Avian Flu Pandemic?

[Eos of the Eons]

Why is this one so much worse than the regular flu?

It kills 50% of those that contract it, or the one in 1918 did. I think this strain is just as deadly to humans?

I've already had people tell me that humans are spreading this avian flu to each other. Just tells you how rampant misinformation can be.

 

[drkitten]

I've already had people tell me that humans are spreading this avian flu to each other. Just tells you how rampant misinformation can be.

That's technically not misinformation. As I said earlier, there are confirmed cases (3?) of human-to-human transmission of this baby.

From a practical standpoint, that won't keep me awake at night. From an epidemiological standpoint, it might and probably should. Was the transmissible virus a new mutation? Is it phase I of the virus' master plan to take over the world? I suspect the medics slept better before there were any confirmed cases at all....

 

[Eos of the Eons]

That's technically not misinformation. As I said earlier, there are confirmed cases (3?) of human-to-human transmission of this baby.

From a practical standpoint, that won't keep me awake at night. From an epidemiological standpoint, it might and probably should. Was the transmissible virus a new mutation? Is it phase I of the virus' master plan to take over the world? I suspect the medics slept better before there were any confirmed cases at all....

Thank you for posting that. I didn't want it to be true though! Can you help point us to these cases so that we may find out the lingering question of how?

 

[YoPopa]

I hope some one does expect to peddle for hundred$

I also hope some of the gas station owners who charged twenty bucks a gallon for gas during the recent evacuations won't think of hoarding quantities of it in anticipation of peddling it on the streets for hundreds of dollars per dose once the pandemic starts.

The expectation of reward is what motivates people to take action. What you call "hoarding" can be looked at as stockpiling. Stockpiling can be very risky from a business perspective. Higher risk deserves higher reward. The only person in a position to judge what risk/reward ratio is worthwhile is the person making the investment.

My fear is that all the Tamiflu or all the vaccine will be demanded by some third world country where the outbreak starts and supplies will be exhausted by the time it reaches our shores. If that happens I will glady thank the person who "gouges" me by charging whatever he wants for saving my life. I value my life higher than my bank balance. I am not in a position to stockpile Tamiflu so I will continue to work hard and save my money so I will be able to purchase it at whatever price it reaches.

 

[drkitten]

Thank you for posting that. I didn't want it to be true though! Can you help point us to these cases so that we may find out the lingering question of how?

I think there is a relatively accessible discussion in a recent issue of National Geographic.

 

[Bowser]

Is it phase I of the virus' master plan to take over the world?

There are six recognized phases in the evolution towards a pandemic. We're probably at phase four, with the recent initial indications of that it can spread human-to-human.

1918 was not a 50% mortality. Probably on average less than 5%, but it could kill very quickly and it was very contagious. 1918 and h5n1 are both "A" influenzas which are much more virulent than the more common "B" influenza for which many of us have a degree of immunity anyway. The annual vaccine tends to be a mix of the most likely A and the most likely B and perhaps another strain. But still a guess as to which strains we are most likely to encounter during a given winter.

 

[luchog]

I think you have that wrong- I believe it goes "The group with the fastest rate of increase is heterosexual females". And that statistic may be out of date, it could have leveled off by now. Isn't the overall rate in the US something like 1:5,000? With a prety stable number now? Does the word "Epidemic" even apply?

According to the World Health Organization, you're very wrong.

The US does not constitute the entirety of the world. AIDS is rapidly becoming one of the worst medical problems in modern Africa. It's particularly bad there, since many African nations will not officially admit to the true extent of the problem (or even to its existence in some places); and screening is practically non-existent. Safe-sex practices are also nearly non-existent (a lot of these regions are places were people still believe that you can cure STDs by having sex with a virgin); and a high rate of male promiscuity has resulted in a much higher female infection rate. Last I checked WHO, the largest HIV+ population is African females (this is based on an estimated infection rate, due to the low rate of reporting in many African countries).

 

[skepticdoc]

Avian Flu

I would like to recommend a PBS documentary- "Secrets of the Dead" on the "Spanish" Flu. The documentary about the "Black Plague" is also very good, you should be able to catch re-runs on your local HD PBS station.

You can also find reliable information at the CDC website.

If you wait for a true pandemic to do anything, it will be too late!

Remember the Ebola virus among others

 

[Dymanic]

The expectation of reward is what motivates people to take action. What you call "hoarding" can be looked at as stockpiling. Stockpiling can be very risky from a business perspective. Higher risk deserves higher reward.

There are some who might consider helping desperate people stay alive to be its own reward even when it isn't good business (and price gouging might not be considered very good business anyway if long term interests mean anything).

My fear is that all the Tamiflu or all the vaccine will be demanded by some third world country where the outbreak starts and supplies will be exhausted by the time it reaches our shores.

As far as prophylactic use of antivirals is concerned, the supply may be considered virtually exhausted already.

U.S. Department of Health and Human Services Secretary Michael Leavitt has called for a Tamiflu stockpile to treat 20 million Americans (there are nearly 300 million of us now, btw), yet there is only enough on hand to treat 2.3 million people. It takes several months to produce a batch of Tamiflu.

Roche doesn't want to relinquish its patent rights to Tamiflu. The WHO has refused to pressure them to do so, even though this would clear the way for other companies to produce generic versions of it in larger quanitities and at cheaper prices. Roche has donated 3 million doses to the WHO for use in attempting to control the first outbreaks.

Looks like Roche is already taking action, and is hard at work gouging in order to save lives. Maybe we should go ahead and thank them now.

 

[casebro]

According to the World Health Organization, you're very wrong.

The US does not constitute the entirety of the world. AIDS is rapidly becoming one of the worst medical problems in modern Africa. It's particularly bad there, since many African nations will not officially admit to the true extent of the problem (or even to its existence in some places); and screening is practically non-existent. Safe-sex practices are also nearly non-existent (a lot of these regions are places were people still believe that you can cure STDs by having sex with a virgin); and a high rate of male promiscuity has resulted in a much higher female infection rate. Last I checked WHO, the largest HIV+ population is African females (this is based on an estimated infection rate, due to the low rate of reporting in many African countries).

Thank you for backing my opinion that it is a lifestyle disease, even in Africa.


Pardon me for being so US-centric, but a virus in Africa has little effect on me in my nice warm suburban home. It's not as if it is expected to become airborne and waft across the Atlantic, is it?

"(this is based on an estimated infection rate, due to the low rate of reporting in many African countries)"

You don't see anyplace for bias in this statement? Do you think an organisation with "Health" in it's name would downplay any 'epidemic'?

 

[Adrian]

Thank you all for great opinions and wonderful information. This is the last time I start a topic on a big news event and then go away for a few days (42 posts to read).

I think there is a relatively accessible discussion in a recent issue of National Geographic.

Could you please locate the source for this statement? The spokesperson I talked to at the WHO stated that there have been no proven direct human-to-human transmittals. The media from WHO seem to support that statement. I would love to read the source that you are stating, which month of NatGeo was it located in?

The real question for me is proper response in proportion to the actual risk. Bush has made statements about asking for support to turnover the 19th century law forbidding the army to be used as a policing force in the event of H5N1 coming to the States. This could have a completely destructive effect on the USA's political structure. There have been many protectionists in Congress calling for bans on Chinese imports and immigration. Such large fears, without the proper data, can be used to manipulate public opinion (for sources, see history ). I just want to make sure the data I am seeing is matching the action(s) of the government.

Pardon me for being so US-centric, but a virus in Africa has little effect on me in my nice warm suburban home. It's not as if it is expected to become airborne and waft across the Atlantic, is it?

Oh! About the quote above. It actually can effect you through so many ways. First, there is an unfortunate activity taking place in Africa where older prostitutes are being held in "blood factories" by their owners to harvest blood for sale to medical agencies around the world. American screening of the blood that comes into the US is good, but not perfect. Just hope that you don't need a blood transfusion.

There are also many economic effects that can and do have an effect on your suburban life (sorry, but an economist always brings it back to the dollars) that are directly and indirectly effected by AIDS in Africa. A great deal of petrolium processing is done in Africa and an immense amount of primary metals are mined in Africa as well. The rising health crisis has had a huge effect on both industries as the costs of maintaining a healthy labor force have risen dramatically. Both of these industries have a large effect on the global economy and the price of the goods and services that you purchase for your suburban home. Can't get around Globalization kid... your suburb is a part of it.

 

[YoPopa]

There are some who might consider helping desperate people stay alive to be its own reward even when it isn't good business (and price gouging might not be considered very good business anyway if long term interests mean anything).

Those folks who think that doing good is its' own reward are just sooo special. Too bad that not very many of them have funded or founded pharmaceutical firms. The do-gooders that I have known are much more likely to do their good deed by insisting that the evil pharmaceutical firms give up their profits.

That strategy has worked so well that it has convinced many of the vaccine manufacturers who once operated in the US to get out of that line all together. OK, frivolous lawsuits and loopy attacks, like Robert F. Kennedy claiming that childhood vaccines may have caused autism in thousands of kids. With do-gooders like that who needs enemas.

Roche doesn't want to relinquish its patent rights to Tamiflu. The WHO has refused to pressure them to do so, even though this would clear the way for other companies to produce generic versions of it in larger quanitities and at cheaper prices. Roche has donated 3 million doses to the WHO for use in attempting to control the first outbreaks.

Has Roche been offered contracts to produce Tamiflu in the quantities that the experts think are needed? Seems to me that if they did the R&D then they deserve the patent rights & profits for the relatively short time that patents apply to pharmaceuticals. Some one is always attacking BIG PHARMA for not relinquishing patent rights on the latest life saver. Don't you ever get tired of that? It's just another socialistic attempt to transfer wealth and it's disguised as a holier than thou attitude of "doing good is its' own reward"

 

[Dymanic]

Those folks who think that doing good is its' own reward are just sooo special. Too bad that not very many of them have funded or founded pharmaceutical firms.

Tamiflu was developed for profit. Under ordinary circumstances, I would have no problem with them taking their due. The avian flu crisis is not ordinary circumstances. They got lucky, and what they do now may have an enormous effect on all of humanity. I suggest that they now have a moral obligation to approach the situation from an aspect not limited to profit-taking and business as usual. If that makes me a 'do-gooder' in your view, I have a suggestion for you as well: check for a pulse.

Seems to me that if they did the R&D then they deserve the patent rights & profits for the relatively short time that patents apply to pharmaceuticals.

Gilead Sciences did the R&D. They licensed it to Roche. For five years, Gilead has been complaining that Roche has not adequately demonstrated the commitment to Tamiflu specified by the agreement, and is currently seeking to get Roche's license revoked.

You develop a new game console, invent a more efficient vacume cleaner, write a hit song, fine; it's all yours. Charge whatever you think the market will bear. You've got the lives of potentially tens or even hundreds of millions of people in your hands, I'm sorry, call me a commie, but that's a different story. They've made many millions off Tamiflu already, and will make many millions more no matter what. (By the way, when starving people in flood-devastated cities take food from stores, I don't regard that as 'looting' either).

It's just another socialistic attempt to transfer wealth

To whom? Other pharmaceutical companies. Is that your idea of socialism?

Has Roche been offered contracts to produce Tamiflu in the quantities that the experts think are needed?

They have been given contracts for quantities far in excess of what they are currently able to produce. Whether those quantities are what the experts think are needed depends on which experts you talk to. I don't disagree with your point that Roche is not solely to blame for the shortage, or that failure on the part of the US government to act once again has great potential to cost many lives. The US lags behind other developed countries in the quantities it has ordered. While the UK, France, Finland, Norway, Switzerland and New Zealand are ordering enough Tamiflu to cover between 20 to 40 percent of their populations, the current U.S. stockpile would cover less than 1% of its population. I do not find it comforting that this crisis is being handled by the same folks that handled the recent disaster in New Orleans.

 

[drkitten]

Could you please locate the source for this statement? The spokesperson I talked to at the WHO stated that there have been no proven direct human-to-human transmittals. The media from WHO seem to support that statement. I would love to read the source that you are stating, which month of NatGeo was it located in?

I believe it was in the past three months -- possibly even October 2005. But I read it in a dentist's office and didn't think to steal it.

However, this site more or less confirms at least one spotting:

Is there evidence of efficient human-to-human transmission now?

No. However, in Thailand, on 27 September 2004 the Ministry of Health announced possible human-to-human transmission in a family cluster. Thai officials have concluded that the mother could have acquired the infection either from some environmental source or while caring for her daughter, and that this represents a probable case of human-to-human transmission. While the investigation of this family cluster provides evidence that human-to-human transmission may have occurred, evidence to date indicates that transmission of the virus among humans has been limited to family members and that no wider transmission in the community has occurred.

Human-to-human transmission, but not efficiently.

Similarly, from this page:

Avian influenza viruses do not normally infect species other than birds and pigs. The first documented infection of humans with an avian influenza virus occurred in Hong Kong in 1997, when the H5N1 strain caused severe respiratory disease in 18 humans, of whom 6 died. The infection of humans coincided with an epidemic of highly pathogenic avian influenza, caused by the same strain, in Hong Kong

 

[Adrian]

Umm...

Quote:
Is there evidence of efficient human-to-human transmission now?

No. However, in Thailand, on 27 September 2004 the Ministry of Health announced possible human-to-human transmission in a family cluster. Thai officials have concluded that the mother could have acquired the infection either from some environmental source or while caring for her daughter, and that this represents a probable case of human-to-human transmission. While the investigation of this family cluster provides evidence that human-to-human transmission may have occurred, evidence to date indicates that transmission of the virus among humans has been limited to family members and that no wider transmission in the community has occurred.

This doesn't seem to confirm human-to-human transmission. Highly possible that there was in this case, but doesn't read to me as confirmation.

Avian influenza viruses do not normally infect species other than birds and pigs. The first documented infection of humans with an avian influenza virus occurred in Hong Kong in 1997, when the H5N1 strain caused severe respiratory disease in 18 humans, of whom 6 died. The infection of humans coincided with an epidemic of highly pathogenic avian influenza, caused by the same strain, in Hong Kong

This just seems to talk about people getting the disease and not human-to-human transmission.

Thanks for the ballpark on the NatGeo article. My grandfather has every issue of NatGeo and he is looking for the data on this for me. I'd like to read the article and see the situation that it discusses.

 

[drkitten]

Duplicate post.

 

[drkitten]

This doesn't seem to confirm human-to-human transmission. Highly possible that there was in this case, but doesn't read to me as confirmation.

Well, what do you want, a handwritten confession from one of the viruses responsible?

Here's another description of the same case

Investigation of possible human-to-human transmission in a family cluster

The most recent cases are part of a family cluster of four cases under investigation to determine whether human-to-human transmission may have occurred. Immediate investigation of any possible human-to-human transmission is always needed to determine whether transmission has been efficient and sustained. Such a situation would be cause for alarm, as it might signal the start of an influenza pandemic. Inefficient, limited human-to-human transmission may occur on rare occasions and is in line with what is known, from epidemiological and laboratory investigations, about the possible behaviour of the H5N1 virus.

The initial case in the family cluster was an 11-year-old girl who died of pneumonia on 8 September. Thai authorities regard her as a probable case of H5N1; laboratory confirmation is not possible as no specimens from this patient are available for testing. The girl, who lived in the northern province of Kamphaeng Phet, resided with her 32-year-old aunt, whose infection has been confirmed. Both patients are known to have had contact with dead chickens.

The girl’s 26-year-old mother, whose infection is also now confirmed, resided in the Bangkok area, but provided bedside care for her daughter while hospitalized, up to the time of the child’s death. The mother fell ill upon her return to Bangkok, where she died on 20 September.

Thai officials have concluded that the mother could have acquired the infection either from some environmental source or while caring for her daughter, and that this represents a probable case of human-to-human transmission.

Good enough, as they say, for folk music.

This just seems to talk about people getting the disease and not human-to-human transmission.

The quote got mangled somehow. Let me try again.

Avian influenza viruses do not normally infect species other than birds and pigs. The first documented infection of humans with an avian influenza virus occurred in Hong Kong in 1997, when the H5N1 strain caused severe respiratory disease in 18 humans, of whom 6 died. The infection of humans coincided with an epidemic of highly pathogenic avian influenza, caused by the same strain, in Hong Kong’s poultry population.

Extensive investigation of that outbreak determined that close contact with live infected poultry was the source of human infection. Studies at the genetic level further determined that the virus had jumped directly from birds to humans. Limited transmission to health care workers occurred, but did not cause severe disease.

The joker in the pack, of course, is the health care workers. They got it from their patients, not from dead chickens....

 

[Dymanic]

Why is this one so much worse than the regular flu?

Influenza viruses come in three types: A, B and C.

Avian flu is type A.

Type A influenzas have, in addition to the protective layer of protein called a 'capsid' (which all viruses have) an 'envelope', which is a phospholipid bilayer typical of cell membranes (and actually made up of material stolen from the outer cell wall of the previously infected host cell when the virus ‘budded’ through its surface).

The envelope has viral protein spikes sticking through it, made up of some of the virus's own protein with some sugars attached. The protein-sugar combination is called a glycoprotein, and it also comes in three varieties: hemagglutinin (HA), neuraminidase (NA), and M2. These are what the immune system 'sees'.

Every year's virus is a slight modification of an earlier model, usually through a slight variaion in the HA glycoprotein (which, besides providing the immune system with a convenient target, is the virus's key to the front door of the host cell). A slight change in an H1 glycoprotein, for example, means that antibodies developed during earlier encounters with that virus or a similar one won't work as well against the new subtype. But they won't likely be completely ineffective, either; as new virons are being produced by cells the virus has already comandeered, and as the virus is trying to comandeer more cells to create more copies, the immune system is working to come up with a new and improved antibody. If an old antibody works even enough to slow the virus's progress, the immune system will win that race -- and, with a typical flu virus, usually does.

What makes H5N1 so dangerous is that the H5 glycoprotein isn't just a slight modification of H1 or H3, it's completely different, so the immune system has to basically start from scratch. By the time it comes up with an effective antibody, the virus will have had time to produce massive numbers of copies.

 

[Bowser]

More information on flu typing. Note that 1918 has been confirmed to be H1N1. Eventually we should have some natural herd immunity to H5N1, but that will take a while.

http://www.iwar.org.uk/news-archive/2005/03-18-4.htm

There are many different subtypes of type A flu viruses. These subtypes differ because of certain proteins on the surface of the flu A virus (hemagglutinin [HA] and neuraminidase [NA] proteins). There are 16 different HA subtypes and 9 different NA subtypes of flu A viruses. Many different combinations of HA and NA proteins are possible. Each combination is a different subtype. All subtypes of flu A viruses can be found in birds. However, when we talk about “bird flu” viruses, we are referring to those flu A subtypes that continue to occur mainly in birds. They do not usually infect humans, even though we know they can do so. When we talk about “human flu viruses” we are referring to those subtypes that occur widely in humans. There are only three known subtypes of human flu viruses (H1N1, H1N2, and H3N2); it is likely that some genetic parts of current human flu A viruses came from birds originally. Flu A viruses are constantly changing, and they might adapt over time to infect and spread among humans.

http://biology.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pbio.0030300

Influenza A viruses are negative-strand RNA viruses of the Family Orthomyxoviridae that infect a wide variety of warm-blooded animals, including domestic and wild birds and mammals (e.g., humans, pigs, and horses). The natural reservoir for influenza virus is thought to be wild waterfowl, and genetic material from avian strains episodically emerges in strains infectious to humans. These human viruses continually circulate in yearly epidemics (mainly during the winter months in temperate climates), and antigenically novel strains emerge sporadically as pandemic viruses [1,2]. In the United States, influenza is estimated to kill 30,000 people in an average year [3,4]. Every few years, influenza epidemics boost the annual mortality level above this average, causing 10,000–15,000 additional deaths. Occasionally, and unpredictably, global pandemics of influenza occur, infecting 20% to 40% of the population in a single year and raising death rates dramatically above normal levels. Pandemic influenza A viruses emerged three times during the last century: in 1918 (H1N1 subtype), in 1957 (H2N2), and in 1968 (H3N2) [2,5]. The recent circulation of highly pathogenic avian H5N1 viruses in Asia from 2003–2005 has caused at least 52 human deaths [6,7] and has raised concern about the development of a new pandemic [5]. How and when novel influenza viruses emerge as pandemic strains and their precise mechanisms of pathogenesis are still not understood.

 

[Adrian]

Well, what do you want, a handwritten confession from one of the viruses responsible?

I accept the sarcasm, but no I don't require that. I just require scientific proof.

Good enough, as they say, for folk music.

Good enough for folk music, but not for science.

The joker in the pack, of course, is the health care workers. They got it from their patients, not from dead chickens....

It doesn't actually say that they have proof that they caught it from their patients. You are making that assumption based upon the close quarters (understandibly due to the circumstances) of that being the case. That still doesn't provide proof. Otherwise, the article would say "the aid workers got the disease from their patients". It does not say this, at least in your quote.

The key here is to remain scientific and not to mix the risk with the reality. Would a massive outbreak of a mutated H5N1 that allows for rapid human-to-human infection be awful and cause many deaths? Yes. This should not be considered in our minds when we are looking at the reality of what is happening right now. That can be tough to do, but it is necessary for rational thought.

Anyone who doesn't think that such paranoid thinking can cause problems, look up the response to the feared "swine flu pandemic" of 1976.That flu was supposed to end the world as well, but it never happened. The US and many world governments got all scared and told everyone to panic (and they did) and the flu never happened. Billions upon billions of dollars were wasted and many lawsuits were filed. Dr. Harvey Fineburg (Harvard, Institute of Medicine) went as far as to state (and I quote):

"In this case the consequences of being wrong about an epidemic were so devastating in people's minds that it wasn't possible to focus properly on the issue of likelihood. Nobody could really estimate likelihood then, or now. The challenge in such circumstances is to be able to distinguish things so you can rationally talk about it. In 1976, some policymakers were simply overwhelmed by the consequences of being wrong. And at the higher level [in the White House] the two - likelihood and consequence - got meshed." - Dr. Harvey Fineburg (Foreign Affairs, August 2005).