A Journey Through The World of Pandemic Influenza

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

5 Jan 08 Miscellanea

Egypt is still an evolving situation. We have reports of a few more suspected cases as well as some of the existing cases testing negative. The phrase that was coined on P4P during the Pakistani outbreak was Flu Facts in Flux, and once again, that is what we have. We can want hard facts all day long, what we get is an evolving situation reported in a language other than English.

There are some in the Cyber Flu Community who treat each suspect case as a genuine infection of H5N1, and any negative test results that come back as "false negatives". While it is statistically likely that some of the negatives we receive from testing for H5N1 are in fact false, to presume they all are seems to be an illogical exaggeration of the likelihood. But in this Avian Influenza arena we have to consciously decide what we do, as well as what we don't, believe.

From Egypt we have this rather disconcerting report [Google translation], my thanks to Theresa42 of FluWiki:

4 seizure of thousands of dead chickens infected with avian influenza in Ismailia
 
Ismailia - Magdi soldier:
 
Been thwarted an attempt to smuggle four thousand chickens dead of a feed factories in Ismailia found to be infected with avian influenza disease.
The governor Ltd. Fakhrani has given directives control the entrances and exits to maintain control of the car and loaded fugitive quantities of live poultry infected with avian influenza.

Those campaigns resulted in the seizure of the car No. 55754 transfer Dakahlia governorate on board, about four thousand chickens were dead on the way to one of feed factories in Ismailia of recycling.

And to medically examine dead poultry by veterinary supervision of Dr Ismail Shmud director general of veterinary medicine show her avian influenza has been disposed of the quantity seized in a cemetery burials health compatible with the specifications and conditions of the environment and liberated the record No. 351 offences against the commander of the hill great car.

 

The bolded paragraph includes the translated words "feed factories" and "recycling". Do these words mean a plant where livestock or pet food is processed? That would seem to be the likely meaning, but is "likely" actual "fact", I do not know.

As we have seen in other countries, dead chickens are routinely "recycled" into feeding this or that. They are tossed into rivers and ponds to feed fish, and tossed to pigs to feed them. That is, when they are not consumed as human food.

Then there is this article, also brought to FluWiki by Theresa42:

EGYPT - Beefed up security in Menoufiya governorate

Google-translated from Arabic:

Hassan Hamida: ambushes of security at all ports Menoufiya to cope with the march of the virus .. And tighten procedures on farms

Wrote Mitwalli Salem 5/1/2008 [5 Jan 2008]

The General Hassan Hamida "governor Menoufiya, a member of the Supreme Committee for the control of avian influenza" decides that the deployment of ambushes fixed and mobile [random checks/check points] various outlets maintain with the rest of the neighbouring provinces to meet the Marching bird flu, and to make sure permits transfer and circulation of live birds within Menoufiya and free of the disease.

He said Hamida, told "Egyptian Today" following the end of the Higher Committee meetings to combat the disease, which was held at the Ministry of Agriculture yesterday, it was decided to tighten procedures for veterinary poultry farms and rural education and to make sure immunizations for the various types of birds, pointing out that the formation of a technical committee to follow-up immunization these farms.

He added:  Decided to entrust the education of local citizens risk contact birds, in the interest of public health, through the passage of these devices to all the villages of the province to educate its population using loudspeakers, symptoms of the disease and the need for immediate reporting of any cases of suspected infection, and deal with all cases absolute transparency.

The governor of Menoufiya that will be periodic traffic to stores that sell live birds to ascertain the source, with the necessary sampling of birds of unknown origin that is seized to make sure that they are free from disease before slaughter Anflonzataior and poultry abattoir at the earliest, stressing the importance of coordination between the departments of agriculture and veterinary medicine and health and local authorities to take immediate action to contain the disease and curb.

He stressed that the mandate of the concerned departments to prepare a report on the situation of the disease and fight to take quick action to control it, pointing out that it had been decided to declare a state of emergency in various hospitals in the province to receive all cases of suspected infection and rapid transportation to hospitals and specialized pleased sampling and analysis to speed treatment and combating disease.

 

 

As more and more suspect cases come forward and become known they are met with an urgency of action. In this sort of evolving situation it would be easy for Egypt to cross over into a panicked oppressive counter-productive response. It may well be a delicate balance, precarious, and easily lost.

I wonder how gracefully my own country would handle an outbreak of this sudden far flung scope.

Situation 3 Jan 08

After no earth shaking news out of Egypt yesterday we find that there are reportedly 16 suspected cases of human H5N1 infection in Egypt today. Not surprising in and of itself. Most now are likely to be hyperaware and diligent; every case presenting with "Influenza like" symptoms would be given a serious look, and it would make sense that any of those illnesses with severe symptoms would be treated as "suspected" until disproved to be in actuality.

Once again I would like to comment on Egypt's apparent transparency of reporting, even to the point of criticisms of the officials being printed in the press. They have a serious problem and they are attempting to address it with the seriousness that is warranted. I get no sense of over-confidence, sense of futility, or lackadaisicalness.

 

The phrase sapere aude comes down to us from the 1^st century BC Roman poet Horace:

• Dimidium facti qui coepit habet; sapere aude; incipe!
  • Translation: He who has begun has half done. Dare to be wise; begin!
  • Book I, epistle ii, line 40

 

When Horace set his stylus to those words he was urging a young friend to wake up, look around at life, taste it before it was too late, have a care for what he was and wasn't doing in the short time allotted him.

Egypt has begun, even if they could have been more proactive, at least they are taking stock of what they have, and just as important, what they haven't been doing and they have begun to have a care. And, just as Horace hoped it was not too late for his young friend, we hope it is not too late for Egypt – or for that matter—the rest of us.

 

So, we wait, and we watch. After Indonesia and Pakistan, we are well practiced.

 

SZ

Egypt 01Jan08

This morning's roundup by Theresa42 at FluWiki offers us the following:

SUMMARY OF CONFIRMED AND SUSPECTED CASES IN EGYPT SINCE DEC 25

5 Confirmed cases / 4 deaths:

Oula Yunis Ali Mohamed (25F) - d. Dec 25, 2007 -- Beni Haroun, Beni Suwayf governorate
Attorh Hanim Ibrahim [aka Hanem Atwa Ibrahim] (50F) - d. Dec 31, 2007 -- Shatt `Ezbet el-Lahm, Damietta governorate
Nora Aboul Abbas Mohamed (21/22F) -- Barhim near Minuf city, Al Minufiyah
Fatma Fathi Mohamed (25F) - d. Dec 30, 2007 -- Dikirnis, Ad Daqahliyah governorate
Firdaus Mohamed Hadad (26F) - d. Dec 31, 2007 -- Al Minufiyah governorate

21 suspected cases reported in the last week / 1 death:

Beheira Governorate

Dec 30 - Mohamed Khalil Abdul Qawi (40M) - Ezbet "Notes", [Centre Kom Hamada] Kawm Hamadah

Al Minufiyah Governorate

Dec 30 - Nader Said Babylonian (5M) - Al Btanoun/Al Batanun

Dec 30 - Ahmad Abdulmohsen [aka Roqayya Ahmed Abdul Mohsen] (6M) - from a village "Tnbdi hamlet" ["Kafr Tunbdi"] in Shibin Al Kawm center Kafr Tambidi

Dec 31 - Abdul Rahman Ibrahim (57M)
Dec 31 - Abed Rabbo (50M?)
Dec 31 - Mohammad Ferdous (36M)

Jan 01 - Adel Mohamed Adel - from [Sers Al-Layan] Sirs al Layyanah

Jan 01 - Doaa - daughter of Adel Mohamed Adel

Jan 01 - Mohamed Said Abdul Rahman - from Barhim

Jan 01 - Karim Mohamed Fawzi - from Kafr Sheikh Khalil village in Shibin Al Kawm

Jan 01 - Hamida Abdul Hafiz Rizk - Aboukls village in the Martyrs

*Note that confirmed case Nora Aboul Abbas Mohamed above is also from Barhim, Al Minufiyah.

Amiriya north of Cairo:

Dec 31 - Salah Eddin Mohamed Ali (43M) - d. Dec 29

Alexandria:

Dec 31 - Faten (23F)

Port Said:

Dec 31 - Reza Abdalmugod Abdilkadir (25M) - husband of Radwan - "Satisfaction village in south of Port Said"
Dec 31 - Radwan - wife of Reza
Dec 31 - Mohammed (9M) - son of Reza & Radwan
Dec 31 - Rajab (5M) - son of Reza & Radwan

Ash Sharqiyah:

Jan 01:  Nabil Ahmed Mohamed (8M) - from the village of Hrbit belonging to Aboukbir center - has tested negative

Al Qalyubia:

Jan 01:  Safaa Mohamed Abdul Razek - nurse in the health unit - village of Al Alzm belonging to Shibin El Kanatar center

Al Gharbiyah:

Jan 01:  "34 years" policeman
Jan 01:  Huda Khaled (1M?)

 

Two of the suspect cases reported this morning (highlighted in red) are reported as a nurse and a police officer. Whether their infections have anything at all to do with their professions is not known at this time. However, anyone who works in a profession that requires close contact, such as a nurse, or as a police officer's often does, requires us to be alert to the possibility of contracting or spreading (or contracting and then spreading) the disease in the performance of those duties.

It is now well understood that the very people who come to our aid are also perfect communicable disease spreaders themselves. While we have long understood the role of health care professionals and their spreading germs from patient-to-patient, the role of first responders in viral spread is just becoming widely understood in light of pandemic planning.

 

I would be remiss if I failed to point out that most of the above cases are still suspect cases at this time. As the days pass we may find that most, if not all, of the above are not infections of H5N1. Until that time, the situation is worrisome.

 

SZ <gratitude to Theresa42 and the other Flubie Newshounds>

Politics and bird flu are not a good mix

I make no secret of my disdain for the Indonesian Health Minister Mdm. Supari and her actions and policies regarding Indonesian samples of H5N1. Yesterday a "voice" from Indonesia was heard.

This from the Jakarta Post:

Politics and bird flu are not a good mix

Emmy Fitri, Jakarta

People will do so much to be called a hero, even if it's too late or way too early to be one. That's a dreadful afterthought having read an interview in the journal Nature with Indonesian Health Minister Siti Fadilah Supari.

In the interview, published online on Dec. 19, Siti explained why Indonesia has persistently refused to share its H5N1 virus samples with the WHO until it is assured of a vaccine supply in the event of a pandemic.

She was quoted as saying "Indonesia is open to international collaboration but this must be fair, transparent and equitable. The WHO's Global Influenza Surveillance Network system is obviously unfair and opaque. Samples shared become the property of the WHO collaborating centers in rich countries, where they are used to generate research papers, patents and to commercialize vaccines. But the developing countries that supply the samples do not share in these benefits."

With those strong words against the world, are we off the hook simply because we are be poor and bear the huge burden of a population over 220 million? Are we excused for being ungrateful after so long relying on the generosity of donors and international agencies in fighting diseases, including the big three -- AIDS, tuberculosis and malaria?

Most of all, is it the right time to challenge a long-standing protocol after decades of compliance? Why now? Why not 10 or 20 years ago, or next year?

By and large, are we really aiming at contributing to a better world by stubbornly holding the samples with one hand while the other hand fumbles about so clumsily for international aid?

[snip]

Isn't it natural that if we want to fly, we cannot just wait for angels to lend us wings? We have to learn how to make aircraft. There is so much to be done to show the world that we are not so poor and needy.

Preventing more deaths by educating the public about proper poultry handling is the top concern. Unlike diplomacy and politics, viruses don't discriminate. It is just irrelevant to bring up a political perspective in the name of the nation's dignity. The minister could have better used a little politics to butter up parliament members and provincial and regental officials in order to get more funds and resources to battle the virus.

[snip]

A tropical country, Indonesia is a hotbed for germs, viruses and bacteria. Yet people show scant awareness of good sanitary practices. They are not the only ones to blame for their ignorance, since apparently the government's development and education programs have not yet picked up on the fact that we are all living with lots of microbes.

Not only is there no effort to translate the threat of disease into public policies and educational content, but generally speaking, health issues are treated as second-class.

It's not surprising that Indonesia is so dependent on the private sector and the international community' generosity in containing diseases, even those endemic to this country. It stems from the government's failure to prioritize money and strategies to strengthen the health sector.

[snip]

Globally, bird flu has vaulted into the limelight because of fears that the H5N1 virus could mutate so that it can be transmitted from human to human, thus laying the groundwork for a pandemic.

The 1918 flu virus caused one of the worst pandemics in human history. It's frightening to think how quickly a disease spread through a cough or handshake might travel today, as people fly from one continent to another at the drop of a hat.

To imagine a pandemic hitting Indonesia -- heaven forbid -- is unbearable.

Do we need human vaccines in a time of pandemic? Even if we do, the global production capacity, currently estimated at less than 500 million doses per year, will never meet the need.

A down-to-earth effort which is less costly than waging war against the world must be devised. As recommended in the December Ministerial Meeting in New Delhi, non-pharmaceutical measures must be pursued vigorously.

[snip]

If anything has to be politicized, let's use political diplomacy to convince state officials that the threat is real and people's lives at stake because of their ignorance.

The author is a staff writer at The Jakarta Post.

 

How refreshing. It is also only one voice to counter HM Mdm. Supari and her fanning of Nationalist flames that have included blunt statements that H5N1 is a creation of the West, and specifically, the US.