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Epidemics: Bird Flu, TB, AIDs, Superbugs, Ebola, etc
Topic: Epidemics: Bird Flu, TB, AIDs, Superbugs, Ebola, etc (Read 30173 times)
Epidemics: Bird Flu, TB, AIDs, Superbugs, Ebola, etc
January 23, 2007, 07:08:35 AM »
The dilemma of a deadly disease: patients may be forcibly detained
Doctors fear TB strain could cause a global pandemic if it is not controlled
Chris McGreal in Johannesburg and Sarah Boseley, health editor
Tuesday January 23, 2007
South Africa is considering forcibly detaining people who carry a deadly
strain of tuberculosis that has already claimed hundreds of lives. The
strain threatens to cause a global pandemic, but the planned move pits
public protection against human rights.
The country's health department says it has discussed with the World Health
Organisation and South Africa's leading medical organisations the
possibility of placing carriers of extreme drug resistant TB or XDR-TB under
guard in isolation wards until they die, but has yet to reach a decision.
Pressure to take action has been growing since a woman diagnosed with the
disease discharged herself from a hospital last September and probably
spread the infection before she was finally coaxed back when she was
threatened with a court order.
More than 300 cases of the highly infectious disease, which is spread by
airborne droplets and kills 98% of those infected within about two weeks,
have been identified in South Africa.
But doctors believe there have been hundreds, possibly thousands, more and
the numbers are growing among the millions of people with HIV, who are
particularly vulnerable to the disease. Their fear is that patients with
XDR-TB, told that there is little that can be done for them, will leave the
isolation wards and go home to die. But while they are still walking around
they risk spreading the infection.
Now a group of doctors has warned in a medical journal that if enforced
isolation is not introduced XDR-TB could swamp South Africa and spread far
beyond its borders. Regular TB is already the single largest killer of
people with Aids in South Africa.
Jerome Amir Singh of the Centre for Aids Programme of Research in South
Africa and two colleagues wrote in the peer-reviewed journal Public Library
of Science Medicine that the government must overcome its understandable
qualms over human rights in the interests of the majority. Without
exceptional control measures, including enforced isolation, XDR-TB "could
become a lethal global pandemic", they say.
"The containment of infectious patients with XDR-TB may arguably take
precedence over any other patients not infected with highly infectious and
deadly airborne diseases, including those with full-blown Aids. This is an
issue requiring urgent attention from the global community," they wrote.
"The South African government's initial lethargic response to the crisis and
uncertainty amongst South African health professionals concerning the
ethical, social and human rights implications of effectively tackling this
outbreak highlight the urgent need to address these issues lest doubt and
inaction spawn a full-blown XDR-TB epidemic in South Africa and beyond."
Mary Edginton of the Witwatersrand university's medical school endorses
"You can look at it from two points of view. From the patient's point of
view, you are expected to stay in some awful place, you can't work and you
can't see your family. You will probably die there. From the community's
point of view such a person is infectious. If they go to the shops or wander
around their friends they can spread it, potentially to a large group of
people," she said.
Karin Weyer of the Medical Research Council has called for enforced
hospitalisation of high-risk TB patients on the grounds that the risks to
society outweigh individual rights. But she opposes forcible treatment
because of the dangers associated with the drugs.
Professor Edginton said that medical authorities in the US and other
countries can obtain a court order to detain a person with infectious TB or
someone who is non-infectious but has failed to adhere to treatment. "The
Americans are much better at enforcing their laws on this," she said.
South African law also permits enforced isolation but some lawyers say it
comes into conflict with the constitutional guarantees on individual rights.
However, the constitution also guarantees communal rights, including
protection from infection and the right to a safe environment.
South Africa's health department yesterday said it has discussed the
possibility of enforced isolation with the country's Medical Research
Council and the World Health Organisation but has not reached a conclusion.
Ronnie Green-Thompson, a special adviser to the health department, said the
issue at stake is the human rights of the individual weighed against the
rights of the wider public. "The issue of holding the patient against their
will is not ideal but may have to be considered in the interest of the
public. Legal opinion and comment as well as sourcing the opinion of human
rights groups is important," he said.
"Also of importance is preventing those factors that lead to infectious TB
and these are poverty, poor housing, overcrowding and poor nutrition and any
other factors that weakens patients' resistance to acquiring infections."
Umesh Lalloo, of Durban's Nelson Mandela School of Medicine and head of the
research team into the first XDR-TB outbreak, said he is not persuaded that
detention is necessary.
"It's a very difficult call. Given our recent past with human rights
violations we need to be careful. I'm not dismissing such a move but it's a
very radical step. What we should be pushing for is a reinforcement of the
TB control programme which would contain the spread," he said. Professor
Lalloo said one consideration is that almost all infections appear to have
spread to patients in hospital.
The doctors and co-authors said that it is essential that patients were
detained in "humane and decent living conditions" and they urged the
government to change the rules so that those in hospital with TB continue to
receive welfare payments which are cut off if they are treated at the
Although cases of XDR-TB were discovered in South Africa a decade ago, the
disease started claiming dozens of lives at the small Tugela Ferry hospital
in rural KwaZulu-Natal two years ago. XDR-TB's origins are uncertain but the
WHO says the misuse of anti-tuberculosis drugs is the most likely cause.
Guardian Unlimited © Guardian News and Media Limited 2007
Last Edit: September 14, 2014, 04:51:46 PM by Crafty_Dog
Re: Epidemics: Bird Flu, TB, etc
Reply #1 on:
January 26, 2007, 02:19:20 PM »
INDONESIA: Two pigs in Bali, Indonesia, have become infected with the bird flu virus, Chinese medical expert Zhong Nanshan said. The virus' detection in pigs raises concerns that the virus could be transmitted to people.
Re: Epidemics: Bird Flu, TB, etc
Reply #2 on:
January 28, 2007, 07:52:34 AM »
Today's NY Times:
Virulent TB in South Africa May Imperil Millions
By MICHAEL WINES
Published: January 28, 2007
JOHANNESBURG, Jan. 27 — More than a year after a virulent strain of tuberculosis killed 52 of 53 infected patients in a rural South African hospital, experts here and abroad say the disease has most likely spread to neighboring countries, and some say urgent action is essential to halt its advance.
Several expressed concern at what they called South Africa’s sluggish response to a health emergency that, left unchecked, could prove hugely expensive to contain and could threaten millions across sub-Saharan Africa.
The director of the government’s tuberculosis programs called those concerns unfounded and said officials were doing everything reasonable to combat the outbreak.
The form of TB, known as XDR for extensively drug-resistant, cannot be effectively treated with most first- and second-line tuberculosis drugs, and some doctors consider it incurable.
Since it was first detected last year in KwaZulu-Natal Province, bordering the Indian Ocean, additional cases have been found at 39 hospitals in South Africa’s other eight provinces. In interviews on Friday, several epidemiologists and TB experts said the disease had probably moved into Lesotho, Swaziland and Mozambique — countries that share borders and migrant work forces with South Africa — and perhaps to Zimbabwe, which sends hundreds of thousands of destitute refugees to and from South Africa each year.
But no one can say with certainty, because none of those countries have the laboratories and clinical experts necessary to diagnose and track the disease. Ominously, none have the money and skills that would be needed to contain it should it begin to spread.
Even in South Africa, where nearly 330 cases have been officially documented, evidence of the disease’s spread is mostly anecdotal, and epidemiological work needed to trace its progress is only now beginning.
“We don’t understand the extent of it, and whether it’s more widespread than anyone thinks,” Mario C. Raviglione, the director of the Stop TB Department of the World Health Organization in Geneva, said in a telephone interview. “And if we don’t know what has caused it, then we don’t know how to stop it.”
Cases of XDR TB exist elsewhere, in countries like Russia and China where inadequate treatment programs have allowed drug-resistant strains of the disease to emerge. The South African outbreak is considered far more alarming than those elsewhere, however, because it is not only far larger, but has surfaced at the center of the world’s H.I.V. pandemic.
Although one third of the world’s people, by W.H.O. estimates, are infected with dormant tuberculosis germs, the disease thrives when immune systems are weakened by H.I.V. At least two in three South African TB sufferers are H.I.V. positive. Should XDR TB gain a foothold in the H.I.V.-positive population, it could wreak havoc not only among the five million South Africans who carry the virus, but the tens of millions more throughout sub-Saharan Africa.
People without H.I.V. have a far smaller chance of contracting tuberculosis, even if they are infected with the bacillus that causes TB. But because tuberculosis is spread through the air, anyone in close contact with an active TB sufferer is at some risk of falling ill.
Most if not all of the 52 people who died in the initial outbreak of XDR TB, at the Church of Scotland Hospital in a KwaZulu-Natal hamlet called Tugela Ferry in 2005 and early 2006, had AIDS. Most died within weeks of being tested for drug-resistant tuberculosis, a mortality rate scientists called unprecedented.
Since then, South African health officials say, they have confirmed a total of 328 cases of XDR TB, all but 43 in KwaZulu-Natal. Slightly more than half the patients have died.
Those numbers are deceptive, however. The Tugela Ferry outbreak was reported in part because the hospital there was part of a Yale University research project involving H.I.V.-positive patients with tuberculosis. Because South Africa’s treatment and reporting programs for tuberculosis are notoriously poor — barely half of TB patients are cured — virtually all experts contend the true rate of infection is greater.
“We’re really concerned that there may be similar outbreaks to the one in Tugela Ferry that are currently going undetected because the patients die very quickly,” said Dr. Karin Weyer, who directs tuberculosis programs for South Africa’s Medical Research Council, a semiofficial research arm of the government.
Some other researchers and experts say they share Dr. Weyer’s concern. They say South African health officials have lagged badly in assembling the epidemiological studies, treatment programs and skilled clinicians needed to combat the outbreak, and say the government has responded slowly to international offers of help.
Virulent TB in South Africa May Imperil Millions
Published: January 28, 2007
(Page 2 of 2)
Dr. Weyer said the council “shares the concern that not enough is being done, quickly enough, to get on top of the problem.” In particular, she said, officials have yet to carry out epidemiological studies or address a “shocking” lack of infection controls in hospitals that could allow TB and other infections to spread freely among H.I.V.-positive patients
“It’s an emergency, and we’re not reacting as if it were an emergency,” said Dr. Nesri Padayatchi, an epidemiologist and expert on drug-resistant TB for Caprisa, a Durban-based consortium of South African and American AIDS researchers. “I think we have the financial resources to address the issue, and we’ve been told the Department of Health has allocated these resources.”
Although the government was first told of the outbreak 20 months ago, in May 2005, “to date, on the ground in clinics and hospitals, we are not seeing the effect,” she said.
In KwaZulu-Natal’s major city, Durban, the sole hospital capable of treating XDR TB patients has a waiting list of 70 such cases, she said.
Dr. Weyer said the waiting list indicates that “capacity is becoming a problem” in KwaZulu-Natal, the outbreak’s center. “I’m quite sure we may find a similar situation in other provinces,” she added.
A spokesman at the hospital said it could not easily determine how many patients were awaiting treatment.
But the manager of South Africa’s national tuberculosis program, Dr. Lindiwe Mvusi, said such complaints were misplaced. The Durban hospital in question, she said, is under renovation, and officials are “looking for accommodations in other hospitals” while construction proceeds.
Hospitals in other provinces have enough beds now for XDR TB patients, and some are expanding isolation wards to handle any spread of the disease, she said.
She said other responses to the outbreak were under way, including a rough assessment of TB cases in hospitals nationwide. A more comprehensive national survey of TB cases may be conducted late this year, she added, and health officials in KwaZulu-Natal have begun surveillance programs to detect new cases of drug-resistant TB in the province.
Dr. Mvusi also rejected the notion that the tuberculosis had moved beyond South Africa’s borders. But in interviews, a number of TB experts and epidemiologists raised that concern, including Mr. Raviglione at the world health organization, Dr. Padayatchi, Dr. Weyer and Dr. Gerald Friedland, director of the AIDS program at the Yale University School of Medicine.
Dr. Raviglione of W.H.O. said that South African health officials were cooperating on responses to the outbreak, and that an official of his organization would arrive in Pretoria within days to discuss placing a team of global TB experts in the country.
“W.H.O. is ready to come to South Africa and to help in any place, for anything, whether surveillance, or detection, or infection control,” he said. However, those arrangements have not been completed.
Dr. Mvusi, the government’s TB program head, said global health experts were welcome, but “in an advisory role, because we want the capacity locally.”
Re: Epidemics: Bird Flu, TB, etc
Reply #3 on:
February 02, 2007, 08:02:55 AM »
Closings and Cancellations Top Advice on Flu Outbreak
By DONALD G. McNEIL Jr.
Published: February 2, 2007
ATLANTA, Feb. 1 — In the event of a severe flu outbreak, schools should close for up to three months, ballgames and movies should be canceled, and working hours should be staggered so subways and buses are less crowded, the federal government said Thursday in issuing new pandemic flu guidelines to states and cities.
This Is Only a Drill Health officials acknowledged that such measures would greatly disrupt public life, but argued that they would provide the time needed to produce vaccines and would save lives because flu viruses attack in waves lasting about two months.
“We have to be prepared for a Category 5 pandemic,” said Dr. Martin S. Cetron, director of global migration and quarantine for the federal Centers for Disease Control and Prevention, in releasing the guidelines. “It’s not easy. The only thing that’s harder is facing the consequences. That will be intolerable.”
Officials are, for the first time, modeling the new guidelines on the five levels of hurricanes.
Category 1 assumes that 90,000 Americans would die, Glen J. Nowak, a spokesman for the disease centers, said. (About 36,000 Americans die of flu in an average year.) Category 5, which assumes 1.8 million dead, is the equivalent of the 1918 Spanish flu pandemic. That flu killed about 2 percent of those infected; the H5N1 flu now circulating in Asia has killed more than 50 percent of those infected but is not easily transmitted.
The new guidelines advocate having sick people and their families — even apparently healthy members — stay home for 7 to 10 days. They advise against closing state borders or airports because crucial deliveries, including food, would stop.
The report urges communities to think about ways to continue services like transportation and meal service to particularly vulnerable groups like the elderly and those who live alone.
The guidelines are only advisory, since the authority for measures like school closings rests with state and city officials, but many local officials have asked for guidance, Dr. Cetron said. The federal government has taken primary responsibility for developing and stockpiling vaccines and antiviral drugs, as well as masks and some other supplies.
The new guidelines are partly based on a recent study of how 44 cities fared in the 1918 epidemic conducted jointly by the disease centers and the University of Michigan’s medical school. Historians and epidemiologists pored over hospital records and newspaper clippings, trying to determine what factors contributed to the varying impact.
A few small towns escaped the epidemic entirely by cutting off all contact with the outside, but most cities took less drastic measures. Those included isolating the sick and quarantining homes and rooming houses; closing schools, churches, bars and other gathering places; canceling parades, ballgames and other public events; staggering factory hours; discouraging use of public transport; and encouraging use of face masks.
The most effective approach seemed to be moving early and quickly. “No matter how you set up the model,” Dr. Howard Markel, a leader of the study, said, “the cities that acted earlier and with more layered protective measures fared better.”
Any pandemic is expected to move faster than a new vaccine can be produced; current experimental H5N1 vaccines are in short supply and are based on strains isolated in 2004 or 2005. Although the government is creating a $4 billion stockpile of the vaccine Tamiflu, it is useful only when taken within the first 48 hours, and Tamiflu-resistant strains of the flu have already been found in Vietnam and in Egypt.
“No one’s arguing that by closing all the schools you’re going to prevent the spread,” Dr. Markel added. “But if you can cut cases by 10 or 20 or 30 percent and it’s your family that’s spared, that’s a big deal.”
School closings can be controversial, and picking the right moment is hard because it must be done before cases soar.
Several public health experts praised the guidelines, though there were objections to some aspects.
Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said he saw no point in worrying about exactly when to close schools, because his experience in meningitis outbreaks convinced him that anxious parents would keep children at home anyway.
“I don’t think we’ll have to pull that trigger,” Dr. Osterholm said. “The hard part is going to be unpulling it. How do the principals know when schools should open again?”
Other experts said that children out of school often behaved in ways that still put them at risk. Youngsters are sent to day care centers, and teenagers gather in malls or at one another’s houses.
“We’ll be facing the same problem, but without the teaching,” said Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at the Mailman School of Public Health at Columbia University. “They might as well be in class.”
Dr. Cetron said that caring for children in groups of six or fewer would cut the risks of transmission. He also said that parents would keep many children from gathering.
“My kids aren’t going to be going to the mall,” he said.
The historian John M. Barry, author of “The Great Influenza” (Viking Adult, 2004), questioned an idea underpinning the study’s conclusions. There is evidence, Mr. Barry said, that some cities with low rates of sickness and death in 1918, including St. Louis and Cincinnati, were first hit by a milder spring wave of the virus. That would have, in effect, inoculated their citizens against the more severe fall wave, and might have been more important than their public health measures.
Re: Epidemics: Bird Flu, TB, etc
Reply #4 on:
February 07, 2007, 08:57:02 PM »
From Bird to Person
By PETER D. ZIMMERMAN
February 7, 2007; Page A15
LONDON -- The "deadly" H5N1 avian flu is back on the front pages of newspapers and TV news shows. The British environment minister has pledged quick action to "eradicate" the disease from the U.K., and over 150,000 turkeys on one farm have been culled. "This is," someone said on the BBC's "Breakfast" show Monday, "a disease of birds, not humans." And so it is.
The H5N1 virus has still not made the critical interspecies leap which would make it easy for an infected person to give the disease to another person. That may happen, or it may not; and nobody can predict the outcome or its timing with any degree of confidence. Meanwhile, as of the World Health Organization's compilation on Feb. 3, there had been a total of 271 laboratory-confirmed cases of the virus in humans, and of that number a staggering 165, or 61%, died, making it one of the most lethal pathogens in history, even if not one of the most infectious.
Still, just 18 months ago many experts were predicting a global pandemic in a matter of months, perhaps one that would kill millions. There is historical precedent: The 1918-1919 "Spanish Flu" swept around the world in a matter of weeks, and before the disease burned out, more than 50 million people had died. Today H5N1 is reminiscent only of the Asian "Swine flu," which threatened the U.S. in 1976 but never turned into a serious threat to human life (although the media hype surrounding it helped undermine Gerald Ford's presidency). In 2004, worried people rapidly bought up much of the world's supply of Tamiflu and Relenza, the only two drugs that seemed to have a chance of beating H5N1. Now most of us have forgotten the names of these drugs.
Influenza viruses have eight genes and these mutate rapidly. Two sites on the viral genome, called H and N, are well catalogued, and each of those genes can come in many forms. Those are the markers that trigger the human immune system. If your body has seen a whiff of a particular virus, it will produce large numbers of antibodies if you later become infected with a strain having the same markers. If you have never been exposed to a particular strain, there are no antibodies in your bloodstream, and your body will fight an uphill battle for survival. The more virulent the virus, the less chance you have.
So far as is known, no H5N1 virus has ever circulated on the planet. That means nobody has any natural immunity. Our good fortune last flu season was that the bird flu virus had not yet learned the trick of passing easily from human to human. The few confirmed victims were almost all people who'd worked very closely with infected fowl in extremely unsanitary conditions. One can suppose that they were massively exposed, allowing this "disease of birds, not humans" to develop in their bodies.
Almost all influenza viruses originate in migrating water fowl in South-East Asia, and by and large the birds don't get sick. However, those birds can pass their viruses to domesticated birds. In the great viral mixing pot of China, where people live in close contact with both their birds and their pigs, influenza viruses can readily pass from one species to another, and sometimes to an animal or person already infected with another flu bug.
In this environment, mutations are guaranteed to occur, and from time to time a new pathogen with the ability to pass between people develops. If it carries the same marker combination as one or another previous flu virus, much of the world's population will have a basic immunity. If it does not have familiar markers, much of humanity is at risk once that virus learns to jump from person to person. Each year a panel of experts tries to guess which strains of flu will pose the highest risk in the coming influenza season, and orders up vaccines to give the vulnerable some protection. H5N1 has not been selected, because it still hasn't become contagious in our species. But it could make the jump at any time.
The last year has brought the world a major advantage, should H5N1 become a "disease of humans." The pharmaceutical industry has learned the difficult trick of making and producing a vaccine against a hitherto unknown disease. GlaxoSmithKline recently claimed that it had succeeded in developing a "second generation" bird flu vaccine that could be given in advance, even before knowing the detailed gene structure that would allow this bird flu to infect people. The vaccine could be given before the bug even learns that deadly trick. Other companies have also developed vaccines which appear to produce broad-spectrum antibodies against many strains of the virus, and many governments have ordered large stocks from various producers.
It is probably worth stockpiling many millions of doses before H5N1 escapes into the human population. Because none of us has any useful immunity, the virus could migrate around the world with the speed of commercial air travel, not the steamships that powered the Spanish Flu. If H5N1 escapes, and if it becomes as virulent as the Spanish Flu (which killed 1% of those who developed the disease), the pessimistic predictions of millions of people dead within months could come true. Only if vaccine bottles were already on the shelf, ready for instant use, could the virus be contained.
However, deadly as it could be, and as harmless as it has so far been, the H5N1 avian flu will not be the last new influenza virus to develop. The process that produced H5N1 is at work every year, and the more intense the agribusiness of raising chickens in China becomes, the more rapidly new viruses can spread and mutate. Even if we may have dodged the H5N1 bullet, another pandemic like the Spanish Flu is inevitable and could break out into the human population so quickly that vaccines cannot be produced in time.
New types of influenza virus must be detected and combated while they are still diseases of birds, not humans. Detection of new viruses will happen where they originate. A global pathogen surveillance system -- as Sen. Joseph Biden suggested almost five years ago -- is necessary because the global first line of defense against influenza is not the U.S. Centers for Disease Control and Prevention, but the public health agencies of China, Vietnam and other nations in that region. Those agencies need multilateral support and encouragement, and the United States must take the lead. And countries where flu viruses originate need the courage to recognize that reporting a new disease does not reveal weakness, but rather demonstrates the strength of their health systems.
Mr. Zimmerman is professor of science and security at King's College London. He was chief scientist of the U.S. Senate Foreign Relations Committee staff and science adviser for arms control at the U.S. State Department.
Re: Epidemics: Bird Flu, TB, etc
Reply #5 on:
February 19, 2007, 11:02:49 AM »
1241 GMT -- RUSSIA -- A bird flu outbreak near Moscow involves the dangerous H5N1 strain that can infect humans, Russian health officials confirmed Feb. 19. Nikolai Vlasov, a senior official at Russia's health watchdog Rosselkhoznadzor, said the strain is probably related to the Asian type of the virus and might have been carried by wild birds migrating from the Caucasus, Balkans or Asian regions. The outbreak, Russia's second of 2007, is the first to be recorded near the capital.
Re: Epidemics: Bird Flu, TB, etc
Reply #6 on:
February 21, 2007, 11:27:00 AM »
The Survivalist Returns
What's wrong with the CDC's new pandemic planning guide.
By David Shenk
Posted Tuesday, Feb. 6, 2007, at 1:25 PM ET
"Cascading consequences" is one of those elegant phrases that disaster planners use to refer to very bad stuff happening later on—hypothetical events that only occur as a result of other events and are therefore very difficult to predict and even more difficult to plan for. It's not the initial head-on collision, but the divorce resulting from the affair precipitated by the sense of worthlessness fueled by the lost job clinched by the rude insubordination fed by the frustration from the lateness from the traffic jam caused by the head-on collision.
If you're Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, and you're trying to figure out precisely how to react to a hypothetical human-transmissible form of the H5N1 "bird flu" virus, cascading consequences are what you live and breathe. Should you quarantine cities? Close schools? Restrict public transportation? What happens to a complex urban civilization when people, supplies, and services get arbitrarily derailed?
Last week, the CDC issued a comprehensive new "pre-pandemic planning" guide (PDF here) for communities that includes contingencies for five category levels of pandemic. In the mildest scenario, Category 1, communities would not be urged to do much beyond voluntary isolation of ill patients in their homes. In Category 5, the most severe, schools might be cancelled for months at a time, work schedules could be staggered, and public events banned.
The CDC guide is well-intentioned and clear, but it suffers from three profound problems. The first is a hindsight/foresight problem. Pandemics can't be tracked in advance with satellites and don't give off measurable wind speeds. In practical terms, as Gerberding has already acknowledged, we're going to have to assume the worst right away and make category distinctions months later. Sending the message now that we can nuance a pandemic—that we're going to be able to respond with anything less than a massive and coordinated effort—could end up spawning dangerous confusion.
The second, and larger, problem is that we simply do not know at this point which social measures will make things better and which will make them worse. School closures sound like a good idea, but they didn't protect any community during the last pandemic in 1918, and they don't work for seasonal flu. Furthermore, there are cascading consequences: What about the millions of kids who depend on schools for meals? What about the economic and infrastructure disruption from adults having to stay home from work? And if the virus seems to be hitting cities in waves and rolling around the country several times, when—exactly—do you re-open the schools?
The third and most important problem is what's missing from this CDC document: a vaccine endgame. The report is candid about vaccine being the best "countermeasure" and explicitly states that its strategy is to delay the epidemic "in order to 'buy time' for production and distribution of a well-matched pandemic strain vaccine." What it doesn't explain is why the federal government can't accelerate a vaccine program given the very real prospect that this could become the worst public-health crisis in nearly a century. "The government is moving way too slowly on the vaccine," says one pandemic expert involved in U.S. policy discussions. "We're on a five-year timeline and we need to be much more ambitious and aggressive. That's the one thing that could change this whole equation."
Where does this leave citizens? The Survivalist sees three separate courses of action.
1. Be a constituent.
We all need to pressure policy-makers to start a crash vaccine program.
2. Be a community citizen.
The CDC plan is a decent start and a vast improvement on past government efforts. But effective pandemic response will require extensive what-if conversations at every level of society—in the workplace, at the PTA, at the water-filtration plant. Do your part by imagining what your practical role would be and discussing it with colleagues and neighbors.
3. Be a survivalist.
If you're as worried about a pandemic as I am (and as Julie Gerberding is), take nothing for granted. Carefully game out your own family response: Could you manage to telecommute for several months? To the extent possible, every family should be prepared for some level of isolation, with necessary food, health, and entertainment supplies. In a pandemic scenario, social distance can slow down the spread of the disease and buy valuable time for a vaccine.
Re: Epidemics: Bird Flu, TB, etc
Reply #7 on:
February 21, 2007, 11:36:04 AM »
From: David Shenk
Subject: How To Survive the Avian Flu, Smallpox, or Plague
In a matter of months, bird flu will probably show up somewhere the United States. A few wild geese will test positive for the H5N1 strain, along with a farm cat or two. Grave precautions will be issued, followed by a flurry of safety assurances from the White House and Tyson farms. CNN and Leno will make a great day of it. Poultry sales will fall off for a few months. It won't mean much.
The real disaster, if it happens, will unfold more quietly at first. A sick farmer in China's Guangdong province will sneeze at dinner. He'll turn out to have been simultaneously infected with the new strain and the more conventional flu bug. Out of his nose a nasty new viral hybrid will hurtle through the air and get unluckily sucked into the lungs of his niece, who will breed it for a day or two and hand it off to the postman, who will hand it off to a truck driver, who will deliver it to a big city saloon. From there, a small army of sneezable new H5N1 bugs will hitch on a few plane passengers to Europe and the United States, and the nightmare will begin.
This is the great fear of world health officials, stoked by the fact that H5N1 is an entirely new strain of flu; no one has any immunity against it, and no traditional vaccine can be prepared in advance. Further, this flu is already eerily reminiscent of the devastating "Spanish Flu" pandemic of 1918 in that most of its human fatalities are, surprisingly, adolescents and young adults. Both viruses seem to trick the healthiest immune systems into a response so strong that it kills the patient. A disease that kills the strongest among us. An estimated 20 million to 50 million people died in the 1918 pandemic (compared with the 9 million soldiers who died around the same time in World War I), and there is every expectation that an H5N1 pandemic could be just as devastating—if it mutates to a more transmissible form.
If that key mutation takes place, public-health officials will have a one-in-a-million shot of spotting and containing the initial human cluster at its source. If they can't pull off that minor miracle, there'll be no way to prevent its worldwide spread. Once it's out, it's out, and we will just have to brace ourselves for it. Big cities won't have to wait long—chances are that the bug will already be in New York, London, and elsewhere before it is even noticed. Within weeks, it would be virtually everywhere.
Of course, it may not happen at all. No one can predict whether or when a pandemic flu will actually occur. We can't even put reliable odds on it. All health officials can say with certainty is that, historically, pandemics do happen, and that conditions are now in place for another one to unfold. The gun is loaded and cocked. It might not fire this year or next, or even in the next 25 years, but everything we know says it is bound to happen sooner or later. "The general consensus among scientists who are studying this is that it is not a matter of if a pandemic will happen, but when," Stanford immunology professor Lucy Tompkins has said, echoing many other similar comments. Considering the horrific potential—tens, or even hundreds, of millions dead before effective vaccines can be manufactured and distributed—we'd have to be nuts not to get ready now.
According to Michael Osterholm, director of the Center of Infectious Disease Research and Policy:
We can predict now 12 to 18 months of stress, of watching loved ones die, of potentially not going to work, of wondering if you're going to have food on the table the next day. Those are all things that are going to mean that we're going to have to plan unlike any other kind of crisis that we've had literally in the last 80-some years in this country.
Avian flu is not, of course, the only looming biological threat. There is also the very real possibility of terrorist attack with agents that cause smallpox, plague, tularemia, or viral hemorrhagic fever. Once introduced, any of these agents could spread widely and cause mass casualties and social disruption. What can we as individuals do to prepare? First, take a minute to imagine the potentially drastic change in the human landscape: Hospitals everywhere are filled beyond capacity. Streets, subways, schools, theaters, and cafes are more or less deserted. The only way to protect yourself and your family is to avoid contact with people, so that's just what you do. You work from home if you can, and you and your family do not socialize at all—no play dates, no dinner parties, no movies or restaurants. You eat at home, play at home, teach your kids at home, even administer medical care at home. (A hospital visit is a surefire way to pick up an infectious agent.) If you don't have an expansive yard, maybe you occasionally take your kids to a big park—but they stick close as a rule and do not bound off with other kids. When you go food shopping, you wear a mask and don't stop to talk to anyone. Every day, you wipe the newspaper and the mail down with bleach. Or better yet, you cancel both. For a large segment of the population, all contact becomes electronic, all interaction virtual. In the case of avian flu, this would go on week after week, month after month, until the vaccine comes. (Due to drugs already available, smallpox and other agents might be contained sooner.)
It sounds absurd, and it is, but this kind of surreal shift is what happens when something comes along that fundamentally changes the social paradigm. Avian flu and bioweapons could be that powerful.
Now that you've swallowed that idea, consider the next, even weirder, level. In the most severe pandemic, social isolation could be the least of our problems. If the infection and death rate get high enough, services and supplies could become dangerously interrupted. With key people absent from filtration plants, city water systems might go in and out of reliability. Same with fire, police, and of course emergency rooms. Electrical grids could fail without sufficient expertise at key moments. Food shortages are a serious possibility if production or transportation stop. The stock market, needless to say, won't enjoy the supply shortages and dearth of shopping. It's not hard to imagine a grave pandemic sparking a worldwide depression, and even an environment of desperation and lawlessness.
Or maybe not. It's also possible that H5N1 will mutate into a much milder human-to-human virus, and that the subsequent pandemic will feel like a nasty but conventional flu season. It's possible that bioweapons will never emerge as anything more than a public-health exercise. The point is, no one knows, and so it pays to prepare for the worst.
Here's how to survive a severe pandemic: Prepare to become self-sufficient for several months; stockpile nonperishable food, water, disinfectants, prescription medication, office supplies, batteries and generators, air-filter masks, cash (small bills), portable gas cookware, entertainment for the kids, and so on. If you happen to be shopping for an air purifier anyway, make sure it has a UV component like these—that's the only type that will actually kill a virus. Consider having to take care of a sick family member if a hospital is out of the question; this would require the antivirals Tamiflu or Relenza (Relenza is likely to be more effective, since Tamiflu more quickly provokes resistance), as well as drugs for nausea, fever, pain, and muscle aches; basic medical supplies like gloves, masks, and a blood pressure monitor would also be prudent. There are a number of extremely thorough preparedness guides here. More generally, you can learn everything you need to know about the causes and consequences of a pandemic here.
If you have a rural retreat, consider using it. Also, consider that in a worst-case scenario, you might have to defend the security of your well-supplied home from desperate outsiders. Finally, consider that everyone has to die sometime, and unless you have no survivors at all, it is reckless not to have your affairs in order.
Aside from whatever personal planning you're comfortable with, be sure to follow this issue closely. There's a reasonable chance that attentive readers will have a few weeks' warning before people start emptying grocery-store shelves. Look for phrases like:
" … a quarantine has been placed around the village of ____"
" … emergency doses of Tamiflu have been rushed to the scene . . ."
" …'this could be what we've been fearing,' said one WHO official."
A little citizen activism wouldn't hurt either. Make sure your state is stockpiling antivirals to the greatest extent possible. USA Today recently reported that many states are not taking advantage of a federal program to acquire large reserves. In addition, contact your local health department and inquire about the particular plans of your city and state. A coherent government plan in advance of any pandemic is vital. If it ever does hit, there will be no time to create one, and laissez-faire health commissioners will have a lot of blood on their hands.
Emergency planning list:
Re: Epidemics: Bird Flu, TB, etc
Reply #8 on:
June 02, 2007, 08:54:44 AM »
By L. MASAE KAWAMURA
Published: June 2, 2007
IF it turns out that none of his fellow passengers were actually infected with the dangerous form of tuberculosis he carries, then Andrew Speaker, the young honeymooner who recently eluded government efforts to keep him off commercial flights, may actually have done a favor to public health. His case has brought to light the neglected but growing problem of super drug-resistant tuberculosis, and the ease with which this deadly airborne disease can travel around the world.
Federal health officials have recently warned state and city TB treatment programs to expect budget cuts of as much as 25 percent over the next five years. But Mr. Speaker is not the first world traveler to carry the most drug-resistant TB, and he will surely not be the last. Instead of cutting back on TB research and treatment, we should be intensifying our efforts to fight the disease.
We urgently need tests capable of diagnosing drug resistance overnight, so that we can know which patients present the most danger to the public. We need new drugs to outwit the disease. And we need to support a worldwide effort to prevent TB bacteria from developing further drug-resistance.
Tuberculosis is an illness that was once thought to be under control. A century ago, it was responsible for one in five deaths in the United States. But then antibiotics came along, and a national effort to develop new drugs and diagnostic tools and to institute TB-control public health programs drove down the rates of tuberculosis in the United States to the point where people assumed it was eradicated.
Twenty years ago, complacency about TB control combined with the H.I.V. epidemic and a growing immigrant population to bring about a resurgence. As a result, in the early 1990s, TB programs in the United States were rebuilt to provide better patient care and case investigation and to improve adherence to treatment.
These programs have become models for TB treatment around the world. But unfortunately, in many countries, public health standards still fall short. Patients infected with tuberculosis are given inadequate courses of antibiotics, or they fail to adhere to the course of treatment they are given. In such cases, the most drug-resistant strains of the bacteria are allowed to multiply.
It’s easy to see how drug resistance in any one country grows into a global problem. One-third of the world’s population carries the TB bacillus in their bodies, and in the stream of people traveling around the world the bacteria are constantly on the move.
The World Health Organization estimates that each person with TB infects 10 to 15 other people, usually by coughing the germs into the air. And once the bacteria reach a new host, they can either progress to disease, keeping the cycle going, or be carried around for years or decades, only to cause illness later on in a chosen few. A robust immune system is needed to contain the infection, but even in healthy people, 5 percent to 10 percent of those exposed go on to develop TB.
The most extremely resistant form of the illness — the kind that Mr. Speaker has, known as XDR-TB, which is impervious to even our most powerful antibiotics — is now found all over the world. It is thought to be rare, though the exact numbers are unknown. But we know that the numbers are rising, because strains of TB that are resistant to multiple drugs — the precursors to XDR-TB — are proliferating. In 2004, almost half a million of the more than 8 million cases of tuberculosis worldwide were resistant to the most potent TB drugs. And drug resistance feeds further drug resistance.
Adding to the problem is the long time, often a period of months, that it takes to detect drug resistance. Doctors are forced to treat in the dark, not knowing whether their drugs are actually working.
What is needed are tests capable of diagnosing drug resistance within 24 hours — tests that do not require letting the bacteria grow in culture for days but rather identify gene mutations that confer drug resistance.
Such genetic tests to detect resistance to first-line TB drugs already exist, though they are in limited use, mainly in New York and California. We need to put in the effort to develop them for the second-line antibiotics, and make the investment to ensure that the quick tests are put into widespread use.
Perhaps if Mr. Speaker’s doctors had known before he left for Paris that his tuberculosis was the drug-resistant kind, they might have taken even stronger action to keep him from flying to Europe in the first place. State and federal laws give public health officials the authority they need to keep contagious patients away from the public, but in exercising that authority, it helps to know the danger that a patient poses.
In addition, we need more drugs to treat TB. No new drug class has been approved for TB since the antibiotic rifampin, 35 years ago. Without effective drugs to treat the new superbugs, patients often suffer longer periods of contagion, and that makes their treatment extremely costly (from about $90,000 to more than $700,000 per patient).
Last fall, the World Health Organization proclaimed XDR-TB to be a public health emergency and called on governments to provide $95 million in 2007 to deal with the problem. Three bills now before Congress would increase domestic and international spending for TB treatment and research.
As global travel continues to increase and the rate of drug-resistant TB rises, the number of cases of drug-resistant tuberculosis inevitably will grow. It is essential that we redouble our efforts to halt the epidemic of drug resistance and the global spread of all forms of TB.
L. Masae Kawamura is the director of the tuberculosis control section of the San Francisco Department of Public Health.
Re: Epidemics: Bird Flu, TB, etc
Reply #9 on:
October 05, 2007, 03:19:04 PM »
NEW YORK (Reuters) - The H5N1 bird flu virus has mutated to infect people more easily, although it still has not transformed into a pandemic strain, researchers said on Thursday.
The changes are worrying, said Dr. Yoshihiro Kawaoka of the University of Wisconsin-Madison.
"We have identified a specific change that could make bird flu grow in the upper respiratory tract of humans," said Kawaoka, who led the study.
"The viruses that are circulating in Africa and Europe are the ones closest to becoming a human virus," Kawaoka said.
Recent samples of virus taken from birds in Africa and Europe all carry the mutation, Kawaoka and colleagues report in the Public Library of Science journal PLoS Pathogens.
"I don't like to scare the public, because they cannot do very much. But at the same time it is important to the scientific community to understand what is happening," Kawaoka said in a telephone interview.
The H5N1 avian flu virus, which mostly infects birds, has since 2003 infected 329 people in 12 countries, killing 201 of them. It very rarely passes from one person to another, but if it acquires the ability to do so easily, it likely will cause a global epidemic.
All flu viruses evolve constantly and scientists have some ideas about what mutations are needed to change a virus from one that infects birds easily to one more comfortable in humans.
Birds usually have a body temperature of 106 degrees F, and humans are 98.6 degrees F usually. The human nose and throat, where flu viruses usually enter, is usually around 91.4 degrees F.
"So usually the bird flu doesn't grow well in the nose or throat of humans," Kawaoka said. This particular mutation allows H5N1 to live well in the cooler temperatures of the human upper respiratory tract.
H5N1 caused its first mass die-off among wild waterfowl in 2005 at Qinghai Lake in central China, where hundreds of thousands of migratory birds congregate.
That strain of the virus was carried across Asia to Africa and Europe by migrating birds. Its descendants carry the mutation, Kawaoka said.
"So the viruses circulating in Europe and Africa, they all have this mutation. So they are the ones that are closer to human-like flu," Kawaoka said.
Luckily, they do not carry other mutations, he said.
"Clearly there are more mutations that are needed. We don't know how many mutations are needed for them to become pandemic strains."
Reply #10 on:
October 17, 2007, 12:37:11 PM »
Antibiotic-resistant bacterium that causes severe infections has migrated from hospitals and now kills more Americans than AIDS.
By Thomas H. Maugh II, Los Angeles Times Staff Writer
October 17, 2007
The number of severe infections by a "superbug," known as methicillin-resistant Staphylococcus aureus, isat least twice as high as researchers previously believed, and the bacterium now kills more Americans than AIDS, researchers reported today.
The antibiotic-resistant infections, commonly called MRSA, were once confined to a few hospitals, but a new study by the national Centers for Disease Control and Prevention found that in 2005 they made an estimated 94,000 Americans seriously ill and killed almost 19,000, compared with 17,000 who died of AIDS.
"Certainly, MRSA now has to be viewed as a very important target for prevention and control," said Dr. David A. Talan, an infectious diseases specialist at Olive View-UCLA Medical Center in Sylmar who was not involved in the study.
The infections have been a growing concern, particularly over the last decade, as they have spread outside hospitals, popping up in prisons, athletic fields and locker rooms.
The study reported that nearly 14% of new antibiotic-resistant staph infections are not linked to hospitals or other medical facilities, indicating that the disease has become ingrained in parts of the wider community.
The finding, reported in the Journal of the American Medical Assn., is the latest evidence of a widespread pattern of increasing drug resistance among a variety of infectious agents, including multi-drug resistant tuberculosis, antibiotic-resistant Clostridium difficile and other once-innocuous organisms.
Some hospitals, gyms and other public facilities have begun to implement more stringent infection controls to prevent the spread of the bacterium, such as more thorough scrubbing of equipment, using hotter water for laundry, banning towel sharing and increasing the use of disinfectants.
The bacterium also remains susceptible to some powerful and expensive antibiotics, such as vancomycin. But experts fear that the ability of the bacterium to mutate will outpace the ability of scientists to create new drugs.
The spread of resistant organisms is "astounding," Dr. Elizabeth A. Bancroft, an epidemiologist with the Los Angeles County Department of Public Health, wrote in an editorial accompanying the report.
Bancroft said the reported incidence of resistant staph infections is just "the tip of the iceberg" because the CDC researchers studied only blood-borne infections that find their way into internal organisms.
Several studies have found that such infections represent only 6% to 9% of all MRSA infections, which can also thrive on the skin in a more innocuous form, waiting for the opportunity to enter the body.
"It appears that the total burden of MRSA is much greater than what was estimated in this study," she said.
Most forms of the staph bacterium are easily killed with common antibiotics, such as amoxicillin. But beginning in 1968, researchers began to see variants that required treatment with stronger antibiotics.
Experts attribute the emergence of the superbugs to indiscriminate use of antibiotics, the failure of patients to complete their antibiotic regimens and the use of antibiotics in animal feed. In each case, incomplete eradication of the bacteria leads to mutations that have increased resistance to the drugs.
Confined to the surface of the skin, the bacteria do minimal damage. But in hospitals, nursing homes and dialysis centers, they can hitch a ride inside the body on needles and other invasive devices, spreading through the bloodstream and causing severe illness.
In the same fashion, they can be spread by tattooing and drug use in prisons and by cuts and abrasions on the athletic field. In 2003, four members of the USC football team were hospitalized and three more infected by MRSA.
Doctors have been aware of the growing staph problem, but there were no hard data to document it.
The new results were obtained by Dr. R. Monina Klevens of the CDC and her colleagues as part of the agency's ongoing Active Bacterial Core surveillance program, which monitors infections in nine regions of the U.S., including San Francisco, Baltimore, Atlanta and Denver. All infections were laboratory confirmed.
The group observed 8,987 cases of blood-borne MRSA infections in the survey area, which was extrapolated to come up with a nationwide estimate of 94,360 cases. There were 1,598 deaths in the area, corresponding to 18,650 deaths nationwide.
Only 26.6% of the cases were infections that occurred in hospitals. An additional 58.4% were infections that occurred in the community but were linked to hospitalization or medical procedures. Infections unrelated to medical procedures accounted for 13.7% of cases.
Infection rates were highest among those older than 65, and African Americans were twice as likely as whites to suffer an infection. In both groups, Klevens said, the higher rates were most likely due to a higher incidence of chronic diseases, which both weaken patients and send them more often to the hospital, where they come in contact with the bacterium.
For infants younger than 1, the rate was four times as high in blacks as in whites.
Healthcare advocates argue that hospitals need to improve hygiene. Some studies, for example, show that hospital workers wash their hands only about half as often as guidelines recommend.
Other critics say hospitals should screen all newly admitted patients for MRSAs and isolate those found to be positive. Hospitals, however, say such isolated patients are likely to receive less care because of the inconvenience associated with entering their rooms.
Despite the best efforts of scientists, the rapid evolution of bacteria gives them a major advantage, as illustrated by another report in the journal detailing the appearance of an ear infection resistant to all antibiotics approved for use in children.
Dr. Michael E. Pichichero and Dr. Janet R. Casey of the University of Rochester reported on nine ear infections caused by a multi-drug resistant strain of Streptococcus pneumoniae that succumbed only to a powerful antibiotic known as Levaquin, whose label carries a warning against using it in children.
The first four children were successfully treated by inserting tubes in their ears, which allowed the infections to resolve naturally. The last five were given a ground-up Levaquin pill, which ended the infection with no adverse effects.
Physicians agreed that Levaquin should be used in children only as a last resort, and only if the bacterium in question has been grown in culture and shown to be susceptible.
Dangerous new MRSA
Reply #11 on:
January 16, 2008, 08:36:54 AM »
S.F. General researchers follow strain of drug-resistant bacteria
Sabin Russell, Chronicle Medical Writer
Tuesday, January 15, 2008
San Francisco General Hospital researchers have been chasing the rogue strain of drug-resistant staph called USA300 since they first isolated it from a patient specimen seven years ago.
With every turn, the aggressive and persistent bug keeps getting worse.
Now, a new variant of that strain, resistant to six major kinds of antibiotics, is spreading among gay men in San Francisco, Boston, New York and Los Angeles.
City doctors first spotted the original USA300 during tests for patients treated at a walk-in clinic for skin infections in 2001. Since then, they have watched it morph from laboratory curiosity into the dominant form of staph infection in much of the United States.
"It stormed into town and just took over, displacing everything else," said Dr. Chip Chambers, infectious disease chief for the renowned hospital.
At first, USA300 hit the down-and-out: injection-drug users, jail inmates, homeless men and women. Today it is also infecting suburban moms, executives, doctors, athletes and children. It has turned up in tattoo parlors and newborn nurseries. People with HIV infection seem especially prone to it, but it also strikes patients, gay and straight, who have no previous health problems.
Staph infections are usually treatable but can be lethal. USA300 is as dangerous as they come - it can attack organs throughout the body, forcing doctors to amputate fingers, toes and limbs. Its most disturbing trait, however, is just how easily it gets around.
"USA300 has a tremendous ability to spread," said Francoise Perdreau-Remington, director of the molecular epidemiology lab at San Francisco General, where the strain was first identified. "It has been described in at least 44 states and is now spreading in European countries."
USA300 is one of a dozen distinct varieties of MRSA, or methicillin-resistant Staphylococcus aureus, now circulating. The first MRSA strain, resistant to the penicillin substitute methicillin, was discovered in 1961. It continues to evolve. More than 200 families of the strain have come and gone since. USA300 is shaping up as the worst of the lot.
The various MRSA families have been gaining strength as a public health menace for years.
MRSA infections used to be confined to hospitalized patients. But in the late 1990s, people began contracting them in community settings - in gyms, jails, schools and even at home. The federal Centers for Disease Control and Prevention calculated last fall that drug-resistant staph was killing 19,000 Americans a year - more than are dying of AIDS.
Tracking down new disease threats is Perdreau-Remington's specialty. The French-born microbiologist was recruited to San Francisco General in 1995 to create the lab because of her expertise in disease detective work at the University of Cologne in Germany. A key to her microbe hunting is the ability to compare new strains to old ones. Her lab at the San Francisco hospital stores a frozen cache of 16,000 germs taken from patients in the hospital and health clinics.
In 2000, San Francisco General had set up a special walk-in clinic catering to drug users and street people to handle the growing volume of skin and soft-tissue infections that were driving up costs in its emergency room.
Perdreau-Remington began running tests to find out what was causing so many infections. Her lab analyzed bacterial specimens to produce genetic fingerprints that look like strips of bar code. It was during that screening program, using samples from the clinic, that she found the genetic fingerprint of what would be called USA300.
The unique signature showed up on March 1, 2001. At first, it represented just one of 15 specimens on a standard computer readout, known as a "gel." When the same new fingerprint showed up in three of 15 specimens three months later, Perdreau-Remington remembers thinking: "Uh-oh, we have a problem."
She labeled the new strain the "S-clone."
By February 2002, six of 15 samples displayed the S-clone's signature. Among patients at the clinic, the new bug shortly thereafter outnumbered all others by a 2-to-1 ratio.
Perdreau-Remington soon learned that the bug had been lurking elsewhere. She began collaborating with her counterparts in Los Angeles County, where inmates of the largest jail system in the United States had been complaining of "spider bites." Samples of the skin sores yielded the same S-clone fingerprints.
Throughout the United States, other researchers were independently finding the same bug.
Fred Tenover, director of laboratory science at the CDC, remembers running a test that pooled drug-resistant staph samples from 12 states, including ones from prisons in Georgia, Texas and California and from a football team in Pennsylvania. "The patterns were indistinguishable," he said. "I looked at the gel and said, 'This can't be.' So we went back and retested them. It was amazing."
The fingerprints were identical to those of Perdreau-Remington's S-clone.
Tenover, who was developing for the CDC a uniform system for describing a dozen distinctive types of drug-resistant staph, named the emerging bug USA300.
Perdreau-Remington's early isolation of USA300 has made her lab at San Francisco General a world leader for the study of it. Once it became clear that a new strain of drug-resistant staph was loose, she set out to discover where it came from. She went back to her freezers and screened hundreds of samples of staph taken since 1996.
Her survey unearthed the earliest known sample of USA300. Its fingerprints were spotted in a frozen specimen taken from a man who visited the newly opened walk-in clinic at San Francisco General on Sept. 25, 2000.
Ominously, the strain that first appeared outside the hospital began to infect vulnerable patients inside as well. By 2002, USA300 accounted for 14 percent of staph infections acquired at San Francisco General, and the numbers keep rising.
"Now, more than 80 percent of MRSA infections in this hospital are caused by USA300," Perdreau-Remington said.
Under a powerful microscope, USA300 resembles a cluster of faintly yellow BBs - indistinguishable from other strains of drug-resistant staph. Like a fancier brand of automobile, however, this one is packed with options that make it potentially more deadly and easier to spread.
Toxic proteins carried by USA300 have been implicated in infections that destroy fingers and toes or cause the rare but frighteningly fast skin- and muscle-tissue destruction attributed popularly to "flesh-eating bacteria" - a condition known as necrotizing fasciitis.
Until recently, flesh-eating infections were thought to be caused by other bugs, such as Streptococcus. A study published in the New England Journal of Medicine in 2005 changed all that. Doctors at UCLA-Harbor Medical Center reviewed 14 cases of the frightening skin disease. All 14 had drug-resistant staph cultured from their wounds. Five samples were tested at Perdreau-Remington's San Francisco lab for strain type. They all turned up USA300.
When drug-resistant staph invades the lungs, it can cause a pneumonia that destroys lung tissue and kills a patient within hours. Last winter, the CDC implicated USA300 in outbreaks of severe pneumonia such as the one that killed six of 10 flu patients in Louisiana and Georgia last winter. Four of the dead were children.
Concern over USA300 is so great that Perdreau-Remington won funding to map the complete genome of the germ, identifying the entire coded sequence of genetic instructions that tell this particular strain of staph bacteria how to make copies of itself.
She chose a sample taken in 2003 from a wrist abscess on a 36-year-old patient who was also being treated for AIDS at San Francisco General. She picked that specimen because it seemed unusually resistant to treatment. It was labeled USA300 FPR3757 - using Perdreau-Remington's initials.
The gene map, published in the British medical journal the Lancet in February 2006, has yielded clues to why this strain spreads so quickly. The bug appears to have swapped genes from Staphylococcus epidermidis, a usually harmless staph species that is commonly found on human skin. Researchers theorize that, by stealing a trick from the milder staph bug, the malevolent USA300 may colonize on human skin more easily than other varieties of MRSA.
Further along the gene map are sections that produce resistance to the antibiotics tetracycline, erythromycin, clindamycin, Cipro and mupirocin, a topical ointment often used to kill MRSA colonies living in people's noses.
Perdreau-Remington did not know it at the time, but the sample she took - FPR3757 - was among the very first isolates found of the highly drug-resistant USA300 variant now spreading readily through San Francisco's gay community. The new bug virtually has her name on it.
USA300 - even the new variant - is treatable with some antibiotics. Perhaps the most important of these is vancomycin, an antibiotic reserved for the most serious staph infections. But FPR3757 is just a short step away from acquiring resistance to that drug as well.
Dangerous intestinal bacteria have already evolved resistance to vancomycin. Known as vancomycin-resistant enterococcus, or VRE, the bugs carry a "cassette" of genes containing all the instructions needed for bacteria to sidestep the antibiotic.
Perdreau-Remington's team has spotted on the USA300 genome a region that is primed to accept this vancomycin-resistance cassette. It could snap into place like a Lego block.
Drug-resistant bacterial strains have been labeled "superbugs," but most infectious disease specialists recognize that these bacteria are not doing anything remarkable. They are performing as they have for millions of years, using their enormous capacity to mutate and multiply to outmaneuver whatever biological or environmental threats they face.
Because both VRE and USA300 are circulating in hospital environments, some patients are probably battling both bugs at the same time. Given the propensity of staph germs to swap genes, these patients provide fertile ground for the evolution of an even more dangerous bug.
If USA300 were to acquire vancomycin resistance from VRE, the result would be a virulent new form of staph, which would spread readily outside the medical setting and be nearly impossible to treat.
Perdreau-Remington believes there's an urgent need for new drugs to combat such a monster.
"This is the horror scenario," she said. "We have very little time left."
E-mail Sabin Russell at
This article appeared on page A - 1 of the San Francisco Chronicle
Re: Epidemics: Bird Flu, TB, etc
Reply #12 on:
January 17, 2008, 06:58:01 AM »
Here is one interpretation of the meaning underlying the preceding article. Comments?
(CNSNews.com) - A drug-resistant strain of a deadly staph infection found in some U.S. hospitals is now spreading among homosexual men, researchers said. A conservative group has characterized the problem as the result of "unnatural behaviors."
Methicillin-resistant Staphylococcus aureus, or MRSA, killed about 19,000 Americans in 2005 -- most of them in hospitals, according a report published in October in the Journal of the American Medical Association. But now the infection is popping up outside hospitals in San Francisco, Boston, New York and Los Angeles, according to Reuters.
"The medical community has known for years that homosexual conduct, especially among males, creates a breeding ground for often deadly disease. In recent years we have seen a profound resurgence in cases of HIV/AIDS, syphilis, rectal gonorrhea and many other STDs among those who call themselves 'gay,' said Matt Barber, policy director for cultural issues with Concerned Women for America (CWA).
Active homosexual men in San Francisco are considered 13 times more likely to be infected with MRSA than heterosexuals, researchers reported in the Annals of Internal Medicine.
"Once this reaches the general population, it will be truly unstoppable," Reuters quoted Binh Diep, a researcher at the University of California, San Francisco who led the study, as saying. "That's why we're trying to spread the message of prevention," he added.
"The human body is quite callous in how it handles mistreatment and the perversion of its natural functions," said Barber. "When two men mimic the act of heterosexual intercourse with one another, they create an environment, a biological counterfeit, wherein disease can thrive. Unnatural behaviors beget natural consequences."
He blamed television shows like "Will and Grace," which "glorify the homosexual lifestyle," and homosexual indoctrination in schools for the "laissez-faire attitude toward sexual deviancy."
"'Stay out of our bedrooms!' we're often commanded by militant 'gay' activists," Barber said. "Well, now the dangerous and possibly deadly consequence of what occurs in those bedrooms is spilling over into the general population. It's not only frightening, it's infuriating."
Barber called for parents to speak out against "politically correct cultural elites" who "endanger our children and larger communities through propagandist promotion of this demonstrably deadly lifestyle."
"Why does it take a potentially deadly staph epidemic for people to acknowledge reality? Will that even do it? Enough is enough!" Barber added.
Re: Epidemics: Bird Flu, TB, etc
Reply #13 on:
January 22, 2008, 08:26:32 AM »
KOLKATA, India : India's worst ever outbreak of bird flu could turn into a disaster, an official warned Tuesday, as five people were reportedly quarantined with symptoms of the virus.
Eight districts in the eastern state of West Bengal have been hit by the virus, and dead birds are being sold and locals said to be "feasting" on cheap chicken.
The state's animal resources minister, Anisur Rahaman, said authorities were "determined to cull all poultry in the districts in three or four days, otherwise the state will face a disaster."
More than 100,000 bird deaths have been reported, and teams are racing to cull two million chickens and ducks.
The Times of India reported five people in West Bengal have been quarantined with "clinical symptoms" of avian flu -- including fever, coughing, sore throat and muscle ache -- after handling affected poultry.
If the tests are positive, this will be the first case of human infection in India, home to 1.1 billion people and hit by bird flu among poultry three times since 2006.
Health officials in New Delhi said they were currently analysing blood samples from close to 150 people who have complained of fever.
On the ground, culling teams have been facing an uphill battle with villagers smuggling birds out of flu affected areas and selling them in open markets.
Thirty-year-old Sheikh Ali, a vendor in Birbhum's Gharisa market, 340 kilometres (192 miles) from the state capital Kolkata, said the sale of poultry had doubled in the past week.
"The prices of chicken have come down from 60 rupees to 20 rupees (1.5 dollars to 50 cents) per kilogramme (2.2 pounds).
"Poor villagers are feasting on chicken. At normal times, they cannot afford to buy as prices are so high. Now they are enjoying the meat," Ali said.
People typically catch the disease by coming into direct contact with infected poultry, but experts fear a flu pandemic if the H5N1 mutates into a form easily transmissible between humans.
Migratory birds have been largely blamed for the global spread of the disease, which has killed more than 200 people worldwide since 2003.
In Birbhum, police seized two trucks of smuggled poultry early Tuesday but culling teams were yet to arrive at the spot, an AFP correspondent said.
"Poultry owners are smuggling their birds out at night and transporting it to different places for fear of culling," said Shubhendu Mahato, a security guard at Arambagh Hatchery, one of the biggest in West Bengal.
Chicken shops had also sprung up along the main highways overnight with people crowding them, the AFP correspondent said.
Neighbouring Nepal, which has banned poultry imports from India since 2006, said its border posts were on high alert.
Bangladesh, which also borders West Bengal, was meanwhile battling its own serious outbreak -- with experts warning the situation was far worse than the government was letting on.
"Bird flu is now everywhere. Every day we have reports of birds dying in farms," said leading poultry expert and the treasurer of Bangladesh Poultry Association M.M Khan.
"Things are now very, very serious and public health is under danger. The government is trying to suppress the whole scenario," Khan said, adding that farmers were also holding back from reporting cases.
In a closely related vein
Last Edit: January 22, 2008, 08:30:02 AM by Crafty_Dog
Re: Epidemics: Bird Flu, TB, etc
Reply #14 on:
February 25, 2008, 02:23:15 PM »
Will the first casualty of a pandemic be "the plan"?
Re: Epidemics: Bird Flu, TB, etc
Reply #15 on:
March 06, 2008, 09:28:07 PM »
(NaturalNews) The avian flu has undergone a critical mutation making it easier for the virus to infect humans, according to a study conducted by researchers at the University of Wisconsin at Madison and published in the journal PLoS Pathogens.
"We have identified a specific change that could make bird flu grow in the upper respiratory tract of humans," lead researcher Yoshihiro Kawaoka said.
The H5N1 strain of influenza, also known as "bird flu," has decimated wild and domestic bird populations across the world since it emerged between 1999 and 2002. This highly virulent variety of the flu has been identified as a public health concern because in the past, varieties of influenza have mutated and crossed the species barrier to humans.
Since 2003, 329 humans have been confirmed infected with H5N1, with 201 fatalities. The vast majority of these worked closely with infected birds, such as in the poultry industry.
One of the primary things that keeps bird flu from infecting humans is that the virus has evolved to reproduce most effectively in the bodies of birds, which have an average body temperature of 106 degrees Fahrenheit. Humans, in contrast, have an average body temperature of 98.6 degrees, with temperatures in the nose and throat even lower (91.4 degrees). This vast temperature difference makes it very difficult for the bird flu virus to survive and grow in the human body.
In the current study, researchers found that a strain of H5N1 has developed a mutation that allows it to thrive in these lower temperatures.
"The viruses that are circulating in Africa and Europe are the ones closest to becoming a human virus," Kawaoka said. But he pointed out that one mutation is not sufficient to turn H5N1 into a major threat to humans.
"Clearly there are more mutations that are needed. We don't know how many mutations are needed for them to become pandemic strains."
"We are rolling the dice with modern poultry farming practices," warned consumer health advocate Mike Adams, author of the book How to Beat the Bird Flu. "By raising chickens in enclosed spaces, treating them with antibiotics, and denying them access to fresh air, clean water and natural sunlight, we are creating optimal conditions for the breeding of highly infectious diseases that can quickly mutate into human pandemics," Adams said. "Given current poultry farming practices, it is only a matter of time before a highly virulent strain crosses the species barrier."
Re: Epidemics: Bird Flu, TB, etc
Reply #16 on:
March 09, 2008, 09:23:13 AM »
The subject of masks came up on WT forum. I haven't checked these for myself, but post them here to have the URLs for reference:
Most of the information I've read suggests than N95 masks are adequate for bird flu.
There's a lot of information on the subject available here;
I'd suggest spending some time studying the available information to determine what level of protection you're comfortable with.
There is a single study that has cast some doubt on the efficacy of N-95 masks in a pandemic influenza situation.
This link is from the IAFF, whose leadership I personally feel are no-talent @ssclowns, but worth reading:
Having masks are a valid tactic for pandemic influenza, but betting your life on them is foolhardy at best. During the SARS outbreak, there is strong circumstantial evidence that universal precautions failed in more than one case of direct transmission to healthcare workers.
A surgical mask will beat nothing, a N-95 is better than a surgical mask and not being exposed to airborne particulate is the best solution.
With N-95's, be aware that moisture will likely degrade their effectiveness, so sweating, heavy breathing and high humidity will burn through.
Reply #17 on:
March 13, 2008, 05:11:01 PM »
The War on Superbugs
Lots of bad news—so little good news
By G.W. (Bill) Riedel, Ph.D.
Special to the Epoch Times Mar 13, 2008
Bacteriophages are one answer to the superbug crisis. (Ada Fitzgerald-Cherry/The Epoch Times)
A report entitled: "The Epidemic of Antibiotic-Resistant Infections" published in Clinical Infectious Diseases, 2008:46, Jan. 15, page 155 starts as follows: "We are in the midst of an emerging crisis of antibiotic resistance for microbial pathogens in the United States and throughout the world."
As of the year 2000 an estimated 70,000 deaths due to nosocomially acquired [hospital acquired], drug-resistant infections occurred per year in hospitals throughout the United States. Methicillin-resistant Staphylococcus aureus seriously sickened more than 94,000 Americans in 2005 and almost 19,000 died, more than the 17,000 Americans who died of AIDS-related causes. As more bacteria become resistant to the old antibiotics there are few new antibiotics being developed because most pharmaceutical companies have withdrawn from research for new antibiotics, in part because developing new antibiotics is a slow and costly process.
In Canada the official body counters tell us that "an estimated 220,000 patients who walk through the doors of hospitals each year suffer the unintended and often devastating consequences of an infection," and they estimate that 8,000 to 12,000 Canadian patients die annually from such infections. That would mean that from January 1, 2000 to April 30, 2008 there will have been 100,000 Canadian victims of superbug infections.
Against so much bad news it would be logical that the news media would jump on any opportunity to publish any good news. So when the Bacteriophage 2008 meeting in Herefordshire was chosen for the release of initial Phase II clinical trail data of the first fully-regulated clinical trail to test whether phage therapy really works as a treatment option for superbug infections, one would have expected a media flurry, especially since the trail reported positive results.
To date only two such reports can be found when using Google-News with the string "phage therapy." The first report, which this author found was entitled: "Technology to defeat bacterial infections shows positive results" and was published by Disease/Infection News, 25-Feb-2008 at
In this trail the U.K. company Biocontrol Ltd. used bacteriophages against Pseudomonas aeruginosa bacteria, which are often resistant to traditional antibiotics. Over a 17-month period a double-blind Phase II trail took place at a specialist London hospital involving 24 patients with chronic ear infections that were not responding to antibiotic treatments. Significant improvements amounting to a mean 50 percent reduction in symptoms were noted as compared to a mean of only 20 percent in the control group who did not receive phages. The company now plans to perform Phase III trails for the ear treatment as soon as possible and is looking at the future possibility of treating patients with cystic fibrosis where lung infections with Pseudomonas aeruginosa are common and dangerous.
, has a Ph.D. in Microbiology/Food Science. He has held various positions in research, industrial food science, and consumer product regulatory affairs in Canada.
Bird Flu: Human to Human in Pakistan?
Reply #18 on:
April 07, 2008, 01:36:48 AM »
First case of human-to-human transmission of bird flu confirmed in Pakistan
April 6 : A report by BBC News has confirmed the first case of human-to-human transmission of bird flu in Pakistan.
Pakistan’s north-west and southern regions were hit by bird flu last year. Thousands of birds were culled to control the spread of the disease.
Tests carried out by the World Health Organisation (WHO) have now shown that bird flu killed some members of a family in north-west Pakistan late last year.
This is the first confirmation of people dying from bird flu in the country, with the samples collected from the family in Peshawar testing positive.
According to Dr Mukhtiar Zaman Afridi, head of the isolation ward for avian flu patients at Khyber Teaching Hospital in Peshawar, a poultry worker in Peshawar apparently passed the disease on to members of his family.
“The worker, whose name is being withheld on the request of the WHO, was brought to the hospital with avian flu symptoms on 29 October 2007,” he said.
Though this worker has fully recovered since then, on 12 November, his elder brother was brought in with similar symptoms. He died a week later.
On 21 November, two more brothers of the same worker came down with bird flu.
“One of them died on 28 November, while the other has recovered,” said Dr Afridi.
Apart from the poultry worker, none of the others was found to have had any direct contact with sick or dead poultry.
Genetic sequencing tests performed by WHO laboratories in Egypt and the US on samples collected from three of the four brothers established human-to-human transmission.
Serum taken from all three was found to have been infected by the H5N1 avian influenza virus.
Though a WHO report said that the tests suggest “limited human-to-human transmission,” it adds, however, that this “outbreak did not extend into the community, and appropriate steps were taken to reduce future risks of human infections.” (ANI)
Indonesia hoards bird flu virus samples
Reply #19 on:
April 17, 2008, 03:26:38 PM »
Recipe for a Pandemic
April 18, 2008
Over nearly 60 years, the World Health Organization has developed sophisticated systems for monitoring the emergence of seasonal influenza and possible pandemics as well as arming scientists with the tools to develop vaccines. Now, one country is jeopardizing all that, putting itself and the rest of the world at risk.
The culprit: Indonesia. Its Health Ministry refuses to give the WHO avian flu virus samples taken from Indonesian victims. This matters because sample sharing allows experts around the world to track mutations of the virus and spot dangerous mutations. Even more important, sharing allows researchers to develop vaccines.
Health Minister Siti Fadilah Supari asserts that Indonesian bird flu is a form of intellectual property, from which the country should benefit. Whether that means Indonesia simply wants to ensure affordable access to any vaccine developed from its samples – or whether Jakarta will demand a share in the profits – is unclear. Ms. Supari has complained in the past of labs using Indonesian samples for "commercial" reasons, raising the question of where she thinks vaccines come from, if not from private companies with a profit motive. Of almost 60 bird flu cases in the past year, Indonesia has given WHO all of two samples – but only for surveillance, not vaccine research. They were from high-profile cases in Bali, and Jakarta worried that tourists would stay away.
The dispute may partly be due to domestic politics. Ms. Supari evidently thinks this viral nationalism plays well in public opinion. She published a book earlier this year titled "It's Time To Change: Divine Hands Behind Bird Flu," in which she speculates the U.S. uses virus samples to conduct research on biological weapons. Next year is an election, and Ms. Supari is becoming a favorite of various Islamic groups, on which President Susilo Bambang Yudhoyono could end up depending.
Whatever Jakarta's motivation, without the samples it's much harder for researchers to develop any vaccine. Viruses mutate constantly. That's especially true in Indonesia, which has the highest number of cumulative bird flu infections – 132 since 2003, compared with 106 in Vietnam. Without samples from those cases, researchers can't tackle the most up-to-date form.
The worst-case scenario would be for a virulent strain to evolve in Indonesia and catch researchers by surprise, because they have no experience working with its predecessors. Even if scientists do develop a vaccine based on samples from, say, Vietnam, they have no way of testing its efficacy against the Indonesian variety. All together, it's a recipe for a pandemic, particularly if other countries start following Jakarta's lead.
Indonesia's leaders now say they want a speedy resolution to the sample-sharing dispute. In a meeting this week with U.S. Secretary of Health and Human Services Mike Leavitt, the Coordinating Minister for the People's Welfare, Aburizal Bakrie, promised to finalize an agreement within two months.
There's no time to waste. Of the 240 human bird flu deaths reported in 12 countries since 2003, 107 have been in Indonesia – 12 already this year. The next highest cumulative death toll is 52 in Vietnam. Better to share samples now and allow scientists to develop a vaccine than scramble to do so when a pandemic hits.
But the world will have vaccines to protect against the avian flu virus only if scientists are able to carry out research. By hoarding samples and trying to tinker with the financial incentives that drive pharmaceutical innovation, Indonesia is endangering everyone.
Economics of Flu Vaccines
Reply #20 on:
August 27, 2008, 12:04:55 PM »
Novavax Moves Closer to Licensing Bird Flu Vaccine
By Kendra Marr
Washington Post Staff Writer
Wednesday, August 27, 2008; D04
Novavax said yesterday that its bird flu vaccine elicited a robust immune response in humans, moving the biotech a step closer to licensing its pandemic vaccine production system.
In the trial, 160 patients received two vaccine injections, of 15 to 90 micrograms, one month apart. Of the patients who received the highest dosage, 94 percent produced antibodies to neutralize H5N1, an Indonesian strain of bird flu that emerged in 2005 and has been linked to 110 deaths.
"These results are strong and very competitive," said Rahul Singhvi, Novavax's chief executive.
Shares of Novavax fell 6 cents, or 2 percent, to $2.91.
Novavax has had a demo of the vaccine manufacturing process set up at its Rockville headquarters since May 1 but does not have a buyer.
There were 385 cases of bird flu in humans, leading to 243 deaths, from 2003 to June 19, according to the World Health Organization's most recent data. Outbreaks have mostly centered on Asia.
Many large multinational biotechs -- GlaxoSmithKline, Sanofi-Aventis, Novartis -- are working on bird flu vaccines in the United States and Western Europe under government contract, said Ken Trbovich, an analyst with RBC Capital Markets.
Novavax has partnered with GE Healthcare to reach the rest of the world by providing other countries a system to quickly mass-produce vaccines.
"If you truly believe a pandemic outbreak is likely, there is reason to believe foreign governments and the U.S. will clamp down and control the supply," Trbovich said. He added, "Other places in the world may have a lot of money, but no amount of money will get you vaccines in the case of a pandemic."
Traditionally, to create flu vaccines, drugmakers grow live virus strains in chicken eggs, which act as incubators. The virus is later killed and bottled into a vaccine. But eggs are a volatile medium, and a scarce supply essentially stops production.
Novavax's bird flu vaccine uses particles that mimic the size and shape of the virus, which trigger an immune response but lack the genetic material to replicate.
Because the particles are produced in more stable insect-cell cultures, yields are seven to 10 times higher than egg-based manufacturing, Novavax said. The vaccine can also be created within 10 to 12 weeks of identifying a pandemic strain -- half the time it takes to make egg-based vaccines.
GE is developing the production equipment, which is cheap to set up and run in case of a pandemic.
In December, Novavax studied low doses of its bird flu vaccine in a much smaller patient population. After tweaking the production process, the biotech was able to elicit a stronger immune response in this recent trial.
Novavax is seeking a governmental or pharmaceutical partner to finance the next set of human trials.
"We see no reason to invest additional money of our own into the pandemic vaccine when we can wait for a foreign government that needs this vaccine to put money in," Singhvi said.
Meanwhile, Novavax will be begin human tests of its seasonal influenza vaccine, using virus-like particles, in the fall. Currently all U.S. flu vaccines are egg-based.
"The pandemic area is difficult to monetize even if you successfully generate a contract," Trbovich said. "There are no reoccurring revenues. Moving a seasonal flu vaccine into clinical trials is their first real commercial opportunity."
Re: Epidemics: Bird Flu, TB, etc
Reply #21 on:
August 29, 2008, 07:04:21 AM »
Amazing that the stock actually fell a bit on this news , , ,
Bird Flu breakout in China?
Reply #22 on:
February 04, 2009, 07:13:45 AM »
A friend forwarded the following to me. The site's reliability is unknown to me
Re: Epidemics: Bird Flu, TB, etc
Reply #23 on:
February 04, 2009, 07:50:34 PM »
Adult Stem Cell HIV Cure?
Reply #24 on:
February 12, 2009, 06:06:55 AM »
Published online 11 February 2009 | Nature | doi:10.1038/news.2009.93
Stem-cell transplant wipes out HIV
But the treatment is too risky to help most who are infected with the virus.
Bone marrow stem-cells may have cured one man of HIV.Getty
A man may have been cured of both HIV and leukaemia after receiving a stem-cell transplant from a donor who is genetically resistant to HIV.
About two years after the procedure, there is still no sign of the virus, even though the patient no longer takes antiretroviral drugs. Nature News takes a look at the promises and limitations of the experimental treatment.
Haven't we heard about this before?
The German physicians announced their finding in November 2008. Since then, the results have been peer reviewed and are now published in the New England Journal of Medicine1.
What did the physicians actually do?
They essentially did what they would do for any leukaemia patient who was not responding adequately to chemotherapy: they searched donor registries for bone-marrow donors who were a match for their patient, and prepared to perform a transplant.
But haematologist Gero Hütter of the Charité Universitätsmedizin in Berlin took the search for a donor one step further. Hütter does not specialize in HIV cases but when he realized that his patient would need a transplant, he remembered a paper he had read more than a decade earlier about HIV resistance in people who carry a specific genetic mutation.
The mutation is a short deletion in the CCR5 gene. The gene encodes a receptor that HIV uses to enter immune cells called CD4+ T cells. About 1% of the European population carries the CCR5 mutation in both copies of the CCR5 gene, making such people much less likely to contract the virus. If Hütter could replace his patient's immune cells with cells that lacked the CCR5 receptor, his patient might be less susceptible to HIV infection.
The patient had 80 matches in the bone-marrow registries of the German Bone Marrow Donor Center, and Hütter reasoned that one of those matches might also carry CCR5 mutations. Donor number 61 turned out to be the one, and in February 2007, the transplant was performed.
Can we really learn anything from an experiment performed in only one patient?
Even though the technique has only been applied in one patient, the results are valuable, says James Riley, an HIV researcher at the University of Pennsylvania in Philadelphia. "Of all the 'n=1' experiments out there, this is a good one," he says. "It's a tremendous proof of principle that if you can make the majority of your cells resistant to infection, you can really stop the virus."
Meanwhile, Hütter says that a different team of physicians intends to perform the same procedure in another HIV-positive patient with leukaemia. So in a few years, the experiment may reach n=2.
Was the patient cured?
That remains unclear. Although the patient has gone about two years without a relapse, it is still possible that the virus will make a comeback. The virus could be lurking in cells that doctors have not been able to test — such as cells in the brain or heart.
In addition, there is another strain of HIV that does not use CCR5 receptors to invade cells. This strain does not typically show up in patients with functioning immune systems, but it is still possible that this form of HIV could eventually proliferate in this patient.
What is clear is that this is not a treatment most HIV-positive people would want to receive. The risks involved with a bone-marrow transplant far outweigh those that come with years of antiretroviral drug therapy, even considering the troublesome side effects of these drugs. Before receiving the transplant, recipients are "conditioned" with drugs and radiation to destroy their own blood-producing stem cells. The procedure leaves them vulnerable to infection, and there is also the possibility that their bodies will eventually reject the transplant.
Instead of risking a transplant, couldn't you just use a drug to block CCR5?
You could. One CCR5 inhibitor, called maraviroc, is made by the pharmaceutical company Pfizer and is approved for use in the United States and Europe. Other companies are busy developing additional CCR5-targeting drugs.
Unfortunately, maraviroc does not completely prevent the virus from binding to CCR5, and it can only be used in combination with other antiretrovirals. "Basically HIV can find its way around the drug and still use CCR5," says Riley, who adds that the virus might outcompete the inhibitor, or may be able to bind to a different region of CCR5 than the drug.
Others are trying gene-therapy approaches to prevent CCR5 from being made at all. For example, Riley has been collaborating with Sangamo BioSciences, a biotechnology company based in Richmond, California, to determine whether the company's technique for snipping out targeted genes could be used to delete the CCR5 gene. Sangamo announced last week that it has launched a Phase I clinical trial that will involve removing a sample of the participant's T cells, deleting the CCR5 gene, and then infusing the cells back into the patient. The trial is a first step towards ascertaining the safety of the technique — not its efficacy — and participants will not be conditioned to destroy their unmodified T cells.
Hütter, G. et al. N. Engl. J. Med. 360, 692–698 (2009).
Re: Epidemics: Bird Flu, TB, etc
Reply #25 on:
February 12, 2009, 11:42:32 AM »
That is fascinating!
I wonder if this sort of thing will meet the approval of the O-bot bureaucrats?
A worrying new blend in swine flu
Reply #26 on:
April 23, 2009, 05:17:49 PM »
Seven people in U.S. hit by strange new swine flu 23 Apr 2009 20:54:48 GMT
*Five new cases found in addition to two people on Tuesday
*CDC says no reason for concern yet
*Flu is unusual mixture but no deaths seen
(Updates throughout with quotes, details)
By Maggie Fox, Health and Science Editor
WASHINGTON, April 23 (Reuters) - Seven people have been diagnosed with a strange and unusual new kind of swine flu in California and Texas, the U.S. Centers for Disease Control and Prevention reported on Thursday.
All seven people have recovered but the virus itself is a never-before-seen mixture of viruses typical among pigs, birds and humans, the CDC said.
"We are likely to find more cases," the CDC's Dr. Anne Schuchat told a telephone briefing. "We don't think this is time for major concern around the country."
The CDC reported the new strain of swine flu on Tuesday in two boys from California's two southernmost counties.
Now, five more cases have been seen -- all found via normal surveillance for seasonal influenza. None of the patients, whose symptoms closely resembled seasonal flu, had any direct contact with pigs.
"We believe at this point that human-to-human spread is occurring," Schuchat said. "That's unusual. We don't know yet how widely it is spreading ... We are also working with international partners to understand what is occurring in other parts of the world."
Two of the new cases were among 16-year-olds at the same school in San Antonio "and there's a father-daughter pair in California," Schuchat said. One of the boys whose cases was reported on Tuesday had flown to Dallas but the CDC has found no links to the other Texas cases.
Unusually, said the CDC's Nancy Cox, the viruses all appear to carry genes from swine flu, avian flu and human flu viruses from North America, Europe and Asia.
"We haven't seen this strain before, but we hadn't been looking as intensively as we have," Schuchat said. "It's very possible that this is something new that hasn't been happening before."
Surveillance for and scrutiny of influenza has been stepped up since 2003, when highly pathogenic H5N1 avian influenza reappeared in Asia. Experts fear this strain, or another strain, could spark a pandemic that could kill millions.
H5N1 currently only rarely infects people but has killed 257 out of 421 infected in 15 countries since 2003, according to the World Health Organization.
The influenza strain is an H1N1, the same family as one of the seasonal flu viruses now circulating. Now that the normal influenza season is waning, it may be easier to spot cases of the new swine flu, Schuchat said.
Only one of the seven cases was sick enough to be hospitalized and all have recovered, Schuchat said.
"This isn't something that a person could detect at home," she said. The new cases appear to have somewhat more vomiting and diarrhea than is usually seen in flu, which mostly causes coughing, fever, sore throat and muscle aches.
The CDC is asking doctors to think about the possibility of swine flu when patients appear with these symptoms, to take a sample and send it to state health officials or the CDC for testing.
Cox said the CDC is already preparing a vaccine against the new strain, just in case. "This is standard operating procedure," Cox said. The agency will issue daily updates at
Seasonal flu kills between 250,000 and 500,000 people globally in an average year. And every few decades, a completely new strain pops up and it can cause a pandemic, a global epidemic that kills many more than usual. (Editing by Eric Walsh)
Re: Epidemics: Bird Flu, TB, etc
Reply #27 on:
April 24, 2009, 10:46:06 PM »
the mexican counts are
different than what we are seeing in the news but it has other good info.
More on Swine Flu
Reply #28 on:
April 25, 2009, 12:50:57 AM »
Reply #29 on:
April 25, 2009, 08:41:14 AM »
Pasting this from the Health thread here too:
WHO ready with antivirals to combat swine flu
Fri Apr 24, 2009 5:11pm EDT Email | Print | Share| Reprints | Single Page[-] Text
By Stephanie Nebehay
GENEVA (Reuters) - The World Health Organization (WHO) said on Friday that it was prepared with rapid containment measures including antivirals if needed to combat the swine flu outbreaks in Mexico and the United States.
The Geneva-based agency has been stockpiling doses of Roche Holding's Tamiflu, known generically as oseltamivir, a pill that can both treat flu and prevent infection.
The new virus, not previously detected in pigs or humans, has proved sensitive to the drug, the WHO said in a statement.
The WHO and its regional office in Washington, D.C., are also sending experts to Mexico to help health authorities with disease surveillance, laboratory diagnosis and clinical management of cases.
Mexican health officials have reported more than 850 cases of pneumonia in the capital, Mexico City, including 59 who died. In San Luis Potosi, in central Mexico, 24 cases including 3 deaths have been detected.
They have also informed the WHO about a third suspected outbreak of swine flu in Mexicali, near the U.S. border, with four suspect cases and no deaths so far.
The U.S. Centers for Disease Control have said there were 8 cases of swine influenza in California and Texas and no deaths.
Health authorities in the two North American countries have the resources required already in place, including Tamiflu, and are "well equipped," according to the WHO.
"WHO is prepared with rapid containment measures should it be necessary to be deployed," WHO spokeswoman Aphaluck Bhatiasevi told Reuters.
The United Nations agency saw no need at this point to issue travel advisories warning travelers not to go to parts of Mexico or the United States. "However, the situation may change depending on what the situation in the field is," she said.
The WHO will convene a meeting of its Emergency Committee on international health regulations, probably on Saturday afternoon, she added.
WHO director-general Margaret Chan was flying back to Geneva overnight from Washington, D.C., for the emergency discussions which would link public health authorities and experts in various parts of world in a virtual meeting, she said.
The emergency committee could make recommendations including whether to change the pandemic alert level, she added.
"Because there are human cases associated with an animal influenza virus, and because of the geographical spread of multiple community outbreaks, plus the somewhat unusual age groups affected, these events are of high concern," the WHO said in a statement.
Reply #30 on:
April 26, 2009, 08:37:24 AM »
XICO CITY — This sprawling capital was on edge Saturday as jittery residents ventured out wearing surgical masks and President Felipe Calderón published an order that would give his government emergency powers to address a deadly flu outbreak, including isolating those who have contracted the virus, inspecting the homes of affected people and ordering the cancellation of public events.
Skip to next paragraph
Students Fall Ill in New York, and Swine Flu Is Likely Cause (April 26, 2009)
Worrying About Every Cough at a Queens School (April 26, 2009)
Dot Earth: Contagion on a Small Planet (April 26, 2009) White-coated health care workers fanned out across the international airport here to look for ailing passengers, and thousands of callers fearful they might have contracted the rare swine flu flooded government health hot lines. Health officials also began notifying restaurants, bars and nightclubs throughout the city that they should close.
Of those Mexicans who did go out in public, many took the advice of the authorities and donned the masks, which are known here as tapabocas, or cover-your-mouths, and were being handed out by soldiers and health workers at subway stops and on street corners.
“My government will not delay one minute to take all the necessary measures to deal with this epidemic,” Mr. Calderón said in Oaxaca State during the opening of a new hospital, which he said would set aside an area for anyone who might be affected by the new swine flu strain that has already killed as many as 81 people in Mexico and sickened more than 1,300 others.
Mr. Calderón pointed out that he and the other officials who attended the ceremony intentionally did not greet each other with handshakes or kisses on the cheek, which health officials have urged Mexicans to avoid.
At a news conference Saturday night to address the crisis, Mexico’s health minister, José Ángel Córdova, said 20 of the 81 reported deaths were confirmed to have been caused by swine flu, while the rest are being studied. Most of the cases of illness were reported in the center of the country, but there were other cases in pockets to the north and south.
The government also announced at the news conference that schools in and around the capital that serve millions of students would remain closed until May 6.
With 20 million people packed together tight, Mexico City typically bursts forth on the weekends into parks, playgrounds, cultural centers and sidewalk cafes. But things were quieter than usual on Saturday.
The government encouraged people to stay home by canceling concerts, closing museums and banning spectators from two big soccer matches on Sunday that will be played in front of television cameras, but no live crowd.
At street corners on Saturday, even many of the jugglers, dancers and musicians who eke out a living collecting spare change when the traffic lights turn red were wearing bright blue surgical masks.
The newspaper Reforma reported that President Obama, who recently visited Mexico, was escorted around Mexico City’s national anthropology museum on April 16 by Felipe Solis, an archaeologist who died the next day from flu-like symptoms. But Dr. Córdova said that it does not appear that Mr. Solis died of influenza.
White House officials said Saturday that they were aware of the news reports in Mexico but that there was no reason to be concerned about Mr. Obama’s health, that he had no symptoms and that his medical staff had recommended he not be tested.
The Centers for Disease Control and Prevention in Atlanta said Saturday that it had sent a team of experts to Mexico to assist with the investigation of the outbreak, which has already been reported in Texas and California and possibly in New York, raising fears that it could spread into a global pandemic.
The possible New York cases were reported at a Queens high school, where eight students tested positive for a type of influenza that health officials suspect could be the new swine flu. Some of the school’s students had traveled to Mexico recently.
Still, the World Health Organization, which held a meeting on Saturday to discuss the outbreak, chose not to raise the level of global pandemic flu alert, which has been at a Level 3 because of the avian flu.
Epidemiologists want to know exactly when the first cases occurred in Mexico. Mexican health officials said they first noticed a huge spike in flu cases in late March. In mid-April, they began noticing that otherwise healthy people were dying from the virus. But it was only on Thursday night that officials first sounded an alarm to the population by closing schools, after United States health officials announced a possible swine flu outbreak.
By issuing the emergency decree Saturday, Mr. Calderón may have been trying to head off criticism that his government had been too slow to act. He had earlier called in the army to distribute four million masks throughout the capital and its suburbs.
Lt. Raymundo Morales Merla, who stood outside a military transport truck parked outside a downtown subway station on Saturday, led a group of 27 soldiers who had arrived at 7 a.m. to hand out as many masks as they could.
The scene at the airport was alarming, with doctors stationed at the entrances to answer questions and to keep an eye out for obviously sick people. Regular public address announcements in English and Spanish warned travelers that anyone exhibiting any symptoms should cancel their flight and immediately seek medical attention.
Even Sunday Mass will probably be affected. The Roman Catholic Church gave worshipers the option to listen to Masses on the radio and told priests who decided to hold services to be brief and put Communion wafers in worshipers’ hands instead of their mouths.
Axel de la Macorra, 46, a physics professor at National Autonomous University of Mexico, said he became worried when he learned recently that a 31-year-man who played at a tennis club he once belonged to had suddenly died. “He got sick at the beginning of April and two weeks later, he was dead,” said Mr. de la Macorra, who was weighing whether to attend a First Communion with 200 guests on Saturday.
“My mother told me to wear it so I did,” said Noel Ledezma, 29, who had his mask pulled down so he could sip a coffee and eat a muffin as he walked to work. “Who knows who will be next.”
Sarahe Gomez, who was selling jewelry at a mall in the upscale Polanco neighborhood, spoke through a mask to the few customers who visited her kiosk. “I’m in the middle of all these people and one of them could have it,” she said. “The virus could be anywhere. It could be right here.”
She then took a half step back.
“This is no joke,” said Servando Peneda, 42, a lawyer who ventured out to pay a bill, but left his two sons home. “There’s 20 million of us in this city and I’d say half of us have these masks on today. I know all of us will die one day, but I want to last out the week.”
Antonio Betancourt contributed reporting from Mexico City, and Sheryl Gay Stolberg from Washington.
Re: Epidemics: Bird Flu, TB, etc
Reply #31 on:
April 26, 2009, 09:36:49 AM »
Stratfor on Pig Flu
Reply #32 on:
April 27, 2009, 11:06:55 AM »
Intelligence Guidance (Special Edition): April 27, 2009 - Swine Flu Outbreak
April 27, 2009 | 1500 GMT
ALFREDO ESTRELLA/AFP/Getty Images
A member of the Mexican Navy stands guard at Pantitlan subway station in Mexico City on April 26Editor’s Note: The following is an internal STRATFOR document produced to provide high-level guidance to our analysts. This document is not a forecast, but rather a series of guidelines for understanding and evaluating events, as well as suggestions on areas for focus.
Related Special Topic Page
We need to ramp up on a number of issues related to the H1N1 swine flu outbreaks. So far there are 1,663 suspected infections and 103 reported deaths. Nearly all of the infections and all of the deaths are in Mexico (98 percent of both have been in Mexico City itself). The high population density of Mexico City has allowed the new strain to spread very quickly and provided ample opportunities for it to be carried abroad. There are now suspected cases in Canada, New Zealand, Spain, France, Israel, Brazil and the United States.
But before we delve deeper into this topic, we must clarify what this is not. It is obvious that we’re not dealing with a 1918 style pandemic. The current H1N1 strain � “H1” and “N1” indicate certain proteins on the surface of the flu virus � was first detected in March. While there obviously have been deaths, we are not seeing numbers that indicate this is particularly horrible disease. Something like the 1918 avian virus would already be killing people in significant numbers in places as scattered as Singapore, Buenos Aires and Moscow. It appears that this H1N1 strain is simply a new strain of the common flu that is somewhat more virulent. All evidence thus far indicates that a simple paper mask is effective at limiting transmission, and that common anti-viral medications such as Tamiflu and Relenza work well against the new strain.
That does not mean there will not be disruptions. Several governments already are banning the import of North American pork products. Considering that the human-communicable strain has already traveled to every continent, this is a touch silly, but governments must appear to do something — and there is nothing seriously that can be done to quarantine a continent from something as communicable as a flu bug. We expect limited travel restrictions to pop up sooner rather than later. EU Health Commissioner Andorra Vassiliou has already recommended that Europeans rethink any plans to travel to North America. This is not yet a ban or even a travel warning, but those are logical next steps for spooked governments. Several states have been using thermal scanners at airports to check passengers for fevers, and so isolate potential carriers (this measure is of limited use — once a carrier is in the airport, he has probably already spread the virus).
The busy folks at the Centers for Disease Control and Prevention (CDC) need to become our new best friends. The CDC is not like the Federal Emergency Management Agency (FEMA) — it is not tasked to provide any hands-on, local support. Instead, they are a sort of brain trust of researchers that decode the virus, and based on their findings, produce recommendations as to how to limit the virus’ spread and mitigate the virus’ effects. At present the CDC has not yet decoded the virus.
We also need to touch base with various national health authorities the world over who were stressed about a possible H5N1 outbreak in 2007. Many of the procedures that were put into place to deal with a potential H5N1 catastrophe (information dissemination, vaccine dissemination, antiviral stockpiles, etc) remain applicable for combating this new H1N1 strain. We need to familiarize ourselves with what the thresholds are for the major health authorities. Some question to ask: At what point would you consider quarantines? At what point would you release antiviral stockpiles? How big are those stockpiles? What steps are you taking to detect new cases? Are there any travel or trade restrictions that you are considering or implementing?
Are there any places in the world where H1 flu strains are not prevalent? Once you have the flu, you develop a natural resistance to not just that specific strain, but any strain that is somewhat similar. H1 has been present in the United States for years and H1 strains regularly make it into American flu vaccines. Since it is believed that it is the H1 portion of this new virus that has been tweaked, in theory this will provide Americans with some limited protection. Are there any national populations that lack this protection?
We need to look at trade as well. Already Russia, China and the Philippines have barred pork imports of North American origin. (Incidentally, you are never at risk of contracting flu viruses from meat products unless you fail to cook it thoroughly.) We need to look at the trade question from two points of view. First, what trade flows (primarily pork) could be directly affected. Second, the global economy really does not need a major confidence hit right now. We need to be extremely vigilant of any indirect impacts this will have on capital availability, travel and consumer spending in the current fragile economic climate. Asian and European stock markets had a bad day today, but not inordinately so (Japan’s Nikkei — one of the world’s largest exchanges by value — actually rose a bit).
But the biggest question is why have there been deaths in Mexico City and not anywhere else? The idea that the Mexican health system is subpar does not hold: most people do not seek medical treatment for flu symptoms, so medical quality does not yet seriously enter into the picture. The explanation could be nothing more complicated than the fact that the strain first broke out in Mexico City and has not yet advanced far enough elsewhere to produce deaths (and if that is the case we should be seeing some terminal cases in the United States in the next few days).
So far the CDC does not have an opinion on this topic, but we need to discover if there is something fundamentally different about the situation — or the virus — in Mexico vis-a-vis the rest of the world.
Re: Epidemics: Bird Flu, TB, etc
Reply #33 on:
April 27, 2009, 03:36:19 PM »
I would not yet jump to the conclusion this article suggests that this virus is not as dangerous as say the one in 1918 - at least not yet.
It is true the one then was an avian virus and this one from pigs. Yet I read the people who are dying are not the typical young and old as in most influenza seasons but the young and healthy which is eerily like the one in 1918. H1 or H5 this applies:
The scientists suspect that with the 1918 flu, changes in just 25 to 30 out of about 4,400 amino acids in the viral proteins turned the virus into a killer. The new work also reveals that 1918 virus acts much differently from ordinary human flu viruses. It infects cells deep in the lungs of mice and infects lung cells, like the cells lining air sacs, that would normally be impervious to flu. And while other human flu viruses do not kill mice, this one, like today's bird flus, does.
Pig Flu gathering momentum here in US
Reply #34 on:
April 27, 2009, 03:48:40 PM »
"Swine flu fears prompt global quarantine plans"
By LAURAN NEERGAARD, AP Medical Writer Lauran Neergaard, Ap Medical Writer –
WASHINGTON – President Barack Obama said Monday the threat of spreading swine flu infections was a concern but "not a cause for alarm," while customs agents began checking people coming into the United States by land and air. The World Health Organization said there were 40 confirmed cases in the U.S. but no deaths.
Countries across the globe increased their vigilance amid increasing worries about a worldwide pandemic, Obama told a gathering of scientists that his administration's Department of Health and Human Services "has declared a public health emergency as a precautionary tool to ensure that we have the resources we need at our disposal to respond quickly and effectively."
The acting head of the Centers for Disease Control and Prevention, Dr. Richard Besser, said that Americans should be prepared for the problem to become more severe, and that it could involve "possibly deaths."
The quickening pace of developments in the United States in response to some 1,600 swine flu infections in neighboring Mexico — and reports of over 100 deaths — was accompanied by a host of varying responses around the world. The European Union advised against nonessential travel to the U.S. and Mexico, while China, Taiwan and Russia considered quarantines and several Asian countries scrutinized visitors arriving at their airports.
U.S. customs officials began checking people entering U.S. territory. Officers at airports, seaports and border crossings were watching for signs of illness, said Customs and Border Protection spokesman Lloyd Easterling.
If a traveler says something about not feeling well, the person will be questioned about symptoms and, if necessary, referred to a CDC official for additional screening, Easterling said. The customs officials were wearing personal protective gear, such as gloves and masks, he said.
Multiple airlines, including American, United, Continental, US Airways, Mexicana and Air Canada, said they were waiving usual penalties for changing reservations for anyone traveling to, from, or through Mexico, but had not canceled flights.
The CDC's Besser said that while the U.S. hasn't advised against travel to Mexico, it has urged people to take precautions, such as frequent hand-washing while there.
A private school in South Carolina was closed Monday because of fears that young people who recently returned from Mexico might have been infected.
"We are closely monitoring the emerging cases of swine flu in the United States," Obama said. "I'm getting regular updates on the situation from the responsible agencies, and the Department of Health and Human Services as well as the Centers for Disease Control will be offering regular updates to the American people so that they know what steps are being taken and what steps they may need to take."
"But one thing is clear: Our capacity to deal with a public health challenge of this sort rests heavily on the work of our scientific and medical community," the president said. "And this is one more example of why we cannot allow our nation to fall behind."
Besser, the CDC official, described the new U.S. border initiative as "passive screening." He said authorities were "asking people about fever and illness, looking for people who are ill."
The U.S. declared a national health emergency in the midst of uncertainty about whether the mounting sick count meant new infections were increasing or health officials had simply missed something that had been simmering for weeks or months. The declaration allowed Washington to ship roughly 12 million doses of flu-fighting medications from a federal stockpile to states in case they are needed.
Besser traveled the morning news-show circuit Monday, telling interviewers the U.S. government was being "extremely aggressive" and saying he wouldn't personally recommend traveling to parts of Mexico where the new virus had taken hold.
Besser said he was not reassured by the fact that so far in the U.S., no one had died from the disease.
"From what we understand in Mexico, I think people need to be ready for the idea that we could see more severe cases in this country and possibly deaths," he said. "That's something people have to be ready for and we're looking for that. So far, thankfully, we haven't seen that. But we're very concerned and that's why we're taking very aggressive measures."
Meanwhile, officials of Newberry Academy in South Carolina said Monday that seniors from the school were in Mexico earlier this month and some had flu-like symptoms when they returned.
State Department of Health and Environmental Control spokesman Jim Beasley said test results on the students could come back as early as Monday afternoon. The agency has stepped up efforts to investigate all flu cases in South Carolina. There have been no confirmed swine flu cases in the state.
A New York City school where eight cases were confirmed will be closed Monday and Tuesday, and 14 schools in Texas, including a high school where two cases were confirmed, will be closed for at least the next week. Some schools in California and Ohio also were closing after students were found or suspected to have the flu.
In Mexico, the outbreak's center, soldiers handed out 6 million face masks to help stop the spread of the virus that is suspected in up to 103 deaths. Most other countries are reporting only mild cases so far, with most of the sick already recovering.
Spain reported its first confirmed swine flu case on Monday and said another 17 people were suspected of having the disease. The European Union health commissioner advised Europeans to avoid nonessential travel to Mexico and the United States. Also, three New Zealanders recently returned from Mexico are suspected of having it.
"These are the early days," said World Health Organization spokesman Peter Cordingley. "It's quite clear that there is a potential for this virus to become a pandemic and threaten globally." He said it was spreading rapidly in Mexico and the southern United States.
Worldwide, attention focused on travelers.
"It was acquired in Mexico, brought home and spread," Nova Scotia's chief public health officer, Dr. Robert Strang, said of Canada's first confirmed cases.
Associated Press writers Mark Stevenson and Olga R. Rodriguez in Mexico City; Frank Jordans in Geneva; Mike Stobbe in Atlanta; Maria Cheng in London and Eileen Sullivan in Washington contributed to this report.
"phase four' says the WHO
Reply #35 on:
April 27, 2009, 05:04:29 PM »
TORONTO, April 27 -- The World Health Organization has raised its pandemic alert system to level four -- sustained human-to-human transmission -- in response to the swine flu outbreak in the U.S., Mexico, and at least two other countries.
The Geneva-based WHO made the change from level three -- some human-to-human transmission -- on the advice of an expert panel meeting today.
Earlier today, acting CDC director Richard Besser, M.D., said the change won't affect the U.S. response to the outbreak.
"It really doesn't matter from our perspective what you call this," he said in a press conference. "Our actions are based on what's happening in our country and our communities."
Stepping up one phase, Dr. Besser said, "would not change anything that we are currently doing."
The pandemic threat level has six major levels. Phases one through three increase from strictly animal-to-animal transmission to some human-to-human transmission, sufficient to create small clusters of disease.
Level four requires sustained human-to-human transmission able to cause what the WHO calls "community-level outbreaks."
Levels five and six are the pandemic levels.
Phase five is characterized by human-to-human spread of the virus into at least two countries in a region, although most countries are not affected.
In phase six, there are community-level outbreaks in at least one other country in a different region. This level is regarded as a signal that a global pandemic is truly under way.
WSJ: Understanding Swine Flu
Reply #36 on:
April 28, 2009, 07:19:39 AM »
By HENRY I. MILLER
The extent and impact of the swine flu epidemic, which appears to have originated in Mexico and spread rapidly to a dozen countries and parts of the U.S., is still unknown. The epidemiology of such disease outbreaks is rather like a jigsaw puzzle, and we are now at the stage where the picture is intriguing even if we're not sure what we're seeing.
We do know the number of cases in Mexico exceeds 1,995, there have been at least 149 deaths, and there have been 20 cases in five U.S. states (with no fatalities as yet). And that the outbreak causes us to confront complex issues that encompass medicine, epidemiology, virology and even politics and ethics.
These events demonstrate that good surveillance is needed in order to detect early on that a new infectious agent, transmissible between humans, has emerged. Unfortunately, conditions in many countries are conducive to the emergence of such new infectious agents, especially flu viruses, which mutate rapidly and inventively. Intensive animal husbandry procedures that place poultry and swine in close proximity to humans, combined with unsanitary conditions, poverty and grossly inadequate public-health infrastructure of all kinds -- all of which exist in Mexico, as well as much of Asia and Africa -- make it unlikely that a pandemic can be prevented or contained at the source.
In theory, a flu pandemic might be contained in its early stages by performing "ring prophylaxis" -- aggressively using antiflu drugs, vaccines and quarantines to isolate relatively small outbreaks of the new infectious agent. Addressing H5N1 avian flu in 2005, Johns Hopkins University virologist Donald S. Burke said, "it may be possible to identify a human outbreak at the earliest stage, while there are fewer than 100 cases, and deploy international resources -- such as a WHO [World Health Organization] stockpile of antiviral drugs -- to rapidly quench it. This 'tipping point' strategy is highly cost-effective."
But a strategy can be "cost-effective" only if it is feasible. Early ring prophylaxis might work in Minneapolis, Toronto, Singapore or Zurich. In places such as Indonesia, China and Mexico, however, the expertise, coordination, discipline and infrastructure are lacking. Moreover, there is no vaccine available to prevent infection of humans by the new H1N1 swine flu (or by H5N1 avian flu, for that matter).
The rapid and constant movement of goods and people around the world makes early containment virtually impossible. We saw this with the SARS (Severe Acute Respiratory Syndrome) epidemic in 2003: Within a matter of weeks, the disease spread rapidly from southern China to infect individuals in some 37 countries, killing about 800.
In the current swine flu outbreak, New York City high-school students apparently brought the virus back from Mexico and infected their classmates. All six cases so far reported in Canada were connected directly or indirectly with travel to Mexico.
Flu viruses can be directly transmitted (via droplets from sneezing or coughing) from pigs to people, and vice versa. These cross-species infections occur most commonly when people are in close proximity to large numbers of pigs, such as in barns, livestock exhibits at fairs, and slaughterhouses. And, of course, flu is transmissible from human to human, either directly or via contaminated surfaces.
Pigs are uniquely susceptible to infection with flu viruses of mammalian and avian origin. This is of concern for a couple of reasons. First, pigs can serve as intermediaries in the transmission of flu viruses from birds to people. And when avian viruses infect pigs, they adapt and become more efficient at infecting mammals -- which makes them more easily transmitted and dangerous to humans.
Second, pigs can serve as hosts in which two (or more) influenza viruses infecting an animal simultaneously can undergo "genetic reassortment," a process in which pieces of viral RNA (the virus's genetic material, similar to DNA) are shuffled and exchanged, creating a new organism. The influenza viruses responsible for the world-wide 1957 and 1968 flu pandemics -- which killed about 70,000 and 34,000, respectively, in the U.S. -- were such viruses, containing genes from both human and avian viruses.
Experience shows that attempts to stem the spread of an outbreak may actually exacerbate it. In 2006, China's chaotic effort to vaccinate 14 billion chickens to control avian flu was compromised by counterfeit vaccines and the absence of protective gear for vaccination teams. This likely spread contagion by vaccinators who carried infected fecal material on their shoes from one farm to another.
The situation in Mexico resembles the scenario we might expect for an outbreak of a major human-to-human pandemic in its earliest stages: a large number of illnesses among social and family contacts of victims; infection of health-care workers and patients in hospitals where the victims are treated; and the rapid spread of confirmed cases from an initial region to other countries as people infected by the virus travel while it is incubating, but before they become seriously ill.
Because they have been stockpiled for use in the event of an avian flu pandemic, large amounts of the antiflu drugs Tamiflu and Relenza are available. However, they must be administered during the first couple of days after symptoms begin to be an effective treatment. They can also prevent the onset of the disease if administered in adequate doses prior to exposure. The danger of using antiflu drugs in poor countries with inadequate public-health facilities such as Mexico is that they may be administered improperly and in suboptimal doses, which would promote viral resistance and intensify an outbreak.
If the swine flu outbreak becomes a pandemic with a high rate of severe complications (such as pneumonia) and death, we will need to be smart, nimble and flexible. That will involve triage on many levels -- including decisions about which patients are likely to benefit from scarce commodities such as drugs and ventilators -- as well as "social engineering" determinations about issues such as mandatory quarantine, the canceling of public events, shutting airports and closing our southern border. Let's hope it doesn't come to that.
Dr. Miller, a physician and molecular biologist, is a fellow at Stanford University's Hoover Institution. He is a former flu researcher and was an official at the National Institutes of Health and the Food and Drug Administration from 1977 to 1994.
NYT: What's in the pipeline?
Reply #37 on:
April 28, 2009, 08:21:05 AM »
Where Will the Swine Flu Go Next?
AS the swine flu threatens to become the next pandemic, the biggest questions are whether its transmission from human to human will be sustained and, if so, how virulent it might become. But even if this virus were to peter out soon, there is a strong possibility it would only go underground, quietly continuing to infect some people while becoming better adapted to humans, and then explode around the world.
What happens next is chiefly up to the virus. But it is up to us to create a vaccine as quickly as possible.
Influenza viruses are unpredictable because they are able to mutate so rapidly. That capacity enables them to jump easily from species to species, infecting not only pigs and people but also horses, seals, cats, dogs, tigers and so on. An avian virus responsible for the 1918 pandemic jumped first from birds to humans, then from humans to swine (as well as other animals). Now, and not for the first time, pigs have given a virus back to humans.
Mutability makes even existing, well-known flu viruses unpredictable. A new virus, formed by a combination of several existing ones as this virus is, is even less predictable. After jumping to a new host, influenza can become more or less virulent — in fact, different offshoots could go in opposite directions — before a relatively stable new virus emerges.
Influenza pandemics have occurred as far back in history as we can look, but the four we know about in detail happened in 1889, 1918, 1957 and 1968. The mildest of these, the so-called Hong Kong flu in 1968, killed about 35,000 people in the United States and 700,000 worldwide. Ordinary seasonal influenza, in comparison, now kills 36,000 Americans a year, because the population has a higher proportion of elderly people and others with weak immune systems. (If a virus like the Hong Kong flu hit today, it would probably kill more people for the same reason.)
The worst influenza pandemic, in 1918, killed 675,000 in the United States. And although no one has a reliable worldwide death toll, the lowest reasonable number is about 35 million, and some scientists believe it killed as many as 100 million — at a time when the world’s population was only a quarter of what it is today. The dead included not only the elderly and infants but also robust young adults.
What’s important to keep in mind in assessing the threat of the current outbreak is that all four of the well-known pandemics seem to have come in waves. The 1918 virus surfaced by March and set in motion a spring and summer wave that hit some communities and skipped others. This first wave was extremely mild, more so even than ordinary influenza: of the 10,313 sailors in the British Grand Fleet who became ill, for example, only four died. But autumn brought a second, more lethal wave, which was followed by a less severe third wave in early 1919.
The first wave in 1918 was relatively mild, many experts speculate, because the virus had not fully adapted to humans. And as it did adapt, it also became more lethal. However, there is very good evidence that people who were exposed during the first wave developed immunity — much as people get protection from a modern vaccine.
A similar kind of immune-building process is the most likely explanation for why, in 1918, only 2 percent of those who contracted the flu died. Having been exposed to other influenza viruses, most people had built up some protection. People in isolated regions, including American Indian reservations and Alaskan Inuit villages, had much higher case mortality — presumably because they had less exposure to influenza viruses.
The 1889 pandemic also had a well-defined first wave that was milder than succeeding waves. The 1957 and 1968 pandemics had waves, too, though they were less well defined.
In all four instances, the gap between the time the virus was first recognized and a second, more dangerous wave swelled was about six months. It will take a minimum of four months to produce vaccine in any volume, possibly longer, and much longer than that to produce enough vaccine to protect most Americans. The race has begun.
John M. Barry, a visiting scholar at the Tulane/Xavier Center for Bioenvironmental Research, is the author of “The Great Influenza.”
And I Bet He Flies Coach, Too
Reply #38 on:
April 30, 2009, 08:53:27 AM »
Guess Joe didn't get the memo that we are supposed to keep going about our business where the swine flu is concerned. Instead, people shouldn't be riding the subway or flying in aircraft:
Some truths about flu
Reply #39 on:
April 30, 2009, 01:51:56 PM »
This is an excellent book on the 1918-19 pandemic:
I wrote an article for a local newspaper on the 1918 pandemic when it was the 75th anniversary of it in 1993.
One thing I have not heard mentioned has to do with the fact that most people who died back then did not die of viral neumonia but of secondary bacterial pneumonia.
Indeed the reason it was even named the influenza epidemic was because pathologists early into it identified on smears the heamophilus influenza BACTERIA. So influenza got it's name by mistake. Of course in those days they could not see or had no way to even know what a virus was.
So most of those people similarly sick today would not have died because we now have antibiotics to cure them.
So the threat with that kind of virus is much less serious for those of us in the US then it was. Maybe in the thousands but definitely not in the hundreds of thousands or millions in the US.
That said for other countries, in sub Sahara Africa, remote places in Asia, S. America where access to care is less robust the death rate for such a virus could be very high.
Additionally, the virus could mutate into something nver seen before with death rates much higher than say the estimated 5% in 1918 more akin to Ebola or Hanta viruses.
So I don't take the potential threat lightly.
Should we quarentine those coming from Mexico or prevent those from going?
Of course I am not a world expert but my feeling is that even trying to prevent the spread of influenza is just a fantasy.
It can't be done.
Even in 1918-19 before the advent of mass travel and migration the virus made its way to EVERY single corner of the world where there was humanity.
All the South sea Islands, Eskimos etc. There was no place to hide. There was no palce that was not hit. None!
This is not trying to prevent a few cased of drug resistent TB. You put armed military on the border with Mexico. Forget it.
Influenza will get here if it is destined to.
Of course the politicians will always try to put blame on the other side.
Re: Epidemics: Bird Flu, TB, etc
Reply #40 on:
May 02, 2009, 09:29:59 AM »
Just a thought. I wonder if I should believe the new and reduced number of flu deaths in Mexico.
It seems reasonable to question the motives and thus the validity of the *new* estimates of the the death toll from flu.
Mexico's economy is being hurt by this whole thing. We hear corruption is rampant. So now I hear that oh, its not nearly as bad as we thought. Well is it or not? I don't know what to believe.
****Lower Mexico flu death toll heartens nervous world 02 May 2009 12:46:21 GMT
(For full coverage of the flu outbreak, click [nFLU])
* Mexico cuts suspected flu death toll to up to 101
* WHO says flu spans 15 countries, 615 people infected
* U.S. responding aggressively to flu outbreak-Obama
* China cancels Mexico flights, Hong Kong seals off hotel
(Adds Obama comments)
By Catherine Bremer
MEXICO CITY, May 2 (Reuters) - New laboratory data showed fewer people have died in Mexico than first thought from a new influenza strain, a glint of good news for a world rattled by the threat of a flu pandemic.
Mexico cut its suspected death toll from the H1N1 flu to up to 101 from as many as 176, as dozens of test samples came back negative. Fewer patients with severe flu symptoms were also checking into hospitals, suggesting the infection rate of a flu that has spread to Europe and Asia was declining.
The World Health Organisation said on Saturday 15 countries have reported 615 infections with the new flu virus A-H1N1, widely known as swine flu [nL2430119].
Italy later confirmed its first case, a man in the Tuscany region who returned from Mexico on April 24. He has recovered.
Almost all infections outside Mexico have been mild. The only death in another country has been a Mexican toddler who was taken to the United States before he fell sick.
The U.S. Centers for Disease Control and Prevention agreed the outbreak may not be as severe as it looked a few days ago, citing many mild cases that were not immediately noticed. [ID:nN01346626]
President Barack Obama said the United States was responding aggressively to the new flu strain [nN01348184].
He outlined steps his administration was taking to address the virus, including school closures, and said antivirals were being distributed to states where they may be needed and new stockpiles had been ordered.
For Mexicans -- spending a second weekend stuck indoors with stores and businesses shuttered across the country and the capital, Mexico City, devoid of its lively restaurants, bars, cinemas and museums -- the data is cheering.
Health Minister Jose Angel Cordova acknowledged the numbers were encouraging but cautioned it was too early to say Mexico had control of the flu.
"For now it's unpredictable," Cordova said late on Friday. "We need more days to see how it behaves and whether there is really a sustained decline."
The new virus is only the third infectious disease experts regard as having pandemic potential in the past 10 years.
It has world health experts racing to find a vaccine and is wreaking havoc with a travel industry that flies hundreds of thousands of people to and from Mexico each week. [ID:nNN0129623]
China suspended flights to Mexico after Hong Kong authorities on Friday confirmed a Mexican man who flew via the Chinese mainland was infected with the flu strain.
HOTEL GUESTS QUARANTINED
Police in surgical masks quarantined 200 guests and 100 staff inside a Hong Kong hotel where the Mexican, 25, had been staying, saying they would be confined for a week. [ID:nT31820]
"They said everybody needed to go back to their rooms. I don't want to go to my room because I want to be out," an Australian man at the hotel told a TV reporter by telephone.
Hong Kong was badly hit by the SARS virus in 2003 and has had many episodes of H5N1 bird flu for more than a decade.
The Asian Development Bank said it was prepared to provide assistance to countries in the region to cope with the possible spread of flu, as it did during the SARS outbreak. [nJAK469756]
Several European countries have confirmed cases of the virus. The United States has been hit with 145 cases in 22 states. [ID:nN01348184]
Mexico has released a confusing batch of flu data in recent days but public hospitals have noted a steady drop in patients turning up with fevers, suggesting the infection rate may be declining as the nation dons face masks and hand gel.
"There are very few deaths worldwide," said Marcelo Musi, a salesman shopping for vegetables in Mexico City, where residents weary of masks, hand sanitizers and frightening headlines clutched at signs of an end to the crisis. "If there are no more cases, they say things will get better."
President Felipe Calderon ordered non-essential businesses to close for five days from Friday, extending a three-day holiday weekend over Monday and Tuesday. [ID:nN01340553]
Analysts say the move will further dent negative economic growth this year.
Countless families were devastated at having their long weekend ruined as restaurants, bars, playgrounds and parks that hold outdoor "cumbia" dances all stayed closed.
Cordova said of 159 files on suspected flu deaths, tests showed 58 died of other causes. He said 16 deaths are confirmed as caused by the H1N1 flu and 85 are being tested. (Additional reporting by Louise Egan and Anahi Rama and Tan Ee Lyn in Hong Kong, Laura MacInnis in Geneva, Silvia Aloisi in Rome; Editing by Janet Lawrence)****
Reply #41 on:
May 05, 2009, 11:51:13 AM »
May 4, 2009
By George Friedman
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Swine Flu Outbreak 2009
Word began to flow out of Mexico the weekend before last of well over 150 deaths suspected to have been caused by a new strain of influenza commonly referred to as swine flu. Scientists who examined the flu announced that this was a new strain of Influenza A (H1N1) derived partly from swine flu, partly from human flu and partly from avian flu strains (although there is some question as to whether this remains true). The two bits of information released in succession created a global panic.
This panic had three elements. The first related to the global nature of this disease, given that flus spread easily and modern transportation flows mean containment is impossible. Second, there were concerns (including our own) that this flu would have a high mortality rate. And third, the panic centered on the mere fact that this disease was the flu.
News of this new strain triggered memories of the 1918-1919 flu pandemic, sparking fears that the “Spanish flu” that struck at the end of World War I would be repeated. In addition, the scare over avian flu created a sense of foreboding about influenza — a sense that a catastrophic outbreak was imminent.
By midweek, the disease was being reported around the world. It became clear that the disease was spreading, and the World Health Organization (WHO) declared a Phase 5 pandemic alert. A Phase 5 alert (the last step before a pandemic is actually, officially declared, a step that may be taken within the next couple of days) means that a global pandemic is imminent, and that the virus has proved capable of sustained human-to-human transmission and infecting geographically disparate populations. But this is not a measure of lethality, only communicability, and pandemics are not limited to the deadliest diseases.
‘Pandemic,’ not ‘Duck and Cover’
To the medical mind, the word “pandemic” denotes a disease occurring over a wide geographic area and affecting an exceptionally high proportion of the population. The term in no way addresses the underlying seriousness of the disease in the sense of its wider impact on society. The problem is that most people are not physicians. When the WHO convenes a press conference carried by every network in the world, the declaration of a level 5 pandemic connotes global calamity, even as statements from experts — and governments around the world — attempt to walk the line between calming public fears and preparing for the worst.
The reason to prepare for the worst was because this was a pandemic with an extremely unclear prognosis, and about which reliable information was in short supply. Indeed, the new strain could mutate into a more lethal form and re-emerge in the fall for the 2009-2010 flu season. There are also concerns about how its victims disproportionately are healthy young adults under 45 years of age — which was reported in the initial information out of Mexico, and has been reported as an observed factor in the cases that have popped up in the United States. This was part of the 1918 flu pandemic pattern as well. (In contrast, seasonal influenza is most deadly among the elderly and young children with weaker immune systems.)
But as the days wore on last week, the swine flu began to look like little more than ordinary flu. Toward the end of the week, a startling fact began to emerge: While there were more than a hundred deaths in Mexico suspected of being caused by the new strain, only about 20 (a number that has increased slightly after being revised downward earlier last week) have been confirmed as being linked to the new virus. And there has not been a single death from the disease reported anywhere else in the world, save that of a Mexican child transported to the United States for better care. Indeed, even in Mexico, the country’s health minister declared the disease to be past its peak May 3. STRATFOR sources involved in examining the strain have also suggested that the initial analysis of the swine flu was in fact in error, and that the swine flu may have originated during a 1998 outbreak in a pig farm in North Carolina. This information reopens the question of what killed the individuals whose deaths were attributed to swine flu.
While little is understood about the specifics of this new strain, influenza in general has a definitive pattern. It is a virus that affects the respiratory system, and particularly the lungs. At its deadliest it can cause secondary infections — typically bacterial rather than viral — leading to pneumonia. In the most virulent forms of influenza, it is the speed with which complications strike that drives death rates higher. Additionally, substantively new strains (as swine flu is suspected of being) can be distinct enough from other strains of flu that pre-existing immunity gained from flus of years past does not help fend off the latest variation.
Influenza is not a disease that lingers and then kills people — save the sick, old and very young, whose immune systems are more easily compromised. Roughly half a million people (largely from these groups) die annually worldwide from more common strains of influenza, with the Centers for Disease Control and Prevention (CDC) pegging average American deaths at roughly 36,000 per year.
Swine flu deaths have not risen as would be expected at this point for a highly contagious and lethal new strain of influenza. In most cases, victims have experienced little more than a bad cold, from which they are recovering. And infections outside Mexico so far have not been severe. This distinction of clear cases of death in Mexico and none elsewhere (again, save the one U.S. case) is stark.
Much of what has occurred in the last week regarding the new virus reminds us of the bird flu scare of 2005. Then as now, the commonly held belief was that a deadly strain was about to be let loose on humanity. Then as now, many governments were heightening concerns rather than quelling them. Then as now, STRATFOR saw only a very small chance of the situation becoming problematic.
Ultimately, by the end of last week it had become clear to the global public that “pandemic” could refer to bad colds as well as to plagues wiping out millions.
A Real Crisis
The recent swine flu experience raises the question of how one would attempt to grapple with a genuine high-mortality pandemic with major consequences. The answer divides into two parts: how to control the spread, and how to deploy treatments.
The flu virus is widely present in two species other than humans, namely, birds and pigs. The history of the disease is the history of its transmission within and across these three species. It is comparatively easy for the disease to transmit from swine to birds and from swine to humans; the bird-to-human barrier is the most difficult to cross.
Cross-species influenza is of particular concern. In the simplest terms, viruses are able to recombine (e.g., human flu and avian flu can merge into a hybrid flu strain). What comes out can be a flu transmissible to humans, but with a physical form that is distinctly avian — meaning it fails to alert human immune systems to the intrusion. This can rob the human immune system of the ability to quickly recognize the disease and put up a fight.
New humanly transmissible influenza strains often have been found to originate in places where humans, pigs and/or fowl live in close proximity to each other — particularly in agricultural areas where animal and human habitation is shared or in which constant, close physical contact takes place.
Agricultural areas of Asia with dense populations, relatively small farms and therefore frequent and prolonged contact between species traditionally have been the areas in which influenza strains have transferred from animals to humans and then mutated into diseases transmissible by casual human contact. Indeed, these areas have been the focus of concern over a potential outbreak of bird flu. This time around, the outbreak began in Mexico (though it is not yet clear where the virus itself originated).
And this is key to understanding this flu. Because it appears relatively mild, it might well have been around for quite awhile — giving people mild influenza, but not standing out as a new variety until it hit Mexico. The simultaneous discovery of the strain amid a series of deaths (and what may now be in hindsight inflated concerns about its lethality) led to the recent crisis footing.
Any time such threats are recognized, they already are beyond containment. Given travel patterns in the world today, viruses move easily to new locations well before they are identified in the first place they strike. The current virus is a case in point. It appears, although it is far from certain, that it originated in the Veracruz area of Mexico. Within two days of the Mexican government having issued a health alert, it already had spread as far afield as New Zealand. One week on, cases completely unrelated to Mexico have already been confirmed on five continents.
In all probability, this “spread” was less the discovery of new areas of infection than the random discovery of areas that might have been infected for weeks or even months (though the obvious first people to test were those who had recently returned from Mexico with flu symptoms). Given the apparent mildness of the infection, most people would not go to the doctor. And if they did, the doctor would call it generic flu and not even concern himself with its type. What happened last week appears to have been less the spread of a new influenza virus than the “discovery” of places to which it had spread awhile ago.
The problem with the new variety was not that it was so deadly; had it actually been as uniquely deadly as it first appeared to be, there would have been no mistaking its arrival, because hospitals would be overflowing. It was precisely its mildness that sparked the search. But because of expectations established in the wake of the Mexico deaths, the discovery of new cases was disassociated from its impact. Its presence alone caused panic, with schools closing and border closings discussed.
The virus traveled faster than news of the virus. When the news of the virus finally caught up with the virus, the global perception was shaped by a series of deaths suddenly recognized in Mexico (as mentioned, deaths so far not seen elsewhere). But even as the Mexican Health Ministry begins to consider the virus beyond its peak, the potential for mutation and a more virulent strain in the next flu season looms.
As mentioned, viruses that spread through casual human contact can be globally established before anyone knows of it. The first sign of a really significant influenza pandemic will not come from the medical community or the WHO; it will come from the fact that people are catching influenza and dying, and are doing so all over the world at the same time. The system established for detecting spreading diseases is hardwired to be behind the curve. This is not because it is inefficient, but because no matter how efficient, it cannot block casual contact — which, given modern air transportation, spreads diseases globally in a matter of days or even hours.
Therefore, the problem is not the detection of deadly pandemics, simply because they cannot be missed. Rather, the problem is reacting medically to deadly pandemics. One danger is overreacting to every pandemic and thereby breaking the system. (As of this writing, the CDC remained deeply concerned about swine flu, though calm seems to be returning.)
The other danger is not reacting rapidly enough. In the case of influenza, medical steps can be taken. First, there are anti-viral medicines found to be effective against the new strain, and if sufficient stockpiles exist — which is hardly universally the case, especially in the developing world — and those stockpiles can be administered early enough, the course of the disease can be mitigated. Second, since most people die from secondary infection in the lungs, antibiotics can be administered. Unlike with the 1918 pandemic, the mortality rate can be dramatically reduced.
The problem here is logistical: The distribution and effective administration of medications is a challenge. Producing enough of the medication is one problem; it takes months to craft, grow and produce a new vaccine, and the flu vaccine is tailored every year to deal with the three most dangerous strains of flu. Another problem is moving the medication to areas where it is needed in an environment that maintains its effectiveness. Equally important is the existence of infrastructure and medical staff capable of diagnosing, administering and supporting patients — and doing so on a scale never before attempted.
These things will not be done effectively on a global basis. That is inevitable. But influenza, even at the highest death rates ever recorded for the disease, does not threaten human existence as we know it. At its worst, flu will kill a lot of people, but the human race and the international order will survive.
The true threat to humanity, if it ever comes, will not come from influenza. Rather, it will come from a disease spread through casual human contact, but with a higher mortality rate than flu and no clear treatment. While HIV/AIDS boasts an extraordinarily high mortality rate and no cure exists, it at least does not spread through casual contact as influenza does, and so the pace at which it can spread is limited.
Humanity will survive the worst that influenza can throw at it even without intervention. With modern intervention, its effect declines dramatically. But the key problem of pandemics was revealed in this case: The virus spread well before information on it spread. Detection and communication lagged. That did not matter in this case, and it did not matter in the case of HIV/AIDS, because the latter was a disease that did not spread through casual contact. However, should a disease arise that is as deadly as HIV, that spreads through casual contact, about which there is little knowledge and for which there is no cure, the medical capabilities of humanity would be virtually useless.
There are problems to which there are no solutions. Fortunately, these problems may not arise. But if they do, no amount of helpful public service announcements from the CDC and the WHO will make the slightest bit of difference.
Reply #42 on:
August 29, 2009, 06:18:34 AM »
WHO warns of severe form of swine flu
By Maggie Fox, Health and Science Editor Maggie Fox, Health And Science Editor – Fri Aug 28, 1:36 pm ET
WASHINGTON (Reuters) – Doctors are reporting a severe form of swine flu that goes straight to the lungs, causing severe illness in otherwise healthy young people and requiring expensive hospital treatment, the World Health Organization said on Friday. Some countries are reporting that as many as 15 percent of patients infected with the new H1N1 pandemic virus need hospital care, further straining already overburdened healthcare systems, WHO said in an update on the pandemic.
"During the winter season in the southern hemisphere, several countries have viewed the need for intensive care as the greatest burden on health services. Preparedness measures need to anticipate this increased demand on intensive care units, which could be overwhelmed by a sudden surge in the number of severe cases."
Earlier, WHO reported that H1N1 had reached epidemic levels in Japan, signaling an early start to what may be a long influenza season this year, and that it was also worsening in tropical regions.
"Perhaps most significantly, clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen during seasonal influenza infections. In these patients, the virus directly infects the lung, causing severe respiratory failure. Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays."
MINORITIES AT RISK
Minority groups and indigenous populations may also have a higher risk of being severely ill with H1N1.
"In some studies, the risk in these groups is four to five times higher than in the general population. Although the reasons are not fully understood, possible explanations include lower standards of living and poor overall health status, including a high prevalence of conditions such as asthma, diabetes and hypertension."
WHO said it was advising countries in the Northern Hemisphere to prepare for a second wave of pandemic spread. "Countries with tropical climates, where the pandemic virus arrived later than elsewhere, also need to prepare for an increasing number of cases," it said.
Every year, seasonal flu infects between 5 percent and 20 percent of a given population and kills between 250,000 and 500,000 people globally. Because hardly anyone has immunity to the new H1N1 virus, experts believe it will infect far more people than usual, as much as a third of the population. It also disproportionately affects younger people, unlike seasonal flu which mainly burdens the elderly, and thus may cause more severe illness and deaths among young adults and children than seasonal flu does.
"Data continue to show that certain medical conditions increase the risk of severe and fatal illness. These include respiratory disease, notably asthma, cardiovascular disease, diabetes and immunosuppression. When anticipating the impact of the pandemic as more people become infected, health officials need to be aware that many of these predisposing conditions have become much more widespread in recent decades, thus increasing the pool of vulnerable people."
WHO estimates that more than 230 million people globally have asthma, and more than 220 million have diabetes. Obesity may also worsen the risk of severe infection, WHO said.
The good news -- people infected with AIDS virus do not seem to be at special risk from H1N1, WHO said.
(Editing by Mohammad Zargham)
Reply #43 on:
September 17, 2009, 01:41:40 PM »
‘Behind the Headlines’? Despite the Headlines!
Posted by Jim Harper
STRATFOR—a group I hadn’t heard of before—provides, in their words, “geopolitical intelligence – independent, non-ideological and non-partisan analysis and perspective that is unavailable anywhere else in the world.” They also say they provide the “intelligence behind the headlines.”
Well, I was struck—delighted, really—to see them outright contradict the headlines in a report of theirs that mercilessly skewers H1N1 (swine) flu fears:
It has been five months since the A(H1N1) influenza virus — aka the swine flu — climbed to the top of the global media heap, and with the start of the Northern Hemisphere’s annual flu season just around the corner, the topic is worth revisiting.
If you take only one fact away from this analysis, take this: The U.S. Centers for Disease Control and Prevention (CDC) believes that hospitalization rates and mortality rates for A(H1N1) are similar to or lower than they are for more traditional influenza strains. And if you take two facts away, consider this as well: Influenza data are incomplete at best and rarely cross-comparable, so any assertions of the likelihood of mass deaths are little more than scaremongering bereft of any real analysis or, more important, any actual evidence.
One would expect “intelligence” reporting firms to have the same incentives as politicians and other media: drum up fear to drum up business. But there is value in providing actual facts and sound strategies for responding to world events. As a non-expert, I’m not able to evaluate the substance of the STRATFOR report or its conclusions, but I give it credibility as a statement against interest.
After the early ineptitude shown by the Obama Administration, I was beginning to think that the steady drumbeat of news about preparation for flu season was appropriate societal girding for what could be a notable disease outbreak. I am more inclined now to believe that we are flushing more money down the drain because of fears the administration generated.
Overreaction harms the country, and it is the responsibility of governments—if they take a role—to quell impulses toward overreaction when incidents of national significance occur.
Re: Epidemics: Bird Flu, TB, etc
Reply #44 on:
September 17, 2009, 08:24:59 PM »
Never heard of Stratfor before? Hah! He needs to spend more time around here
Do Flu Immunizations Work? I
Reply #45 on:
October 14, 2009, 01:38:18 PM »
Whether this season’s swine flu turns out to be deadly or mild, most experts agree that it’s only a matter of time before we’re hit by a truly devastating flu pandemic—one that might kill more people worldwide than have died of the plague and AIDS combined. In the U.S., the main lines of defense are pharmaceutical—vaccines and antiviral drugs to limit the spread of flu and prevent people from dying from it. Yet now some flu experts are challenging the medical orthodoxy and arguing that for those most in need of protection, flu shots and antiviral drugs may provide little to none. So where does that leave us if a bad pandemic strikes?
by Shannon Brownlee and Jeanne Lenzer
Does the Vaccine Matter?
IMAGE CREDIT: JASON REED/REUTERS/CORBIS
DRIVE TOO FAST along Red Lion Road, beside Philadelphia’s Northeast Airport, and you will miss the low-rise cement building where the biotech company MedImmune has been quietly pumping out swine flu vaccine at about a million doses a week. Through the summer and fall, workers wearing protective gear that covered them from head to toe brewed up batches of live, genetically modified flu virus. Robots then injected tiny doses of virus-laden fluid into glass vials, which were mounted into nasal spritzers, labeled, and readied for shipment at the direction of the Centers for Disease Control and Prevention, in Atlanta, which is helping to coordinate the nation’s pandemic-preparedness plan. In the most ambitious vaccination program the nation has mounted since the anti-polio campaign in the 1950s, the federal government has commissioned MedImmune and four other companies to produce enough vaccine to cover the entire U.S. population.
Vaccination is central to the government’s plan for preventing deaths from swine flu. The CDC has recommended that some 159 million adults and children receive either a swine flu shot or a dose of MedImmune’s nasal vaccine this year. Shots are offered in doctors’ offices, hospitals, airports, pharmacies, schools, polling places, shopping malls, and big-box stores like Wal-Mart. In August, New York state required all health-care workers to get both seasonal and swine flu shots. To further protect the populace, the federal government has spent upwards of $3billion stockpiling millions of doses of antiviral drugs like Tamiflu—which are being used both to prevent swine flu and to treat those who fall ill.
But what if everything we think we know about fighting influenza is wrong? What if flu vaccines do not protect people from dying—particularly the elderly, who account for 90 percent of deaths from seasonal flu? And what if the expensive antiviral drugs that the government has stockpiled over the past few years also have little, if any, power to reduce the number of people who die or are hospitalized? The U.S. government—with the support of leaders in the public-health and medical communities—has put its faith in the power of vaccines and antiviral drugs to limit the spread and lethality of swine flu. Other plans to contain the pandemic seem anemic by comparison. Yet some top flu researchers are deeply skeptical of both flu vaccines and antivirals. Like the engineers who warned for years about the levees of New Orleans, these experts caution that our defenses may be flawed, and quite possibly useless against a truly lethal flu. And that unless we are willing to ask fundamental questions about the science behind flu vaccines and antiviral drugs, we could find ourselves, in a bad epidemic, as helpless as the citizens of New Orleans during Hurricane Katrina.
THE TERM INFLUENZA, which dates back to the Middle Ages, is taken from the Italian word for occult or astral influence. Then as now, flu seemed to appear out of nowhere each winter, debilitating or killing large numbers of people, only to vanish in the spring. Today, seasonal flu is estimated to kill about 36,000 people in the United States each year, and half a million worldwide.
Yet the flu, in many important respects, remains mysterious. Determining how many deaths it really causes, or even who has it, is no simple matter. We think we have the flu anytime we fall ill with an ailment that brings on headache, malaise, fever, coughing, sneezing, and that achy feeling as if we’ve been sleeping on a bed of rocks, but researchers have found that at most half, and perhaps as few as 7 or 8 percent, of such cases are actually caused by an influenza virus in any given year. More than 200 known viruses and other pathogens can cause the suite of symptoms known as “influenza-like illness”; respiratory syncytial virus, bocavirus, coronavirus, and rhinovirus are just a few of the bugs that can make a person feel rotten. And depending on the season, in up to two-thirds of the cases of flu-like illness, no cause at all can be found.
Nobody knows precisely why we are much more likely to catch the flu in the winter months than at other times of the year. Perhaps it’s because flu viruses flourish in cool temperatures and are killed by exposure to sunlight. Or maybe it’s because in winter, people spend more time indoors, where a sneeze or a cough can more easily spread a virus to others. What is certain is that influenza viruses mutate with amazing speed, so each flu season sees slightly different genetic versions of the viruses that infected people the year before. Every year, the World Health Organization and the Centers for Disease Control and Prevention collect data from 94 nations on the flu viruses that circulated the previous year, and then make an educated guess about which viruses are likely to circulate in the coming fall. Based on that information, the U.S. Food and Drug Administration issues orders to manufacturers in February for a vaccine that includes the three most likely strains.
Every once in a while, however, a very different bug pops up and infects far more people than the normal seasonal flu variants do. It is these novel viruses that are responsible for pandemics, defined by the World Health Organization as events that occur when “a new influenza virus appears against which the human population has no immunity” and which can sweep around the world in a very short time. The worst flu pandemic in recorded history was the “Spanish flu” of 1918–19, at the end of World WarI. A third of the world’s population was infected, with at least 40million and perhaps as many as 100million people dying—more than were killed in World Wars I and II combined. (Some scholars suggest that one reason World WarI ended was that so many soldiers were sick or dying from flu.) Since then, two other flu pandemics have occurred, in 1957 and 1968, neither of which was particularly lethal.
In August, the President’s Council of Advisors on Science and Technology projected that this fall and winter, the swine flu, H1N1, could infect anywhere between one-third and one-half of the U.S. population and could kill as many as 90,000 Americans, two and a half times the number killed in a typical flu season. But precisely how deadly, or even how infectious, this year’s H1N1 pandemic will turn out to be won’t be known until it’s over. Most reports coming from the Southern Hemisphere in late August (the end of winter there) suggested that the swine flu is highly infectious, but not particularly lethal. For example, Australian officials estimated they would finish winter with under 1,000 swine flu deaths—fewer than the usual 1,500 to 3,000 from seasonal flu. Among those who have died in the U.S., about 70 percent were already suffering from congenital conditions like cerebral palsy or underlying illnesses such as cancer, asthma, or AIDS, which make people more vulnerable.
Public-health officials consider vaccine their most formidable defense against the pandemic—indeed, against any flu—and on the surface, their faith seems justified. Vaccines developed over the course of the 20th century slashed the death rates of nearly a dozen infectious diseases, such as smallpox and polio, and vaccination became one of medicine’s most potent weapons. Influenza virus was first identified in the 1930s, and by the mid-1940s, researchers had produced a vaccine that was given to soldiers in World WarII. The U.S. government got serious about promoting flu vaccine after the 1957 flu pandemic brought home influenza’s continuing potential to cause widespread illness and death. Today, flu vaccine is a staple of public-health policy; in a normal year, some 100 million Americans get vaccinated.
But while vaccines for, say, whooping cough and polio clearly and dramatically reduced death rates from those diseases, the impact of flu vaccine has been harder to determine. Flu comes and goes with the seasons, and often it does not kill people directly, but rather contributes to death by making the body more susceptible to secondary infections like pneumonia or bronchitis. For this reason, researchers studying the impact of flu vaccination typically look at deaths from all causes during flu season, and compare the vaccinated and unvaccinated populations.
Such comparisons have shown a dramatic difference in mortality between these two groups: study after study has found that people who get a flu shot in the fall are about half as likely to die that winter—from any cause—as people who do not. Get your flu shot each year, the literature suggests, and you will dramatically reduce your chance of dying during flu season.
Yet in the view of several vaccine skeptics, this claim is suspicious on its face. Influenza causes only a small minority of all deaths in the U.S., even among senior citizens, and even after adding in the deaths to which flu might have contributed indirectly. When researchers from the National Institute of Allergy and Infectious Diseases included all deaths from illnesses that flu aggravates, like lung disease or chronic heart failure, they found that flu accounts for, at most, 10 percent of winter deaths among the elderly. So how could flu vaccine possibly reduce total deaths by half? Tom Jefferson, a physician based in Rome and the head of the Vaccines Field at the Cochrane Collaboration, a highly respected international network of researchers who appraise medical evidence, says: “For a vaccine to reduce mortality by 50 percent and up to 90 percent in some studies means it has to prevent deaths not just from influenza, but also from falls, fires, heart disease, strokes, and car accidents. That’s not a vaccine, that’s a miracle.”
The estimate of 50 percent mortality reduction is based on “cohort studies,” which compare death rates in large groups, or cohorts, of people who choose to be vaccinated, against death rates in groups who don’t. But people who choose to be vaccinated may differ in many important respects from people who go unvaccinated—and those differences can influence the chance of death during flu season. Education, lifestyle, income, and many other “confounding” factors can come into play, and as a result, cohort studies are notoriously prone to bias. When researchers crunch the numbers, they typically try to factor out variables that could bias the results, but, as Jefferson remarks, “you can adjust for the confounders you know about, not for the ones you don’t,” and researchers can’t always anticipate what factors are likely to be important to whether a patient dies from flu. There is always the chance that they might miss some critical confounder that renders their results entirely wrong.
When Lisa Jackson, a physician and senior investigator with the Group Health Research Center, in Seattle, began wondering aloud to colleagues if maybe something was amiss with the estimate of 50 percent mortality reduction for people who get flu vaccine, the response she got sounded more like doctrine than science. “People told me, ‘No good can come of [asking] this,’” she says. “‘Potentially a lot of bad could happen’ for me professionally by raising any criticism that might dissuade people from getting vaccinated, because of course, ‘We know that vaccine works.’ This was the prevailing wisdom.”
Nonetheless, in 2004, Jackson and three colleagues set out to determine whether the mortality difference between the vaccinated and the unvaccinated might be caused by a phenomenon known as the “healthy user effect.” They hypothesized that on average, people who get vaccinated are simply healthier than those who don’t, and thus less liable to die over the short term. People who don’t get vaccinated may be bedridden or otherwise too sick to go get a shot. They may also be more likely to succumb to flu or any other illness, because they are generally older and sicker. To test their thesis, Jackson and her colleagues combed through eight years of medical data on more than 72,000 people 65 and older. They looked at who got flu shots and who didn’t. Then they examined which group’s members were more likely to die of any cause when it was not flu season.
Jackson’s findings showed that outside of flu season, the baseline risk of death among people who did not get vaccinated was approximately 60 percent higher than among those who did, lending support to the hypothesis that on average, healthy people chose to get the vaccine, while the “frail elderly” didn’t or couldn’t. In fact, the healthy-user effect explained the entire benefit that other researchers were attributing to flu vaccine, suggesting that the vaccine itself might not reduce mortality at all. Jackson’s papers “are beautiful,” says Lone Simonsen, who is a professor of global health at George Washington University, in Washington, D.C., and an internationally recognized expert in influenza and vaccine epidemiology. “They are classic studies in epidemiology, they are so carefully done.”
The results were also so unexpected that many experts simply refused to believe them. Jackson’s papers were turned down for publication in the top-ranked medical journals. One flu expert who reviewed her studies for the Journal of the American Medical Association wrote, “To accept these results would be to say that the earth is flat!” When the papers were finally published in 2006, in the less prominent International Journal of Epidemiology, they were largely ignored by doctors and public-health officials. “The answer I got,” says Jackson, “was not the right answer.”
THE HISTORY OF FLU VACCINATION suggests other reasons to doubt claims that it dramatically reduces mortality. In 2004, for example, vaccine production fell behind, causing a 40 percent drop in immunization rates. Yet mortality did not rise. In addition, vaccine “mismatches” occurred in 1968 and 1997: in both years, the vaccine that had been produced in the summer protected against one set of viruses, but come winter, a different set was circulating. In effect, nobody was vaccinated. Yet death rates from all causes, including flu and the various illnesses it can exacerbate, did not budge. Sumit Majumdar, a physician and researcher at the University of Alberta, in Canada, offers another historical observation: rising rates of vaccination of the elderly over the past two decades have not coincided with a lower overall mortality rate. In 1989, only 15 percent of people over age 65 in the U.S. and Canada were vaccinated against flu. Today, more than 65 percent are immunized. Yet death rates among the elderly during flu season have increased rather than decreased.
Vaccine proponents call Majumdar’s last observation an “ecological fallacy,” because he fails, in their view, to consider changes in the larger environment that could have boosted death rates over the years—even as rising vaccination rates were doing their part to keep mortality in check. The proponents suggest, for instance, that influenza viruses may have become more contagious over time, and thus are infecting greater numbers of elderly people, including some who have been vaccinated. Or maybe the viruses are becoming more lethal. Or maybe the elderly have less immunity to flu than they once did because, say, their diets have changed.
Or maybe vaccine just doesn’t prevent deaths in the elderly. Of course, that’s the one possibility that vaccine adherents won’t consider. Nancy Cox, the CDC’s influenza division chief, says flatly, “The flu vaccine is the best way to protect against flu.” Anthony Fauci, a physician and the director of the National Institute of Allergy and Infectious Diseases at the NIH, where much of the basic science of flu vaccine has been worked out, says, “I have no doubt that it is effective in conferring some degree of protection. To say otherwise is a minority view.”
Majumdar says, “We keep coming up against the belief that we’ve reduced mortality by 50 percent,” and when researchers poke holes in the evidence, “people pound the pulpit.”
THE MOST vocal—and undoubtedly most vexing—critic of the gospel of flu vaccine is the Cochrane Collaboration’s Jefferson, who’s also an epidemiologist trained at the famed London School of Tropical Hygiene, and who, in Lisa Jackson’s view, makes other skeptics seem “moderate by comparison.” Among his fellow flu researchers, Jefferson’s outspokenness has made him something of a pariah. At a 2007 meeting on pandemic preparedness at a hotel in Bethesda, Maryland, Jefferson, who’d been invited to speak at the conference, was not greeted by any of the colleagues milling about the lobby. He ate his meals in the hotel restaurant alone, surrounded by scientists chatting amiably at other tables. He shrugs off such treatment. As a medical officer working for the United Nations in 1992, during the siege of Sarajevo, he and other peacekeepers were captured and held for more than a month by militiamen brandishing AK-47s and reeking of alcohol. Professional shunning seems trivial by comparison, he says.
“Tom Jefferson has taken a lot of heat just for saying, ‘Here’s the evidence: it’s not very good,’” says Majumdar. “The reaction has been so dogmatic and even hysterical that you’d think he was advocating stealing babies.” Yet while other flu researchers may not like what Jefferson has to say, they cannot ignore the fact that he knows the flu-vaccine literature better than anyone else on the planet. He leads an international team of researchers who have combed through hundreds of flu-vaccine studies. The vast majority of the studies were deeply flawed, says Jefferson. “Rubbish is not a scientific term, but I think it’s the term that applies.” Only four studies were properly designed to pin down the effectiveness of flu vaccine, he says, and two of those showed that it might be effective in certain groups of patients, such as school-age children with no underlying health issues like asthma. The other two showed equivocal results or no benefit.
Flu researchers have been fooled into thinking vaccine is more effective than the data suggest, in part, says Jefferson, by the imprecision of the statistics. The only way to know if someone has the flu—as opposed to influenza-like illness—is by putting a Q-tip into the patient’s throat or nose and running a test, which simply isn’t done that often. Likewise, nobody really has a handle on how many of the deaths that are blamed on flu were actually caused by a flu virus, because few are confirmed by a laboratory. “I used to be a family physician,” says Jefferson. “I’ve never seen a patient come to my office with H1N1 written on his forehead. When an old person dies of respiratory failure after an influenza-like illness, they nearly always get coded as influenza.”
Do Flu Immunizations Work? II
Reply #46 on:
October 14, 2009, 01:38:37 PM »
There’s one other way flu researchers may be fooled into thinking flu vaccine is effective, Jefferson says. All vaccines work by delivering a dose of killed or weakened virus or bacteria, which provokes the immune system into producing antibodies. When the person is subsequently exposed to the real thing, the body is already prepared to repel the bug completely or to get rid of it after a mild illness. Flu researchers often use antibody response as a way of gauging the effectiveness of vaccine, on the assumption that levels of antibodies in the blood of people who have been vaccinated are a good predictor—although an imperfect one—of how well they can ward off the infection.
There’s some merit to this reasoning. Unfortunately, the very people who most need protection from the flu also have immune systems that are least likely to respond to vaccine. Studies show that young, healthy people mount a glorious immune response to seasonal flu vaccine, and their response reduces their chances of getting the flu and may lessen the severity of symptoms if they do get it. But they aren’t the people who die from seasonal flu. By contrast, the elderly, particularly those over age70, don’t have a good immune response to vaccine—and they’re the ones who account for most flu deaths. (Infants with severe disabilities, such as leukemia and congenital lung disease, and people who are immune-compromised—from AIDS, or diabetes, or cancer treatment—make up the rest. As of August8, only 36 deaths from swine flu had been confirmed among children in the U.S., and the overwhelming majority of those children had multiple, severe health disorders.)
In Jefferson’s view, this raises a troubling conundrum: Is vaccine necessary for those in whom it is effective, namely the young and healthy? Conversely, is it effective in those for whom it seems to be necessary, namely the old, the very young, and the infirm? These questions have led to the most controversial aspect of Jefferson’s work: his call for placebo-controlled trials, studies that would randomly give half the test subjects vaccine and the other half a dummy shot, or placebo. Only such large, well-constructed, randomized trials can show with any precision how effective vaccine really is, and for whom.
In the flu-vaccine world, Jefferson’s call for placebo-controlled studies is considered so radical that even some of his fellow skeptics oppose it. Majumdar, the Ottawa researcher, says he believes that evidence of a benefit among children is established and that public-health officials should try to protect seniors by immunizing children, health-care workers, and other people around them, and thus reduce the spread of the flu. Lone Simonsen explains the prevailing view: “It is considered unethical to do trials in populations that are recommended to have vaccine,” a stance that is shared by everybody from the CDC’s Nancy Cox to Anthony Fauci at the NIH. They feel strongly that vaccine has been shown to be effective and that a sham vaccine would put test subjects at unnecessary risk of getting a serious case of the flu. In a phone interview, Fauci at first voiced the opinion that a placebo trial in the elderly might be acceptable, but he called back later to retract his comment, saying that such a trial “would be unethical.” Jefferson finds this view almost exactly backward: “What do you do when you have uncertainty? You test,” he says. “We have built huge, population-based policies on the flimsiest of scientific evidence. The most unethical thing to do is to carry on business as usual.”
JUST AFTER 6 P.M. on a warm Friday evening in July, Dr. David Newman is only minutes into a 10-hour shift in the emergency room of New York City’s St. Luke’s Hospital, and already he has assumed responsibility for 11 patients. The young Italian tourist sitting on the bed in front of the doctor has meningitis, and through an interpreter, Newman tells him he almost certainly has the viral form of the disease, which will do nothing more than make him feel ill for a few days. There is a tiny chance, says Newman, that the illness is caused by a bacterium, which can be deadly, but he is almost positive that’s not what the tourist has. He says to his patient, “I can’t tell you with 100 percent certainty that you don’t have it, but if you do, you’ll begin to feel worse and you’ll need to come back.” The tourist, on learning that he might be infected with a potentially lethal disease, looks down at his feet and confesses that he is much more worried about another illness: swine flu. Newman smiles patiently. “It would be nice if you had swine flu,” he says. “Compared to bacterial meningitis, swine flu is safe.”
Late last spring, as headlines and airwaves warned of a possible pandemic, patients like Newman’s began clogging emergency rooms across the country, a sneezing, coughing, infectious tide of humanity more worried than truly sick, but whose mere presence in the emergency room has endangered the lives of others. “Studies show that when there is ER crowding, mortality goes up, because patients who need immediate attention don’t get it,” says Newman, the director of clinical research in the Department of Emergency Medicine at the hospital, which is affiliated with Columbia University. In an average year the ER at St. Luke’s, a sprawling 1,076-bed hospital on 113th Street, takes in 110,000 patients, some 300 a day. At the height of the summer swine flu outbreak, that number doubled. The vast majority of panicky patients who came in the door at St. Luke’s and other emergency departments didn’t actually have the virus, and of those who did, most were not sick enough to need hospitalization. Even so, says Newman, when patients with even mild flu symptoms show up in the hospital, they vastly increase the spread of the virus, simply because they inevitably sneeze and cough in rooms that are jammed with other people.
Many of the worried sick come to St. Luke’s and other hospitals in search of antiviral drugs. The CDC recommends the use of two drugs against H1N1: oseltamivir and zanamivir, better known by their brand names, Tamiflu and Relenza, which together form the second pillar of the government’s anti-pandemic-flu strategy. Public-health officials at the state and local levels are also recommending the drugs. Guidelines issued by the New York City Department of Health, says Newman, “encourage us to give a prescription to just about every patient with the sniffles,” a practice that some experts worry will quickly lead to resistant strains of the virus.
Indeed, that’s already happening. Daniel Janies, an associate professor of biomedical informatics at Ohio State University, tracks the genetic mutations that allow flu virus to develop resistance to drugs. Flu can become resistant to Tamiflu in a matter of days, he says. Handing out the drug early in the pandemic, when H1N1 poses only a minimal threat to the vast majority of patients, strikes him as “shortsighted.” Indeed, samples of resistant H1N1 were cropping up by midsummer, increasing the likelihood that come late fall, many people will be infected with a resistant strain of swine flu. Alarmed at that prospect, the World Health Organization issued an alert on August 21, recommending that Tamiflu and Relenza be used only in severe cases and in patients who are at high risk of serious complications. By mid-August, two U.S. swine flu patients had developed Tamiflu-resistant strains.
The U.S. first began stockpiling Tamiflu and Relenza back in 2005, in the wake of concern that an outbreak in Southeast Asia of bird flu, a far more deadly form of the disease, might go global. On November 1, 2005, President George W.Bush pronounced pandemic flu a “danger to our homeland,” and he asked Congress to approve legislation that included $1billion for the production and stockpiling of antivirals. This was after Congress had already approved $1.8billion to stockpile Tamiflu for the military, a decision that was made during the tenure of Defense Secretary Donald Rumsfeld. (Before joining the Bush Cabinet, Rumsfeld was chairman for four years of Gilead Sciences, the company that holds the patent on Tamiflu, and he held millions of dollars’ worth of stock in the company. According to Roll Call, an online newspaper covering events on Capitol Hill, Rumsfeld says he recused himself from all government decisions involving Tamiflu. Gilead’s stock price rose more than 50 percent in 2005, when the government’s plan was announced.)
As with vaccines, the scientific evidence for Tamiflu and Relenza is thin at best. In its general-information section, the CDC’s Web site tells readers that antiviral drugs can “make you feel better faster.” True, but not by much. On average, Tamiflu (which accounts for 85 to 90 percent of the flu antiviral-drug market) cuts the duration of flu symptoms by 24hours in otherwise healthy people. In exchange for a slightly shorter bout of illness, as many as one in five people taking Tamiflu will experience nausea and vomiting. About one in five children will have neuropsychiatric side effects, possibly including anxiety and suicidal behavior. In Japan, where Tamiflu is liberally prescribed, the drug may have been responsible for 50 deaths from cardiopulmonary arrest, from 2001 to 2007, according to Rokuro Hama, the chair of the Japan Institute of Pharmacovigilance.
Such side effects might be worth risking if the antivirals prevented serious complications of flu, such as pneumonia, hospitalization, and death. Roche Laboratories, the company licensed to manufacture and market Tamiflu, says its drug does just that. In two September2006 press releases, the company announced, “Tamiflu significantly reduces the risk of death from influenza: New data shows treatment was associated with more than a two third reduction in deaths,” and “Children with influenza [are] 53 percent less likely to contract pneumonia when treated with Tamiflu.” Once again cohort studies (the same kind of potentially biased research that led to the conclusion that flu vaccine cuts mortality by 50 percent) are behind these claims. Tamiflu costs $10 a pill. It is possible that people who take it are more likely to be insured and affluent, or at least middle-class, than those who do not, and a large body of evidence shows that the well-off nearly always fare better than the poor when stricken with an infectious disease, including flu. In both 2003 and 2009, reviews of randomized placebo-controlled studies found that the study populations simply weren’t large enough to answer the question: Does Tamiflu prevent pneumonia?
As late as this August, the company’s own Web site contained the following statement, which was written under the direction of the FDA: “Tamiflu has not been proven to have a positive impact on the potential consequences (such as hospitalizations, mortality, or economic impact) of seasonal, avian, or pandemic influenza.” An FDA spokesperson said recently that the agency is unaware of any data submitted by Roche that would support the claims in the company’s September 2006 news release about the drug’s reducing flu deaths.
WHY, THEN, HAS the federal government stockpiled millions of doses of antivirals, at a cost of several billion dollars? And why are physicians being encouraged to hand out prescriptions to large numbers of people, without sound evidence that the drugs will help? The short answer may be that public-health officials feel they must offer something, and these drugs are the only possible remedies at hand. “I have to agree with the critics the antiviral question is not cut-and-dried,” says Fauci. “But [these drugs are] the best we have.” The CDC’s Nancy Cox also acknowledges that the science is not as sound as she might like, but the government still recommends their use. And as with vaccines, she considers additional randomized placebo-controlled trials of the antiviral drugs to be “unethical” and thus out of the question.
This is the curious state of debate about the government’s two main weapons in the fight against pandemic flu. At first, government officials declare that both vaccines and drugs are effective. When faced with contrary evidence, the adherents acknowledge that the science is not as crisp as they might wish. Then, in response to calls for placebo-controlled trials, which would provide clear results one way or the other, the proponents say such studies would deprive patients of vaccines and drugs that have already been deemed effective. “We can’t just let people die,” says Cox.
Students of U.S. medical history will find this circular logic familiar: it is a long-recurring theme in American medicine, and one that has, on occasion, had deadly consequences. In 1925, Sinclair Lewis caricatured a medical culture that allowed belief—and profits—to distort science in his Pulitzer Prize–winning book, Arrowsmith. Based on the lives of the real-life microbiologists Paul de Kruif and Jacques Loeb, Lewis tells the story of Martin Arrowsmith, a physician who invents a new vaccine during a deadly outbreak of bubonic plague. But his efforts to test the vaccine’s efficacy are frustrated by an angry community that desperately wants to believe the vaccine works, and a profit-hungry institute that rushes the vaccine into use prematurely—forever preempting the proper studies that are needed.
The annals of medicine are littered with treatments and tests that became medical doctrine on the slimmest of evidence, and were then declared sacrosanct and beyond scientific investigation. In the 1980s and ’90s, for example, cancer specialists were convinced that high-dose chemotherapy followed by a bone-marrow transplant was the best hope for women with advanced breast cancer, and many refused to enroll their patients in randomized clinical trials that were designed to test transplants against the standard—and far less toxic—therapy. The trials, they said, were unethical, because they knew transplants worked. When the studies were concluded, in 1999 and 2000, it turned out that bone-marrow transplants were killing patients. Another recent example involves drugs related to the analgesic lidocaine. In the 1970s, doctors noticed that the drugs seemed to make the heart beat rhythmically, and they began prescribing them to patients suffering from irregular heartbeats, assuming that restoring a proper rhythm would reduce the patient’s risk of dying. Prominent cardiologists for years opposed clinical trials of the drugs, saying it would be medical malpractice to withhold them from patients in a control group. The drugs were widely used for two decades, until a government-sponsored study showed in 1989 that patients who were prescribed the medicine were three and a half times as likely to die as those given a placebo.
Demonstrating the efficacy (or lack thereof) of vaccine and antivirals during flu season would not be hard to do, given the proper resources. Take a group of people who are at risk of getting the flu, and randomly assign half to get vaccine and the other half a dummy shot. Then count the people in each group who come down with flu, suffer serious illness, or die. (A similarly designed trial would suffice for the antivirals.) It might sound coldhearted, but it is the only way to know for certain whether, and for whom, current remedies actually work. It would also be useful to know whether vaccinating healthy people—who can mount an immune response on their own—protects the more vulnerable people around them. For example, immunizing nursing-home staff and healthy children is thought to reduce the spread of flu to the elderly and the immune-compromised. Pinning down the effectiveness of this strategy would be a bit more complex, but not impossible.
IN THE ABSENCE of such evidence, we are left with two possibilities. One is that flu vaccine is in fact highly beneficial, or at least helpful. Solid evidence to that effect would encourage more citizens—and particularly more health professionals—to get their shots and prevent the flu’s spread. As it stands, more than 50 percent of health-care workers say they do not intend to get vaccinated for swine flu and don’t routinely get their shots for seasonal flu, in part because many of them doubt the vaccines’ efficacy. The other possibility, of course, is that we’re relying heavily on vaccines and antivirals that simply don’t work, or don’t work as well as we believe. And as a result, we may be neglecting other, proven measures that could minimize the death rate during pandemics.
“Vaccines give us a false sense of security,” says Sumit Majumdar. “When you have a strategy that [everybody thinks] reduces death by 50 percent, it’s pretty hard to invest resources to come up with better remedies.” For instance, health departments in every state are responsible for submitting plans to the CDC for educating the public, in the event of a serious pandemic, about hand-washing and “social distancing” (voluntary quarantines, school closings, and even enforcement of mandatory quarantines to keep infected people in their homes). Putting these plans into action will require considerable coordination among government officials, the media, and health-care workers—and widespread buy-in from the public. Yet little discussion has appeared in the press to help people understand the measures they can take to best protect themselves during a flu outbreak—other than vaccination and antivirals.
“Launched early enough and continued long enough, social distancing can blunt the impact of a pandemic,” says Howard Markel, a pediatrician and historian of medicine at the University of Michigan. Washing hands diligently, avoiding public places during an outbreak, and having a supply of canned goods and water on hand are sound defenses, he says. Such steps could be highly effective in helping to slow the spread of the virus. In Mexico, for instance, where the first swine flu cases were identified in March, the government launched an aggressive program to get people to wash their hands and exhorted those who were sick to stay home and effectively quarantine themselves. In the United Kingdom, the national health department is promoting a “buddy” program, encouraging citizens to find a friend or neighbor willing to deliver food and medicine so people who fall ill can stay home.
In the U.S., by contrast, our reliance on vaccination may have the opposite effect: breeding feelings of invulnerability, and leading some people to ignore simple measures like better-than-normal hygiene, staying away from those who are sick, and staying home when they feel ill. Likewise, our encouragement of early treatment with antiviral drugs will likely lead many people to show up at the hospital at first sniffle. “There’s no worse place to go than the hospital during flu season,” says Majumdar. Those who don’t have the flu are more likely to catch it there, and those who do will spread it around, he says. “But we don’t tell people this.”
All of which leaves open the question of what people should do when faced with a decision about whether to get themselves and their families vaccinated. There is little immediate danger from getting a seasonal flu shot, aside from a sore arm and mild flu-like symptoms. The safety of the swine flu vaccine remains to be seen. In the absence of better evidence, vaccines and antivirals must be viewed as only partial and uncertain defenses against the flu. And they may be mere talismans. By being afraid to do the proper studies now, we may be condemning ourselves to using treatments based on illusion and faith rather than sound science.
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BO's declaration of emergency
Reply #47 on:
October 25, 2009, 11:37:32 PM »
Obama declares H1N1 national emergency
Washington (CNN) -- President Obama has declared a national emergency to deal with the "rapid increase in illness" from the H1N1 influenza virus.
"The 2009 H1N1 pandemic continues to evolve. The rates of illness continue to rise rapidly within many communities across the nation, and the potential exists for the pandemic to overburden health care resources in some localities," Obama said in a statement.
"Thus, in recognition of the continuing progression of the pandemic, and in further preparation as a nation, we are taking additional steps to facilitate our response."
The president signed the declaration late Friday and announced it Saturday.
Calling the emergency declaration "an important tool in our kit going forward," one administration official called Obama's action a "proactive measure that's not in response to any new development." Having trouble finding vaccine? Share your story
Another administration official said the move is "not tied to the current case count" and "gives the federal government more power to help states" by lifting bureaucratic requirements -- both in treating patients and moving equipment to where it's most needed.
The officials didn't want their names used because they were not authorized to speak on the record.
Obama's action allows Health and Human Services Secretary Kathleen Sebelius "to temporarily waive or modify certain requirements" to help health care facilities enact emergency plans to deal with the pandemic.
Those requirements are contained in Medicare, Medicaid and state Children's Health Insurance programs, and the Health Insurance Portability and Accountability Act privacy rule.
Since the H1N1 flu pandemic began in April, millions of people in the United States have been infected, at least 20,000 have been hospitalized and more than 1,000 have died, said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.
Watch how to find out if you have H1N1
Frieden said that having 46 states reporting widespread flu transmission is traditionally the hallmark of the peak of flu season. To have the flu season peak at this time of the year is "extremely unusual."
The CDC said 16.1 million doses of H1N1, or swine flu, vaccine had been made by Friday -- 2 million more than two days earlier. About 11.3 million of those had been distributed throughout the United States, Frieden said.
"We are nowhere near where we thought we would be," Frieden said, acknowledging that manufacturing delays have contributed to less vaccine being available than expected. "As public health professionals, vaccination is our strongest tool. Not having enough is frustrating to all of us."
Frieden said that while the way vaccine is manufactured is "tried and true," it's not well-suited for ramping up production during a pandemic because it takes at least six months. The vaccine is produced by growing weakened virus in eggs.
What does this have to do with firearms politics you ask? well, many in the U.S(mostly conspiracy buffs) believe there are more sinister plans involved.
The first and biggest question being asked is what emergency?
The declaration of this national emergency seems suspicious from the start. Where’s the emergency? The number of people killed by swine flu in the United States is far smaller than the number of people killed each year from seasonal flu, according to CDC statistics. People obviously aren’t dropping dead by the millions from H1N1 influenza. Most people are just getting mild flu symptoms and a few days later they’re fine.
So what does this mean for Americans? The decleration of a national emergency means the government trumphs the bill of rights. They now, by decleration of this emergency, have the power to:
•The power to force mandatory swine flu vaccinations on the entire population.
• The power to arrest, quarantine or “involuntarily transport” anyone who refuses a swine flu vaccination.
• The power to quarantine an entire city and halt all travel in or out of that city.
• The power to enter any home or office without a search warrant and order the destruction of any belongings or structures deemed to be a threat to public health.
• The effective nullification of the Bill of Rights. Your right to due process, to being safe from government search and seizure, and to remain silent to avoid self-incrimination are all null and void under a Presidential declaration of a national emergency.
None of this means that federal agents are going to march door to door arresting people at gunpoint if they refuse the vaccine, but they could if they wanted to. Your rights are no longer recognized under this national emergency declaration.
Pigs, & Birds, & Pandemics, Oh My!
Reply #48 on:
November 03, 2009, 02:55:53 PM »
The Pandemic Is Political
Michael Fumento, 10.16.09, 7:15 PM ET
As evidence continues to mount that swine flu is more of a piglet than a raging razorback, why isn't curiosity mounting as to why the World Health Organization declared it a pandemic? And definitions aside, why does the agency continue to insist we're going to get hammered? The answers have far less to do with world health than with redistribution of world wealth.
Medically, the pandemic moniker is unjustifiable. When the sacrosanct World Health Organization (WHO) made its official declaration in June, we were 11 weeks into the outbreak, and swine flu had only killed 144 people worldwide--the same number who die of seasonal flu worldwide every few hours. The mildest pandemics of the 20th century killed at least a million people worldwide. And even after six months, swine flu has killed about as many people as the seasonal flu does every six days.
So how could WHO make such an outrageous claim?
Simple. It rewrote the definition of "pandemic."
A previous official definition (and widely used unofficial one) required "simultaneous epidemics worldwide with enormous numbers of deaths and illness." Severity--that is, the number--is crucial, because seasonal flu always causes worldwide simultaneous epidemics. But one promulgated in April just days before the announcement of the swine flu outbreak simply eliminated severity as a factor.
That's also how we can have a "pandemic" when six months of epidemiological data show swine flu to be far milder than the seasonal variety. New York City statistics show it to be perhaps a 10th as lethal.
In Australia and New Zealand, flu season has ended, and almost all cases have been swine flu. Yet even without a vaccine, these countries are reporting fewer flu deaths than normal. (In New Zealand, that's just 18 confirmed deaths compared with 400 normally.) Swine flu is causing negative deaths! The best explanation is that infection with the milder strain (swine flu) is inoculating against the more severe strain (seasonal flu) it has displaced.
This all makes sense once you realize that swine flu isn't some sort of alien from outer space as we've been led to believe, but rather "the same subtype as seasonal A/H1N1 that has been circulating since 1977," as the BMJ (formerly the British Medical Journal) observes. It's "something our immune systems have seen before," echoes Peter Palese of New York's Mount Sinai School of Medicine.
The older you are, the more you've been exposed and the higher your immunity level--hence the need to give two swine flu vaccinations to those under age 10.
Nevertheless, because WHO dubbed this a "pandemic," vaccination plans, emergency response measures and frightening predictions have been based on comparisons with true pandemics that by definition were especially severe. That includes the August report from the President's Council of Advisors on Science and Technology with its "plausible scenario" of "30,000 - 90,000 deaths" peaking in "mid-October."
Check your calendar.
So, then, why did WHO do it?
In part, it was CYA for the WHO. It was losing credibility over the refusal of avian flu H5N1 to go pandemic and kill as many as 150 million people worldwide, as its "flu czar" had predicted in 2005. Around the world, nations stockpiled antiviral medicines and H5N1 vaccine.
So when pig flu conveniently appeared, the WHO essentially crossed out "avian," inserted "swine," and WHO Director-General Margaret Chan could boast: "The world can now reap the benefits of investments over the last five years in pandemic preparedness."
Yet this doesn't explain why the agency hyped avian flu in the first place, nor why it exaggerated HIV infections by more than 10 times, or why it spread hysteria over Severe Acute Respiratory Syndrome (SARS). That disease ultimately killed a day's worth of seasonal flu victims before vanishing.
But the SARS scare was enough, leading to a broad expansion of WHO powers, including a degree of direct authority over national health agencies. It's now using that to leverage more authority and a bigger budget. No shocker there.
What may be surprising is that it wants to use that power to help bring about a global economic and social revolution--and that Director-General Chan was so blunt about it in a speech in Copenhagen last month.
She said "ministers of health" should take advantage of the "devastating impact" swine flu will have on poorer nations to tell "heads of state and ministers of finance, tourism and trade" that:
--The belief that "living conditions and health status of the poor would somehow automatically improve as countries modernized, liberalized their trade and improved their economies" is false. Wealth doesn't equal health.
--"Changes in the functioning of the global economy" are needed to "distribute wealth on the basis of" values "like community, solidarity, equity and social justice."
--"The international policies and systems that govern financial markets, economies, commerce, trade and foreign affairs have not operated with fairness as an explicit policy objective."
Splendid! So let's put the WHO in charge of worldwide economic and social engineering.
Then let's form a new agency that sees disease as something to prevent and treat rather than something to exploit.
Michael Fumento is director of the nonprofit Independent Journalism Project, where he specializes in health and science issues, and author of The Myth of Heterosexual AIDS: How a Tragedy Has Been Distorted by the Media and Partisan Politics.
Reply #49 on:
December 08, 2009, 12:54:07 PM »
Almost started a new topic on this source, "Pathological Aid" perhaps. Be that as it may, came across an interesting source monitoring the effectiveness of various sorts of aid to poorer people/countries. Like how the folks here focus on the empiric rather than the feel good. There "about us" blurb states:
ABOUT AID WATCH
The Aid Watch blog is a project of New York University's Development Research Institute (DRI). This blog is principally written by William Easterly, author of "The Elusive Quest for Growth: Economists Adventures and Misadventures in the Tropics" and "The White Man's Burden: Why the West's Efforts to Aid the Rest Have Done So Much Ill and So Little Good," and Professor of Economics at NYU. It is co-written by Laura Freschi and by occasional guest bloggers. Our work is based on the idea that more aid will reach the poor the more people are watching aid.
“Conscience is the inner voice that warns us somebody may be looking.” - H.L. Mencken
The Political Economy of Aid Optimism or Pessimism
By William Easterly and Laura Freschi | Published October 27, 2009
Bill and Melinda Gates are making a big media presentation today at 7pm of their Living Proof Project, in which they document aid successes in health. They call themselves “Impatient Optimists.” We can comment more after we hear their presentation. However, they invited comment already by posting progress reports on the Living Proof website.
Actually, we have also previously argued that aid has been more successful in health than in other areas. However, one petty and parochial concern we had about the progress reports is that Bill and Melinda Gates continue to make a case for malaria success stories based on bad or fake data that we have criticized on this blog already twice. The Gateses were aware of our blog because they responded to it at the Chronicle of Philanthropy.
Yet they continue to use the WHO 2008 World Malaria Report as their main source for data on malaria prevalence and deaths from malaria in Africa. As we pointed out in the earlier post, the report establishes such low standards for data reliability that some of the numbers hardly seem worth quoting. From the WHO report: “reliable data on malaria are scarce. In these countries estimates were developed based on local climate conditions, which correlate with malaria risk, and the average rate at which people become ill with the disease in the area.” Where convincing estimates from real reported cases of malaria could not be made, figures were extrapolated “from an empirical relationship between measures of malaria transmission risk and case incidence.”
In Rwanda, which the Gateses say showed a dramatic 45 percent reduction in the number of deaths from 2001 to 2006, a closer look at the WHO data shows that there is an estimate of 3.3 million malaria cases in 2006, with an upper bound of 4.1 million and a lower bound of 2.5 million. And, according to which method is used to estimate cases, the trend can be made to show that malaria incidence is actually on the rise. The Gateses also highlight Zambia as a “remarkable success,” claiming that “overall malaria deaths decreased by 37 percent between 2001 and 2006.” While they provide no citation for this figure it appears to come from the very same WHO report, which concedes that compared to African countries with smaller populations, “nationwide effects of malaria control, as judged from surveillance data” in Zambia are “less clear.”
The downside of all this is that it appears we are having no effect whatsoever on the Gates’ use of fake or bad numbers and thus on the highest profile analysis of malaria in the world. The Gateses ignore our recommendation (and that of others) that they invest MUCH more in better data collection to know when GENUINE progress is happening. (Would Gates have put up with a Microsoft marketing executive who reported Windows sales were somewhere between 2.5 and 4.1 million, which may be either lower or higher than previous periods’ equally unreliable numbers?) Are we insanely pig-headed for insisting that African malaria data be something a little more reliable than if the Gateses had asked the pre-K class at the Microsoft Day Care Center to give their guess?
Well, this is the third time we are saying this on this blog, so maybe we should give up. When people like the Gateses are so tenacious in the face of well-documented errors, it’s time for us economists to shift from normative recommendations (don’t claim progress based on pseudo-data!) to positive theory (what are the incentives to use bad numbers?)
What is the political economy of “impatient optimism”? Here is a possible political economy story – there are two types of political actors: (1) those who care more about the poor and want to make more effort to help them relative to other public priorities, and (2) those who care less and want to make less effort relative to other priorities.
Empirical studies and data that show that aid programs are having very positive results are very helpful to (1) and not to (2), while of course the reverse is helpful to (2) and not to (1). So each type has an incentive to selectively choose studies and data. Knowing this and knowing the public knows this, the caring type (1) might want to signal they are indeed caring by emphasizing positive studies and data, and may have no incentive to actually evaluate whether the positive data are correct or not. So the Gateses might want to say (as they did): “The money the US spends in developing countries to prevent disease and fight poverty is effective, empowers people, and is appreciated.”
If this purely descriptive theory is true, it could explain why some political actors stubbornly stick to positive data even if some obscure academic argues it is false or unreliable.
It cuts both ways – the anti-aid political actors would also have no incentive to recheck their favorite data or studies. Then the debate over evidence will not really be an intellectual debate at all, but just a political contest between two different political types.
Of course, we HATE this political economy theory when it’s applied to US. We are VERY unhappy when people conclude that because we are skeptical about malaria data quality (and thus whether they show progress), therefore we really don’t care about how many Africans are dying from malaria and wish that all government money went to subsidize fine dining in New York. And, the Gateses would probably not be fond of this political economy explanation of their actions and beliefs either. Both of us would prefer the alternative “academic” theory of belief formation, in which it is all based on evidence and data, not political interests.
How to distinguish which theory explains the behavior of any one actor is determined by the response to evidence AGAINST one’s prior position – do you change your beliefs at all? The Gateses seem to fail this test on malaria numbers. We hope we do better when it comes our time to be tested, as we should be.
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