A Journey Through The World of Pandemic Influenza

H5N1 Autopsies in Indonesia

One of the things experts, public officials, and Flubies have been dealing with is the lack of autopsies on those that die from H5N1 infections.  That lack has dramatically hindered our understanding of how the virus behaves and kills.   

In Indonesia, a predominately Muslim country, autopsies are extremely rare, as in almost never... ever.

Autopsies suggested in bird flu fight

National News - Tuesday, April 03, 2007

Emmy Fitri, The Jakarta Post, Jakarta

The national commission on bird flu has suggested the government conduct autopsies on all bird flu victims to better understand how the disease moves through the human body.

A panel of experts appointed by the commission said Friday that while the virus was primarily transmitted from birds to humans through the respiratory system, it spread through other organs, potentially resulting in fatal multiple organ failure. 

Indonesia has the world's highest number of human deaths from the H5N1 bird flu virus. As of last week, 71 people died in Indonesia of the disease. Seven deaths were reported in March alone. 

"There is no specific data on which of the (victims) died of multiple organ failure. Nor is there detail on whether it's a trend in the most recent cases. But experts are saying most of the 71 cases (resulted in multiple organ failure)," chairman of the National Commission for Avian Influenza and Pandemic Preparedness, Bayu Krisnamurthi said. 

Speaking after Friday's closed-door meeting with the expert panel, Bayu said postmortem examinations performed on infected chickens showed the H5N1 virus had ravaged all of the animals' organs as severely as it had the lungs. 

"In human cases, we haven't come so far (that we know) whether or not the virus is also spreading to other organs. Such a conclusion can only be reached through autopsies. It's really still a mystery," he said. 

Bayu said performing autopsies would "need careful further consideration", since the procedure was laden with significant religious, social and legal considerations. 

By law, only the police can ask for a family's consent for an autopsy on a dead body for investigation purposes. Religion is the main ground on which families refuse such requests.

The last time I remember seeing a figure it stated that only ten autopsies had been conducted on human victims world-wide.  That's 10 out of 170 WHO confirmed H5N1 deaths.

It is the 21st Century and the world is facing a potential threat the likes of which humanity hasn't seen since the Black Death in the Middle Ages and we are facing that threat ignorant of important information.  We do not have the information we need because of religious considerations.

I make a concerted effort to be respectful of all religions, but when the world faces this severe of a potential threat, a threat that could cost upwards of 100's of millions of lives, it is time, actually long past time, for religion to step aside, or more appropriately, step up, to help us all face it.

There are over one billion Muslims in the world today, a moderately severe influenza pandemic, along the lines of 1918, with a comparable mortality rate in developing countries, could see somewhere around 60 million deaths amongst Muslims.  Put another way, that's roughly twice the entire population of Canada.

[snip]

Bayu said the key to tackling the disease's high mortality rate was the early detection of bird flu infections and the immediate treatment of those showing the symptoms of avian influenza. 

Without giving an exact date, Bayu said the commission's panel of experts would compare the DNA sequences recovered from humans with those from poultry.

Any difference between the DNA sequences found from humans and poultry would signify that the virus had mutated. Scientists fear the possibility of a mutation allowing the virus to transfer from one human to another, which could trigger a deadly worldwide pandemic.

Let us hope that the unspecified date is not too terribly far in the future.  And equally important, let us hope they don't find anything newsworthy.

 

SZ

H5N2 in West Virginia

Today it was learned that turkeys on a commercial farm were found to be infected with Low Pathogenic H5N2.

I am, in no way, concerned about this outbreak of H5N2, in and of itself.  It is not at all unusual, or unheard of that we would have an Avian Influenza outbreak in any one or a number of our commercial poultry farms.  It has happened in the past, and it will certainly happen again in the future.  What does concern me is the apparent Ho-Hum treatment of this event.

There is a reason why domestic poultry is culled.  Any Avian Influenza has the capability of turning into a Highly Pathogenic variety and we don't know the why's behind the switch.  But it begs the BIG QUESTION...

How, exactly, are these birds, in what are supposed to be bio-secure facilities, getting infected?  It happens periodically, and is treated as a "cost of doing business", but I would have assumed (oh how I HATE that word) that with the threat of H5N1 hanging over the heads of these commercial operations that bio-security would rival a NASA lab, and in fact, we have been told just such platitudes and reassurances.

 

Likely low-path bird flu found in W. Virginia: USDA

Turkeys at a farm in West Virginia have tested positive for what government officials believe is a low-pathogenic strain of the bird flu virus, the U.S. Agriculture Department said late on Sunday.

Preliminary tests indicated the turkeys had a low-pathogenic H5N2 avian influenza virus. USDA officials said they can say "for certain" it's not the highly pathogenic H5N1 virus that has spread through birds in Asia, Europe and Africa.

A spokesman with the West Virginia Department of Agriculture would not identify the farm but said it was located in Pendleton County in the east-central part of the state.

"Every indication is that the virus is consistent with low pathogenic strains of avian influenza, or LPAI, which are commonly found in birds and typically cause only minor sickness or no noticeable symptoms," USDA Chief Veterinarian John Clifford said in a statement.

He added the detection in West Virginia should not "significantly impact" exports of U.S. poultry.

The samples were collected by an industry group as part of a routine before slaughter, USDA said. The birds showed no sign of illness or mortality. The samples were collected on Friday from a flock of about 25,000 birds that will now be destroyed to prevent the virus from mutating and spreading.

A low-pathogenic strain, which produces less disease and mortality in birds than does a high-pathogenic version, poses no threat to humans.

Continues at link...

 

From Wikipedia's entry on H5N2...

Japan's Health Ministry said May 11, 2006 that 93 poultry farm workers near Tokyo may have been exposed to H5N2 (which was not previously known to infect humans) in 2005. "Preliminary tests on the workers were positive for H5N2 antibodies, indicating they were previously exposed, Takimoto said. While exposure carries with it the possibility of infection and illness, he said none had positive for the virus itself or had developed flu symptoms. About 5.7 million birds have been destroyed in Ibaraki following the H5N2 outbreak

So, H5N2 has a demonstrated ability to infect humans, although at present there is no indication of disease of any consequence.  But, as H5N1 has so often demonstrated, what was true yesterday may not be true tomorrow.

 

This is a snip from the USDA's site, the entire page on Avian Influenza can be found here.   While today's news deals with Low Pathogenic H5N2 and the USDA snip deals with the Highly Pathogenic variety it demonstrates that infection is not heard unheard of, and HP H5N2 is also no stranger to the US.

Historically, highly pathogenic strains of avian influenza have been detected in domestic poultry populations three times in the United States: in 1924, 1983 and 2004. There have been no occurrences of highly pathogenic avian influenza in wild birds in the United States and no significant human illness resulted from any of these outbreaks.

• The 1924 H7 outbreak was contained and eradicated in East Coast live bird markets. 
• The 1983-84 H5N2 outbreak resulted in the destruction of approximately 17 million chickens, turkeys and guinea fowl in the northeastern U.S. to contain and eradicate the disease.
• In 2004, USDA confirmed an H5N2 outbreak in chickens in the southern United States. The disease was quickly eradicated thanks to close coordination and cooperation between USDA, state, local and industry leaders. Because of the quick response, which included quarantine and culling of birds, the disease was limited to one flock.

 

And finally, as if by the Grace of Providence, it was announced today that Bernard Matthews will not have to answer, in any legal sense, for the H5N1 episode in the UK of recent.

 

FURY AS BERNARD MATTHEWS IS 'CLEARED' OVER BIRD FLU

Monday April 2,2007

Geoff Marsh for express.co.uk

 

---

 

BERNARD Matthews is to escape prosecution for the bird flu outbreak which hit Britain last month. 

Food Standards Agency investigators were examining possible failings at the site in Holton, Suffolk, but found “insufficient evidence” for legal action.

The FSA probe was focused on food waste storage at the Bernard Matthews plant.

A Department for Environment, Food and Rural Affairs report published in February listed a catalogue of failings at the turkey plant.

Inspectors saw gulls feeding on meat scraps left in uncovered waste bins and polythene bags used for meat products left in open bins.

But the Food Standards Agency today said its probe had found “no evidence” that the firm breached animal by-product or food hygiene laws.

The watchdog said in a statement: “We have carefully scrutinised and considered the evidence in this case and concluded there is insufficient evidence to provide a realistic prospect of conviction.

Continues at link...

I am compelled to point out that just because a law or regulation is not in place, on the books, to deal with the gross mismanagement on the part of Bernard Matthews doesn't mean that they did things the proper, safe, and responsible way.  Just in ways that are not currently actionable.  I certainly hope that the regulatory agencies, in all countries, are addressing the egregious errors made.   

It also points out that no matter how safe you think things are, or should be, it isn't always the case in fact.

 

SZ

Influenza Pandemic Vaccines

As has been widely reported, Indonesia reached an agreement with WHO to resume the sharing of H5N1 samples for analysis and research.  They did not, however, agree to any usage in vaccine development, as that part of the agreement still needs to be worked out.  While I was surfing around for the latest tidbits I checked NewScientist.com for their latest and came across an after issue publication story on the Indonesian agreement.

[snip]

It could take some doing. Virtually all flu vaccine is made in rich countries, which have laws prohibiting its export in an emergency. So poor countries hit hard by H5N1 are effectively sending virus samples to develop pandemic vaccines that they may never have access to.

There is not much more to the story than what is publicly available, but it does restate the problem of getting vaccines out of the countries where they are manufactured during a time of crisis.  A pandemic is a time of emergency, even a relatively mild pandemic.

 

I have been operating on the assumption that the vaccine that the US has contracted for will not likely make it to us should the pandemic happen because a country, any country, would likely insist that their citizens are vaccinated prior to any vaccine leaving their borders.  For some reason the "assumption" and "likely" withholding is conceptually different to me than finding out that there are laws enforcing this.  That it's not really assumption or likely but more of a certainty, something that should be written into the response plans of our governments and essential services providers.  In case you didn't know, it's not, it it were, they wouldn't be contracting for the purchase(s) in the event of a pandemic.

We need to start understanding the fact that the only chance we have of protecting HCW's, Police, EMS, Firefighters, and Essential Services and Infrastructure workers is to start bringing in a Pre-Pandemic vaccine NOW.  While the US does have a small strategic supply of Pre-Pandemic Influenza vaccine, some of it is loosing potency due to aging, and this is the vaccine that proved to only be about 40% effective to begin with, and some of it requires massive doses of antigen to gain the presumptive levels of presumed immunity to H5N1. Plus, most of it is in the hands of DOD (Dept of Defense), who will be in desperate need of it since everyone will be looking to the military to provide all manner of services when the private sector falls flat on its face.

Even as slow as vaccine development is, there have been major strides made in the last year.  Baxter has released news of its candidate vaccine that looks very promising, but it is a Press Release, so of course the slant is on the positive side, but I tend to smile and welcome any positive news on the vaccine front...slant or not.

Baxter International, Inc. (NYSE: BAX) has officially announced the completion of phase I/II testing for its adjuvant-free investigational pandemic H5N1 influenza vaccine. Having finished Phases I and II, they are ready to begin Phase III, which entails testing their vaccine on the general public to insure the safety and efficacy of this vaccine.

Baxter’s Bird Flu vaccine has proven very effective in Phase I and II studies already, and it shows promise as the only vaccine that fights multiple strains of influenza, as opposed to the seasonal flu vaccines we are used to. This means that the vaccine can be used as a preventative agent rather than a treatment.

Baxter’s new influenza vaccine is one of the only vaccines to use the Vero cell-based system. This means that the vaccine will not be using an adjuvant to stimulate the body’s immune system. Instead, the vaccine is effective enough on its own, even in small doses, to prevent influenza without additional stimulants. So far the vaccine tested with a 76.2 success rate of neutralizing antibodies by day 42, and this is without an adjuvant.

According to Dr. Hartmut Ehrlich, vice president of Global Research and Development for Baxter's BioScience business, “These preliminary results suggest that the vaccine produces a highly immunogenic vaccine with a favorable safety profile without the need for an adjuvant to boost the immune response. Adjuvant can add considerable cost and may have a negative effect on tolerability.” 

Continues here.

 

Incredibly, sadly, criminally, insanely, the US does not have the vaccine manufacturing capacity to address the needs of its citizens.  We purchase most of our vaccines from manufacturers based in other countries.  Those countries will not be overly anxious to send vaccine our way if, and when, a pandemic happens, and as pointed out in the opening of this post, they may not be able to by law.  This is the very reason that I have become such a supporter of the Pre-Pandemic vaccine.  While not perfect, it will be leagues better than a whole bunch of nothing.

A post from FuturePundit almost a year ago...

2006 June 18 Sunday

Support Builds For Pre-Pandemic Vaccination

One of the problems with use of vaccines to stop a flu pandemic is that it takes many months to develop and manufacture vaccines against a new flu strain. Even worse, the manufacturing capacity for making vaccines is woefully inadequate for the case of a global pandemic. In a pandemic the need for vaccine would go up over an order of magnitude and the current process for making flu vaccine is hard to scale up. One way to partially solve this problem would be to manufacture vaccines in advance using flu strains that are not exact matches for an eventual pandemic strain. Support for pre-pandemic vaccine production is building.

"People are taking pre-pandemic vaccination seriously," says Derek Smith at the University of Cambridge. In May, a meeting of scientists and manufacturers at the World Health Organization in Geneva, Switzerland, recommended the development of vaccines that could be used to inoculate people before a pandemic takes hold. These, they said, must have long-lasting effects, and be "broad-spectrum" enough to work against whatever pandemic virus emerges. Several novel vaccines that do both are now close to testing in humans. They include the addition of immunity-stimulating chemicals called adjuvants, vaccines made of DNA instead of the virus itself, and perhaps the ultimate - a vaccine that protects against every kind of flu.

While there is no way of knowing before a pandemic starts exactly how well the vaccine will work, the risks of doing nothing could be far greater. "Stockpiling pre-pandemic vaccines is more valuable than people realise," Robert Webster of St Jude Children's Research Hospital in Memphis, Tennessee, told a flu conference in Singapore last month. "It may not necessarily protect you from infection, but it will probably stop you dying."

I've been in favor of this idea for years and continue to think that movement in the direction of developing pre-pandemic vaccines is too slow. The problem with pre-pandemic vaccines is that they won't be an exact match for whatever strain of influenza eventually becomes pandemic. But if an H5N1 avian flu strain mutates into a human pandemic strain then even a vaccine made from a different H5N1 strain will provide partial immunity to the pandemic strain. That partial immunity might some day save millions of lives.

The article reports on promising advances in DNA-based vaccines and in adjuvants (which amplify immune system response to vaccines). Production of DNA vaccines could be scaled up much more rapidly than the current chicken egg-based vaccine manufacturing process.

By Randall Parker    2006 June 18 10:29 PM

 

I'm sorry to report that we are not much better off today than we were when Mr Parker wrote the above piece.  Perhaps the Pandemic after next will see us better prepared and more capable of thinking outside the box, because this (potential) pandemic not only finds us not able to think outside the box, we can't even seem to see over the top, a box officialdom is so comfortable in they don't even know that's where they are residing.

 

SZ (Still as vaccineless as the average Indonesian)

Indonesia Agrees to Share H5N1 Samples

The AP is running a story that Indonesia has agreed to end its H5N1 boycott of sharing its H5N1 samples.

Indonesia will resume sending bird flu virus specimens to the World Health Organization immediately, the health minister said Tuesday, ending a four-month standoff health officials feared could potentially put the entire world at risk.

If Indonesia acts according to this agreement the world will be gaining a clearer picture of the ever evolving situation.  Why, exactly, is it important that Indonesia make these samples available to the world's influenza researchers, after all, there is no shortage of countries where they can, and do, get samples.  It's all a matter of how important you view the potential "ifs" to be.

If it is reasonable to believe that H5N1 stands a reasonable chance of mutating into a form capable of being passed from person-to-person then it is equally reasonable to need to keep as close an eye on its "doings" as we can.  Humanity is lucky (this time), we have singularly focused, dedicated experts devoting all of their knowledge and technical expertise to watching, analyzing, and contributing to an ever expanding understanding of Avian Influenza, pandemic issues, and potentials, but without viral samples a large piece of the puzzle is missing, and Indonesian samples consist of a large portion of that large piece.

I have no sympathy for Indonesia, nor do I accept their justifications for withholding vital samples from those that need them.  The vast majority of the collective effort amongst the experts, labs, governments, and yes, even for profit private enterprises, is directed at helping the world, the entire world, Indonesia included, beat H5N1, and if not beat it, then at least face it as well armed as humanly possible. 

It is also difficult for me, personally, to have sympathy for Indonesia, after all, I am in exactly the same vaccine-less state as the average Indonesian.  But, unlike the vocal Indonesian authorities, I understand the limits of our knowledge, capabilities, and capacities.  Do I like those limits?  NO.  Do I sit on my rear end and whine about it, pointing an accusing finger at everyone else?  NO.  I get said rear end in gear and do what I am capable of, all that I am capable of, to protect and prepare myself, and my loved ones.  I expect no less from any government that presumes to label itself a government, or should that read "pretends to be a government"?

When facing a challenge of the magnitude of a potential severe pandemic, where millions, and even an outside chance of some portion of billions, could sicken and die, we must all do what we are capable of doing, whether individual, company, organization, and yes, even government.  Period.

So, while I applaud and celebrate Indonesia's announcement to resume viral sharing, it is only doing the barest minimum of what it is morally obligated to do.  Just like the developed world is morally obligated to offer what assistance to Indonesia it is capable of offering, which in the face of a severe pandemic is pitifully little, but sometimes a little is the difference between life and death, and there lies the moral part of that obligation.

 

 

Vietnam: H5N1 and a Game of "Craps"

As the original Hot Spot for H5N1, both in humans and in domestic poultry, any word that the hard learned lessons of the past have been forgotten or deliberately ignored is distressing.

Perhaps no amount of care and caution would make a difference but it would seem to be in the best interest of the peasant farmers to guard their flocks, which are, after all, their livelihood.  If an outbreak were to reoccur, their flocks would once again be ruthlessly culled, and yet the picture this article paints is one of either total ignorance of the threat, which I find impossible to believe, or total indifference.

Why would there be indifference?  If there is, and I'm not saying that this is what is behind the laxness, but, perhaps, the Vietnam H5N1 eradication program is a victim of its own success.  Should an outbreak occur in a flock experts will swoop in, cull the flock, place everyone on prophylactic Tamiflu, pay the peasant farmer for loss of the poultry and everyone is just fine.  So, what would really motivate a peasant farmer to be diligent and practice whatever measures of biosecurity that could be utilized on a peasant homestead in the hinterlands of Vietnam?  Well, that's the 684 billion dollar question, isn't it.

Mekong Delta duck farms lax about bird flu precautions A study in Dong Thap province in Vietnam’s Mekong Delta has found that around 90 percent of duck farms there fail to meet sanitation standards despite the threat of bird flu, a government official said Tuesday. Deputy Minister of Agriculture and Rural Development Bui Ba Bong also said local authorities failed to ensure that eggs bought by these farms went through the quarantine system. The study, commissioned by the ministry to review poultry farming activities since a two-year ban was lifted this month, discovered some farms bought eggs without certificates of origin. In north Vietnam too, sales of unchecked chicken have increased. Authorities in six provinces seized last week and culled 60,000 eggs, almost six tons of chicken meat, and 6,000 fowls after their owners failed to furnish papers showing their origin. Bong warned provinces that the risk of a new bird flu outbreak remained high though no new cases had been reported in the last 21 days.

You may have chuckled when I mentioned "biosecurity" and "peasant farmer" in the same sentence.  Yes, it is certainly an oxymoron when thought of by a citizen of the 21st Century Industrialized portion of the world, but what term do  you apply to common sense precautions and animal husbandry?

Surely, washing away goose excreta with a garden hose whilst walking barefooted through the puddle is not only not common sense biosecurtity, it is down right stupid, insane, ignorant... insert your adjective.

These snippets from Fluwikie.com page on H5N1 Resources....

• 0 deg C/32 deg F = more than 30 days Poultry Health Services Ltd
• 4 deg C/39 deg F = 35 days WHO Factsheet
• 17 deg C/63 deg F = 207 days Persistence of avian influenza viruses in water maybe not be specifically H5N1
• 22 deg C/71 deg F = 4 days Poultry Health Services Ltd
• 28 deg C/82 deg F = 102 days Persistence of avian influenza viruses in water maybe not be specifically H5N1
• 37 deg C/98.6 deg F = 6 days WHO Factsheet

[snip]

For the highly pathogenic form, studies have shown that one gram of contaminated manure can contain enough virus to infect 1 million birds.
Highly Pathogenic Avian Influenza by USDA Animal and Plant Health inspection Service (APHIS)

For some reason I had the image of a game of Craps enter my mind as I was contemplating the name of this entry which might shed light on the inspiration of its title.  I may never be able to view a set of dice again without seeing Duck poop.

The Gates Foundation and PanFlu Vaccines

I just love it when someone understands that government is not always the answer to every problem the world faces.

I sincerely hope that The Gates Foundation, and the un-named other organizations really do step up to help address this, as yet, intractable problem. 

Need I say that it has often been lamented around the Flubiehood that Bill Gates/The Gates Foundation was silent on PanFlu issues and that he had the money to build any number of vaccine plants.  It's the physical plants and production capacity that is at the heart of this problem, there just aren't enough of them. 

Given the Gates Foundation's interest in chronic health conditions in Africa, and specifically AIDS, much of what they could do to help the world face PanFlu would be directly translatable to their other charitable endeavors.

Bravo Bill and Melinda Gates!

Bird-Flu Goal Scrutinized

By Nicholas Zamiska

JAKARTA, Indonesia -- Several organizations, including the Bill & Melinda Gates Foundation, are considering funding a stockpile of bird-flu vaccine as one possible way to ensure access for people in developing countries most at risk of dying from the disease.

The idea of creating a global vaccine stockpile has come to the fore at a meeting the World Health Organization has called here in Jakarta. The meeting aims to bridge an impasse that emerged earlier this year after Indonesia's government decided to withhold sharing its samples of the avian-flu virus.

A Double Threat...but not really

This piece hit the internet Friday.  At first it sounds quite alarming, but it isn't.  It isn't alarming because it is nothing new.  As you (hopefully) think about what this article is saying it would be helpful to remember that Thailand is actively attempting to ride Indonesia's coattails in extorting PanFlu vaccine from the developed world.

The officials quoted in this article are utilizing nothing more than "scare tactics" and "fear mongering".

 

The Nation (Thailand) March 24, 2007

Experts See Double Threat From Flu Strains

Experts yesterday voiced concern over the possibility that the two different genotypes, called "sub-clades", of the H5N1 bird-flu virus found in Thailand could meet and merge into an unknown and "unpredictable" mutated form.

Chulalongkorn University has found that a virus sample from Nakhon Phanom province in the Northeast was of a strain newly observed in Thailand and more closely related to H5N1 strains that have been circulating since 2005 in southeast China.

In contrast, H5N1 samples from Phichit province in the lower North region were similar to the cluster of samples isolated during 2004 and 2005 outbreaks in Thailand and Vietnam, said Professor Yong Poovorawan, author of the Chulalongkorn University study.

The viruses isolated from Phichit belonged to genotype Z, whereas the virus isolated from Nakhon Phanom belonged to genotype V, he wrote in his report.

The latest bird-flu outbreak, in the Northeast province of Mukdahan, has raised concerns that the genotype V virus from the Northeast could spread to meet with the genotype Z virus endemic in the lower North and Central region, said veterinarian Rakthai Ngampak, head of the Department of Livestock Development's Bird Flu Control Centre. Although the results of DNA sequencing of the virus samples taken from Mukdahan are yet to be known, it is very likely that they are the same strain found in Nakhon Phanom, given the way the virus killed poultry, Rakthai said.

Yong and Rakthai agreed that the consequences of a new strain of H5N1 emerging from the mixing of the two genotypes might or might not be serious.

However, Professor Pilaipan Puthavathana, a virologist at Mahidol University's Siriraj Hospital, said: "It won't be good if the two genotypes meet and mix.

"That will create an extraordinary virus with unknown and unpredictable dangers," she said.

Scientists would have to start studying the new virus from scratch, though the existing vaccine could work well against the new strain, Pilaipan said.

Rakthai said various measures were needed for blocking the spread of the Northeast strain to other regions, particularly the Central region. Bird-flu screening measures carried out during past outbreaks did manage to intercept certain infected poultry, he added.

However, there are other ways the virus could spread besides infected poultry, including migratory birds, he said.
"Since we cannot control the migratory birds, what could be done is keep the poultry away [from them] in closed farms," he said.

The problem is a lot of poultry is raised outdoors, including free-range ducks, backyard chickens and fighting cocks, Rakthai said.

As a result active laboratory surveillance is very important to provide warning signs of the two genotypes getting mixed, said Yong.

Arthit Khwankhom
The Nation

H5N1 has had the two main genotypes V and Z for quite some months now.  The "V" is the one so well studied from Vietnam and the "Z" is what the Cyber Flu Community usually refers to as the Qinghai strain.  "V" is deadly, but "Z" is frightfully deadly, and experts around the world are diligently and frantically studying both to gain a better understanding of each.

On the forums it has been discussed that there are roughly 2,400 different identifiable variations of H5N1, each unique, but that's the nature of influenza, a virus known for its rapid mutation.  There is nothing intrinsically frightening about "V" and "Z" meeting up and swapping genes or even polymorphisms.  Both genotypes are H5N1, both are wholly avian in nature, both are killers, neither has gained the ability to easily transmit from person to person.  But voicing the "possibility" of them creating a "third" genotype sounds alarming as hell, and guess what, Thailand could be the epicenter of this new and improved "Frankenvirus" if...IF...the world doesn't give Thailand that vaccine it feels it is entitled to.

 

The problem is that Thailand is trying to scare the world into giving them a vaccine that doesn't exist yet.  Yes, there is the legitimate worry and complaint that vaccines will go to wealthy nations that can afford to pay for them while poor countries, Indonesia and Thailand amongst them, will have none. 

The fallacy to that lament is, as stated elsewhere in this blog, is that even countries that are willing and able to pay for a vaccine will not see any for an extended period should a moderate to severe pandemic happen.  There just isn't enough manufacturing capacity in the entire world to meet the demand.

Also, as previously stated, the likelihood of any country releasing a vaccine to another, whether contracted and paid for, before all of their citizens are inoculated is somewhere around that proverbial slim and none.  See the chart below for all the countries planning to purchase vaccine, the demand will far outstrip the supply.

From the UN & World Bank's report on Responses to Avian and Human Influenza Threats: Progress, Analysis and Recommendations

(The blue bar represents countries planning to manufacture their own vaccine, the purple bar represents countries that plan to purchase it from another country)

 

OK... so I'm going to ask the Politically Incorrect question, someone has to, and I am not known for shying away from painful truths.

Does being a poor, mismanaged, corrupt country (read government) entitle it to vaccine before any other country?  Should the US, Britain, Saudi-Arabia, and many others, go to the back of the line because we/they are willing and able to pay for something? 

Tough questions... glad I don't have to make the decisions.

 

SZ (Still as vaccineless as the average Indonesian, and now Taiwanese, citizen)

My Government's Valuation of Me in a Pandemic

This from Forbes.com...

Associated Press
Lawmakers OK $870M for Bird Flu Vaccine
Associated Press 03.22.07, 12:03 PM ET

The Department of Health and Human Services would get $870 million this year to fund vaccine development and prepare for a bird flu epidemic under a bill approved by the House Appropriations Committee.

That's an incredible $2.90 per person in the US, in toto, and don't ya know, there is always huge overhead, so that stunningly generous two dollars and ninety cents per person in reality is going to be a whole lot less.

The committee, chaired by David Obey, D-Wis., approved the bird flu funds by a 36-28 vote late last week as part of a supplemental fiscal 2007 spending bill for the Defense Department and other agencies.

So, let's see... added to the 2006 Budgeted amount of around one billion dollars we arrive at somewhere around $6.25 per person to fund Pandemic Influenza Mitigation and Research.

In 2006, the government awarded more than $1 billion to drug companies to research and develop bird flu vaccines. In January this year, HHS awarded $132.5 million in bird flu program contracts to British drug maker GlaxoSmithKline (nyse: GSK - news - people ) PLC, Novartis (nyse: NVS - news - people ) AG and Iomai Corp. (nasdaq: IOMI - news - people )

Vote for the spending bill have yet to be scheduled. The bill must be approved by the full House and then the Senate before becoming law.

In fairness, I always get cranky during the time I fortify myself to pay Uncle Sam our short-fall of our annual tribute (Federal Taxes).  Added to that crankiness, I am watching gas prices rise on an almost daily basis and every time I look at the price per gallon I think about the taxes that I pay as part of that per gallon price.  The Federal portion is 18.4 cents per gallon...in case you didn't know, states vary, so you will have to look up your own if you are interested.

Between FIT, FICA and MC Uncle Sam steals a usurious amount of my household's gross income.  As Dual Income Empty Nesters we belong to that much reviled group of people known as "The Evil Rich", although decidedly middle-class in reality... 'cause Uncle Sam takes too much of that Dual Income.

Of our direct transfer payments we are going to receive the benefit of the $6.25 in PanFlu Mitigation funding. Put another way, that's 0.00031 of our direct transfer payments, which doesn't include the various and sundry miscellaneous Federal Taxes that we pay throughout the year, such as per gallon of gas, federal telecommunications taxes, etc.  And, by the way, those Federal Excise Taxes that we pay on gasoline add up to roughly $277.00 annually in my household.

Since I am a Libertarian, that's with a capital "L", it would not be within my political, or otherwise, philosophy to sit here and say that I am not "getting my fair share" but when I look at the inequity of what we have taken from us vs what we receive I am sorely tempted... especially this time of year and while contemplating the ramifications of a severe pandemic of H5N1 with the woeful lack of meaningful governmental mitigation preparations.

PS: For all you nosy people with nothing better to do, you can not arrive at our GI by the figures supplied, so I thought I would spare ya the effort.

Pandemic Vaccine Politics and Posturings

Indonesia has been playing tough on the virus samples front for awhile now.  One of the clades used in the current vaccine formulation testing and pre-pandemic stock-piles is the Indonesian Clade.  They have claimed ownership to this virus Clade as it is their citizens catching it and in over 70% of the cases dying from it. 

Do they have the "right" to withhold the virus samples from the rest of the world?  Sure.  It occurs within the boarders of their country.  China denies the world H5N1 samples regularly and has a very long history of doing so, why should we be shook and shaken when another country realizes that it is within their "rights" to do so as well?  We'll not worry about the fact that should the pandemic happen it will effect the entire world, not just the "Rich Selfish Western" portions of it.

Reuters Wednesday, March 21, 2007; 4:22 AM

JAKARTA (Reuters) - The inability of poor countries to get vaccines in the event of an influenza pandemic could threaten world peace, Indonesia's health minister said on Wednesday.

Siti Fadilah Supari said the virus-sharing scheme under the World Health Organization system did not guarantee poor countries access to vaccines and urged developed countries to help the developing world with the technology to produce them.

"If the rule is not changed there will be a huge gap between rich and poor countries and this will perhaps threaten world peace," Supari told reporters.

"If we want the world to be a harmonious place, the poor should be helped with the technology. If the situation remains like this poor nations will become poorer, sicker and more helpless." Indonesia, the nation worst hit by avian influenza with 66 deaths, has created a controversy by saying it will only share samples of the H5N1 avian influenza virus if it has guarantees they will not be used to make vaccines that will profit a company or another country.

Some health and aid agencies criticized Indonesia for refusing to share samples, while others defended the stance because developing countries often struggle to get access to life-saving drugs due to patent laws and high costs.

"Do poor and developing countries have to be sacrificed just because they don't have the technology because of ignorance and poverty?" Supari asked.

Sharing of virus samples is crucial as it allows experts to study their make-up and map the evolution and geographical spread of any particular strain. Samples are also used to make vaccines.

WHO and health ministers from the Asia-Pacific region are due to meet in the Indonesian capital, Jakarta, from March 26-27 to sort out the best ways of making sure companies can make more vaccines against influenza, and that these vaccines will be available to all who need them.

The H5N1 avian flu virus has swept through poultry across Asia to Africa and Europe. Experts believe it could mutate into a form that would easily pass from one person to another, killing tens of millions in months.

Few companies make vaccines, and total world capacity is only about 300 million to 400 million doses of vaccine a year -- far below what would be needed in a pandemic.

And that's vaccines at the normal dosage of antigen.  The H5N1 vaccines are proving to need eighteen times the antigen as a yearly influenza vaccine without adjuvants to even approach acceptable success levels of immune system response.  This means that however much the antigen needs to be increased is however much the world's yearly capacity is reduced.  Even with the adjuvant, we are back to roughly the amount of antigen that a seasonal vaccine requires, meaning there is no increase from the baseline in supply.  Since there are over six billion humans facing a possible pandemic, it is easy to see that not just the poor countries, and their citizens, will be facing the viral tsunami without benefit of vaccination.

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17 February 2007 From New Scientist Print Edition.

Editorial: Self defence over bird flu is no crime

[snip]

Everyone in the vaccine business knows that when a pandemic appears, countries with vaccine factories will ensure their own citizens are catered for before any vaccine gets exported. That is what happened in the swine flu scare in the US in 1976. If a pandemic does begin, countries without factories will probably not receive vaccine in time for the first wave.

That means even the citizens of the United States.  Until 2009 we have a grand total of ONE vaccine manufacturing plant.  Our vaccine plan consists of purchasing it from companies with plants in other countries, France, Germany, Canada, Britain.

......................................................................................................................

From the World Health Organization (WHO)

H5N1 avian influenza – first steps towards development of a human vaccine

12 August 2005

On 6 August, government scientists at the US National Institute of Allergy and Infectious Diseases announced results from initial clinical trials of a vaccine being developed to protect humans against infection with H5N1 avian influenza. Preliminary data indicate that the experimental vaccine evoked an immune response in a small group of healthy adults.

Although more trials are needed, the new findings reconfirm the feasibility of developing an H5N1-specific vaccine.

H5N1 is presently considered the most likely virus to ignite the next pandemic. The increasing spread and evolution of H5N1 viruses in Asia have brought the world closer to another pandemic than at any time since 1968, when the last of the previous century’s three pandemics began.

Vaccines are the principal medical intervention for protecting individuals against pandemic influenza. If available rapidly and in sufficient quantities, they can reduce the morbidity and mortality that have traditionally made pandemics such socially disruptive as well as deadly events.

However, many problems need to be resolved before vaccines can assume such a role in mitigating the effects of the next pandemic. The most important need is to find vaccine formulations that make the best use of limited antigen supplies.

Antigen is the component of the vaccine that elicits an immune response. The US trial provides important insight into possible vaccine formulations. It used doses that are higher than the amount of virus antigen contained in influenza vaccines produced yearly for normal seasonal epidemics.

Strategies for stretching limited antigen supplies – by adding an adjuvant to the vaccine formulation or injecting the vaccine into the skin rather than into muscle – have been proposed. Adjuvants are chemicals that can be added to the vaccine formulation to boost the immune response, theoretically allowing the use of smaller doses of antigen to achieve an immune response. Such antigen-sparing strategies using adjuvants are currently being tested by several manufacturers, and preliminary results are expected within the next three months.

At present, 90% of production capacity for all influenza vaccines is concentrated in Europe and North America in countries that account for only 10% of the world’s population. Current global manufacturing capacity (estimated at 300 million doses of regular trivalent influenza vaccine per year) is inadequate to meet the expected global needs during a pandemic and cannot be rapidly augmented.

Influenza pandemics are unique infectious disease events that can spread to every country in the world within months, resulting in a high and universal demand for preventive and treatment measures. Pandemics thus throw into sharp relief inequities in global access to vaccines and other medical interventions during an emergency. Based on past experience,countries with local manufacturing capacity are likely to meet domestic demand for vaccines and other critical resources fully before freeing supplies for the export market.

Because the present total global manufacturing capacity for influenza vaccine is limited, any decision to manufacture a pandemic vaccine in large quantities prior to the start of a pandemic would, of necessity, compromise the capacity to produce vaccines for seasonal influenza. Seasonal epidemics of influenza predictably cause an estimated 250,000 to 500,000 deaths each year. In the current situation, the capacity to respond to seasonal influenza must be balanced against preparations for pandemic influenza. However, once a pandemic has been declared, all manufacturers would stop production of seasonal vaccines and produce only the pandemic vaccine.

WHO has produced advice on a broad range of preparedness measures that can be undertaken by countries, taking into consideration that adequate supplies of vaccine will not be available at the start of a pandemic in any country.

 

So whether Indonesia, Thailand, and this just in, ten other Asian countries realize it, there are a whole lot of people, roughly six billion of us, who will not see a PanFlu vaccine any time soon.  Of course, there is hardly anyone around who says it better than Revere at EffectMeasure :

[snip]

Everyone is arguing about a vaccine that doesn't exist and won't exist in enough quantity to supply more than a tiny fraction of the world's population -- or even a tiny fraction of Indonesia's population -- for years to come. Indonesia is playing a very dangerous game. Either technical develops or a shift to a pandemic strain outside of Indonesia could make their bargaining chip worthless at any time. Then their current negotiating stance would be tremendous weakness, putting them far down the line for any vaccine supplies that might exist.

SZ (As vaccineless as your average Indonesian)

Rift Valley Fever (RVF) in Tanzania

While I watch H5N1 and PanFlu issues, articles like this one remind me that people die everyday from exotic diseases and the world doesn't so much as bat an eye.  The Cyber Flu Community also watches outbreaks of this sort as it is believed that in the earliest stages of an outbreak, depending on the area, H5N1 could easily, and likely, be mistaken for a disease endemic to the area. 

When H1N1 first burst upon the world in 1918 it was frequently diagnosed as Dengue, cholera, plague, typhoid fever, or any number of other diseases, anything but the "flu".

Tanzania: Rift Valley Fever spreads, death toll up

DAR ES SALAAM, 20 March 2007 (IRIN) An outbreak of Rift Valley Fever (RVF) has killed 16 people and infected at least 100 in Tanzania, spreading to more regions, Health Minister David Mwakyusa said on Tuesday.

Mwakyusa said the central region of Dodoma was the worst affected by the mosquito-borne illness, which spreads from infected livestock to humans. The disease had also claimed lives in Arusha and Manyara regions, which border on Kenya, where a RVF outbreak killed at least 154 people between December 2006 and February 2007. Up to 41 people are still receiving treatment in hospitals in Tanzania after developing RVF symptoms.

Veterinary officials in Kenya have since reported that an ongoing livestock vaccination campaign has stemmed the spread of the disease in that country. A ban imposed by the Kenyan government on the slaughter of livestock in the affected areas has been lifted, but a restriction on livestock movement from 33 districts where cases of the disease had been reported is still in force.

Mwakyusa said there was no RVF vaccine for humans and advised the public to be careful when handling meat and other livestock products and the carcasses of dead animals.

"I am not asking you to avoid eating meat, but make sure that it is inspected by relevant health authorities. Don't eat nyamafu [dead animals] or sick ones. Avoid slaughtering animals when they are sick and about to die," Mwakyusa, a former professor of medicine, told reporters on Monday when he visited Dodoma.

Tanzanian authorities imported RVF vaccines from South Africa in February and embarked on a livestock vaccination campaign in affected areas in a bid to stop the spread of the disease.

The RVF virus is spread to humans from livestock via the aedes mosquito, which breeds rapidly during floods. It can be transmitted through contact with infected animal material, such as blood or organs. Consumption of milk, a staple for many pastoral people, is also thought to lead to infection. Symptoms in humans include bleeding through the nose and mouth, and liver failure.