Forum: News Reports for October 3

Summary from Indonesia Outbreak tracking as at 2 October 2006

Summary of News for 2 October 2006

(From WHO as at 28 Sep)
Total human cases worldwide 251, deaths 148 (2006 – 104 with 70 deaths)

(If you want the links to open in a new window, hold down the shift key and then click on the link)

Indonesia

• Translation of news within the thread at 01:22, 06:28, 19:24, 21:08
• Separate thread for outbreak discussion (link Indonesia Outbreak XIII )
• Separate thread for Summary of cases (link Case Summaries )

Thailand

• Latest surveillance update (suspect cases increasing) (link http://tinyurl.com/j8t3k)
• Disease screening controls to be doubled at airport (link http://tinyurl.com/qx6tz)

(Inner) Mongolia

• Bird flu outbreak under control, no human infection reported (link http://tinyurl.com/rzrof)

India

• Delhi dangerously close to Dengue epidemic (link http://tinyurl.com/fqpuf)

Congo

• Pneumonic plague in Congo (link http://tinyurl.com/kesuj)

United Kingdom

• Spreading our way? What is the risk? (link http://tinyurl.com/ope4c)
• Pandemic planning dilemma – within 3 years (link http://tinyurl.com/ez9rb)

United States of America

• Roche says Tamiflu in ample supply in US (link http://tinyurl.com/q2pqw)
• Avian-flu samples on the way to CDC (link http://tinyurl.com/h6g62)
• Schools, Red Cross positioned to combat avian flu (link http://tinyurl.com/earl7)
• Roche says Tamiflu in ample supply in US (link http://tinyurl.com/q2pqw)
• (Boston, MA) Pandemic flu soon? The odds seem to worsen (link http://tinyurl.com/j7zmd)

General

• Scientists say better diagnostics for bird flu needed (link http://tinyurl.com/p8626)
• WHO: Risk remains (link http://tinyurl.com/mey5t)
• Tamiflu prevents pneumonia in kids, study finds (link http://tinyurl.com/h8k5t)
• Threat of ‘superflu’ rampage as mutant viruses resist drugs (link http://tinyurl.com/lomeu)

Link to news thread for 2 October (link News Reports for Oct 2 )
(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.

Bird flu campaign in West Java to involve school children

Yuli Tri Suwarni, The Jakarta Post, Bandung [link http://tinyurl.com/z2ndn ]

The West Java provincial administration is mulling the possibility of involving school children in its campaign about the spread of the deadly bird flu virus, an official said Monday.

Fatimah Resmiati, head of the West Java Health Office’s environmental sanitation unit, said that the plan to involve school children had been adopted as the current campaign had been ineffective, as shown by the increasing number of people falling sick from bird flu. <snip>

“As we’ve already become the ‘top scorer’, we badly need a better prepared campaign to help prevent more fatalities,” Fatimah said in Bandung after attending a coordinating meeting with representatives of the Ministries of Health and Agriculture. Over the next two days, Fatimah said officials from the relevant offices would discuss the possibility of establishing a regional bird flu prevention commission.

<snip> A similar concern was expressed by Fatum Basalamah, head of standardization at the zoonosis subdirectorate of the Ministry of Health, who underlined the importance of involving school children as a means of conveying information on the bird flu danger to their parents and the public at large.

Fatum said that the existing anti bird-flu campaign through the mass media had not been able to heighten public awareness.

<snip> A similar campaign involving children was waged by the West Java Health Office during an outbreak of dengue hemorrhagic fever two years ago, when school children were involved in eradicating the mosquito larvae.

Study recommends strategies for distributing flu vaccine during shortage.

AUSTIN, Texas—When faced with potential vaccine shortages during a flu outbreak, public health officials can turn to a new study by mathematical biologists at The University of Texas at Austin to learn how to best distribute the vaccine.

The scientists used contact network epidemiology to model various vaccine distribution strategies, including the United States Centers for Disease Control strategy of targeting high-risk groups, like infants, the elderly and people with health complications. They also tested the idea of targeting school children, who are critical vectors in moving diseases through communities. More on optimal vaccine stategies to reduce morbidity caused by influenza. This one based on a mathmatical model.

They found that the best vaccine distribution strategy depends on the contagiousness of the flu strain.

“If we only have a limited flu vaccine supply, the best distribution strategy depends on the contagiousness of the strain,” says Dr. Lauren Ancel Meyers, assistant professor of integrative biology. “We can more effectively control mildly contagious strains by vaccinating school children, while we can more effectively control moderately and highly contagious strains by vaccinating high-risk groups

For indepth analysis the site at Plos medicine: http://tinyurl.com/mqkqh

http://tinyurl.com/hb2wh

U.S. governors prepare for flu pandemic, WASHINGTON, Oct. 2 (UPI) — The National Association of Governors is launching a project to help U.S. states prepare for the arrival of bird flu or some other deadly pandemic. The Pandemic Preparedness Project will focus on best practices in areas such as the development of response strategies and maintaining vital public services in the midst of a health crisis. The centerpiece of the project will be a year-long series of regional exercises involving state teams representing areas such as public health, homeland security, agriculture, education and the private sector. The tabletop exercises will test preparedness and cooperation among state, local and federal agencies, and will more importantly bolster the working relationships that already exist.

http://tinyurl.com/l337d Two U.S. scientists win Nobel for ‘gene silencing’ (World) October 02

“The discovery is already being used in clinical trials for viral diseases, for eye diseases, for cardiovascular metabolic diseases,” Bertil Fredholm, a member of the prize-giving Nobel Assembly of Stockholm’s Karolinska Institute, told Reuters.

“But even more importantly, it is being used in every drug industry as a fundamental research tool,” he added, saying RNAi has “invaded” laboratories worldwide. Phillip Sharp of the Whitehead Institute for Biomedical Research in Massachusetts, himself a 1993 Nobel prize winner, has used RNAi to kill HIV, the virus that causes AIDS.

San Francisco-based Alnylam Pharmaceuticals Inc. has used RNAi to block a gene involved in cholesterol metabolism, for example, and this week won a grant from the National Institute of Allergy and Infectious Diseases to use the technology against H5N1 avian influenza.

http://tinyurl.com/mvl9s

The article is liberally excerpted here for length…

October 2006 Issue of Emergency Medical Services - A Place at the Table (USA) — From the beginning, the medical and research communities have been divided on whether avian flu would be the next big pandemic. And although it now appears that avian flu cases are occurring less frequently, it is clear that historically and statistically, we are due for such a pandemic in the next 5–10 years. For this reason, planning for a potential pandemic should continue, and it’s important that fire and EMS services become active participants in planning for their communities. Your department should have a seat at the table. This article is designed to assist you in preparing your department for this role. It offers talking/discussion points and information for active participation in a successful planning process.

First, it is important that your department have plans in place to take to the discussion table.

Second, ensure that your department has its own plan before taking on discussions and recommendations in a group.

Third, begin an evaluation and education program. You will need to consider the emotional reaction and potential for fear among your fellow providers if and when a pandemic occurs. During the 1918 Spanish flu pandemic, 25% of fire and police employees did not report for duty. One reason was fear of contracting the disease; another was concern for family members.

~ Hong Kong example - The Hong Kong Department of Health prepared ongoing informational booklets for the public. These kept the population up to date on the outbreak and gave them instructions for personal protection. The government set up practice drills for a high-case-rate event in which the public also participated. This is not currently being done in this country, but could be a key component of reducing fear and panic in the public. A mass panic situation would have disastrous results. Why can’t the public know and practice reporting to points of distribution (PODs)?

Staff Education - In Hong Kong, education and training were provided for emergency medical personnel, and their fears and concerns were assessed. Generally, their commitment to work depended on how safe they felt their family was.

In a survey of 100 physicians by the American Medical Association, 80% said they would care for infected patients, and 40% said they’d work even if they were at risk for infection. What are the views of your workforce? Your staff’s attitudes and needs should be established to formulate an effective plan and meaningful education program.

Fourth, reports suggest there may not be enough vaccine for the pandemic strain, and it also appears that there will not be enough antiviral drugs. Therefore, isolation of infected persons or quarantine of the exposed may be the only approach open to you. It should be a focal point of your planning and education.

Suggest a survey of local residents to obtain data on how they might cooperate with an ordered quarantine and/or isolation. Suggest supplying the public with commonsense lists of food and medication needs.

Fifth, work in the group to ensure that any approach is evidence-based. Science should prevail, not fear and emotion. Companies may use fear to sell products. Become familiar with what’s out there and bring this information to the attention of the planning group. For example, no special cleaning agent is needed or recommended for avian flu, but there are companies selling special agents to kill it.

Sixth, encourage annual flu vaccine programs and a plan to address rationing, supply and distribution. The concern is that an individual infected with a normal type A flu virus might become coinfected with a pandemic flu virus, and the two would come together to form a new virus that we might not have anything available to combat. This is a part of the rationale for, and increased emphasis on, annual flu vaccine programs.

Maintaining Medication Supplies - Currently, the government recommends individuals keep extra supplies of their prescription medications on hand to sustain them through an emergency like an avian flu pandemic. It is important to know, and be sure that others know, that there has not been discussion or agreement with insurance companies underlying this policy. How might needed medications be obtained and paid for if insurance companies will not authorize payment? One suggestion is that extra medications could be purchased without going through an insurance company, if one can afford it. This is a very important aspect for both family and workplace planning.

Health | 01.10.2006 Health Experts Urge EU to Prepare for More Bird Flu Cases

There are over 480 million people across the EU and there are substantial differences across different countries with demographics, geography and available services and health systems,” he said. “Now there is free movement across borders. This means there will be free movement of diseases.”Health professionals meeting at the 2006 European Congress on Disaster Management in Bonn all agreed that it is not a question if an outbreak of bird flu will happen, but when.

They recommended establishing a common EU position and making sure there are clear communication channels between member countries. They also addressed stockpiling of Tamiflu, one of the only known drugs that can cure bird flu symptoms.

http://tinyurl.com/nso8s

http://tinyurl.com/zux7o - Bird flu fears: Why prepare now for bird flu? A Mayo Clinic specialist discusses timely questions about bird flu and its potential to cause a human pandemic.

No one knows if bird flu (avian influenza) will be the next crisis. But experts are worried that it could turn into a worldwide outbreak among humans — a pandemic. Since 1997, the H5N1 bird flu strain has killed millions of birds. Hundreds of humans have become infected from birds, and more than half have died. So preparing for a pandemic is simply smart.

Here, James Steckelberg, M.D., chair of the Division of Infectious Diseases at Mayo Clinic, Rochester, Minn., answers questions about bird flu.

How long might it take for the bird flu to mutate into a serious human threat? That’s the question of the hour, and the truth is, no one knows. We do know a few important things about H5N1. First, it’s particularly virulent. Second, the virus appears to be spreading among birds. Third, it seems to be affecting more species, including cats, which usually aren’t susceptible to bird flu. But whether this virus will ever make the genetic changes needed to infect humans on a mass scale, or how long that might take — there’s just no way of knowing.

COMMENT - this is not news, but what is said by CIDRAP halfway through, ‘is’…

http://tinyurl.com/j4oww - Mild flu virus found in Illinois ducks CIDRAP, Oct.2 - Initial tests on wild ducks in Illinois suggest they have a low-pathogenic strain of avian influenza, not the deadly H5N1 strain, federal officials said late last week.

~

Further testing at the NVSL will clarify if one or more of the virus strains are present, identify a specific subtype, and determine the pathogenicity, officials said. Results are expected in 2 to 3 weeks.

Low-pathogenic avian influenza is common in wild birds and can be found in many duck populations, including green-winged teal. Low-pathogenic strains typically cause minor sickness or no noticeable symptoms.

Mild strains include the “North American” H5N1, which is different from the lethal H5N1 virus strains circulating in Asia, Europe, and Africa. However, low-pathogenic strains sometimes mutate into high-pathogenic forms.

An older NPR story. A very good read.

http://tinyurl.com/g26nw - Staving Off Panic in a Flu Pandemic

…Barry says that sort of panic wasn’t caused by the flu alone. It came after officials tried to reassure the public by telling half-truths, and even lies. “The obvious lies led to a breakdown in all trust in authority,” Barry says.

~

When people can’t trust the government, they turn to other sources of information, including rumors. The result can be extreme behavior.

~

U.S. health officials say such episodes have taught them how important it is to tell the full truth. Health and Human Services Secretary Mike Leavitt has been making a point of describing a potential flu pandemic in graphic terms.

~

Peter Sandman, a risk communications expert in Princeton, N.J. talks about this: “The only panic we saw during the SARS outbreaks was in China,” Sandman says. “It was as a result of the Chinese government misleading people about the existence of SARS in China, which the Chinese government maintained it was doing in order to prevent panic.”

Sandman calls this “panic panic.” He says it occurs when the government fears the public can’t handle the truth. He says that’s a mistake. Sandman says U.S. officials have offered some false reassurances about bird flu. For example, they like to remind people that the bird-flu virus has yet to infect any birds in this country. But Sandman says that doesn’t make most of us any safer.

Recent efforts to reassure Americans suggest that the Bush Administration hasn’t fully learned the lessons of the 1918, says Dr. Jody Lanard…”That’s why we end up having President Bush on his first major pandemic statement talking about martial law,” Lanard says. “They’re going to the rare, unusual case of public hysteria and disorder, instead of counting on the public to be the way Americans usually are — highly, highly resilient.”

Lanard says officials can tap into that resilience by telling people how they can work together to protect themselves even when things get really bad.

(UK) Norfolk is ready for a flu pandemic [link http://tinyurl.com/oqvcz]

SARAH HALL 03 October 2006 09:20

Patients in Norfolk are being reassured that NHS doctors and nurses are prepared if a flu pandemic hits Britain.

Fears have been raised that frontline staff have not been warned on how to deal with the outbreak, after senior health officials admitted at a conference this week many doctors do not know what to do when flu arrives.

<snip> A human flu pandemic could be caused by a mutation of a variety of human flu and/or bird flu and it is believed it could kill up to 700,000 Britons. However, the director of public health for Norwich said plans were in place for all health officials to deal with an outbreak.

Dr Peter Brambleby said: “Norwich Primary Care Trust issued a city specific plan on dealing with a flu pandemic in February this year. “This has gone to every GP in Norwich and has been subsequently discussed with them.

“Each GP practice has a plan for dealing with an outbreak and every department under the PCT has produced a continuity plan.

“There is only so much we can do because we do not know what the next strain of flu could be. But patients and GPs can be reassured that whatever plans can be put in place have been.”

<snip> (And the story was reading well until this line …)

There are three types of flu: Seasonal flu, human flu and bird flu.

Thailand Bird flu outbreak possible after storms and floods [link http://tinyurl.com/ryqm3]

BANGKOK, Oct 3 (TNA) - Thai authorities are warning of a possible bird flu outbreak after the recent rainstorms and floods, followed by the impending arrival of cool season which brings migratory birds.

Yukhon Limlamthong, Director-General of the Livestock Development Department said freak weather in Thailand has brought about persistent rains and floods, intensifying the risk of another bird flu outbreak.

Although no signs of an outbreak have been detected to date, Mr. Yukhon said he is concerned that after the monsoon season—with some areas being persistently under water, poultry and other birds may weaken and become vulnerable to the virus.

Compounding the situation is the arrival of cool season which follows the rains, and both domestic poultry and wild birds must adapt to another round of change. [more..]

Because of the Shortage of human resources and the Support Masyarakat the New Bird Flu Vaccination 40% Bandung,
- When the bird flu virus continued to spread in various areas, the target of the poultry vaccination in Kab. Bandung precisely was not yet optimal. From the target 1.5 million tails of the poultry that will be vaccinated this 2006, just were reached approximately 600. 000 tails of the poultry or 40% then. This was caused by the shortage of available human resources in the related service. That was acknowledged drh. Adiyoto, Kasubdin resources and fisheries of the Livestock Breeding Service (Disnakkan) Kab. Bandung, on Monday (2/10). ”Kadang we also had difficulty carrying out the mass vaccination because the community did not too much respond to him.
-snip-
Moreover, there was not one subdistrict then that could claim that his area was freest from bird flu because of the characteristics of the spreading of this illness that sporadic.
[more] http://tinyurl.com/zfdan

http://tinyurl.com/kh2zm

From today’s Washington Post Federal Pages, page A15

Nancy Cox, a scientist at the Centers for Disease Control and Prevention, won the top award, Federal Employee of the Year, for “leading the world’s efforts to prepare for a catastrophic flu pandemic.”

Avian influenza – situation in Indonesia – update 35

http://tinyurl.com/ljwbs

3 October 2006

The Ministry of Health in Indonesia has confirmed the country’s 69th case of human infection with the H5N1 avian influenza virus.

The case is a 21-year-old female from East Java Province. She developed symptoms on 19 September and was hospitalized on 25 September. She remains hospitalized.

She is the sister of a confirmed H5N1 case, an 11-year-old male who died on 18 September. Following that fatal case, health authorities initiated contact tracing, and on 24 September they received reports of symptoms in the sister. In line with the national protocol, she was immediately given the antiviral drug, oseltamivir, and isolated in hospital.

The source of her infection is presently under investigation. Poultry deaths in the family’s household were noted both before and during the illness of the brother. The woman was likely exposed to these poultry as well as to her brother.

Of the 69 cases confirmed to date in Indonesia, 52 have been fatal.

Experts to Release Recommendations for Improving Pandemic Flu Science and Technology Policy in Audio Press Conference

http://tinyurl.com/heuf3

10/3/2006 9:30:00 AM

To: Assignment Desk, Daybook Editor

Contact: Laura Segal of Trust for America’s Health, 202–223–9870 ext. 278, or lsegal@tfah.org

News Advisory:

WHAT: Trust for America’s Health (TFAH) and the Infectious Disease Society of America (IDSA) will release policy recommendations that outline actions that should be taken now to better prepare the nation for a pandemic flu outbreak. The recommendations are part of a new report, “Pandemic Influenza: The State of the Science,” that examines what is known scientifically about influenza viruses, as well as recent developments in vaccines, medications and diagnostics that could be used in the event of a pandemic, based on interviews conducted with 14 leading pandemic and infectious disease experts.

WHEN: Wednesday, Oct. 4 at noon EDT

A replay of the audio conference will be available by dialing 888–266–2081, Participant Code 975966, from Oct. 4th at 3 p.m. until Oct. 5 at 11:59 p.m.

Indonesia: Two Siblings 7 and 4-years treated for Bird Flu

03/10/2006

SCTV6.com (Software translations from Indonesian)

“The doctor’s public hospital Wahidin Sudiro Husodo, Makassar, South Sulawesi, on Tuesday (3/10), again accepted two children who it was suspected suffered bird flu.

Dion, seven years, and his brother, Mustari, four years, was expected terjangkit the bird flu virus because they once contact with the poultry that died because of bird flu. Was based on the medical note, the two children suffered the high fever, issued mucus from the lungs and coughs. As far as this is concerned the team of the doctor took the sample of blood of the two patients to be checked in Jakarta.

The two children increased the list of assumption casualties of bird flu in five last days in Makassar. Beforehand two children were named Paturungi and Apriani also was treated in isolation space the same hospital also because of being expected by bird flu. “ - excerpt

(Streaming video from hospital at URL)

http://tinyurl.com/o26js

Map of Makassar:

I did not see this in yesterday’s or today’s news thread; please excuse if it is a duplicate:
NEWS - CHINA:
Bird flu outbreak in N. China under control
Xinhua
Updated: 2006–10–02 22:34
An outbreak of bird flu in north China’s Inner Mongolia Autonomous Region last week has been put under control and no human infection was reported, according to the regional government.
As of zero hour of October 2, no new deaths of poultry and no human case of bird flu were reported, a regional government spokesman said on Monday.
Nearly 1,000 chickens and ducks reportedly died suddenly in a poultry farm in Xincheng village of Jiuyuan District of Baotou city on September 27. The national avian influenza laboratory later confirmed that the H5N1 virus was found in samples of the dead poultry in Xincheng village.
[snip]
To date, 17,616 chickens and ducks have been culled to control the outbreak.
A batch of bird flu vaccines allocated by the Ministry of Agriculture reached Baotou early Monday morning. All poultry in Jiuyuan District will be inoculated in the coming 10 days.
Investigation is being conducted to find where did Zhang bought these chickens and ducks and where did he sold the poultry.
China has reported nine outbreaks of bird flu in poultry this year, in northwestern Xinjiang Uygur Autonomous Region, north China’s Shanxi Province and Inner Mongolia, east China’s Anhui Province, southwestern Guizhou and Sichuan provinces and the central province of Hunan.

Indonesia

http://tinyurl.com/gk5v7

An editorial in the Jakarta Post paints a very worrisome picture…

“On the disease management level, the situation is worse and is an omen of the disaster it would be, should a pandemic strike. What alarms most is the regrettable absence of the medical community from the battle field as a whole. Cases of infected patients who have seen a doctor a week or a few days before being admitted with the wrong diagnosis to the wrong hospital are rising in number. The majority of the victims reached specialized medical centers too late. How can general practitioners, in the most affected country in the world, continue to overlook the diagnosis despite suspicious pneumonia-like symptoms?”

Edna Mode – at 12:50

“An editorial in the Jakarta Post paints a very worrisome picture… “

Edna, just to clarify, this is not an editorial. It is a letter to the editor posted under the Jakarta Post’s “Your Letters” section. In essence it is something any of us could have written to the J.P.

The situation in Ino is indeed worrisome, but we need to make sure we do not let our fears get the best of us and keep the tidal wave of information as clear;y organized as possible.

Good catch on this letter all teh same. You are a tribute to the wiki! : )

Thanks for clarifying. Can’t take credit for the catch. Hat tip to Crof’s blog.

Edna Mode – at 12:50 wrote:

An editorial in the Jakarta Post paints a very worrisome picture…

http://tinyurl.com/gk5v7

Edna, thanks for connecting another dot.

WHO: “We now have only “God-given time” to prepare for it.”

Issue date: 10/2/06

Tuftsdaily.com

“However, on Sept. 6 in New York, Dr. David Nabarro, the UN senior coordinator for avian flu, said that there will be a pandemic and that we now have only “God-given time” to prepare for it.

He also said that officially reported H5N1 cases and deaths were likely significantly under-reported. He said that, while we were now officially at Level 3 on the pandemic warning scale (1= no worries; 6 = run for the cellar), levels 4, 5 and 6 might come very quickly.

Recent World Health Organization warnings say that H5N1 is mutating, making vaccine production harder and raising fears of resistance to current medicines used to control it.

The other uncertainty is how bad it will be. Part of “bad” is how many will be infected and what percentage of those infected would die. Part of “bad” is what the impact will be on our society and economy.

Would power and other utilities continue to function? Would healthcare workers report for work? Would food and fuel deliveries keep being made? It is very difficult to predict just how difficult life would become or for how long.” (excerpt)

http://tinyurl.com/nsbkt

This is a report from the conference I attended.

WHO: Avian influenza – situation in Indonesia – Update 35

3 October 2006

“The Ministry of Health in Indonesia has confirmed the country’s 69th case of human infection with the H5N1 avian influenza virus. The case is a 21-year-old female from East Java Province. She developed symptoms on 19 September and was hospitalized on 25 September. She remains hospitalized.

She is the sister of a confirmed H5N1 case, an 11-year-old male who died on 18 September. Following that fatal case, health authorities initiated contact tracing, and on 24 September they received reports of symptoms in the sister. In line with the national protocol, she was immediately given the antiviral drug, oseltamivir, and isolated in hospital.

The source of her infection is presently under investigation. Poultry deaths in the family’s household were noted both before and during the illness of the brother. The woman was likely exposed to these poultry as well as to her brother. Of the 69 cases confirmed to date in Indonesia, 52 have been fatal.”

http://tinyurl.com/fnx54

VERY good article!

I mean the one Goju gave at the end of his recap!

Dennis in Colorado at 11:34 - yes, it is a duplicate but not an obvious one - reports out of China say Northern China, reports from elsewhere say (Inner) Mongolia. Similarly, reports from within China show Hong Kong and other autonomous territories as part of China. Rightly or wrongly, I chose to show them on the News Summary as ‘independent’ regions.

However, I would rather see things posted twice than not at all ;-)

you have discussed statins before, but here is a new study.

Best way to treat bird flu

“The report in Nature describing the increased host immune response caused by the 1918 pandemic influenza virus (report, Sept 29) is the latest in a series of studies suggesting it is the host response (the “cytokine storm”) that is probably responsible for most deaths now being seen with H5N1 infections. If the H5N1 virus leads to the next human pandemic, and if the situation is similar to that in 1918, there could be 350 million deaths worldwide. Conventional vaccines will be too little too late, and limited supplies of antiviral medications will be available in only a few countries. However, we have recently learnt that statins (the drugs used to treat high cholesterol) decrease mortality due to pneumonia by 40–60 per cent, suggesting that, by modifying the influenza “cytokine storm”, statins could be life-saving. “

http://tinyurl.com/efukx

Patient Suspect Bird Flu (Cluster) in Makassar To Six

On Tuesday, October 03 2006

(Software translation from Indonesian)

‘’‘MAKASSAR — MIOL: the Patient suspect bird flu that was treated in special isolation space the patient of bird flu of the regional Public Hospital (RSUD) Dr Wahidin Sudirohusodo Makassar, currently reaches six people. This increase happened on Tuesday (3/10) dawns, after beforehand have been treated by four patients, namely Patturungi, 7, Vani, 8, the Lamp, 4 and Mustrisa, 7. The two additional patients were Nur Azis, 6 and Muh Salsabil, 6.’‘’

Patturungi that was domiciled at Street Flamboyan, the District, Mattoangin, the Mariso Subdistrict and Vani that were domiciled at Street Makmur, the Karuwisi District, the Panakkukkang Subdistrict was treated in RSUD Wahidin on the same day, that is since Saturday (30/9). Whereas the Lamp and Murtarisa that were the brother’s older brother were treated since Sunday (1/10). Nur azis and Muh Salsabil the citizen of this Makassar Subdistrict was beforehand treated with the Lamp and Mustira in maintenance space of the child RSUD Wahidin, Makassar.

Parents Mustaria, Nursia, 45, claimed last week to be his seven chickens died suddenly, but was not known by his cause.The chicken died this only was buried around the house.Because of spreading him the case of this bird flu, the South Sulawesi Service of Province Livestock Breeding, took the sample of blood of a chicken, birds, and the cat belonging to Sarida, the neighbour Vani, the citizen Street.

Prosperously, the Karuwisi District, the Panakkukang Subdistrict.The sample of this blood was poultry that was destroyed, last Friday, related the assumption of the infection of the bird flu virus of a local citizen, Vani. He experienced the fever with the temperature of the body 38.3 Celcius levels and breathless.Apart from, the Vani fever that high, the temperature of the patient’s other body then high and changing in the range 37–39 Celcius levels.

However, the side of the Livestock Breeding Service claimed not all that the co-ordination followed the existence of the assumption.

“We indeed not all that the co-ordination with the local government, and us still the lack of the team in menagani the case of this bird flu.”

This virus was very dangerous and must be handled by the team, said Nurlina, the team of bird flu that was formed by the Livestock Breeding Service, on Tuesday.”

http://tinyurl.com/rrq3s

DennisC – at 16:38

“you have discussed statins before, but here is a new study.

Best way to treat bird flu…”

DennisC - this was a letter to the editor citing the opinion of three people, not a specific medical study.

Maybe I have missed it. Does such a study exist to your knowledge?

Thank you.

I normally don’t reply to anonymous posts especially I don’t understand the question about the existance of the study.

However, if you don’t like a Times article, you might try: Clinicians Biosecurity Network Weekly Bulletin (issue of 9/27/05) Borio and Bartlett who reviewed the suggestion of David Fedson concerning statins. They seem to work via preventing activation of the transcription factor NF-kappaB. or perhaps: 2004 Almog et al. (Circulation, Aug 17 2004;110(7):880–885) were it is reported that patients admitted to the hospital with acute bacterial infections and who were on statins for more than a month for other reasons had a dramatically reduced incidence of severe sepsis (19% versus 2.2%) and reduced admission to the Intensive Care Unit (12.2% vs. 3.7%). An interesting point is that patients on statins might be expected to be at greater risk because they are taking a medication for a pre-existing medical condition.

or you might wait for the Science article by Enserink to appear shortly. Enserink examined influenza seasons between 1996 to 2003, and using a database of 60,000 primary care patients compared those with at least two statin prescriptions in the previous year to those without. There was a 26% lower risk of pneumonia in the statin group.

My background tells me to expect that the statin effect my prove to to be quite useful in all Type A fues. But this is a news thread and not a science thread so we don’t want to get too far afield. Realize some reviewers and editors my have access to articles before they appear in print or posted to the web.

If you want more info, you should always go to the primary source. You could call or email the principle investigators. Perhaps they will send you a preprint.

DennisC – at 18:09

Thank you.

My apologies if my question wasn’t clear to you. I suppose I could have phrased it as, “Was there a study to back up this suggestion of the efficacy of statin use?”

Please keep in mind that what you linked to was not a “Times article” as you stated, but rather a letter to the editor which is quite a different thing entirely.

I will look forward to reading up on the anecdotal information, as well as any dedicated studies on the subject as they are published.

My thanks again.

Comment-

Yes it was a letter to the editor but it did appear in the UK Times on Oct4 and is therefore a published Times Article. There is nothing special or sacred about a professional journalist that exalts them over an average citizen. One is just paid to churn out something on a schedule. In both cases it is just second hand information. The only way to check such things is to contact the principle investigator and not rely on some guy trying to meet a deadline.

Again, the function of the news thread is to notify people of what is new. It is for general popular consumption. It is not to promote scientific views or to teach science. People wh want that should go first to the scientific literature, which is designed for that purpose. I will sign off now and avoid cluttering the News thread anymore. I apologize to others for being drawn into to question on the news thread. – I just snapped.

 !!! Bandung:”5 Suspect People, New Possibility…Liquid in His Lungs”	

Tuesday, October 03 2006 12:49

Lima the Patient Suspect Bird Flu in RSHS Bandung Membaik

(Software Translation from Indonesian)

Bandung — MIOL:” The condition for the ‘’‘health of five people suspect bird flu that was treated in RS Handsome Sadikin (RSHS) Bandung continued to improve.

The four patients were Santi, 18, the citizen of the Gardener Waru, the Bandung City, of Ajis, 9, the Tasikmalaya citizen, Kusna, 17, and Wildan, 20, both of them the citizen of the Andir Village, Lembang, the Bandung Regency, as well as Holy Rahmawati, 14 months, the citizen Jatinangor, the Sumedang Regency. ‘’‘

The “condition for the patient generally continues to improve.” From five patients, just two patients that his status already clear, that is the negative terjangkit the bird flu virus. Both of them were Santi and Ajis, explained the member Tim the Handling of RSHS Sri Sudarwati Bird Flu.

Now three other patients, Kusna, Wildan and Holy, the sample of his blood has been sent to Jakarta, and results of the new possibility on Wednesday (4/10) was known. Santi, Ajis, Kusna and Wildan, his condition continued to improve, and their breathing has been normal. Keempat

This patient did not need respiratory accessories again, and entered the restoration period. Now Holy, that entered poinciana tree space on Monday afternoon (2/10), still experienced the cough and breathless. Although his body heat has been far decreased, and the team found the existence of the liquid in his lungs.” - excerpt

http://tinyurl.com/rfkju

Did anybody notice that the Times letter was co-signed by one of the Flu Wiki moderators?

:-)

anon_22: I did and congratulations - you are in a distinguished group with an important message.

working on it, working on it……

DennisC at 18:41:

Anonymous’ clarification is valid. A letter to the editor is not the same and does not count as a published Times article.

The letter did not mention a specific study, only the phrase “we have learnt” in relation to Statins.

Though I agree with you about anonymous postings, the politely phrased question to you was not out of line.

Letters to the Editor

The Times October 04, 2006

Best way to treat bird flu

“Sir, The report in Nature describing the increased host immune response caused by the 1918 pandemic influenza virus (report, Sept 29) is the latest in a series of studies suggesting it is the host response (the “cytokine storm”) that is probably responsible for most deaths now being seen with H5N1 infections. If the H5N1 virus leads to the next human pandemic, and if the situation is similar to that in 1918, there could be 350 million deaths worldwide.

Conventional vaccines will be too little too late, and limited supplies of antiviral medications will be available in only a few countries. However, we have recently learnt that statins (the drugs used to treat high cholesterol) decrease mortality due to pneumonia by 40–60 per cent, suggesting that, by modifying the influenza “cytokine storm”, statins could be life-saving.

The scientific rationale for considering statins for pandemic use is persuasive, but the public health rationale is hugely compelling. Unlike vaccines and antivirals, generic statins are available in almost all countries, and treating an individual patient would probably cost less than £1.

The pandemic might be imminent, yet nothing is being done by scientists and health officials to explore this idea. Why?”

DAVID FEDSON Former Professor of Medicine University of Virginia SUSAN CHU Editor, fluwiki.com PETER DUNNILL Professor of Biochemical Engineering University College London

http://tinyurl.com/efukx

Klatu – at 19:19 wrote: Bandung:”5 Suspect People, New Possibility…Liquid in His Lungs

Tuesday, October 03 2006 12:49 Sumedang Regency

Map Sumedang Regency

All an all, I would I give more weight to a letter by a MD and a PhD than to some journalist on a deadline that only gives un-named “experts”. And I still say that a letter to the editor in a published paper is an Article(= written composition in prose, usually nonfiction, on a specific topic, forming an independent part of a book or other publication, as a newspaper or magazine),and it is fine to cite it that way. But perhaps someone else uses a different citation style.

However, the main point is that statins may save lives - perhaps millions of them. You should not discount the source even if it was by “just” an MD (Vaccine specialist) and a PhD Biochemist instead of a journalist. Do not let you citation style overshadow the importance of what is cited. Lives hang in the balance.

DennisC at 20;14

I don’t think the subject matter or the authors were being discounted. I think Anonymous was probably interested and wanted to know where he or she could find more information, esp if the authors of the letter were referring to a specific study.

As per letter to the editor vs. article, all I will say is that they are judged differently. I know not what field you are in, but would imagine that if your CV or those of persons you hired involved listing publications in which their work had been published, your definition of “article” would be much more narrow in scope.

DennisC – at 20:14 wrote”

“However, the main point is that statins may save lives - perhaps millions of them. You should not discount the source even if it was by “just” an MD (Vaccine specialist) and a PhD Biochemist instead of a journalist.”

The Wright Brothers built bicycles before they built airplanes.

DennisC – at 20:14

“You should not discount the source even if it was by “just” an MD (Vaccine specialist) and a PhD Biochemist instead of a journalist.”

I looked back through the thread and don’t see anyone discounting the sources and no mention of “just” an MD, etc.

I think this is getting a little blown out of porportion, DennicC.

Erh, can we call time out on whether it should be posted here, since it is already posted? :-)

But for those who want references, since I had a hand in writing that letter, let me point out Fedson had written the major paper on statins as pandemic treatment. A more thorough discussion is available with references on this thread Statins Revisited

Newsie – at 20:23 Neither newspaper “articles” nor letters to the editors appearing in newspapers would be accepted in my field as a “publication”. ANY newspaper item would be “laughed at” in such a list. Letters to the Editor appearing in a Scientific Journal might be listed in some people’s publications but would not carry as much weight as a full reviewed Journal article, patent or a funded government report. The reason that Letters to the Editors in Science Journals are sometimes included is that most editors send out such items for peer review/comment. However, a letter of any kind signed by both a MD and a PhD would be read.

Again the focus should be on the fact that there may be a “fall back” approach to saving lives while vaccines are being made and not the initial venue use to draw attention to the need of more study. Again do not throw out the baby with the bath water.

(Hopefully this doesn’t belong in this thread.)

http://www.alertnet.org/thenews/newsdesk/N03219590.htm

“Mystery illness kills at least six in Panama, 03 Oct 2006, Source: Reuters”

“PANAMA CITY, Oct 3 (Reuters) - Panama’s Health Ministry declared a national epidemic alert on Tuesday after a mystery illness killed at least six people and left others suffering with fever, diarrhea and partial paralysis.

Doctors do not know the cause but say the disease progresses rapidly to the renal system and causes neurological damage.

Another six people may have died from it in the last month.

“These symptoms are completely unusual, and have not been detected before in our country,” Panama’s health director, Cirilo Lawson, told Reuters.

Ten more people have been stricken but survived.

Doctors in the central Panama and Cocle provinces are taking samples from the affected people and seeking advice from abroad”

On the BBC site I have no idea who wrote it or who their “experts” are. I am still looking for more about it.

Treatment “to neutralise all flu”

“In preliminary tests, it was found to protect animals against various strains of the virus - and may also protect against future pandemic strains.

Warwick University researchers took a flu virus and genetically modified it.

This, they say, created a “protecting virus” which slows down the rate of infection so much that the flu virus effectively becomes its own vaccine.

Experts warned much more testing was required. “

http://tinyurl.com/zwdzu

Dennis C - at 21:32

See In vivo antiviral activity: defective interfering virus protects better against virulent Influenza A virus than avirulent virus

It is a study authored by Nigel Dimmock from Warwick, so is probably the study referred to in the BBC article.

more on the Panama “mystery illness” they keep updating and changing the site and it “reads differently at different times”. the primary problem seems to be Kidney failure. I seem to remember that Kidney failure was a symptom in some of the early H5N1 cases (98?)

http://tinyurl.com/ejmg8

The syndrome presents basically as follows:

Nausea Vomiting High Fever Diarrhea Severe Headache Kidney Failure Paralysis, especially around the face Difficulty Walking and Physical Coordination “Eventually, death if the patient does not receive dialysis. patients infected have been older than 60 years of age and have a history of diabetes, kidney failure, or high blood pressure. Other sources have reported cases in people as young as 25 years of age. They are presenting with Acute Renal Failure, and their production of urine basically shuts down. Eventually toxins build up in the blood and the patient is basically poisoned from the inside, out. In other words patients are not catching it in the hospital. On the evening news today there are reports of another person dying in the capital. There is also a case of one man presenting with acute renal failure in Veraguas but that case has not been identified as linked to this syndrome…the patients infected have been older than 60 years of age and have a history of diabetes, kidney failure, or high blood pressure. Other sources have reported cases in people as young as 25 years of age. “

also,Thanks, to Dennis in Co

I am about to create the News Summary then I shall start a new thread so you might like to hold your post for about 30 minutes.

Cheers and thanks