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  • #76
    Re: Pakistan: December 18+, WHO Begins Investigations

    No threat of bird flu pandemic: govt
    * WHO experts investigating outbreaks in Abbotabad and Peshawar

    ISLAMABAD: Pakistan said on Wednesday there was no threat of a pandemic from bird flu, as World Health Organisation (WHO) experts carried out tests in the country?s northwest after eight people were infected by the virus, Reuters reported.

    Pakistani authorities confirmed the eight cases over the weekend, including one death. The WHO said they were likely to be a combination of infections from poultry and limited human-to-human transmission of the H5N1 avian flu virus due to close contact.

    The WHO says a similar case occurred in Indonesia in 2006 among family members believed to have contracted the virus while caring for sick loved ones.

    ?There is no threat of epidemic or pandemic and there are no fresh cases being reported,? said Ministry of Health spokesman Orya Maqbool Jan Abbasi. The last human case was reported on November 23. ?I think we are safe, but we are very cautious and have taken all the precautionary measures,? the spokesman added.

    A WHO report is due in the coming days, he said. The man believed to have been infected first ? a veterinarian who helped operations to cull chickens ? recovered, but his two brothers died.

    One of his dead brothers tested positive for the virus. It was not clear if the other brother was infected with H5N1. Six people have since recovered, while the remaining case is still being treated. The H5N1 virus is hard for humans to catch and is mainly a bird disease. But experts fear the strain could spark a global pandemic and kill millions if it mutates into a form that spreads easily between people.

    Keiji Fukuda, coordinator of the WHO?s global influenza programme said on Tuesday there was no immediate cause for alarm and the UN agency was not raising its level of pandemic alert for Pakistan for the time being.

    ?Right now it doesn?t look like pure human-to-human transmission. It looks like the veterinarian, who was the index case, and a number of other suspect cases had poultry exposure,? Keiji Fakuda added. ?It is definitely possible that we have a mixed scenario where we have poultry to human infection and possible human to human transmission within a family, which is not yet verified,? he said.

    WHO experts: Three WHO experts, led by Hassan El-Bushra of its regional Cairo office, are in Pakistan helping investigate the outbreak. Health Ministry spokesman Abbasi said the team on Wednesday visited Abbotabad, one of the two areas where the outbreak was reported. ?They (WHO) are not telling us anything until they reach a conclusion,? he added.

    However, Abbasi said earlier that the team had arrived on Wednesday, while WHO spokesman in Geneva Gregory Hartl said that they were due a day later, AP reported.

    ?The experts from the US Naval Medical Research Unit No 3 in Cairo are scheduled to arrive on Thursday,? he added.

    A separate WHO team visited a hospital in Peshawar on Tuesday that treated some of the patients. Since H5N1 resurfaced in Asia in late 2003, the virus has killed 209 people in 11 countries, according to the WHO. The latest Pakistan cases have yet to be included in the formal WHO tally. agencies

    Daily Times is an English-language Pakistani newspaper. Daily Times, is simultaneously published from Lahore, Islamabad and Karachi.

    Comment


    • #77
      Re: Pakistan: December 18+, WHO Begins Investigations

      Ahh, here we go. Knew I had read it on more than one occasion.




      <TABLE cellSpacing=0 cellPadding=0 width=470 border=0><TBODY><TR xmlns=""><TD vAlign=top height=22>Letter</TD></TR><TR xmlns=""><TD></TD></TR><TR xmlns=""><TD height=14></TD></TR><TR><TD>Nature Medicine - 12, 1203 - 1207 (2006)
      Published online: 10 September 2006; | doi:10.1038/nm1477
      Fatal outcome of human influenza A (H5N1) is associated with high viral load and hypercytokinemia

      Menno D de Jong<SUP>1</SUP>, Cameron P Simmons<SUP>1</SUP>, Tran Tan Thanh<SUP>1</SUP>, Vo Minh Hien<SUP>2</SUP>, Gavin J D Smith<SUP>3</SUP>, Tran Nguyen Bich Chau<SUP>1</SUP>, Dang Minh Hoang<SUP>1</SUP>, Nguyen Van Vinh Chau<SUP>2</SUP>, Truong Huu Khanh<SUP>4</SUP>, Vo Cong Dong<SUP>5</SUP>, Phan Tu Qui<SUP>4</SUP>, Bach Van Cam<SUP>4</SUP>, Do Quang Ha<SUP>1</SUP>, Yi Guan<SUP>3</SUP>, J S Malik Peiris<SUP>3</SUP>, Nguyen Tran Chinh<SUP>2</SUP>, Tran Tinh Hien<SUP>2</SUP> & Jeremy Farrar<SUP>1</SUP> <SUP>1</SUP> Oxford University Clinical Research Unit, 190 Ben Ham Tu, Ho Chi Minh City, Vietnam.
      <SUP>2</SUP> Hospital for Tropical Diseases, 190 Ben Ham Tu, Ho Chi Minh City, Vietnam.
      <SUP>3</SUP> State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, The University of Hong Kong, 21 Sassoon Road, Hong Kong SAR, China.
      <SUP>4</SUP> Pediatric Hospital Number One, 2 Su Van Hanh, Ho Chi Minh City, Vietnam.
      <SUP>5</SUP> Pediatric Hospital Number Two, 14 Ly Tu Trang, Ho Chi Minh City, Vietnam.
      Correspondence should be addressed to Menno D de Jong dejongmd@gmail.com
      <TABLE cellSpacing=0 cellPadding=0 width=450 border=0 xmlns=""><TBODY><TR><TD height=20></TD></TR><TR><TD height=1></TD></TR><TR><TD height=20></TD></TR></TBODY></TABLE>Avian influenza A (H5N1) viruses cause severe disease in humans<SUP>1, </SUP><SUP>2</SUP>, but the basis for their virulence remains unclear. In vitro and animal studies indicate that high and disseminated viral replication is important for disease pathogenesis<SUP>3, </SUP><SUP>4, </SUP><SUP>5</SUP>. Laboratory experiments suggest that virus-induced cytokine dysregulation may contribute to disease severity<SUP>6, </SUP><SUP>7, </SUP><SUP>8, </SUP><SUP>9</SUP>. To assess the relevance of these findings for human disease, we performed virological and immunological studies in 18 individuals with H5N1 and 8 individuals infected with human influenza virus subtypes. Influenza H5N1 infection in humans is characterized by high pharyngeal virus loads and frequent detection of viral RNA in rectum and blood. Viral RNA in blood was present only in fatal H5N1 cases and was associated with higher pharyngeal viral loads. We observed low peripheral blood T-lymphocyte counts and high chemokine and cytokine levels in H5N1-infected individuals, particularly in those who died, and these correlated with pharyngeal viral loads. Genetic characterization of H5N1 viruses revealed mutations in the viral polymerase complex associated with mammalian adaptation and virulence. Our observations indicate that high viral load, and the resulting intense inflammatory responses, are central to influenza H5N1 pathogenesis. The focus of clinical management should be on preventing this intense cytokine response, by early diagnosis and effective antiviral treatment.

      <TABLE cellSpacing=0 cellPadding=0 width=450 border=0 xmlns=""><TBODY><TR><TD height=20></TD></TR><TR><TD height=1></TD></TR><TR><TD height=20></TD></TR></TBODY></TABLE>
      <!-- generated by Nature-branded standard table template -->MORE ARTICLES LIKE THIS

      These links to content published by NPG are automatically generated.
      RESEARCH

      Fatal outcome of human influenza A (H5N1) is associated with high viral load and hypercytokinemia Nature Medicine Letter
      Experimental Infection of Human Volunteers with Equine Influenza Virus Nature Article (03 Apr 1965)
      Genesis of a highly pathogenic and potentially pandemic H5N1 influenza virus in eastern Asia Nature Letters to Editor (08 Jul 2004)
      See all 22 matches for Research

      </TD></TR></TBODY></TABLE>
      Please do not ask me for medical advice, I am not a medical doctor.

      Avatar is a painting by Alan Pollack, titled, "Plague". I'm sure it was an accident that the plague girl happened to look almost like my twin.
      Thank you,
      Shannon Bennett

      Comment


      • #78
        Re: Pakistan: December 18+, WHO Begins Investigations



        <TABLE class=content_box_outer_table align=right><TBODY><TR><TD><!-- beginning of inner table --><TABLE class=content_box_inner_table><!-- citation --><TBODY><TR><TD class=content_box_title_highlight colSpan=2>This Article</TD></TR><TR><TD class=content_box_space_between_sections colSpan=2></TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>Full Text </TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>Full Text (PDF) </TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>Other Versions of this Article:
        JVI.01134-07v1
        81/22/12439 most recent
        </TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>Alert me when this article is cited </TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>Alert me if a correction is posted </TD></TR><TR><TD class=content_box_space_between_sections colSpan=2></TD></TR><TR><TD class=content_box_title colSpan=2>Services</TD></TR><TR><TD class=content_box_space_between_sections colSpan=2></TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>Similar articles in this journal </TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>Similar articles in PubMed </TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>Alert me to new issues of the journal </TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>Download to citation manager </TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>Copyright Information </TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>Books from ASM Press </TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>MicrobeWorld </TD></TR><TR><TD class=content_box_space_between_sections colSpan=2></TD></TR><TR><TD class=content_box_title colSpan=2>Google Scholar</TD></TR><TR><TD class=content_box_space_between_sections colSpan=2></TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>Articles by Zeng, H. </TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>Articles by Katz, J. M. </TD></TR><TR><TD class=content_box_space_between_sections colSpan=2></TD></TR><TR><TD class=content_box_title colSpan=2>PubMed</TD></TR><TR><TD class=content_box_space_between_sections colSpan=2></TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>PubMed Citation </TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>Articles by Zeng, H. </TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>Articles by Katz, J. M. </TD></TR><TR><TD class=content_box_arrow vAlign=top width=4></TD><TD class=content_box_item>Pubmed/NCBI databases <TABLE class=content_box_inner_table style="FONT-SIZE: 100%" summary="Entrez Links for this Article"><TBODY style="FONT-SIZE: 100%"><TR style="FONT-SIZE: 100%"><TD style="FONT-SIZE: 100%; WHITE-SPACE: nowrap" colSpan=2>Substance via MeSH</TD></TR><TR style="FONT-SIZE: 100%"><TH style="FONT-SIZE: 100%; TEXT-ALIGN: left" colSpan=2>Medline Plus Health Information</TH></TR><TR style="FONT-SIZE: 100%"><TD style="FONT-SIZE: 100%; WHITE-SPACE: nowrap" colSpan=2>Bird Flu</TD></TR><TR style="FONT-SIZE: 100%"><TD style="FONT-SIZE: 100%; WHITE-SPACE: nowrap" colSpan=2>Flu</TD></TR></TBODY></TABLE></TD></TR></TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE>Journal of Virology, November 2007, p. 12439-12449, Vol. 81, No. 22
        0022-538X/07/$08.00+0 doi:10.1128/JVI.01134-07
        Copyright ? 2007, American Society for Microbiology. All Rights Reserved.

        Highly Pathogenic Avian Influenza H5N1 Viruses Elicit an Attenuated Type I Interferon Response in Polarized Human Bronchial Epithelial Cells<SUP></SUP>

        Hui Zeng,<SUP>1</SUP> Cynthia Goldsmith,<SUP>2</SUP> Pranee Thawatsupha,<SUP>3</SUP> Malinee Chittaganpitch,<SUP>3</SUP> Sunthareeya Waicharoen,<SUP>3</SUP> Sherif Zaki,<SUP>2</SUP> Terrence M. Tumpey,<SUP>1</SUP> and Jacqueline M. Katz<SUP>1</SUP><SUP>*</SUP>

        Immunology and Pathogenesis Branch, Influenza Division, National Center for Immunization and Respiratory Diseases,<SUP>1</SUP> Infectious Disease Pathology Branch, Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333,<SUP>2</SUP> Thai National Influenza Center, National Institute of Health, Ministry of Public Health, Bangkok 11000, Thailand<SUP>3</SUP>
        Received 24 May 2007/ Accepted 29 August 2007
        <!-- ABS -->The unparalleled spread of highly pathogenic avian influenza<SUP> </SUP>A (HPAI) H5N1 viruses has resulted in devastating outbreaks<SUP> </SUP>in domestic poultry and sporadic human infections with a high<SUP> </SUP>fatality rate. To better understand the mechanism(s) of H5N1<SUP> </SUP>virus pathogenesis and host responses in humans, we utilized<SUP> </SUP>a polarized human bronchial epithelial cell model that expresses<SUP> </SUP>both avian alpha-2,3- and human alpha-2,6-linked sialic acid<SUP> </SUP>receptors on the apical surface and supports productive replication<SUP> </SUP>of both H5N1 and H3N2 viruses. Using this model, we compared<SUP> </SUP>the abilities of selected 2004 HPAI H5N1 viruses isolated from<SUP> </SUP>humans and a recent human H3N2 virus to trigger the type I interferon<SUP> </SUP>(IFN) response. H5N1 viruses elicited significantly less IFN<SUP> </SUP>regulatory factor 3 (IRF3) nuclear translocation, as well as<SUP> </SUP>delayed and reduced production of IFN-? compared with<SUP> </SUP>the H3N2 virus. Furthermore, phosphorylation of Stat2 and induction<SUP> </SUP>of IFN-stimulated genes (ISGs), such as MX1, ISG15, IRF7, and<SUP> </SUP>retinoic acid-inducible gene I, were substantially delayed and<SUP> </SUP>reduced in cells infected with H5N1 viruses. We also observed<SUP> </SUP>that the highly virulent H5N1 virus replicated more efficiently<SUP> </SUP>and induced a weaker IFN response than the H5N1 virus that exhibited<SUP> </SUP>low virulence in mammals in an earlier study. Our data suggest<SUP> </SUP>that the H5N1 viruses tested, especially the virus with the<SUP> </SUP>high-pathogenicity phenotype, possess greater capability to<SUP> </SUP>attenuate the type I IFN response than the human H3N2 virus.<SUP> </SUP>The attenuation of this critical host innate immune defense<SUP> </SUP>may contribute to the virulence of H5N1 viruses observed in<SUP> </SUP>humans.<SUP> </SUP>
        <HR align=left width="50%"><!-- null -->* Corresponding author. Mailing address: Centers for Disease Control and Prevention, 1600 Clifton Road, MS G16, Atlanta, GA 30333. Phone: (404) 639-4966. Fax: (404) 639-2350. E-mail: jmk9@cdc.gov<SCRIPT type=text/javascript><!-- var u = "jmk9", d = "cdc.gov"; document.getElementById("em0").innerHTML = '<a href="mailto:' + u + '@' + d + '">' + u + '@' + d + '<\/a>'//--></SCRIPT>


        <!-- FN --><!-- null --><SUP></SUP> Published ahead of print on 12 September 2007.<SUP> </SUP>
        <HR>Journal of Virology, November 2007, p. 12439-12449, Vol. 81, No. 22
        0022-538X/07/$08.00+0 doi:10.1128/JVI.01134-07
        Copyright ? 2007, American Society for Microbiology. All Rights Reserved.
        Please do not ask me for medical advice, I am not a medical doctor.

        Avatar is a painting by Alan Pollack, titled, "Plague". I'm sure it was an accident that the plague girl happened to look almost like my twin.
        Thank you,
        Shannon Bennett

        Comment


        • #79
          Re: Pakistan: December 18+, WHO Begins Investigations

          This does not look as promising for reducing the incidence of fatal outcomes with lower viral loading.



          doi:10.1016/j.clim.2005.11.004
          Copyright ? 2005 Elsevier Inc. All rights reserved.
          The immune system provides a strong response to even a low exposure to virus

          Timothy J. Powell<SUP></SUP><SUP>, </SUP><SUP></SUP>, David W. Dwyer, Tammy Morgan, Joseph A. Hollenbaugh and Richard W. Dutton<SUP></SUP><SUP>, </SUP><SUP></SUP>
          Trudeau Institute, 154 Algonquin Avenue, Saranac Lake, NY 12983, USA
          Received 6 May 2005; accepted 8 November 2005. Available online 4 January 2006.


          Abstract

          How influenza virus dose affects the size of the immune response has not been clearly documented. Mice were challenged with three doses of influenza virus spanning a 100-fold range. Increasing the viral input dose increased the degree of weight loss observed, the clinical score and eventual mortality. Maximum viral loads increased with viral input and lower doses peaked and declined earlier. The level of the immune response only varied 2-fold and was independent of viral dose with near maximal responses elicited by the lowest dose, as measured by influx of antigen-specific and non-specific leukocytes into the lungs and by influenza antibody titers. We conclude that a strong immune response is mounted to a small dose of virus and curbs the spread of virus early and prevents weight loss whereas larger doses of virus elicit a slightly greater response but the associated disease can overwhelm the host.




          Keywords: Virus infection; T lymphocytes; Cellular activation; In vivo response Abbreviations: Tc1/2, CD8<SUP>+</SUP> effector T cell type 1/2; APC, antigen presenting cells
          Please do not ask me for medical advice, I am not a medical doctor.

          Avatar is a painting by Alan Pollack, titled, "Plague". I'm sure it was an accident that the plague girl happened to look almost like my twin.
          Thank you,
          Shannon Bennett

          Comment


          • #80
            Re: Pakistan: December 18+, WHO Begins Investigations

            From Post #73
            Hartl said no new cases have been discovered, but increased awareness has led to more people with flu?like symptoms being checked.
            Does this indicate more than usual mixing of patients with seasonal influenza in the same hospital with avian influenza?
            JT
            Thought has a dual purpose in ethics: to affirm life, and to lead from ethical impulses to a rational course of action - Teaching Reverence for Life -Albert Schweitzer. JT

            Comment


            • #81
              Re: Pakistan: December 18+, WHO Begins Investigations

              Originally posted by Thornton View Post
              From Post #73

              Does this indicate more than usual mixing of patients with seasonal influenza in the same hospital with avian influenza?
              JT
              Yes, it means that the results for the new patients are not confirmed, so they are not new confirmed cases.

              Comment


              • #82
                Re: Pakistan: December 18+, WHO Begins Investigations

                No threat of bird flu outbreak in Sindh
                KARACHI (December 20 2007): Director, poultry production and provincial co-ordinator Avian influenza Sindh has said that there is no confirmed outbreak of H5NI in any kind of poultry in the province.

                In a statement on Wednesday, the director stated that in the current situation of bird flu threat in Pakistan surveillance (Disease Analysis through Sample Collection) is in progress in Sindh for which seven teams are working in all districts of province besides awareness campaigns regarding person protection and vaccination in poultry is taking place in every district.

                He further stated that all poultry concerned offices of department have been asked to arrange discussions and convene meetings at each poultry office to update the people of the current situation and of the preventive measures.
                http://www.brecorder.com/./index.php...&term=&supDate=
                CSI:WORLD http://swineflumagazine.blogspot.com/

                treyfish2004@yahoo.com

                Comment


                • #83
                  Re: Pakistan: December 18+, WHO Begins Investigations

                  Originally posted by Thornton View Post
                  From Post #73

                  Does this indicate more than usual mixing of patients with seasonal influenza in the same hospital with avian influenza?
                  JT
                  I think there are more suspect cases, but none will be confirmed until the NAMRU-3 mobile labs gets going and confirms the earlier cases as well as newer suspect cases. However, my guess is that there are also weak positives, which may be missed by the mobile lab, which is probably not as fine tuned as the lab in Cairo.

                  Comment


                  • #84
                    Re: Pakistan: December 18+, WHO Begins Investigations

                    Dr. Niman,

                    I have been following your commentaries on your site for two years now, and I know that you post many commentaries that relate specifically to the role of recombination in H5N1 evolution. However, the events in Pakistan appear, in your most recent commentaries, without statements about whether they prove your ideas about recombination. For that, very many people are grateful for your ability to focus on the danger to everyone regardless of how the danger evolves.

                    You recently posted: "Local confirmation of the initial lab positives was projected to be completed yesterday, and disease onset dates for the cluster members should have been known for some time. This information is usually released in WHO situation updates, which give the age and gender of confirmed cases, as well as disease onset dates, hospitalization dates, and dates of death as well as relationships between cluster members.

                    Virtually all of the data has not been released even though the outbreak began almost 2 months ago, and WHO has been aware of this cluster for at least a week."




                    Are you suggesting that the missing information described above is known and is intentionally being withheld by either the Pakistani Government or WHO? And if so, why do think they might be witholding this information?

                    Regards, Snicklefritz

                    Comment


                    • #85
                      Re: Pakistan: December 18+, WHO Begins Investigations

                      Commentary at

                      Comment


                      • #86
                        Re: Pakistan: December 18+, WHO Begins Investigations

                        Thank you, sir. That answers my questions very well.

                        Comment


                        • #87
                          Re: Pakistan: December 18+, WHO Begins Investigations

                          Originally posted by niman View Post
                          Commentary

                          More Suspect H5N1 Cases in Pakistan

                          Recombinomics Commentary
                          December 19, 2007

                          Five brothers were sickened last month in Abbotabad, north of Islamabad. Two died, one of whom was buried before tests were conducted. The other four tested positive for the virus. Up to six more people were suspected of being infected, including several who were in contact with poultry. WHO and the Health Ministry had initially said only four brothers were suspected of being infected, but one patient identified as a cousin was actually another brother.
                          The above comments describe additional suspect cases in Pakistan. The WHO update with disease onset dates of confirmed cases has not been released, which may be related to the start of confirmatory testing by the NAMRU-3 mobile lab, which may not be set up until tomorrow.

                          Earlier reports suggested new suspect cases were being called in, and confirmation of these cases, as well as the cases described in media reports may be delayed until the lab is functional.

                          Among these cases are one or two health care workers described earlier. If they are confirmed positives, the transmission chain will be extended. Similarly, additional positives linked to poultry culling would provide more data supporting more efficient transmission from poultry to people.

                          Confirmation of the cases, as well as disease onset dates and sequence data, would be useful.


                          .
                          Last edited by Niko; December 20, 2007, 01:39 AM. Reason: added quote box
                          "The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation

                          Comment


                          • #88
                            Re: Pakistan: December 18+, WHO Begins Investigations

                            AVIAN INFLUENZA, HUMAN (171): PAKISTAN
                            **************************************
                            A ProMED-mail post
                            <http://www.promedmail.org>
                            ProMED-mail is a program of the
                            International Society for Infectious Diseases
                            <http://www.isid.org>

                            Date: Wed 19 Dec 2007
                            Source: Associated Press (AP) report [edited]
                            <http://malaysia.news.yahoo.com/ap/20071219/tap-as-gen-pakistan-bird-flu-2nd-ld-
                            writ-d3b07b8.html
                            >


                            A 2nd team of health experts were on their way to Pakistan on Wed 19 Dec
                            2007 to analyze samples from suspected bird flu cases to determine how the
                            virus spread and whether human-to-human transmission may have occurred. The
                            experts from the United States Naval Medical Research Unit No. 3 in Cairo,
                            scheduled to arrive Thu 20 Dec 2007, were expected to retest samples
                            already gathered from a number of patients who were positive for the H5N1
                            bird flu virus in initial government analysis. Once the cases are
                            confirmed, work will begin to piece together how the victims became
                            infected. Orya Maqbool Jan Abbasi, spokesman for Pakistan's health
                            ministry, said earlier the team had arrived on Wed 19 Dec 2007, but World
                            Health Organization (WHO) spokesman Gregory Hartl in Geneva said they were
                            due a day later.

                            Five brothers became unwell last month [November 2007] in Abbotabad, north
                            of Islamabad. Two died, one of whom was buried before tests were conducted.
                            The other 4 tested positive for the virus. Up to 6 more people were
                            suspected of being infected, including several who were in contact with
                            poultry. WHO and the health ministry had initially said only 4 brothers
                            were suspected of being infected, but one patient identified as a cousin
                            was actually another brother. Outbreaks were reported among birds
                            [poultry?] in the area before the human cases. However, Abassi stressed
                            that there have been no new reports of bird flu in poultry or people.

                            On Tue 18 Dec 2007, a separate WHO team visited a hospital that treated
                            some of the patients in the north western city of Peshawar. They were
                            working with doctors and nurses on how to handle suspected cases and
                            improve infection control measures. "They want to go through the records in
                            the hospital for the last month or two to see if there's been any upsurge
                            in respiratory cases that weren't identified as H5N1 but which could
                            actually be [cases]," said Gregory Hartl, a WHO spokesman in Geneva. The
                            team will look to see which patients could have been exposed to the virus
                            by infected birds and also whether human-to-human transmission could have
                            occurred.

                            One of the brothers who survived said he was hospitalized with flu symptoms
                            after slaughtering chickens suspected of carrying bird flu without wearing
                            protective clothing last month [November 2007]. His brothers who died
                            visited him in a hospital, he said.

                            Hartl said no new cases have been discovered, but increased awareness has
                            led to more people with flu-like symptoms being checked. "What this is
                            showing is that they're taking everything very, very seriously," Hartl
                            said. "Surveillance has been enhanced, more people are reporting cases and
                            more people have been sensitized on the heath care worker side of the need
                            to notice."

                            At least 209 people have died worldwide from the virus, which began
                            plaguing Asian poultry stocks in late 2003, according to the WHO. It
                            remains hard for people to catch, but scientists worry it could mutate into
                            a form that spreads easily among people, potentially sparking a pandemic.

                            [byline: Margie Mason]

                            --
                            communicated by:
                            Christian Griot <Christian.Griot@ivi.admin.ch>

                            [This is another variation on the same theme, which begins with
                            contradicting statements about the date of arrival of a 2nd WHO team.
                            Nonetheless, there is now greater hope of clarification of the situation in
                            the near future.

                            The 4 brothers at the centre of the outbreak have become 5, and all but one
                            of the 2 deceased brothers tested positive for H5N1. One other case
                            previously identified as a cousin has been identified as a 5th brother, but
                            there is no mention of another brother previously reported to have tested
                            H5N1 negative on return to the USA.

                            The relationships of another 6 suspected cases are not stated. - Mod.CP]

                            [see also:
                            Avian influenza, human (169): Pakistan 20071218.4072
                            Avian influenza, human (168): Pakistan 20071217.4059
                            Avian influenza, human (167): Pakistan 20071216.4049
                            Avian influenza, human (166): Pakistan, WHO 20071215.4038
                            Avian influenza, human (165): Pakistan 20071214.4023
                            Avian influenza, human (163): Pakistan 1st report 20071213.4008]

                            ....................cp/msp/sh

                            Comment


                            • #89
                              Re: Pakistan: December 18+, WHO Begins Investigations

                              Pakistan urges safer culling after bird flu outbreak

                              By Alistair Scrutton

                              ISLAMABAD (Reuters) - Pakistan is urging provincial authorities to obey health guidelines to stop any bird flu outbreaks after fears lapses in poultry culling methods led to eight people being infected with the H5N1 virus.

                              The Health Ministry is sending out messages via radio and pamphlets to villages and farms in North West Frontier Province, where the eight people, including a veterinarian involved in culling, were infected in South Asia's first human cases.

                              The vet's brother died of bird flu. A third brother also died but it is unclear if he was also infected with the virus.

                              "These winter months are critical," Federal Health Secretary Khushnood Akhtar Lashari told Reuters on Thursday.

                              "We are asking provincial authorities to adhere to safely guidelines, but it is quite difficult because many of these places are in remote areas and many people have the attitude that 'it can't happen to me'."

                              Authorities now believe there is no threat of a pandemic from the bird flu cases in Pakistan as World Health Organisation experts carried out tests in the region.

                              But the H5N1 thrives best in winter months in part because people spend more time indoors and in close proximity to each other and their livestock. Lashari said the man believed to have been infected first, a veterinarian who helped operations to cull chickens and who has now recovered, might have not worn a mask because he suffered from asthma.

                              He might also have taken his culling equipment back home with him. While he recovered, his two brothers died.

                              Six people have since recovered, while the remaining case is still being treated, the Health Ministry says.

                              The case highlights the difficulty of health control in Pakistan, where the health system is weak, particularly in the countryside. Many villagers are also illiterate, making communications harder.

                              In the Pakistan cases, the WHO said they were likely to be a combination of infections from poultry and limited human-to-human transmission of the H5N1 avian flu virus due to close contact.

                              The WHO says a similar case occurred in Indonesia in 2006 among family members believed to have contracted the virus while caring for sick loved ones.

                              A WHO report on Pakistan is due in the coming days.

                              The H5N1 virus is hard for humans to catch and is mainly a bird disease. But experts fear the strain could spark a global pandemic and kill millions if it mutates into a form that spreads easily between people.

                              A WHO team, led by Hassan El-Bushra of its regional Cairo office, have been in Pakistan this week helping investigate the outbreak.

                              Since H5N1 resurfaced in Asia in late 2003, the virus has killed 209 people in 11 countries, according to the WHO. The latest Pakistan cases have yet to be included in the formal WHO tally.

                              (Editing by Robert Birsel)
                              "The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation

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                              • #90
                                Re: Pakistan: December 18+, WHO Begins Investigations

                                RPT-INTERVIEW-Mixed scenario seen behind Pakistan birdflu spread

                                Wed Dec 19, 2007 2:53am EST

                                (Refiles to add dropped word in lead)
                                By Stephanie Nebehay

                                GENEVA, Dec 18 (Reuters) - The eight suspect human bird flu cases in Pakistan are likely a combination of infections from poultry and limited person to person transmission due to close contact, a top World Health Organisation expert said on Tuesday.

                                Keiji Fukuda, coordinator of WHO's global influenza programme, said while unconfirmed, any human to human spread seemed similar to previous outbreaks in Thailand and Indonesia
                                -- affecting close family members caring for sick loved ones. -- affecting close family members caring for sick loved ones.
                                There was no immediate cause for alarm and the United Nations agency was not raising its level of pandemic alert for the time being, he said, adding it was very reassuring that "we are not seeing large increases in the number of cases".

                                "Right now it doesn't look like pure human to human transmission. It looks like the veterinarian, who was the index case, and a number of other suspect cases had poultry exposure," Fukuda told Reuters in an interview.

                                "It is definitely possible that we have a mixed scenario where we have poultry to human infection and possible human to human transmission within a family, which is not yet verified." But human to human transmission "would not be particularly surprising or unprecedented," he added.

                                Eight people have tested positive for the H5N1 bird flu virus in North West Frontier Province since late October, and one of the confirmed cases has died. A brother of the dead man also died, but was never tested, so is not counted among them.

                                H5N1 is mainly an animal disease, but experts fear it could mutate into a form that could spread easily between people, causing a pandemic which could kill millions of people.

                                In Thailand, a mother was killed by the virus in 2004 after cradling her dying infected daughter all night. The largest known cluster of human bird flu cases worldwide occurred in May 2006 in Indonesia's North Sumatra province, where as many as seven people in an extended family died.

                                Three WHO experts, led by Hassan El-Bushra of its regional Cairo office, is in Pakistan helping investigate the outbreak.

                                The "index" case, who recovered, is a veterinarian who helped with culling operations and it is his two brothers who died after taking care of the ill man, according to Fukuda.

                                "This type of close contact we know can result in human to human transmission sometimes," he said.

                                "Right now, based on the information we have, the investigation going on and the feedback from the field team, we don't have anything pointing to push the alarm bells or increase the (pandemic alert) phase," he added.

                                The WHO uses a series of six phases of pandemic alert to gauge the level of threat. The world is currently in phase 3, a new influenza virus subtype is causing disease in humans, but is not yet spreading efficiently and sustainably among humans.

                                "In terms of public health implications, we are looking for human to human transmission where casual contact can lead to infections and allow big outbreaks in communities," Fukuda said.

                                A team from the U.S. Naval Medical Research Unit NAMRU-3 laboratory in Cairo was expected in Pakistan on Wednesday to carry out further tests on the samples from the suspect cases.

                                (Editing by Sami Aboudi)
                                ((stephanie.nebehay@reuters.com; tel.: +41 22 733 38 31; Reuters Messaging: stephanie.nebehay.reuters.com@reuters.net)) Keywords: BIRDFLU PAKISTAN/WHO

                                Last edited by Niko; December 20, 2007, 10:07 AM. Reason: format

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