Summary from Indonesia Outbreak tracking as at 25 September 2006
| Cases Discussed | Jun-06 | Jul-06 | Aug-06 | Sep-06 | Total |
|---|---|---|---|---|---|
| Died, no tests | 2 | 2 | 4 | 3 | 11 |
| Died, tested positive | 4 | 3 | 2 | 2 | 11 |
| Other tested positive | 0 | 1 | 3 | 0 | 4 |
| Suspected symptoms | 4 | 2 | 46 | 37 | 89 |
| Tested negative | 0 | 6 | 25 | 5 | 36 |
| Totals | 10 | 14 | 80 | 47 | 151 |
(From WHO as at 25 Sep – excludes Thailand case reported late today)
Total human cases worldwide 249, deaths 146 (2006 – 102 with 68 deaths)
(If you want the links to open in a new window, hold down the shift key and then click on the link)
Indonesia
Czech Republic
United Kingdom
Egypt
Canada
United States of America
General
Link to news thread for 25 September (link News Reports for Sept 25 )
(Usual disclaimer about may not have captured everything. Feel free to add your own where omissions have occurred.)
Please note that I copy the links directly from the thread so if they don’t work you may need to re-visit the Thread.
Sorry about that - still a bit of refining required of my editing skills …
COMMENT With reference to the latest case announced in Thailand. This person became ill on July 14 and died Aug 10 and we get confirmation / announcement on 25 September! Not even the daily update on the Thai communicable diseases site could indicate that specific tests were pending - the suspected cases line really doesn’t tell you anything ..
In six weeks, this virus could easily have travelled a long long way … have to go for a walk, my blood pressure is soaring!
Updated information from Indonesia (link http://tinyurl.com/omanw )
Yuli Tri Suwarni and Apriadi Gunawan, The Jakarta Post, Bandung, Medan
More possible cases of bird flu have been identified in families in West Java and North Sumatra, triggering fears of new disease clusters, as the national death toll hit a record of 51 Monday.
A 23-year-old male resident of Bandung died Sunday afternoon. His 20-year-old brother is in critical condition in an isolation room at Hasan Sadikin General Hospital.
“Based on the symptoms, we suspect they are a new cluster,” said Fatimah Resmiati, the head of the environmental health department at the West Java health office, Monday.
Fatimah added that the elder brother died before he could be taken to a hospital for testing.
“Unfortunately, we don’t have his blood sample,” she said.his leukocyte (white blood cell) level was only 1,600 and he was suffering from heavy pneumonia, which is usually confirmed as positive.”
The brothers’ cousin said the brothers had fed their dogs dead chickens they bought from a nearby market.
<snip>
Meanwhile, five members of a family were being treated as suspected cases in Adam Malik Hospital in Medan, North Sumatera.
Two of the children were released Monday, but another of the family’s children, R.S., 11, died last Monday. Hospital spokesman Sinar Periangin-Angin said the family was admitted Friday for high fever.
<snip>
It is a real concern that the dead chickens are being sold in the markets - I assume they would not have fed them to the dogs unless they were sold as ‘dog food’.
Indonesia This is another story from the Jakarta Post today but I am not sure if it is ‘recent’. Worth a read if you want to know what is being done. (link http://tinyurl.com/easxr )
What we have done so far on bird flu may not be enough
The government has stepped up its fight against avian influenza with the launch of a mass vaccination campaign earlier this month. The executive chairman of the National Committee for Avian Influenza Control and Pandemic Influenza Preparedness, Bayu Krisnamurthi, recently spoke with The Jakarta Post’s Emmy Fitri about measures and plans designed to contain the outbreak of the disease. More ….
NOTE that the use of the term cluster cases in the above story (02:42) means that there is human-to-human transmission being considered. (The same story in the Antara News specifically uses the words H2H)
Fatimah Resmiati, from the West Java health office, said that a 25-year-old man died in Bandung on Sunday suffering bird flu symptoms, but he was buried without samples being taken for testing.
His 20-year-old brother, displaying similar symptoms, was admitted to the same hospital with him, she said.
He was transferred to Hasan Sadikin hospital, a government-appointed centre for bird flu treatment, where he was joined by the third brother, aged 15, on Monday.
“As the three are blood-related and suffer from the same symptoms, we are suspecting a new cluster case here, but we still have to make the necessary tests to ascertain what they are suffering from,” Resmiati told AFP.
I don’t know where to write this - at the “updated human cases” there has been an update based on Reuters’ info. I’m not sure if it’s WHO confirmed. I don’t have time to check and I might be wrong.
I think we should only place “WHO confirmed cases” in that table, and be specific about it so contributors will keep the information “reliable” (i.e., consistent with WHO, in this case).
See http://fluwikie.com/pmwiki.php?n=Main.Last50Changes and look for “Main.Confirmed Cases Updated . . . September 25, 2006, at 06:54 PM by Tamarin?: updated number of deaths according to Reuters uk”
???
lugon those numbers are not the same as WHO so I will update them
September 26, 2006 Avian flu Avian flu drill to be held
The Centre for Health Protection will conduct an exercise September 27 to review Hong Kong’s preparedness for human avian flu cases.
The Health, Welfare & Food Bureau, Department of Health, Hospital Authority and Fire Services Department will participate in the one-day exercise, along with more than 100 players.
The drill will focus on frontline issues, such as the handling of patients in public hospitals and contact tracing by the centre’s Surveillance & Epidemiology Branch, in the event of human cases of avian influenza.
More … (link http://tinyurl.com/ntlgm )
Russia steps up bird flu measures in light of fall migration
VLADIVOSTOK, September 26 (RIA Novosti) - Measures against bird flu have been stepped up in Russia’s Far East due to the fall migration, the local administration said Tuesday.
Veterinary services took 1,100 blood samples from wild fowl and domestic birds throughout the Primorye Territory, eight time zones east of Moscow, from July to September 2006.
“No case of bird flu has been reported,” the administration said.
Domestic birds were vaccinated against avian flu in the spring, when over 830,000 poultry at farms and private households were inoculated.
<snip>
Primorye borders on three Asian nations, and thousands of migrating birds cross its territory during the spring and fall migrations.
The administration said it opened a center to fight the disease, allocated funds to buy medicines for massive vaccination campaigns and set up mobile veterinary brigades. The measures, it said, will help deter outbreaks in the region this fall. Link http://tinyurl.com/h5b68
Guess the Indonesians are turning to Rabbit meat
(excerpt) http://tinyurl.com/z6698
“Setiap his month in general needed 1.000 rabbits. To comply with the request of rabbit meat in Kulonprogo, must bring in from the Magelang area, Wonosobo, Purworejo and Kebumen,” Barren words (49) the trader of rabbit satay in front of the UNY Wates campus. According to the citizen of the Flower, the Margosari Village, of the Pengasih Subdistrict the difficulty of getting the rabbit from the Kulonprogo area has been felt since the first time opened selling efforts rabbit satay. The price of one rabbit revolved around Rp 10.000. Now the seller of rabbit satay in the Wates city and surrounding area, several last years continued to improve so as the rabbit request experienced the increase. Moreover was around the satay trader did not sell because of running out of the rabbit to be cooked. The section head developed efforts Subdin Animal the agricultural Service and Marine (Diperta and Sea) Kulonprogo Ir Leo Handoko that was met by KR in his office, on Monday (25/9) explained since having the bird flu virus attacked the poultry in his territory, there was the trend of some communities to mengonsumsi meat chose rabbit meat. The occurrence of the increase in this request of rabbit meat, efforts of the rabbit livestock had the market opportunity of being good enough. Nevertheless in his territory did not yet have the farmer’s group that was interested, especially developing rabbit livestock breeding. “Seperti him was not interested menekuni efforts raised rabbits. Has had some communities maintained the rabbit but still only a side work in one keluarga,” said Ir Leo Handoko.
The Associated Press
Published: September 26, 2006
BANGKOK, Thailand “A 59-year-old Thai man who bred and raised fighting cocks in northeastern Thailand contracted the H5N1 bird flu virus and has died, bringing the country’s human death toll from the disease to 17, health officials said Tuesday.
Meanwhile in Indonesia, laboratory tests confirmed Tuesday that an Indonesian man has been sickened by bird flu, health officials said, pointing to a possible new family cluster. - excerpt
Jakarta Post
Sept 26/06
But there is also another aspect that is completely foreign to other countries. I remember quite well how a poultry farmer in Karo, North Sumatra, Pak Simbolon, who was so cooperative with us when we told him that his chickens must be culled. He was willing to take the Rp 12,500 compensation, but then he asked an honest question: What will I do to feed my family if you cull all my chickens? - excerpt
Recombinomics Commentary September 26, 2006 - excerpt
“The above translation confirms an H5N1 bird flu cluster in Bandung. The index case (23M) has died with symptoms, but no sample was collected for testing. One of his brothers (20M) has now tested positive for H5N1, while another brother (15M) as been hospitalized with milder symptoms.
The index case was buried in Garut, where a dead chicken had been bought and fed to their dog. This cluster is similar to one of three clusters in Cikelet in Garut regency. That cluster also was linked to the feeding of dead chickens to dogs. In those linked clusters, three patients were confirmed, but like the cluster above, several relatives died prior to sample collection, and many additional contacts or relatives developed symptoms. A Tamiflu blanket was applied and most contacts recovered and tested negative for H5N1. However, the Tamiflu treatment may have masked the H5N1. The initial cases developed symptoms at the end of July, so testing of recovered patients for neutralizing H5N1 antibodies would be useful at this time. The cluster exceeded 20 and would be the largest reported to date if these patients tested positive for antibodies, because initial tests were negative, and a positive would signal sero-conversion and the patients would be confirmed cases.
The sequence of the H5N1 from one of the fatal cases in the earlier cluster was similar to the H5N1 found in patients on Java. These sequences have a novel cleavage site and do not match poultry isolates from Java, strongly suggesting an alternate reservoir of H5N1. Testing of dogs and other mammals in the Garut regency would be useful.”
26 September, 2006
THAILAND – INDONESIA
AsiaNews.net (excerpt)
Bangkok (AsiaNews) – “A 59-year-old Thai man who contracted the H5N1 bird flu virus has died, health ministry officials said today. His is the third case this year and the 17th since the beginning of the outbreak.
The farmer from the north-eastern Thai province of Nong Bua Lamphu bred and raised fighting cocks. He fell ill on July 14 and died on August 10. Lab results confirmed the H5N1virus was the cause of death.
“He didn’t give his full history to the doctor,” said Thawat Suntrajarn, director-general of the Department of Communicable Disease Control. Instead, the man claimed that “he raised chickens, that they were sick, and that they had died.” But in fact, he “was scared that the agriculture officials would kill his birds.” His wife said he also raised 40 fighting cocks that got sick and died.”
Indonesia
Health officials probe bird flu cluster cases
Jakarta - Indonesian health officials said on Tuesday that they were examining possible person-to-person transmission of bird flu after three brothers developed symptoms of the virus, one of whom has died.
So-called cluster cases, where the H5N1 virus is spread from human to human rather than from poultry, increase the chance of the virus mutating to become easily transmissible between people.
[snip]
Fatimah Resmiati, from the West Java health office, said that a 25-year-old man died in Bandung on Sunday suffering bird flu symptoms, but he was buried without samples being taken for testing.
His 20-year-old brother, displaying similar symptoms, was admitted to the same hospital with him, she said.
He was transferred to Hasan Sadikin hospital, a government-appointed centre for bird flu treatment, where he was joined by the third brother, aged 15, on Monday.
“As the three are blood-related and suffer from the same symptoms, we are suspecting a new cluster case here, but we still have to make the necessary tests to ascertain what they are suffering from,” Resmiati told AFP.
[snip]
Hadi Yusuf, who heads the bird flu control team at the hospital, told AFP that the 20-year-old was in a critical condition but declined to comment on the youngest brother.
Comment
The key issue is onset dates.
Doctors have expressed concerns about the government’s plans for a flu pandemic. (UK)
Boston Effectmeasure Commentary
Boston Medical Reserve Corps program
Category: Bird flu • Pandemic preparedness • Public health preparedness
Posted on: September 26, 2006 7:57 AM, by revere
The City of Boston is now soliciting volunteers for a new Boston Medical Reserve Corps Program, designed to help the city prepare for disasters:
“I want everyone in Boston to consider joining the Boston Medical Reserve Corps; people in our medical, health and business communities, our residents, our college students, retirees — anyone who wants to help,” said Mayor Menino in announcing the recruitment drive. “We’re looking for everyday heroes to help make Boston safer and more prepared.”
Following many disasters, large numbers of people often come forward to help. Many of those well-meaning volunteers are turned away because without special training, or a management structure to guide them, their presence at an emergency scene can be unsafe for volunteers and for public health and safety personnel responding to the incident.
This situation presents an interesting irony: Government agencies often need help in responding to large disasters, but an unorganized spontaneous influx of volunteers can sometimes make an emergency situation worse.
The Boston Medical Reserve Corps (MRC), a program managed by the Boston Public Health Commission, is designed to leverage the good will and desire to help that many people display in the wake of a disaster. It offers both medical and non-medical volunteers a chance to be part of a network of people who are trained and ready to respond to an emergency in Boston when called to assist city health and safety officials.
The target audience for this recruitment is doctors, nurses, pharmacists, dentists an EMTs, as well as those without medical training who might want to use their non-medical skills to help out in an emergency. Training will be provided so people can “learn how to prepare themselves and their families during an emergency.”
There is a website for volunteers in the Boston area to sign up. Here it is. Other communities might take a look to see how Boston is doing it. It is my understanding this is a national effort but I’m not sure how many other communities have gotten started on it. Maybe readers can provide some information from their localities.
Anyway, this is just the kind of thing that needs to be done ahead of time, so Boston should be commended for their effort. We’ll be interested to hear how it’s working. http://tinyurl.com/esvrb
North Carolina task force moves toward specific guidelines for triaging patients in situation of limited resources, such as ventilators. They want doctors and nurses to have written ethical priorities to help them make life and death decisions they never have had to make before.
snip:Those include the responsibility of doctors and nurses to provide care during a pandemic and a hospital’s responsibility to make sure those workers are safe, properly trained to handle unfamiliar tasks and paid for service during a crisis. The task force, which will issue a final report by spring, has also drafted recommendations about limiting individual liberties during a pandemic, including the use of quarantine and the closing of schools, churches and other mass gatherings.snip
http://www.newsobserver.com/102/story/490941.html
COMMENT If this chilling summary of the task force’s work doesn’t get people thinking, what will? At least it should open people’s mind to PFAW in October.
Worried in Wales @ 09:18
Quote from the professor at the dept of health
“….public health measures such as good hygiene and the use of masks among health workers would provide a good defence. But she said it was “highly, highly unlikely” that there would be mandatory restrictions on travel in the event of an outbreak, although people may be advised to avoid large crowds and only take essential journeys.”
Doesn’t the declaring level 5 & 6 by the WHO require certain closings of borders and restrictions on travel??
SEPT 26/06
The Associated Press
“LONDON Members of a pandemic flu task force discussed how they might advise the World Health Organization if a global outbreak strikes, in the group’s first meeting since being formed by the WHO, officials said Tuesday.
Sixteen of the 21 experts on the Ad Hoc Influenza Pandemic Task Force met in Geneva on Monday to define their role if a pandemic flu strain was identified, WHO spokesman Gregory Hartl said. However, representatives from China, Thailand and Indonesia — three countries hit hard by recent bird flu outbreaks — were noticeably absent.
Computerized “early warning” system for tracking increase of flu/pneumonia cases in Great Britain. It’s called QFLU and will cover the 17 million people who are patients of the doctors who have signed up.
http://www.sciencedaily.com/releases/2006/09/060925085145.htm
COMMENT- Klatu, that definitely sounds like a silent protest to me. I wonder if Thailand and Indonesia will deny WHO task force members access into their countries, anytime in the near future as another form of protest? Wish we knew more…
COMMENT-Regarding the death of the man in Thailand, who reportedly died on August 10……
A 60-year-old man from Thailand’s northeastern Nong Bua Lamphu province died on Aug. 10, Praj Boonyawongwirojana, the health ministry’s permanent secretary, told reporters in Bangkok today. Samples were collected Aug. 12 though a positive test for the H5N1 avian flu strain wasn’t confirmed until four days ago. http://tinyurl.com/epozu
And this older article dated Sept 14, which indicated the suspension of Bird Flu watch in Thailand, which clearly states that the country had been free of bird flu for 32 days…
Bird flu watch in Thai provinces suspended
www.chinaview.cn 2006–09–14 17:18:49 http://tinyurl.com/rbkh4
BANGKOK, Sept. 14 (Xinhua) — With no new bird flu outbreak reported in the last 21 days, the fourth round of bird flu monitoring imposed in Thailand’s two worst-hit provinces, Phichit and Nakhon Phanom, has been suspended, a senior official said here Thursday….
Throughout the whole country, Charal said, the spread of bird flu among fowls has not been found for 32 days now.
I can only begin to wonder where he picked it up from.. >;)
IMHO..we cannot believe any report from any country that says it is “free” of bird flu. The virus might be in hiding, but it is still there. (EU, Russia, etc.) In Asia, it is not a case of cases being found, but it is being intentionally overlooked, and unfortunately, I believe that human cases fall into this latter category. Only wish I could prove it. :)
The article posted posted by Jane at 10:06 also has this information in a sidebar.
N.C. FLU SCENARIOS Public health and emergency officials across North Carolina are planning for a flu pandemic they say is inevitable. Here are three scenarios for how a pandemic would affect the state, given three different rates of infection. The North Carolina scenarios are based on a computer model developed by the Centers for Disease Control and Prevention.*
Infection rate/Deaths/Hospitalizations/Outpatient visits
20%/4,441/19,610/915,163
30%/6,662/29,415/1,372,745
50%/11,102/49,026/2,287,907
COMMENT
Worst-case scenario based on 1918 pandemic? Scratching my head. What part of the current numbers are they (the federal health officials) missing?
Recombinomics Commentary September 26, 2006
“The above translation appears to be describing the transfer of the sister of the 66th confirmed H5N1 bird flu case in Tulungagung who was brought to Dr Iskak Tulungagung at 19:00 and died at 22:45 on September 18. Samples were collected from 5 family members of the boy’s (11M) family, as well as 20 hospital workers at RSUD Dr Iskak.
The transfer of his sister one week after the death of the confirmed index case is cause for concern. It remains unclear if additional family members are hospitalized at RSUD Dr Iskak or health care workers have shown symptoms, but the collection of 25 serum samples from contacts suggest there were significant concerns over a week ago.
Although the latest WHO update describing the index case mentions the dead poultry of a month ago, it fails to describe the case’s hospitalized sister. The withholding of this information is cause for concern.
beehiver…my understanding is they are still using the CFR of Spanish Flu in 1918 to make these extrapolations and not using the current CFR of “bird flu”. If they used the CFR of bird flu, the numbers would be quite different.
September 26, 2006
RALEIGH, N.C. — “With a flu pandemic inevitable, North Carolina’s medical professionals must prepare now for what could be wrenching moral decisions about who will be treated and who won’t if the illness overwhelms hospital resources, members of a state task force said.
The Task Force on Ethics and Pandemic Influenza Planning met recently to discuss a strong set of ethical guidelines for the state’s doctors and nurses in the event of a global outbreak of a new and more virulent strain of flu virus.
The list would help them decide who gets priority for medical care in the face of a wave of flu-stricken patients that would rapidly outstrip the supply of hospital beds, medicine and equipment.
“It’s going to exceed our capacity,” Philip Rosoff, director of clinical ethics at Duke Hospital, said during a four-hour meeting of the task force Monday. “The more stringent and robust our guidelines are, the less chance there is for decisions being made for arbitrary and morally unjustifiable reasons.”
Hospitals across North Carolina are already at 85 percent to 90 percent capacity, and even a mild pandemic would force doctors and nurses to ration medicine and equipment.
The 40-member task force, a joint project of the North Carolina Institute of Medicine and the state Division of Public Health that began meeting in May, wrestled with the wisdom of giving children priority for scarce anti-viral drugs and vaccines.
They also worried whether their guidelines would cut off the poor and disadvantaged, or Hispanic immigrants.
‘’‘They debated a scenario involving three gravely ill patients — a 10-year-old with a 30 percent chance of survival, a 40-year-old doctor with a 25 percent chance and a 65-year-old retiree with a 10 percent chance — who all needed the only ventilator available to help them breathe.
“Let’s say I’ve got a hospital full of 85-year-olds on ventilators and I’ve got a 20-year-old who needs a ventilator: Do I take an 85-year-old off and give it to the 20-year-old?” Rosoff asked. ‘’‘
The task force settled on two broad guidelines for rationing vaccines, anti-viral drugs and medical equipment during a flu pandemic. The first is to assure that crucial functions of society aren’t disrupted. That means giving priority for vaccines and anti-viral medication to health care workers, police, firefighters and employees of critical industries such as utilities.
The second is to reduce the number of deaths and infections and prevent the spread of the illness.
We’re up here at 30,000 feet making these broad, philosophical statements, but nobody’s going to read a paper like that,” he said. “We’ve got folks with 100 doses of vaccine and everybody wants it, and we’ve got to give them specific guidelines on who gets it and why.
(excerpt)
Bird flu experts call for sharing virus samples - WHO
Tue Sep 26, 2006 5:47 PM GMT
‘’‘GENEVA (Reuters) - International experts on Tuesday called on countries to share freely all influenza virus samples and genetic sequencing data, key to developing a vaccine against a potential bird flu pandemic.
The appeal was among recommendations issued by the World Health Organisation’s (WHO) new influenza pandemic task force, whose experts held a first, closed-door meeting in Geneva.’‘’
The 21-member task force was launched last May to advise the WHO’s director-general on technical issues amid fears that the H5N1 virus could spark a human pandemic and could kill millions.
“They endorsed proposals for best practices in sharing of influenza viruses and specimens and genetic sequences…,” David Heymann, WHO’s acting special representative on avian influenza, told a news briefing.
Under WHO’s system, virus samples should be shared by laboratories free of charge and any candidate viruses for vaccine production given to drugmakers at no cost.
But health officials have expressed concern that some developing countries are reluctant to release H5N1 animal and human virus information, with China often named as a hold-out.
The viruses remain the property of countries, and before any of the genetic sequence data is made available, the WHO seeks a country’s specific permission to have the genetic sequence data posted on publicly accessible websites.
Some developing countries have voiced concerns that they may lose out on lucrative drugs’ patents if data is handed over to Western pharmaceuticals.
“There was widespread agreement that this is an absolute critical public health activity for protecting us all against influenza,” said Keiji Fukuda, coordinator of WHO’s global influenza programme, after the meeting.
The task force will also advise the U.N. agency on issues including raising the phase of pandemic alert, which WHO officials said remained at level three out of six.
“I do want to emphasise that we are at pandemic alert phase three. We have not seen any event to indicate that we should be moving to the next phase,” Fukuda said.
Snowhound1 – at 11:50 beehiver…my understanding is they are still using the CFR of Spanish Flu in 1918 to make these extrapolations and not using the current CFR of “bird flu”. If they used the CFR of bird flu, the numbers would be quite different.
If the infectousness of the virus remains constant, the CFR should evolve down. With the tamiflu blankets, etc. the infectousness will probably increase (survival of the best jumper) so there would be no need for the CFR to decrease.
Nine tests failed to detect H5N1, doctors reveal from The Nation (Thailand)
A 59-year-old man from Nong Bua Lamphu was yesterday declared the latest victim of bird flu, bringing Thailand’s death toll to 17 since the disease was first detected in 2004…Officials said he was the first to die of complications rather than H5N1 itself…”This case study has taught us that having the antiviral drug oseltamivir at hand doesn’t necessarily mean we can cure it,” said Dr Kumnuan Ungchusak, head of the Bureau of Epidemiology…An autopsy revealed the man had succumbed to a drug-resistant bacteria called Acinetobacter…He was the first person to undergo nine PCR tests, yet the virus was still not detected until an autopsy was conducted on tissue taken from his lungs and faeces, he said…That PCRs failed to detect the virus could be because of the effects of oseltamivir, which might have prevented the virus from being present in the respiratory-tract areas where swabs were taken for testing…The Department of Livestock Development, meanwhile, insisted Nong Bua Lumphu was not on the list of bird-flu districts and past testing on poultry had found no signs of H5N1 there…
Comment: There are a lot of little things in this article that concern me.
Colleges vulnerable in flu outbreak, expert says from WDBJ 7 (Virginia)
…Virginia’s colleges are NOT prepared for a pandemic flu outbreak. That’s what representatives from over 100 colleges and universities were told yesterday at a pandemic flu planning conference at the University of Richmond…
County prepares for possible crisis from Sapulpa Daily Herald (Oklahoma)
…“It’s important for us to realize that if the pandemic is coming in from the coasts, that the federal government is going to be quickly overwhelmed, and our community will have to take care of itself during a situation like this,” said Dannie Whitehouse, Director of Creek County Emergency Management…“Public schools would be dramatically impacted by this flu,” said Jerry Lomenick, Assistant Superintendent of Bristow Public Schools. “Parents would begin pulling their children out of school as soon as the first case was reported, so it’s important then that we have a plan of action to ensure student safety and health…” “It’s important that we let the public know what’s coming and tell them the truth about the situation…
Sept 27/06
The Nation
“A 59-year-old man from Nong Bua Lamphu was yesterday declared the latest victim of bird flu, bringing Thailand’s death toll to 17 since the disease was first detected in 2004.
The man is the third confirmed death from the infection this year. Officials said he was the first to die of complications rather than H5N1 itself.
“This case study has taught us that having the antiviral drug oseltamivir at hand doesn’t necessarily mean we can cure it,” said Dr Kumnuan Ungchusak, head of the Bureau of Epidemiology.
The case was the first that took almost a month from the day the patient fell ill to his eventual death, compared to past cases in which victims died within a few days of falling sick, Kumnuan said. The Nong Bua Lumphu man, who lived in Nong Sang district, fell ill on July 14 with high fever and muscular pains. He was treated at the nearby primary care unit, but his condition did not improve, said Dr Prat Boonyawongwiroj, the permanent secretary for Public Health. Before his death, the man had been transferred to the Nong Sang district hospital and then to the Nong Bua Lumphu provincial hospital, where he died on August 10, the doctor said.
At first, doctors treating the man were not aware he had been in contact with sick chickens before falling ill, Dr Thawat Suntrajarn, the director-general of the Disease Control Department, said.
About two weeks after becoming ill, his wife finally told doctors he had touched some sick chickens earlier, Thawat said, explaining that was why doctors suspected he had leptospirosis instead of bird flu.
The patient had nursed about sick 40 chickens and treated some of them with a herbal drug, but most eventually died, Thawat said.
An autopsy revealed the man had succumbed to a drug-resistant bacteria called Acinetobacter, he said, adding the patient was given the antiviral oseltamivir right after his wife told doctors he had been in contact with sick chickens.
When the man was initially taken in for treatment, he was tested for H5N1 even though it was not known at that stage whether he had been in contact with sick poultry, Department of Medical Sciences chief Dr Paijit Warachit said.
‘’‘The first advanced Polymerase Chain Reaction (PCR) test detected no signs of the H5N1 virus, nor did several repeat PCRs conducted later after the man’s wife finally said that her husband had been in contact with sick chickens, Paijit said.
He was the first person to undergo nine PCR tests, yet the virus was still not detected until an autopsy was conducted on tissue taken from his lungs and faeces, he said.’‘’
Jane at 1006 or anyone- please explain ‘PFAW in October’
Grace RN-Pandemic Flu Awareness Week
North Carolina’s medical professionals have been advised to prepare for a flu pandemic and to focus on who will be treated and who won’t if the illness overwhelms them.
Duh. Didn’t notice Jane – at 10:06.
just listing this because H5N1 has been misdiagnosed as dengue every now and then.
Dominican Republic
“the dengue fever has left 37 dead in the Dominican Republic, according to news from Santo Domingo, capital of the Caribbean country, on Monday. A man aged 33 and a six-year-old girl died of the disease on the weekend, local health authorities said, noting the country has found 3,562 cases of dengue fever so far this year. “The outbreak is in decline,” Bautista Rojas Gomez, Secretary of State for Public Health told local media on Monday. “We are improving the measures already established in public hospitals to reduce the number of those affected,” he said. Local health authorities said only 38 were considered potentially infected among the 2,180 patients observed from early Saturday to early Sunday.”
is no news, good news?
I notice that the government Thailand AI site is now down. They had been updating their site daily as to the number of cases and suspected cases for the last few months. Yesterday there here was confirmation of a third death (this year) and they now have taken down the site. I don’t know what it means, but it is interesting that they have now taken down the site and even all the old daily listings.
yesterday’s listing (of the previous day’s data-see our news thread) was: “Cumulative number of patients under surveillance are 4,976 cases 71 provinces. Today reports are 4 cases; Two cases from Kampaengphet, and 1 each from Kanchanaburi and Suphanburi. Confirmed human case of avian influenza 2006 = 2 cases, with 2 death cases. · The first death case, reported from Phichit province, Tabklo district is 17 years old male. He had onset on July 15, 2006 and died on July 24, 2006. · The second death case, reported from Uthai Thani province, Sawang Arom district is 27 years old male. He had onset on July 24, 2006 and died on August 3, 2006. There are 7 cases under investigate reported, of which waiting for laboratory result. “
DennisC - yet again a possible source of information is closed out for us - the same happened with the VLA site in the UK.
Has anyone heard about China taking a week and closing customs for exporting? My organization was just told that our order would be delayed a week because Customs is taking a week holiday.
Recombinomics Commentary
September 26, 2006
….59-year-old man from Nong Bua Lamphu was yesterday declared the latest victim of bird flu
He was the first person to undergo nine PCR tests, yet the virus was still not detected until an autopsy was conducted on tissue taken from his lungs and faeces, he said.
That PCRs failed to detect the virus could be because of the effects of oseltamivir, which might have prevented the virus from being present in the respiratory-tract areas where swabs were taken for testing, according to Dr Tawee Chotpitayasundond, of the Queen Sirikit National Institute of Child Health.
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“The above comments describe confirmation of a fatal H5N1 infection in a patient in Thailand who died almost a month after being admitted. Although H5N1 was present during the entire time of hospitalization, it was not detected until autopsy in spite of running 9 PCR tests.
The data raise serious questions about the WHO reliance on PCR test to confirm H5N1bird flu infections, especially on samples collected after Tamiflu treatment has begun. The number of false negatives in Thailand is not known, but the number of such negatives in Indonesia is likely to be high, especially in pandemic regions where Tamiflu blankets are applied.
The recent outbreak in Garut in West Java in Indonesia is an example of such false negatives. Patients linked to three separate clusters where H5N1 confirmed, but initial cases died prior to sample collection and subsequent patients were tested after the Tamiflu blanket was applied. Consequently, only three of the more than 20 hospitalized patients were confirmed.
There are three current clusters being reported in Indonesia. In two of the clusters, H5N1 has been confirmed. However, several patients are improving after initiation of Tamiflu treatment and have not been reported to be H5N1 positive.
The recovered patients should be tested 3–4 weeks after disease onset to determine if they have neutralizing H5N1 antibodies, signaling a recent H5N1 infection. Without these additional tests, the extent of H5N1 spread among contacts of the index cases will remain unclear and the repeated false negatives will create a significant undercount in the number of cluster and length of transmission chains.
I know we have had some info on the Geneva meeting but I thought people here would want to know some of those WHO is turning to now.
WHO names experts who will advise when pandemic risk appears to be rising
“The World Health Organization has announced the membership of the panel of experts it will turn to for advice if it believes the threat of a flu pandemic is mounting. The list of 20 or so international disease experts includes leading avian influenza expert Dr. Robert Webster of St. Jude’s Research Hospital in Memphis, Tenn., Dr. Ab Osterhaus, a veterinary virologist at the Erasmus University in Rotterdam, and Dr. Nancy Cox, director of the influenza division at the U.S. Centers for Disease Control in Atlanta. Dr. Theresa Tam, director of the Public Health Agency of Canada’s respiratory infections division, is also on the committee, which convened for the first time Monday in Geneva. Membership is drawn from the six administrative regions of the World Health Organization: Africa, the Americas, Southeast Asia, Europe, the Eastern Mediterranean and the Western Pacific.
Other members of the task force include Dr. Maria Zambon from Britain’s public health agency; Dr. Martin Cetron, head of the global migration and quarantine division at the CDC; Masato Tashiro, director of Japan’s National Institute of Infectious Diseases; and Russian virologist Dmitri Lvov…
Evidence of some clustering of cases of human infections of H5N1 avian flu virus in Indonesia and elsewhere this year has led to questions from some quarters about whether the WHO ought to raise the pandemic alert level to Phase 4, characterized as “evidence of increased human-to-human transmission.”
This new committee would be the body that would advise on that issue, if asked. But Monday’s meeting was not called for that purpose”
UK financial hub urged to improve pandemic plans from The Scotsman (UK)
…Britain’s banking and financial services industry needs to make better preparations for the threat of avian flu or another pandemic, the head of the financial industry watchdog said on Tuesday…needs to involve the availability of key staff, services and systems, the effect on liquidity and markets and the impact of widespread voluntary absenteeism…McCarthy said although the risk of a pandemic was low for any short timescale, there was a high risk of a pandemic in the long term, and the major economic impact of SARS in Asia in 2003 highlighted the risk that an avian flu pandemic posed…
The Straits Times Publication Date: 27–09–2006
“Indonesia is again investigating possible human-to-human bird-flu transmission, after a West Java man died and his brother and sister were admitted to hospital.
A 20-year old - identified as Mr Taufik from the provincial capital Bandung - was named as the latest to catch the H5N1 virus. He is in hospital, and has been put on a respirator.
His elder brother died on Sunday (Sept 24) and was buried before tests could be carried out, but Ms Fatimah Resmiati of West Java’s Health Ministry said that he had probably contracted the virus and that medical records were being examined.
His 15-year old sister, Intan, was admitted to hospital on Monday with fever and breathing difficulties, and was being treated as a potential bird flu case pending tests.
“We fear there may have been human-to-human transmission within this family,” Fatimah said.
The two surviving siblings have been treated with Tamiflu, the drug commonly used to treat bird flu, at Hasan Sadikin Hospital.
Tests are also being carried out on their parents and others who have had recent contact with them.
Fatimah said the family might have contracted the virus after[]B feeding their dog chicken [/B]bought from a local market.
Meanwhile, in Medan, North Sumatra, four people, three from the same family, were being treated for symptoms similar to bird flu.
The patients’ symptoms had improved, but they were still receiving treatment pending their test results, hospital officials said.
Indonesia has reported the world’s highest number of human bird-flu fatalities - at 51, more than a third of the global total - including a nine-year old boy who died on Friday.
The government has so far denied any human-to-human transmission, but the World Health Organisation estimates that there have been about half a dozen cases in Indonesia.
Already, 30 of Indonesia’s 33 provinces have seen their poultry infected by the avian virus, with North Sulawesi being the latest hit.”
…“Algeria received only 2.1 million units of bird flu treatment equals to 30% of Algeria’s last year order to the Suisse lab Roche”. In case of bird flu spread as of this month end and next month beginning, TAMIFU quantities are insufficient to allow facing up the pandemic….
Suspected bird flu case in Sydney
An international traveller with suspected bird flu has been taken to hospital from Sydney Airport. NSW Health issued a statement saying the patient arrived at the airport this morning and was taken to hospital for a routine medical check. “The person has a recent history of being in an area with chicken in Vietnam and of having a previous influenza-like illness,” said the statement. While health experts believe it is very unlikely the diagnosis will be avian influenza, the man has still been quarantined for testing…
snip
It was on the news as well in Au. The rest of the flight was not quarantined.. or detained.
Wednesday, September 27, 2006. 11:08am (AEST)
ABC Online
“A man who became unconscious on a flight arriving in Sydney this morning from Vietnam is being treated at St George Hospital.
The man, believed to be about 40-years-old, was aboard Vietnam Airlines flight 783, arriving just before 8.30am AEST.
Ambulance workers went to Sydney International Airport to assess the man’s condition before taking him to hospital.
A Health Department spokeswoman says the man has been isolated in hospital in case he has bird flu. She says tests are being carried out because he comes from a region where cases of bird flu have been recorded.” -excerpt.
I thought I would do a bit of research on Dr Theresa Tam -
found this quote from the Jan 27, 2006 Vancouver Sun which does NOT give me the ‘warm & fuzzies!! http://tinyurl.com/osrn9
But, “we really have no idea how this virus will behave next if it undergoes some mutation.”
The updated influenza pandemic plan will include recommendations for the use of masks. Droplets, or larger “blobs” of secretions primarily spread flu. General surgical masks should be enough should a pandemic happen, Tam says.
“Public health experts feel that putting a mask on an ill person when they’re coughing or sneezing and have to move around … is a sensible thing to do.
“Having well people milling about on the streets wearing masks all the time, we don’t know if it’s effective or not.”
The public focus will be on hand hygiene, Tam says.
66 page Report on Enhancing Biosecurity from the American Center for Progress
… Only seven states and four cities currently have the capability to administer stockpiled vaccines on a large scale, let alone deal with the other aspects of detecting and containing an outbreak in a timely manner….
…half of U.S. states do not use modern information technologies or standard national formats to report and share data on infectious disease. This critical deficiency makes it less likely that CDC officials will detect outbreaks rapidly and communicate their findings to multiple jurisdictions…
…a natural outbreak of avian influenza, might occur with little or no advance warning and emerge in several geographic locations simultaneously…
…President Bush’s plan for pandemic influenza preparedness illustrates the point: more than 90% of the $3.8 billion that Congress appropriated as the first installment of the administration’s $7.1 billion budget request was for the acquisition of vaccines and antiviral drugs. Disease surveillance and other public health preparedness measures received only $350 million, despite major deficiencies in these areas, and there was no funding for hospital preparedness. Simply put, vaccines will not save lives if they cannot be delivered and administered fast enough to stop an epidemic. Moreover, states are expected to bear 75% of the cost burden for purchasing antiviral drugs, with only a 5% match from the federal government, amounting to an unfunded mandate of about $510 million…
…public health preparedness measures will make a difference only if the public is willing to follow instructions from federal, state, and local officials during an outbreak. Studies of how people might behave during an epidemic suggest that the ordinary citizen is poorly informed about biological threats and often disinclined to obey official instructions. A September 2004 survey found that only two out of every five Americans would travel to a designated vaccination center in the event of a smallpox outbreak, and that only three out of every five respondents said they had confidence in official instructions…
Comment: There is a lot of interesting things in the document. Above are just a few snippets. Someone more technical might want to move this over to the regular wiki.
Saudi Arabia
Clean Bill of Health for Poultry Roger Harrison, Arab News
JEDDAH, 27 September 2006 — The winning of three internationally recognized awards recently by the Radwa Food Production Company for the quality of management and health secures its position as one of the safest poultry production facilities in the world. After the recent scares over bird flu health and safety concerns have figured high on the buying public’s list of priorities. The awards will go a long way to allaying those fears.
“This is a tremendous achievement for us,” said Tarek Taher, president and CEO of the Aal Taher Group of Companies that owns the Radwa poultry farm. “We feel it recognizes both our company’s commitment to our efficiency of production, the health and welfare of our customers and the concern for the environment that underpins our way of approaching a very necessary food production facility.” ….
Comment
Now let’s watch for the outbreak that always accompanies these ‘there ain’t no bird flu here’ statements!!
Enhancing Biosecurity from the Center for American Progress
The House votes today on the Biodefense and Pandemic Vaccine and Drug Development Act of 2006. This legislation amends the Public Health Service Act to require the Secretary of Health and Human Services to develop a strategic plan for integrating new technologies into current biodefense and emerging infectious disease requirements.
The bill seeks to accelerate the development of countermeasures to pandemic diseases such as vaccines and disease treatments, and directs the Department of Health and Human Services to establish a Biomedical Advancement and Development Authority to oversee planning and progress…Until now, the federal government’s plan for responding to the twin threats of natural pandemics and biological terrorism has assumed that state and local entities have the resources and capabilities to take over primary responsibility for managing a crisis. The reality is that they do not. Establishing a central federal authority to promote advancement is a good first step toward making America safer.
Canada
Expert urges greater focus on fighting bird flu
A Canadian authority on viruses says governments should invest more in developing drugs to combat bird flu and other possible pandemics.
Dr Jeremy Carver is the chief executive officer of the International Consortium on Anti-Virals that has just met on Queensland’s Gold Coast.
He says governments are stockpiling two drugs to treat bird flu, but there are already drug-resistant cases in Vietnam and Indonesia.
“If that particular strain that’s resistant to Tamiflu becomes easily transmissible between humans then we have a major challenge because the stockpiles that governments around the world have spent billions of dollars on would be useless, so we need drugs that are going to work regardless of which strain it is that emerges as a pandemic,” he said.
Includes a picture…
Suspected bird flu case sent to hospital Wednesday Sep 27 12:30 AEST An international traveller with suspected bird flu has been taken to hospital from Sydney Airport.
A NSW health spokeswoman said the person, who arrived on a flight from Vietnam, had been taken to a Sydney hospital for tests.
“This person has a recent history of being in an area with chickens in Vietnam and of having a previous influenza-like illness,” the spokeswoman said.
While health experts believe it is very unlikely the diagnosis will be avian influenza, the man has still been quarantined for testing.
COMMENT: I really feel that this will be a “nothing” in the overall scheme of things, but at the same time I am very positive about how quickly this was picked up by MSM, including Reuters, ABC online and others. They all might be tracking this a little closer than many of us believe.
COMMENT
The irony of this article hitting this thread at this precise moment slays me. I just got off the phone with my sister who informed me that she is attending a wedding in India in December, but that it’s in a “very protected” place where “nothing will go wrong.” And this is the sister who seemed to be “getting it.” Sometimes you just have to cry.
N.C. Panel Prepares For Flu Pandemic, Moral Questions from WRAL.com.
“POSTED: 11:18 am EDT September 26, 2006
RALEIGH, N.C. — With a flu pandemic inevitable, North Carolina’s medical professionals must prepare now for what could be wrenching moral decisions about who will be treated and who won’t if the illness overwhelms hospital resources, members of a state task force said.”
Hang in the Edna Mode…In the end, we are only responsible for ourselves and those within our direct infulence.
Obviously, I type faster than I can think (re:infulence)…that is a scary thought.
Thanks, Snowhound1.
If the H2H aspect was slightly more transmissible, the Sydney case would be IT for us.
I am creating the news summary then I will open a new thread so please give me about 30 minutes to complete this