H5N1

Flu drug shortage has wide-ranging impact

The Saturday Globe and Mail has a story with ominous implications for Canadian health-care workers: Flu drug shortage has wide-ranging impact. In effect, people ill with H5N1 will have priority access to antivirals ahead of doctors, nurses and hospital staff.

And even the front-line medical workers -- who are further up the priority list than those responsible for keeping the peace, feeding and heating the country, and burying the dead -- would not likely get access to Tamiflu until they themselves fell ill.

The plan estimates that if a flu pandemic hit, between 15 per cent and 35 per cent of Canadians would become so ill that they would be at least temporarily debilitated; it also estimates that as many as 58,000 would die. To be effective in reducing the severity of the disease, Tamiflu must be administered within two days after its onset, but not all of the infected would get treatment in that time period.

If the Vietnamese experience is any guideline, it will be small loss; Tamiflu seems not to have worked very well on H5N1 patients there. But if health-care workers stay home to protect themselves and their families, who's going to administer the Tamiflu to infected patients?

H5 confirmed in Iraqi poultry

Thanks to the reader who passed along the OiE report on Highly Pathogenic Avian Influenza in Iraq.

This report indicates that an H5 virus (almost certainly H5N1) broke out in two villages on January 18; confirmation took place on February 1. "All outbreaks in poultry," the report says, "occurred in backyard flocks which generally included chickens, geese, turkeys and ducks."

The implication is that avian flu was widespread in the Sulaimaniyah region before the human cases occurred. And if it's in Iraq's backyards, it seems likely that it's still spreading through the backyards of Iran, Syria, Georgia, Armenia, and Azerbaijan.

Vietnam importing vaccines from China

Thanh Nien Daily reports Vietnam is importing more Chinese flu vaccines.

Vietnam has imported 150 million doses of bird flu vaccines for poultry from China, the Tien Phong newspaper reported Friday.

The US$1 million worth vaccines would be used in the early part of this year, the paper quoted the agriculture ministry as saying.

Last year, Vietnam imported 340 million doses of vaccines from China and 6 million doses from the Netherlands and France each for its mass vaccination of more than 120 million birds.

Ministry officials said the vaccination, which began last August, had helped reduce the number of poultry outbreaks nationwide.

The country, which has been hardest hit by bird flu, has not detected any new outbreaks among poultry in almost two months. No human cases have been reported since November.

However, experts warned that these achievements could be marred if newly-hatched poultry were not inoculated.

"There are tens of millions of newly-hatched birds nationwide every month ... if they are not vaccinated on time, the vaccine barrier [preventing the epidemic's spread] will risk becoming useless," Le Van Tao, deputy director of the National Animal Health Institute, said.

The H5N1 virus has now claimed 86 lives, including 42 in Vietnam, among 161 known cases since reemerging in Asia in late 2003.

Maybe the hysteria is lost in translation, but the Vietnamese seem from their English-language news reports to be dealing with H5N1 calmly, rationally, and decisively—much more so than other hot-zone countries. They don't complain about the cost of culling, they don't dither about whether a human case is H5N1 or not, and they appear to report cases promptly.

Other countries, including Canada and the US, should be sending health professionals and government planners to Vietnam—not just to give assistance, but to learn from Vietnam's hard experience.

Low turnout for pandemic talk

Thanks to the reader who sent me the link to a story in the Palladium-Item, a newspaper serving Richmond, Indiana: Low turnout for pandemic talk.

The story begins with the reminiscences of Mary Morgan, whose grandmother had died in the Spanish flu. Ms. Morgan went to a local pandemic-preparedness talk with that family tragedy in mind.

Morgan, though, is apparently the only resident worried about Avian or bird flu, which many epidemiologists fear will be the next pandemic. She was the only non-media person in attendance Friday.

Those of us who've been following the spread of H5N1 should bear this news story in mind. We are a very small minority. For many people in North America, and even in Europe, avian flu is on a par with ferry sinkings in the Red Sea and train wrecks in Colombia—unfortunate, but nothing to do with us.

Bird-flu hype "harming vital health issues"

The Scotsman runs a story combining two of my interests: H5N1 and the health impact of inequality: Bird-flu hype "harming vital health issues."

A former adviser to the Queen has urged medical chiefs to tackle health inequalities exposed by an Evening News investigation instead of sensationalising issues like bird flu.

Ex-Royal press secretary Michael Shea said he had been shocked by last week's report, which revealed huge disparities in the life expectancy of people in different areas of Edinburgh.

Mr Shea will outline his views during a lecture next week. He believes that, rather than trying to add their own views and opinions to topical debates like bird flu, health professionals should be trying to address the huge health gap between the rich and poor.

The Evening News investigation found that a boy growing up in affluent Fairmilehead is expected to live to the age of 82, and a girl to 89. But a few miles away in Craigmillar, the average life expectancy is 65 for a boy and 70 for a girl.

I deal with inequality issues (not often enough) at Bridging the Income Gap, but this deserves a comment here.

Every socioeconomic class in industrial nations is healthier than the class below it and sicker than the class above it. In countries with wide gaps between richest and poorest, life expectancy is lower. Where the gap is narrow, life expectancy is higher. A century of research has established this, though the causes are still debatable.

In a pandemic, it seems likely that the poor will therefore suffer more than the rich. With their health already weaker, they will be more vulnerable to infection. As we saw with Katrina, they may even lack the simple resources to reach medical help.

I'm not aware, though, of any plans that take this vulnerability into account. If you know of any resources that deal with the poverty/pandemic problem, please let me know.

Stormy weather

A storm hit the BC coast overnight, with winds high enough to force the closing of the Lions Gate Bridge for the first time in over 40 years. The winds are supposed to go on all day.

I usually walk the dogs through the woods every morning, but not today. Several communities have been blacked out, and I wouldn't be surprised if we are too: We have lots of trees next to lots of power lines.

If it happens, I'll have more cause to reflect on what a blackout could mean in a pandemic, when crews may not be available to restore power.

Bulgaria: "No bird flu threat," just more dead birds

Via Sofia News Agency: No Bird Flu Threat for Bulgaria's People - Health Minister.

There is no threat for the people in the area where the dead swan infected with bird flu has been found, Health Minister Professor Radoslav Gaydarski said.

Gaydarski, who is in Danube city Vidin, where the dead bird was found, explained that all bird should obey the instructions for such situation issued by the authorities

Minister Gaydarski has issued an order to all municipal governors for tightened control.

There is no place for panic, Zheko Baychev from the National Veterinary Service said.

Everything will be fine as long as the birds understand that they have to follow orders.

Meanwhile another story from SNA reports that a number of dead birds are being tested:

Two dead swans have been found south of the Black Sea port Burgas and a dead pelican has been detected near the Danube village of Marten. Another dead bird - a falcon - has been found near Russe. Other birds have also been sent for tests in Russe.

Another dead swan has been found in the Tudzha river near Yambol.

All birds will be sent to Sofia for tests.

Indonesia: four more cases, two deaths

Via Yahoo! Asia News: Indonesia says four more bird flu cases confirmed.

A Hong Kong laboratory recognised by the World Health Organisation has confirmed four more human bird flu cases in Indonesia, including two deaths, a senior Indonesian Health Ministry official said on Saturday.

Hariadi Wibisono, the ministry's director of control of animal-borne diseases, said that raised Indonesia's total confirmed human bird flu cases to 23.

"There are now 23 confirmed cases in Indonesia. Of these, 16 have died," Wibisono told Reuters.

Turkey and Iraq last month became the latest countries outside Asia to report human cases of the H5N1 strain of avian flu. While it mostly affects birds, bird flu has infected 161 people and killed 86 of them since 2003, according to the World Health Organization.

Wibisono said the newly confirmed Indonesian deaths were of a 22-year-old male chicken seller from Jakarta who died late last month and a 15-year-old boy who died in the West Java city of Bandung this week.

Latest cases raise WHO's avian flu tally to 161

CIDRAP reports that Latest cases raise WHO's avian flu tally to 161.

The World Health Organization (WHO) tally of human cases of H5N1 avian influenza rose to 161, including 86 deaths, with the final confirmation of 12 cases in Turkey and one in Iraq this week.

The WHO said on Jan 30 its collaborating laboratory in Britain had confirmed 12 of the 21 cases reported so far in Turkey, including four deaths, leaving nine cases still awaiting final confirmation. Yesterday the agency announced confirmation of the first case in Iraq, that of a 15-year-old girl in the northern Kurdish region.

The WHO does not add cases to its official count until they have been confirmed by one of its collaborating labs.

In Iraq, test results from two other cases were still being awaited, the WHO said yesterday. Samples from the 15-year-old girl's uncle, who died Jan 27 after suffering an illness similar to hers, and samples from a 54-year-old woman with a respiratory illness were sent to the British lab.

The deceased girl had been exposed to sick birds, but no poultry outbreaks of avian flu had been found in the country as of yesterday, the WHO said. A team of WHO and other experts was sent to northern Iraq to investigate, but because of security problems they were not expected to arrive until next week, the agency reported.

For Kurds, chickens mean food, cash, and death

The Kurdistan Regional Government has an article by a foreign correspondent named Richard Oppel on the impact of the cull on ordinary Kurds. Very much worth reading.

I should also mention that the "162 suspected cases" in Iraq, mentioned here last night, seem to have vanished. One or two sources picked up the original stories, but I haven't seen anything to confirm it...least of all from the Kurdistan Regional Government.