A Journey Through The World of Pandemic Influenza

A Pandemic Seminar in Mobile Alabama, US

Alabama's agency for Influenza Pandemic Emergency Preparedness held a seminar in Mobile aimed at nurses, social workers, and emergency first responders describing what a 1918 style pandemic (our last severe pandemic) could mean for the US. That translates to roughly 100 million people falling ill and a potential of 1.9 million dead, with each state suffering their statistical percentage.

The Press-Register report of the seminar is one of the few that I have read that states the situation law enforcement may well find themselves in during a severe pandemic.

[snip]

Lt. Joseph McClellan of the Alabama Department of Homeland Security said that law enforcement agencies and other first responders have to prepare to lose about half their work force because they will either be sick or caring for dying relatives.

It's unclear if crime will increase, but it certainly won't decline, he said.

"Bad people will take advantage of good people during bad times," McClellan said.

Security will need to be provided for mass burial sites, hospitals and pharmacies as fear and chaos could take hold of the community, McClellan said. Officers will have to reprioritize their calls; burglaries and robberies may not be on the top of the list.

While looking over various agencies' plans, McClellan said he's found that too many call for support from Alabama State Troopers.

"There aren't enough state troopers to fill those spots," he said. Those plans need to be changed, he said.

 

In late 2006 I posted my assessment of Law Enforcement during a severe pandemic here and again here. Since law enforcement is also near and dear to me I pay extra attention when the issues of policing and pandemic meet.

Unfortunately, in the year and a half since I wrote those entries the only thing that has really changed when it comes to law enforcement's planned response to a severe pandemic is that now they are planning to plan instead of being blissfully ignorant. That means, to put it bluntly, that now they are informed but still lacking in any meaningful preparations, although they plan to plan.

There are a few exceptions of course, but the vast majority still feel that they will handle a pandemic as they handle every other "incident"… they will do what needs to be done.

Someone needs to tell the rest that doing what needs to be done presupposes personnel to do the "doing". And as it stands currently that means doing it without adequate personal protection against infection, no vaccine, no prophylactic antivirals, no proper and modern medical treatment should they become ill or injured. And last, the very real likelihood of having no available and timely "backup" from fellow officers should they find themselves in an "Officer Needs Assistance" situation.

 

As the mother of a patrol officer under 30 years old I take these issues personally. It's hard to get more personal than a threat to one's own child. To help him meet the threat of what he may face as a cop during a pandemic I have taken it upon myself to make sure he has the means of protecting himself from infection as well as anyone can and still perform their public functions. But I know there is nothing I can do to protect him from potential injuries sustained in the performance of those duties. Injuries, perhaps life-threatening, that will likely go medically untreated, or at best, inadequately treated.

I have come to question whether I will support his decision to remain on patrol or if the "mother" in me will over ride my sense of civic duty and encourage him to be one of the many who will refuse to put themselves in such a tenuous and precarious position. When I am being honest with myself there is no question: I value my son's life far, far more than I value the property or life of some anonymous stranger.

If strangers want to be protected those strangers need to demand that their local law enforcement agencies adequately prepare for a severe pandemic. Otherwise, well, those strangers may find they have to protect themselves.

It's as simple as that.

 

SZ

Mixed Messages: Thermometers and Mass Graves

There are times when I find it difficult to remain gracefully dispassionate, especially when I come across something that I believe to be not only egregiously ignorant, but also a danger to the public. What makes today's topic so angering is the latest on the Influenza Pandemic front out of Ireland.

From IrishMedicalNews.com:

Flu medication stock-up advise

For all Ireland's high profile stocking up on antiretrovirals, each household will be urged to have the humble thermometer and paracetamol or ibuprofen in the event of a flu pandemic, according to a new Government handbook.

An introductory handbook on the Government's emergency planning plan, distributed recently to households across the country, says that while there will be more worldwide flu pandemics, the time and severity of their occurrence and the age groups on which their impact will be most severe cannot be predicted.

However, every household in the country will receive a leaflet before the pandemic reaches Ireland advising the measures including stocking up on a thermometer, paracetamol/ibuprofen, that should be taken. The Government will advise citizens to begin these preparations if and when the WHO confirms that a pandemic is imminent.

The guide also advises buying enough food and other supplies in advance of the pandemic to last "you and your household for at least one week", and advises awareness of hygiene measures to prevent infection.

Under the plan, the handbook says it is essential that people with flu symptoms stay at home while the indications persist, unless they receive other advice from a telephone hotline, which will be set up to provide advice and support, or from official Government announcements through the media.

The PDF of the handbook may be found here for those who wish to verify, as I did, that this is not a misquote but what is really being said.

 

Advising action only after the WHO declares an Alert Level Four pandemic threat will no doubt ensure that just about every household in Ireland will be out trying to purchase supplies at exactly the same time. As someone who is threatened with hurricanes on a regular basis I can attest to what it is like when many people attempt to buy the exact same supplies at exactly the same time. There just isn't enough supply to meet demand.

However, the entire timing strategy could prove to be naively misguided as publicly Ireland's Office of Emergency Planning is telling everyone that there will be time for everyone to become prepared (buy that thermometer and fever reducer). What if there's not?

What if an influenza pandemic bursts upon the world much as SARS did in 2003? Not an unreasonable question as influenza spreads much easier from person to person than SARS did, and we could find ourselves in the grips of said pandemic even before WHO has time to verify and announce its arrival.

Well actually, Ireland does have plans in place to deal with an unprepared public should a severe pandemic befall the world. This from NewsLetter.co.uk February 9, 2007:

Straw poll on grave crisis

A straw poll among district councils across Northern Ireland
yesterday revealed they are planning for at least 20,000 extra
graves to cope with a possible flu pandemic. Ian Starrett, Johnny Caldwell, Laura Murphy and Philip Bradfield report on how different councils are managing.

Continues….

 

Since the advice given to the Irish people, diligently mailed to every household, is so meager, and by any logic ridiculously inadequate, it's a good thing the district councils have planned to bury so many.

But it begs the question: Why is the official assumption that they will need those mass graves and yet the only advice they are giving their citizens is to purchase a thermometer and fever reducer? Would it not be wiser to advise people to stock up on a few more weeks of food so they don't have to be out and about possibly becoming infected, and a few more medical home treatment items?

Could it be that Ireland's Office of Emergency Planning has decided that the only effective action any citizen can effect is to depend on the Office of Emergency Planning? And that when they are exhausted and depleted it's just easier to toss the flu victims into those well thought out mass graves? Do the planners in the Office of Emergency Planning think their constituents are that stupid and personally incapable as to have no need of genuine guidance and advice? It certainly appears that way to me.

 

Officials are preparing for the range of severity of a potential pandemic, from mild-to-severe; meanwhile they are telling the public it will be little more than an inconvenient case of "the flu". Well, OK, they are not saying that explicitly, but it is what their message implies.

 

I would suggest that the citizens of Ireland politely suggest where the Office of Emergency Planning can stuff those thermometers.

 

SZ

A Brief Personal Note

Once again we have hired someone to take the Head Accountant's position at my "day job". His report date is this coming Monday morning. Once again it is my hope that my life will get back to what passes for normal, although it will still be hectic for a month or three as the New Guy is brought up to speed and we work on two major projects that have had to be side-lined as we struggled along with only the two of us running the department.

Heck who knows? Maybe this guy will actually have the gumption and courtesy to show up.

At this stage that's all I'm asking… just show up.

 

SZ

Update: Japan’s Pre-Pandemic Vaccine

Updating yesterday's posting about Japan's plans to administer their stockpiled human H5N1 influenza vaccine to 6,000 health care professionals and quarantine officials a new story hit the wires today [thanks unpathedhaunts @ FluWiki] introducing the idea of expanding their preemptive vaccination program into the general population.

From the Daily Yomiuri Online and The Associated Press

Vaccinations for new flu strains eyed for public

The Health, Labor and Welfare Ministry on Wednesday began a feasibility study on inoculating the general public with avian influenza vaccine to prepare for the possible outbreak of a new strain of pandemic flu, sources said.

Under the ministry's current plan, the vaccinations for 10 million people engaged in occupations maintaining social functions, such as police officers and those working for water and electric utilities, will start in fiscal 2009.

Hoping to eliminate concern over a possible epidemic, the ministry also will discuss whether to include the general public in the vaccination plan.

The ministry currently stockpiles sufficient avian flu vaccine concentrate solution for 20 million people and has already indicated that it would increase the amount of the stock.

However, expanding the vaccination to the public at large could cause social confusion over possible side-effects.

The ministry, therefore, will discuss the target population and timing of vaccinations, among other issues, after examining the safety of the inoculation, according to the sources.

Even people who have been vaccinated will likely develop symptoms in the event of an outbreak of a new type of influenza from any source, avian or otherwise.

Taking these factors into consideration, the ministry plans to inoculate 6,000 people who wished to receive flu vaccinations by the end of March next year. Falling into this category are doctors and quarantine officers who will most likely come into contact with patients.

The vaccination will be administered on a clinical test basis as a preemptive measure against the possible outbreak of a new type of flu.

If the vaccination proves to be effective, the ministry plans to expand the program to 10 million people in preparation for an epidemic.

Switzerland also is considering conducting a preemptive vaccination for the general public, but has yet to introduce it.

 

The Health Ministry is laying groundwork to see how effective their stockpiled vaccine is in the first 6,000, then if proven effective the 10 million who are classed as critical infrastructure personnel, then, (or at the same time as the 10 million, the story is a bit fuzzy on the timing here) 10 million of the general population.

Japan has a population of roughly 127 million so if they vaccinate the entire 20 million it is about 15.5% of their population. While the percentage of total population is impressive in and of itself, the fact that their critical infrastructure personnel will be protected is even more so. A severe pandemic would likely be a terrible, frightening, and profoundly stressful situation, having no public utilities or fresh food shipments would likely cause unimaginable cascading misery and unnecessary deaths over and above the pandemic proper.

 

This proposed program of advanced protection for an uncertain future threat is interesting when one compares what Japan is exploring and a recent report by CIDRAP's Maryn McKenna:

Flu vaccination still a challenge for hospitals [US].

Apr 9, 2008 (CIDRAP News) – Healthcare institutions still face significant hurdles in getting their staff members vaccinated against seasonal influenza, and fear of flu infection and caring for sick family will keep many staff home during an influenza pandemic, according to research released this week,

Four teams of researchers reported at the 18th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America, held in Orlando, Fla., that large proportions of hospital staff believe that flu vaccine causes influenza or triggers other side effects. Others believe that previous bouts of flu have made them immune to contracting the flu again.

Continues….

 

After reading Ms. McKenna's report I was left shaking my head in stunned sadness. Sad because I'm fairly confident that even if my government were as proactive as Japan's (and they are not by a long and wide margin) most of those offered this advanced protection in the US would decline the vaccine.

In fairness, many are not as big a fan of vaccines as I, some after rationally weighing the pros and cons, but many due to simple misinformation and downright ignorance of the facts. It's the latter that causes the dismayed shaking of the head.

 

If trained healthcare professionals can be so ignorant of such simple facts what hope the general public?

Not for the first time I find myself envious of Japan.

 

SZ

Japan and Pre-Pandemic Vaccination

Japan announced today that they are moving forward with plans to vaccinate medical staff and quarantine officials with their stockpiled pre-pandemic vaccine against H5N1. 

[Thanks to Pixie @ FluWiki] From Reuters Japan to vaccinate medical workers for bird flu:

Japan plans to vaccinate 6,000 medical workers and quarantine officers with stockpiled bird flu vaccines to check their effectiveness and possible side-effects, the health ministry said on Tuesday.

The plan, which follows suggestions made by some lawmakers and experts that vaccinations take place before a feared flu pandemic, will be submitted to a panel of experts for approval on Wednesday, an official said.

If approved, vaccination will take place before the end of the fiscal year in March 2009, and mark the first case in the world in which the vaccines -- based on strains of the H5N1 virus from China and Indonesia -- have been given to such a large group of people prior to a possible pandemic.

[continues at link]

 

I have been a proponent of pre-pandemic vaccination of as many Health Care Providers, First Responders, and critical infrastructure personnel as possible for about as long as the concept has been floating around.  I do always caveat that support though with the stipulation that the vaccine not contain any adjuvant, as I believe they are an unnecessarily dangerous inclusion for healthy younger adult, a wild card that even I am not willing to gamble on.

 

By protecting the Front Line we protect the maximum number of those who will need them to be on post should the pandemic happen.  The currently unanswerable question is just how much protection will be afforded to those who receive the pre-pandemic strain of vaccine.

Under normal circumstances vaccines are meant to convey immunity to a disease.  Unfortunately it is the current assumption that vaccination with a mismatched strain of H5N1 will not convey immunity.  So, with the stockpiled pre-pandemic vaccines the bar has been considerably lowered; it is simply hoped that it will greatly reduce the severity of illness in those that receive it, full immunity being viewed as unattainable.

No one assumes that the virus that attains the means to transmit from human-to-human [H2H] will be the same strain [closely matched on a genetic and/or amino acid level] as the stockpiled vaccine.  Since influenza undergoes rapid changes, and H5N1 is demonstrating a propensity for regional specificity, there is a strong possibility the strain used for the vaccine will be significantly different than the eventual (should it be eventual) pandemic strain.

The level of protection will be measured by the amount of antibodies that those who receive it produce.  Unfortunately, with the human H5N1 vaccines approved thus far there has been a discouraging weak immune response, which is why those who are in development and production, as well as those in procurement, are eying the adjuvants so strongly.

 

The pre-pandemic vaccine is a gamble.  It's a gamble to stockpile a potentially useless vaccine.  It's a gamble to give it before a pandemic presents itself, after all, the next pandemic may never happen, or it may not happen for any number of years, or even a decade or two, and the antibodies produced from vaccine wane with each passing month.   It's a gamble that there will be no adverse reactions for a percentage of those receiving the vaccine, a risk that goes up as the number of recipients goes up.

Will Japan's gamble pay off?  Almost certainly if a pandemic happens in the next year or three.  In and of itself that makes the gamble worthwhile.  Japan's existing policy is to vaccinate when the World Health Organization (WHO) raises the pandemic alert level from 3 (current) to 4.  Should the proposed plan be approved the initial administration will happen while the world is still in pandemic threat level 3.  Further, should the plan go forward Japan will be the first nation in the world to do so.  Will others follow?  I can only hope, since time may well not be on our side.  It takes boldness to be the first, it takes decidedly less to follow a sound and reasoned example.

 

I applaud Japan's Health Ministry for the bold initiative to protect those who will be on the forefront of an outbreak.  Since it takes roughly a month for the body's production of antibodies against influenza to be meaningful pre-administering the vaccine has a huge timing benefit.  Those on the front lines will not have to wait, or be needlessly unprotected, even though this is an admittedly a probable nominal level of protection.

I think of the level of protection along the lines of the bullet-proof vest my son dons prior to every patrol shift.  While the vest does not offer 100% protection against a bullet, it is far better than nothing, and it greatly reduces his odds of being the recipient of a fatal gunshot wound.  And, let's be honest here: when we are talking life-and-death, it's the "fatal" part that carries the most weight. 

Whether a wound or illness it's easier to stand on that ever so important to society Front Line if those standing know that recovery is the most likely outcome should the protection they have been issued (vest or vaccine) prove to be less than that Golden One Hundred Percent. 

 

Sometimes in life "recovery" is the best we can hope for because prevention is beyond the moment's reality.  With this gamble Japan is not only grasping its best current hope for the individual, but also for the nation as a whole, that it will be recovery, and not a fatal blow, that is faced should a severe pandemic happen anytime in the near term.

A Disturbing Glimpse into another Reality

Last July I did a piece on pandemic influenza and megaslums in which I briefly touch on the issue of megacities and the mega-slums attached to them and life for those dwelling in them. Today while I was buzzing around the net catching up on the happenings in the world I happened to visit CNN.com, something I haven't done in many months as I generally avail myself of other news portals. There I found a special feature titled Orphaned Boy Lives in Garbage Dump by Dan Rivers. I knew instantly what the story would be about as it is a story that is repeated on the outskirts of nearly every megacity in world.

The CNN piece happens to be about a seven year old boy in Bangkok, Thailand named Khin Zaw Lin.

He doesn't know how old he is, but he thinks he's 7. His name is Khin Zaw Lin. He's lived in a garbage dump virtually his entire life.

I find Lin walking in a festering landscape of rotting food, plastic bags and junk at the Mae Sot garbage dump in Thailand near the Thai-Myanmar border. His parents are long gone. His home is a makeshift shelter made from salvaged bags, cloth and wood.

Lin is one of about 300 refugees in the dump who survive on other people's trash. Many are children. Some are women with babies.

Their daily routine follows the same pattern: They mill about the dump, waiting for the next truck to arrive, hoping for enough discarded food to get them through the day.

Lin pokes through the rubbish with a machete. He says he collects bottles and plastic for three cents a sack. He shows me his feet, which were filthy and ribbed with cuts.

He tells me through an interpreter that he can't afford shoes. He walks barefoot through the treacherous landscape.

Continues…

 

No one has hard numbers about how many Thrown Away Children existing on their society's refuse exist throughout our world as they are willfully ignored by their governments and societies even in times classed as "normal". It would be no stretch of the imagination to assume that they are not considered in their society's pandemic plans (such as they may or may not be), and further assume that many, if not most, will be uncounted victims of a future pandemic.

These children are not only unnumbered, but will be un-ministered to, and then un-mourned should they pass from their mean and meager existence as a wave of disease passes over them and their reality.

 

Mr. Rivers closes his story with these paragraphs:

I thought I had become accustomed to the grinding poverty I had encountered in parts of Asia. I've met my fair share of children who are denied the luxury of hope. But Lin's story angers me. I feel close to losing all objectivity.

Near the end of my meeting with Lin, I ask his adopted mother if she, and Lin, would ever escape the rubbish dump.

Her answer is as hard as the world she and Lin inhabit.

"Never."

 

Should I happen to face a severe pandemic in my future I hope that I have the presence of mind to remember that no matter how bad it might be, it could be worse, I could have been born into young Lin's reality.

 

SZ

End of March

First a bit of personal business:

My "Day Job" is still in crisis mode as the newly hired Head Accountant decided six hours before he was due to show that he had changed his mind and would not be joining us after all. At this point in time we have no replacement candidate(s) so we are back to square one.

I am also facing yet another Month-end cycle where I will be performing the functions of three people so Journey will remain more dormant than not until such time as I either quit myself or we get that elusive replacement.

 

In a Reuters interview microbiologist Dr. Yi Guan of the University of Hong Kong, a highly respected and a leading expert in Avian Influenza, gave his long held assessment that diligent surveillance and rapid containment can prevent avian influenzas from gaining sustained human-to-human (H2H) transmission.

Proper Surveillance can stop flu pandemic

Reuters Tan Ee Lyn

[snip]

Guan, who studied the H5N1 bird flu virus after it showed up in people in Hong Kong in 1997 and has tracked its footprints all over the world ever since, is convinced that the world can stop the bug in its tracks if it has enough resolve.

"If proper surveillance is in place for animals and humans, yes, we can stop pandemic influenza forever. Not just for H5N1, it may also work for other subtypes of viruses," he said in an interview over the weekend.

"We have the ability to remove pandemics if we have a long-term strategy."

Guan, a professor at the University of Hong Kong, knows just how backbreaking and mundane surveillance work can be.

 

Reading the interview the phrase "In a perfect world" came to mind. Many things are "possible" but that doesn't make them necessarily something humanity can, in reality, accomplish.

Given that H5N1 is endemic in many countries, with many of them not known for their effective or efficient governance, surveillance and containment is something currently only theoretically possible.

But the theoretically possible has been accomplished before. Given dedication, audacity, and funding we have gone to the moon and eradicated Small Pox. Two things never previously accomplished and thought impossible by many. By reminding us that we have the potential to keep the lid on pandemics perhaps Dr. Guan will inspire greater effort and greater cooperation.

 

One can always hope.

 

SZ

 

US Pandemic Vaccine Supply

It has been awhile since I addressed anything specifically on influenza pandemic vaccines so I will restate my long held adamant belief and support of the development and stockpiling of pre-pandemic H5N1 vaccines. To be sure, pandemic vaccine, pre-pandemic or otherwise, is a complicated issue.

One need only review Maryn McKenna's seven part series for CIDRAP The Pandemic Vaccine Puzzle to glimpse the seemingly intractable complications (at least in the shorter term) and the difficult choices and decisions required.

Thursday US Health and Human Services (HHS) announced that their stockpile of H5N1 pre-pandemic vaccine supply currently stands at enough to immunize 13 million people. Unfortunately the US has a current population estimated at somewhere around 303 million people. That figures out to be roughly four percent of the population.

 

From CIDRAP:

US has enough H5N1 vaccine for 13 million people

Mar 20, 2008 (CIDRAP News) – A progress report released today says the US government has stockpiled enough prepandemic H5N1 influenza vaccine for 13 million people, more than double the number listed in the previous report, issued last July.

The United States is a large and prosperous country (when measured against the average). We are now in our eleventh year of facing the potential threat of a human pandemic from H5N1. Even if I choose to be generous and only count backward in time to when H5N1 began its forays into human infections with an ever forward and outward march around the globe to 2003 we are still five years on. After five years to only have four percent of our population covered by a pre-pandemic vaccine is not only sad, in my opinion, but pathetically so.

The report on pandemic preparations by the Department of Health and Human Services (HHS) also says the government plans to release a new version of its pandemic vaccine allocation plan in coming months, after considering comments at a series of recent meetings and forums.

The last (draft) version of the vaccine allocation guidance document can be found here.

As the allocation stands currently we are still 10 million shy of tier 1 qualified recipients. Those 10 million, according to these guidelines, would be the Infants/toddlers.

I anticipate changes to the above categories, a swapping of tiers for certain segments of the population. There are just far more who need to be protected than there is protection at this point, and to move a segment into Tier 1 priority means moving another segment out and farther down the priority line.

 

Tough choices. However tough it may be it is still something that has to be decided. And it has to be decided because we as a country, our leaders, and those who have been appointed by those leaders have failed to act with vision and boldness in the face of a potential severe influenza pandemic.

The 16-page report from HHS Secretary Mike Leavitt lists a wide range of HHS pandemic preparations. It emphasizes the agency's efforts to collaborate with other stakeholders in tackling problems like vaccine allocation and who should bear the burden of stockpiling supplies such as face masks, respirators, and antiviral drugs. The report is the fifth in a series that began in March 2006.

Concerning the H5N1 vaccine, the report says, "By the end of 2007, HHS had purchased and stockpiled 13 million courses of pre-pandemic vaccine." The previous report, issued in mid-July, said the agency had acquired 12 million doses of the vaccine, enough for 6 million people.

The vaccine, based on a clade 1 virus isolated from a Vietnamese patient in 2004, was approved by the Food and Drug Administration in April 2007. Although no one knows how well it would work against an emerging pandemic strain of H5N1, HHS officials hope it would provide some protection to those most at risk for exposure in the early months of a pandemic.

And there is the Cosmic Joke (or insult). Even though I am a staunch supporter of the pre-pandemic vaccine program, yes, even given the Swine Flu debacle of the '70s, the pre-pandemic vaccine may only provide the barest minimum of protection against H5N1. By "barest minimum" I mean that it is likely to keep most people from having a fatal infection, but they will still have a high probability of getting sick, some even severely so. Severe or no, recovery beats dead any day.

Additionally, if we encourage our critical front line personnel, Tier 1 folk, to also get the pneumonia vaccine (guards against bacterial pneumonia but not viral pneumonia), we will go a long way in avoiding the "severely ill" side of the potentials of being vaccinated with a far less than optimal pre-pandemic influenza vaccine – or so it is reasonably assumed given current understanding.

 

If it is safe to assume that the pre-pandemic vaccine for H5N1 that we do have will not protect most from getting ill from H5N1 while they perform their critical duties what about those workers bringing H5N1 into their homes, exposing their unprotected family members?

 

My son is a police officer, a "street cop", for a small city. As such he is in Tier 1 for vaccine priority as it stands currently. But honestly, knowing what I know about the vaccine, I shudder at the thought of him bringing infection home to his wife and (currently) one year old daughter, both of whom will be without even the minimal protection offered by the vaccine because there just aren't enough of them.

And what causes my shudders will be faced by all of those who receive this scarce vaccine. By not having enough we have reduced its benefit even further.

 

It is my belief that we have squandered valuable time and in so doing have potentially squandered human life. Fortunately, sometimes, we are afforded the opportunity to remedy our mistakes.

I take comfort in knowing that the vaccine issue is being attacked on any number of fronts, and perhaps, just perhaps, we will have all the time needed to overcome the difficulties and shortfalls.

 

One can only hope anyway.

 

SZ

News and Information during a Pandemic

My thanks to Lisa Schnirring of CIDRAP for bringing us a report from the recent US Department of Health and Human Services (HHS) tabletop exercise. This event brought together representatives from governmental agencies, health institutions, traditional news outlets, and internet forums and bloggers. The exercise was focused on then needs, dynamics, and interactions of information dissemination during a pandemic. Flublogia luminaries DemFromCT of FluWiki and Fla_Medic of Avian Flu Diary were in attendance as representatives of the Cyber Flu Community's "voice".

From Ms. Schnirring's CIDRAP report:

HHS includes online services in pandemic communication drill

[snip]

The exercise was the second time HHS has reached out to blogs. In May 2007, the department featured posts from bloggers such as Michael Coston of Avian Flu Diary and Greg Dworkin, MD, of FluWiki in a 5-week pandemic preparedness blog series. HHS Secretary Mike Leavitt hosts his own blog on the HHS Web site. He is the first cabinet secretary to use the online forum, according to HHS.

[snip]

"We recognize that during a pandemic information could be life-saving. As more and more people turn to the Internet for information and news, blogs have emerged as an important and influential communications tool," HHS said in its invitation to attend the tabletop exercise.

[snip]

At several points during the exercise, moderator Forrest Sawyer, a former news anchor with ABC and NBC who now runs his own media production and strategy company, Freefall Productions, asked the news media and online outlets to predict what their headlines would be and what information they would need from HHS, CDC, and other agencies.

During the exercise the communications officials from HHS floated the idea of "embedding" some of their staff in media organizations to ease access to official information during a pandemic. The agency also said its media access policies now treat reputable blogs and other reputable online services the same as traditional media organizations.

Stephanie Marshall, director of pandemic communications at HHS, told CIDRAP News that because growing numbers of people are going to online sources for news and information, "It's important for the government to understand how best to work with bloggers and other online journalists to distribute information. The exercise and the insights offered by the participating bloggers will help us improve and refine our existing pandemic communications plan."

 

Fla_Medic (Mike Coston) of Avian Flu Diary offers his own thoughts and observations of the off the record tabletop exercise:

HHS Pandemic Exercise

[snip]

The decision to include the flu forums and Internet bloggers in this exercise was a bold one.   I'm not sure that they know quite what to make of  us yet, but they obviously believe they can't ignore us. 

We are, in their words, `The New Media', and they are working out ways to work with us. 

 

 

As an Influenza Pandemic Blogger and Cyber Flu Community Addict I was nothing short of thrilled to see that the federal government recognizes the internet as something not easily ignored or dismissed and acknowledged the community as having a legitimate "place at the table".

 

Although we cyber "Flu Obsessed" are a small virtual community we can be vociferous, cantankerous, and downright self righteous at times. HHS's first experience with dealing with the Cyber Flu Community was during their Pandemic Flu Leaders Blog, on which DemFromCT and Fla_Medic were Flublogia's blogger representatives as well.

During that first intrepid online experiment there were times that members of Flublogia were so raucous and vitriolic that I found myself actually embarrassed, and for those that don't know me – that's pretty hard to accomplish. There are places within "the community" that I spare myself the aggravation of visiting (out of politeness I will refrain from mentioning them specifically). I find, alternately, their censorship or their "conspiracy theory" nature to be just too much for the Critical Thinking Libertarian region of my brain.

 

Flublogia, the Online Cyber Flu Community, is not without its faults. As such I am appreciative of the government's cautious trepidation in opening the door to us. I applaud their understanding that we are a "force" that isn't going anywhere any time soon so accommodation will, it is greatly hoped, benefit everyone.

During a pandemic, especially the early stages, information dissemination will be vital. At times of crisis and emergency the public's appetite for information is ravenous and insatiable and the traditional press has become sloppy. We in Flublogia, faults and all, do a remarkable and rapid job of "self-policing" in general when measured against the "traditional press". Additionally, we have been around long enough now to be a "known commodity", so while I understand the government's trepidation I am hopeful they are not paralyzed by it and the caution it inspires. Time will tell.

 

As it happens, while I have been composing this entry, I have been listening to CSPAN's program Tonight, Washington where the topic is Influence of foreign media on global issues. The juxtaposition of questions of purpose, credibility, sources, and dissemination between the "traditional" and the "new" media may be serendipitous and coincidental but at the same time informative of the terrible hurdles the government will have to surmount if and when the time comes to actually disseminate credible and timely pandemic information to the public.

I do not envy them their task.

 

SZ

Did She or Didn’t She

The influenza virus undergoes continual evolutionary change.  The swapping of whole genes between strains of influenza, reassortment, is known to be the mechanism that produced the 1957 and 1968 influenza pandemics, and therefore considered the main mechanism of producing our pandemic strains. 

Scientists, along with the “Flu Obsessed”, have been concerned that H5N1, currently a wholly avian influenza virus, would reassort with a human influenza virus. H1N1 and H3N2 being the two current human type A Influenza viruses in circulation.  In order to accomplish this sleight of hand on the genetic level a single virion (a single virus) from each different strain of virus, one from H5N1 and one from a currently circulating strain would have to infect the exact same human cell at the same time.

Now, without getting into a whole bunch of mind numbing scientific minutia there are tremendous hurdles that the second virus would have to overcome in order to infect a cell already co-opted by another virus.  For those curious, the mechanisms of those hurdles at work are cell apoptosis and cell superinfection; high points relevant to influenza can be found at the links. 

For those satisfied with the broad-brush strokes nature has it set up so that it is almost impossible for more than one influenza virion to gain entry into a cell, and apoptosis (the death of the invaded cell) occurs within hours of influenza entering a cell, variable, but 4 – 6 hours is probably the operative range.  Combined they form rather strong prima facie evidence that a single cell being infected by two different influenza strains is generally an extremely rare and difficult happenstance.

Yesterday CIDRAP’s Maryn McKenna reported on a bombshell that was dropped at the International Conference on Emerging Infectious Diseases by Indonesia’s Vivi Setiawaty of Biomedical and Pharmaceutical Research and Development about a 16 year old Indonesian girl who is reported to have been infected by H5N1 and H3N2 at the same time, known as a co-infection.

A snip from Ms. McKenna’s report offering an excellent glimpse into the confusing issues presented by this paper:

Throat and nasal-swab samples that were taken on the 6th day of her symptoms tested positive by reverse-transcriptase polymerase chain reaction (RT-PCR) for both avian influenza H5N1 and the seasonal flu strain H3N2 at the Indonesian National Institute of Health Research and Development. Serology test results were less clear. Antibody titers from serum samples taken the 6th day provided a weak indication of H5N1 infection (titer of 1:10) but were negative for H3N2; convalescent sera, on the other hand, gave a strong indication of H3N2 infection (titer of 1:640) but were negative for H5N1.

RT-PCR testing, the first test performed, and the one that came back positive for both H5N1 and H3N2, is the most prone to false results, and officially treated as presumptive pending further testing.  Blood was drawn the same day (6^th day of illness) and it came back showing a weak titer response for H5N1 but none at all for H3N2.  Blood tests that early in an infection are notorious for giving “false negatives” as the body generally hasn’t had enough time to produce antibodies that would be freely circulating in the blood.  This is true for human influenza infection, and as far as I am aware, at least generally true for an H5N1 infection.

The later blood test, referred to as “convalescent sera” (blood taken later or after recovery) was strongly positive for H3N2, and would be what one would expect to see after an infection since the body has had time to produce the freely circulating antibodies.  This same test came back negative for H5N1.  Blood tests several weeks after an infection are considered definitive when proving infection or non-infection, with the caveat that the tests were performed correctly of course.  Lastly, it is worth noting that H5N1 has historically produced a strong- to- excessively strong human immune response, so a lack of climbing antibody titers would seem unlikely in the extreme for an infection in a sixteen year old.

We have two choices when deciding what to believe.  We can believe the most prone to error test shows the correct results and believe that the most definitive test was done incorrectly producing a “false negative”.  Or we can believe that the test results as this report states are what they are but the interpretation of them may need further review.  Since no independent verification from a WHO reference laboratory was conducted we may never know for sure, but I choose to class this as a “maybe, but highly unlikely” case of a co-infection of H5N1 and H3N2 until I have more information.

I would be remiss if I didn’t say that being ill with two different strains of influenza at the same time is probably not impossible, and may not even be that terribly unusual when multi-strains are co-circulating in the population.  However, I am trying to say that those two strains would not likely infect the same human cell within such a short time span, something evolution has mechanisms in place to guard against. 

Added to the time and biological improbability is that now, to the best of our knowledge, avian influenza and human influenza do not infect the same types of human cells.

Since it is that, the two strains meeting up in the same cell(s) and exchanging genetic material, which makes this case such a potential bombshell I felt it important to list out all of the issues as I understand them that would argue against it, both in general and with this case specifically. 

Who knows, perhaps next week more information will be available and I will revise my opinion and assessments.  I would be the last person to say I have the answer to this puzzle, but I do have an insatiable appetite – an appetite not likely to be satisfied any time soon – to understand the myriad pieces spread out on the table before us.

SZ

Fifty Percent Staffing Level

Tomorrow we will be half way through the month of March, and tomorrow I hope to "put February to bed" at work.

For those that do not know, or may have forgotten, I work in the accounting department of a Vacation Rental Company that is wholly owned by a publicly traded Holding Company. The department started the year with a staffing level of four, a controller, his "second" (me), and two others.

At the beginning of January one of my coworkers announced his unexpected and immediate retirement and I absorbed his duties in their entirety. Then in February the controller left us. My department has been running with a staff of two. But since we are a subsidiary of a publicly traded company the reporting that we have to generate and submit to our corporate office is federally mandated (Sarbanes – Oxley, commonly known as SOX) and rigidly scheduled to meet those federal mandates.

 

It is widely suggested, as well as supported, that businesses and organizations will find themselves operating at somewhere around a fifty percent staffing level during a moderate to severe influenza pandemic, something I can relate to personally. Although I do not work in a business or industry that will find itself operating during a time of pandemic, and accounting is not exactly an "essential service", although, to be sure, money will still have to flow, I thought I would share with you a few of the things that I learned and equally enlightening, what had to happen to support my efforts and success.

 

I had an existing broad base of knowledge of all aspects of the department, database, and accounting software, however, since I am not the controller there were reporting functions, data collations, and spreadsheets that I only had a basic superficial knowledge of. I found myself hour-by-hour struggling to comprehend how "this or that" fed into "this or that", often getting it wrong any number of times until I finally managed the logic of the data flow and plopped the right number(s) in.

I had adequate basic knowledge of the myriad functions. I had a well established and proven matrix to follow. I had an entire company at my beck and call to support my stupid ill-informed questions. I had our software programmer made available to me at a moment's notice to assist with database malfunctions and miscellaneous support questions. I had a General Manager that "baby sat" me for two weeks, checking on me every other hour offering encouragement, cheerleading, offers of providing anything else that I might find myself requiring (within a business framework of course), at one point in the process the entire company was "booted off" the server for several hours so that I could have its resources all to myself, and lastly, I was determined to succeed.

And even with all of that, with every resource and advantage I could be given, I was only able to just manage. Perhaps a better way to state my point: The only way I could have been in a better position to succeed was to have my former boss standing over my shoulder walking me through the processes.

 

During a moderate to severe pandemic those who find themselves struggling to perform the duties of two or three missing colleagues will probably not [read surely not] have all of the wonderful support that I had. Many will not have a clear "play book" to refer to as they find themselves struggling with unfamiliar processes and procedures. And, unlike my situation where it was "just numbers" those struggling people may hold someone else's health, or even more frightening, life in their hands with their actions.

After my experiences these past three weeks I have a band new appreciation about how impossible those tasks will be – and my concern about our critical infrastructure has deepened considerably.

 

The good news from a personal perspective is that our new "third body" reports on March 24^th, a week from Monday. We will then be all the way up to a seventy-five percent staffing level, and after this that will feel wonderful indeed, as that will be manageable under the new organizational structure.

So all the "bad stuff" is behind me, with the caveat as long as our new accountant actually shows up on the 24^th.

I know I've said that I was back to posting before and then almost instantly made a liar, but I'm saying it yet again, this time I hope successfully with only life's normal interruptions and breaks for sanity.

 

SZ <Exhausted but pleased with accomplishing the impossible with a great deal of wonderful support>

 

 

A Few Stolen Minutes

We are still in search of our "Third Body" at work and not much promising on that front. After today I am pretty much ready to say if they are breathing and can show up, hire them. If anyone writing the pandemic plans for their companies or organizations happens to read these words at some time in the future, I am here recording that running a department at 50% staffing levels is not fun, nor is it especially efficient.

I have reached the point that I am tempted to record a message on my voice mail that states: "I don't know the answer to your question but please feel free to leave it anyway; I will eventually get to it and then eventually find the answer. Although I'm confident that by the time I actually get back to you with said answer it will no longer be relevant – but by all means – please do leave it just the same – it does my ego good to be reminded of my ignorance. "

Of course, I wouldn't really leave such a greeting on my voice mail, but it is tempting at times.

 

This blog has never been strong on chronicling the news as it relates to pandemic influenza, generally if a story of the day catches my interest I will comment on it, but for the most part this blog is about me running my cyber mouth about PanFlu issues in a more general fashion. Being a person who possesses an opinion on just about everything it just seems to come natural.

Another opinionated woman is making a cyber splash of late, Standingfirm of PreparedCitizens. I have come to know Jackie (aka: Standingfirm) quite well as we participate in several of the same forums. She is a woman of unbounded passion and energies when it comes to preparing to face a severe pandemic. I hope you check out her offerings if you have not already done so, I promise, she will more than make up for my silence as I less than patiently wait for that elusive "Third Body" at my day job.

I was inspired to dust off my old (OK – ancient) and tattered copy of Thoreau's Walden the other day when someone tickled a long forgotten memory of formative inspiration and as it has sat on my table I have picked it up at random moments, yearning to re-read it with loving thoroughness. Doing so I came across a passage that brought Standingfirm clearly to my mind's eye as I read it:

BUT WHILE WE are confined to books, though the most select and classic, and read only particular written languages, which are themselves but dialects and provincial, we are in danger of forgetting the language which all things and events speak without metaphor, which alone is copious and standard. Much is published, but little printed. The rays which stream through the shutter will be no longer remembered when the shutter is wholly removed. No method nor discipline can supersede the necessity of being forever on the alert. What is a course of history or philosophy, or poetry, no matter how well selected, or the best society, or the most admirable routine of life, compared with the discipline of looking always at what is to be seen? Will you be a reader, a student merely, or a seer? Read your fate, see what is before you, and walk on into futurity.

 

The cyber flu community is enriched by her energy and her contributions.

 

[Jackie, I know you are blushing – sorry – sometimes praise just has to be gracefully accepted.]

 

SZ

Yet Again

Yet again my life was turned upside down. By now it has begun to feel normal. My boss turned in his resignation and without dwelling on it – life is not especially blog friendly.

There is a promising candidate being interviewed tomorrow so wish me luck.

But I will admit – I'm beginning to think there's some sort of cosmic conspiracy going.

 

SZ

 

The Germs of Discord

As the below piece highlights, the propensity to lay blame is a practiced art and past time. It is not something that only occurs in South Asia, sadly, look just about anywhere where there are intractable problems and you will see finger pointing and vitriol.

The piece does have it right in that we just can't seem to work together, even when doing so is in the best interest to all involved.

From India's Economic Times:

The germs of discord 9 Feb, 2008, 0000 hrs IST, TNN

You can have all the regional agreements, pacts of friendship and mutual understanding you want, but dark deeds and shady plots are never quite far away in our brotherly region. It is also a truth subcontinentally recognised that we never seem to want to accept responsibility for any of the myriad ills plaguing our lands. Bangladesh, it seems, has now decided that the bird flu that's now spreading fast over there is a prime example of Indian perfidy. But then, that's quite usual. Everyone habitually blames everyone else in South Asia, for everything from illegal immigration, smuggling to terrorism — Afghanistan blames Pakistan, the latter blames the former as well as India, we here periodically blame everyone around us — and now Dhaka has waded in as well. In fact, it could be rather enlightening were one to substitute 'terrorism' for 'bird flu' in the statements emanating from Dhaka and New Delhi as well as the reports on the spread of the potentially deadly virus. Bangladesh is alleging that it's them birds from India that are spreading the virus in its territory, while some Indian politicians are now claiming that it is the illegal poultry trade from Bangladesh into India which started the crisis in the first place. Here, we seem to have suddenly forgotten that birds, after all, do have a propensity to fly. And borders possibly don't signify much to them. And one can hardly expect a virus to be mindful of the BSF or the Bangladesh Rifles. But then, that's just us, officious South Asians, sticklers for protocol, all. Where else, one could ask, would we find the external affairs ministries of both nations trading charges over the spread of a virus? Not to put too fine a point on it, we just don't make for good neighbours. And one might as well forget proper, sane practices like putting collective heads together and seeking a joint response to a problem during such a crisis, as would happen in any other part of the world. Now, formal requests, one wearily learns, have finally been made to share the genetic history and other information on the virus. While that is duly processed, we can regale ourselves with watching denizens of the affected areas on both sides cheerily chomping chicken on TV. It's certainly never a dull moment, living in South Asia.

Super Tuesday

No Pandemic or Avian Influenza post today so that I can feed my love of politics. Today being the all important, and oh so exciting (at least to us political junkies), Super Tuesday Primaries/Caucuses for the US Presidential race.

 

SZ

Clamp on Itahar

An interesting little tidbit of news about Itahar, West Bengal, India

The Telegraph Calcutta, India

Clamp on Itahar

Feb. 4: The North Dinajpur administration has promulgated prohibitory orders under Section 144 of the CrPC to prevent poultry owners from smuggling birds out of Itahar, where mop-up operations are under way.

"We apprehend attempts to smuggle out poultry by people travelling in groups. The assembly of more than five persons in public places has been prohibited until the end of the mopping-up operation," said Raigunj subdivisional officer Asoke Kumar Das.

[snip]

Das said police stations in the area had been asked to step up patrol and arrest those violating Section 144.

In the 13 bird flu-hit districts, animal resource teams went house to house for the mop-up. Police teams accompanied them but villagers handed over their remaining birds willingly. The operation will continue for another five days.

"We wanted the police to accompany officials to pressure villagers to hand over their birds. But our door-to-door campaign in the past few days worked," animal resource minister Anisur Rahman said.

Poultry samples have been sent for tests from Sultanpur in ward 46 of the Howrah Municipal Corporation after 200 chickens died there over the past few days.

 

This is a tiny blurb and, as always, may not be entirely accurate. That said, however, it raises my concern on several levels.

First, and probably most: OK—they are concerned about bird smuggling. Good to be aware of this all too familiar problem when it comes to controlling the spread of H5N1 but— why are they concerned about smuggling carried out only by groups? The single or even tandem smuggler is not a problem? Or, do the officials feel that constraints of personnel allow for only the bands of smugglers, easier to spot, with fewer vehicles to stop, are the most effective utilization of human resources?

I certainly hope that is not the reason only groups are being checked. Five lone smuggles could potentially spread H5N1 farther and faster than a single group of five. This just doesn't make any good sense to me.

Secondly, why are "groups" mentioned again as being prohibited in general if it is five or more gathering? Why five, why not ten, why any at all? Why the restriction to begin with? Is this instead some form of political dissent being cracked down on in the guise of containing the spread of H5N1? If so, the world doesn't need control and containment response tied up with a blood red bow of political strong arm tactics. Containment and control is difficult enough even under the best of circumstances.

Lastly, why are the police involved? Goodness knows I love police, well, the law abiding, civil rights respecting police anyway, but they are not trained in the health issues of gathering and culling of birds. Should they become infected they would be near perfect vectors of wide transmission if a transmissible virus was operative.

Needless to say, I found this little tidbit of an article more disturbing than anything.

 

As always, I suppose time will tell.

The Developing World, AI, and Taiko Drums

As I often do when I sit down to compose a blog post I am sitting under my noise cancelling headphones. Today's music of choice happened to be Oedo Sukeroku Taiko's The Drums of Tokyo. I particularly enjoy percussion, whether Native, Urban, New Age, or the Formal as is Taiko.

For me drumming recalls a time before I was middle-aged, but more specifically, when I was a patrol officer, when life, and survival, had a flow and energy all its own, often an immediacy that was raw and primal. Now, as a member of America's middle class, living an insular, staid, and safe life I no longer "hear the beat" of urgent survival as an integral part of that life—hence the artificial invocation through music.

Life in Third World or developing countries is often dominated by the ever present "beat" of simply surviving. Sometimes I chuckle, albeit mockingly, at so many Western Environmentalists who envision a pre-industrial existence as the optimal human condition. I have found myself wondering how many of them have felt the raw immediacy of just making it through the day alive and in reasonably one piece as they pushed their shopping carts through their local organic grocery.

Don't misunderstand: I appreciate the environmental and the organics movements, but I believe there is a genuine disconnect between idyllic fantasy and harsh reality. I was reminded of the dichotomy of fantasy vs. reality as I thought about some of the posts on the flu forums in regards to Bangladesh, India, and Pakistan and listened through my headphones to the drums being struck.

 

When surviving is at stake there isn't much room for magnanimity and world viewpoints. Back in the days when surviving a day weighed heavy upon my mind the world still faced the threat of a nuclear exchange. Fingers on Buttons seemed so bloodless and calculated, so sterile. Today the threat the world faces may see actualization from a small holding of chickens in the slums of Calcutta or Dhaka. Nothing bloodless, calculated or sterile there. Instead life's blood pulses to the all too primal rhythm and beat of simply surviving.

Who can worry about tomorrow when this day, this hour, this moment has to be survived?

 

The drums are beating—do you hear them?

A Lesson in Real Life

This post will be more a recap of why I had pretty much dropped out of Flublogia for a month, but as always, I will try to tie what happened into a general PanFlu perspective.

On January 2^nd my counterpart at work (what I call my "Day Job" and what pays my bills) announced his immediate retirement and the fourth member of my four member department had to go out on emergency medical leave. This left my boss and me to run the entire department just as we were facing end of fiscal year requirements.

I tend to lean to being a Type "A" person, highly driven and action oriented. To say that my life during the month of January became all about my job would not exactly convey the fact that I was pretty much reduced to work and a few hours of sleep each day. I would occasionally drop into Flublogia to glimpse the overall situation but with all the demands on my time and attention I really lost touch; I no longer had my fingers on the pulse of the virtual world that is Flublogia.

The thing that I found most illuminating for me was the simple fact that my life had so many "here-and-now" demands that I was nearly buckling under I just didn't care about some theoretical threat in the distant realm of "maybe".

Upon reflection I found this fascinating.

I have found it difficult to impossible to understand how so many people could turn a blind eye to such a potentially catastrophic event. I found out how easily it can and does happen.

Being someone who at least believes I know and understand the myriad potentials we would face during a severe pandemic I very consciously turned away from pretty much everything AI and PanFlu at the exact moment that threat levels were rising as significant new outbreaks in new geographic locations were occurring. If I could do it with an intrinsic understanding how much easier is it for someone who has a superficial, at best, grasp of the potentials?

 

The traditional Navajo concept of hózhó encompassing beauty, balance, order and harmony distills, at least to me, to the concept of grace, or gracefulness: handling life and all that it throws at us with grace.

During the month of January my life was decidedly out of balance and chaotic. Grace and gracefulness were nowhere to be found within my tiny personal universe. But, isn't that what we will each have to face and deal with should a severe influenza pandemic strike anytime in the near future? We will each have to do what I did: buck up and just do what has to be done in the tiny personal universe that represents our individual lives.

The degree that our lives will become unbalanced and lacking in grace will be a direct reflection of our in-place knowledge and preparations. Unlike the situation I found myself in at the beginning of January we will have had plenty of time to inform and prepare ourselves.

The fact that life in general often affords us little to no time, or inclination, to peer into our futures for potential threats on the horizon will offer us no comfort or succor should we face the worst. Instead we have to adjust like I had to do. Sometimes we have to reach inside ourselves with deliberateness and find that new point where hózhó leaves little room for chaos or the unattended necessities.

While I will probably never attain that perfect place where there is nothing but hózhó I have at least realigned enough to be back at the optimal operative point for me. Now, I have the daunting task of catching up.

 

One last personal note:

A heartfelt Thank You to all of you who dropped me a line to check up on me or to let me know that my cyber voice was missed. It was much appreciated during a time that found me not only stretched to my capacity but coinciding with an all-time low PanFlu morale in general. I drew strength from knowing that others were standing watch and that even during a time when I had to withdraw the invisible web of connectedness to "Fellow Travelers" gave me comfort.

 

Egypt’s Poultry Vaccines

Discontent and finger pointing has been showing up in some of the translated articles out of Egypt about the poultry vaccine efficacy, quality, and proper administration, whether singly or a combination of the three factors. The al-Masry al-Youm article addresses the issue with a little more thoroughness.

New Conditions On Import Of Bird Flu Vaccines

By Metwalli Salem 8Jan08

Minister of Agriculture and Land Reclamation Amin Abaza unveiled that his ministry would prepare a study to determine the types of serums and vaccines the companies import from outside and set new conditions on private companies importing anti-bird flu vaccines.

He said the most important of these conditions is that the companies must be registered in the World Organization for Animal Health (OIE) and that the vaccine must be effective against the lethal H5N1 strain of bird flu in Egypt.

Commenting on the paper's yesterday exclusive report about the doubts over the validity of vaccines imported by these companies, the minister told al-Masry al-Youm that it is a scientific fact that the vaccine is not 100% effective against the disease, as its efficiency ranges between 75% and 90%, and that the circulation of vaccine is as important as the type of vaccine used in immunization, indicating that the ineffectiveness of vaccines imported from abroad is not in the interest of companies importing the vaccines.

He noted that about more than one billion anti-bird flu doses have been imported either by the state or the private sector since February 17, 2006. "All of these doses have been tested in the ministry's Institute of Veterinary Vaccines," he added.

Abaza stressed that all the vital safety regulations would be strictly applied and stringently enforced through the control of veterinary services affiliated with the General Authority for Veterinary Services, indicating that the increased number of infections in recent weeks were mainly attributable to the fact that many poultry farms are lax in applying vital safety standards, making them believe that they have entirely brought the virus under control.

Abaza accused some owners of farms where bird flu infections are reported of selling the remaining stock in the other coops in several provinces, contributing to the spread of the virus to other areas instead of culling all birds in all the farm's coops. He maintained that this behavior is a crime against citizens and the State.

 

This is certainly not a new issue, and unfortunately, it continues to crop up. The following piece is from an offering from December 2005:

Fake animal vaccines 'boosting bird flu risk'.

Source: Europe Intelligence Wire

Publication Date: 09-DEC-05

(From Western Daily Press)

Widespread use of ineffective and fake animal vaccines may be greatly increasing the threat of a human flu pandemic, a leading expert said yesterday.

WIDESPREAD use of ineffective and fake animal vaccines may be greatly increasing the threat of a human flu pandemic, a leading expert said yesterday.

Many vaccines given to poultry in bird flu hot-spots such as south-east Asia fail to control the virus, said Dr Robert Webster, from the World Health Organisation. As a result, even in apparently healthy birds, the virus is allowed to spread and evolve into new forms.

[snip]

Dr Webster, Director of the WHO Collaborating Centre for Studies on the Ecology of Influenza in Animals and Birds, said: "There are good vaccines and bad vaccines. Good vaccines reduce virus load; bad vaccines stop the signs of disease but the virus keeps replicating, spreading and evolving. The chickens look perfectly healthy but go on pumping out viruses for a long time.

"We have to ask the question, why are these animal influenza viruses showing so much antigenic drift? I would argue that contributing to this is the use of bad vaccines."

He said there was an urgent need for international standards to be applied to animal vaccines, as they are to those made for humans.

[snip]

Animal vaccines should also have minimum amounts of antigen, said Dr Webster. Poor quality veterinary vaccines are commonly used across the developing world, he said. Two major problem areas were China and Indonesia.

Government scientists in China produced some "excellent" high quality animal vaccines, said Dr Webster. But small regional factories were also making cheap, inferior vaccines that may contain no antigen at all. There was even one reported case of bottled water being sold as a vaccine.

Dr Webster pointed out that the problem was not new. An investigation into H5N1 outbreaks in Mexico in the 1990s found that only half the vaccines being given to poultry were effective.

 

Some things one just has to learn the hard way. It appears the poultry vaccine is one of those things.

 

SZ

A Prime Directive Forgotten

In the month of December I took an unexpected and protracted hiatus from my humble blog. You see, sometime early on in the month I suffered what I term a "buckling of the knees". I lost hope. I lost sight of the fact that Pandemic Influenza preparation, information dissemination and education, as well as event watching and analysis is a marathon and not a sprint.

I had naively thought that PanFlu preparation and awareness was a cumulative, always forward moving, positively accretive process. In the month of December we seemed to suffer one blow after another to our "message". After an unusually slow summer and fall official word was coming down about how the pandemic threat from H5N1 had abated. That was the "message" that people who are not "flu obsessed" were hearing and hanging their hats on. Suddenly a difficult task, being heard and taken with any seriousness at all, went from being difficult to impossible.

Coupled with feeling the futility of the message, I was also struggling with an understanding of knowing that even with all the ground we in Flublogia have gained it will not be enough. Not enough by a large and agonizingly deadly margin.

Suddenly, it just all seemed futile.

 

As a highly visual person my mind's eye tended to see an image of Salvador Dali's Metamorphosis of Narcissus when I thought about the process of pandemic information dissemination and preparation.

Nothing elegant, graceful, or beautiful, and yet the discordant symmetry, reflection, and juxtaposition are none the less evocative of "process". It is also the image that I often "see" when I follow the goings-on in Russia as she continues her metamorphosis from communism to democracy.

Tenacity, perseverance, and opportunistic luck is shown by the flowering narcissus having rooted, and even found the nurturance to bloom, in the egg shaped stone on the crumbling and decrepit "reflection in stone" of Narcissus.

Flublogia is a reflection of society at large, albeit one of discordant symmetry. We are them, they are us, and yet—we, the inhabitants of Flublogia, are also "other", in mathematical terms: a (unique) subset within the whole. We have heard a warning and taken it with seriousness, oft, deadly seriousness—as we measure the potential threat in human lives. We have heard a message that others seem to be deaf to.

 

But it was our "uniqueness" that I stumbled over. You see, I have come to believe that all of those capable of understanding, or hearing the message if you will, of the real potential threat of a severe influenza pandemic, and all that it could mean, already understand it. Further, that it would take an escalation of the threat to bring new people to the issue with any seriousness.

Sadly, I fear that the next escalation of events may well be the pandemic, thus affording no opportunity to take constructive and meaningful action based on this newly acquired understanding. Boiled down: I lost hope that anything I did would make a difference, or has made a difference. My words are read by those who already understand.

 

Egypt showed me the fallacy of my logic. Blissful ignorance and disregard of a clear and present danger, even when it jumps up and bites you in the hindquarters, can be overcome. Again, perhaps with inelegant and asymmetric grace, but with constructive and positive action never the less.

 

Many months ago I made a comment to a poster on one of the forums that it was not our job or responsibility to save the world, we had not been tasked with that obligation, and how terribly presumptuous to assume any one of us carried that burden. Another favorite phrase of mine: The bucket I carry is filled with my own water, and it's pretty much all I am capable of carrying… please carry your own.

 

After much personal reflection I have come to the conclusion that my "bucket" contains a requirement for me to keep at this—whatever this is, irrespective of its effectiveness. And, although I am suffering an acutely felt abandonment of muse, I am an optimist at heart, an optimist that hears the clarion call of responsibility. Even if my responsibility isn't to save the world, I feel it is my responsibility to continue to "speak", to continue to chip away at the crumbling stone statue reflecting Narcissus in the hopes that the flower of understanding will take root and receive enough sustenance to bloom. Presumptuous? No doubt. I am, admittedly, a rather presumptuous person.

 

It was the framing of this post that led me to dig up the quote from Horace that I used recently, refreshing my memory on his intent behind the words sapere aude. A more modern interpretation could be thought of as "Dare to think for yourself". But Horace's original meaning was so apropos to the situation in Egypt that I chose to use it in the previous post. In fact, this posting was originally titled Sapere Aude! with the more modern "flavor".

 

My "bucket" may not contain anyone else's water, but hopefully, it will help provide an informative "drink" whenever someone is ready to come to the issue of pandemic influenza should they happen to stumble upon me and my presumptuous offerings.

 

So, I guess I haven't lost all hope after all, but I do ask for longanimity as I struggle a bit with this bucket of mine.

 

SZ