Entries by Scott McPherson (423)
More trouble in Bali
Scott McPherson
in influenza and infectious diseases
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Theresa42, faithful poster to the Website flutrackers.com, has toggletexted a translation of an Indonesian newspaper story (the link is below).
15/08/2007 19:17 WIB
Two babies being treated at bird flu space RSUP Sanglah
Gede Suardana - Detikcom
Denpasar - Two babies, namely I Wayan Tendi Cahyadi (3) and Ni Nyoman Nisa Putri (3,5) from Tengah Village, Sambangan Village, Mengwi, Badung [this is about 13 km NNW of Denpasar - dbg] undergo intensive maintenance at special space bird flu handling Nusa Indah, RSUP Sanglah, Denpasar.
"They still in observation and enter category lidik(?) and be observed at hospital," said Kasubdin(?) Destruction of Contagious Disease and Sanitation Environment Settlement Dept. Bali dr I Ketut Subrata to journalist, Wednesday 8/15/07.
Subrata say both aforementioned babies that are neighbors enter hospital struck 18:00 Central Standard Time, Tuesday (14/08/2007). When was brought to hospital both babies suffer temperature 38 degrees Celcius, pilek and cough.
"Parents are afraid for child's health, exceedingly there is chicken at surroundings that died. Parents are afraid by spreading information bird flu," he said.
After undergo maintenance, condition of both aforementioned babies begin improved and said not spread epidemic bird flu. Temperature of the body already restored normal. Was estimated both babies be permitted return home on Thursday 8/16/07. "Not there is signs of disturbance breathing canal and lungs are normal," said Dr Ni Luh Siadi Purniti.
http://detiknews.com/index.php/detik...780/idkanal/10
Ary Hermawan, The Jakarta Post, Denpasar
Aug 16, 2007
The very real threat posed by bird flu to Bali was underlined by Sunday's death of a 29-year-old female resident of Jembrana regency in western Bali from the disease, as tourism officials now worry about the impact on their industry.
"We have to admit that we are very concerned about the issue. It would surely affect the number of visitors to Bali," said Ida Bagus Sidharta Putra, chairman of the Sanur Development Foundation, which is organizing the 2007 Sanur Village Festival.
The Bali Tourism Agency said travel agents have been receiving questions from potential tourists about bird flu on the island.
"I have told them not to be fully open about it. What matters is the way we deliver the information. We don't want them to misconstrue the situation," agency head Gde Nurjaya said. (Bold mine and Theresa42's.)
Health officials in Jakarta confirmed Monday that Sri Widiantari, a resident of Tukad Aya village, Negara, Jembrana regency, who died at Sanglah Hospital last Sunday, was positive for bird flu.
She is the first human case on Bali. Across the country a total of 83 people have died of the disease.
This is the third blow to Bali's tourist industry in the last two months. In early July, the European Commission discouraged its citizens from flying with Indonesian airlines when visiting Bali.
Shortly afterward the Australian government issued a new travel advisory, warning Jakarta and Bali were currently being targeted by terrorists.
Officials are concerned the warnings and bird flu case will derail the local tourist industry's current recovery.
According to the latest numbers, the number of international tourist arrivals rose by 35 percent from 552,573 in the first semester of 2006 to 745,949 in the same period this year.
"The situation is actually improving," Nurjaya said, adding that the number of tourist arrivals for the year had already passed the 900,000 mark.
The Bali Health Agency said the administration had taken necessary measures to contain the bird flu virus and prevent it from spreading to other regions. It has put in place security measures around Tukad Aya village and its surroundings, and is checking all residents for bird flu symptoms such as cough and fever.
The administration is also conducting a mass cull of chickens in the area.
"No farmers will be allowed to make contact with H5N1-infected fowl," agency head Dewa Ketut Oka said.
Tabanan Hospital has been prepared to handle suspected bird flu patients from western Bali, and Gianyar Hospital for patients from eastern Bali.
Oka, however, said Sanglah Hospital would continue to be the main hospital for suspected bird flu patients, because it boasts better human resources and equipment.
"We have also prepared 1,100 packets of Tamiflu that are available in all district hospitals and community clinics. The medicine will be given to those who show symptoms and who have a history of contact with chickens," he said.
The health agency's head of contagious diseases, Ketut Subrata, said that as of Tuesday the agency had not found anyone in Jembrana regency with symptoms of bird flu.
"We have also taken blood samples from nine people related to the bird flu patient who died over the weekend, as well as from her neighbors," he said.
The agency will send the samples to Jakarta for laboratory tests.
Nurjaya said the administration would not prevent tourists from visiting Jembrana, but added that most people would understandably avoid the area.
"I don't think they need to be told not to go there," he said.
When Worlds Collide
Scott McPherson
in influenza and infectious diseases
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Indonesian intransigence, Bali's suspected H2H2H and Australia's worsening seasonal flu epidemic spells T-R-O-U-B-L-E for the rest of the world.
"Daddy, when did the pandemic begin?"
"Well,dear, it began in 2007. You see, the government of Indonesia stopped sending samples of a very, very dangerous flu virus to the rest of the world. This flu virus was not making too many people sick, but almost everyone who got sick died. And it came straight from birds, so no one had ever seen it before.
"The rest of the world's scientists all needed samples of this bird flu virus, so they could make a vaccine to fight it if it ever changed and made lots of people very, very sick very, very quickly. But when the people who ran Indonesia refused to share their bird flu samples -- those people kind of stamped their feet and threw a little government tantrum, like you do when you don't get a toy that you want in the store -- well, dear, the rest of the world's scientists could not possibly know what was going on down there. They were in the dark, sort of feeling around, not sure of what was going on.
"Then events started moving way too quickly, and things sort of spun out of control, like you do when you get off that thing in the playground that goes around and around. First, Australia had a nasty flu epidemic -- not bird flu, more like the flu we get up here in America in the winter. But it was much, much worse than normal. It made so many people sick that the Australian government started using special drugs on their people that they had been saving for the day when the flu pandemic would come.
"
Then, in a place in Indonesia called 'Bali,' the bad flu virus changed again. Instead of people getting sick from birds, they started getting the bird flu from each other. The worst possible thing was that Bali is a place where Australian people like to fly to go on vacation, like we used to do at Disney World before the pandemic came. Anyway, those Australians liked to travel all over the island of Bali, and they traveled to that village where those other people all got sick. And they traveled to other villages where people were getting each other sick, too, but they didn't know it. Then these Australian people caught that new bird flu virus, and took it home to Melbourne, Brisbane, Sydney -- all over the country. And the people who had the bird flu also got the regular flu, and the genes inside both viruses mixed up and became a very bad virus that people caught real easy. Once that happened, it was only a matter of time before all of Australia, New Zealand, and Indonesia was sick. Then, the rest of the world got sick."
"Why couldn't anyone stop it?"
"Because too many people got on too many planes, and flew too far, and it just sort of sprang up all at once."
"How many people died, Daddy?"
"I don't know, honey. They are still counting the dead."
"And that's when Mommy died?"
"Yes, that's when Mommy died. She was pregnant with your sister Sarah and they both got very sick and died. A lot of pregnant mommies died in the pandemic. And you almost died, too."
"Why didn't the people in Indonesia help the rest of the world? Why did they let Mommy die, Daddy?"
Good hypothetical question. This is what can, and possibly will happen when two worlds collide. We are watching events unfold slowly, agonizingly, then suddenly and with tremendous speed accelerate in the South Pacific. Indonesia's inability to face up to its global responsibility and its previous agreements is on a collision course with the fate of the rest of the world. And the consequences of that collision are too high a price to pay for State reneging on previous agreements and treaties.
So let us now openly, firmly, and with great candor speak of punishing Indonesia economically and in the court of world opinion. Perhaps we should begin discussing the "quarantine" of Indonesia. With more documented cluster H2H cases of H5N1 than the rest of the world combined, the Indonesian government would seem to gladly hold the rest of the world hostage. It is the equivalent of Nero fiddling while Rome burned.
It is also the epitome of ingratitude. When the December, 2004 tsunami struck that embattled, beleaguered nation of 18,000 islands, the rest of the world stepped up and produced emergency support on a level never before seen in peacetime. Why now, and why suddenly, would the Indonesian government hold the health of the world at bay?
Let us call it what it is. Indonesia is committing viral extortion. The nation and its leaders will be held to account if its tantrums result in the next pandemic.
It will not be pretty.
Scott McPherson
Indonesian authorities have released a statement regarding the condition of the 2-year-old girl neighbor of the dead 29-year-old woman and her dead 5-year-old daughter in Bali. The child tested negative for H5N1. Testing on her father, who is also apparently ill and originally diagnosed with typhus (according to a report from Dr. Henry Niman of www.recombinomics.com) , would be entirely appropriate.
Give me a one-armed bird flu researcher...
"After consulting the leading economists of his day about where the economy was going and getting a constant stream of forecasts of 'On the one hand this and on the other hand that,' Harry Truman allegedly said, 'Hell, what I need is a one-armed economist.' " -- Time magazine.
These words were uttered by the plain-speaking, no-nonsense Harry S. Truman during his presidency. They could just as easily apply to US government bird flu researchers.
A lot of hullabaloo has been given to the latest press statement from the National Institute of Allergy and Infectious Disease, or NIAID. NIAID is part of the Department of Health and Human Services, or HHS. So is the Centers for Disease Control and prevention, or CDC for short.
Anyway, NIAID researchers believe that while tinkering with both the H5N1 and H1N1 (1918 killer) viruses, they have found the amino acid changes necessary to allow H5N1 to adhere to the epithelial cells in the human respiratory tract. Or more simply put, they have found the Hemagglutinin "velcro" that would stick to human throats and nasal passages. I quote directly from the Reuters story:
To better try and understand the threat, researchers have studied various strains of H5N1 and compared them to the worst known flu virus ever — the H1N1 virus that killed anywhere between 50 million and 100 million people in 1918 and 1919.
They found a mutation that makes one strain of the H1N1 virus more easily infect birds, and another one prefer humans. It lies in the part of the virus that attaches to cells in the respiratory tract. (Bold type mine.)
They then made the same alteration in an H5N1 virus, and vaccinated mice with some of this genetically engineered H5N1 DNA. They found an antibody that could neutralize both types of H5N1 — H5N1 adapted to birds, and an engineered form that would in theory prefer humans.
“It delivers a powerful blow against this virus and really hits it where it lives,” Nabel said.
If a vaccine could be designed to protect people against viruses with this mutation, it might be used before a pandemic even started, Nabel said.
A monoclonal antibody could be used to treat people who were already infected, he added.
But wait, I thought these changes would be much more difficult to produce in a lab! I quote directly from a CDC press release of July 31, 2006:
Researchers then swapped genes from a 1997 H5N1 avian flu virus with genes from an H3N2 virus, in a process called reassortment. When tested using the ferret model, these “hybrid” viruses (viruses that contained both avian H5N1 and human H3N2 influenza virus genes) did not pass easily between ferrets and, in fact, caused less severe disease than the original H5N1 virus. The reassortment work was designed to mirror the phenomenon that occurs in nature when two flu viruses combine to form a new virus, a process that led to the 1957 and 1968 pandemics. It is still unknown whether the H5N1 virus could reassort with a human influenza virus in nature.
In a final study, CDC researchers passed a hybrid virus through a series of ferrets to see if the virus would accumulate genetic changes necessary to transmit more easily. The researchers found the process introduced only one genetic change in the virus but didn't enhance its transmissibility.
Although the findings apply only to the specific viruses used in the study, the research suggests that significant genetic changes in the H5N1 virus would likely be needed to create a strain that could cause a pandemic (bold type mine). Future CDC studies will examine whether combining genes from H3N2 strains with more recent H5N1 strains makes the new virus more easily transmissible.
So you have one US government agency claiming they have isolated the amino acid changes in the hemagglutinin protein, while barely a year ago a second US government agency said the changes would be considerably harder to find and create.
Perhaps the answer lies in the very H5N1 samples used in these two experiments. CDC was, by its own admission, using the original 1997 killer strain of H5N1. The NIAID researchers were using "various types" of H5N1, implying several clades, or subtypes of H5N1. We can only speculate that the well-known Qinghai Clade 2.2 substrain was among them. Perhaps that key difference is what made the NIAID experiment apparently successful, while the CDC experiment failed to produce a pandemic strain.
So one the one hand you have NIAID saying that only one change in HA causes a profound affinity for human respiratory cells, while CDC is saying significant changes must occur before the change takes place. But on the other hand, ferrets are supposed to be much better predictors of human response than mice, so... Harry? Harry?
Of course, all this laboratory tinkering with primal forces of nature should also make one (justifiably) uneasy. Witness the recent "DOH!" with our friends the British. Within the past few days it has been disclosed that one single, solitary lab goof is apparently responsible for the accidental re-release of foot and mouth disease in the UK. And now, to top things off, an employee of the facility has contracted Legionnaire's Disease.
I quote from the AP story:
Britain's health and safety agency says there was a "strong probability" the outbreak originated at the Pirbright laboratory southwest of London and was spread by human movement. The laboratory houses both a government Institute for Animal Health research center and vaccine-maker Merial Animal Health.
Lab accidents have resulted in human cases of everything from meningitis to Ebola, but are rare and most are self-contained. Still, diseases that can kill humans have made it out of labs.
"With the amount of virus there is in laboratories around the world, I'm surprised that this kind of thing doesn't happen more often," said Dr. Juan Lubroth, head of infectious diseases at the Food and Agriculture Organization. "This would not be the first time that we've had an event linked to a virus escaping from a lab," said Dr. Bernard Vallat, director-general of the World Organization for Animal Health. He noted that Britain's rapid response should ensure the outbreak is properly contained.
The World Organization for Animal Health says foot-and-mouth warrants the highest containment level possible. Among its recommendations are that sewage be treated to ensure infectious material is destroyed and that staff shower and change clothes before leaving the lab. Experts also recommend that labs working with the virus be isolated from animals that could be infected.
Concerns about biosafety were triggered after three laboratory-related outbreaks of Severe Acute Respiratory Syndrome in Singapore, Taiwan and China in 2003 and 2004. In Singapore and Taiwan, lab workers inadvertently infected themselves. That was also the case in China, where the infection spread from two lab workers to seven family members and contacts outside the lab.
In 2005, scientists worldwide scrambled to avert a possible global flu outbreak by destroying samples of the 1957 flu pandemic virus that were accidentally sent to 5,000 labs in 18 countries. (Bold type mine)
Though WHO says many laboratory practices have improved since the SARS accidents, much remains to be done.
"We can try to mitigate the risk, but zero risk is probably one of things we can never achieve," said Dr. Nicoletta Previsani, project leader of WHO's global biosafety and biosecurity program.
"It's like when you work in your own kitchen preparing dinner," Previsani said. "You do your best, but sometimes you still cut yourself with a knife."
And now, let us turn to the Overview: International Conference on Biosafety and Biorisks.
I quote from the report on the 2005 Conference:
(Dr. Robert) Webster explained that there is significant evidence that the 1977 H1N1 pandemic was due to an accidental lab release, as it was genetically identical to a strain that circulated naturally decades before.
Yes, if you were born after 1956, the 1977 H1N1 virus WAS a pandemic. That is because influenza (usually) plays King of the Mountain, and H2N2 had forced H1N1 into retirement -- except when the lab mistake unleashed H1N1 back upon society. Now two strains of A -- H3N2, which forced H2N2 into retirement back in 1968 -- along with H1N1, are co-circulating the globe, which is unprecedented, at least for the few decades we can actually determine different influenza types in the lab.
The virus that co-circulates with H3N2 today was, in the opinion of the world's foremost expert on influenza, the result of an accidental lab release (recall it is nicknamed the "Russian Flu"). How comforting, then, that today's modern labs apparently have biosafety measures on par with security at "24's" CTU headquarters -- as Dave Barry would say, the security of a Dairy Queen. So lax that a lethal virus can simply leave the building, a la Elvis, and wreak havoc on the economy, not to mention people's lives.
Nebraska steps into the avian flu spotlight
Scott McPherson
in influenza and infectious diseases
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Nebraska is a great state. I love it dearly, and not just because my boy played college football for the Huskers for a season. OK, well, that has a lot to do with it. I just love the people and their excellent attitude. Go Big Red!
So I hope they are coping well with two news stories, the double-whammy of which elevates the Cornhusker state as a kind of Ground Zero for infectious disease -- for fifteen minutes, anyway. First, the Lincoln Journal-Star is reporting the banning of Nebraska-raised poultry, following the discovery of H7N9 avian influenza on a turkey farm in Seward County.
Apparently the mild strain was discovered in June, and things didn't hit the fan until the FAO and OIE were dutifully notified of the findings. Then Russia, Japan and the Philippines, in succession, banned Nebraska poultry.
Nebraska's Deputy State Veterinarian Del Wilmot says that migratory wildfowl brought the disease in. The farm in question remains unnamed. The Journal-Star's story link is below.
http://www.journalstar.com/articles/2007/08/08/news/local/doc46b900ad7f2fe001280419.txt
The next story revolves around West Nile Virus. Again, the Lincoln Journal-Star is reporting that a Seward County man has tested positive for West Nile, bringing the state total for 2007 to 14. I'll bet Seward County hasn't had this much excitement since its namesake bought Alaska from the Russkies. A Knox County man also tested positive for WNV. Last year, some 264 Nebraskans tested positive, making their state fifth overall on the list of states with documented human cases of WNV (Idaho led the list with 996). Now Nebraskans normally will take a Top Five ranking gladly, but not when it comes to life-threatening, mosquito-driven disease.
Since West Nile cases since 2002 have climed at a rate making us wish it were the stock market, we can assume that Nebraska has not lost WNV cases, but instead, people are not being tested for the disease. And since Nebraska had 264 cases in 2006, and Florida only reported three human cases, what case is made for surveillance in the south and east? If you look at the maps below, reported cases of WNV east of the Mississippi (with the exception of Illinois and Mississippi itself) are virtually non-existent. And 2007's numbers are dramatically less than 2006's, and it will take veritable epidemics of WNV to surpass 2006's totals in most states. This doesn't exactly square with global warming, summer rainstorms and all.
By the way, Seward is only 20 miles from the capital, Lincoln. It is a beautiful area, with rolling hills and much farmland. Very nice to drive through.
http://www.journalstar.com/articles/2007/08/01/news/local/doc46b0c427c5afb874871248.txt
The 2006 and 2007 reported West Nile Virus official CDC maps follow. Any explanation for the reduction in reported cases would be greatly appreciated.
Agwunobi resigns, joins Wal-Mart
Scott McPherson
in Politics and government, influenza and infectious diseases
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5 Comments
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2 References
Current HHS Assistant Secretary for Health, Dr. John Agwunobi, has resigned to accept an appointment with Wal-Mart Corporation. This move should not really come as a surprise, as Washington insider speculation had Agwunobi pegged early on as a contender for the position of Surgeon General. When President Bush decided to appoint another individual to serve in that position, Agwunobi realized his political and government service careers had, at least temporarily, reached their zenith.
What is not in the press (and one of the reasons why you hopefully read and subscribe to this blog) is the Rest of the Story on the Wal-Mart move. The individual who recruited Agwunobi to the Bentonville, Arkansas megacorp is none other than Bill Simon. Bill is former Secretary of the Department of Management Services under former Governor Jeb Bush, and served as Secretary while Agwunobi served as Florida's Secretary of Health. Simon left State government, in no small part, because of radiation poisoning from the still-radioactive PeopleFirst debacle. Simon had nothing to do with that project, except try in vain to repair it and make it workable. When it became apparent his legacy as Secretary would revolve around that unstable radioactive mass, he wisely left and cashed in at the House That Sam Built.
Ditto Agwunobi. Here are the HHS and Wal-Mart press releases, in full. I also wanted to give a hat-tip to the "reveres" at flu blogsite Effect Measure for breaking the story.
For Immediate Release Contact: HHS Press Office
August 7, 2007 202/690-6343
STATEMENT FROM HHS SECRETARY MIKE LEAVITT ON THE RESIGNATION OF ASSISTANT SECRETARY FOR HEALTH DR. JOHN AGWUNOBI
I regret to announce the resignation of Dr. John Agwunobi as Assistant Secretary for Health (ASH) and an Admiral in the US Public Health Service (USPHS) Commissioned Corps effective September 4th, 2007.
Since joining HHS in 2005, Dr. Agwunobi has been a passionate voice for advancing the health care of all Americans. His leadership, counsel and expertise have contributed greatly to increasing American's awareness and preparedness for pandemic influenza, encouraging adoption of healthier lifestyles and leading the renewal of the USPHS Commissioned Corps.
Dr. Agwunobi has distinguished himself through the energy and commitment with which he has approached every task at HHS. I will miss him personally and professionally and wish him well in his future endeavors.
FOR IMMEDIATE RELEASE Contact: Sarah Clark, Wal-Mart1-800-331-0085
Dr. John Agwunobi to join Wal-Mart as Senior Vice President and President for the Professional Services Division
BENTONVILLE, Ark., Tuesday, August 7, 2007 --Wal-Mart Stores, Inc. is pleased to announce that Dr. John Agwunobi, current Assistant Secretary for Health for the U.S. Department of Health and Human Services and an Admiral in the U.S. Public Health Service Commissioned Corps, has been named Senior Vice President and President for the Professional Services Division for Wal-Mart in the U.S. effective September 4.
Dr. Agwunobi will oversee the company's health and wellness business unit including pharmacies, vision centers and health care clinics. He is the country's expert on public health, and he will bring new perspective, diverse talents and tremendous expertise to our company in his new role.
He will report to Bill Simon, executive vice president and chief operating officer for Wal-Mart Stores U.S.
"John is the country's expert on public health, and I look forward to his contributions in furthering Wal-Mart's health and wellness efforts," said Simon. "He will bring new perspective, diverse talents and tremendous expertise to our company in his new role."
Added Dr. Agwunobi, "Wal-Mart touches many lives in many communities and this position provides me with a new opportunity to reach people in the places where they live, work and shop. I am very excited to join the Wal-Mart team."
Dr. Agwunobi, also a pediatrician, is a seasoned public health professional with experience in health care delivery, managed care and health care policy. As Assistant Secretary for Health, he was responsible for disease prevention, health promotion, women and minority health efforts, the reduction of health disparities, the fight against HIV/AIDS, pandemic influenza planning and vaccine preventable disease initiatives.
Prior to his current position, Dr. Agwunobi served as Florida's Secretary of Health and State Health Officer from October 2001 to September 2005. In this role, he confronted many public health challenges, including leading the state's public health and medical response to four major hurricanes, led the call for a healthier Florida, managed the response to the nation's first-ever intentional anthrax attack, and guided Florida's nationally-recognized efforts to protect the state against bioterrorism.