Scoring the Turkey outbreak against the WHO Pandemic Influenza Alert System.
Earlier this evening, the case count in the hospital at Van stood at 11, including two deceased.
“Two cases — a 14-year-old Turkish boy who died Sunday and his sister, 15, who died Thursday — have been added to the WHO’s list of confirmed H5N1 cases. At least nine other children from the same and nearby families have been hospitalized and are under investigation.”
“Two siblings of the dead children are in serious condition, on mechanical ventilators. And a doctor from the hospital where the suspect cases are being treated called in a local television interview for more ventilators to be sent to the region.”
“Dr. Scott Dowell finds the suggestion that several suspected cases may require mechanical help to breathe a worrisome sign.”
“Dowell, director of global disease detection and preparedness at the U.S. Centers for Disease Control, studied family clusters of H5N1 human flu cases last year, reporting on 15 such groupings from December 2003 through July 2005.”
“There have certainly been clusters, there’ve been family clusters before,’‘ he said from Atlanta.
“But to have a number of people on ventilators at the same time from a similar exposure, that would say That looks like something is a little bit different from what’s happened before.”
The largest of the clusters Dowell and his co-authors reported on contained five members of one Vietnamese family. Most were groups of two or three family members.
“I think really, (illness in) people like health-care workers and first responders would be our first indication that something is changing in the virus to make it more transmissible,” WHO spokeswoman Maria Cheng said from Geneva.
Here are the current WHO global pandemic phases, courtesy of Viral Protein. (These definitions haven’t been made easy to find, by the way.)
WHO has currently identified six specific phases that would cover the generation of a pandemic:
Inter-pandemic period
Phase 1: No new influenza subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. The risk of human infection is considered to be low.
Phase 2: No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease.
Pandemic alert period
Phase 3: Human infection(s) with a new subtype are reported. There are no instances of human to human spread, or at most, rare instances of spread to a close contact.
“* Phases 4 and 5: these numbers are only intended to provide an example of what criteria might be considered in these phases. They are not definitive and will most likely be revised depending on the actual situation.”
Pandemic period
Phase 6: Virus transmission increases significantly, and there is sustained transmissibility in the general population.
“Revising the pandemic level (up or down) requires that WHO consult a board of external experts to review all available data. The board will then make recommendations to the WHO Director-General, who will then decide whether the pandemic level should be changed.”
“Turkish health authorities have informed WHO that, since 1 January, a total of 11 patients (including the two confirmed fatal cases) have been hospitalized in Van Province with symptoms suggesting infection with avian influenza. Most patients are children between the ages of six and fifteen years and all reside in the Dogubayazit district. Two of the children are siblings of the two confirmed cases.”
Meanwhile, a reminder of what Dr. Michael Ryan had to say on the CBS 60 Minutes Bird Flu segment:
“There have been several cases in Vietnam and Thailand, where the virus seems to have spread from human to human, but only to close family members and caregivers. Then the transmission stopped.”
“What we haven’t seen is sustained efficient human to human transmission. We have not seen chains of infection. And of that we’re sure. And that’s what we need to look out for,” says Dr. Ryan.
“We won’t have time, possibly, at the beginning of a pandemic even to get laboratory confirmation. It may take days to get laboratory confirmation,” says Dr. Ryan. “We may have to make this judgment on the basis of the existence of a cluster that’s spreading quickly. And that signal will be very strong. You’ll see the disease extend very quickly from two to four to ten. To 20. To 30, 50, and beyond number of… And when you start to see that mini explosion of cases, we’re going to have a very, very short time in which to do something about that. Very short.”
How long do scientists have?
“The intervention time will be measured from days to weeks. I think no longer than a month at the extreme,” says Dr. Ryan.
Dr. Ryan says if an outbreak isn’t stopped or controlled in 30 days, scientists may lose the battle, “and nobody knows whether that can be done.”
Here are a couple of travel tour links to pictures of the dogubayazit / Mt. Ararat area.
http://www.ezoptravel.com/ezopnew/intours/mountain/mt_climb_mini.html
http://www.galenfrysinger.com/dogubayazit_turkey.htm
Now, oric’s latest report:
“The news is from VAN Hospital again (despite all my requests I can’t get any news from other hospitals .. )
The surgeon general of the hospital said that there were 47 people who came to the hospital since yesterday 18 of them were clean so they were sent home the remaining people are in hospital … 26 patients are in hospital (3 were dead 26 + 3 = 29) Although 3 patients are in critical condition none of them are on artificial respiration.
Those 26 patients 18 of them are in bed, the rest are in observation but not too sick
Total cases (in hospitals)
26 in Van 5 in Erzurum 6 in Igdir 1 in Ercis (Van) 38 sick + 3 dead = 41 cases
What to make of these numbers vis-à-vis the WHO Pandemic Influenza Alert System?
This is bound to be discussed and possibly resolved sometime soon, as the facts on the ground now lend new meaning to erstwhile abstractions.
Taking the earlier report first, of eleven cases in the Van hospital, Van Province, from the Dogubayazit district. Dogubayazit is a small town or a place about two hours drive from Van near Mt. Ararat, a 17,000 ft mountain of some biblical renown. Thus, while one account speaks of the eleven cases as being from one family or from nearby that family, it’s not yet clear how close the other cases were, or if they had any mutual contact. We suppose those questions will be addressed as soon as possible.
Add to that earlier report 30 new human cases in Van, some, possibly from Van, others from Erzurum, Igdir and Ercis, plus new bird flu outbreaks in the central Turkish province of Yozgat, the southeastern province of Sanlýurfa, and in the eastern provinces of Erzurum, Igdýr and Agrý.
Once again, evidence suggests the human cases stem either from a virus that transmits more readily to humans than previously, or, from some h2h transmission yet to be confirmed, orm from some combination of those two possibilities.
Taking the WHO Phases literally, we should know in less than two weeks if we’re going to Phase 4. Likewise, we should know in less than 4 weeks if we’re going to Phase 5 / Phase 6. In any case, at this point, I’d put the odds that we go to Phase 4 in ten days or so are maybe 3 to 1.
I’m no epidemiologist, just trying to integrate the news.
Dubina,
Good summary of current conditions… like waiting for a hurricane to go to Cat4.
“The surgeon general of the hospital said that there were 47 people who came to the hospital since yesterday 18 of them were clean so they were sent home”
Are there relatively definitive tests that are done to indicate absence of virus? If it takes days to determine a patient is positive for H5N1, how can they know he/she is negative in a few hours?
Love the forum title! it’s nice to see some levity when you are waiting for the axe to fall…
closed for volume issues