Avian Flu Diary

Hong Kong Swine Influenza Surveillance

2012-02-14T10:17:00.001-05:00

# 6144

Every few months we get an update from Hong Kong’s swine surveillance program – conducted by the University of Hong Kong - that looks for influenza viruses in pigs arriving at Sheung Shui for slaughter.

Several influenza viruses commonly circulate in swine (primarily H1N1, H1N2, H3N2), but what these researchers are looking for are signs of new, or novel strains.

Of 1,500 samples tested between October 2011 and January 2012, 27 were found to be reassortments of standard swine flu viruses with the 2009 H1N1 virus.

Reassortment happens when two different influenza viruses co-infect the same host, swap genetic material, and produce a hybrid virus.

Two of the 27 were reassorted H3N2 viruses, while 25 were H1N2 strains.

While neither particularly alarming or surprising, these virus detections are further evidence of the ongoing evolution of influenza viruses in swine populations.

For more on the potential threat posed by such reassortant viruses, I would invite you revisit my 2010 essay called:

The (Swine) Influenza Reassortment Puzzle

This from the Hong Kong Government.

FEHD releases latest results of influenza virus surveillance in pigs

The Centre for Food Safety (CFS) of the Food and Environmental Hygiene Department (FEHD) today (February 14) announced the latest round of results of the regular influenza virus surveillance programme for pigs at the Sheung Shui Slaughterhouse conducted by the University of Hong Kong (HKU).

Among some 1,500 samples collected and tested from mid-October 2011 to January 2012, one sample tested positive for the human swine influenza virus (pandemic H1N1).

A total of 27 samples were found to contain viruses that were essentially swine influenza viruses but had picked up some genes of human swine influenza virus. Among them, two samples were detected with a swine influenza, H3N2, while the remaining 25 samples had H1N2. Swine influenza viruses carrying the genes of the human swine influenza virus were also found in the last two rounds of the surveillance programme (i.e. for May to July and August to October last year).

According to Professor JSM Peiris, the HKU expert in charge of the surveillance programme, given the wide transmission of the pandemic H1N1 virus in humans, detection of the virus in pigs is no surprise. Positive findings might continue to appear from time to time in future.

"There have been similar reports from many parts of the world showing that swine influenza viruses carried the genes of the human swine influenza virus. Such viruses are unlikely to pose any major human health risk or cause problems in food safety," Professor Peiris added.

Under the regular influenza virus surveillance programme for pigs, the CFS has been helping HKU researchers to collect blood and tracheal and nasal swabs from pigs at the Sheung Shui Slaughterhouse twice a month to monitor influenza virus activity in pigs.

"The CFS will continue to monitor reports of the HKU surveillance programme and make announcements on a regular basis. Results will be announced immediately if there are significant public health impacts," a CFS spokesman said.

(Continue . . .)

Branswell On the CFR Of H5N1

2012-02-14T09:27:00.001-05:00

Credit CDC PHIL - BSL-4 Lab Worker

# 6143

Yesterday we saw an article in Nature by Declan Butler that looked at the evidence (for and against) a high CFR (case fatality ratio) for the H5N1 virus (see Declan Butler On the CFR Of H5N1).

This, as you probably know, has been a major topic of debate in recent weeks as the controversy over H5N1 research in ferrets roils on. Some researchers maintain that the virus is not nearly as dangerous as others have portrayed.

Helen Branswell weighs in with her own highly informative piece, which appears in Scientific American today.

Follow the link to read:

Dread Reckoning: H5N1 Bird Flu May Be Less Deadly to Humans Than Previously Thought--or Not

Are fears of human-to-human transmitted bird flu overblown or does it make sense, based on current fatality rates, to anticipate a worst-case scenario for a future outbreak of H5N1 flu?

By Helen Branswell | February 14, 2012

Indonesia: Concerns Over Changes In Avian Flu Symptomology

2012-02-14T08:51:00.001-05:00

Photo Credit – FAO

# 6142

With influenza viruses, the only true constant is change.

Viruses must continually evolve and adapt in order to survive. The legacy of infection by a virus is usually some degree of immunity, and if viruses did not evolve they would soon run out of susceptible hosts.

Minor mutations happen all of the time, but most turn out to be evolutionary dead-ends. They confer no biological advantage to the virus, fail to thrive, and die out.

It is only when the right combination of changes occurs that changes the virus’s antigenic profile or enhances transmissibility or replication – or expands its host range – while still remaining `biologically fit’, that a new strain begins to flourish and spread.

And those types of changes can happen very quickly, or they can take years in coming.

It is this evolutionary process that has led to having 20+ clades (major versions) of the H5N1 virus circulating around the world, including the vaccine resistant strain clade 2.3.2.1 (see FAO Warns On Bird Flu) that began to emerge in 2010.

With so many different clades in circulation, it is no wonder we see some variations in the way the virus behaves.

All of which serves as prelude to a long report appearing today in the Indonesian Newspaper Kompas, which talks about a moderation in outward signs of infection among poultry.

Those with long memories may recall we discussed similar concerns back in 2009 (see Bird Flu Symptoms Changing In Indonesia). Three years ago the Dean of Faculty of Veterinary Medicine, Institut Pertanian Bogor was quoted as saying:

“Common signs as cyanosis of wattle, comb or fetlock are not observed anymore. Mortality also decreases so that it’s difficult to differ between ND and AI”

So while perhaps becoming more common today, these changes do not appear to be entirely new.

Included are also some comments by Professor C.A. Nidom, on the dangers of H5N1 reassortment. My thanks to Shiloh on FluTrackers for finding, and translating the following article (original link).

Be warned, this is a machine translation, and so the syntax is a bit mangled.

Can Bird Flu Virus More Dangerous

Asep Chandra | Tuesday, February 14, 2012 | 9:28 pm

Jakarta, Kompas - The bird flu virus (H5N1) in Indonesia is thought to have changed. The virus is feared more dangerous than before. Further research is needed to ensure the fatality rate of the new virus.

Reports from a number of areas, until Monday (13/Feb), indicating the change. Even so, not yet ascertained the impact of the change.

Head of Animal Husbandry and Animal Health in Central Java Semarang District Whitono reveals, some poultry that died of bird flu now has features that are not as usual, ie no black or bluish spots on the comb or body part that is not hairy.

Meanwhile, Head of Animal Health Animal Husbandry and Animal Health Central Java Eko Sutarti revealed, though not sure about the new virus, characteristics of birds that died of bird flu part shifted. Usually the birds that died of bird flu are marked with blue or black spots on the comb or body parts that are not covered in fur.

Now the poultry that died suddenly without these spots were found positive for bird flu.

Of Brebes, Central Java, reportedly, the body's defense system against virus attacks poultry in the region changed when compared with previous years. This is evident from the clinical symptoms found in cases of chicken deaths in the region last week.

Head of Animal Health and Veterinary Public Health Veterinary Services Brebes Jhoni Murahman say, around 2003, when he first outbreak of bird flu virus in Bradford, clinical symptoms of bird deaths at that time happened very quickly and in large quantities.

Physical signs in birds that died of bird flu is also very clear, that the body was black, very much saliva, swollen heads and blue crest on the head.

However, at present, clinical symptoms are not very visible. Poultry deaths tend to be in unison, but one by one. Body of dead birds as well just turn blue with not a lot of saliva and the head is not swollen.

Chairman of the Avian Influenza Research Center, zoonosis, which is also a lecturer at the Faculty of Veterinary Medicine Airlangga University, Surabaya, CA Nidom, say, the existence of the bird flu virus in Indonesia to worry about. "There are allegations of meetings between the H5N1 virus (bird flu) and pan2009 A H1N1 (swine flu) in Indonesia. This could produce a new type of virus is more dangerous, "he said.

(Continue . . . )

Over the years concerns have been voiced that inconsistent or poorly matched poultry vaccination programs could be driving the evolution of the H5N1 virus.

As new clades emerge, vaccination of birds with existing vaccines may still lessen morbidity and mortality in the flocks, but not prevent infection.

Creating, in a sense, a `stealth' bird flu virus; one that doesn't announce itself with clearly observable symptoms.

And that, one would have to assume, only serves to increase the chances that more people and more poultry will be inadvertently exposed to the virus.

Declan Butler On the CFR Of H5N1

2012-02-13T14:00:00.001-05:00

# 6141

Declan Butler, who is a senior reporter Nature.com, was one of the first journalists to call attention to the H5N1 virus. He holds a degree in biology from Queen's University, Belfast, has a PhD from the University of Leeds, and writes on a variety of scientific topics.

The CFR (Case Fatality Ratio) of the H5N1 virus – which hovers around 60% of known cases - has been the subject of considerable discussion over the years, and is currently front and center in the recent debate over H5N1 research in ferrets.

Some scientists maintain that a great many `mild’ cases go undetected, and that the true CFR is far lower (perhaps `orders of magnitude lower’) than the official numbers would indicate (see Vincent Racaniello’s argument Should we fear avian H5N1 influenza?).

As we saw in a CIDRAP article last week by Robert Roos (Undetected H5N1 cases seem few, but questions persist), not everyone buys into that theory.

Today Declan Butler talks to a number of experts (including Malik Peiris and Jeremy Farrar), who say they’ve not found much evidence to support a claim that we are missing a lot of `mild’ cases.

While the true CFR may be far lower than 59%, many experts believe this virus is fully capable of producing a pandemic that could far exceed what we saw with the 1918 Spanish Flu.

Very much worth reading, so follow the link to:

Nature | News

Death-rate row blurs mutant flu debate

Even if a 59% mortality rate for H5N1 is too high, the virus could still cause a flu pandemic more serious than that of 1918.

Declan Butler

13 February 2012

(Continue . . . )

ECDC Launches Weekly Communicable Disease Threat Report (CDTR)

2012-02-13T10:09:00.001-05:00

# 6140

Infectious disease geeks and health professionals get a new resource this week with the announcement by the ECDC today of the launching of their new weekly Communicable Disease Threat Report (CDTR).

Here is the announcement from the ECDC, along with a link to the first edition.

ECDC starts publishing its weekly communicable disease threat report (CDTR)

13 Feb 2012

ECDC

The ECDC communicable disease threat report (CDTR) is a weekly bulletin intended for epidemiologists and health professionals in the area of communicable disease prevention and control. It summarises information gathered through epidemic intelligence by ECDC regarding communicable disease threats of concern to the European Union. It also provides updates on the global situation and changes in the epidemiology of communicable diseases with potential to affect Europe, including diseases that are the focus of eradication efforts. It is prepared by the epidemic intelligence team at ECDC and will be published on a weekly basis from now on.

Between 5 and 11 February, three threats affecting the EU were followed. An outbreak of Legionnaires' disease associated with a hotel in Spain was identified by the European Legionnaires' Disease Surveillance Network on 13 January 2012. As of 9 February 2012, 18 cases were confirmed, 15 of them being travel-associated. Cases are from the United Kingdom (12), France (2) and Spain (4).

Local measles outbreaks were reported in the media in Spain. There have been 22 cases during the first two weeks of 2012 in Valencia and 77 cases since the beginning of January in Alicante, including 31 reported during the last week. In Romania, a measles outbreak was notified at the Theological Seminary of Arad involving 15 cases, some of whom were hospitalised in a serious condition. Neighbouring countries such as Ukraine, Russia and Belarus also reported measles outbreaks.

Influenza activity continued to increase in week 5 in a very varied way across Europe with no clear geographic progression this season. The dominant viruses remain A(H3N2)-type. Medium influenza activity was reported by nine countries and increasing clinical activity in primary care was reported by 18 countries, compared with 12 countries last week.

Influenza A(H5N1), poliomyelitis and dengue were also monitored. Even though they don’t present a major risk for the EU at the moment, vigilance remains important.

Communicable Disease Threats Report (CDTR), 05 – 11 February - Week 6

Egrets, They’ve Had A Few . . .

2012-02-13T08:41:00.001-05:00

Photo Credit- Wikipedia

# 6139

This morning Hong Kong is reporting the discovery of two more H5N1 positive egrets. The dead birds were collected on February 6th and 7th and laboratory testing over the weekend has confirmed the presence of HPAI bird flu.

While we rarely hear of infected birds out of China (likely due to less than robust surveillance & reporting) - most years Hong Kong detects a couple of dozen cases - suggesting that the virus among wild birds on the mainland is probably more prevalent than is officially acknowledged.

In December of 2008 Hong Kong saw their first outbreak of H5N1 in domesticated poultry in nearly 6 years. In early 2009 it was announced that the H5N1 outbreak was `likely’ caused by infected migratory birds. See Wild Birds Eyed As Likely Source Of Hong Kong Bird Flu Outbreak.

Since then, local authorities have become even more diligent in their surveillance and testing of dead birds.

Over the past few weeks we’ve seen reports of magpie robins, egrets, peregrine falcons, and black-headed gulls testing positive for the virus in Hong Kong.

This from the Hong Kong government today:

Little egrets test positive for H5N1 virus

A spokesman for the Agriculture, Fisheries and Conservation Department (AFCD) said today (February 13) that two dead little egrets found in Tuen Mun on February 6 and 7 were confirmed to be H5N1-positive after a series of laboratory tests.

The two dead birds were found and collected at the northern entrance to Tuen Mun Park, Tuen Mun Heung Sze Wui Road, on February 6 and 7.

The little egret is a common resident bird in Hong Kong.

The AFCD will continue to conduct inspections of poultry farms to ensure that proper precautions against avian influenza have been implemented.

The spokesman reminded people to observe good personal hygiene.

"They should avoid personal contact with wild birds or live poultry and clean their hands thoroughly after coming into contact with them," he said.

Ends/Monday, February 13, 2012
Issued at HKT 15:00
NNNN

HFMD: An Old Illness With A New Cause

2012-02-13T07:21:00.001-05:00

Vesicular eruptions in A) hand, B) foot, and C) mouth of a 6.5-year-old boy from Turku, Finland, with coxsackievirus (CV) A6 infection. Credit - CDC EID Journal

# 6138

Since late in January the newshounds on FluTrackers have been following a story out of Alabama, where public health authorities have been dealing with an offseason outbreak of Hand Foot and Mouth Disease (HFMD).

Hand Foot and Mouth Disease is often confused by the public with Foot and Mouth Disease (FMD) seen in cattle, swine, and sheep. Despite the similar name, the diseases are in no way related.

HFMD is a very common viral infection, usually peaking late summer or early fall, and mainly seen among children under the age of 10 (although adults may be vulnerable as well).

It is caused by several of the non-polio enteroviruses.

While this virus classification may be unfamiliar to a lot of people, the 60+ viruses that fall into this category are among the most prevalent viral infections in the world, probably only second to the myriad and ubiquitous variants of Rhinovirus (`common cold’) that circulate every year.

The two most common causes of HFMD have been the Coxsackie A16 virus, and the Enterovirus-71 (EV-71), and rarely, the Coxsackie A10 virus.

The disease in the United States is commonly caused by the Coxsackie A16 virus and is generally mild. Outbreaks are not uncommon in schools and childcare facilities.

Over the past decade we've seen outbreaks - particularly in the Far East - caused by the more pathogenic EV-71 virus, and this version of the HFMD can occasionally be quite serious.

Last year, Vietnam reported more than 90,000 cases of HFMD and reported more than 150 deaths, mostly among young children.

And two years ago , the Virology Journal, published an analysis of an EV-71 HFMD virus that caused a major disease outbreak in Fuyang City, China in 2008 that showed it was due to an emerging recombinant virus (see China: A Recombinant EV-71).

In 2008, the CDC’s EID Journal carried a dispatch describing an outbreak of HFMD in Finland due to an unusual, and apparently emerging, viral cause; the Coxsackie A6 virus.

Dispatch

Coxsackievirus A6 and Hand, Foot, and Mouth Disease, Finland

Riikka Österback, Tytti Vuorinen, Mervi Linna, Petri Susi, Timo Hyypiä, and Matti Waris

Abstract

During fall 2008, an outbreak of hand, foot, and mouth disease (HFMD) with onychomadesis (nail shedding) as a common feature occurred in Finland. We identified an unusual enterovirus type, coxsackievirus A6 (CVA6), as the causative agent. CVA6 infections may be emerging as a new and major cause of epidemic HFMD.

This dispatch describe a prolonged nationwide outbreak of HFMD starting in 2008, in Finland:

During fall 2008, a nationwide outbreak of HFMD occurred in daycare centers and schools in Finland, starting in August and continuing at least until the end of the year and possibly into the following year. From vesicle fluid specimens of hospitalized children, we identified the etiologic agent as coxsackievirus A6.

Since then, we’ve seen a growing number of reports of HFMD outbreaks around the world due to this particular coxsackievirus, including:

An outbreak of coxsackievirus A6 hand, foot, and mouth disease associated with onychomadesis in Taiwan, 2010

Sung-Hsi Wei, Yuan-Pin Huang, Ming-Chih Liu, Tsung-Pei Tsou, Hui-Chen Lin, Tsuey-Li Lin, Chen-Yen Tsai, Yen-Nan Chao, Luan-Yin Chang and Chun-Ming Hsu

BMC Infectious Diseases 2011, 11:346 doi:10.1186/1471-2334-11-346

Published: 14 December 2011

Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6, Japan, 2011

Fujimoto T, Iizuka S, Enomoto M, Abe K, Yamashita K, Hanaoka N, et al.

Emerg Infect Dis [serial on the Internet]. 2012 Feb

Until now, this A6 virus has not been associated with HFMD outbreaks in the United States. This from the Alabama Health Department’s website:

Alabama Department of Public Health monitors new cases of hand, foot and mouth disease

FOR IMMEDIATE RELEASE
CONTACT: Mary McIntyre, M.D.
(334) 206-5325

The Alabama Department of Public Health asks the public to be aware that cases of the contagious viral illness called hand, foot and mouth disease are more numerous and severe than normal in Alabama this winter. No known deaths have resulted from the virus, although there have been hospitalizations and there can be some rare, severe complications.

As of Feb. 10, the ADPH has interviewed patients and collected and submitted specimens to the Centers for Disease Control and Prevention for individuals with febrile illnesses and rash. Based on the results of testing done by the CDC, the Coxsackie A6 virus has been identified.

This specific type of virus has been identified in other countries but has not previously been
associated with an outbreak in the U.S. There is no specific treatment for hand, foot and mouth
disease.

“As this is a new virus for our population, we can expect more cases and are monitoring for any change in the clinical presentation,” Dr. Donald Williamson, state health officer, said. “We will continue statewide surveillance on severe cases of this emerging disease and ask physicians and infection control specialists to make notifications to us.”

The public should not be unduly alarmed at this time; however, individuals diagnosed with hand, foot and mouth disease need to follow the recommendations of their health care provider to remain at home until they have no fever, all lesions have scabbed over, and no lesions have appeared for two days.

The viral disease affects the hands, feet and mouth and usually infects infants and children younger than 5 years old in summer and early autumn. There is no vaccine to protect against it, but learning about the disease and following these recommendations can reduce the risk of illness.

Hand, foot and mouth disease spreads:

Person-to-person: Direct contact with saliva, sputum or nasal mucus from the infected person’s nose and throat or with fluid in blisters, or with stool.

Surface-to-person: Touching objects and surfaces touched by infected persons.

Infected persons are most contagious during the first week of the illness, but can still pass the virus for weeks after symptoms have gone away.

These are the symptoms:

Fever, rash, sores, poor appetite, a vague feeling of illness and sore throat.

Painful sores in the mouth may blister and become ulcers.

Skin rash, flat or raised red spots, develops over 1 to 2 days.

Rash usually on the palms of the hands and soles of the feet and may appear on the knees, elbows, bottom or genital area.

Dehydration may occur because of painful mouth sores.

Recommendations to protect yourself and prevent its spread:

Wash hands with soap and water carefully and frequently, especially after going to the bathroom, after changing diapers, and before preparing foods or beverages.
Disinfect surfaces and items, including toys. First wash the items with soap and water; then disinfect them with a solution of 1 tablespoon of bleach and 4 cups of water.
Avoid close contact such as kissing, hugging or sharing eating utensils or cups with infected people.

Health care providers are being asked to notify the Alabama Department of Public Health if higher than normal numbers of cases are being hospitalized with hand, foot and mouth disease symptoms. Please call (800) 338-8374 immediately for hospitalized cases.

-30-

2/10/12

While apparently a bit more serious than the garden variety of HFMD we are used to seeing in the United States, this A6 virus doesn’t appear to be as pathogenic as the EV-71 virus seen in Asia.

But its arrival in the United States serves as a reminder that well adapted emerging viruses are very good at spreading, and that with today’s highly mobile society, oceans and borders provide little in the way of protection.

A Flu Flew Review

2012-02-12T17:53:00.001-05:00

UPDATED 1800hrs EST: The latest news reports out of NZ indicate that unaffected passengers have been allowed off the plane are now going through customs. As expected, authorities now believe the sick passengers probably contracted seasonal H3N2 influenza while in Japan.

# 6137

While we wait for an update (see update) on the Boeing 777 currently quarantined on the tarmac at Auckland airport with scores of passengers complaining of flu-like symptoms (see New Zealand : Airline Passengers Quarantined) this would seem an opportune time to look back at some of what we’ve learned about airplanes, airports, and influenza over the years.

What follows are excerpts from previous blogs, you can follow the links to read them in their entirety.

As I mentioned in my last blog, New Zealand has a very aggressive influenza pandemic plan, and I wrote about their drills and preparations back in October of 2008.

New Zealand: Testing Pandemic Quarantine Plans

New Zealand, being an island nation, is one of the few countries that believe they have at least the possibility of blocking a pandemic virus from entering their borders.

It is an ambitious goal.

And the odds of carrying it out successfully are pretty long.

How far they will go to try to block a pandemic virus from entering their country hasn't been decided yet by their Ministry of Health (MOH).

In their FAQ on pandemic influenza, the question is answered this way:

Will New Zealand stop travellers from coming into the country in an effort to stop the spread of disease?

Because we are an island nation, active management of the border (i.e. limiting arrivals from affected areas to allow us to impose effective on-arrival measures) needs to be considered among the range of options as we plan our response. Other countries are also considering border management options.

Any final decision on border management will be made by the Government with input from a range of government departments.

The details of how New Zealand might manage its borders are laid out in the National Health Emergency Plan: New Zealand Influenza Pandemic Action Plan 2006.

But whether the goal is to try to stop the virus from entering the country, or to simply slow the introduction while a vaccine is being produced, it takes planning and training.

The enormity of the job of interdicting infected passengers was the subject of a blog I wrote just one month before the outbreak of the 2009 H1N1 pandemic virus.

How The Next Pandemic Will Arrive

# 2876

There is a lot we don't currently know about the next pandemic. We don't know when it will arrive. We don't know what virus will cause it. And we don't know how bad it will be.

But there is one thing almost certain.

It will arrive in most countries by airplane.

The video above, which as been making the rounds for several months, was made by ZHAW (Zürcher Hochschule für Angewandte Wissenschaften) or The Zurich University of Applied Sciences.

It is a simulation (using real data) showing 24 hours of air traffic around the world. Notice how the level of activity follows the daylight.

Every year there are more than 17,000,000 commercial airline flights (data from year 2000 - it's probably higher now) that carry hundreds of millions of passengers each year.

As far as the transmission of the influenza virus aboard an airliner, in May of 2010 we saw a study in the BMJ that looked at that very topic. And as the fates would have it, this study was done on a plane flight into the same airport in Auckland, New Zealand.

Note: Given the incubation period of most respiratory viruses, those who are symptomatic on today’s flight almost certainly were exposed and infected prior to boarding the flight.

Friday, May 21, 2010

BMJ: Flu Transmission Risks On Airplanes

# 4586

BMJ 2010;340:c2424

Research

Transmission of pandemic A/H1N1 2009 influenza on passenger aircraft: retrospective cohort study

Michael G Baker, associate professor¹, Craig N Thornley, medical officer of health², Clair Mills, senior lecturer³, Sally Roberts, microbiologist⁴, Shanika Perera, medical officer of health², Julia Peters, medical officer of health², Anne Kelso, director⁵, Ian Barr, deputy director⁵, Nick Wilson, associate professor¹

I’ve reproduced portions of the abstract below. The entire study is available online at the BMJ.

Objectives To assess the risk of transmission of pandemic A/H1N1 2009 influenza (pandemic A/H1N1) from an infected high school group to other passengers on an airline flight and the effectiveness of screening and follow-up of exposed passengers.

<SNIP>

Setting Auckland, New Zealand, with national and international follow-up of passengers.

Participants Passengers seated in the rear section of a Boeing 747-400 long haul flight that arrived on 25 April 2009, including a group of 24 students and teachers and 97 (out of 102) other passengers in the same section of the plane who agreed to be interviewed.

Conclusions A low but measurable risk of transmission of pandemic A/H1N1 exists during modern commercial air travel. This risk is concentrated close to infected passengers with symptoms. Follow-up and screening of exposed passengers is slow and difficult once they have left the airport.

And lastly, a long hard look at attempts by countries to detect and isolate infected travelers during a pandemic. As countries discovered in 2009, travel restrictions are very difficult to implement, and will likely fail in the long run.

Travel-Associated H1N1 Influenza in Singapore

(Thermal Imaging in 2003)

The idea sounds simple.

By screening passengers for fever when they arrive via airplane (or boat or train) from another country you can hopefully reduce the number of infected passengers that enter during a pandemic.

In reality, it isn’t simple at all.

Today a summary from NEJM Journal Watch of a new study that has been published, ahead of print, in the CDC’s EID Journal entitled:

Epidemiology of travel-associated pandemic (H1N1) 2009 infection in 116 patients, Singapore. Emerg Infect Dis 2010 Jan; [e-pub ahead of print]. Mukherjee P et al

Travel-Associated H1N1 Influenza in Singapore

Airport thermal scanners detected only 12% of travel-associated flu cases; many travelers boarded flights despite symptoms.

Travelers play a key role in spreading many infections, including influenza. Such was the case with the spread of 2009 H1N1 influenza to Singapore, a major travel hub serving 37 million air passengers annually.

(Continue . . .)

New Zealand : Airline Passengers Quarantined

2012-02-12T16:56:00.001-05:00

# 6136

On an otherwise quiet Sunday afternoon here in the states, news wires are carrying reports of a Boeing 777-200 inbound from Japan that has landed at Auckland’s airport with roughly 60 passengers exhibiting flu-like symptoms.

While this sounds like the opening scene to a pandemic disaster movie, in all likelihood this will sorted out to be standard H3N2 influenza which is currently spreading across much of Japan.

The sudden onset of so many cases during this flight has obviously set off alarm bells for local health authorities, however.

New Zealand has developed one of the most aggressive airport disease surveillance and interdiction systems in the world.

For now, local media is reporting that all 274 passengers remain on the plane, and health authorities are setting up some sort of quarantine.

A couple of reports:

First from TVNZ

Health scare at Auckland Airport

breaking news

Published: 9:48AM Monday February 13, 2012

A major health response is under way after an Air New Zealand plane landed at Auckland Airport with children with flu-like symptoms on-board.

A group of 60 passengers arrived into Auckland off NZ90 from Narita, Tokyo, this morning with the symptoms.

Air New Zealand is following public health procedures and has advised the Auckland Regional Public Health Service.

(Continue . . .)

And this report from 3News New Zealand.

Flu-like symptoms on Air NZ Tokyo flight

By 3 News online staff

Sixty passengers arriving at Auckland International Airport this morning have reported flu-like symptoms, Air New Zealand has confirmed.

Flight NZ90 from Tokyo landed a short time ago and passengers remaining on the plane could be seen on the plane wearing face masks.

(Continue . . . )

While the odds favor this outbreak turning out to be something fairly mundane, I’ll keep an eye on it and update this blog if I hear more.

CDC: On The Slow Start To The Flu Season

2012-02-11T07:40:00.001-05:00

# 6135

Most years, north of the equator we find ourselves deep in the heart of flu season by the first week in February. Sometimes, we are even post-peak by now, and beginning to see a decline in cases.

But this year, influenza has been unusually slow to arrive in North America and Europe (although it is beginning to pick up).

The reasons for this late arrival are not abundantly clear, although I suspect the mild winter and growing community immunity after 3 years of having basically the same flu strains in circulation, probably have something to do with it.

While unusual, it is not unprecedented to have a late start to the flu season, as this latest entry from the CDC’s Have You Heard? website explains.

CDC Says U.S. Seeing Latest Flu Season in Nearly Three Decades

Still Not too Late to Vaccinate

February 10, 2012 --According to the CDC influenza surveillance report “FluView,” flu activity in the United States increased for the week ending February 4, 2012. The percentage of respiratory specimens testing positive for influenza nationally rose to 10.5 percent from 7.6 percent the prior week. This is the first time this season that the percent of respiratory specimens testing positive for influenza has surpassed 10 percent, which is generally a marker to indicate that flu season is beginning.

By this measure, flu is off to a late start this season. In the past 29 years, the percent of respiratory samples testing positive for flu has remained below the 10 percent mark until February only once before (1987-1988).

CDC tracks influenza activity through 8 surveillance categories. At the moment, other influenza activity indicators are lagging as well. Influenza-like-illness (ILI) remains below baseline nationally, which is again late for this time of year. However, this week, two regions of the country – the central and northwest regions – are reporting ILI activity above baseline for the first time this season, and one state – California – is the first to report widespread geographic influenza activity this season. Additionally, the second pediatric death of the season was reported in this week’s FluView, which was associated with an unsubtyped influenza A virus.

These key flu indicators are expected to increase in the coming weeks. “The increases we are seeing in the number of respiratory samples testing positive for flu should forecast increases in other flu activity indicators in the coming weeks,” says Lyn Finelli, chief of domestic surveillance for CDC’s Influenza Division.

(Continue . . . )

Although influenza may be down this year, you shouldn’t count it out. We could still see a late season surge of Influenza A, and Influenza B typically doesn’t peak until March or April.

Complicating matters, yesterday’s FluView report indicates roughly half of the B viruses tested are of the Yamagata lineage, which has not been included in the seasonal vaccine for several years.

Influenza B (B/Victoria/02/87 and B/Yamagata/16/88 lineages) [37]:

Victoria Lineage [17]: Seventeen (45.9%) of the 37 influenza B viruses tested belong to the B/Victoria lineage of viruses and were characterized as B/Brisbane/60/2008-like, the influenza B component of the 2011-2012 Northern Hemisphere influenza vaccine.

Yamagata Lineage [20]: Twenty (54.1%) of the 37 influenza B viruses tested belong to the B/Yamagata lineage of viruses.

Only a small number of influenza B viruses from the United States have been available for testing so far this season. While less than 50% of these viruses are similar to the influenza B component in the 2011-2012 influenza vaccine, the majority of influenza B viruses circulating worldwide have been similar to the influenza vaccine strain.

It is too early in the influenza season to determine how well the seasonal influenza vaccine strains and circulating strains will match.

Ample enough reason to make good flu hygiene (covering coughs & sneezes, washing hands, staying home when sick) a priority all year round.

Because the only thing truly predictable about influenza is its unpredictability.

FluView: Week 5

2012-02-10T11:38:00.001-05:00

# 6134

According to the CDC’s latest FluView report, influenza activity is increasing across the United States but still remains below normal of this time of year. Unlike reports we have been seeing out of Mexico over the past month, the predominant strain here is H3N2.

A few excerpts from this week’s report, the most striking of which (and most encouraging) is the near absence of pediatric deaths from influenza reported so far this year.

2011-2012 Influenza Season Week 5 ending February 4, 2012

All data are preliminary and may change as more reports are received.

Synopsis:

During week 5 (January 29-February 4, 2012), influenza activity in the United States increased.

U.S. Virologic Surveillance: Of the 3,586 specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division, 378 (10.5%) were positive for influenza.

Pneumonia and Influenza (P&I) Mortality Surveillance: The proportion of deaths attributed to P&I was below the epidemic threshold.

Influenza-associated Pediatric Mortality: One influenza-associated pediatric death was reported and was associated with influenza A virus for which the subtype was not determined.

Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 1.7%, which is below the national baseline of 2.4%. Regions 7 and 10 reported ILI above region-specific baseline levels. One state experienced moderate ILI activity, 5 states experienced low ILI activity, New York City and 44 states experienced minimal ILI activity, and the District of Columbia had insufficient data.

Geographic Spread of Influenza: One state reported widespread geographic activity; 9 states reported regional activity; 12 states reported local activity; the District of Columbia, Puerto Rico, and 27 states reported sporadic activity; Guam, the U.S. Virgin Islands and 1 state reported no influenza activity.

Pneumonia and Influenza (P&I) Mortality Surveillance:

During week 5, 7.3% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage was below the epidemic threshold of 7.8% for week 5.

Influenza-Associated Pediatric Mortality:

One influenza-associated pediatric death was reported to CDC during week 5 and was associated with influenza A virus for which the subtype was not determined. The death reported during week 5 occurred during the week ending January 21, 2012 (week 3). This brings the total of influenza-associated pediatric deaths reported during the 2011-12 season to 2.

While it seems as if we are getting off unusually easy this year, there are still a couple of more months left in the traditional flu season, and as we saw in 2009, an off-season flu can also appear with little warning.

CIDRAP: Exploring the CFR Of H5N1

2012-02-09T14:53:00.001-05:00

# 6133

Since the H5N1 virus reappeared in 2003, the CFR (Case Fatality Rate) of that strain of avian flu has hovered around 60%. Some countries – like Indonesia & Cambodia are well into the 80% fatal range, while Egypt has somewhat lower CFR of about 35%.

The 1918 pandemic, by comparison, is believed to have only killed 2.5% of its victims.

Over the years a number of researchers have insisted that the true fatality rate must be far lower, and that limited surveillance systems in countries where the virus is endemic are only picking the `sickest of the sick’, who are most apt to die.

While long a bone of contention among flu specialists, recently this has become a part of the larger debate over the implied risks of publishing dual use’ H5N1 research.

Robert Roos of CIDRAP takes on this daunting topic today in a lengthy and important article.

Undetected H5N1 cases seem few, but questions persist

Robert Roos News Editor

Feb 9, 2012 (CIDRAP News) – The fatality rate for officially confirmed human cases of H5N1 avian influenza infection is a stunningly high 59% (345 deaths in 584 cases). But the current controversy over publishing data about transmissible H5N1 viruses has revived a debate about whether the virus is as lethal as those numbers say.

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CDC/Medscape Video: Expert Guidance On The H3N2v Virus

2012-02-09T13:17:00.001-05:00

# 6132

While we’ve heard very little over the past two months regarding the small number H3N3v (formerly called trH3N2) cases detected last fall across five states, the CDC continues update their guidance information, and has taken steps towards developing a seed vaccine.

This novel swine-origin virus is a reassortant between swine H3N2 and the 2009 H1N1 virus, and while it does not appear to be transmitting efficiently, some human-to-human transmission is suspected.

A sampling of earlier blogs on this emerging virus include:

WHO/FAO/OIE: Call It A(H3N2)v

WHO Comment: Testing For Novel Flu Viruses

Branswell On The New trH3N2 Flu Virus

CIDRAP: New Details In The trH3N2 Story

CDC Update On Iowa trH3N2 Cases

The CDC, in partnership with Medscape, produces a series of Expert Commentary videos aimed at physicians, nurses, pharmacists, and other healthcare professionals.

Earlier this week they posted an Expert Commentary video on the H3N2v virus. Follow the link below to watch:

Variant H3N2 Influenza Virus: What You Should Know

Michael Jhung, MD, MPH

Vietnam:`New’ H3N2 Swine Flu Virus Reported

2012-02-09T08:20:00.001-05:00

UPDATED: 1500hrs

Henry Niman has posted this afternoon that after further review, he believes this report to be a badly translated repost of a story from December on 10 Cases in the United States we already knew about.

Today’s story is ambiguous enough to make that a plausible explanation. Unless and until we can get some confirmation of this story I would advise that you view the following report with caution.

# 6131

This morning Editor & Senior Moderator Tetano on FluTrackers has picked up a series of news articles coming out of Vietnam talking about 10 human cases of infection by a `new’ H3N2 swine flu virus.

Two of these articles are machine translated from Vietnamese, and are therefore a bit garbled, but the third is an English Language report from the VOV (Voice of Vietnam).

Assuming the major points of today’s report are correct (not always a given), there is not enough information provided to know how this virus compares to the A/H3N2v virus which has been detected in a handful of cases in the United States (see CDC Releases Updated H3N2v Interim Guidance).

Keeping the usual caveats in mind regarding early media reports, here is the story from the Voice of Vietnam.

New strain of swine flu detected

Updated : 5:16 PM, 09/02/2012

(VOV) - The Heath Ministry has quoted sources from the Ho Chi Minh City Pasteur Institute confirming that a new kind of porcine flu virus, A/H3N1, has appeared, apparently a combination of the pig-related A/H1N1 and A/H3N2 flu viruses.

The medical sector has monitored 10 patients infected with the A/H3N2 virus with porcine origin, and found that three of them had not had direct contact with any diseased pigs.

Therefore, the sector has not ruled out the possibility of a mutation in the A/H3N2 strain which could lead to transmission between humans, instead of strictly from pigs to humans as previously.

However, the situation has not reached an alarming level because the virus has not changed much; it has low toxicity and has shown no sign of drug resistance.

Flu vaccines are able to cope with small changes in this kind of virus, said Le Hoang San, Vice Director of the HCMC Pasteur Institute.

Swine are highly susceptible to the influenza virus, and are capable of serving as `mixing vessels’, allowing them to reassort into new hybrid strains.

Reassortment happens when two different influenza viruses co-infect the same host, swap genetic material, and produce a hybrid virus.

That is essentially what happened in 2009, when the H1N1 swine flu virus emerged after bouncing around swine herds for a decade or more, picking up genetic changes along the way.

And not surprisingly, this recently emergent `humanized’ H1N1 virus has re-entered the swine population and is once again mixing and matching with other circulating swine flu viruses.

As a result we now have a Swine H3N2 virus that has reassorted with the 2009 pandemic H1N1 virus, producing a new hybrid that has – in a limited fashion – begun to emerge into the human population.

The article above calls the Vietnamese strain a `combination of the pig-related A/H1N1 and A/H3N2 flu viruses’ – which if we take literally – suggests a different reassortment than the one we’ve seen in the United States.

As stories in the media often gloss over or confuse crucial scientific details we really need to wait for a more definitive report before we can talk about the origin, genetic makeup, and potential of this new virus.

For now, this is simply something new to keep an eye on in the ever changing and always surprising world of influenza.

Update: In a conversation with Sharon Sanders of FluTrackers this morning, she pointed out that this article refers to this new reassortant virus as H3N1 (once) and H3N2 (twice).

I took the first mention (H3N1) as a likely misprint, but until we can get some clarification, I don’t think we can say with any confidence exactly which strain this new virus is.

Nature Editorial: Facing Up To Flu

2012-02-08T14:44:00.001-05:00

BSL-4 Lab Worker - Photo Credit –USAMRIID

# 6130

Tying in with my last post (see Declan Butler: Lab flu may not aid vaccines), we’ve an editorial appearing today in Nature that calls into question the short-term benefits of so-called `dual use’ H5N1 research.

Follow the link to read:

Nature | Editorial

Facing up to flu

Nature 482,131

(09 February 2012) doi:10.1038/482131a

Published online 08 February 2012

The potential for mutant-flu research to improve public health any time soon has been exaggerated. Timely production of sufficient vaccine remains the biggest challenge.

(Continue . . .)

I expect that we’ll see vigorous counterpunching on this issue in the not too distant future as both sides prepare for the meeting in Geneva next week.

Stay tuned.

The stakes here are extraordinarily high, the issues are complex, and I expect no shortage of fireworks.

Declan Butler: Lab flu may not aid vaccines

2012-02-08T14:14:00.001-05:00

Photo Credit – CDC PHIL

# 6129

One of the counter arguments offered by researchers when biosecurity experts have warned on the dangers of `dual use’ H5N1 research, is that these experiments put us in a position to create a vaccine faster, should these genetic changes occur in nature.

Today Declan Butler, writing for Nature, explores that argument and finds that while the logic behind it is appealing, the reality may fall a bit short.

Lab flu may not aid vaccines

Game-changing vaccine technologies are needed to strengthen global pandemic defences.

Declan Butler

08 February 2012

Video: NYAS H5N1 Debate

2012-02-08T12:20:00.001-05:00

# 6128

Last week (Feb 2nd) the New York Academy of Sciences hosted a 2-hour debate over H5N1 `dual use’ research.

The discussion – called Dual Use Research: H5N1 Influenza Virus and Beyond – was moderated by famed epidemiologist and virus hunter Professor Ian Lipkin, who among his many accomplishments is Director, Center for Infection & Immunity, and John Snow Professor of Epidemiology at Columbia.

The panel members consisted of:

Arturo Casadevall, MD, PhD, Albert Einstein College of Medicine, and member, NSABB;
Laurie Garrett, PhD, Council on Foreign Relations;
Barbara R. Jasny, PhD, Science;
Veronique Kiermer, PhD, Nature Publishing Group;
Michael T. Osterholm, PhD, MPH, Center for Infectious Disease Research and Policy, University of Minnesota, and member, NSABB;
Peter Palese, PhD, Mount Sinai School of Medicine;
Vincent Racaniello, PhD, Columbia University;
Alan S. Ruldolph, PhD, Defense Threat Reduction Agency.

The result was a lively, sometimes heated debate.

Today, the NYAS has posted video of that debate (in 2 parts) on their website.

"Dual Use Research: H5N1 Influenza Virus and Beyond" Panel Sparks Lively Debate

A hat tip to Vincent Racaniello & Laurie Garrett for tweeting the announcement.

The CDC Responds To The Cochrane Group’s Tamiflu Study

2012-02-08T08:31:00.001-05:00

Photo Credit – Wikipedia

# 6127

Three weeks ago, The Tamiflu Controversy Continues we looked at the ongoing debate over the effectiveness of oseltamivir (Tamiflu ®) in the wake of the release of a new Cochrane group analysis that found insufficient evidence to show whether the drug reduces influenza complications and transmission.

Robert Roos of CIDRAP provided a good summation of that Cochrane group analysis in:

Review renews questions about oseltamivir benefits

Robert Roos News Editor

Jan 19, 2012 (CIDRAP News) – A lengthy new analysis of unpublished clinical trial data is renewing questions about the effectiveness of the influenza drug oseltamivir (Tamiflu), saying that although the drug shortens flu symptoms by about a day, there is no evidence that it reduces hospital admissions.

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While research purists may applaud their methods, the problem that I (and many others) have with this analysis is that the Cochrane group set the bar very high as to what studies they would consider, and effectively ignored any observational studies.

As few studies met their criteria, they were unable to determine one way or the other, the overall effectiveness of the drug.

Despite the fact that their analysis was inconclusive, some aspects of the media immediately latched onto this as `proof’ that Tamiflu was ineffective.

No doubt spurred by this media buzz, yesterday the CDC on their Have You Heard? website published their rationale for continuing to recommend the use of Oseltamivir for severe influenza.

CDC Recommendations for Influenza Antiviral Medications Remain Unchanged

February 7, 2012 -- A recent review of randomized clinical trial data for the influenza neuraminidase inhibitor antiviral medications published by the Cochrane Collaboration, and two related commentaries [“Rethinking credible evidence synthesis” and “Questions Remain over safety and effectiveness of oseltamivir”] published in the British Medical Journal, raised questions about the value of antiviral medications for the prevention and treatment of influenza. After careful consideration of all available evidence, CDC guidance on the use of antiviral medications remains unchanged. The Centers for Disease Control and Prevention (CDC) continues to recommend the use of the neuraminidase inhibitor antiviral drugs (oral oseltamivir and inhaled zanamivir) as an important adjunct in the prevention and treatment of influenza.

The Cochrane review assessed unpublished and published data from randomized controlled trials (RCTs) of oral oseltamivir or inhaled zanamivir versus placebo for early treatment (within 48 hours after illness onset) or chemoprophylaxis of uncomplicated seasonal influenza in otherwise healthy adults and children. The review concluded that in adults and children with influenza-like illness, early oseltamivir treatment shortens the duration of symptoms by approximately 21 hours compared to placebo. This finding is similar to results in published RCTs which reported a reduction of approximately one day of laboratory-confirmed influenza illness by early oseltamivir treatment. One RCT in children aged 1 to 3 years with influenza found a reduction of 3.5 days when oseltamivir treatment was started within 24 hours after illness onset. The Cochrane review was unable to reach conclusions about the efficacy of oral oseltamivir or inhaled zanamivir treatment to reduce health complications, including those which might result in hospitalization. The review authors reported that they did not have full access to all unpublished data for oseltamivir RCTs as requested from the manufacturer.

A systematic review of RCTs should include unpublished and published data, and researchers should have full access to these data. However, such a review may not fully inform the question of whether antiviral treatment reduces severe influenza complications such as those resulting in hospitalization in generally healthy persons because enormous numbers of participants are needed. The burden of influenza disease is greatest among the elderly, persons with underlying medical conditions such as chronic obstructive pulmonary disease, asthma, congestive heart failure, diabetes, pregnant women, and young children. These groups are at highest risk for developing severe complications from influenza resulting in hospitalization or death, and generally have not been studied in RCTs.

The Cochrane review did not consider any data from uncontrolled observational studies of oseltamivir treatment. While such studies have inherent design limitations, they can inform clinical practice and public health, especially when data from RCTs are unavailable or have not been conducted among high-risk groups or hospitalized influenza patients, or because having a placebo group would be unethical since antiviral treatment is recommended for these groups. Indeed, many observational studies of antiviral treatment of seasonal influenza or influenza A (H1N1) pdm09 (2009 pandemic H1N1) have been conducted among hospitalized patients, including critically ill children and adults. These observational studies from many countries have consistently found that early oseltamivir treatment of influenza patients reduces the duration of hospitalization and risk of severe outcomes such as intensive care unit admission or death. These studies have reported that clinical benefit is greatest when oseltamivir treatment is started within 48 hours of illness onset; however clinical benefit has still been observed when oseltamivir treatment is started up to less than 5 days after illness onset.

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While falling short of the `gold standard’ employed by the Cochrane group for inclusion into their analysis, we’ve a number of compelling observational studies to look at, including:

In 2010 we saw an observational study that appeared in JAMA (see Study: Antivirals Saved Lives Of Pregnant Women) that strongly suggested that Tamiflu was life saving for some patients with pandemic flu.

And again in 2010, in BMJ: Efficacy of Oseltamivir In Mild H1N1, we saw a study which suggested that the administration of oseltamivir may have significantly reduced the incidence of pneumonia among otherwise healthy pandemic H1N1 patients.

And lastly, in Study: Antiviral Therapy For H5N1, we saw the largest study to date on the outcomes of H5N1 patients who either received, or did not receive, antiviral treatment.

The research appears in the IDSA’s Journal of Infectious Diseases. The bottom line is essentially out of 308 cases studied, the overall survival rate was a dismal 43.5%.

But . . . of those who received at least one dose of Tamiflu . . . 60% survived . . . as opposed to only 24% who received no antivirals.

There are other concerns when it comes to use of oseltamivir, of course. Including the possibility inducing side effects and the possibility of generating resistant strains of the influenza virus.

But for now, it remains one of the few pharmacological options we have available to treat severe influenza.

Nature Video: Debating research into mutant H5N1 flu virus

2012-02-07T16:39:00.001-05:00

# 6126

My thanks to Vincent Racaniello & @HelenBranswell for tweeting about the uploading this afternoon of the following 5-minute Nature.com video interview with several of the major players in the H5N1 research debate.

You can view it on the Nature Newsblog website, or via the Nature Video channel on Youtube.

Study: The Effects Of School Closures During A Pandemic

2012-02-07T09:17:00.001-05:00

# 6125

Although not without its critics, extended school closures have been promoted as one of a list of NPIs (non pharmaceutical interventions) that might be used to slow the spread of illness during a severe influenza pandemic.

The chart above, taken from the PNAS journal article entitled Public Health Interventions and Pandemic Intensity During the 1918 Influenza Pandemic, shows the excess mortality in two American cities. The tall spike represents Philadelphia, while the lower curve represents St. Louis.

Many researchers believe the startling difference in attack rates, and mortality, in these two cities can be explained by the way each city dealt with the outbreak.

In St. Louis, the Health Department closed public venues such as schools, theatres and churches very early in the outbreak, while Philadelphia did not.

During the spring of 2009, when novel H1N1 first began to spread, schools closures were recommended by the CDC, and by other public health entities around the world.

By early May it became apparent that the severity of this particular influenza virus was less than originally feared, and many public health agencies moderated their recommendations (see CDC No Longer Recommending School Closures For A/H1N1).

Some school districts, in the U.S., and elsewhere around the world, continued to close schools on a case-by-case basis well into the fall of 2009.

School closings are controversial and they do not come without some social and economic costs (see The Debate Over School Closures).

Critics point out that working parents rely on schools to watch their kids for much of the year during the day, and many low income families benefit from the school lunch program.

And of course, when schools are closed during a pandemic, some kids may congregate elsewhere and spread the virus anyway.

While decisions on whether to close schools during a pandemic might well be trumped by parental concerns, it is important for policymakers to get some idea of the benefits that proactive school closings would generate.

To that end we’ve seen a number of studies that came out of the most recent pandemic, and while the results have not all been in alignment, many have indicated substantial benefit from school closures.

In a report that appeared last year in the journal Eurosurveillance (see Eurosurveillance: New Research On Pandemic Influenza), we saw several studies that attempted to quantify the benefits of school closures:

Three studies out of Japan found a beneficial effect during the 2009 pandemic by using antiviral drugs and/or school closure (of varying length and timing) to interrupt its transmission.

Conversely, a fourth study suggested that early school closures could have adversely affected herd immunity in the school environment, with lower cumulative infection rates in schools that delayed closure.

Last May (see NIH: School Closings Effective In 2009 Pandemic) we saw a report indicating that school closings in Mexico reduced disease transmission by as much as 37%.

This from the NIH.

Tuesday, May 24, 2011
5 p.m. EDT

Mexican flu pandemic study supports social distancing

Fogarty research published in PLoS Medicine

Eighteen-day periods of mandatory school closures and other social distancing measures were associated with a 29 to 37 percent reduction in influenza transmission rates in Mexico during the 2009 pandemic. The research was carried out by scientists at the Fogarty International Center at the National Institutes of Health and published in PLoS Medicine.

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I’ve posted on a number of other studies of the effects of school closures over the past few years, including:

Study: Pandemic Mitigation by Early School Closure

Study: Student Behavior During Pandemic School Closings

School Closures Revisited

All of which serves as prelude and introduction for a new study, just out in the Annals of Internal Medicine, that looks at the effects of school closures in Canada during the 2009 pandemic.

Effects of School Closure on Incidence of Pandemic Influenza in Alberta, Canada

David J.D. Earn, PhD; Daihai He, PhD; Mark B. Loeb, MD, MSc; Kevin Fonseca, PhD; Bonita E. Lee, MD, MSc; and Jonathan Dushoff, PhD

Abstract (excerpts)

Background: Control of pandemic influenza by social-distancing measures, such as school closures, is a controversial aspect of pandemic planning. However, investigations of the extent to which these measures actually affect the progression of a pandemic have been limited.

<SNIP>

Results: The ending and restarting of school terms had a major effect in attenuating the first wave and starting the second wave of pandemic influenza cases. Mathematical models suggested that school closure reduced transmission among school-age children by more than 50% and that this was a key factor in interrupting transmission. The models also indicated that seasonal changes in weather had a significant effect on the temporal pattern of the epidemic.

<SNIP>

Conclusion: Analysis of data from unrestricted virologic testing during an influenza pandemic provides compelling evidence that closing schools can have dramatic effects on transmission of pandemic influenza. School closure seems to be an effective strategy for slowing the spread of pandemic influenza in countries with social contact networks similar to those in Canada.

While the entire article is behind a pay wall, for more on this we can go to the press release from McMaster University.

School closures slow spread of pH1N1

Should be considered as a control measure during pandemic outbreaks

Hamilton, ON (Feb. 6, 2012) - Closing elementary and secondary schools can help slow the spread of infectious disease and should be considered as a control measure during pandemic outbreaks, according to a McMaster University led study.

Using high-quality data about the incidence of influenza infections in Alberta during the 2009 H1N1 flu pandemic, the researchers show that when schools closed for the summer, the transmission of infection from person to person was sharply reduced.

"Our study demonstrates that school-age children were important drivers of pH1N1 transmission in 2009," says David Earn, lead author of the study published in Annals of Internal Medicine. Earn is professor in the Department of Mathematics and Statistics and member of McMaster's Michael G. DeGroote Institute for Infectious Disease Research (IIDR).

Alberta was the only Canadian province to continue extensive virologic testing throughout the first wave and continuously to the middle of the second wave of the 2009 pandemic, allowing researchers to identify the causes of changes in incidence as the pandemic progressed.

"The data that we obtained were so good that our plots immediately revealed a huge drop in incidence when schools were closed for the summer," says Earn. "Using state-of-the-art modeling, we then demonstrated that transmission was reduced by at least 50 per cent."

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Although the severity of any novel pandemic virus will no doubt figure into the equation (as will the social and economic costs of shuttering schools), today’s study adds considerable weight to the notion that school closures could be an effective intervention during the next influenza pandemic.

Reminder: Great Central U.S. Shakeout Today

2012-02-07T07:14:00.001-05:00

# 6124

The Great Central U.S. Shakeout, scheduled for today (Feb 7th) at 10:15am, will hopefully bring more than 3 million people together for a multistate earthquake drill.

This exercise will be conducted in the style of The Great California Shakeout which has been been running successfully for a number of years (see Reminder: Great Shakeout On Thursday).

As far as how to protect yourself during an earthquake, officials advise:

PROTECT YOURSELF. SPREAD THE WORD.

Official rescue teams who have been dispatched to the scene of earthquakes and other disasters around the world continue to advocate use of the internationally recognized "Drop, Cover and Hold On" protocol to protect lives during earthquakes:

DROP to the ground (before the earthquake drops you!),

Take COVER by getting under a sturdy desk or table, and

HOLD ON to it until the shaking stops.

If there isn’t a table or desk near you, cover your face and head with your arms and crouch in an inside corner of the building. Do not try to run to another room just to get under a table.

www.dropcoverholdon.org

H5N1 Research: A Plethora Of Positions

2012-02-06T10:49:00.001-05:00

BSL-4 Lab Worker - Photo Credit –USAMRIID

# 6123

While historically politics, religion, or sporting contests can be counted on as being the most divisive of subjects, over the past few months we’ve seen rise to a different bitter line of debate;

Under what circumstances should potentially dangerous life or bioscience research be conducted and/or published?

Although it has been simmering in the background for years, this issue came to the forefront several months ago when Ron Fouchier announced at a scientific conference in Malta that he’d successfully `mutated the hell’ out of the H5N1 virus and turned it into a highly transmissible (and still lethal) virus in ferrets.

At the same time, in a different lab half a world away, virologist Yoshihiro Kawaoka accomplished very nearly the same feat, albeit without the high lethality seen in Fouchier’s ferrets.

In November alarm bells were raised by bio-terrorism experts, who warned that this information in the wrong hands could be catastrophic (see NPR: Bio-Terrorism Concerns Over Bird Flu Research).

Last December, the NSABB - after reviewing the papers from both of these projects - recommended unanimously that key details on how they were conducted be redacted from the publically available journals.

And that has unleashed a firestorm of controversy.

You can find a nice recap of all of this by Debra MacKenzie in this morning’s edition of New Scientist (Doomsday flu decision time: The story so far).

Later this month, in a closed-door meeting in Geneva, a small, select group of scientists will gather to discuss this controversy. The hope is they will forward some recommendations on how to proceed for consideration by the greater international scientific community.

In the meantime, the media is filled with diverse opinions on this subject.

One of the more extreme views comes this morning via John Horgan writing for Scientific American. He gives his list of available options, and finds all of them lacking. He proposes that the `least bad’ option is:

Let’s Ban Research That Makes the Bird-Flu Virus and Other Pathogens Deadlier

By John Horgan | February 6, 2012 |

While at the far end of the spectrum in this debate, Horgan echoes many of the same sentiments as Tom Inglesby, Director of the Center for Biosecurity at the University of Pittsburgh Medical Center.

In a letter to the Editor of the New York Times, Inglesby recently argued:

The potential benefits of the research do not justify the potential dangers, so the research should be discontinued. While in almost all circumstances basic research should be fully disseminated in the science community, in this case the results should not be published in a way that allows them to be replicated by others. If allowed to continue, the research should be performed only in pursuit of concrete, urgent goals under international approval and the greatest possible safety conditions.

TOM INGLESBY
Baltimore, Jan. 24, 2012

The Director of Australia's National Centre for Biosecurity, Professor Ian Ramshaw, warned in an article yesterday in The Canberra Times that potentially dangerous H5N1 research is being conducted in labs with insufficient biosecurity measures, and even states that these mutated viruses should not have been created to begin with.

Killer bug in the system

BY PHILLIP THOMSON

05 Feb, 2012 01:00 AM

THE CANBERRA scientist who argued against details of a new strain of potentially apocalyptic bird flu being published has warned of inadequate security at the lab where the virus was developed and says the virus should not have been developed at all.

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A bit ironic, as Professor Ramshaw gained considerable notoriety a decade ago when he and his research team published details on how they created a new, and highly pathogenic form of mousepox.

Comparatively speaking, the above views make the recommendations of the NSABB appear almost centrist, as they only called for the redaction of key elements from two scientific papers, not for a ban into this type of research.

Surprisingly, an opinion published last week by none other than Robert G. Webster, considered to be one of the world’s foremost authorities on influenza, got very little mention in the press.

Mammalian-Transmissible H5N1 Influenza: the Dilemma of Dual-Use Research

Robert G. Webster

While conceding that the details of how these two H5N1 experiments were conducted will likely leak out at some point, he nonetheless believes the details on how to create a transmissible H5N1 virus should not be published.

Webster believes this type of research must continue, but also worries that the lower biosecurity level labs (BSL-3) may not have adequate safety measures for containing H5N1.

He has a lot more to say, so by all means follow this link to read it in its entirety.

Last week, in an apparent response to the BSL-3 / BSL-4 debate, the Public Health Agency of Canada issued a Biosafety Advisory for working with transmissible strains of the H5N1 virus, relegating such work to their highest containment (CL-4) labs.

On the other end of the spectrum are researchers and scientists who believe that concerns over the biosafety aspects of these experiments are overblown, and that work on these viruses must continue and the results should be published in their entirety.

Virologist and blogger Professor Vincent Racaniello argues strenuously for this position in his recent mBio article:

Science Should Be in the Public Domain

Vincent R. Racaniello

Department of Microbiology and Immunology, Columbia University College of Physicians and Surgeons, New York, New York, USA

ABSTRACT

Variants of avian influenza H5N1 virus that are transmitted by the airborne route among ferrets have been identified. The National Science Advisory Board for Biosecurity has advised against publication of the details of the methods used to obtain these viruses and the amino acid changes that lead to transmission in ferrets. This decision is not based on sound scientific principles and risks setting a precedent that will make it easier to put in place highly restrictive regulations on scientific research and publication.

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And similarly, noted microbiologist Peter Palese, in an opinion piece recently published in PNAS – argued:

H5N1 influenza viruses: Facts, not fear

Peter Palese 2. Taia T. Wang

Abstract

The ongoing controversy over publication of two studies involving the transmission in ferrets of H5N1 (H5) subtype influenza viruses and the recommendations of the National Science Advisory Board for Biosecurity to redact key details in the manuscripts call for an examination of relevant scientific facts. In addition, there are calls in the media to destroy the viruses, curtail future research in this area, and protect the public from such “frightening” research efforts. Fear needs to be put to rest with solid science and not speculation.

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As a non-scientist, I must rely on the opinions and judgments of scientists I trust.

Here, that proves exceedingly difficult, as the range of opinion from people I highly respect covers the gamut – from preserving the ideals of scientific and intellectual freedom . . . to an outright ban on conducting this type of research.

In this issue we have an honest disagreement among experts, and all sides have at least some solid ground to stand on. And no matter how diverse, I believe these opinions to be heartfelt and sincere.

We are on the cusp of a new era of life sciences, where scientists can manipulate and even create life forms in the laboratory. Although the potential for good that this research offers is immense, there is also the possibility of serious mishap as well.

While we are focused today on the fate of two H5N1 research papers, the real problem runs far deeper;

Our failure to anticipate and deal with the numerous ethical and practical issues that these new bioengineering sciences presents.

The Fouchier and Kawaoka papers have merely brought this issue to a head.

Whether these papers end up published in their entirety or not, the bigger issue is that the international scientific community must come up with a consensus over rules and guidelines for life sciences research.

Otherwise, these bitter debates will form an ongoing rift between scientists, and over time, further erode the public’s confidence in the scientific establishment.

An Off-Season Reminder

2012-02-05T13:25:00.001-05:00

Photo – GOES Weather Loop 2/5/12

# 6122

The Atlantic Hurricane season runs from June 1st through the end of November, but over the years we’ve seen a number of off-season tropical weather systems develop – albeit rarely in February or March.

Today, NOAA has their eyes on a disturbance off the western tip of Cuba that has a slim possibility of intensifying before it reaches Florida.

Early models drag it up and across the peninsula of Florida over the next couple of days, bringing with it some much needed precipitation.

Model Credit – SWFTMD

There appears to be very little chance that this system will amount to much, but history records at least one February Tropical storm.; the famous Groundhog Day storm of 1952.

Photo Credit –Wikipedia

Sporting winds of 50 MPH when this system came ashore near Cape Sable, it did little damage, but surprised a lot of folks with its offseason arrival.

While not of tropical origin, the far more destructive `Super storm’ of March 1993 brought a 10 foot surge tide out of the Gulf of Mexico, pushed by hurricane force winds that battered the coast for 12 hours.

As it raked up the eastern seaboard it dumped record amounts of snow from the Florida Panhandle to New England. Along the way it claimed more than 300 lives and inflicted more than $6 billion dollars in damage.

That storm is a vivid memory for me, as it saw me spending 12 very tense and cold hours aboard my 32-foot sailboat, trying to keep her from being damaged or sunk as the winds and tides battered us.

A not-so-gentle reminder that disasters can occur with little or no warning, and that severe storms can show up even when the calendar says they shouldn’t.

Preparedness is truly a year-round responsibility.

For more information on how to prepare for disasters or emergencies, the following sites should be of assistance.

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

A few of my preparedness blogs you might wish to revisit including:

When 72 Hours Isn’t Enough

In An Emergency, Who Has Your Back?

An Appropriate Level Of Preparedness

The Gift Of Preparedness 2011

In the meantime, it will be interesting to see if this little-storm-that-could turns into anything more than the answer to some future meteorological trivia question.

Nepal: Bird Flu Reported In Two Provinces

2012-02-05T09:02:00.001-05:00

Map Credit - Wikipedia

# 6121

Located as it is between two nations with a long history of outbreaks of H5N1 (India and China), and separated by but a few kilometers from Bangladesh – another bird flu hotspot – it isn’t surprising that Nepal finds itself dealing bird flu outbreaks on occasion.

Nepal first confirmed the H5N1 virus in their nation in January of 2009 (see Nepal: Concerns Rise Over More Poultry Deaths).

In early December of last year the OIE was notified of a small outbreak of H5N1 near Kathmandu (see Bird Flu Reports From Nepal). Prior to that outbreak, the last OIE report I can find was filed in February of 2010; Final report 12669.

The media has complained in the past that officials have been slow in dealing bird flu, such as in this report which appeared in the Kathmandu Post last November describing a `cursory probe’ and `lax response’ by public health officials during the most recent outbreak.

One complication for local officials is they must send off samples to labs outside of the country in order to confirm the presence of H5N1, which has led to delays in implementing control methods.

Today, after several days of reports of suspicious poultry deaths in Nepal, we get media confirmation that the H5N1 virus has been detected among poultry in two provinces; Sumari and Ilam.

Two reports from Nepalnews.com:

Lab tests confirm outbreak of bird flu in Sunsari

Sunday, 05 February 2012 13:27 Read this : 105 times

The government authorities Sunday confirmed outbreak of bird flu in Sunsari district where around 5,000 chickens had died earlier this week.

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Bird flu found in Ilam also

Sunday, 05 February 2012 18:28 Read this : 40 times

On the same day bird flu outbreak was confirmed in Sunsari district, local authorities in Ilam Sunday said the the similar case was detected in Ilam district also.

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Nepal is finding - as have nations like Vietnam, India, Egypt, Indonesia, and Bangladesh before it - that once the H5N1 virus establishes itself in an area, it can be very difficult to eradicate it completely.

For now, the H5N1 virus remains poorly adapted to human physiology, and while rare human infections have been reported, the virus has not figured out how to transmit efficiently among humans.

Recent laboratory experiments have shown, however, that there is no biological barrier to the virus someday achieving that ability.

And so we watch outbreaks such as these with considerable interest.

Bangladesh: Charges That A Lack Of Compensation Sends Infected Birds To Market

2012-02-04T10:01:00.001-05:00

Photo Credit – FAO

# 6120

While its not exactly breaking news that some H5N1 infected poultry have made their way into local food markets, most of the countries where the virus is endemic have taken steps to reduce those risks.

Many nations have introduced poultry vaccination against the bird flu virus (albeit, not always a good thing), and most countries have some form of monetary incentive for farmers to cull their flocks if their poultry become infected.

Today (h/t Cottontop on the Flu Wiki) we’ve a lengthy and scathing report on the proliferation of the H5N1 virus in Bangladeshi poultry, and deficits in their compensation program that are claimed to be responsible for farmers sending infected birds to market.

This via the Financial Express. Follow the link to read it in its entirety.

Bird flu affected chickens being supplied to local markets

Arafat Ara Dhaka, Saturday February 4 2012

Bird flu affected chickens are being supplied to the local markets due to lack of monitoring and proper policy support to the poultry farmers by the authority, said sector insiders.

They said the farmers are selling their infected chickens in the markets hiding the information as the government does not compensate the farmers adequately.

(Continue . . . )

While media reports can sometimes slant stories - and part of this story relies on information obtained from unnamed `insiders’ - it is worth noting that the most recent report filed with the OIE on bird flu in Bangladesh ( 15/01/12 Follow-up report No. 37 ) lists 526 outbreaks in that country since 2007.

Map Credit OIE

Hardly a reassuring picture that Bangladesh is anywhere close to getting control over their endemic bird flu situation.

The Great Central U.S. Shakeout: Feb 7th, 2012

2012-02-04T08:23:00.001-05:00

# 6119

We are now only 3 days away from The Great Central U.S. Shakeout, scheduled for 10:15am on February 7th, 2012. Last year, in the first central states shakeout drill, more than three million people registered to participate.

This year they hope to improve those numbers.

This exercise will be conducted in the style of The Great California Shakeout which has been been running successfully for a number of years (see Reminder: Great Shakeout On Thursday).

To date, more than 2.2 million individuals, businesses, organizations, and entities have registered to participate in this year’s Shakeout.

To learn how to join in, click on the image below:

And to learn what do during an earthquake, Shakeout.org has a number of short videos at this link.

You don’t have to live near the New Madrid fault, or in California, the Pacific Northwest, or Alaska to be impacted by an earthquake.

While large earthquakes in the eastern half of the country are relatively uncommon, they do happen. Charleston, S.C. was devastated by a 7.3 magnitude quake in 1886.

USGS map

As you can see by the map above, much of the United States is seismically active – with Alaska, Hawaii, the west coast, and the mid-west seeing the most – and strongest, quakes.

Few places, however, can claim to be completely immune to quakes.

Several months ago, during the 2011 National Preparedness Month campaign, I wrote at length about earthquake preparedness (see NPM11: Are You Earthquake Prepared?).

There you’ll find many resources, including the The L. A. County Emergency Survival Guide.

To become better prepared as an individual, family, business owner, or community to deal with all types of disasters, I would invite you to visit the following preparedness sites.

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

A few of my preparedness blogs you might wish to revisit include:

When 72 Hours Isn’t Enough

In An Emergency, Who Has Your Back?

An Appropriate Level Of Preparedness

The Gift Of Preparedness 2011

Because no matter where you live, its just a matter of time before the next disaster strikes.

Pathogens, Publishing, And The Precautionary Principle

2012-02-03T15:39:00.001-05:00

# 6118

Over the past few months we’ve been witness to a fascinating, volatile, and sometimes unseemly debate over controversial `dual use’ H5N1 research. I’ve tried to present both sides of this issue as fairly as possible, without interjecting my own opinion.

Not because I don’t hold an opinion on this topic (I most certainly do), but because I believe that these issues are far too important this non-scientist to marginalize either side by taking pot shots at them in this blog.

I certainly understand (and share) the deep feelings that many scientists hold regarding the sanctity of independent and unfettered scientific research, and their abhorrence of anything that smacks of government censorship.

And from a practical standpoint, given the backchannel communications in the scientific community, I have considerable doubts as to whether this H5N1 genie can now be coaxed back into its bottle.

But I also know from my years working as a paramedic –where patient safety and the principle of Primum non nocere ("First, do no harm") reign supreme - why the NSABB would have been hard pressed to come up with any recommendation other than the one they did.

And it boils down to the Precautionary Principle, which is a basic tenant of public policy which says:

When the health of humans and the environment is at stake, you need not wait for scientific certainty of risk before taking protective action.

So basic and widespread is this ideal that its use has become a statutory requirement in many countries.

In 1998, the Wingspread Conference on the Precautionary Principle summarized the policy as:

When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically.

Essentially, if an action, or a byproduct of some action can reasonably perceived as being potentially harmful to the environment or to public health, the onus of proof of its safety falls to the activity’s proponent.

The NSABB’s role, as defined in their FAQ, is to

` . . . provide advice, guidance, and leadership regarding biosecurity oversight of dual use research to all Federal departments and agencies with an interest in life sciences research.

The NSABB advises on and recommends specific strategies for the efficient and effective oversight of federally conducted or supported dual use biological research, taking into consideration national security concerns and the needs of the research community.’

In other words, it was their job to look at these research projects, and if they found a reasonable concern for public safety, to raise a red flag.

Which is precisely what they did.

The dismissive arguments over the true CFR of the H5N1 virus, or whether transmissibility in ferrets necessarily translates transmissibility in humans, completely misses the point.

Whether you agree or disagree with the committee’s conclusions, the NSABB simply did what they were designed to do as part of a system of checks and balances.

While there is no scientific certainty that any harm would come from the publication of these papers, it can be reasonably argued that - in the wrong hands - this information could potentially lead to a serious, even catastrophic mishap.

And under the Precautionary Principal, the NSABB had little choice but to raise their concerns, with the onus then falling on those wishing to proceed to prove the safety of doing so.

Although there has been a lot of outrage and posturing on both sides of this issue - it seems clear to me that however flawed - the system has worked this time.

The NSABB committee raised their concerns, and in doing so, has forced a conversation that’s been too long overdue.

How are we to handle this brave new world of life sciences, where new viruses and other life forms can be created in the laboratory?

Who decides what is appropriate, or safe research? Or what should be published, and who should have access to redacted information?

What laboratory protocols and protections are necessary for working the the H5N1 virus?

And under the WHO’s PIP (Pandemic Influenza Preparedness) Framework, adopted last May by the 64th World Health Assembly, who is entitled to receive samples of these new strains of the virus?

Over the past few weeks I’ve been saddened to see some of the world’s best scientists and researchers maligned by the media as crazed present day Dr. Frankensteins – ready to unleash a killer plague that would wipe out half of humanity for the sake of getting another research grant.

While those urging caution - recommending a review of research protocols and possible redaction of these papers - have been characterized as being tools of an oppressive and paranoid biosecurity industry.

When the simple truth is, both sides are simply doing the job we rightfully expect of them. They may have different mandates, and priorities, but both are valid and important.

If we manage to keep ahead of the H5N1 virus, it will be due in large part to the kind of groundbreaking work being done in the labs of Ron Fouchier, Yoshiro Kawaoka, and others.

But these research projects are not without some risk, and that is why some oversight is necessary.

While the NSABB won’t be the final arbiter of this case (this needs to have an International solution), the only reason we are now having this conversation today is because they took a difficult and unpopular stance.

The hard work lies ahead; forging some sort of workable compromise that will protect important scientific research, and at the same time shield the public from unnecessary and avoidable risks.

I don’t pretend to have the answers. And I fully expect that there is no `perfect’ solution to be had.

But I do know that the first step towards reaching any meaningful compromise is for all sides involved to accept as valid the concerns held by the other stakeholders in this debate, instead of simply trying to dismiss them as unfounded or overblown.

And discouragingly, so far I’ve seen precious little of that in the debate so far.

The NYAS H5N1 Panel

2012-02-03T08:53:00.001-05:00

# 6117

For those of you who may have missed the fireworks at last night’s New York Academy of Science (NYAS) panel discussion on the benefits and dangers of H5N1 research we’ve a few ways this morning for you to catch up.

The panel members consisted of:

Arturo Casadevall, MD, PhD, Albert Einstein College of Medicine, and member, NSABB;
Laurie Garrett, PhD, Council on Foreign Relations;
Barbara R. Jasny, PhD, Science;
Veronique Kiermer, PhD, Nature Publishing Group;
Michael T. Osterholm, PhD, MPH, Center for Infectious Disease Research and Policy, University of Minnesota, and member, NSABB;
Peter Palese, PhD, Mount Sinai School of Medicine;
Vincent Racaniello, PhD, Columbia University;
Alan S. Ruldolph, PhD, Defense Threat Reduction Agency.

Anyone suspecting that this would be a dull affair – a stately debate bereft of fire or emotion – would have found their illusions bashed early on.

First stop, science writer Carl Zimmer provides a lengthy recap this morning in his Discover Magazine blog The Loom.

Flu Fighters

February 3rd, 2012 2:26 AM by Carl Zimmer

From the Sydney Morning Herald, we get this account.

Bird flu mutation sparks fears of deadly pandemic

Nick Miller, New York
February 4, 2012

And you can go back and watch the live tweeting of this event on Twitter by searching for the hashtag #NYAS.

Things will get even more explosive later this month when this debate moves to a small, closed door meeting in Geneva to be hosted by the World Health Organization.

This debate has deeply polarized the scientific, and flu community. Both sides are claiming the moral high ground, and both are able to make good arguments to support their position.

After hearing both sides of this argument for months, I’ve come to the conclusion that anyone who believes there to be an obvious, easy, or guaranteed to be correct solution to to this scientific dilemma, hasn’t fully considered all sides of the issue.

Media Reports Bird Flu Fatality In Vietnam

2012-02-01T14:05:00.001-05:00

# 6116

Crof over at Crofsblog (link Vietnam: 2012’s second H5N1 death confirmed) has picked up an English language report from TuoiTreNews.vn of a recent H5N1 fatality in Soc Trang Province.

Reportedly this involves a 26-year-old female who fell ill after slaughtering and eating `infected meat’.

Assuming a confirmation from the World Health Organization, this would make the second human case reported in Mekong Delta region of Vietnam this year (the first occurring in Kiên Giang Province).

McKenna: Man Vs. MRSA

2012-02-01T12:06:00.001-05:00

# 6115

Among the many fascinating topics Maryn McKenna covered in her book Superbug: The Fatal Menace of MRSA was the possibility that a vaccine might someday be developed against this growing epidemic of antibiotic resistant staph.

Today, Maryn follows up with a terrific feature that appears in the prestigious Journal Nature, which focuses on Robert Daum, the founder of the University of Chicago's MRSA Research Center, and others who are in search of this as-yet elusive goal.

Follow the link to read:

Vaccine development: Man vs MRSA

For decades, Robert Daum has studied the havoc wreaked by methicillin-resistant Staphylococcus aureus. Now he thinks he can stop it for good.

Maryn McKenna

01 February 2012

Canada Issues Biosafety Advisory For H5N1 Research

2012-02-01T10:02:00.001-05:00

# 6114

With the recent flap over the creation of two highly transmissible laboratory strains of the H5N1 virus, there have been calls to restrict this kind of research to labs with only the highest levels of biosecurity.

In the United States, this level of containment is called Biosecurity Level 4 (BSL-4) or sometimes BL-4, but in other parts of the world similar high containment labs go by different names.

In Australia, they are designated "PC4,'' which stands for "physical containment 4”, while in Canada, these labs are called Containment Level 4 (CL-4).

While most of these facilities boast truly impressive biosecurity precautions, there are no universally mandated standards, and so practices and techniques may vary from one country to the next.

Today, the Public Health Agency of Canada has issued a Biosafety Advisory for working with transmissible strains of the H5N1 virus, relegating such work to their highest containment (CL-4) labs.

Biosafety Advisory: Efficiently Transmissible Engineered Influenza A H5N1 Viruses

February 01, 2012

This biosafety advisory is being provided by the Public Health Agency of Canada (PHAC) in response to recent publications of efficiently transmissible engineered Influenza A H5N1 viruses. The Pathogen Regulation Directorate (PRD) has developed this advisory based on current scientific evidence available on this pathogen and is subject to review and change as more information becomes available. The Risk Group (RG) of efficiently transmissible Influenza A H5N1 viruses is RG4.

1. Background

Influenza A H5N1 is a highly pathogenic avian influenza virus that emerged as a human pathogen in 1997 when it was transmitted from avian populations to humans in Hong Kong^(1,2). Since then, various countries around the world have reported human infections, particularly in Southeast Asia, the Middle East, and Africa. From 2003 to 2011, 574 human cases and 337 deaths have been confirmed by the World Health Organization; this correlates to a mortality rate of 59%⁽³⁾. H5N1 can cause death in healthy individuals with no pre-existing medical conditions.

In November 2011, three independent studies on H5N1 transmission in ferrets were either published online or submitted for publication. These studies have received a significant amount of attention due to their relative success in producing engineered H5N1 viruses capable of efficient transmission in ferrets, including via the air^(4-10). Ferrets are considered a good model for studying human influenza viruses⁽¹¹⁾. The engineered transmissible H5N1 viruses are not currently in circulation, but it is widely agreed that if released, the clinical and economic impact could be devastating.

2. Biosafety Requirements

The following table summarizes the containment requirements for laboratories working with efficiently transmissible engineered Influenza A H5N1 viruses. No containment requirements are stipulated for non-proliferative clinical/diagnostic activities based on the fact that this virus is currently not in circulation. Laboratories should refer to the Laboratory Biosafety Guidelines, 3^rd Edition, 2004 for a complete listing of the biosafety requirements.

H5N1 viruses capable of efficient human-to-human transmission, including via aerosols or the airborne route, are considered Risk Group 4 human pathogens and require Containment Level 4 physical containment and operational practices.

3. Additional Risk Considerations

If an efficiently transmissible H5N1 virus was introduced into circulation, a risk assessment would be necessary to determine the regulatory requirements for different types of work, such as non-proliferative clinical/ diagnostic activities.

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ACIP Broadens Adult Immunization Recommendations

2012-02-01T07:33:00.001-05:00

Photo Credit PHIL

# 6113

ACIP, the CDC's Advisory Committee on Immunization Practices, has published their revised recommendations for adult immunizations today in the February 1st edition of the Annals of Internal Medicine.

Among the changes, ACIP now recommends routine HPV vaccination for males aged 11 to 12 years, and has broadened their recommendations for administering the Hepatitis B vaccine.

The entire recommendation can be read at:

Recommended Adult Immunization Schedule: United States, 2012*

Advisory Committee on Immunization Practices†

But for the short version, we have this press release from the American College of Physicians.

2012 adult immunization schedule broadens recommendations for HPV and hepatitis B vaccinations

Annals of Internal Medicine early release article for Feb. 1, 2012

Philadelphia, February 1, 2012 – The CDC's Advisory Committee on Immunization Practices (ACIP) now recommends routine HPV vaccination for males aged 11 to 12 years and catch-up vaccination for males aged 13 to 21. These are just two of the changes to the 2012 Recommended Adult Immunization Schedule being published February 1 in Annals of Internal Medicine (www.annals.org), the flagship journal of the American College of Physicians (ACP).

In addition to the changes in the HPV vaccine, the ACIP now recommends vaccination against Hepatitis B for adults younger than age 60 who have diabetes, as soon as possible after diabetes is diagnosed. Hepatitis B vaccinations should also be given to adults with diabetes aged 60 years or older based on a patient's need for assisted blood glucose monitoring, likelihood of acquiring hepatitis B, and likelihood of immune response to vaccination.

The ACIP is comprised of the ACP and 16 other medical societies representing various medical practice areas. Each year, the ACIP reviews the CDC's Recommended Adult Immunization Schedule to ensure the schedule reflects current clinical recommendations for licensed vaccines. The recommendations are intended to guide physicians and other clinicians about the appropriate vaccines for their adult patients. In October 2010, the ACIP adopted an evidence-based process that considers quality of evidence, benefits and harms, values and preferences of affected populations, and economic impact. Voting to expand routine HPV vaccination to males and hepatitis B vaccinations to young adult diabetics was the first exercise of this approach.

Changes were also made to when mothers should receive the tetanus, diphtheria, and acellular pertussis (Tdap) booster that is designed to protect infants from pertusiss. According to the 2012 schedule, women should receive the vaccine during pregnancy, preferably after 20 weeks of gestation. Protective maternal antibodies will pass to the fetus.

Adult patients should continue to be vaccinated against influenza. Egg allergy is no longer a contraindication, but patients with an egg allergy should get the inactivated flu shot because that is what has been studied.

A footnote was added to the schedule directing readers to links for the full ACIP vaccine recommendations. Specific vaccine recommendations for travelers also were added. In another new addition, the schedule now includes a table summarizing precautions and contraindications for vaccines.

###

The full 2012 Recommended Adult Immunization Schedule can be viewed at www.annals.org.

Hong Kong: Gull & Peregrine Falcon Test Positive For H5 Virus

2012-02-01T07:10:00.001-05:00

# 6112

Despite few reports of infected wild birds from mainland China (no doubt due to less than robust surveillance and reporting), most years we hear of a dozen or more H5N1 infected migratory birds making it into Hong Kong.

With each announcement, calls go out to increase biosecurity measures at local poultry farms, and for citizens to avoid contact with sick or dead birds.

In December of 2008 Hong Kong saw their first outbreak of H5N1 in domesticated poultry in nearly 6 years. In early 2009 it was announced that the H5N1 outbreak was `likely’ caused by infected migratory birds. See Wild Birds Eyed As Likely Source Of Hong Kong Bird Flu Outbreak.

Since them, local authorities have become even more diligent in their surveillance and testing of dead birds.

Today, the Hong Kong government has announced the discovery of two more birds, from two different locations in the city, that have tested positive for the H5 virus in preliminary testing.

Peregrine falcon and black-headed gull test positive for H5 virus

February 1, 2012 Issued at HKT 18:47

Preliminary testing of a dead peregrine falcon in Tung Chung and a dead black-headed gull in Yuen Long have tested positive for the H5 avian influenza virus, a spokesman for the Agriculture, Fisheries and Conservation Department (AFCD) said today (February 1), adding that further confirmatory tests are being conducted.

On January 30, the dead peregrine falcon and black-headed gull were found and collected in the park of Seaview Crescent, Man Tung Road, Tung Chung and Chun Yin Square Playground, Yuen Long respectively.

Peregrine falcons are rare winter visitors to Hong Kong, while the black-headed gull is a common visitor.

The spokesman said there were no poultry farms within three kilometres of where the dead peregrine falcon was found, but four chicken farms are within three kilometres of where the dead black-headed gull was found. AFCD staff inspected the farms and found no abnormal mortality or symptoms of avian influenza among the chicken flocks. These farms will be put under enhanced surveillance.

In view of these cases, the AFCD has phoned poultry farmers to remind them to strengthen precautionary and biosecurity measures against avian influenza. Letters have been sent to farmers, pet bird shop owners and licence holders of pet poultry and racing pigeons reminding them that proper precautions must be taken.

The spokesman said the department would conduct frequent inspections of poultry farms and the wholesale market to ensure that proper precautions against avian influenza have been implemented. The department will continue its wild bird monitoring and surveillance.

"People should avoid personal contact with wild birds and live poultry and their droppings. They should clean their hands thoroughly after coming into contact with them. The public can call 1823 for follow-up if they come across suspicious sick or dead birds, including the carcasses of wild birds and poultry," the spokesman said.

(Continue . . . )

China ranks 174th in Reporters without Borders Press Freedom Index 2011/2012 (out of 179), while Hong Kong places 54th (not far below the United States which ranks 47th).

Which may help explain (in part, anyway) why most years we hear of more H5N1 infected birds from within the 426 sq. miles of Hong Kong than we do for the entire 3,704,426 sq. miles of mainland China.

NSABB Statement, mBio Commentaries & A `Dual Use’ Webinar

2012-01-31T11:32:00.001-05:00

# 6112

About an hour ago a 3-page PDF statement from the NSABB appeared on Science/ AAAS.org’s Public Health, Biosecurity, and H5N1 Forum, providing that committee's rationale for requesting the redaction from science journals of key portions of recent controversial `dual use’ H5N1 research.

30 JANUARY 2012 | POLICY FORUM

Adaptations of Avian Flu Virus Are a Cause for Concern

K. I. Berns et al.

Members of the National Science Advisory Board for Biosecurity explain its recommendations on the communication of experimental work on H5N1 influenza.

Full Text (PDF)

Comments

Meanwhile, mBio has published four views on all of this from Paul S. Keim, Vincent R. Racaniello, Robert G. Webster, and Arturo Casadevall & Thomas Shenk.

I’m headed there now to read:

Mammalian-Transmissible H5N1 Influenza: the Dilemma of Dual-Use Research

Robert G. Webster doi:10.1128/mBio.00005-12

Science Should Be in the Public Domain

Vincent R. Racaniello doi:10.1128/mBio.00004-12

The NSABB Recommendations: Rationale, Impact, and Implications

Paul S. Keim doi:10.1128/mBio.00021-12

The H5N1 Manuscript Redaction Controversy

Arturo Casadevall and Thomas Shenk doi:10.1128/mBio.00022-12

And on Thursday night, many of the major players in the world of influenza virology and biosecurity will convene for a 2 hour panel discussion, to be webcast by the New York Academy of Sciences (this appears to be a Pay-per-view event for non-members).

Here is the Press Release from the New York Academy of Sciences

Dual use research: H5N1 influenza virus and beyond

Experts to discuss controversial studies on avian flu virus at live event

WHAT: Dual Use Research: H5N1 Influenza Virus and Beyond

WHEN: Feb. 2, 6pm to 8pm

WHERE: The New York Academy of Sciences

REGISTER: www.nyas.org/H5N1

The US National Science Advisory Board for Biosecurity (NSABB) recently recommended that journals Nature and Science remove certain methodological details from controversial studies on the avian influenza virus (H5N1) to minimize the risk of these findings being misused by would-be bioterrorists. On February 2 from 6pm to 8pm, the Emerging Infectious Diseases & Microbiology Discussion Group of the New York Academy of Sciences presents Dual Use Research: H5N1 Influenza Virus and Beyond, a discussion between scientists, publishers, and legal experts that will explore the myriad issues surrounding the impending publication of these two studies and measures that will need to be undertaken to ensure the security of future such research.

To weigh in on matters of censorship and public safety, W. Ian Lipkin, MD, Center for Infection & Immunity at Columbia University, will moderate a panel discussion with Arturo Casadevall, MD, PhD, Albert Einstein College of Medicine, and member, NSABB; Laurie Garrett, PhD, Council on Foreign Relations; Barbara R. Jasny, PhD, Science; Veronique Kiermer, PhD, Nature Publishing Group; Michael T. Osterholm, PhD, MPH, Center for Infectious Disease Research and Policy, University of Minnesota, and member, NSABB; Peter Palese, PhD, Mount Sinai School of Medicine; Vincent Racaniello, PhD, Columbia University; and Alan S. Ruldolph, PhD, Defense Threat Reduction Agency.

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Attendees must register at www.nyas.org/H5N1. Media must RSVP to Diana Friedman, dfriedman@nyas.org.

C. A. Nidom On Bird Flu In Indonesia

2012-01-31T08:07:00.001-05:00

Photo Credit – FAO

# 6111

Virologist Chairul Anwar Nidom of the Institute of Tropical Disease, Airlangga University probably knows more about how the H5N1 virus is evolving in Indonesia than anyone else.

Regular readers of this blog have come across his name dozens of times over the past few years, including here, here, and here.

Dr. Nidom demonstrated in 2006 that 20% of feral cats he tested in Jakarta carried antibodies to the H5N1 virus (see here), and his team has detected the bird flu virus in pigs as well (see When Pigs Flu).

Today we’ve a long article by Dr. Nidom appearing in the Indonesian newspaper Kompas on the fight against bird flu, and some of the obstacles that lie ahead.

The bad news here is that his remarks are in the Indonesian language (Bahasan), and we must content ourselves with machine translations which can sometimes lose a bit in the process.

Despite this impediment, we can glean a good deal from Dr. Nidom’s article. A hat tip to Diane Morin and Sharon Sanders of FluTrackers for this find.

I’ve links to two different translations below - which I encourage you to read - followed by a bullet list of some of his main points.

As you’ll see, the finished product varies somewhat between the Google Translation and the Microsoft translation. It really takes reading both of them to get the most out of this story.

Via Microsoft’s Bing Translator:

The Fight Against Bird Flu

and from Google’s Translator:

Warring Against Bird Flu

Among the points raised by Dr. Nidom:.

Of the 33 provinces in Indonesia, 32 are endemic areas of bird flu in poultry and other animals.

Control measures have not made visible progress over the past eight years.

The National Commission on Bird Flu was disbanded last year, and they still await the Disease Control National Zoonoses program which they hope will have more impact.

Unlike most cases in the past, officials have been unable to establish a link to infected poultry in the recent human cases in Bali, Jakarta and Tangerang.

Dr. Nidom asks for a fatwa, or religious regulation so victims of bird flu or other contagious diseases can be autopsied (rarely done now due to cultural, societal, and religious reasons).

He goes on to say that hospitals need to be trained to recognize and treat the H5N1 virus, and that it is likely that many cases go undiagnosed. He likens the number of cases we see to the `tip of the iceberg’.

He calls for vaccination (when available) for people at the highest risk – particularly those living in the `triangle of bird flu, namely Jakarta, West Java, and Jakarta’, and suggests that Oseltamivir be made available over the counter.

Dr. Nidom warns that the co-circulation of influenza viruses (H1N1, H3N2, H5N1) in Indonesia may lead to a reassortment, producing new – potentially dangerous – strains.

At one point Dr. Nidom states (ToggleText Translation): In 2006, was carried out by the "artificial" mutation in the virus H5N1 from the poultry in Indonesia without the coalition. Evidently the virus H5N1 the poultry that formed a coalition with H3N2 more virulent (see PNAS: H3N2 And H5N1 Reassortment).

One of the concerns expressed by Dr. Nidom in the past is that vaccines – as they lose their effectiveness – could mask the symptoms of bird flu in poultry, but still allow the virus to spread. (see Bird Flu: Confusing Reports Out Of Indonesia). He reports today: Healthy chickens positive for bird flu are located in Riau, Central Java, East Kalimantan, West Kalimantan and South Kalimantan.

Dr. Nidom warns that a (shift/drift/coalition) of the virus could result in human-to-human transmission of the virus and concludes by saying: It is very important for Indonesia to confront the pandemic, given our region an ideal place of the coalition. All strains are available, while structuring the environment of animals and humans remains unclear.

While these are most of the highlights, there is more to glean from this article, and should we see a better translation I’ll certainly post the link.

In the meantime, there is much to consider here.

PBS: Ebright, Racaniello, & Zimmer Weigh In On Bird Flu Research

2012-01-30T14:46:00.001-05:00

BSL-4 Lab Worker - Photo Credit –USAMRIID

# 6110

We are now 10 days into the self-imposed 60 day moratorium on the conducting (and publication) of controversial H5N1 research, and the meeting to discuss the future direction of such work in Geneva is still more than a couple of weeks away.

Meanwhile, the war of words - and the battle for the hearts and minds of the public - continues full throttle with advocates on both sides of this issue making their case in the media.

Today PBS Newshour has posted responses from three experts to a series of questions about this debate.

Richard H. Ebright - a molecular biologist at Rutgers

Vincent Racaniello - a microbiologist at Columbia, and author of the Virology Blog

Carl Zimmer, a journalist, author, and blogger

As you might imagine, there is a considerable difference of opinion over what should be done. Follow the link below to read:

SCIENCE -- January 30, 2012 at 11:54 AM EDT

Experts Weigh in on Bird Flu Research

By: David Pelcyger

For earlier coverage of this story, you may wish to revisit:

Nature: Yoshihiro Kawaoka Talks About His H5N1 Research

WHO: Will Host H5N1 Talks In Geneva

ScienceMag: Ron Fouchier Interview On The H5N1 Research Moratorium

Science Magazine: Public Health, Biosecurity, and H5N1

There’s an old saying that Academic infighting is so vicious, because the stakes are so low. But in this case, both sides view the stakes here as being enormously high.

Biosecurity and concerns over public safety versus revered and well established principles of Scientific Freedom.

Given the tenor of some of the discussions I’ve seen over the past couple of weeks, the gulf between these two sides doesn’t seem to be getting any narrower.

Surviving A Different Kind Of Aftershock

2012-01-30T08:57:00.001-05:00

# 6109

FEMA and Ready.gov, along with organizations like the American Red Cross (and indeed, this blog), spend a great deal of time trying to convince individuals, families, businesses and communities to prepare for emergencies and disasters.

The standardized advice is that everyone needs to be prepared to deal with a disaster for at least 3 days (meaning having a first aid kit, emergency supplies, and a plan) before help arrives.

Sure . . . they’d like you to be prepared for longer . . . but few enough Americans can be bothered to prepare for even 72 hours.

I personally advocate a minimum of a week’s worth of supplies (two would be better), but then I live in the heart of hurricane country, and am admittedly a bit of a belt-and-suspenders kind of guy (see NPM11: Living The Prepared Life).

There are some post-disaster aftershocks, however, that even two weeks of supplies won’t prepare you for.

The recent earthquakes in Haiti and in Fukushima, Japan – along with Hurricane Katrina in New Orleans – have shown how communities can be forever changed by a disaster.

With our short attention span, and the news media’s proclivity for moving on to the next big disaster or story, we often forget that the struggle to rebuild devastated communities can take years.

And sometimes, for some of the people caught in harm’s way, there is no going back to the way things used to be.

Today, in a sobering news story by ABC (Australian Brocasting Corp), we learn that the first of what may eventually become 5,000 homes are to be demolished in the wake of their recent series of earthquakes near Christchurch, NZ.

The land they were built on experienced significant liquefaction during the September 2010 and February 2011 earthquakes, and so homes will not be rebuilt on these lots.

NZ begins demolishing Christchurch suburbs

By New Zealand correspondent Dominique Schwartz

Updated January 30, 2012 18:50:35

As this story indicates, that despite some compensation offered by the government, many residents have lost tens (or even hundreds) of thousands of dollars and say they have `no way of moving forward’.

With tremors continuing (see map above), those who escaped with only minor or moderate damage get nerve-wracking daily reminders that the ground beneath their feet could move violently again at any time.

And for those who would like to move away and start anew, the reality is that there are few buyers willing to purchase a home or a business in an area where the ground continues to shake.

Not all of the aftershocks of a disaster are seismic in nature. Some are economic, while others can be psychological.

While often hidden from view, the psychological impact of a disaster can be enormous and ongoing. Last year in Post Disaster Stress & Suicide Rates we looked at the impact of disaster-related PTSD (Post Traumatic Stress Disorder).

Although a good disaster plan and emergency kit are imperative to get you through the opening hours and days of a disaster, knowing how to help friends, family, and neighbors deal with the psychological effects of a disaster can be equally important.

Luckily, there are things that can be done - even by the layperson - to help reduce the psychological impact of a disaster.

A few resources you may wish to revisit:

In Psychological First Aid: The WHO Guide For Field Workers we looked a simple guidebook anyone can use to help others in emotional distress.

The CDC also provides a website which contains a number of resources devoted to coping with disasters.

Coping With a Disaster or Traumatic Event

Trauma and Disaster Mental Health Resources

The effects of a disaster, terrorist attack, or other public health emergency can be long-lasting, and the resulting trauma can reverberate even with those not directly affected by the disaster. This page provides general strategies for promoting mental health and resilience. These strategies were developed by various organizations based on experiences in prior disasters.

As does the National Center For PTSD - including videos - on how to provide Psychological First Aid.

Psychological First Aid: Field Operations Guide

For Disaster Responders

Developed jointly with the National Child Traumatic Stress Network, PFA is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism: to reduce initial distress, and to foster short and long-term adaptive functioning.

A small reminder that not all wounds are readily visible to the naked eye, and that the proper bandage for them may not always reside inside your first aid kit.

Referral: McKenna On India’s Denial Of TDR-TB

2012-01-29T12:42:00.001-05:00

# 6108

When I saw the reports on Friday about India’s Health Ministry’s attempts to downplay reports of totally drug resistant tuberculosis, I was immediately reminded of the old joke about the doctor who couldn’t cure you, but for a small fee he’d touch up your X-rays.

Today, Maryn McKenna takes a closer look at India’s denials (which are similar to the official reaction we saw last year over NDM-1) in her Superbug Blog.

Follow the link to read:

TDR-TB: The Indian Government Denies It

By Maryn McKenna

January 29, 2012

An update to the news two weeks ago of totally drug-resistant tuberculosis, TDR-TB, being identified in India (and earlier in Italy and Iran): The Indian government has announced that it doesn’t exist, and is putting pressure on the physicians who identified it to say they made a mistake.

(Continue . . . )

The Kolkata Crow Mystery

2012-01-29T09:24:00.001-05:00

Indian House Crow – Photo Credit Wikipedia

# 6107

Roughly two months ago crows by the hundreds (some say thousands) began falling from their perches and dying in Jharkhand, India.

By mid-December the Indian Veterinary Research Institute (IVRI), Bhopal, confirmed that it was the H5N1 virus that was behind these deaths. (see EpiSouth Bulletin eweb_195_15_12__11.pdf).

You can find additional AFD coverage of this event in Media Report: H5N1 Killing Crows In Jharkhand and several from Crofsblog, including India: ‘New bird flu strain killed Jharkhand crows’.

Today the Times of India is reporting (h/t Emily on FluTrackers) that after ignoring dying crows in the capital city of Kolkata for weeks, West Bengal authorities are finally launching an investigation.

Govt gets cracking on crow deaths
TNN | Jan 29, 2012, 07.36AM IST

KOLKATA: After ignoring the mysterious crow deaths in the city for nearly two months, the state government flew into action mode on Saturday and sent scientists to Rabindra Sarovar to gather carcasses and blood samples.

TOI on Friday first reported on crows dropping dead all over the city.

(Continue . . . )

Somewhat remarkably, two weeks after the discovery of H5N1 in Jharkhand crows, India declared itself to be bird flu free, leading to some highly critical media coverage (see Dying crows deny India is bird flu free).

There are other possible causes of the crow deaths in Kolkata; insecticides, accidental poisoning, and Newcastle disease to name a few.

But with the recent positive test results in neighboring Jharkhand positive for H5N1, concerns are running high that the virus may be behind these deaths as well.

NYTs: The Bird Flu Research Controversy Continues

2012-01-29T08:05:00.001-05:00

BLS-4 Lab – Photo Credit CDC PHIL

# 6106

The weekend edition of the New York Times contains a `dialog’ – well, actually letters to the editor – received over the past few days by some well known academics and researchers on the volatile subject of H5N1 research.

The recent successes in turning the H5N1 virus into a more transmissible virus have raised alarms among many of those in the bio-security field (see The Furor Over H5N1 Research Continues).

At the same time, many scientists are decrying what they see as heavy-handed attempts to halt, or censor what they see as crucial research.

You’ll find a lot of familiar names weighing into the NYTs dialog today, including Tom Inglesby, Philip Alcabes, and Vincent Racaniello.

Sunday Dialogue: Bird Flu Experiments

The World Health Organization has tentatively scheduled a meeting of experts in Geneva in a couple of weeks with hopes of resolving some of the thornier issues involved.

But as we continue to see by the arguments coming from both sides of this debate - there is a sizable chasm separating them – making a workable compromise coming out of this meeting far from assured.

Stay tuned.

EuroFlu: H3N2 Dominates But Overall Activity Is Low

2012-01-27T08:53:00.001-05:00

# 6105

Photo Credit- EuroFlu Report.

In stark contrast to this time last year - when much of Europe was seeing significant H1N1 influenza activity - reports of flu for week 3 of 2012 (while rising slowly) - remain low across Europe - and predominantly H3N2 related.

Influenza activity continues to rise slowly in the WHO European Region due to A(H3N2)

This issue is based on data for week 3/2012 reported by 46 Member States in the WHO European Region.

Consultation rates for influenza-like illness (ILI) and acute respiratory infection (ARI) continue to be relatively low in most countries of the Region, but with many countries reporting increasing activity.

29 % of sentinel specimens tested positive for influenza, which is an increase over last week: 95% of these were influenza A.

Of the 352 influenza A viruses from sentinel sources that were subtyped, 99 % were A(H3N2).

Comment

Influenza activity has increased consistently over the past several weeks, but influenza detections remain low compared to the same period of the 2010/2011 season. Influenza A and B viruses are co-circulating in the Region, with the vast majority of detections in both outpatient clinics and hospitals being A(H3N2).

We’ll get the latest FluView and FluWatch numbers later today for the United States and Canada.

Eurosurveillance: Older People May Be Susceptible To The H3N2v Virus

2012-01-27T08:08:00.001-05:00

# 6104

The detection of a new swine H3N2v virus among a handful of people across five states in recent months has sparked concerns that a new influenza virus might be trying to establish a foothold in the human population.

Since the infections reported in the 2nd half of 2011 were predominantly among young children, there has been some speculation that those over the age of 20 might have some limited immunity to this strain.

The CDC, in their January 6th MMWR Update: Influenza A (H3N2)v Transmission and Guidelines — Five States, 2011, writes:

Limited serologic studies conducted to date indicate that young children have little preexisting immunity to influenza A (H3N2)v viruses. Because the hemagglutinin genes of these viruses are related to human influenza A (H3N2) viruses that circulated in the 1990s, older children and adults might have limited immunity against these viruses

Yesterday the Journal Eurosurveillance printed an article called:

Cross-reactive antibody to swine influenza A(H3N2) subtype virus in children and adults before and after immunisation with 2010/11 trivalent inactivated influenza vaccine in Canada, August to November 2010

by DM Skowronski, G De Serres, NZ Janjua, JL Gardy, V Gilca, M Dionne, ME Hamelin, C Rhéaume, G Boivin

As the title might suggest, this isn’t exactly `light’ reading.

Luckily we’ve the talented Helen Branswell to lead us through this medical morass, in her report for the Canadian Press. As with any Branswell article, you would be well served to follow the link and read the whole thing.

Older adults may also be vulnerable to new swine influenza virus, study suggests

By: Helen Branswell, The Canadian Press

Briefly, the Eurosurveillance study finds indications that acquired immunity carried by adults from exposure to similar viruses that were circulating prior to 1990 may wear off as adults age.

Since years when the H3N2 seasonal flu dominates often result in a more severe flu season, any decline in immunity among the elderly elicits concern.

Right now, the H3N2v virus hasn’t shown the ability to spread efficiently in the human population, although some human-to-human transmission has occurred.

But over time, it may acquire that ability.

Which is why the CDC is working on a vaccine (see H3N2v Vaccine Trials) for this new strain should the need arise.

Meanwhile, with the exception of reports out of Mexico where they are seeing a large number of H1N1 cases, influenza reports in North America and Europe remain well below average for this time of year.

Australia Finds LPAI H5 On Two Duck Farms

2012-01-27T07:20:00.001-05:00

Victoria, Australia – Credit Wikipedia

# 6103

Overnight the wire services have been abuzz with news of the discovery of a low pathogenic form of of avian influenza (LPAI) on a couple of duck farms in Victoria, Australia.

A few samples of the media coverage include:

Chicken safe to eat, despite Victorian bird flu

Bird flu detected in ducks near Melbourne

Bird flu outbreak sparks duck cull

While all of the stories (rightfully) point out that this is a low-path strain - and not considered to be a serious health hazard to humans – noticeably absent from any of the above reports is any identification of the strain of avian flu detected.

There are, of course, a great many LPAI strains out there, but only the H5s and H7s are required to be reported to the OIE because of their potential to evolve into a more pathogenic strain.

For a good background on avian influenza in agriculture I would invite you to visit CIDRAP’s Avian Influenza (Bird Flu): Agricultural and Wildlife Considerations - Last updated January 21, 2012

A visit to Victoria’s Department of Primary Industries website solves the subtype mystery (stated to be H5), which is included in the following statement by Victoria’s Chief Veterinary Officer, Dr Andrew Cameron.

Chief Veterinary Officer’s Avian Influenza Update

27 January 2012

The Department of Primary Industries (DPI) has quarantined a commercial duck farm in two locations north-west of Melbourne after birds there tested positive to Low Pathogenic Avian Influenza (LPAI).

DPI Chief Veterinary Officer, Dr Andrew Cameron said analytical tests carried out at the Australian Animal Health Laboratory at Geelong, Victoria, had given a positive response to low pathogenic H5 subtype avian influenza virus, prompting authorities to act immediately.

This low pathogenic subtype of avian influenza is not the highly pathogenic H5N1 virus affecting poultry and humans throughout much of Asia. The wider community is not at risk from this incident.”

Dr Cameron has said, “The virus is relatively harmless now, but we do not want to take the risk it could linger in bird populations and mutate to a more virulent strain.”

The farm has been placed under strict quarantine and no birds, eggs, meat or associated equipment can be taken off the property.

The Consultative Committee for Emergency Animal Diseases (CCEAD) will meet on Friday 27 January, to discuss containment, surveillance and next steps.

Victoria’s Acting Chief Health Officer Dr Rosemary Lester reinforced the assurances that the public is not at risk. “Our poultry meat and eggs continue to be safe under normal food handling and cooking arrangements” she said.

For further information about Avian Influenza review the links below or call 1300 135559.

In Victoria, strict biosecurity guidelines apply to all poultry farms to prevent poultry, feed and water from mixing with wild birds. This minimises the risk of disease. It is a good practice to protect the food and water used for your pet birds and to ensure wild birds cannot come into contact with them. Finally, it is important for all of us to follow good hygiene practices to minimise the risk of any disease, such as washing hands after contact with animals and birds and, in particular, not handling sick or dead birds. These are sensible precautions that will prevent many diseases, not just AI.

Dr Andrew Cameron
Chief Veterinary Officer, Victoria

You’ll find another press release on this site, providing greater detail on the steps that are being taken to eradicate this virus.

Media release: Swift Action to Contain Avian Influenza

27 January 12

Hong Kong: H5N1 Infected Goose Carcass Found On Beach

2012-01-26T08:34:00.001-05:00

#6102

With an avian punctuality usually reserved for the arrival of swallows to Capistrano or the buzzards to Hinckley, Ohio - January once again finds an H5N1 infected bird carcass on the beaches of Hong Kong.

Located adjacent to mainland China - which has a long history of H5N1 outbreaks in poultry and in wild birds – Hong Kong sits at the outflow of the Pearl River to the sea.

Photo Credit- Wikipedia

The Pearl River Delta serves as a catchment area for dozens of tributaries flowing out of the highly industrialized and economically booming Guangdong Province, has been described as one of the more heavily polluted waterways in the world.

Industries, and farms, are known to use these rivers as a convenient disposal system, and what gets dumped upstream flows out to the sea past Lantau island.

In the winter of 2009, we saw a number of decomposed poultry carcasses wash up on the beaches of Hong Kong, presumably carried to the sea via the Pearl River, which flows out of Guangdong Province, China.

Some of my blog coverage of those events included:

Hong Kong Authorities Investigating More Dead Birds

All Eyes On Mainland China

More Concerns Surface Over China

Chinese authorities denied knowledge of any bird flu outbreaks in Guangdong Province and eventually the number of dead birds showing up on shore declined.

Again, over the winter of 2010-2011 we saw multiple reports of badly decomposed poultry carcasses washing up on Hong Kong beaches.

H5N1 Infected Chicken Carcass On Hong Kong Beach

Hong Kong: More H5N1 Infected Chickens Wash Up On Beach

And today, via Hong Kong’s Centre for Health Protection, we get this report of a badly decomposed goose carcass on the beach near Sham Tseng.

While this report doesn’t explicitly state that the carcass washed ashore, that has been the pattern observed in past years.

Goose carcass found in Sham Tseng tests positive for H5N1 virus

Ends/Thursday, January 26, 2012

A spokesman for the Agriculture, Fisheries and Conservation Department (AFCD) said today (January 26) that a goose carcass found in Sham Tseng was confirmed to be H5N1 positive after laboratory testing.

The goose carcass was found and collected at Anglers' Beach, 13 milestone, Castle Peak Road, Sham Tseng, on January 20. It was highly decomposed when found and required a series of tests before H5N1 avian influenza was confirmed today.

The spokesman said there were no poultry farms within 3 kilometres of where the dead goose was found. AFCD staff have conducted inspections and found no evidence of any backyard poultry being kept there. AFCD will continue to monitor the situation and conduct inspections of the area.

In view of the case, the AFCD has phoned poultry farmers to remind them to strengthen precautionary and biosecurity measures against avian influenza. Letters have been issued to farmers, pet bird shop owners and licence holders of pet poultry and racing pigeons reminding them that proper precautions must be taken.

The spokesman said the department would conduct frequent inspections of poultry farms and the wholesale market to ensure that proper precautions against avian influenza have been implemented. The department will continue its wild bird monitoring and surveillance.

"People should avoid personal contact with wild birds and live poultry and their droppings. They should clean their hands thoroughly after coming into contact with them. The public can call 1823 for follow-up if they come across suspicious sick or dead birds, including the carcasses of wild birds and poultry," the spokesman said.

(Continue . . . )

Admittedly one infected carcass doesn’t tell us much about what may –or may not – be going on upstream from Hong Kong, but it will be interesting to see if – as in years past – more of them continue to show up over the next few months.

Nature: Yoshihiro Kawaoka Talks About His H5N1 Research

2012-01-25T13:50:00.001-05:00

BSL-4 Lab Worker - Photo Credit –USAMRIID

# 6101

Although two scientists, working independently and a half-a-world-apart have recently created a more transmissible version of the H5N1 virus, it has been the work of Ron Fouchier at Erasmus University that has garnered the most press.

The reason is pretty simple.

Fouchier announced his findings at a scientific conference late last summer (see Katherine Harmon’s Sci-Am article and in a follow up to this story in New Scientist: Five Easy Mutations), while Yoshihiro Kawaoka has – until now - refrained from discussing his work publicly.

Today in a Nature commentary, flu virologist Yoshihiro Kawaoka breaks his silence and talks about his research into the H5N1 virus, and why such research should continue.

H5N1: Flu transmission work is urgent

Yoshihiro Kawaoka

Nature (2012)
doi:10.1038/nature10884 Published online
25 January 2012

Yoshihiro Kawaoka explains that research on transmissible avian flu viruses needs to continue if pandemics are to be prevented.

Taking a different approach than that used by Fouchier, Kawaoka created a reassortant virus combining H5N1 and the 2009 H1N1 virus, which while transmissible between ferrets, was no more pathogenic than regular flu.

As you might expect, Helen Branswell is already all over this story, and you can find her take on it at:

The Canadian Press - ONLINE EDITION

Researcher at heart of bird flu studies controversy reveals details of his findings

By: Helen Branswell, The Canadian Press

Situational Awareness: Google Public Alerts

2012-01-25T13:07:00.001-05:00

Google Alerts Page – Close up on the United States

# 6100

By now, just about everyone on the Internet is familiar with Google maps, and the broad range of information they can display. Google Earth has redefined the way we look at maps and terrain, satellite imagery, storm tracks and data.

Today, Google has unveiled their latest creation - a Public Alerts Page that allows the user access to real-time emergency alerts from all around the world.

As you mouse over color-shaded areas of the map, specific warnings are displayed. Clicking on the embedded markers will pop up a display, such as the one below:

Part and parcel to good emergency preparedness is situational awareness, and tools like this can quickly provide warnings of current or potential hazards.

Last summer, in NOAAWatch: Your Daily All-Hazards Briefing, I wrote about several other websites that you can use to gauge and monitor potential threats.

NOAA, the National Oceanic and Atmospheric Administration has a terrific all Hazards Monitor page for anyone wanting a heads up on what threats to be cognizant of.

While the home page provides links to dozens of resources ranging from the NWS, EPA and USGS to the World Meteorological Organization, the DAILY BRIEFING PAGE nicely compiles the most important information on a single page.

Now, getting a daily all-threats briefing can be as easy as clicking a single link.

Another important resource is NOAA WEATHER RADIO (NWR).

Once thought of as mainly a source of local weather information, NWR has now become an `All-Hazards' alert system as well. Working with the FCC’s Emergency Alert System, NWR provides warning and post-event information for natural disasters, man-made disasters, and local public safety information.

Like having an emergency kit and a first aid kit - having a weather radio is an important part of being prepared.

Of course, just knowing about the threats isn’t enough. You have to make use of that information. And NOAAWatch provides some links for that as well:

· Ready America - DHS
· Plan Ahead - FEMA
· Preparedness for People With Disabilities
· HHS - Disasters & Emergencies
· American Red Cross
· DisasterAssistance.gov

You’ll also find a long list of preparedness essays on this site by searching on PREPARE or NPM11.

More Conflicting Bird Flu Reports Out Of Indonesia

2012-01-25T07:42:00.001-05:00

# 6099

One of the hazards of blogging about bird flu is that the news we get out of countries where the virus is endemic and most active (Egypt, Indonesia, China, Vietnam, Bangladesh, Cambodia) is often fragmented, contradictory, or heavily state controlled.

You soon learn that relying too much on machine translations from Arabic, Indonesian, Vietnamese, or Chinese language sources risks compounding a felony, as that can add another layer of ambiguity to what is sometimes already less than accurate local reporting.

But some days, that’s all we have to go on.

Case in point, several days ago an 18-year-old man was hospitalized in Tangerang, Indonesia suspected to have been infected by the H5N1 virus. The local papers first reported him as a bird flu suspect, then yesterday the Jakarta Globe reported that he was not infected.

Tangerang Bird Flu Scare a False Alarm

January 24, 2012

A man in Tangerang thought to have bird flu has tested negative for the virus, the Health Ministry said on Tuesday.

Instead of being the end of this story, today local media is reporting that this unfortunate young man died of respiratory failure . . . and, you guessed it . . . bird flu is still suspected.

This translation comes from the always excellent Arkanoid Legent website:

Again, Bird Flu Patient Dies

After 5 days treated in isolation space bird flu, RO, 18 years, men who indicated suspect bird flu died. RO died at 12:30 pm in the isolation room bird flu Tangerang District Hospital.

"The patient died at 12.30 pm, due to respiratory failure," said Head of Public Relations Tangerang District Hospital, Achmad Muchlis to VIVAnews.com , Wednesday, January 25, 2012. Dikatakanya, since entering the room isolation, the condition of critically ill patients and no progress.

Until finally died of respiratory failure. "Until now there has been no official information related to the correct patient infected with bird flu," he said."

Although we don’t know right now with certainty that this patient died from H5N1, suspicions run high.

If sounds a bit familiar, you may recall that last week we learned of a 5-year-old girl (see Indonesian MOH Announces Bird Flu Fatality) who died from the bird flu virus after first being declared free from infection (see 5-Year-Old Brother of Bird Flu Victim Cleared by Doctors Dofa Fasila | January 10, 2012).

Testing for the H5N1 virus in Indonesia has always been difficult, particularly once a patient is placed on antivirals. We’ve seen some cases where patients tested negative up until a post-mortem exam of lung tissue could confirm the diagnosis.

Newshounds are currently watching several other suspected H5N1 cases in Indonesia, including that of a 4-year-old who died after 6 days of treatment in the hospital at Bekasi.

This translation, again, is from Arkanoid Legent:

Allegedly Infected with Bird Flu, Boy 4 Year Deaths

JAKARTA : Nazril Ilham (4) single-child couples Maimunah (25) and Mohammed Enzen (24), of Kampung Sungai Bintaro Branch 4 RT 1.1 Hurip Jaya Village, District Babelan, Dies Bekasi District. Suspected Bird Flu Nazriel.

The victim died after being treated for six days in hospital Anna Bekasi. The atmosphere of grief is still visible at the funeral home shortly after the victim was buried in the cemetery not far from his home, Wednesday (01/24/2012). Surprisingly burial victims without assisted the hospital or health department Bekasi.

Gert van der Hoek at FluTrackers has a report this morning from MetroTVnews that a hospital in North Suluwesi is treating two suspected bird flu patients.

Kandow Hospital is Treating Two Bird Flu Suspects

National / Wednesday, January 25, 2012
Metrotvnews.com, Manado: Two people are now in intensive care at the Hospital Professor Kandow in Manado, North Sulawesi. Patient origin Bolaang Mongondow and Minahasa, North Sulawesi, was allegedly exposed to bird flu.

The two residents that are 81-year-old AP, the village residents Bintauna, Bolmon District, and RP was 4 years old, a resident Kanonang, Minahasa regency. When taken to the hospital, the patient experienced high fever and shortness of breath accompanied by flu.

Previously the two patients was treated in the clinic area where each of them. Until now, both patients are still undergoing intensive care in a bird flu isolation room
MetroTVnews

While obviously suspected, we’ll have to wait for laboratory confirmation before we can know if any of these cases are due to the H5N1 virus. There are, after all, other illnesses that can mimic the symptoms of bird flu.

And it is quite possible – given the limits of testing -that for some of these cases, we’ll never know their H5N1 status with absolute certainty.

And one final example of how stories can quickly change, last Friday the Indonesian Minister of Health Endang Rahayu Sedyaningsi was quoted in the media as worrying that oseltamivir may be losing effectiveness against the Indonesian strains of bird flu (see Indonesia: MOH Suspects H5N1 May Be Gaining Antiviral Resistance).

Three days later, in what appears to be a bit of hasty `damage control’, we get a newspaper column penned by Professor Tjandra Y. Aditama, Director General of Disease Control and Environmental Health, Ministry of Health, Jakarta, Indonesia.

Oseltamivir is still OK to Overcome Bird Flu

24/01/2012

Tamiflu Oseltamivir by the brand as we know as a drug used to treat bird flu. The research data from 6 countries including Thailand, Vietnam, Cambodia, Turkey, Egypt and Indonesia showed substantial recovery.

This was conveyed by the Director General of Disease Control and Environmental Health (P2PL) Ministry of Health, Prof. Dr. Tjandra Yoga Aditama SpP (K), MARS, DTM & H, DTCE to SEHATNEWS.com in Jakarta.

Of the 188 who were treated with oseltamivir, 88 or 47 percent had recovered healing. Of 56 untreated oseltamivir, 7 who recovered (or only 12%) "So there are real differences between the use of oseltamivir with that do not use drugs," said Tjandra.

Data from the World Health Organization says that of 81 cases using oseltamivir global, 21 gain in the first 2 days of fever. Of the 21 men, 18 survived, three died.

The statistics cited above appear to come from an older study of H5N1 outcomes (with and without Tamiflu treatment) conducted across several Asian nations. No cite was given, so I have not been able to run it down.

While encouraging for the global stage (as is this 2010 study), this is not the most convincing evidence that might have been offered by D.G. Aditama for the current state of antiviral sensitivity in Indonesia.

And so it goes.

We view the events in Indonesia, China, Vietnam, and other nations through a fogged and oft times distorted lens. What light that comes through can sometimes give us a hint of what is happening, but details are often absent, or badly mangled.

Welcome to the world of flu blogging and internet news hounding, where the motto is, and will probably always be:

Caveat Lector.

Bangladesh: Nipah Claims 5 Lives

2012-01-24T16:12:00.001-05:00

Nipah/Hendra Virus & Fruit Bat Home Range – WHO

# 6098

Last summer the movie `Contagion’ showed the world how a bat virus might mutate, evolve, and eventually move into the human population. While the movie used a fictionalized MEV-1 virus, it was based on the all-too-real Nipah Virus, which first came to prominence in the 1990s after a deadly outbreak in Malaysia in 1998.

While human infections with Nipah (or its Australian cousin Hendra) have been relatively uncommon, when they have occurred they have proven particularly lethal, with fatality rates pushing 60%.

During the Malaysian outbreak in 1998, the virus jumped to local swine herds from bats, and along with infecting hundreds of people caused the loss over 100 lives. The virus was then exported via live pigs to Singapore, where 11 more people died.

Over the past decade, Nipah has sparked a number of small outbreaks across Southern Asia, although the most intense activity has been centered around Bangladesh.

Over the past 48 hours we’ve seen some reports coming out of Bangladesh indicating that several people have been infected with the Nipah virus. Nipah reports out of this region typically come between December and May.

Today, the IEDCR issued the following statement, indicating there have been 5 fatalities thus far.

Nipah Outbreak at Joypurhat in January 2012

From 20 January 2012, two clusters of Nipah were identified in the Joypurhat Municipality area and Khetlal upazila of Joypurhat district. A joint team of IEDCR and ICDDR,B are working in the field now.

Till date (23 rd January 2012), the team identified 3 cases from the municipal area and 2 cases from Khetlal. All 5 cases have died. Laboratory tests for Nipah were done in IEDCR. All four samples collected from suspected cases were positive for Nipah.

Map Credit- Wikipedia

CIDRAP has a nicely done Overview of the Nipah Virus including the clinical symptom chart below:

Exactly how the Nipah virus is transmitted from human-to-human isn’t well understood, although it is thought to be mostly through direct contact with respiratory secretions or other bodily fluids.

For now - while Human-to-human transmission has been documented - only limited outbreaks have been reported.

Last February, in Bangladesh: Updating The Nipah Outbreak I wrote about a couple of EID Journal studies that looked at Nipah transmission between humans.

The World Health Organization has this to say about the human-to-human transmission of the Nipah Virus.

Transmission

During the initial outbreaks in Malaysia and Singapore, most human infections resulted from direct contact with sick pigs or their contaminated tissues. Transmission is thought to have occurred via respiratory droplets, contact with throat or nasal secretions from the pigs, or contact with the tissue of a sick animal.

In the Bangladesh and India outbreaks, consumption of fruits or fruit products (e.g. raw date palm juice) contaminated with urine or saliva from infected fruit bats was the most likely source of infection.

During the later outbreaks in Bangladesh and India, Nipah virus spread directly from human-to-human through close contact with people's secretions and excretions. In Siliguri, India, transmission of the virus was also reported within a health-care setting, where 75% of cases occurred among hospital staff or visitors. From 2001 to 2008, around half of reported cases in Bangladesh were due to human-to-human transmission.

Reducing the risk of infection in people

In the absence of a vaccine, the only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus.

Public health educational messages should focus on the following.

Reducing the risk of bat-to-human transmission. Efforts to prevent transmission should first focus on decreasing bat access to date palm sap. Freshly collected date palm juice should also be boiled and fruits should be thoroughly washed and peeled before consumption.

Reducing the risk of human-to-human transmission. Close physical contact with Nipah virus-infected people should be avoided. Gloves and protective equipment should be worn when taking care of ill people. Regular hand washing should be carried out after caring for or visiting sick people.

Reducing the risk of animal-to-human transmission. Gloves and other protective clothing should be worn while handling sick animals or their tissues, and during slaughtering and culling procedures.

While the Nipah Virus may not pose anywhere near as great of a threat to the world as a pandemic influenza, it does point out the need for increased surveillance and improved public health programs around the world.

FluTrackers: Assessment Of H5N1 In China

2012-01-24T10:50:00.001-05:00

# 6097

The newshounds on the major flu forums do an incredible job searching for, translating, and analyzing media reports of infectious diseases from all over the world. I’ve said it before, but much of what I do in this blog is only possible due to their efforts.

In terms of organization, quality, and volume of information, it would be hard to find a more impressive repository of emerging disease news than one can find at FluTrackers.com.

With two recent high profile human infections from the H5N1 virus in China (and others being reported in Indonesia, Cambodia, Egypt, and Vietnam), along with the ongoing controversy over the merits and dangers of H5N1 research, media attention has once more turned towards bird flu.

Sharon Sanders, Editor of FluTrackers, has distilled the combined efforts of the FluTrackers team into a handy overview of the H5N1 risks in China based on information they have been able to accumulate.

Anyone wanting a crash course on the H5N1 situation in China need only follow the embedded links to get a grasp of the situation. As this overview emphasizes, state control of local media makes making definitive statements difficult.

FluTrackers.com Risk Assessment of H5N1 type influenza in China

The FluTrackers Team
January 24, 2012

We feel that we can not say with 100% certainly what the exact situation is but this is our opinion based on the facts as we ascertain them as of this date and time.

Humans are at continuous risk of exposure to H5N1 poultry.

1) China has an endemic H5N1 problem in poultry. We know this for several reasons:

a) There have been warnings over the years to clean eggs shells due to surface contamination including H5N1:

China - Experts Call for More Stringent Standards for Cleaning Eggs - Avian Flu Mentioned As Risk May 2011

China - Nutrition Society warns on poultry egg shells, meat, and storage due to avian influenza H5N1 contamination January 2012

2) There are numerous H5N1 drills to train emergency personnel how to react to human and poultry outbreaks. A sample of recent drills includes:

China - Human Bird Flu H5N1 Drill held in Qinzhou, Guangxi province – January 2012

China - CDC Holds Suspected Human H5N1 Emergency Drill in Binzhou City, Shandong province December 2011

China - Emergency Poultry Bird Flu Drill Held in Rizhao City, Shandong province December 2011

China - Major H5N1 Poultry Farm Drill Held in Jangmen, Guangdong province November 2011

3) There are recent H5N1 poultry outbreaks in countries that border China: Tibet, Vietnam (Human), Vietnam (poultry), Hong Kong (wild bird), Hong Kong (poultry), Bhutan, & Nepal

4) The Russian health minister warned citizens on January 4, 2012 to be vigilant about H5N1 when traveling in China here.

5) Other hints and tips in the Chinese press regarding H5N1 status:

China - "Raw" poultry not allowed on trains in Shenzhen due to bird flu fears January 15, 2012

Ministry of Health: human infection of highly pathogenic avian influenza surveillance will be strengthened for the sporadic cases January 2012

China - Shanghai public health requires all medical institutions to monitor carefully for unexplained pneumonia November 2011

6) No country, where H5N1 has become endemic in the environment, has been able to successfully eliminate this disease. Indonesia, Vietnam, and Egypt, each experiencing current poultry and human H5N1 cases, are the most outstanding examples of this unfortunate phenomena. Therefore, despite the fact that China is not reporting any current H5N1 outbreaks in poultry we believe they occur and this is a constant threat to human health.

We see no evidence of sustained and efficient H5N1 infection between humans in China. However, we feel this risk is unknown since China is not forthcoming, generally, about its disease status.

On June 14, 2011 the Ministry of Health announced a creation of a “black list” for media that do not report government sanctioned information. We feel this represents a risk to human health, in general, in China.

The risk of human contamination from H5N1 positive wild birds is unknown in China.Hong Kong reports sporadic cases of H5N1 in wild birds but there are no corresponding human infections that result from contact with such wild birds.

The risk of human contamination from animals (other than poultry), or the environment, in general, is not known.

Many studies have demonstrated that animals can harbour the H5N1 virus, including domestic cats and dogs. In an H5N1 endemic environment, it should be assumed that there are many possible vectors for infection.

It is unclear how the most recent human cases of H5N1 were infected here and here. The government of China denied any human-to-human transmission in the Shenzhen case. The government also denied H5N1 poultry as the source. There were some press announcements that contact with a wild bird may have been the cause of the human case in Shenzhen. If this is true, then, logically, there must be many human cases of H5N1 in China amongst people who frequent parks and other outdoor venues. We feel this scenario, while possible, is not likely.

In conclusion, we feel there is a risk to the human population in China from H5N1 type influenza. A culture of hand washing, avoidance of wild birds and poultry, sanitary contact with domestic pets, and social distancing in public is advisable.

Survey: Gen X & The 2009 Pandemic

2012-01-24T07:40:00.001-05:00

# 6096

Generation X – that is, the generation born after the post-war baby boom - comprise about 80 million Americans who are now in their 30s and 40s.

The University of Michigan’s Institute for Social Research - in conducting their Longitudinal Study of American Youth - has collected data from roughly 3,000 participants aged 36 to 40 on how they perceived and reacted to the 2009 H1N1 pandemic.

While this study reports that Gen X responded reasonably well to the pandemic, only about 20% appear to have availed themselves of the flu shot.

And despite believing they were `well informed’ on the subject of pandemic flu, overall they scored only moderately well when tested on 5 areas of general flu knowledge.

Gen Xers indicated they trusted their family practitioner, and the NIH the most when it came to flu information, and Youtube videos, drug companies the least.

Here is the press release, I don’t find the study available yet on the Lsay.org website.

Generation X: How young adults deal with influenza

ANN ARBOR, Mich. -- Only about one in five young adults in their late 30s received a flu shot during the 2009-2010 swine flu epidemic, according to a University of Michigan report that details the behavior and attitudes of Generation X.

But about 65 percent were at least moderately concerned about the flu, and nearly 60 percent said they were following the issue very or moderately closely.

Using survey data collected from approximately 3,000 young adults during the 2009-2010 H1N1 influenza epidemic—the first serious infectious disease this group had ever experienced—The Generation X Report explores how Americans ages 36-39 kept abreast of the issue and what actions they eventually took to protect themselves and their families.

"These results suggest that young adults in Generation X did reasonably well in their first encounter with a major epidemic," said Jon D. Miller, author of The Generation X Report. "Those with minor children at home were at the greatest risk, and they responded accordingly, with higher levels of awareness and concern."According to Miller, understanding Gen X reactions to this recent threat may help public health officials deal more effectively with future epidemics.

The results show that a majority of Generation X young adults felt that they were "well informed" or "very well informed" about the issue. However, they scored only moderately well, overall, on an Index of Influenza Knowledge, a series of five items designed to test the level of knowledge about viral infections generally and about the swine flu epidemic specifically.

Miller directs the Longitudinal Study of American Youth at the U-M Institute for Social Research. The study, funded by the National Science Foundation since 1986, now includes responses from approximately 4,000 Gen Xers—those born between 1961 and 1981.

Among the other findings:

Young adults with minor children at home were most likely to follow the news about influenza closely and were most concerned about the swine flu epidemic.

Young adults were most likely to report getting information about the epidemic from friends, co-workers and family members. In the month before the survey, they reported having about nine such conversations, compared to getting news about the flu less than three times via print or broadcast media, and about five times from searching the Internet.

The most trusted sources of information about the influenza epidemic were physicians, followed by the National Institutes of Health, pharmacists at local drug stores and nurses from county health departments. The least trusted sources were YouTube videos, drug company commercials and Wikipedia articles.

(Continue . . . )

Academics Debate Odds Of Tokyo Earthquake

2012-01-23T09:11:00.001-05:00

(Mashup of an original map from USGS depicting 3 areas and 4 major earthquakes over the past year on the ring of fire)

# 6095

Just before noon on September 1, 1923 a massive - and by all reports long-duration - 7.9 magnitude earthquake struck beneath Sagami Bay devastating Tokyo, the port city of Yokohama, and several nearby prefectures.

The timing of the quake, at lunchtime, meant many people were cooking when it struck, and that – combined with winds from an offshore typhoon – contributed to the firestorm that swept Tokyo.

Estimates vary, but more than 100,000 people are believed to have perished.

Since 1960, September 1st has been designated as an annual "Disaster Prevention Day" in Japan.

With the horrific events from last year’s Tohoku 9.0 earthquake, tsunami, and resultant nuclear crisis still fresh, the prospect of Japan enduring another great quake continues to haunt.

The Japanese government has stated that there is a 70% of a strong earthquake striking the capital over the next 30 years, but some academics see the threat as being much closer in time.

Over the past year, seismologists have detected an increase in the number of small quakes in and around the nation’s capital. A scenario not unlike what was seen in the lead up to last year’s massive quake.

This from the Tokyo Times.

The “Big One” was preceded by 1,000 smaller quakes

Monday, January 23, 2012

More than a thousand small, repeating earthquakes migrated towards the epicenter of the 2011 Tohoku Quake in the month before the disaster, scientists have learned.

(Continue . . . )

Today, the news wires are filled with stories on a report issued from researchers at the University of Tokyo that claims the likelihood of a strong (7+) Tokyo quake is greater than the government has maintained.

Major Tokyo quake more likely than government says: academics

(Reuters) - A major earthquake is far more likely to hit Tokyo in the next few years than the government predicts, researchers at the University of Tokyo said on Monday, warning companies and individuals to be prepared for such an event.

There is a 70 percent chance a magnitude 7 quake will jolt the southern part of the Tokyo metropolitan area in the next four years, the university's Earthquake Research Institute said.

(Continue. . .)

As I wrote last year in Divining Japan’s Seismic Future, Japan does not lack for devastating earthquake potential.

The most widely anticipated seismic event is the Tokai Earthquake – expected to be an 8+ magnitude, and forecast to occur between the Bay of Suruga and Cape Omasezaki in Shizuoka Prefecture sometime in the near future.

Major earthquakes have occurred in this region every 100-150 years, with the most recent recorded in 1498, 1605, 1707 and 1854.

That puts the Tokai region 157 years since their last major quake, and in the estimation of Dr Kiyoo Mogi – Japan’s leading seismologist – well overdue for another. In 1969, Dr Mogi began warning that the Tokai area was particularly vulnerable, and today the area is monitored continually by the JMA.

Which is why the Prime Minister of Japan called upon Chubu Electric to shut down its No. 4 and No. 5 reactors at the Hamaoka nuclear plant last May, located roughly 200 km south-west of Tokyo.

As for the seismic threat to the Tokyo region, Shinichi Sakai - associate professor at the earthquake research institute - is quoted today as saying:

"The government, individuals and corporations should make preparations for that now"

For more on earthquakes, you may wish to revisit:

UN Agency Warns On Global Seismic Risks

The Great Central U.S. Shakeout:2012

NPM11: Are You Earthquake Prepared?

WHO: Will Host H5N1 Talks In Geneva

2012-01-22T07:41:00.001-05:00

# 6094

On Friday a coalition of H5N1 researchers offered a 60 day moratorium on controversial bird flu research in order to `allow time for international discussion’ (see Scientists Announce 60 Day Moratorium On Some H5N1 Research).

Late yesterday the World Health Organization announced that they will host talks in Geneva among a small group of scientists next month. As you might expect, @HelenBranswell of the Canadian Press is all over this story.

Follow the link to read her coverage:

Meeting to address bird flu research impasse: WHO

The Canadian Press

Date: Saturday Jan. 21, 2012 5:39 PM ET

A small -- in relative terms -- group of technical experts will be invited to Geneva in mid-February to begin the difficult task of trying to break an impasse arising from the proposed publication of controversial bird flu research, the World Health Organization revealed Saturday.

(Continue . . .)

With both sides seemingly solidly entrenched,we’ll have to wait to see whether any substantial compromises can be forged during this relatively short 60 day time-out.

China Reports 2nd Bird Flu Fatality In A Month

2012-01-22T07:13:00.001-05:00

# 6093

On the heels of recent human H5N1 infections reported in Indonesia, Egypt, Vietnam, and Cambodia - China has announced their second bird flu fatality in less than a month.

This time it reportedly involves a 39-year-old man living in Guizhou, a province in southern China.

The AP and AFP are reporting this patient, who was described as being in critical condition several hours ago, as having died on Sunday (AP link)

Here is the official notification from the Hong Kong Centre For Health Protection.

Notification of a human case of H5N1 in Guizhou

The Centre for Health Protection (CHP) of the Department of Health received notification from the Ministry of Health (MoH) today (January 22) concerning a confirmed human case of influenza A (H5N1) in Guizhou.

A CHP spokesman said the patient was a 39-year-old man living in Guizhou. He developed symptoms on January 6 and was admitted to a hospital on the same day. He is now in critical condition. The man did not report obvious exposure history to poultry before the onset of symptoms.

Laboratory tests on the patient's specimen by the Chinese Centre for Disease Control and Prevention yielded a positive result for H5N1.

The CHP is maintaining close liaison with the MoH to obtain more information on the case. We will heighten our vigilance and continue to maintain stringent port health measures in connection with this development, the spokesman said.

The spokesman reminded members of the public to remain vigilant against avian influenza infection and to observe the following measures:

Avoid direct contact with poultry and birds or their droppings; if contacts have been made, they should wash hands thoroughly with soap and water;

Poultry and eggs should be thoroughly cooked before eating;

Wash hands frequently;

Cover nose and mouth while sneezing or coughing, hold the spit with tissue and put it into covered dustbins;

Avoid crowded places and contact with sick people with fever;

Wear a mask when you have respiratory symptoms or need to take care of patients with fever;

When you have fever and influenza-like illnesses during a trip or when coming back to Hong Kong, you should consult doctors promptly and reveal your travel history.

For further information on avian influenza, please visit the CHP website: www.chp.gov.hk.

Ends/Sunday, January 22, 2012
Issued at HKT 15:44
NNNN

Despite the standard cautions about exposure to poultry listed above, the AFP report indicates - that like the case in Guangdong province in late December - this victim claimed no known contact with poultry over the past 30 days.

The report goes on to say that 71 contacts of this victim are being monitored, but none have developed any signs of illness.

This recent spate of cases comes amid the traditional Lunar New Years celebration, a 6-week period which sees hundreds of millions of Asians returning to home and family to celebrate each year.

The Lunar New Year occurs on January 23rd this year, and as they do every year, public health officials will be on the lookout for any signs of unusual disease outbreaks in the wake of this mass migration.

The recent spike in human H5N1 infections is something we see each winter, but fortunately we’ve yet to see any signs of sustained human-to-human transmission of this virus.

Nevertheless, as these cases continue to trickle in scientists keep watch for any signs that might indicate the virus is adapting better to humans.

Indonesia To Increase Surveillance For H5N1: MOH

2012-01-21T09:46:00.001-05:00

Photo Credit – FAO

# 6092

My thanks to Arkanoid Legent for picking up on this Jakarta Post story on the proposed government response to the two recent bird flu deaths in north Jakarta.

Bird flu alert raised after death of Jakarta siblings

Elly Burhaini Faizal, The Jakarta Post, Jakarta | Sat, 01/21/2012 12:31 PM

While you should follow the above link to read the entire story (which relates in some detail the events leading the deaths of these siblings) the Minister of Health Endang Rahayu Sedyaningsih is quoted as saying that the will conduct sentinel surveillance for the H5N1 virus in people presenting with influenza-like-illness, both in hospitals and community health centers.

“In the community health centers, we take specimens from people seemingly infected by the flu and test to see whether they have the seasonal flu virus only or H5N1.” - Indonesian MOH

Yesterday, the Health Minister was quoted as being concerned that the high fatality rate among known H5N1 cases in Indonesia might be due to growing antiviral resistance (see Indonesia: MOH Suspects H5N1 May Be Gaining Antiviral Resistance).

What is not known, of course, is whether there are mild, or subclinical cases going uncounted in Indonesia. Most researchers suspect that there are, but how many is anyone’s guess.

What is desperately needed in Indonesia, Egypt, and other places where the virus is endemic are systematic seroprevalence studies, to determine the actual rate of infection.

Without them, we are basically just guessing.

Earlier this week we learned that a mild case of H5N1 was picked up by routine surveillance from a sample taken from an outpatient seen last October at a sentinel flu clinic (see WHO Updates H5N1 In Egypt & Indonesia).

Lastly, it should be noted the newshounds at FluTrackers and the Flu Wiki are watching multiple suspected cases of H5N1 infection in Egypt and Indonesia being reported in the local media.

Given that this is cold & flu season, it is certainly possible that some (or even all) of these cases have something other than bird flu.

When we get more solid information, I’ll post it.

AFD Turns 6

2012-01-21T08:04:00.001-05:00

# 6091

Yesterday marked my sixth blogiversary at Avian Flu Diary - my very first essay under this banner , A humble Beginning – having appeared on January 20th, 2006.

Looking back at the prose and content of that first entry, that essay was aptly named. Of course, I never expected anyone to actually read it.

I originally created this blog as a personal diary, and to hopefully let a handful of friends and relatives stay updated on the pandemic threat.

I had no idea anyone else would ever discover it, otherwise I assure you, I’d have worked harder on coming up with a better name.

While it is my name on the masthead, this blog is by no means a solitary effort.

Each day I rely upon the newshounds on the flu forums (I frequent FluTrackers and the Flu Wiki) to help dig up, and translate, news items from all around the world. They not only find these tidbits of information, they often provide analysis as well.

While I mention them often, you can read my tribute to these terrific volunteers in Newshounds: They Cover The Pandemic Front.

If I had to do all of this research personally, I wouldn’t have time left to blog. So my heartfelt thanks go out to each and every one of these newshounds.

I’m blessed to be part of a greater blogging community we call Flublogia, including (but not limited to) Crof at Crofsblog, Arkanoid Legent, BFIC, Scott McPherson, Ironorehopper at A Time’s Memory along with related, but non-flu-centric blogs like Maryn McKenna’s Superbug blog, Ian York’s Mystery Rays, and Vincent Racaniello’s Virology blog.

Class acts every one.

And beyond Flublogia, there are other terrific bloggers who specialize in public health and/or science related issues, such as The Pump Handle, and Jim Garrow’s The Face of the Matter blog, and David Dobb’s Neuron Culture.

You’ll find more examples on my sidebar.

Of course, I’ve also been fortunate to be able to rely upon the great reportage from ace medical and science writers like Helen Branswell of the Canadian Press, Maggie Fox of the National Journal, Jason Gale of Bloomberg News, Lisa Schnirring & Robert Roos at CIDRAP, and everyone’s favorite `scary disease girl’; Maryn McKenna.

But I owe a special thanks to my `inner circle’, the people with whom I’ve spoken often, and who have provided me with wise counsel, good ideas, and when needed – a reality check - along the way.

In no particular order, they include:

Sharon Sanders of FluTrackers, Lisa at CIDRAP, my good buddy and fellow blogger Scott McPherson, Chacal in England, Cheryl, my high school buddy Cliff, and the always insightful and supportive Camille.

You guys are terrific.

And not listed – but deeply appreciated - are the scores of others who have graciously emailed, twittered, phoned, left comments telling me what they’d like to see me do with my blog, or found other ways to connect with me over the years.

Many of them you’ll find mentioned in my yearly Thanksgiving roll call blog, so I won’t repeat that list here today.

And lastly, there are the readers of this blog.

I can see, using my site meter software, many of the identities of those who visit each day (not people’s names, but IP addresses and domains).

I’m constantly amazed and delighted at the number of hospitals, universities, government agencies, and big corporations who elect to come here. This blog may not draw huge numbers of visitors, but their quality is undeniable.

Thank you.

In short, this blog has been a wonderful journey. One that has brought many new friends, and an avalanche of new knowledge into my life.

While six years is a long time in `internet years’, I look forward to continuing into the future; hopefully for as long as I can find something new and interesting (even if only to me) to write about.

It Gives You Fever

2012-01-21T07:37:00.001-05:00

# 6090

Amid blogging the sound and fury of this past week’s controversial bird flu news, I’ve spent a number of good hours enjoying a freshly minted copy of Peter Christian Hall’s pandemic novel American Fever, which he was kind enough to send me.

You may recall that twice in 2009 (Catching An American Fever, A Recurrent Fever) I wrote about the genesis of this online novel, which is written through the eyes of a New York City flu blogger as he watches his world unravel into a dystopian nightmare during an H5N1 pandemic.

Hall - a well established writer, journalist, and filmmaker – has seen his works published in The Huffington Post, Reuters, and Rolling Stone – just to name a few.

Peter recently interviewed Crof, Scott McPherson, Cottontop, and myself for an article on flu bloggers, and our reaction to the movie Contagion, for The Huffington Post (see Contagion Grips 'Flublogia').

In American Fever Peter weaves real-life flu bloggers into his narration, referring to (and providing links) to most of Flublogia as the novel progresses.

The web version remains online (edited, tightened up, and better than ever) which you can access for free, but now there is an e-book, and a printed version you can purchase.

Although I miss the ability to click and follow embedded links (of which Peter provides hundreds), personally I find it a lot easier to read a printed novel than one that is online.

It’s probably an age/eyesight issue.

Since I’m not a professional book reviewer, for a true literary dissection I’ll refer you to a couple of reviews of American Fever (here and here) that have appeared elsewhere.

For my part I’ll say that I thoroughly enjoyed the novel, and actually learned (and in some cases re-learned) a few things about flu in the process.

I do hope that Peter’s dark vision of what happens to outspoken flu bloggers during an H5N1 pandemic never comes to pass.

I keep repeating to myself . . . It’s only fiction . . .

Bottom line: American Fever – catch it, before it catches you.

Branswell On The Research Moratorium

2012-01-20T20:55:00.001-05:00

# 6089

Tonight Helen Branswell provides us with context and comments from no less than Ron Fouchier, Dr. Anthony Fauci, and Michael Osterholm on the big flu story of the day; the 60 day moratorium being offered on conducting certain types of bird flu research.

At this point I’m going to do the sensible thing; step aside and invite you to follow the link below to read the whole story.

Flu scientists halt research on lab-made viruses for 60 days to foster talks

Helen Branswell, Friday, January 20, 2012 8:4 PM

Avian Flu Diary

Hong Kong Swine Influenza Surveillance

Branswell On the CFR Of H5N1

Indonesia: Concerns Over Changes In Avian Flu Symptomology

Declan Butler On the CFR Of H5N1

ECDC Launches Weekly Communicable Disease Threat Report (CDTR)

Egrets, They’ve Had A Few . . .

HFMD: An Old Illness With A New Cause

Dispatch

Riikka Österback, Tytti Vuorinen, Mervi Linna, Petri Susi, Timo Hyypiä, and Matti Waris

Abstract

A Flu Flew Review

Will New Zealand stop travellers from coming into the country in an effort to stop the spread of disease?

Friday, May 21, 2010

Research

New Zealand : Airline Passengers Quarantined

CDC: On The Slow Start To The Flu Season

FluView: Week 5

Synopsis:

CIDRAP: Exploring the CFR Of H5N1

CDC/Medscape Video: Expert Guidance On The H3N2v Virus

Vietnam:`New’ H3N2 Swine Flu Virus Reported

Nature Editorial: Facing Up To Flu

Declan Butler: Lab flu may not aid vaccines

Video: NYAS H5N1 Debate

The CDC Responds To The Cochrane Group’s Tamiflu Study

Nature Video: Debating research into mutant H5N1 flu virus

Study: The Effects Of School Closures During A Pandemic

Fogarty research published in PLoS Medicine

Abstract (excerpts)

Should be considered as a control measure during pandemic outbreaks

Reminder: Great Central U.S. Shakeout Today

H5N1 Research: A Plethora Of Positions

ABSTRACT

An Off-Season Reminder

Nepal: Bird Flu Reported In Two Provinces

Bangladesh: Charges That A Lack Of Compensation Sends Infected Birds To Market

The Great Central U.S. Shakeout: Feb 7th, 2012

Pathogens, Publishing, And The Precautionary Principle

The NYAS H5N1 Panel

Nick Miller, New York

Media Reports Bird Flu Fatality In Vietnam

McKenna: Man Vs. MRSA

Canada Issues Biosafety Advisory For H5N1 Research

1. Background

2. Biosafety Requirements

3. Additional Risk Considerations

ACIP Broadens Adult Immunization Recommendations

Annals of Internal Medicine early release article for Feb. 1, 2012

Hong Kong: Gull & Peregrine Falcon Test Positive For H5 Virus

NSABB Statement, mBio Commentaries & A `Dual Use’ Webinar

Experts to discuss controversial studies on avian flu virus at live event

C. A. Nidom On Bird Flu In Indonesia

PBS: Ebright, Racaniello, & Zimmer Weigh In On Bird Flu Research

Surviving A Different Kind Of Aftershock

For Disaster Responders

Referral: McKenna On India’s Denial Of TDR-TB

The Kolkata Crow Mystery

NYTs: The Bird Flu Research Controversy Continues

EuroFlu: H3N2 Dominates But Overall Activity Is Low

Eurosurveillance: Older People May Be Susceptible To The H3N2v Virus

Australia Finds LPAI H5 On Two Duck Farms

Hong Kong: H5N1 Infected Goose Carcass Found On Beach

Nature: Yoshihiro Kawaoka Talks About His H5N1 Research

Situational Awareness: Google Public Alerts

More Conflicting Bird Flu Reports Out Of Indonesia

Bangladesh: Nipah Claims 5 Lives

FluTrackers: Assessment Of H5N1 In China

Survey: Gen X & The 2009 Pandemic

Academics Debate Odds Of Tokyo Earthquake

WHO: Will Host H5N1 Talks In Geneva

China Reports 2nd Bird Flu Fatality In A Month

Indonesia To Increase Surveillance For H5N1: MOH

AFD Turns 6

It Gives You Fever

Branswell On The Research Moratorium