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Well, it didn't take long for Indonesia to reaffirm its standing as Bird Flu Capital of the Planet. A bunch of chickens died en masse and some villagers started feeling sick in Makassar, South Sulawesi, and presto! The Indonesian government moves in and starts testing. Plus, the Health Ministry actually starts talking about it! This sudden government transparency is both a surprise and a welcome development.

Note it is not Supari, but rather the acting head of communicable disease control who is making the announcement.This may or may not be H5N1. We have seen so many false alarms recently that I do not normally even mention them unless we have very strong suspicions and anecdotal evidence that bird flu is the culprit.

In this case, I will make an exception, expecially since the Indonesian government has.

Here's the Reuters story:

Indonesia to test 17 for bird flu in Sulawesi 13 Nov 2008 12:53:23 GMT Source: Reuters

JAKARTA, Nov 13 (Reuters) - Seventeen people from the same neighbourhood in the Indonesian city of Makassar in South Sulawesi are due to be tested for bird flu after falling sick, a health ministry official said on Thursday. Chandra Yoga Adhitama, acting director-general of communicable disease control, said the group had been hospitalised after chickens in the surrounding area suddenly died.

"Some were hospitalised yesterday and some today. I think it is a precaution by our officials after chickens died there," Adhitama said.

He described the general health condition of the 17 as good and said that blood samples had been taken and would be sent to the health ministry laboratory in Jakarta for testing.

"We are continuing to monitor their condition," he said, adding that only four of the group were adults.

Suspected cluster cases can raise concerns about rare human-to-human transmission or that the virus might have mutated into a form that can pass easily among people.

The country's largest known cluster of bird flu cases in humans occurred in May 2006 in the Karo district of North Sumatra province, where as many as 7 people in an extended family died.

The World Health Organisation said at the time that limited human-to-human transmission could not be ruled out but that the virus samples from the scene did not show any significant genetic mutations.

Bird flu remains mainly an animal disease but experts fear the H5N1 virus might mutate into a pandemic strain that would sweep the globe, possibly killing millions and hobbling economies.

Indonesia has the highest toll of any nation and a health official said on Wednesday that a 15-year-old Indonesian girl has died of bird flu in central Java, bringing the country's death toll from the disease to 113. (Reporting by Telly Nathalia; Editing by Ed Davies and Valerie Lee)

And from the Jakarta Post:

17 treated in Makassar for suspected bird flu

Andi Hajramuni , The Jakarta Post , Makassar | Thu, 11/13/2008 8:23 PM | National

Wahidin Sudirohusodo Hospital in Makassar, South Sulawesi, has been treating 17 patients since Wednesday for suspected bird flu.

The suspects, 13 of them children, are residents of Sudiang subdistrict. Seven were admitted to the hospital Wednesday, the rest arrived Thursday.

Hospital spokesperson Andi Kurnia Bintang said the patients were suffering from high fever, coughing and breathing difficulty, all symptoms closely associated with bird flu.

"Rapid tests showed they may be infected with the H5N1 avian influenza virus, but we are waiting for blood test results to come back from the Hasanuddin University lab," Kurnia said.

Kurnia said 31 chickens had died in the subdistrict in the past week before three toddlers started to show symptoms Monday.

Separately, head of Makassar's husbandry office, Sulistiawati, said that his office had found several chickens which tested positive in the bird-flu quick test.

She said she had sent officers to cull 20 birds and spray disinfectant at chicken farms in the area. (dre)

Stay tuned.

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

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

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

Here's part of what he said:

I guess a number of possibilities here

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

2) a seasonal affect?

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

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

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

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

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

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

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

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

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

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

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

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

Test drill at Miami International Airport aims to slow pandemics

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

BY INA PAIVA CORDLE

icordle@MiamiHerald.com

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The complete article and links can be found at:

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

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

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

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

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