Wednesday, November 08, 2006

European recomendations on Non Pharmaceutical Interventions

On 2006-10-12, the European Centre of Diseases Control has published "Personal (non-Pharmaceutical) Public Health Measures for Reducing Transmission of Human Influenza - Interim ECDC Recommendations". (The US has a similar document, called "Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Health Care Settings during an Influenza Pandemic".)

It makes a reference to two documents by the World Health Organisation (one on National and Community Measures and another on International Measures). My short summary: local measures will work to a certain extent and we should prepare for them, but international measures probably won't do much. Of course, don't take my word for it: go read the reports.

The ECDC document doesn't yet acknowledge the publication of very important data on "modeling community containment" by the Institute of Medicine (US).

A number of things are pretty obvious:
  • There won't be a vaccine for the first many months after the beginning of a pandemic. Antivirals will be available to some and not to others. So we need to explore "non pharmaceutical interventions" (NPI) and get used to that term.
  • Closing schools will mean less exposure to children, a flattening of the curve for all, and possibly less cases overall.
  • Adding other "social distance" measures will provide aditional benefit. (There seems to be no substitute for closing schools early.)
  • For it to work, school closure and other measures must be carried out really early in the pandemic, which means proactively. (If the pandemic is bad enough, schools will close reactively anyway. Accept it and get over it: schools will close, now what?.)
  • Proactive things are acceptable if teachers and parents and employeers talk about it openly, now.
  • For these measures to work, there's some preparation that needs to be carried out on many levels: how do communities (and businesses and essential services and families) deal with absentee rates due to parents taking care of children at home? Who needs to cross-train (how many people at your office can fix a computer problem)? Who needs to stock-up on food, water and other essential items?

Tell your family, friends, colleagues and citizens about it:

  • Schools will close.
  • It's better to close them proactively.
  • They may be closed for more than two months.
  • If things are bad we will need to add more "social distance" layers (closing schools will be the right thing to do but may not be enough).
  • What will be the effects in our community?
  • What should we do to prepare?
  • Why wait, really?

Monday, June 26, 2006

It's not the antivirals that matter in a bad pandemic

Here a GP is reported to request that electricity continues to power his practice.

A flu pandemic across the UK could result in "1,000 September 11ths" and preparations are "woefully inadequate", a doctor warned today.

Dr Steve Hajioff will tell doctors at the British Medical Association's annual conference on Tuesday that a flu pandemic would have "enormous" implications. He believes stockpiling anti-virals is less important than getting transport, fuel and water companies to make adequate plans.

[...]
Dr Hajioff said the Government had taken action but stocking anti-viral drugs was the "icing not the cake".

He added: "It's not anti-virals that are important, it's how we keep going, keep functioning as a country and keep the flu from spreading. I'm a GP and I can prepare my surgery, but if the electricity company that supplies my power has not prepared, then I am not going to be able to treat patients.

It looks like the "bad pandemic" scenario is starting to sink in.

A "not bad" pandemic would disrupt health-care services. Just do the numbers: no surge capacity, and many people simultaneously ill. Yes, that means health-care providers too.

The magic word is ... simultaneously.

Simultaneously in your hometown and mine. Simultaneously all over the country. Simultaneously all over Europe. Simultaneously all over the world.

Now, add the length of time it takes for a pandemic wave to unfold. What would that be? 4 to 8 weeks? A simultaneous, long-lasting mess.

Ah, yes, but there's bound to be a period of calm after that, right?

Wrong! It will be a period of calm before the second wave. So, no matter if the first wave is mild or not, people will remember 1918. (I certainly will remember it.) They will remeber the second wave was much worse.

And they'll stockpile. In a rush. And of course, again, simultaneously.

Do you really think a "now that there's no pandemic going on" buying panic would hurt us? Well, then, I suggest you multiply that by whatever amount you chose, and that's what the real thing would be like.

Look: we don't know when there will be a pandemic. But even with a "not so bad" one there will be panic buying. Lots of it. So better start now and build things up slowly (fast!). Doesn't it make sense?

Saturday, June 10, 2006

EU says H5 virus found in Hungary

The European Commission said Friday that a H5 highly pathogenic strain of bird flu had been found in a domestic flock of geese in Hungary.

Samples will be sent to the European Union (EU)'s reference laboratory for avian flu in Weybridge, near London, for further tests to determine whether it is the deadly H5N1 strain, the commission said in a statement.

The Hungarian authorities found the infected flock in Bacs- Kiskun in southern Hungary. Cases of highly pathogenic bird flu were detected in wild birds earlier this year in this county.

All 2,300 geese in the flock were immediately culled upon suspicion of the virus. All poultry in the 1 km radius around the outbreak are also being culled Friday, the commission said.

If confirmed, it would be the fifth outbreak of high pathogenic H5N1 avian flu in domestic poultry in a EU member state, following outbreaks in domestic poultry in France, Sweden, Germany and Denmark.

Source: People's Daily Online from Xinhua: EU says H5 virus found in Hungary

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Friday, June 09, 2006

Ghana: Aftermath of bird flu Poultry farmers saddled with bank loans

Although poultry farmers were compelled to drop the prices of their produce by 30% to 40% during the peak of the bird flu scare the measure has done little to save the industry from collapse. The result is the huge debts hanging on the necks of poultry farmers.

Mr. Kofi Agyei-Henaku the Executive Secretary of the Ghana National Association of Poultry Farmers said the measures have eroded the capital base and cash inflows of many poultry farms, especially farmers with large operations that are indebted to financial institutions.

Speaking at the National Bird Flu briefing programme in Accra on Tuesday, Agyei-Henaku observed that during the peak of the bird flu scare hatcheries had to destroy a large number of day old chicks and gave example of how a reputable hatchery in the Greater Accra region destroyed 49,760 day old chicks within six weeks because prospective customers failed to collect them leading to a loss of more than ¢358 million.

Source: Ghana web: Aftermath of bird flu Poultry farmers saddled with bank loans

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China plagued by bird-flu coverups

Qiao Songju, a resident of Gaoyou county in Jiangsu province, attained a brief heroic reputation for informing authorities of a massive bird-flu outbreak in Anhui province in October 2005. Tipped by Qiao, the Ministry of Agriculture confirmed the outbreak of the deadly H5N1 bird flu among geese and chicken in Liangying village of Chuzhou city.

Qiao gained overnight fame as the first informer of a bird-flu outbreak. But his joy did not last long. One month later, Gaoyou police paid a midnight visit to Qiao’s home and “invited” him to the station for a “chat”, which turned out to be the prologue to detention. The next day, Qiao was arrested on suspected fraud and blackmail activities. His arrest happened 2 days after he attempted to report another bird flu outbreak — this time in his own hometown. His arrest made headlines.

Observers pointed out that the timing of Qiao’s arrest suggested it was hardly coincidental. Many believed he was being framed. The Guangzhou-based and often outspoken South Metropolis News pointed out Qiao’s arrest took place when he was preparing to expose the bird flu outbreak in Gaoyou.

Qiao was tried on 21 and 26 Apr 2006. The court has yet to hand down a verdict. In China, it is rare for such a case to be tried twice without a court ruling. Analysts said it was likely that the central government intervened, so the case now seems to be moving to Qiao’s advantage.

Near the Jiangsu provincial capital Nanjing, Gaoyou abounds in geese and ducks. Poultry and eggs provide almost the entire gross domestic product (GDP) to Gaoyou. For the locals, an outbreak of bird flu there could mean the end of the world.

To the local farmers, Qiao was just a “bad guy”. Because of his tip-off, the government decided to destroy all reared poultry in the neighborhood, but the state compensation did not suffice to cover the colossal loss.

Source: Asia Times Online: China plagued by bird-flu coverups

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EU: Bird flu incidence in wild birds falling

The survey found that between February 2006 and 21 May 2006, 741 cases of highly pathogenic avian influenza , most of them confirmed as the deadly H5N1 strain, have been detected in wild birds in 13 member states – Greece, Italy, Slovenia, Hungary, Austria, Germany, France, Slovakia, Sweden, Poland, Denmark, Czech Republic and UK.

There have been four outbreaks of H5N1 avian influenza in poultry in the EU, and all of these were swiftly eradicated following detection. No human case of the H5N1 virus has occurred in the EU.

There is considerable variation in the number of cases of highly pathogenic avian influenza in wild birds, ranging from 326 in Germany to one found in the UK.

The peak in terms of the number of cases in wild birds was reached in March with 362 cases, compared to 200 in February, with cases declining to 162 in April and 17 in May.

The most commonly affected wild birds have been swans, representing 62.8 per cent of the total, followed by ducks (16.3 per cent), geese (4.5 per cent), birds of prey (3.9 per cent) and others (13 per cent).

Source: Food production daily: Bird flu incidence in wild birds falling in EU

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2 months of food: $1,200; Emergency-prepared pantry: Priceless

Outstanding article. Nice picture of pandemic preps. Includes meal by meal list with prices. Way to go Ms. Price!
LOVELAND - In a cool, dry basement room, shelves full of canned food and hulking bags of flour and other staples act as Suzy Price’s insurance policy.

It’s a policy against a blizzard, flood, pandemic flu, even job loss.

As federal, state and local health officials urge America to stockpile two weeks’ to two months’ worth of food, medical supplies and emergency items in case of a flu pandemic, perhaps one caused by the H5N1 strain of bird flu, experts say the public can learn from people like Price.

She didn’t outfit herself and her family in a day or a week or a month. She amassed what she estimates to be at least a year and a half of food supply over the course of years, buying 10 cans of cream of mushroom soup when it was on sale or a couple extra jars of peanut butter when the price was too good to pass up.

She buys only items her family eats anyway - tuna, peanut butter, canned peaches, cereal - and uses the oldest ones before they go bad, then replaces those with fresher products.

The government’s Web site urges families to stock two weeks of emergency items. Others, including Larimer County’s chief health official, suggest two months of supplies.

Source: The Coloradoan: 2 months of food: $1,200; Emergency-prepared pantry: Priceless

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China says it contains bird flu outbreak

"China has contained a newly discovered outbreak of the H5N1 bird flu virus in its far western region of Xinjiang by culling more than 17 100 poultry, the official Xinhua news agency said on Friday.

The Ministry of Agriculture revealed on Wednesday that poultry on a farm in Xinjiang's Hetian County had died from the bird flu virus.

Experts and veterinarians killed birds and disinfected the area to prevent possible new outbreaks, and no new suspected case has been discovered near the infected area, the ministry said on Friday. It did not specify how many birds had been infected."

Source: IOL from Xinhua: China says it contains bird flu outbreak

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Hungary: H5 Virus Found in Poultry Farm

"The H5 virus has been found in a poultry farm in Hungary, but it is unclear yet whether it is the H5N1 bird flu strain, which is dangerous to humans, AFP reported citing a statement of the European Commission. The Hungarian authorities confirmed the information."

Source: Focus English News: H5 Virus Found in Poultry Farm in Hungary

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Russia: Bird Flu Still Not Eliminated In Six Locations

"Bird flu still has not been eliminated in six locations in Russia - four locations in the Omsk region and two locations in the Altai region, the federal veterinary watchdog Rosselkhoznadzor reported Thursday.

Altogether this year bird flu was reported in 90 locations in 11 districts of the Southern Russia and three districts in Siberia."

Source: Dow Jones Newswires: Bird Flu Still Not Eliminated In Six Locations In Russia

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Malta gearing up to combat flu pandemic

"New equipment installed at St Luke's Hospital will enable health authorities to know whether the influenza virus causing the dreaded pandemic has arrived.

Within three hours of taking a sample from a sick person, the health authorities would know if the virus is the same as that identified by the World Health Organisation as causing a world-wide pandemic, which flu experts have long been saying is overdue.

'An influenza pandemic can come at any time and we need to be prepared by joining forces and coming up with the best plan for Malta,' the Principal Permanent Secretary, Godwin Grima, who is chairing the multi-ministerial pandemic preparedness committee, said."

Source: The Times & The Sunday Times: Malta gearing up to combat flu pandemic

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WHO lab indicates Indonesian girl did not die of bird flu

"A lab approved by the World Health Organization said a seven-year-old Indonesian girl who tested positive locally for bird flu did not have the virus, a senior Health Ministry official said Friday.

The girl, from Pamulang on the outskirts of Jakarta, died June 1 after apparently coming into contact with sick poultry, said Nyoman Kandun. Her 10-year-old brother died three days earlier with similar flu-like symptoms but no samples were taken.

'This is the first time local tests came back positive and Hong Kong laboratory tests negative,'' said Kandun, adding WHO needs to carry out new tests to reconfirm its findings."

Source: National Post: WHO lab indicates Indonesian girl did not die of bird flu

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Indonesia: Medan bird flu patient recovering

"A man being treated for bird flu at Adam Malik Hospital in Medan may soon be released after doctors determined he had fully recovered from the illness.

The patient is part of a large family cluster of bird flu cases that emerged in Karo, North Sumatra. Seven of the man's relatives died of the disease."

Source: The Jakarta Post: Medan bird flu patient recovering

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UK: Bird flu hits holiday sales at Thomas Cook

"The number of British holidaymakers using Thomas Cook has fallen by almost 25,000, or 2.8%, as fears over avian flu in Turkey, one of the most popular destinations for Britons, hit the German group's sales.

Europe's second-largest tour operator said weak UK sales were 'more or less in line with market levels'. There have been several deaths in Turkey linked to the H5N1 virus."

Source: Guardian Unlimited: Bird flu hits holiday sales at Thomas Cook

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Indonesia: Bird sellers say bird flu does not exist

"Bird sellers in Jakarta said Thursday they did not believe that bird flu really existed, although it has killed at least 37 people in the country, 13 of whom were from the capital.

'I do not believe that bird flu really exists. There is no bird trader here infected with the disease,' Santoso, 30, a bird trader at Pramuka bird market in Central Jakarta was quoted by Antara news agency as saying.

"If there is bird flu, all the birds in the market would have already died," he added."

Source: The Jakarta Post from Antara: Bird sellers say bird flu does not exist

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Russia govt assigns large funds for bird flu fight

"The Russian government decided to pay a fee of up to three million dollars in the multi-donor trust fund of the World Bank for the fight against flu, including bird flu, in 2006-2008, the governmental press service said Thursday with reference to a governmental decree issued on June 5."

Source: ITAR-TASS: Russia govt assigns large funds for bird flu fight

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Thursday, June 08, 2006

Tanzania announces total ban on poultry imports

"The Tanzanian government has announced a total ban on imports of poultry and poultry products to help check against the threat of bird flu.

The ban had to be exercised following reports that the disease had already been spotted in Sudan and Djibouti, according to Tanzanian Livestock Development Minister Shukuru Kawambwa."

Source: People's Daily Online from Xinhua: Tanzania announces total ban on poultry imports

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Chinese ambassador calls for int'l cooperation for bird flu prevention

"China supported the setting up of a multilateral cooperation system for bird flu prevention and control, Chinese ambassador to the Vienna Office of the United Nations and other international organizations said on Wednesday.

'The International community should set up a global monitoring and forewarning system against avian influenza and other infectious diseases.' Ambassador Tang Guoqiang told a senior official meeting on bird flu issues.

He appealed for improved education and instruction on systems of prevention and control of the epidemic for developing countries.

'Moreover, the international community should also develop joint scientific research as soon as possible, in order to make a breakthrough in the fundamental scientific research on avian influenza,' he added.

The Chinese ambassador also called on relevant countries and international organizations to honor their commitments of contributions and donations as soon as possible, so as to provide sufficient funds to the countries hit by the avian influenza in time."

Source: People's Daily Online from Xinhua: Chinese ambassador calls for int'l cooperation for bird flu prevention

Science: CDC: States Should Aim to Contain Bird Flu

"States preparing for a possible bird flu outbreak should focus on how to contain the virus because a vaccine will be unavailable for several months, the head of the Centers for Disease Control and Prevention said Wednesday.

The preparation could help medical centers, which are likely to experience shortages in staffs, supplies, beds and medicine in the event of a pandemic, Dr. Julie Gerberding said.

'Out of the starting gate there won't be any vaccine, it'll take some time,' Gerberding told The Associated Press. 'So we've got to look at old-fashioned ways of slowing the virus down.'"

Source: 620 ktar.com: CDC: States Should Aim to Contain Bird Flu

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Indonesia launches bird flu awareness campaign

"Indonesia launched a bird flu awareness campaign on Wednesday in a bid to stop the rapid increasing of bird flu cases in the country.

The Health Minister Siti Fadilah Supari asked the people to watch out for the avian influenza (AI) virus by avoiding direct contact with poultry and keeping poultry out of their homes.

'The number of bird flu patients has increased rapidly in Indonesia, and in Medan, the largest bird flu patient cluster has been found recently. Laboratory-check results show that they were infected with the avian influenza virus from poultry. Therefore, poultry must be kept separate from human being,' said the minister.

She cited Vietnam as an example, saying that Vietnam had been able to stop the spread of bird flu virus infection after the country freed its areas from poultry for six months."

Source: People's Daily Online from Xinhua: Indonesia launches bird flu awareness campaign

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China reports new bird flu case

"China has discovered a new H5N1 bird flu case in poultry in the western Xinjiang Uygur Autonomous Region, the Ministry of Agriculture (MOA) said on Wednesday.

Epidemic prevention workers prepare to put killed poultry on trucks in Hetian of northwest China's Xinjiang Uygur Autonomous Region, Nov. 15, 2005. Highly pathogenic bird flu epidemic was reported in Hetian City of the Xinjiang Uygur Autonomous Region, the Chinese Ministry of Agriculture said on Thursday.

The case was identified after domestic poultry at a farm in Xinjiang's Hetian County died of an unclear illness.

The dead poultry were confirmed to have been infected with the bird flu virus on Wednesday after testing at the national bird flu laboratory"

Source: China Daily: China reports new bird flu case

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Hungary: Fresh doubts over flu vaccine

"HUNGARY'S vaccine for bird flu came under yet more criticism last week, days before the EU extended its ban on neighboring Romania's live poultry and poultry products across the country.

The Hungarian vaccine against H5N1 (the virulent strain of avian influenza), was accused of being 'nothing but a bluff,' according to daily Népszabadság, reporting on an article published by the Bloomsberg news agency.

Bloomsberg raised doubts over the vaccine, saying no scientific evidence to corroborate its effectiveness had been presented in the seven months following the announcement of its development.

The Hungarian government and Omninvest Kft, the private company that developed the vaccine, had last spoken of its effectiveness and, in a publicity drive, the vaccine was taken by the Health Minister."

Source: The Budapest Sun Online: Fresh doubts over flu vaccine

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Africa needs $760 mln to fight bird flu-report

"Africa needs $760 million to fight bird flu over the next three years, about three times as much as donors pencilled into their $1.9 billion pledge made in January, the African Union and aid organisations said Wednesday.

The pledge made at a donors conference in Beijing did not assume bird flu would break out in Africa, according to a study by the AU, the Food and Agriculture Organisation (FAO) and the World Organisation for Animal Health (OIE) presented in Vienna.

But eight African countries have reported the virus since February, and OIE Director General Bernard Vallat told Reuters on the sidelines of a Vienna conference of bird flu coordinators that this increased the funds needed significantly.

'During the Beijing conference, Africa was not yet infected,' Vallat said in an interview. 'In Beijing the cost was calculated only for prevention. But when a country is infected, the cost is multiplied by at least three or four.'"

Source: Reuters: Africa needs $760 mln to fight bird flu-report

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Indonesia Is Running Out of Ideas on Bird Flu, Supari Says

"Indonesia's Health Minister Siti Fadilah Supari said she is struggling to warn of the danger of bird flu, which has killed three of every four people it has infected in the world's fourth-most-populous nation.

``I am running out of ideas how to make the public aware,'' Supari told reporters in Jakarta today. Yesterday the health ministry confirmed the 49th human avian influenza case. The H5N1 strain has infected people in more than half of Indonesia's 33 provinces since July."

Source: Bloomberg: Indonesia Is Running Out of Ideas on Bird Flu, Supari Says

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Zambia: More resources needed to counter avian flu

"Zambia has repeatedly said it lacks the technical expertise, personnel and funds to tackle a possible outbreak of H5N1 bird flu, but recent donations will help to remedy this situation.

The European Union contributed $200,000, while the UN Food and Agricultural Organisation (FAO) this week donated US$89,000 worth of test kits and other equipment to counter the deadly virus.

Richard Chizyuka, permanent secretary in the Ministry of Agriculture and Cooperatives, said a lack of resources had stalled many of the government's prevention initiatives - despite a national response plan and a budget - but the protective gear from FAO would help step up active surveillance.

Zambian officials have time and again underlined a lack of capacity to handle a possible outbreak. Earlier this year, the cabinet approved a $4.8 million budget to tackle avian influenza, with the emphasis on prevention."

Source: IRIN: ZAMBIA: More resources needed to counter avian flu

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Roche: Companies need to stockpile flu drugs

"Companies should plan on stockpiling avian-flu vaccines and antiviral medications to protect employees from the ravages of a possible avian-flu pandemic, rather than relying solely on the government, a senior executive of pharmaceutical giant Roche Group said Wednesday.

According to George Abercrombie, chief executive of Roche's Hoffman-LaRoche division, companies should consider stockpiling enough of the flu-fighting products to protect at least 25% of their workers."

Source: MarketWatch: Roche: Companies need to stockpile flu drugs

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Bilgaria: Bird Flu Perched on Border

"The latest site with the lethal H5N1 bird flu in Romania was confirmed to be just 40 km away from the northern Bulgarian border, in the Gurgevo province.

A statement posted on a municipal website denounces earlier refusals on the availability of the lethal virus in the area.

The site with detected infection is located around the village of Balbukata, and Romanian authorities are pledging it has been disinfected. The settlement is under quarantine and some 800 birds were culled, Bulgarian National Radio (BNR) informed. "

Source: Novinite: Bird Flu Perched on Bulgarian Border

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Indonesia: Bird flu explode

Indonesia averaged one human bird flu death every 2 1/2 days in May, putting it on pace to soon surpass Vietnam as the world's hardest-hit country.

"We're tying to fix this leak in the roof, and there's a storm," World Health Organization spokesman Dick Thompson said. "The storm is that the virus is in animals almost everywhere and the lack of effective attention that's being addressed to the problem."

Indonesia, an archipelago of 17,000 islands with a population of 220 million people, has a patchwork of local, regional and national bureaucracies that often send mixed messages. The impression, health officials said, is often that no one is truly at the helm.

"I don't think anyone can understand it unless you come here and see it for yourself," said Steven Bjorge, a WHO epidemiologist in Jakarta. "The amount of decentralization here is breathtaking."

National government officials concede there is a problem.

Source: SiLive: Bird flu explodes in Indonesia

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Threat of Flu Pandemic Means Employers Must Geographically Distribute Workers

"With worker absenteeism expected to exceed 40 per cent for weeks or months should a pandemic like bird flu strike, Canadian governments and corporations must begin to geographically distribute their workforces now, a pandemic preparations conference has heard.

'There's an old saying that when you hear thunder it is too late to build an ark,' Distributed Work expert George Horhota today told the International Centre for Infectious Diseases' National Business Summit on Pandemic Preparedness, Mitigation and Recovery in Winnipeg.

Distributed Work utilizes technology to enable employees to get out of only working from corporate and government offices and work from various locations, including the home, community offices in their neighborhoods, client offices, airports, even coffee shops."

Source: NewsWire from CNW Group: Threat of Flu Pandemic Means Employers Must Geographically Distribute Workers

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Russia: 1.5 mln birds die or culled in 2006 bird-flu outbreak

"About 1.5 million birds have died or been culled in Russia due to bird flu since the start of the year, the Agriculture Ministry said Wednesday.

Although no human lives have been claimed in Russia, figures made public in April indicated that around 1.1 million birds had died of the disease and 300,000 had been culled to control the spread of the virus since the beginning of February."

Source: RIA Novosti: 1.5 mln birds die or culled in 2006 bird-flu outbreak in Russia

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India: Bird flu has subsided

"Bird flu has subsided in India with no new cases reported since March, the top official in charge of prevention efforts told Reuters on Wednesday.

Since the March outbreak there has been no incidence of bird flu in the country, said P.M.A. Hakeem, secretary of the department of animal husbandry and dairying, the central body dealing with the crisis.

'We feel that it has subsided. Of course, the onset of summer has also helped in containing this,' Hakeem said."

Source: Reuters: Bird flu has subsided in India - top official

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EU, World Bank set up trust fund

"A trust fund's been set up by the European Commission and the World Bank aimed at helping developing countries boost their preparedness for bird flu.

Europe and the World Bank have pledged some 96 (m) million dollars to the account, which will support national and regional acton plans. Several other countries -- including China, Russia and Australia, have also agreed to pay into the fund."

Source: WAVY.COM: EU, World Bank set up trust fund to help boost bird flu preparedness in developing world

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China plagued by bird-flu coverups

Having learned a bitter lesson from covering up the severe acute respiratory syndrome (SARS) epidemic in early 2003, the central government of China now is said to be taking a more positive, responsible attitude in dealing with avian influenza, or bird flu. But that hasn't filtered down to the provinces.

As the market economy has taken root in China, the country has become increasingly decentralized. Because of this, Beijing's tough orders regarding the prevention of a bird-flu outbreak may not necessarily be carried out at all levels. Overwhelmingly concerned with economic growth, some local officials still tend to cover up any outbreak of bird flu, defying Beijing's order to report new cases immediately.

Beijing has punished some local officials for their incompetence in dealing with bird-flu outbreaks. For instance, in May it was announced that five officials in Dazhu county in Sichuan province had been sacked for of dereliction of duty because they did not report and contain the local outbreak in time.

But during an investigative reporting trip to three locations in China, Asia Times Online found that in rural areas, local officials and residents really don't like any action that might expose a possible bird-flu outbreak, fearing the damage it would do to the economy.

More than half a year has passed since the bird-flu epidemic in Tianchang city, Anhui province, was exposed to the outside world. A recent visit by ATol found residents there still eager to see their hated local informer turned into a criminal defendant, while little attention has been paid to prevention of a possible return of the epidemic.

Ducklings and goslings roamed all over Liangying village, showing that no one was paying attention to the Animal Epidemic Prevention Law. Among other things, the law stipulates a six-month ban on breeding poultry after an outbreak, and the current ban only expired on May 24. "We started raising poultry after the Chinese New Year, and village leaders never stop us," a local farmer said.

The death of Li Juhua, a female farmer in Chenzhou, has not been reported by the Chinese media. Yet a lot of fanfare was extended to her son, six-year-old Junior Ouyang, who is to date the youngest person to catch bird flu in China, according to official records. Junior Ouyang has recovered and been discharged from hospital.

Throughout the three months the ATol correspondent roamed among infested provinces, a lot of coverups were detected. This case of covering up a human death closely related to avian flu was, however, the most repugnant.

Source: Asia Times Online: China plagued by bird-flu coverups

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EU Fails To Back Anti-Viral Drug Stockpiling For Bird Flu

"European Union health ministers have failed to back a plan to set up a stockpile of anti-viral drugs to help prepare against a flu pandemic in Europe, the European Commission said Tuesday.

E.U. Commissioner for Health Markos Kyprianou said the measure would have reinforced defences throughout the E.U. and this setback made it even more important that members states now take individual action.

'The responsibility now lies fully with national authorities to ensure there are sufficient resources, at the very least for the most vulnerable, in the case of a pandemic,' he said.

It wasn't immediately clear what the main sticking points were that prevented an agreement."

Source: Dow Jones Newswires: EU Fails To Back Anti-Viral Drug Stockpiling For Bird Flu

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Thailand takes preventive measures against bird flu

"Thailand's Ministry of Agriculture and Cooperatives has taken preventive measures against bird flu despite the fact that no outbreak has been reported in the country for 200 days.

Thai Minister of Agriculture and Cooperatives Khunying Sudarat Keyuraphan was quoted by the Thai News Agency (TNA) as saying that although there has been no bird flu outbreak in Thailand for 200 days, the situation remains uncertain."

Source: Viet Nam News Agency: Thailand takes preventive measures against bird flu

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UN: Deputy Secretary-General calls for stepped-up US engagement

"The United Nations Deputy Secretary-General today called for greater United States engagement with the UN, warning that Washington cannot "go it alone" in approaching diverse problems ranging from the threat of bird flu to the situation in violence-wracked Darfur, Sudan, while the world body needs its host country’s leadership to tackle these pressing challenges.

In an address on 'Power and Superpower' delivered in New York, Mark Malloch Brown warned that "a moment of truth is coming" since the world's challenges are growing but the UN's ability to respond is being weakened without US leadership."

Deputy Secretary-General calls for stepped-up US engagement with UN

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World Bank: Bird Flu Is 'Risk' for South Asia

"Bird flu is a "high risk" for India, Pakistan and other South Asian countries because of the number of poultry kept in the region, where a spread of the virus among humans would cause a recession, the World Bank said.

"The economic consequences of a human-to-human transmission would be gigantic," said Julian Schweitzer, the World Bank's director for human development in South Asia. "There would be huge economic disruption - trade, goods, food, and transport of all types."

South Asia is home to almost a quarter of the world's population, according to statistics released by the World Bank in April. The Bank, which funds projects to alleviate poverty, is working with developing countries to improve hospitals and laboratories to bolster disease surveillance and management of H5N1 cases."

Source: Bloomberg: Bird Flu Is 'Risk' for South Asia, World Bank Says

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WHO confirms another bird flu death

"The World Health Organisation on Tuesday confirmed a 15-year old Indonesian boy as the 128th person to have died of bird flu, but said four nurses in the Asian country have tested negative for the deadly H5N1 virus.

The boy, from the town of Tasikmalaya, died May 30 after being infected, presumably from sick and dying chickens in his household, the United Nations health agency said. The cause of death already had been confirmed in Indonesia, which had a spike in human bird flu cases last month."

Source: IOL: WHO confirms another bird flu death

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UK: Brits worry about attacks/bird flu

I wonder how people would have reacted if they were to the real worst-case-scenario, rather than the tame version of 1918/19 pandemic. Sheer and utter panic I would guess.
"Britons are more likely to worry about terrorist attacks and catching bird flu than they are about losing their job or getting into debt, a recent survey has showed.

Nearly four out of 10 people say one of the things they worry about most is terrorist attacks, while 31% are concerned about violent crime, 18% fret about superbugs and the same proportion worry about catching bird flu.

People blamed their heightened state of anxiety on a combination of television and newspaper reports and Government warnings"

Source: Ananova: Brits worry about attacks/bird flu

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So who's really to blame for the spread of bird flu?

According to experts, wild birds are spreading the deadly H5N1 virus that's wiping out poultry worldwide. But are they really to blame? Or is the disease not only a direct result of intensive farming - but actually being spread by the industry?

Multiple cracks are beginning to show in the supposed scientific consensus on the origins of avian flu. A growing number of non-governmental organisations, bird experts and independent vets are pointing the finger at the global intensive poultry industry. A new report from Grain, an international environmental organisation, challenges the official line. "H5N1 is essentially a problem of industrial poultry practices," it says. "Its epicentre is the factory farms of China and south-east Asia. Although wild birds can carry the disease, at least for short distances, [the main infection] route is the highly self-regulated transnational poultry industry, which sends its products and wastes around the world through a multitude of channels."

Source: Guardian Unlimited: So who's really to blame for bird flu?

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Tuesday, June 06, 2006

Avian influenza – situation in Indonesia – update 18

"6 June 2006

The Ministry of Health in Indonesia has confirmed the country’s 49th case of human infection with the H5N1 avian influenza virus.

The case occurred in a 15-year-old boy from Tasikmalaya District, West Java Province. He developed symptoms on 24 May, was hospitalized on 26 May, and died on 30 May.

An investigation conducted by provincial health authorities found a history of contact with sick and dying chickens in the boy’s household in the week before the onset of his symptoms. Monitoring of family members and close contacts has detected no cases of influenza-like illness.

Of the 49 cases confirmed to date in Indonesia, 37 have been fatal.

The H5N1 virus is considered firmly entrenched in poultry throughout much of Indonesia. Unless this situation is urgently and comprehensively addressed, sporadic human cases will continue to occur.

The newly confirmed case is one of several where exposure occurred despite a clear signal of a high-risk situation arising from poultry deaths. Pending better control of the disease in animals, WHO and officials in the Ministry of Health see an urgent need to improve public awareness of this disease, the risk factors for infection, and the behaviours that should be avoided."

Source: WHO: Avian influenza – situation in Indonesia – update 18

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Avian influenza – situation in Indonesia – update 17

"6 June 2006

For the past four days, Indonesian health authorities and WHO have been monitoring cases of influenza-like illness in four nurses who were involved in the care of confirmed H5N1 patients.

Test results have now convincingly ruled out H5N1 infection in all four nurses.

Two of the nurses cared for siblings, a 10-year-old girl and her 18-year-old brother, who were hospitalized in Bandung, West Java, on 22 May and died the following day. Test results for both nurses are negative for H5N1 infection. One nurse was shown to be infected with a seasonal influenza A (H1N1) virus, which is now circulating widely throughout Indonesia. The second nurse experienced only mild and transient symptoms, but was tested urgently as a precautionary measure. Her test results were also negative for H5N1 infection.

The two additional nurses, who work at a hospital in Medan, North Sumatra, were involved in the care of confirmed H5N1 cases among members of an extended family from the village of Kubu Simbelang in Karo District. One of the nurses, a 34-year-old woman, experienced only mild symptoms and has subsequently tested negative for H5N1 infection. The second nurse, a 42-year-old woman, developed influenza-like illness on 1 June. Test results received today are also negative for H5N1 infection.

The speed and thoroughness with which influenza-like illness in these nurses was investigated are indicative of the heightened concern among Indonesian health authorities. The negative test results for all four nurses provide reassuring evidence that the virus is not spreading efficiently or sustainably among humans at present."

Source: WHO: Avian influenza – situation in Indonesia – update 17

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Cumulative Number of Confirmed Human Cases of H5N1 Reported to WHO - 6 June 2006

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO as of 6 June 2006

Country

2003

2004

2005

2006

Total

No

dead

No

dead

No

dead

No

dead

No

dead

Azerbaijan0000008
585
Cambodia0000442
2
6
6
China00008510
7
1812
Djibuti0000001010
Egypt00000014
6
14
6
Indonesia0000171132
26
49
37
Iraq0000002222
Thailand00171252002214
Turkey000000124124
VietNam3329206119009342
Total334632954181
52
225
128

Total number of cases includes number of deaths. WHO reports only laboratory-confirmed cases.

Source: WHO: Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO

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Indonesia: Bird flu patient released

"A patient who had been infected with bird flu was released on Tuesday by a hospital in the East Java provincial capital Surabaya, the second largest city in Indonesia.

The patient had been treated at Dr. Soetomo state hospital since mid-May, after being treated at another hospital in his hometown Kediri, Antara news agency quoted Urip Murtedjo, a hospital spokesman, as saying.

'Medically, he is declared free from the disease,' Urip said.

The patient was admitted to a hospital in Kediri with high fever, respiratory problems and cough -- all symptoms of bird flu."

Source: People's Daily Online from Xinhua: Bird flu patient in Indonesia released

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Science: Nutrient-Based Approach Shows Promise Against ARDS

One of the main causes of concern about H5N1 Avian Influenza (bird flu) is that approximately 1/2 of the confirmed cases have died. Experts attribute this mortality rate to an unfortunate immune response called a "cytokine storm." This often fatal side-effect is triggered when a virus gets past the frontline defenses and the immune system over-reacts. Dr. Guilford likens this occurrence to urban warfare, in which the weapons used to take out the enemy also inflict heavy civilian casualties. "Without instructions to back off, the immune system not only destroys the virus but the tissues around the virus, causing such acute respiratory distress (ARDS) that the immune system can readily kill the infected individual as well as the virus."

Describing the process in somewhat more clinical terms, Dr. Guilford says, “In a pandemic virus like H5N1 the body releases TNF (tumor necrosis factor) from immune and epithelial cells to help kill the virus. However, the virus produces a protein that causes the energy producing mitochondria of the cell, located in the cell’s nucleus, to become suddenly sensitized to TNF. This causes the mitochondria to break down and release substances that trigger rapid cellular death. While fighting a virus, excessive TNF can simultaneously attack cellular membranes and intercellular biochemical machinery. When enough of these mechanisms are compromised in the lungs, Acute Respiratory Distress Syndrome (ARDS) occurs, and it is ARDS that can lead to death from bird flu.”

Dr. Guilford notes the need to both strengthen the body's frontline defenses and to inhibit the damaging effects of a large-scale release of cytokines. He points out, “There is accumulating evidence indicating TNF is modulated by antioxidants in normal tissues, especially the antioxidant called reduced glutathione. People with acute respiratory distress syndrome have been tested to be low in reduced glutathione in lung fluid.”

These findings have put Dr. Guilford onto the trail of a potentially effective treatment for the disastrous effects of H5N1 infection. He is currently investigating the use of liposomal encapsulated reduced glutathione to maintain normal glutathione levels. He says, “Medical research to date has previously focused primarily on stopping replication and proliferation. However, if glutathione can be shown in clinical studies to modulate the cytokine storm, it will prove to be an effective and inexpensive approach to dealing with viral infections. Currently, we have very few medical tools for the cytokine storm, and this approach appears promising.”

Source: PRWeb: New Nutrient-Based Approach Shows Promise Against Deadly Bird Flu Symptoms

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IBM service offers Contingency Planning Assessment for flu pandemic

IBM is introducing a service that seeks to answer a question that few would like to ask: Are we ready for a flu pandemic?

The Contingency Planning Assessment, offered by IBM Global Services, is designed to give corporations a better picture of the vulnerabilities they could face in the event of a widespread outbreak of avian influenza.

"Customers are being more proactive in trying to understand the risk and vulnerability they have from all hazards, natural and man-made," said Brent Woodworth, global leader of IBM's Crisis Response Team.

IBM will examine a company or government's business processes and technical infrastructure, and make recommendations on how to deal with an outbreak.

Specific questions Woodworth said IBM could help companies answer include: "How do I operate my business if I have to operate with dramatically reduced staff, and what impact will my suppliers have?" and "Where do I downsize operations and how?"

Source: CNET News.com: IBM service hedges flu pandemic

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APEC bird flu exercise launched

"All 21 APEC economies will test their emergency communication and response to a human influenza pandemic in an exercise launched on Tuesday in Canberra.

Senior officials from around the region will make real-time decisions based on a hypothetical scenario in the 'APEC Pandemic Response Exercise 2006.'

'This is the first exercise in a series that will prepare the emergency management sector for a large-scale medical emergency,' said Australian Attorney-General Philip Ruddock.

Large screens, maps and TV monitors feature the exercise headquarters set up at the National Emergency Management Coordination Center. Three or four officials were seen busy with work before a row of computers."

Source: People's Daily Online: Writethru: APEC bird flu exercise launched

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Brazil: Hundreds of Brazilian Veterinarians Get Training for Bird Flu Handling

"Approximately 420 veterinarians from Brazil's Ministry of Agriculture, Livestock, and Supply (MAPA) and state agriculture departments across the country began to receive training on how to handle situations in which bird flu is suspected in places where poultry is bred.

This information was provided by Luiz Cláudio Coelho, a veterinarian in the MAPA Poultry Health Coordination Unit."

Source: Brazzil Mag: Brazil: Hundreds of Brazilian Veterinarians Get Training for Bird Flu Handling

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World Bank To Help Armenia Tackle Bird Flu

The World Bank has approved a $6.25 million loan to Armenia designed to help its government guard against and, if necessary, cope with a possible outbreak of bird flu already registered in all of the four neighboring countries.

The Armenian authorities will also receive a $800,000 from the government of Japan for the same purpose, the bank said in a statement released by its Yerevan office on Monday.

“This project will assist the Government of Armenia in minimizing the threat posed to humans by avian influenza infection in domestic poultry and prepare for the control and response to an influenza pandemic and other infectious disease emergencies in humans,” the statement said. “Upon project completion, Armenia will achieve improved effectiveness of animal and public health services in limiting the spread of an avian influenza outbreak and a possible pandemic in the country,” it added.

Source: www.armenialiberty.org: World Bank To Help Armenia Tackle Bird Flu

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Chinese scientist urges improvement of bird flu control methods

The Chinese government should review the strategies and effects of the bird flu control efforts of the past two years and improve them to cope with the epidemic which is still a serious threat, said a Chinese scientist in Beijing on Monday.

"When, and to what extent, the current avian influenza virus could evolve into a human pandemic is unpredictable. We should do our best to reduce the risk of a human pandemic influenza breaking out and make necessary preparations before such a risk becomes reality," said Chinese bird flu control expert Liu Xiufan.

Liu, a member of the Chinese Academy of Engineering (CAE), said at a national conference of the CAE members that controlling the H5N1 virus in poultry at its source is the best way to reduce or even eliminate the risk of a human pandemic virus.

Some changes in the H5N1 virus have taken place recently. The virus has increased virulence to ducks, and the currently available vaccines are not effective for protecting poultry, said Liu.

The H5N1 viruses isolated during the 2004-2006 period have increased their ability to replicate in mammalian cell culture. The transmission mode of the viruses is changing from fecal-oral to aerosol, said the scientist, adding that the viruses have increased resistance to the environment, especially to temperature.

Because bird flu infection has become endemic in some areas in China and cannot be stamped out in a short time, the government should draw up a short-term plan of prevention and control and a long-term program of eradication, Liu added.

Source: People's Daily Online from Xinhua: Chinese scientist urges improvement of bird flu control methods

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