pandemic Concerns
Recombinomics Commentary 15:42
May 15, 2008
H5N1' Elder brother virus ' 2.3.2' Was confirmed as the channel virus

The above translation confirms that the H5N1 in South Korea is the Fujian sub-clade 2.3.2. This sub-clade has the HA cleavage site of RERRRKR and the most recent clade 2.3.2 isolate in the phylogenetic tree in the WHO vaccine target update is A/common magpie/Hong Kong/645/2006, which is among the Fujian isolates that annually appear in Hong Kong around the beginning of the year.
This identification increases the likelihood that the H5N1 in South Korea and Japan this season is linked to the northern migration of wild birds infected with clade 2.3.2 from the south. Movement of clade 2.3.2 into areas where clade 2.2 has been reported would result in recombination and acquisition of clade 2.2 polymorphisms. Analysis of newly acquire polymorphisms in the above isolate indicates that most are shared with clade 2.2 isolates.
The report of clade 2.3.2 in whooper swans in Japan increases the likelihood that these type of exchanges will increase, and clade 2.2 migrating into Europe, the Middle East, and Africa will have additional clade 2.3.2 polymorphisms. Moreover, the report of 2.3.2 in South Korea and northern Japan increases the likelihood that clade 2.3.2 will migrate into areas where clade 2.2 was reported previously, as well as Alaska, which lies within the East Asia flyway that is delivering clade 2.3.2 to Korea and Japan.
The finding of clade 2.3.2 in Korea and northern Japan significantly increases pandemic concerns and the likelihood that H5N1 will once again significantly expand its global reach and genetic diversity."

"Misinformation Associated With Canadian Train Fatality
Recombinomics Commentary 18:25
May 11, 2008
OPP Const. Marc Depatie said he believed the woman who died had boarded the train in Jasper, Alta., as part of a tour group. Depatie said there were reports she had flu-like symptoms when she boarded.
Tests results on the sick woman taken off the quarantined train stuck in Foleyet, northern Ontario, show she is negative for influenza A and B and she and the other five patients seem to be getting better, said Dr. Donald Low.
The rapid antigen tests are negative for influenza and Respiratory Syncytial Virus (RSV).
'Now they are doing the molecular testing, a more sensitive test. I suspect they'll be negative,' he said.

The above comments from media reports on Friday raise a number of transparency issues concerning the medical emergency on then train in Canada. The fatal case was said to have had influenza symptoms prior to board the train in Jasper, Alberta and her death sparked a medical emergency, which was compounded the flu-like symptoms in other travelers belonging to the same tour group.
However, subsequent media reports indicating most of all of the six travel companions have tested positive for influenza A and the fatal case died of “natural” causes. However, the deceased was initially described as being in her 60's, followed by 86, followed by an identity who was 43 and from South Africa. The relatively young age of the deceased has increased concerns.
The official press release did not indicate the infectious disease was influenza A, and claimed there was no infectious outbreak on the train, apparently based on the fact that the ill passengers has symptoms prior to boarding the train, and contacts had not yet shown any symptoms.
However, since contact with the tour group had been only 2-3 days, the lack of symptoms did not indicate a lack of transmission. Similarly, the false negatives linked to the initial rapid tests on the symptomatic tour group members indicated any influenza testing on the train would be unreliable.
The attribution of the death of the index case is similar to claims linked to the index H5N1 case in Iraq as well as the index case in Azerbaijan. Both were said to have died from complications of a heart condition, and both where subsequently H5N1 confirmed when contacts began to die.
The travel history of this tour group remains unclear. Earlier reports indicated they originated in Australia and traveled through Asia before arriving in Canada. However, the index case is from South Africa, so the true travel history remains unclear.
Similarly, the serotype of the seasonal flu has not been released, and the timing of the lab confirmation of seasonal flu relative to the release of the other passengers remains unclear.
Detail on the influenza serotype, travel history, and autopsy of the deceased patient would be useful."

Ärhäkkä tauti levisi junassa Kanadassa
STT
Julkaistu: pe 9. toukokuuta 2008, klo 22:40
"Kanadalaiset lääkärit tutkivat junassa puhjennutta tautia, jonka takia lähes 300 ihmistä oli karanteenissa. Sairastuneet olivat nousseet junaan Jasperin kansallispuistossa Kalliovuorilla.
Seitsemällä ihmisellä oli influenssan kaltaisia oireita. Yksi matkustaja ehti kuolla ja toinen kuljetettiin helikopterilla sairaalaan.
---
Viranomaiset eristivät junan Foleyetissa Pohjois-Ontariossa. Vaunuihin ei päästetty muita kuin lääkäreitä ja sairaanhoitajia."
*********************************************
Train quarantined in Ont. after passenger dies
CTV.ca News Staff
Updated Fri. May. 9 2008 3:21 PM ET
"--- A Via Rail train passenger train, carrying more than 270 people, was quarantined in the northern Ontario town of Foleyet after officials notified police of a medical emergency on Friday morning.
As many as 10 passengers fell ill, suffering from flu-like symptoms.
Const. Marc Depatie added that it's the 'totality' of the circumstances that led police to believe the death and illnesses are not linked.
Authorities also reached that conclusion upon advice from health experts and reports that the woman was feeling unwell when she got on the train in Jasper, Alta., as part of a group of tourists.
---
Depatie said the victim's body remains on the train as of Friday afternoon as --- teams are finalizing their plan before they launch their investigation.
Provincial police Staff Sgt. Rob Knox told The Canadian Press that one person was airlifted to hospital but the other passengers and crew members are still in quarantine.
A physician had been travelling on the train, which was en route from Vancouver to Toronto, and tried to attend to the victim after she became ill from a yet-undiagnosed ailment.
She later died, and the doctor's attention to other passengers who became ill.
The passenger who was airlifted to hospital was diagnosed with a respiratory illness and is now in stable condition, according to Knox.
The remaining five sick passengers are said to be in good spirits and stable condition.
A spokeswoman for Via Rail told CP that the train departed Vancouver three days ago and hadn't reported any problems before Friday. The illnesses appeared to have been contained to two train cars.
'As far as determining what it is, we're not there yet,' OPP Sgt. Laura Nichols told CTV.ca from the North Bay Communications Centre on Friday morning.
The Canadian Press reported that only emergency response personnel are being allowed on or off the train.
Meanwhile, a CN Rail sleep station has evacuated and local health facilities are on standby.
'The train is going to be here for quite a while,' town chairperson Deborah DesRochers told CTV's Canada AM.
The matter has become one of federal jurisdiction because the train travelled through a number of provinces, said DesRochers.
Health Minister Tony Clement's office released a statement saying his department and the Public Health Agency of Canada have been notified of the quarantine.
'Federal officials are collaborating with provincial and regional counterparts to assess the situation and take action as appropriate,' the statement said.
Clement has been briefed and has directed his officials to collaborate with provincial, regional and local authorities both in Foleyet and at all points along the route the train travelled.
Foleyet is a town of 380 about 100 kilometres southwest of Timmins."

Kiina määräsi koko maan valmiustilaan tappavaa virusta vastaan
Julkaistu 03.05.2008, klo 13.56 (päivitetty 03.05.2008, klo 17.50)
Reuters, AP via YLE Uutiset
"Kiinan terveysviranomaiset varoittivat lauantaina koko maata nopeasti leviävästä enteroviruksesta, joka on maaliskuusta lähtien tappanut ainakin 23 lasta. Tartunnan on saanut lähes 4000 ihmistä.
Lapsista 22 on menehtynyt Fuyangin kaupungissa Kiinan itäisessä Anhuin maakunnassa. Kiinan terveysministeriön mukaan virus uhkaa levitä kuumina kesäkuukausina. Perjantaina 18-kuukautinen poika kuoli viruksen aiheuttamaan tautiin eteläisessä Guangdongin maakunnassa.
Paikallisviranomaiset on määrätty raportoimaan kaikista tautitapauksista vuorokauden sisällä. Päiväkotien ja esikoulujen hygieniavalistusta tehostetaan.
Sairastuneet ovat 2 - 6-vuotiaita. Lapset kärsivät kuumeesta, rakkuloista, suun haavaumista tai kutiavasta ihottumusta käsissä ja jaloissa. Sadat ihmiset ovat edelleen sairaalahoidossa ja osa heistä on kriittisessä tilassa.
Enterovirusten aiheuttamat epidemiat ovat yleisiä Suomessakin, ja yleensä lapset toipuvat taudista nopeasti. Aasiassa yleinen enterovirus 71 saattaa kuitenkin aiheuttaa pahimmillaan vakavia keskushermostoinfektioita ja jopa kuoleman.
Vakavaoireisten EV-71 -epidemioiden osuus on kasvanut maailmanlaajuisesti kuluneiden kymmenen vuoden aikana. Vakavimmat epidemiat ovat olleet Malesiassa vuonna 1997 ja Taiwanissa vuonna 1998. Taiwanissa virus surmasi lähes 80 ihmistä."
*****************************
So far the case fatality rate (CFR) seems to have been under 0,5 %. It's interesting: why are the Chinese officials now alarming the world for a disease that has lower CFR than the seasonal influenza?

WHO denies avian flu warning for Beijing Olympics
The Associated Press via the CTV
GENEVA
Updated Thu. May. 1 2008 10:07 AM ET
"The World Health Organization denies it is recommending that visitors to China for this summer's Olympic Games should pack an antiviral drug to protect themselves against avian flu.
The denial comes in the wake of a report Monday by the Italian news agency Ansa, which said WHO is warning tourists going to Beijing for the August sports event to arm themselves with the drug Tamiflu 'in case of exposure to the disease virus.'
The Ansa story quotes Walter Pasini, director of the WHO Collaborative Centre of Medicine for Tourism in Rimini, Italy.
But WHO spokesman Gregory Hartl said Wednesday that Pasini does not work for the international agency itself and the report quoting him has 'set off alarm bells' ---.
'We would categorically deny that WHO's ever made any kind of recommendation to this effect or that there would be any need or justification ... in any context, including going to the Olympics in Beijing,' Hartl said.
Pasini could not be reached for comment late Wednesday.
The WHO's website shows there have been 30 cases of avian flu, also known as H5N1, reported in all of China since 2003 -- three of them so far this year -- and 20 of them ended in death.
The hardest-hit country has been Indonesia, with 133 cases, including 108 deaths. Worldwide, there have been 382 cases, with 241 deaths since 2003, the website said."
**************************************************************
Denying Pasinis' commentary, Hartl denies that the WHO Collaborative Centre of Medicine for Tourism is working for the WHO?

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO 30 April 2008
Epidemic and Pandemic Alert and Response (EPR)
WHO
30 April 2008


Total number of cases includes number of deaths.
WHO reports only laboratory-confirmed cases.
All dates refer to onset of illness.
******************************************
The case fatality rate (CFR) seems to be about 63 % for all WHO detected cases and about 70 % for 2007-2008 this far.

Avian influenza – situation in Indonesia – update 42
ndemic Alert and Response (EPR)
WHO
30 April 2008
"The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 3-year-old male from Wonogiri District, Central Java Province developed symptoms on 14 April, was hospitalized on 21 April and died on 23 April. Investigations into the source of his infection indicate exposure to sick and dead poultry.
Of the 133 cases confirmed to date in Indonesia, 108 have been fatal."