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It could be nothing, or it could be the biggest news of the year. A South Korean man has died in Vietnam; specifically, in the region we used to call South Vietnam. He died of suspected avian influenza. The man, accompanied by his Vietnamese wife, was visiting her relatives when he was suddenly (and I mean suddenly) stricken with "bird flu-like symptoms," according to the Vietnamese physicians who attended him.

The following is the news story, from the Xinhua news agency:

http://news.xinhuanet.com/english/20...nt_7025977.htm

Read that passage again: The dead man's father, who is in South Korea, is suffering from the same symptoms. The Vietnamese newspaper Thanh Nien offers some specifics on the dead man's arrival and departure, leading one to believe they have better inside sources.

A South Korean man died of pneumonia in Can Tho city Monday, local doctors, who suspect he had contracted bird flu, said.

The man was taken to the city General Hospital at 3:00AM Monday with high fever and breathing problems. He died at 2:00PM.

The doctors have sent his blood samples to Pasteur Institute in Ho Chi Minh City to test for the H5N1 strain of bird flu virus, which has caused 100 infections and 46 deaths in Vietnam in the last few years. (bold mine)

The man’s family said his father in Korea too was suffering from pneumonia-like symptoms. http://www.thanhniennews.com/healthy/?catid=8&newsid=33199

We know very, very little right now, except that Can Tho is near the border with Cambodia, and the newspaper accounts are growing in number and are appearing in both the Vietnamese and the Chinese press. Complicating things is the knowledge that human H5N1 cases have not been reported in this particular Vietnamese province, and there have been no real cases of South Korean human H5N1 infections, save for a January, 2007 infection of a poultry worker, who tested positive for antibodies to H5N1 and suffered only a mild infection. 

We do not know anything about the father of the dead man, his travel patterns -- nothing.  We do know one thing -- if the infection started in South Korea, the WHO could have an interesting next few days' worth of tracking down airline passengers.

Vietnam is considered the world's best practice at bird flu removal and containment. Last year, President Bush even stopped at the aforementioned Pasteur Clinic in Ho Chi Minh City to meet with the head researchers on avian influenza. The photo of that meeting is at left, since the American press, by and large, saw fit not to publish it. Vietnam has an extremely aggressive surveillance and culling operation going, and despite the nation's best efforts, there has been a resurgence of H5N1 cases in poultry, especially ducks. The U.S. government has given the Vietnamese government over $22 million to date to fight bird flu, with a focus on surveillance and payments to affected poultry farmers for culled birds.  In a striking coincidence, it was just announced today that an additional $10.5 million will be given to Hanoi to fight avian influenza -- and another $1.5 million to the WHO, earmarked for a human vaccine to be developed by the Pasteur Institute.

But Vietnam is cursed with its own "Ho Chi Minh Trail," and the bitter irony of this is certainly not lost on former US servicemen and women who served gallantly in Vietnam. The trail, this time, is a trail of smuggled poultry from China, on trails that snake along the Vietnam-China border. The photo at left shows this pattern of smuggling, and it serves as evidence that the laws of supply and demand apply, even in dueling Communist nations. Well, Communist in name and in totalitarianism, at least. Chickens and ducks have become much more expensive since bird flu came along, and farmers have found it more economical to simply smuggle their poultry in from China, rather than have to deal with the requirements of the military and health authorities.

If we first suspect H5N1 in the death in Vietnam, we must also suspect SARS, according to Dr. Henry Niman. In his latest commentary at http://www.recombinomics.com/News/11070701/H5N1_Vietnam_Korea.html , Dr. Niman states:

The above report of suspected bird flu among family members in southern Vietnam and South Korea raises more questions than it answers. Although reported transport of H5N1 via commercial airliner has been limited to exotic birds, transport of SARS CoV via airline accelerated the SARS outbreak in early 2002, and is a major red flag for the spread of infectious diseases in general.

The world anxiously awaits the outcome of testing of both Lu Chin-chu and his father.

Jim Oberg has written a dandy little piece of cosmic speculation.  Jim, or James Oberg as you may know him, is one of America's best space writers, and is also an expert at Russian space history.  His seminal work Red Star in Orbit is one of my all-time favorite books, and has nifty pictures such as cosmonaut group photos -- and the same photos with certain cosmonauts airbrushed out, which helped the CIA determine which Soviets went up but never came back.

Anyway, Oberg recognizes that this is the 50th anniversary of not only Sputnik, but "Muttnik," when spacedog Laika was blasted into orbit.  The article, titled "How a dog blazed the trail for life in space -- Russia’s Laika and microbial hitchhikers were launched 50 years ago" can be read in its entirety at: http://www.msnbc.msn.com/id/21596557/

Oberg writes specifically about the microbes that Laika carried with her into space -- and postulates that some of those microbes are still floating in space, or may have settled on the moon.  Read on:

Even during that first flight, Laika did not ride alone. Like all advanced organisms on Earth, the dog carried an array of microorganisms in every nook and cranny of her body. Laika herself died of overheating just a few hours after launch, due to a thermal control system failure — a fact concealed by the Russians for decades. But that was hardly the end of the voyage.

The other living organisms in Sputnik 2 would have continued to thrive for the nearly six months the satellite remained in orbit, living off the biological materials and water provided by Laika’s body. Temperatures inside the inert vehicle were well within the range in which Earth life can function, and the pressurized cabin would have remained intact.

Everything was destroyed — and likely sterilized — when the satellite slipped into the upper atmosphere on April 14, 1958. The forms that the "Laika biosphere" took can only be speculated about. But some microbes almost certainly survived until the very end.

Humans may be contaminating the solar system by the most innocent of methods.  Here's a report about a technician with a cold, who might have further contaminated the moon:

A decade later, an even bolder small step for earth germs may have occurred when a worker at a spacecraft workshop in California sneezed on a television camera he was assembling. Installed in the Surveyor 3 robot moon lander, the device landed on the moon in April 1967. Apollo 12 astronauts retrieved samples of the lander in November 1969, and when several spots inside the camera were tested in a laboratory for microorganisms, one sample turned out to provide viable human-borne germs.

That idea has a broader but still widely unrecognized implication: Such conditions — exposure to terrestrial contamination during manufacture, followed by protection in a survivable environment after launch — also could apply to dozens of other space vehicles that have been launched to the moon, Mars and Venus. This is particularly true for Russian space probes, where deliberately pressurized canisters hold the electronics.

The thought of our own germs coming back to haunt us in strange and alien-mutated ways has always been a staple of science fiction.  My personal favorite in the genre is The Quatermass Experiment (aka The Creeping Unknown with Brian Donlevy, one of my favorite movies of all time).  However, in the vacuum of space, with no gravity and with an interesting playpen of humans living in a canister together, the possibilities for a mutant bacteria or virus are legion.  Oberg continues:

It’s impossible to know how long microbes or spores could survive in dormant state. Certainly, barring an accidental splash or two of borscht, they would have had no nourishment for growth. Maybe someday it will be possible to retrieve one of those early interplanetary probes and take a look — if the descendants of its original inhabitants permit it!

Closer to Earth but still in space, the lustiness of microbial growth is strikingly illustrated by experience on long-term space stations, such as Skylab (where bacteria probably thrived for years on garbage and human waste in the craft's trash module) and on the Russian Mir station, where fungi colonies actually grew on portholes (feeding on human skin peelings) and were so thick they obscured the view. (bold mine)

The fungi on Mir also excreted highly corrosive waste products that actually etched into the porthole glass and its titanium frame. Russian scientists found that the fungi and other microorganisms mutated wildly in the higher radiation levels of space. (ditto)

Researchers already have found that when salmonella bacteria were carried into orbit, they morphed into a new strain that was even deadlier when it was brought back to Earth. In the far future, the most dangerous space aliens might turn out not to be aliens at all — but rather the creatures we've been bringing with us to the final frontier, starting 50 years ago with one dog and several million microbial hitchhikers. (bold again mine)

The quarantine the Apollo 11 astronauts endured (and their fellow sojourners) was a dang good idea.  No telling what alien life forms might have hitchhiked along with them!  This does, I think, bring up an excellent point about the possibility that future microbial life on distant planets and planetoids might be terrestrial in origin, after all. 

Multiflusite poster Laidback Al put together a very useful map of the Tangerang H5N1 human cases over the past few weeks.  He posted it on FluTrackers.com and I am reprinting it here, because it is an excellent visual aid to see where the human cases are.

Please note this map also includes the latest victim -- the 30-year old woman known as "Eti," who died Nov. 3, after an illness that started October 23rd and went progressively downhill.

Not to be outdone by Tangerang, Riau is heating up again with the suspected death from H5N1 of a 31-year old man named Muhammed Nabi.  Test results have not been released as of yet.

When you are lookingat Laidback Al's map, please note the closeness to Jakarta of the human cases.  A veritable next door neighbor, as the crow flies. 

Indonesian child diagnosed with H5N1 goes home to play

Tangerang's Sholeh Alfaruq has been taken home by his parents.  Ordinarily, that would seem to be extraordinary news, a real cause for celebration.  And any child in Indonesia who recovers from H5N1 is reason to celebrate, considering the 80%-plus death rate from H5N1 there.

But Sholeh is an exception to a rule; an anomoly that needs to be studied carefully.  For Sholeh Alfaruq showed only mild H5N1 symptoms; played with neighborhood children even while undergoing treatment; and has gone home against the wishes of his doctors and the Health Ministry. My original blog on him is at: http://www.scottmcpherson.net/journal/another-h5n1-infected-toddler-in-tangerang.html

Sholeh was a neighbor and presumed playmate of Dewi Aprilliani, the four-year old H5N1-infected girl who died October 22, and her death was reported to the world the following day.  Her death marked the second death in as many weeks in Tangerang, which is located on the outskirts of the capital of Jakarta.  My blog on that death can be found at: http://www.scottmcpherson.net/journal/2007/10/24/new-h5n1-death-in-tangerang-indonesia.html

From the Borneo News via wire service AFP:

http://www.brunei-online.com/bb/thu/nov1w5.htm

So this child has apparently fully recovered from H5N1 and has returned to his neighborhood.  Tangerang has experienced multiple H5N1 fatalities in the past year.  As alert multiflusite poster Theresa42 points out, this raises many, many fundamental questions.  The following is taken from her Flutrackers.com post, and she hat-tips fellow poster BlueJay.  This is from television station Liputan6.com. Machine translation from the native Malay.

Flu parents Deny Diagnosis Be Positif towards Anak
01/11/2007

Liputan6.com, Tangerang: Although being diagnosed positive terjangkit the bird flu virus, Sholeh that was the Tangerang resident, Banten, was still undergoing the activity as usual. He playing was proper for the healthy child. The child was three years old this could be treated in the hospital, but was returned by his parents that regarded his illness of only common fevers.

In fact in the area of his residence, the Suka Asih Village, of Kecamatan Pasarkemis, Tangerang, some time set had one resident who was killed resulting from bird flu [read: Menkes Pesimistis Indonesia Bebas Flu Burung]. After the incident, the official of the local Health of the Service checked the example of villagers's blood. The official afterwards stated Sholeh positive was affected by the same illness. Sholeh could be then carried to the Hospital of Penyakit Infeksi Professor Doktor Sulianti Saroso, Sunter, Jakarta Utara.

However, parents Sholeh forced Putra him to be returned because of being convinced the healthy child. Moreover, the good intention to the official of the Health of the Service was then refused by parents Sholeh, including the medicine that was given by them. As for till October 29 2007, the Kesehatan Service side recorded had 14 people died in the Banten Province resulting from bird flu.

http://www.liputan6.com/sosbud/?id=150093

OK, here's the bottom line:  We have a situation in this neighborhood in Tangerang where a four-year old girl died from H5N1, and a week earlier a twelve-year old boy also died.  According to the television station, fourteen people have died from bird flu in the province since 2005. 

Immediately following the deaths, the authorites swarmed over the village, taking blood samples of the neighbors and especially their children.  That is apparently how young Sholeh was found to be H5N1-positive.  He was apparently showing flu-like symptoms as early as October 22, although that date is not set in granite and may also have been October 26th.  After just a half-day in hospital, however, Sholeh is released at the insistence of his parents, and is apparently being monitored at home by physicians, although competing news accounts also allege the parents have not seen medics in days.

This sudden existence of a mild case of H5N1 is not unique to Indonesia.  In Egypt, the further south you are along the Nile Delta, the more likely the human cases of H5N1 are mild and survivable.  The further north along the Delta, the more likely you are to die from H5N1. 

This emergence of almost asymptomatic H5N1 among children is very disconcerting.  The good news is that this may actually indicate the case fatality rate from H5N1 is significantly less than the 60% worldwide, or the 80% found in Indonesia.  On the other hand, it could mean the virus is far more prevalent and widespread than first thought, and we are much further along the path to a reassortant or even worse, a recombined pandemic flu virus than anyone originally thought.

How can the world health community determine this?  Only by developing a quick, easy test for H5N1 antibodies that is as prevalent and easy to obtain results from as the swab test people get at the doctors' office. 

Can we please stop the overuse and misuse of the word "Pandemic?" 

Like many of you, I subscribe to Google Alerts to get information on influenza and other diseases.  One of my keywords is "pandemic."  And while it assures me of the latest links to articles and blogs regarding pandemic preparedness, it also sends me some pretty needless stuff -- plus it gets my blood boiling sometimes.

First, we can understand when Pandemic Studios comes up, and there's not much we can do about that.  Pandemic Studios is a video game company (or interactive entertainment company, as their trade association likes to say).  Pandemic is in the news quite a lot, because they a) are very good at what they do, and b) just got bought out by Bono's video game investment capital firm.

But it's the other references that drive me crazy.  We have the "obesity pandemic;" the "drug addiction" pandemic; the "insomnia pandemic"; the "stress pandemic;' we even have a "sexual violence pandemic," according to the UN Secretary General.

My gosh, what we really have here is a pandemic pandemic.  The overuse of the word, the misuse of the word, has itself reached pandemic status. My favorite definition of the word comes from the Website MedicineNet.com, and the link is: http://www.medterms.com/script/main/art.asp?articlekey=4751 .

Pandemic: An epidemic (a sudden outbreak) that becomes very widespread and affects a whole region, a continent, or the world.

By contrast:

• An epidemic affects more than the expected number of cases of disease occurring in a community or region during a given period of time. A sudden severe outbreak within a region or a group as, for example, AIDS in Africa or AIDS in intravenous drug users.
• An endemic is present in a community at all times but in low frequency. An endemic is continuous as in the case of malaria in some areas of the world or as with illicit drugs in some neighborhoods.

The word "pandemic" comes from the Greek "pan-", "all" + "demos", "people or population" = "pandemos" = "all the people." A pandemic affects all (nearly all) of the people. By contrast, "epi-" means "upon." An epidemic is visited upon the people. And "en-" means "in." An endemic is in the people.

Of course, in the influenza world, the definition is refined.  From the WHO:

There is only one pandemic in the world today: HIV/AIDS.  That's it.  There are epidemics of all kinds of diseases, but only one true pandemic -- at least right now.  So let's curtail the use of the word "pandemic" so it carries the necessary and appropriate weight when a real pandemic does happen.  Please spread the word and flog the next reporter -- or blogger -- who misuses the word.