H5N1

Indonesia: Farmers, public told to be alert to bird flu threat

Via The Jakarta Post, a report from Denpasar, capital of the island of Bali: Farmers, public told to be alert to bird flu threat. Excerpt:

A senior government official asked the island's poultry farmers and residents to be even more alert for Avian Influenza (AI) as the island would soon enter the rainy season during which influenza usually occurs.

"Avian Influenza (AI) on the island is currently under control. However we ask the poultry farmers and the general public to be more vigilant because we will soon be entering the rainy season," head of Bali's Animal Husbandry Agency, IB Ketut Alit said earlier this week.

"The rainy season is particularly prone to influenza outbreaks."

The increase in alertness level, Alit said, should be focused on early warning measures such as monitoring and reporting any initial signs of an outbreak.

From January to October 2008, the agency recorded only one case of an AI infection. It was detected and reported in March and involved five chickens from Bebandem village, Karangasem regency.

"The case illustrates the importance of an early warning system and public participation."

The local farmers at Bebandem's Pande Sari hamlet immediately notified the authorities when they discovered that several chickens had died suddenly without any apparent cause, he said.

"The early warning system implemented by the local farmers has enabled us to contain the disease. Such public participation is very critical in our effort to free the island from AI next year," he stressed.

The island has had its share of an AI nightmare. In 2004 more than 722 chickens and ducks were culled to prevent the spread of the deadly epidemic.

Following that drastic measure, the island's governor issued executive order No 44/2005 which prohibited traders and farmers from transporting any live poultry onto the island.

A virtual pandemic

I'm a total stranger to online games (computer solitaire is my vice of choice). But according to a reader, something bad is happening in the World of Warfare:

... the Massive Multiplayer Online Game (MMOG) with hundreds of thousands of players on all seven continents just released a zombie plague into all the major cities on to continents.

Yesterday there were literally hundreds of sick and dying players and non-player characters in the streets, this morning there was hardly anyone moving outside, the streets were deserted, except for the obligatory corpses. This plague has a cure and acts quickly infecting others, and killing in 30 min.

I shall be back playing tonight and will be interested to see who is about. I also noticed this morning it has started spreading to small towns and villages as people exited the cities.

I suspect the reader meant "this plague has NO cure," but in any case I look forward to frequent updates. Something like this may actually offer some insights into behaviour in a real pandemic.

A correction

Yesterday I posted an item, supposedly from AP: Home drug stockpiles—not a good idea? Helen Branswell has just advised me that CTV.ca mislabelled the report, which she wrote for Canadian Press. I am happy to correct the error.

Hong Kong subsidizes flu shots for children

Via the Hong Kong government website: Flu shot subsidy to launch Nov 1. Excerpt:

More than 500 private doctors will provide influenza vaccinations to children aged six months to six years under a five-month subsidy scheme from November 1, Centre for Health Protection Controller Dr Thomas Tsang says.

Under the scheme these children, or those aged six or above attending kindergartens or childcare centres, and who are Hong Kong residents, can receive a government subsidy of $80 per dose of flu vaccine received from enrolled private doctors.

Dr Tsang told reporters today another 500 to 600 private doctors will join by mid-November.

Indonesia: Faith-based flu fighting

Via Poultry Indonesia Online, a report on how the country is using a religious organization to educate people about H5N1. Excerpt:

Red spaghetti, a chicken roll and hot chili fried eggs replaced the usual banners, posters and stickers in a bird flu campaign late last month. 

The campaigner, one of the country's biggest Muslim organizations Muhammadiyah, said it knew better approaches were needed to ensure its campaigns could engage locals.

"Specific activities would make them feel they're really involved in the campaigns against bird flu," event organizer Ahmad Imam M. Rais said. 

In the past two and half years, Muhammadiyah has seen 12,000 members in 12,000 villages carry out bird flu campaigns across the country, Ahmad said.
 
Campaigners work to remove poultry from residential areas, train local residents to properly handle infected chickens by covering up and burying diseased fowl instead of dumping it in rivers, and promote regular use of disinfectants to kill the H5N1 virus. 

Under the Muhammadiyah Team to Tackle Avian Influenza, the organization has also established a network of 7,000 "Avian Influenza Force" volunteer groups in nine provinces: Jakarta, North Sumatra, Lampung, Banten, West Java, Central Java, Yogyakarta, East Java and Bali.

"Our approach is to make people believe there is nothing to be afraid of with bird flu, because it is preventable," Ahmad said. 

However, he said, it was not easy to teach villagers about the epidemic, especially when it comes to changing their deep-rooted knowledge and behavior.

"In many cases, villagers were confused about the difference between symptoms of bird flu and those of Newcastle disease (ND). So, when they found their H5N1-infected chickens died, they thought it was simply because of ND, resulting in improper burying and the spread of the virus," Ahmad said. 

The government has said it cannot control the avian influenza epidemic on its own due to limited resources.

"As the government can't walk alone in fighting bird flu, community groups can definitely act to bring bird flu campaigns closer to the public as they have members across the country," Health Ministry Director General for Disease Control and Environmental Sanitation, I Nyoman Kandun, said during the campaign. 

He said Muhammadiyah, with some 30 millions members, could help the government prevent and control bird flu outbreaks across the country.

"With 500 hospitals and health clinics, as well as 17,000 educational institutions across the country, Muhammadiyah can back the government's effort to fight the epidemic in remote areas," Kandun said.

The story is followed by one on the increased 2008 poultry mortality in Purbalingga regency over that of 2007. But since B2B H5N1 is now endemic in Indonesia, we don't hear about outbreaks very often.

An experiment in machine translation

Over at The Flu Clinic, I've just learned that Google Translate now works from Indonesian to English. While I'm hesitant to accept machine translation, I was willing to give it a try. So here's an item from TempoInteraktif about the conference in Sharm el-Sheikh, with my comments [in brackets]:

Cases of bird flu in Indonesia decreased in number, both confirmed and died. Indonesia was also successful in controlling diseases caused by the Avian Influenza virus.

Chairman of the National Committee for Avian and Pandemic Influenza Preparedness (Komnas FBPI) Bayu Krisnamurthi said to October, the number of cases that died of bird flu reached 17 cases, while last year reached 37 cases.

Cases of bird flu is confirmed to October reached 20, while 37 cases last year. "The data confirmed and died as a result of AI decreased in number, this is good omen," Davis said in a press conference in his office on Wednesday (29/10). [I think Davis is Krisnamurthi, but I'm not sure.]

The number of cases of bird flu around the world also declined. Case totals are 36 and the 88 confirmed cases. Number fewer than last year, where the number of cases, 59 died and 88 confirmed cases. [I don't follow this comparison. Does "case totals" = deaths?]

This data is revealed in the Conference Minister Level VI on Avian and Pandemic Influenza in Sharm El Sheikh, Egypt, on October 24-26, yesterday.

Davis gave his appreciation to all the people who contributed over the declining number of cases of the bird flu. Appreciation was mainly directed to families, households, children, schools and the community in general.

According to him, school children have a big role in controlling bird flu. In 2007 and 2008 survey conducted on 1,700 samples, among other shows the number of school children are aware of hand washing increased from 37 to be 68 percent. Children who remind their families to cook the chicken dihidangkan increased from 57 to be 92 percent. The children who do not want to play near the henhouse also emingkat of 23 percent to 66 percent.

Yes, you can guess at the meaning of "emingkat of 23 percent," and the toggletexting newshounds have picked up a smattering of Bahasa Indonesia that must make it easier to understand such translations.

But I also notice that it wasn't easy to find this article, even though Dutchy at Flu Clinic had mentioned the periodical. Once I reached TempoInteraktif, I couldn't find "flu burung" until I did a search for it.

Even worse, it turned out to be a pretty dull piece of government bumf, faithfully transcribed without any analysis or criticism.

Still, I'll set up a Google Alert for "flu burung" and see if it turns up anything worth translating and passing along.

What did we ever do before Google?

Routine disasters

Thanks to the reader who sent me the link to this Newsweek story about XDR-TB: A Virulent New Form of TB. It's worth posting about because of something said in an interview by a WHO official:

NEWSWEEK: Why have we heard so little about XDR-TB? When did it emerge? Anna Cataldi: It emerged several years ago. [The first official reports from the WHO and CDC were published in March 2006.] It didn't get much attention because of all the publicity surrounding avian flu.

This raises a big issue about the way we learn about public-health issues. The media tend to prefer new threats, and they make the threats worth reading about by throwing in lots of "experts fear" remarks.

The sheer rarity of flesh-eating disease or human H5N1 makes it newsworthy. Then, when it stays rare, the stories turn to "Whatever happened to..." before the media go in search of fresh disasters.

At the same time, the media ignore the routine disasters: ordinary TB, as the Newsweek story observes, still infects millions and kills one in six of them. Every year, malaria kills about 750,000 African children under the age of five. Simple diarrhea will kill several children worldwide in the time it takes you to read this sentence, and 3 million persons by October 30, 2009. HIV/AIDS has been pandemic for decades.

Around 40,000 Americans die every year in auto-related accidents, meaning about 110 Americans in good health today will be dead by midnight tomorrow. I had to do some digging to find that statistic, which suggests we take this carnage as just the price we pay for mobility.

But imagine 110 Americans dead in a day from H5N1. The country would go into economic and political convulsions, and so would the rest of the planet.

Somehow, public-health experts and the media need to find a better way to work together to inform the public about both emerging and ongoing diseases.

We can't go on with a "Threat of the Week" approach, while ignoring problems that already cause intense and remediable harm.

Trouble in the hot zone

Via The Globe and Mail, a column by Carl Mortished of the London Times: The West in retreat, the pot running dry. After discussing the economic trouble in Hungary and Ukraine, Mortished goes on to say:

The World Bank has told Bulgaria to prepare an emergency financial plan and Romania's Prime Minister has compared his nation to party-goers on the Titanic, oblivious to the water penetrating the lower decks.

On Monday, Standard & Poor's reduced the rating on Romania's sovereign debt to “junk bond” status, and on Tuesday, Germany sounded the alarm on another front line in South Asia.

Pakistan is suffering a balance of payments crisis and is badly in need of funds to meet its debt repayments.

These are all countries that have had at least one outbreak of B2B H5N1 in the last three or four years. When their economies are crashing down around their ears, they don't seem likely to worry much about a disease of poultry. The woes of their poultry industries will be trivial in the larger wreck.

So if H5N1 returns to these countries, it is likely to go unreported by hard-pressed farmers. Once it is detected, underfunded government veterinary and public-health services will be unlikely to respond as they should. Like any disease allowed to progress, it will be harder to cure than if caught early.

Leavitt's parting shot at Supari

I mentioned HHS Secretary Leavitt's valedictory yesterday, but that story didn't cover what this Bloomberg report deals with: Withheld bird flu samples endanger world, US says. Excerpt:

The U.S. should continue to oppose countries that expose the world to "even more danger'' by demanding payment in return for sharing samples of H5N1 bird flu, said the U.S. government's outgoing top health official.

Michael Leavitt, preparing to step down as U.S. secretary of health and human services after next week's presidential elections, urged his successor to "strongly defend'' a 60-year practice of countries sharing virus samples for free, according to the text of a speech in Washington yesterday.

Indonesia began withholding avian-flu virus samples in December 2006, saying the pathogens are its intellectual property. The country has demanded access to affordable drugs for Asia in exchange for sharing the H5N1 samples. Doctors can't produce up- to-date vaccines without the latest versions.

"Once compensation is paid, there will be no end to demands, and the system will fail, subjecting every one in the world to even more danger,'' according to the speech, which was e-mailed to Bloomberg News. The text didn't name specific countries.

Branswell: Home drug stockpiles—not a good idea?

Via CTV.ca, a CP story by Helen Branswell: U.S. questions home drug stockpiles for flu pandemic. Excerpt:

Concerns were raised about whether people could be trusted to store and use the drugs appropriately and whether misuse might fuel the development of resistance to the few influenza drugs on the market.

Some experts worried whether parents would be able to gauge the amount of drug their children would need and mix a solution - by breaking open capsules - based on the child's weight.

Still others echoed the concerns raised by representatives of physician and pharmacist groups who argued against taking the responsibility for deciding when a person needs a prescription drug out of the hands of medical professionals.

But some members of the panel favoured the notion, reminding colleagues that personal stockpiling of the drugs oseltamivir (Tamiflu) and zanamivir (Relenza) is already taking place.

"It's going on already. What we need to do is to figure out a way to do it intelligently," said Dr. John Bradley, director of the division of infectious diseases at the Children's Hospital and Health Center in San Diego, Calif.

Note: CTV.ca attributed this report to AP. Helen Branswell has advised me that she wrote it, and I'm very happy to set the record straight.