Reports and Alerts on SARS, Flu and Pandemic Prevention.
The number of cases of the deadly bird flu virus is increasing around the world as scientists struggle to combat the disease that is now threatening to jump species and infect humans. The news comes as Britain confirmed its first ever case of H5N1 in a farm in Suffolk. More than 160,000 birds will now be slaughtered as the country's farming industry goes on high alert for more outbreaks.
As the authorities responded to the outbreak in Suffolk, local residents questioned why it had taken some 48 hours after the first chicks died last Tuesday for the government's Department of Food and Rural Affairs, Defra, to be informed. But there was also wider concern. Japan and Nigeria have reported a series of cases of the lethal virus, and China, Egypt, Russia, South Korea and Vietnam have also revealed outbreaks in birds and in humans in the past two months. Indonesia began a mass bird cull in the capital city of Jakarta last Wednesday. At least 164 people are now known to have been killed by the disease across the globe.
The rapid spread of avian flu can be traced to the fact that the H5N1 virus is mutating as it spreads through birds and a variety of mammals including cats, tigers and pigs, said Robert Webster, a researcher at St Jude Children's Research Hospital, in Memphis, Tennessee.
Last night British health officials insisted the risk to the public was still negligible. It set in motion a series of emergency measures aimed at halting the spread of the disease among poultry in Britain. All the turkeys on the affected farm at Holton near Lowestoft, the largest poultry centre run by the breeder Bernard Matthews, are now being culled. Yesterday, piles of slaughtered birds were being scooped into open tractor trailers before being removed for incineration.
An exclusion zone of three-kilometres (nearly two miles) has been set up around the farm. All poultry in the area are to be kept indoors and tested for the H5N1 virus. A further 10km zone has been established in which all movements of poultry are banned, and last night another 2,090sq km restriction zone was created to isolate poultry from wild birds. Other measures will include a ban on bird shows, poultry markets and pigeon racing. This follows a decision by Defra to revoke the national general licence on bird gatherings.
Last night, the National Farmers' Union president, Peter Kendall, said his organisation had warned members to be vigilant. A spokesman for Matthews said his organisation could confirm there had been a case of H5N1 avian influenza at its Holton site. But he added: 'It is important to stress that there is no risk to consumers.'
Dr Andrew Landeg, the government's deputy chief veterinary officer, revealed he had called in ornithologists in a bid to understand how wild fowl - now thought to be the most likely source of the Suffolk outbreak - might have carried the virus into one of the 22 turkey breeding sheds at the farm. Officials also needed to know what other areas of the country might now be at risk of outbreaks.
Last night, it was revealed that Defra had identified several areas in Britain considered to be at particular risk of picking up H5N1 from infected wild fowl. The farm at Horton was one of them.
Avian flu expert Dr Colin Butter of the Institute of Animal Health said it was now crucial that veterinary scientists discover whether the farm was the first place this strain of flu had emerged. It could be that the outbreak was an 'unhappy chance event', or it could indicate a significant level of the disease in wild birds indigenous to the UK, which in turn would make the virus harder to stamp out. Exclusion zones and culling would not be sufficient to contain the virus, Butter added.
However, Landeg yesterday ruled out the alternative - the introduction of vaccinations for poultry, a measure already introduced in Holland - as being ineffective.
As a result, farmers with free-range flocks may face serious threats to their livelihood. However, one organic poultry producer said moves to house birds permanently indoors would be counter-productive. 'My birds are resistant to the range of diseases that affect conventional flocks because their immune systems have been boosted through living outdoors. I accept that as a new strain of bird flu, special measures may be required in the short-term, but these should not be at the expense of the principles of good husbandry.'
However, Landeg yesterday insisted that the disease could be contained. 'There's a good hope, if this is not the first case, we will be able to contain this disease.'
It was revealed last night that five people in Indonesia have died from the virus since the beginning of the year while Japan yesterday confirmed its fourth outbreak of H5N1 bird flu this year and Thailand has reported three outbreaks during the past month.
The meeting, "Seasonal & Pandemic Influenza 2007," a follow-up to a similar conference held one year ago, is focusing on the progress made to date in implementing pandemic flu preparedness plans at the national, state, and local levels, as well as in the business sector -- and how far we have yet to go to be ready for bird flu. This year's gathering will examine H5N1 epidemiology and surveillance, pathogenesis and treatment, vaccine development, impact on the health care delivery system, and lessons learned from the 2003 SARS outbreak in Canada. The meeting will also review the national response to seasonal flu in the U.S. -- less-feared than bird flu but currently a cause of greater morbidity and mortality.
"The pace of human H5N1 infections is accelerating but our plans to prepare for bird flu on a massive scale are moving at business-as-usual speed," said Richard Whitley, MD, co-director of the Center for Emerging Infections and Emergency Preparedness at the University of Alabama at Birmingham and meeting co-chair. "We don't want to cause bird flu panic, but we do need to have a sense of urgency as we move forward to respond to this public health challenge of potentially catastrophic proportions."
At a Senate hearing last week, the director of the Centers for Disease Control and Prevention, Julie Gerberding, MD, MPH, echoed this concern and urged states to ramp up preparations for bird flu by conducting state-wide simulations of pandemic scenarios.
H5N1 is a potentially lethal influenza A virus sub-type that mainly infects birds. Since 2003, however, an increasing number of humans have been infected. Initially, human H5N1 cases were restricted to countries in South East Asia, but infections spread dramatically in 2006, with many countries reporting cases for the first time. As of January 30, 2007, H5N1 has been reported in 270 people -- resulting in 164 deaths. Increasing numbers of infections could permit the virus to mutate into a form that is easily transmitted among humans. A recent study in the medical journal Lancet concluded that an influenza pandemic similar in virulence to the 1918 "Spanish" flu would today kill an estimated 62 million people worldwide.
"Seasonal & Pandemic Influenza 2007" will also focus on the U.S. response to the seasonal flu, which strikes up to 20 percent of the U.S. population each year, leading to an estimated 36,000 deaths and 200,000 hospitalizations. Seasonal flu issues to be highlighted include medical management in vulnerable populations, especially the elderly and newborns; updated guidelines for treatment; and innovations in flu diagnostics.
"We can do a much better job of preparing for seasonal and pandemic influenza," said Arnold Monto, MD, epidemiology professor at the University of Michigan's School of Public Health and event co-chair. "We already have the tools to reduce morbidity and mortality caused by all types of flu. Now is the time to make a concerted effort to put them to work."
State-of-the-art meeting speakers include some of the world's leading public health authorities on flu and infectious disease, including: Anthony Fauci, MD, National Institute of Allergy and Infectious Diseases/National Institutes of Health; Julie Gerberding, MD, MPH, Centers for Disease Control and Prevention; Bruce Gellin, MD, MPH, National Vaccine Program Office, U.S. Department of Health and Human Services; Michael Perdue, PhD, World Health Organization Global Influenza Programme; Frederick Hayden, MD, World Health Organization and University of Virginia; Don Low, MD, FRPC, Mt. Sinai Hospital, Toronto; and Robert Webster, PhD, St. Jude Children's Research Hospital, Memphis, Tennessee.
"Seasonal & Pandemic Influenza 2007" is endorsed by the National Institute of Allergy and Infectious Diseases, the Centers for Disease Control and Prevention, the American Academy of Pediatrics, the Infectious Diseases Society of America, and the Society for Healthcare Epidemiology of America. Unrestricted educational grant support for the event has been provided by Gilead Sciences, Roche Laboratories, GlaxoSmithKline, and BioCryst Pharmaceuticals, Inc.
SOURCE Seasonal & Pandemic Influenza 2007
WASHINGTON -- States should plan for a flu pandemic much as coastal areas gear up for hurricanes: You act differently when a weak Category 1 storm's heading in than when a powerhouse Category 5 is offshore.
The message is central to guidelines being released Thursday to help states prepare for the next worldwide outbreak of a super-flu.
Old-fashioned infection control -- nondrug measures such as voluntary quarantine or closing schools -- is a cornerstone of those preparations, which are attempts to slow a pandemic's spread until vaccines become available.
But it is far from clear how well those measures would work or if some could cause more harm than good.
An Associated Press look in December at the nation's preparations found little agreement on best policies, even among neighboring states.
The new guidelines from the Centers for Disease Control and Prevention will not tell states what infection-control steps to take. But officials familiar with the document say it urges a tiered response that ratchets up depending on how bad the new flu is in each community -- and reserves the most drastic actions for the worst outbreak.
Most preparations until now have focused on the worst-case scenario of a pandemic as severe as in 1918, when 50 million people worldwide died. But states should not race to close schools, for example, if the next pandemic is much less severe, like the one in 1968 that killed 1 million people.
"You kind of plan for the worst, but the odds are it won't be," said Dr. Robert Stroube, Virginia's health commissioner and president of the Association of State and Territorial Health Officials. "We're coming out with consensus so we don't have to reinvent it in every state throughout the country."
Federal health officials would not discuss important parts of the guidelines before their release Thursday.
But public health specialists cited one: During all but the least severe pandemic, when someone gets the new flu, everyone in that household voluntarily should stay home for seven days, That would help avoid spreading the virus before they realized that they, too, are sick.
This approach is called "voluntary self quarantine." Questions about who should hole up and for how long have been debated hotly. With the official definition, communities should determine how they would deliver food and other necessities to such families, said Jeff Levi of the Trust for America's Health.
It also should spur state discussions about stockpiling extra doses of anti-flu medications for family members to take during that week of quarantine in hopes of warding off infection, Levi added.
Pandemics can strike when the easy-to-mutate flu virus shifts to a strain that people never have experienced. Scientists cannot predict when the next pandemic will arrive, although concern is rising that the Asian bird flu might trigger one if it starts spreading easily from person to person.
Keeping society functioning normally as long as possible diminishes a pandemic's economic fallout, and minimizes unintended consequences of infection-control steps. Closing schools means adults lose work to care for children and does not help if older kids sneeze on each other at the mall.
"The challenge to this (taking such steps) is finding the sweet spot of when to turn this on and turning this off," Dr. Martin Cetron, head of CDC's quarantine division, said Wednesday in Atlanta as agency scientists conducted a drill to practice how they would respond to a bird-flu outbreak.
The question is how well CDC will be able to judge the severity of a newly brewing pandemic -- and then whether states and a worried public believe predictions that it will not be too severe, Levi said.
Federal officials are "concerned about pulling the trigger too fast" on these measures, he said.
Some states were developing similar tiered approaches, said Dr. Pascal James Imperato, a former New York City health commissioner who now directs public health at the State University of New York-Downstate Medical Center.
Thursday's document "elevates to a national level guidelines that can be used everywhere in the country," he said.
On the Net: Federal pandemic info: www.pandemicflu.gov
London (ANI): A new research has revealed that the difference between a flu virus that kills millions, and one that kills only a few comes down to just two amino acid changes.
The finding could allow scientists to stay one step ahead of a H5N1 flu pandemic, by screening for the specific mutations that would enable it to spread.
A new study investigating the difference between the 1918 pandemic flu virus - which killed at least 50 million people - and a virus which kills but does not spread, turned out to be two small mutations on the virus's surface.
Just two amino acids - the building blocks of protein - need to change on the virus's surface in order to allow it to spread easily between people, the researchers found.
Haemagglutinin, the main surface protein on flu viruses, binds to sugars on cells in the nose and lungs; the virus then enters the cells and replicates. Bird flu prefers a sugar called 2,3-sialic acid. Flu adapted to mammals attaches better to 2,6-sialic acid. Mammals have the 2,3 sugar deep in their lungs, but 2,6 in the nose and throat.
H5N1 prefers 2,3. It had been thought that that was why it causes a devastating deep-lung infection in humans, but does not spread between people, because it does not bind and replicate in the nose.
Terrence Tumpey and colleagues at the US Centers of Disease Control in Atlanta, Georgia, US, found this was not how the 1918 virus worked.
What a virus needs to spread, the CDC team concluded, is an ability to bind 2,6 sugars, whether or not it needs this to replicate. What this binding does do is not clear. One clue, they speculate, is that ferrets with non-contagious viruses - H5N1, or mutant 1918 - do not sneeze. Contagious ferrets do.
"The cells with 2,3-sialic acid receptors have been associated with the bronchial mucins," New Scientist quoted Tumpey, as saying. This viscous secretion might inhibit these viruses, and prevent the irritation that causes sneezing, which 'may contribute to the spread of influenza, at least in ferrets'.
But what is important is what this tells us about how the next pandemic might begin. The same mutations that made the 1918 flu contagious will not apply to H5N1, as it has a different haemagglutinin. However, the CDC results suggest finding out what mutations make H5N1 bind to 2,6-sialic, as those could make it contagious. (ANI)
Health officials in the USA and around the world have warned for years that a flu pandemic is coming, and the world needs to prepare. There's no telling when it will come, they say, but once it does, it could overwhelm society.
That message, once heard loud and alarmingly clear by the American public, is growing muted. Interest in a pandemic, and in the bird flu some believe may one day cause it, has waned.
And that may be just fine.
"You need your response people to be interested but don't expect to have everybody at high response to this threat all the time," Barbara Reynolds, a communications expert with the Centers for Disease Control and Prevention, said during a conference call last week with state and local health officials.
The concern in the public-health sector can be seen this week as experts gather at pandemic-planning meetings and the CDC tests strategies in a pandemic flu response exercise.
"There's an issue with complacency, in that we've been talking about pandemic for years and it hasn't arrived," says Rich Besser, director of the CDC's Coordinating Center for Terrorism Preparedness and Emergency Response. But "there's incredible work going on around the country in terms of pandemic preparation."
But for the average American right now, it may be enough to be aware of the threat and know where to get more information should a pandemic become imminent, Reynolds says.
Readiness checklists posted by the Department of Health and Human Services at www.pandemicflu.gov advise families to store two weeks' worth of food and water and to make sure to have a portable radio, flashlight and other necessities.
Reynolds says one measure of public interest was an unprecedented spike in traffic to the CDC's flu website. That occurred on Jan. 24, 2006, between 4 and 5 p.m. ET, momentarily mystifying the communications office until the CDC identified the cause: That was the day Oprah Winfrey hosted a program on pandemic flu.
"The risk of pandemic had its moment in the sun, where the public was interested, and people were talking about it in grocery lines," risk-communications expert Peter Sandman says. "Then people got used to it, and interest settled into the new normal."
In the USA, no birds carrying the virus have been found, and no Americans have been infected. Most human cases were caused by direct contact with infected poultry, but scientists have warned that the virus could change and spread quickly from person to person.
"My concern is that the pandemic was overblown to start with," says Phil Geis, a microbiologist in Cincinnati. Geis, who works in the food industry, posted a message on a food safety electronic mailing list that read in part: "No doubt the sensationalist news media drove my thinking, but it does seem health officials projected a much more timely and dramatic scenario of pandemic."
But the risk of a pandemic remains and may be increasing, health officials say, as cases continue to be reported.
The H5N1 bird flu has spread across Asia and into Europe since early 2003 and has infected at least 270 people in 10 countries, killing 164. On Wednesday, Nigeria announced its first suspected human H5N1 death. In Indonesia, 63 of 81 cases have been fatal, the highest number in any country.
Pandemic is "on the back burner for the majority of Americans, where it should be," Sandman says, but "it's not on the back burner of governments and companies."
Among planning efforts:
"I don't think you'd find in the White House, HHS or the public health community any reduction of concern, and probably there's heightened concern because the odds keep going against us."
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