Following are two posts made by Michelle and I in the Indonesia Outbreak thread. I would like to start this thread as a discussion of the ramifications of a Tamiflu blanket and the false negatives that may result.
Michelle in OK – at 22:51 COMMENT: I’ve been looking over the cases to fill in gaps in our understanding, and the patients Hendra (21) and Gilang (9) have always concerned me. We have no information on them except that they are from Garut. We aren’t even sure of their gender. They are the only patients which have tested positive but have not yet been listed on the WHO website.
The thing that bothers me is this. Cikelet is in Garut. If you have cases testing positive 1 1/2 weeks after the Tamiflu blanket, that is of concern.
I searched flutrackers.com and found an article posted by AlaskaDenise. Link to article Here are some excerpts:
“In Garut, the virus first appeared in the villages of Cikelet and Cigadog, but it has since spread to other villages. The number of suspected bird flu victims continues to rise each day…
Health Ministry officials who hope to check the spread of the virus in the area are monitoring seven villages in Garut. Officials have also gone to each village looking for people who show signs of infection and sending them to the nearest hospital. Hendra, 21, and Gilang, 9, were the latest victims to test positive for the bird flu virus. They received medical treatment at Dr. Slamet Hospital in Garut. Four others are under observation in their homes by Health Ministry teams. If their conditions worsen, the teams will bring them to the hospital.”
We have 4 others from Cikelet who were hospitalized after 8/25/06, the date of this article. I think it is possible that Hendra and Gilang are also from Cikelet.
Okieman – at 23:08 Here is an article from Bloomberg addresses the issue of tamiflu affecting test results. Very good article and worth reading. Kudos to Jason Gale for good reporting.
Michelle, this article along with the information in your 22:51 post makes a host of questions arise.
Bird Flu Patients Need Testing Before Starting Drugs (Update2)
By Jason Gale
Aug. 22 (Bloomberg) — Bird flu cases may go undetected in patients who took antiviral drugs days before being tested because treating the virus may mask infection, said virologist Menno de Jong, whose team observed 18 cases in Vietnam. Specimens should be collected from suspected cases before or soon after medicines such as oseltamivir are administered, said de Jong, head of virology at an Oxford University clinical research unit in Ho Chi Minh City. Nasal and throat swabs from Vietnamese patients who responded well to oseltamivir, marketed by Roche Holding AG as Tamiflu, were unable to detect the virus 48-to-72 hours after beginning treatment, he said. If a patient is on oseltamivir for three days before the first swab is taken for diagnostic testing, it’s possible the result will be negative, but the patient could be infected’‘ with the H5N1 strain of avian influenza, de Jong said in a telephone interview yesterday. A delayed or incorrect diagnosis is a concern for disease trackers as they monitor human cases for signs H5N1 is becoming contagious to people, not just birds. A mutated virus spreading easily from human to human might spark a pandemic that could kill millions of people. Since 2003, H5N1 is known to have infected 240 people in 10 countries, killing 141 of them, the World Health Organization said yesterday. Almost all human H5N1 cases have been linked to close contact with sick or dead birds, such as children playing with them or adults butchering them or plucking feathers, according to the Geneva-based agency.
Early Detection
Early detection and isolation of suspected cases are important to limit the spread of the virus should it begin to spread easily between people, the WHO said last year in a recommendation of strategic actions to fight a pandemic. The most recent H5N1 cases occurred this month in a remote village in the Garut district of Indonesia’s West Java province. Indonesia’s Ministry of Health confirmed H5N1 in three villagers, two of whom died, prompting officials to investigate whether the virus had spread directly between the people. No evidence of human-to-human transmission has been found, Health Minister Siti Fadilah Supari told reporters in the capital, Jakarta, today. Authorities distributed Tamiflu to about 2,100 villagers in Garut, the Jakarta Post reported today, citing Fatimah Resmiati, a spokeswoman from the ministry’s West Java environmental health office. Indonesia, the world’s fourth-most-populous country, accounts for a third of the 141 known H5N1 fatalities since 2003.
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I asked Nabarro about that and several other med people at the conference.
They all agreed that it could be masking infections - they just dont know Nabarro said he was going to indo next week to try to figure out what was up. The reporting is a mess. Noone knows whats really going on now. It seems things may have changed there.
What does that mean - “it seems things might have changed there?”
“it seems things might have changed there?”
Well, the cluster size at least in Cikelet is far bigger than anything we have seen. Many of those cases are more likely to be b2h than h2h. In case you are relieved, this may not be a good thing.
For several years, increasing numbers of people have been exposed to this virus. In millions and millions. And yet the incidence of human infections are miniscule compared to the exposure. In fact, as Monotreme pointed out a while back, it seemed that H5N1 was finding it (relatively) easier to go h2h than b2h. This led some people to suggest a pandemic was not likely because it appears that the species barrier is quite high.
Now, if the incidence of b2h is indeed increasing, then the virus is in the beginning stages of achieving a major milestone, which bodes ill for the world.
anon 22. I agree completely. Hear is how I now look at it. One virus produces millions or billions of mutations per single virus infection in an individual organism and H5N1 now has the absolutely unique ability to have its choice of a plethora of potential hosts.
Therefore, it is producing that pandemic virus repeatedly…all the time…with infinite mutations there is also an infinite chance that this is happening…
…what is missing is a confluence of events…human pandemic virus in birds is a dead end…human pandemic virus in a non-mobile person with few contacts goes relatively no where.
There is a one hundred percent chance after Q. Lake that it is only a matter of time until a confluence events puts all the factors together (like that doctor with SARS in the elevator in Hong Kong) and it is around the world in one day…or at least it will have seeded the world in one day.
By the way…I believe that its target all along was assimilation and harmony with mammals are therefore its target species was humans…that can be the only explantion given the data and Monotreme’s excellent derivations.
anon_22 – at 10:11
How do we explain Cikilet? The WHO said it’s not easier B2H. It may now be suppressed by Tamiflu blanket.
“We may never know”.
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