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

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

Naturally, the villagers are extremely shaken by the experience. 

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

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

Hopefully it is NOT some new and dangerous disease.

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

I honor her as well. 

From FluWiki:

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

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

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

This week has marked an escalation of sorts -- not regarding bird flu, but regarding the emergence of stories on bird flu, some of them second-guessing whether or not there will ever be a bird flu pandemic.  From blogger Orange and the site The Coming Influenza Pandemic?,  a link to the Cosmos story asking loudly if everyone overdid it when H5N1 was on everyone's lips from 2004 to 2006.  Orange also links to a Nature story via Effect Measure, written by the veteran Nature bird flu journalist Declan Butler.  Effect Measure's thoughtful analysis is here.

Allow me to weigh in on this topic.

Science has only recently been able to peek into the fascinating genetic makeup of influenza viruses.  The ability of scientists to unwrap and decode the actual genetic code of this viral killer has been prodigious over the past three or four years.  We all know the statements that knowledge will double every so many years, based on the accumulation of new knowledge and the ability of the Internet to make that knowledge available to yet even more scientists.

The one thing we cannot do except in very rare, Hultin-Taubenberg -esque circumstances, is to reconcile history with science.  On this score, we are as much in the dark as we have ever been.

Here's what I mean:  From an epizootic standpoint, our real, hardcore, boots-on-the-ground knowledge of past pandemic incubation is very, very limited.  We just don't have the data.  We still don't know how exactly how the 1918 Spanish Flu pandemic really started, although the evidence now points to Kansas, and not China, as the point of insertion.  Or maybe both:  Science is still debating whether or not Hope-Simpson's theory of a kind of viral spontaneous worldwide reveal is what actually happens.  Researching centuries-old historical accounts of viral activity flaring up pretty much simultaneously aboard ships at sea for weeks, all over the globe, simply does not match up with what science has uncovered about the virus thus far.

Want further proof?  Where is the thoughtful, detailed historical analysis of the 1957 Asian Flu pandemic?  It was not the killer 1918 was, but it nonetheless wrought economic calamity and did kill between one and two million people globally. Yet we know virtually nothing about where it came from, or what the spark was that sent the virus on its way across the planet.  We don't know how long it incubated, or where it made the species jump.  We can only guess.

So we think we know how the influenza virus evolves.  But we are far from certain about how it can do this within a limited time frame in various places, all at the same time.

Likewise, we do not know how long it takes for a virus to evolve to the point where it can make a major species jump.  Dr. Mike Osterholm recently made a huge point when he spoke of equine influenza.  Dr. Osterholm reminds us that it took forty years -- forty years! -- for equine influenza to make the species jump and show up in dogs in Florida.  That's forty years from when H3N8 was first typed.  Who knows how long it really took?  And it apparently accomplished this species jump without any major structural change in the virus' genetic footprint, according to a recent study I read.

So how did H3N8 equine influenza jump to, and kill, dogs in Florida and elsewhere without sacrificing a major change in its viral DNA?  Science has no answer.

Naysayers and critics point to the noticeable drop in the number of human deaths from H5N1.  And we all can certainly say that this is both welcome and unexpected news.  Surely we can chalk this up to better coordination, a Return on Investment of American and WHO dollars toward education of agrarian populations, poultry culling and other eradication efforts, and possibly (and I think in a very minor way) rudimentary poultry vaccination efforts.

For example: The minute India began experiencing its worst and massive H5N1 infestation in poultry last year, I said "Game over!" and refreshed my personal inventories of stuff.  I was more than surprised at the subsequent and apparent lack of human victims of H5N1 among cullers. I was downright shocked that a major outbreak of human H5N1 did not occur.  This prompted me to blog my speculation that Qinghai H5N1, as it exists today, might not be the pandemic strain after all, and wrote that the Fujian clade should get more attention.

We need to think more like the virus thinks and respect its patience.  H5N1 is now endemic in many areas and regions of the world.  Things may be calm now, but they can change with one day's notice.

As the Reveres did, let's turn to the topic of pandemic planning.  I believe we are worse off now than we were two years ago.  Why?  First, because pandemic fatigue has hit everyone, especially in the private sector.   Not to toot my own horn, but I am considered an expert in pandemic planning, and I am one of less than a handful of global IT pandemic planning experts.  I used to get several calls a day to lecture on panflu from all over the world.  

I have not gotten a call to do a bird flu lecture in months. 

Second, everyone has less money to devote toward pandemic preparedness.  Governments are broke all over the nation, and anyone who thinks things in the economy will be getting better anytime soon is living in a fool's paradise.  So no government has the money to buy antivirals, masks, hand sanitizer or anything else helpful.  This probably is why Roche decided to change its strategy with Tamiflu and sell it directly to businesses and corporations.  They realized governments were no longer able to spend taxpayer money on antivirals, and needed to change their business model to move product languishing in warehouses all over the planet.  Or to "lease" product, based on the releases I have read.  Kind of like buying gold stocks as a hedge against inflation.  Corporations would "reserve" their right to get Tamiflu in exchange for Roche warehousing the drugs and distributing them at a different pricepoint if the excrement hit the fan.

Likewise, knowledge will be much harder to impart.  Many governments have laid off their training departments or have made major cuts in personnel.  The focus of training will turn toward events that must be planned for, such as hurricane preparedness and the mitigation of other risks.  People in the Midwest, especially along the Mississippi River, have much more important things to attend to than pandemic planning.  And their real-time, immediate health care needs more closely resemble the health care needs of Indonesia than they do Indiana. 

Viruses have a tendency to kick humanity when it is down.  Bird flu has already deprived millions and millions of people worldwide of a primary and essential protein source.  The madness that is ethanol production from corn has raised food prices to an unconscionable level worldwide.  The combined loss of poultry to H5N1 eradication efforts, coupled with the increase in the price of everything, will reduce the quality of life for many poor nations and their residents.   Sick people get sicker; the pace accelerates.  This puts heavy pressure on the world's "haves" to help resupply starving people and offer compensation for culled birds, as well as putting enormous pressure on poor farmers to cover up their diseased flocks and keep their mouths shut if they don't get compensation.

Peering into this malestrom of uncertainty, protein deprivation, starvation, economic and political instability sits the H5N1 virus, along with many, many other "emerging" diseases.  Aided by these factors and the globalization and "flattening" of everything, these diseases bide their time, enduring setbacks here and advances there.  As Dr. Henry Niman says, H5N1 does not read press releases.  Nor does it read scientific journals.  And if it decides it will not be the next pandemic strain, another virus will come along to take its place.

When, where, and how severe will never be known to us.  We can only do what we can to prepare in this brave new world of ours.

In one 24-hour period, three people have died in Turkey from tick bites.  Apparently, these people self-removed argasid or ixodid ticks that were infected with a disease known as CCHF, or Crimean-Congo Hemorrhagic Fever.  This is based on proMED reports from the region.

According to the WHO, the viral disease CCHF was first discovered in 1944 in the Crimean Peninsula and named appropriately.  But in 1956, it was found that the source of the virus was a germ traced back to the Congo, which as we all know is a hotbed of one sort of hemorrhagic fever or another.  So the virus was renamed Crimean-Congo Hemorrhagic Fever.

From outbreaks in 2001 and 2003 in Mauritania and Kosovo to 2006's outbreaks in Turkey, the disease continues to expand its footprint.  Anyway, because of warmer-than-usual temperatures in the region that includes the border between Turkey and Greece, there have been many recent cases of CCHF. 

Here are the symptoms, according to the CDC:

The onset of CCHF is sudden, with initial signs and symptoms including headache, high fever, back pain, joint pain, stomach pain, and vomiting. Red eyes, a flushed face, a red throat, and petechiae (red spots) on the palate are common. Symptoms may also include jaundice, and in severe cases, changes in mood and sensory perception. As the illness progresses, large areas of severe bruising, severe nosebleeds, and uncontrolled bleeding at injection sites can be seen, beginning on about the fourth day of illness and lasting for about two weeks. 

In documented outbreaks of CCHF, fatality rates in hospitalized patients have ranged from 9% to as high as 50%.

Nasty stuff.  While currently limited to remote areas along the border between the two nations, a total of 2 cases with one fatality are currently reported in Greece, and more than 550 cases are currently reported in Turkey, with 37 deaths, including the three from Monday.

This serves as a stark reminder that while H5N1 has apparently gone underground from the moment, there are more than enough emerging diseases to keep surveillance crews busy.

And in our globalized world, a disease with a slow incubation period (such as CCHF, where it can stretch from one to nine days, according to the WHO) can mean trouble anywhere.

As you know all too well, I have not been blogging much on avian flu lately.  there are several reasons, the top three being the relative lack of news on the H5N1 front; the ability of my blogging colleagues to report on these in a timely and professional manner, rendering my posts on the same topics nothing more than redundant; and my focus on my "day job" as CIO for a Florida agency.

And let me assure you I am working on a very long and important series of flublogs. 

But occasionally things happen that just make me so mad, I have to speak out.  And so today, I am calling on the US Navy, the CDC and the WHO to get NAMRU-2 the Hell out of a clearly ungrateful Indonesia and get it to some place that welcomes it.  Like, ironically, Vietnam.  Or Australia, which would probably be easier to get samples to anyway. 

There is little doubt that Indonesia is politically sliding the way of pain-in-the-neck nations such as Iran, North Korea and Venezuela.  Now I know that the United States is a ripe target for ridicule.  We have done things around the world that the average American is not proud of.  But I am sick and tired of America being kicked in the groin by nations that we are trying to help.  From a health perspective, the nation doing most of the kicking these days is Indonesia. 

People have posted replies to my earlier blogs regarding Indonesia, asking me to be patient and to understand that if the US pulls out of any medical support for Indonesia, it will harm the Indonesian people.

Those pleas need to be vectored toward the real source of potential hardship:  The Indonesian government.  They are the ones harming their own people, and the United States cannot and should not be held responsible for what other nations deliberately do to their own people. 

Back to the title of the blog.  It is time to close the doors on NAMRU-2, and to relocate it somewhere else.  It is time to bring closure to this whole sad story.  Put NAMRU where it is appreciated, not condemned by some paranoid schizophrenic regime. 

Speaking of paranoid schizophrenic regimes: Last night, I watched the film The Last King of Scotland, and was mesmerized by the Oscar-winning performance of Forest Whitaker as Idi Amin.  Today, as I write this blog, I am haunted by that film.   How a charismatic person could lead a nation to ruin and mass death is so sad.  And we see several other nations and entire regions of the planet where government madness, fueled by anti-Western sentiment, is destabilizing this planet.  Supari and the Indonesian government overall would be wise to remember that the West wants to help, but its patience is not infinite, nor should it be.