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Tuesday, May 23, 2006

Bird Flu Heats Up

Authorities are now hinting that exposure to natural bodies of water frequented by H5N1 infected birds might pose a threat to human life. No kidding.

I don't think it is safe to assume that the US doesn't have infections in wild birds. There are reports of birds dying from NJ, Kansas, Texas etc. In Kansas and in NJ I have heard or read reports of local cats dying as well as bird deaths. One person in NJ said that the wild turkeys have disappeared. Turkeys seem to be very susceptible to H5N1. In many cases the assumption is that birds are dying from West Nile or starvation and no one is even testing the birds. This seems unsafe under the circumstances.

Last month in NJ at least one chicken at a poultry market tested positive for H5. H5 and even H5N1 has been reported in North America before, and of course could arrive via infected bird products or even people as well as by migration of infected birds.

Poultry biosecurity recommendations are not to hire people who have contact with outside birds, even parrots, for example, because a person may have a virus without symptoms which could be transferred into poultry. Poultry and swine infected with H5N1 don't necessarily die, especially if already vaccinated. They may or may not be infectious after exposure. In Indonesia, as a result of the latest cluster, pigs have been tested and reported to have H5 antibodies, but they don't seem to have active infections.

I would assume, for safety purposes, that some form of this thing is here. Testing in Alaska has just begun, and it's quite possible that it came in to the east coast instead of from the west. I wouldn't be swimming or boating in lakes and ponds, and handling raw poultry or eggs should be done with gloves and the work area should be cleaned with bleach afterwards. Of course, eating raw or undercooked eggs or poultry is unwise. It always has been.

Researchers are working on a combo vaccine of the sprayable type which could help limit the disease in poultry flocks.

WHO's Cheng on the situation in Indonesia:
"We have seen these types of transmission before in Thailand and Vietnam and China where people living in close contact with an infected person have themselves become ill with bird flu without coming into contact with poultry," Cheng said.

"It is possible it is happening in Indonesia, we do not have any confirmation right now. But it is possible."
WHO's guidelines for drug treatment place household contacts of sick persons in the highest risk category and recommend a course of Tamiflu:
High risk exposure groups are currently defined as:

* Household or close family contacts of a strongly suspected or confirmed H5N1 patient, because of potential exposure to a common environmental or poultry source as well as exposure to the index case.
Denmark reported its first H5N1 in poultry at a small farm on an island. Ducks, geese and chickens were culled.

In Romania, the bird flu is causing big problems. They have one neighborhood in Bucharest now cordoned off, and they are letting no one in or out except for medical emergencies. They may do this with another. They have not reported any human infections, but they are prosecuting people for not stopping poultry sales from infected farms. Media reports have been sparse, but unofficial reports are that the number of quarantined people might be as high as 13,000?! Also, other areas in the country are under quarantine.

A medical official in Iran said two humans (dead) tested positive for H5N1. They have sent the samples to an international lab for confirmation. At least two more people are in the hospital with suspected bird flu there, and it looks like one won't make it. The area in which they supposedly got ill is very close to Iraq. (And, breaking news, now the Iranian Health Minister is saying the two patients did not test positive for bird flu. I bet those samples never get out of the country....)

Pakistan has reported many outbreaks of bird flu in the north. Its media has also reported that no humans anywhere have ever died from bird flu, so it is hard to be sure of the other media reports. But they are definitely culling chickens.

Malaysia is getting worried about the Medan cluster next door in Indonesia:
Veterinary Services Department acting director-general Datuk Dr Mustapa Abdul Jalil said the department had been informed by its counterparts in Indonesia that the situation in Medan was serious.

"We have also been told that the source of the deaths were chickens," he told the New Straits Times.
An AFP report yesterday quoted Nyoman Kandun, director of the Indonesian health ministry communicable disease control centre, as saying that an epidemiological investigation had been launched into the deaths.

Five died some weeks ago with the sixth death, that of the father of one of the other victims, occurring yesterday.

He said experts feared this might be Indonesia’s first few cases of human-to-human transmission of the virus.
Indonesia continues to be a hot spot. The recent cluster of cases from one village (four different houses) seems to have caught everyone's attention. Supposedly the CDC has now sent a team to Indonesia. The news is that they still don't have confirmed infections in animals that would have passed it to the humans. I can't understand why this is suddenly worrying people. The first such cases of H5N1 in Indonesia was a cluster of three (a father and two daughters) with no known contact with sick animals, and there have been very similar clusters since then. One with five cases last year had over a month between the first exposure and the last illness. Whatever is happening in Indonesia does not seem to have suddenly changed, and is very similar to what happened in Turkey (large extended family cluster) and in Azerbaijan (large extended family cluster). Dowes Ginting died on the 22nd and first became ill on May 17th; the first person became ill on April 27th and died on May 4th.

It may be that the realization is finally sinking in. The US announced this week that it is sending some Tamiflu for an Asian supply.

Burkina Faso has bird flu in its capital and another major city in backyard flocks. Bird flu in Africa has been confirmed in Niger, Nigeria, Ivory Coast (Cote d'Ivoire) and Cameroon. Human cases have been reported in Egypt and Djibouti. Last week Egypt reported another human death from bird flu (75 year old woman) and denied reports that a two year-old had it. Their total is 14 cases and 6 deaths.

It's not all that likely that many African countries will pick up most sporadic cases of bird flu. Many areas don't have the resources to do it, even in birds.

No new reports from Israel, so maybe it has succeeded in stamping it out. They culled hard.

Russia continues to have problems in Siberia and is culling and quarantining as they find outbreaks. The Altai is still having outbreaks. There don't seem to have been any more reports from the Ukraine since the end of April.

The official WHO case count as of May 19th is 217 cases and 123 deaths, but that is widely acknowledged to be an undercount because it is only a lab-confirmed count. For example, Turkey's official case count was 21 cases, but WHO shows 12 total for Turkey, and five out of six siblings died. Four of them were confirmed, but the fifth wasn't. The first woman to die in the current group of eight in Indonesia is not counted, because she was buried without being tested. I don't think anyone would plausibly maintain that the fifth child in Turkey and the first woman in Indonesia did not die of H5N1. More cases in Indonesia have been reported since Friday.

You have me wondering. One of my sister's cats died recently. She had just taken him into the vet a week or so earlier to be fixed.

He was an outdoor cat and only a year old but supposedly died of a severe "blood infection" that was caused by fleas. The infection attacked his red blood cells.

I've just never heard of an infection like that in outdoor cats. I was halfway listening to my sister's conversation with my cousin who lives near her out in the country.

They were talking about her cat's death and my cousin said that also happened to her young cat. Weird. You would think the vets would be studying it.
There are diseases which sweep through areas. Animals get plagues just like humans. So no one can definitely say that any particular situation is unusual.

In one area in Kansas, a person wrote of dead birds all over and a neighbor having five cats die within a month.

When the birds start dying and the cats start dying and no one is even looking at it, the wise person will quietly take their own precautions.

In other news, 60,000 chickens died on a poultry farm in Texas from a 2 hour power outage. Or they say that was the cause. Two hours? I am skeptical. It is possible. It is quite possible that all of these incidents have other causes. However I have checked around with a small private sample, and taken altogether, what is being reported is wildly improbable.

What I did was to try to find people up and down the Atlantic flyway near bodies of water, who were rural and knew the areas well (so they would panic over one dead bird). The results were stunning.

Another very perturbing matter is that very low mouse populations were also reported in these areas. This may not be H5N1, but it is worthy of investigation.
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