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Deadly bird flu surging in China

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    Posted: March 03 2017 at 9:36am

The virus has a fatality rate of up to 40 percent.

A strain of bird flu that’s considered the top pandemic threat is surging in China, and experts are warning that the US isn’t ready if it were to arrive here.

According to an assessment from the World Health Organization this week, China had 460 lab-confirmed human cases of the H7N9 bird flu virus over this winter — the most of any flu season since the virus was first reported in humans in 2013.

This makes the current outbreak the largest on record for H7N9, a virus that typically circulates around poultry markets and can be deadly when it strikes humans.

The risk of the virus causing a epidemic is low right now, the WHO said in a briefing this week, since almost all of the current infections were caught directly from birds and there’s no evidence yet of ongoing human-to-human transmission.

But whenever bird flu spreads to people, there’s always the worry it’ll mutate to become more easily transmittable. Forty percent of those with confirmed H7N9 infections have died — including at least 87 people this year alone.

What’s also concerning is that seven percent of the cases so far have carried genetic markers associated with drug resistance to treatments for the disease, such as Tamiflu.

To be clear, the people most at risk of an outbreak right now are in China, particularly those who work in the poultry sector. Vietnam should also be on guard, where reports suggest the virus has surfaced.

With a highly mutable virus like influenza, these dynamics could always change. And if the virus were to reach the United States, experts say we’re woefully unprepared.

As the former Ebola Czar Ron Klain wrote on Twitter, the Trump administration is still understaffed and has trumpeted the kind of isolationist approach that could really cripple a pandemic response.

The administration hasn’t yet appointed a new head to the Centers of Disease Control and Prevention, the agency that would lead a pandemic response. With the repeal of the Affordable Care Act looming, Trump is also poised to gut a key public health fund that accounts for 12 percent of the CDC’s budget.

If it’s not a bird flu outbreak, there’s a very slim chance Trump will finish a four-year term without facing a global health threat of some kind. Over the past decade, the WHO has declared four global health emergencies. Two of them happened during Obama’s tenure (the Ebola epidemic in West Africa and the Zika outbreak that's spread through the Americas). The pace at which pathogens are flying around the globe and threatening pandemics is only accelerating.

When the next deadly outbreak arrives, here are the three main challenges for the Trump administration.

1) Working with other countries at a time of “America first”

President Donald Trump has already shown signs that he favors an isolationist approach to international relations. But countries can’t isolate themselves from the flow of disease-causing viruses and bacteria across borders. Fighting and preventing pandemics requires cross-border collaboration and cooperation. Countries need to share information transparently about outbreaks within their borders. They need to agree on plans for preventing and fighting those outbreaks.

Higher income nations also have to lend resources — from researchers, to funding and lab training — to their lower income counterparts to help keep local outbreaks from spreading globally.

So when the next Ebola-level threat strikes, Trump will need to put aside his isolationist, “America first” politics for the benefit of public health.

And it is possible. There are many examples throughout history where public heath issues were put before politics to save lives, former CDC director Tom Frieden told Vox. At the height of the Cold War, the US and the Soviet Union worked together on smallpox eradication. During El Salvador’s civil war in the 1980s, officials created days of tranquility to vaccinate children and bring up the country’s low immunization rates. “We often find health can be a bridge,” Frieden said.

2) Resisting the urge to close down borders to countries harboring outbreaks

During the Ebola outbreak, Trump was advocating for sealing up our borders and tweeted things like, “Keep them out of here,” about health workers who had helped the Ebola effort.

But health officials discourage travel bans or other trade restrictions on countries harboring outbreaks for good reason. Such measures punish economies for circumstances that are often outside of their control, they haven’t been shown to stop the spread of pathogens, and they also discourage countries from honestly reporting outbreaks within their borders.

“When there are any sanctions or negative consequences, countries will hide disease outbreaks,” Osterholm said. “Early notification of a problem should be the ultimate get out of jail free card.”

During the Ebola outbreak, Trump was advocating for sealing up our borders and tweeted things like, “Keep them out of here” about health workers who had helped the Ebola effort. It’s not clear how he’ll respond in an outbreak, but these kinds of actions would be harmful to public health responses.

They’d also be hypocritical, said Baylor College of medicine global health researcher Peter Hotez. “We have widespread neglected tropical diseases spreading among the poor in the US. We have 12 million Americans already living with a neglected tropical disease. You can make the wall as high as you want but we still have Chagas disease in Texas.” Overwhelmingly, these diseases are helped along because of poverty, climate change and urbanization, Hotez added, and shutting borders down won’t help undo those conditions.

3) Not letting immigration restrictions get in the way of life-saving research

Developing vaccines or researching deadly diseases requires global collaboration these days, particularly in the context of an outbreak.

Consider the first successful Ebola vaccine, which, if approved, could help prevent another Ebola outbreak from every happening: The vaccine candidate was first developed by Canadians, and during the 2013-2016 Ebola epidemic, West African, European, and US governments and universities worked together with the World Health Organization and other international partners to design the clinical trials and recruit patients to find out whether the vaccine worked.

That’s often how treatments and vaccines are developed and tested, and it requires a high level of international collaboration.

With the current H7N9 outbreak in China, we’re already seeing that it may be resistant to treatment, and according to Stat’s Helen Branswell, the virus evolved in a way that “undermines the usefulness of a 12 million-dose emergency stockpile of H7N9 vaccine made for the United States several years ago.” This means researchers will need to work together on a new vaccine candidate. Travel bans shouldn’t get in the way of that.
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