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| -Signs, Portents, and the Weather- |
| H5N1 Pandemic Potential - Tight 8 Member Cluster in Kien Thuy |
| 2005-03-29 |
| More on bird flu with Dr. Niman's commentary. Ngo Viet Hung, head of the infectious disease ward at Viet Tiep hospital, said in the latest case, the family's symptoms, which included high fever, coughing and a mild lung infection, have largely disappeared. Family members are currently being kept in an isolation ward. Hung said the family's neighbour, a 32-year-old woman from Haiphong, was admitted on March 25 with high fever and coughing. Test results on her have not been completed, he said. The neighbor described above is probably Vu Thi Hoan, who was listed as being 41 years-old in an earlier report. She is a neighbor who was admitted to Vist-Ysp hospital on March 25. The cluster for the commune in the Kien Thuy district of Haiphong province has now grown to eight and all eight were admitted to Viet Tiep within a few days of each other. In addition to the family of five and their neighbor, two other commune members, a 41 year-old male and a child were admitted into Viet Tiep hospital with breathing difficulties last week. The admission of five family members on the same day signals efficient transmission of bird flu. There have been many reports of families eating sick chickens, but not reports of 5 family members being hospitalized on the same day. Now there are three more neighbors, also admitted with bird flu symptoms. The close clustering in time and space of all 8 members in possibly 4 different households, strongly suggests efficient transmission of H5N1 spreading through the neighborhood. Such spread among birds has been seen many times, However, a parallel spread among neighbors signals a more efficient transmssion to humans, which is a major step in the evolution of a pandemic. I found a report yesterday at Novosti about a computer model for flu transmission in Russia. The model said it would take 78 days after the first case for the pandemic to peak and on the peak day there would 180,000 deaths (presumably in Russia). The point to note is how fast it will spread and consequently how little time there will be to react and how quickly healthcare systems will be overwhelmed. There appears to have been another 5 Marburg deaths in the last 24 hours. Two simultaneous epidemics will just overwhelm the available healthcare and disease control resources that much quicker. I have a bad feeling about this. |
| Posted by:phil_b |
| #13 Even if we have the time to manufacture enough vaccine, and I very much doubt we will have the time, there are issues about how effective the vaccine will be. From the New Scientist: The first human trials of a vaccine against H5N1 bird flu are likely to be a waste of time and money. The formulations that the US plans to test are thought likely to be ineffective - and even if they do work it will take far too long to manufacture enough doses to prevent a pandemic strain wreaking havoc. Other countries are following more promising approaches, but they are not ready to start trials. Fears that the H5N1 virus might mutate into a form capable of triggering a human pandemic have persuaded several countries to change strategy. Instead of waiting for a pandemic strain to emerge, health authorities are creating human vaccines against the current strain. Although these vaccines might not be perfect, the hope is that they will make the difference between life and death. The sooner prototype vaccines are tested, the sooner vaccine makers can prepare to manufacture the vast quantities that might be needed. But so far the US is the only country to have ordered enough prototype vaccine to do clinical trials - and there are two major problems with its formulations. The key ingredient in any flu vaccine is the viral protein haemagglutinin, or HA. Vaccines against ordinary flu contain 15 micrograms each of three varieties of HA. The clinical trials planned by the US National Institute of Allergy and Infectious Diseases will test doses of 15 and 45 micrograms of H5 - the HA of the H5N1 virus killing people in Vietnam. The aim is to make the vaccine as similar to ordinary flu vaccines as possible, to ease approval by the FDA. |
| Posted by: phil_b 2005-03-29 8:40:16 PM |
| #12 Okay, say the infection strikes and hits the third world pretty hard but the Anglosphere is protected by stockpiled medicines. How long until the conspiracy theories or racism charges start? |
| Posted by: rjschwarz 2005-03-29 6:28:50 PM |
| #11 Yes, Britain is stockpiling Tamiflu sufficient for one-quarter of its population. Unfortunately there's no way for the US to do that. Our population is too large, and production capacity is nowhere near sufficient. |
| Posted by: HV 2005-03-29 5:27:51 PM |
| #10 .com (#1) Britain IIRC has stockpiled antiviral meds for the same reason. |
| Posted by: too true 2005-03-29 12:17:03 PM |
| #9 Mom Several weeks ago you expressed you would like to have further details about a post I made about the french revolution being a scam and about litteracy rates in pre-civil war United States. You told it would help your daughter. Unfortunately I saw the post when comments were closed and you don't let your e-mail. Feel free to contact me if I can be of any help. Regards |
| Posted by: JFM 2005-03-29 12:08:41 PM |
| #8 The women in the family may have had some residue from the chicken on their hands when handling the baby. Chickens can be really messy things to prepare. Because of the threat of salmonella, I bleach my cutting board and utensils after preparing chicken and turkey, and I put newspapers under the cutting board on the table to protect the table from splatter. I also wash the cloth afterward. And I don't have to kill, singe, and pluck the chicken myself. |
| Posted by: mom 2005-03-29 9:11:37 AM |
| #7 P2p can be casual or intimate. The baby nurses. Intimate contact and far more likely to pread the germ. Not just in mom's milk, but also being held close while mom is coughing or sneezing. Also, isn't it Asian to blow your nose on your fingers, not a handkerchief or tissue? So far, p2p cases seem to be "all in the family", and still rare. |
| Posted by: Chuck Simmins 2005-03-29 9:00:57 AM |
| #6 Good point. The timing of the incubation period will probably resolve that, then, as it would mean a delay before the baby's initial exposure. We shall see what sort of clinicians they are, at the least. |
| Posted by: .com 2005-03-29 8:41:07 AM |
| #5 It could have been transmitted through mother's milk. |
| Posted by: Sobiesky 2005-03-29 8:34:01 AM |
| #4 Oops. #4 is reply to #2. |
| Posted by: .com 2005-03-29 8:28:55 AM |
| #3 Perhaps, but a 4 month old baby, too? I recognize that there are cultural differences, but as far as I know, you probably don't give 4 month old babies chicken to gum - I sure didn't with mine - it's a serious choking risk. Following the "efficient transmission" link: "Although the transmission may have come from the dead or culled chickens, it is not clear that a 4 month old baby would be infected from eating chicken." I'm inclined to believe that the "effiency" of transmission, which is all they will claim at the moment, is not all that they wanted to claim. They are being ultra-cautious, of course. Me - I'm a wild-eyed extremist, y'know. Chicken, Turkey, no difference - they're both foul, er, fowl, heh. I've got to keep up appearances and maintain my rep. ;-) |
| Posted by: .com 2005-03-29 8:27:56 AM |
| #2 If it is p2p xmission, it will become very obvious very soon. Use the incubation period as the cycle of generation. Current estimate can be anywhere from 2 to 7 days before the onset of symptoms, and a 4 day period before and after onset of symptoms when the victim is most infectious. Assuming this cluster is the "1st generation", the "2nd generation" should then show symptoms any time from about March 27th to April 1st. Calculating out the infectious cycle is a top priority in planning quarantines and other measures. On the plus side, the disease may have too short an incubation period, which would strongly help in its control. |
| Posted by: Anonymoose 2005-03-29 8:21:05 AM |
| #1 .com, from the story it appears that they did not cook their chickens well. I don't want to diminish the threat, but I don't see this as yet a proof of HtoH transmission. |
| Posted by: Sobiesky 2005-03-29 8:14:21 AM |