H5N1

Dog flu in Thailand

Thinlina at the Finnish blog Penumbra of Pandemia picked up this story from the Thai periodical The Nation: Dogflu proved.

A dog in Suphan Buri has been found contracting the bird flu after eating infected ducks, a doctor said Wedneday.

Professor Dr Yong Pooworawan, a lecturer at the Chulalongkorn University's Faculty of Medicine, disclosed the findings at a seminar yesterday.

According to him, a researcher at the Kasetsart University's Kamphaengsaen Campus found the bird-flu infection in a dog and the findings will be published in a foreign journal - Emerging Infectious Diseases - soon.

Yong refused to elaborate further on the findings."

They've found dogs and cats with H5N1 antibodies in Thailand, so this is not really a surprise.

But it poses a problem for me: We have B2B (bird to bird), B2H (bird to human), B2C (bird to cat, including tigers), and B2D (bird to dog). H2H (human to human) has occurred a few times, but fortunately isn't easily transmissible.

If I have to start using expressions like B2D2C2H2H, I plan to revert to plain English.

Five in Sulawesi tested for bird flu

Via Reuters: Five in Indonesia's Sulawesi tested for bird flu. Excerpt:

Five people have been admitted to hospital on Indonesia's Sulawesi island with bird flu-like symptoms and local authorities have sought funds from the government to help cull poultry, officials said on Wednesday.

Samples from the patients in Palu, the capital of Central Sulawesi province, have been sent to a government laboratory in Jakarta to be tested for bird flu, said Runizar Ruesin, head of the ministry's bird flu information centre.

No further details about the five people were available.

A commenter today observed that it's hard to keep track of the suspected cases, confirmed cases, deaths, and recoveries. It certainly is. A WHO report from Thailand mentions 75 possible cases still awaiting test results.

While I'm frustrated by the "no further details" of most Indonesia flu reports, a flood of information might be even worse. The amazing folks at the CurEvents Flu Clinic are machine-translating all kinds of Indonesian news stories and emerging with long lists of patients and deaths. But are we better off for knowing the name of every suspected case in West Java?

A trained epidemiologist might learn something from such a list, but the information is more likely available behind the scenes, and not drawn from local media of doubtful reliability.

China police break up fake Tamiflu ring

Via TVNZ, a New Zealand news source: China police break up fake Tamiflu ring. The spirit of free enterprise is unfortunately thriving in China these days:

Police in China's commercial hub of Shanghai have broken up a ring that was selling a fake version of Tamiflu - considered a key medical defence against bird flu in humans, an official state newspaper said on Wednesday.

The group made more than 1.6 million yuan ($NZ311,000) selling the drugs online and via other channels in China and in southeast Asia, the China Daily said.

Police arrested 13 people and seized 400 kilograms of the fake drugs and 46 tonnes of raw materials, it said.

"The ingredients of the pill were not released because of fears it would be copied, but it is said to be extremely volatile as the method of production can easily cause explosions," the report said.

We will certainly see more such rackets as H5N1 keeps spreading.

Would survivors' blood help H5N1 patients survive?

I was aware of this story yesterday but didn't pursue it. So extra thanks to the reader who nudged me out of my torpor and sent me to this report in the Annals of Internal Medicine: Meta-Analysis: Convalescent Blood Products for Spanish Influenza Pneumonia: A Future H5N1 Treatment?. Excerpt:

Studies from the Spanish influenza era reported that transfusion of influenza-convalescent human blood products reduced mortality in patients with influenza complicated by pneumonia. Treatments for H5N1 influenza are unsatisfactory, and convalescent human plasma containing H5N1 antibodies could be an effective therapy during outbreaks and pandemics.

It's just a conjecture, but also a reminder that we need to learn more about (and from) the last great pandemic.

When the patients don't believe the doctors

The Washington Post has an article on the Sumatra cases: Battling a Virus and Disbelief. Excerpt:

Dowes Ginting, the most wanted man on Sumatra island, lay dying. He had abandoned the hospital where he had seen his relatives succumb one after another, and he had fled deep into the mountains, trying to outrun the black magic he feared had marked him next. For four nights, witnesses recalled, a witch doctor hovered over him in a small clapboard home, resisting the evil spell.

Ginting, a wiry 32-year-old, had watched disease burn through his family over the previous two weeks, killing six and sickening two others, including himself. International health experts grew increasingly concerned when laboratory tests confirmed they were sickened by bird flu, the largest cluster of the disease ever recorded. But Dowes feared medical treatment more than he did the flu. And so he ran, potentially exposing villagers across the province to the highly lethal virus.

Health experts fear that the virus might develop into a strain that passes easily from human to human, the genesis of the 1918 epidemic that killed tens of millions of people worldwide, as new research has shown.

In the end, the outbreak in May did not presage the start of a worldwide epidemic. But the enormous difficulties that Indonesian and international disease specialists confronted in investigating the outbreak and protecting against its spread raised fundamental questions about whether bird flu could be contained if it mutated into a form more easily spread among people.

Two more suspected human bird flu patients treated in Garut

Via Antara News Agency: Two more suspected human bird flu patients treated in Indonesia. Excerpt:

Two more people from a bird flu-hit area in Indonesia's West Java have been admitted to hospital on suspicion of contracting avian influenza, health officials said.

The first patient, 17-year-old Asep Ridwan, was taken on Tuesday to hospital in Garut, West Java, from the hamlet of Ranca Salak in the subdistrict of Cikelet where three people have already been infected by bird flu, said Iman Firmanullah.

Birds in Ranca Salak tested positive of the H5N1 strain of the disease but no information was obtained whether Ridwan had been in contact with them, said Firmanullah, who heads the contagious disease section at Garut's health office.

The Garut general hospital overnight received a 39-year-old man from the nearby hamlet of Cigadog who showed symptoms of bird flu, Firmanullah told AFP.

Three other people from Cikelet are also suspected of having been killed by the disease.

Bad news from Hanoi

Via Xinhua: Ducks in Vietnamese capital contract bird flu virus.

Two ducks in Vietnam's capital, Hanoi city, have been infected with bird flu virus, local newspaper Labor reported Wednesday.

Specimens from the ducks in a market in Thanh Tri district have been tested to positive to bird flu virus strain H5, the paper quoted sources from the country's Central Veterinary Center as saying.

Recently, Vietnam has also detected some waterfowls in the three southern provinces of Ben Tre, Long An and Tien Giang contracting bird flu viruses, including the strain H5.

Vietnam will form anti-bird flu task forces at both central and local levels to stamp out any disease outbreaks timely and comprehensively.

Bird flu outbreaks, starting in Vietnam in December 2003, have killed and led to the forced culling of dozens of millions of fowls. The last outbreak of bird flu among poultry in the country was in December 2005, according to the Department of Animal Health under the Vietnamese Ministry of Agriculture and Rural Development.

Indonesia: Bird flu info campaign planned

Via the Jakarta Post: Bird flu info campaign planned. Excerpt:

The National Commission on the Eradication of Bird Flu on Friday will launch a nationwide information campaign to raise awareness of the disease.

The commission's acting head, Bayu Khrisnamurti, said the campaign was intended to increase public knowledge of the dangers of bird flu and what steps could be taken to curb its spread.

"We have carried out every measure according to the World Health Organization and Food and Agriculture Organization, but we see that public participation is still lacking here," Bayu said in Bandung on Tuesday.

He added the public needed to play an active role in monitoring and reporting cases of the disease in poultry and humans.

Bayu denied this new national campaign was being introduced because local administrations had failed to educate people about bird flu.

He said the campaign was necessary to reach remote areas like Cikelet, Garut, where several cases of infection by the H5N1 virus have been reported since July.

WHO case definitions for human infections with influenza A(H5N1) virus

The World Health Organization has published case definitions for human infections with influenza A(H5N1) virus. Excerpt:

1. The case definitions apply to the current phase of pandemic alert (phase 3) and may change as new information about the disease or its epidemiology becomes available.

2. National authorities should formally notify only probable and confirmed H5N1 cases to WHO. The case definitions for persons under investigation and suspected cases have been developed to help national authorities in classifying and tracking cases.

3. The case definitions are not intended to provide complete descriptions of disease in patients but rather to standardize reporting of cases.

4. In clinical situations requiring decisions concerning treatment, care or triage of persons who may have H5N1 infection, those decisions should be based on clinical judgement and epidemiological reasoning, and not on adherence to the case definitions. While most patients with H5N1 infection have presented with fever and lower respiratory complaints, the clinical spectrum is broad.

Avian flu could hit hard on campuses

Via the Iowa State Daily: Avian flu could hit hard on campuses. Excerpt:

An outbreak of avian flu in the United States could threaten college students more than other segments of the population, a disease control expert said.

Dr. Nancy Cox, chief of the influenza division at the Centers for Disease Control and Prevention, said influenza outbreaks can severely affect college students because infections spread more easily in environments with high concentrations of people, such as dorms.

"We have seen large outbreaks occur in university and college populations during pandemics in the past," Cox said.

She spoke at the Iowa Community Conference, an annual meeting of community leaders from throughout Iowa's 4th Congressional District, which was held Thursday at the Scheman Building. Rep. Tom Latham, R-Iowa, hosted the conference, which featured presentations designed to prepare Iowa communities to face new challenges.

It's encouraging to see at least some post-secondary institutions start to think about H5N1, but educating educators is always a challenge.