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Same strain of swine flu found in Mexico, US.

The "Mexican flu" has taken a huge leap in the American press today, with everyone, including the Drudge Report, headlining the outbreak. In fact, the Drudge headline trumpets Outbreak!on its front page. The link is to a Breitbart.com story from French news service AFP of this morning.

This is not trivial, nor is it something that is being overblown. In a matter of days, this report- starting with the curious report of two San Diego-area youths who contracted swine flu in March -- has now blown up into a full-fledged crisis Down South.

So in a matter of days -- DAYS! -- we have gone from Zero to:

1. Novel strain of influenza

2. Suspected human-to-human transmission (see below)

3. No immunity in the general population

4. Only one continent (not for long, I fear).

We do not know its virulence. We do not know its exact genetic makeup other than it is a fusion of European and Asian avian and swine and human genes. But we do know that it may have passed under our surveillance net as an "untyped Influenza A strain," only to be revealed by going back and re-testing the samples (read below).

Earlier today, Breitbart/AFP reported:

The government of Mexico City said Friday it was launching a massive vaccination campaign against swine flu, after authorities said they were probing 45 deaths and 943 possible infections from the virus. (bold mine)

Reuters has weighed in with a chilling story of the seven confirmed US swine flu infections. Excerpts below:

In the United States, the CDC reported the new strain of swine flu on Tuesday in a boy and a girl from California's two southernmost counties.

Now, five more cases have been found via normal surveillance for seasonal influenza. None of the patients, whose symptoms closely resembled seasonal flu, had any direct contact with pigs.

Two of the new cases were among 16-year-olds at the same school in San Antonio "and there's a father-daughter pair in California," Schuchat said. The boy whose case was reported on Tuesday had flown to Dallas, but the CDC has found no links to the other Texas cases.

The agency will issue daily updates at http://www.cdc.gov/flu/swine/investigation.htm.

HUMAN TO HUMAN

"We believe at this point that human-to-human spread is occurring," Schuchat said. "That's unusual. We don't know yet how widely it is spreading ... We are also working with international partners to understand what is occurring in other parts of the world."

The CDC's Dr. Nancy Cox said virus samples from the seven appear to carry genes from swine flu, avian flu and human flu viruses from North America, Europe and Asia. (bold mine)

"We haven't seen this strain before, but we hadn't been looking as intensively as we have," Schuchat said. "It's very possible that this is something new that hasn't been happening before."

Surveillance for and scrutiny of influenza has been stepped up since 2003, when H5N1 bird flu reappeared in Asia. Experts fear this strain, or another strain, could spark a pandemic that could kill millions.

The influenza A strain is an H1N1, the same subtype as one of the seasonal flu viruses now circulating. Now that the normal influenza season is waning, it may be easier to spot cases of the new swine flu, Schuchat said.

The CDC is asking doctors to think about the possibility of swine flu when patients appear with flu-like symptoms, to take a sample and send it to state health officials or the CDC for testing.

Cox said the CDC is already preparing a vaccine against the new strain, just in case.

"This is standard operating procedure," he said.

A vaccine will take months. It would be very interesting to see if the existing vaccine makers can quickly turn around and begin making enough swine H1N1 vaccine to do any good.

The best article I have seen to date is from MSNBC, so I include excerpts here for you to read and get caught up.

Deadly outbreak in Mexico caused by swine flu

All 7 U.S. victims recovered but more cases expected; source a mystery msnbc.com news services updated 11:25 a.m. ET, Fri., April 24, 2009

The unique strain of swine flu found in seven people in California in Texas has been connected to the deadly flu that has broken out in Mexico, killing as many as 60 people, NBC News has confirmed. (bold mine)

The strain has never been seen before and is raising fears of a possible pandemic.

The World Health Organization said it was concerned at what it called 800 "influenza-like" cases in Mexico, and also about the confirmed outbreak of a new strain of swine flu in the United States.

Mexico canceled classes for millions of children in its sprawling capital city and surrounding area on Friday after authorities noticed a higher number of flu-like deaths than normal in recent weeks.

"It is a virus that mutated from pigs and then at some point was transmitted to humans," Health Minister Jose Angel Cordova told the Televisa network.

He put the death toll at 16 confirmed cases and dozens of other suspected deaths. WHO estimates about 60 people have died in the country.

U.S. health experts said Thursday they expect to find more cases of the swine flu as they check people who had contact with seven California and Texas residents diagnosed with the illness.

All of the seven U.S. victims recovered from the flu that combines pig, bird and human viruses in a way that researchers have not seen before, the U.S. Centers for Disease Control and Prevention said.

The cases are a growing medical mystery because it's unclear how they caught the virus. The CDC said none of the seven people were in contact with pigs, which is how people usually catch swine flu. And only a few were in contact with each other.

Still, health officials said it's not a cause for public alarm: The five in California and two in Texas all recovered, only one person was hospitalized and testing indicates some mainstream antiviral medications seem to work against the virus.

Dr. Anne Schuchat of the CDC said officials believe it can spread human-to-human, which is unusual for a swine flu virus.

The CDC is checking people who have been in contact with the seven confirmed cases, who all became ill between late March and mid-April.

Because of intensive searching, it's likely health officials will find additional cases, said Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases.

Unique combo virus
CDC officials detected a virus with a unique combination of gene segments that have not been seen in people or pigs before. The bug contains human virus, avian virus from North America and pig viruses from North America, Europe and Asia.

Health officials have seen mixes of bird, pig and human virus before, but never such an intercontinental combination with more than one pig virus in the mix.

Scientists keep a close eye on flu viruses that emerge from pigs. The animals are considered particularly susceptible to both avian and human viruses and a likely place where the kind of genetic reassortment can take place that might lead to a new form of pandemic flu, said Dr. John Treanor, an infectious disease specialist at the University of Rochester Medical Center.

The virus may be something completely new, or it may have been around for a while but was only detected now because of improved lab testing and disease surveillance, CDC officials said.

The virus was first detected in two children in southern California — a 10-year-old boy in San Diego County and a 9-year-old girl in neighboring Imperial County.

The cases were detected under unusual circumstances. One was seen at a Navy clinic that participates in a specialized disease detection network, and the other was caught through a specialized surveillance system set up in border communities, CDC officials said.

On Thursday, investigators said they had discovered five more cases. That includes a father and his teenage daughter in San Diego County, a 41-year-old woman in Imperial County who was the only person hospitalized, and two 16-year-old boys who are friends and live in Guadalupe County, Texas, near San Antonio.

Puzzling cases
The Texas cases are especially puzzling. One of the California cases — the 10-year-old boy — traveled to Texas early this month, but that was to Dallas, about 270 miles northeast of San Antonio. He did not travel to the San Antonio area, Schuchat said.

The two 16-year-olds had not traveled recently, Texas health officials said.

The swine flu's symptoms are like those of the regular flu, mostly involving fever, cough and sore throat, though some of the seven also experienced vomiting and diarrhea.

CDC are not calling it an outbreak, a term that suggests ongoing illnesses. It's not known if anyone is getting sick from the virus right now, CDC officials said.

It's also not known if the seasonal flu vaccine that Americans got last fall and early this year protects against this type of virus. People should wash their hands and take other customary precautions, CDC officials said.

The Associated Press and Reuters contributed to this report.

URL: http://www.msnbc.msn.com/id/30386163/

And the always-good Canadian Pres has offered up its take:

Swine flu cases in US, mystery ailment in Mexico have experts scrambling

TORONTO — Concurrent outbreaks of human cases of swine flu in the southwestern United States and a mystery respiratory illness in Mexico had health authorities across the continent struggling Thursday to figure out what is unfolding.

Laboratories in Atlanta and Winnipeg are looking at clinical specimens trying to determine if the mounting number of human cases of swine flu - seven and counting - in California and Texas, and an unusual explosion of severe respiratory illnesses in Mexico are pieces of the same puzzle or confusing coincidences.

Even on its own the human infections with swine flu viruses are significant enough to have experts wondering whether the world is watching the start of a flu pandemic.

But official pronouncements are being crafted with caution by authorities, who remember all too well the 1976 swine flu scare - a feared pandemic that didn't materialize.

The World Health Organization, which has been monitoring the situation, said at this point it does not believe the threat of a pandemic - the first since the 1968 Hong Kong flu - has risen.

"We would not see any evidence yet for this being a phase change," said WHO spokesman Gregory Hartl, referring to the organization's six step pandemic alert scale. The world is currently at phase 3 - occasional human cases with a novel flu virus - because of ongoing sporadic human infections with the H5N1 avian flu virus.

"We never want to overestimate or underestimate something, so we're following it closely," Hartl said from Geneva. "But as of the moment we see no evidence to change the global pandemic phase."

The U.S. Centers for Disease Control, which earlier in the week revealed they had found two human cases of swine flu, announced Thursday that the number of confirmed cases has risen to seven. There are two clusters, a father-daughter pairing and two 16 year old boys who attended the same school.

Symptoms are similar to seasonal flu, though there are more reports of vomiting and diarrhea that is seen with regular flu. All of the cases have recovered, though one person required hospitalization. It appears none of the cases had contact with pigs.

"We believe at this point that human-to-human spread is occurring," said Dr. Anne Schuchat, director of the CDC's national centre for immunization and respiratory diseases. (bold mine)

"That's unusual. (Really? - Scott.) We don't know yet how widely it's spreading. And we certainly don't know the extent of the problem."

Genetic sequencing done to date reveals a seemingly unique influenza A virus of the H1N1 subtype made up of a distinctive mix of swine, bird and human flu virus genes. There have been no reports of this virus in pigs, said Dr. Marie Gramer, a swine flu expert with the University of Minnesota's college of veterinary medicine.

"It doesn't seem to be very similar to anything that is currently circulating, from what I have," said Gramer, who has an extensive library of swine flu virus isolates.

The CDC said they expect to confirm more cases in coming days as contacts of the cases are checked and doctors and clinics are put on notice the CDC wants samples of flu viruses that can't be identified by standard methods.

They also cautioned they can't currently tell if the events unfolding represent something new or something that happens occasionally but which has gone unnoticed in the past.

"We have improved and intensified influenza surveillance over the past few years. So it certainly is possible that events like this occurred in the past and we simply didn't detect them," said Dr. Nancy Cox, head of the CDC's influenza division.

The first of the known cases fell ill on March 28 and the most recent developed symptoms last Sunday. Most of the cases have been children or teenagers, though two are adults. Ages range from nine to 54 years. They live in and around San Diego and in San Antonio, Tex., cities that are nearly 3,000 kilometres apart. Except for the family pairing and the school mates, there don't appear to be links among the cases.

No infections with this virus have been found in Canada, Canadian authorities said.

Nor does it seem that any cases of an unusually severe respiratory illness plaguing parts of Mexico have turned up in this country, said Dr. Danielle Grondin, assistant deputy minister for the Public Health Agency of Canada.

One person from Ontario was ill after returning from Mexico but Grondin said it seemed unlikely the illness was related to the apparent outbreak, which is affecting mainly young, previously healthy adults. (bold mine)

Alerts that have been sent out to health providers and public health officials in Canada say 20 deaths have been associated with the outbreak, which seems to be centred around central Mexico and Mexico City.

Grondin said Canada would issue a travel advisory warning Canadians who plan to travel to Mexico of the problem, though it was not released Thursday.

And she said the National Microbiology Laboratory in Winnipeg is testing samples from Mexico looking for the cause or causes of the illnesses. Samples were also en route Thursday to the CDC's labs in Atlanta, Cox said.

Copyright © 2009 The Canadian Press. All rights reserved.

OK, you're all caught up!  That's why you come here, right?

No word on whether or not Tamiflu helps this H1N1 variant.  In light of the failure of Tamiflu against H1N1 in the past two seasons, I am not optimistic.  But it can always be hoped that this hybrid currently ciurculating in Mexico and the American Southwest might not contain the Tamiflu-resistant gene. 

At least not for now.

Everyone needs to pay very close attention to this rapidly-developing situation.

Ordinarily this headline would be met with smirks and admonitions of "Don't drink the water!"  But it is glaringly apparent that in Mexico, a virus of some sort has caused hospitalizations and deaths. 

From the Canadian Press:

Doctors warned to watch for mystery illness in tourists returning from Mexico

TORONTO — Public health units, quarantine officers and medical practitioners across the country have been warned to be on guard for cases of a mystery illness in Canadians returning from Mexico.

The warning follows reports from that country of cases of severe respiratory illness, which in some cases has led to death.

Mexican authorities have insisted the outbreak is not an epidemic and that preventive measures are being taken to reduce the risk of transmission of disease.

Mexican authorities informed Canadian counterparts about the situation on April 17, asking for help with their investigation. Scientists at the National Microbiology Laboratory in Winnipeg are assisting in efforts to determine the cause or causes of the illnesses.

"We are aware of the reports and are looking into them," said Andrew McDermott, a spokesperson for the Public Health Agency of Canada.

It's not clear if there is any link between these illnesses and the recent discovery of several human cases of swine flu infection in California. (bold mine)

Dr. Arlene King, who is the Public Health Agency of Canada's point person for pandemic influenza preparedness, said samples from Mexico will need to be studied to see if there is any link.

King, who was named Ontario's new chief public health officer on Thursday and takes on the job in mid-June, said it is important to be on the lookout for new infectious disease outbreaks.

"We absolutely have to remain vigilant in the country around the situation in Mexico and globally," said King, who is director general of the public health agency's centre for immunization and respiratory infectious diseases.

"We need to be prepared for any emerging infectious disease threat that may occur outside of our borders. It's absolutely fundamental."

A spokesperson for the Pan American Health Organization - the World Health Organization's Americas branch - said PAHO is also working with Mexican authorities to look into the reports.

"We're co-operating with (Mexican) authorities on it," Donna Eberwine-Villagran said from Washington.

"We have people in our field office in Mexico City and also in our border office working with Mexican authorities looking at the cases."

The illnesses are said to have been occurring in south and central Mexico and involve mainly young, previously healthy adults. Some reports have suggested health-care workers have become ill.

To date, two clusters of severe respiratory infections with death have been reported in April, one in Mexico City and one in San Luis Potosi. Mexico City has reported 120 cases including 13 deaths while San Luis Potosi, in central Mexico, has reported 14 cases including four deaths. (bold mine)

In addition there has been a death reported in Oaxaca, in southern Mexico and two deaths reported in Baja California Norte, which borders California.

Health authorities have been told some of the cases have tested positive for influenza, but some cases are influenza A and others are influenza B.

A leading infectious diseases expert said a number of pathogens could be the culprit or culprits.

"It could be anything," said Dr. Allison McGeer of Toronto's Mount Sinai Hospital. "Full range from new and unidentified virus to stuff that goes on every day and somebody just did a test."

She added, though that it was "improbable" that the illness was being caused by anything exotic and was most likely the work of influenza or an adenovirus. (bold mine)

An advisory from Toronto Public Health to health professionals said that given the severity of the illness, health care workers should be actively looking for cases of severe respiratory infection in people who have been in Mexico in the previous two weeks.

But the advisory stressed that there is no evidence the infections are caused by an unusual pathogen or a novel flu strain.

Mexican health officials held a news conference Wednesday to discuss the situation, putting the surge in illnesses down to end-of-season flu activity.

Mauricio Hernandez Avila, the undersecretary for health prevention and promotion, said the health department had initiated an active search for cases of serious pneumonia associated with the illness in the country, especially in the federal district that encompasses Mexico City.

Copyright © 2009 The Canadian Press. All rights reserved.

The pattern of cases to deaths looks similar to what the pacific Northwest saw with its most recent documented outbreak of Adenovirus 14, or Ad14 for short.  A ten to twenty-five percent CFR (Case fatality Rate) in hospitalized patients would mirror the findings in the Seattle study, which can be found in great detail on this Blogsite (keyword search: adenovirus).

Of course, a 10% CFR is also reminiscent of SARS, but it is highly doubtful that SARS would have skipped oceans and continents and found its way to Mexico.

Likewise, influenza is just not a killer in these numbers, even swine flu.  So my vote is good old Ad14, and the sooner the CDC starts testing for it, the sooner we all will find that is our latest "silent epidemic" and then someone can set about finding a vaccine for Ad14 and other flavors of adenovirus.

Just today, the news-gathering sites are absolutely aflame with the twin stories of the (for them, bless their hearts) "sudden" increase in Egyptian bird flu infections -- and the revelation that two Southern California youtes (that's "youths" for those of you not from New Jersey) were infected in march with swine flu.

The swine flu in question is good old swine H1N1, the decendant of the 1976 "swine flu scare" virus. According to the MSNBC story, the children were diagnosed last week. One was a 10-year-old boy in San Diego County, and the other a 9-year-old girl in neighboring Imperial County. Both recovered.

As you recall, in 1976 a soldier in Fort Dix, New Jersey, died of H1N1 swine flu, and some 500 other soldiers showed antibodies. That promoted the biggest mobilization of government and the scientific community to combat a viral plague in the shortest timeframe in recorded history.

Of course, the result was a vaccine that caused Guillain-barre syndrome in an uncomfortable number of elderly people,especially in and around Pittsburgh, PA. A few people died and the vaccine went on the shelf until after the swearing-in of president Jimmy Carter. Just after Carter took office, an outbreak of A/Victoria occurred, with its starting point a nursing home in Miami. The only vaccine against A/Victoria was in the swine flu cocktail. Then-HEW secretary Joe Califano ordered the release of the swine flu vaccine, and there was no statistically significant difference in the number of complications due to Guillain-Barre than if there was no vaccine at all! This has confounded researchers to this very day.

OK, so now you are all caught up on swine flu. Oops, not quite: Swine flu was diagnosed in Texas in 2008. A person was tending pigs, including a sick one. The Texan developed swine H1N1 and recovered.

But wait, there's more: In December 2005, a Wisconsin teenager developed respiratory distress after he helped his brother-in-law slaughter pigs.

From the (always excellent) CIDRAP report:

At an outpatient clinic a few days later, healthcare workers collected nasal wash specimens, which tested positive for influenza A and were forwarded to the Wisconsin State Laboratory of Hygiene. Though further testing isolated influenza A, the virus didn't match human H3 or H1 subtypes or the H5 avian subtype. CDC investigators sequenced the virus, identifying it as a swine influenza A (H1N1) triple reassortant virus, A/Wisconsin/87/2005 H1N1.

Back to today's story: According to the AP, this new H1N1 is a variant of a variant. They say:

Health officials have long feared the emergence of a deadly form of flu. They have not noted a spike in flu cases or a rash of severe illnesses. But they are continuing to investigate the genetics of the virus and track down and test people who may have been in contact with the children.

Both children became sick in late March and experienced fever and cough. The boy also vomited.

The two had not been in contact with each other, CDC officials said.

The boy's mother and brother also had a flu-like illness recently, as did a brother and a cousin of the girl. None of those relatives were tested for flu at the time of their illness.

The San Diego County boy and his 8-year-old brother flew from California to Dallas in early April and are currently with relatives in Texas. Health officials also are trying to contact the plane's flight crew and two children who sat near the boys, CDC officials said.

In the past, CDC received reports of approximately one human swine influenza virus infection every one or two years. But more than a dozen cases of human infection with swine influenza have been reported since late 2005.

Most cases occur in people who were exposed to pigs. Neither child had touched a pig, according to their families, although the girl had been at an agricultural fair four weeks before she got sick.

The jump in cases in the past few years could be because of technological improvements and expansion of public health laboratories, which have improved testing capacity. But genetic mutations could also play a role.

The new flu contains a unique combination of gene segments that have not been seen in swine or human flu viruses before, CDC officials said.

Here in Tallahassee, we are experiencing something which is much nastier than our traditional "Tallahassee crud," or "southernus capitolus cruditis." And look at the huge numbers of flu samples that go "untyped" each season, meaning they cannot be conclusively identified as A or B, H1N1 or H3N2.  In light of this new story, one cannot help but wonder if this new variant of swine flu has a wider dispersion than anyone realizes.

As we all know, and as the New York Times has dutifully picked up on in today's editions: There is something decidedly different going on in Egypt right now. The number of human cases seems to be accelerating, with almost a case a day on average in the past week alone.

Not just that: The news reports of a dead 6-year old boy, first admitted to hospital on march 28th of this year, breaks a pattern of (generally) mild H5N1 symptoms in younger children and returns the virus to lethal status. The dead boy lived in what MSNBC calls a "gritty" suburb of Cairo.

I have not taken the time to map the locations of the numerous human cases, but Dr. Henry Niman has, and it can be seen here. The data are pretty amazing to see mapped out.

And if you look at the chatter on Egyptian Websites, especially news-gathering sites, the number of suspected cases continues to climb and will continue to climb.

In the past several weeks, the human cases seemed to be confirmed to younger children, and the virus itself seemed to be mild. In fact, the virus' effects seemed to be so mild that speculation began to infect even the highest scientific and medical circles that a mild form of human H5N1 might be circulating all along the Nile Delta. This speculation was added to be others who then began to openly speculate about the possible presence of asymptomatic human carriers of H5N1. Asymptomatic human carriers of a pandemic-ready virus, whether or not it was capable of sustained human-to-human transmission, would mark the official Tipping Point of H5N1's transition from killer of birds to mass murderer of humans.

But last week, the first two adult cases of H5N1 in several weeks surfaced.  Curiously, the two adult cases were female -- a pattern we have seen before.

However, the cacophony regarding the possible presence of asymptomatic human carriers was not universal. Far from it: The Pope of Influenza himself, Dr. Robert G. Webster of St. Jude, proclaimed that all this worry was a lot of "hot air." From the New York Times:

“Right now, it’s all hot air,” said Dr. Robert G. Webster, a flu expert at St. Jude Children’s Research Hospital in Memphis. “I hope to hell it’s not happening, because it would mean the virus is adapting to humans. But there’s not a shred of data.”

I admire and respect Dr. Webster greatly, and I communicate with his protege on occasion.  Another scientist who is in my personal Hall of Fame is the late Dr. J. Allen Hynek, founder of the Center for UFO Studies, and was a consultant to the USAF's Project Blue Book.  But Hynek is probably and wincingly best known for his proclamation that certain Michigan 1960's UFO sightings were "swamp gas."  Of course, he was taken out of context -- but the comment remained.

So, hopefully, Doctor Webster's "hot air" comment will be borne out; because if not, as he says, it would mean the H5N1 virus would have evolved toward H2H transmission. But his tone also suggests he has had the opportunity to personally view samples of the Egyptian virus, as a WHO world-class reference lab.  The Egyptian government is refreshingly transparent when it comes to reporting and disclosing bird flu cases and samples. 

One thing is absolutely certain: The number of human H5N1 cases in Egypt is double that of the entire year of 2008. It is on track to be the worst year for human H5N1 in Egypt since its introduction in 2006.  More than 6,000 Egyptians have been suspected of having H5N1 and were given Tamiflu as a precaution.  Egypt is averaging a confirmed human case of H5N1 every six days.  At this rate, and even factoring in seasonal fluctuations in the virus' appearance, it will be a long 2009 for the Egyptian government and its people.

The concept of asymptomatic human carriers being the final prerequisite for pandemic is not new; as readers know, I frequently refer to the good works of the late Dr. R. Edgar Hope-Simpson, who felt that a pandemic would not start with any sort of localized outbreak; rather, it would start with simultaneous infections either across a continent or across many continents.  These asymptomatic carriers of infections would explain the ability of previous flu pandemics to "jump" across entire oceans and mountain ranges within days of the diagnosis of preliminary cases.  It would help explain the argument about whether the Spanish Flu first appeared in China or in Kansas; whether it first appeared in pigs or in people.  The answer would be "yes."

The world needs to stay focused on Egypt.  The news coming out of there is bad, bad, bad.

This is another long blog, so prepare your posterior. I ask you to follow the story and be patient.

CIDRAP News has delivered another bang-up story on Panasonic's shocking decision to remove its foreign dependents and bring them home prior to the end of September.

I don't need to revisit the details: Just follow my blogsite, Crof's, FLA_MEDIC's, Zoe's, FluTrackers and Flu Wiki and about a million others. Here is the CIDRAP article, and then a Time Magazine story that I will interlace with current events. So settle back and enjoy.

Panasonic addresses speculation over employee pandemic order

Lisa Schnirring, Staff Writer

Feb 12, 2009 (CIDRAP News) – A spokesman for Panasonic Corp. said today that the company had no proprietary information about any increased risk of an influenza pandemic in December 2008 when it instructed some of its overseas employees to send their families back to Japan by September.

Jim Reilly, a Panasonic spokesman based in New York City, also denied speculation that the company ordered the families to return to Japan as a cost-saving measure to mitigate the effects of the global economic downturn.

However, he told CIDRAP News that the company realizes its move may seem unusual, given that they are the first major company to enact such a pandemic planning measure. "They realize that there are different perceptions around the world," Reilly said of Panasonic officials.

No change in pandemic risk
Masato Tashiro, MD, PhD, a virologist at Japan's National Institute of Infectious Diseases and a consultant to the World Health Organization (WHO), told CIDRAP News that he hasn't seen any increase in the global pandemic risk. "As far as I understand, the recent situation of poultry outbreaks and human infections in China is within our prediction," he said.

Panasonic said its request to the employees was based on a review of where the H5N1 virus has been detected and an assessment of medical facilities in the areas, according to previous reports.

The regions that were named align with its operational divisions, Reilly said. He reiterated that Japanese employees have been asked to return send their families back from Asia (except Singapore), China, the Middle East, Africa, the Commonwealth of Independent States (the former Soviet republic states), and Latin America. Divisions that aren't subject to the repatriation request include North America, Western Europe, and Oceania (Australia and New Zealand).

He said it was difficult to determine how many people are affected, but he said, for example, that Panasonic has 60 factories and about 100,000 employees in China. The company has 307,000 employees worldwide, including 13,500 in North America.

Panasonic gave the affected employee families several months to make their moving arrangements, because Japanese families aren't typically as mobile as those in other countries, Reilly said. Making new living and school arrangements might be more complicated and take longer, because families don't frequently make such adjustments.

Importance of business preparedness
One element of Japanese culture is that the country is very prepared to address natural disasters, Reilly said. "People from outside of Japan are always impressed when they see lots of information on what to do about earthquakes," he said, alluding to a 1995 earthquake centered in Kobe that killed nearly 6,500 people and one in 1923 that killed 140,000.

"Companies know the importance of continuing business," he said.

Japan's pandemic plan, posted on the health ministry's Web site, contains 14 pages of guidance on business preparedness. It urges employers to consider options for evacuating employees and their families assigned overseas in regions that experience pandemic outbreaks, minimizing travel to outbreak areas, and ensuring that returning employees and families follow quarantine guidelines.

William Raisch, executive director of the New York University International Center for Enterprise Preparedness, told CIDRAP News that Panasonic's action shows that some of the largest corporations still see a pandemic as a continuing and real threat.

"Further, this announcement by Panasonic indicates that they are actively monitoring the prevalence of bird flu and have begun to assess the capability and access to healthcare in key elements of their supply and distribution networks," said Raisch, who is an editorial board member of the CIDRAP Business Source.

Earlier this month, Japan's defense ministry said it had developed a plan to fly Japanese citizens in foreign lands home in government-chartered jets in the event of an influenza pandemic, the Yomiuri Shimbun, an English-language newspaper in Japan, reported on Feb 4.

Strict quarantine, mass cremation
The country's health ministry today announced some new details of its pandemic plan, which includes strict quarantine measures such as shutting down all but four airports and three ports, the Associated Press (AP) reported today. Other plans include closing schools and conducting mass cremation of pandemic flu fatalities.

The ministry said, "It is important to delay as much as possible the virus' entry through measures such as strengthening quarantine to take advantage of the special qualities of our nation as an island nation," according to the AP report.

Some pandemic flu experts have said that closing borders won't stem the spread of a pandemic virus and could hamper the flow of crucial supplies.

Health minister Yosuke Yamaki told the AP that Japan is updating its pandemic plan, based on public feedback collected in recent weeks.

As I mentioned, I see absolutely no coincidence between the Panasonic announcement/admission and the sudden fervor that the Japanese government has shown in upgrading and preparing its population for the management of a flu pandemic.

Now let's shift to Time Magazine, and its story on the sudden resurgence of H5N1 in the country of China:

Is China Making Its Bird Flu Outbreak Worse?

One thing is certain about avian influenza: it's deadly. Of the three people who contracted the H5N1 strain of the virus in China last year, three died. In the first six weeks of 2009, eight people have come down with bird flu and five have died. Another thing is that — while the disease has yet to go pandemic as many doctors fear it could — it remains worryingly persistent. Every year since 2003, about 100 people in Asia, the Middle East and Africa contract the disease. Last year, in a rare exception, the number dropped below 50.

But bird flu, it seems, is back. This year, China has already recorded eight human cases of the disease. Last month five people died in locations as far removed from each other as Beijing in the north, Xinjiang in the west, Guangxi in the south, Hunan in the center and Shandong in the east — and one of the highest tallies of bird flu deaths China has ever recorded in a month. "From a disease-control perspective, the increase in cases in China is notable — as is the wide geographic spread," says Dr. Hans Troedsson, the World Health Organization's representative in China. There is still no evidence that the virus has mutated to spread easily between humans, he says. But while such a nightmare scenario, which could set off a global flu pandemic that could kill millions, has shown no signs of being an immediate threat, serious concerns remain. "The fact that this is the highest number for a single month in China reminds us that the virus is entrenched and circulating in the environment," Troedsson says. See pictures of the resurgence of bird flu.(bold mine)

On Feb. 10, authorities in the far western region of Xinjiang culled more than 13,000 chickens in the city of Hotan after 519 died in a bird flu outbreak. But until this week China had reported no widespread outbreaks of the virus among bird populations, prompting concerns among some public health experts that mainland health and veterinary authorities could be missing — or even concealing — the spread of the disease through mainland poultry and wild birds. Hong Kong, "Hong Kong, where the first human cases of H5N1 infection were found in 1997, reported finding a dozen birds with the deadly strain of the virus earlier this year — a good indication that the virus is very likely present in adjacent Guangdong province. But so far Guangdong has reported no bird cases. Equally unusual is that after such a busy month of infections in China, reports of human cases have gone silent. "It's a surprise for me since in January the human cases, you have so many, but in February it suddenly stops," says Dr. Guan Yi, a virologist from the University of Hong Kong. Read "Is Hong Kong's Bird Flu Vaccine Failing?"

The human deaths in China, plus new outbreaks among poultry in neighboring Vietnam and northeast India indicate the likelihood of a firm presence of the virus on the mainland. Some experts worry that China could be missing the disease's deadly progression. Last week Dr. Lo Wing-Lok, an advisor on communicable diseases to the Hong Kong government, said the mainland had not been forthright about the spread of bird flu in poultry. "There's no doubt of an outbreak of bird flu in China, though the government hasn't admitted it," he told Bloomberg. Yu Kangzhen, the Ministry of Agriculture's chief veterinarian, responded in an interview with the state-run Xinhua news service that human bird flu cases are not necessarily linked with animal cases. Read about living with bird flu in Indonesia.

If mainland investigators are missing the virus, it may be because efforts to block it are inadvertently hiding it. China developed an avian influenza vaccine for poultry in 2005 and inoculates millions of birds annually. But not everyone agrees it's a panacea. In 2005 Dr Robert Webster, a influenza expert at St Jude's Children's Hospital in Memphis, Tennessee, suggested that China may have been using substandard vaccines that stopped symptoms of bird flu in poultry but allowed the virus to continue to spread. Recently, Guangzhou-based expert Zhong Nanshan has also said there is a danger that China's widespread vaccinations could conceal the virus. "Special attention should be paid to such animals, including those that have been vaccinated," Xinhua news service quoted him as saying on Feb. 6. "The existing vaccines can only reduce the amount of virus, rather than totally inactivating it."

Mainland controls may also be lacking another layer of more basic prevention in the way that live chicken markets, prevalent throughout Asia, are inspected. Some worry that Chinese monitors may only be calling for culls once a large number of poultry has become sick, as in the Hotan case this week in which 519 birds died. In contrast, last year Hong Kong culled thousands of birds after a regular inspection found only infected chickens in a wet market. The infected birds, experts say, showed no external signs of disease, and could have been missed if inspectors were only screening birds that were dead or visibly ill.

Ramping up preventative measures may increasingly be a matter of life and death. Since bird flu re-emerged in 2003, 254 people in 15 countries have died from it. Researchers now fear that other crises like global warming and the global recession have crowded the virus out of the news. But the disease survives — in the limelight or out of it. "The point is this virus has not disappeared at all," says Malik Peiris, a virologist at the University of Hong Kong. "It kind of dropped off the radar screen of media attention, but the virus itself has increased its spread. It's not only entrenched in Asia, the Middle East, in Egypt, Africa, parts of India and Bangladesh. It's really a problem."

This is the best digest of news written for the casual reader I have seen since 2006. It also mirrors the concerns I have raised for months and months now. The widespread cases of deaths are somehow reassuring to some, because to them it implies no H2H outbreak center. But to me, it implies the potential confirmation of Hope-Simpson's belief that pandemic influenza appears simultaneously all over the place, not just emanating from an isolated location. Avid readers of this blog know of my affinity toward Hope-Simpson's theories and life's work. And Hope-Simpson's theories may solve the one nagging and inconvenient question regarding previous pandemics -- namely, how did panflu reach out across oceans and mountain ranges simultaneously when it took weeks or even months for people to cross? That little question unravels almost all conventional theories of pandemic flu spread. As Sherlock Holmes said, "Once you eliminate the impossible, whatever remains, no matter how improbable, must be the truth."

So as late as the mid-1800s, it was impossible to cross the Atlantic, Pacific or the Eurasian continent and deposit flu virus in as many widespread places as were simultaneously experienced during pandemics. Migrating birds explain part of the story, but not the whole story.  Hope-Simpson believed that a single, simultaneous change in the virus became the tipping point and enabled influenza to cross over genetically to become a human pandemic.  Keep this in mind as you read on. From the English-language Vietnamese newspaper, the Saigon GP-Daily:

Illegal poultry slaughter, sales: HCMC fears bird flu epidemic

Veterinary workers fear Ho Chi Minh City could be hit by a bird flu epidemic since illegal slaughter and sales of poultry are rife in some districts and water fowls bred on small farms have not been vaccinated.

One of the poultry hotspots is Cau market on Quang Trung Street in Districts Go Vap and 11. It is a notorious wet market where poultry has been slaughtered illegally for many years, and it continues to flourish despite the bird flu scare.

Neither district has cleared it. A Go Vap official said sellers in the market flee to the other district when they see inspectors. Besides, he said, since most are migrants from other provinces, it is difficult to catch them.

The situation is similar at Tan Son market which is situated in both Districts 8 and Binh Chanh. The city’s Steering Board for Bird Flu Prevention is unhappy that district authorities have not closed down these illegal markets. The head of the city Department of Animal Health, Phan Xuan Thao, said the city faces the threat of bird flu from the widespread smuggling in of water fowls from neighboring provinces.

Nguyen Trung Tin, vice chairman of the city People’s Committee, expressed worry about a possible human bird flu epidemic. He said inspectors must be posted round the clock at “hot” spots to deal with violations, assisted by police officers. He warned officials in charge of preventing the disease that they would be taken to task if live poultry is found to be sold in their area by inspectors or the media.

The photo here is of confiscated poultry, illegally smuggled into a Ho Chi Minh City market.

I am going to proclaim something here, and for some it may be profound, and for others it may provoke a "DUH!" response.  Here we go:

I believe something has changed.  Not necessarily in the virus itself; it still has not "gone H2H."  But I do believe that the chickens themselves are adapting to the virus.  And once that happens, the virus must also adapt to find new hosts or it will perish.

There is absolutely no reason to believe that H5N1 is going to do anything but adapt.  This virus is amazing, even by influenza standards.  Now factor in the extreme and absolutely sudden number and geographic spread of human cases in China that we know of, and re-read the Time story.  Now also factor in the situation in eastern India, Bangladesh and Nepal.  Look at the new Vietnamese human cases and the continuing situation in Indonesia.

Here's what I think has happened:  H5N1 has won its latest battle with the human race and has completely overrun its defenses.  It has not won the war, but it is clear that it has completely  outmaneuvered every attempt by humans to thwart its advance.  But this latest victory may, eventually, be considered as the turning point in the war. 

Consider the circumstances.  The global economy is in shambles. Surveillance is about to become very lax and unaffordable.  Farmers are risking imprisonment and even execution by bringing in illegal poultry.  Culls cannot keep the virus out of any region. And now the chickens are not doing their duty and dying to warn us -- at least not according to the latest news coming out of China.

Open speculation from leading Chinese scientists regarding this "living chickens" theory leads me to believe that the government itself is stymied and this is how they are asking -- no, begging for outside help to solve the riddle.  This collective shrugging of scientific shoulders from a country that is welling with pride and also within a couple of years of putting a Chinese man on the surface of the Moon is very telling.

So let's review these signs and portents. 

Panasonic is not recanting its earlier plans; in fact, it is restating them and telling anyone who listens not to question their motives nor their methodology.

China has lost the handle on containing H5N1, according to the Time article.  And the widespread geographic location of human cases is not assuring; it is downright troubling (thank you, Time).

Vietnam has also lost the ability to rein in illegal smuggling of poultry, usually from China.

Chickens are not dying in certain areas of China.  But people are.

Human cases are abundant, compared to last year.

Pandemic money is in the US stimulus bill.  Of course there are skateboard parks and a quadrillion condoms, but the presence of panflu monies in both versions was eyebrow-raising.

And the British government recently announced plans to double its antiviral stockpile with Relenza, and not Tamiflu, as the antiviral centerpiece (as I have advocated for two years).

These signs and portents may be the first real indications that the Pandemic Doomsday Clock is ticking. The countdown may have begun, and the cumulative weight of these separate events may have convinced both the Japanese government and Panasonic executives that the countdown has indeed begun; that the clock is no longer stuck at five minutes to midnight; and that the first outbreaks of bona-fide, H2H2H2H avian influenza are just weeks or months away.

It may have also served to convince the Chinese government to lay in additional supplies of their human bird flu vaccine, although to be honest I would rather take my chances with the virus. 

We keep hearing  that the WHO and others are emphatically saying there is no need to raise the pandemic threat level and that there are no outward signs that the virus has mutated.  We don't know if this is true or not; not that we think anyone is lying, but it may take longer than a few days to look at the virus and make that pronouncement. 

But the WHO protocol for changing the threat level ignores the holistic situation and should force us to question if a change in the virus itself is the best/only way to proceed with moving from Phase 3 to Phase 4. 

Everyone needs to be renewed and refreshed and vigilant as heck right now.  And we need to find more signs and portents.  I am uncomfortably sure they are out there and will manifest themselves in due time.