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PANDEMIC ALERT LEVEL
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Tracking the next pandemic: Avian Flu Talk

GENERAL BF NEWS ITEMS

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    Posted: January 20 2006 at 4:49pm

Story location: http://wireservice.wired.com/wired/story.asp?section=Breakin g&storyId=1147674&tw=wn_wire_story

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Bird flu virus survives for days in droppings: WHO 

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Friday, January 20, 2006 6:59 p.m. ET

By Maggie Fox, Health and Science Correspondent

WASHINGTON (Reuters) - The H5N1 avian influenza virus can survive for more than a month in bird droppings in cold weather and for nearly a week even in hot summer temperatures, the World Health Organization said on Friday.

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When people become infected with bird flu, they get a high fever and pneumonia very quickly, according to an updated factsheet from the WHO, posted on the Internet at http://www.who.int/csr/disease/avian_influenza/avianinfluenz a_fa ctsheetJan2006/en/index.html.

The new factsheet incorporates the most recent findings on the avian flu virus, which WHO says is causing by far the worst outbreak among both birds and people ever recorded.

It has been found from South Korea, across Southeast Asia, into Turkey, Ukraine and Romania. It has infected 149 people and killed 80, according to the WHO figures, which do not include the most recent deaths and infections in Turkey.

Bird droppings may be a significant source of its spread to both people and birds, the WHO said.

"For example, the highly pathogenic H5N1 virus can survive in bird feces for at least 35 days at low temperature (4 degrees C or 39 degrees F)," the WHO site reads.

"At a much higher temperature (37 degrees C or 98.6 degrees F), H5N1 viruses have been shown to survive, in fecal samples, for six days."

Poultry, especially those kept in small backyard flocks, are the main source of the virus.

"These birds usually roam freely as they scavenge for food and often mingle with wild birds or share water sources with them. Such situations create abundant opportunities for human exposure to the virus, especially when birds enter households or are brought into households during adverse weather, or when they share areas where children play or sleep," WHO says.

H5N1 has different qualities from seasonal flu, the WHO said.

LONG INCUBATION PERIOD

"The incubation period for H5N1 avian influenza may be longer than that for normal seasonal influenza, which is around 2 to 3 days. Current data for H5N1 infection indicate an incubation period ranging from 2 to 8 days and possibly as long as 17 days," it said.

"Initial symptoms include a high fever, usually with a temperature higher than 38 degrees C (100.4 degrees F), and influenza-like symptoms. Diarrhea, vomiting, abdominal pain, chest pain, and bleeding from the nose and gums have also been reported as early symptoms in some patients."

And with H5N1 infection, all patients have developed pneumonia, and usually very early on the illness, the WHO said.

"On present evidence, difficulty in breathing develops around five days following the first symptoms. Respiratory distress, a hoarse voice, and a crackling sound when inhaling are commonly seen."

There is bloody sputum, it said.

"Another common feature is multiorgan dysfunction, notably involving the kidney and heart," WHO said.

The WHO recommends using Tamiflu, Roche AG's flu drug known generically as oseltamivir, as soon as possible to treat bird flu.

WHO stresses that H5N1 remains mostly a disease of birds, with tens of millions infected in two years.

"For unknown reasons, most cases have occurred in rural and periurban households where small flocks of poultry are kept. Again for unknown reasons, very few cases have been detected in presumed high-risk groups, such as commercial poultry workers, workers at live poultry markets, cullers, veterinarians, and health staff caring for patients without adequate protective equipment," it adds.

"Also lacking is an explanation for the puzzling concentration of cases in previously healthy children and young adults."

 

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The latest information from WHO on clinical presentation of AI patients...

LINK

Clinical features 1. In many patients, the disease caused by the H5N1 virus follows an unusually aggressive clinical course, with rapid deterioration and high fatality. Like most emerging disease, H5N1 influenza in humans is poorly understood. Clinical data from cases in 1997 and the current outbreak are beginning to provide a picture of the clinical features of disease, but much remains to be learned. Moreover, the current picture could change given the propensity of this virus to mutate rapidly and unpredictably.

The incubation period for H5N1 avian influenza may be longer than that for normal seasonal influenza, which is around 2 to 3 days. Current data for H5N1 infection indicate an incubation period ranging from 2 to 8 days and possibly as long as 17 days. However, the possibility of multiple exposure to the virus makes it difficult to define the incubation period precisely. WHO currently recommends that an incubation period of 7 days be used for field investigations and the monitoring of patient contacts.

Initial symptoms include a high fever, usually with a temperature higher than 38oC, and influenza-like symptoms. Diarrhoea, vomiting, abdominal pain, chest pain, and bleeding from the nose and gums have also been reported as early symptoms in some patients.

Watery diarrhoea without blood appears to be more common in H5N1 avian influenza than in normal seasonal influenza. The spectrum of clinical symptoms may, however, be broader, and not all confirmed patients have presented with respiratory symptoms. In two patients from southern Viet Nam, the clinical diagnosis was acute encephalitis; neither patient had respiratory symptoms at presentation. In another case, from Thailand, the patient presented with fever and diarrhoea, but no respiratory symptoms. All three patients had a recent history of direct exposure to infected poultry.

One feature seen in many patients is the development of manifestations in the lower respiratory tract early in the illness. Many patients have symptoms in the lower respiratory tract when they first seek treatment. On present evidence, difficulty in breathing develops around 5 days following the first symptoms. Respiratory distress, a hoarse voice, and a crackling sound when inhaling are commonly seen. Sputum production is variable and sometimes bloody. Most recently, blood-tinted respiratory secretions have been observed in Turkey. Almost all patients develop pneumonia. During the Hong Kong outbreak, all severely ill patients had primary viral pneumonia, which did not respond to antibiotics. Limited data on patients in the current outbreak indicate the presence of a primary viral pneumonia in H5N1, usually without microbiological evidence of bacterial supra-infection at presentation. Turkish clinicians have also reported pneumonia as a consistent feature in severe cases; as elsewhere, these patients did not respond to treatment with antibiotics.

In patients infected with the H5N1 virus, clinical deterioration is rapid. In Thailand, the time between onset of illness to the development of acute respiratory distress was around 6 days, with a range of 4 to 13 days. In severe cases in Turkey, clinicians have observed respiratory failure 3 to 5 days after symptom onset. Another common feature is multiorgan dysfunction, notably involving the kidney and heart. Common laboratory abnormalities include lymphopenia, leukopenia, elevated aminotransferases, and mild-to-moderate thrombocytopenia with some instances of disseminated intravascular coagulation.

Limited evidence suggests that some antiviral drugs, notably oseltamivir (commercially known as Tamiflu), can reduce the duration of viral replication and improve prospects of survival, provided they are administered within 48 hours following symptom onset. However, prior to the outbreak in Turkey, most patients have been detected and treated late in the course of illness. For this reason, clinical data on the effectiveness of oseltamivir are limited. Moreover, oseltamivir and other antiviral drugs were developed for the treatment and prophylaxis of seasonal influenza, which is a less severe disease associated with less prolonged viral replication. Recommendations on the optimum dose and duration of treatment for H5N1 avian influenza, also in children, need to undergo urgent review, and this is being undertaken by WHO.

In suspected cases, oseltamivir should be prescribed as soon as possible (ideally, within 48 hours following symptom onset) to maximize its therapeutic benefits. However, given the significant mortality currently associated with H5N1 infection and evidence of prolonged viral replication in this disease, administration of the drug should also be considered in patients presenting later in the course of illness.

Currently recommended doses of oseltamivir for the treatment of influenza are contained in the product information at the manufacturer’s web site. The recommended dose of oseltamivir for the treatment of influenza, in adults and adolescents 13 years of age and older, is 150 mg per day, given as 75 mg twice a day for 5 days. Oseltamivir is not indicated for the treatment of children younger than 1 year of age.

As the duration of viral replication may be prolonged in cases of H5N1 infection, clinicians should consider increasing the duration of treatment to 7 to 10 days in patients who are not showing a clinical response. In cases of severe infection with the H5N1 virus, clinicians may need to consider increasing the recommended daily dose or the duration of treatment, keeping in mind that doses above 300 mg per day are associated with increased side effects. For all treated patients, consideration should be given to taking serial clinical samples for later assay to monitor changes in viral load, to assess drug susceptibility, and to assess drug levels. These samples should be taken only in the presence of appropriate measures for infection control.

In severely ill H5N1 patients or in H5N1 patients with severe gastrointestinal symptoms, drug absorption may be impaired. This possibility should be considered when managing these patients.

 

 

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HEADS UP...THIS IS WHAT WE WILL SEE TUESDAY AFTER OPRAH!

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/01 /22/nflu22.xml&sSheet=/news/2006/01/22/ixhome.html

Experts sceptical as thousands rush to buy anti-bird flu kits
By Adam Lusher
(Filed: 22/01/2006)

Scientists describe them as "a total waste of time and money" but that does not appear to have dissuaded thousands of Britons from rushing to stockpile biohazard suits and surgical masks to protect against bird flu.

Suppliers claim that they have been inundated since the deadly H5N1 strain of the virus spread through Turkey.

 
An Anti-bird flu suit is modelled in Redditch
An Anti-bird flu suit is modelled in Redditch

They are offering everything from 14p surgical masks to £493 "ultimate family packs", complete with hooded chemical and biological boiler suits, matching protective goggles and scores of high-powered face masks. It is even possible to purchase a £468 "powered suit", with hood, visor, and integral battery-powered filtered air pack.

But John Oxford, the professor of virology at Queen Mary's School of Medicine in London, questioned the wisdom of some buyers.

He said: "There will be sensible precautions if this virus arrives, like hand washing and avoiding rush hour trains, but running out in a high-powered mask is a total waste of time and money. You would look a complete idiot. The idea should be to educate people, not alarm them."

However, Nick Powell, the managing director of UK Survive, which sells anti-bird flu kits, said: "People have decided it is better to have these products in their cupboard unnecessarily than to need them and not have them.

"Sales have been staggering," he said. "Our website has been overloaded twice, which has never happened, not even when we were selling anti-terrorism kits after July 7."

Fears of bird flu in Britain mounted last week as the number of infected humans in Turkey rose to 21. If the virus became capable of spreading easily from human to human, it could cause a pandemic, which the chief medical officer, Sir Liam Donaldson, has said could conceivably kill 750,000 in Britain.

Mr Powell said sales leapt within minutes of bird flu being mentioned on news bulletins. "I have watched the number visiting the website go from 30 to over 500 within 10 minutes of the News at 10."

One of the items in heaviest demand was a German-made child's mask pre-ordered by more than 2,000 parents.

Mr Powell said the four "single-use bio suits" in the "ultimate family pack" would offer eight hours protection, but added: "You would have to be careful about how you took them off and disposed of them. They should be incinerated."

The packs also contain 400 latex gloves, 200ml of alcohol-based hand cleaner as used in hospitals, and 200 "electrostatically charged" fabric masks, each offering 99 per cent protection against harmful droplets for a day.

Mr Powell said: "We have been selling to individuals from all walks of life. Corporations have been buying on average 3,000 masks for staff. We have been asked for quotes by universities, and doctors' surgeries have been buying masks in bulk. Anything we sell is what the World Health Organisation recommends for health workers coming into contact with the virus."

 
Bird flu factfile

But Prof Hugh Pennington, the president of the Society for General Microbiology, questioned how useful the equipment would be for people in everyday life. "In certain circumstances, like a crowded train, there is a case for a mask, but I would be sceptical about how much good it would do," he said.

"People tried wearing masks in the 1918 flu outbreak. It might do some good, but there isn't the evidence to say more than that - an ordinary mask is probably as good as anything fancy. I don't think the practicalities match the benefits. Are you really going to wear your mask in the pub?"

Publishers wishing to reproduce photographs on this page should phone 44 (0) 207 538 7505 or e-mail syndication@telegraph.co.uk

16 January 2006: 12-year-old girl is latest victim of bird flu in Turkey

Information appearing on telegraph.co.uk is the copyright of Telegraph Group Limited and must not be reproduced in any medium without licence. For the full copyright statement see

 

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: January 21 2006 at 8:40pm

More of the recent stuff out of Britain but with this added twist:

http://www.timesonline.co.uk/article/0,,2095-2003468,00.html

Doing nothing is no longer an option. The Sars virus may have turned out to be a near miss with just 8,000 cases and 774 deaths worldwide. But bird flu is being seen as a different matter. The WHO’s director-general, Lee Jong-wook, warned that an outbreak in Britain was “inevitable and possibly imminent”.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: January 22 2006 at 9:13am

This is encouraging for Canadians.  Maybe other country's grocery firms will take note.

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20060122 /corporatecanada_flupandemic_060122/20060122?hub=Canada

Corporate Canada preparing for influenza pandemic

Generic medical graphic

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Updated: Sun. Jan. 22 2006 11:07 AM ET

TORONTO — Corporate Canada is increasingly dedicating time and money to preparing for an influenza pandemic, as awareness of the possibility rises.

"About six months ago, there was really no concern, and I think it makes sense to be concerned," says Sherry Cooper, chief economist of BMO Nesbitt Burns and the author of some awareness-raising reports on the topic.

Robert Wilkerson, the global head of Kroll Inc.'s corporate preparedness practice, says "the financial community in Canada is almost in the lead on this, because Canada's experience with SARS was a real eye opener."

He was in Toronto late last year to give a planning workshop based on a scenario in which avian influenza, or bird flu, swept through the human population, causing a pandemic.

But awareness has spread beyond Bay Street, and numerous industries are now taking steps to prepare for such a crisis, which health experts estimate sill hit from one-quarter to one-half of the population in a series of waves.

Air Canada (TSX:ACE.B), Dofasco Inc. (TSX:DFS), CIBC (TSX:CM), Inco Ltd. (TSX:N) and Manulife Financial (TSX:MFC) are among the companies that say they are working on a contingency plan in case of a pandemic.

The level of preparation ranges among firms. Hamilton-based Dofasco held its first high-level meeting on the issue earlier this month to look at other firms' plans.

"At this point, we're really at the stage of recognizing that responsible organizations are giving this issue some attention, acknowledging we should do so as well, and discussing how we will approach the planning process," says the steelmaker's spokesman, Gord Forstner.

Toronto-based nickel miner Inco Ltd. is "well advanced on avian flu pandemic preparedness planning at our global operations," says spokesman Steve Mitchell. "Because of its location, our Indonesian operations have been at the forefront of our site specific planning activities."

At the Canadian Council of Grocery Distributors, chief executive Nick Jennery says "this is something that we started working on, pandemic specific, probably about seven, eight months ago."

The council's members represent 80 per cent of all grocery distribution sales in Canada, and more than 500,000 employees.

"We are dealing with this as an industry," Jennery said. "What's driving our whole plan is to make sure that the public has access to product should a worst case scenario unfold.

"So, we are looking at things like surge buying, how to keep distribution centres open, whether we consolidate around stores. The details, we are obviously working out."

Jennery notes that, when it comes to contingency planning, "we're pretty good at this." The industry has dealt with trucker blockades, port strikes, and hurricanes. "What makes this a bit different is just the sheer scale of it," he says.

In a recent article written for the Harvard Business Review, Cooper said that most companies have not adequately planned for a pandemic, and notes that it's "very different" than traditional crisis management.

"An influenza pandemic will likely be prolonged -- measured in months, not weeks or days -- and it will be pervasive," she wrote.

"For most businesses, it would be prudent to take some actions immediately. Even though the probability of an influenza pandemic might be low, the consequences are enormous."

Ron Lennox, vice-president of trade and security at the Canadian Trucking Alliance, said the alliance is already in discussions with other infrastructure networks and Transport Canada.

One key challenge the industry would face in the event of a pandemic is how to deal with fewer employees when truck drivers are already in short supply, Lennox said.

"This may mean dedicating trucks to haul 'essential' products such as food, medicine and fuel. It may also require some temporary adjustments to existing regulations to ensure demands can be met with available resources," he said.

The alliance is also trying to ensure it will have adequate fuel and spare parts ready.

Mark Hallman, spokesman for Canadian National Railway Co., said the company (TSX:CNR) has attended meetings with other major employers to benchmark its pandemic preparedness.

In the U.S., CN has participated in a Homeland Security exercise, along with other U.S. railroads, to assess the impact on an influenza pandemic on the transportation of goods.

In Canada, CN has given public health authorities in Ontario information on the number of essential service employees it has.

Canada's pandemic influenza plan says about one million people will be deemed essential service providers for the purposes of doling out vaccines. Those people include utility workers, funeral service personnel, and people employed in public transportation and the transport of essential goods like food.

If there were an outbreak, CN says it would take direction from public health agencies about travel restrictions and would cooperate in the distribution of vaccine and antiviral drugs, but would not store or distribute medication unless recommended.

"In the interest of preventing infectious diseases and of limiting the spread of infectious diseases, CN would provide employees with information on good hygiene to minimize the risk," Hallman added.

That is likely music to Bill Gastle's ears. The chief executive of Toronto-based Microbix Biosystems Inc. (TSX:MBX) has made his company's pandemic response plan publicly available on the Internet, and he says a plan has to do more than enable employees to work from home -- it has to teach them about hygiene to minimize exposure.

Cooper says multinational companies, which will be dealing with governments around the world, will be at the forefront of disseminating information. All firms should consider stockpiling key hygiene-related supplies, including face masks, disinfectants and hand-washing materials, she says.

She also recommends buying extra replacement parts for vital equipment, as travel and transport will be disrupted in the event of a pandemic.

"It's very important that businesses make it very clear to their employees that there will be a very liberal sick leave and family policy," she adds. "What you don't want is sick people coming to work, and the biggest reason that people would come to work is the fear of lost salary."

Cooper suggests planning for a 30 per cent reduction in workforce, which might include measures like cross-training or establishing a pool of available contract workers and retirees.

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Scientist: Bird Flu Threatens Security
by UPI Wire
Jan 24, 2006


http://www.postchronicle.com/news/health/article_2124360.sht ml

CHICAGO, Jan. 24, 2006 (UPI) -- A University of Illinois professor says national leaders must talk less about war and terrorism and more about infectious diseases.

Julian Palmore, director of the university's Program in Arms Control, Disarmament and International Security, says world leaders and policymakers need to seriously consider the potential international security implications that would result from an avian influenza pandemic.

"Natural disasters, especially pandemics, can and do affect international security in many ways," he writes in a brief critical commentary in the March issue of the journal Defense and Security Analysis. the U. of I. professor said. "They can have disastrous effects on countries' economies, infrastructures, populations, public health and stability. As a consequence of natural disasters, governments may fail and populations may be decimated.

"Thus," Palmore writes, "planning for international security needs must take into account the effects of natural disasters. Since avian influenza is of utmost concern in Asia and in many other parts of the world, it is imperative that states' governments and non-governmental organizations pay attention to the evolution of the ... H5N1 virus."

Palmore addresses the topic in a more detailed article scheduled for future publication in the same journal.

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