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| Jump in suspected bird flu cases in people: Bird-to-Mammal mutation increases spread |
| 2005-11-14 |
| Indonesia said on Monday a 20-year-old woman has died of bird flu and several other countries also reported more suspected cases in people. Adding to the sense of alarm, researchers in Vietnam say the H5N1 avian flu virus has mutated allowing it to replicate more easily inside humans and other mammals. Taiwan said it had detected another bird flu strain that can infect people. Avian influenza is known to have infected 125 people in Asia, killing 64, and is endemic in most poultry flocks in the region. There are at least a dozen other suspected cases as governments in Asia struggle to control outbreaks in poultry to prevent more people from catching the virus, which experts fear could trigger a pandemic. Vietnam and China said on Monday they had had more suspicious cases in people, while Thailand said a toddler confirmed infected with bird flu was recovering. In the Indonesian capital, tests confirmed the woman died from H5N1, a Health Ministry official said and that tests were also being conducted on samples from a 13 year-old girl. Both died over the weekend in the Sulianti Saroso Hospital, Jakarta's hospital for treating bird flu patients. Initial tests on the girl were negative... The laboratory, affiliated with the World Health Organization, has confirmed five people have died of bird flu in Indonesia. But President Susilo Bambang Yudhoyono put the toll higher, telling a news conference on Monday seven of the 11 people who had contracted avian influenza in Indonesia had died. HIGHLY VIRULENT IN MAMMALS In Vietnam, scientists at the Ho Chi Minh Pasteur Institute who have been studying the genetic make up of H5N1 samples taken from people and poultry said it had undergone several mutations. "There has been a mutation allowing the virus to (replicate) effectively in mammal tissue and become highly virulent," the institute said on its Web site at http://www.pasteur-hcm.org.vn/english/index.jsp. State media said bird flu might have infected two more people in Vietnam, where 42 people have died from the virus since the latest outbreak in Asia began in late 2003. State newspapers said on Monday a student was being tested in hospital after eating chicken eggs, while a 78-year-old woman died from pneumonia in central Quang Binh province on Friday. China is probing a possible human case of bird flu in northeastern Liaoning province, the WHO said on Monday. More than 10 million birds have been culled in Liaoning, where a female poultry worker has bird flu-like symptoms, said Roy Wadia, the WHO's China spokesman. The WHO is also sending a team this week to the southern province of Hunan to investigate three pneumonia cases. One of the cases, a 12-year-old girl, has died. China has not confirmed any cases in people and bird flu remains hard for humans to catch. But scientists fear the H5N1 virus will mutate into a form that passes easily among people. If it does so, millions could die. The disease has so far killed half the people it has infected and governments are stockpiling anti-viral drugs that are believed to limit the effects of H5N1 if taken early enough. By far the most sought-after is Tamiflu made by Swiss company Roche. But Japanese subsidiary Chugai Pharmaceutical Co. said on Monday two teenaged boys exhibited abnormal behavior that led to their deaths after taking the drug. Shinichi Watanabe, deputy director of the health ministry's safety division, said the ministry had ordered Chugai in May last year to include in the literature accompanying the drug a list of psychological and neurological disorders that could arise as side effects. Michael Richardson, a senior research fellow of the Institute of Southeast Asia Studies in Singapore, said bird flu was a major threat to mankind. "A pandemic triggered by H5N1 could become a fearsome insurgency against human health, with the potential to be far more lethal than terrorism," he said in a briefing paper on Monday. Perhaps just as worrying, Taiwan said on Monday it had found another highly pathogenic strain of avian flu, H7N3, in droppings left by a migratory bird and is carrying out tests to see if the virus has spread to nearby poultry farms. Like H5N1, the H7N3 strain can infect humans, said an official at the Council of Agriculture. |
| Posted by:Anonymoose |
| #7 Influenza A is clearly adapted to species jumping and causing pandemics. While the record prio to the 20th C is patchy, its clear flu pandemics have been happening for a long time and at approximately 30 to 40 years intervals. Link The 1918 virus appears to be a bird flu virus. But if it is from a bird, it is not a bird anyone has studied before. That puzzled me when I first read it and I'm curious to know why he thinks this. |
| Posted by: phil_b 2005-11-14 22:38 |
| #6 Horse hockey! Sorry, folks, but Horse Hockey! H7N3 is NOT new. It was isolated as early as 1963 in England. In humans it typically presents as an eye disease. H5N1 is blamed for outbreaks as far back as 1959 in Scotland. LINK There is no pandemic cycle known. We know of three, in the last 87 years, and they happened at different intervals and with differing flu variants. While the Spanish Flu is often cited, the researchers who mapped its genome feel differently. In a NY Times article, Dr. Jeffery Taubenberger, a molecular pathologist at the Armed Forces Institute of Technology who led the research team that reconstructed the long-extinct virus, said that a few things seemed clear. Influenza kills by weakening the body for other, opportunistic infections, primarily pneumonia. Nearly all of these infections are treatable with antibiotics. In fact, the pneumonia vaccine currently available may do more than anything else to prevent a deadly pandemic. The evidence of a cytokine storm is slim, based on assumptions being made from accounts of the Spanish Flu and experiments done in petri dishes. There is zero evidence that a cytokine storm is the cause of death in any of the A)H5N1 cases. The World Health Organization has stated that laboratories in Southeast Asia are not capable of definitive analysis which would determine the existance of H5N1 in any given case. Announcements from a Communist government in SE Asia should be particularily suspect, shouldn't it? My analysis and commentary is here. Michael Fumento has an extensive article, full of cites, on his website. |
| Posted by: Chuck Simmins 2005-11-14 19:51 |
| #5 Moose, I also follow this closely and I have concluded the pandemic is highly unlikely to occur. My reasoning is as follows. The key event is sustained transmission. Until that occurs there is no risk, when (if) it occurs a pandemic will be difficult to stop. Sustained transmission is also significant because it allows the virus to acquire adaptations specific for infecting humans. We don't know how many adaptions are required, but its at least one and likely several. Despite much ill informed media and so called expert opinion. These adaptations can not be acquired in birds. So we have the situation where the virus periodically jumps to humans may have one or two generations of H2H and then dies out (and any human specific adaptions are lost). A recent Thai study clearly showed that size of (H2H)clusters has not increased over the last 2 years and hence the virus is not getting better at transmitting between humans (which is what theory would predict). However, this leads to an apparent paradox. The necessary human specific adaptations can only be acquired and retained when sustained transmission has been achieved. Sustained transmission can only occur when human specific adaptations are present. The second part of this apparent paradox is not correct because pure chance could result in sustained transmission. For a number of reasons, I put sustained transmission as 10 generations of H2H, and this will be enough time to get enough adaptions that chance is no longer the primary determinant of continued transmission, i.e. sustained transmission goes from being unlikely to highly likely. Let's say an infected person has a .5 chance of causing a H2H transmission (currently it seems somewhat lower). So to get a chain of 10 h2H transmissions is .5^2, i.e. a 1,000 to 1. So all other things being equal, get enough bird to human transmissions and a few years and the 1,000 to 1 will pay off and a pandemic occurs, which would have been the situation in the past. However, various control measures currently being implemented (including things like putting infected people in isolation wards) sends those 1000 to 1 odds way higher (change the 0.5 to 0.25 and the 1000 to 1 odds become a million to 1 odds), and rather than the pandemic being likely in the next few years, it becomes likely in the next few millenia. |
| Posted by: phil_b 2005-11-14 19:45 |
| #4 I have been on top of this one since the 1970s, even written a paper or two on the demographics of killer flu. The "big one" has been expected at least since then, coming in a roughly cyclic manner, and we are way past the due date. America at the time of the Spanish Flu wasn't a naive place, as far as the health authorities were concerned. Medical sanitation was reasonably good, and disinfectants were widely available and used. Add that to the fact that they were familiar with epidemics, and epidemic control policies were commonplace. Public quarantines were matter-of-fact. Where I live in the southwest, every summer they had to contend with polio, typhus, typhoid fever, whooping cough, smallpox, chickenpox, mumps, and god knows what all else. Elsewhere, "sick rooms" were part of the architecture in better homes, a place where an infectious member of the family could be isolated. The big difference is that the public was not as aware of hygiene and sanitation as they should have been. Epidemics ran through the population when they shouldn't have, because the people just didn't know any better. Methods of prevention were anecdotal. One woman in Indiana made a fortune overnight because of a rumor that her knitted wool sweaters were proof against the disease. Because the disease lasted so long, 18 months to two years, people became exhausted from trying to protect themselves and just gave up to take their chances. The unfairness of the flu was also noted, that weak people would more likely live than healthy people, again, perhaps due to their overactive immune systems. So what I am really suggesting is a change in behavior, nothing terribly drastic. With mental preparation, to work off the assumption that for as long as a year or more, your will have to sanitize your hands when you have been out in public. You will have to train yourself to not touch your face in public unless you know your hands are clean. To even avoid things like shaking hands. Etc. Not terribly hard, but they do require a change in behavior, and only really matter when the disease is about. Lastly, a point that few have mentioned. That is, while everyone is concerned about the lethal effects of the avian flu, few have mentioned that it may make a person sick for weeks or months without killing them. I remember some neighbor adults being afflicted with Hong Kong flu, and for weeks being incapacitated, relying on their young children to take care of them. With hospitals full of such invalids, other problems will be exacerbated. It will be a hard time for us all. |
| Posted by: Anonymoose 2005-11-14 17:51 |
| #3 Moose is right about touch being the main mode of transmission to the mucous membranes. |
| Posted by: phil_b 2005-11-14 15:05 |
| #2 just noticed the handle-wipes at the Albertson's entrance....good idea |
| Posted by: Frank G 2005-11-14 14:47 |
| #1 (updated repost) Life saving trivia. I heartily recommend saving this information. 1) It has recently been determined that most pulmonary illnesses are spread by hand contamination, not coughing or sneezing as previously believed. If you are out in public or around those who are during an outbreak, using alcohol-based hand sanitizer six times a day will reduce your chance of catching flu by 80%. If there is obvious contamination, use soap and water. Antiseptic soap is not significantly more effective than ordinary soap in this regard. Consciously force yourself not to touch your face until you have sanitized your hands. Ordinary surgical masks and glasses of any type will keep pathogen-carrying large droplets out of your mouth, nose and eyes, if you are around those who are coughing and sneezing. They do not have to "capture" viruses, just the large droplets of moisture that carry them. 2) The worst public sources for air and surface contamination are public restrooms and restaurants. Avoid them. Sanitize telephone handsets and often touched surfaces in work areas, especially doorknobs. Parts of automobile interiors can also be cleaned routinely, such as the steering wheel, door handles and shift nobs. Some grocery store chains are already providing grocery cart handle wipes and have complimentary bottles of hand sanitizer for use by customers. 3) Even though you cannot eliminate contamination, you significantly improve your odds by reducing it. Ordinary bleach and other household cleaners work well as decontaminants. Change your cleaning method to adding cleaner to bulk messes before cleaning them, instead of after removing the bulk. Use additional cleaner for the final cleaning of the surface after the bulk is removed. This will reduce airborne contamination from the cleaning process. 4) Some metals are not directly anti-viral, but inhibit viral reproduction in some circumstances. Cold-Eeze brand throat lozenges contain a patented form of zinc that is readily uptaken into the mucous membranes, unlike most zinc supplements. With FDA approval, it can state that it lessens severity and duration of colds and flu. Perhaps it can do more. 5) Most colds and flus reproduce in the sinuses and trachea, so it is important to keep them a less friendly environment for viruses. The use of ordinary saline nasal spray to reduce large build-ups of mucous removes breeding medium. NOTE: avian flu is different, in that it can reproduce in several other organs, including the liver. This makes it especially important to keep it out in the first place. 6) Another newly discovered trick that may work is ordinary store-bought cranberry juice, which has been determined to inhibit cellular adhesion by several viruses, BUT ONLY IN QUANTITY. It is unknown if it would work for avian flu, but drinking large amounts as a possible prophalaxis should not be too much an inconvenience, if that is all you've got to protect yourself with. Interfering with cellular adhesion and inhibiting reproduction have a "one-two punch" effect on viruses, so both should be used. Cold-Eeze lozenges and cranberry juice. 7) There will undoubtedly be shortages of several items once an outbreak has occurred. Surgical masks, protective glasses, latex gloves, sanitary wipes and rubbing alcohol may all become scarce, so it is not unreasonable to stock up now. Substitutes such as grain alcohol, sunglasses, etc. are almost as good. Remember that gloves only keep the contamination off of your skin. In turn they must be assumed to be contaminated and either cleaned or disposed safely. Be aware if you track through contaminated muck that your shoes should be cleaned at some point. Shoes are the second most often contaminated area of the body after the hands. 8) The vaccination priority that we are used to has been changed because of the severity of this illness. Instead of giving injections to the elderly, infirm and very young, the emphasis will be on school-aged children (the largest human vector of the disease), and in outbreak areas. It would be wise to familiarize yourself with traditional quarantine measures, as they can be unexpectedly harsh. In time of an epidemic, the Health Department can be authoritarian. 9) The avian flu also has a large number of animal vectors, and until these are determined for certain, it would be wise to avoid large assemblages of animals and birds, even dogs and cats. Already, some birds have been identified that can carry the disease for great distances without immediately dying. If domestic mammals do the same, it may amplify the spread of the disease. Note: there is an "ordinary" flu specific to dogs in an epidemic right now, but it is not transmittable to humans. It is dangerous to dogs, however. 10) Flu vaccine takes from several days to two weeks for optimum immunity. This immunity may last perhaps six months or more in a healthy, young adult, and as little as two to three months in the elderly. A severe flu epidemic usually appears in two waves, and can last from one to two years. Therefore, a single shot may not be enough. 11) Symptomology of avian flu so far seems to indicate that death occurs very quickly, perhaps within 72 hours, and is often from blood and fluid build-up in the lungs. Though this sounds morbid, some people may die in public and it is important not to touch the body. An incapacitated person may spew large amounts of infectious fluids about. Do not attempt to render significant first aid if it places you at risk, instead call 911 and let suited professionals help them. 12) Traditionally, government has been slow to react to epidemics, often waiting too long before instituting strong restrictions on the public. However, this can be deadly serious, even if ineffective. There may be circumstances where armed guards are used, and response to public panic may be severe. Do not travel without expectation that you could be placed in quarantine for at least several days. 13) It is believed that an over-reaction from the immune system might be even more lethal than the disease itself, but this is not yet proven for the avian flu. That is, people with healthy immune systems might die when weaker people might live, much like a severe allergic reaction can kill. So it is important to find out if this is the case, when it is determined. If it *is* the case, then you might want to avoid immune system enhancing supplements. Again, right now we don't know. 14) It is unlikely that this winter's cold and flu season will be the avian flu. However, these weaker diseases should be your final warning as to your probability of catching the avian flu. If, in cold and flu season, you practice step #1 above and still catch either disease, you need to strongly reevaluate hygiene in your environment. Links: Flustar -- current status of flu in your area. http://flustar.com/ Flu Wiki -- good detailed general information about the flu. http://www.fluwikie.com/ CDC Travel Information -- international outbreaks http://www.cdc.gov/travel/ *********** (most recent information added to this repost) There are 2 distinct H5N1's, and 3 distinct H1N1's making the rounds in Asia. The H5N1's have identical 20 amino-acid deletions, and the H1N1's have identical 16 amino-acid deletions in the neuraminidase sequences. The net effect of these deletions is to drastically decrease the effectiveness of NA inhibitors such as oseltamivir (Tamiflu). The current substrains require 30 times the threshold dose of oseltamivir to effect control as similar strains last year. To date, of Vietnamese contracting the H5N1 strain, there have been no survivors among the group receiving Tamiflu as an anti-viral. Other modifications include an M2 sequence change in all five strains that renders ion-channel blockers such as amantadine and rimantidine ineffective. Of common anti-virals, only zanamivir (Relenza) at present appears to retain any effectiveness. |
| Posted by: Anonymoose 2005-11-14 13:20 |