Avian Flu - What we need to know

Dear Readers:

It is with sadness that we announce that avianflu.typepad.com is going dormant.  This is for two reasons.  First, our original mission was to provide accurate information on a newly developing topic.  While misconceptions continue to prevail, there are now numerous informative and excellent sites on the avian flu topic.  You will find many of these listed on this very blog.  Second, both Silviu and Tyler have some external commitments, which prevent them from upgrading our offerings to remain unique.

We have not forgotten about the issue and we will keep the site standing, if only as a directory to other sites.  And we have not ruled out resurrecting the blog at some point in the future, especially if the issue becomes more pressing.

Thank you all for reading us and thank you for your comments and suggestions.  Let's all hope that this blog can stay dormant forever.

Tyler & Silviu

Latest bird flu news

China announced its 12th human casualty today:

A 21-year-old migrant worker has died of the H5N1 bird flu virus in China, the country's 12th human fatality from the disease since November, the government said Friday.

The man, identified only by the surname Lai, died Wednesday at a hospital in the central city of Wuhan, the official Xinhua News Agency said, citing health officials.

The government hasn't said how Lai was exposed to the virus. China has suffered dozens of flu outbreaks in poultry, prompting the government to destroy millions of chickens, ducks and other birds that contain the virus.

Lai became ill on April 1 and was hospitalized with a fever and pneumonia. He was confirmed Monday to have the H5N1 strain.

Earlier this week Indonesia confirmed its 24th casualty.

Elsewhere, two wild swans found dead in France earlier this week tested positive for H5N1. A new poultry outbreak was discovered in Pakistan. In Denmark an airplane was briefly quarantined when a passanger was suspected of being infected with H5N1 (turned out to be a false alarm). Finally, the WHO cleared a Sudanese poultry farmer suspected of having contacted bird flu.

Indonesian family infected with bird flu

A family of five was admitted to Abdul Moeloek hospital in Bandurlampung on Sunday, all suffering from suspected bird flu.

The family -- Abidi, the husband and his wife Sarmawati, both 52, and three of their six children, Septi, 12, Fitri, 8 and Putra, 5 -- are now being treated in an isolation room. The five have all demonstrated a high fever and a cough, symptoms of the deadly bird flu.

Sarmawati has been treated at the hospital since last Thursday. Her other three children had been diagnosed with bird flu earlier. Mohtar Rozi, 15, died March 31, and Betharia, 19, died April 4, while Bakhrudin, 26, is still being treated at the hospital.

Both Mohtar and Betharia died at home before they could be sent to the hospital. Their parents had limited funds and knew little about the virus.

Laboratory tests on drug samples taken from the patients confirmed Bakhrudin, Septi, Fitri and Putra were infected with the bird flu virus, while Abidi and Sarmawati were negative, according to data from the Lampung health office.

From the Jakarta Post, via H5N1.

China reports 17th human case

China has reported its 17th human case of the H5N1 strain of bird flu since November, in a 21-year-old security guard from the central city of Wuhan.

A WHO spokesperson said the man was confirmed to have the virus, but the source of his exposure was still under investigation.

He became ill on April 1 and was hospitalised in a critical condition with a high fever.

Source.

South Asia's bird flu struggles

Reuters published a good article on the current situation in the region. Here are a few bits:

Since February, India, Pakistan, Afghanistan and Myanmar have culled hundreds of thousands of chickens and shut poultry farms, yet the virus has kept spreading to new areas.

Surprisingly, no humans are known to have been infected in South Asia, where hundreds of millions in the countryside live with their livestock.

[...] "Has any disease which has come in the last 50 years into India gone away?" said H.K. Pradhan, head of India's only animal diseases laboratory that carries out tests for bird flu.

Worse still is a lack of laboratories, trained veterinary personnel and ignorance about the disease.

Officials admit they face an uphill battle against bird flu, which experts fear could mutate and spread easily from person to person, triggering a pandemic.

In a region where many have little or no access to stretched health services, a mutated strain could spread rapidly among humans, leaving countless numbers of people to fend for themselves.

While officials might feel a sense of crisis, the reaction of many ordinary people is slowly turning from panic to cautious resignation.

In a region of more than 1.3 billion people, bird flu is just one of many threats they face as they try to overcome poverty, the danger of other illnesses, militancy and natural disasters.

Pakistan finds bird flu on second farm

The H5N1 bird flu virus has been confirmed at another Pakistani poultry farm, an Agriculture Ministry official said on Sunday.

Authorities confirmed outbreaks of the H5N1 virus at two poultry farms in the Northwest Frontier Province (NWFP) in February.

The new outbreak was discovered on a farm near the capital, Islamabad.

"It was an small farm and we have already destroyed a total 3,500 chickens there," Mohammad Afzal, the ministry's livestock commissioner, told Reuters.

From Reuters.

The Washington Post on US pandemic plan

President Bush is expected to approve soon a national pandemic influenza response plan that identifies more than 300 specific tasks for federal agencies, including determining which frontline workers should be the first vaccinated and expanding Internet capacity to handle what would probably be a flood of people working from their home computers.

The Treasury Department is poised to sign agreements with other nations to produce currency if U.S. mints cannot operate. The Pentagon, anticipating difficulties acquiring supplies from the Far East, is considering stockpiling millions of latex gloves. And the Department of Veterans Affairs has developed a drive-through medical exam to quickly assess patients who suspect they have been infected.

The document is the first attempt to spell out in some detail how the government would detect and respond to an outbreak, and continue functioning through what could be an 18-month crisis, which in a worst-case scenario could kill 1.9 million Americans. Bush was briefed on a draft of the implementation plan on March 17. He is expected to approve the plan within the week, but it continues to evolve, said several administration officials who have been working on it.

[...] To keep the 1.8 million federal workers healthy and productive through a pandemic, the Bush administration would tap into its secure stash of medications, cancel large gatherings, encourage schools to close and shift air traffic controllers to the busier hubs -- probably where flu had not yet struck. Retired federal employees would be summoned back to work, and National Guard troops could be dispatched to cities facing possible "insurrection," said Jeffrey W. Runge, chief medical officer at the Department of Homeland Security.

The administration hopes to help contain the first cases overseas by rushing in medical teams and supplies. "If there is a small outbreak in a country, it may behoove us to introduce travel restrictions," Runge said, "to help stamp out that spark."

Read the full article here.

Seven suspect cases hospitalised in India

Seven persons, including six women, suspected to be affected with bird-flu were admitted in the isolation ward of the TB Hospital, Chief Medical Officer KK Vijayvargiya said on Wednesday.

"Their blood samples have been collected and were sent to Delhi for examination," he said.

"The suspected persons were referred from Mortakka in Khandwa district with suspected bird flu fever," he said, adding that they were examined by doctors and initial reports did not reveal anything suspicious.

Only after getting the report from the Delhi laboratory it can be confirmed whether they are affected with the bird flu or not, he said.

The suspected persons consumed a chicken dish few days back following which it was suspected that they are affected with the disease, he said.

They complained of vomiting, fever and pain in hands and legs, he added.

Source.

Bird flu preparedness

Nicholas Zamiska writes in a WSJ article that there is wide variability between European countries when it comes to bird flu preparedness. The piece is a review of a coming Lancet Journal article. Some received the story with skepticism:

"It's like looking at the wiring diagrams of a Maserati and a Ferrari, and looking at which one handles better on the road without turning on the ignition," said Angus Nicoll, influenza coordinator for the European Centre for Disease Prevention and Control in Stockholm, who was sent an early draft of the study for review. However, he called the study "a useful piece of work."

Effect Measure briefly reviews the status of the US flu defenses.

Latest human cases

Indonesia reported two more cases on Monday, read the details at Recombinomics. For more on Indonesia try the Jakarta Post here and here, or this recent Bloomberg story.

Yesterday Egypt reported its 12th human case of bird flu, the BBC has some details.

Myanmar claims to have bird flu under control

Bird flu in Myanmar has been brought under control, and restrictions will be lifted in two affected regions by the end of the month, a livestock official said Wednesday, just days after the U.N. said the situation in this impoverished nation was more serious than originally thought.

Several areas have been free from infection for one or two weeks, said Dr. Than Tun, director of the Livestock Breeding and Veterinary Department.

"The situation seemed serious because of several outbreaks around March 24-28, but the situation is under control now," Than Tun said.

On March 13, authorities confirmed bird flu outbreaks in the central Mandalay and Sagaing regions.

A report by a U.N. Food and Agriculture Organization expert who inspected those areas noted that "the last date of bird flu infection and culling (in Mandalay) was April 5 and the disease has been brought under control," the livestock department announced in a statement Wednesday.

It said the FAO expert, identified as Dr. Prasat, inspected the regions from March 28 to April 10, and that restrictions in Mandalay and Sagaing would be lifted by the end of April.

As of Tuesday, authorities had culled a total of 326,884 chickens and 317,305 quails, and destroyed 175,338 chicken and quail eggs, it said.

Source.

The risks of eating food contaminated with bird flu

Read Effect Measure for a good analysis.

Vietnam finds new outbreaks near Chinese border

Vietnam has detected bird flu on three farms near the Chinese border, the second such finding in the past few days, an animal health official said on Saturday.

Health workers slaughtered 157 chickens and ducks after farmers said 30 birds died on March 19 on three farms in Cao Bang province, said Dang Quang Binh, head of the provincial Animal Health Department.

"We sent samples for testing and on March 25 the results showed H5 was found in poultry samples from the three farms," Binh told Reuters by telephone from Cao Bang, 270 km (167 miles) north of Hanoi.

He was referring to the H5 subtype avian flu virus.

No further tests were likely be done to confirm if the strain was H5N1, which has killed 42 people in Vietnam since late 2003.

Source. This story comes days after infected birds were found smuggled from China.

Myanmar struggles with outbreaks

Bird flu is spreading fast in secretive, military-ruled Myanmar, which is now battling more than 100 outbreaks in poultry since the virus was first reported a month ago, U.N. agriculture officials said on Monday.

After visits by two teams from the United Nations Food and Agriculture Organisation (FAO), the situation in the former Burma appeared to be "more serious than what we imagined", said He Changchui, the Rome-based body's Asia-Pacific representative.

"Up to now, there are over 100 outbreaks, mainly in two districts, Mandalay and Sagaing," He told a news conference in Bangkok.

Source.

Bird flu found in Lagos

A deadly strain of bird flu has been detected in Africa's most populous city, the Nigerian commercial capital Lagos, Information Minister Frank Nweke confirmed.

"The virus has so far been indentified in 12 states, including Lagos, as well as around the federal capital Abuja," Nweke told AFP.

The detection of the virus in Lagos will raise fears that Nigeria's outbreak H5N1 strain of bird flu, which has killed more than 90 people since it broke out in Asia in 2003, could be spreading out of control.

Source.

The 1951 mystery flu

Revere comments on a fascinating article at Effect Measure. The bottom line: we have a very poor understanding of flu viruses.

Bird flu found in poultry smuggled from China to Vietnam

Health authorities in Vietnam have discovered bird flu in poultry illegaly imported from China and are conducting tests to find out if it is the deadly H5N1 strain of the virus, officials said Thursday.

"We made test last week on 30 samples of smuggled poultry in northern Lang Son province," said Le Van Tao, deputy director of the Animal Health Institute at the agriculture ministry.

"Results have shown one of the samples was positive to the H5 virus of avian flu," he said.

Experts still had to determine whether it was the deadly H5N1 virus that has claimed 42 lives in the communist nation since December 2003.

Tests were also under way done on another 40 samples in neigbouring Quang Ninh province, which also borders China.

No new bird flu cases have been identified in Vietnam since December and the last human death was reported in November.

Source.

More human cases found in Egypt

Health and Population Minister Hatem el-Gabali, quoted by the state MENA news agency late on Wednesday, said the latest cases were a 16-year-old girl and an 8-year-old boy from two provinces north of Cairo.

The deadly H5N1 strain of the bird flu virus has so far killed two Egyptians.

"The girl and the boy were infected after coming into contact with domestic birds which had died, and tests ... confirmed they (the boy and girl) had been infected with bird flu," Gabali said, adding the two were in a stable condition.

The government says 11 Egyptians have now been infected by bird flu.

[...] Earlier on Wednesday, Egypt confirmed it's ninth case of human bird flu infection, in a girl aged 16 months from southern Egypt. On Sunday two sisters were confirmed to have the virus.

The avian flu virus has so far not been transmitted from human to human, but can be caught from infected birds.

Source.

H5N1 found in Scotland

Tests have confirmed a dead swan found in Scotland had the deadly H5N1 strain of bird flu, Britain's national farming union said Thursday. Britain's Department of Environment, Food and Rural Affairs contacted the union to confirm the result, said Peter Kendall, the union president.

An announcement from the department was expected later Thursday, said a spokesman, speaking on condition of anonymity in accordance with policies for civil servants.

The wild swan was discovered last Wednesday at a harbor in Cellardyke, more than 450 miles north of London. British government officials have restricted the movement of poultry and are considering whether to expand a two-mile protection zone around the harbor.

Source.

Germany finds bird flu on poultry farm

The H5N1 bird flu virus has for the first time been detected on a poultry farm in Germany, the ministry for social affairs in the eastern state of Saxony said.

A spokeswoman for the ministry, Elke Reinking, said Wednesday that a special protection zone of three kilometres (1.9 miles) had been drawn around the poultry farm in Leipzig, where orders have been given to slaughter some 15,000 turkeys.

It was not yet clear whether the disease detected in dead turkeys on the farm on Tuesday was the highly pathogenic form of H5N1 which can prove fatal to humans, the ministry said.

From AFP via Yahoo!

Burkina Faso reports H5N1

Burkina Faso has detected the dangerous H5N1 strain of bird flu in poultry on the outskirts of its capital Ouagadougou, making the West African country the fifth nation on the continent to report the disease.

Nigeria, Niger, Cameroon and Egypt have already confirmed the virus in Africa, a continent which a top UN official said on Tuesday needed more funding to cope with a disease which has killed more than 100 people worldwide.

Burkina Faso's Livestock Minister Tiemoko Konate said in a televised announcement late on Monday that the bird flu strain had been confirmed by the World Organization for Animal Health (OIE) in samples taken from poultry at a motel on the eastern outskirts of Ouagadougou.

Source.

Indonesia reports 24th bird flu death

An eight-year-old Indonesian girl who died last year has been confirmed by the World Health Organisation (WHO) as the nation's 24th bird flu fatality, a health ministry official said.

Runizar Rusin, the head of the ministry's bird flu command post, told AFP that samples taken from the girl were only recently sent to Hong Kong for testing by a WHO-affiliated laboratory.

"Following testing at the WHO laboratory in Hong Kong, the results were sent back to us yesterday and were positive," he said, adding that the results meant Indonesia now had 24 confirmed deaths.

Source.

UK plans mass grave

Mass burials are being considered by the Home Office as part of contingency plans for a possible avian flu pandemic.

A "prudent worst case" assessment suggested that 320,000 could die in Britain if the H5N1 virus mutated into a form contagious between humans, according to a confidential report.

The paper - said to have been discussed by a Cabinet committee - said that the huge number of deaths would lead to delays of up to 17 weeks in burying or cremating victims. It warned that the prospect of "common burial" would stir up images of the mass pits used to bury victims of the Great Plague in 1665.

"It might involve a large number of coffins buried in the same place at the same time, in such a way that allowed for individual graves to be marked," said the report.

Town halls could deal with what it termed a "base case" of 48,000 deaths in England and Wales during a 15-week pandemic.

"Even with ramping local management capacity by 100 per cent, the prudent worst case of 320,000 excess deaths is projected to lead to a delay of some 17 weeks from death to burial or cremation."

Source.

Egypt reports new human infections

Two more Egyptians have been infected with the bird flu virus, Egyptian Health Minister Hatem el-Gabali said on Sunday, taking to eight the number of reported human cases in the country.

The two were sisters, one aged 18 months and the other six years, from Kafr el-Sheikh province north of Cairo. The pair, who had handled dead birds, were in a stable condition. Blood tests on their immediate family were negative for the virus.

An Egyptian labourer working in Jordan was diagnosed with the disease on Friday.

A World Health Organisation spokesman said only five cases had been confirmed by the organisation. Of the five, two have died, two have recovered and one is still in hospital. Bird flu has killed at least 105 people worldwide.

Source.

Vietnam update

In an impressive burst of action, Vietnam, once the epicenter for bird flu, has temporarily stamped out the disease: no people infected since November, and no poultry outbreaks since December.

The poor communist nation says it accomplished this feat by vaccinating millions of chickens and ducks, slaughtering millions more, by being honest with international health officials, and by educating its citizens.

There were even crackdowns on local delicacies, like duck blood pudding, believed to be the source of at least one death.

[...] Vietnam spent $18.9 million vaccinating 120 million birds last year and plans to immunize 160 million more birds, said Hoang Van Nam, deputy director of the Department of Animal Health. Eighty percent of the poultry sampled after vaccination had enough immunity to protect against the disease and none was found to be carrying the virus.

China claims to have vaccinated all of its 14 billion domestic birds, but it has continued to see outbreaks and human infections. Last week, Shanghai logged its first human bird flu death, bringing the human toll in China to at least 11, according to WHO.

Widespread immunization requires thousands of workers who must keep the vaccine chilled and return to farms to give booster shots three or four weeks after the first inoculation. A third injection is given four months later to poultry raised up to a year. But many birds have much shorter life spans, meaning the cycle constantly starts over.

Read more at CNN.

Avian flu vaccine safe but not very effective

The vaccine, which the United States already is stockpiling in the event of a pandemic, was given to 451 healthy adults between the ages 18 and 64, making it the largest such study to date.

[...] Of the participants given two shots of the highest dose of the vaccine 28 days apart, only 54 percent of them had adequate protection from the virus when researchers tested their blood for antibody response. Not all participants were given the same dosage.

Researchers were trying to determine if the vaccine is safe and what dosage would provide sufficient protection from the virus should it become pandemic. The ongoing clinical trials are being funded by the National Institutes of Health.

[...] the study, published in the March 30 edition of the New England Journal of Medicine, shows that while the shot is safe, only about half of those receiving the highest dose of the vaccine -- 90 micrograms -- produced enough antibodies to stave off H5N1 bird flu, if they were exposed.

The seasonal flu shot, by comparison, provides adequate protection in 70 to 90 percent of those receiving one 15-microgram dose of the vaccine.

Source, here is the NEJM paper (available for free). Effect Measure has more.

US to stockpile Relenza

The U.S. health department said it ordered about 1.75 million courses of Relenza on March 2 and another 2.2 million courses on March 26.

The department has already ordered 22 million courses of Tamiflu, which until the launch of Relenza was the only drug on the market with the capabilities to prevent influenza A and B and also be used as a treatment for people with the infection.

From CNN.

Avian flu stock index

Trend Macroanalytics, a research firm serving institutional investors, has taken its analysis a step further and created an "avian-flu index" comprising 17 stocks in the health-care sector that can be expected to see a surge in demand for their products should the flu become a threat to humans.

[...] Donald Luskin, chief investment officer at Trend Macro, said the index has gained 105% since its inception last Aug. 31 and is up 40.5% so far in 2006.

Source.

New York Times articles

Two contrasting pieces in the NYT yesterday, one by Elisabeth Rosenthal - The Skeptic, and another by Donald McNeil - The Worrier. If you like the worrier/skeptic debates you may also enjoy Revere's Effect Measure post taking on an article by Marc Siegel.

Using horse antibodies to fight bird flu

Chinese scientists have produced antibodies in horses that are an effective treatment for bird flu – at least in mice.

Jiahai Lu at Sun Yat-sen University in Guangzhou and colleagues repeatedly inoculated horses with a chicken vaccine against H5N1 bird flu to make them produce antibodies.

They then collected the horses’ blood, separated out the antibodies and split them to make them less likely to cause an allergic reaction when injected into a human. When they injected mice with a tenth of a milligram of these antibodies 24 hours after they had been given an otherwise lethal dose of H5N1, all the mice lived.

In theory, such antibodies could be made quickly against a pandemic strain of H5N1, potentially saving many lives and limiting the spread of the virus. The trouble is that most drug companies have stopped making antibodies this way.

This is because keeping horses is expensive and until now the markets for antiserum have been in poor countries and offer low financial returns. In addition, animal rights campaigners object to the technique.

Companies have instead invested in making modern, monoclonal antibodies using cell cultures. "It would be complex and expensive for a company to hugely scale up its monoclonal production to treat whole populations rather than a few people,” says David Fedson, founder of the vaccine industry’s pandemic task force.

Source.

New casualty in Egypt

A 30-year-old woman died of the H5N1 bird flu strain on Monday, Egypt's second human death from the virus since it appeared in the country last month, the health ministry announced. Czech authorities said they suspected their first case of H5N1 in a dead swan.

Fatma Mahmoud Youssef Sabra came from a village just north of Cairo, near Egypt's other human bird flu death, said Abdel-Rahman Shahin of the health ministry.

Source.

US government's flu website

If you haven't done so in a while it may be worth browsing through pandemicflu.gov, the government's flu website. Lots of information and preparedness advice.

The difficulty of containing bird flu

The speed of its migration, and the vast area it has infected, has forced scientists to concede there is little that can be done to stop its spread across the globe.

"We expected it to move, but not any of us thought it would move quite like this," said Dr. David Nabarro, the United Nations' coordinator on bird flu efforts.

The hope was once that culling millions of chickens and ducks would contain or even eradicate the virus. Now, the strategy has shifted toward managing a disease that will probably be everywhere. Officials are hoping to buy a little more time to produce human vaccines and limit the potential economic damage.

"We cannot contain this thing anymore. Nature is in control," said Robert G. Webster, a virologist at St. Jude Children's Research Hospital in Memphis, Tenn., who has been studying the virus since it emerged in 1997.

Read the full article here, and some commentary at Effect Measure.

Six new suspected cases in Asia

Three people were under observation in Cambodia today, suspected of having contacted bird flu:

The three -- one adult and two children -- are being treated for fever and respiratory problems at a hospital in the capital Phnom Penh, said Ly Sovann, head of the health ministry's department of infectious diseases.

The suspected cases come from a village neighbouring that of a three-year-old girl who died Tuesday after falling ill with the H5N1 strain of the virus.

Five other people who had contact with the suspected cases are also being tested, Ly Sovann said.

It is unknown how the three might have become infected with the deadly virus, Ly Sovann said.

Seven Cambodians thought to have caught bird flu after the girl died tested negative for the virus, Ly Sovann said earlier.

"All the seven suspected patients are negative ... all of them are better," he said.

AFP also reports two new suspected cases in Malysia:

A three-year old girl from northern Penang state and a 26-year-old man from neighbouring Perak state are in isolation while awaiting test results for the H5N1 virus, said the ministry's director for disease control, Ramlee Rahmat.

"They have been isolated pending further investigation. They are both stable," Ramlee told AFP. "The test results will come back in one or two days."

Finally, Indonesia reported today a one year old girl who died eariler this week tested positive for bird flu:

The girl, a resident of West Jakarta, died Thursday at Jakarta's Sulianti Saroso main state-run hospital for bird flu patients, said health ministry official Hariyadi Wibisono.

"The local tests for the girl came out positive. She had a history of contact with sick chickens near her house and suffered serious respiratory problems during hospitalisation," Wibisono told AFP.

Samples from the girl have been sent to a Hong Kong laboratory accredited by the World Health Organisation for confirmation, the official said.

If confirmed, the girl would be Indonesia's 23rd bird flu fatality. Results from local tests are usually accurate.

WSJ piece on Henry Niman

Most of the regular readers have no doubt checked out Henry Niman's blog Recombinomics at some point or another. Nicholas Zamiska now gives you an in depth look at the person behind the blog in his latest WSJ article.

Another casualty in Cambodia, suspected case in China

Bird flu killed a 3-year-old girl in Cambodia. The virus may also have infected a 29-year-old woman who died in Shanghai, China's second most-populous city.

Samples from the girl tested positive for the H5N1 avian influenza strain at the Pasteur Institute in Phnom Penh, the Health Ministry and World Health Organization said in a statement today. The WHO asked China's Health Ministry for details on the woman in Shanghai, including any test results and whether she had contact with fowl, said Aphaluck Bhatiasevi, a WHO spokeswoman.

``It's a suspected case and the first found in Shanghai,'' Song Guofan, a spokesman at the city's health bureau, said today.

Source.

WHO's count of human cases of avian influenza

See the table here. The grand total: 185 confirmed cases and 104 deaths from H5N1.

Why bird flu does not spread easily from person to person

This week, two research groups are independently reporting results that help explain why the H5N1 avian influenza virus is so lethal to humans but so difficult to spread. Unlike human influenza viruses, the teams report, H5N1 preferentially infects cells in the lower respiratory tract. Residing deep in the airways, the virus is not easily expelled by coughing and sneezing, the usual route of spread. The results "explain a lot of the mysteries" surrounding H5N1, says K. Y. Yuen, a virologist at the University of Hong Kong.

[...] One team, led by Yoshihiro Kawaoka of the University of Wisconsin, Madison, tested various tissues of the human respiratory tract for receptors to which the virus can bind. Human flu viruses preferentially bind to what are known as α 2,6 galactose receptors, which populate the human respiratory tract from the nose to the lungs. Avian viruses prefer α 2,3 galactose receptors, which are common in birds but were thought to be nearly absent in humans. Using marker molecules that bind to one receptor or the other, the team found that humans also have α 2,3 galactose receptors, but only in and around the alveoli, structures deep in the lungs where oxygen is passed to the blood. They describe their findings in the 23 March issue of Nature.

The second team, led by pathologist Thijs Kuiken of Erasmus University in Rotterdam, the Netherlands, used a more direct technique to show that H5N1 readily binds to alveoli but not to tissues higher up in the respiratory tract. Kuiken, whose team will publish its findings online tomorrow in Science, notes that this pattern is consistent with autopsies that have shown heavy damage to the lungs but little involvement of the upper respiratory tract. Among experimental animals, the team reports, cats and ferrets more closely match the human pattern of infection than do mice and macaques. "This is an important factor to consider when planning experiments" to understand the pathology of H5N1, says Kuiken.

Yuen notes that the findings also explain clinical anomalies such as why nasal swabs of H5N1 patients are less reliable than throat swabs in detecting the virus. And they suggest that clinicians need to exercise particular care when performing procedures, such as intubation, that might give the virus a route out of a patient's lungs.

From ScienceNOW Daily News. The Washington Post has a slightly different version of the same story.

Addendum: Effect Measure offers excellent comentary, as usual.

Seven people test positive for H5N1 in Azerbaijan

WHO said seven of 11 patients from Azerbaijan had tested positive for H5N1 in samples checked at a major laboratory in Britain. Five of those cases were fatal.

The sources of infection were still under investigation, but officials suspected a connection to the feathers of dead swans.

"The majority of cases have occurred in females between the ages of 15 and 20 years," WHO said. "In this community, the defeathering of birds is a task usually undertaken by adolescent girls and young women."

So far, there was no indication of direct exposure to dead or diseased poultry in some of the cases. That has been the usual source of exposure for humans who caught bird flu.

Source.

More on the WHO and bird flu samples

The World Health Organization is discussing whether to expand access to its private bird-flu database, as pressure mounts on the United Nations agency to do so as a way to spur wider research on the virus. Meanwhile, in an apparent effort to increase the amount of data available to scientists, the WHO will ask its 192 member states to adopt a resolution in May that includes a pledge to share virus data, Margaret Chan, the WHO's pandemic-flu chief, said yesterday. It isn't yet clear if the resolution will seek to make the data publicly accessible. In a related development, China is set to share a large number of virus samples that it has withheld for more than half a year, a WHO official said.

That is from and article by Nicholas Zamiska, published in today's WSJ. Read more at Effect Measure.

Bird flu found in Cameroon, new outbreaks in a number of countries

About 240 dead birds were found in the coastal town of Limbe, near the Nigerian border and several hundred kilometers from the northern town of Maroua, where Cameroon's first outbreak was confirmed in a duck, the United Nations Integrated Regional Information Network reported yesterday. Agriculture Minister Aboubakary Sarki is visiting northern provinces to review control measures, the report said.

Twenty new outbreaks in poultry of the H5N1 avian influenza strain were reported to the World Organization for Animal Health in the week ending March 16, boosted by infections on farms in Nigeria and Romania. The disease in poultry raises the risk of human cases and creates opportunities for the virus to mutate into a pandemic form that may kill millions of people.

From Bloomberg. The article is a good summary of the latest outbreaks:

France reported a new H5N1 infection in a wild duck in the Ain region, near the border with Switzerland. France had its first outbreak of the disease in birds last month.

In Romania, several domestic hens in Magurele, 20 kilometers (12 miles) east of the capital Bucharest, tested positive for the H5 subtype of bird flu after health authorities sampled poultry in the area. Authorities are testing to see whether the virus is the H5N1 type that can infect humans.

[...] Israel last week became the 29th country this year to report an initial H5N1 outbreak in either wild birds or fowl.

[...] In Nigeria, Africa's most-populous country, the virus spread to the southwestern state of Lagos, said Abdulsalami Nasidi, head of the Nigerian health task force charged with coordinating efforts to halt the spread of the virus. The affected farm was close to the Ogun state border and the virus hasn't been found near the city of Lagos, where about 11 million people live, since H5N1 was first reported in Nigeria six weeks ago, he said.

Finally,

A third Egyptian may have been infected with H5N1, Agence France-Press reported, citing Health Minister Hatem al-Gabali.

Pakistan confirmed bird flu in poultry today and Malaysia found new outbreaks in the North of the country.

Bird flu virus now in two distinct strains

The H5N1 virus responsible for the current virulent strain of bird flu has evolved into two genetically distinct strains, US scientists have confirmed.

They fear this could increase the risk to humans - and complicate the search for an effective vaccine.

The US team analysed more than 300 H5N1 samples taken from infected birds and people between 2003 and summer 2005.

Details were presented to the International Conference on Emerging Infectious Diseases in Atlanta.

Full story at BBC.

The H5N1 genome

Last Friday the journal Science published a paper with some preliminary findings.

Four quarantined in Malaysia

The four are in quarantine in two hospitals in the northern state of Perak, they said.

"They will be quarantined for a few days. We need to ascertain the cause of their fever," said Health Ministry disease control department director Ramlee Rahmat.

[...] Ramlee said one of the suspected victims was a 43-year-old chicken breeder who lives a kilometre (about half-a-mile) from an outbreak in Changkat Tualang village, and another was his seven-year-old neighbour.

The other two live about 10 kilometres from the Laketown Resort nature reserve where the disease has also been discovered.

Veterinary officials have slaughtered tens of thousands of birds at both sites since the outbreaks were discovered on Thursday.

However, state veterinary officer Wan Mohamad Kamil said his colleagues were finding it difficult to kill all the birds in the affected areas, with some staying in trees and others flying away.

"We have a problem. Some of the birds are high up on the trees and others are migrating to neighbouring villages," he said, adding that 41,979 poultry have been killed so far.

Source.

Woman dies of bird flu in Egypt

Initial tests at a U.S. Navy lab show that a 35-year-old woman who died this week in Egypt had bird flu, officials said Saturday. If the results are confirmed, she would be the country's first known human death from the disease.

[...] Egypt's health minister, Hatem El-Gabali, said earlier that the woman from the area of Qalyoubiya, north of Cairo was raising poultry at her home and some of her birds also died, according to the official news agency MENA.

Police identified the woman as Amal Mohammed Ismail and said she was hospitalized in the regional capital, Qalyoub, about two weeks ago. She subsequently was transferred to the Cairo Fevers' Hospital, where she died.

Ismail's home since has been sealed off, police said.

Source. According to AFP, a second human case was suspected in Egypt:

Mohammed Bahaa Abdel Moneim, 28, has been in hospital since Thursday after suffering symptoms of the disease, Health Minister Hatem al-Gabali was quoted as saying by the MENA news agency.

It said he kept a chicken farm and that a number of them had died last Monday.

Israel confirms H5N1 outbreak

Israeli officials have confirmed that thousands of turkeys and chickens found dead in the south of the country had the H5N1 strain of the bird flu virus.

Tests were ordered after the dead poultry were discovered on two farms in Ein Hashlosha and Holit, next to the Gaza Strip in the western Negev desert.

Several people have been admitted to hospital with flu-like symptoms.

A quarantine has been imposed around the area and thousands of birds are expected to be culled over coming days.

From BBC.

Is business ready for a flu pandemic?

In a survey of more than 100 executives in the United States by Deloitte & Touche, released this January, two-thirds said their companies had not yet prepared adequately for avian flu, and most had no one specifically in charge of such a plan.

"Business is not prepared for even a moderate avian flu epidemic," the report concluded.

In contrast, corporations in Southeast Asia have made more headway, in part because the avian influenza virus has been circulating in birds in Asia for years. Also, Asian companies learned in the 2003 outbreak of Sudden Acute Respiratory Syndrome, or SARS, that even a small infectious outbreak could have devastating consequences, bringing commerce in Hong Kong, Singapore and Beijing to a near standstill.

A recent survey of 80 corporate officials at an avian flu seminar held by the American Chamber of Commerce in Hong Kong found that nearly every company had someone in charge of avian flu policy, and 60 percent had clearly stated plans that could be put in place immediately. These included provisions for employees to work at home to prevent the spread of disease in the office, and for relaying warnings to workers by text messages to mobile phones.

Read the full story in the  New York Times.

Bird flu found in stray dog in Azerbaijan

"The virus has been found in a dog ... laboratory analysis is continuing," a statement from an official committee against bird flu said Thursday, adding that the animal had tested positive for the "A strain" of bird flu.

It was not immediately clear if the dog had died of the disease or was undergoing treatment.

Source. Read more at Effect Measure.

Afghanistan, India, Myanmar and Malaysia confirm H5N1

Four Asian nations confirmed the presence of the deadly H5N1 strain of bird flu on Thursday while China said it faced a long struggle to contain the disease before the arrival of flu-carrying migratory birds in spring.

Afghanistan, India and Myanmar said tests had now confirmed H5N1 caused recent outbreaks in birds, while Malaysia reported two new cases in a wild bird and dead chickens.

[...] So far, no human cases have been reported in India, Afghanistan, Myanmar or Malaysia but hundreds of people near India's latest outbreak in western Maharashtra state have complained of fever. Doctors say they are most likely suffering from dengue but further tests are being done.

Indian health authorities said they were not taking any chances and had sent dozens of medical teams looking for people with flu-like symptoms to every household of the affected area.

Veterinary and civic workers wearing protective gear moved door-to-door in Jalgaon district of Maharashtra collecting chickens and eggs after paying owners 40 rupees (90 cents) for every bird as compensation. Eggs went free.

In Myanmar, officials have slaughtered more than 5,000 birds, temporarily closed poultry markets and banned bird movements in two bird flu-hit townships, state media said.

Source.

Turkish H5N1 site

Openturkey.com is one of the best resources I have seen for tracking Turkey's battle with bird flu. Thanks to editor Hasan Basri Karabey for the link.