Scott McPherson's Web Presence

The bird flu news is coming strong out of Vietnam and Indonesia again this week.  In Tangerang, Indonesia, (search my blogs for previous references to Tangerang) a familial cluster has manifested itself.  A 38 year-old mother came down with H5N1 on or about January 23, and, wouldn't you know it, but about a week later her 15 year-old daughter exhibited bird flu symptoms.  Both have tested positive for H5N1 and are in hospital. the human-to-human (H2H) potential is huge, because of the staggered onset of symptoms.  I would say, based on that staggering of onset dates, that H2H is the most likely cause here, although not yet set in concrete.

Now, in northern Vietnam, not one, but two H5N1 human cases have flared up in less than a week.  One 40 year-old male patient has already died, and the other, a 27 year-old man, is on a ventilator and not doing well at all.

The Indonesian cases are almost certainly of their peculiar clade 2.1, while the Vietnamese cases are speculated to be the newer Fujian clade, designated 2.3.4 by the WHO.  As you recall, Fujian H5N1 was identified in 2006 by a research team that included Doctors Yi Guan of the University of Hong Kong and Robert Webster of St. Jude's.  You don't get much better than that!  From the CIDRAP news release of November 3, 2006, titled "Study says new H5N1 strain pervades southern China":

The authors contend that their findings show that the spread of the Fujian-like strain "has initiated a new transmission wave in Southeast Asia," comparable with the first wave in the region in early 2004 and the spread of H5N1 to Europe and Africa following China's Qinghai Lake outbreak in the spring of 2005. They say it is to blame for recent poultry outbreaks in Laos, Malaysia, and Thailand and for recent human cases in Thailand. 

http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/nov0306China.html

Sure enough, look at the human cases since 2005.  Since the discovery of Fujian H5N1, human cases have been reported in Southeast Asia.  The statistics point to a higher mortality rate than existed before 2006, which makes it a very strong competitor in terms of mortality with the Indonesian substrain. It is becoming apparent that Fujian H5N1 has acquired the same kliller instinct as its Indonesian kin. 

If we don't get some really good data from Indonesia soon, I am deeply concerned where this whole Tangerang thing is going.  Exactly where we stand in this Mexican standoff with the Indonesian government, I am not sure.  Let's hope we have a breakthrough on the diplomatic front soon.  The longer the world is deprived of the Tangerang samples, whenever and wherever source they come from, the deeper the hole we make for ourselves.

It is equally important that we get good sequencing data on Fujian H5N1's evolution.  While Qinghai spreads like proverbial wildfire across south Asia, I am absolutely amazed there have been no cases of mass infections of H5N1 in humans.  So maybe Qinghai is not the eventual pandemic substrain.  A killer of economies and a bane to the existence of poultry worldwide to be sure, but maybe not the substrain that will do us in.  Maybe that substrain still smoulders in Tangerang, Indonesia, or closer to Jakarta, or maybe in some Laotian jungle.  

I am in Heaven.  Jericho, the series even CBS could not kill by incompetent scheduling, makes its return tonight, Tuesday, February 12, 2008 at 10PM EST - on CBS. 

Long-suffering fans can rejoice that CBS thought enough of the fan revolt to order up seven new episodes.  And considering that the Writers Strike (I backed the writers all the way, natch) is just over, it means that Jericho (along with the Sarah Conner Chronicles) is about the only fresh drama on any network.

If you want a recap of Jericho, and why it is the most relevant show on television, just search this Blogsite using "Jericho."  You will get important plot information and maybe you won't have to cram for the season premiere.  Or, you can go to CBS.com and go to the phenomenal Jericho Website.

Basically, about two dozen American cities are radioactive dust.  Jericho, Kansas, is miraculously spared any real problems.  Then, Russian cargo planes drop Chinese-made generators and supplies to the townspeople.  The government has reconstituted itself in Wyoming.  The flag has dramatically changed (Where are the 50 stars?  WATCH THE SHOW!).  An influenza epidemic almost killed the mayor early in the season, and eventually he recovered -- only to die in a skirmish between Jericho and a warring nearby town.  And just as the two towns are about to square off in a nasty battle, the army -- somebody's army -- drops in from Nebraska.  Pity -- Hawkins was about to do something cool with that M-1 Abrams tank!  Who is Hawkins?  WATCH THE SHOW.

That's where Season Two picks up.  Jericho message boards are rumbling about a potential epidemic of a new virus, so flubies should enjoy the show.  Emergency managers and disaster recovery experts should enjoy the show.  Hell, everyone should enjoy the show!  So watch, please.  Especially those who get Nielsen stuff.

Now, for those of you who are fearful you'll miss American Idol:  CBS has decided to schedule the show at 10PM EST, so it does not run up against Idol!  So there.  Now you have no excuses left to see a series that was saved from cancellation by the tremendous fan passion.  And with only seven episodes, the producers have packed a ton of surprises and non-stop action into the show!

Here, read this review from Newsday:

http://www.newsday.com/entertainment/tv/ny-ettell5572872feb12,0,7256205.story

And be sure to buy the Season One boxed set:

It may not be as bad as 2004, but it is looking increasingly like this year's flu vaccine may have been as bad a repository of guesses as thinking the Baltimore Ravens and Atlanta Falcons were headed to the Super Bowl this past season.  Or perhaps thinking that Inspector Clouseau mixed the vaccine this year.

As you recall, last week I blogged on the appearance of A/H3N2/Brisbane-like Influenza A.  The location for that blog is: http://www.scottmcpherson.net/journal/2008/2/6/australia-gives-the-us-an-unwelcome-present.html .  To digest:

This past Southern Hemispheric flu season, an H3N2 substrain appeared and confounded the vaccine target Down Unda.  Now the virus has spread to the United States, which is bad because Brisbane-like was not known before the annual vaccine confab (please read my analogy to understand how that process works.  I guarantee you'll understand it!).  I use an easy-to-follow pro football analogy.

By the way, Antonio Cromartie had two interceptions in yesterday's NFL Pro Bowl, tying a record.

But I digress.  A Reuters story from last week confirms that this Brisbane-like H3N2 is playing havoc with doctors. 

WASHINGTON - The influenza vaccine given to Americans may not protect as well as expected, U.S. health officials said on Friday as the number of flu cases increased nationwide.

The U.S. Centers for Disease Control and Prevention said slightly more than half of the influenza virus strains reported to its surveillance system are not good matches against the strains included in this flu season’s vaccine.

The number of states reporting widespread flu activity jumped to 31 this week compared with 11 a week ago, the CDC said. But Dr. Joe Bresee of the CDC’s influenza division said there are no indications this flu season is worse than usual.

“Seasonal flu activity was slow to start this year but has increased sharply in recent weeks,” Bresee told reporters.

One measure officials use to gauge the severity of the season is the number of flu-related child deaths. Bresee said the CDC has heard of six U.S. children who have died from the flu, a relatively low number compared with recent years.

Flu viruses mutate and change all the time, so every year a different vaccine is created as officials predict which particular strains will circulate.

The vaccine is designed to protect against three influenza strains — two from Type A, an H1N1 and an H3N2 version, and one for Type B.

Bresee said about 30 percent of the overall strains of influenza in the United States may be a Type A strain that emerged in Australia called H3N2 A/Brisbane. It emerged too late to be included in the flu vaccine offered in the United States beginning in September and October. (Bold all mine)

But wait, there's more!  It seems that the WHO also missed the target -- almost Clouseau-like --  when it came to picking the right Influenza B virus, as well.  Continuing from the Reuters story:

The Type B strain chosen for this year’s vaccine also was not a good match for most of the B virus strains seen in the United States this flu season, Bresee said.

“While a less-than-ideal virus match between the viruses in the vaccine and those circulating viruses can reduce vaccine effectiveness, we know from past influenza studies that the vaccine can still protect enough to make illness milder or prevent flu-related complications,” Bresee said.

Bresee noted that decisions on the composition of the annual vaccine are made about nine months before it is made available to the public in the fall, and it is sometimes hard to know that far in advance which strains will circulate.

Flu vaccines take months to make.

And now for the trifecta!  Another mention of Tamiflu resistance to this year's flu:

Bresee also said some resistance is being reported to the antiviral drug Tamiflu, made by Switzerland’s Roche Holding AG and Gilead Sciences Inc of the United States. Of the viruses tested in CDC flu labs, 4.5 percent are resistant to the drug, Bresee said.

Influenza kills an estimated 36,000 Americans in an average year, and puts 200,000 into the hospital, the CDC said.

http://www.msnbc.msn.com/id/23075303/

This explains why, in spite of your dutifully-administered flu vaccine, you may wind up feeling a little like Chief Inspector Charles Dreyfus this flu season.

Dogs are dying in Miami and are very ill in Fort Myers, Florida.  Everyone knows where Miami is; Fort Myers is located at the opposite tip of the Florida peninsula, on the Gulf of Mexico.  But the two municipalities are sharing a sad distinction:  Dogs in shelters are dying of a sudden, overwhelming and as-yet-unknown disease.

Things started this time last week at the Miami-Dade Animal Shelter.  the shelter is located in Medley, which is an industrial area northwest of Miami.  last week, dogs started getting very sick -- and dying quickly and horribly.  The descriptions of the dead dogs reminded me immediately of the deaths of GIs during the 1918 pandemic.  Lungs and abdomens filled with blood and fluid,; dogs lying in pools of their own blood.

Dr. Sara Pizano, director of animal services at the county-run shelter, told two television stations -- the CBS and ABC affiliates -- that she suspects a new and emerging pathogen. "It's not a normal infectious disease for a shelter," said Pizano, "it's well beyond that so we think we're looking at a new emerging disease."   the Miami Herald reported:

Neither she nor the shelters' other vets -- with 50 years' combined experience, she said -- ''have ever seen lungs so bad'' as the latter.

Lab tests have shown the Streptococcus zooepidemicus bacterium sickened the dogs, but Pizano believes further tests might indicate a virus is also at work.

On the opposite tip of the peninsula, in Fort Myers, the daily News-Press is reporting an outbreak of a mystery illness at the Lee County Animal Shelter:

About six to 12 dogs at the shelter have coughing and a runny nose, said Jim Desjarlais, interim animal services director. Desjarlais said it is unknown exactly what the disease is, but it might be a new strain of canine respiratory corona virus, or CRCV.

The University of Florida (Go Gators!  Go Tebow!) has been called in to do research.  Samples have been collected and the University's school of veterinary medicine, which is one of the best veterinary schools in the nation, is desperately seeking the viral cause of the outbreak. Samples have also been sent to California for independent analysis.

But the words "corona virus" in the News-Press story are ominous.  Recall that SARS was/is a coronavirus gone mad.  The supposition that it could not only be H3N8, but also possibly a SARS-like coronavirus that impacts dogs, is worrisome. 

From a paper titled "(WO/2004/011651) CANINE RESPIRATORY CORONAVIRUS (CRCV) SPIKE PROTEIN, POLYMERASE AND HEMAGGLUTININ/ESTERASE":

CANINE RESPIRATORY CORONAVIRUS (CRCV) SPIKE PROTEIN, POLYMERASE AND HEMAGGLUTININ/ESTERASE The present invention relates to biological material, and in particular to a canine respiratory coronavirus that is present in dogs having canine infectious respiratory disease.

Canine infectious respiratory disease (CIRD) is a highly contagious disease common in dogs housed in crowded conditions such as re-homing centres and boarding or training kennels. Many dogs suffer only from a mild cough and recover after a short time, however in some cases a severe bronchopneumonia can develop (Appel and Binn, 1987).

The pathogenesis of CIRD is considered to be multifactorial, involving several viruses and bacteria. The infectious agents considered to be the major causative pathogens of CIRD are canine parainfluenzavirus (CPIV) (Binn et al., 1967), canine adenovirus type 2 (CAV-2) (Ditchfield et al., 1962) and the bacterium Bordetella bronchiseptica (Bemis et al., 1977, Keil et al., 1998). Also, canine herpesvirus, human reovirus and mycoplasma species have been isolated from dogs with symptoms of CIRD (Karpas et al., 1968, Lou and Wenner 1963, Randolph et al., 1993) Additional factors like stress may also be important.

CIRD is rarely fatal but it delays re-homing of dogs at rescue centres and it causes disruption of schedules in training kennels as well as considerable treatment costs.

Vaccines are available against some of the infectious agents associated with this disease, namely Bordetella bronchiseptica as well as CPIV and CAV-2.

However, despite the use of these vaccines, CIRD is still prevalent in kennels world-wide, which is possibly due to the vaccines not providing protection against all the infectious agents involved in CIRD.

We have discovered a novel coronavirus, which we have called canine respiratory coronavirus (CRCV), in a large kennelled dog population with a history of endemic respiratory disease, and we have shown that this virus is associated with CIRD.

Some members of the family coronaviridae are known to cause respiratory disease in humans, cattle, swine and poultry (Makela et al., 1998, Pensaert et al., 1986, Ignjatovic and Sapats 2000). For example, bovine respiratory coronavirus is associated with shipping fever in cattle which is a multifactorial respiratory disease (Storz et al., 2000).

However, coronaviruses were not suspected to have a role in the pathogenesis of CIRD. Indeed, with only a single exception, canine coronaviruses have been reported to be enteric viruses and to cause acute diarrhoea mainly in young dogs (for example, Tennant et al., 1993). In a large study of viruses involved in canine respiratory diseases, Binn et al. (1979) reported the detection of a canine coronavirus in the lung of a single dog that was also infected with SV5 and canine adenovirus 2, two other viruses that are associated with canine respiratory disease. (Bold all mine).

So, in 2003 -- about the same time that SARS was raging across Asia, and experts were digging in for the Next Pandemic -- a novel coronavirus was beginning to also afflict dogs.  Thus was CRCV discovered.  Is this simply coincidence, or was a freak coronavirus on the march, leaving its wild natural host and searching for other mammals to infect?  

Kennel cough is a bacteria, Bordetella bronchiseptica, and vaccines are widely available to prevent its occurrence.  What is occurring in South Florida may or may not be viral -- but there is ample previous evidence to suggest something old, or something new.

Dog flu, or H3N8 canine influenza, is not new to Florida.  There have been multiple outbreaks over the past few years, the most serious occurring in 2005.  The virus attacked racing greyhounds first; then, the disease spread to shelters and veterinarians' offices.  The virus was typed by the University of Florida and the CDC.

As Dr. Mike Osterholm of the University of Minnesota recently said, H3N8 was sequestered in horses for decades; then, suddenly, and sometime between 1999 and 2003, H3N8 jumped the species barrier and attacked dogs.  No surveillance prompted alerts or warnings; the species jump was unanticipated, sudden and devastating.  The outbreak threatened the entire greyhound racing industry, which is sick enough already due to lagging pari-mutuel activity across Florida.  Whatever your feelings about dog racing (I am not a fan), it is pitiable to see such fine animals stricken with influenza.

The problem with the 2004/05 outbreaks in Florida was how quickly the virus jumped up the Eastern Seaboard of the state.  One day it was in Miami, Pompano Beach, and West Palm Beach, all on the Gold Coast; the next, it seemed that animal clinics in Jacksonville, some 300 miles away, were experiencing cases.  From there, the virus spread to New York and Massachusetts.

Dr. Henry Niman reminds us that polymorphisms of H3N8 canine influenza from Florida have been discovered in H5N1 in mammals in Indonesia as recently as 2006.  Those specifically would be: DQ124152 A/canine/Florida/43/2004, and DQ124160 A/canine/Florida/242/2003, both H3N8.  How the heck did that happen? How did Florida dog flu polymorphisms get into Indonesian H5N1?

The CRCV paper can be read at: http://www.wipo.int/pctdb/en/wo.jsp?WO=2004%2F011651&IA=WO2004%2F011651&DISPLAY=DESC

The University of Florida maintains a Website devoted to dog flu. It can be found at: http://www.rgp.ufl.edu/publications/explore/v11n2/story3.html 

The entire Flutrackers thread on the Florida outbreak, including links to television video, can be found at: http://www.flutrackers.com/forum/showthread.php?t=53517 .

As we all recall, the influenza season in the Southern Hemisphere last summer was pretty severe.  You can Google, or search "Australia" on my Blogsite for past stories on the 2007 epidemic Down Unda.  Suffice it to say that it was pretty bad, with headlines crowing "Worried Mums Search for Tamiflu," stuff like that.

A vestige of that Summer 2007 epidemic has now reached our shores.  Labeled A/H3N2/Brisbane-like, the virus was too new to be a part of the WHO's travalent (3-flus) cocktail for the annual vaccine.  But it has crossed the Equator and is now infecting Americans.  This thwarts the ability of the seasonal vaccine to do 100% of its work.

For the uninitiated:  Each year, usually around February and March, the WHO holds a little party.  All the influenza rock stars from around the world get together and try to predict the next season's Super Bowl winner in each hemisphere, based on surveillance.  Think of it as disease scouting, and the scouts all get together and talk about which virus has picked up the best players via free agency, trades with other teams, etc. 

They get to pick two teams from the Influenza A conferences H3N2 and H1N1, plus one team from Influenza B (let's call it the Canadian Football League winner, in deference to my buddy Crof).  Usually, the WHO's people are pretty good at it.  But surprises can occur, and there really is little they can do to overcome those surprises.  Sort of like predicting that LaDianian Tomlinson and Phillip Rivers would both be ineffective in the AFC Championship Game (while my friend Antonio Cromartie played a helluva game, as usual!).  What were the chances of THAT?

But I digress.  From the AP story:

Each year's vaccine contains protection against three influenza strains — two members of the nasty Type A family, an H1N1 and an H3N2 version, plus a milder Type B — that experts predict will cause the most illness.

So far this year, H1N1 is causing the vast majority of disease, Gerberding said.

But a new H3N2 strain emerged near the end of Australia's flu season, too late to be included in the U.S. vaccine. Called H3N2/Brisbane-like, it is now sickening Americans, although it still is making for a small proportion of cases, Gerberding cautioned.

Some 132 million doses of vaccine were produced this year, more than ever before. It's too early to know how many people got vaccinated, but Gerberding said a record number of doses were distributed to doctors and other vaccine providers — and that there is still some available.

CDC has found flu affecting most of the country but widespread outbreaks in Alaska, Colorado, Hawaii, Kansas, Massachusetts, Mississippi, New Mexico, New York, Pennsylvania, Texas and Virginia.

The full story is at: http://news.yahoo.com/s/ap/20080202/ap_on_he_me/flu_season . And can you tell I am going to miss football season?