H5N1

Vietnam: B2B H5N1 spreading again

Via Xinhuanet: Vietnam sees 2 more bird flu-stricken provinces. Excerpt:

Vietnam's southern Tra Vinh province and northern Nam Dinh province have recently been hit by bird flu, raising the total number of affected localities in the country to four, a local veterinary agency confirmed Thursday.

Bird flu, starting to strike a large flock of two-month old ducks raised by a household in Tra Vinh's Chau Thanh district on Oct. 29, has killed 400 waterfowls and sicken 500 others, said the Department of Animal Health under the Ministry of Agriculture and Rural Development.

Among a flock of 400 unvaccinated ducklings bred by a household in Nam Dinh's My Loc district, 210 waterfowls died on Oct. 28. Recent tests showed that they were infected with bird flu virus strain H5N1.

Local veterinary agencies have killed all ducks in the two affected flocks, and disinfected the farms.

Now, bird flu is hitting Tra Vinh, Nam Dinh, northern Cao Bang province and central Quang Tri province, the department said, noting that cities and provinces nationwide are keeping on vaccinating poultry against bird flu viruses.

CIDRAP: The pandemic vaccine puzzle, part 5: What role for prepandemic vaccination?

Via CIDRAP: The pandemic vaccine puzzle, part 5: What role for prepandemic vaccination? Excerpt, re-paragraphed:

The scientific, logistical, and especially ethical questions raised by prepandemic vaccination are grave.

Any vaccination that took place before a pandemic was detected would offer uncertain amounts of both benefit and risk. The vaccine might be cross-protective against a future pandemic—but the lag time to the pandemic’s emergence might be so long that the vaccination would seem pointless.

As well, the vaccine might cause a greater-than-expected rate of adverse events, causing both direct harm to recipients and indirect damage to government credibility—results that would be particularly difficult to tolerate if vaccination proved unnecessary because the pandemic did not arrive.

Those risks are not theoretical: They have been demonstrated in the United States twice in recent history, in the abortive 2002 smallpox vaccination campaign and the 1976 swine-flu campaign (see Bibliography: Kotalik 2005), which has haunted US flu decision-making ever since.

The danger demonstrated by both those campaigns, of causing adverse events while protecting against a disease that might never arise, has been noted in World Health Organization (WHO) policies as well.

"Possible high-risk shortcuts in response to a potential emergency would be difficult to justify prior to the actual occurrence of the emergency," the agency said after the June 2006 meeting of its Global Advisory Committee on Vaccine Safety.

"Effectiveness of pandemic vaccines will not be known before the pandemic and possibly only after it is over" (see Bibliography: WHO 2006: Global Advisory Committee on Vaccine Safety, 6-7 June 2006).

Yet the potential benefits of prepandemic vaccination are so alluring that governments have begun gingerly to lay groundwork for its consideration, despite the obvious difficulties of putting the idea into practice.

This is clearly one of the most important contributions CIDRAP has made to the H5N1 issue (and that is saying a lot). I'm posting a link to CIDRAP's news page in the H5N1 Technical Sources list, so you can visit the whole series.

Housekeeping changes

If you look at the lists in the left-hand column, you'll see I've moved them around. Newsgatherers are now at the top, followed by Hot Zone Sources and Bloggers, then H5N1 Discussions. WHO links, which used to be at the top, are now below Discussions.

This is mostly for my own convenience, but I hope you find it convenient also. WHO is very quiet these days, and the Discussions links (especially CurEvents Flu Clinic and Flu Trackers) are providing very up-to-date reports. I still don't like the toggle-text translations from Bahasa Indonesia, but they generally spot cases that turn up two or three days later in the English-language Indonesian media. (Some future history of the pandemic will recognize the enormous work these folks put into learning about a language, a culture, and a disease.)

Avian influenza epizootie: where do we stand in 2007

Via CIDRAP, a lecture from Australia: Avian influenza epizootie: where do we stand in 2007.

The 2007 Snowdon Lecture, titled Avian influenza epizootie: where do we stand in 2007 was delivered on 11 July byDr Bernard Vallat, Director General, World Animal Health Organisation, the Office Internationale des Epizooties (OIE).

The lecture provided an insight into the global threat posed by the current epidemic of H5N1 avian influenza.

I haven't had a chance to review it, but I'd be grateful for comments on it.

Japan, Indonesia discuss vaccine production

Via Antara: Japan, RI exploring cooperation in bird flu vaccine production. Excerpt:

Indonesia and Japan are holding intensive talks on Indonesia's desire to develop its own capacity in handling the spread of bird flu disease and on possible cooperation in the production of bird flu medicines and vaccines.

"Japan understands Indonesia's strong desire to develop its own capacity in the production of bird flu vaccines and medicines to help overcome the spread of endemic bird flu," Chairman of National Commission for Bird Flu Control, Bayu Krisnamurthi said here on Wednesday.

Krisnamurthi said that Japan and Indonesia had been holding talks on possible bilateral cooperation in the production of bird flu vaccines.

He said the talks were aimed at building mutual understanding on the form of cooperation based on the principles of the World Health Organization (WHO) but in support of Indonesia's desire to build its capacity in producing its own medicines without depending too much on foreign assistance.

Business continuity planning: the legal aspects

Via Metropolitan Corporate Counsel, a law-related website: Pandemic Planning: Active Participation by the Legal Department is Critical. Excerpt, re-paragraphed:

Unlike other emergency and business continuity planning, pandemic planning requires consideration of short and long term impacts on a variety of topics, including: employee safety and health, community support and coordination, communication strategies, critical task coverage and employee/management succession, supply chain continuity, business services continuity, and for when the pandemic subsides, rapid recovery policies and claims processes for claims that might arise.

The breadth of topics to be covered requires a diverse group of representatives from different parts of the company to develop an adequate plan.

Legal co-ordination of the people involved and the process of planning is critical for at least two principal reasons.

First, planning requires an assessment of potential legal liability. Human resources policies may need to be modified considering the potential length and severity of a pandemic, as well as the need to limit the spread of infection and to account for the unavailability of public services such as schools and public transportation.

Disability and leave policies, therefore, should be reviewed. They may need to be amended to encourage contagious individuals to remain at home and to ensure compliance with statutory and regulatory requirements in the context of a pandemic.

Employee and labor union agreements may need to be amended to permit, among other things, cross-training and succession planning. Contracts with customers and suppliers of both critical inputs and business services must be reviewed to ensure the company has adequately taken into account the potential financial impact of failure to perform.

Insurance programs must be reviewed to determine the adequacy of coverage for health and death benefits, as well as the availability of coverage for business losses.

Second, because a pandemic has the potential to impact such a large number of people, even the most robust pandemic plan may not protect the company's employees and their families from illness and/or death and may not prevent breach of contractual obligations or economic losses.

Any of these outcomes could result in claims by employees, by customers, or by investors. In any lawsuit, every choice the company made in the planning process will be compared to a "standard of care" drawn from publicly available checklists, guidelines, and government statements.

Legal control over the planning process will ensure that proper documentation for choices is developed and preserved and that the legal risks associated with each choice, including the potential use of that choice in future litigation, have been adequately considered.

More news from Tangerang

Via KOMNAS FBPI, an update: Latest bird flu case from Tangerang. Excerpt:

Test results from the  Health Research and Development Center of the Ministry of Health  and Eijkman Institute confirmed that S, a 3-year old boy, from Tangerang, Banten Province is positive infected by H5N1 virus.

S is still being treated at Sulianti Saroso Hospital in Jakarta. Overall, Indonesia has now recorded 111 confirmed human H5N1 cases with 89 fatalities. The case fatality rate now stands at 80.18%.

Up to today, Banten Province has recorded 17 bird flu positive cases with 14 fatalities.

Bird Flu in Riau
Test results conducted towards 5 neighbors of the latest bird positive case in Riau, LT (M,44), showed negative results.  

The Riau comment seems to be a belated follow-up to a death reported about a month ago.

Meanwhile, KOMNAS doesn't tell you what The Straits Times does: that the 3-year-old's parents have taken him out of the hospital. Excerpt:

The boy from Tangerang, a satellite city west of the capital Jakarta, stayed in hospital for just half a day last Saturday, said Sardikin Giriputro, deputy director of Sulianti Saroso hospital.

'We had no choice but to let the boy leave the hospital as his parents insisted on taking their child home,' he said.

He added that a patient should remain in isolation until a test showed the infection was over.

Doctors wanted him to remain in isolation to ensure there would be no possibility of human-to-human infection, he said.

The boy was under home observation by medics from a health centre in Tangerang and Wednesday's report said that his condition was improving, Mr Giriputro added.

Never mind repetitive stress injury...

...your computer keyboard (or someone else's) could lay you low. Via Scott McPherson, a report that poses a big problem for computer-using educators like me. Excerpt:

A research paper was sent to me by alert blogger Robyn Klein, AHG herbalist, MSc. Medical Botany, and an adjunct instructor with the Department of Plant Sciences and Plant Pathology at Montana State University. Her blogsite is http://www.rrreading.com/index.html.

The paper is titled "Public computer surfaces are reservoirs for methicillin-resistant staphylococci", and the authors are Issmat I Kassem, Von Sigler and Malak A Esseili of the Laboratory for Microbial Ecology, Department of Environmental Sciences, University of Toledo, Toledo, Ohio.

The following is just from the foreword!

The role of computer keyboards used by students of a metropolitan university as reservoirs of antibiotic-resistant staphylococci was determined. Putative methicillin (oxacillin)-resistant staphylococci isolates were identified from keyboard swabs following a combination of biochemical and genetic analyses.

Of 24 keyboards surveyed, 17 were contaminated with staphylococci that grew in the presence of oxacillin (2mgl1). Methicillin (oxacillin)-resistant Staphylococcus aureus (MRSA), -S. epidermidis (MRSE) and -S. hominis (MRSH) were present on two, five and two keyboards, respectively, while all three staphylococci co-contaminated one keyboard.

Furthermore, these were found to be part of a greater community of oxacillin-resistant bacteria. Combined with the broad user base common to public computers, the presence of antibiotic-resistant staphylococci on keyboard surfaces might impact the transmission and prevalence of pathogens throughout the community.

This evening I used a computer in my classroom; it had been used all day by other teachers. We have computer labs all over campus where scores and hundreds of students bang away on keyboards before leaving them to still other students.

And while I've long been aware of the unpleasant look of "plaque," the dirt and grease we see on so many keyboards, I hadn't thought about the possibility of picking up a serious infection from just another public computer.

This is like the famous pump handle in London whose removal is said to have ended a cholera epidemic in the 19th century. If computer keyboards are vectors of disease, we're going to have to develop some new habits. Fast.

CIDRAP: The pandemic puzzle, part 4: The promise and problems of adjuvants

CIDRAP has published The Pandemic Puzzle, Part 4: The promise and problems of adjuvants. Excerpt:

Adjuvanted vaccines appear to hold the greatest promise for solving the grave supply-demand imbalance in pandemic influenza vaccine development. They come with obstacles—immunologic, regulatory, and commercial—but they also have generated more excitement than any other type of vaccine thus far.

In an example of the hope being hung on adjuvants, the WHO last week issued a statement declaring that the pandemic vaccine supply is "sharply" increasing and forecasting that annual manufacturing capacity will rise to 4.5 billion two-dose courses by 2010 (see Bibliography: WHO 2007: Projected supply).

The forecast is based on the expectation that flu vaccines made in 2010 will include an adjuvant permitting the use of just one-eighth of current vaccines' antigen content. (Adjuvants are chemicals that are incorporated in some vaccines to improve response to the vaccines' active ingredient. Adjuvants make it possible to reduce the dose of antigen in a vaccine without dampening the immune response.)

SophiaZoe already has a detailed discussion of this article.

Overcrowded Indonesian prison blamed for deaths of dozens of inmates

Thanks to the reader who sent the link to this item from The Raw Story, dated last April 5: Overcrowded prison blamed for deaths of dozens of inmates. Excerpt:

Overcrowding and poor sanitation at an Indonesian prison were believed to have caused the deaths of some 50 inmates over the past four months, a local media report said Thursday.

Warden Kosad Purwanto claimed that West Java's Tanggerang Penitentiary, just west of the capital Jakarta, was only designated to accommodate 800 people but now held 3,816 inmates. He said the existing 418 cells measured 1.5 square metres each and were occupied by eight to 10 inmates.

"The poor conditions have made inmates susceptible to disease. We have asked the Tanggerang Municipal Health Agency to provide more paramedics for inmates but there was no response," The Jakarta Post quoted Purwanto as saying, adding that there are only four doctors working there.

Tangerang is in Banten province, which has so far seen 17 human cases of H5N1 and 14 deaths, for a case fatality ratio of 82%.