Surveillance
revere | May 24, 2008Bangladesh now has its first confirmed human case of avian influenza. That's news. Maybe:
Bangladesh announced its first human case of bird flu on Friday in a 16-month-old baby boy, bringing the number of countries which have recorded human infections to 15. Avian Influenza has already spread through 47 of Bangladesh's 64 districts and concerned Indian authorities say when the disease is so widespread in poultry, it is really a matter of time before humans start getting infected. (Times of India)
Specimens from the case had been sent to CDC in the US and the diagnosis confirmed by WHO. So why…
revere | May 18, 2008Almost all stories in the news about H5N1 (bird flu) have some obligatory line in them, "It is believed that all or almost all human cases come from contact with infected poultry." This is like a mantra of many public health officials and I suspect some reporters have the requisite disclaimer as a cut and paste text they mechanically insert into their stories. But it isn't true. There are an awful lot of human cases for which no poultry source has ever been located and we have yet another example in the latest Indonesia cases:
The city's husbandry, fishery and maritime agency said Friday it…
revere | April 15, 2008US Secretary of Health and Human Services, Michael Leavitt, is in Indonesia to discuss matters of mutual interest with the Indonesian government. Topic number one was the Indonesian government's opt out of the international influenza surveillance system which has been in place for almost 60 years and provides vital information on what flu strains to include in the next year's seasonal flu shots. But the system is not limited to seasonal influenza and is an important part of the global surveillance of all influenza viruses that might be of human health concern, chiefly among the non-seasonal…
revere | April 11, 2008I have professional colleagues who are dedicated birders but it has never interested me, and their interests are mainly independent of their lives as epidemiologists, toxicologists or whatever else they do at work. But the biosphere is truly interconnected in strange ways and sometimes what seems an unrelated realm intrudes itself front and center in a different context. Bird migration is a good example. How is bird flu spread? Is it human enabled movements of infected poultry or the rare bird trade? Or is it the "natural" movements of wild, migratory birds, the natural reservoir for the…
revere | April 9, 2008If you pay attention to the latest news about bird flu I will not be telling you anything new that there is a detailed description in The Lancet (a British medical journal) of a case in China of probable person to person transmission of bird flu. You can get details from the incomparable reporting of Helen Branswell (Canadian Press), James Macintyre (The Independent), Deborah MacKenzie (New Scientist) or your favorite wire service. You don't need this blog for the facts, although we also try to provide you with some of those, too. What we try to do is always add some value. Usually it's just…
revere | April 7, 2008To everything there is a season, including flu. We are now emerging from the other end of one of the more difficult flu seasons in recent years, although by no means out of the ordinary for the genre. Last time we commented, almost every state was experiencing widespread flu activity by the end of March only seven states reported widespread activity according to CDC:
States that were still reporting widespread flu the week of Mar 22 through 29 were Connecticut, Iowa, Maine, New York, North Carolina, Pennsylvania, and Vermont. Regional flu activity was reported in 27 states and local activity…
revere | April 3, 2008The index case was a 5 year old Miniature Schnauzer with 5 days of nasal discharge and sneezing. The dog recovered but the next case, a 3 year old Cocker Spaniel wasn't so lucky, nor were the 2 Korean hunting dogs (Jindos) or a 3 year old Yorkshire terrier. Then 13 dogs in a shelter started to show signs of nasal discharge, cough and high fever. Antibody studies showed that they had all been suffering from influenza infection, subtype H3N2. These cases happened in the spring and summer of 2007 (NB: this is not flu season). H3N2 is the most common subtype involved in human seasonal influenza.…
revere | March 31, 2008Trust is not transitive, as someone recently pointed out, when reporting on the airline pilot who carried a gun into the cockpit and then accidentally or negligently discharged it and blew a hole in the plane. We had every reason to trust the pilot to be able to fly a 747, but not necessarily to handle a firearm properly. Trust isn't transitive.
There is no doubt that Yi Guan, a professor at the University of Hong Kong, is an expert on H5N1 virus, its genetic lineages and surveillance for the virus in wild birds. He has reportedly screened, via cloacal swabs and fecal specimens, more than…
revere | March 28, 2008Hard on the heels of my semi-facetious prediction that bird flu would return to Germany because Germany had declared itself bird flu free, the Swiss announced an infected wild duck on the shores of Lake Sempach. Since this duck didn't have a passport on him I am sure he never strayed over the nearby border with Germany. We don't know what kind of duck this was [see update, below], a question that is of surprising interest in light of a new paper.
Bird flu is avian influenza, i.e., an infection of birds by the influenza virus. The role of wild migratory birds versus human caused movement of…
revere | March 25, 2008We've covered the Indonesian refusal to cooperate with international influenza surveillance system to a fare thee well (see posts posts here, here, here, here, here, here, here, here, here, here, here, here, here and links therein), so this is just an update with some additional observations how Indonesia's deplorable behavior isn't that different than the US's deplorable behavior in the Middle East. First, Indonesia. When last we checked in Indonesia had sent off half a dozen flu specimens from the period after the end of January 2007 when it started its boycott. The hope was that the…
revere | March 19, 2008The chief veterinary officer of the UN's Food and Agriculture Organization (FAO) reaffirmed what everyone paying attention already knows: the bird flu situation in Indonesia is critical. The archipelago nation is the fourth most populous country in the world fragmented geographically on 17,000 islands and politically by a disastrously decentralized government. Of its 31 provinces, FAO says 31 have reported infected poultry, and on some of the largest -- Java, Sumatra, Bali and southern Sulawesi -- it is endemic and solidly entrenched. There are an estimated 30 million poultry smallholdings in…
revere | March 6, 2008If you look at the bar chart below you will see that this year's bird flu season is shaping up to look pretty much like last year. In the first two months of the year there are a few more cases but essentially the picture looks much the same. If that is indeed true, then also expect a spike of cases this month (March) since you can also see that is the past pattern. Already cases are being reported in Egypt, and of course, Indonesia. The countries involved this season have been Vietnam, China, Egypt and Indonesia, just like last year. Whether you consider that reassuring or worrying probably…
revere | March 3, 2008Highly pathogenic variant of avian influenza A of the subtype H5N1 is here to stay, at least in the world's poultry population. While it's around it continues to cause sporadic but deadly human infections, some 369 of them of whom 234 have died (official WHO figures as of 28 February 2008). So this virus can infect humans and make them seriously or fatally ill. There is truly massive exposure because people live in close contact with infected domestic poultry in many countries. And the human population has not seen this subtype of virus before so there is little natural immunity. All that's…
revere | February 29, 2008All I can say is that it's a good thing Canadian Press's Helen Branswell isn't a blogger or she'd put all the rest of us flu bloggers out of business. She is the professional flu reporter's professional (one of the best of the flu reporters once described a story of hers to me as "annoyingly good"). Being in Canada she also has more of an international perspective, as in a recent story about differences between seasonal flu in the US and Canada this year, a story that would have escaped the notice of US based reporters (hat tip to crof):
Maps generated by the Public Health Agency of Canada…
revere | February 28, 2008When WHO tells us that there is no bigger bird flu problem in China I guess it's all relative. Like the old joke where one old man asks the other how he feels, the answer is "compared to what"?
The World Health Organization says that while there have already been three deaths from bird flu in China this year, there are no signs the deadly disease is becoming a bigger problem.
In a statement Wednesday, the WHO's top representative in China, Hans Troedsson, says the three recent cases were not unexpected considering the winter season. (VOA News)
Despite the occurrence of three deaths in China…
revere | February 21, 2008A notice from ProMed yesterday alerted many of us to a new published report [subscription firewall] about H5N1 influenza detection in an arthropod species in the vicinity of an infected poultry farm. The arthropods were mosquitoes (Culex tritaeniorhynchus) in Thailand. Two years ago a similar report implicated blowflies (Calliphora nigribarbis and Aldrichina grahami) near some infected farms in Kyoto, Japan. Both papers suggested using arthropods near infected farms as surveillance tools. But both, especially the Japanese paper, raised the open question whether arthropods might play a part in…
revere | February 19, 2008There's bird flu in poultry all over Bangladesh and new human cases reported in China, Vietnam and Indonesia. Is this the sound of the other shoe dropping? Or is it just this:
This barchart is from February 5 so it doesn't include all the new cases. But it clearly shows that when we get to flu season we also get to bird flu season. How will we know if something different is happening? It's a good question and I don't have an easy answer. Here are four signals and what I would make of them.
Sudden increase in number of cases that are not connected or are connected by a common source (as…
revere | February 17, 2008When my colleagues announced early afternoon on Friday he was headed home because he was sick, I knew the flu had finally arrived on my doorstep. It was already here, of course. The emergency rooms are jammed, clinics have long waits and hospital admissions for flu are up -- way up. The flu situation was the page one column eight story in Saturday's Boston Globe:
The flu virus is rampaging across New England, spawning waves of coughs and fevers, causing patients to flood doctors' offices, and raising questions about the effectiveness of flu shots given to tens of millions of Americans.
During…
revere | February 16, 2008A lot of things that seem on first glance to be "news" are really just reprints or slight edits of press releases written to tout a commercial product. This is also true of "Newsletters" that charge money for inside news.
Datamonitor is a company that claims to be "the world's leading provider of online data, analytic and forecasting platforms for key vertical sectors. We help 5,000 of the world's largest companies profit from better, more timely decisions" (Datamonitor website). Some of the stuff they give away, since I see it and I don't subscribe to anything they sell. But based on its…
revere | February 5, 2008Bangladesh is a country with more than its share of woes. Now there is H5N1 galloping through its poultry. Bangladesh needs all the help it can get. Which also means it needs to help others, too. How can a resource poor country like Bangladesh help other nations? They can start by sharing the genetic sequences of the viruses isolated from their poultry:
Bangladesh has refused to share the genetic details of its H5N1 bird flu virus with India. In a blow to India's efforts to find the origin of the highly pathogenic avian influenza strain that is presently wreaking havoc in West Bengal,…