Helen Branswell Latest Article May 2006

[Snowy Owl]

<!-- story starts here--> <table border="0" cellpadding="0" cellspacing="0" width="411"> <tbody><tr> <td valign="top" width="271">[SIZE=+2]Grounding air travel won't substantially slow spread of pandemic flu: study
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http://travel.canoe.ca/Travel/News/2006/05/01/1559648-cp.html

By Helen Branswell

[/SIZE]TORONTO (CP) - World leaders could face serious pressure to impose travel bans on affected nations in the early days of a flu pandemic. But even grounding virtually all air travel would only serve to moderately delay spread of a pandemic strain, a new study suggests.

Using mathematical models, researchers with Britain's Health Protection Agency concluded that even if 99.9 per cent of air travel could be halted, a pandemic strain would be delayed from hitting most cities by, at most, about four months.


"Even large and widely enforced travel restrictions would usually delay epidemic peaks by only a few days," the authors wrote in the journal Public Library of Science Medicine. "To have a major impact, restrictions would have to be almost total and almost instantaneous."


A leading U.S. modelling expert said the findings confirm work he and other groups have shown - that flu cannot be contained this way.


"It spreads so fast and the epidemics are so explosive that (in spite of) almost anything you do, cases are going to get through unless you're incredibly - unrealistically - effective at . . . shutting down transportation," said Ira Longini of the School of Public Health and Community Medicine at the University of Washington.
"It's just not a practical control strategy. It just buys you a few weeks at best." And that's not enough time to make a real difference. It wouldn't be sufficient time, for instance, for the few countries with flu vaccine production capacity to protect their citizenry by making and widely administering a vaccine.


"Even when 99.9 per cent of air traffic was suspended, most cities had a low probability of ultimately escaping the pandemic and delays large enough to be of clinical significance (six months or more) were common only if interventions were made after the first few cases," wrote the authors, who are with the British agency's Centre for Infections.
The study was not commenting on the likelihood of success of the World Health Organization's plan to try to contain a pandemic at source.


That plan, supported by mathematical models, hypothesizes that it might be possible to extinguish an nascent pandemic strain in the very early days if movement out of the area where it emerged was cut off and if people within the area were given antiviral drugs to prevent spread of flu.
In fact, the authors of this study suggest focusing resources on that containment effort would probably be more valuable than drawing up plans to ban air travel once a pandemic has started.


Grounding all international air travel would create huge problems for the transport of essential goods and would decimate an already fragile industry.
The director of immunization and respiratory infections for the Public Health Agency of Canada said this study, along with two other recent modelling efforts, reinforces the belief of experts that grounding planes isn't an appropriate response.


"Shutting down plane travel is unlikely to be effective or sustainable because of the way influenza behaves," said Dr. Theresa Tam. Some diseases lend themselves to containment using travel restrictions - something like SARS, for instance, where only people showing symptoms were infectious and there was a long incubation period that allowed authorities to monitor people who'd been exposed.


But influenza is not one of them. Flu has a short incubation period, typically one to four days. And people who are incubating the disease can spread it before realizing they are sick.


The authors conclude that attempting to screen incoming air travellers for disease once a pandemic has started would also be a wasted effort, saying "such an intervention would have a negligible impact on the course of a pandemic once it was underway."


They suggested that rather than working on strategies to restrict travel in the early phases of a pandemic, public health authorities should focus their efforts on planning ways to slow spread within a community once a pandemic strain has arrived. School closures are considered one possible way to slow spread.

 

[KC]

Re: Helen Branswell Latest Article May 2006

Using mathematical models, researchers with Britain's Health Protection Agency concluded that even if 99.9 per cent of air travel could be halted, a pandemic strain would be delayed from hitting most cities by, at most, about four months.

A four month delay could save millions of people by allowing them time to prepare.

 

[Snowy Owl]

Re: Helen Branswell Latest Article May 2006

A four month delay could save millions of people by allowing them time to prepare.

Consequent conclusion Lob

But I wonder, UK is insulary, so much dependant on the Mainland of Europe or of former colonies or Dominions.

Four months cut off from importations, th esocial and intra-muros economical consequences...would it not bring down the Health status of their citizens, of their society, or their social flegmatism ??

Considering that would it not be wisier for UK to let their border opened ???

I have not the expertise to do the math of this, but it makes me wonder.

Despite I would like to see the arguments of UK, I sincerely doubt that the same model should be applied in North America.

But then again I certainly would like to have some figures, not done by lobby or political agendas, but with the cold light of reason.

JMO

 

[KC]

Re: Helen Branswell Latest Article May 2006

Thanks SnowyOwl.... I did not consider it using another countries perspective.

 

[GaudiaRay]

Re: Helen Branswell Latest Article May 2006

Longini proves himself to be unbelievable.

Everyone here remember what Longini wrote about...the Tamiflu blankets that he urged be enacted in Asia, at the outbreak site, and how important it or they would be?

Remember that tripe?

Well now, we have Mr. Forked Tongue Longini speaking out of the other side of his mouth. He's now a bootlick over this new report. Longini loves computer models. He has not a single shred of integrity.

Lesson: When Longini starts tomorrow to pipe off about what is what, remember who he is intellectually. He's meaningless and distractive. Another example of why we humans in the first world country, the USA, are going to get screwed.

Here's his latest, from above: >
"It spreads so fast and the epidemics are so explosive that (in spite of) almost anything you do, cases are going to get through unless you're incredibly - unrealistically - effective at . . . shutting down transportation," said Ira Longini of the School of Public Health and Community Medicine at the University of Washington.

"It's just not a practical control strategy. It just buys you a few weeks at best." And that's not enough time to make a real difference. It wouldn't be sufficient time, for instance, for the few countries with flu vaccine production capacity to protect their citizenry by making and widely administering a vaccine.

 

[AlaskaDenise]

Re: Helen Branswell Latest Article May 2006

A four month delay could save millions of people by allowing them time to prepare.

Ditto to that.

Also it would allow mass vaccination with regular flu VAX and the cross-reactive immunity might lessen the impact of pandemic infections.

Delays might allow for a "rolling pandemic" - which may be more manageable.

.

 

[KC]

Re: Helen Branswell Latest Article May 2006

Also it would allow mass vaccination with regular flu VAX and the cross-reactive immunity might lessen the impact of pandemic infections.

Delays might allow for a "rolling pandemic" - which may be more manageable.

.

I didn't say that exactly. Hopefully, H5N1 will be addressed in future seasonal vaccinations and in looking at emerging non-traditional research and disease findings.

Two places, a research firm in San Diego and St. Judes (A non-profit research hospital) are coming up with some similiar ideas.

Good for them for thinking outside the box.

 

[Snowy Owl]

Re: Helen Branswell Latest Article May 2006

Too few funds earmarked for Africa, Middle East to fight H5N1: UN flu czar
By HELEN BRANSWELL
http://cnews.canoe.ca/CNEWS/World/2006/05/07/1568712-cp.html

TORONTO (CP) - There are major gaps in the distribution of international funding intended to combat the dangerous H5N1 avian flu virus, with little cash earmarked to help African and Middle Eastern countries, the UN's avian and pandemic flu czar says.

As well, the United Nations and UN agencies have too few funds to meet increasing demands as they spearhead twin efforts of trying to stop the spread of the H5N1 virus in poultry and help the world prepare for the next human flu pandemic, Dr. David Nabarro says.
"No part of the UN system has got anything like enough money for the work it's trying to do," Nabarro said in an interview with The Canadian Press.

"And frankly, the resources for African nations and the resources for Middle Eastern nations are really very, very slight."
Leading donor countries are expected to take stock of the funding gaps at a meeting of senior officials of the international partnership for avian and pandemic influenza in Vienna in early June.

Current analysis shows the bulk of the cash, loans and offers of technical assistance pledged for H5N1 containment at a landmark meeting in Beijing in mid-January was set aside for East Asia, which has borne the brunt of H5N1's assault since the current wave of outbreaks was ignited in late 2003.

In the wake of the Beijing meeting, H5N1 virus has been discovered in a succession of about 35 central Asian, Middle Eastern, European and African countries. And in that time, Iraq, Azerbaijan and Egypt have joined the list of countries - now numbering nine - which have experienced human cases.

About a dozen of the countries that have recorded the presence of the virus since the Beijing meeting are in Africa or the Middle East.
Nearly $1.9 billion US was pledged in Beijing. But in most cases, donors named a country or countries to which they intended to funnel their assistance, often even specifying which activity - improving laboratory capacity for instance - their monies would finance.
As a consequence, co-ordinators have had little leeway when H5N1 has struck countries such as Nigeria, Niger and Sudan.

"Analysis of the pledges made in Beijing during January reveals that there is only a few million dollars of unrestricted funding available as grants to African, Middle Eastern and Latin American countries should they need urgent assistance (including rapid availability of funds for compensation) without the encumbrance of additional loans," an assessment from Nabarro's office reveals.

The same review shows the Beijing meeting set aside for UN and UN agency operations much less than half of what the organization requested to finance its myriad efforts. They include preparing the UN system to respond in a pandemic, giving countries technical assistance for pandemic planning, and providing hands-on help combatting outbreaks in poultry and people in affected countries.

"Our preliminary estimate is that to provide all those services through the UN system and through other sources - though the UN will have to co-ordinate them - is not cheap," says Nabarro, who is the UN system's influenza co-ordinator.

"Certainly it's going to cost more than the amount of money we've currently got at our disposal."

He estimates the UN system is currently spending between $5 million and $10 mllion a month on work related to avian influenza and pandemic preparedness.

"I suspect that the amounts of money that we ought to be spending are considerably more than that, when you look at the fact that there are nearly 50 countries with H5N1," he says.

Despite the gaps, Nabarro is heartened by the way H5N1 containment and pandemic preparedness efforts have been gathering momentum in recent months.

"In general, I see enormous goodness happening and good progress. And political engagement is strong."

While he says he encounters little skepticism about the need to do this work, Nabarro has developed a response for the occasional disbelievers who argue that H5N1's failure to trigger a pandemic to date is proof it may never do so.

"I look at them in the eye and I just say: 'Thank you. I hope you can go on saying that to me. I hope you can ridicule me in that way for ages. Because I don't want it ever to happen.' "

​

 

[Snowy Owl]

Re: Helen Branswell Latest Article May 2006

Priority urged for youth in pandemic

Top ethicist suggests 'life-cycle' principle approach for vaccines


By Helen Branswell
The Canadian Press
TORONTO (May 12, 2006) A leading American ethicist says government plans that place seniors and healthy adults above children on the priority list for pandemic vaccine miss the mark.
Dr. Ezekiel Emanuel argues that children ought to move much higher up the vaccination priority lists of countries such as Canada and the United States.
"That goes to an intuition that we all have, which is (that) kids and young adults have just gotten to the stage of living their lives. They have their future before them. They're who you want to save," Emanuel, chief of the department of clinical bioethics at the U.S. National Institutes of Health, said in an interview.
"Certainly if you asked me, if I got the vaccine or you'd give it to one of my daughters, I would say clearly: 'Give it to one of my daughters.' And I think most people's intuition is like that."
In a commentary published today in the journal Science, Emanuel and co-author Alan Wertheimer argue that the preliminary prioritization done by U.S. pandemic planners -- Canada's planning is quite similar -- places undue emphasis on saving as many lives as possible, whether the individual is 20 or 65 years old.
Rather than employing a "save the most lives" approach, the authors argue the countries ought to consider what they call a "life-cycle principle" approach. Others call it a "fair innings" model -- the notion that if faced with a choice between improving the survival chances of someone who has already lived through the various cycles of life or someone who is just beginning that process, it is more intrinsically fair to give higher priority to the younger person.


"The 20-year-old has about 60 years to live and the 65-year- old has about 15 years to live," Emanuel argued.
But preliminary priority lists drawn up by both countries place children towards, if not at the back of the queue for vaccine, using the rationale that while influenza provokes high rates of illness among children, children are less likely than older people to die when they experience a bout of flu.
Officials insist these lists are for planning purposes and are starting points for public debate. Final decisions, they say, would only be made when a pandemic begins and it is clear which age groups seem to be at greatest risk of dying.
"It depends on what the strain is that emerges," said Dr. Arlene King, director general of pandemic preparedness for the Public Health Agency of Canada.

http://www.hamiltonspectator.com/NA...3&call_pageid=1020420665036&col=1112101662670

 

[Snowy Owl]

Re: Helen Branswell Latest Article May 2006

Agricultural vaccine capacity could be tapped to fill pandemic shortfall: WHO
By HELEN BRANSWELL
http://cnews.canoe.ca/CNEWS/Canada/2006/05/14/1579883-cp.html

<table border="0" cellpadding="0" cellspacing="0" width="631"><tbody><tr bgcolor="white"><td valign="top" width="463"><table border="0" cellpadding="0" cellspacing="0" width="463"><tbody><tr><td valign="top" width="463"> TORONTO (CP) - Is what's good for the goose good for Mr. and Mrs. Gander? Public health authorities exploring the possibility of protecting people against an influenza pandemic with vaccine produced for poultry say "Maybe."


The World Health Organization and others are studying whether it would be possible to tap into the global agricultural vaccine production capacity to help bridge the enormous gap between the amount of human flu vaccine the world can produce and how much would be needed in a severe pandemic.


While the idea of giving people vaccine produced for poultry may seem, well, for the birds, the proposal - advanced by eager agricultural vaccine-makers - hasn't been dismissed out of hand.


"I think it's something that does merit consideration," says Dr. Jesse Goodman, director of the U.S. Food and Drug Administration's Center for Biologics Evaluation and Review. (Vaccines are considered biological products.)


Goodman and others would rather not have to resort to this option, hoping a pandemic is far enough off and new investment in novel production methods and facilities is sufficient to vastly expand output within the human influenza vaccine sector.


But given the current limited vaccine capacity, all sorts of options would have to be on the table if a harsh pandemic were to strike soon. And harnessing agriculture vaccine production is one of them, Goodman says.


"I would say our goal would be to keep an open mind about possible approaches in an emergency," he said in an interview from Washington.


"For a medium-to long-term approach, certainly enhancing the capacity and use of the human vaccines in my mind would be the first priority. . . . (But) in the short-term emergency point of view . . . I think it is wise to look at all possible approaches and alternatives."


Canada is unlikely to need to explore this option. The country has a long-term contract for pandemic vaccine to be made at a production facility located in Ste-Foy, Que.


But most other countries, including the United States, currently don't have enough domestic production capacity to be able to vaccinate their citizens during a flu pandemic - hence the outside-the-box exploration of options.


Experts say the agricultural vaccine sector's greatest potential for humans lies as a possible source of antigen (vaccine-ready virus) for live attenuated vaccines such as FluMist, the inhaled vaccine produced by MedImmune Inc., headquartered in Gaithersburg, Md.
That's because antigen used in live attenuated vaccines is not put through the investment-intensive purification and sterilization processes used in the manufacture of inactivated (killed virus) vaccine, the type contained in flu shots.


The production processes for live attenuated vaccine and agricultural vaccine are quite similar, says Dr. Klaus Stohr, the WHO's special adviser on influenza pandemic vaccine development. So are the criteria - known as good manufacturing practices - set down for production of agricultural and human flu vaccines.


"So theoretically - theoretically - it's conceivable that this antigen, and there's a lot of antigen produced by the agricultural vaccine makers, could with much less investment be transformed into live attenuated vaccines," Stohr says.


A MedImmune executive says the company doesn't yet know what to make of the idea, raised at a recent meeting in Geneva hosted by the WHO.


"We're just beginning to discuss this in MedImmune and we really haven't looked into it to be able to understand what that would mean," says Kathleen Coelingh, senior director of scientific affairs.
"We're not ruling anything in or anything out."


Goodman says companies which make inactivated flu vaccine might also be able increase their output by processing some antigen produced by agricultural vaccine makers.


But Stohr says human flu vaccine makers carefully match their antigen production to their capacity to purify, sterilize, bottle and label, suggesting these essential downstream steps create a bottleneck around which there is no easy or inexpensive route.


Dr. David Fedson, a retired vaccine industry executive, says there are hitches that may limit the ability to use antigen from agricultural sources to vastly increase the output of live attenuated vaccine as well.


FluMist, for instance, currently must be kept in a freezer until it is administered - a factor that might limit its usefulness in some parts of the world. As well, individual doses come pre-packaged in an inhaler, raising questions about whether adequate numbers of additional inhalers could be made and whether MedImmune or another company could expand capacity to package mass numbers of extra doses.


Modifying the delivery mechanism so that the vaccine is given in the form of nose drops could get around that potential bottleneck, Fedson says. (The Russians have been using live attenuated vaccine delivered this way for at least two decades.) But changing the vaccine would require regulatory approval.


Still, Stohr insists that with few options for rapidly and affordably increasing human flu vaccine production capacity, the notion of exploiting agricultural antigen sources is worth further study.


"There are so many things which we have seen may not work out quickly or will cost too much," he says.
"But here we have an option which has not been fully explored which has a good chance or which has a greater chance of success. And if it succeeds, it would make a profound contribution to the efforts to fill the pandemic vaccine gap."


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[Snowy Owl]

Re: Helen Branswell Latest Article May 2006

Family pets should be in pandemic strategies, experts say
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http://www.theglobeandmail.com/servlet/story/RTGAM.20060516.wxpets16/BNStory/National/home
​

HELEN BRANSWELL
Canadian Press

TORONTO<!-- /dateline --> ? A team of veterinary medicine researchers has an important message for public-health officials drawing up strategies for a possible flu pandemic or other emerging infectious diseases: Don't forget the family pet.
As a series of recent public-health crises have shown -- SARS, the monkeypox outbreak in the United States, the H5N1 avian flu virus -- companion animals can, on occasion, become infected and even transmit a host of disease agents, the researchers argue in a commentary to be published in next month's issue of the journal Emerging Infectious Diseases.


"The potential for household transmission through pets should be considered for any new disease where information is incomplete regarding potential hosts and the risk for interspecies transmission," sugges physicians Scott Weese and Stephen Kruth of the Ontario Veterinary College in Guelph.

With tens of millions of animals ensconced in North American households, outbreak planners would be well advised to address some key questions in advance, Dr. Weese and Dr. Kruth argue.

They include: When should pets be quarantined?
What type of animal-human contact should be allowed when a household is being quarantined? How should potentially contaminated pet feces be disposed of? How can sick animals be allowed to access veterinary care so as not to spread contagion to other animals in a veterinarian's clinic?

​

Dr. Weese, who specializes in zoonotic diseases (diseases that can pass from animals to humans) and veterinary infection control, said that he and colleagues had concerns about the possible role of pets during Toronto's SARS crisis, when thousands of people were asked to go into quarantine.

​

"We broached the subject a couple of times. The problem is, you can't address this during a crisis," he said, noting that human concerns pushed animal issues to the side.
​

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"Really, we should have mechanisms in place now so that if something new hits, we at least know who needs to be contacted to start looking at these things, to start coming up with some ideas. As opposed to having yet one more of 2,000 things that have to be done in the next day."

​

Ab Osterhaus, a Dutch virologist who has done extensive work studying the interspecies transmission characteristics of SARS and avian influenza, said working out some protocols makes sense.

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"Definitely we should . . . consider that under certain circumstances, indeed infections could spread from domestic animals to humans and vice-versa," Dr. Osterhaus said from Rotterdam, where he heads the virology department at the Erasmus Medical Centre.

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"You have to consider the whole system as basically an integral system, where humans are just part of it. And of course, we, living in our cities and far away from nature, don't realize that any more."​

 

[Snowy Owl]

Genetic link to bird flu cluster?

Genetic link to bird flu cluster?

Genetic link to bird flu cluster?
By HELEN BRANSWELL, CP
http://www.edmontonsun.com/News/World/2006/05/19/1587791-sun.html

A large cluster of human cases of H5N1 avian flu in Indonesia is raising questions about whether genetic susceptibility explains why some people exposed to the dangerous virus become infected while many more do not.


Scientists have been puzzled by why H5N1 doesn't jump to humans from birds more often, given the vast numbers of exposures people have had to infected poultry in affected countries - primarily in South Asia.


News that six members of one family have been confirmed to have contracted the virus (another likely had it but died without being tested) inevitably points suspicion to some genetic feature of this family's make-up that rendered its members more vulnerable than others in their village in the Karo district of North Sumatra.


"It makes perfect sense. It would not surprise us at all," said Dr. Richard Webby, an influenza virologist at St. Jude Children's Hospital in Memphis, Tenn.


"There's plenty of evidence, not necessarily in influenza, but there are other . . . viruses where there are certainly host factors that predispose someone to more severe disease."

The World Health Organization confirmed details of the cluster yesterday.


A 37-year-old woman from the village of Kubu Sembelang fell ill on April 27 and died on May 4. No samples were taken during her illness or before her burial and it's unlikely the cause of death will ever be confirmed.


Since then, six of her blood relatives have fallen ill - two sons, a brother, a sister, a nephew and a niece. All have tested positive for the virus and five have died
​

 

[Sally Furniss]

Re: Helen Branswell Latest Article May 2006

Bird flu cases in Indonesia raise questions about pandemic containment plan
By HELEN BRANSWELL

(CP) - A worrisome cluster of human cases of H5N1 avian flu in a remote village in Indonesia is raising serious questions about the feasibility of an international plan to try to stop an emerging pandemic at source.

Mathematical models have suggested containing a pandemic could be possible with a swift and sweeping response. Based on those findings, experts at the World Health Organization has been working for months on a strategy to try to effect containment, if and when the need arises.

But the outbreak in Indonesia, where disease investigators have been met with fear and suspicion, illuminates the enormous challenges the pandemic SWAT team would face in trying to snuff out a nascent pandemic strain before it could spread from its place of origin to sweep the globe.

"This cluster in Indonesia is a test case for the pandemic," Maria Cheng, a spokesperson for the WHO, said from Geneva.

"It's basically testing our capacity to respond as quickly as possible, and how quickly we can detect it, and how willing the community is to respond."

As such, the Indonesian outbreak should serve as a stark reminder to all involved of the difficulties inherent in trying to translate the models' findings into reality, said infectious diseases expert Dr. Michael Osterholm.

"Our experiences with the virus during the last six months in Turkey, Iraq and now in Indonesia should give even the most ardent supporters of containment cause to realize why, while such an approach is an ideal, it also is a fantasy."

Osterholm has been skeptical since the modelling studies were published last summer that the optimistic outcome predicted by the work could be achieved outside of the hard drives of the computers on which they were devised.

"This was never about wanting to contain the virus. It's about the reality of what happens in everyday life," Osterholm said Saturday from Minneapolis, where he is director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

"One of the problems models can't address is the impact of politics, fear, panic and lack of compliance on written guidelines for public health actions."

The models, by two international teams of scientists, suggested the WHO could contain an emerging pandemic if it discovered the virus was spreading among people within the first 20 human cases or within seven to 21 days of the start of transmission.

People in the area where the virus was spreading would be given antiviral drugs to keep them from falling ill, and the area would be effectively cut off from the rest of the world. Depriving the virus of new human hosts would be like starving a fire of oxygen, hence the shorthand many in scientific circles use to describe the containment strategy - the fire blanket.

The WHO keeps a sharp eye out for clusters of cases, which could signal that H5N1 is changing in ways that make it easier for it to jump into and between humans.

The Indonesian case cluster is the largest seen to date, with at least seven members of an extended family - and perhaps more - falling ill to the disease in the village of Kubu Sembelang in North Sumatra. Six of the seven have died.

Only six of the cases have confirmed as H5N1 cases; no samples were taken from the initial case, a 37-year-old woman who died and was buried in early May.

At least one suspected additional case in the same family - the father of a 10-year-old boy who died - has raised the spectre of possible person-to-person spread.

But more than three weeks after the first woman fell ill, investigators from the WHO and elsewhere are still trying to determine if the man is infected, what the source of the infections is and how far, if at all, illness has spread.

Fear in the village is running high, according to local reports, which also point to a reluctance on the part of villagers to co-operate with authorities trying to investigate the outbreak.

"I think that there are some problems getting information out of the people who've been affected," admitted another WHO spokesperson, Dick Thompson.

http://cnews.canoe.ca/CNEWS/World/2006/05/20/1590247-cp.html

 

[Sally Furniss]

Re: Helen Branswell Latest Article May 2006

Human-to-human spread suspected in latest Indonesian bird-flu death
19:15:48 EDT May 22, 2006
HELEN BRANSWELL

(CP) - The World Health Organization appears to be edging closer to suggesting that an Indonesian man who died from H5N1 avian flu Monday may have been infected by his 10-year-old son, not through exposure to sick poultry or some other environmental source.

WHO officials had earlier expressed the theory that a thorough investigation might reveal a potential source of contagion in the community, such as use of contaminated chicken feces as manure. But expert disease investigators seem to be ruling out that possibility, a spokesperson for the WHO said from Geneva.

"There's no supporting evidence to suggest that this is a continuing environmental source that we've uncovered yet in the investigation," said WHO spokesperson Dick Thompson.

"The investigation is still ongoing. We wouldn't discount the possibility that it is human-to-human transmission."

Limited spread of the virus among people is believed to have happened on several previous occasions. But in each of these suspected cases, transmission of the virus petered out. Sustained human-to-human spread of the virus would be needed to trigger a pandemic.

Meanwhile, an Indonesian official revealed that the man who died Monday refused treatment and fled from authorities after falling ill - behaviour that highlights the difficulties of disease containment in settings where an unfamiliar disease is extracting a high death toll.

"This is precisely what we see, time and time again," medical anthropologist Barry Hewlett, a veteran of a number of WHO missions to contain outbreaks of Ebola virus in Africa, said of the panicked reactions Indonesian media have reported.

Reports have suggested fear and distrust have been running high in the affected community, which has watched in horror as multiple members of an extended family fell gravely ill in recent weeks, with most dying.

Dr. Heinz Feldmann of the Public Health Agency of Canada's National Microbiology Laboratory said in his experience fighting outbreaks of diseases like Ebola and Marburg fever, panic and distrust of authorities and medical outsiders is exacerbated when the death toll starts to rise.

"There are these white doctors who come in. Everyone thinks they're getting help, and then they're realizing they're not getting help. And everyone who goes into isolation (in hospital) is basically dying or a lot of them are dying," said Feldmann, a leading expert on hemorraghic fevers who heads the Winnipeg lab's special pathogens division.

"Then the community turns against you."

In cases dating back to late April, three of the man's siblings, two nephews, and two of his children became infected with the H5N1 virus. Only one family member who fell ill, a brother, has recovered from the infection.

The man's older sister, believed to be the first case in this cluster, died without being tested and is not on the WHO's official case count. With this latest case, the number of confirmed H5N1 cases in this family rises to seven, with six deaths.

The man, 32, is said to have nursed his son while the boy was dying, putting him in the path of blasts of virus-laced droplets.

When he himself became ill, he evaded authorities, the director-general of communicable disease control for the Indonesian health ministry told a news conference Monday.

"He ran away after he received Tamiflu," said I. Nyoman Kandun. "He was found in the village later but refused treatment."

Both Hewlett and Feldmann said getting people in such settings to co-operate with public health officials is a significant challenge that requires lots of communication with the community, sensitivity and a willingness to try to figure out what is motivating the behaviour.

Hewlett, a professor at Washington State University in Vancouver, Wash., recalls seeing Ugandans fleeing ambulances during a major Ebola outbreak in that country in 2000.

It turned out that there were rampant rumours that the team wasn't fighting disease, but was kidnapping Ugandans for body parts. The urban myth was fuelled by the fact that family members weren't allowed to visit their loved ones during their illnesses or after their deaths because of the fear of further spread of disease.

"My point is simply that you need to work with local people if you're going to make these things successful. Otherwise there's going to be resistance and the outbreaks will get worse rather than get better," said Hewlett, adding the WHO often now includes medical anthropologists or psychologists on outbreak teams as "social mobilizers" who can bridge the divide between the people affected and medical experts.

Feldmann said he can see another possible source of conflict with the Indonesian villagers - the fact that H5N1 control requires the culling of affected poultry. Demanding people give up animals they need, and which they often don't believe are a source of infection, can create tension, he suggested.

? The Canadian Press, 2006
http://www.cbc.ca/cp/world/060522/w052252.html

 

[Snowy Owl]

WHO pandemic alert level unchanged despite 7 deaths in Indonesian family

WHO pandemic alert level unchanged despite 7 deaths in Indonesian family

WHO pandemic alert level unchanged despite 7 deaths in Indonesian family

http://www.cbc.ca/cp/world/060525/w052504.html
01:38:36 EDT May 25, 2006

<table align="right" border="0" width="155"><tbody><tr><td> </td><td> [FONT=Arial, Helvetica]

[FONT=Arial, Helvetica] Joned Ginting, the only remaining family member of a family of seven which has been decimated by bird flu deaths, is treated for the disease in a hospital. (AP Photo/Diaz Ridho) [/FONT][/FONT]</td></tr></tbody></table> HELEN BRANSWELL



<!-- CPPara1-->(CP) - There is no current need to raise the global pandemic alert level, the World Health Organization said Wednesday, a day after admitting that a family of eight infected with H5N1 avian flu in Indonesia likely involved the first recorded case of human-to-human-to-human spread of the virus.

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<!-- CPPara2-->WHO spokesperson Maria Cheng said the agency believes the pattern of person-to-person spread mirrors fairly closely that seen in earlier case clusters and doesn't signal that the virus is becoming more easily transmitted among humans.

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<!-- CPPara3-->"It may be slightly different than the pattern we've seen in the past but it still fits the larger mould," she said of the cluster, which saw eight members of an extended family fall sick in at least three waves of illness. Seven of them have died.

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A leading U.S. infectious disease expert supported the WHO's decision, saying this cluster, while "sobering" doesn't appear to mark a departure for H5N1.


"I don't think it's of the nature of a paradigm shift that makes me more concerned that something has happened that absolutely indicates that we're going in a different direction - or we're going in a direction that I don't want to go," Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, told The Canadian Press in an interview in Washington.


"But you never take anything like this lightly."


The cluster appears to have originated with a 37-year-old woman in the village of Kubu Sembelang in the Karo district of North Sumatra who fell ill on April 27 and died on May 4. She was never tested for the virus and cannot be added to the WHO's official case count, though the agency acknowledges she was likely a case.


Following her death a succession of her extended family members fell ill - two sons, three brothers, a niece and a nephew. All but one brother have subsequently died.


The WHO now believes that the initial case infected her nephew and most of the other members of her family. When the 10-year-old boy fell ill, his father (one of the index case's brothers) nursed him. The man, 32, then became ill and died Monday.


For four days before his death the man fled authorities and disease investigators, fearful as others in the community have been about the wave of deaths and the treatment being offered.


Local reports suggest that members of the village, many of whom have refused to co-operate with investigators, hid the man. Cheng said Wednesday that the hostility in the community seems to be abating, however.


"I don't think that we have as much information as we would ideally like. But we have had indications in the last few days that the community is starting to come around," she said from Geneva.


"They did agree to meet with the team to provide a more complete picture of the situation, with behaviour patterns. What people might have been doing that put them at risk. That's good news."


To date, there are no reports that the illness has moved beyond the confines of this family.


"The somewhat encouraging news within the framework of a serious situation is that with very careful surveillance now by Indonesia, WHO and our own CDC ( the U.S. Centers for Disease Control), there doesn't appear to be any secondary or tertiary cases outside of the immediate family unit," Fauci said.


That would be the type of signal experts would read as a change in the pandemic threat posed by the virus, he said.


"If we saw cases that emanated from contact with the family and then those cases gave it to somebody else," Fauci explained.


"It could be one generation more or two generations more - but it has to go beyond the initial cluster."


The WHO's alert level remained at Phase 3, where it has been for some time.


According to the WHO's six-level pandemic staging plan, Phase 3 is no human-to-human spread, or only on rare occasions after close contact with a sick individual. Phase 4 is a small cluster or clusters of limited and localized human-to-human spread, a pattern suggesting the virus had not yet fully become efficient at infecting people. Phase 6 is a pandemic.


Meanwhile, a leading Canadian infectious disease expert called the development in Indonesia "quite bothersome" and suggested the WHO might have to consider raising the alert level to Phase 4.


Dr. Donald Low, who runs Ontario's Public Health Laboratory in Toronto, noted it's a large family cluster of cases with a high death rate among victims who were very young to middle aged.


"But probably the most disconcerting," Low said, "is evidence suggesting the virus had been transferred from one person to another, who became ill and passed the virus to yet another person."


"That's what we refer to as a second-generation transmission and we've never seen this before."


<center>? The Canadian Press, 2006</center>

 

[Snowy Owl]

WHO: disease containment plan needs more work

WHO: disease containment plan needs more work

WHO: disease containment plan needs more work

By HELEN BRANSWELL
The Canadian PressTORONTO
​

The World Health Organization issued a revised version of its pandemic containment strategy Tuesday, but the events of a recent large cluster of bird flu human cases in Indonesia suggest further revision will be needed, a spokesperson for the agency said.

"The outbreak in Indonesia, the Sumatra cluster, highlighted a lot of things, perhaps a lot of gaps that we need to address," Maria Cheng said from Geneva.

"So I wouldn?t say we have to go back to the drawing board, but it?s certainly going to influence development of this strategy."

A major lesson to be learned from the cluster in Sumatra is that it cannot be assumed people will want to take the antiviral drug Tamiflu ? a key component of the containment plan.

In the village of Kubu Sembelang, where a cluster of eight people fell ill, many people who had been in contact with the cases initially refused to take the drug, believing it, not the H5N1 avian flu virus, was the source of illness.

Seven members of that cluster of cases died, the last after spending days on the run evading officials who wanted to test him and treat him.

"I think the response from the local population was very instructive as to a need to involve local social mobilization experts and to make sure the local community understands what?s going on," Cheng said.

"What is actually going to happen when Tamiflu arrives? We can?t just expect that it shows up and people will embrace the WHO teams."

The 50-page document outlines how the WHO would attempt to stop a pandemic in the earliest days of the emergence of a new influenza virus that was showing the ability to transmit in sustained fashion from person to person.

Mathematical models suggest that if a high percentage of people in an affected region were given antiviral drugs in the early days of human-to-human spread, and if movement out of the affected region was cut off, a pandemic strain could be snuffed out.

Many scientists are dubious about the chances of success. And even senior officials at the WHO are on the record saying containment might fail. But the agency is committed to trying.

The containment plan spells out what the various players in the effort ? the WHO, the affected countries, and Hoffman-La Roche, maker of the antiviral Tamiflu ? would be required to do and how quickly.

For instance, the recipient country would need to ensure it had enough forklifts and forklift operators at the airport to which the drugs would be sent and capacity to move the Tamiflu from the airport to the affected area within 12 hours of the drug arriving in the country.

The plan even spells out how many pallets of drugs would be shipped ? and how much those pallets would weigh ? depending on the number of people needed to be treated.

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