Saturday, October 15, 2005
The Politics Of Bird Flu
Nature is publishing a study about H5N1 developing resistance to Tamiflu, and it will make a big splash. But the joke is that the case cited is one in which human to human transmission occurred at least twice, and that the case is old. It happened in Vietnam early this year. See Recombinomics commentary:
The above comments from a pre-released Nature paper raise serious questions about the prophalactic use of Tamiflu and human-to-human (H2H) of H5N1. The sister, Nguyen Thi Ngoan, of the index case, Nguyen Si Tuan, was taking the FDA approved prophylactic dose of Tamiflu, 1 pill per day. However, even while on Tamiflu, she developed H5N1 bird flu symptoms. Genetic analysis of the virus suggested that she was infected by her brother, even though she was taking Tamiflu.WHO has been denying human to human transmission, but it has been taking place in Vietnam and it now appears to be taking place in Indonesia. Why WHO has been acting to suppress this information is beyond my imagination, but it has been working up until now. See, for example, this EUobserver article from October 13 discussing H5N1 in Turkey:
The above paper focuses on resistance markers in isolated clones from the sister. However, the brother and sister were part of a large case cluster of H5N1 infections. The grandfather of the two patients also tested positive for H5N1 antibodies. Although H5N1 was not isolated, it is not clear if the grandfather was taking Tamiflu when his grandson was in the hospital.
Similarly, the index case's nurse developed avian influenza. He maintained that he had no exposure to poultry, yet developed laboratory confirmed H5N1. It is not clear if the nurse was taking Tamiflu at the time of his infection.
Panic is spreading in Europe as tests results from Turkish birds released on Thursday confirmed that the bird flu virus found in Turkey is in fact the H5N1 virus which has killed over 60 people in Asia.And suddenly, today WHO puts out a statement saying that H5N1 is mutating into a human to human form. This is not new news.
Professor Angus Nicoll, influenza coordinator at the European Centre for Disease Prevention and Control told the EUobserver on Wednesday that the chance of getting infected by the bird virus is minimal.
"Out of millions and millions of infected birds in Asia, some 60 persons have died, and they were all in direct contact with the birds for a long time", he said and added:
"The virus in its actual form is extremely difficult for humans to catch."
And suddenly, today the EU panel announces that the Romanian bird flu cases are indeed H5N1 (although earlier this week we were told that the samples hadn't even arrived at the lab), and that the strain is the Asian strain related to the one found in Turkey, which was the Qinghai strain that traveled to Russia, Mongolia, Siberia and central Asia:
Tests have confirmed a link between the bird flu found in Romania and the deadly virus that has devastated flocks in Asia and turned up in Turkey, the European Commission said Saturday.This means that the dying/dead birds in Bulgaria and Iran (over three thousand reported) probably have the same strain. See BBC map:
"Tests confirmed that the virus in Romania was an H5N1 strain, but further tests were required to confirm the link with the strain found in Asia and Turkey," the European Union's executive body said in a statement. "This link has now been confirmed."
The Qinghai strain was in Mongolia and Siberia by summer, and some of the birds there travel to Alaska and down into the continental states. The real question is whether the Qinghai strain is one of the ones which is pretty good at infecting humans, and this is why viral sequences from the cases in Thailand are so desperately needed.
So President Bush was wise to attempt to set up an independent coalition including Asian countries to deal with the problem, and very wise indeed to go to the UN and push for taking the problem seriously. Not, of course, that the US will get credit for the initiative, because the US and Bush are evil.. Now the question is whether the US will start a comprehensive sampling of our birds and whether the information will be disseminated quickly enough to alert people. The virus is spread through the droppings of the birds infected, and depending on the concentration of infected birds, it seems to take a month to two months before widespread disease is noted after the birds enter an area.
Incredibly, there has been a huge "birds are more important than people" contingent working very hard to suppress the news that wild migratory birds have been carrying the virus. Up until now they had been gaining ground, but the indisputable evidence from Europe seems to have thrown a spanner into the environmentalist wacko propaganda engine. But I am sure our native enviro-whacko population will erupt as soon as the US attempts to institute any significant control measures to suppress sporadic outbreaks among waterfowl.
I would recommend following the commentaries at the "What's New" page at Recombinomics, because Dr. Niman has been dead on in his predictions about the spread of it up till now. He also maintains that the virus is spreading in a milder form between humans in various parts of Asia and is close to going epidemic. If he's right about that too, then we need a crash program to institute public health measures in North America and teach individuals how to avoid infection by the use of hygiene.
There is one possibility that worries me severely. The evidence from part of Vietnam seems to show that many individuals show H5N1 antibodies without ever having developed severe illness. These individuals are probably ones that have come into consistent contact and so have developed some residual immunity. In that regard, it is extremely alarming that the earliest cluster confirmed in Indonesia was that of an urban government official and his two children, all three of whom died. It is possible that much of the native population in Indonesia has developed some degree of immunity and the European and North American populations exposed to birds will run a greater risk of developing clinical disease.
I will start setting up the business/individual flu containment blog this weekend. Do not listen to those who are calling the furor over bird flu hype. It is not hysteria, but a recognition of reality.
It sounds like a bunch of universities around the US are scrambling to set up H5N1 testing programs. Cornell is testing in NY.
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