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Fever grips Congo, over 100 persons dead

From the Times of India:

30 Aug 2007, 0637 hrs IST,AP

Ebola is such an efficient killer, it is its own agent of destruction.  It kills so quickly and so violently that people (normally) do not have the ability to leave their villages before the disease strikes.  This, as opposed to influenza, whose goal is more "peaceful coexistence," as it cannot really live outside the host.

But if for some unknown reason Ebola, or Marburg, ever mutated to the point where it could incubate for longer periods of time before it became lethal -- that is too frightening, even for me.

This is the biggest outbreak of hemorrhagic fever I can remember for some time.  Let's watch this carefully.

National Geographic is reporting that on the island of Lazzaretto Vecchio, in the Venetian lagoon, a mass grave of bubonic plague victims has been unearthed.  From the National Geographic news release:

The island is believed to be the world's first lazaret—a quarantine colony intended to help prevent the spread of infectious diseases.

It is fascinating to read that historians speculate that this policy may have saved Venice.  The article also goes on to say that rich and poor alike were treated equally during the plague: 

"Nobles or lower class didn't make any difference," Gambaro said. "All the sick were forced to stay on Lazzaretto Vecchio, and if they died, they were buried together."

Although today's standards will call for a much higher standard of health care, the discovery -- laden with artifacts, documents and bones, is another confirmation -- calling to us from centuries past -- that NPIs such as isolation and quarantine work.

A blog or two ago, I mentioned that the people of Indonesia would tire of incessant government denials, lies and subterfuge in the battle against H5N1 avian influenza.

A letter writer in the Jakarta Post gives a chronicle of the frustrations Bali islanders must be feeling right now regarding their island paradise's descent into Bird Flu Hell. 

First, veteran blogger FLA_MEDIC has reported that another Bali child is sick and in hospital with symptoms of bird flu.  His post can be found here. http://afludiary.blogspot.com/2007/08/new-suspect-case-in-bali.html

Now the excellent public health blogsite and forum Effect Measure, recently affiliated with ScienceBlogs.com, has revealed an unbelievable letter from a resident of Bali.  The blog and letter can be found here. http://scienceblogs.com/effectmeasure/2007/08/bird_flu_in_indonesia_these_ne.php

In a nutshell, Giuseppe Verdacchi, a resident of the capital city (!) of Denpasar, reports to the Post about his frustrating inability to get any government official on Bali to help him dispose of a dead wild bird he found on his property.  particularly enlightening is the admonishment of his village leader.  Quoting from the blog/letter:

I tried then to contact the head of my village (in the Kerobokan area) and his reaction was: "Just bury the bird, there is no problem." How would he know?

As the "Reveres" of Effect Measure so eloquently and accurately point out:

Mind you, this is the country with more cases and more bird flu deaths than any other country in the world. The island of Bali, a major tourist area, has had two recent deaths from bird flu. The Indonesian authorities have been vocal and self-righteous about other countries profiting from influenza virus sequence information and viral isolates obtained from cases within their borders and for this reason do not consistently share this information with the world scientific community. Yet at the same time, through negligence, corruption and incompetence Indonesian authorities allow a continuous breeding ground for a virus that threatens everyone on the globe.

With the hospitalization of today's patient, the list of suspected H5N1 cases in Bali grows to 12.  Five have been sent home with negative test results; four are dead, and we are awaiting results of tests on the last death; and three remain hospitalized, awaiting test results.  And with the exception of the index case and her mother, the remaining cases are all within 20 km of the capital city.

Yet again, a mighty tip of the cap to the intrepid blogger at birdflunewsflash.com, a site living up to its domain name.  The site reports that the government of Bali has decided to call in the spin doctors and will filter all news regarding human and bird H5N1 infections.

The link to the blog is here, http://birdflunewsflash.wordpress.com/2007/08/29/bali-to-censor-news-about-the-current-bird-flu-outbreak/

and the link to the Jakarta Post story is here. Could we put these intrepid Jakarta Post staff writers up for a global Pulitzer?  http://www.thejakartapost.com/detailbali.asp?fileid=20070829.D08&irec=1

Now back to the analysis.

It seems Bali is taking the Mayor Larry Vaughn approach to their new bird flu situation.  That, of course, is to ignore the problem and try to spin its way out of it.  Let me pull some quotable quotes from the story.

The administration's spokesperson, Anak Agung Bagus Netra, on Tuesday said Governor Dewa Beratha had ordered all information regarding bird flu be delivered only by the public relations department.

"We are talking about a new outbreak here. We can't have (ill-informed) people speaking about it on behalf of the administration. This is about Bali's image. These days any information can fly overseas in a second," he told The Jakarta Post.

OK, so the spin doctors have now used the word outbreak.  I don't know if we would consider the Bali cases/deaths an outbreak just yet, but the Bali government seems perfectly content to accelerate the danger themselves. You've got ill-informed people speaking for the government now. Reading on:

Farmers are questioning new poultry regulations issued by the administration in an effort to eradicate H5N1 from the province. Bali deputy governor Alit Kesuma Kelakan last Sunday hinted at the idea of culling all fowl on the island, without elaborating on compensation for farmers.

Meanwhile, Udayana University virologist Ngurah Mahardika suggested that tourist destinations such as Kuta, Sanur and Nusa Dua be free from fowl, following the rapid spread of bird flu virus on the island.

"This is a better move than simply taking chicken off menus," Ngurah told the Post over the weekend.

The de-fowling of Bali will place local farmers directly at odds with tourist officials, hoteliers and restaurateurs.  Killing poultry without compensation is a prime factor in the re-emergence of H5N1 in flocks, according to multiple sources all over the planet.  Witness the laughable escapade in Egypt just last year, where farmers successfully and clandestinely moved a thousand chickens across town under the noses of Egyptian government cullers.  What Woody Allen or Mel Brooks could have done with that scene!  So Bali civic leaders had better pony up the money for the soon-to-be-dead chickens and ducks.

Ngurah said the human-fowl population density in Bali, especially in Denpasar, made the region prone to a bird flu outbreak. Lagging precautionary measures, Ngurah said, could help the virus spread and develop more quickly, thereby increasing the threat of a pandemic on the island.

By my count as of 4PM EDT on the 29th of August, a total of 11 people have been hospitalized with suspected H5N1 infections on Bali.  Four have died, and five have been released.  Two remain in hospital -- admitted in the past 48 hours.  Two of the four deaths are absolutely H5N1, and the index case -- the daughter of one of the dead -- died and was cremated before tests were able to be conducted.  It is strongly assumed she was infected with H5N1 and gave the virus to her 29 year-old mother, who in turn died and was buried (photo at left).  The fourth death is still to be resolved.  Whether or not the world gets the truth may be up to the Indonesian Health Minister, and we already know which side she is on. 

Additionally, thousands of poultry are being culled as we speak, as the Bali fathers desperately try to salvage their tourist season.  I certainly hope a secondary vector has not been established on the island yet.  Perhaps Bali should swab the throats of their housecats, too.

Dr. Henry Niman frequently utters an excellent quote:  "H5N1 does not read press releases."  Never has this been more appropriate than with this latest complication from Bali.

First, a tip of the hat to flu blogsite Birdflunewsflash (http://birdflunewsflash.wordpress.com) for breaking an amazing press release out of Seattle.

The Fred Hutchinson Cancer Research Center (!), a well-known and publicly funded organization, has released a study, to be published in the CDC publication Emerging Infectious Diseases, in September.  The study confirms limited human-to-human transmission within the famous Sumatra, Indonesia family cluster in May, 2006.  I qoute from the release:

The cluster contained a chain of infection that involved a 10-year-old boy who probably caught the virus from his 37-year-old aunt, who had been exposed to dead poultry and chicken feces, the presumed source of infection. The boy then probably passed the virus to his father. The possibility that the boy infected his father was supported by genetic sequencing data. Other person-to-person transmissions in the cluster are backed up with statistical data. All but one of the flu victims died, and all had had sustained close contact with other ill family members prior to getting sick — a factor considered crucial for transmission of this particular flu strain.

As we all know, the only survivor, a man in his 20s, has permanent brain damage as a result of the H5N1 virus attacking his brain -- something only pandemic strains are known for.

The release -- and the study -- goes on to say:

The researchers estimated the secondary-attack rate of the virus in Indonesia — the risk of one infected person passing it to another — to be 29 percent, a level of infectiousness similar to statistical estimates for seasonal influenza A in the United States.

Whoa nelly, as Keith Jackson would say!  A secondary H5N1 human attack rate equaling that of seasonal influenza A??  That is troublesome, as it implies that once the virus has passed from chicken to human in Indonesia, as least, there is a secondary rate of infection that makes it nearly as easy to catch as seasonal H1N1 or H3N2. 

Now for something we already strongly suspected:  The famous Turkish cluster of 2006.  The authors point out:

The researchers also aimed their statistical transmission-assessment technology at another large avian-flu cluster in eastern Turkey that in 2006 infected eight people, four of whom died. In this case, the researchers did not find statistical evidence of human-to-human transmission, most likely due to a lack of sufficient data. "There probably was person-to-person spread there as well but we couldn't get all the information we needed for the analysis," Yang said.

No surprises there.  The lack of samples and the lack of knowledge speak volumes about the Turkish government's attitude toward reporting outbreaks.  But it is nice to see scientists and statisticians agreeing with us that H2H(2H) in all probability occurred there.

The study was funded and supported by the National Institute of General Medical Sciences, MIDAS network, and the National Institute of Allergy and Infectious Diseases.  NIAID doesn't give money easily or lightly. This institute is legit, and the study is peer-reviewed and comes out in a few days in CDC's flagship publication.

A recent study from St. Jude's, in Memphis, speaks about the Unlucky 13 genetic pointers that make a flu virus pandemic.  I have not read the study yet, but plan to on my way to Happy Valley to watch my boy (and FIU) play Penn State.  I will blog on that study upon my return.  In the meantime, this study shows that the Sumatra cluster hit a very, very unlucky Lotto jackpot last May.  And when you couple that with the August, 2006 Tamiflu blanket the WHO and the Indonesian government placed on 2,000+ members of four remote villages, it means -- let me say it again -- that something is going on down in Indonesia, and we need to know what it is now, rather than later.