[CanadaSue]

ProMed stuff here. I tend to post their articles in their entirety. Their policy permits that, as long as you give their stuff the right attribution, (always) & often it's hard to summarize.

For the first, I'm simply including ProMed mod's comments as the article is simply a reposting of the article Pepper posted yesterday. It's the comments that are interesting:

***[HPAI H5N1 in Mataram represents further eastern spread of the disease,
following its reporting in Bali at the beginning of 2004. Indonesia's last (6th) follow-up report to the OIE was received on 6 Oct 2004; it mentioned 2 new outbreaks, of which, one occurred in East Jawa province. So far, no outbreaks have been reported from Sulawesi (see the HPAI map, as of 21 Oct
2004, at <http://www.fao.org/ag/AGA/AGAH/EMPRES/maps/e_maps.htm>).

Mentioning Sulawesi as a potential source of infected migrating birds raises the question of whether suspected HPAI cases have been observed/recorded on this big island.

According to OIE's statistics summarizing the number of outbreaks
accumulated since the beginning of the Eastern-Asia epizootic in early 2004, Indonesia ranks 3rd, with 169 foci, following 1749 in Viet Nam, and 994 in Thailand (see graph at <http://oie.int/downld/AVIAN%20INFLUENZA/graph%20HPAI%2010122004.pdf>).
- Mod.AS]***

The original article didn't mention the strain - glad at least, to see that confirmed. Sulawasi IS a large island - lots of nativ birds & many 'passing through' - I've love to see s survey done of birds there - are some species harbouring any strain of H5N1?

Indonesia has GOT to 'get its stuff' together. It's a huge archipelago which much interaction of man & animal/bird. Reports are slow, lacking in crucial detail & piracy is a huge problem there. Watch for far worse problems to develop both there & in other nations as a result of problems originating there.

That's my bet anyway.

[CanadaSue]

The material first:

***AVIAN INFLUENZA - EASTERN ASIA (143): THAILAND

[1]
Date: Mon 13 Dec 2004
From: Henry Niman <henry_niman@recombinomics.com>
Source: TNA via mcot.org, 13 Dec 2004 [edited]
<http://www.mcot.org/query.php?nid=33764>


Avian flu discovered among Thailand's wild bird population
-----------------------------------------------
The government announced today [Mon 13 Dec 2004] that a recent survey of wild birds in central Thailand had shown 6 species infected with bird flu.

The results came from a random sampling of more than 1000 migratory and
indigenous birds in 4 central provinces where infected poultry had previously been discovered.

The head of the Avian Influenza Operations Center, Dr. Charal
Trinvuthipong, told journalists at Government House in Bangkok that, while
the source of the latest infection remained unknown, it would be the subject of further close study.

The bird samples were collected in the provinces of Nakhon Sawan, Lop Buri,
Chachoengsao, and Saraburi.

Dr. Charal sought to allay public fears about the possible transmission of the virus from birds to humans. "It has not been concluded yet that the avian flu virus can be transferred from birds to humans," he said.

The infected local species were identified as the Little Cormorant, Asian
Openbill, Scaly-breasted Munia (Spotted Munia), Red Turtle-Dove, Black
Drongo, and pigeon.

Dr. Charal added that he would propose a more extensive survey, with a
random sampling of 6000 specimens of each kind of bird.

Meanwhile, the Livestock Development Department has announced that, as of 9 Dec 2004, 71 areas in 19 provinces have reported cases of the virus, with new outbreaks in the southern provinces of Pattani and Narathiwat.

Since the country was hit by a 2nd-round bird-flu outbreak in July [2004],
Thailand has recorded 5 confirmed cases of bird flu among humans. 4 of the
victims died, while the last patient recovered.

--
Henry L. Niman, PhD
<henry_niman@recombinomics.com>

******
[2]
Date: Mon 13 Dec 2004
From: ProMED-mail <promed@promedmail.org>
Source: AFP via Yahoo News, 13 Dec 2004 [edited]
<http://news.yahoo.com/news?tmpl=story&u=/afp/20041213/hl_afp/thailandhealthflu_041213135628>


Bird flu outbreaks detected in 2 more Thai provinces
-----------------------------------------------
Thai officials reported 2 more outbreaks of bird flu in the kingdom, saying wild birds had also tested positive for the deadly virus in 4 provinces already listed as outbreak zones.

Infected backyard chickens were behind the 2 new outbreaks in the southern
provinces of Pattani and Nakon Sri Thammarat, officials said, on Monday [13
Dec 2004], without indicating how many birds had succumbed to the virus,
which has killed 12 people in Thailand and 20 in Viet Nam in the past year
[2004].

The director of Thailand's bird flu center, Charal Trinvuthipong, said 10 wild birds had also tested positive in 4 northern and central provinces during tests of 68 local and migratory birds. [10 positives out of 68 tested is indicative of an exceptionally high prevalence, but figures in the previous item mention different data, namely, a random sampling of more than 1000 migratory and indigenous birds. Clarification will help. - Mod. AS].

"We now have to check whether those birds got flu from chicken droppings or
somewhere else," Charal told reporters, adding that health officials planned to conduct another 6000 tests.

The Thai livestock department said that, since Thursday [9 Dec 2004], it had outbreaks in 19 of the 21 affected provinces under control.

Thailand's poultry export industry, the 4th largest in the world, had lost up to 80 billion baht [USD 2 billion] in revenue since the start of the outbreak in late 2003, representing a 1.2 percent loss in national earnings, according to the government.

--
ProMED-mail
<promed@promedmail.org>

[If confirmed, this is a disappointing -- though not unexpected -- development. Thailand's last follow-up report to the OIE was sent on 9 Dec
2004 by Dr. Yukol Limlamthong, Director General, Department of Livestock
Development, Ministry of Agriculture and Cooperatives, Bangkok. It stated
that between 2 and 9 Dec 2004, there were no new outbreaks of highly
pathogenic avian influenza in Thailand. The said follow-up report is included in OIE's current accumulated update on avian influenza in animals in Asia (type H5), dated 13 Dec 2004, which can be seen at<http://oie.int/downld/AVIAN%20INFLUENZA/A_AI-Asia.htm>. - Mod.AS]***


6 species infected is not good news. Pigeons are no surprise - not the first report we've had of those birds being infected & I'm not familar with the other 5. I'll look u at east some basic info about them.

This statement sent me postal:

***Dr. Charal sought to allay public fears about the possible transmission of
the virus from birds to humans. "It has not been concluded yet that the
avian flu virus can be transferred from birds to humans," he said.***

Well, where in blazes do they think people are contracting it FROM? If any of these birds are routinely encountered by man, hunted, killed & disposed of, then there's a risk. The urgency at ths point would be to determine the prevelence & how much virus these birds are excreting. Are any of them getting sick or is it simply blood tests revealing the infection. I'd like them to extend the range of species sampled to if that part of the sampling wasn't thorough.

At this point, I think any expectation of control of H5N1 in Thailand is futile. And if such is the case in Thailand, neighbouring countries will be next.

It's just a matter of time now.

[y2kmisfit]

I don't think this article has been posted yet.



Dissecting flu's deadly weaponry
By Rachael Buchanan
BBC News



In a quiet little village in Hampshire there's a very potent reminder of the power influenza can occasionally wield.
Lined up with the characteristic precision of a military cemetery are the graves of 318 Canadian soldiers, who lived and died here in Bramshott during the First World War.

As you move through the ranks of simple limestone headstones, the dates climb gently, sequentially; until you reach September 1918.

For the next few months, bodies poured into this little village graveyard.

In October and November, there were 137 deaths; on 8 November alone there were 12 funerals, and they were so overwhelmed some burials were held at night.

But this is not a roll call of war dead; most of these men were victims of the Spanish Flu Pandemic that swept the globe that year.

The Great War slew 15 million in 4 years. Influenza racked up a death toll three times that number in less than a third of the time.

Pressing need

Few people know more about the exceptional power of the 1918 flu pandemic than Professor John Oxford, of Queen Mary's College, London.

Oxford has dedicated most of his professional life to solving the molecular mystery behind one of history's most efficient serial killers; tracking its legacy around the globe, from Southwark to Spitzbergen.


Mother Nature has always been the greatest threat - bigger than any bio-terrorist
Prof John Oxford

Back in his East London laboratory he carefully opens up a battered cardboard box to reveal four blackened, irregular cubes, each about the size of a sugar lump.
These are lung samples from 1918 victims, carefully preserved in paraffin.

They may be nearly a century old but locked inside are samples of the virus.

These nuggets are more than biological curios to Oxford; they amount to a warning from history - the next global outbreak could be just as devastating, and just around the corner.

"I would class the potential threat from the next pandemic as exceeding high," he told BBC News.

"I don't think we have ever been so close to an outbreak; a global outbreak as we are now. Mother Nature has always been the greatest threat - bigger than any bio-terrorist," he warned.

Building a virus

The virus that is making Oxford and the world's flu experts nervous made its debut in the Far East around two years ago and has so far infected 44 people across Thailand and Vietnam, killing more than three-quarters of them.

Not a huge death toll, but then this new strain is still in its infancy. A flu virus particle is little more than a bag of genetic material with two types of protein sticking out of its shell; spikes that help it infect cells and then spread.

The haemagglutinin spike spears the body's cells and helps the virus enter where it hijacks our own cells' mechanics to replicate many times over.

The neuraminidase spike provides the escape route, rupturing the cell wall to release the newly made viruses and so spread the infection.





Flu strains are named for these two proteins "H" for haemagglutinin and "N" for neuraminidase. The 1918 virus was an early version of H1N1, and the other two pandemics of the last century represent mutations of one or both of these proteins; the 1956 strain being H2N2 and the 1968 strain, H3N2.
And Mother Nature's newest far eastern formula? H5N1.

These proteins are what the body's immune system targets - fine when your immune system is presented with something it has met before - it already has an antibody template to work with.

But when influenza generates totally new proteins, an H5 for example, the immune system is caught out - it has no template to build its defences.

Before it can learn how to build the right shaped antibodies, the whole body may succumb, overwhelmed by this novel virus.

This is what has killed those 32 victims in Thailand and Vietnam; their immune system did not catch up in time. New strains of flu are zoonotic diseases - they start in animals, usually chickens, and cross the species barrier to cause unique human infections.

The origin of the current H5N1 outbreak was chickens where it was particularly deadly. But for now each case has been an isolated example of bird to human transmission, a viral dead end.

Time constraint

Scientists will really worry when someone that already has human flu, also catches H5N1. Then, the two may combine, emerging as a new strain with the virulence of the chicken flu and the transmissibility of human flu.

The result - a deadly pandemic which in the age of easy international travel could spread around the globe in weeks.

So now around the world, influenza monitoring centres which study local flu outbreaks are watching out for novel strains, too.


Included in this network is the UK's Health Protection Laboratory in North London. At the moment it is business as usual, but the lab's head of Virology, Maria Zambon, is in no doubt what effect a new strain could have.
"We are worried that a new pandemic might turn out to be 'force 10 on the Richter scale' of new emerging viruses in humans," she said.

"It would cause an enormous global burden of disease and death and we are particularly concerned that it might well affect the young adult population and in doing so bring society to a halt."

Of course this is the 21st Century and medical science has undergone a revolution since the 1918 pandemic.

We have drugs and vaccines that can work against the virus. But the problem is that even this modern technology takes time to get up to speed.

First, the new strain has to emerge, and then a vaccine must be developed and millions of doses grown.

The minimum time span is around several months; by which time millions could be dead.


Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/1/hi/sci/tech/4092709.stm

[Mr_Larry]

Are there any estimates of the mortality rate for H5N1 in humans? Do we know how many people have died from it and how many have been infected? Granted that there have surely been some human cases where people recovered on their own, and have not been identified as ever being infected with H5N1.

Anyone have any totals for the past year?

[CanadaSue]

impossible for a number of very good reasons. I can give ou an estimate range & MY reasons/factors for the variables I use if that will do for now.

[Mr_Larry]

It seems to me that roughly 75% of the people that are know to have it have died. The real question is: How many people have been infected with it but have not been diagnosed with it?

Could the mortality rate be close to 50%?

[CanadaSue]

Jst gathering my data...

[CanadaSue]

First we have no way of knowing how many cases have really occured & here's why. The cases we KNOW of have occured in Vietnam & Thailand - 2 countries where basic medical care is spotty at best. Many can't access it so... we may have had cases which were never reported because they never came to the attention of any medical service - applies to both countries. Because of the lack of medical care, people are used to 'sucking it up' far more trhan we are. You treat your sick ones as best you can manage & some are quite skilled at diagnosis of endemic conditions & what local treatments work. They live or die.

There is a high background level of sickness anyway & respiratory illness is as common there as it is here. I'm hoping many contracted H5N1 & were never more sick than most of us would be with a minor or bad cold or 'ordinary' bout of flu. They got sick, didn't waste precious time or scarce cash on doctors or other medical attention, simply were sick & got over it. If that's the case & it should be - more on that in a bit - fatality rates go way down.

Alternately, many may gave caught it & died without getting any medical help either. Because they were buried, cremated, whatever well before deaths might have been officially reported - have no clue what policies are in those nations for such matters - bodies ain't around for testing. No testing, no flu. Officially, clean & tidy.

I'm betting both these have happened - just not sure in what proportions.

Okay, back to known cases & death rates. Right now the known death rate in THIS year's outbreaks is running at 32 deaths from 44 cases - a fatality rate of 72.7%. The only diseases with higher death rates are real nasties such as rabies, a few strains of Ebola & a few others, if they're not caught & treated early enough. Rabies isn't something that's transmitted easily, neither is Ebola & the latter fizzles after several generations of transmission.

Note that flu seasons wane every spring here & multigenerational 'fizzle' may account for some of that. I do not KNOW that - it's a question I've not found an answer to & am patiently waiting answers from several really important flu dudes. I'll be waiting a while - they've got better things to do right now.

We have a strain we have no immune system template for so the potential attack rate is high. It has a short incubation & a 24 hour period in which it can be transmitted before a case knows he or she is a case. It's respiratory & a robust virus in the environment.

Here's my best guess - don't bank on it. When it makes the jump to human transmission, it will hit hard & fast because of our crowded workd & travel patterns. I think 1 month - max - will see it around the globe. I'm going to be conservative & say a 25% attack rate. 1.5 billion people & over no more than a year. We can't stop it, we can't begin to come close to slowing it muhc. We'll have no vax until it's too late. By the time we have a vax, I think we'll have new strains causing subsequent waves - even worse than the first. Then, it may wane. Based on what we've seen so far, if 25% of those 25% of the world's population who catch it die, as I think is likely, we're looking at 375 million dead.

The usual weak will go first, then others. We won't have the facilities or what we need to properly care for those who have it. Secondaries will take their toll. My numbers are high, I think considerably higher than what the WHO is saying publicly. The numbers they're using are mind boggling enough to most. The numbers I use give a 6.25% death rate. Spansh Flu had a death rate of 6.25% & this one, in its trail runs, is showing a far higher rate than we suspect the Spanish Flu precursers did.

But in the end, I don't know. Nobody does. I'm sure not eager to find out.

[revtaz]

:confused: Question? Has anybody thought to figure the mortality rate from this flu to those who are infected with HIV? What effect would pandemic flu have on those whose immune systems have been challenged by that disease? I am thinking of African countries, also Russia and China where HIV is pretty much out of control.

just being my usual optimistic self :eek:

[CanadaSue]

The easy answer is to assume at least a 75% mortality rate. Those with full blown AIDS - close to 100% & probably that, given a bit of time & secondaries. H5N1 flu may not immediately & directly kill those who are HIV+ BUT that alone may trigger fullblown AIDS.

I suspect anyone with any significantly compromised immune system is in a major world of hurt but am only guessing on that.

We know Spanish Flu attacked healthy adults & ONE of the working asumptions is that pandemic H5N1 would act in similar fashion. Bit of a caveat here though. Spanish Flu was H1N1 - different strain altogther & we can't assume an H5 will act in the same manner as an H1. With H5N1, the preponderance of cases SEEMS to be among kids. The question is - why? So far because it's been contracted through exposure to poultry, I have to ask - in Vietnam & Thailand are children more likely to be involved with the day to day care of flocks while their older siblings & parents take on more 'adult' work? Or does H5N1 truly have more of an affinity for kids?

Russia's health system has completely fallen apart. Many of her citizens don't eat well, can't rely on heating during their long winters & maybe the only thing that will slow a massive regional epidemic there is that people may travel less - I'm speculating. I know thei annual flu case rates can be staggeringly high but unfortunately, I STILL can't find a decent source of stats for Russia. I do know this, vaccine preventable disease rates are soaring as are rates of complications from those diseases. Their prisons are jammed & full of HIV/HEP/TB - you name it. Prisoners released bring those illnesses & more into the community. TB is a pulmonary disease & pandemic flu on top of TB? Yup - not good.

China is always a special case. From dead silence on HIV/AIDS to a ramping up of articles about it & the growing problem in China - from Chinese press. When I start seeing 'stats' in the Peoples Daily & increased warnings about the looming impact of HIV/AIFS, my tendency is to take their timeslines & divide by 5, their numbers of cases & multiply by 5. Picked that number our of a hat during the SARS tjig & it held up for that - why not HIV? HIV/AIDS in recent weeks is getting more & more press over there - gotta be many reasons for that.

China's conditions in rural areas & the type of human/agricultural interactions between rural & urban settings leave them ripe for pandemic. It may start there - the seeds were certainly sown there & with the population they have & its varied nature - nightmare time.

[y2kmisfit]

Based on what we've seen so far, if 25% of those 25% of the world's population who catch it die, as I think is likely, we're looking at 375 million dead.

To put this in a more personal perspective...picture your Thanksgiving or Christmas get together. One out of every four getting the flu. One out of every sixteen dieing.
And that may be a conservative number! We just don't know.

[CanadaSue]

The 'big picture' numbers are hard to grasp. Here are more day to day examples...

A full 72 seater school bus - 4 kids dead.

A class of 32 kids or so - 2 dead.

What I didn't mention was many of the ill will REMAIN ill a long time. The experience with H5N1 in HK was that several patients relapsed - with FLU. Many took months to recover completely & some were left iwth permanent cardiac, hepatic & renal damage.

So we could be looking at 375 million dead & possibly souble that out of commission for months or permanently harmed... 1.125 BILLION people dead, enduring slow recovery or left with permanent harn.

And ya know what? I didn't even look at the permanent harm that is often xcaused by many of the secondary infections. These could include permanent decreased lung, cardiac, hepatic & renal damage, zorched immune systems, amputations...

Do pandemic plans even BEGIN to look at medical care needed on an ongoing basis AFTER pandemic wanes?

[revtaz]

Do pandemic plans even BEGIN to look at medical care needed on an ongoing basis AFTER pandemic wanes?

Maybe they are, and that's why so many seem covertly concerned.

[CanadaSue]

Frankly, I'm one guilty of not having given it much thought - strike that - any thought at all.

Spanish Flu saw millions of cases of Encephalitis lethargica - might we again -scaled up to match however many get flu? Other neurological problems might certainly be seen - I'd have to play 'spider web' with mixes & matches of possible underlying conditions, flu itself & possible secondaries. I'm a bear of too little brain to do that easily.

Imagine kidney failure & an increased need for dialysis & orgen donations, donations too for livers, hearts, lungs? Not to mention the ongoing monitering, heds, etc. And what worries me is another thing we've not seen addressed. How many medical people will themselves die? How many young people will be willing to enter those fields if pandemic is awful & we can't guarantee a better, safer for them medical response next tine? With an aging population & potentially greater needs of pandemic survivors - not a time to go short of trained & experienced staff.

Economically, if this attacks the young & healthy both children & adults, where the tax base? We're already below 'replacement level breeding' & what would happen? There's an instinct to breed after wars & pesilence but what about willinhess? Folks might be worried about the 'next' plague.

Yeah, a post-pandemic world may not be a pleasant place for quite some years.