Scott McPherson's Web Presence

After an unnaturally quiet summer and fall, we are seeing the signs of an increase in bird flu activity across Asia and Europe, in poultry and in people. In just the past few weeks, we have seen increases in suspected bird flu cases and one confirmed death -- a 15-year old Indonesian. Poultry cases are cropping up again in Laos, Vietnam and Thailand, and we can expect these to accelerate as temperatures drop.

But I suspect we will be more prepared this season if we expect the unexpected from our nemesis H5N1.

Recently, I had a dialogue with one of my subject matter experts, Dr. Richard Webby of St. Jude. I asked him about the roll-off in bird flu cases and gave him my theory of being in the middle of a mutation/evolution of the virus that infects neither poultry nor human with lethality -- yet.

Here's part of what he said:

I guess a number of possibilities here

1) we are just not hearing about ongoing activities as much as we used to (at least in birds)

2) a seasonal affect?

3) Some evolution of the virus as you have suggested.

Also worth considering is the use of vaccine and methods of detection of the virus. We may not be hearing as much about the bird infections if the infection is not lethal (dead birds are easiest way to spot H5). This could be vaccine related in some regions but also could be virus related. So one could argue that birds are still getting infected, but the lethality of the infection is diminishing. This would be expected as a pathogen and host start to co-evolve. Of course this is all hand waving.

In any hypothesis in terms of virus evolution you also need to keep in mind that in essence we have a number of different viruses out there now. So if there is an evolution of the virus in a biologic sense then it is happening simultaneously in all clades?? I am not sure of precedent for any of this. As you know, we really don’t have good data on what was going on before the last pandemics.

I thought about his last statement. We would need to scour the almanacs and agricultural records of the past 100 years to see if any of our flu pandemics were preceded by a sudden reduction of such things as fowl plague, large-scale poultry die-offs and other events.

Let's say that we saw a big die-off of wild birds and poultry worldwide in, say, 1914 through 1916. Then, suddenly, poultry stopped dying in large numbers. Would this have signaled the coming ofthe 1918 pandemic? We have read anecdotal information suggesting the 1918 pandemic was actually around in humans as early as 1915, although this is unproven and could be explained as nothing more than a severe epidemic of whatever strain was going around back then.

But what if it wasn't? What if we saw deaths in 1915-1916 from people exposed to H1N1 Spanish Flu in the same way we see people exposed to and dying from H5N1 today? A case here, a death there. Poultry dying in numbers too large to count. Suddenly, domestic poultry stop dying in large numbers. Everyone slaps themselves on the back, claiming victory over the fowl plague, then WHAMO! The pandemic hits. Hard.

Maybe this is the new direction our historical flu researchers should take. These records should not be hard to find, considering the agrarian history of our nation and the comparatively good diaries and records kept by farmers. If we know the 1918 virus was a bird flu that jumped straight to humans, and if we believe that Kansas was the epicenter, then American farm records might yield a pivotal clue.

We have speculated that H5N1 might evolve away from human pandemic status. Perhaps this has happened or is happening as we speak. But another scenario which I washoping Webby would dismiss -- but he did not and by not dismissing it, actually gave it some credibility-- is the possibility thatH5N1 is once again evolving and mutating into a form whose ultimate victims are as yet unknown.

But considering influenza's proclivities, I am not optimistic for us.

The aviation department of Miami-Dade County, in conjunction with the Centers for Disease Control and prevention, held a simulation recently to test their pandemic capabilities.

Miami is such a gateway city -- not just to the Caribbean and the Americas anymore.  Daily flights to London, paris, Frankfurt, you name it:  Anything can come through Miami International Airport (and frequently does).

The Miami Herald did a nice job covering the event.  The Herald article is below.

Test drill at Miami International Airport aims to slow pandemics

About 400 people participated in the nation's first pandemic flu exercise at Miami International Airport.

BY INA PAIVA CORDLE

icordle@MiamiHerald.com

What if a deadly global pandemic were sweeping across the world and the United States needed to try to delay its effect on our shores?

For the first time, at Miami International Airport on Wednesday, about a dozen federal, state and local agencies participated in a simulation exercise to review the steps needed to screen international passengers arriving in the face of a severe influenza pandemic.

''It's an opportunity to test the plan, see how it works and what needs to be improved, so that when we need to use it for real we are ready,'' said Christine Pearson, spokeswoman for the Centers for Disease Control and Prevention in Atlanta.

About 400 people participated in the test drill, including about 200 voluntary actors. CDC, the Department of Homeland Security and the Department of Transportation led the effort.

In the 20th century, the nation faced three influenza pandemics, in 1918, 1957 and 1968. A pandemic is defined as a new virus for which no one has immunity, which can affect humans and is spread easily between people.

And more pandemics are expected. Bird flu, which affects mostly poultry and wild birds in Asia, Africa and Europe, is being watched, because it sickened about 300 humans during the past decade.

''A pandemic is inevitable, but we can't say it's imminent,'' said Dr. Martin Cetron, director of global migration and quarantine for the CDC.

Yet in a global economy, it is not possible to create an ''ironclad fortress'' and not be affected, he said. ''The goal is not to stop it from coming here, but to delay its entry and slow down the speed in which it affects our citizens.'' That enables the government to prepare vaccines and distribute antiviral medication, while educating the public.

In the simulation, which took place earlier than scheduled at MIA's South Terminal, pretend passengers filled out health forms, were scanned for fever and assessed for potential exposure. All passengers from the plane must stay together until it is determined whether someone is sick, Pearson said.

Those who are ill or potentially exposed then would have a medical evaluation. Those who are sick are sent to a hospital for testing and evaluation. If passengers are not sick but potentially exposed, their health would be monitored to see whether they develop symptoms.

''The exercise exceeded our expectations,'' Cetron said. ``We learned a lot, but perhaps the most important was the ability of all the agencies to work together.''

Newsweek magazine has assembled a very nice and concise photo essay on the history of influenza. One may pick up a very quick capsule of the history of flu pandemics in about five minutes of reading photo captions and examining pictures. Several of these photos and drawings are new to me, which is always a treat.

It was both refreshing and surprising that Newsweek would devote resources to this topic.  Kudos to them for keeping this in the public eye. 

The URL is: http://www.newsweek.com/id/166335

Study suggests migratory wildfowl may eventually bring bird flu to North America.

A study by the U.S. Geological Survey (USGS) alongwith researchers at the U.S. Fish and Wildlife Service in Alaska and the University of Tokyo has confirmed the common transfer of avian influenza from Asia to North America via Alaska.

Migratory flyways with Asia and Alaska as their common points of intersection carry ducks back and forth among the two continents. Gene segments from Alaskan pintail ducks confirms gene segments from Asian low pathogenic avian influenza (LPAI) instead of American LPAI.

Northern pintails were selected because of their proclivity for acquiring LPAI. More than 1,400 pintails were tested and roughly half had gene segments from Asian LPAI.

"Although some previous research has led to speculation that intercontinental transfer of avian influenza viruses from Asia to North America via wild birds is rare, this study challenges that," said Chris Franson, a research wildlife biologist with the USGS National Wildlife Health Center and co-author of the study.

The complete article and links can be found at:

http://www.medindia.net/news/Movement-of-Bird-Flu-from-Asia-to-North-America-Via-Birds-Confirmed-43541-1.htm

These findings are huge in their implication.  First, it completely validates the importance of surveillance, and specifically the huge surveillance effort taking place in Alaska.  The surveillance effort is so detailed and comprehensive up north that even prison inmates have been trained on how to report dead birds found on prison grounds.

It also makes a very strong case for increased surveillance everywhere and along all flyways that lead from Asia and Eurpoe into North America. 

Finally, it validates all those maps and charts we use in our pandemic presentations regarding the migration of wildfowl and the eventual findings of H5N1. 

Fortress America -- the nation/continent protected from foreign enemies by the massive expanse of oceans -- was a myth first debunked the morning of 9/11/01.  Its second debunking will surely happen within the bellies and intestines of migrating birds coming from Siberia toward Alaska.

The mystery behind the outbreak of some sort of hemorrhagic fever in Zambia is beginning to be solved by the CDC and the South African government. For those not watching such things: Three people are dead from what is now believed to be a form of arenavirus.

The index case -- Patient Zero of this new and so-far unknown variant -- is a Zambian who was hospitalized in Johannesburg, South Africa. Two persons who were in the hospital for treatment unassociated with the index patient's disease (nosocomial) also develped symptoms and died. A fourth patient -- a nurse treating the second, NOT the index patient -- is in isolation and is being treated with ribavirin, which helps against lassa fever but is experimental when dealing with this new virus.

Here's a chilling paragraph from the proMED report:

"Arenaviruses cause chronic infection in wild rodents (multimammate mice) with excretion of virus in urine, which can contaminate human food or house dust. Arenaviruses have been found in southern African rodents in the past, but there has been no previous association with human disease. The virus associated with the present outbreak may prove to be a new member of the group." (bold mine)

So we have a new and previously undiagnosed form of arenavirus which has apparently jumped the species barrier from animals (rodents) to humans. Isn't that just lovely? And the virus is highly contagious to boot, as evidenced by the rapid spread to other patients in the hospital -- and the infection of the nurse who was attending one of the follow-on cases.

Now it could be forcefully argued that this could be a case of lax hospital protocols, were it not for the fact that South Africa is no stranger to Ebola, Lassa Fever and Marburg.  This means they may have made some protocol errors, and that may be a leading, if not likely source of the contamination of the two other patients. But it also shows how devastatingly contagious this new disease is.

Samples are undergoing further testing to see if they can quantify the virus further. Again, from the proMED report: A chilling incubation period also exists for this new disease, an even longer incubation period than influenza.

"The incubation period for cases in the present cluster ranges from

7-13 days. There is a prodromal illness of about 7 days with myalgia, headache, diarrhoea, and a severe pharyngitis. This is followed by a more severe illness with moderate thrombocytopenia but no bleeding.

Hepatic dysfunction with raised transaminases has typically occurred late in the course of disease."

Stay tuned.