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The world press is beginning to focus on the province of Bak Kan (or Bac Can), Vietnam.  Bak Kan is in the extreme north of Vietnam, near the Chinese border.  Last week, I blogged on the potential H5N1 bird flu cluster that was threatening to emerge within that province. Just scroll down to read my previous blog.

Following my blog, a second story appeared regarding a second human infection.  It was dated at 6:01 PM, 04/09/2010.  It appears below, and the link to the VOV story is in the headline:

Another A/H5N1 infection case reported in Bac Kan

Yesterday, Vietnam confirmed yet another human bird flu case.  This time, however, this case bears watching, because it could signal something far more disconcerting than just a single human case.

From the proMED report:

The Director of the Bac Kan provincial Health Department, Nong Quoc Chi, confirmed an A (H5N1)-infected case on [5 Apr 2010]. The patient, [male], 22, from Na Tao hamlet, Nhu Co commune, Cho Moi district, is currently in critical condition. He is being treated at the [National Institute of Tropical and Infectious Diseases]. The patient got sick on [30 Mar 2010] with symptoms of high fever and cough. He was admitted to Bac Kan provincial hospital, and then sent to the [National Institute of Tropical and Infectious Diseases] on [3 Apr 2010] where he tested positive for the lethal strain of A (H5N1) virus.

At present, 4 other people in Nhu Co commune show similar symptoms of high fever and cough. They are under quarantine and being treated at Bac Kan provincial hospital.

The patient in question was taken ill on the 30th of March, and then sent to Hanoi when his condition worsened. The four suspected human bird flu cases are currently in quarantine at the provincial hospital in the provincial capital of Bak Kan. (Or Bac Can, as shown on map at left).

There are many unanswered questions.  The most obvious of these is whether these four suspected cases are bird flu, or swine flu?

If these cases are indeed bird flu, has there been human-to-human chain transmission, or were these people all infected during the same timeframe by a single vector?  Were they all infected by sick poultry, or were they sickened by a human infection?

OK, let's assume these four people were all H1N1/swine flu infections.  That is not good news!  That would mean that, once again, bird flu and swine flu had "rubbed elbows" in rural Vietnam.  Search my Blogsite for the earlier known case, back in 2009. 

According to the Vietnamese Department of Preventive Medicine and the Environment, there are no outbreaks of H1N1 anywhere in Vietnam.  From VOA News:

No more A/H1N1 outbreaks in Vietnam

I just got a news story in my Google Alerts folder.  Opening it and clicking on the accompanying link, I was shown something I had not seen in ages and ages -- namely, the WHO statistics for H5N1 bird flu for 2009.

Now, you know how fond I am of saying that influenza plays "King of the Mountain."  That image of children trying to topple the reigning King at the top of the dirt pile (growing up in southern Florida, with all its construction and fill dirt, that game was enormously popular) is exactly what I try to convey with regards to flu strains.

Pandemic viruses play that game quite well.  In fact, I have not bothered to even get my seasonal flu shot yet, because I believed that there would be no seasonal flu until very late in the season.  based on the stats I have been getting from various flu sources, I was right on the money.

So there is virtually no seasonal flu, anywhere in the world, save for some Influenza B that I recently read was either in China or Japan.

But there is one flu strain that keeps on trucking, unabated by events that combine to make seasonal flu virtually nonexistent.  And that is H5N1 bird flu.

It can be argued, possibly successfully, that H5N1 isn't seen in people enough for swine flu to even care about it.  H1N1v just casts a look over its shoulder at H5N1 and ignores it.

But I was really, really surprised to find that 2009 was a pretty good year, or a pretty bad year, depending on whether you are a researcher or the virus itself.  Globally, there were 72 cases of H5N1 in humans, with 32 deaths.  That is still a 44.4% case fatality rate, or CFR. The two extremes for CFR were Egypt, with 39 reported human cases and 4 deaths, for a 10% CFR; and Indonesia, with 20 reported cases and 19 deaths, a whopping 95% CFR.  Of course Indonesia has just gotten over years of governmental madness courtesy of their former health minister.  This somewhat refreshing reporting of cases may skew the CFR heavier, as certainly more human bird flu cases must have been encountered and just not reported.  Or reported and covered up.  Who knows?

In fact, the year 2009 shaped up as the fourth-worst year for human H5N1 cases on record, surpassed by (in order) 2006, 2005 and 2007 in terms of the sheer number of confirmed human cases. From 2008 to 2009, confirmed reported human bird flu cases jumped by 63% while deaths stabilized.

In 2010, we already are reading about more accounts of bird flu in poultry, in all the usual spots.  This recent news, when combined with the 2009 data, should make us all more concerned than ever that a hybrid virus is more than just hypothetically possible.  A glance at the WHO chart also shows us that the areas of the world where human H5N1 cases proliferate are also areas where the H1N1v virus is just beginning to make its inroads. China has recently announced it expects a constant flow of H1N1v human cases throughout 2010.  China had 7 reported human bird flu cases in 2009, its third-highest year on record and the highest number since 2006.

Indeed, in those areas where H5N1 is assumed to be endemic, human cases are on par with previous years.  For example, Egypt's 2009 human bird flu total (39) was 500% higher than 2008's (8).  Vietnam's 5 cases was not statistically different than the previous two years.  And in each and every one of those nations, H1N1v insinuates itself further and deeper rural villages and farms. 

In the midst of all this, we read news reports accusing the WHO of generating a "fake pandemic".  What are these people ingesting?   A key indicator of a pandemic (you know, other than a genetically novel virus)  is a rising of pediatric mortality.  Pediatric mortality in 2009 was three or five times the running average for a normal flu season, according to different sources.  Our own CDC now says upwards of 11,000 Americans died of swine H1.  The overwhelming majority of them were under age 55.  And this virus is far from finished. 

To its credit, the WHO fired back to the flat-Earthers who claimed that the raising of the pandemic level to Phase Six was inspired by the drug companies, and some even claim this virus was genetically engineered.  These are the same drug companies who do not make a lot of money from vaccines.  To even insinuate that drug companies make huge sums of money from vaccines is to show a colossal lack of understanding about how drug companies make their fortunes.  Vaccines represent a huge downside financial risk to their bottom lines, precisely for the reasons we are seeing and reading about today.  Stories abound regarding this nation and that nation trying to renegotiate its vaccine buying agreements in an effort to reduce its purchases.  It is a wonder that drug companies even make vaccines anymore.

But that is a rant best saved for another time.  I wanted to close this blog by saying that we need to watch Asia and Egypt like a hawk.  Because H5N1 had a very good year on the books in 2009.  It continues to be productive and it has not read the memo that it is supposed to roll over and play dead while swine flu takes center stage.

Happy New Year to readers of this blog, who have been doubtless wondering if I have fallen off the planet somehow.  A combination of holiday mirth, coupled with a Special Legislative Session and a few days out of town, left me with little time to blog.  On top of that, I have not seen much reason to blog.  As I have said many times before, I really do not blog unless I have something I have to say which might add something to the ol' knowledge base.  My fellow bloggers have done such a splendid job that I have not had anything really lucent to say.

Oh yes, plus I went and got sick at Disney World!  My wife had this delightful idea to hold a family reunion at Disney World over the New Years holidays.  We rented a house, packed it with relatives and took in three Disney theme parks in three days.  That totaled 38.5 hours in three days, or almost an entire work week in just three days' time.

What I noticed was the conspicuous lack of hand sanitizing stations.  In fact, the only stations I noticed were 1) few, and 2) were only at the Magic Kingdom.  With so many persons appearing from so many different nations, plus the people who came over as part of a Disney Cruise, I found it interesting that there were not hand sanitizing stations at every ride entrance or at every eatery. 

Also, I have been to Hell, and it is being caught in line indoors at Toy Story at Hollywood Studios.  No way out.  Screaming kids in the hundreds.  And a six-foot tall Mr. Potato Head in Don Rickles' voice, telling bad jokes while you move less than 30 feet in more than 40 minutes.  I finally acted decisively, found an emergency exit, and ushered my party to safety and myself to sanity.  This included my wife, who was in a wheelchair suffering from terrible knee pain caused, no doubt, by strenuous walking the previous two days at Epcot and the Magic Kingdom.

So over the past several days, I have been laboring through rhinovirus C, or Ad14, or whatever it is that I caught at Disney.  Same with my wife.

OK, now on to the top question of 2010:  What the Sam Hill is going on with this flu pandemic?

As best as I can make out, the flu has pretty much subsided in the United States.  Despite the record cold temperatures (and as I write this, Tallahassee continues to have sub-20 degree mornings), flu has all but disappeared.  Only one state apparently reports widespread flu activity, and only time will tell if returning college students and resumption of classes at all grade levels, combined with this ungodly weather, will spark the predicted Third Wave of swine flu.

But there are two nations whose flu activities remind me that this pandemic is still stretching its tendrils across the globe:  India and China.  By all accounts, India has reported around 1,100 flu deaths.  China reports even fewer deaths.  If you are thinking what I am thinking, you are saying, "Dangit!  Who is Marvel going to cast in the role of Captain America?!?! They better get this resolved, since the film is due in mid-2011!"

But I am also thinking, "No way India, with a billion people living in varying conditions of comfort and health, can only have a thousand dead from H1N1v.  Ditto China."

Obviously the reporting of cases and deaths is spotty in those countries.  But it also tells me that this virus is still insinuating itself into those regions of the world, where things travel by the older standard.

Think about it:  H1N1v was borne on the wings of airliners and within the airways and lungs of spring breakers to the four corners of the North American continent.  It travelled across the pond to our British friends and from there, to Europe.  But once the virus hit eastern Europe and Asia, it began to circulate under a more conventional (slower) timetable.

In fact, this timetable coincided with the "second wave" of H1N1v that began in the fall here in the US.  While the second wave has seemingly subsided, Asia still appears to have not even crested its first wave! 

In Florida, we fear the Category 4 hurricane, but we absolutely fear the Category 4 hurricane that moves slowly across the state.  The slower the storm moves, the more damage it is capable of creating.  I want to apply that line of thought to this virus.  The slower this virus moves throughout Asia, the more opportunities it has to infiltrate remote hamlets and villages.  The more opportunities it has to intersect with H5N1.  And the more opportunities it has to mutate/evolve and gain lethality.

Influenza's goal is not to mutate itself out of existence.  Its goal is to co-exist with a host organism.  If H1N1v is such a "mild" virus today (and I think several thousand American families would vehemently disagree with anyone who would call swine flu a mild flu), then its goal is not to become milder.  Its proclivity would be to enhance its ability to make people sick.  It will enhance either its lethality or its target population, or both. 

That is one reason why I think it is important for seniors to begin receiving their swine flu shots now, along with the rest of us who have not done so already.  Suddenly, entire nations are (foolishly) raffling off their reserves of H1N1v vaccine. 

Finally, I redirect you to the words of John Oxford, who foresees a very difficult spring of 2010.  Combine his words with the admonitions of the WHO.  The WHO is saying it may take until the end of 2011 for this pandemic to conclude (meaning, to turn into seasonal flu).  Professor Oxford said that selective mutations of H1N1v will begin to take root once about 30% of the world's population had been exposed to the current virus.

But I am not afraid.  After all, I have been in close contact with Mr. Potato Head.

The old adage was, once you were infected with a strain of influenza, you were golden.  Immune.  Bulletproof.  Superman.  Hence, the absolutely pointless, silly and criminally reckless Swine Flu parties conducted on both sides of the Atlantic.

Well, in light of some stories beginning to circulate, you might parrot the words of former FSU player and ESPN legend Lee Corso: "Not so fast, my friend!"

You see, we are beginning to see evidence of reinfection with swine H1N1v, even after clinical tests proved the victim already HAD the swine!  From the Charleston, West Virginia Daily Mail: