posted
The last really bad influenza pandemic was in 1918 when something like fifty million people died worldwide, more than in all the combat in the 20th century, I read. Now the very deadly avian influenza in Southeast Asia is likely to mutate into a form that can be transmitted easily person to person. When that happens we're likely to see worldwide some very high death rates. They are trying to figure out what we can do that might make things better but even the most optimistic scenarios are pretty awful.
Because of the way the flu virus behaves, it's not so much a matter of "if" as "when". But we have no idea how much time we have. And we just don't have the capacity to generate enough doses of vaccine to be very effective (witness the debacle over the ordinary flu shots this last year).
Does the human species need to invest in more pharmaceutical manufacturing facilities for vaccines? Even ten times as much as we now have? What should we do? And what would the world be like if 1/3 of the people died next year? I haven't read Pepys. What is it like living in plague times? Would the normal social fabric strain to the breaking point?
I'm interested in the deeper questions behind this, too.
1. What do we personally do in a situation where 2/3 of the population comes down sick with the flu and half of those die? Are we personally prepared? Should we do what we can to look after the sick or stay as far away as possible in an effort to reduce our exposure?
2. Health care workers get the most exposure so they usually take a bigger hit than other professions. So we will be coping with a crisis with fewer doctors and hospital staff members than our usual number, meanwhile the number of patients will be off the charts.
3. What can we do to personally prepare? Should we attempt to obtain anti-virals in advance for our families? Or possibly antibiotics in case we survive the initial flu and get secondary pneumonia? Should we keep Gatorade and Pedialyte on hand? Death comes very quickly from multiple organ failure to many, but supposing we survive that phase, what drugs/supplies would we need?
4. Should we go to the hospital in the event we become sick during a pandemic, or would it be safer to stay at home?
I just want to know the right answers to these questions in advance, so that I don't have to waste time pondering alternatives when the time comes.
It's possible that in the course of mutating into a form that is easily transmissable between humans the virus will become much less deadly, but we don't know that for certain. It makes sense to know ahead of time what is the right thing to do in any event.
The mortality rates are chilling. Over half the people who get sick die within days.
Regardless of the specifics of the pathogen, plagues are a fact of nature. They've occurred again and again throughout history, and if our ability to cope has improved some, the increase in population density worldwide coupled with the rapid speed of travel nowadays has eaten up those gains and them some. It's really not a matter of "if" but "when" a plague (whether of influenza or some other pathogen) will occur. So what would you do? Doesn't it make sense to spend at least a little time deciding now?
Will the fabric of society break down? How do we strengthen it to prevent that?
quote: 1918-19, "Spanish flu," [A (H1N1)], caused the highest number of known influenza deaths: more than 500,000 people died in the United States, and up to 50 million people may have died worldwide. Many people died within the first few days after infection, and others died of complications later. Nearly half of those who died were young, healthy adults. Influenza A (H1N1) viruses still circulate today after being introduced again into the human population in the 1970s.
Phase 1: No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infection or disease is considered to be low.
Phase 2: No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease.
Pandemic alert period
Phase 3: Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact.
Phase 4: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.
Phase 5: Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk).
Pandemic period
Phase 6: Pandemic: increased and sustained transmission in general population.
From the same page as above. We're currently in phase 3 for bird flu, it seems.
EDIT: The latest news out of Northern Vietnam seems to indicate we may be moving into phase 4.
posted
What I read that made me realize the danger was this. Influenza viruses have only eight genes, and they reassemble spontaneously inside the cells where they're produced. Any time someone gets infected with more than one flu virus at once, say a human type that transmits easily person to person and the new bird flu type that is so deadly, every possible combination of the eight genes gets generated in the millions of infected cells inside that person's body.
So it's only a matter of time before a strain emerges that has both those factors. When that happens the world's health care infrastructure will be totally overwhelmed and there is no possible way we can make enough vaccine in time to have much effect at all.
The 1918 Spanish Flu pandemic killed people within hours, sometimes. They'd start to get sick and by the next day they were dead. Avian flu is every bit as deadly, if not moreso, it just lacks so far the ability to travel easily from person to person.
Posts: 6246 | Registered: Aug 2004
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posted
Great. And living in Asia, will we be among the first to see it? Probably.
Okay, in all seriousness, I've also known this was coming for a while. Heck, I have plans to somehow work something like this into a novel somewhere. No firm plans, but the germ of the idea is there at any rate. But still.
Eh. In other words, I have nothing to add.
Posts: 8355 | Registered: Apr 2003
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quote: Findings pointing to an altered role for domestic ducks join other recent evidence that the H5N1 virus circulating in parts of Asia has increased its pathogenicity in chickens and mice (a laboratory model for mammals), and has expanded its host range to include mammals, such as felines, not previously considered susceptible to infection.
posted
quid, do you have lots of domestic ducks and chickens in the area? There are guidelines for how to avoid infection directly from the birds, which is the primary means of transmission so far.
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quote:In the past, pandemics have announced themselves with a sudden explosion of cases which took the world by surprise. This time, we have been given a clear warning. During 2004, large parts of Asia experienced unprecedented outbreaks of highly pathogenic avian influenza, caused by the H5N1 virus, in poultry. The virus crossed the species barrier to infect humans, with a high rate of mortality. Monitoring of the evolving situation, coordinated by WHO, has produced many signs that a pandemic may be imminent.
quote: As yet another feature, the genetic content of these viruses is neatly segmented into eight genes. This facilitates the most greatly feared event: the swapping of gene segments during coinfection with human and avian influenza viruses, creating a new virus subtype that will be entirely or largely unfamiliar to the human immune system. If this new “hybrid” virus contains the right mix of genes, causing severe disease and allowing easy and sustainable human-to-human transmission, it will ignite a pandemic. This strategy, known as antigenic shift, works well as a long-term survival tactic: immunologically, a new virus subtype starts from scratch and is guaranteed a very large population of susceptible hosts.
quote: As a virus from the H5 subtype will be foreign to the immune system of everyone alive today, vulnerability to an H5N1-like pandemic virus would be universal.
quote: Although the second wave of outbreaks has been far less conspicuous in the numbers of humans and animals affected, it has demonstrated several unusual features. These features, confirmed by findings from recent epidemiological and laboratory studies, suggest that the virus may be evolving in ways that increasingly favour the start of a pandemic. Evidence strongly indicates that H5N1 is now endemic in parts of Asia, having established a permanent ecological niche in poultry. The risk of further human cases will continue, as will opportunities for a pandemic virus to emerge. Studies comparing virus samples over time show that H5N1 has become progressively more pathogenic in poultry and in the mammalian mouse model, and is now hardier than in the past, surviving several days longer in the environment. Evidence further suggests that H5N1 is expanding its mammalian host range. For example, the virus has recently been shown to cause severe disease and deaths in species, including experimentally infected domestic cats and naturally infected captive tigers, not previously considered susceptible to disease caused by any influenza A virus. The outbreak in tigers, which began on 11 October in Thailand, had a second disturbing feature. Altogether, 147 tigers in a population of 418 developed high fevers, usually progressing to severe pneumonia, as a result of H5N1 infection. Preliminary investigation found no evidence of tiger-to-tiger transmission. As infection was linked to the feeding of chicken carcasses, the amount of infected chicken moving in the food supply must have been great to have caused disease in so many large animals.
All these are from the same WHO pdf file as above.
posted
That pdf file is awesome, btw. I'm reading the whole thing. It's clear, complete, and factual. It tells the whole story, what you really need to know. I highly recommend it for anyone for some good bedtime reading.
I stay up at night thinking about these things, worrying about the human species, heh. Posts: 6246 | Registered: Aug 2004
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posted
You know what? I'd be very careful with birds of any sort, anywhere in the world. Once they're properly cooked they don't transmit disease, but when you're cleaing raw chickens or ducks preparatory to cooking them, it's probably wise to be extremely careful. Wear protective gloves especially if you have any cuts or scrapes on your hands. Those tigers got it from eating raw chicken carcasses, so the transmission risk must not decrease very rapidly after the bird is dead. Certainly anyone who slaughters live birds or handles newly killed birds is at risk.
I'm really glad I'm vegetarian nowadays. However, once the virus changes to become easily transmissable between humans, nobody anywhere in the world will be safe from it.
posted
Tatiana, in the country, yes. In my neighborhood, no. In other words, I'm never exposed to live chickens or birds of any description. Oh, but we do have some birds that land on our balcony or stair railing or that sort of thing, but I'm never withing five or ten feet of them.
Posts: 8355 | Registered: Apr 2003
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posted
Okay that's good. You're probably about as safe as any of us, in that case.
Pandemics always spread very rapidly to all parts of the world. With international travel and shipping nowadays, once the virus becomes readily transmissable between humans, there will probably be no more than a few months difference in when you're exposed no matter where you live.
For the moment, though, it's all about direct contact with infected birds.
Posts: 6246 | Registered: Aug 2004
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posted
In my reading of this excellent World Health Organization pdf file, I came across the recommendations for handling raw poultry and eggs. Though we may have seen this many times, it bears repeating in context of this highly deadly disease.
quote:WHO advice on the preparation of poultry for consumption
1. Avoid contamination Separate raw meat from cooked or ready-to-eat foods. Do not use the same chopping board or the same knife for preparing raw meat and cooked or ready-to-eat foods. Do not handle both raw and cooked foods without washing your hands in between and do not place cooked meat back on the same plate or surface it was on before it was cooked. 2. Cook thoroughly Thorough cooking will inactivate influenza viruses. Either ensure that the poultry meat reaches 70 degrees C (160 degrees F) or that the meat is not pink and there are no pink juices. 3. Be careful with eggs Eggs, too, may carry pathogens, such as the birdflu virus inside or on their shells. Care must be taken in handling raw eggs and shells. Wash shells in soapy water and wash hands afterwards. Egg yolks should not be runny or liquid. Do not use raw or soft-boiled eggs in foods that will not be cooked. 4. Keep clean After handling raw or thawed raw poultry or eggs, wash your hands and all surfaces and utensils thoroughly with soap and water.
posted
Okay I'm obviously nearly if not totally alone in finding this fascinating. But here are the mortality figures on cases of bird flu (H5N1) in humans last year (2004). In Viet Nam of 33 people known to have had the disease, 25 died. In Thailand of 17 people who got it, 12 died. The disease manifested itself with respiratory symptoms in all cases, and all came from contact with poultry. A mortality rate of 2/3rd is unheard of in past plagues, even the black death in medieval Europe, ebola, the Spanish Flu of 1918, all have much lower mortality rates than this. I should say too that the WHO only lists cases confirmed by laboratory testing. Other highly suggestive deaths are omitted.
Here's a list of the countries with outbreaks of the highly deadly H5N1 influenza A virus in poultry in 2004.
Cambodia China Indonesia Japan Lao People’s Democratic Republic Malaysia Republic of Korea Thailand Viet Nam
I'm not trying to get people alarmed, I'm trying to figure out how we should prepare, and to spread knowledge that might serve to keep more people alive, and more of society functioning in the event of a disaster.
posted
Out of curiosity, would you consider this more or less important than an asteroid defense project?
Posts: 6213 | Registered: May 2001
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quote: I'm not trying to get people alarmed, I'm trying to figure out how we should prepare, and to spread knowledge that might serve to keep more people alive
Wash your hands, cook your food, don't pee in your drinking water, and continue to lead a healthy life. Oh, and get a good night's sleep, that always helps.
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posted
Papa, I think that it's important for the people and governments of the world to prepare for both things, it's not an either/or thing. The resources required are miniscule compared to the risks involved in both cases.
For LDS church members, we're used to thinking in terms of preparedness. It's great that in emergencies we usually have the needs of our own families covered and are able to reach out and help others.
I'm really fascinated lately with what causes the social fabric to break down, or in the case of widespread war or chaos, what factors serve to bring it back into existence after it's gone, to build it back up and strengthen it when it's weak. Like why does democracy yield freedom in many countries and still result in widespread corruption and oppression in others? What factors lead to everyone pulling together as opposed to the dog-eat-dog, everyone for himself mindset that is so much more destructive, usually, than whatever catastrophe might have originally unleashed it? I think our species needs to understand these things much better than we currently do in order to survive the next few hundred years.
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posted
kaioshin, tapping into the resistance of animals is not mentioned as a possiblity in any of the information I've come across in my researches.
I thought about widespread advance vaccination against any chosen H5N1 strain, that it would greatly decrease the severity of any outbreak even if the particular strain was rather different. They do say the reason the mortality is so high and the resistance so low is because the immune systems in humans alive today have never had any challenges from H5 viruses. Why not do that? Too expensive? I'm not sure.
I understand why spreading a mild form isn't considered, because they mutate into more virulent forms quite readily. Apparently the influenza virus coopts cellular machinery in such a way that any transcription errors are not checked and corrected, so it mutates with exceeding rapidity compared to other organisms.
Posts: 6246 | Registered: Aug 2004
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quote:3. What can we do to personally prepare? Should we attempt to obtain anti-virals in advance for our families? Or possibly antibiotics in case we survive the initial flu and get secondary pneumonia? Should we keep Gatorade and Pedialyte on hand? Death comes very quickly from multiple organ failure to many, but supposing we survive that phase, what drugs/supplies would we need?
One of the best things you can do personally is to work on building a strong immune system for yourself and your family. No matter what the pathogen, a strong immune system is always the best way to fight it.
Americans currently practice dietary and exercise lifestyles that are NOT conducive to healthy living. Just because you're not symptomatic doesn't mean you're healthy. People who eat right and exercise and don't rely heavily on prescription drugs are always more successful at fighting infection.
Eat balanced meals low in saturated fats and simple sugars and starches. Eat plenty of fruits and vegetables, and a variety of them. Eat as many whole grains and fresh green vegetables as you can. Exercise regularly.
Try to lessen your intake of non-vital pharmaceuticals. People who use antibiotics at ever sign of a sniffle weaken their body's natural ability to fight off infection. Even relying on milder medications like NSAIDS (advil, etc.) compromises your natural defenses. Flu shots are not the panacaea that popular opinion treats them as.
Posts: 8504 | Registered: Aug 1999
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quote:Originally posted by Tatiana: The last really bad influenza pandemic was in 1918 when something like fifty million people died worldwide, more than in all the combat in the 20th century, I read. Now the very deadly avian influenza in Southeast Asia is likely to mutate into a form that can be transmitted easily person to person. When that happens we're likely to see worldwide some very high death rates. They are trying to figure out what we can do that might make things better but even the most optimistic scenarios are pretty awful.
Because of the way the flu virus behaves, it's not so much a matter of "if" as "when". But we have no idea how much time we have. And we just don't have the capacity to generate enough doses of vaccine to be very effective (witness the debacle over the ordinary flu shots this last year).
Does the human species need to invest in more pharmaceutical manufacturing facilities for vaccines? Even ten times as much as we now have? What should we do? And what would the world be like if 1/3 of the people died next year? I haven't read Pepys. What is it like living in plague times? Would the normal social fabric strain to the breaking point?
I'm interested in the deeper questions behind this, too.
1. What do we personally do in a situation where 2/3 of the population comes down sick with the flu and half of those die? Are we personally prepared? Should we do what we can to look after the sick or stay as far away as possible in an effort to reduce our exposure?
2. Health care workers get the most exposure so they usually take a bigger hit than other professions. So we will be coping with a crisis with fewer doctors and hospital staff members than our usual number, meanwhile the number of patients will be off the charts.
3. What can we do to personally prepare? Should we attempt to obtain anti-virals in advance for our families? Or possibly antibiotics in case we survive the initial flu and get secondary pneumonia? Should we keep Gatorade and Pedialyte on hand? Death comes very quickly from multiple organ failure to many, but supposing we survive that phase, what drugs/supplies would we need?
4. Should we go to the hospital in the event we become sick during a pandemic, or would it be safer to stay at home?
I just want to know the right answers to these questions in advance, so that I don't have to waste time pondering alternatives when the time comes.
It's possible that in the course of mutating into a form that is easily transmissable between humans the virus will become much less deadly, but we don't know that for certain. It makes sense to know ahead of time what is the right thing to do in any event.
The mortality rates are chilling. Over half the people who get sick die within days.
Regardless of the specifics of the pathogen, plagues are a fact of nature. They've occurred again and again throughout history, and if our ability to cope has improved some, the increase in population density worldwide coupled with the rapid speed of travel nowadays has eaten up those gains and them some. It's really not a matter of "if" but "when" a plague (whether of influenza or some other pathogen) will occur. So what would you do? Doesn't it make sense to spend at least a little time deciding now?
Will the fabric of society break down? How do we strengthen it to prevent that?
... I think we should be more worried about High Fructose Corn Syrup and McDonald's since those two things kill more people a year than anything else.
Posts: 4 | Registered: May 2005
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quote:I thought about widespread advance vaccination against any chosen H5N1 strain, that it would greatly decrease the severity of any outbreak even if the particular strain was rather different. They do say the reason the mortality is so high and the resistance so low is because the immune systems in humans alive today have never had any challenges from H5 viruses. Why not do that? Too expensive? I'm not sure.
I suspect that the reason why a plan to immunize the general public against H5N1 would fail is twofold--first, it would be expensive. Not as expensive as doing nothing will eventually be, but most governments are pretty short sighted, and are going to focus on the pain of immediate expense over long term expense. Second, it's guaranteed that a certain percentage of the people immunized would die as a result of the immunization. That percentage would be a fraction of the number killed if H5N1 were to sweep through the population unobstructed, but again, the cost would have to be paid now, rather than later.
Combine these two things, both of which basically boil down to short sightedness, with the fact that a relatively small percentage of the population is aware that there might be a problem on the horizon, and the fact that of those that are aware of it it seems more like a possibility than a certainty, and I think you have your answer.
Posts: 16059 | Registered: Aug 2000
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posted
And don't keep a huge number of birds in small cages right in the middle of high population areas.
I know it has been a major problem in Hong Kong, Beijing and other large Asian cities where there are humongous livestock markets. And most recent flu outbreaks have been traced to those places...
Posts: 2848 | Registered: Feb 2003
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posted
Annie, flu shots act by strenghtening the immune system, though. I think they are good things, along with all the other things you mentioned.
According to my doctor, aspirin and advil and such drugs do not compromise the immune system's ability to fight infections, though being healthy in all ways, nutrition, exercise, sleep, and cleanliness can certainly help a great deal.
One of the problems with pandemics as opposed to the normal yearly flu epidemics is they sometimes target the young and healthy preferentially over the old and sick, for some reason. The 1918 flu did that and bird flu so far seems to be doing it as well.
kai, if everyone else gets the vaccine, you don't have to. And maybe it could be the under-the-skin type like tuberculosis, that you don't have to be impaled on a long thin spike to receive. Do you dislike the air pressure gun type injections too? Or are those okay?
Posts: 6246 | Registered: Aug 2004
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quote:Annie, flu shots act by strenghtening the immune system, though. I think they are good things, along with all the other things you mentioned.
In a very specific way, though. It's incredibly difficult to vaccinate against something that doesn't actually exist yet, even if you have some idea of what form it's going to take. There's no guarantee that your vaccine will do anything, aside from being oppressively expensive. I'll go so far as to say it's impossible to create an effective vaccine in this scenario. Sadly, you can't buy science.
You're going to save more lives by sinking all that money into hospitals to save people that are ill now, rather than vaccinating the world against something that may or may not come into existence.
Posts: 3243 | Registered: Apr 2002
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posted
Jeff Grubb, those things (high fructose corn syrup and McDonalds) might kill lots of people over time but they are voluntary so that anyone who wishes to avoid exposure can easily do so, and they kill people gradually, so that they don't overwhelm the entire health care infrastucture of the world with dying people. That's why I feel bird flu merits more consideration.
Noemon, I think you're right about the reasons why no advance vaccine is distributed, yet the WHO does suggest that clinical trials go forward on vaccines for other H5 strains, so that most of the work can be done and the hurdles crossed in advance. Then later when the pandemic strikes, they can file slightly modified paperwork on the vaccine for the actual strain, and save time that way. Naturally it will be put on the fast track to approval. Still I am dubious that it could reach the public in time in sufficient quantities to make a huge difference. I'm still thinking we need ways that can be implemented in advance.
One thing they suggest is that if more people got the annual flu shot, the manufacturing and distribution capabilities of the whole system would be increased. Perhaps that's a good idea, for public health systems to reach out and advertise with the goal of increasing the number of people who get annual flu shots tenfold.
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posted
BtL, you're right that all that money and risk and effort from a worldwide advanced H5 vaccine might easily result in no increase in immunity. I guess that's why they don't consider it. Still for my own self and my family, I'd like to have it. I wonder if it (perhaps the one produced in those advanced trials that the WHO is recommending) could be made available to those who understand the risks and benefits, and who can afford it.
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posted
Sopwith, the largest transmission potential of the virus now exists in rural areas where nearly every family has a flock of domestic ducks and chickens that are free ranging and able to mingle with wild birds and share their water supplies. Bird feces in water is an excellent transmission method, it turns out, and there's virtually no way to control the situation in small flocks in remote areas (as is possible with larger commercial poultry farmers) or to eliminate the virus.
So while, for now, staying out of close contact with birds will protect people, eventually the generation of a strain that's easily passed directly from person to person seems inevitable. At that point, birds will no longer be important. We'll all be exposed within a few months at most.
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posted
No, Tatiana, I very much doubt it. If you're going to convince a company to develop this for you you're looking at spending hundreds of millions of dollars for something that may never pan out.
It comes down to it not existing yet. You just can't design an effective vaccine against an imaginary threat. The best you can hope for is continued influenza shots to combat co-infection and the genetic mingling that would come along with that, but I don't think that's what you're looking for. I can't in good faith tell you that it's impossible to develop an effective vaccine by shooting blind, but the odds are astronomically against you, and not much better for a partial vaccination. The money would be better spent elsewhere.
Posts: 3243 | Registered: Apr 2002
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posted
Yeah, BtL, you make very good points. What I was referring to was the WHO recommendation that vaccine manufacturers produce a mock-up vaccine.
quote:Regulatory agencies have established procedures for advance approval of a “mock-up” vaccine and subsequent fasttrack marketing authorization once a pandemic is declared.
Once the mock up vaccine is approved in advance, all the work and investment has been made. At that point it might be nice to make it available to the public so long as they understand the potential risks and benefits, and they know they aren't getting a vaccine for the real thing. If the price was rather high it would even help fund the whole process when the time came to produce the real one.
I'm also really interested in stockpiling antiviral drugs, particularly the ones that have a long shelf life (a decade). That would increase manufacturing capacity as well, if governments and people began to buy these in advance. It would spread out over time the demand which would likely peak sharply during an actual pandemic.
Posts: 6246 | Registered: Aug 2004
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posted
Everyone, if your friend or neighbor was sick with a highly lethal highly contagious disease, would you try to help or stay far away? I wonder what I would do? I like to think I would try to help in any way possible, while still taking every precaution to prevent infection of myself or anyone else, but I'm not sure. Would it depend on how easy it is for me to ignore it?
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posted
Flu vaccines are always for the various "last year's model". So the basic problem preventing the creation of a human "bird flu" vaccine is ya don't know what the surface proteins will look like until after the virus becomes human-to-human transmissible.
Posts: 8501 | Registered: Jul 2001
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posted
Would doctors know how to go about buying antiviral drugs to keep on hand? That seems really wise and useful to encourage everyone to do, and yet I think they are not available without a prescription. Is there some process we can initiate to change that? Or some way to work within the current laws but still allow this to happen? Pharmacists or doctors, do you know?
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posted
I'm concerned about my cats as well, now that those tigers got it. I wonder if canned cat food is cooked enough to kill viruses.
All the information talks about ducks and chickens but I wonder if migrating songbirds might get it as well? I will watch for any sudden drops in the number of birds that come to the feeders. That would be very sad.
posted
What reports are there of the disease among birds in the Western Hemisphere so far? The stuff I've read all seems to come from around January of this year, at which time it seems only birds in Asia were affected.
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posted
In the May 2005 Scientific American, they are reporting on computer simulation studies that consider prevaccination schemes, and blanketing the area of any outbreak with antivirals.
R0 ("R-naught") is the reproductive number, or the average number of new infections that one infected person will cause. We don't know in advance how infectious a new strain will be. At low R0s, outbreaks can be contained if detected with 14 days, and victims and their contacts are targeted with Tamiflu. Odds of containment become better still if everyone in the geographic area receives prophylactic Tamiflu when outbreaks are first detected.
"The higher the R0, however, the lower the likelihood of containing the virus. When the R0 is set at 2.4, for example, the outbreak quickly grows uncontrollably large in 75 percent of the simulations -- with the exception of scenarios in which the population has been vaccinated in advance, even if the vaccine is not a perfect match to the adapted H5N1 strain. With prevaccination, you can contain even a large R0 with antivirals. It basically buys you time; it effectively lowers the reproductive number."
Posts: 6246 | Registered: Aug 2004
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quote: Tuesday, March 15, 2005 Merial Launches New H5N1 Avian Influenza Vaccine GLOBAL - Merial today announced the introduction of a new inactivated vaccine, GALLIMUNE(R) Flu H5N9, developed and shown to be effective specifically for use against the highly pathogenic avian influenza virus H5N1 that has caused devastating economic losses in the poultry industry in Asia, and which has been linked to the deaths of over 29 humans.
Once vaccinated by GALLIMUNE Flu H5N9, chickens can be readily differentiated from infected birds through the use of the DIVA (differentiating infected from vaccinated animals) serological diagnostic test, which detects a non-pathogenic influenza strain contained in the vaccine.
GALLIMUNE Flu H5N9, an inactivated vaccine, joins TROVAC(R) AIV H5 as Merial's second major introduction of avian influenza vaccines. Recently conducted experiments with TROVAC AIV have shown the efficacy of this fowlpox vector avian influenza vaccine against the pathogenic Asian H5N1 virus. Tests conducted at government laboratories in the United States and Australia demonstrated significant levels of protection against viruses isolated in Korea and Vietnam. The vaccine was also able to reduce or eliminate the shedding of the virulent virus from the vaccinated chickens.
TROVAC AIV H5 is the only USDA licensed avian influenza vaccine for administration to chickens at one day of age. More than one billion doses of the TROVAC AIV H5 vaccine have been sold in Mexico and Central America since 1998.
TROVAC data is also being evaluated by international agencies and experts for inclusion in international guidelines for controlling and preventing avian influenza outbreaks.
Merial is a world-leading, innovation-driven animal health company, providing a comprehensive range of products to enhance the health, well-being and performance of a wide range of animals. Merial employs approximately 6,000 people and operates in more than 150 countries worldwide. Its 2004 sales were in excess of $1.8 billion. Merial Limited is a joint venture between Merck & Co., Inc. and sanofi-aventis.
I think this is a positive development. Vaccinate the birds instead of slaughtering them, yay! This is from the poultry industry news here.Posts: 6246 | Registered: Aug 2004
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quote: Monday, March 14, 2005 Bird Flu Clusters May Signal Virus Change
THAILAND - A cluster of human bird flu cases among relatives and possibly health workers in Vietnam may show the virus is changing into a form that can be passed on by humans, the World Health Organization said. The WHO is worried that bird flu, which has killed 47 people in Asia, could mutate into an easily spread form that sparks the next influenza pandemic, killing millions.
"Such cases can provide the first signal that the virus is altering its behavior in human populations and thus alert authorities to the need to intervene quickly," the WHO said in a statement seen on Monday.
The main concern of the WHO was a series of cases of the deadly H5N1 bird flu virus in a family in the northern Vietnam province of Thai Binh and the possible infection of two nurses who cared for one of the patients.
It also said it had received confirmation of an additional 10 cases of human infections from Vietnam's Health Ministry.
"Full information on new cases, including those that may be closely related in time and place, is critical to ongoing assessment of the pandemic risk posed by the H5N1 virus," the U.N health agency said in a statement.
The new cases were detected in early March or through re-examination of older cases, some of which dated back to late January and three of which had been fatal, the WHO said.
This, however, is extremely bad news. It's from Reuters 14 March, 2005.
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quote: What if the next pandemic were to start tonight? If it were determined that several cities in Vietnam had major outbreaks of H5N1 infection associated with high mortality, there would be a scramble to stop the virus from entering other countries by greatly reducing or even prohibiting foreign travel and trade. The global economy would come to a halt, and since we could not expect appropriate vaccines to be available for many months and we have very limited stockpiles of antiviral drugs, we would be facing a 1918-like scenario.
Production of a vaccine would take a minimum of six months after isolation of the circulating strain, and given the capacity of all the current international vaccine manufacturers, supplies during those next six months would be limited to fewer than a billion monovalent doses. Since two doses may be required for protection, we could vaccinate fewer than 500 million people — approximately 14 percent of the world's population. And owing to our global "just-in-time delivery" economy, we would have no surge capacity for health care, food supplies, and many other products and services. For example, in the United States today, we have only 105,000 mechanical ventilators, 75,000 to 80,000 of which are in use at any given time for everyday medical care; during a garden-variety influenza season, more than 100,000 are required. In a pandemic, most patients with influenza who needed ventilation would not have access to it.
quote: Clinical, epidemiologic, and laboratory evidence suggests that a pandemic caused by the current H5N1 strain would be more likely to mimic the 1918 pandemic than those that occurred more recently.5 If we translate the rate of death associated with the 1918 influenzavirus to that in the current population, there could be 1.7 million deaths in the United States and 180 million to 360 million deaths globally. We have an extremely limited armamentarium with which to handle millions of cases of ARDS (respiratory distress syndrome) — one not much different from that available to the front-line medical corps in 1918.
From a very good article in the New England Journal of Medicine, May 5, 2005, here.Posts: 6246 | Registered: Aug 2004
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April 23rd 2005 Washington Post article here.
quote: More than a year after avian influenza emerged in East Asia, killing more than two-thirds of the people with confirmed cases, Vietnamese doctors are reporting that the mortality rate in their country has dropped substantially.
Nguyen Sy Tuan lies in bed at Hanoi's Bach Mai Hospital as he recuperates from bird flu. Experts say dropping death rates could signal a wider outbreak.
But while this is good news for survivors, it could mean the outbreak of bird flu in Southeast Asia is taking an ominous turn. If a disease quickly kills almost everyone it infects, it has little chance of spreading very far, according to international health experts. The less lethal bird flu becomes, they say, the more likely it is to develop into the global pandemic they fear, potentially killing tens of millions of people
quote: Also worrying is the discovery of at least five cases, including that of Tuan's grandfather, in which people tested positive for bird flu but showed no symptoms. This could make it more difficult to contain an epidemic because people could transmit the disease without anyone realizing it.
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From the April 14, 2005 News Telegraph in Britain here.
quote: Peter Horby, the WHO medical epidemiologist in Hanoi, said that while the mortality rate from H5N1 infections was falling, the virus appeared to be adapting to human hosts, which was taken to be an indication that transmission between humans would become easier.
"The fact that it's been around for a year and we haven't seen a pandemic is no reason to be complacent," he said.
"I'm more concerned than I was a year ago." He estimated the probability of a pandemic at "more than 50 per cent".
Dr Klaus Stohr, the WHO global influenza programme chief, reported an increase in the number of cluster cases reported recently, with the biggest a family of five cases.
There have been seven cluster cases in Vietnam, all within single families, most recently in the northern province of Haiphong.
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I remember working at USAMRIID in 1993 when the Four Corners outbreak happened. I know a ton of people were worried about the same sorts of fears, but it came to naught.
Just like this probably will.
I think you seriously underestimate the cost of most of the precautions you are suggesting, and I know most of them won't come to pass because of the cost and the questionable effectiveness of the proposed treatment.
To be honest this sounds like chicken little...something needs to be done, some sort of precautions need to be taken.... but I doubt that it will become a pandemic. If it does, it would have even if we tried to avoid it.
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So your assessment that there is no threat, and that if there were any threat there's absolutely nothing we can do about it, is based on what, exactly? The fact that the last time there was concern about some disease outbreak that you were aware of it turned out to be less bad than feared?
That seems a valid scientific basis for risk assessment to you?
I think the assessment by these experts I've been quoting has a better basis than that. I think it's based on these things.
1. Historical records of influenza pandemics dating back through centuries of recorded history.
2. Knowledge of the epidemiology of influenza viruses, and the susceptibility of the human immune system to novel strains.
3. Knowledge of the propensities of mutation and genetic reassortment among influenza viruses.
4. Knowledge of the history of influenza pandemics to become successively more deadly and more easily transmissable with each wave of infection.
5. Understanding of the increase of population densities and international travel since the last serious pandemics.
To me all these considerations have much more weight to them, have a deeper ring of truth, than your facile dismissal based on a single experience with some entirely different organism.
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As for there being nothing we can do, I think the computer models answer that question the best it can be answered.
But even assuming we can't stop the spread of the organism in time using prevaccination and antivirals (and it's possible we've waited too late by now, though since we don't know for sure, we should be doing everything we can to advance these things regardless) we still need to plan where will the thousands of patients go once hospitals are overwhelmed? High school gyms or other tornado shelters? What will we do for nursing and doctors in the severe dearth of licensed health care workers? Can we use community volunteers and can they be trained in advance? What about police and fire and garbage and other essential services if half the workforce is out sick? What about facemasks, gloves, or other barriers or needed supplies? Can we increase the number of respirators in hospitals by 10% over the next year? Each respirator can be expected to save perhaps 10 people's lives. Can we get any of these things done in advance? All these things could be extremely helpful to have arranged, and are relatively easy to do with enough lead time but nearly impossible during the peak of a crisis. Isn't this exactly what public health officials and governments are charged to do? To anticipate such needs and plan for them?
Also, what can we personally do to prepare? Having a good supply of food and water and medicines at home might be one very important thing. Face masks and gloves might be another (though these may or may not be effective in preventing transmission.) Depending on how long we might have to prepare, getting antiviral drugs, antibiotics for secondary infections, and sick food such as soups and crackers might seem advisable.
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And maybe it could be the under-the-skin type like tuberculosis, that you don't have to be impaled on a long thin spike to receive. 
