Pakistan - BF Suspected Human Cases December 18, 2007 to Feb 2, 2008

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Commentary at

http://www.recombinomics.com/News/12280706/H5N1_Pakistan_False.html

 

[AlaskaDenise]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Commentary at

http://www.recombinomics.com/News/12280706/H5N1_Pakistan_False.html

Commentary

H5N1 False Negatives in Pakistan

Recombinomics Commentary 17:20
December 28, 2007

Testing done by Pakistan's National Institute of Health earlier in December identified nine possible cases, five in the family cluster, a female doctor who had treated members of the family and three poultry cullers who were unrelated to the family. A 10th possible case, another brother in the family, died without having been tested.

Some of the testing was done using a PCR or polymerase chain reaction test that looks for traces of virus in sputum samples. In other cases the Pakistan lab looked for antibodies in blood using a test which has not been validated as effective in finding H5N1 infections.

Retesting by the WHO collaborating centre for influenza in London and by experts from a U.S. naval laboratory in Cairo - known as NAMRU-3 - did not support the initial positive findings on all the suspect cases, Hayden admitted.

The negative results may be the product of degradation of specimens due to multiple freezing and thawing of the samples, he said. Other factors could have affected the results, including when in the course of infection the specimens were taken or whether suspect cases were started on antiviral drugs before a sample was taken.

The negative results may be the product of degradation of specimens that were shipped to a WHO collaborating lab in London for confirmatory testing, Hayden said. Other factors could also have affected the results, including when in the course of infection the specimens were taken or whether suspect cases were started on antiviral drugs before a sample was taken.

"We've got a host of technical issues," he said. "There are practicalities of samples breaking down over time in the transportation."

The above comments are from recent media reports in response to the WHO situation update on the H5N1 infections in Pakistan. As noted above, ten patients tested positive by labs in Pakistan, but only one was positive in testing done by WHO regional reference labs (a mobile unit shipped to Pakistan from NAMRU-3, and Mill Hill testing of samples shipped to London). Additional antibody testing will be done on serum samples, and sequencing is in progress. However, the negative data indicate that at most there will only be sequence data from the second fatal case.

The above comments also give a litany of reasons for the false negatives, but these false negatives raise concerns about past and future cases, as well as risk assessments.

The limited release of disease onset dates clearly shows sustained human to human transmission for a month, at a minimum. This chain may have stretched from the index case to a surviving brother to a deceased brother to a second deceased brother, to one or more health care workers. The exact components of the chain are still unclear because all of the onset dates have not been released, and all of the positives have not been supported by clear clinical data. However, not all H5N1 infections produce easily differentiated clinical presentations, which is why lab confirmation is important and why the false negatives increase concnerns.

Clusters are useful for delineating problems that lead to false negatives. In the cluster from Pakistan, factors for negative data include failing to test, or testing after repeated freeze and thaws or after the start of Tamiflu treatment.

The test failure for the first fatality remains unclear. Although most media reports indicate no sample was collected, at least one report quotes a health care worker as saying samples were collected from both fatal cases. It is unclear if there was no sample, or if it was lost, dropped, improperly tested, or results were lost, withheld, etc.

False negatives could have been due to sample degradation due to a failure to make aliquots of the sample resulting in multiple freeze / thaws. Freeze / thaws could also be due to packaging, shipping, or receiving issues.

There are literally hundreds of ways to generate false negatives, which is why such negatives are viewed with caution by the scientific community, but these negatives frequently drive press releases, risk assessment, and policy by others.

Unfortunately, false negatives are quite common in H5N1 testing. Most surveillance groups have yet to find H5N1 in a live wild bird. On clinical samples, negatives were eventually generated for serum samples collected from patients in northern Vietnam in 2005. In Turkey, only 12 of the 21 positives were confirmed in England, and sequences were released from only four of the positives. Many patients initially test negative, and those on Tamiflu continue to test negative because of suppression of viral RNA levels.

The assays used for H5N1 are largely confirmatory, and work best when samples are collected at the proper time and handled correctly. Virtually all human H5N1 isolates come from samples collected when the patient is near death.

Thus, in Pakistan viral isolation is limited to two patients, and samples are missing from one of the two. False negatives also lead to false transmission chain terminations, as well as failures to test contacts of the falsely negative patients.

Thus, the false negatives in Pakistan increase pandemic concerns.


.

 

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Commentary at

http://www.recombinomics.com/News/12290702/H5N1_Cluster_Concerns.html

 

[AlaskaDenise]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Commentary at

http://www.recombinomics.com/News/12290702/H5N1_Cluster_Concerns.html

Commentary

H5N1 Cluster Concerns

Recombinomics Commentary 03:53
December 29, 2007

In Pakistan, for example, the World Health Organization is investigating what could be the largest cluster of human-to-human transmission so far. A veterinarian and five members of his family are suspected cases, along with three others involved in culling infected chickens. Such clusters are rare, but they have occurred in Thailand, Vietnam and Indonesia.

The comments above are among the many describing the longest and most sustained H5N1 human to human (H2H) transmission chain reported to date, but these comments create confusion because the simple concept of H2H has been very carefully defined to avoid calling short transmission chains H2H.

Therefore, it is worth review the history, since the number of H2H clusters is much greater than the general public (and journalists writing for the general public) realizes, and clusters are likely to increase in number and length in the near term

All H2H is a cluster, but not all clusters are H2H. For H5N1, virtually all clusters really are H2H, but they aren’t PROVEN H2H, and WHO makes a distinction, creating the allusion that most clusters are not H2H, when in fact the exact opposite is true.

H5N1 is transmitted from birds to humans very inefficiently. Consequently a cluster, defined as two or more people linked by time and space, is cause for concern because it signals a more efficient transmission to a human.

Clusters can have two different origins. One is a common source such as poultry, while the second is H2H. These two possibilities are distinguished by the time gap between disease onset dates, which is usually 2-4 days from exposure. Consequently, two people infected by a common source will develop symptoms at the same time (within 1-2 days of each other), while H2H will create a gap of 5-10 days because of the incubation time between the initial infection, and the infection rising to a level that supports H2H.

The vast majority of clusters have this time gap between disease onset dates, because most clusters involve family members in close contact. That is because an infected family member creates many opportunities for transmission during care. Other family members don’t have training in universal precautions, don’t wear gloves, and are under the misconception that almost all H5N1 come from birds (which is perpetuated by the media)..

WHO avoids acknowledging that these small clusters are H2H by saying they are not PROVEN H2H, and requiring as proof an absence of a common source. H5N1 is not governed by WHO definitions, and the H2H happens, regardless of how many birds died within a 50 mile radius of the cluster.

Consequently the number of H2H examples that fit the WHO definition is few because most of the time the index case is infected by a poultry source and family members live with the index case. Although individual clusters are difficult to prove using WHO’s definition, an overview clearly demonstrates that most of these clusters have a 5-10 day gap between disease inset dates and are H2H.

However, since even common source clusters can be due to an ease of transmission, clusters alone signal problems. When the transmission chains grow from H2H to H2H2H or H2H2H2H, the transmission become obvious, as is the case for the cluster from Pakistan (false negatives not withstanding).

In summary, short chains (H2H) are common and most short clusters do have the time gap. The number of PROVEN H2H clusters is not very relevant, because the transmission is the issue. The WHO definition is just for deniability of H2H for use in panic control.

However, when the transmission chain length makes H2H obvious, then a new definition comes into play, which currently has evolved into sustained COMMUNITY transmission. H2H is not an all or none event, and as the transmission chains become longer and more common, the approaching pandemic becomes more obvious.

The H2H trend is clear, WHO press releases and evolving definitions not withstanding.


.

 

[Giuseppe]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Pakistan - as well other countries such as India and China - is characterized by a densely populated urban areas, with people packed in sometimes unigienic residential compounds. Also, people uses to stay very close one to one in mass gathering events and transportation with buses, mini-buses, trains overloaded creates the optimal environment for communicable diseases spread.
As influenza is one of the more infectious viral disease, if a viral strain such as a pandemic H5 becomes promptly transmissible between humans, an explosive outbreak will be under our eyes.
Perhaps, a more detailed, field-based, enquiry may help to dismay (or confirm as well) pandemic rumors and hoarding suspicions. Contacting reporters from the area may be useful, because I don't see the rationale of a continuous ''disaster'' mantra, useful for public awareness but in the long term useless: a pandemic doesn't relent crying wolf.

 

[Treyfish]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

LGH cancels holidays of doctors, nurses
Staff Report

LAHORE: The vacation of all doctors and nurses of Lahore General Hospital was cancelled on Friday on the directives of Post Graduate Medical Institute (PGMI) principal Dr Sajaad Hussain.

The hospital?s on leave workers have been asked to report back on duty immediately. LGH medical superintendent (MS) Dr Omer Farooq Baloch said the decision had been taken in the wake of the current situation. ?The decision has been taken to tackle any untoward situation,? he said. ?The interviews for the posts of trainee house officers have also been postponed and interviews will now be held on December 31.? :tiphat: http://www.dailytimes.com.pk/default.asp?page=2007\12\29\story_29-12-2007_pg7_40

 

[Treyfish]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Internet, telephone services suspended: Protesters attack optical fibre cable near Nawabshah
By Hasan Ali

LAHORE: Internet and telephone services were suspended in Lahore after an attack on the optical fibre cable near Nawabshah, the Pakistan Telecommunication Company Limited (PTCL) officials told Daily Times on Friday.

Internet service suffered most due to the attack and remained suspended in Lahore, Islamabad, Rawalpindi Sialkot, Okara, Gujranwala, Peshawar, Sahiwal, Faisalabad and Southern Punjab. The officials said nationwide international dialling had also been affected.

PTCL Public Relations general manager Ali Qadir Gillani said an angry mob had burned the main optical fibre cable of the company near Nawabshah on early Friday due to which an Internet link remained down in the country. A PTCL team, he said, immediately reached the place from Hyderabad to restore the link but could not because of the angry mob.

?If the problem had occurred at an international level, PTCL could have shifted the link from cable 3 to link cable 4. But the link has been broken locally and there is no option except to repair the cable,? he said.

?The repair work will take some time as angry protesters have also damaged the PTCL property,? Gillani said. ?The PTCL high officials have asked the staffers to first save their lives.?:tiphat: http://www.dailytimes.com.pk/default.asp?page=2007\12\29\story_29-12-2007_pg7_28

 

[Giuseppe]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

[Also reported by CIDRAP.]
--
Pakistan bird flu virus shows no mutations; chicks in Israeli daycare succumb

The genetic structure of H5N1 virus recovered from Pakistan's first confirmed human case of the illness suggests the virus did not mutate to become better adapted to humans, an expert with the World Health Organization said Thursday.

Dr. Frederick Hayden said initial sequencing of several genes of the virus showed no worrisome genetic changes. The London-based influenza laboratory that did the work reported that the virus was identical to a number of H5N1 viruses isolated from chickens in the region, he said.

The virus fragments were recovered from specimens taken from a man who died of H5N1 infection on Nov. 28.

The WHO believes the man became infected while caring for his brother, a veterinary worker who fell ill after culling H5N1-infected poultry.

"There were no adaptive mutations in the hemagglutinin that would suggest that it have moved towards human binding characteristics, which is of course good news," said Hayden, a medical officer with the WHO's global influenza program.

"If you look at the sequence findings combined with the epidemiologic investigations that have been done to date, it really does suggest that the H5 virus has not gained a capacity for spread from human-to-human within either Pakistan or more broadly."

Several other members of the family initially tested positive in diagnostic work conducted by Pakistan's National Institute of Health.

But confirmatory tests done by international labs working with the WHO only produced the one positive result.

The WHO cautioned last week that doesn't mean others in the family weren't infected, noting the samples could have deteriorated by the time they reached the London lab.

It is hoped follow-up blood testing will reveal whether - as the WHO suspects - a number of other members of the family were also infected, including the veterinary worker. Another brother who nursed the veterinary worker also fell was ill but he died without being tested.

Hayden said the initial sequencing shows the virus is from a family or clade of H5N1 viruses identified as "Qinghai Lake" like viruses. [Clade 2.2, according CIDRAP]

That family of viruses spread from a lake in northwestern China in 2005 into Russia, Europe and eventually the Middle East and Africa.

Like most viruses in that grouping, known as clade 2.2, the virus from the Pakistan man appears to be susceptible to both classes of influenza drugs - neuraminadase inhibitors (Tamiflu and Relenza) and M2 inhibitors (amantadine and rimantadine).

Hayden said sequencing of the full genome of virus grown from a specimen taken from the Pakistani man remains to be completed.

In other H5N1 developments, Israeli media reports Thursday suggested authorities in that country had ordered the culling of poultry in part of Israel's north after chickens kept at a kindergarten tested positive for the strain of avian flu.

Most of the chickens in the coop in a Binyamina kindergarten died, and veterinarians determined they were infected with the H5N1 strain of avian flu, it was reported.

Israel TV showed footage of yellow-suited, masked workers disinfecting the kindergarten in the northern Israeli town.

Fowl were to be culled in a three-kilometre radius from Binyamina, near Israel's Mediterranean coast south of the port city of Haifa, the reports said.
-
http://canadianpress.google.com/article/ALeqM5hzVNDNi9TjlNv5Oo4_V5C7t6Us4g

 

[cartski]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

[Also reported by CIDRAP.]
--
Pakistan bird flu virus shows no mutations; chicks in Israeli daycare succumb

The genetic structure of H5N1 virus recovered from Pakistan's first confirmed human case of the illness suggests the virus did not mutate to become better adapted to humans, an expert with the World Health Organization said Thursday.

Dr. Frederick Hayden said initial sequencing of several genes of the virus showed no worrisome genetic changes. The London-based influenza laboratory that did the work reported that the virus was identical to a number of H5N1 viruses isolated from chickens in the region, he said.

The virus fragments were recovered from specimens taken from a man who died of H5N1 infection on Nov. 28.

The WHO believes the man became infected while caring for his brother, a veterinary worker who fell ill after culling H5N1-infected poultry.

"There were no adaptive mutations in the hemagglutinin that would suggest that it have moved towards human binding characteristics, which is of course good news," said Hayden, a medical officer with the WHO's global influenza program.

"If you look at the sequence findings combined with the epidemiologic investigations that have been done to date, it really does suggest that the H5 virus has not gained a capacity for spread from human-to-human within either Pakistan or more broadly."

Several other members of the family initially tested positive in diagnostic work conducted by Pakistan's National Institute of Health.

But confirmatory tests done by international labs working with the WHO only produced the one positive result.

The WHO cautioned last week that doesn't mean others in the family weren't infected, noting the samples could have deteriorated by the time they reached the London lab.

It is hoped follow-up blood testing will reveal whether - as the WHO suspects - a number of other members of the family were also infected, including the veterinary worker. Another brother who nursed the veterinary worker also fell was ill but he died without being tested.

Hayden said the initial sequencing shows the virus is from a family or clade of H5N1 viruses identified as "Qinghai Lake" like viruses. [Clade 2.2, according CIDRAP]

That family of viruses spread from a lake in northwestern China in 2005 into Russia, Europe and eventually the Middle East and Africa.

Like most viruses in that grouping, known as clade 2.2, the virus from the Pakistan man appears to be susceptible to both classes of influenza drugs - neuraminadase inhibitors (Tamiflu and Relenza) and M2 inhibitors (amantadine and rimantadine).

Hayden said sequencing of the full genome of virus grown from a specimen taken from the Pakistani man remains to be completed.

So, the story about this H2H outbreak is nearly over. The genetic tests from the index case have not shown the mutations capable of supporting a pandemic. The acid test for the index case has not been met.

We await confirmation that the virus that infected the other members in this outbreak was the same as the index case. If so confirmed, this situation remains an H2H outbreak without pandemic potential.

Is this a fair summary?

J.

 

[Giuseppe]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Is this a fair summary?

J.[/QUOTE]

It seems. But I am sure that someone else will not.
It remains to establish the scope of respiratory illness in the country, clinical features, outcomes.
To date, no further WHO updates are available.

 

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

So, the story about this H2H outbreak is nearly over. The genetic tests from the index case have not shown the mutations capable of supporting a pandemic. The acid test for the index case has not been met.

We await confirmation that the virus that infected the other members in this outbreak was the same as the index case. If so confirmed, this situation remains an H2H outbreak without pandemic potential.

Is this a fair summary?

J.

No. There is only one isolate. The rest of the samples are garbage.

 

[Blue]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

No. There is only one isolate. The rest of the samples are garbage.

Sounds about right to me. Thank you, Dr. Niman!

 

[Treyfish]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Travel advice for Pakistan...Baluchistan, North-West Frontier Province, federally-administered tribal areas, border areas with Afghanistan and India..Do not travel...Avian influenza: The World Organisation for Animal Health (OIE) has confirmed cases of avian influenza in birds in a number of countries throughout the world. For a list of these countries, visit the OIE website. For information on our advice to Australians on how to reduce the risk of infection and on Australian Government precautions see our travel bulletin on avian influenza.
There has been a human death from avian influenza in Pakistan. The Department of Health and Ageing advises Australians who reside in Pakistan for an extended period to consider, as a precautionary measure, having access to influenza antiviral medicine for treatment. Long term residents are at a greater risk of exposure to avian influenza over time. Medical advice should be sought before antiviral medicines are commenced. Australians intending to travel to Pakistan for shorter periods are at much lower risk of infection but should discuss the risk of avian influenza with their doctor as part of their routine pre-travel health checks.
If the avian influenza virus mutates to a form where efficient human-to-human transmission occurs, it may spread quickly and local authorities could move quickly to impose restrictions on travel. Australian travellers and long-term residents in Pakistan should be prepared to take personal responsibility for their own safety and well-being, including deciding when to leave an affected area and ensuring they have appropriate contingency plans in place. Australians in Pakistan should monitor the travel advice and bulletin for updated information and advice, and ensure that their travel documents, including passports and visas for any non-Australian family members, are up to date in case they need to depart at short notice.
In January 2006, the Australian Government decided as a precautionary measure to hold a limited supply of the antiviral medicine oseltamivir (Tamiflu) and protective face masks at its missions in Pakistan. The antivirals would primarily be used to protect emergency staff providing consular and other essential services in the event of a widespread outbreak of avian influenza amongst humans. Australian missions will not be in a position to provide influenza antiviral medicines to Australians in affected areas and it is the responsibility of individual Australians to secure their own supply of such medicines (such as Tamiflu or Relenza), if required.This Advice was issued on Monday, 07 January 2008, 16:16:20, EST. :tiphat: http://www.smartraveller.gov.au/zw-cgi/view/Advice/Pakistan#Health_Issues

 

[tropical]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

I don't see an alarming text for travel restrictions other if we must be alarmed with the bolded part of Aussi text, that is similar to the text for the embassies (Hong Kong) one year ago.

The WHO site is not daily refreshed, and I don't see that kind of awareness on the avian link.

The iner Aussi statement don't point to any new ways of spread:

"People are at risk of contracting avian influenza if they have close contact with infected birds, their faeces or other body fluids. The virus does not spread easily from birds to people. There is a very low risk of contracting the disease from occasional contact with an infected bird such as when travelling on public transport."


_____________________________________________________________
Travel Bulletin

Health: Avian Influenza

This Bulletin is current for Thursday, 10 January 2008.
The Bulletin was issued on Friday, 21 December 2007, 11:35:18, EST.
Summary

• Avian influenza is primarily a disease of birds and only rarely causes infections in humans and other mammals.
• Human cases of avian influenza continue to occur in a number of countries as a result of exposure to infected birds, usually domestic poultry. There is currently no evidence of efficient spread of avian influenza from person to person.
• Australian travellers, long-term residents and businesses overseas should inform themselves about the risks of avian influenza, be prepared to take personal responsibility for their own safety and put appropriate contingency plans in place.
• Australians who live in an avian influenza affected area for an extended period should consider, as a precautionary measure, having access to influenza antiviral medicine for treatment.
• Australians intending to travel to affected countries for shorter periods are at much lower risk of infection, but should discuss the risk of avian influenza with their doctor as part of their routine pre-travel health checks.
• If you are visiting or living in a country affected by avian influenza, you should follow sensible precautions to reduce infection risk.
• If the threat of sustained human-to-human transmission appears serious, we will advise Australians in affected countries to consider leaving. If they don't leave when first advised to do so, they may be prevented from leaving later.
• Australians should ensure that their travel documents are up-to-date in case they need to depart an affected country at short notice.
• If a widespread outbreak occurs, the delivery of consular assistance to Australians could be severely constrained. Australian missions and offices overseas will not be in a position to provide influenza antiviral medicines to Australians in affected areas. Australian travellers, long-term residents and businesses are responsible for securing their own supply of influenza antiviral medicine, if required.

<HR>On this page:
Summary
Avian influenza outbreak
Advice for Australians
Australian Government precautions
Reducing the risk of infection
Avian influenza amongst birds
Further information

Avian influenza outbreak

Since November 2003, the World Health Organisation (WHO) has confirmed human cases and deaths from avian influenza in Azerbaijan, Burma, Cambodia, China, Djibouti, Egypt, Indonesia (including Bali), Iraq, Laos, Nigeria, Thailand, Turkey and Vietnam.
The Department of Health and Ageing (DOHA) is maintaining a list of frequently asked questions on avian influenza for Australians.
Advice for Australians

The Department of Health and Ageing advises Australians who reside in an avian influenza affected area for an extended period to consider, as a precautionary measure, having access to influenza antiviral medicine for treatment. Long-term residents are at a greater risk of exposure to avian influenza over time. Medical advice should be sought before antiviral medicines are commenced.
DOHA advises that Australians intending to travel to avian influenza affected areas for shorter periods are at much lower risk of infection, but should discuss the risk of avian influenza with their doctor as part of their routine pre-travel health checks.
Currently, there is only a limited availability of influenza antiviral medicines in many countries including Australia. Australians should familiarise themselves with the advice regarding personal protective and infection-control measures provided on DOHA's Pandemic Influenza website, including the "Prepared and Protected" video.
Individual Australians and Australian businesses overseas are responsible for securing their own supply of influenza antiviral medicine (such as Tamiflu or Relenza), if required. Australian missions and offices overseas will not be in a position to provide influenza antiviral medicines to Australians in affected areas.
Should a sustained human-to-human outbreak occur, Australians should be aware that the delivery of consular assistance to Australians could be severely constrained by local health conditions and restrictions on travel. Australian travellers, long-term residents and businesses overseas should be prepared in these circumstances to take personal responsibility for their own safety and well-being and should monitor this bulletin and the relevant country travel advice for updated information and advice.
If the threat of sustained human-to-human transmission appears serious, we will advise Australians in affected countries to consider leaving and Australians planning travel to affected countries to reconsider their need to travel. At the same time, the Australian Government would likely direct staff not providing emergency services and all dependants of staff in those countries to leave. As a precautionary measure in case they need to depart at short notice, Australians should ensure that their travel documents are up-to-date, including passports and visas for any non-Australian family members. Australians who return to Australia from any areas affected by human-to-human transmission may be subject to quarantine measures at Australian borders.
If the virus mutates to a form where efficient human-to-human transmission occurs, it may spread quickly and local authorities could move quickly to impose restrictions on travel. Australians who don't leave affected countries when first advised to do so may be prevented from leaving later. Borders may be closed, commercial air services may be curtailed or halted and quarantine requirements may further restrict options for leaving. Australians need to consider in advance how they can care for themselves and put appropriate contingency plans in place.
Australian Government precautions

The Australian Government has decided as a precautionary measure to hold a limited supply of the influenza antiviral medicine oseltamivir (Tamiflu) and protective face masks at most of its overseas missions. The antivirals would primarily be used to protect emergency staff providing consular and other essential services in the event of a widespread outbreak of avian influenza amongst humans. These medicines are not currently being taken by staff and will only be taken on medical advice.
This is a prudent measure to ensure that Australian officials overseas will be able to maintain essential services to Australians if a human outbreak does occur. The limited influenza antiviral medicine supplies held at these missions and offices is not intended and does not allow for provision to other Australians who may be in an affected area.
Reducing the risk of infection

People are at risk of contracting avian influenza if they have close contact with infected birds, their faeces or other body fluids. The virus does not spread easily from birds to people. There is a very low risk of contracting the disease from occasional contact with an infected bird such as when travelling on public transport.
Australians travelling to areas affected by avian influenza can reduce their risk of infection by:
- avoiding situations where they may come into contact with farms and live bird markets;
- ensuring all uncooked poultry and eggs are handled hygienically with careful attention to hand washing after handling
- ensuring all poultry and eggs are cooked thoroughly before consumption (proper cooking destroys the virus in poultry and eggs); and
- washing hands thoroughly after contact with infected or potentially infected birds, their faeces or other body fluids.
In affected areas, you should avoid contact with cats and their faeces as there is some evidence that these animals can be infected with avian influenza.
The United States embassy in Jakarta is advising American citizens in Indonesia to avoid wild and stray cats and ensure domestic cats do not eat or interact with sick or dying poultry. A warden message issued by the embassy notes there are no documented cases of feline to human transmission of avian influenza.
Avian influenza amongst birds

For a list of countries in which outbreaks of avian influenza amongst birds have been reported, see the website of the World Organisation for Animal Health.
The World Health Organisation is working to support national disease authorities in the affected countries to investigate the outbreaks. The WHO has not advised against travel to any of the affected countries.
Further information

Information about how the virus spreads from birds to humans, including frequently asked questions about avian influenza, is available from the Department of Health and Ageing's website or by phoning the department's communicable disease hotline on 1800 004 599 between 8am to 6pm Monday to Friday.
The Department of Foreign Affairs and Trade in conjunction with the Department of Health and Ageing will continue to monitor avian influenza closely including for any implications for overseas travel.


<HR noShade SIZE=1>While every care has been taken in preparing this travel information for travellers, neither the Australian Government nor its agents or employees including any member of Australia's consular staff abroad, can accept liability for injury, loss or damage arising in respect of any statement contained therein.

 

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Tests show US man, member of Pakistan bird flu family, never contracted virus

37 minutes ago
Blood testing has confirmed that a U.S. resident whose brother was Pakistan's first confirmed case of H5N1 infection never contracted the disease.
The New York State health department revealed that the man's blood showed no antibodies to H5N1, indicating he had not caught the virus while attending his brother's funeral in Pakistan late last year.
"His final test came back. He showed no avian flu and no antibodies to avian flu, which means he never got it," Claudia Hutton, the department's director of public affairs, said in an interview from Albany.
The man, who lives on Long Island, is part of a large family of brothers involved in a cluster of confirmed, probable and suspect cases. The other surviving brothers live in Pakistan's North-West Frontier Province.
Because of the pattern of illnesses within the family, the World Health Organization believes there was limited person-to-person spread of the virus among the relatives. But initial diagnostic efforts were only able to confirm one case, so follow-up blood work will be needed to determine how many people were actually infected.
One member of the family, a veterinary worker, fell ill in late October after helping to cull H5N1-infected poultry. While he was sick, at least two of his brothers nursed him, first at home, then at the hospital.
The veterinary worker survived but the two brothers died, one in mid-November and the other on Nov. 28. The first man to die was never tested for H5N1. But a specimen taken from the second showed he was infected with the virus. Another brother was also ill and was hospitalized. Still another showed no signs of illness.
The brother from Long Island experienced mild cold-like symptoms after returning from Pakistan. And his young son, who did not make the trip with him, also had a cold; it appeared to get worse after his father's return.
The man went to his doctor, the doctor notified local public health authorities and they in turn alerted the state. The U.S. Centers for Disease Control even sent a plane to New York to collect specimens from the man and his son for testing in the CDC's Atlanta labs.
They were both negative. But, a negative test isn't proof positive there was no infection. A test taken too late in the course of an infection could come back negative.
To close the book on the incident, authorities collected blood samples from the man and the son to look for the antibodies that would be present if they had been infected with the virus. Both the father and the son were negative in antibody testing.
The WHO said this week that blood samples from the surviving family members in Pakistan have been sent to a U.S. Naval laboratory in Cairo that does influenza testing for the WHO. But it could be a couple of weeks or longer before results are available.

http://canadianpress.google.com/article/ALeqM5huoyjAVXl48BfUHrQk5VY83I5LrQ

 

[sharon sanders]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

"A test taken too late in the course of an infection could come back negative."

 

[Gert van der Hoek]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

HEALTH-PAKISTAN: National Alert Over Bird Flu Deaths

By Ashfaq Yusufzai

PESHAWAR, Jan 24 (IPS) - Although genetic sequencing tests conducted by the World Health Organisation (WHO) of samples from a man who died of H5N1 avian influenza do not confirm human-to-human transmission, authorities in this region, bordering Afghanistan, are taking no chances.

Ilyas, 28, a livestock official was admitted to the Khyber Teaching Hospital (KTH) on Nov. 22 with symptoms of bird flu and died on Nov. 22. But when it became known that his brother, Idrees, 22, had developed similar symptoms and died four days earlier it sent alarm bells ringing through the community and health officialdom.

On Dec. 28, WHO's headquarters in Geneva announced that a case of human-to-human virus transmission may have occurred in Pakistan, but a later statement on Jan. 3 said that a ''preliminary risk assessment found no evidence of sustained or community human-to-human transmission''.

Meanwhile, KTH had received another three brothers and one cousin; all were tested positive for carrying H5N1 strain of virus.

Initially, the Ministry of Health, Islamabad dragged its feet on the result of the death of Ilyas, despite its confirmation by the National Institute of Health (NIH), Islamabad. The ministry was cautious, fearing that it would cause panic among the people, and pilgrims could face delay in flights to Saudi Arabia for Hajj.

Now it has issued an alert and started training doctors and health workers on the management of bird flu in the province. It has established two respiratory isolation units (RIUs) to cope with an emergency.

"The WHO is assisting the health department to establish two RIUs, one each at Peshawar and Abbottabad where six cases and three cases respectively of H5N1 were found," said WHO’s Dr Saeed Akbar Khan.

In addition, the world health agency has agreed to establish two wards each at KTH and Ayub Teaching Hospital, Abbotabad in NWFP, at an estimated cost of 500,000 dollars, Dr Mukhtiar Zaman Afridi, a pulmonologist and focal person for bird flu told IPS.

The WHO has urged the health and agriculture departments in the NWFP to coordinate efforts because an estimated 35 percent of the population could be at risk. In case of a pandemic, thousands of people could die, and hospitals, which together have roughly 9,000 beds, would be unable to meet the challenge.

"About 14 private rooms designated as the isolation ward are not up to the standard of the world health agency. There is no ventilation and investigation facility, such as x-rays, etc., due to which the affected patients had to be shifted to and from the ward," Dr. Saeed Akbar Khan told IPS.

The global health agency believes the world is closer to another influenza pandemic than at any time since 1968. Last month, its experts flew into Pakistan and visited Peshawar and Abbottabad districts of NWFP where some 200,000 poultry have been culled.

Two teams collected data on the nine bird flu cases reported from the two districts in effort to determine the epidemiological link between them. While one patient died, the rest have recovered.

Dr Khalife Mahmud Bile, WHO's country chief, said the visiting teams had validated the findings of the NIH.

Global health experts fear the virus -- which has killed 211 people out of 343 infections reported since 2003 -- could mutate into a form that spreads easily from one person to another, possibly triggering a pandemic that could kill millions.

WHO teams in Pakistan also investigated the possibility of human-to-human transmission in the reported cases. Since 2005, the government has confirmed the deaths of five people from bird flu.

"Stocks of Tamiflu, an antiviral drug used for influenza virus, have been rushed to the affected districts to meet any eventuality," said Bile.

Concerned officials warn there is a need to educate ordinary people and health professionals about the risks. Most doctors are afraid of coming into contact with patients infected by the avian influenza.

According to Dr Khalid Khan of the NWFP’s livestock department, the virus flourishes in zero temperature. "There is a need to inform the people, especially those associated with the poultry businesses, about the preventive steps," he added.

Up to December, Pakistan reported 79 outbreaks of bird flu, the last on Nov. 29 in Murree, Punjab province. Of these, 53 outbreaks involved commercial and backyard poultry.

The NWFP, which houses 85 percent of the country's poultry farms, is introducing a law aimed at protecting people from bird flu, confirmed Shah Rukh Khan, secretary agriculture and livestock department.

Under the proposed legislation the sale of poultry would be permitted only in designated places. Poultry farms not be allowed in residential areas and poultry waste would be compulsorily buried in deep ditches.

Bird flu has crippled the provincial government. An estimated two million dollars has been paid in compensation to poultry owners who have suffered losses.

http://www.ipsnews.net/news.asp?idnews=40906

 

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

?Move poultry farms, selling points out of populated areas?

* Dr Masood says poultry workers should use gloves, masks and gowns
* Says domesticated ducks and other birds can carry H5N1 virus
* Dr Israr says the greatest contagion of bird flu seems to be contact with sick birds

Staff Report

LAHORE: Doctors demanded that the government should shift poultry farms and poultry selling points from the densely populated areas to the places designed for this purpose in order to control bird-to-human transmission of bird flu.

A workshop, Check on the Human Transmission of Bird Flu Cases in Asian Countries, was held under the auspices of the Pakistan Medical Society (PMS) on Sunday. PMS Chairman Dr Masood Akhtar, Dr Ali, Dr Israr Hussain Asif and Dr Fouzia addressed the workshop.

Dr Masood said the poultry business in most of the Asian countries was conducted in an orthodox and non- professional style, where proper measures were not being taken.

The government should make it compulsory for poultry workers to use gloves, masks and gowns to avoid the transfer of H5N1 ? the pathogen responsible for the human cases of bird flu.

He said, ?A comprehensive vaccination of birds makes them less vulnerable to the avian influenza. Poultry waste should be properly disposed of.?

The workers associated with the poultry business should be imparted proper training for the safe handling of poultry products and excreta.

There were two pandemics of the influenza virus in 1937 and 1968, which took millions of life. He said health experts had predicted that another pandemic could break out any time as the span of 30 years was completed.

?Domesticated ducks and other birds can carry the H5N1 virus, which is more dangerous than the one that poultry birds carry. The government should form proper legislation to prevent people from domesticating poultry folks and dangerous birds.?

Dr Israr Hussain said, ?The greatest contagion of bird flu seems to be contact with sick birds and with surfaces contaminated by their feathers, saliva or droppings.? The World Health Organisation has confirmed a handful of cases of limited human-to-human transmission of bird flu; but, unless the virus begins to spread more easily among people, infected birds and associated material present the greatest hazard.

Sajid Butt said, ?The pattern of human transmission remains mysterious. Young children seem especially vulnerable to the virus, although some experts note that children are more likely to have contact with sick birds or to play on ground contaminated with droppings.?

http://www.dailytimes.com.pk/default.asp?page=2008\01\28\story_28-1-2008_pg7_33

 

[Laidback Al]

Re: Pakistan: December 18+, WHO Begins Investigations

Re: Pakistan: December 18+, WHO Begins Investigations

Thread closed - please post to new thread here:

http://www.flutrackers.com/forum/showthread.php?t=52679