H5N1

Planning for an Arctic pandemic

Via the Nunatsiaq News, a news source in Canada's Arctic territory of Nunavut: Pandemic could hit most Nunavimmiut. Excerpt:

Nunavik’s regional health board has a plan on how the region can cope during a pandemic – a worldwide outbreak of illness that could kill billions of people.

A summary of the plan, which was presented to the recent meeting of the Kativik Regional Government council, paints a grim picture of such a pandemic’s effect on Nunavik.

This pandemic could be a new virus like the deadly influenzas of the past or the emerging H5N1 bird flu virus strain.

For now, the H5N1 bird flu is only transmitted by direct contact with affected birds, but that could change.

According to the World Health Organization, if bird flu does spread to human beings, this virus has the potential to assume pandemic proportions, spreading around the world.

If this happens, one in three people in southern Quebec could fall ill or die, and more than seven in nine in Nunavik could be hit by the pandemic, which would sweep over the region in two waves.

A region-wide quarantine would be one way to limit the northward spread of a pandemic to Nunavik, health officials told the regional council. This lock-down would continue until the first wave of the illness ended, and a vaccine could be manufactured.

The first wave of illness would strike over two or three months; the second would follow in three to nine months.

Under this worst-case scenario, food destined for a quarantined Nunavik would be dropped off at airports and pilots would not go outside the aircraft, and patients needing special care would go to Chibougamou instead of Montreal.

The health board says the challenges in managing a pandemic in Nunavik include overcrowded houses that encourage a virus to spread more quickly, the young age of the population, its vulnerability to lung conditions and difficult access to specialized medical services.

The result?

A pandemic could sicken 3,850 to 7,700 Nunavimmiut. About half would require medical care and, of these, some would need to be hospitalized. From eight to 23 of the sick would die out of an expected 8,575 fatalities throughout Quebec.

With these numbers of gravely ill predicted, the health board wants collaboration from the KRG to organize emergency services in the communities because, as the health board’s interim executive director Gilles Boulet said, “if the houses don’t have water, we’re not going to go anywhere.”

Given the notoriously poor housing Canada provides for most of our Inuit and First Nations communities, the estimated death toll seems awfully optimistic.

More on the Zakaria cases

Via the Jakarta Post, a report that the Zakaria outbreak in Bandung may not be over: Bird flu deaths hit 52 after man dies in Bandung. Excerpt:

"The virus crushed his lungs and caused the creation of progressive pneumonia which led to breathing problems," Cissy Rachiana Prawira, director of Hasan Sadikin Hospital, said.

The government confirmed the 20-year-old was positive for H5N1 earlier this week. The man's 23-year-old brother died with bird flu symptoms on Sunday just before being admitted to the hospital.

A third sibling, a 15-year-old female, is currently being treated at the same hospital even though she has been declared negative for the virus.

The younger brother was in critical condition since his admittance to the hospital Sunday from Santo Yusuf hospital in Bandung. Although he showed signs of improvement after he was put on a ventilator and administered high doses of Tamiflu, he remained in an unstable condition.

"The terrible condition of his lungs caused his breathing problems, which later spread to his kidneys, heart and blood vessels," Cissy said.

The Hasan Sadikin hospital has admitted another relative of the family showing bird flu infection symptoms. The 18-year-old is a niece of the brothers who lived with them at Kebonwaru, Batununggal district, Bandung.

The girl complained of high fever upon returning from the burial of the man's brother in the West Java town of Garut. She constituted one of about 20 people living near the dead patient, from whom employees of the local health office took their blood samples for examination.

More on the latest Indonesian case

Antara News Agency has some details on the case reported here last night: Indonesian woman tests positive for bird flu: hospital official. Excerpt:

An Indonesian woman hospitalised in East Java has tested positive to the bird flu virus, a hospital official said Friday, bringing the total number of cases in the world's worst-hit country to 69.

The woman, 21, is the elder sister of an 11-year-old boy who died on September 18 after being infected with the H5N1 virus, but human-to-human transmission is unlikely as both came into contact with infected poultry.

"The results came out this morning. She is still alive despite having had direct contact with infected chickens," said Urip Murtejo, a spokesman for Sutomo Hospital in Surabaya, where the woman has been treated since Monday.

"She has to use a ventilator to help her breathe," he told AFP.

Test results from two laboratories at the health ministry in Jakarta showed that she had contracted the H5N1 virus, Murtejo said.

Positive results from two Indonesian laboratories mean that the World Health Organization (WHO) includes the case in its records.

According to the WHO, poultry began dying in the family's household in the month before the boy's symptoms appeared and poultry deaths continued later in their neighbourhood.

Branswell: Don't forget the poor

Via C-Health, Helen Branswell has another must-read: Efforts to prevent, plan for pandemic must address needs of the poor: experts. Excerpt:

Efforts to prevent a flu pandemic from occurring and planning for one should prevention fail must pay particular attention to the needs of the disadvantaged and the poor, a group of international experts said in a statement released Friday.

The Bellagio group, as they call themselves, noted small farmers in Asian countries are currently paying the highest price for efforts to stamp out H5N1 avian flu in poultry. And they said the toll on people at the bottom of the socioeconomic ladder will be highest should culling of infected poultry fail to stop a pandemic from igniting.

H5N1 in a quarter of Indonesia's poultry?

Via Bloomberg.com: Bird flu may infect a quarter of Indonesia's domestic birds. Excerpt:

Bird flu may have infected a quarter of backyard fowl in some of Indonesia's most densely populated areas, the country's top veterinary official said, risking human lives and increasing the threat of a pandemic.

Random tests carried out in areas where the virus is most prevalent on the island of Java detected the H5N1 influenza strain in as much as 27 percent of fowl and caged birds, said Director of Animal Health Musny Suatmodjo. He didn't say how many birds were tested or when the survey was done.

Contact with infected birds risks spreading the disease to humans. The prevalence of H5N1 among Indonesia's 300 million poultry helps explain why the country accounts for one-in-three human deaths from the disease worldwide since 2003.

The infection creates chances for H5N1 to mutate into a form that spreads easily among people, touching off a global outbreak that could kill millions.

"The backyard sector is the weakest link'' in controlling the virus, Suatmodjo said in a Sept. 27 interview in the capital, Jakarta.

"The survey of hotspots in the backyard sector showed almost every flock has been previously infected,'' though not all birds show symptoms of the disease, he said.

And that last comment is food for thought.

Sister of Indonesia bird flu casualty also has H5N1

Via Reuters: Sister of Indonesia bird flu casualty also has H5N1. Excerpt:

A 21-year-old Indonesian woman, the sister of a boy who died of bird flu earlier this month, is suffering from the same disease, the health ministry said on Friday.

The patient, currently being treated at a hospital in East Java province, had contact with sick and dead fowl, as had her brother, said Runizar Ruesin, the head of the ministry's bird flu information center.

"She has been declared a bird flu positive case by the ministry lab and NAMRU," he told Reuters, referring to a U.S. Naval Medical Research Unit based in Jakarta.

The Soetomo hospital in East Java capital Surabaya said the woman was also suffering from pneumonia.

"Her condition is stable but her pneumonia has not improved yet. She is still being supported by a respirator," Urip Murtejo, the hospital's deputy director, told Reuters.

At first I thought this was the sister in the Zakaria family—then I realized the Zakaria girl is 15, and lives in West Java. So this is yet another likely family cluster.

WHO: H5N1 is mutating

Via the Washington Post: WHO: Deadly Bird Flu Virus Mutating.

The deadly H5N1 strain of bird flu which has killed at least 148 people is showing signs of being able to mutate and develop resistance to the most effective anti-viral drugs and any possible vaccines yet to be produced, a WHO scientist said Thursday.

The H5N1 virus is splitting into genetically different groups, said Mike Perdue, a team leader with WHO's influenza program who took part in a two-day bird flu conference earlier this week sponsored by the U.N. health body.

No vaccine for the H5N1 virus has been produced yet, but scientists are confident they will develop one in future.

However, the virus has now been shown to mutate like seasonal flu viruses that require new vaccines every year. "We are going to have to come to the realization that these viruses are genetically variable," Perdue said. "The vaccines that we have predicted to be protective today may not be protective a year from now."

The two most effective anti-viral drugs currently in use are also in danger of losing their potency, according to influenza experts.

"We know from surveillance studies and from hospital clinical studies that resistance to the two primary anti-viral drugs, the Tamiflu and Amantadine drugs, have already occurred," Perdue said.

Away on Thursday

I work in Sechelt on Thursday, so my day will be spent commuting (via car and ferry) and teaching (a very nice class of documentary-production students). I won't have time to post here until probably around 7 pm PDT.

Also on Thursday, The Tyee is publishing my review of Andrew Nikiforuk's new book Pandemonium, which deals with H5N1, mad cow disease, and a host of other 21st-century plagues.

Thailand: "No sign of outbreak"

Via MCOT: No bird flu found in Thailand's lower northeast. Excerpt:

There was no outbreak of bird flu in Thailand's lower northeastern region after the last outbreak in Nakhon Phanom on August 2, a senior Department of Livestock Development official said Wednesday.

Deputy Director General Chaweewan Leowijuk said the department had campaigned intensively to prevent the spread of bird flu during the past month, and there was no sign of outbreak in the northeast or elsewhere in the country.

She said that although the latest bird flu virus fatality was confirmed in Nong Bua Lam Phu, a northeastern province, it will not be declared a "red-zone" under a special monitoring for bird flu since the latest checks found no outbreak there.

"Since the victim developed the bird flu-like symptoms in August, livestock officials inspected and culled poultry in the vicinity of his home, but found no trace of the virus," she said.

1918 flu virus's secrets revealed

Via BBC News Online: 1918 flu virus's secrets revealed. Excerpt:

An experiment to reconstruct the deadly 1918 flu virus has given a new insight into how the infection took hold of its many victims.

Scientists discovered a severe immune system reaction was triggered when mice were infected with the recreated virus.

The US team believe the extreme immune response could have provoked the body to begin killing its own cells, making the flu even deadlier.

The study, published in Nature, may aid the hunt for new influenza treatments.

It's hard to get access to articles in Nature without a subscription, but if I can find a free link I'll post it.