Bangladesh's used car

Revere(s) got anything to say about how GSK abandoned clinical trials of injectable zanamivir despite the predictable (to anyone capable of reading a research journel) weaknesses of oseltamivir. Realistically what antiviral defence do we have against H5N1?

P.S. No-one's got money for your Volvo, I've been selling shares in the Brooklyn Bridge to everyone with a stash of Tamiflu (in case of a pandemic).

miso: I don't understand why GSK abandoned the zanamivir trial except that they have been slow to develop and market the drug. One assumes it is financial, once again pinpointing the inadequacy of the the IP system in this instance. However Ihave to point out (again) that Tamiflu and injectable zanamivir have potentially different roles. Tamiflu can be used as a prophylactic as well as outpatient treatment, while injectable zanamivir is for inpatient therapy.

Following up on the Bangladesh "single case" myth..,

"The boy was among the more than 3,000 people suspected of being infected with bird flu in Bangladesh, but his was the only case that tested positive, a health department official said."

That's from this article:

http://www.ipsnews.net/news.asp?idnews=42493

We hadn't heard much about that many suspected cases there until now. Now the truth leaks out??

How best to sell a used car? Make it look like the only one of it's kind, and you're really getting some special deal.

The strongest argument in favour of Tamiflu is it's ability to fight systemic infection, otherwise inhaled Relenza is superior. I lament the absence of injectable zanamivir because it could have been used to fight systemic infection.

I apologise for not making my point clearer, miss-spelling "journal", and distracting attention from the topic of this blogg.

miso: No apologies needed.

Bangladesh has made remarkable progress in improving its health system. It has surpassed most of its neighbours in reducing maternal mortality and most life-saving medicines are produced locally and available throughout the country.

I also do not believe this case was the only H5N1 positive in the country but I am pretty sure that if multiple cases would occur in one location, the alarm bells would have rung. We have seen that happen when the NIPAH virus struck.

Note that January was still flu season here, so among the multitude of normal colds and flu cases, a patient who survives might not be seen as very suspicious.

Although my car is older than your Volvo, I don't want it. Volvos are difficult to maintain here and the spare parts are expensive.

Ter

Spread of avian flu by drinking water:

Proved awareness to ecology and transmission is necessary to understand the spread of avian flu. For this it is insufficient exclusive to test samples from wild birds, poultry and humans for avian flu viruses. Samples from the known abiotic vehicles also have to be analysed. There are plain links between the cold, rainy seasons as well as floods and the spread of avian flu. That is just why abiotic vehicles have to be analysed. The direct biotic transmission from birds, poultry or humans to humans can not depend on the cold, rainy seasons or floods. Water is a very efficient abiotic vehicle for the spread of viruses - in particular of fecal as well as by mouth, nose and eyes excreted viruses.

Infected birds and poultry can everywhere contaminate the drinking water. All humans have very intensive contact to drinking water. Spread of avian flu by drinking water can explain small clusters in households too. Proving viruses in water is difficult because of dilution. If you find no viruses you can not be sure that there are not any. On the other hand in water viruses remain viable for a long time. Water has to be tested for influenza viruses by cell culture and in particular by the more sensitive molecular biology method PCR.

There is a widespread link between avian flu and water, e.g. in Egypt to the Nile delta or Indonesia to residential districts of less prosperous humans with backyard flocks and without central water supply as in Vietnam: http://www.cdc.gov/ncidod/EID/vol12no12/06-0829.htm. See also the WHO web side: http://www.who.int/water_sanitation_health/emerging/h5n1background.pdf .

Transmission of avian flu by direct contact to infected poultry is an unproved assumption from the WHO. There is no evidence that influenza primarily is transmitted by saliva droplets: �Transmission of influenza A in human beings� http://www.thelancet.com/journals/laninf/article/PIIS1473309907700294/a… .

Avian flu infections may increase in consequence to increase of virus circulation. In hot climates/the tropics flood-related influenza is typical after extreme weather and floods. Virulence of influenza viruses depends on temperature and time. Special in cases of local water supplies with �young� and fresh H5N1 contaminated water from low local wells, cisterns, tanks, rain barrels, ponds, rivers or rice paddies this pathway can explain small clusters in households. At 24�C e.g. in the tropics the virulence of influenza viruses in water amount to 2 days. In temperate climates for �older� water from central water supplies cold water is decisive to virulence of viruses. At 7�C the virulence of influenza viruses in water amount to 14 days.

Human to human and contact transmission of influenza occur - but are overvalued immense. In the course of influenza epidemics in Germany, recognized clusters are rare, accounting for just 9 percent of cases e.g. in the 2005 season. In temperate climates the lethal H5N1 virus will be transferred to humans via cold drinking water, as with the birds in February and March 2006, strong seasonal at the time when drinking water has its temperature minimum.

The performance to eliminate viruses from the drinking water processing plants regularly does not meet the requirements of the WHO and the USA/USEPA. Conventional disinfection procedures are poor, because microorganisms in the water are not in suspension, but embedded in particles. Even ground water used for drinking water is not free from viruses.

http://www.un.org/apps/news/story.asp?NewsID=26096&Cr=&Cr1
Ducks and rice [paddies = flooded by water] major factors in bird flu outbreaks, says UN agency
Ducks and rice fields may be a critical factor in spreading H5N1
26 March 2008 � Ducks, rice [fields, paddies = flooded by water! Farmers on work drink the water from rice paddies!] and people � and not chickens � have emerged as the most significant factors in the spread of avian influenza in Thailand and Viet Nam, according to a study carried out by a group of experts from the United Nations Food and Agriculture Organization (FAO) and associated research centres.

�Mapping H5N1 highly pathogenic avian influenza risk in Southeast Asia: ducks, rice and people� also finds that these factors are probably behind persistent outbreaks in other countries such as Cambodia and Laos.
The study, which examined a series of waves of H5N1 highly pathogenic avian influenza in Thailand and Viet Nam between early 2004 and late 2005, was initiated and coordinated by FAO senior veterinary officer Jan Slingenbergh and just published in the latest issue of the Proceedings of the National Academy of Sciences of the United States.
Through the use of satellite mapping, researchers looked at a number of different factors, including the numbers of ducks, geese and chickens, human population size, rice cultivation and geography, and found a strong link between duck grazing patterns and rice cropping intensity.

In Thailand, for example, the proportion of young ducks in flocks was found to peak in September-October; these rapidly growing young ducks can therefore benefit from the peak of the rice harvest in November-December [at the beginning of the cold: Thailand, Viet Nam, Cambodia, Laos are situated � different from Indonesia � in the northern hemisphere].

�These peaks in congregation of ducks indicate periods in which there is an increase in the chances for virus release and exposure, and rice paddies often become a temporary habitat for wild bird species,� the agency said in a news release.

�We now know much better where and when to expect H5N1 flare-ups, and this helps to target prevention and control,� said Mr. Slingenbergh. �In addition, with virus persistence becoming increasingly confined to areas with intensive rice-duck agriculture in eastern and south-eastern Asia, evolution of the H5N1 virus may become easier to predict.�

He said the findings can help better target control efforts and replace indiscriminate mass vaccination.
FAO estimates that approximately 90 per cent of the world�s more than 1 billion domestic ducks are in Asia, with about 75 per cent of that in China and Viet Nam. Thailand has about 11 million ducks.

Dipl.-Ing. Wilfried Soddemann - Epidemiologist - Free Science Journalist soddemann-aachen@t-online.de

Well Wilfried I owe you a bit of an apology. I didnt think that the viral load out in ponds/lakes could possibly be high enough from bird doo to infect another bird, but I was wrong. Niman asserted that about two years ago along with you. Then it was indeed detected in ponds in India, Thailand, all with endemically infected ducks in and around the water.

Revere for a long time asserted that there had to be a reservoir that we didnt see or detect. Well, that does seem to be the case because perhaps it is indeed just that.....a reservoir. In Pakistan, India, Bangladesh the people cluster around the water supply and the ducks/geese and other birds also cluster. What is the one thing that all of the mammals involved have in common? Water. We have seen the information that H5N1 stays alive in poop and dirt for upwards of 5 days in 98 degree F heat, and 30 days in 35 degree F. How long does it stay alive in moderately warmer water especially if it has a constant reseeding of fresh poop?

Contact and consumption is surely the way that some of these people are being infected but water might be the reservoir....literally.

Revere: Despite mistakes and Biocryst's pretty shaky leadership do you see Peramivir as a viable alternative to the anti-viral choices now available?

Woodpuppy: Peramivir is potentially valuable in treatment, but since the trials were stopped we don't really know if it is better, worse or neither. We need more therapies for those who get sick with flu (not just pandemic flu) but my main interest has always been strengthening public health as a whole and prevention.

poultry manure is used as a fertilizer in fish farms in SE Asia to increase plant/algae growth for carp species.

poultry offal from slaughterhouses is used in SE Asia to feed snakehead fish reared in fish farms.

Fish die-offs in reserviors in China involving thousands of TONS of fish have been blamed on the overfertiliizing of water by carp farmers

Live carp taken to market could concievably serve as mechanical carriers for live H5N1 virus