H5N1

World AIDS Day

It's still November 30 as I write this, but for most of the world it's already December 1: World AIDS Day. An excerpt from Dr. Margaret Chan's message:

The first World AIDS Day was staged by WHO in 1988, at a time when the world was waking up to this disease and its multiple catastrophic impact. Since then, the face of the epidemic has changed in significant ways, and we are gaining better insight every day.

Some trends have been positive. Leaders in most countries are fully awake to the threat. Awareness has brought commitment, and resources continue to increase, including for the development of new tools.

This year’s report on the epidemic, jointly prepared by UNAIDS and WHO, indicates that HIV incidence peaked in the late 1990s and prevalence has been level since 2001. Data set out in this report further suggest that prevention efforts are leading to fewer new infections, especially in young people, and that greater access to treatment is contributing to fewer HIV-associated deaths.

These positive trends mask some alarming changes in the epidemic. My main message today is straightforward: do not forget Africa, and do not forget women.

Today, HIV/AIDS is overwhelmingly concentrated in sub-Saharan Africa, where it thrives on and traps people in poverty. This region accounts for over two thirds of people living with HIV and over three quarters of HIV-associated deaths.

In all regions, the proportion of women living with HIV is growing. In sub-Saharan Africa, it now approaches 61%, the highest in the world. The infection of women amplifies the tragedy. These are wives, mothers, caregivers, and often the backbone of family and community cohesion.

The 17th-century French author François de La Rochefoucauld once observed that "We all have strength enough to endure the misfortunes of others." But it is a perilous strength.

For a quarter-century we have endured the misfortunes of AIDS sufferers—thanks to our sexual neuroses, our contempt for homosexuals, and our racism toward the Africans whose 500 years of unpaid toil and sorrow established us in our present easy circumstances. We owe our own good health to dumb luck, not to superior genes or morals.

Just visit allAfrica.com Health and Medicine to see what a real pandemic does to the world. Measured against the ongoing catastrophe of AIDS, we Flublogians are microscopic.

I hope we continue to be microscopic. An H5N1 pandemic would likely kill countless AIDS victims who would otherwise get on with a few more years of productive and meaningful life.

If our attention to a hypothetical pandemic has any value at all to the millions of AIDS sufferers around the world, it's that we may buy them some time—if we can help smother yet another viral attack on them.

Let us find the strength not merely to endure the misfortunes of AIDS victims, but to embrace them and save them.

Margaret Chan as songbird

Via the International Herald Tribune, an AP story: WHO Director-General uses musical diplomacy to fight health problems. Excerpt:

Fighting global health problems like bird flu, AIDS and malaria requires money, drugs — and in some cases, a bit of singing.

During a handful of recent high-profile international meetings, the World Health Organization's Director-General Dr. Margaret Chan broke out into song, entertaining top United Nations leaders and staff members with a few bars of her favorite classic tune, "Getting to know you."

"There are different ways of communicating," Chan said in an exclusive interview with the Associated Press on Friday. "And singing is one of my ways of communicating."

Since the karaoke-loving Chan took over the UN health agency in January, she has slowly been reshaping the organization, shuffling top directors and identifying priorities she wants to be judged on, such as women's health and Africa.

Under WHO's last chief, Dr. Lee Jong-Wook, some critics accused the agency of being unduly influenced by several large member countries, most notably the United States.

While public health remains politically charged, Chan has brought a charismatic and cooperative management style that many say is essential in today's crowded global health arena.

The 60-year-old Hong Kong native started out as a schoolteacher before jumping into medicine. As director of Hong Kong's health department, she headed the city's response to containing the 2003 outbreak of Severe Acute Respiratory Syndrome before joining WHO the following year.

When WHO was created nearly 60 years ago, it was the only agency working in global health. Since then, other organizations have gotten involved, including other UN agencies like UNICEF, the Bill & Melinda Gates foundation, and the Global Fund to fight AIDS, tuberculosis and malaria.

"In some ways, it has been hard for WHO to recognize that it is no longer the only player in the game," said Barry Bloom, dean of Harvard's School of Public Health. "The name of the game now is partnership."

That may be where Chan's musical inclinations come in handy. "So much of WHO's identity is invested in its director-general," said Dr. Jim Yong Kim, a former WHO director and professor at Harvard University's School of Public Health.

"Margaret charms the pants off of people when she sings."

I'm as happy as the next guy to have my pants charmed off by an intelligent and good-looking woman. All the same, if I ever meet her, I'm wearing belt and suspenders.

Siti Fadilah Supari claims a win

The Indonesian ministry of health has published its version of the Geneva conference: Minister of health succeeds fighting for equal, transparent, and fair sharing virus. Excerpt:

One of debated problem root is Global Influenza Surveillance Network (GISN) regulated in WHO. Under the protection of GISN, WHO has a right to ask all viruses in the world, without any conditions. Ironically, the virus can be accessed only by developed country. Processed by "medmunn" technology (not all countries have the capability), those viruses will be changed into seed virus. This seed, then will be legalized by countries who can process it.

That was mentioned by Minister of Health, dr. Siti Fadilah Supari, Sp JP on press conference at Jakarta after attending Inter Governmental Meeting on Pandemic Influenza Preparedness (IGM-PIP) in Geneva, on Saturday, November 24, 2007.

According to Minister of Health, dr. Siti Fadilah Supari, Sp JP, it is not fair for countries that have sent viruses and are generally developing countries. Products generated from seed virus that can be made into vaccine and drugs, are unaffordable for the developing countries that which is the owner of the virus. This GISN rules has been occurring 50 years and made based on health law of progress country, which is certainly benefit to those countries.

Until the forming of new system that are: fair, transparent, and equal, IGM-PIP has committed that mechanism of virus sharing should be consistent with each national rules and law. To guarantee virus sharing in this interim, IGM-PIP meeting commit to provide traceability mechanism to detect the flow of Indonesia H5N1 virus sharing in the world. IGM-PIP also asks Directorate General of WHO to build advisory mechanism to monitor and strengthen new system which is based on each other trust.

Bird to cat H5N1 in Romania?

It wouldn't be the first case by any means. Via Yahoo News, an AFP story: No new bird flu cases in Romania, but tests pending on cat: officials. Excerpt:

Samples from a farm in south-eastern Romania have revealed no new cases of bird flu, but tests were to determine if a cat found dead at the farm was infected, veterinary health officials said Friday.

Some 200 samples taken Thursday, a day after bird flu was found at the farm in Murighiol, tested negative for the potentially deadly H5N1 virus, the head of the National Veterinary Health Agency ANSV Radu Roatis said.

But tests were still being conducted on a cat found dead at the farm to determine whether the animal died of bird flu, said Ioan Lazar, also from ANSV.

UN/World Bank pandemic readiness report available

Thanks to the American Council for Voluntary International Action for posting the complete report: Responses to Avian Influenza and State of Pandemic Readiness, Third Global Progress Report. It's a 1.7MB PDF file.

Junta says everything's under control

Via Vietnam News Agency: Myanmar keeps bird flu under control.

Myanmar has announced it kept the fresh bird flu outbreak in its border area of Kengtung in eastern Shan state under control, foreign news reported.

H5N1 virus was detected on some chickens and ducks of local species at a village farm in Kengtung on Nov. 18 which died unusually. The local authorities culled 14,889 chickens, ducks, geese and Muscovy ducks within a week after those unusual deaths were found on the fowls traded in the area, foreign media quoted a statement of the Myanmar Livestock and Veterinary Department as saying.

Other measures of disinfecting of the farm, restriction of transport of chicken and biosecurity were also taken, and it also urged the people to prevent the entry of poultry and birds from neighbouring countries into Myanmar.

Earlier in October, trace of H5 virus was found at a poultry farm in Yangon division's Hmawby township with no symptom of bird flu detected.

So the junta had to admit the outbreak once Mizzima News blew the whistle yesterday. The "trace" of H5 last month is also interesting. Does this mean that Burmese poultry are developing resistance to H5 versions of avian flu?

Vietnam tracking free-range ducks

Via Viet Nam News: EXperts say monitoring free-range ducks will help prevent bird flu. Excerpt:

Better surveillance of free-range ducks by the authorities will help contain bird flu, experts told a seminar that opened yesterday in HCM City.

In his opening remark at the two-day seminar, Deputy Minister of Agriculture and Rural Development (MARD), Bui Ba Bong, said Viet Nam had the largest population of ducks in Southeast Asia, and 80 per cent of the ducks ranged freely on paddy fields and between provinces.

Figures from the MARD’s Livestock Production Department show the country has 230 million poultry and 68 million waterfowl in 2007. Waterfowl farms are centred in the Red River and Mekong Delta regions.

"Ducks are allowed to range freely in the fields because they can feed on the rice grains spilled after harvest and other stuff," Bong explained.

However, since 2003 experts have identified them as a risk because ducks carry the deadly H5N1 bird flu virus and free-range ducks spread it.

Romania says bird flu brought in by migratory birds

Via Xinhuanet: Romania says Bird flu brought in by migratory birds.

Poultry in Romanian eastern county Tulcea was contaminated with the bird flu virus from migratory birds, the National Sanitary Veterinary and Animal Safety Authority announced on Thursday.

Fodder for the poultry bred in the contaminated household came from a region intensely sought by wild birds, according to the preliminary epidemiological investigation.

At a meeting held on Thursday, the Tulcea County Anti-epizootic Command decided to have the local Hunters and Fishermen Association organize test hunts of wild birds and collect the bodies for specific lab tests.

According to data presented in the report of the Danube Delta Biosphere Natural Reserve, 6,800 wild birds were tracked here on Wednesday.

The Romanian Institute for Animal Diagnosis and Health confirmed on Wednesday the bird flu outbreak, the H5N1 virus strain, after a laboratory testing of samples taken from dead chickens in a household at Murighiol of Tulcea County.

Is Burma covering up a B2B outbreak?

Via Mizzima News: Authorities conceal bird flu detection in Shan State. Excerpt:

An alarming situation is developing with the deadly avian flu once again surfacing in Burma's eastern Shan State. Reports are tricking in that the virus is fast spreading in the region while authorities remain silent and inactive, sources said.

Sai Muing, a Thailand based journalist, who covers Shan State, said the flu had been first noticed in October in Nawng Ming village. But with authorities concealing the information, the flu has spread to many more areas in Shan State.

"There are rumors that the flu was first noticed when a local villager lost about 20 of his ducks bought from China . He bought about 600 ducks from China ," Sai Muing said.

Following the detection of the flu, local authorities including the Myanmar Red Cross and fire brigade were sent into slaughter chickens from local farm houses, local residents said.

"So far, the worst hit is Keng Tong township, and local authorities have culled over 1,800 chickens and fowls," a local resident told Mizzima.

Even more worrying than the outbreak is its suspected source in China.

Nabarro: "A time bomb in our midst"

Via Reuters, a report on a statement by the UN and the World Bank: Animal health crucial in bird flu battle - report. Excerpt:

"Highly pathogenic avian influenza is currently entrenched in Indonesia, Egypt and Nigeria, and possibly in some locations in China and Bangladesh," the report reads.

"Once the virus is entrenched, control and elimination become a major challenge, and the risk of human infection with H5N1 increases."

One big problem is veterinary services in poor countries, some of which lack the facilities to even test for bird flu.

"Controlling disease in animals lies at the root of preventing human infections and reducing the probability of a pandemic," the report reads. "Livestock and farm animals are a kind of time bomb in our midst," [Dr. David] Nabarro said. "We must rear our animals in a healthy way."

I quote this passage because we haven't anything out of Nigeria, Egypt, or China in a long time, and not much out of Bangladesh. The Indonesians don't even bother to publish English-language reports of B2B outbreaks any more. Yet the UN is prepared to say H5N1 is "entrenched" in those countries.

And what about all the other countries where it's broken out more than once, most recently the UK? If we can't utterly destroy the virus, how and where does it survive before it breaks out again? Surely it can't all be in migratory birds.

Nabarro doesn't say wild geese and swans are the time bomb—he points to livestock and farm animals.

You can find a detailed UN news release here. For the full report you have to email a UN press officer mentioned on the page.