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The post-mortem (forgive the expression) for H5N1 around the world in 2007 shows, by any yardstick, an improved situation.  There were fewer reported human cases; fewer nations experienced the disease; and fewer human deaths.

Poultry, however, did not fare so well.  The numbers of poultry culled were in the tens of millions of birds.  There may be no real way to measure how many ducks, geese, swans, turkeys and chickens gave their lives for the eradication of H5N1.  Well, most of them were going to give their lives sooner or later, anyway.  Some 600,000 birds were culled in Russia in one week in late 2007. 

It reminds me of the 1976 swine flu scare, when it was revealed to President Ford how many eggs were going to have to be laid in order to produce enough vaccine for every American.  Ford called in the ever-jovial Earl Butz, whose joviality eventually cost him his job as Secretary of Agriculture.  When Ford queried him about the sheer volume of eggs required for 200 million-plus doses of vaccine, Butz replied in deadpan:

"Mr. President, the roosters of America are prepared to do their duty!"

The economic impact of H5N1 was especially felt hard in Britain this year.  Roughly two hundred thousand British turkeys, geese and chickens in total were culled in February, November and December of 2007.  Holiday fowl had to be imported from as far away as Brazil.  And Britons were shelling out as much as $200 for a holiday bird! 

Britons Buy $200 Turkeys as Bird Flu Shrinks Christmas Supplies
By Brian Lysaght

Dec. 19 (Bloomberg) -- The 1,800 turkeys on Sheepdrove Farm in Britain's Berkshire Downs spent the summer and autumn feasting on grubs and wheat and roaming through meadows.

This month, these Norfolk Bronze birds with dark plumes and scarlet beaks were being slaughtered, hand-plucked and hung for 14 days on the 2,500-acre organic farm 60 miles west of London. It's the end of their rural idyll and the first step toward a hallowed British holiday tradition -- Christmas Day lunch.

Organic farms such as Sheepdrove are flourishing after one of the toughest-ever years for Britain's poultry industry. Nearly 200,000 birds were culled after outbreaks of a deadly form of bird flu and feed prices surged on higher wheat costs. That's pushed up holiday bird prices by as much as 38 percent and increased demand for organic turkeys, which cost as much as 100 pounds ($205).

Although Sheepdrove Farm stopped taking orders on Dec. 10, ``we've had about 100 calls since we sold out,'' said Michael Benson, the farm sales manager. He plans to raise 2,500 turkeys next year.

Sales of organic turkeys, which must be free ranging and raised on additive-free feed, will jump 46 percent this year, the British Retail Consortium predicts. That compares with a 7 percent increase the industry group forecasts for total turkey sales.

Consumers say the organic birds are safer and tastier.

Helen Day, a 36-year-old administrative assistant in London, said she'll splash out on a free-range turkey for Christmas. ``The flavor's better, and it's worth the money,'' she said.

A Better Bird

Richard Corrigan, chef at the Michelin-starred Lindsay House restaurant in central London, isn't balking at paying 15 percent more this year for organic birds to be served in his festive turkey salads as part of the restaurant's 55 pound tasting menu.

``The food I put in my mouth has to have lived a certain life,'' Corrigan said. ``Who wants to have hundreds and hundreds of birds in a shed?''

England had its first outbreak of the deadly H5N1 strain of bird flu last February at a turkey farm operated by Bernard Matthews Holdings Ltd., Europe's largest factory poultry producer. More than 150,000 turkeys were killed to control the virus.

In November, another outbreak forced the slaughter of 15,500 turkeys, ducks and geese on two farms in Suffolk, eastern England. That may have been caused by wild birds mixing with free-range farm poultry, the U.K. government said in a report on Nov. 29.

Waitrose Ban

Premium supermarket chain Waitrose said Dec. 7 it won't stock organic Christmas turkeys this year because the farms where the disease was found, Redgrave Park Farm and Hill Meadow Farm in Suffolk, were suppliers.

The cancellation will probably further boost independent organic farmers, according to Anna Bassett, a poultry specialist with Britain's Soil Association. The group advises farmers about organic methods, which include rules about crop rotation, natural fertilizer and additive-free animal feeds.

In addition to the aftermath of the bird-flu outbreaks, farmers also face higher feed prices because of rising commodity costs. Wheat traded in Chicago rose above $10 a bushel for the first time on Dec. 17. The grain's price has more than doubled in the last year as drought reduced output from Canada to Australia.

Tom Copas, who raised 50,000 free-range and organic birds at his farm in Cookham, England, boosted his prices by 10 percent.  A medium-size organic Copas turkey is 13 pounds a kilo (2.2 pounds) with free-range, non-organic birds costing 9 pounds a kilo.

American Import

``Orders are coming in very well,'' said Copas, whose family has raised turkeys for 50 years and said most of the birds have been sold.

Turkeys first arrived in Britain in 1526, brought by Yorkshireman William Strickland, who acquired six birds from American Indian traders, according to the British Turkey Association. The tradition of eating turkey at Christmas dates from the 19th century, when it began to replace goose and more exotic fare such as swan and peacock. Last year, Britons bought 10 million Christmas turkeys.

Wholesale prices for turkeys have risen as much as 38 percent, according to a Nov. 30 survey by the U.K. government. Birds of up to 9 kilos are selling for 2.60 pounds a kilo compared with 1.88 pounds a year earlier, the survey said.

Last year, retail sales of organic products in the U.K. rose 22 percent to 1.94 billion pounds, the Soil Association said. The country's market for organic goods has grown 27 percent annually on average over the last decade. It's still a relatively small market, with organic making up 3 percent of all meat, poultry and fish sales, the group estimates.

Farmers say they believe the crisis will continue to drive sales.

``Our customers have the money to spend, they want the best for their families and are willing to pay the price,'' said Sheepdrove's Benson.

http://www.bloomberg.com/apps/news?pid=20601085&sid=aohK8JhZoZLo&refer=europe with a hat-tip to Shannon of FluTrackers.

So why was 2007 more moderate for H5N1 than 2006?  I would give the following reasons:

Climate.  The year 2007 was, on balance, a much milder year than 2006. http://www.hprcc.unl.edu/nebraska/winter-2007-global.html  The effects of climate on Influenza A are still not clearly understood, but the rule of thumb has been the milder the winter, the milder the virus.

Surveillance.  Surveillance has dramatically improved since 2003.  The world is, for the most part, operating solidly when it comes to surveillance.  There are far too many surveillance holes for us to become even remotely comfortable, but it is a much more favorable situation than in 2003.

Education.  People in remote areas have learned to better handle sick, dying and dead wildfowl, and to practice better hygiene.  People are also learning how to fully cook the virus out of their food. Word travels fast, even in remote areas of the planet, when death and disease are concerned.

Payments.  Compensation to farmers is becoming more equitable, and farmers are thus more apt to report when their flocks are infected.  This is not the rule everywhere, sadly.  It needs to become more prevalent.

Culling.  While difficult to track all culling operations, indications are that more poultry were culled in 2007 than in 2006.  This equates to fewer opportunities for the virus to mutate.  Also, culling technology and science is improving, as information and knowledge passes in ones and zeros, in real-time over the Internet.

Fewer nations reported the virus.  The FAO reports that 2007 saw initial emergence of H5N1 in five new nations, which is bad.  But the number of nations reporting H5N1 in poultry and in humans declined over the same period in 2006. http://www.fao.org/docs/eims/upload//237149/ah693e.pdf

While we all can light cigars and celebrate this collective series of improvements, we also must recognize the flip side: 

Indonesia continues to worry us.  Sub-Saharan Africa is a powderkeg when it comes to -- well, when it comes to everything, including H5N1.  The new cluster cases in Pakistan and Egypt show us the virus is continuing to confound the experts. 

And finally, the sobering conclusion from the FAO:

Happy New Year.  Keep watching.

To the leadership of the nation of Indonesia:

Today, as you know, marks the third anniversary of the terrible tsunami that ravaged your nation of 18,000 islands.  The world grieves today, as it did the day after Christmas, 2004.  And we continue to grieve at your loss of life, as we grieve today for the deaths due to the mudslides that have hit your nation and killed scores of your citizens.

So long as the human race has any modicum of compassion left in it, the world will rush aid to your people.  May we never let you down on that score.

But the world also works on a principle of reciprocity.  The ying and the yang, if you will.  Quid pro quo.  And there is a way the nation of Indonesia can help repay the world for its ongoing compassion.

And that is by showing some compassion back.  Simply put:  Please share all of your H5N1 human, swine and avian samples with the world community -- beginning today.

You believe you have some sort of stake in the game with your samples.  You believe you have some currency.  And it is understandable that you would want to try and leverage the little you have on behalf of your people. 

However, the world's next pandemic may not start at your door.  Your versions of bird flu may not even start the next pandemic.  And then again, perhaps your nation is indeed at the eye of the viral typhoon to come.  Only God/Allah knows the answer to that question -- and He ain't giving the answer away easily.

There is an army of scientists -- legions of them, on every continent on Earth save Antarctica -- that are prepared to work with you on this issue.  These men and women can help decipher the clues to the next mutation that might turn H5N1 into the most efficient, ruthless killer of human life ever seen on this planet. 

To withhold this viral information in the hope that you can somehow get into line first among equals is simply not right.  Remember that a vaccine is probably eight months away from a pandemic's start, in the best of circumstances.  Time and again the world has shown it is ready to fly antivirals into your nation in the hope that the Next Pandemic can be stopped at the rural village level, before it has the chance to mutate and enter your largest cities.  And that is where the First Wave will be fought.  With antivirals, possibly at your front door.  Not with vaccine.

Your contract with America's Baxter Pharmaceuticals is understandable.  Your desire to begin injecting your citizens with prepandemic vaccine underscores your nation's obvious and justified preoccupation with this disease.  And if indeed the Indonesian strain is the trigger of the next pandemic, I am sure the shots and the royalties from Baxter will be most helpful.  As you also know, H5N1 is a mutating wonder.  What guarantees are there that any prepandemic vaccine will even work?  Even if Baxter's formula does work, I do not believe Baxter alone will not be able to manufacture enough vaccine for your entire nation.  Sooner or later, you will be calling upon the collective manufacturing capability of the rest of the world to help you.  And the perception that Indonesia may be putting profits ahead of lives creates global enemies that your nation cannot (literally) afford to have. 

Also heed the lessons of 1976 and Swine Flu H1N1.  Read the history of that debacle before you store vaccine "in people, not in warehouses."  Learn from the mistakes the US made in 1976 and 1977. 

Above all, practice proper diplomacy.  The world has a long memory.  If indeed the next pandemic comes from an Indonesian strain, and your government was withholding the strain's viral molecular information in order to obtain financial and/or vaccine guarantees, and the world determines that Indonesia could have saved countless millions of lives by sharing virus samples now and deliberately chose not to:  Know that the world's compassion has limits. 

Choose wisely.. 

There are two apparently conflicting schools of thought, when it comes to predicting which strain of influenza will eventually "go pandemic."  The first school believes that a novel strain -- usually, as we all believe, H5N1 --  will be the one to eventually explode.

But the second school rarely gets attention.  That school believes that pandemic viruses recycle themselves and reappear every so often.  There is not a lot of information available Out There on that subject, but one of its strongest proponents was the late scientist, Dr. Maurice Hilleman.

Hilleman's name should be a household word by now, but the man was not into that sort of thing.  I offer you, verbatim, and from Amazon.com, the Booklist starred review of Dr. Paul Offit's superb work Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases.

From Booklist
*Starred Review* Maurice Hilleman's name isn't well known, and according to infectious disease expert Offit's riveting biography, that is both a shame and a blessing. It's a shame because the outspoken, brilliant, yet humble scientist from Montana invented vaccines that all but wiped out a number of infectious diseases. Thanks to his genius, such diseases as mumps, rubella, measles, and hepatitis A and B no longer claim millions of lives, mostly children's. He merits greater recognition. His obscurity is a blessing because it prevents more people from using his name in vain, for Hilleman's vaccines have recently become increasingly controversial and their efficacy clouded by questions about adverse side effects. Still, Offit pulls no punches in defending Hilleman against those who would crucify him for combining measles, mumps, and rubella vaccines into one shot and for the choice to add thimerosal to extend the shelf life of all vaccines. Despite the fact that Offit's bias on behalf of public health shows, the book is a powerful examination of the kind of single-minded determination it takes to tackle diseases that threaten the world's children. And to do so without bravado—no vaccine bears Hilleman's name, no awards his mantle—is to define what it is to be simply heroic. (Chavez, Donna)

Flu aficionados who are not aware of Hilleman need to look carefully at the work he did in 1957.  Offit makes a persuasive case that it was Hilleman who first uncovered the 1957 H2N2 flu pandemic and was the first to develop a vaccine -- in four months!  Admittedly, he did this without regard to the Feds, and he took risks.  But the results of his work are indisputable.  The mortality of 1957's H2N2 was ten percent of the 1918 pandemic.  And with astonishingly little available in the literature regarding the 1957 pandemic, any time anyone devotes multiple pages to that event, it is worthwhile reading.  And since the book opens with a look back at the 1997 emergence of H5N1, and closes with a prediction of H2N2 as the next Big One, it is also required reading -- if even using the index on a cold Sunday at Borders -- for all who are interested in influenza and infectious diseases.

Before his death, Hilleman said he did not think H5N1 would produce the Next Pandemic.  But he believed he had stumbled onto a pattern of viral behavior that may be hard to shake.  He believed that pandemic influenza viruses came in 68-year intervals.  using this technique, he believed that the 1889 pandemic was an H2 virus.  He supported this with testing which (at the time and using 1957 science) purported to show that elderly people who survived the 1889 pandemic possessed antibodies to the H2 substrain.  Influenza textbooks have also adopted this view; namely, that 1889 was an H2; 1900, an H3; and so on. 

This view is hotly debated in microbiological circles.  Some researchers, such as W.R. Dowdle of the Task Force for Child Survival and Development in Decatur, Georgia, believe that an H3, not an H2, was responsible for the 1889 pandemic.  Hilleman believed an H3 was responsible for the mini-pandemic of 1900; Dowdle also believes differently.

But not too differently:  I quote from the abstract of Dowdle's research paper, H2 variants should be included in pandemic planning for a number of reasons, but not because of evidence of recycling. It is not known when the next pandemic will occur or which of the 15 (or more) haemagglutinin subtypes will be involved. Effective global surveillance remains the key to influenza preparedness.

OK, now on to today's events.  A brand new research paper has uncovered a new reassortant hybrid swine/avian H2N3 virus, previously only detected in wild birds.  Dr. Richard Webby of legendary St. Jude Childrens Research Hospital in Memphis (home of Dr. Robert Webster), along with researchers at the University of Iowa (where swine influenza was first discovered) and the University of Minnesota (also no slouches at the flu) released a major work.  The short form:  Pigs can, indeed, be the "Mixing Vessel" to produce a potential pandemic strain.

The bigger news is that H2 is now officially back on the Short List for the Next Pandemic Strain.  No doubt this will be welcome news to those who are laboring fruitlessly to persuade/convince their superiors that a flu pandemic is around the corner, if not outright imminent.  Anyone under the age of 50 is not immune to H2.  Also, no one is immune to the neuraminidase N3.  And a swine/avian H2 reassortant may not afford complete immunity to those who lived through 1957, as I did.  I recall my fever:  I was 2 at the time, and I hallucinated that a train was running up the wall of my bedroom.  The memory of that hallucination stays with me today. And no, it was not provoked by the 60s!. Wise guys.

By the way, the H2N3 was not found in Guangdong Province, China.

It was found and typed in Missouri last year, which is ironic, since it is the Show Me state.

Now, do we go back, like the Indonesians and Pakistanis have done, and try to find untyped influenza infections in farms in Missouri that were passed off as seasonal flu, no biggie?

Hmmmmm.

A huge hat-tip to Crof and FLA_MEDIC for breaking this story on H5N1 and Avian Flu Diary.

Make yourself comfortable, as this blog is unusually long -- even by my standards

The first World Health Organization team is on the ground and working in Peshawar province in northwest Pakistan.  And barely within hours of the arrival of the advance team, declarations were made and assurances were given that things were not as bad as first thought.

But Shakespeare also deplaned in Pakistan, accompanying the WHO team to the microphones.  First, the stories on the arrival of the WHO.  This is from Pakistani newspaper The News:

WHO team visits families of bird flu victims

By Mushtaq Yusufzai 12/19/2007

PESHAWAR: A team of the World Health Organisation experts on Tuesday visited the NWFP where they visited the Khyber Teaching Hospital and also met the ill-fated family of two young students who died of bird flu virus in October.

Also, a WHO technical team is also arriving Pakistan today (Wednesday) which, according to sources, would verify the results of bird flu victims diagnosed by the NIH Islamabad.

After their arrival, the WHO officials held talks with senior officials of the NWFP health department who told them of the situation in the province created after the bird flu virus.They went to the Khyber Teaching Hospital (KTH) where the two young brothers, Muhammad Idrees and Muhammad Ilyas, died on October 19 and 29 respectively mainly because of sheer negligence of the hospital administration, the NWFP health department as well as of the National Institute of Health (NIH), Islamabad.

In KTH, the WHO team arranged an informative workshop for doctors and nurses of the hospital, especially those dealing with bird flu patients.

Officials in the KTH told 'The News' the WHO team had brought Personal Protection Equipment (PPE) for the staff of the hospital.

The team also visited isolation rooms in the hospital where patients suffering from bird flu virus were admitted and advised the hospital administration to select some safe place at a distance from the rest of the hospital for keeping the bird flu victims, so that the virus could not spread in the hospital. It is very painful to mention here that in the entire province, there is not even a single isolation room for infectious diseases.

With the consultation of the WHO team, the KTH administration selected a separate portion in the hospital for keeping bird flu patients. There are 11 isolation rooms in the portion, which would accommodate 22 patients.

Acting Chief Executive KTH, Prof Dr Siddiqur Rahman, nominated Dr Mukhtiar Zaman Afridi as the head of a team that would handle bird flu related cases.

The WHO officials praised doctors and health workers of the KTH for their efforts, which the officials felt saved many lives. The team members said in the world so far 60 per cent of the bird flu patients died while the ratio in Pakistan, 35 per cent, was quite encouraging.

The team members later went to Tajabad town in Peshawar and met the family members of two young brothers died of the disease.

Note the October reference to the deaths, which we think was actually November 19 and 29, respectively.  But everything is up in the air these days, as we try to figure out if a brother is really a cousin, etc.  So let's stay loose on relatives, and dates of death for the time being.

Now a second report on the activity in the region, this time from Indian newspaper The Hindu.  All bolding is mine.

Experts comb Pak. for signs of human-to-human bird flu infection

ISLAMABAD, Pakistan (AP): A second team of health experts arrived in Pakistan on Wednesday to analyze samples from suspected bird flu cases to determine how the virus spread and whether human-to-human transmission may have occurred.

The experts from the US Naval Medical Research Unit No. 3 were expected to retest samples already gathered from a number of patients who were positive for the H5N1 bird flu virus in initial government analysis. Once the cases are confirmed, work will begin to piece together how the victims became infected.

"They are now investigating," said Orya Maqbool Jan Abbasi, spokesman for Pakistan's Health Ministry. ``The next day or two is very important.''

Four brothers were sickened last month in Abbotabad, north of Islamabad. Two died, one of whom was buried before tests were conducted. The other three tested positive for the virus. Up to six more people were suspected of being infected, including several who were in contact with poultry.

Outbreaks were reported among birds in the area before the human cases. However, Abassi stressed that there have been no new reports of bird flu in poultry or people.

A separate WHO team visited a hospital Tuesday in the northwestern city Peshawar that treated some of the patients. They were working with doctors and nurses on how to handle suspected cases and improve infection control measures.

``They want to go through the records in the hospital for the last month or two to see if there's been any upsurge in respiratory cases that weren't identified as H5N1 but which could actually be,'' said Gregory Hartl, a WHO spokesman in Geneva.

The team will look to see which patients could have been exposed to the virus by infected birds and also whether human-to-human transmission could have occurred.

One of the brothers who survived, Mohammed Ishtiaq, said he was hospitalized with flu symptoms after slaughtering chickens suspected of carrying bird flu without wearing protective clothing last month.

His brothers who died visited him in a hospital, he said.

Hartl said no new cases have been discovered, but increased awareness has led to more people with flu-like symptoms being checked.

``What this is showing is that they're taking everything very, very seriously,'' Hartl said. ``Surveillance has been enhanced, more people are reporting cases and more people have been sensitized on the heath care worker side of the need to notice.''

Pakistan has requested additional supplies of the antiviral Tamiflu as a precaution, Hartl said.

At least 209 people have died worldwide from the virus, which began plaguing Asian poultry stocks in late 2003, according to the WHO. It remains hard for people to catch, but scientists worry it could mutate into a form that spreads easily among people, potentially sparking a pandemic.

Associated Press medical writer, Margie Mason, contributed to this report from Hanoi, Vietnam.

But wait, according to WHO influenza head Dr. Keiji Fukuda, there is nothing extraordinary going on in Pakistan.  This story is from Reuters, dateline Islamabad (as was the above AP story), so we know for sure we have Mainstream Journalist Boots On the Ground!  I am bolding all Fukuda quotes and references.

WHO probes Pakistan's first bird flu death