How Dangerous is Bird Flu (H5N1) to Global Public Health? Part 1 (Feb 16, 2011 - Oct 16, 2011)

Laidback Al · Jul 8, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Another H5N1 Case in Egypt reported by the media - Lack of offcial transparency?

Yesterday another woman was reported in the media as a suspected bird flu victim in Gharbia governorate (link). But little official information on current H5N1 infections is available in Egypt. As noted by Ironorehopper in another thread (link):

ironorehopper said:
With the exception of media outlets, no official reports about human avian influenza cases (H5N1) are available for the public and accessible through internet, as the Ministry of Health of Egypt removed Media Reports page as well as any link to tables, figures and other tool useful to track the evolution of H5N1 in humans in the country.
It is really advisable that the tools will be put online as soon as possible to improve knowledge and confidence among the public and concerned people.
See at: http://www.mohp.gov.eg/default.aspx

Comment - The fact that the Egypt Ministry of Health is no longer posting official information is disturbing. This lack of information is coming right at the time as infections and deaths from H5N1 are increasing in Egypt. This lack of transparency is cause for concern. One can speculate that perhaps there is concern in Egypt that with increasing H5N1 cases, Egypt might surpass Indonesia as the country with the most H5N1 infections. Of course, there is every reason to believe that several years ago public health officials in Indonesia made the decision to downplay or even obscure the rate of human H5N1 infections in Indonesia. Now it seems that Egypt is following in the same path.

Laidback Al · Aug 12, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Call for open data on human avian influenza cases from around the world

An important research paper on the epidemiology of avian influenza A(H5N1) has just been published by Eurosurveillance (Avian influenza A(H5N1) in humans: new insights from a line list of World Health Organization confirmed cases, September 2006 to August 2010 FluTracker?s link to full article).

Since 2005, researchers from Robert Koch Institute (RKI) in Germany have been compiling a ?line list? of confirmed, probable, and suspected human cases of avian influenza (AI) from around the world. They performed several statistical analyses on the data set which consisted of a total 294 cases of which 234 were confirmed by WHO between 2006 and 2010. The RKI authors make several observations about the results of their analyses that are worth pointing out.

But first a couple of corrections and comments about the article.

With this study, we summarised the current global AI situation in humans. It is, to our knowledge, the first study that not only analysed human AI cases worldwide on the basis of a line list collected over several years but in addition made these case-based data available online.

The first part of this sentence is correct, the second part is not. The first on-line case-based data for avian influenza that I am aware of was posted on February 2, 2006, as an Microsoft Access database as an adjunct to the ?Influenza Report? and online textbook. (Link). The database included 116 WHO confirmed cases. The database was updated for several months in 2006 with the final downloadable database including 176 cases as of May 5, 2006. After May 2006 the online database was no longer updated and by March 28, 2007 it was no longer available on line.

Between November, 2003 and July 31, 2010, a total of 483 human cases of A(H5N1) were confirmed by WHO. The analysis of the RKI researchers only includes 234 of these cases, less than half. Care should be taken in interpreting the epidemiological results in this article.

Important Conclusions and Discussions in the Article

In our study all patients hospitalised eight or more days after symptom onset died. This suggests a rather narrow time window for antiviral drug administration.

This observation indicates that in most cases, especially severe, virulent cases of AI, early hospitalization and treatment with antivirals is critical for survival when infected with H5N1.

Our study was solely based on data from publicly available case reports and is subject to several limitations. Our monitoring instrument was only entirely implemented in August 2006 and thus trend analyses were not exploited to its full extent. Within the used reports, negative values, e.g. ?case not hospitalised?, were not systematically mentioned, which may lead to biases. Time specifications, e.g. on dates of exposure or hospitalisation, needed for time-to-event analyses, were often incomplete. Case reports did not systematically contain details on medical care and specific antiviral treatment. Therefore, analyses were restricted to ?hospitalisation? as general indicator for access to medical care. Given the sparse information on possible contact with infected individuals and clusters of human AI cases available from the serial reports within the investigated period, clusters could not be evaluated as initially planned. Other studies reporting on clustered cases had mostly accessed additional case-investigation reports and patient interviews [23,30]. We based our analyses on WHO confirmed cases, although unconfirmed cases had been recorded in our line list, due to lacking information for probable and suspected cases. Including probable cases in our analyses did, however, not change the cases? sex ratio or CFR substantially when compared to confirmed cases only.

The gist of this observation is simple. The RKI researchers were hampered by lack of publicly available data. As I have previously discussed, there is little publicly available detail on human H5N1 cases. Several years ago, media reports on human cases could be used to supplement details from WHO reports on these human cases. Information on age, sex, specific location, family contacts and relationships, etc. could often be obtained from media reports. Now these media reports no longer have critical details, and often times media outlets no longer even report details of suspected or confirmed cases of AI.

A line list needs to be flexible in view of potential new information to be entered. . . . Presenting cases in the format of a line list is not a goal in itself, but a prerequisite for targeting surveillance and identifying risk factors, as well as a starting point for prospective studies, e.g. investigating potential human-to-human transmission, the transmissibility of avian influenza viruses, and host-related factors including age-dependent immunity in humans.

All of us at FluTrackers supports the development and maintenance of open databases to track emerging infectious diseases. In 2009, FluTrackers members compiled a database of some of the earliest media reported cases of pandemic H1N1 and made it publicly available. (Link)

We would like to encourage that an anonymised case-based database for AI in humans is directly placed publicly and continuously updated, e.g. by an internationally renowned organisation such as WHO. Open access to analysable data might accelerate the identification and implementation of research questions and surveillance priorities and thus enhance our understanding of ? still mostly fatal ? AI in humans and permit the rapid detection of epidemiological changes with implications for human health.

FluTrackers.com agrees that a publicly available database of all human A(H5N1) cases be maintained and updated by WHO. The data should be consistent across all fields and provided in a timely manner by all WHO members as required by International Health Regulations.

Avian Influenza is an emerging infectious disease that has affected less than 600 people worldwide since 1997. So far it has been unable to easily transmit between humans. But with an overall death rate of more than 50% among confirmed cases, an avian influenza pandemic could wipe out large portions of the world?s population if it becomes easily transmissible between humans. That is why all countries throughout the world need to comply with IHR and report human outbreaks of A(H5N1) immediately. And that is also why WHO needs to maintain and update, on a daily basis, a publicly accessible database of human cases of A(H5N1).

Laidback Al · Aug 17, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Time to Start Worrying about Bird Flu Again?

In the article entitled “World too complacent on bird flu”, Robert Gatter points out that bird flu (H5N1) has not gone away and continues to infect humans in North East Africa and South East Asia. He reiterates several important facts about bird flu, most notably that the death rate from all reported human cases is about 60%. And . . .

But the global commitment to preventing human infections with novel bird flu appears broken. . . Even more telling is how the focus of international giving has shifted from prevention to response strategies. Between 2005 and mid-2008, pledged funds were split almost equally between programs aimed at preventing bird flu infections and those that developed human pandemic response plans. Starting in 2008, however, commitments to response programs have more than doubled while pledges to prevention strategies have been cut in half.

This is depressing information. Gatter is pointing out that the world’s countries are no longer trying to prevent an epidemic outbreak of H5N1 among humans. Funds in these countries are now being directed to an after-the-fact response to human clusters of H5N1. This suggests that some world agencies believe that humans have lost fight against preventing a pandemic strain of H5N1. And it will only be a matter of time before there is a human strain of H5N1 that will produce a local epidemic and possibly develop into a world-wide pandemic.

Robert Gatter published his opinion piece in the Altanta Journal-Constitution. Altanta, Georgia, is the national headquarters of the U. S. Dept. of Health and Human Services Centers for Disease Control and Prevention.

Hat-tip, Treyfish :tiphat:

mixin · Aug 17, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

It's been so quiet on the bird flu front, that I was very surprised to hear of the new syfy thriller coming out in Sept. The trailer shows empty grocery store shelves, garbage piling up in the streets.

Contagion

From the trailer:
So we have a virus.. no treatment protocol and no vaccine at this time.

Is there some way someone could have weaponized the bird flu: someone doesn't have to weaponize the bird flu, the birds are doing that.

http://trailers.apple.com/trailers/wb/contagion/

Laidback Al · Aug 23, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Bird Flu Cases in 2011 exceed 2010

In post #39 above (June 17th, 2011), I speculated that the number of confirmed human H5N1 cases in 2011 would eventually exceed the total for 2011. With the confirmation by WHO of case number 49 for 2011 from Cambodia on 19th of August, indeed, the number of confirmed human bird flu cases has exceed the total for 2010. Whether this is the year we will exceed the highest annual total ever recorded (115 in 2006) remains to be seen.

Laidback Al · Aug 23, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Edited note added August 23, 2011. --- Based on additional translated media reports by dbg, my original suggestion that A/Indonesia/Unair/2005 was collected from a H5N1 survivor in November, 2005 is incorrect. The additional media reports indicate that the sample was collected from a male who died. That individual would be Slamet Wibowo, a 23 year old male from Bogor, West Java. He was was admitted to the hospital on September 28, 2005 and died two days later (link). The published sequences of (A/Indonesia/CDC7/2005(H5N1)) are associated with this individual. . . .

H5N1 Vaccine Developments in Indonesia

Indonesia now appears to have a viable seed strain of a human vaccine for influenza A(H5N1) according to posts in this thread. Nidom and his colleagues at the University of Airlangga in Surabaya have been working on a seed strain for human H5N1 vaccine production in Indonesia for several years. These media reports have some specifics that were not previously reported. The strain is reported to be based on A/Indonesia/Unair/2005 H5N1 which was apparently obtained from a male under 35 years old from Bogor, West Java in 2005.

-{deleted text}-

Certainly, the ability of Indonesia to develop and produce a seed strain of H5N1 coupled with the capacity to manufacture an H5N1 vaccine is good news. However, there has been speculation that H5N1 has already reassorted in the countries that it is endemic in the poultry populations (link). Indonesia should be concerned that antigenic drift has already diluted or even neutralized its seed strain from 2005.

Laidback Al · Aug 29, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

WikiLeaks - H5N1 in Southeast Asia 2004-2009

In his blog from August 25, 2011, Crawford Kilian notes that WikiLeaks has released numerous cables from US government agencies relating to H5N1. http://crofsblogs.typepad.com/h5n1/2011/08/wikileaks-indonesia-and-h5n1.html

A review of a number of these cables from the US embassies between 2004 and 2009 chronicles how the US diplomats reacted to local information about H5N1 as it related to their diplomatic mission. There is a lot of details in these cables that is now only of historical interest.

But what can be interpreted from these cables in toto is that US agency officials were very concerned about a pandemic outbreak of H5N1 in southeastern Asia during this period. There were concerns about the lack of transparency in reporting of human cases. There was a concern about the potential for a pandemic outbreak at any moment. One of the cables even presents the "tripwires" to implement contingency plans to move US diplomats and family members out of Indonesia in the event of bird flu pandemic. The concerns expressed in these cables parallel those expressed by flu forum posters and flu bloggers during this period. It is even possible that the online concerns of flublogia at the time instigated some of these cables.

There is an apparent urgency in these cables from several years ago, that seems to be lacking in official responses from the US government today. Perhaps a bird flu pandemic is no longer high on the list of natural disasters that could affect American citizens and everyone else in the world. Perhaps there is a belief that a bird flu pandemic is no longer as likely as it was 4-5 years ago.

The reality is that there is no scientific basis to conclude that an H5N1 pandemic is less likely today than it was several years ago. The fact that H5N1 is now endemic in domestic poultry population in several areas around the world makes it even more likely that a strain of H5N1 will eventually reassort and become transmissible among humans with the potential to cause a pandemic.

Laidback Al · Sep 5, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Seasonality of Influenza A (H5N1) Infections – A Clue to Understanding Influenza Viruses

In a recent PLoS article, Murray and Morse (1) analyze 185 human cases of H5N1 infections between 2005 and 2008 from Indonesia and Egypt in an attempt to link seasonal incidence of H5N1 infection with meteorological data in these two countries. The authors state

“H5N1 incidence in humans oscillated seasonally in Egypt in 2006 to 2008 with a period of 14 months, and in Indonesia in 2005–2008 with a period of 18 months. By contrast, H5N1 incidence in commercial poultry was estimated to oscillate in Egypt with a period of 7 months (2006–2008) and did not show significant oscillation in Indonesia between 2005 and 2006. Peak human H5N1 incidence in Egypt appears to occur two months later each year, while in Indonesia incidence may peak every other year, with each peak occurring six months later in the year than the previous peak. Periods of highest risk for H5N1 infection could potentially be predicted from these data; however, validation of this model with more recent incidence data is needed to verify these results.”

The seasonal distribution of H5N1 infections was apparent to FluTrackers members as early as 2006 after the first few hundred cases were reported by WHO (link and link). However, the periodicity of oscillation for H5N1 infections the authors proposed for these two countries is suspect. Since January 1, 2009 there have been 16 officially reported H5N1 cases in Indonesia (although as noted in posts above, many more cases are suspected but have not been officially reported) and 99 reported cases in Egypt. Including these additional cases in the analysis would mostly likely skew the seasonal oscillations proposed by Murray and Morse. Below is a graph of the approximately 147 worldwide cases of H5N1 since January 1, 2009 by month. Most of these cases since the beginning of 2009 are from Egypt and Indonesia. The seasonal incidence of H5N1 infections is clear.

Worldwide H5N1 cases by month 2009-2011.webp

The authors admit that that their small dataset is not sufficiently robust to confirm any correlation. “Seasonality of human H5N1 was observed but not statistically significant in Egypt, while in Indonesia H5N1 incidence did not correlate with changes in meteorological variables. Therefore, it remains possible that the observed correlation between weather and human H5N1 in Egypt can be explained by chance.” Nonetheless, the authors conclude that “In Egypt, human H5N1 peak incidence was preceded by and coincided with low precipitation and absolute humidity, and moderate temperature and relative humidity.” And they go on to state that “meteorological conditions appear to have favored droplet transmission, such as may occur in during close contact between humans and infected poultry.”

Beside contact with infected poultry, H5N1 can be contracted by human transmission, through tainted meat and blood consumption, and probably through fomite transmission including infected feathers. The question of droplet versus aerosolized transmission of H5N1 deserves further research, but other transmission modes need to be considered, independent of meteorological variables.

The seasonal incidence of influenza A (H1N1 and H3N2) is well documented, particularly in temperate zones, even though the mechanisms are not well understood as noted by Murray and Morse. Although only 500+ individuals have official been confirmed with H5N1 from around the world, the seasonality of human H5N1 infections is pronounced and unmistakable.

These data indicate that the pattern of seasonal fluctuations in influenza A (H5N1) infections is congruent with seasonal fluctuations among influenza A (H1N1 and H3N2) infections. This suggests that even though the mechanisms of influenza infections are very different among these strains (avifauna-to-human versus human-to-human) there is something inherent in the nature of influenza viruses as a group that manifests itself in differential seasonal incidence of infection.

(1) Murray EJ, Morse SS, 2011 Seasonal Oscillation of Human Infection with Influenza A/H5N1 in Egypt and Indonesia. PLoS ONE 6(9): e24042. doi:10.1371/journal.pone.0024042

Laidback Al · Sep 19, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Nonsymptomatic Cases of H5N1 and H9N2 in Thailand

An abstract of a study of antibody titers for avian influenza among villagers in Thailand was posted here at FluTrackers today. See http://www.flutrackers.com/forum/showthread.php?t=173542

The full text of the article is available at this link: http://cid.oxfordjournals.org/conte...html?sid=8a98ec6e-ad5f-4015-b750-2d92f6bfe732

Interesting passages from the article -

We found that 45 participants (5.6%) had elevated antibody titers against A/Thailand/676/2005(H5N1) and 28 participants (3.5%) had elevated titers against A/Thailand/384/2006(H5N1). . . .

Study data suggest that a number of cohort members had previously been infected with either low-pathogenic avian H9N2 or highly pathogenic avian H5N1 inﬂuenza viruses. These serological ﬁndings were not associated with poultry exposure or with recent clinical disease.

The above quotes are important. According to this article, between 3 to 5% of the study population has been exposed to one or another strain of H5N1 in Thailand. More importantly though, it seems the exposure was not from direct association with poultry, but possibly transmission from infected outdoor water sources.

This study has implications about the potential for unrecognized and unreported human avian influenza cases from southeastern Asia. It also confounds the assumption that most human cases of avian influenza in this region result from direct poultry contact. Indirect and secondary transmission pathways need to be considered.

:tiphat: Gert van der Hoek

Giuseppe · Sep 19, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

The suggested higher than recognized incidence of influenza virus infections of animal origin, detected through serologic surveys was previously cited in literature but current papers seem to substantiate further this assumption.

In China, Cambodia, Thailand etc. the widesperad circulation of flu virus of animal origin for decades resulted in a massive exposure of population - or at least a substantial portion of it - to these pathogens.

However, the number of laboratory confirmed human cases of infections remained negligible if compared with other infectious diseases in the region.

In Cambodia, similar studies highlighted the likelihood of an enviromental exposure rather than a direct contact with diseased poultry, thus complicates the control measures to reduce human morbidity and mortality.

The real extent of human immunity achieved through asymptomatic or mild infections with influenza virus of animal origin remains largely unknown, but if the studies like those cited in the above post will be confirmed by further analysis, the risk assessment will be affected as well.

Until now, for example, avian influenza virus A (H5N1) is considered one of the most lethal among the animal origin viruses, with a case fatality ratio comprised between 20-to-more than 50% - varying greatly among affected countries; for comparison, the other influenza virus of avian origin A (H9N2) also circulating in Asia and Middle-East has a CFR very low for the few cases laboratory confirmed of infection.

In other words, these viruses are circulating for at least a decade massively in contact with domestic poultry, pigs, cats, dogs and humans, having an immense opportunity to mix with other subtypes but so far this circumstance has not happened.

Our knowledge about the reason for these inability to mix or reassort is perhaps the biggest shortcoming in the knowledge of influenza ecology.

alert · Sep 19, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Let us also not forget the other trade-off; the more unrecognized H5N1 exposures and infections, the lower the true CFR of the virus. The CFR of H5N1 is only the alarming 60-80% reported in some countries if the denominator of recognized cases is correct. If the true number of cases is many times higher, the true CFR is that many times lower.

Remember, this is the same phenomenon that suggested a CFR for H1N1 of 5% or more based on original testing in Mexico.

Pathfinder · Sep 29, 2011

How Dangerous is Bird Flu (H5N1) to Global Public Health?

How Dangerous is Bird Flu (H5N1) to Global Public Health?

Machine translated

You are now in provincial news

The emergence of new human cases suspected bird flu in Menoufia

Dr. Salah Cain Director of the Directorate of Veterinary Medicine has been set Menoufia new investment plan is decimal and the financing plan includes a number of projects to replace and refurbish some of the veterinary units in addition to completing some units and establishing some new units at the level of veterinary centers and villages of the governorate.

And that the Directorate is working on the advancement of livestock and poultry conservation through animal welfare and veterinary services as tracking active investigation Directorate to control bird flu and prevent it from spreading.

And under active investigation campaigns for pandemic avian influenza under the auspices of the Department of preventive medicine Directorate was suspected in a number of cases by County stations (bagour, quesina–, zagazeeg, the seven martyrs, pond, followed, Sadat) was the sampling of live birds and sent to the central laboratory for examination and redefinition of the positive statement it might entail actions biosecurity standard.

And in blood sampling campaigns from large and small ruminants detected cases of positive twinkle albrucella and are as follows:

4 the status of the seven, if one pool in the Centre of the martyrs, one case status read out, 3 cases status monof

And procedures have been taken to execute the infected parts and compensate owners of cases.

As the Department of veterinary outreach role in educating the public

Through the work of seminars to educate and guide the citizens to do them during the 69 month seminar on the indicative level of maintenance centers and villages included lectures on veterinary care and reproductive and joint diseases and animal welfare, prevention, and avian and livestock insurance and massacres.

Edifice declared the doctor glory heights of manager the general office the art that he under the aegis of administration the general health and the joint illness the illness and compliance of compliance on safety of the citizens and the border lessen cases of the random injuring was complete renewal campaigns of execution of the dogs stray on level hospitality and centers conservative centers and execution of number was complete 1218 dog through the use of substance poisonous and equipments of number 419 dog through the use of the cartridge in the addition for execution number 50 from the stray cats also through the use of the shots.

The Department also carried out massacres of seizure of meat and poultry invalid with adjust the number of cases outside the slaughterhouse, slaughter as well as anonymous meat was totaled 10 tons.

And Dr. Hisham Abdel-Razek Director of Information Directorate of the cases that follow-up scrutiny of the disease, bird flu has been reported for a number of suspected cases of Adamic during this month are as follows district Apinhs Quisna Center 40 years old woman and booked Bhmyat Shebin.

And the SRS allien monof and booked the Centre issued monof.

And smalage hand and booked to read status viruses zagazeeg and had a negative result for all cases. (I am not sure if these negative results include the 3 year old mentioned below - s.)

There were also new suspected case of human figures to a child 3 years old district Smlay Ashmun Center and has been detained Fever Hospital Menouf infected sore throat and difficulty breathing, fever, the child has been subjected to dead birds and have been notified of the competent authorities and the Implementation of bio-security measures.

http://misrwalalm.com/news.php?id=1333

sharon sanders · Sep 29, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Pathfinder said:
Machine translated

snip

And Dr. Hisham Abdel-Razek Director of Information Directorate of the cases that follow-up scrutiny of the disease, bird flu has been reported for a number of suspected cases of Adamic during this month are as follows district Apinhs Quisna Center 40 years old woman and booked Bhmyat Shebin.

And the SRS allien monof and booked the Centre issued monof.

And smalage hand and booked to read status viruses zagazeeg and had a negative result for all cases. (I am not sure if these negative results include the 3 year old mentioned below - s.)

There were also new suspected case of human figures to a child 3 years old district Smlay Ashmun Center and has been detained Fever Hospital Menouf infected sore throat and difficulty breathing, fever, the child has been subjected to dead birds and have been notified of the competent authorities and the Implementation of bio-security measures.

http://misrwalalm.com/news.php?id=1333

This article mixes poultry and human infections. Apparently there were at least 2 suspected human cases of bird flu in September and that all of them tested negative at some point. I am not sure if the 3 year old is included in the comment about all of the tests results for Menoufia being negative in September.

We have no clear visibility into the status of the human bird flu situation in Egypt.

Laidback Al · Oct 2, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Imported Poultry Vaccine in Egypt

In a translated article posted today here at FT, it seems Egypt plans to stop the importation of any types of vaccines for avian influenza

Anflonzataioroqrt Higher Committee to combat avian influenza, the Ministry of Agriculture and Land Reclamation, stop the import of any types of vaccinations for avian influenza infection from abroad, in order to tighten control over the markets vaccines in Egypt after the spread of about 30 species of the vaccines. Which hurt the effort to combat the disease.

<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w

unctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w

oNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w

ontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:EnableOpenTypeKerning/> <w

ontFlipMirrorIndents/> <w:OverrideTableStyleHps/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--> This is an interesting development. H5N1 vaccination of poultry is the main strategy to control avian influenza in countries where it is now endemic. The article is not clear as to why importing poultry vaccines into to Egypt should be stopped. Is it a monetary issue or some underlying concern about a mismatch between the imported poultry vaccines and the strains of H5N1 circulating in poultry in Egypt?

hattip Pathfinder

Gert van der Hoek · Oct 2, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Laidback Al said:
Imported Poultry Vaccine in Egypt

In a translated article posted today here at FT, it seems Egypt plans to stop the importation of any types of vaccines for avian influenza

This is an interesting development. H5N1 vaccination of poultry is the main strategy to control avian influenza in countries where it is now endemic. The article is not clear as to why importing poultry vaccines into to Egypt should be stopped. Is it a monetary issue or some underlying concern about a mismatch between the imported poultry vaccines and the strains of H5N1 circulating in poultry in Egypt?

hattip Pathfinder

A mismatch of the current available vaccins seems to be the most probable reason. The vaccins don´t help, rather could worsen the situation because of possible reassortment?

Giuseppe · Oct 2, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

From W.H.O., Antigenic and genetic characteristics of zoonotic influenza viruses and development of candidate vaccine viruses for pandemic preparedness - September 2011, http://www.flutrackers.com/forum/showthread.php?t=174175

(...)

Clade 2.2.1 viruses continue to circulate in backyard poultry in Egypt with sporadic transmission to humans. All recent human A(H5N1) viruses in Egypt belong to this clade (Figure 2). Clade 2.2.1 viruses were also detected in poultry in Israel. Viruses isolated during this period were genetically similar to those isolated previously. Recent human viruses reacted well with post-infection ferret antiserum against A/Egypt/N03072/2010 from which a candidate vaccine virus has been developed (Table 5).
Clade 2.2.1.1 (previously part of clade 2.2.1) viruses continued to circulate primarily within the commercial poultry sector in Egypt and were isolated from this population during the reporting period. Genetically these viruses were similar to other recent clade 2.2.1.1 viruses (Figure 2).

(...)

-
------

Pathfinder · Oct 2, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Gert van der Hoek said:
A mismatch of the current available vaccins seems to be the most probable reason. The vaccins don?t help, rather could worsen the situation because of possible reassortment?

Yes, I do believe that this is the case. According to this article, Egypt will use their own bird flu vaccine.

"Saber Abdul Aziz, announced the discovery of 14 cases of bird flu, over the past 45 days, explaining that the virus has become more aggressive because of the winter season and high humidity, which is a fertile environment for its activity, and that has spread to 21 provinces. Abdul Aziz said that the Ministry of Agriculture declared a state of emergency in preparation for the winter season, and was processing 25 million doses to vaccinate birds affected governorates, at a cost of 3 million pounds. Director of ?epidemiology? noted that the system of mass immunization campaigns, which had been followed in the past, contribute to the transmission. Official revealed that the virus could mutate in the farms, because they use the vaccines are imported, and change shape constantly because of these vaccines made from non-local, and less efficient vaccines local, adding that Egypt is currently importing vaccines from China, Mexico, France and the Netherlands, while preparing 3 companies Egyptian in collaboration with the Research Institute of serums and vaccines, the Ministry of Agriculture, for the manufacture of a vaccine depends on the Egyptian local breeds, rather than imported vaccines, saying that the vaccine will be used during the Egyptian year, and can be eliminated by the virus in three years."

http://www.flutrackers.com/forum/showthread.php?t=173747

Laidback Al · Oct 17, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health?

While most of the recent posts above discuss Egypt, H5N1 is coming into season in Indonesia. . .

New Family Cluster of H5N1 cases in Bali in Indonesia

A family cluster of H5N1 of a mother and two children is being reported from Bali in Indonesia (link). The mother is a suspected case and is being treated while both of her children died from locally confirmed H5N1.

If these three cases are confirmed by WHO, it would be a significant announcement for Indonesia. Although family clusters of H5N1 infection in various countries are not rare, many of the infected family members, even if they die, are never confirmed. The largest cluster of H5N1 cases in Indonesia to date is the Karo cluster with seven confirmed cases in 2006 (timeline link). The largest H5N1 family cluster in Indonesia after the Karo cluster is the Hendriansyah family from Lampung, Sumatra, in 2005 (link 1, link 2, link 3) with three WHO confirmed cases.

The current outbreaks of three locally confirmed and suspected H5N1 human cases in Bali and the two separate suspected cases from the adjoining island of Lombok (link) need to be carefully monitored for human-to-human transmission.

Laidback Al · Oct 17, 2011

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health? Part 1 (Feb 16 - Oct 16, 2011)

Re: How Dangerous is Bird Flu (H5N1) to Global Public Health? Part 1 (Feb 16 - Oct 16, 2011)

This thread is now closed.

Please post to the new thread How Dangerous is Bird Flu (H5N1) to Global Public Health? Part 2

How Dangerous is Bird Flu (H5N1) to Global Public Health? Part 1 (Feb 16, 2011 - Oct 16, 2011)

Laidback Al

Well-known member

Laidback Al

Well-known member

Laidback Al

Well-known member

mixin

Well-known member

Laidback Al

Well-known member

Laidback Al

Well-known member

Laidback Al

Well-known member

Laidback Al

Well-known member

Laidback Al

Well-known member

Giuseppe

Emeritus

alert

Senior Moderator

Pathfinder

Editor, Senior Moderator

sharon sanders

Editor-in-Chief & President

Laidback Al

Well-known member

Gert van der Hoek

In Memoriam - Editor, Senior Moderator

Giuseppe

Emeritus

Pathfinder

Editor, Senior Moderator

Laidback Al

Well-known member

Laidback Al

Well-known member