Summary from Indonesia Outbreak as of 14 November 2006
| Cases Discussed | Jun-06 | Jul-06 | Aug-06 | Sep-06 | Oct-06 | Nov-06 | Total |
|---|---|---|---|---|---|---|---|
| Died, no tests | 2 | 2 | 4 | 3 | 7 | 0 | 18 |
| Died, tested positive | 4 | 3 | 2 | 3 | 3 | 1 | 16 |
| Other tested positive | 0 | 1 | 3 | 1 | 0 | 1 | 6 |
| Symptoms, tests pending | 4 | 2 | 46 | 38 | 30 | 9 | 129 |
| Tested negative | 0 | 6 | 26 | 19 | 11 | 0 | 62 |
| Totals | 10 | 14 | 81 | 64 | 51 | 11 | 231 |
Special thanks to Michelle in OK for helping to keep us all organized on the Indo Outbreak thread!
(If you want any of the links to open in a new window, hold down the shift key and then click on the link)
Please visit these threads for latest information from these regions or to add news
| No | Region Name | No | Region Name | No | Region Name |
|---|---|---|---|---|---|
| 1 | USA | 8 | East Africa | 15 | Arab Peninsula |
| 2 | Canada, Greenland and the Arctic Circle | 9 | Southern Africa and Madagascar | 16 | Central Asia |
| 3 | Central America and Caribbean | 10 | Northwest Europe and British Isles | 17 | Southern Asia |
| 4 | South America and Surrounding Islands | 11 | West and Southwest Europe | 18 | Mainland East Asia and Japan |
| 5 | Northern Africa | 12 | Central and Southeast Europe | 19 | Southeast Asia |
| 6 | West Africa | 13 | Eastern Europe and Baltic Region | 20 | Australasia Melanesia and Micronesia |
| 7 | Central Africa | 14 | Middle East and Caucasus Region | 21 | Pacific Islands and Antarctic |
(Please see the thread Volunteers Needed as Lookouts Worldwide if you want to help)
Separate forum threads for India, Indonesia and Nepal
link to Indonesia wiki page
(From WHO as at 13 Nov - latest update) Total human cases worldwide 258, deaths 153 (2006 – 111 with 76 deaths)
China
Indonesia
Bulgaria and Romania
European Union
USA
General
Link to news thread for 14 November (link News Reports for November 14 )
(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.
Thanks to all of the newshounds!
originally posted by nsthesia after the summary was completed, thanks nsthesia!
‘Here is the update from the Hungarian situation:
I do not see any mention of flu in this write up. No respiratory component. Symptoms sound gastro-intestinal.
Translation:
“The Visitor and Patient Registration Area at Kutvolgyi Hospital in Budapest has been closed. Six floors/wings/departments have been closed completely because of increased patient complaints of diarrhea, high fever, vomiting, chills and (abdominal distress/cramping/? - not completely sure about this word). The Medical Officer, Bujdoso, said we are seeing more of these symptoms at this hospital. The onset of symptoms is 6–48 hours. They will remove the quarantine if the patients are symptom-free for 3 days.”
I was told by my Hungarian friend that closure of hospitals has happened before for infection. She says that these closures also involve “lockdown” of the staff. She said she would monitor the local TV for more info.’
Has the ‘confusion’ in Indonesia been sorted out - there were some later reports suggesting the 35yr old woman had not died - cannot find any links to it at present.
AnnieB, she is still alive but in intensive care. Here’s the link http://tinyurl.com/tkmy8
INTERVIEWIndonesia needs better birdflu controlhospital head
GENEVA, Nov 14 (Reuters) - “Poultry control measures must be tightened in Indonesia where public awareness of bird flu is poor even though it has the highest number of human deaths, the head of the country‘s main treatment hospital said on Tuesday.
Cock fighting and backyard chicken farming remain common in the sprawling archipelago, according to Sardikin Giriputro, head of Sulianto Saroso Hospital, the national hospital for infectious diseases in Jakarta.
“The virus is still circulating in poultry, not in commercial farms but in backyard farms which is very difficult to control,” Sardikin told Reuters in an interview…”
…”His hospital has investigated more than 225 suspect bird flu cases, confirming 22 cases with 19 deaths to date, he said.
“Most of the patients who died came in the late stage. We gave Tamiflu but it was already 48 hours after (disease) onset,” he said…”
…”Indonesia has only one laboratory with sufficient biosafety measures to confirm bird flu and this will rise to three labs next year, he said. “It can take days to diagnose cases. We think there may be some missed cases.
“It is a result of laboratory testing, which depends on quality and timing of the swabs. Sometimes the virus is no longer in the throat or on nose swabs even though clinically we may believe it is a case of avian flu but the laboratory can‘t prove it,” he said.”
http://tinyurl.com/yl2psr
It must be extremely frustrating and disheartening to have his job.
S. Korea to train ASEAN officials to detect bird flu
Yonhap news- “South Korea plans to train livestock experts from Southeast Asian countries, which have reported bird flu cases since the late 1990s, to detect the potentially fatal disease, the Ministry of Agriculture and Forestry said Wednesday.
The proposal, which includes detection kit support, will be forwarded at the Association of Southeast Asian Nations (ASEAN) plus three agricultural ministers meeting in Singapore later this week…”
http://tinyurl.com/y6slzu
Romania is (ready) for new outbreak of bird flu
Romania is prepared from a strategic viewpoint to combat a new outbreak of the H5N1 bird flu virus, local epidemiologists were quoted as saying on Tuesday by the national Rompres news agency.
After the eradication of all bird-flu outbreaks registered in 2005 and 2006, the Romanian authorities, during the period of “ epidemiological peace”, laid emphasis on the clinical and lab surveillance.
An epidemiological investigation of about 300–500 poultry and wild birds has been conducted weekly, according to the Institute of Diagnosis and Animal Health.
Experts of the United Nations Food and Agriculture Organization were present in the Danube Delta for two weeks to take collect samples from wild ducks and geese arrived in the area. All the samples collected, 162 wild birds and 26 bird corpses of several species, were tested last week in the lab and none showed traces of the H5N1 virus…”
http://tinyurl.com/ybrppf
http://www.alertnet.org/thenews/newsdesk/HKG24761.htm
HONG KONG, Nov 14 (Reuters) - A prominent Chinese health expert has called on scientists in Hong Kong and China to cooperate and conduct joint research to prevent a flu pandemic, a pro-Beijing newspaper reported. The call comes after China’s Ministry of Agriculture and Chinese scientists criticised scientists in Hong Kong and the United States in recent weeks for publishing a study saying that a new, vaccine-resistant strain of the H5N1 bird flu virus had emerged in China. Zhong Nanshan, a respiratory disease expert based in China’s southern Guangdong province, told the Ta Kung Pao newspaper that both sides must communicate.
“China and Hong Kong are one family and they may be facing a dangerous co-explosion of the common flu and avian flu in coming days.
I hope there can be more co-ordination, sharing of information in the future,” he told the newspaper in an interview published on Tuesday.
While China rejected the findings by the Hong Kong and U.S. scientists, it agreed last week to share long-sought bird flu virus samples from 2004 and 2005 with the World Health Organisation. Although the H5N1 strain remains largely a disease that affects birds, it has killed more than 150 people around the world since late 2003. Experts fear though that it could start a pandemic that could kill millions of people if it were to mutate into a version that could spread efficiently among humans.
US Dept of Health and Human Services News Release FOR IMMEDIATE RELEASE Tuesday, Nov. 14, 2006 Contact: HHS Press Office (202) 690–6343
U.S. and Mexico Pledge Increased Cooperation in Pandemic Influenza Preparedness Along Border
The United States and México today announced the signing of an agreement to boost cooperation on pandemic influenza preparedness among the six Mexican states and four U.S. states that share the international boundary.
Meeting in Hermosillo, Sonora, México, HHS Assistant Secretary for Public Health Emergency Preparedness Craig Vanderwagen and the Mexican Director-General of Epidemiology of the Mexican Federal Secretariat of Health Pablo Kuri signed a joint declaration to strengthen the commitment of the two nations to coordinate preparedness efforts, domestic and international disease surveillance activities, and response planning in the event of an outbreak of pandemic influenza.
“An influenza pandemic knows no political or geographic boundaries and responding to a potential outbreak will demand the cooperation of all nations, especially those that share common borders like México and the United States,” Assistant Secretary Vanderwagen said. “This agreement reflects the strong relationship between our nation and México and is a critical step in protecting our citizens.”
For more information, please visit Border Health (comment: interesting site; most of the front page is on various pandemic issues right now)
Clarification of the situation in Budapest, Hungary - cross posting from the Central Europe lookout thread:
Calici virus breaks out at four Budapest hospitals
More than 100 patients have contracted the calici virus in four Budapest hospitals, Kútvölgyi Hospital, Ferenc Jahn Hospital, the National Rheumatology and Physiotherapy Institute and János Hospital. According to hirszerzo.hu, 74 patients are being treated at Kútvölgyi Hospital. Kútvölgyi Hospital and the Phisiotherapy Institute are closed to visitors; Ferenc Jahn Hospital is partly closed, while no limitation has yet been introduced at János Hospital.
Calicivirus info from CDC
Note: this is snipped from a larger article titled Calicivirus Emergence from Ocean Reservoirs: Zoonotic and Interspecies Movements
Caliciviral infections in humans, among the most common causes of viral-induced vomiting and diarrhea, are caused by the Norwalk group of small round structured viruses, the Sapporo caliciviruses, and the hepatitis E agent. Human caliciviruses have been resistant to in vitro cultivation, and direct study of their origins and reservoirs outside infected humans or water and foods (such as shellfish contaminated with human sewage) has been difficult. Modes of transmission, other than direct fecal-oral routes, are not well understood. In contrast, animal viruses found in ocean reservoirs, which make up a second calicivirus group, can be cultivated in vitro. These viruses can emerge and infect terrestrial hosts, including humans.
<snip>
PJ - Well done. I sent this article to people in two different health institutions here in Texas.
Jeddah: Hospital Staff Overworked as Flu Spreads from Daiji World News (Saudi Arabia)
…delivered a more serious threat — an extremely painful and possibly fatal strain of influenza. Arab News visited hospital emergency rooms and polyclinics across Jeddah and witnessed the same scene of weeping and feverish children clinging to exhausted parents who are doing their best to keep their cool with overworked and weary hospital staff…
…Al-Tantawi said this season he witnessed as many as three strains of flu, which are known as Malaysian, H1N1 and Neocaltonia. All of them show the same symptoms: fever, muscular pain and congestion…
…Dr. Noha Dashash, director of Primary Health Care in Jeddah, told Arab News that the number of flu cases has been on the rise around the city due to the massive number of Umrah pilgrims that had come to the region during the Ramadan and Eid Al-Fitr holidays. Some estimates say that Jeddah welcomed an additional 2 million visitors this year…
…Dashash said it would be quite difficult for the ministry to offer a vaccination program as most flu vaccines are manufactured in North America or Europe and wouldn’t match the flu strains experienced in the Kingdom…
N Korea battles scarlet fever
Wednesday, November 15, 2006 (Seoul):
N Korea battles scarlet fever
Nov. 15, 2006 / http://tinyurl.com/y5kcp9
Scarlet fever is spreading in North Korea and threatens to become a full-blown epidemic despite efforts by authorities to contain the disease, a news report said.
The disease broke out in northern Ryanggang Province last month. It was rapidly spreading to other parts of the communist state, including the capital Pyongyang, South Korea’s Yonhap news agency reported. <snip>
Scarlet fever nearing pandemic in N.Korea—Yonhap from Reuters
North Korea could be facing a scarlet fever pandemic after the disease broke out last month in its Ryanggang province which borders China, South Korea’s Yonhap news agency reported on Wednesday.
It quoted a source close to North Korea, who declined to be named, as saying the disease had been spreading fast to other parts of the country and risked turning into a full-blown pandemic…
…Scarlet fever is normally easily contained with antibiotics but can lead to serious infections if left untreated.
As part of an ongoing outreach using social software, I’ve made a “loop” (aka thread) on bird flu here at Hot Soup, a relatively new political/social site. Feel free to join and comment. Sharing what we know is part of our mission.
Scientists find bird flu mutations related to human infections from USA Today
An international research team has identified genetic mutations in the H5N1 birdflu virus enabling it to infect human cells, according to Thursday’s edition of the science journal Nature. “The amino acid changes,” the magazine said, “might prove useful molecular markers for assessing the pandemic potential of H5N1 samples.”
To trigger a pandemic by replicating in humans, avian influenza viruses must be able to recognize human host cell receptors…[more]
Comment;
I don`t see scarlet fever becoming a pandemic. Epidemic in NK, now that could happen. Says a lot about the level of medical care available in NK.
From the US State Department website:
New Research Center To Combat Animal Diseases Affecting People
Animal-based microbes cause 75 percent of new human disease, veterinarian says
Washington — Avian influenza, HIV/AIDS, ebola hemorrhagic fever, West Nile fever. In recent years these diseases have caused immeasurable misery and alarm in the international health community.
They also share a common origin. They are zoonoses — diseases caused by pathogens that have moved from animal populations to humans.
“If you look at the significant epidemics over the last 20 to 25 years, there’s certainly a preponderance of animal disease going to people,” said Dr. Lonnie King, acting director of the National Center for Zoonotic, Vector-Borne and Enteric Diseases (diseases caused by microorganisms in the intestines), a newly organized unit at the U.S. Centers for Disease Control and Prevention (CDC).
King, a veterinarian and the former head of the Animal and Plant Health Inspection Service of the U.S. Department of Agriculture, says microorganisms of the animal world cause fully 75 percent of newly emerging infectious diseases.
Diseases have been transmitted from animals to humans for thousands of years, but the pace of the pathogenic exchange is accelerating because of sheer numbers — the size of human populations and the number of animals raised to feed them.
“There are 6 billion people in the world, and last year there were 21 billion food animals produced to help support that population,” said King in a Washington File interview from his office at CDC’s Atlanta headquarters. “The microbes are adapting, and they have more opportunities to adapt as the hosts change.”
NEW SUSCEPTIBILITIES
A 2003 report from the Institute of Medicine of the National Academies of Science identified 13 individual factors accounting for new or enhanced microbial threats. Human influences — such as poor nutrition, land-use patterns, poverty and war — dominated the list over factors arising from nature.
Globalization is also a significant factor in the transmission of disease. As money, products and humans travel about the world, King said, disease-causing microbes go along for the ride, providing more opportunities for transmission to new populations.
“People can travel around the world faster than the incubation period for any of these single diseases,” King said. “So we now have new susceptibilities like we found in SARS [severe acute respiratory syndrome] for a local outbreak to become an international incident in a matter of a few hours or a few days.”
The 2003 SARS outbreak has become the benchmark incident demonstrating the capacity of disease to travel. The disease emerged from China as a sometimes-fatal respiratory condition with an unknown cause.
Several Asian nations most dramatically were affected by the outbreak, but SARS appeared ultimately in 29 countries. More than 8,400 people took ill with the flu-like disease; nearly 1,000 died.
A coronavirus related to the common cold was identified as the cause of the serious respiratory distress the pathogen induced. Some evidence indicated that the Asian civet cat was a source of the virus, but the new microbe’s reservoir in nature remains unknown.
GLOBAL MISSION
Recognition that zoonotic diseases, or zoonoses, are a globalized phenomenon is inherent in the mission, “tomaximize public health and safety nationally and internationally through the prevention and control of disease, disability and death caused by zoonotics,” according to the mission statement of the new center, which still is pending official status.
Achieving that goal will require a change of thinking in the health profession. Historically, there has been little dialogue between practitioners of animal and human health, based on the belief that the two groups were in different fields and had little to discuss.
Although awareness of the connection between diseases affecting humans and animals is growing, King said recognition must evolve into a broad strategy to better control disease in livestock populations, which provide the greatest opportunity for pathogens to make their leap from one species to another.
“It makes sense to reduce the viral load in animal populations and reduce the potential spread in animal populations,” King said, “and if we do that, it is also a good public health strategy.”
It is a simple strategy in theory, but a daunting undertaking to spread that message to all the places where livestock is raised – from the largest industrial-scale poultry producers to families raising small flocks in rural villages of the developing world.
Examination finds no avian flu in Azerbaijan (link http://tinyurl.com/y8lw28)
Research of abnormal tissues performed during investigating reasons of poultry death in Tezekend village of Jalalabad region of Azerbaijan has been completed, REGNUM was informed at Azerbaijan’s state veterinary service press office. Carriers of coccus and coli-infection were found in the samples during comprehensive examination conducted at the republican veterinary laboratory. The diseases have nothing in common with bird flu or Newcastle disease; also, they do not pose a serious threat to humans. Local veterinaries disinfected local peasant homesteads and gave necessary instruction to residents, Azerbaijani SVS informs.
It is reported that veterinary control at border checkpoints is on the alert, and regional veterinary institutions have enough disinfectants. The ban imposed on imports of poultry and poultry-related products from countries where the bird flu has been registered remains in force, as well as catch of migrating birds.
Iran Successful in Combating Avian Flu (link http://tinyurl.com/yxce2b)
TEHRAN, Nov. 15--World Health Organization (WHO) and UN Food and Agriculture Organization (FAO) have confirmed Iran’s success in preventing bird flu in the country, ISNA quoted the head of State Veterinary Organization as saying here Wednesday.
Addressing the First Meeting of ECO Veterinary Heads, Hossein Hassani added that in the year after avian flu virus was confirmed in migratory birds of Anzali wetland in Gilan province, Iran undertook effective measures in the affected regions and even the areas bordering the countries where the bird flu was detected and was successful in preventing the spread of virus to other parts of the country.
The official said that Iran performed all the guidelines approved at the first meeting of veterinary experts from Economic Cooperation Organization (ECO) member states in Tehran; for example a preliminary workshop attended by international experts was held on October 30.
“Given that the flu virus poses serious threats to humans and livestock, ECO members should create a regional inspection networks to check animal diseases and diagnose the risky diseases and prevent their spread,“ he added. ECO members have high potentials for livestock trades, so he said that they can undertake special health and quarantine plans to minimize the spread of animal-borne diseases. He expressed Iran’s readiness to establish standard laboratories for the mentioned tasks.
Nimbus – at 14:23
To obey fair use laws, can you please post only a couple relevant paragraphs followed by a link?
Thanks. ; - )
Govt. sites ARE fair use and have no copyright restrictions. we the public own the material.
To follow up on banshee’s report (at 13:24), here’s the abstract from Nature:
H5N1 influenza A viruses have spread to numerous countries in Asia, Europe and Africa, infecting not only large numbers of poultry, but also an increasing number of humans, often with lethal effects1, 2. Human and avian influenza A viruses differ in their recognition of host cell receptors: the former preferentially recognize receptors with saccharides terminating in sialic acid-alpha2,6-galactose (SAalpha2,6Gal), whereas the latter prefer those ending in SAalpha2,3Gal (refs 3–6). A conversion from SAalpha2,3Gal to SAalpha2,6Gal recognition is thought to be one of the changes that must occur before avian influenza viruses can replicate efficiently in humans and acquire the potential to cause a pandemic. By identifying mutations in the receptor-binding haemagglutinin (HA) molecule that would enable avian H5N1 viruses to recognize human-type host cell receptors, it may be possible to predict (and thus to increase preparedness for) the emergence of pandemic viruses. Here we show that some H5N1 viruses isolated from humans can bind to both human and avian receptors, in contrast to those isolated from chickens and ducks, which recognize the avian receptors exclusively. Mutations at positions 182 and 192 independently convert the HAs of H5N1 viruses known to recognize the avian receptor to ones that recognize the human receptor. Analysis of the crystal structure of the HA from an H5N1 virus used in our genetic experiments shows that the locations of these amino acids in the HA molecule are compatible with an effect on receptor binding. The amino acid changes that we identify might serve as molecular markers for assessing the pandemic potential of H5N1 field isolates.
Yamada S et al. Haemagglutinin mutations responsible for the binding of H5N1 influenza A viruses to human-type receptors. Nature 444, 378–382 (16 November 2006).
on the Nature article above:
“…..”The bottomline is that the changes (on the two spots) can be used as molecular markers to identify the potential of the viruses that may grow well in humans,” said Yoshihiro Kawaoka of the Institute of Medical Science at the University of Tokyo.
‘Using 21 samples of the H5N1 virus taken from human victims in Indonesia and Vietnam, the team of scientists found that three of them bound especially easily to human receptors.…. “
Niman’s post for today is that H5N1 Acquisition Matches Influenza B Receptor Binding Domain
stating in part “….The H5N1 HA sequence of the recent fatal infection in Egypt was released …. The acquisition of the mammalian polymorphism, M230I, produced a match with the sequence adjacent to the human receptor binding domain of influenza A (H3N2 and H1N1) and influenza B. The change creates identity between positions 226–230 (QSGRI) in the ‘receptor binding domain of influenza B’.
That is interesting in light of the type B flu that hit NC. Does anyone here have the sequences of the type B flu that hit NC schools?
No wonder they are pushing flu shots this year.
DennisC at 17:12 and 17:32 - I found both of those postings disturbing. The virus is getting much closer to spreading h2h than I would like it to be.
Well it that B influenza that hit NC then it is good news, as not many are in hospital or dying. I don’t think that is the one.
Comment:
Sniffles – at 17:51
If the Egypt and Turkey versions of H5N1 obtain the same “receptors” as influenza B and have a fair polymerase activity a cooler temp (as Niman conjectures), then it is far from the best case. If it gets so it can spread like type B did in the NC schools and still have a CFR of 50–60%….. then we will have big problems. I keep thinking that something will happen that will move H5N1 from that path. But it keeps doing things that I fear the most.
I feel an order to Honeyville may be in my near future.
I think this is related (actually probably same article but phrased differently) to Nimbus-13:24:
Bird flu mutations may offer early warning of pandemic Last Updated: Wednesday, November 15, 2006 | 4:54 PM ET CBC News
Japanese scientists have discovered two genetic mutations in a deadly strain of bird flu that may help assess its potential for causing a pandemic.
The H5N1 strain — which has led to the cull of millions of birds and the deaths of more than 100 people since 2003 — has surface proteins that allow it to easily infect birds but not humans. However, experts have been afraid it will gain the ability to spread easily among humans, leading to millions of deaths worldwide.
Yoshihiro Kawaoka of the Institute of Medical Science at the University of Tokyo and his team studied 21 samples of the H5N1 strain taken from people in Vietnam and Thailand who died from it.
The scientists were looking for changes that appeared to be important for infecting humans.
They think they’ve found them — two spots in a protein called hemogluttinin that the virus uses to bind to receptors in the respiratory tracts of its hosts.
In contrast, the samples of H5N1 taken from infected chickens and ducks could only recognize receptors in birds.
“The amino acid changes that we identify might serve as molecular markers for assessing the pandemic potential of H5N1” samples collected in the field, the team wrote in Thursday’s issue of the journal Nature.
The mutations do not allow H5N1 to easily recognize the surface of human cells, but are key steps in the process, Kawaoka said.
However, the researchers also noted that a pandemic could also stem from mutations in proteins other than hemogluttinin.
The research was supported by the Japan Science and Technology Agency; the Japan Ministry of Education, Culture, Sports, Science and Technology; the Japan Ministry of Health Labor and Welfare; and the U.S. National Institutes of Health.
I don’t understand how this provides a ‘heads-up.’ Isn’t it more likely that as soon as this mutates in the way they suggest needed for easier H2H, they probably won’t know it until it has already rapidly spread, likely around the world before the DNA results come back? And so what if they happened to somehow isolate the case? “Oh, sure glad we caught it, after our careful analysis it looks like it could have gone pandemic!” Well that’s great, thanks. I don’t mean to be a sourpuss, but I don’t understand how this is significant in fighting H5N1 as the title of the article suggests.
But I’m actually wondering is there something useful about this? Can they now perhaps tweak the gene in a lab and make a vaccine in advance, or do they have to wait and see if in real-life the virus mutates this way, or in some other way that they can’t define yet. They say in the article that the two mutations they see could spark the pandemic are not the only ways it could mutate and go H2H. They just don’t have them defined yet.
To me it seems like kind of useless (reporting of???) research.
My commentary of the above article I just posted:
I don’t understand how this provides a ‘heads-up.’ Isn’t it more likely that as soon as this mutates in the way they suggest needed for easier H2H, they probably won’t know it until it has already rapidly spread, likely around the world before the DNA results come back? And so what if they happened to somehow isolate the case? “Oh, sure glad we caught it, after our careful analysis it looks like it could have gone pandemic!” Well that’s great, thanks. I don’t mean to be a sourpuss, but I don’t understand how this is significant in fighting H5N1 as the title of the article suggests.
But I’m actually wondering is there something useful about this? Can they now perhaps tweak the gene in a lab and make a vaccine in advance, or do they have to wait and see if in real-life the virus mutates this way, or in some other way that they can’t define yet. They say in the article that the two mutations they see could spark the pandemic are not the only ways it could mutate and go H2H. They just don’t have them defined yet.
To me it seems like kind of useless (reporting of???) research.
DennisC—
Do you remember the story from a couple of weeks ago about the mystery woman who was found sick on a bus station bench? She died a couple of days later in the local hospital. I remember it being in Baltimore or something—she identified herself by an odd name (I cannot remember what), and she had apparently either recently been to Egypt, or she was from Egypt. At the time, NC was just breaking out and they were closing the schools. Just for fun, I looked up how far it was from Yancey County—about 2 or 3 hours by car on interstates is what I got.
This discussion probably belongs on the Rumor or Seasonal cases in NC thread, but I found you here, so, here I post…
Can any of the medical pros lurking on fluwikie comment about the article and commentary posted at 18:22–23?
Thanks
mcjohnston92 – at 18:26 Yes,
Back to News: news report about the same Nature article,
Two Threatening Bird Flu Mutations
Either of two simple bird flu virus mutations could trigger a deadly pandemic, Japanese scientists warn. Both mutations already have popped up in humans infected with the H5N1 bird fluflu virus. They’ve been seen in bird flu viruses isolated from two people in Azerbaijan and from one person in Iraq, according to the Japanese scientists. Neither mutation has been seen among the more than 600 H5N1 viruses isolated from birds….
Fortunately, the H5N1 viruses carrying these mutations do not appear to have caused any outbreaks of human-to-human transmission….They found that either of two mutations — single amino-acid changes at specific places in the viral DNA — did the trick….
Comment: remember that the Iraq case where the uncle that got sick in the ambulance ride. - Just 15 minutes or so of exposure. If I remember correctly.
Comment: I was looking for an update on the 20 people being tested in Indonesia in connection with Amirul and came across this article. I thought it was important enough to put here too.
16/11/2006 WHO and PKP
KARAWANG, (GM). - the Health Body of the World (WHO) with the Livestock Breeding Service, Marine, and fisheries (PKP) Kab. Karawang, still was continuing to carry out investigation from the source of the virus avian influenza (AI) that spread to Amirul Afrianto. According to the Head of the Field of Livestock Breeding of the Livestock Breeding Service, fisheries, and Marine Kab. Karawang, Tuti Sri Pujiastuti when being found “GM” in his office, on Wednesday (15/11), beforehand the official did not find the existence of the case of bird flu to the poultry in the Village Cikampek the City. Moreover, around casualties’s residence also did not have the poultry farm that it was suspected will become the source spread him this virus. “All of us surprised and felt robbed because suddenly had the patient suspect bird flu to humankind, in fact beforehand was not found by the existence of the AI case to the poultry in this location,” said Tuti. He mentioned, his side was with WHO carrying out investigation from the source of the virus that attacked Amirul until dying, especially against the poultry that property of the citizen of the Village Krajan the Adolescent, the Village Cikampek the City, Kec. Cikampek that was the environment of the residence of bird flu casualties. Other efforts that was carried out by the PKP Service to prevent the occurrence of the spread of the AI virus around parents’s residence Oboy, being carried out by the vaccination towards various poultry kinds belonging to the citizen who was done from the house to the house including the chicken, the duck, the dove and chirping birds that was maintained by the citizen that was in a radius of one kilometre. Moreover also was accompanied with spraying disinfektan around this location, especially in the chicken coop, the poultry, and the chirping birds pen.
mcjohnston92 – at 18:26
here it is:
http://wtopnews.com/?nid=25&sid=963567
ROCKVILLE, Md. — An unidentified woman found last month at a Metro station has died, and Montgomery County Police are asking for the public’s help in identifying her.
The woman died Thursday and was found unconscious and suffering from a life-threatening illness two weeks ago at the Shady Grove metro station, police say.
She remained hospitalized until her death, but did not allow doctors to treat her and showed signs of mental illness, police say.
Police say the woman suffered from amnesia and referred to herself as “Happy Richard” and had recently arrived from Egypt.
Anyone with information should call the Montgomery County Police’s non-emergency number at 301–279–8000.
Influentia2 – at 21:14 I thought that the initial report of testing of 20 contacts illuminating. This article further indicates that they are , perhaps, (and with WHO guidance?) coming to grips with what niman has been saying for some time - the sequences do not match. Humans are not catching H5N1 from birds. Thanks for the update. Definitely important enough.
Wolf 21:35
Comment - I will post the info on the Indonesian Outbreak thread and here too if it warrants. I was thinking the same about the birds and I can see a small child playing with a cat (or a kitten) too, even though cats are not thought of the same there, but only time will tell. It may be several days before we can find out more if at all now.
Pixie – at 02:01 ( On Indonesian thread)
Waaay ahead of me, I see :) (darn day jobs!!!!)
Influentia2 – at 21:44
Yes, we know cats (strangely for influenza) are susceptible (Jerimenko(sp) made a point of that). However at this stage my thoughts linger with disgruntled’s “2 footed, 2 stroke” analysis. Both (and more) could certainly be in play today.
A sobering thought-it has been documented that H5N1 can cause meningitis/brain abcesses-either of which can cause mental status changes. It is easy to see how an human who could be ill with H5N1 in a panflu could be mistaken for having any number of respiratory infections and thought to be mentally ill, but have the potential to be a ‘super-spreader’.
look at the increase in CDC’s flu cases
this is the CDC’s weekly flu charts for the nation. http://tinyurl.com/vtg2q a preview for those that don’t want to go directly to an unknow link http://preview.tinyurl.com/vtg2q
Notice the first graph. The numbers of cases this last week has jumped from around 45 to around 80. Notice especially the numbers of unknow type A cases. Notice that the number of “unknown” type A has doubled during the week of Nov 4. (Hint, H5N1 is one of a number of a type A flus)
Week A(H1N1) & A(H1N2) A(H3N2) A(Unk) B Total # Tested % Positive
40 13 2 18 12 1720 2.6
41 16 1 24 6 1770 2.7
42 8 2 27 12 1984 2.5
43 7 0 36 8 1720 3.0
44 5 1 58 20 1743 4.8
Week 44 is the week of Nov 4. Yes it includes those NC cases that week. But notice they are type B and not unknow type A.
data here: http://tinyurl.com/w7e5e http://preview.tinyurl.com/w7e5e
I don’t think you can look at China’s continuingt lack of candour with Bird Flu and be surprized by the following story. But then, they are not alone.
Globe and Mail Update
7:52 PM EST ON 15/11/06
BEIJING —” A federal cabinet minister has pushed ahead with a critique of China’s human rights record, despite suggestions that Beijing’s resentment of such criticism led to a diplomatic snub of Prime Minister Stephen Harper this week.
Gary Lunn, the natural resources minister, said he raised human rights issues with senior Chinese officials when he met them in Beijing this week. He also raised his government’s concerns about Huseyin Celil, a Canadian citizen who is being held in a Chinese prison. China has prevented Canadian diplomats from gaining access to Mr. Celil, who has been jailed in an unknown location on allegations that he is a Muslim terrorist, despite international treaties that require it to give access to diplomats from the home country of any imprisoned foreigner.
Mr. Harper had planned to raise the Celil case in a meeting with Chinese President Hu Jintao during the APEC summit in Hanoi this week, but China told Canada this week that it has rejected the meeting.”
Yes, comments on the Nature paper, link Haemagglutinin mutations responsible for the binding of H5N1 influenza A viruses to human-type receptors
This is a similar study to the paper published last year by Stevens et al, discussed on this thread, which also contains various bits of dummies guide to receptor binding. :-)
Essentially, what both these groups of authors did, was to use a technique that measures what kind of receptors that the haemagglutinin from a particular virus binds to. Generally, we would say that avian viruses tend to bind to alpha 2,3-linked receptors, while human viruses bind to 2,6 receptors.
What this present study used, was a whole bunch of HA from different H5N1 isolates. However, what may be controversial (and I emphasize the word may, since I’m still uncertain whether I’m right), is that 2 out of the 3 HA’s that showed some preference to 2,6 binding, (VN/3028IIcl3, and VN/30408cl7) were from human samples that showed a mixture of different HA’s, and these different HA’s were extracted by cloning in MDCK cells.
I wonder if someone can tell me whether cloning in MDCK cultures before sequence analysis would make the results unreliable.
Anyway, let’s just assume they are reliable for the moment. They then analysed the HA’s and compared them to VN1194, a human isolate previously sequenced and known to be exactly the same as an avian sequence. This gave them a number of different mutations. They then introduced these mutations into the reference HA VN1194, to see if any of these mutations would change its receptor binding preference from 2,3 to 2,6.
For VN/3028IIcl3, the mutations were Q192R and S223N. Introduction of Q192R alone, but not S223N alone, to VN1194 increased binding to 2,6 receptors, while introduction of both increased that binding even further.
For Thai/KAN, the changes were G139R and N182K. Introduction of either one into VN1194 increased 2,6 receptor binding, and an additional increase in binding was shown when both mutations were present.
For VN/30408cl7, the mutations were E75K,S123P,N193K,R167K(HA2). While N193K enhanced binding slightly, none of the others had any effect when introduced alone. Introduction of 2 of these produced varying degrees of increased binding, and 3 mutations enhanced that even further.
So what does this mean? Probaby that there are multiple ways to achieve receptor binding change, and that sometimes, but not always, these effects are additive. Beyond that, we are not very sure. Remember these are all in vitro assays, so far there hasn’t been any good animal model that we can use for receptor binding studies of this type. This means we do not know whether these laboratory tests actually co-relate with increased transmission or virulence.
They do, however, give us a sense of some of the molecular requirements that may be important for host switching. Whether these requirements are sufficient is something that we don’t know about.
Secondly, according to Taubenberger in last week’s videocast, Great Teachers - Influenza: Past Pandemics and Future Threats, it isn’t enough that we discover whether the virus binds to 2,3 or 2,6-linked terminal dissacharides (the sugars at the end of the receptor molecule) but that it appears that the internal sugar structure is also important. That is, 2 viruses that both bind to 2,6-linked terminals may nevertheless be binding to different receptors with different internal sugars. These different types of 2,6 receptors may have different distribution along the respiratory tract, so that these individual binding specificities may have additional significance beyond just whether the virus binds to ‘avian’ 2,3 or ‘human’ 2,6 receptors. He suggested as something to consider whether such receptor distribution might change with age. We may also speculate whether that could account for differences in severity of illness, for example.
I put the words ‘avian’ and ‘human’ in quotes because Taubenberger also says that both these types of receptors can be found in varying degrees in the epithelial cells of all species.
Now, I’m not saying these changes are not significant. Certainly the fact that some of them have been found in patients in Azerbaijan (2) and Iraq (1) is cause for concern.
However, given that this paper and the 2005 one together gave a number of different mutations that appear to affect the binding affinity, one might think that what this shows it that there are multiple ways for the virus to achieve that kind of affinity. Beyond that, I don’t knkow if we can say to any degree of accuracy what each individual mutation means with regards to pandemic potential.
The authors of the current study suggests in the last sentence “Thus, such residues might provide useful molecular markers in assessments of H5N1 field isolates for their capacity to replicate in humans—an essential indicator of pandemic potential.” One of the authors, Suzuki, presented some of this data in June in Paris, and he was advocating the use of glycan assay as screening test for pandemic potential of the virus.
Personally, I don’t know that we have enough information to know what exactly we are screening for. I think they should do a lot more of these studies, to delineate all the different mutations etc, and study the significance a lot more. Rushing into using this as screening aka something that you are going to depend on to make important decisions, maybe, is IMHO a little premature, and may lead us to false sense of security if these ‘tests’ are negative.
But then I could be wrong. Any input from someone with more knowledge or info is welcome.
Well, that was way too long for a news thread. Should have put it into another thread.
Went down the tunnel once I started writing. Its 4am. Which means it only took 4 hours, to read, think, look up stuff, and write. Not bad. :-)
I should go to bed.
johnO – at 18:35
“Can any of the medical pros lurking on fluwikie comment about the article and commentary posted at 18:22–23? Thanks”
johnO – at 18:22
Bird flu mutations may offer early warning of pandemic Last Updated: Wednesday, November 15, 2006 3
johnO – at 18:22
To me it seems like kind of useless (reporting of???) research.
I look at the risk reward ratio. If spending a few million dollars can help save hundreds of millions of lives, why not? What have we got to lose?
The commentary on the Nature paper has also been posted to the H5N1 receptor binding thread. Please post comments over there. Thanks.
November 16, 2006 at 08:28 AM
“Medan (SIB) the Child OS (6) the Medan inhabitants the patient suspect bird flu that was treated in RSUP H Adam the Medan Owner, died, on Wednesday (15/11) dawns.The last condition around died, his sign it was suspected was similar to bird flu like the fever, coughs, breathless and always experienced the bleeding. However the assurance whether positive casualties bird flu or still was not waiting for results of the sample of his blood that was sent to Jakarta to be researched.
Information was received, before being brought came home, the OS body was first wrapped by using the plastic material. That was done in order to anticipates the possibility of spreading him the illness that was suffered by casualties. OS was the reconciliation patient from one of the private hospitals in Medan.
Already his two weeks experienced the fever and coughs.A week before him was feverish, the chicken piaraan they died suddenly. The situation made the family and the place hospital beforehand he was treated reconciled him to RSUP HAM. he was placed in space of this illness patient of the place Isolation was treated. However at intervals of two OS days died. The head of the Room of the Longing of A RSUP human rights Dr Adlin that it was confirmed said, his side still could not confirm whether OS bird flu or not because still was waiting for results of the laboratory of Jakarta.
The patient Suspect the HIV More 3 In The Meantime it was reported, in a patient’s day was expected by the sufferer of the HIV illness/the AIDS improved 3 people in RSUP human rights, on Tuesday (14/11). The three of them the man aged 19,20,dan 23, the year, the Medan inhabitants.Suspected they were contaminated resulting from the free association and illegal drugs. Was not yet it was known certain whether the three people were positive the HIV/the AIDS because still in the diagnosis stage. Therefore had 11 patients who still were treated in A. Longing space.”
Published on Taipei Times
Thursday, Nov 16, 2006, Page 4
“No scientific evidence links the anti-viral drug Tamiflu with delirium and abnormal behavior, despite recent reports of alleged cases in Japan, said Lin Ting, deputy director-general of the Center for Disease Control. Lin said that while some flu patients might indeed display disturbed behavior after being treated with Tamiflu, the effects are likely the result of encephalitis associated with the influenza, not the treatment.
According to an AP report, 103 possible cases of psychiatric side-effects in Japan have prompted the US Food and Drug Administration to recommend the addition of a warning message on Tamiflu packaging.
“We keep a large stock of Tamiflu for use against influenza epidemics or a bird flu outbreak,” Lin said. “But we do not use it routinely to treat flu patients as they do in Japan.”
Klatu - 23:13
I certainly agree that spending a few million to save potentially hundreds of millions is well worth the money.
My problem is that either the research, or the author/reporter of the article, doesn’t make it clear how the research will actually help give a heads up. I feel like the details might be missing.
My comment was this:
“ Isn’t it more likely that as soon as this mutates in the way they suggest needed for easier H2H, they probably won’t know it until it has already rapidly spread, likely around the world before the DNA results come back? And so what if they happened to somehow isolate the case? “Oh, sure glad we caught it, after our careful analysis it looks like it could have gone pandemic!” Well that’s great, thanks. I don’t mean to be a sourpuss, but I don’t understand how this is significant in fighting H5N1 as the title of the article suggests.”
So I was hoping someone would chime in to fill in the details on how monitoring the change in the two genes could really provide advance warning. It seems like once they test someone and find that the sequence has changed, and they realize it’s H2H capable, it’s probably out of control by then. So what am I missing? How was the money spent on this research going to save several hundred million lives?