Bird Flu March 08' - Bird flu closing in on humans: expert

[cHeroKee]

Aggressive H5N1 in Egyptian Patients
March 3, 2008

The Ministry of Health and Population has declared a new AI H5N1 human case, a female 25 years old from Sennoris district, Fayum governorate. The symptoms started on 24 February 2008 and hospitalized in Fayoum Fever Hospital on the 27th of the same month. The case was referred to Giza chest hospital on 28 February 2008. The field investigation is still ongoing to indicate the source of infection. The general condition of the patient is critical and she is on ventilator.

The above comments are from the WHO Eastern Mediterranean report (http://www.emro.who.int/) on the most recent confirmed case (http://www.recombinomics.com/News/03010801/H5N1_Fayoum.html) in Egypt. The above dates suggest that the H5N1 was very aggressive, even though the patient was hospitalized three days after disease onset. The patient has pneumonia in both lungs and is in critical condition.

This rapid progression may reflect genetic changes in the H5N1. Last season the case fatality rate was markedly different in the fall than the spring. In late 2006, early 2007, the first seven confirmed H5N1 cases died. In contrast, there was only one fatality in the following seventeen case, which peaked in the spring. Many of the spring cases were in central or southern Egypt and patients (http://www.recombinomics.com/News/03260702/H5N1_Aswan_Mild.html) did not develop pneumonia.

There were clear genetic differences between the cases in the fall, which were primarily in northern Egypt, and the spring cases. Three of the fatalities were family members of the Gharbiya cluster. Sequences from this group had two receptor binding domain changes, V223I (http://www.recombinomics.com/News/01310802/V223I_Togo.html) and M230I (http://www.recombinomics.com/News/12260704/H5N1_Egypt_M230I_Again.html), and were Tamiflu resistant due to N294S (http://www.recombinomics.com/News/01180701/H5N1_Egypt_N294S.html).

Subsequently, poultry sequences similar to the human sequences were found in Gharbiya (http://www.recombinomics.com/News/04050701/H5N1_Gharbiya_Chicken.html), A/chicken/Egypt/1892NAMRU-3 HK-49 (http://www.ncbi.nlm.nih.gov/entrez/viewer.fcgi?db=nuccore&id=134251799)/2007, or Beni Suef (http://www.recombinomics.com/News/11030701/H5N1_Gharbiya_Beni_Suef.html), A/chicken/Egypt/F6 (http://www.ncbi.nlm.nih.gov/entrez/viewer.fcgi?db=nuccore&id=158389154)/2007. Although both HA sequences had V223I and M230I, the Gharbiya chicken did not have N296S and the NA sequence from the Beni Suef chicken has not been released.

This season, NAMRU-3 released another series of sequences (http://www.recombinomics.com/News/03010802/H5N1_Egypt_Evolution.html)which were similar to the Gharbiya sequence from last season, including V223I and M230I, but there were also a large number of additional non synonymous changes raising concerns that H5N1 in Egypt was being driven in part by the vaccination program.

The concern over mismatched vaccines is also increased due to recent sequences released by the national veterinary lab in Egypt. Sequences from vaccinated farms (http://www.recombinomics.com/News/03020801/H5N1_Egypt_Evolution_Pandemic.html) also had a large number of newly acquired polymorphisms, which were predominantly non synonymous. Similar sequences were found at additional locations in the Nile Delta in isolates from December, 2007 and January, 2008.

Last season, all reported H5N1 infections with M230I were fatal. This season, four of the five confirmed cases in late 2007 were fatal, but sequences from these cases have not been released. The recent sequences released from the National labs had M230V, which may also be linked to a higher case fatality rate.

The two confirmed patients in the past week have developed pneumonia, and the most recent cases is in critical condition.

Release of the human H5N1 sequences from the seven confirmed cases this season would be useful.

[cHeroKee]

Indonesian father and son suspected of bird flu infection: doctor

<!-- Google TOP Adsense block --> A nine-year-old boy and his father have been admitted to a hospital in Indonesia, suspected of having bird flu, a medic said Sunday.
<!-- Google FISRT Adsense block --> <!-- ads for no java browsers --> <noscript> http://www.physorg.com/banner/lifesci468x60.gif (http://physorg.tradepub.com/?pt=cat&page=_INTL) </noscript> Both were admitted to the Dr. Muwardi general hospital in the Central Java city of Solo on Saturday showing all the symptoms of infection, Reviono, who heads the hospital's bird flu unit, told AFP.

<!-- Google SECOND Adsense block --> <!-- ads for no java browsers -->
He said the pair had buried chickens that had died after being infected with H5N1, while several chickens in their neighbourhood had also tested positive for the disease.

Both have been put in the hospital's isolation ward and blood and tissue samples will be sent to the health ministry laboratory in Jakarta on Monday, he added.

Two positive results are needed before Indonesian authorities confirm a human bird flu infection.

Indonesia has the highest number of human bird flu casualties in the world, with 105 killed by the disease.

The father and son were referred from a hospital in nearby Klaten district where they live, Reviono said.

Experts fear the virus, which is usually spread directly from birds to humans, could mutate into a form easily transmissible between people, sparking a deadly global pandemic.

Eleven people have died of bird flu in Indonesia this year, 10 of them from Jakarta and its surrounding areas.

[cHeroKee]

H5N1 Re-emerges in IraqRecombinomics Commentary 19:04
March 2, 2008

A case of Bird Flu has been discovered on Sunday in the southern Iraqi city of Basra.

An Iraqi higher committee Secretariat in combating Bird Flu from the Iraqi cabinet council said the new discovery is in Al-Fedagiya village in the Fao area.

The above comments suggest H5N1 has been identified in southern Iraq. The location is close to Kuwait (see satellite map (http://maps.google.com/maps/ms?ie=UTF8&hl=en&msa=0&msid=106484775090296685271.00043f5c9d8d148051c15&ll=30.363396,48.383789&spn=8.336233,14.040527&t=h&z=6)), where there was an H5N1 outbreak a year ago. The sequences (http://www.recombinomics.com/News/02210802/H5N1_Kuwait_G743A.html) from that outbreak were recently released and were clade 2.2.3 which traced back to the Uvs Lake outbreak. Recently an H5N1 HA and NA sequences were published from the more recent outbreak in Saudi Arabia (http://www.recombinomics.com/News/02180802/H5N1_Uva_Saudi.html). Those sequences are also closely related to the earlier sequences from Kuwait.

Therefore, it is likely that the H5N1 will be closely related to these sequences and reflect increased H5N1 activity in the region. Iran (http://www.recombinomics.com/News/01200805/H5N1_Iran_WB_Confirmed.html) has also recently reported H5N1 to the north, along the shores of the Caspian Sea.

This is the first confirmed outbreak in Iraq since 2006.

[cHeroKee]

Rapid H5N1 Evolution in Egypt Raises Pandemic ConcernsRecombinomics Commentary 05:21
March 2, 2008

New H5N1 poultry sequences have been released by the National Lab of Veterinary Quality Control on Poultry Production in Egypt (see list here (http://www.flutrackers.com/forum/showthread.php?t=56899)). The eighteen HA sequences are largely from isolates collected in December, 2007 or January 2008. Included in this collection are H5N1 sequences from vaccinated flocks. These sequences have an alarming number of new polymorphisms, most of which are non synonymous. As noted earlier (http://www.recombinomics.com/News/03010802/H5N1_Egypt_Evolution.html), the sequences released from NAMRU-3 had a number of non synonymous changes at targeted positions. The sequences from the National Lab extend these observations.

There are now multiple positions which have changed to two or more amino acids. Position 144 which had changed to three different amino acids (R144K, R144I, and R144S), now includes a fourth amino acid change, R144G. Similarly other positions with two or more changes include K123R and K123N, D158N and D158G, M230I and M230V.

The above changes are seen in a limited analysis. The number may go higher. However, many of these changes are not just in vaccinated flocks. They are present in subsequent collections at a variety of locations in the Nile Delta, raising concerns that these changes are being driven by poorly matched vaccines and these changes are becoming widespread.

This dramatic increase in genetic diversity raises serious pandemic concerns. H5N1 evolves via recombination, and the large number of diverse sequences concentrated in regions fed my the Nile in Egypt increases co-infections and the rate of evolution, which presents significant problems for vaccination programs.

The National Labs in Egypt are to be commended for releasing these sequences in a timely matter. These sequences define a serious problem in Egypt.

Release of the H5N1 sequences from the human cases from the same time period would be useful.

[cHeroKee]

MANILA (AFP) - The bird flu virus is "firmly entrenched" in Asia and a pandemic among humans remains possible, a World Health Organization (WHO) expert warned Wednesday.

While Asian countries are more prepared to react to any outbreaks than before and have vaccine stockpiles, deaths and infections have continued, noted Takeshi Kasai, the WHO's regional adviser in communicable disease surveillance and response unit.
"The virus has been firmly entrenched in this region, I'm afraid," Kasai told reporters during an exercise to test the Philippines' preparations against the disease.
"The virus itself keeps changing, so the risk of pandemic persists."
Experts fear the virus, which is usually spread directly from birds to humans, could mutate into a form easily transmissible between people, sparking a deadly global pandemic.
Three people have died in China this year of bird flu while a boy and his father were admitted this week to a hospital in Indonesia on suspicion of having the disease.
Since the first human cases were reported in 2003, at least 200 people have died from the H5N1 virus around the world, the WHO said. Indonesia is the world's worst-hit country, with 11 deaths so far this year.
Brunei, Singapore and the Philippines remain the only countries in the region where the flu, either in birds or humans, has not been detected.
Kasai praised China for being more transparent in reporting suspected cases.
"I think China now is very open and has been positively sharing information, including lab results," he said.
China has been highly criticised in the past for withholding information relating to the spread of Severe Acute Respiratory Syndrome (SARS) that ravished the region several years ago.

[cHeroKee]

Does Tamiflu work for bird flu?


Posted on: March 4, 2008 7:52 AM


<!--proximic_content_on--> Press releases are the way a lot of scientific information is released today. Straight to the public, no peer review. This has advantages and disadvantages. The advantages are speed and directness. No filtering through reviewers, journal editors, colleagues. And of course that's the disadvantage, too, especially when the news comes from an interested party as it usually does in a press release. This is part of the interpretation of data these days. All that being said, the maker of Tamiflu, Hoffman - La Roche, has released data they have gathered from physicians treating cases of H5N1 in various countries that seem to support the antiviral drug's efficacy. It was reported at the International Symposium on Respiratory Viral Infections (ISRVI) in Singapore:

In Indonesia, of the total of 119 H5N1 human cases reported, 22 survived - an 18 percent survival rate overall. Of these, 33 patients received no Tamiflu, all of whom died. Tamiflu was administered to 86 patients with a 26 percent survival rate overall. Time from onset of illness to initiation of treatment appeared to influence survival. Of the 2 patients who received Tamiflu within 24 hours of illness onset both survived. 55 percent survived if given the drug within four days (6/11), and 35 percent survived if given Tamiflu within six days (13/37). The survival rate of those receiving it later than 6 days after illness onset was 18 percent (9/49) Recent information on 8 Vietnamese patients infected with H5N1, was also presented. All 8 patients received Tamiflu. However, all 8 patients presented to the hospital later than 5 days after onset of illness. Only 3 of the 8 patients survived reinforcing that treatment benefit is reduced for patients that receive the drug later in the course of illness. In 2 patients who were unable to take the drug orally due to the severity of their illness physicians administered the drug by nasogastric tube and found it was well absorbed and there was a reduction in H5N1 virus in these patients. Susceptibility of circulating H5N1 strains to Tamiflu These clinical findings are supported by new animal data, also presented at ISRVI, which shows that oseltamivir treatment was effective against H5N1 influenza viruses representing different clades/subclades. However higher doses were required for the more pathogenic H5N1 viruses.(Press releases (http://www.pressreleases.be/script_UK/newsdetail.asp?nDays=d&ID=43319) [cites omitted]) While Roche is publicizing (and putting its own spin on) these data, they do not appear to be Roche's data but rather part of a study from a highly respected flu scientist, Dr. Elena Govorkova, working out of St. Jude's in Memphis, one of the world's best research groups. Included in the same press release is Roche's view on the likelihood that significant resistance will develop to Tamiflu, making the drug useless. Not surprisingly they minimize the possibility, noting that laboratory evidence of resistance is scant, affecting only a few percent of H5N1 isolates tested. But indications from modeling are that even much lower frequencies of genetically fit resistant strains would spread through the population after the first wave where significant proportions of the population were treated therapeutically or prophylactically with Tamiflu. Despite this, the models show (http://scienceblogs.com/effectmeasure/antiviral_model_series/) that there is still a substantial benefit during that first wave, so this is not a strong argument against stockpiling. However, in our view it is a strong argument against antivirals as the main line of defense in a pandemic.
This isn't a lot of clinical data to go on and other explanations than the efficacy of the drug are clearly possible. But it's the data we've got and they do suggest that Tamiflu is of benefit in H5N1 infection. Better than a poke in the eye with a sharp stick.

[cHeroKee]

http://www.naturalnews.com/022787.html


Bird Flu Virus has Mutated into Form That's Deadly to Humans
by David Gutierrez

(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."

[cHeroKee]

The heart of bird flu season coming up



<!--proximic_content_on--> If you look at the bar chart below you will see that this year's bird flu season is shaping up to look pretty much like last year. In the first two months of the year there are a few more cases but essentially the picture looks much the same. If that is indeed true, then also expect a spike of cases this month (March) since you can also see that is the past pattern. Already cases are being reported in Egypt, and of course, Indonesia. The countries involved this season have been Vietnam, China, Egypt and Indonesia, just like last year. Whether you consider that reassuring or worrying probably depends on whether you are an optimist or a pessimist. We tend to be cautious pessimists. Your mileage might vary. Here is the chart, uptdated to the end of February and courtesy WHO's Western Pacific Regional Office:

http://scienceblogs.com/effectmeasure/s2-1.jpg

[Dolcezza]

oh dear!:w00t:

[LoudmouthMormon]

The heart of bird flu season coming up
this year's bird flu season is shaping up to look pretty much like last year.Just to make sure I understand all this:

Bird flu has a high mortality rate, which is bad. And we hear different things about how treatable it is, but basically viruses are hard to treat, and that's also bad.

But so far, it pretty much passes from bird to human, not human to human, which is good. But viruses mutate, and we humans have great fear it will mutate to something that will spread from human to human. If that happens, we humans are at risk of varying levels of -demics, necessitating quarantines, threatening to overload services, etc. At this point, we're done with the good things, the only relevant news is how bad will it get and when will it be done.

We want to take this seriously because of what happened in 1918 (http://en.wikipedia.org/wiki/Spanish_flu), when upwards of 5% of the global population died.

Is that about right?

[MAAD]

Just to make sure I understand all this:

Bird flu has a high mortality rate, which is bad. And we hear different things about how treatable it is, but basically viruses are hard to treat, and that's also bad.

But so far, it pretty much passes from bird to human, not human to human, which is good. But viruses mutate, and we humans have great fear it will mutate to something that will spread from human to human. If that happens, we humans are at risk of varying levels of -demics, necessitating quarantines, threatening to overload services, etc. At this point, we're done with the good things, the only relevant news is how bad will it get and when will it be done.

We want to take this seriously because of what happened in 1918 (http://en.wikipedia.org/wiki/Spanish_flu), when upwards of 5% of the global population died.

Is that about right?

Yep that about sums it up. I was in a presentation last week on this and that was basically what was said.

A few other things to consider is that the Spanish flu killed 53 million people worldwide. It spread across the entire US within 2 weeks. This was before mass travel, mass transit, airplanes, cars, and all the globe trotters. They estimate that once this virus mutates to be transmitted from human to human that it will spread world wide within a few days.

[cHeroKee]

Egyptian boy confirmed with bird flu, 47th case

Sat 8 Mar 2008, 16:21 GMT
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CAIRO, March 8 (Reuters) - An 8-year-old boy in Fayoum province has contracted the bird flu virus after coming into contact with infected birds -- the 47th case among humans in Egypt since 2006, the Health Ministry said on Saturday.
The boy, Abdel Hamid el-Sayed Youssef, was taken to a local hospital with a high temperature, difficulty breathing and a pulmonary inflammation, spokesman Abdel Rahman Shahine said in a statement.
He moved to a Cairo hospital on Friday and is being treated with Tamiflu, the standard treatment for humans, it said.
An Egyptian woman from the same province southwest of Cairo died of the disease last week but a health official said there did not appear to have been contact between them.
Altogether 20 people have died of bird flu in Egypt since it arrived in the country in February 2006.
It is the third winter the virus has struck after lying low during Egypt's hot summers.
Around 5 million households in Egypt depend on poultry as a main source of food and income, and the government has said this makes it unlikely the disease can be eradicated despite a large-scale poultry vaccination programme.
Deaths from bird flu total more than 230 worldwide since 2003 and have been reported in several African and Asian countries. Egypt has been the worst-hit country outside of Asia.

[cHeroKee]

Scientists discover new key to flu transmission


Julie Steenhuysen , Reuters


CHICAGO - Flu viruses must be able to pick a very specific type of lock before entering human respiratory cells, U.S. researchers said on Sunday, offering a new understanding of how flu viruses work.
The discovery may help scientists better monitor changes in the H5N1 bird flu virus that could trigger a deadly pandemic in humans. And it may lead to better ways to fight it, they said.
The scientists found that a flu virus must be able to attach itself to an umbrella-shaped receptor coating human respiratory cells before it can infect cells in the upper airways.
What the lock needs is the right key. It opens the door," said Ram Sasisekharan, a professor of biological engineering and health sciences at Massachusetts Institute of Technology in Cambridge.
The H5N1 avian flu virus now almost exclusively infects birds. But it can occasionally pass to a person.
Experts have feared that the bird flu virus would evolve slightly into a form that people can easily catch and pass to one another, triggering an epidemic.
"We now know what to look for," said Sasisekharan, whose study appears in the journal Nature Biotechnology.
Before a flu virus can enter a human respiratory cell, a protein on the surface of the virus must bind with chains of sugars called glycans that sit on the outside of the cells.
Scientists have classified these chains according to how they are linked together chemically. In birds, the virus binds with alpha 2-3 receptors; in humans, it binds with alpha 2-6 receptors.
To infect humans, scientists thought the H5N1 bird flu virus would need to simply mutate so it could bind with alpha 2-6 receptors. But it turns out not all alpha 2-6 receptors are the same. Some are short and cone-shaped and some are long and umbrella-shaped.
"Defining human and bird receptors just by linkage forgets to take shape into account," Sasisekharan said in a telephone interview.

VIRUS SURVEILLANCE
Shape difference may explain why humans can get bird flu from a bird and not pass it along easily to other humans, he said.
So far, the bird flu virus has found a way to bind only to the cone-shaped structures in human upper airways. The virus has already killed 216 people and infected 348 people in 14 countries, according to the World Health Organization.
But the study found that the most infectious human flu viruses bind with the umbrella-shaped receptors in the upper respiratory tract. The researchers believe the H5N1 bird flu virus would need to adapt so it could latch on to these umbrella-shaped receptors before it could be spread readily from human to human.
Understanding this mechanism could lead to better surveillance of changes in the virus and may lead to the development of new and better drugs to treat flu viruses.
"It opens up ways for people to bring in different kinds of small molecule approaches for new drug development," Sasisekharan said, adding the work could help seasonal flu sufferers as well.
cHeroKee


http://a123.g.akamai.net/f/123/12465/1d/media.canada.com/reuters/test_reutersushealthonlinereport_iptc/2008-01-07t132531z_01_nootr_rtridsp_2_health-birdflu-shape-dc.jpg?size=l
http://a123.g.akamai.net/f/123/12465/1d/www.canada.com/images/widgets/bullet_story_headline_bigger.gif View Larger Image (http://javascript%3Cb%3E%3C/b%3E:void%20window.open%28%27http://www.canada.com/storyimage.html?id=ae144ff1-7941-4a2e-aeb5-51ce67a98eec&img=8ee5e960-beea-454b-8cea-d2a588a98f8f&path=%2ftopics%2fbodyandhealth%2f%27,%20%27storyim age%27,%20%27width=760,height=550,location=no,menu bar=yes,scrollbars=yes,resizable=yes%27%29)
Flu viruses must be able to pick a very specific type of lock before entering human respiratory cells, U.S. researchers said on Sunday, offering a new understanding of how flu viruses work. (L-R) Massachusetts Institute of Technology postdoc Karthik Viswanathan; research scientist Rahul Raman; Ram Sasisekharan, MIT Underwood Prescott Professor of Biological Engineering and Health Sciences and Technology; postdoc Aravind Srinivasan and, seated, graduate student Aarthi Chandrasekaran. REUTERS/MIT/

[cHeroKee]

<headline>Bird flu closing in on humans: expert</headline>



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March 11, 2008 - 3:23PM</date>

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<!--articleDetails--> <bod> </bod>One of China's top doctors has disclosed that the H5N1 bird flu virus has shown signs of mutation and can kill human victims more easily if treatment is not given early enough, newspapers reported today.
Zhong Nanshan, an expert on respiratory diseases, told reporters in Beijing that vigilance should be kept up especially when H5N1 human cases are surfacing at a time when seasonal human influenza is at a peak.
"When avian flu is around and human flu appears, this will raise the chances of avian flu turning into a human flu. We have to be very alert and careful in March," Zhong was quoted by the Ming Pao newspaper as saying.
"People who were killed by bird flu last year and this year were too poor to seek treatment. If you happen to have high fever and pneumonia, you must seek treatment fast."
Three Chinese people have died this year of H5N1 bird flu and they were infected probably through contact with sick poultry. The World Health Organisation said there was no evidence of transmission between humans in all three cases.
Although the H5N1 virus has infected only 368 people around the world since 2003, its mortality rate has been worryingly high, killing 234 of them.
Experts fear it could trigger a pandemic killing millions if it ever learns to transmit efficiently among people.
Hong Kong, which lies at the south of China, is going through a seasonal flu peak, with outbreaks reported in a growing number of schools.
A three-year-old girl died last week of human H3N2 flu and authorities have ordered schools to conduct fever checks and advise those who are unwell to stay home.
A seven-year-old boy was admitted into hospital last week after he complained of flu-like symptoms and is now in a critical condition. Authorities are still trying to determine the cause of his illness.
Reuters