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Friday, June 09, 2006

Bird Flu - In Specific, But Mutually Reinforcing Reports

There's been a lot of chatter among flu-watchers about Dr. Nidom's recent comments on his testing in Indonesia. He is an Indonesian scientist who has been working on H5N1 for several years. We are also seeing more forthright discussion about the real state of affairs in both China and Indonesia, and the real state of affairs in both countries is cause for concern. See an article from China (I can't believe this was published - it includes an obvious reference to another human-to-human H5N1 case) and a few regarding Indonesia. (See this 2004 article for Thailand and Indonesia doings.) Last year several Thai scientists had expressed their suspicion that the virus was passing human to human, and they also feel it's adapting to mammals and aerosol transmission.

Given the consistency of these statements from different scientists in different countries, it would not be surprising if the flu strains circulating in Asia had unknown qualities. According to Dr. Nidom, recent testing (Feb-Mar) in Indonesia showed that a significant percentage of virus isolated from samples showed mammalian-specific receptors. Furthermore, infected pigs were asymptomatic. There is an excellent discussion relating to this on Flu Wiki. It includes comments by a western doctor who has worked at the NAMRU lab in Indonesia.

Given WHO's cryptic statement that the recent Indonesian cluster showed higher levels of virus in their upper respiratory tracts, it appears that the situation in Asia might be shifting rapidly. There was also a recent comment from a supposed authority in China that between 2004-2006, H5N1 had shifted from fecal/oral transmission to aerosol (airborne) transmission. This would explain why, for the last six months, China has been instituting measures that look as if they were targeted to detect human to human transmission.

In other developments, the CDC released expanded and more specific H5N1 testing guidelines for the US.

No one can tell whether this virus will break out and become an epidemic, much less a pandemic. It could also become a pandemic virus with the approximate lethality of a bad cold. It is becoming much harder to believe that it will not jump the species barrier and become capable of efficient and sustained mammal transmission, which includes human to human transmission. Indeed, if you take the Dr. Nidom's pig results seriously, it appears to be on the verge of doing so in Indonesia.

It's in the world's interest to see that a mild form goes global, and that can only happen if cases of human illness resulting from H5N1 infection are rapidly isolated and treated. This is not happening in either China or Indonesia (and almost certainly not in India and Thailand). Very little research money is going into Asia, and it is time for this state of affairs to change. Compare the type of cases seen in Egypt to what is occurring in China and Indonesia, and you can see the problem. Once you get a high penetration rate of virus and concurrent infections in mammals and birds, you have the right conditions for the emergence of multiple mix-n-match strains.

The US military has been building labs throughout central Asia - but that may not be enough, because testing and monitoring on the ground where the various strains are mixing and matching is what is required now.

Comments:
Two weeks ago, I took my dad to the ER for a strained muscle in his back. (His regular doc was out of town, and since it wasn't a refill, the covering doc wouldn't call in the really good drugs. So we went to the er for a shot of the really good drugs.)

At intake (not with the triage nurse, but before that, with the business office forms), he was asked about overseas travel and if he had been having any respiratory symptoms.

This is a very small hospital. (Not one of the large Atlanta hospitals, but a tiny neighborhood one, specifically chosen because it is such a small hospital, there's rarely more than 3 people in their ER. They all go 2 miles away to the bigger hospitals.)

Those questions raised some low-grade alarm, and prompted some additional actions (after the research.) MoM--I can't believe that I haven't told you this--just shows you how crazed I am.

In any case, my next trip to Sams, I'll be stocking up on basic flu supplies.
 
Around here the stores are sold out of basic medical supplies such as medicinal alcohol and alcohol swabs for injections. I've been to four stores looking for them so far. It's hard to find the masks as well.

The thing is, many people have their suspicions about the wave of illness I described before. I think a lot of people have quietly drawn their own conclusions, and are acting on them.

Thanks for letting me know, Carson. A sudden wave of geese flew into the farm over the last few weeks. They came in as single geese or small groups - nothing above four geese. It looks like the breeding season was a flop, or they'd be stuck on the ground with the goslings. Some of their droppings do not look right, and birds have started dying again.
 
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