Surveillance
revere | February 9, 2009I am frankly baffled by a news release from Gideon Informatics, a company that describes its mission as developing and marketing "point-of-care medical-decision support applications that help reduce diagnostic errors." It claims to be "managed by an expert executive team and medical advisory board." Apparently they forgot to give this press release to their advisory board before releasing it:
Despite the recent fatal case of avian flu in Beijing, overall avian flu cases in humans worldwide have decreased 55%, from 88 to 40, from 2007 to 2008, according to GIDEON Online (www.gideononline.com…
revere | February 3, 2009On Sunday DailyKos frontpager, DemFromCT (who is also a founder of the FluWiki and a pulmonary specialist) finished up his two part interview with us. It's cross-posted here below the fold. If anyone doubted we were academics, the display of watching us argue with ourselves would have but those doubts to rest. Scientists cherish the hope that we will make difficult things simple, but often we wind up making simple things difficult. We see complications in everything, even the simple question of what is public health infrastructure. Witness:
Q. Last week I asked you about public health…
revere | January 11, 2009We've been blogging about flu for over four years. It's not a rare topic these days. But when we started we only found two other bloggers with an interest in the subject. One was the late (and much missed) Melanie Mattson at Just a Bump in the Beltway blog. The other was DailyKos frontpager DemFromCT. Dem is still on the front page at dKos and still on top of flu. He is one of the blogosphere's pre-eminent flu experts, being not only an accomplished blogger but a medical professional whose specialty is pulmonology. He sees flu up close, in the lungs of his patients. So whenever Dem writes…
revere | November 14, 2008The idea of stopping flu "at the border" has received almost uniformly bad reviews from public health experts. Once human to human transmission starts we won't be able to stop it by closing our borders, although we likely will cause the usual unintended consequences, like preventing vital personnel and supplies from getting to where we need them. At least if we do it in the usual ham handed way this administration is famous for. We learn via CIDRAP News that federal officials are still willing to give a "risk-based border strategy" (RBBS) a go, at least in the form of an exercise. Now, at…
revere | October 13, 2008Food poisoning can be a miserable experience and sometimes you feel like you want to die rather than endure another minute of the agony, but people rarely die from food poisoning. At least for most causes of food poisoning. The exceptions are the exceedingly rare cases of botulism and the much more common occurrence of listeriosis, infection with the organism Listeria monocytogenes. Listeria is a really nasty bug and serious cases are often fatal. The most at risk are the elderly, the immunocompromised, and pregnant women, biologically immune altered, and their fetuses and neonates. Listeria…
revere | October 9, 2008Every parent's or grandparent's nightmare is to have their darling little one suddenly carried off by illness. Flu isn't on the radar screen of most parents but in recent years the public health community is taking notice. The first alarm occurred in the bad flu season of 2003 - 2004 when a retrospective tally showed over 150 pediatric deaths associated with flu. That was more than half again as much as we thought were occurring, although data was not very good. So a new pediatric surveillance system was put in place. One of the things it is showing is that methicillin resistant…
revere | October 5, 2008An article in The Straits Times from newswire Associated Press (AP) drew my attention to a festering disagreement between proponents of an innovative global sharing initiative for influenza information and the World Health Organization, the official UN Agency that has run the global influenza surveillance system for more than a half century. The new system, The Global Initiative on Sharing Avian Influenza Data (GISAID), began midway through 2006 and has made rapid progress. It came into being to deal with dissatisfaction with the existing system wherein WHO allowed influenza gene sequence…
revere | September 30, 2008A fascinating paper in CDC's journal, Emerging Infectious Diseases has more details on a problem we first mentioned, on the basis of news reports, back in June. It's about a possible relationship between West Nile Virus infection and the mortgage crisis, but the paper also gives a dramatic example of how the physical, biological and social environment can affect disease patterns and risks in populations.
Infection with West Nile Virus is primarily a disease of birds. It is transmitted from bird to bird by mosquito bites and the disease is maintained by the cycling between birds and mosquitoes…
revere | September 10, 2008We're well into September and flu season is approaching. Seasonal likely won't peak for another four or five months in the US and Europe but we should expect to start seeing cases in the northern hemisphere soon. A pandemic strain could happen at any time. The 1918 flu's second wave started in late August, so the timing of the start of a pandemic is not so predictable. At least one things seems certain, however. We shouldn't expect to see it starting in the current hot spot for human bird flu, Indonesia. Because the Indonesian government, in the person of Health Minister Siti Fadilah Supari,…
revere | August 27, 2008I have been severely critical (many posts among those here) of the Indonesian government's irresponsible assertions of ownership of potentially pandemic pathogenic viruses isolated from their citizens. The question of Intellectual Property is a difficult one in many instances but when it comes to a public good involving a global scourge, some of the gray areas become more black and white. The world has been struggling with the issue regarding the global influenza surveillance system for two years now, precipitated by Indonesia's refusal to cooperate any longer, resulting in a significant gap…
revere | August 5, 2008The Health Care Renewal blog has made a business of chronicling the undreside of the American health care system: fraud, conflicts of interest by respected academics, bureaucratic incompetence and malfeasance. I do basic research and don't get involved in health care delivery so I only refer to them occasionally, but it's a terrific resource -- if you like that kind of thing. Last week, however, they hit pretty close to home. Not literally, but professionally. I'm a cancer epidemiologist and in a long career have made frequent use of state cancer registries. If you don't know what a cancer…
revere | July 31, 2008There's a tremendous amount of influenza A/H5N1 ("bird flu" virus) all over southeast asia and other areas where the virus is endemic in poultry. Where is this virus, exactly? We know it's in the infected birds and in their respiratory secretions and feces. We know it occasionally infects mammals (including humans). Is it found in the environment? We know very little about this, although there is good evidence it is in water where aquatic birds like ducks spend time and likely one way the virus is spread from bird to bird. In lab experiments, the virus remains intact on inanimate surfaces for…
revere | July 21, 2008Lots of bloggers follow HIV/AIDS, although we haven't. Maybe because it's no longer an automatic death sentence, it has fallen off the public radar screen, but not because it isn't a huge public health problem. Just how big a problem seems to be a matter of some sensitivity for the Bush administration:
Since the fall of last year, rumors have been circulating that the Centers for Disease Control and Prevention (CDC) will release revised statistics indicating that the number of people with new HIV infections living with HIV in the United States is actually higher than previously reported. Some…
revere | July 9, 2008While CDC and FDA struggle to figure out where the Salmonella saintpaul in a large multistate outbreak is coming from they are not being forthcoming about where it has gone. We know the case total but not much about who is getting sick, where and when. There is no good scientific or privacy reason not to release more information. It's just the usual tendency to keep control. But some of the information is "out there" anyway, in news reports and other sources of information. People interested in disease outbreaks discovered years ago that this information could be harvested and disseminated to…
revere | June 30, 2008We started blogging on public health at the beginning of the 2004 - 2005 flu season, although we didn't concentrate on flu immediately. We intended to use the public health problem of influenza, a disease that contributes to the death of almost 40,000 US citizens a year, as a lens through which to look at public health. The interest in bird flu and pandemic flu followed naturally. The intervening years saw seasonal influenza outbreaks that were milder than previous years, but this resourceful virus made a comeback in the flu season just concluded. CDC has just summarized the 2007 - 2008 flu…
revere | June 25, 2008In our earlier discussion of the science behind greenhouse gases we pointed out that all objects radiate electromagnetic radiation, doing so at a peak wavelength dependent upon their surface temperatures. That means two things. One is that things at the usual temperatures in our world are radiating EM radiation at wavelengths characteristic of the far infrared region. The other is that by measuring the intensity of infrared you can also measure the surface temperature of the body without touching it. Commercial devices are touted as highly accurate. Clinicians use them to measure body "core…
revere | June 21, 2008The beach in Indonesia may look nice, but don't let that distract you:
There is an English word for deliberately neglecting to tell people something they have asked you about. It's called lying. On that basis, the Indonesian government, primarily in the person of their Minister of Health, Siti Fadillah Supari, are liars. They have publicly declared their intention to lie by announcing they will no longer notify the world promptly about new human cases of bird flu. The acknowledged motive is to improve the reputation of Indonesia in the eyes of the world. Currently the country is the world's…
revere | June 12, 2008Crof, over at H5N1, has an important piece on Indonesia that is worth thinking about. He observes something that lots of us haven't paid attention to: Indonesia hasn't been notifying the UN agency on animal health, the OIE, about bird flu outbreaks in poultry for almost two years:
Here is the very last post from Indonesia: OIE DAILY UPDATE ON AVIAN INFLUENZA SITUATION IN BIRDS. As you will see, the date is September 26, 2006. Since then, Indonesia has told the world nothing about its poultry panzootic.
Look at this map of B2B H5N1 outbreaks. Indonesia looks as clean as Argentina.
Look at this…
revere | June 6, 2008The Indonesian Health Minister, Siti Fadilah Supari, has figured out how to deal with her country's reputation as being the bird flu capital of the world. She isn't going to announce deaths from the disease as they happen:
A 15-year-old girl died of bird flu last month, becoming Indonesia's 109th victim, but the government decided to keep the news quiet. It is part of a new policy aimed at improving the image of the nation hardest hit by the disease. Health Minister Siti Fadilah Supari said Thursday she will no longer announce deaths immediately after they are confirmed. But she promised to…
revere | May 28, 2008Stories on the wires this weekend highlight a new study published in the Proceedings of the National Academy of Sciences (PNAS) suggesting that some bird flu viruses are adapting to the human respiratory tract, thought to be a prelude to increased transmissibility and possibly ushering in a pandemic of influenza in humans. We need to sort out a number of things here, beginning with the idea that "avian influenza viruses" are mutating in a way woy to make humans more vulnerable. Let's take it apart.
First, influenza. Influenza can either be a syndrome (a package of clinical symptoms and signs…