Mixing Vessels For Influenza

[Excellent post at Avian Flu Diary - link to the blog is located on the right side-bar. Or click on the title]

Jan 7th 2010

From The Economist print edition

Which animal species are most likely to get flu?

Science Photo Library

What, me?

THE scientific value of zoos is sometimes called into question, but Mark Schrenzel and Bruce Rideout, two experts on wildlife diseases who work at San Diego Zoo’s Institute for Conservation Research, have just shown the value of having a wide range of animals to hand for study. They have been looking at which species might act as reservoirs for influenza viruses and—worse, from the human point of view—which might act as “mixing vessels” in which new strains of virus are generated.

(Continue . . . )

New strains of influenza come about from reassortment, or the mixing and matching of genetic material between two compatible flu strains in a shared host.

While any host (human, swine, avian) could produce a reassorted virus, hosts (like pigs) that are susceptible to a wider range of viruses are thought to be more likely to serve as an efficient mixing vessel.

Human adapted influenza have an RBD - Receptor Binding Domain (the area of its genetic sequence that allows it to attach to, and infect, host cells) that `fit’ the receptor cells commonly found in the human upper respiratory tract; the alpha 2,6 receptor cell.

Avian adapted flu viruses bind preferentially to the alpha 2,3 receptor cells found in the gastrointestinal tract of birds.

While there are some alpha 2,3 cells deep in the lungs of humans, for an influenza to be successful in humans, it needs to bind to the a 2,6 receptor cell.

(Very Simplified Illustration of RBDs)

Some mammalian hosts (like pigs) have both types of receptor cells, and therefore, increase the range of influenza viruses to which they are susceptible. And that, in turn, increases the odds that they could host two different viruses at the same time, and help facilitate a reassortment of two flu viruses into a new hybrid.

Drs. Schrenzel and Rideout at the San Diego Zoo have examined 60 different species of small mammals, and have determined that several carry the type of receptor cells (a2,3) favored by the H5N1 avian flu virus; including opossums, the Arctic Fox, and the Chinese wolf.

Additionally, we’ve seen H5N1 infections among dogs, cats, civets, raccoons, martens, and – of course – humans. And researchers have successfully infected cattle with the H5N1 virus, along with ferrets and mice for testing.

Over the years, scientists have openly wondered about possible mammalian reservoirs of the virus, which could help explain how the virus can be reintroduced to an area after massive poultry cullings have taken place.

The list of potential hosts is likely to continue to grow.

Schrenzel and Rideout have also identified a handful of small carnivores that carry both the a2,3 and a2,6 receptor cells, making them potential mixing vessels. These include the Persian leopard and the North American striped skunk.

For more on mammalian and avian hosts for influenza, you wish to revisit these blogs.

Japan: Bird Flu Antibodies Found In Raccoons

Reservoir Ducks

Reservoir Dogs (Cats, Foxes, and Raccoons)

And for more on RBDs, the following essays might be of interest.

Study: H1N1 Receptor Binding

RBD: Looking For The Sweet Spot

Receptor Binding Domains: Take Two

While we are learning more about influenza viruses, and the hosts they inhabit, we obviously have a long way to go. The novel H1N1 and H5N1 viruses have rewritten the science text books over the past five years, and more rewrites are likely in store.

National Health Security Strategy of the USA (HHS) - Excerpt

[This is from the pdf at the end of the previous post]

Our Nation, like all countries, faces many threats with the potential for large-scale health consequences, including disease outbreaks, natural disasters, and terrorist attacks. Preparing for and responding to these and other threats requires the commitment of, and cooperation among, all segments of society: government, the
private sector, local communities, and international partners.

This document presents the Nation’s first National Health Security Strategy (NHSS), which is intended to help galvanize efforts to minimize the health consequences associated with significant health incidents.1 The NHSS was developed in consultation with a broad range of stakeholders, including representatives from local,
state, territorial, tribal, and federal government; community-based organizations; private-sector firms; and academia. The statutory authority and requirements for the NHSS are provided under section 2802 of the Public Health Service Act.
--snip--
Excerpt:

7. Ensure prevention or mitigation of environmental and other emerging threats to health
The increasing mobility and density of human populations increase the odds of disease spread by bringing people more in contact with new environments and with each other. Many common pathogens that come from such environmental sources as food, water, and air undoubtedly account for more of the overall burden of disease than do novel pathogens or, to date, those intentionally spread through bioterrorism. Improved information sharing is needed across the human, animal, and food/agricultural sectors. It is important to develop and use these sources of information to maintain comprehensive situational awareness (as discussed in strategic objective 3) and inform actions to mitigate the effects of both acute and longer-term environmental and other emerging threats to health.32 Information about disease risks, environmental threats (e.g., to water and air quality), and food safety should be widely disseminated.

The public health system needs to be able to fully leverage the resources of and be fully coordinated with those organizations and individuals responsible for food safety,
environmental protection, and workplace safety. Improvements are required in monitoring emerging infectious agents, including zoonotic and agricultural disease threats and their effects on health; providing adequate biosafety and biosecurity; conducting surveillance of disease vectors; and mitigating any health impacts of climate change. Efforts are also needed to modernize food, plant, and animal safety systems, including mitigation of vulnerabilities at critical production and processing nodes, and to improve screening procedures and protection of the food supply and food products from intentional and unintentional contamination.

Enhancements are also needed to protect the environment and the safety and health of responders, including procedures to protect responders and the general workforce from existing and emerging workplace hazards. Procedures for evacuation, shelter in place, and response and recovery should also be improved.
--snip--

Roles and Responsibilities
Achieving national health security is ultimately the shared responsibility of all organizations (both governmental and non-governmental), communities, and individuals. Local, state, territorial, and tribal governments have primary authority for health security but receive support from the federal government before, during, and after incidents. The federal government also helps ensure comparable levels of health security across local jurisdictions by providing funding and guidance, developing performance measures and standards, sponsoring research, and
providing technical assistance.

But, as noted previously, a key principle of the NHSS is that other sectors—including the health care, emergency management, law enforcement, private/non governmental, and academic sectors—as well as individuals and families and the international community, all play a vital role in national health security.
For instance,18

• In the private sector, businesses should develop and practice plans for protecting their employees and ensuring business continuity.
• Critical infrastructure entities, such as power companies and other utility services, must also be engaged in planning for public health emergencies because of our society’s dependence upon their services.
• Academia can contribute to national health security through conducting research to identify best practices for national health security and providing education and training in activities necessary to ensure health security.
• Individuals and families play a critical role by developing family emergency plans, stockpiling food and water, and having available a reserve of their regular prescription drugs as well as over-the-counter medications and first aid supplies .
• Non-governmental organizations, including community-based organizations, are an
important partner in recruiting and supporting volunteers, particularly medical
professionals in activities such as dispensing countermeasures and providing medical care to casualties as needed.
• The international community plays a key role in surveillance, detection, and communication of health security threats to their own nations, which may also pose a threat to our Nation.

Each of these actors is critical in ensuring the Nation’s health security. Specific roles and responsibilities of each sector will be outlined in greater detail in the forthcoming Implementation Plan.

National Health Security Strategy

[This is the document linked in the previous post: HHS Delivers the Nation's First Health Security Strategy]

National Health Security Strategy (December, 2009)

This document presents the Nation's first National Health Security Strategy (NHSS), which is intended to help galvanize efforts to minimize the health consequences associated with significant health incidents. The NHSS was developed in consultation with a broad range of stakeholders, including representatives from local, state, territorial, tribal, and federal government; community-based organizations; private-sector firms; and academia. The statutory authority and requirements for the NHSS are provided under section 2802 of the Public Health Service Act.

The vision for health security described in the NHSS is built on a foundation of community resilience - healthy individuals, families, and communities with access to health care and with the knowledge and resources to know what to do to care for themselves and others in both routine and emergency situations. Communities help build resilience by implementing policies and practices to ensure the conditions under which people can be healthy, by assuring access to medical care, building social cohesion, supporting healthy behaviors, and creating a culture of preparedness in which bystander response to emergencies is not the exception but the norm.

Securing our Nation's health is a formidable task and must be a responsibility that is broadly shared among virtually all segments of society. The NHSS reflects current approaches and priorities for improving our Nation's ability to prevent, prepare for, respond to, and recover from a major health incident. However, the NHSS also acknowledges that achieving national health security is a long-term proposition, one that requires a process of continuous learning and improvement, strict accountability, a willingness to engage domestic and global partners, and an on-going commitment to measuring, evaluating, and improving our collective ability to recognize, confront, and resolve existing and emerging threats to our Nation's health. Learn More >>[http://www.hhs.gov/aspr/opsp/nhss/nhss0912.pdf]

HHS Delivers the Nation’s First Health Security Strategy

News Release

FOR IMMEDIATE RELEASE Thursday, January 7, 2010

Contact: HHS Press Office (202) 690-6343

HHS Delivers the Nation’s First Health Security Strategy

HHS Secretary Kathleen Sebelius today released The National Health Security Strategy, the nation’s first comprehensive strategy focused on protecting people’s health during a large-scale emergency. The strategy sets priorities for government and non-government activities over the next four years.

“As we’ve learned in the response to the 2009 H1N1 pandemic, responsibility for improving our nation’s ability to address existing and emerging health threats must be broadly shared by everyone – governments, communities, families, and individuals,” Secretary Sebelius said. “The National Health Security Strategy is a call to action for each of us so that every community becomes fully prepared and ready to recover quickly after an emergency.”

National health security means that the nation and its people are prepared for, protected from, and resilient in the face of health threats or incidents with potentially negative health consequences such as bioterrorism and natural disasters. The strategy provides a framework for actions that will build community resilience, strengthen and sustain health emergency response systems, and fill current gaps.

“Events which threaten the health of the people of this nation could very easily compromise our national security. Whether it’s a pandemic or a premeditated chemical attack, our public health system must be prepared to respond to protect the interests of the American people. In order to be prepared to both respond to an incident and to recover, we need a strong national health system with individuals and families ready to handle the health effects of a disaster,” Secretary Sebelius said.

The National Health Security Strategy and the accompanying interim implementation guide outline 10 objectives to achieve health security:

1. Foster informed, empowered individuals and communities
2. Develop and maintain the workforce needed for national health security
3. Ensure that situational awareness so responders are aware of changes in an emergency situation
4. Foster integrated, health care delivery systems that can respond to a disaster of any size
5. Ensure timely and effective communications
6. Promote an effective countermeasures enterprise, which is a process to develop, buy and distribute medical countermeasures
7. Ensure prevention or mitigation of environmental and other emerging threats to health
8. Incorporate post-incident health recovery into planning and response
9. Work with cross-border and global partners to enhance national, continental, and global health security
10. Ensure that all systems that support national health security are based upon the best available science, evaluation, and quality improvement methods

The National Health Security Strategy also highlights specific actions that the nation – including individuals, communities, non-government organizations, and government agencies – should take to prevent, protect against, respond to, and recover from health threats.

Among the initial actions for the federal government are conducting a review to improve the system for developing and delivering countermeasures – medications, vaccines, supplies and equipment for health emergencies; coordinating across government and with communities to identify and prioritize the capabilities, research, and investments needed to achieve national health security; and evaluating the impact of these investments.

Federal, state, local, tribal, and territorial government agencies, as well as medical, public health and community-based organizations, collaborated to develop the strategy and interim implementation guide. To determine any additional issues and themes the strategy should address, the HHS solicited direct input from non-federal participants during six regional workshops. HHS also worked with the Institute of Medicine to engage the medical community.

The Pandemic and All Hazards Preparedness Act directed the HHS Secretary to develop the National Health Security Strategy with an accompanying implementation plan by 2009 and to revise the documents every four years. HHS, however, will update the implementation plan every two years to reflect advances in public health and medicine.

Because of the close relationship between health and national security, the National Health Security Strategy that complements and supports other U.S. strategies and guidelines related to security preparedness, response, and recovery.

To obtain a copy of the strategy and implementation guide, visit www.hhs.gov/disasters. [I posted working link below]

http://www.hhs.gov/disasters/

Indonesia: Central Java: Cilacap - H5N1 in Poultry

1/7/10

Cilacap, Central Java – At least 50 backyard chickens belong to locals in Desa Karangmangu, Kecamatan Kroya found suddenly dead. Head of Agriculture and Livestock Service of Kabupaten Cilacap, Gunawan, confirmed those chickens had died of bird flu or avian influenza (AI) virus.

“Field investigation revealed chickens have died of AI virus. Together with locals, all positive chickens have been diminished and buried immediately. After that, we sprayed disinfectant to the area,” mentioned Gunawan.

Even though the incident hit backyard chickens, but disinfection was also done to several farm centers to inhibit further spreading. So far, broiler and layer chickens reared in close proximity survived from AI attack. Commercial farms mostly applying proper biosecurity practices such as regular disinfection so that they survived from the outbreak.

Case of sudden death in chickens was not the first time observed in Desa Karangmangu. Hundreds of chickens in Desa Karangtengah Kecamatan Sampang have experienced the same incident.

Head of Health Service of Kabupaten Cilacap, Sugeng Budi Susanto, separately commented there was no bird flu transmission to human so far.

Source: Indonesia local newspaper. Jawa Pos National Network (JPNN).

http://www.jpnn.com/index.php?mib=berita.detail&id=56016.

Indonesia: Map of Poultry Outbreak H5N1 in Kalimantan

Courtesy of Bird Flu Information Corner

Kalimantan Indonesia. Red circles are outbreak locations in Central Kalimantan province.

Indonesia: Central Kalimantan H5N1 outbreak in chickens (Update)

1/7/10

This is related, and also a correction, to the previous post “Kapuas, South Kalimantan ::: Mass chicken deaths confirmed H5N1 positive”, which mentioned bird flu outbreak in “South Kalimantan”. Kapuas is actually a municipal (Kabupaten) in “Central Kalimantan” (Kalimantan Tengah). We appologize for misleading the location of Kapuas. This post also give additional information other outbreaks in Kabupaten Pulang Pisang and Palangkaraya city (capital of Central Kalimantan). -adm-.

Palangkaraya – Thousands of poultries in Kabupaten Kapuas and Kabupaten Pulang Pisau, also Palangkaraya city, in Central Kalimantan province, contracting bird flu or avian influenza (AI) virus. Vice governor of Central Kalimantan, Ahmad Dran, stated those birds possibly entered Central Kalimantan from neighboring province, Banjarmasin, South Kalimantan. To stop expansion of outbreak, regional government paused incoming poultry traffic from Banjarmasin, in mean time, poultry product needs will be supplied from Kabupaten Sampit.

All ports of poultry trading routes, added Diran, will be strictly watched by building up poultry inspection point in Kapuas and Barito Timur, which are located in the border of Central – South Kalimantan.

Until now, numbers of dropped dead chickens and confirmed positive bird flu infection have reached 6,298 backyards and 1,353 broilers in Kabupaten Kapuas; 9,756 broilers in Kabupaten Pulang Pisang; and 29 broilers in Palangkaraya city.

Head of Agriculture and Livestock Service of Central Kalimantan, Tute Lelo, said all infected chickens had been burned. No symptoms in human yet reported.

Meanwhile, Head of Health Service of Central Kalimantan, Don Leiden mentioned their party had prepared special unit for bird flu patient in Dorrys Silvanus regional hospital in Palangkaraya.

Source: Indonesia national newspaper, Koran Tempo.

Indonesia: Urgent need for Tamiflu in Basarang Bird Flu Attack Kalteng

Thursday, 07 January 2010, 11:44:00

KUALA KAPUAS - The discovery of cases of positive cases of bird flu virus in District Basarang which caused thousands of dead domestic poultry, making people more nervous. This is due to the lack of availability of vaccines and medicines to the deadly disease is not contagious to humans.

Head of Puskesmas Basarang Tilda Yusmiati Nanjan through their representatives do not claim to have instansinya tamiflu drug supply in anticipation of bird flu disease. Therefore, if you found any symptoms of people who contracted the virus H5N1, which carried out the steps that make referrals to hospitals Kapuas.

"If people who have flu symptoms, so patients are given drugs paracetamol and vitamins, to reduce fever. If the symptoms of bird flu must be referred," Yusmiati.

Added, the needs of these drugs is urgent that there is no suspect case of bird flu that can not be handled properly and resulted in the death of the patient.

Earlier, Chief of Health Dr. Ani Handaningroem Kapuas revealed, for the prevention of virus transmission from poultry to humans, health office has done tamiflu to droping drug-health clinic in Kapuas district. Unfortunately, it has not received droping the health center Basarang the vulnerable areas of the bird flu. (Art / yon / fuz)

Indonesia: Another BF outbreak in poultry in Lampung

[Another outbreak in Lampung]
Bird Flu Virus Spreads

Excerpt:
THURSDAY, 07 JANUARI 2010 - 06:47 PM
Assessment Online: / 0
Worst Best
KALIANDA - Outbreaks of bird flu virus spread in South Lampung. Local farming office again to find cases of bird flu or avian influenza (AI) in the Village II, Village Tajimalela, District Kalianda, yesterday (6 / 1).

Previously, this work unit to find a similar case in the Village II, Village Building, District Palas, on Saturday (2 / 1) and. Poultry disease caused by H5N1 virus in the village was declared positive Tajimalela and kill at least 44 chickens owned by the five heads of households (families), local.
Chickens died suddenly it's known as many as 15 tails Bunyamin, Bahri (20), Amina (1), Jahidin (2), and Riduan (6). This bird flu is known as local residents reported the findings Bunyamin to Animal Husbandry Department (Disnak) Lamsel yesterday.
Kadisnak Lamsel drh. Accompanied Kabid Khandri Animal Health and Veterinary Public Health drh. Great Kusmartuti admitted after getting information of chicken died suddenly, it took the quick movement by inspecting chickens died with a rapid test.
''The chickens that died suddenly positively infected by avian influenza virus.
-snip-

Indonesia: Blood samples of five patients Suspect Bird Flu Sent to Jakarta

Thursday, 07 Januari 2010
DENPASAR - MI: Blood samples of five patients suspect bird flu (H5N1) is now being treated at the Hospital (RS) Sanglah Denpasar, Bali, sent to Jakartal to ascertain whether the five men positively infected by avian flu.

"We have sent blood samples to Jakarta, so just waiting for the result if it later tested positive or negative," said Head of Provincial Health Office Dr. Nyoman Bali Suteja in Denpasar, on Thursday (7 / 1). But Suteja not specify the names of the five patients.

Tapinya, the symptoms the patient has not shown a strong lead to the bird flu. The reason is the recent weather changes that affect one's health condition.

The symptoms indicated a very common, such as body temperature rises, and shortness of breath. Even so, he still would not take any chances and did not immediately examine the blood samples as the anticipation of things unwanted. "So, they keep the patients treated in isolation," said Suteja.

Susfect bird flu patients who entered the Sanglah Hospital, Tuesday (6 / 1), the initials WR, 65, from Banjarangkan, Klungkung regency. WR suspected that H5N1 virus following the death of some chickens in the neighborhood of a sudden.

Based on the record, since the emergence of bird flu case in Bali, of all patients who had been treated in hospital Sanglah two of whom died in 2007. Both were from the district of Tabanan and Jembrana. (RS/OL-01)

Egypt: The deaths of 10 flu cases raise the number for 172 cases

Wednesday, January 6th, 2010

The Ministry of Health for the death of ten new cases of HIV (er HP 1 that 1) strain of swine flu, bringing the total number of deaths since the disease appeared in Egypt so far 172 cases.

The ministry said that the ten cases and two cases occurred in Daqahlia, Cairo, Assiut (two cases), Helwan (two cases), and the Western cases, the status of the governorates of Sohag, and the lake.

Vietnam: Ca Mau: Bird flu recurrence [in Poultry]

Wednesday, 6 / 1 / 2010, 15: 49 (GMT +7)
5-1 days, leaders Tran Van Thoi District, Ca Mau province said the bird flu recurrence in the Khanh Hung's district.

Accordingly, on 31-12-2009, veterinary agencies detected Forum Khanh Hung industrial chicken raising children in households in 1995, Mr. Tran Van To, Hamlet Factory C, Khanh Hung dead series. Afternoon 2-1-2010, test results showed that product samples were positive with all influenza A/H5N1.

The competent authority as soon as it has destroyed all poultry and processed on the outbreak prescribed.

D.Mui

(Source: VNA)

Bangladesh: At least three children dying from strange diseases

Wednesday, January 6, 2010

2 / 1, the private UNB agency to believe at least three babies were dying from a strange disease in Sylhet district, northeast of the Bangladesh capital Dhaka.

We have seven more children infected again this mysterious disease.

Arafat's family, a boy 10 years old, said they took him hospitalized in a state of children today 30/12 diarrhea and difficulty breathing. After hospitalization for some time, Arafat died.

The next day, a two-month-old boys and a girl 10 months old and die with similar symptoms at a different hospital. There patients infected strange expression is being treated at the same hospital.

About Bangladesh health officials said patients were comatose due to diarrhea and difficulty breathing. This is totally unusual signs.

Egypt H1N1 Deaths Case List

This case list will be located on the right side-bar, and updated as needed.

12/5: _____26
12/17:_____74
12/19:_____84
12/20:_____89
12/21:_____93
12/23:_____101
12/26:_____106
12/27:_____109
12/28:_____115
12/29:_____120
12/31:_____133
1/1:_______141
1/5:_______162
1/7:_______172
1/9:_______181
1/9:_______187
1/10:______195
1/11:______201
1/18:______228
1/19:______232
1/20:______238
1/23:______244

Egypt: Ministry Health, Reports death number 162 from H1N1

Twall's edits are in (blue)
Tuesday, January 5th, 2010 - 22:33


Dr. Abdel Rahman Shahin, official spokesman of the Ministry of Health

The Ministry of Health for three deaths, new HIV (er HP 1 that 1) the world-renowned swine flu in order to increase the total deaths since the disease appeared in Egypt and so far 162 cases.

According to the ministry - in a statement on Tuesday - that the situation of (case number) 160 women from the province of Fayoum, and old (40 years),

and the situation of (case number) 161 women from the province of Beni Suef and old (16 years).

The statement pointed out that the situation of a man (case number) 162 from Monofia old (74 years).
hat-tip Twall

Egypt: "Health" expect 200 deaths the flu in January

Tuesday, January 5th, 2010 - 14:57


Dr. Abdel Rahman Shahin, official spokesman of the Ministry of Health
Abdul Salam wrote Princess


Dr. Abdel Rahman Shahin, official spokesman of the Ministry of Health, the high number of deaths from infection to 159 cases after recording the deaths of 10 cases, only yesterday, that is to be expected not surprised the Ministry of Health.

For his part, predicted the Minister of Health Dr. Hatem mountain high number of deaths as a result of infection during the month of January to in excess of 200, added to the cases recorded so far, which amounted to 159 deaths, while the number of casualties exceeded 15 thousand cases registered so far.
The Minister of Health in January that will exacerbate the outbreak of the relatively limited, and for a period of two months and then start a new wave of Ttorart virus and that no one knows so far.
hat-tip Twall

Indonesia: H5N1 in Poultry - South Kalimantan

Kapuas, South Kalimantan ::: Mass chicken deaths confirmed H5N1 positive

January 5, 2010

Kuala Kapuas – Thousands of chickens confirmed to have died of bird flu H5N1 virus in Kabupaten Kapuas. Confirmation test to dead bird specimens, such as organ, serum and swab, was done by Veterinary Investigation and Diagnostic Center (BPPV) Regional V, Banjarbaru, South Kalimantan.

Total 82 specimens were collected from dead chickens in several sub-districts (kecamatan), i.e. Kecamatan Pulau Petak, Selat, Kapuas Timur and Basarang.

For Desa Batu Nidan, Kecamatan Basarang, 3 backyard chicken samples tested positive bird flu infection.

For Kuala Kapuas, 1 of broiler chicken samples tested positive bird flu infection.

Sudden deaths in chickens in Kuala Kapuas were started at beginning of December 2009 until 3 January 2010. Total chicken deaths in 7 sub-districts are 6,615 chickens. Numbers in detail according to sub-districts are: Kecamatan Basarang 3,909, Selat 360, Petak 953, Kapuas Hilir 422, Kapuas timur 255, Kapuas Murung 500 and Kapuas Kuala 16 chickens.

So far, bird flu H5N1 virus only attack chickens in South Kalimantan. No bird to human virus transmission is reported.

Source: Indonesia local newspaper, Kapuas Zone.

hat-tip Dutchy

H1N1 response shows need for better medical emergency plans

By Bob Graham and Jim Talent

Monday, January 4, 2010

For generations, the United States has neglected to nurture the technologies and systems needed to respond to emergencies related to disease. Nowhere has this been more evident than in the response to H1N1.

To make flu vaccine, we rely on a 60-year-old production method based on chicken eggs. It is safe but slow and has led to long lines at clinics and shortages of vaccine. It is not just that priority groups have been left unprotected. We learned last month that this method leads to multiple manufacturing issues, such as the recall of 800,000 children's vaccine doses, due to diminished potency.

Our nation relies on a disease surveillance system that doesn't give useful information about an epidemic, such as the severity of illness, transmission rates and spread of disease in communities. Even today, we have no idea how many people have had the H1N1 virus. If this country had an up-to-date system, we could make better decisions about school closings, infection control guidance and antiviral drug use.

We also rely on an outdated, slow method for diagnosing cases of H1N1. Our diagnostic technologies are difficult, expensive and time-consuming. If rapid tests were available, people who are sick could get treatment sooner, and we could determine the size of an outbreak, whether the disease is getting more severe and how to target limited health resources.

In short, despite the tireless efforts of public health and health-care workers, America's experience with H1N1 shows that the nation is not prepared to deal with a flu pandemic.

The really bad news is that we are far more prepared to respond to a flu outbreak than to any other biological event, natural or manmade, such as the ebola virus.

In six to nine months last year, the United States was able to identify this new H1N1 virus, make vaccine and begin distributing it, though in inadequate amounts. There is no other disease to which our public health infrastructure could respond anywhere near as quickly. For most new diseases, the response time would be more like six to nine years.

We are the leaders of the congressionally mandated Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism, which found in 2008 that it was not just possible but probable that terrorists would succeed in using a weapon of mass destruction somewhere in the world by 2013 and that the weapon would most likely be biological. We can anticipate the likely pathogens terrorists would use, but this information is meaningless if we do not have the stockpiles, medical countermeasures and tested plans for distributing them to affected areas. Terrorists will not give us six months' warning before deploying a biological weapon.

The major review that Secretary of Health and Human Services Kathleen Sebelius announced recently for our nation's capabilities for developing and distributing countermeasures is a step in the right direction. But this must happen quickly, and it is only the beginning of the journey to full preparedness.

The good news is that science has the means to develop and stockpile countermeasures to known pathogens, and to vastly improve our capacity for responding to new diseases. Unfortunately this will not happen through private-sector action alone, and our government, including the last several administrations, has not given this issue the consistent priority it deserves.

If the planned review is simply a sporadic response to the high visibility of H1N1, or to the repeated and highly public warnings by our commission, it will result in yet more talk without action. The H1N1 epidemic will subside and be forgotten, and our commission will go out of business in the spring. But the danger, both natural and manmade, will grow.

As bad as H1N1 has been for affected families, it could have been much worse. It could have been a human-to-human transmissible form of H5N1, which could kill up to 70 percent of those infected. It could have been an anthrax or ebola attack on a major city, which could expose several million people to deadly pathogens.

We don't know how to repeat our warning or our recommendations more plainly: In the judgment of our bipartisan commission, such an event is not only possible but likely; and it could result in the death of a few people or hundreds of thousands, depending on whether our government develops the complete chain of response, including links for surveillance, diagnosis, stockpiles of medical countermeasures and effective distribution networks.

We know from the attempted airplane bombing on Christmas Day that al-Qaeda is a determined enemy. We also know -- from the discovery and dismantling of biological weapons labs in Afghanistan -- that they are pursuing biological weapons research.

The necessary investment of public funds is relatively modest. What has been in short supply is leadership. The announced review is a good first step. But will real action follow, and will it happen in time?

Bob Graham, a former Democratic senator from Florida, and Jim Talent, a former Republican senator from Missouri, are chairman and co-chairman of the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism.

Cold increases cases of A H1N1 USA

Doris Gomora
El Universal
Monday, 04 enero of 2010
politica@eluniversal.com.mx

Epidemiological Control Center (CEC) reported a significant increase in influenza cases AH1N1 United States in the last week, as a result of snowfall affecting U.S. and reported that the number of related deaths has also increased.

The first report of 2010 the CDC, based in Atlanta, said that pandemic influenza has increased nationwide, representing the first increase in this indicator after eight consecutive weeks in which they had been cutting case reports of influenza.

In addition the CDC showed that the proportion of deaths attributed to pneumonia and pandemic influenza rose from 122 cities in the United States in the last week.

He also reported that in pediatric groups, four deaths were reported last week, bringing the total 289 deaths, in this sector, since April 2009 product of AH1N1 virus in the United States.

Additionally, he mentioned that there was an increase in the percentage of doctor visits as part of routine medical checkups of the season, in which cases were detected AH1N1 throughout the U.S..

The CDC noted that until this moment the majority of influenza is identified in U.S. AH1N1 type, and the virus remains similar to that found at the beginning of the pandemic, which developed the vaccine was applied to knock it out.
hat-tip Tonka

Indonesia: Pekanbaru, Riau: Outbreak rises in Kabupaten Indragiri Hulu

January 4, 2010

Pekanbaru, Riau – Livestock service is still waiting H5N1 confirmation result from Veterinary Investigation and Diagnostic Center (BPPV) that suspected to have attacked birds in Kabupaten Indragiri Hulu, said Head of Livestock Service Riau, Patrianov.

Previously, dozens of backyard chickens suddenly died in two separated areas in Kabupaten Indragiri Hulu. Following to the case, at the end of December 2009, two toddlers from Kabupaten Indragiri Hulu were suspected of having bird flu infection.

One of the child – resident of Dusun Tuo Pelang, Kecamatan Kelayang – has died, while the other, resided in Desa Bongkal Malang, Kecamatan Simpang Kelayang is still under intensive treatment in Arifin Achmad hospital, Pekanbaru.

Initial rapid test to the dead chickens showed negative H5N1, however Livestock Service is still waiting more valid result from the BPPV . “We hope to get the result by Monday (4/1),” said Patrianov.

Indragiri Hulu has been stated as H5N1 endemic area since 2007.

Until November 2009, Livestock Service of Riau have recorded total 17,353 birds in Riau died of bird flu virus. The virus has infected 8 people where six of them died.

Indonesia: Pekanbaru, Riau: Bird flu suspect girl is recovering

January 4, 2010

Pekanbaru, Riau – A bid flu suspect (H5N1) toddler from Desa Bongkal Malang, Kecamatan Simpang Kelayang, Kabupaten Indragiri Hulu, Riau, is recovering. This is stated by Head of Bird Flu Control Team of Arifin Achmad hospital, dr Azizman Saad.

Patient, named An Nisha (4) is currently in normal state, with body temperature about 36℃ and breathing rate 36 per minute.

Before receive intensive treatment at isolation unit for infectious disease patient, the girl was in critical condition with breathing difficulty.

At time of admission she had breathing rate 60 per minute, body temperature up to 39.8℃ with leukocyte count was 3,200 and thrombocyte count was 77,000.

Blood and throat samples are still under evaluation of Ministry of Health laboratory, in mean time, patient has not been discharged from the hospital. Samples were sent to Jakarta last Saturday (2/1).

An Nisha was stated as bird flu suspect patient after developing high fever and having contact history with dead birds within a radius of 10 meters from her house.

She was previously treated at Indrasari regional hospital, and then transferred to Pekanbaru.

Source: Indonesia news office, ANTARA.

China: Anti-pandemic effort shifts to rural areas

2010-01-04

The nation is confronted with a new front in the battle to contain the H1N1 flu outbreak as the virus spreads into the vast countryside where medical facilities lag far behind cities, health officials and experts warned yesterday.

As the pandemic appears to be declining in cities where a nationwide H1N1 vaccination program has started, the Ministry of Health pledged to concentrate more on rural areas, particularly schools, for prevention and control.

Students, pregnant women and the chronically ill are at particularly high risk, and so special attention will be paid to them, said an online statement issued by the ministry over the weekend.

The risk of outbreaks in the countryside will increase as hundreds of millions of migrant workers in cities go back to their rural homes for the Spring Festival, which falls on Feb 14.

"They might take the virus back to their hometowns," Feng Zijian, who heads the emergency response department of the Chinese Center for Disease Control and Prevention (CDC), said yesterday.

In response, the government is rushing medical equipment such as respirators to 17 central and western provinces, particularly rural areas, to "increase the overall ability to deal with severe cases", the statement said.

By the end of last year, the nation had reported 120,000 lab-confirmed H1N1 cases, including 648 deaths, official figures showed.

Nearly 50 million had been vaccinated against the flu by Dec 31, falling short of the 65 million target announced by Health Minister Chen Zhu.

In many parts of the country, vaccinations are first given to the high-risk population with local permanent residency permits, or hukou, largely due to limited vaccine supplies, according to previous reports.

Health experts estimate that 15 percent of the population have thus far developed immunity to the virus, the statement said.

In other words, H1N1 vaccine recipients and those who have contracted the virus - without their cases being officially reported - could amount to about 195 million, Zeng Guang, CDC's chief epidemiologist, explained yesterday.

"The immunity level will increase as the virus keeps spreading," he added.

The higher the proportion of individuals who are immune, the more unlikely the virus would spread, health studies show.

However, "as long as susceptible individuals and the virus exist, the battle against H1N1 cannot stop, especially in rural areas", he said.

Meanwhile, the ministry called for a rational attitude toward the disease among the public.

"There is no need to panic. Passengers who display flu-like symptoms should not be driven out of the public transport. A facial mask would work well to prevent infection," it said.

Media reports said some migrant workers traveling by public transport during the New Year holiday were thrown out by other passengers for showing flu-like symptoms.

Hong Kong: Oriental Magpie Robin tests positive for H5N1 virus

Monday, January 4, 2010
Issued at HKT 11:23

The Agriculture, Fisheries and Conservation Department said today (January 4) that an Oriental Magpie Robin found in Hok Tau, Pat Sin Leng was confirmed to be H5N1 positive after a series of laboratory tests.

The bird carcass was found and collected on December 29 near the Hok Tau Management Centre in Pat Sin Leng Country Park. The Oriental Magpie Robin is a common resident bird in Hong Kong.

A department 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.
hat-tip Ironorehopper

Influenza A (H1N1) continues raging in the world

04-01-2010
ND - According to Reuters and Xinhua, days 3-1, the World Health Organization (WHO) said that the number of victims killed as influenza A (H1N1) worldwide had reached more than 12,220 people.

In China, the Health Ministry said the country has more than 120 thousand people infected with influenza A (H1N1), including 648 deaths. Currently China is facing the risk of influenza A (H1N1) will spread throughout the country as millions of people in big cities flock to welcome home on the occasion of the upcoming Lunar New Year.

In Egypt, more than 10,777 infected with ca influenza A (H1N1), including four deaths, bringing the total number of deaths due to disease to 145 people.

In Algeria, more in deaths, bringing the total number of deaths due to influenza A (H1N1) to 47. In the U.S., more than 6670 people died and in Europe at least 2422 people die from influenza A infection (H1N1).

M. Chan WHO Director General calls the world should continue to closely monitor the disease within six to 12 months, and note, influenza virus A (H1N1) and continuous variation of this disease will be able to become more dangerous.

Influenza took the life of 759 Ukrainians

03.01.2010

759 deaths - such as the Ministry of Health data on the evening of January 2. Over the past day influenza claimed 19 lives.

Total in the country since the epidemic began (and conventional, and "swine" flu) was recorded 3 789 200 cases (of which 15 261 - Only in the last day). Hospitalized 217 056 (from the beginning of the epidemic), and the last day - 2 347 people. In the intensive care unit is now 259 patients. Thirty-one - on mechanical ventilation.

Maximum number of cases in the last day recorded in Donetsk, Dnipropetrovsk and Kharkiv regions - 1 636, 1 291 and 1 361 respectively. High morbidity and Kiev - 1 895 persons.

In the Donbas from the beginning of the epidemic became ill 332 606 (this is the highest rate in Ukraine). Hospitalized on January 2 196 people, five - in the intensive care unit.

Today in the Donbass region of influenza and SARS (as well as from complications - pneumonia) died 97. Three - the last day.
hat-tip sharon sanders

China tells health officials to brace for possible fresh wave of swine flu cases at New Year

By Christopher Bodeen (CP) – 5 hours ago

BEIJING — China is warning officials to brace for a possible new wave of swine flu infections as the country enters the busy Lunar New Year travel period.

Tens of millions of Chinese take to the rails, roads and air during the most important holiday of the traditional calendar, creating crowded conditions ideal for the spread of the virus. The holiday period this year runs from late January into February.

"During the 2010 New Year and Lunar New Year period, various factors such as spring travel, tourism, shopping, and other group activities will increase the risk of H1N1 infection," the Health Ministry said in a bulletin posted on its Web site Sunday. "Disease prevention measures must remain rigorous."

China has already taken severe measures seen to control the spread of the virus, quarantining large numbers of travellers and setting up temperature checks at virtually all schools and public buildings.

Experts differ on how effective those steps have been and the ministry said China, with 1.3 billion people, had recorded more than 120,000 cases of infection by the end of December, including 648 deaths.

It said 447, or 69 per cent, of those deaths were recorded in December alone, a spike attributed partly to a rise in virus fatalities among pregnant mothers from 8.8 per cent of November's total to 18.6 per cent of all December deaths.

People with chronic illnesses and the obese also succumbed to the disease in larger numbers in December, the ministry said.

Underscoring the striking rise in the death toll in December, new H1N1 cases for the month accounted for only 23 per cent of the total, it said. However, the ministry said it had not discovered mutations in the virus or the emergence of drug-resistant strains, appearing to put much of the monthly increase in deaths down to seasonal factors.

While it said numbers of cases have fallen strikingly in Beijing, Shanghai and other major cities, rural areas - where medical resources are typically poorer and emergency response times slower - will likely suffer the brunt of a renewed outbreak, the ministry said. Rural schools should especially be on guard, it said.

It cited monitoring, prevention, immunization and treatment as the key strategies to contain the virus, with almost 50 million people having received the H1N1 vaccine already.

Copyright © 2010 The Canadian Press. All rights reserved.
hat-tip Tonka

Swine Flu spikes again in U.S.

ATLANTA – There has been an upsurge in visits to doctors for Swine Flu and deaths associated with flu and pneumonia are again higher than the national epidemic threshold, the CDC said in a report released on Saturday.

“Visits to doctors for influenza-like illness (ILI) nationally increased slightly this week over last week. This is the first increase in this indicator after eight consecutive weeks of national decreases,” said the CDC.

“The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report increased over the previous week and is now back above the epidemic threshold after dipping below it last week for the first time in 11 weeks,” it said.

But there is no indication that the expected third wave of Swine Flu has struck. One explanation for the increase in visits to doctors is that people sometimes put off visits until after Christmas as is often seen in other flu seasons.

But the CDC did not offer an explanation about why the number of deaths from flu and pneumonia moved higher again after dipping the previous week for the first time. Other experts had suggested Christmas gatherings may cause the virus to spread more.

Swine Flu continued to kill more children. The CDC has said the pandemic virus killed five times more kids than a regular flu season.

“In addition, four flu-related pediatric deaths were reported this week compared to 9 reported last week: two of these deaths reported this week were associated with laboratory confirmed 2009 H1N1, and two were associated with influenza A viruses that were not subtyped (suspected to beSwine Flu.)
“Since April 2009, CDC has received reports of 289 laboratory-confirmed pediatric deaths: 243 due to 2009 H1N1, 44 pediatric deaths that were laboratory confirmed as influenza, but the flu virus subtype was not determined, and two pediatric deaths that were associated with seasonal influenza viruses.”
“Since August 30, 2009, CDC has received 225 reports of influenza-associated pediatric deaths that occurred during the current influenzaseason (42 deaths in children less than 2 years old, 25 deaths in children 2-4 years old, 83 deaths in children 5-11 years old, and 75 deaths in children 12-17 years old),” said the agency.

“One hundred eighty-three (81%) of the 225 deaths were due to 2009 influenza A (H1N1) virus infections, 41 were associated with influenza A virus for which the subtype is undetermined, and one was associated with an influenza B virus infection. A total of 243 deaths in children associated with 2009 influenza A (H1N1) virus infection have been reported to CDC.”

Between August 30 and December 26, there had been 37,090 hospitalizations and 1,697 deaths caused by influenza and pneumonia. The CDC says while there are lab confirmed cases, the actual figures are far higher.

Delaware, Maine, New Jersey and Virginia are the only states reporting widespread Swine Flu activity.
hat-tip sharon sanders

Outbreak of bird flu outbreak near the border Vietnam

The only death I am aware of is posted here:

18 December 2009

The Ministry of Health of Cambodia has announced a new confirmed case of human infection with the H5N1 avian influenza virus.

The 57-year-old male, from Ponhea Kreak District, Kampong Cham Province, developed symptoms on 11 December.

http://pandemicinformationnews.blogspot.com/2009/12/who-confirmed-case-of-h5n1-in-cambodia.html

January 02, 2010
Outbreak of bird flu outbreak near the border Vietnam

Cambodia has announced a new outbreak of bird flu in villages in Kampong Cham province, southeast of this country, near the border with Vietnam.

Cambodia veterinary agencies reported on the situation in the notice directly, dated December 28, the World Organization for Animal Health (OIE).

Notification service for flu outbreaks from December 16 in La-ak area of Kampong Cham. 143 birds died and the rest were destroyed. The review shows that the health of H5N1 influenza viruses cause mass death poultry.

Today 14 quarters, Cambodia has confirmed an outbreak of avian influenza outbreaks in Ponhea Kreak district, Kampong Cham province, bordering Vietnam. Outbreak was discovered a week after a 13-year-old girls in the province died of bird flu.

According to the press in Cambodia, the authorities had the power to cull poultry within a 3km radius around where the victim lived, and check within 10km radius to prevent disease spreading.

Tra Giang
According Meattradenewsdaily, Xinhua

Egypt: 5 More Deaths - Total 141

Friday, January 1st, 2010 - 20:55


Minister of Health

The Ministry of Health for the deaths of five new cases of HIV, "eh HP 1 The 1" is known internationally as the swine flu, bringing the total number of deaths in Egypt since the emergence of the disease and so far 141 cases.

The Ministry of Health - in a statement on Friday -

(case) No. 137 that the situation of a woman at the age of 40 years from Qalyoubia province,

and case No. 138 a man from the Governorate of Cairo at the age of 54,

Case No. 139 of a lady 77 years old from the province Alexandria.

The statement added that the situation of (case number) 140 men aged 67 years of Alexandria Governorate

and the situation of the (case number) 141 men aged 52, from Alexandria.
hat-tip Twall