Bird flu kills 48th victim

BIRD flu had killed a 28-year-old Cambodian man, officials said today, the 48th Asian victim of a virus experts fear could unleash a global influenza pandemic capable of killing millions of people.

Keo Saran is Cambodia's second bird flu victim after a 25-year-old woman, who lived in the same southern province of Kampot, died while being treated in a Vietnamese hospital in late January.

more....
http://www.news.com.au/story/0,10117,12647545-23109,00.html

oh...wait

Or how about West Nile, where millions upon millions of mosquito bites produce a few hundred cases, and of those only a dozen or so die?

and thank goodness for my plastic sheeting and duct tape too

This is the third Cambodian death (20 km from home of the other two)

http://news.google.com/news?hl=en&lr=&tab=wn&ie=UTF-8&q=h5n1+kampot+cambodia

This one may be bigger than the mining of Haiphong harbor. Friday afternoon paper in Vietnam reports hospitalization of family of 5 in Haiphong. If confirmed this would signal a MAJOR improvement of human transmission for H5N1 and might be signaling the start of the pandemic. Bird to human transmission is very poor. Infecting a family of 5 is very significant

http://news.google.com/news?hl=en&ned=au&ie=UTF-8&filter=0&q=bird+flu+haiphong+vietnam

Look, I'm an ex-epidemiologist. Yes, the media overplays these things and makes a bigger deal out of them than should be made.

However, do not let that lull you into thinking it ain't ever gonna happen. In fact, influenza that has undergone a radical shift like this is the most likely suspect for another epidemic like we had in 1918.

That does not mean we can predict that this particular mutation will be "the big one." However, we can pretty well assure you that "the big one" will happen sometime in the next 50-100 years, probably sooner. Most likely through flu, but perhaps some other virus or even a bacteria that becomes totally resistant or even a prion.

Our medical care of patients will be considerably better in the Western world than it was in 1918, so I doubt that death rates will be as high as in 1918, ...at least here. But God help the underdeveloped countries. It would be one thing if there was such a thing as producing a very quick vaccine to immunize everyone, but these bugs change every year.

Further, although SARS is certainly less likely to spread as quickly as does the flu, remember that a vast containment project was undertaken. How do you know that prevention effort wasn't all that stood between you and SARS?

I wrote this...

Strep, Infarct, Spanish Flu

A month before he passed away,
Art, my next-door neighbor
tottered over to my house.
He stood and watched me
resting on the porch,
silent for a moment.

Then, like a felon
knows another felon,
he said, "You're sick,
ain't ya?"

"Strep throat," I said.

He went distant
for a moment.

"When I was a tyke,
maybe five or six,
my oldest brother Danny
went over there,
fought the Huns
in the great war.
We lived in Kansas then,
over in Argentine."

Art leaned against his cane and paled.
Sweat broke out on his forehead.
He glanced upward at the clouds,
his eyes went round and his face
slackened as he spoke.

"Danny seemed puny,
under weight
when he came home.
We paid it no mind,
even when he told us
his tales of Spanish flu,
how half his unit
sickened, and how the
sick all died off.

We were the first family
in Wyandotte county
to get it.
Danny went first,
then Mom, Wendy, Phil.
A month later,
Dad and sister Judith,
next youngest to me,
were gone.
Aunts and Uncles asked me
to cry at he funerals.
I couldn't.
Then I took sick.
Damnedest thing,
I can't remember
being ill at all;
I was so delirious.
When I came to,
thousands were down
with it,
hundreds already dead.

The nurses and the doctors
got hit hardest.
Neighbors
took care of neighbors
or didn't,
and left whole houses
full of victims,
like the plague."

He looked at me queerly.
"This happened sixty years ago,"
he wheezed, then spat whitish phlegm
on my sidewalk.
"Nobody remembers now,
or talks about it,
'cept us old-timers;
we still don't know what to say."


I raised up on my cushion,
my throat
stung as I talked:

"Ain't it always some damned thing,
or another?
A sickness we can't stop,
a war, and then,
when it finally runs down,
we don't know what to say.
We can't congratulate each other
so we say nothing, let it pass.
We don't solve a damn thing anymore;
we wait for things to peter out
and sigh, no words,
ready to forget."

My head spun,
and my ears buzzed
with fever.
He walked away,
not saying
goodbye,
get well,
or anything.

I love this poem. It has everything in it that pushes my buttons. A story. Simplicity. Kansas. The flu. History. The echoes of sorrow.

I am glad it resonated with you.
At the time I wrote it, I had finished a 12 year stretch working in medicine, most of those years at KUMed. And I had decided no more medicine for me. I went back to school.

I had just taken two courses, KC, History of a regional metropolis, and epidemics and the rise of the American city.

So my neighbor's story was incredibly compelling. Sadly, he really did die right afterward.

Oh, and I realized about that time that my marriage was unsavible, and my ex refused to consider divorce unless I walked away with nothing and took all the debt. It took her six years to get me to agree.

Yeah, all of that is in the poem, under the surface, I guess.

if you would have said sharky instead of "snarky". Kidding aside though, you are correct. It's just difficult to always respond the way we should with the fear-fatigue inducing chum-bucket media we have.

Jay

You gotta trademark (sloganmark?) that baby!

Too funny...

Avian flu might become a major human pandemic and kill tens of millions, perhaps including you and I. On the otherhand, it might not. The chances are better for the former than the later, but the point is that if not the Asian flu then maybe the next one, or the one after that. Influenza is a stone killer when you don't have immunity. So far we've been lucky for almost a century that the right combination of virulence and wide open host susceptiblity have not co-occurred, but they will. If not this time, then perhaps the next.

Your statement is like saying that a fire in you house that was put out by the fire department wasn't dangerous and offering the fact that only part of one wall was burned instead of the whole house as proof of your contention that it wasn't dangerous. Of course, if they had done nothing, and SARS had been allowed to propogate you would be the first one screaming that they should have done somehting.

SARS was deadly, and it was stopped because a gov't took action. You are trying to use the results of their action as proof that SARS was nothing.

Asian bird flu, if you would bother to become actually informed about it, is an extremely serious threat to all of humanity. At this point it does not easily travel from one human to another, but since flu mutates so extemely easily, it WILL eventually mutate into a transmissible form. The part of the flu's RNA that controls the lethality of it, and the part that controls the transmissibility of it are on different sections of the genome. So WHEN it becomes easily transmissible, it will still be just as deadly.

You remind me of the people in Hurricane Camille, 1969, who refused to believe that it was anything to be concerned about. After all, it isn't "hip" to display concern. So they did the "cool" thing. They organized a hurricane party at the Richelieu Apts. They laughed at the people that were leaving. That had the same type attitude that you are showing. The learned the hard way about what a Category 5 hurricane can do to apartments on the beach. Twenty-four partied, one person survived.

If ABF is stopped, and I hope it is stopped, it will be because some people took it very seriously and did something. It won't be because they stuck their head in the sand.

Try googling about the 1918 flu epidemic sometime. We are not much better prepared than they were back then, and in some ways are worse off. We have faster international travel.

i was just being a snarky bastard

It allows a new virus to be identified much quicker than if we were all still traveling around the globe by sailboat. Medications and medical personnel can be delivered anywhere in the world within a matter of hours rather than weeks or even months. We can seal off any affected part of the world instantly by closing air travel to that area.

This day of instantaneous information helps out a lot too. Vital information that used to take months to get from point A to point B now takes seconds. That is a very good thing that was not available in the past.

Don

...doesn't that concern you just a bit, or are you too busy belittling people interested in following this story?

To the credit of the Chinese, once they decided to act, they quarantined large urban areas to contain the spread of SARS. But, SARS had a difficult time infecting on a human-to-human basis, otherwise, even the aggressive policies enacted by the Chinese government would have eventually failed. The disease still killed 9% of the people that were known to have been infected.

Now, let's talk about Avian Flu. This disease has been infecting and killing birds for quite some time. It jumped to pigs last year with the same result. It has just recently been discovered infecting jungle cats with...you guessed it...the exact same results. Lab tests have proved that domestic cats can also be infected. We knew a couple of years ago that Avian Flu could kill humans....but now we know that the disease is starting to make the jump to transmitting the disease human to human.

Research done over the last couple of years has established that the current Avian Flu has the same roots as the virus that killed 5% of those infected during the 1918 Flu Pandemic...roughly 40 million people worldwide.

The current version is killing 70-75% of all people known to have been infected by this disease. The good news right now is that the current version is not yet very good at infecting human to human...but it appears to be getting better at it. The bad news is that the Vietnamese have been very slow to report this disease...much like the Chinese were slow in reporting the SARS disease. Additionally, the disease may no longer be capable of being contained in Vietnam.

Media-Lies-Daily wrote: "The current version is killing 70-75% of all people known to have been infected by this disease."

How could you POSSIBLY know that? Could you link to the basis for that statement? I think it is a fanciful estimate. How many people who have 'bird flu' recover after just flu symptoms?

The kicker here is the word known. Most people seem to skip right over that word.

First, there can be many true cases that are just passed off as the flu and never get "into the system" whether they lived or died.

Second, since clinicians are not perfect, there may be some false cases who are diagnosed with H5N1, but actually had another strain. With an outbreak like this, epidemiologists try to have confirmation of the clinical diagnosis through lab tests. However, lab tests are imperfect and often the person is already dead and buried and cannot be tested. If that occurs the person is listed as a suspected case.

Third, there may be people who were at some time infected and have antibodies to H5N1, but who never became ill enough to even suspect they were infected (unapparent infections). One of the biggies about these people is the question of whether or not they can transmit the virus to others who may become much sicker than the original person they got it from. No one really knows about this yet.

You try to narrow down 'official' cases to only those who actually became visibly ill and were lab tested. Sometimes you add the suspected cases with highly visible signs for whom lab tests were not feasible. Then you see how many of those died. You divide the fatalities by the number of known cases. That is the case fatality rate. Since the criteria are pretty strict for being a 'case', that tends to make the case fatality rate rather high. And it has differed from outbreak to outbreak of H5N1.

However, remember, there were all those people in the first category who never got reported at all.

Furthermore, in the real world, if the real mortality rate was as low as say 5%, you can easily calculate the number of world-wide deaths to be expected by looking at the size of the world population. In 1918, there were few areas that escaped exposure to the virus--in our global world now, I doubt that any area would completely escape exposure to the virus.

You can talk about undiagnosed deaths or recoveries in any disease (for H5N1 a number of index cases were never tested and others initially tested negative - they were only re-tested because relatives became sick with same symptoms - all but one of the index cases died, and the one that didn't is still hospitalized).

Large study in Thailand failed to find H5N1 in milder respiratory cases (they looked at over 600 cases).

In southern Vietnam and Cambodia this season the rate is actually 100%. There have been NO reported discharges of any H5N1 patient.

Yes, you can talk about undiagnosed deaths and recoveries in any disease. But the extent of depends upon how complete your surveillance is. If your surveillance is thought to be pretty incomplete (as I was assuming, perhaps incorrectly, that it was in this disease in Asia), that leaves you with more uncertainty as to what is going on re: incidence and prevalence.

That is interesting about Thailand. I read somewhere that someone HAD found antibody-positive people who did not become ill. But have to go look it up.

As to the patients in Southern Vietnam and Cambodia, have they all died--or just not released from hospitals yet?

Where has it spread to geofraphically? Is it true that the virus was found in poultry smuggled into U.S.? This shit is scary.

Birds and pigs can get a wide variety of influenza infections (just as we can). So the term "Avian Flu" can be misleading. We have had Avian flu infections of birds here in the US, but as far as I know, not of this particular type (called H5N1).

Outbreaks in North America
See: http://www.cdc.gov/flu/avian/outbreaks/us.htm

We have an embargo on importing of birds or bird products from Southeast Asia and from Malaysia.

Embargo of Birds from Specified Southeast Asian Countries
See" http://www.cdc.gov/flu/avian/outbreaks/embargo.htm

This particular type (H5N1)has appeared in poultry in Cambodia, China, Indonesia, Japan, Laos, South Korea, Malaysia, Indonesia, Thailand and Vietnam. Way back in 1997 or so it jumped from birds to humans in Hong Kong.

Update: Isolation of Avian Influenza A(H5N1) Viruses from Humans -- Hong Kong, 1997-1998
See: http://www.cdc.gov/mmwr/preview/mmwrhtml/00050775.htm

Since then it has jumped from birds to humans in at least Vietnam and Thailand. But what they are really worried about is the potential for it to start spreading efficiently from human to human--I have seen recent reports of it starting to spread this way, (not all that efficiently yet) but I don't know if these are confirmed yet.

Recent Avian Influenza Outbreaks in Asia
See: http://www.cdc.gov/flu/avian/outbreaks/asia.htm

Some good 'popular' books to read on the subject are:

The Coming Plague by Laurie Garrett
The Global Crisis in Public Health by Laurie Garrett
The Great Influenza by John M. Barry
Flu : The Story of the Great Influenza Pandemic of 1918 by Gina Kolata

The first two cover all sorts of infectious outbreaks.

Pretty good site for flu info.IMO


http://effectmeasure.blogspot.com/

Great site. Very informative. I have bookmarked it. Anyway, here is the paragraphy I mentioned:

"Meanwhile, reports from Cambodia and Vietnam indicate that the H5N1 strain may be changing once again. We will follow up with a summary shortly. So while we wait for the other shoe to drop with bird flu, the "garden variety" viruses are still with us, causing serious illness and death in Asia, and co-circulating with H5N1, with the obvious increase in chances for reassortment and recombination."

I retired less than two years ago and am happy to find a site like this. I haven't been all through it yet, but I can imagine that many senior public health people in government and academic areas would post on something like this anonymously.

It is so difficult to strike the correct balance--the first thought of most in public health is "Okay, don't panic and most of all don't let the population panic." But at times that can go too far--for example when Tommy Thompson came out and tried to ascribe the first report of anthrax in the Florida man to a naturally-acquired form of the disease--didn't seem at all plausible to me.

I was even on the bioterroism team for my state public health agency. Yes, it is a real threat, but in a more limited way than most would think. Likely to happen somewhere sometime but also likely to be contained to less than a complete melt-down. A naturally-occurring epidemic is more likely to be something we should fear.

I get so tired of the two extreme reactions among people: they either want to pooh-pooh the whole idea (whether natural or terrorism) or they want to be absolutely protected from everything that could conceivably happen.

I often feel like saying, "Okay, you guys over there in the pooh group, pull up your socks and get a little education on the subject. Take a few mild protective measures". Then to the other group wanting protection from absolutely everything, I feel like saying "Suck it up you guys--you were never invulnerable--you just thought you were."

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:hi:

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I'm going to Asia this summer and I'd like to play it as safe as possible. :scared:

And a great big welcome to DU!! :hi:

I appreciate your hospitality. For an earlier comment, see

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=104&topic_id=3335653&mesg_id=3336047

:D

where resources to fight it are limited. This article outlines what they are up against there:

He's using a cell phone list to corral bird flu in Cambodia
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2005/03/24/MNGL4BTS5N1.DTL&type=health

Phnom Penh, Cambodia -- The man who might save the world from a devastating bird flu pandemic makes $38 a month.

As Cambodia's chief of disease surveillance, Ly Sovann is responsible for spotting the stirrings of an epidemic in a country where the public health and veterinary systems are so impoverished that experts acknowledge they are probably failing to detect most of the human cases and have no idea how rampant the virus is among poultry.

Ly Sovann, a 36-year-old physician, heads a team of 10 Cambodian flu hunters struggling, from their 10-by-12-foot office at the Health Ministry, to head off an epidemic. The epidemic alert system is a network of personal cell phones. Through his wide-ranging contacts and charisma, Ly Sovann has cobbled together a national network of informants. Cambodia is seeking $10,000 from foreign donors to purchase prepaid phone cards to allow local health workers to report on suspicious respiratory cases.

But the monitoring effort has stumbled. Cambodia's one confirmed human case of bird flu, unrecognized two months ago by local doctors, was diagnosed only after the victim's family took the woman across the border for treatment in Vietnam, where the health system is more advanced.

So far, international health specialists report that the disease is less prevalent in Cambodia than in neighboring Vietnam and Thailand, where 45 people have died since early last year. But health specialists fear the rudimentary medical and veterinary care in Cambodia and its destitute neighbor Laos may be unable to diagnose or report human cases of bird flu, allowing the virus to spread.

more . . .

in most of the world. I would guess that Cambodia and Laos are worse off than the other Southeast Asian countries. But no one ever thinks they have much to spend on public health or especially on disease surveillance, a subset of public health. In Africa its even worse than in Asia.

Even in the US, prevention and disease surveillance get far less of the public health pie than do, say, health services (at least for HIV/STD, which was my field). And the public health pie, in turn, is minuscule compared to the amount we spend on private health care.

HIV/STD was one of the best-funded public health efforts here in the US (probably exceeded by bioterrorism now). So, having read a lot of exciting novels and non-fiction about CDC, portraying them as the people with endless expertise and (unstated) endless money to do exciting things to save us, I was shocked the first time I went over there to Atlanta to visit.

I found that not only did the person who supervised all my research grants have a tiny little cubicle in an office-park office, but (this being but days after the Oklahoma City bombing) they had rigged a device on their front door with scotch tape to try to get some kind of alarm, currently not working, to go off if an intruder tried to get in.

Things in the US are better than in most other places, but public health is grossly underfunded everywhere, usually in direct proportion to the country's extent of poverty.

I knew there wasn't a lot of money put into the CDC, but Scotched taped burgular alarms?

Oh dear.

I should note here that the offices did not contain any labs or any hairy-scary organisms (other than us).

http://www.legitgov.org/flu_oddities.html

...including this gem:
Gene From 1918 Virus Proves Key to Virulent Influenza (University of Wisconsin News Release) 10/6/2004 Contact: Yoshihiro Kawaoka "Using a gene resurrected from the virus that caused the 1918 Spanish influenza pandemic, recorded history's most lethal outbreak of infectious disease, scientists have found that a single gene may have been responsible for the devastating virulence of the virus. Writing Oct. 7 in the journal Nature, virologist Yoshihiro Kawaoka of the University of Wisconsin-Madison and the University of Tokyo, describes experiments in which engineered viruses were made more potent by the addition of a single gene. The work is evidence that a slight genetic tweak is all that is required to transform mild strains of the flu virus into forms far more pathogenic and, possibly, more transmissible... Using a comparatively mild form of influenza A virus as a template, Kawaoka's team added the two 1918 genes that code for hemagglutinin and neuraminidase and infected mice with the engineered viruses."

Lori Price

both

(1)for valid and necessary scientific reasons having to do with proving that indeed the gene (or genes) being investigated are actually the ones causing all the big problems

and

(2)for the less honorable reasons of biowarfare.

One of the current bioethical conundrums, given that science is almost literally based upon peer-reviewed publication of results that can be globally shared, is, in this climate of fear (some of it justified, unfortunately), how many of the details of valid scientific studies as in (1) should still be published in things like Science, Nature, NEJ, JAMA, etc.

Here is a real reason to be afraid. The link is to a column I did for the Washington Dispatch, an on-line opinion journal.

Religion, Politics, and the Decline of Science
http://www.washingtondispatch.com/article_9253.shtml

17 in just 4 months starting in October of 2001. The total is up to what now? 30+? When do we start to ask serious questions?

Why do you keep posting such nonsense?

Many of these have been solved. Most are just accidents, including the one discussed most, Don Wiley.

Even the murders (hacking to death by friends of daughter) have nothing to do with terrorism.

Good luck, I'll never believe it, he called his wife and family to tell them he was on his way home. Good luck, once again.

Wiley does not add up in any direction.

I don't post nonsense, ever.

Dearest, Dr. Wiley was not a suicide, but believe what you will.

See:
North Korea reports outbreak of bird flu for first time, claims no spread to humans

http://www.signonsandiego.com/news/world/20050327-0625-nkorea-birdflu.html

The pandemic potential is significant

http://news.google.com/news?hl=en&lr=&tab=nn&ie=UTF-8&q=h5n1+pandemic+korea