From Flu Wiki 2

Forum: Are Humans and Other Mammals the Source of Most H 5 N 1 Infections in Humans

17 May 2006

Monotreme – at 09:37

Are Humans and Other Mammals the Source of Most H5N1 Infections in Humans?

Although we have been conditioned to believe that birds are the source of most human infections of H5N1, what is the evidence that this is so? Certainly, many, many birds have been infected. It is also true that a close association between infected birds and some patients have been observed. For example, the owner of a prize fighting cock applied mouth-to-beak resuscitation when blood was impairing the bird’s ability to breathe.

However, in most cases, the association between human patients and infected birds is either absent or very tenuous - some birds in the village died, or the patient ate chicken a week ago, or the patient walked past a chicken on their way home from work.

It also interesting to note that poultry workers who would be expected to have the most exposure are rarely infected. Nor do they have antibodies to the virus.

Many of the human cases involve clusters. One person is infected, there is a delay consistent with H5N1’s incubation period, and then one or more additional people are infected. Which is more likely, first one person was infected by birds, then other family members, were infected by birds or that the first person infected others? Also, why do we expect that it’s easier to get infected from birds than other people? If the spread from birds is fecal-oral, isn’t that route of infection also possible from human to human, especially caregivers? There are many viruses that are spread human to human this way. Think Norovirus.

Other mammals are also possible vectors. Here is a list of the mammals that have been shown to be infected by H5N1. Perhaps human infections of H5N1 are rare because it is really, really hard to get it from birds. But perhaps, it’s not so hard to get it from mammals, but relatively few mammals have been infected thus far.

Cat H5N1 sequences in Indonesia are apparently more similar to H5N1 sequences from humans than either are to H5N1 sequences from birds. What is the most logical interpretation of these results? I submit that there may be a mammalian reservoir for H5N1 in Indonesia and other countries and that H5N1 is under selection to adapt to mammals in this reservoir. Further, at least some of the human cases may be due to mammal-to-human infections. (See also Dr. Jeremijenko’s post at 23:14 on the Suspected BF Clusters in Indonesia 6 thread)

I cannot prove any of the above. However, it has also not been proved that all H5N1 patients were infected by birds. The reader can decide which scenario is more likely.

Medical Maven – at 09:48

Monotreme: Noroviruses are notorious for cruise ship epidemics and for emptying schools at times. Could we have a first class threat from H5N1 if it just simply becomes more efficient via the oral/fecal route?

European – at 09:48

An article from Qinghai suggests that Bird flu caused by fish farms.

Over the past year, the spread of the flu has not been correlated with the migratory routes and seasons of wild birds. Indeed, some global studies have found that migratory birds are not the cause of the current wave of bird flu outbreaks stalking large parts of the world. Rather, outbreaks have been concentrated in the factory farms of China, South East Asia and elsewhere in the world. In India, the epicenter of outbreak of bird flu took place in 18 poultry farms in and around Navapur in Maharashtra. Since the Qinghai Lake outbreak last year, outbreaks in other parts of world have occurred along major transport routes. However increasing evidence suggests that commercial poultry and its products, not migratory bird populations, are the likely vectors of avian flu.

Fish farms and wild bird flu on Qinghai Lake At present, a new theory is gaining ground that the outbreak in wild birds near Qinghai Lake may be linked to fish farms around the lake. As early as 1998, scientists cautioned that human health hazards like an influenza pandemic could arise from the practice of bringing together fish farms with farm livestock. Some researchers say that bird flu may be spread by using chicken dung as feed in fish farms, a practice now routine in Asia.

According to Le Hoang Sang, deputy director of the Ho Chi Minh City’s Pasteur Institute, “Chicken excrement is one of the main carriers of the H5N1 virus, which can survive in a cool and wet environment for a month and slightly less if in water.” In January, a 9-year-old boy died from bird flu in the Mekong Delta province of Tra Vinh after he caught it while swimming in water in which the bodies of infected poultry had been thrown. BirdLife International, a global body for bird protection groups in more than 100 countries, is calling for an investigation into the possibility that the fish in these ponds, which are fed with chicken dung, may be the means by which the new strain of avian influenza, H5N1, is being spread. It says that outbreaks of H5N1 have occurred this year at locations in China, Romania and Croatia where there are fish farms.

European – at 13:08

bump

DemFromCTat 13:23

revere has an insightful post on epidemiology at Effect Measure.

One thing I’ve learned in many years as an epidemiologist is that disease outbreaks are rarely what they appear to be at first. Sometimes they are worse and sometimes they are better, but mostly they are different. I’ve spent a lot of years dealing with cancer clusters and I am a strong believer these clusters are real. But there is a school of thought that says they aren’t and there is a strong argument to make there. I disagree with them, for technical reasons. The one thing I know about clusters, though, is that it is important to verify all the initial information. A large proportion of the time the cancers in a cancer cluster aren’t even cancer, or they are a different kind of cancer than initially reported. Numerous other facts usually turn out to be different than originally thought .
Leo7 – at 13:37

This is an interesting thread. Maybe the vegans have been right all along. I wonder if parasitic infections, or exposure to toxic chemicals (lungs) play a role in dropping immunity allowing a springboard for a virus to breakout and thrive. I’m not sure, but they never discovered the true mammal source for 1918, did they?

Tom DVM – at 13:48

Hi European, Medical Maven and Monotreme.

This in a sense is a continuation of our discussion on Montreme’s previous thread.

First, H5N1 did not arise in wild birds. It entered China’s factory farms as a wild strain of low pathogenicity…in entering these farms, it entered the best culture medium for animal viruses…and became ‘weaponized’…the end result was a bird flu epidemic in Asia and the weaponized virus then re-entered wild bird populations.

In answering the question raised by European, the spread from 1997–2003 was due to factory farms and farming methods in China…wild birds had little to do with it. From 2003 to Q. lake in 2005, the spread was by factory farms and farming methods in Asia…wild birds had little to do with it. From 2005 (Q.lake) to present, there has probably been spread as a result of both factory farming and farming methods accentuated by the now spread in migratory birds…and it is being spread worldwide with amazing efficiency helped on both fronts at the same time.

H5N1’s behaviors at this time can be explained by Monotreme’s previous hypothesis. The jump between humans is much easier than that from bird to humans. Some mistake this for genetic susceptibility but genetics does not play a role in it…the spread is due to proximity.

I have always had a problem with this - contact with chickens story - because it is a convenient excuse to assist with other strategies…namely to downplay the risks and consequences…to explain away lack of real substancial action on the issue by the WHO and Governments…’it’s only a disease of birds’ ‘H5N1 will not produce a pandemic’ ‘fear mongering’ etc.

As I have said, just because I can connect every seasonal flu case in North America to contact with poultry…it does not make it true.

Although H5N1 is a completely different animal than H1N1, the history of the long lead up to the 1918 outbreak is clear in the history books…and mimics what we are seeing now with H5N1.

H5N1 is remarkably adaptive…more adaptive than any virus in human history that we know of.

It has done the unimaginable, it has made itself asymptomatic in migrating waterfowl and maintaining extreme lethality for domestic avian species.

And in answer to Montremes query, it has adapted to many mammalian species also in some cases asymptomatically.

The big question being raised now in Indonesia is what is it doing in pigs, is it causing disease of spreading asymptomatically. In the answer to this specific question is the answer to when the pandemic will begin…my conclusion being within 12 months.

Since H5N1 has a demonstrated ability to harbour in mammals then it follows that more and more human cases will come from mammalian species rather than birds…

…and my suggestion would be for them to stop trying to explain this disease away by using chicken contacts to explain away every human case.

Since Monotreme brought up the point about increased efficiency of H-H than B-H it has been interesting to see these clusters and distributions of cases in a ‘new light’.

maryrose – at 13:52

lood samples from all kinds of animals from chickens, ducks, geese, birds, pigs, cats and dogs turned out negative so far. Manure has also been checked. The result is negative,” the Jakarta-based official said.

In Indonesia, they’ve checked chickens, ducks, geese, birds, pigs, cats and dogs ….with negative results for H5N1. Are they checking any rodents?

Tom DVM – at 13:59

maryrose.

Your comment about rodents makes perfect sense…

…and particularly when considering Clark’s comments on the raising of doubt by some researches that at least some of the epidemics related to the Black Death may have been due to influenza instead.

johnnystop – at 14:25

Three weeks ago I was hospitalized with a massive Strep A infection. At first it was suspected Necrotizing Fasciitis but after immediate surgery it turned out to be more akin to toxic shock syndrome - I understand that I bordered on shock for a day or two before I came around. I spent 5 days in ICU and another three days in hospital before being released to home where I am presently recovering. That week in hospital - my wife, my 25 year old son, a close friend, her husband, and a 14 year old girl on a soccer team I coach - all came down with Strep throat - a cluster of 6! But after cultures came back - only two were actually positive for Strep. Me and the soccer player (who had far less contact with me than anyone else on the list) 1. Clusters aren’t always clusters. 2. When you are very sick - you are exceedingly helpless. 3. Multiply 1 very sick 55 year old guy being treated in a major university hospital by 5,000? 10,000? very sick flu patients. 4. In the end I really do not know how I became infected - I am healthy and active - hardly ever sick - wash my hands several time a day - 3 or 4 months of preps on hand - so how did this happen? Points to ponder.

johnnystop – at 14:32

Tom DVM - Have you encoutered any human positives without symtoms?

Tom DVM – at 15:01

Hi johnnystop.

Your comments pretty much describe the realities of the situation and put things completely in perspective, in a few short words. Thanks.

The short answer to your question is that there have been no asymptomatic H5N1 infections in humans despite a lot of looking and analysis.

The finding of widespread asymptomatic infections would, in a sense, let regulators and governments off the hook: that the actual mortality rate of H5N1 would be much lower than 50%. Presently, H5N1 has a mortality rate greater than Ebola.

Epidemiologists used survey questions to conclude there were asymptomatic cases while all known serology (blood samples) have turned up nothing.

There are two ways that you can look at these results. 1) the virus has not adapted very well to humans or 2) the virus geographically has expanded and has increased rather than decreased it’s mortality rate…and therefore remains the single greatest pathogenic threat to humanity observed in hundreds of years.

If hidden blood tests indicated widespread asymptomatic infecions, you can bet they would be released to decrease the overall threat level. The only way out for the WHO and Governments in respect to their relative inaction to the threat of H5N1, is if it adapts to become harmless or just goes away…it seems H5N1 doesn’t agree with them and is not going to go ‘quietly into the night’.

niman – at 15:15

The human sequence from Indonesia has a cleavge site of RESRRKKR, which appears to have also been found in a cat sequence in Indonesia. Since NO H5N1 at GenBank has this sequence, the match is a bit beyond “similar”.

European – at 15:21

Could the virus be carried by fleas? Not adapted to them, but carried from a host like a rat or bird.

Leo7 – at 15:24

Tom DVM:

For months I’ve enjoyed your posts, you have a unique insight as a vet which I wish I had. Thanks for the many eye-openers.

If you make the case for rats-then you mean flea bites as a possible vector? ( I wince as I type this). Flooding as you know really bring them out from hiding. What is your best guess estimate this may be the transmission mammal and mode?

In your opinion do you believe the antibiotics given at the farms exacerbate the chances of viral cesspools?

johnnystop – at 15:25

I seem to remember bird feathers being infectious. Fleas or lice.

Tom DVM – at 15:46

Leo7. Thanks for the kind comments. I do not think fleas would be a major carrier but who knows. There is no doubt that rats in particular live in close association to humans. If they are to be involved, it could be through a tertiary host such as cats eating sick rats and then cats transmitting the virus to humans or it could be through rat faeces. I don’t think they will be a major factor but who nows…no one would have considered a Civet Cat with SARS either.

Antibiotics treat bacteria and have no effect on viruses. Therefore, they would have no influence in the emergence of viruses. The development of massive factory farms in Asia in the last twenty-years provide all that is needed.

I have never agreed with the use of antibiotics as growth promotants etc. I do not think they did farmers any good, it was just a crutch they were talked into using by those who stood to profit. These antibiotics are extremely expensive and most often are only used as a last resort.

The medial profession likes to blame farmers for antibiotic resistant bacteria but the truth be told, the reason is not from excessive use but because humans stop their treatments before the end of the treatment period (stop the antibiotics in three days rather than 10 days) This is the reason for the development of antibiotic resistance, not the use on farms but it is easier to put the blame there.

There is now an additional argument that the widespread use of anti-bacterial disenfectants in the house is also contributing to bacterial resistance as well only this time to disenfectants.

Leo7 – at 16:05

Thanks Tom DVM. I had to look up a picture of a Civet cat years ago. If it turns out to be cats, I forsee a lot of weeping and wailing.

Tom DVM – at 16:07

Leo7. I think the risk from cats is overblown but I can’t prove it. You’ve got me beat…I have no idea what a Civet Cat looks like.

DemFromCTat 16:22
Tom DVM – at 16:30

DemFromCT.

What can I say…OK you got me!!!!!!!!!!!!!!

Thanks…interesting looking little critter.

slow reader – at 17:03

transmision between species can go both ways. During a human h5n1 pandemic many species of mammals could be infected by humans. We could easily pass this to pigs,dogs,cats,etc.

anonymous – at 17:48

johnnystop – at 15:25 I seem to remember bird feathers being infectious. Fleas or lice.

Here is an “antique” article about poultry mites from the California Poultry Letter 1979 I believe. I wonder if it would have any application to our thinking today on the transmission of H5N1. G.

DERMATITIS ON EGG RANCH EMPLOYEES (BELT COLLECTION) During May we were called to observe a problem with poultry ranch workers in a high-rise triple deck laying unit. Their complaint was that they had severe itching when they worked in the high rise unit, but not when they worked in the conventional housing on the ranch. All workers were not affected, and some were severely infested. The workers were interviewed and one woman who worked in the egg collection room had been to a doctor for examination. The doctor told her that it appeared that a bug of some sort had drilled a hole in her skin. The doctor gave her Kwell@, which she stated was for crabs and had stopped the itching. The most severely affected worker had many lesions on his arms, shoulders and ‘back. He had scratched the skin off the lesions on his arms and shoulders. On his back, where the lesions had not been scratched, there were white pustules. This worker complained of being “bitten” not only in the house, but also in the manure pit. It was recommended that this worker be sent to a doctor, and that scrapings be taken from the lesions for examination. At this time scabies or the human itch mite was suspected. The laying hens were checked for external parasites and found to have a light 2 infestation of Northern Fowl mites. Samples of feed and manure were collected. Microscopic examination revealed only Northern Fowl mites and manure mites. The following day, another visit was Made to the laying unit to collect more specimens. Northern Fowl mites were observed in many places in the day, probably because this was a warm house and optimum temperature for this mite is 86OF. Mites were observed on the edges of the rubber sponges that deescalate the eggs on to the main collection belt. One investigator placed his hand under the top cage on a dropping board for two minutes. His hand was examined and about 50 Northern Fowl mites were seen on each side of his hand. Five-inch-square areas on sheets of white p LB er were lightly coated with Vaselin and placed near egg belts, feeders, dropping boards and cages. The Northern Fowl mite was the on thing that appeared in the Vaselin & . The manure pit was examined and only fly predators were found - beetles and manure mites. The laying with Rabon R 8 use and birds were sprayed and one week later, no living mites could be found on the birds or in the house. The dermatologist who had examined the most severely affected worker reported that nothing was found in the lesion scrapings. This worker had given the dermatologist small insects that he suspected had been the cause of his itching. Upon microscopic examination, these insects were identified as thrips, which have chewing mouth parts and feed on green vegetation. The doctor had prescribed two kinds of medicine for this worker, and one week later his lesions were healing nicely. Another ranch worker who was also subject to severe itching after working in this unit, also itched after spraying the unit. He -observed that only once he did not itch severely when spraying and that was when he had worn a raincoat and rain hat. The dermatologist sent a copy of a paper, “Avian Mite Dermatitis” from the May 1979 issue of Cutis magazine to the investigators. This paper was written by Martin Braun III, M.D., who described a case of avian mite dermatitis and stated that this was the first he had ever seen. Dr. Andy Deal, Assistant Director of Cooperative Extension, said that this problem had occurred in southern California years ago. No mite was ever found on the affected empolyees, however, Braun pointed out that the Northern Fowl mite cannot be demonstrated on the human host, as it quickly drops off after its bloodmeal. Fred Price, Poultr Farm Advisor Stanislaus-Merced- H an Joaquin Counties

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anonymous – at 17:50

johnnystop - I just happened to be reading the article when you posted the question/comment!

johnnystop – at 18:30

anonymous - curious. I’ve plucked many a chicken in my back-to-the-farm mania 20 years ago - I think we incinerated the feathers or hauled them to the landfill. I remembered a news story a couple months ago about young girls testing positive for H5N1 in either China or Vietnam - possibly they were employed collecting feathers which seemed to be their pricipal contact with chickens or fowl.

anonymous – at 18:38

Yes! I found it so interesting that you asked the question as I was reading the article. I figured I should bring it up.

THis is the followup story that they in April 1981 AND CHECK OUT THE CAT ANGLE! It fits in curiously with this discussion. G.

April 1981

THE ITCHING PROBLEM AGAIN For a year and a half, we have been trying .to solve the itching problem of some people who work. with chickens. Last fall, Dr. Arthur Craigmill, Extension Toxicologist, looked at this problem and discussed it with several employees. He stated that he would check the literature when he returned to UCD. As a result of his search, he sent the following article: Cheyletiella Dermatitis in Humans A $-year-old woman and her 6-year-old daughter visited the dermatology clinic of the Yale University Health Service in January 1979 complaining of recurrent, intensely pruritic (itchy), grouped, red papules (pimple-like bumps > on the chest, abdomen, and thighs. A diagnosis of insect bites or pediculosis corporis (body lice) was considered. While microscopic examination of skin scrapings from the woman showed no evidence of mites, she was urged to have the household pets—a dog and cats —examined by a veterinarian. She ignored the suggestion until several bald spots developed on the dog’s rump. Dermatologic examinat,ion of the dog and cats confirmed the diagnosis of “walking dandruff” caused by the ectoparasite Cheyletiella sp. The owner recalled that the cats had had severe dandruff for several months. The pets were successfully treated with an organophosphate (4 dippings at l-week intervals with Paramite), after which signs and symptoms in the 2 patients Fred C. Price, April 1981 Editor Farm Advisor Stanislaus County also disappeared. (Ed. note. Paramite no longer on the market.) The prevalence of Cheyletiella in animals is unknown but the disease has been diagnosed, more frequently by veterinarians in the United States in the last several years. Associated cases in humans are not an uncommon finding. This is the third reported instance of human Cheyletiella dermatitis in North America and the first recorded in the Northeast. It is clinically indistinguishable from scabies (human itch mite), and it is likely that previously reported human cases have been misdiagnosed or gone unrecognized, as the disease has been heretofore relatively unknown by American physician dermatologists. - CDC Vet. Pub. Health Notes, 6/80 In all this time we have never found the “bug”. We placed sheets of paper covered with Vaseline throughout one lay unit. The Vaseline picked up Northern Fowl mites, manure mites, etc., but nothing that could be identified as causing the problem Dr. Ed Loomis, Extension Parasitologist, collected samples of dust from the unit and took it back to UCD to examine under the microscope. Nothing was found. We have examined fresh bites on the worker’s skin, but have never seen any sort ‘ of bug, and skin scra,pings were also negative. The same problem on a pullet ranch was diagnosed as being caused by a clover mite but none were ever found. The description of Cheyletiella dermatitis seems to fit the problem very precisely. Fred C. Price Farm Advisor

Ralph A. Ernst, Editor-in-Chief Ext. Poultry Specialist University of California, Davis

European – at 18:41

johnnystop – at 18:30

I believe the girl was from Aserbajan

niman – at 18:42

johnnystop,

The feathers were from wild birds in Azerbaijan (but the cluster was H2H - feathers were just an excuse and maybe the source of H5N1 in the index case)

johnnystop – at 18:43

Anon. Amazing stuff and coincidence - I started a new thread - insects as vectors.

Tom DVM – at 19:12

When we started out in 2003–2005, they talked about contact with poultry being direct contact with live birds. Now they are talking about manure and feathers etc. If this was the case then why are poultry farm workers who work in an environment where faeces can become airborne in dust particles not have high rates of infection (the answer can not be that they are immune because there has been no serology demonstrated in these workers). Secondly, there are probably also workers who slaughter chickens all day every day. Again, if the feathers carried live virus in sufficient quantity (viral load) to cause disease,this group of workers would have exposures far in excess of the general public…and children.

anonymous – at 19:12

johnnystop – at 18:43 Anon. Amazing stuff and coincidence - I started a new thread - insects as vectors.

Cool as coincidences go – eh!

niman – at 18:42 The feathers were from wild birds in Azerbaijan (but the cluster was H2H - feathers were just an excuse and maybe the source of H5N1 in the index case)

That is informative - as was the comment regarding the 17-day incubation rate they cited.

G.

The feathers were from wild birds in Azerbaijan (but the cluster was H2H - feathers were just an excuse and maybe the source of H5N1 in the index case)

Melanie – at 19:20

Dem,

Where did you find the civit photo? They’re cute!

johnnystop – at 19:28

Tom DVM - are the workers day after day slaughtering infected chickens? Are infected chickens pretty much caput and need less slaughtering? Or culled with caution? Could dead deseased chickens be valuable to some for their feathers?

De jure – at 19:28

Melanie, um, I believe in China, they call them “food”.

anon_22 – at 19:58

This post is not addressed to or about any person in particular, but some thoughts that I feel ought to be interjected into this and probably a couple of other threads currently open.

I have been watching a trend in this forum for some weeks, and I am wondering out loud about several things:

1) Is it ever possible to discuss science without jumping from speculations into conclusions about unsavoury motivations (or conspiracy theories), or has fluwikie become that sort of platform?

2) The virology of influenza is one of the biggest puzzles of science, and despite intense study, particularly in the past few years, many prominent flu scientists are now saying that they know a lot less than they thought. What makes us think that just pulling ideas out of thin air here on the wikie gives us enough reasons to conclude that cover up’s and stuff has happened? Now I’m not saying that they haven’t, but it is just that jumping to premature conclusions stops us from engaging with the issues in a more rigorous and critical manner.

3) Epidemiology is a discipline that requires an extreme ability to attend to the minutest details while operating with numerous uncertainties. In fact, uncertainties and missing and incorrect data are all part of a day’s work, and it is far more common for an individual investigation to end inconclusively than successfully. Now, people generally do not tolerate uncertainties well. I think that may explain some of the theorizing we see here.

4) Theorizing is fine if it exercises your brain and causes you to go look for wider possibilities, which makes you more knowledgeable over time. But theorizing to gain closure, to arrive at premature and not well thought out conclusions does not serve us well, especially if some folks then mistake these as established science and make decisions based on them.

5) Finding a scapegoat is often the shortest route to short-term intellectual triumph (and therefore comfort). I have a feeling that the WHO has become the catch-all villain for all our uncertainties and disappointments, and that does not bode well for seekers of truth.

Truth and humility and saying “I don’t know” may be harder but probably more fruitful in the long run.

Tom DVM – at 19:59

johnnystop. I guess the point is that if faeces and feathers are significant vectors for the virus, then we would expect workers who have the most contact with them (exposure) to demonstrate an increased frequency of disease and this is not the case.

johnnystop – at 20:09

Tom DVM - I’m just posing questions of rodents, ducks, fleas, lice, feathers, faeces, as a source of or transmission of infection. Maybe it’s undercooked chicken - but are you comforatable with that?

DemFromCTat 20:15

anon_22, hear hear!!

anonymous – at 20:25

can anyone tell me if other flu viruses are capable of infecting such a wide range of birds and mammals that is linked on monotremes post? Did the 1918 flu affect animals

Tom DVM – at 20:34

johnnystop I am comfortable with any discussion that you may develop on any potential vector. Not only are there many potential vectors but there are probably several potential vector species of animals. There is always room for scientific debate and discussion.

Anon 22. There is a fine line between silence and appeasement. I guess I am going to need some direction on where that line is.

Nikolai---Sydney – at 20:37

Pardon me for being so dense, but I cannot pick up on the ‘conspiracy theory’ warning on this thread. I am not being confrontational—just genuinely curious at the failure of my brain—and a little anxious, too!

Would someone (gently?) point me in the direction?

DemFromCTat 20:45

Nikolai---Sydney – at 20:37

I don’t see a conspiracy theory on this thread; there are occasional “they’re covering it up’ comments on other threads, but only occcasional. We do relatively well, I suppose, on that score.

But I think more to the point is to recognize the uncertainty and complexity of this H5N1 situation. That means that, e.g., if WHO doesn’t instantly recognize what’s going on, it could be less from incompetence and lying and more from the difficulties in putting the picture together.

And whereas we may put some interesting theories on the table, it doesn’t become Truth just because it’s put up on the internet, even if the site is Flu Wiki.

I am humbled by the posters and their wisdom, but “I don’t know’ is still often the most accurate answer.

To me, anon_22′s post is a reminder of that.

Racter – at 20:51

I agree with Dem: anon_22 has hit it right on the head.

Tom DVM – at 20:54

DemFromCt. When the WHO, CDC and the Governments they represent demonstrate any level of respect for the basic principles of science and the same time are honest with friends and family and community and country…then I will give them the respect they deserve.

Until then I have no intention of being silent because there are many times in history when silence equaled appeasement.

If the WHO, CDC and Governments want to stick their heads out of the hole they are hiding in, and debate these issues as has been done ever since plato…then they can come on flu wiki and debate with our band of merry gentlemen.

If I am accused of passing on conspiracy theories…so be it. Think for a moment of the consequences of their actions if they continue doing what they have been doing in the past nine years…silence is not an option.

niman – at 20:59

Comments on swine H5N1 and novel cleavage sites.

European – at 21:05

anon_22,

probably a deserved admonition to us in general. The cause is that we, the ordinary people ;-) , are not used to the normal restraint shown by scientifically trained people. We have problems with understanding the delay in announcing data that we more or less have or know anyway from other sources. We have problems with aparent “slowness” of the system. We would like correct data now, not next week.

Even if we do understand, we cannot really understand why they, the people with the information, cannot come out and say “We do not know” or “We do not understand” or “We do not have all the facts yet”. This issue is so important that we need that kind or level of honesty. They have to understand that it is better with some partial data than with no data. No data or information gives ground to unfound accusations and speculations.

Just MHO.

Nikolai---Sydney – at 21:11

Dr Niman — 20:59:

Thank you. Timely and very relevant to this thread. BTW, the use of red in the sequences is very helpful to we many interested but semi-literate readers!

Tom DVM – at 21:14

Read Dr. Niman at 20:59 and tell me again why these people deserve my respect: they certainly do not deserve the respected title…scientist.

anon_22 – at 21:22

Tom, I am advocating neither silence nor appeasement. I am talking about critically examining ones arguments to find out if there are places where inferences and conclusions might be too hasty. Just to use your post at 13:48 as an example (although I must stress that this is not directed towards you in person but more as an example of a common habit that I am seeing recently, so apologies for picking on you :-)

Also this might answer Nicholai’s question:

1) “First, H5N1 did not arise in wild birds.” First H5N1 did arise in wild birds, although this sentence might just be a abridged way of speaking.

2) “the spread from 1997¨C2003 was due to factory farms and farming methods in China¡­wild birds had little to do with it” What exactly do you mean when you say ‘factory farming’? If you are talking about large scale battery style farms, well, H5N1 did not arise in those, but in small backyard family farms. In addition, 1997–2003 was an almost silent period as far as evidence of what happened with H5N1 go. We simply do not have very good data or ideas about what happened. Yes, there were pockets of disease, maybe, but not enough to draw any conclusions about what factors were important in this period to drive the virus. There are some hypothesis, such as the role of domesticated water fowl that were ‘shepherded’ rather than fed, but no clear pathway exists in our understanding.

3) “H5N1¡äs behaviors at this time can be explained by Monotreme¡¯s previous hypothesis. The jump between humans is much easier than that from bird to humans.” Monotreme has his hypothesis, and at least he calls it a hypothesis. But, pardon me, what basis do you have for that categorical statement “some mistake this for genetic susceptibility but genetics does not play a role in it¡­the spread is due to proximity.” Surely it is at least possible that genetic susceptibility AND proximity might be both important? Notice I use the phrase ‘might be’ and not ‘are’. The problem is more than semantics, because the way we structure our language also shapes our thinking; the relationship between language and thought is interactive and they feed on and reinforce each other.

4) “ I have always had a problem with this - contact with chickens story - because it is a convenient excuse to assist with other strategies¡­namely to downplay the risks and consequences¡­to explain away lack of real substancial action on the issue by the WHO and Governments¡­¡¯it¡¯s only a disease of birds¡¯ ¡®H5N1 will not produce a pandemic¡¯ ¡®fear mongering¡¯ etc.”

So having established those thoughts as logic and therefore dismissed the ‘contact with chickens story’, it is just one short slip on that slippery slope to assert the existence of those seemingly co-ordinated strategies that you listed.

5) I agree that there is far too much downplaying of the problems, using the phrases that you quoted. I agree because we hear these phrases and they do not actually describe the threat accurately. But to connect the two ends, namely the ‘chicken excuse’ and these quoted remarks as belonging to the same category of attempts to explain away the lack of substantial action of the WHO (and BTW without identifying who it was who was supposed to have come up with such connected strategies and successfully disseminated them) is the leap that in my mind we have to be very careful about.

Just because something is PLAUSIBLE doesn’t mean that it IS. Just because two events might appear to have similar outcomes (although I question that even) does not mean that they were co-ordinated strategies which by implication mean attempts at cover up and (Nicholai take note) conspiracies.

Let me repeat that this is NOT directed towards you Tom, but just your post gave me a convenient example to illustrate the hazards. It is only an example of a trend that is beginning to worry me, cos that path is likely to lead us further and further away from the truth.

This does not serve us well.

anonymous – at 21:26

· Litter Beetles (Darkling Beetles) · Ectoparasites · Poultry Lice · Poultry Mites · Bedbugs · Other Insect and Mite Pests of Poultry · Flies

Poultry is infested – with all these critters. They live on skin, feathers and blood and they can seriously effect poultry production in weight, growth rates, egg production and in case of heavy infestation, death.

For starters, Litter Beetles are very serious. They are difficult to control, they are vectors of disease, and cause considerable damage to poultry facilities.

The Litter Beetle feeds on carcasses and they in turn are eaten by poultry.

Now you have a natural vector.

They are believed to be responsible for

Marcks Disease, Avian influenza, salmonella, fowl pox, coccidiosis, botulism and New Castle Disease. They also harbor tapeworm and cecal worms.

Interesting. G.

anon_22 – at 21:28

Interesting.

We have an immediate live example.

anonymous – at 21:31

Note their name…Litter Beetle.

Now, have we all expressed a concern for overcrowding and chicken litter falling on other chickens, pigs and could they also have the ability to walk off a truck and hop a ride on something else?

The Beetle Vector - sounds catchy. : ) G.

Tom DVM – at 21:33

annon 22. I have no problem with you using my post as an example. I give my honest opinion…nothing less, nothing more. You and I disagree on the science and the origins of H5N1 and the role of factory farming vs backyard flocks and wild birds…so be it…this is part of an ethical and respectful debate.

However, what does that have to do with the WHO, CDC and Governments who have consistently deliberately mislead IN MY OPINION. There is a world of difference between their behavior and our respectful debate.

If they want to debate and disagree with everything I say…fine…come on flu wiki and debate the issues and they can start with Dick Thompson and the bull-**** statement about the maximum worldwide mortality of seven million persons they have quoted and quoted again for the last 16 months…

…or maybe they would like to answer Dr. Nimans question that has been asked and asked and asked again…

…or maybe they would like to explain the term ‘this is only a disease of chickens’ or the term vaccine will be avaliable in 6 months etc. etc. etc.

They don’t deserve my respect.

Tom DVM – at 21:38

By the way, I don’t see how you translate this into a conspiracy theory…in my opinion they are incompetent…nothing more…nothing less. They are not conspiring to do anything other than as little as possible.

De jure – at 21:39

Anon_22, how can you even have the discussion without the data? And who (WHO) is holding the data? I thought science was supposed to be based on transparency. What is the reason for withholding the sequences, for example? Just because the sample was taken within a sovereign entity, the WHO needs to ask permission from the government? What if we were dealing with enriched uranium instead of virus sequences? Would anyone argue that the finding of enriched uranium should be withheld because it would somehow violate the sovereignty of the country? Sorry, I don’t buy it. Especially when a flu virus knows no boundries. I have yet to hear a good reason why viral sequences should be withheld from the public. It’s not like proprietary Microsoft code, for crying out loud. Again, why the secrecy? Such secrecy invites “theories”. They only have themselves to blame.

anonymous – at 21:45

Ah ha…De Joure, you beat me to it! I was going to say… If we are discussing Avian Influenza in poultry invariably must discuss poultry practices. Poultry practices are just that – practices – they are facts. Whether they are pleasant or not is not the issue. The issue is in understanding the development and transmission of a disease. How do we talk about the disclosure of information without discussing what is or is not being disclosed and by WHO (Whom) ? How do you talk about the pink elephant in the kitchen when we have hidden him under a tablecloth and serve tea and cakes off his back? G.

slow reader – at 21:46

back to monotremes post.

There are 12 known mammals that can carry h5n1. The most common mammals to be infected other than people are cats. people don’t have close contact with tigers,civet cats,martins or pigs to the extent they do with cats. If people are getting h5n1 from a mammal the obvious choice is cats.

DemFromCTat 21:48

They only have themselves to blame.

No doubt, they make things worse by a lack of transparency. That’s not being defended. Nor is CDC’s withholding of data. But I somehow don’t think the epidemiologists and others doing the field work for WHO are responsible for that anymore than those who work at CDC are responsible for the sequence withholding. These are decisions made at the top. And it remains unclear, at least to me, what’s being withheld by WHO and what’s being withheld by the local governments.

anon_22 – at 21:48

Tom,

“what does that have to do with the WHO, CDC and Governments who have consistently deliberately mislead IN MY OPINION.”

The WHO may have misled you, me, us, everyone. (Or not.) But we as outsiders have no way of knowing whether this was deliberate. At least I don,t, do you?

I for one am willing to give them some benefit of the doubt, not least because I have been a student of international politics and international institutional frameworks for a little while, and have rubbed shoulders with diplomats and bureacrats - not frequently - but sufficiently for me to be acutely aware that the biggest constraints that exist are in the structure of those institutions.

I am also willing to give them some benefit of the doubt because for better or worse they are all we’ve got. Sure we all want them to do a better job; I’m just not convinced that unjustified accusations are the way to go. They either end up backfiring on the accuser or increase the constraints on an agency already struggling with a problem way beyond what it was designed to deal with.

I am willing to give them some benefit of the doubt if it will increase dialogue and understanding. It may be easier to bash them if we think of the WHO in the abstract, but bottom line we are also talking about human beings some or even most of whom are just as worried as you and I and just as tirelessly butting their heads against a system in frustration trying to move faster and go further. We must be careful in our scrutiny, criticize where specific criticism is due, but baseless accusations can only be destructive on all sides.

anonymous – at 21:50

We are not eating cats.

anon_22 – at 21:51

“Just because the sample was taken within a sovereign entity, the WHO needs to ask permission from the government?”

That would be my understanding. And please do not underestimate ‘just because’. Countries treat their sovereignty extremely seriously.

anonymous – at 21:52

anon_22 – at 21:48

That makes very good sense and we could learn from this. Take the high road, there is a better view there. G.

DemFromCTat 21:52

slow reader – at 21:46

Cats, pigs and other mammals certainly aren’t ruled out a priori. And as far as backyard farms go, pigs are a major exposure factor.

sue – at 21:53

what about a monkey?

1mother – at 21:55

Inquiring minds might ask are there more compelling reasons than not for not releasing the sequences as they are obtained? Money, politics,fame, terrorism, intellectual property rights, religious ideology etc vs. the fate of many of the world’s species. It is hard as a layman to read theories and speculations about the course of H5N1, and not want to consider the human motive elements. But I for one will just read along and keep my theories quiet so as to not disturb this thread’s focus.

Tom DVM – at 21:58

annon 22.

This train is headed for a wall. We either stand aside and be nice and let things happen or we start speaking out…

…you do what you have to do…and I will do what I have to do…and I will respect your actions and I will expect you to do the same.

Melanie – at 22:01

anon_22,

As our friend the reveres said the other day:

One thing I’ve learned in many years as an epidemiologist is that disease outbreaks are rarely what they appear to be at first. Sometimes they are worse and sometimes they are better, but mostly they are different.

Don’t assume that we know and understand what is going on.

Tom DVM – at 22:02

By the way. Using the 2–7 million estimate, taken from a scientific study without sourcing it, and calling it the truth when the scientific study in question specifically said in the limitations that it should not be used in this manner….is where I come from…deliberately misleading…and you can tell me why they did it and continue to use the same numbers.

anon_22 – at 22:03

Tom, I am not talking about being nice. I am talking about being true.

Of course everyone must do what they have to do. As I said, I was commenting on a trend that I thought was worth discussing. If after discussion we agree to disagree, fine. Not to discuss it would not have served the community. I hope you don’t take this personally.

Medical Maven – at 22:04

anon_22: All well and good, but these embittered and suspicious musings of ours may be our only chance to come close to the truth. There may be no tomorrow in a few months or years for some of us. It is a macabre thought, but definitely in the realm of possibility.

Heat as well as light are necessary to illuminate this situation. Rein us in with your measured thoughts as you feel the need.

anon_22 – at 22:04

Tom, I respect your right to make interpretations. I am just a lot more cautious in mine.

anon_22 – at 22:06

MM,

“All well and good, but these embittered and suspicious musings of ours may be our only chance to come close to the truth.”

Absolutely! That’s why we must keep talking. Even if it is occasionally painful and not totally harmonious here.

Never once did I suggest that we should keep quiet. Just to reflect on what we say so as to make our utterances as accurate as possible to improve our credibility and more importantly our own ability to arrive at the truth.

anon_22 – at 22:08

MM, and everyone,

“Rein us in with your measured thoughts as you feel the need.”

Please do not interpret this as any attempt to ‘rein in’ anyone.

PLEASE.

I would be very disappointed and upset if that was the result of this discussion.

Tom DVM – at 22:08

annon 22. I also respect your right to make interpretations.

Therefore, based on our understanding of scientific principles and the scientific method, was their continued use of the 2–7 million mortality estimate deliberately misleading the public or not?

DemFromCTat 22:10

Medical Maven – at 22:04

You will recall similar discussions in months past, especially regarding posts that were frontal assaults on individuals. In a community as diverse as ths one, its not a surprise that there are different POV. But the question becomes what’s effective action and what’s ineffective action, what’s effective discussion and what’s not. That is a very legitimate debate (and none of us have “the only right and true answer”). ;-P

It is helpful to acknowledge that, IMHO.

anon_22 – at 22:16

De jure,

sorry, jumping back to this :-)

“Would anyone argue that the finding of enriched uranium should be withheld because it would somehow violate the sovereignty of the country”

Actually, I don’t know about ‘should be’, but they ARE.

Do I like it? Not one bit.

Do I feel powerless? You bet.

Do I wish I could fix it? Sure, but I can’t.

Do I wish I was God? Probably worth it, in this context, but it is not an option that is open to me.

So it is not just about right or wrong, it is also about recognizing the limitations of reality, and finding a delicate path through it that might have some effect. Rather than bludgeoning it with a sledgehammer, IMHO.

Many Cats – at 22:24

I would tend to agree that many in WHO are feeling extremely pressured to “get it right” and so are proceeding at a painfully cautious pace, let alone the problems with bureaucratic delays, but venting frustrations and pointing out where they are obviously off track (and perhaps negligently so) is one of the only ways that many of us have of pointing out to TPTB that they need to do a better job. Yes, cut them slack but NO, do not let them off the hook. If they are listening to this site at all, they need to know where their own credibility is at risk. And if they don’t like it, what are they going to do? Withold sequence data?

Medical Maven – at 22:25

DemFromCT and anon_22: The spiritedness of our discusssion provokes thought. I don’t think anyone of us should dispair that we will descend into some “Punch and Judy” show. Virtually all of us here are intelligent enough to see through the embellishments and exaggerations. We have all done it to make a point.

I know it is tedious, but the mods need to do as they have done in the past-logically refute each point that they disagree with. Too make a blanket statement does no good. It has to be point by point as the perceived inaccuracy occurs.

Unfortunately for you mods this place doesn’t run on “automatic”. : )

sue – at 22:26

I believe this site has been read and influenced many. I would very much like to see this site be responsible for influencing the release of more sequences. Fluwikie is read and heard! Maybe we can help “Fix it”

De jure – at 22:28

Anon_22: There’s an old saying that you can’t catch fish unless your line is in the water. There may be only one fish in the whole darned lake, but you won’t catch him unless you try. I say that there is nothing wrong with being a bit provocative from time to time. You might get someone’s attention. They may have to provide you with the right answers for the wrong reasons. Who cares, as long as you have your answer? When you are not playing on a level playing field, I say you take the ball and run with it however you can. If that means speculating to the point where you get a politician nervous and putting him in the position where he has to come up with some answers, then so be it. When all you have is a hammer, then everything looks like a nail. ;-)

Tom DVM – at 22:32

annon 22. You didn’t answer my question.

DemFromCTat 22:53

Yes, cut them slack but NO, do not let them off the hook.

I think all the mods are okay with that. ;-)

Many Cats – at 23:05

:)

Monotreme – at 23:15

I think I’ll start a new WHO thread to discuss that. But in the mean time…

The scenario I present above is predicated on the assumption that we have incomplete information regarding how people are getting infected. I accept Revere’s cautions in interpreting clusters and anon_22′s warnings regarding premature conclusions. My point is that these cautions should be applied equally to all possible explanations of infection. They have not been. The WHO, and others, have consistently suggested nearly everyone infected with H5N1 have acquired it from birds, with little or no evidence. No-one outside of the flu blogosphere have called them on their dangerous speculations. Dangerous, because if they are wrong, we are much closer to a pandemic than they imply. This danger is amplified by their seeming authority. It is easy to criticise anonymous posters on flu boards. There is almost no criticism of the WHO speculations regarding the source of H5N1 infections (except here).

I have no objection to anyone pointing out flaws in my original post. Please, have at it. But please, let’s take off the Kidd gloves when examining conventional wisdom on bird-to-human transmission. If we don’t, who will?

anon_22 – at 23:27

Tom,

(This post is not succinctly written as it is 4 am here and I’m too sleepy to edit, so apologies.)

“Therefore, based on our understanding of scientific principles and the scientific method, was their continued use of the 2–7 million mortality estimate deliberately misleading the public or not?”

The problem here is the issue of ‘plausible denial’. Estimates are just that, estimates, guesses about something that has not happened yet. By its very nature it is very hard to pin them down and say “Gotcha!” For example, if the WHO were to say, “nobody died of H5N1 infection in Indonesia this past week” then yes, you can catch them red-handed and they will have to be held accountable for that.

So I would say yes, one could argue that statement is misleading to the public. Was it deliberate? Maybe, maybe not. It will be hard to prove.

But there is a higher level problem of which this is only a consequence.

The WHO is an agency of the UN, controlled via the general assembly by 190+ member states. Individual officials may have some discretion on policy but not much. Even the phrase ‘member state’ is misleading, cos what you have at the UN is only a collection of diplomats representing mostly the interests of that particular government where they came from, the vast majority of which are not democracies, where corruption, cronyism are the order of the day. For these representatives, their posts in New York are nothing more than another opportunity to scramble for the riches that come with the territory. The UN ‘Oil for Food Programme’ for Iraq was the most blatant but far from unique example.

Here let me pause and tell you a story:

Either Feb or March this year, a big conference was organized by the UN and held in Africa to discuss Avian Flu. Now here at the fluwikie we have people frequently expressing concern about Africa. Did you know what happened? After 2 full days of discussions about how to allocate the aid money for agricultural compensations, NOT ONE WORD was raised about a HUMAN pandemic. The subject of HUMAN deaths did not end up on the table AT ALL. Why? Cos most of these governments are the same as the businesses that control agriculture, and all they want is the money.

It broke my heart to read that. Truly. The extent of human greed, what human beings will do to each other, is sometimes beyond comprehension.

These people and their cronies are the same ones who get to sit in on judgment on the actions of the WHO. Directly. Not you or I.

Now I’m not saying all governments are like that. But if you study this even in moderate detail, you will discover that they are far far more common than anybody would care to talk about.

How does that justify the actions of the WHO, you might ask? On one level, it doesn’t. But on another level, let me ask you a pragmatic question. If you, Tom, are employed in the WHO, how much leeway do you think you have to tell the ‘truth’? Against such powerful interests?

Now I come back full circle to the notion of conspiracy. Yes, there is a conspiracy, but it is not conspiracy at the level of the WHO. It is not even a conspiracy at the level of the UN. But a general conspiracy that we all help to prop up, a conspiracy that pretends that countries and governments are inherently, as you Americans would say, “of the people, for the people, by the people”.

The sad truth is that as global citizens we have not succeeded in some very basic battles against the evils of human greed. We turn a blind eye when catastrophes happen elsewhere, because it is not happening to us. We are complacent when people kill and maim and enslave each other, because it is happening in countries we cannot identify on a map whose names we cannot pronounce.

And yet I don’t blame ‘us’, not at all. Why? Because there exists a limit to human capabilities. Because as biological beings we are constrained as much as any other species. With all the good will in the world, we as a species have made mighty progress in certain things, but have failed miserably in others.

So the issue is not whether the WHO is living up to our expectations. It is not. The issue is whether we have any right, absent of personal obligations to improve the planet, to ask for more.

(I did not intend to take this discussion to this level. And yet I’m glad it did.)

anon_22 – at 23:45

How many of you Americans like John Bolton and think he represents integrity and accountability?

I can probably guess your answers.

And yet America is the No1 democracy in the world. Supposedly with the highest standards. If you guys cannot produce a better specimen than John Bolton to grapple at these issues at the UN, what gives you the right to expect more from others?

Monotreme – at 23:50

anon_22. I understand your points (and am in basic agreement), but could we discuss them on the new WHO thread I started?

Please.

anon_22 – at 23:51

So by all means point out the failings of the WHO. But don’t get all moralistic about it. They are no better and no worse than any one of us.

anon_22 – at 23:52

Mono,

I’m sorry.

I’m going to bed, though. It’s almost 5am.

18 May 2006

Olymom – at 00:02

Ah, speaking as a Texan (one never really manages to be an ex-Texan) know that arrogance and confidence swap places constantly. Can-do and should-not-have do the same. We’re impressive and aggressive, we’re admired and distained — John Bolton is a mean-spirited SOB — and exactly who Bush wants to play the position of “bump off criticism through nastiness” — makes sense in a go-for-the-throat stoat sort of way.

We expect more of others because it is convenient to us.

I’m not embracing this — just explaining it.

Monotreme – at 00:02

One point that I made in my first post on this thread, which may have gotten lost, is that if my hypothesis is correct, and there is a mammalian reservoir for H5N1 in Indonesia and possibly elsewhere, the odds of H5N1 causing a pandemic sooner, rather than later, go way up.

The reason is that a mammalian reservoir would result in selective pressure for H5N1 to adapt to mammals. We discussed whether it was possible for H5N1 to be evolving towards a pandemic strain on other threads. Some had argued this would be impossible because the virus would have to start over again every time it jumped from bird to human. But if it starts out in a mammal, it’s got a head start when it infects a human.

This paper Avian Influenza (H5N1) Viruses Isolated from Humans in Asia in 2004 Exhibit Increased Virulence in Mammals is worth reading, again.

Strains of H5N1 isolated from humans were more lethal to ferrets than strains isolated from birds. Why would this be? I had interpreted this to mean that the virus had mutated while in the patients to become more adapted to mammals. But, there is another explanation. Suppose the virus isolated from patients was more lethal to mammals (ferrets) because it infected the patients directly from mammals. This would have given the virus much more time to adapt to mammals. Just an idea.

Monotreme – at 00:04

I like liberals. I like conservatives.

Please, please keep politics off this thread.

Monotreme – at 00:13

Medical Maven – at 09:48 Noroviruses are notorious for cruise ship epidemics and for emptying schools at times. Could we have a first class threat from H5N1 if it just simply becomes more efficient via the oral/fecal route?

That’s a good point. There are many environments where a virus that is spread via bodily fluids could potentially infect alot of people. My biggest concern in this regard is Africa. I’m thinking here of the spread of the Marburg virus as a result of certain funeral customs where the body of the deceased is washed and bathing fluid is drunk. I think we could have horrendous outbreaks there if H5N1 is spread fecal-oral.

Clean water, once again, becomes paramount.

lugon – at 04:30

How does selective pressure work? I’ve heard sometimes it fosters variations and other times it’s the oposite. I don’t understand how it works. Maybe knowing the general mechanism would help (help me understand, help others understand, help prevent or look for warnings, etc).

Kiwi – at 04:33

Saw this comment on another forum:

Pigs have tested positive for bird flu in the same village on Indonesia’s Sumatra island where five people have been confirmed infected with the H5N1 avian influenza virus, a minister said on Thursday. The case involving up to seven family members, six of whom have died, has raised alarm around the world because authorities cannot rule out human-to-human transmission. But the World Health Organisation and Indonesian health officials had been frustrated by the lack of evidence pointing to a source of the virus, usually infected poultry. The WHO confirmed on Wednesday that five members of the family had contracted H5N1 and tests on a sixth were pending. Officials had said earlier that on-the-spot testing of various animals living around Kubu Simbelang village in North Sumatra province had given negative results for avian influenza.

However, Agriculture Minister Anton Apriyantono told reporters on Thursday the pig samples from the village had been brought to a leading animal research centre on Java island, and scientists there found a positive result for bird flu. After we brought them to Bogor, the serology test found positive results. From 11 pig samples, 10 are positive. Reconfirmation testings are still underway, he said, but did not specify the H5N1 virus. Bogor is a West Java city where a veterinarian institute is located. Clusters of human infections are worrying because they indicate that the virus might be mutating into a form that is easily transmissible among humans. That, experts say, could spark a pandemic in which millions might die. For the moment, the virus is mainly a disease in birds and is hard for humans to catch. The minister’s comments are also likely to concern health officials. Pigs can act as mixing vessels in which human and bird flu viruses can swap genes, leading to a strain that can mutate to human to human transmission rapidly.

Chrazer – at 05:03

Ebola is also spread by bodily fluids. The worst form the “Zaire ebolavirus” has a 90% CFR. Already H5N1 is killing more people than Ebola. The Marburg virus is from the same family as Ebola “Filoviridae”. Although they are considered the most dangerous viruses known to man they seem to pale in comparrison to H5N1.

FrenchieGirlat 08:23

With respect to host reservoirs of virii, transmission of virii to humans, may I direct you to the following links on Promedmail. They deal with the subject of bats, civet cats and other animals as reservoirs/vectors for SARS and Marburg Hemorrhagic fever. Any room for lateral thinking? H5N1-birds-pigs-cats-rats-insects-bats-civet-other??? BTW, cats and dogs ARE eaten in some countries, so are rats. And not just in Eastern/Asian countries. I am reminded that during the 1870 Franco-Prussian war, in Paris, France, when the town was besieged, famished inhabitants did eat rats.

http://tinyurl.com/h3ejh
http://tinyurl.com/nxzsy
http://tinyurl.com/edwsf
http://tinyurl.com/q4kxk
http://tinyurl.com/kepfs
http://tinyurl.com/qvvnn
http://tinyurl.com/zzpbu
http://tinyurl.com/oacm2
http://tinyurl.com/n52tb

niman – at 10:29

The huamn sequences will almost certainly be from swine, orginally, but probably humans now. These infections were NOT from poutry and the CDC, WHO, and Hong Kong (and anyone with access to the private database) know it.

Monotreme – at 10:47

lugon,

The source of all genetic variation is random mutation. These mutations may be exchanged in viri via reassortment or recombination.

Monotreme – at 10:52

Frenchiegirl, the chain of infections is likely to follow a food chain of some sort. The only way to sort it out is to get as many samples as possible from mammals and compare sequences.

If H5N1 is being spread pig-to-pig or any mammal-to-mammal, now, evolution of a pandemic strain is almost a certainty, IMO.

Mathematician – at 10:58

Monotreme: If H5N1 is being spread pig-to-pig or any mammal-to-mammal, now, evolution of a pandemic strain is almost a certainty, IMO. Strong words. Why? And do you believe that some H2H has been happening in the clusters? And if so, do you, in fact, think that the evolution of a pandemic strain is almost a certainty? And if not, why not?

Hoping you actually meant something a bit more constrained…

Mathematician – at 10:59

I mean, if you do believe there’s been limited H2H in the clusters but you don’t yet believe a pandemic strain to be almost a certainty, that would seem not strictly consistent with what you said at 10.52

anonymous – at 11:04

Monotreme – at 10:52

Could the original transmissions have followed “Feed” and hatchlings.

Monotreme – at 11:10

Mathematician, I do believe limited H2H has been happening for some time. I think it is spread via close contact. My guess is fecal-oral. That, in itself, doesn’t mean it has to become a pandemic strain. To do that, it would have to spread via respiratory droplets. There are important biological differences between birds and mammals which influence evolution of flu viruses. Evolution of a pandemic strain is less likely if the reservoir for H5N1 is exclusively avian. If there is a mammalian reservoir for H5N1, the barrier to a pandemic strain, ie, one that is transmitted easily between people, is much lower.

I don’t want to assign probabilities, but if H5N1 is being transmitted pig-to-pig, evolution of pandemic strain is almost a certainty, IMO.

Monotreme – at 11:12

anonymous, sure, but there is no way to know without sequence data.

DennisCat 11:19

Monotreme – at 00:02 Yes, the swine connection is worrisome. It would not be fun to start culling all mammals. The fact that the pigs had antibodies is godd and bad. It is nice to know that they could produce antibodies. However, it also means that it can stay in them longer so there can be more “mixing”. Dead pigs don’t fly and are not good mixing vessels. But live sick pigs…….or one asymtomatic pig. Now with the three more human cases in Indo. it does not look much better than last week.

I hear the news sugar coat things and say the risk is less now, but when I look at there being more human cases the first half of this year than all of last year- I am worried. This thing is adapting and doing so very fast.

FrenchieGirlat 12:03

Monotreme at 10:52 - I agree entirely. What brought it home to me was reading the fact that pigs have now, in the Indonesian case, been found without doubt to harbour antibodies whatever way they came to contact with the virus (bird-to-pig, human-to-pig, mammal(X)-to-pig). So far as I remember, correct me if wrong, it is the first time that this event is so very LOUD. Up until now, scientists were very worried about the possible happening of this in the future, but for us mere mortals, it was a rather theoretical question of “what if bird meets pig, hahaha, bad problem”. [Ten of 11 pigs in the district where the infected people lived were found to have avian flu antibodies in their blood, Apriantono told reporters in Jakarta today.]

I was not so sure that other FluWikians just realised how worrying this finding of pigs antibodies is (hence my post at 08:23). And yes, we should test all mammals, right, left and center (maybe non-mammals – do they eat insects/reptiles there - as they do elsewhere in the world? And that’s looking for the proverbial needle in the haystack. Can Indonesia do it, financially, technically, logistically? How much help does Indonesia need? Do we have time to do useful research (it took 2 years for SARS and still there are gaps in our knowledge of host/reservoir/transmission)?

If scientists are so struggling to get to the gist of it, can the humble and combined efforts of other specialists on FluWikians bring them some wee bits of help, can we, with our collaborative thinking, reduce somewhat the size of the haystack? One may be a world reknowned epidemiologist/scientist in one area, and know nothing of some other subjects. We have FluWikie, we did not have SARSWikie… I am not on this high-up-the-scientist-ladder thing, yet, if my communications can bring something to other ordinary FluWikians, why not? Isn’t this some form of flu education which is what we also want?

Dennis C at 11:19

Dead pigs don’t fly – but swine meat, viscera, embryo/ova /semen, processed animal proteins, bone meal etc. are commodities of world-wide trade, travelling in crates by plane. Would asymptomatic dead pigs be contagious?

DennisCat 12:13

FrenchieGirl – at 12:03

I am more worried about live pigs with anitbodies than dead ones. The longer they live with the virus in them, the more probable they can allow mixing with human viruses. I think the “creation” of the pandemic form of the virus is more likely in the pigs but the spread of the virus to be more likely from people. My “crystal ball” is now saying 4 months to US, EU outbreak - but that is just a big guess.

FrenchieGirlat 12:19

Well then, live pigs fly… they are also commodities, just like one-day old chicks

cabingirl – at 12:30

Really hate to post such a stupid question….Do we know if these tested pigs or chickens had been vaccinated? If not, and they have been exposed and survived, does this offer any optimism that should reassortment take place, that CFR would be lower???

anon_22 – at 13:07

I would agree that pigs is probably the biggest worry currently. Having a substantial and growing pig reservoir would be a significant precursor to a pandemic.

cabingirl,

“Really hate to post such a stupid question….Do we know if these tested pigs or chickens had been vaccinated? If not, and they have been exposed and survived, does this offer any optimism that should reassortment take place, that CFR would be lower???”

There are no stupid questions, only stupid answers, sometimes. :-)

I don’t believe there is a vaccine for H5N1 for pigs at the moment. Some of the chickens might be.

The fact that they survived will have very little significance for CFR in humans, because there is no consistency in virulence across different species. The fact that they survived, however, may mean an increased pool of animals excreting viruses, and thus more human exposure.

DemFromCTat 13:20

closed for length… to start another momentarily.

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