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Admittedly, this is a rerun of a July, 2007 blog I wrote.  But things are pretty slow right now on the avian flu front, and we need talking points to keep people focused on the Big Picture.  So I felt a rehash of this old blog would be appropriate.

Scott 

With apologies to David Letterman, here is a quick list that you can keep handy and use to win arguments on the likelihood of an influenza pandemic. Feel free to add to this list, but it is written to be easily and quickly understood.

Top 10 reasons why we have not seen a pandemic since 1968:

10. The H5N1 virus has not “made it” around the globe – at least we have not seen high-path H5N1 yet in North America (at least none that any authority is willing to admit).

9. Surveillance of poultry and wildfowl, including aquatic wildfowl, has improved exponentially since 1968.

8. Rapid typing of influenza genetics allows public health officials to quickly make good decisions and move decisively to contain virus.

7. Education campaigns help to better promote awareness, especially in nations where H5N1 is becoming endemic. So when people get sick, or poultry gets sick, people are now a little more likely to report it.

6. Mass culling of poultry has beaten back the virus many, many times around the world. One major influenza researcher even went so far as to state that a pandemic strain of H5N1 has probably already died with a mass cull somewhere in this world.

5. Financial compensation for culled poultry helps convince some farmers to report deaths of poultry to the authorities.

4. The neuraminidase inhibitor antivirals (Tamiflu in particular) have been repeatedly effective in reducing H5N1 symptoms and ultimately in saving patients, but only in cases where a) the virus may not be as lethal, and b) when administered within 24 – 48 hours after onset of symptoms.

3. The WHO and global health authorities are ready to fly in supplies and “stamp out” outbreaks quickly. The August, 2006 “Tamiflu blanket” of 2,000 Indonesian villagers in four separate hamlets serves as evidence of the ability of public health authorities to combine Reasons #9, #8 and #5 into a coordinated action plan.

2. The Hong Kong government’s 1997 action to cull every bird in the city as the first suspected human-to-human transmission of the “new” H5N1 virus probably saved the world from a pandemic. Saved, or at least delayed the pandemic.

1. Global seasonal flu vaccine programs -- and the WHO's trying to pick the "Super Bowl winner" of three viruses (two Influenza A's and one B for the trivalent formula) in the February before the upcoming flu season -- have proven pretty accurate.  They miss the B formulation more often than they miss the A, but still it has helped reduce the amount of seasonal flu, which helps reduce the potential for a pandemic.  After all, each of us is a potential "mixing vessel" for a reassortant pandemic strain..

co-#1: We are damned lucky.

Top 10 Reasons why, despite all these efforts, we will still have a pandemic one day and probably soon.

10. H5N1 is becoming endemic in many parts of the planet, especially where people live in close physical proximity to poultry.  It is a mutating fool and cleverly defies attempts to kill it.  It is a supremely adept player at "King of the Mountain," which is the game all influenza viruses play.

9. Financial compensation for culled poultry helps somewhat, but the amounts paid usually are far short of actual losses incurred. If farmers do not feel that reporting avian flu losses are worth it in financial terms, they may (and already do) decide not to report the infections – unless their own family members become infected.

8. Smuggling of poultry, exotic birds and fighting cocks continues to accelerate. While not likely to be a principal source of spread of the disease, smuggling can nonetheless cause new outbreaks (ask the Vietnamese about their own “Ho Chi Minh Trail” issues along their border with China).

7. Modern industrial farming practices may actually and inadvertently encourage the spread of virus. Even a tiny particle of virus, trampled underfoot and brought into a poultry shed by a worker or farm machine, can kill thousands of poultry. And if left unchecked, even a “low path” avian flu can incubate, recombine with itself and emerge as a lethal, highly pathogenic influenza virus.

6. Despite the best 21^st Century medicine and technology, avian flu of all types continues to spread and the frequency continues to accelerate. Witness the recent outbreaks of H7N2 in the Delmarva (Delaware, Virginia and Maryland) peninsula of the United States (2004), the H5N2 outbreak in West Virginia (2007), the outbreak of H7N7 in the Netherlands and other parts of Europe which killed a veterinarian and infected at least 89 people via human-to-human transmission and possibly hundreds more (2003), and the outbreak of H7N2 in Wales which also infected 17 humans (2007).

5. Globalization has also inadvertently encouraged the spread of virus. Witness the Bernard Matthews disaster of early 2007. Hungarian-raised poultry, shipped to England for processing, carried high-path H5N1 with it. This was introduced into one shed, and then workers carried the virus to three adjacent sheds. In the end, over 160,000 turkeys had to be killed and disposed of. The Hungarian poultry were contaminated, in all likelihood, by wildfowl droppings laden with H5N1 virus that were carried into turkey sheds.

4. Migratory wildfowl continue to transport the H5N1 virus, along with every other flu virus known to Humankind, in their bellies. Migratory wildfowl are the custodians and reservoir of avian influenza. As they shed virus, it either dies or is picked up by other creatures.

3. H5N1 has jumped the species barrier. In Indonesia, a study postulated that up to 20% of all stray cats in the archipelago nation showed antibodies to high-path H5N1. That means cats can be asymptomatic carriers of the most potentially lethal virus ever seen. The Indonesian television videos of Army regulars accompanying healthcare workers into residential neighborhoods to swab the mouths of housecats is chilling.

2. The only continents where H5N1 does not have a strong foothold are the Americas, Australia and Antarctica. H5N1 can be found from sub-Saharan Africa to the Middle East, most of Europe, Asia, and Indonesia. Only in Europe has human death not yet occurred from H5N1. Unfortunately, that statistic can be wiped out with a single transcontinental or transoceanic airplane flight.

1. History is against us. In the past 300 years, no fewer than ten influenza pandemics have ravaged the world. Some, such as 1918’s Spanish Flu and the pandemic from 1562–1568 were extremely lethal. The 1562 pandemic may have had a death rate higher than 1918’s, which is almost unthinkable. Others, such as 1889’s, had a less lethal but still severe effect on the planet.