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Thursday, October 06, 2005

Indonesian Bird Flu (H5N1) Update # 5

Previously: #4, #3, #2

About a week ago the number of bird flu cases in Indonesia were variously given in the 40s or 50s. Yesterday's number was 89. Eleven people have died. The last two are already PCR confirmed as having been infected with H5N1:
Two other people in Indonesia have reportedly contracted the avian influenza (AI) virus which is blamed for deadly bird flu disease, Health Ministry`s disease control and environmental sanitation director general I Nyoman Kandun said here Thursday.

The two patients were identified as H (21) a resident in Lampung who had been treated at the Abdul Moeloek general hospital in Lampung and SW (23) a resident in Bogor, West Java, who died at the Sulianti Saroso hospital here few days ago, Kandun said.
In the link above the case count is given as 90. The CDC is now there checking matters out:
He also said a team of the Health Ministry and Atlanta-based Centre for Disease Control and Prevention (CDC) were conducting investigation in Lampung following the report.

Data dated Oct 5 of the Health Ministry showed 75 people in Indonesia were believed to have contracted the bird flu virus, 11 others were probably infected with the H5N1 virus as they had laboratory test showing the tendency of Avian Influenza virus infection, and 4 others were confirmed by WHO laboratory in Hong Kong to have been infected with bird flu.

Another one reportedly had undergone a positive serological test but did not show a clinical symptom, the data said.
These positive antibody tests without clinical disease should be of great concern to everyone. They mean that milder cases are probably circulating and no one knows how many of them there are. If enough public health resources can be put into the area and broader testing is instituted, perhaps the more severe strains can be isolated and milder forms of the virus will eventually break out. The same pattern had been noted earlier this year in parts of Vietnam, but WHO never followed up on it. There were a bunch of positive Western blot tests from asymptomatic people about which no more was ever heard.

The H5N1 virus is changing rapidly, and at least one Indonesian researcher has found a mutated strain in birds he believes was caused by non-specific vaccinations. We are not going to stuff this genie back in the bottle.

Tamiflu resistance in H5N1 strains (pdf) has already been observed in Asia, so don't rely on that. Relenza may be more effective briefly but not if widely used; it is the same class of drug. It should surprise no one that Tamiflu resistance has evolved, because bloodwork has shown that 16% of flu sufferers have a Tamiflu resistant strain circulating in their blood after being treated with the drug. One can only hope and pray that Tamiflu is being given in Indonesia at higher than recommended dosages for longer periods of time, because treating and leaving mildly infectious people is a recipe for breeding resistant strains of the virus.

This CurEvents.com thread discusses other remedies including elderberry. They are all unproven in action, of course.

At this time, we have a rapidly mutating virus, drugs which will not be effective for long if an efficient H2H strain appears (and are in incredibly short supply), evidence of some human to human transmission in Vietnam and Indonesia, and no vaccine. We also have poor testing results; this may change later if the virus becomes more adapted to the human upper respiratory tract or it may not. In other words, the only possible weapons are symptomatic case tracking and quarantine. Consider the Toronto mystery virus a dry run on what is likely to happen, and be warned.

What is important in the short term is that businesses like banks, pharmacies and grocery stores develop business continuity plans. Masks (N95) and gloves may be needed for employees. Once an efficient human to human strain develops it will not be possible to keep it out of North America, so the focus has to be put on dealing with the virus and preventing infections as much as possible.

Hospitals need to develop protocols assuming that they will be presented with an influx of very infectious patients. Special precautions should be used in emergency rooms and public areas of hospitals. Ambulance services and the like will need the mask/glove/heavy cleaning routine.


I often wonder why you spend so much time on avian flu eversince I read your blog; it is not exactly the most interesting subject. But the last few days reveals that you had foresight I lack.

Of course, now that I am way behind the curve, all I can do is link your post.

I often wonder why you spend so much time on avian flu eversince I read your blog; it is not exactly the most interesting subject. But the last few days reveals that you had foresight I lack.

Of course, now that I am way behind the curve, all I can do is link your post.
Minh-duc, you are right- MOM has been on top of this for a while now.

That said, it looks like the Tamilflu I stockpiled may well be useless.

Plastic sheeting and duct tape.
I just came over from Minh-Duc -- this after reminding myself several weeks ago to start coming here on a regular basis to keep up with the subject.

I'm annoyed: my family doctor pooh-poohs any notion that we're going to have an avian flu problem here. It's irritating to be so airily dismissed with comments about the CDC, so I ask:

-- do you know what the "official" CDC stance is? Is it the usual clumsy "nothing to see here, just move along" broken record that the anti-terrorism bureaucracy plays endlessly?

Since it looks like any medical intervention is going to be too little too late, are any recommendations being drawn up re what we should do/plan/consider for a worst-case scenario? Do we even know what a worst-case scenario looks like?

As one who lost her grandmother and uncle in the 1918 epidemic (her death shattered my family cohesion down to the fourth generation) I am not going to take this one lightly.

Any ideas where to go for good information about practical planning?

And thanks for keeping on top of this.

BTW, Right Wing Nuthouse has the same take on it you do. Glad there are some serious people out there...we sure aren't going to get any professional help, are we?..

...I take that back. Heard bits of Bush's take on it recently and was surprised at the obvious thought he's given the situation. You have to wonder how one presidency can incorporate so many disasters. I feel for him, despite my anger at his domestic policy decisions.
I am assuming that you saw te NYT article today atributing the 1918 flu pandemic to the brid flu?
in not...

Dingo, actually, I heard about it last month.

Influenza viruses seem to recombining in swine and birds for just about forever.
Dymphna - I am favorably impressed with Bush's efforts here.

I will post a list of good flu resources tomorrow. Some of the ones I have have been wiped out because of too much traffic.

The focus now has to be on pressuring our local institutions to do what is necessary. Like a hurricane, this is not something the federal government can do effectively. It can help, but a lack of local effort will cause deaths.
> Plastic sheeting and duct tape.


MREs and home water filtration is more like it.

The hysterical response to this sort of thing, if it does get out, is going to do more damage than the disease.
> Any ideas where to go for good information about practical planning?

Talking off the top of my head, the worst disruption is likely, hopefully, to be about 2-3 months long. You should aim to be holed up for at least that long and to presume all other services are unavailable.

MREs, water potabilty, first aid and needed drugs, and Guns and ammo along with reachable defensible quarters (what good is a mountain cabin if you can't make it there in a few hours?) are the things to consider.

A copy of the US Army survival manual, along with a few other things like that, is a Real Good Idea.
BTW, is there a fixed link to your latest entry on this information?

If you don't have one, you might consider it desirable to establish one so people can make it a standard visitation checkpoint.

Hopefully, this is just going to be y2k all over again. The smart person at least stays aware of the current knowledge on the matter, though.
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