H5N1

Indonesia teenager dies of bird flu

Via Reuters: Indonesia teenager dies of bird flu: health ministry. This is all we know so far:

An Indonesian girl from Central Java has died of bird flu, a health ministry official said on Friday.

The girl, 15, from the Kendal area near the city of Semarang, died on Tuesday after coming into contact with a dead chicken, Muhammad Nadirin of the ministry's bird flu centre said by telephone.

Antara carries the same story, almost verbatim. If confirmed, this will be Indonesia's 79th fatality from H5N1.

Vietnam: Another province goes H5N1-positive

Via Reuters, more discouraging news: Bird flu spreads among ducks in central Vietnam. Excerpt:

Bird flu spread to a second province in central Vietnam this week, killing 370 ducks which had not been vaccinated against the H5N1 virus, the Agriculture Ministry said.

Tests confirmed the virus in the 2-month-old ducklings at the farm in Quang Nam province and animal health workers slaughtered the remaining 30 ducks in the flock, a ministry report seen on Friday said.

In early May bird flu broke out among ducks in Nghe An province, the first outbreak in the central coastal region, which is 500 km (310 miles) north of Quang Nam. Both the provinces lie along the north-south Highway One.

The outbreak in Quang Nam on Wednesday brought to 13 the total areas affected by the disease in Vietnam in the past month, spreading from Son La in the country's far northwest to Can Tho city in the southern Mekong delta.

Agriculture Minister Cao Duc Phat has said Vietnam was on the brink of a bird flu epidemic in poultry after the virus spread rapidly in May at the start of summer, which is unusual as experts say bird flu thrives best in cool temperatures.

Branswell: Japanese students blocked from flying home under Quarantine Act over measles

Whether it's the XDR-TB case, or the spread of mumps in eastern Canada, or this report by Helen Branswell, we seem to be experiencing some foreshocks: Japanese students blocked from flying home under Quarantine Act over measles. Excerpt:

Federal officials invoked the Quarantine Act to block a group of 39 Japanese students and two of their chaperones from boarding a flight to Tokyo on Thursday when departure screening in Vancouver revealed one girl was ill with symptoms that could be measles.

"The decision to hold them back was made under . . . the federal Quarantine Act, which essentially is designed to protect against the import and export of infectious diseases," said Dr. Howard Njoo, director of the Public Health Agency of Canada's centre for emergency preparedness and response.

They are part of a larger group of 130 Japanese tourists - 123 students and seven chaperones - who had previously been quarantined by local public health authorities in Banff, Alta., after one student developed measles shortly after arriving in the country on May 24.

While in Banff the entire group was tested to see if they had antibodies to measles and the 39 students and two chaperones were identified as having no immunity to the highly contagious disease.

Public health agency officials said with a new potential case, it was felt that these people - who could be incubating the disease - posed a health risk to other passengers on the 12-hour flight to Tokyo.

Small though these cases are, they're providing useful tests of our transportation and public-health systems. If those tests reveal weaknesses, and we move fast to fix them, we'll be in much better shape for a full-scale pandemic.

New B2B outbreak in Thailand?

Via The Nation, some worrying news from Thailand: Sakon Nakhon bird flu fear.

Suspicious poultry deaths in a village in Sakon Nakhon's Sawang Daen Din district last week have triggered fears of a bird-flu outbreak, prompting officials to test the carcasses, cull the remaining birds and spray the area with disinfectant.

Sakon Nakhon veterinarian Pisut Eaukingpetch said yesterday dozens of free-range chickens died suddenly last week in Ban Non Rang in Tambon Bong Tai. Officials culled 158 remaining chickens, disinfected the owner's house and the surroundings, and set up checkpoints to prevent birds being taken out of the area.

The carcasses showed signs of death from lung complications and results of tests for the H5N1 virus should be known in two days, he said.

Pisut said there were 56 chicken-rearing households in the area with a total of 1,055 birds.

You can't get away with this in fiction

The latest twist in the plot of the flying XDR-TB patient is so bizarre that not even Michael Crichton or Stephen King could get away with it: Quarantined TB patient the son-in-law of a CDC microbiologist. Excerpt from the Globe and Mail:

One thing is clear about the honeymooner who put airline passengers at risk of getting an especially dangerous strain of tuberculosis: He can't claim ignorance.

Andrew Speaker didn't just have doctors' warnings against flying to Europe, and again against flying back. As a personal injury lawyer, he presumably knew something about the dangers of reckless behaviour.

And most amazingly, Speaker has a new father-in-law with a vast knowledge of the disease he carried aboard two trans-Atlantic flights.

Bob Cooksey, a CDC microbiologist specializing in TB and other bacteria, said he gave his 31-year-old son-in-law some “fatherly advice” when he learned the young man had contracted the disease. He would not comment on whether he reported his son-in-law to federal health authorities, and the Centers for Disease Control and Prevention did not explain how the case came to their attention.

Better late than never

Via Channel NewsAsia.com, a report that tell us more than we might want to know: Indonesia hands out kits to fight bird flu. Excerpt:

Indonesian officials Thursday began distributing kits containing masks, gloves and bars of soap to fight bird flu in villages across the archipelago nation, they said.

About 100,000 leaders of hamlets will receive the kits in Indonesia, the nation worst hit by the deadly virus with 78 deaths, a senior official said.

The latest death was recorded earlier Thursday, that of a 45-year-old man who had come into contact with infected chickens, the most common way for humans to contract the virus, officials said.

The first Avian Influenza kits were handed out in Tenggulun Timur village, in a high-risk area of West Java, by officials from the national committee charged with trying to halt deaths from the virus.

"These kits are a simple way to inform your communities about bird flu," committee chairman Bayu Krisnamurthi told leaders of the village.

The kits also include a street banner warning against bird flu, two VCDs on the virus, stickers, flyers and a booklet explaining how to reduce the risk of contracting the virus.

"This is a chance for everyone to discuss the issue of bird flu and find ways to solve it," he said adding that simple precautions could reduce the risks of contracting the virus.

Since Indonesia has been suffering human deaths for over two years, this seems like a sadly belated effort to alert the public to the danger. But it's better than nothing.

Bird flu waning but global pandemic risk still high

Via Reuters, a story from an anti-flu conference in France: Bird flu waning but global pandemic risk still high. Excerpt:

The spread of bird flu may be waning but the world must keep up its guard against the threat of a human influenza pandemic, which is almost certain in the longer term, senior health experts said on Thursday.

Senior international bird flu experts meeting at the Anti-Avian Influenza conference in Paris said the rise in the rise in the number of cases both in birds and in humans had slackened, especially since the start of this year.

"The disease is weakening. It does not mean it could not come back but there is something happening," Bernard Vallat, head of the World Animal Health Organisation (OIE), told Reuters.

The highly pathogenic H5N1 bird flu strain that appeared in Asia at the end of 2003 has infected 309 people around the globe, killing 187. Data for the first half of 2007 might indicate the disease was coming closer to the end of a cycle, Vallat said, but worries remained over Indonesia, Nigeria and Egypt.

"If the those last pockets were crushed it would be much more reassuring," he said.

Vietnam: Government trying to crack down on H5N1

Via Vietnam News Agency: Bird flu outbreaks spark new rounds quarantines, supervisions.

The Head of the National Steering Committee for Avian Influenza Prevention and Control on May 31 ordered all local committees to guide the supervision of rural farms and farming households in order to get a jump on possible bird flu and flu type A (H5N1) outbreaks and transmissions.

Health officials have become alarmed at how the virus has been developing in Viet Nam recently. From early this month, the disease has been recorded in 21 communes/wards, 17 districts/towns of the nine provinces and cities of Nam Dinh, Nghe An, Quang Ninh, Son La, Bac Giang, Hai Phong, Ninh Binh, Can Tho and Dong Thap.

Of greater concern to health workers were the reports of the first human case infected with the H5N1 virus since early 2006.

In order to deal with the worsening situation, the Prime Minister called on the Health Ministry and the Standing Committee of the National Steering Committee for Avian Influenza Prevention and Control to dole out drastic measures to control and contain the disease.

People’s Committees, medical, agricultural, rural development, border quarantine and preventive medical units were asked to prepare and supply bird flu kits to localities in order to prevent transmissions to humans.

The health sector has also been asked to remain vigilant when supervising patients, who are suspected to be infected with H5N1 by placing them in quarantine and isolation wards.

The official report on the 78th death

The Indonesian Ministry of Health has published details on the 98th AI case in 37th district. Ignore the English errors and reflect on what the story suggests:

From observation of provincial health office of Central Java , before getting illness, SA had contact with dead chicken. In addition to dead chicken in his neighboring, he also killed, cooked and ate those sick/dead chicken.

He has his onset on May 17, 2007. On May 19, he went to general practitioner and two days later to Gubug Health Center. He was referred to Purwodadi Hospital, and then to Ario Wirawan Hospital, Salatiga on May 26, 2007. Still in the same day, hospital referred him to Dr. Muwardi Hospital, Solo, Central Java.

His symptoms included high temperature (39.3ºC), cough and difficulty in breathing. Arriving at hospital, his hemoglobin, leukocyte and thrombocyte straightly decreased.

Comparing number of death with total cases, Case Fatality Rate (CFR) of AI among human is 79.59%. It means 4 of 5 cases are dead. It shows the fatality or savage of H5N1 virus on human. Moreover, virus growth can rapidly destruct internal parts of human body.

Averagely, dead cases occur after 5 days showing symptoms. Therefore, when someone has symptoms of fever, cough, especially if there is sick/sudden dead chicken in his/her neighboring, people should immediately report it to health center or government hospital to get treatment.

Drug for obstructing virus growth is only effective to patients within 2 days after the symptoms occur. Do not wait until difficulty in breathing appears to go to doctor.

If the average time between symptoms and death is five days, then Mr. SA was lucky to live past May 21. That average implies that some cases are fatal within a couple of days.

And if Mr. SA actually cooked and ate chickens that had fallen ill and died, it's clear that the Indonesian government needs to do far more to educate its people about what might happen.

As usual, we get no indication of other steps the government might have taken, such as culling poultry in Mr. SA's neighbourhood or testing his family members.

More questions than answers

The New York Times and many other media are covering the story of the XDR-TB patient: Near Misses Allowed Man With Tuberculosis to Fly.

Just as Katrina taught us what we could expect from the government in a pandemic, this case shows how easily such a pandemic could start. So far, we've learned just enough to raise some questions.

The patient is reportedly a lawyer. He's evidently prosperous enough to fly to Greece to get married and then to fly around Europe before flying back home via Canada. He'd been advised before leaving that US that his TB was at least multi-drug resistant. He learned while in Europe that it was actually XDR-TB, and was cautioned not to fly home.

First question: So why would such an educated person do such idiotically dangerous things? Surely his doctors made it clear that he might spread his disease to others (including his fiancee).

Second question: Why did his new bride go along with this nonsense?

Third question: Why did the health authorities, according to the patient, tell him they "preferred" he not go abroad?

Fourth question: When you have to take your shoes off and ditch your hand cream before you can board an aircraft, how did this man get on several flights to and from Europe?

In many of the scenarios for the start of a pandemic, someone is exposed to an H2H form of H5N1 in Vietnam or Indonesia or China, and then immediately flies to Europe or North America before symptoms can develop. The assumption is that the carrier is either a medically ignorant Asian or an innocent westerner.

Now we have to consider the possibility that a carrier might well know he or she is dangerously sick, and still board that flight to San Francisco or Frankfurt.

Like the H7N2 outbreak in Britain, this episode is a kind of sloppy good luck: A relatively low-cost way to test our defences against the spread of infection.

Our grades on these tests have been D or C- at best. But at least we know where we have to improve if we want to pass the final.

Update: The patient has now been flown to a special facility in Denver, according to this C-Health report.