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A 38-year old male cargo worker from Tangerang, 20+ miles west of Jakarta.  A 19-year-old male factory worker from Tangerang.  The data may not be sufficient to make a distinction, but I have an uneasy feeling about these last two reported human H5N1 deaths from the same province of Indonesia. 

We don't know much yet about either case.  The cargo worker is not "officially" dead of H5N1, although locals familiar with the case swear that tests confirmed the presence of H5N1 bird flu.  And the details are just coming in on the teenage factory worker. 

But so far, there is nothing solid to tie these two deaths to exposure to sickened poultry.  Both had poultry, apparently, but there is no evidence that their poultry was sick; nor was there clear evidence of sick poultry in the neighborhood. 

Previously, we have been conditioned to see Tangerang women die from H5N1 (for reference, look back to my October, 2007 blog entry, New H5N1 death in Tangerang, Indonesia).  These two men, from basically industrial occupations and from the same province, raise some fresh concerns about the Indonesian government's decision to withhold precious information until it is rolled up and placed into summary reports.

It also raises fresh concerns regarding Tangerang, which I think we all regard as the top hot spot for human H5N1 infection in the entire world.  This is also where the US government placed over a million dollars' worth of aid just a few months ago.  Recall that the US ambassador to Indonesia personally handed the aid to the Tangerang government.

Two male deaths that do not immediately track back to poultry, in the same province, within two weeks of each other.  It bears close watching.

I have been a vocal advocate for the mass stockpiling of the antiviral inhalant Relenza, or zanamivir, for some time.  The idea of giving first responders pills to take just doesn't seem to be the right way to go.  The idea is to try and prevent influenza in those first responders, and a 45-day course of a pill a day sounded a little excessive.

Relenza is not as effective as Tamiflu when you have the flu, because it is hard to inhale the medicine deep into the lungs, where, for example, H5N1 likes to go.  But a convenient inhaler in a container that can fit into a utility pocket -- NOW we're talking proactive, easily-administered antiviral dosages!

Yesterday's Bloomberg article regarding the effectiveness of a more potent version of Relenza, manufactured by a Japanese company, should help to promote Relenza as a must-have antiviral in everyone's stockpile -- if your stockpile includes preventing bird flu as well as limiting its symptoms.  I can tell you that my antiviral stockpiling has switched from acquiring any more Tamiflu, to acquiring Relenza.  And, of course, the state antiviral programs under the federal deal with Roche mandate a default 80/20 split between Tamiflu and Relenza.  So for those states who elected to participate in the HHS program, 20% of your stockpile includes Relenza.  Get those dosages out quickly to your first responders whenever the pandemic starts.

Longer-Acting Relenza Fights Flu as Well as Tamiflu (Update1)
By Jason Gale

July 31 (Bloomberg) -- Daiichi Sankyo Co.'s longer-acting version of GlaxoSmithKline Plc's flu drug, Relenza, was as effective as a course of Tamiflu, a patient study found.

The safety and efficacy of a single dose of the inhaled medicine was ``statistically indistinguishable'' from a twice-a- day dose of Roche Holding AG's Tamiflu taken for five days, said Melbourne-based Biota Holdings Ltd., which is developing the drug with Japan's Daiichi Sankyo. The study, involving ``several hundred'' patients with seasonal flu, was the second of three stages of human trials usually needed for regulatory approval.

The companies plan to start final-stage tests in Japan, Taiwan, Hong Kong and South Korea by the Northern Hemisphere winter, Biota said in a statement today. If approved, the medicine could provide a new treatment for flu, a disease causing 250,000 to 500,000 deaths worldwide a year. Previous studies also showed the medicine fights the H5N1 version of bird flu, which world health officials say might set off a lethal pandemic.

``If it's successful, then it would be a very useful drug,'' Scott Power, an equities analyst with ABN Amro Morgans Ltd. in Brisbane, Australia, said today by telephone. He rates Biota's shares ``buy.''

Biota gained 2.5 Australian cents, or 3.6 percent, to 72.5 cents on the Australian Stock Exchange. Power expects the shares to reach A$1.30 within the next 12 months.

Shares of Daiichi Sankyo, Japan's third-largest drugmaker, increased 80 yen, or 2.6 percent, to 3,190 yen on the Tokyo Stock Exchange at 11 a.m. local time.

Governments worldwide are stockpiling anti-flu medicines, including Tamiflu and Relenza, to reduce the severity and spread of disease in the event of a pandemic. A treatment that's taken only once, rather than twice a day for five days, would reduce the amount of medicine needed to be kept on hand, Power said.

Daiichi's experimental medicine, known as CS-8958, is in the same class of antiviral as Tamiflu and Relenza, which works by preventing flu viruses from spreading from infected cells.

http://www.bloomberg.com/apps/news?pid=20601101&sid=aDCmbqrVxu3M&refer=japan

I had no idea how widespread the threat of tick infestation is on Italian transports such as trains and ferries, but this article is downright scary. From Tropical Medical Bureau:

Complaint as Italian ferry cabin infested with ticks

News about: ITALY

Date: Tue, 29 Jul 2008 13:11:05 +0200 (METDST)

ROME, July 29, 2008 (AFP) - An Italian woman is suing a ferry company after waking up in a first-class cabin "covered in ticks from head to toe", newspapers reported Tuesday. Cristina Sassudelli, 41, was making a night crossing at the weekend from the northern city of Genoa to the port of Olbia on the southern Italian island of Sardinia. "At six thirty in the morning I was wakened by the itching on one arm and I realised I was covered with ticks from head to toe," she said, according to accounts in several Italian dailies. "I have always had dogs and I saw immediately that these weren't any kind of insect. There were hundreds of them," she added.

Staff on the ferry, run by a company called La Tirrenia, took her infested clothes and gave her new ones that were far too big, she said. Once they had arrived at Olbia a member of the crew accompanied her to a shop where she was able to buy new clothes. But the company did not reimburse her for her first-class ticket, she said. La Tirrenia told La Stampa newspaper: "This episode happened at a period of heavy traffic and hot, humid conditions. It is the first time, after many years of navigation, that it has happened." It added that the contaminated zone had been sealed off and was being disinfected. Sassudelli said she was taking action against the company to make sure no one else had to go through the same "nightmare." In recent years, there have been several cases of infections from ticks or fleas on Italian transport, particularly on trains.

Source: AGENCE FRANCE-PRESSE Date: 29/7/2008

I am sure Chinese PR types are absolutely apoplectic with concern over the proMED reports coming out of Wanjiakou Village, Xiaoguan Town, Wensind City, Shandong Province.  Apparently, some sort of hemorrhagic fever has broken out there.

Details are sketchy to say the least, but according to the proMED report's citation, it spread quickly and at least three villagers are dead.  A half-dozen or so are in treatment.  The first death, a man, turned dark purple and began bleeding from his mouth, nostrils, ears and eyes before he died.

Naturally, the villagers are extremely shaken by the experience. 

the person who sent the alert is Dr. Stephen O. Cunnion, the national security health policy director for the Potomac Institute for Policy Studies.  Lest we glodd over that info, proMED reminds us that it was none other than Dr. Cunnion who first sounded the alarm bells to proMED on a curious respiratory disease in 2003 that later became known as SARS.  So Dr. Cunnion is at least battling 1.000 on his disease alert front.

We will see what transpires.  ProMED lists the odds of hantavirus being the culprit at 57%, and Crimean-Congo Hemorrhagic Fever at less than 1%.

Hopefully it is NOT some new and dangerous disease.

The news today is not kind to bird flu bloggers, posters and readers. Melanie Mattson, veteran blogger and one of the true pioneers in Flublogia, has died. Melanie helped found FluWiki, the first Website that combined information about avian flu with commentary from readers and experts alike. Every flu blogsite and Website owes a debt to Melanie, and all are paying respect to her memory today.

I honor her as well. 

From FluWiki:

In Memoriam - Melanie Mattson by: DemFromCT Fri Jul 11, 2008 at 07:20:17 AM EDT Melanie Mattson was one of the founding Editors of the Flu Wiki, its initial "public face," the official publisher, and our colleague. More importantly she was our friend. We are grieved to announce her unexpected death. On her blog, Just a Bump in the Beltway, Melanie was among the first on the internet to understand and write about the significance of reported human cases of avian influenza as a potential harbinger of a pandemic. She joined forces with us to start the Flu Wiki in June 2005 where she was a dedicated and innovative practitioner of a new medium, collective information generation and dissemination. At the time of her death she was engaged in expanding what she learned from her blog and Flu Wiki to a wide range of natural disasters. Melanie was a wonderful human being, a lovely person and a Grand Lady in every sense of that term. Melanie sometimes used salty language, could be bluntly honest and had an irreverent and earthy sense of humor, so she would no doubt be amused to be referred to as a Grand Lady. But that's what she was and still survives in the affection of those of us fortunate to have known her. She'll be missed.

http://www.newfluwiki2.com/showDiary.do?diaryId=2588

Melanie (along with Greg Dworkin, Mike Coston and Sharon Sanders of FluTrackers) helped me navigate some treacherous political waters when I began posting on other flusites and when I first started this Blogsite. Her counsel was much appreciated. She will be missed.