Bird Flu Takes Flight

Winter in the Northern Hemisphere means one chilling prospect for global health officials: it's bird-flu season. Nine countries have announced outbreaks in recent weeks, and a replay of 2006--when H5N1 killed 80 people and spread to the Middle East and Africa--could well be on the way. In an effort to stay ahead of the virus, the Department of Health and Human Services on Wednesday said it is giving $132.5 million to makers of bird-flu vaccines that rely on immune-system boosters called adjuvants. "In the event of an influenza pandemic," said HHS Secretary Mike Leavitt, "adjuvant could provide a way to extend a limited vaccine supply to more people." Here's a look at what's helping kick in such cash.

In Egypt three family members died in late December of H5N1, probably contracted from infected poultry in the household. On Jan. 12 Nigeria announced a cull of some 20,000 birds after two farms reported outbreaks.

In the north, more than 100 ducks were found dead from H5N1 on Jan. 10; further south, the disease killed several wild birds in December. A major poultry exporter, Thailand is a hot zone for the virus; 17 Thais have died from it since 2003.

Indonesia, where millions of people reside in close quarters with live poultry, led the world with 57 human fatalities by the end of 2006. Four more people have died since Jan. 10, and several patients remain hospitalized. The 18-year-old son of one victim tested positive for H5N1 as well, raising fears of human-to-human transmission.

A scaly-breasted munia, found dead in a crowded shopping district on New Year's Eve, and a crested goshawk collected on Jan. 9 both tested positive for H5N1, prompting concerns that the virus had returned to the city that reported the world's first human cases in 1997.

Seven of Vietnam's 64 provinces have reported poultry outbreaks this year, and more than 30,000 birds have been culled since December. Officials fear that caged birds transported on crowded buses and trains during next month's Lunar New Year festivities could spread the virus throughout the country. Over the past four years, 42 people in Vietnam have died of avian flu.

Bird Flu Mutations Found

World Health Organization says Egyptian bird flu mutations suggest antiviral resistance

LONDON, Jan. 18, 2007
By MARIA CHENG AP Medical Writer

(AP) Mutations in the bird flu virus have been found in two infected people in Egypt, in a form that might be resistant to the medication most commonly used to treat the deadly disease, the World Health Organization said Thursday.

The mutations in the H5N1 virus strain were not drastic enough to make the virus infectious enough to spark a pandemic, WHO officials said. But more such mutations could prompt scientists to rethink current treatment strategies.

Samples taken from two bird flu patients in Egypt _ a 16-year-old girl and her 26-year-old uncle _ were not as responsive as regular H5N1 viruses to Tamiflu, a drug also know as oseltamivir that is used to treat the disease, the officials said.

The girl and her uncle died in late December, as did the man's 35-year-old sister, although she has not yet been confirmed as having had H5N1. The three _ who lived together in Gharbiyah province, 50 miles northwest of Cairo _ fell ill within days of one another after being exposed to sick ducks.

"Based on the information we have, we can't yet rule out human-to-human transmission," said Dr. Fred Hayden, a WHO bird flu and antivirals expert. "We need to better understand the dynamics of this outbreak."

Although people have passed the virus on to other people, such infections are rare, and most patients have been infected by direct contact with sick birds.

Scientists fear, however, that the virus could mutate into a form more easily passed between people, which could spark a flu pandemic.

The drug-resistant strains found in Egypt likely developed after the patients were hospitalized and treated with Tamiflu, with the virus responding directly to the drug, Hayden said. It was not proven, however, that that was the case, and a more worrying scenario would be if drug-resistant strains were already circulating among birds.

Although Tamiflu remains the drug of choice to treat H5N1, experts may have to consider other options if they find more resistant viruses.

Because flu viruses evolve constantly, mutations are only worrisome if they make the virus more infectious, lethal or drug-resistant.

"What the resistance tests look for are markers associated with antiviral resistance," though finding the markers did not necessarily mean Tamiflu would not work, said Dr. Angus Nicoll, flu director at the European Centre for Disease Prevention and Control.

Hayden said the mutations found in Egypt were different from Tamiflu-resistant H5N1 viruses found in patients two years ago in Vietnam. The Vietnamese strains were definitely resistant to Tamiflu, whereas the Egyptian viruses have only proven they are not as susceptible to the drug, he said.

Tamiflu-resistant viruses such as those found in Vietnam are often treatable with an older, less expensive class of antivirals, known as amantadanes. Some bird flu virus strains from Indonesia and China have also proven susceptible to amantadanes.

H5N1 first hit Egypt last year, and has since infected 18 people, 10 of whom have died.

Since the H5N1 outbreak first began in late 2003, it has decimated the Asian poultry industry and infected at least 265 people worldwide, 159 of whom have died, according to WHO.

Thursday, January 18, 2007

Study: Bird virus acts like 1918 flu

By DAVID WAHLBERG

The deadly 1918 flu virus harms monkeys the same way today's bird flu strikes some people, says a new study led by a UW-Madison researcher. Both viruses inflict an unusual immune response that kills instead of protects, the study found.

The discovery could encourage doctors to treat bird flu with immune-suppressing drugs such as steroids in addition to the antiviral medications now used, said Yoshihiro Kawaoka, a UW-Madison virologist and lead author of the study.

Kawaoka said the research also could help health officials better prepare for a possible flu pandemic, or worldwide outbreak of flu. The 1918 pandemic killed up to 50 million people.

Experts say another pandemic likely will hit in the coming years. It could be triggered by the H5N1 bird flu virus, which has killed 161 people since 2003, mostly in Southeast Asia; at least four people died from H5N1 this month in Indonesia. Other flu viruses also could cause a pandemic.

In the study, published in today's issue of the journal Nature, scientists infected cynomolgus macaque monkeys with the 1918 virus. The monkeys virtually drowned in their own inflammatory fluid that poured into their lungs, as many people reportedly did during the 1918 pandemic.

The finding could quicken officials' response to a new pandemic by enabling doctors to treat an immune reaction along with the flu itself, Kawaoka said.

"We may be able to reduce the symptoms by coping with that immune response," he said.

He said more research is needed, however, before a recommendation is made to treat the immune response in patients with bird flu.

Kawaoka worked on the study with researchers from the University of Washington in Seattle and Canada's National Microbiology Laboratory in Winnipeg, Manitoba.

The monkeys were infected in a tightly-controlled part of the Canadian lab. It is designated biosafety level 4, or BSL- 4, meaning it is equipped to handle the most dangerous germs.

Ten monkeys were infected with the 1918 virus. Three were given a routine flu virus from 2001.

The monkeys that received the routine flu had strong immune reactions that subsided as the monkeys recovered from the infection.

The immune reactions in the monkeys that got the 1918 virus were weaker initially - but failed to go away. As the virus continued to grow in their bodies, their immune systems unleashed "profuse watery and bloody liquid" into their lungs, causing deadly disease, the researchers reported.

"The immune response is actually contributing to the lethality of the virus," said co-author Michael Katze, a University of Washington microbiologist.

The researchers recreated the 1918 virus in the BSL-4 lab using genetic information assembled by other scientists from particles stored from autopsies and samples from a flu victim preserved in the Alaskan permafrost.

Kawaoka said the study confirms that the unique makeup of the 1918 virus contributed heavily to the deadliness of the pandemic at the end of World War I. It was the worst of three flu pandemics in the last century.

Some experts have said that the poor medical conditions of the day, including a lack of antibiotics, were largely to blame for the pandemic's severity.

While those factors also likely contributed, the study shows that the virus itself was a major factor, Kawaoka said. It also suggests that a similarly dangerous virus could be problematic today even with medical advances.

The 1918 virus had been tested in mice before but not in primates, Kawaoka said. The monkey results carry more implications for humans, he said.

Next up for the researchers: figuring out which proteins in the 1918 virus, or chemical signals produced by it, account for the unusual immune response.

Meanwhile, scientists continue to look for genetic clues that could forecast when the H5N1 virus might become more easily spread among people, and thus more likely to start an pandemic.

In a study last year, Kawaoka identified two amino acids - building blocks of proteins - that allow the H5N1 virus to recognize human flu receptors in people's cells. That recognition is considered necessary for the virus to be transmitted easily among people.

UW-Madison's $9 million Institute for Influenza Viral Research, to be run by Kawaoka, is set to open in the University Research Park by September, he said.

Lab accident sparks bird flu outbreak fear

Thursday, 18th January 2007, 07:27

A lab accident has sparked fears that a modified bird flu virus could escape and possibly infect millions of people.

The near-miss happened last April at the University of Texas in and has only just been exposed - leading to calls for such incidents to be more widely publicised.

A researcher put tubes into a centrifuge - a spinning device that sorts particles - to separate the contents which included a human flu virus altered to carry a gene from H5N1 bird flu.

But the machine became unbalanced and stopped and when the researcher opened it he found the lid of a safety cup holding one of the tubes had fallen off.

Fearing the tube inside had leaked the researcher disinfected everything and called the lab's safety officers, reports New Scientist.

He was wearing a protective hood and respirator, and the whole room was at negative pressure to prevent leaks to the outside.

But the researcher had opened the centrifuge and removed the samples without waiting the recommended 30 minutes to allow any virus-laden aerosol to settle.

In fact, the tube was intact. But if aerosol had escaped, the consequences could have been serious, since the virus would have been able to infect humans with unknown effects.

Experiments since the accident show the virus replicates more slowly in the lab than human flu, said microbiologist Dr Bob Krug, head of the Austin lab.

But its behaviour in people might be different, and an escapee could also share its new gene with other flu viruses.

Such research has been criticised for creating unpredictable viruses that may never emerge naturally.

"The University of Texas dodged a bullet," said Ed Hammond, director of the Sunshine Project, an Austin-based pressure group.

He said the incident only came to light because he demanded to see the university safety committee's records.

The committee was not unduly secretive and plans to publish its minutes.

But Mr Hammond says more government oversight and public disclosure is needed from labs handling dangerous microbes

further thought:
-how well does your indoor toilet run without electricity to pump water?
-antibiotics work against bacteria, not virus'. By the way, 40% of health care workers say they are not showing up to work. Of the remaining 60%, ~30% of them will be sick. The US has ~ 950,000 staffed hospital beds. On any given day, 95% of them are in use. There is NO spare capacity. Just in time logistics will kill us.
-the anti virals (Tamiflu etc.) are being bypassed by the virus' mutation, are in grossly low supply, and have a single point of manufacture
-hand washing and social distancing were promoted in 1918 as the primary defense against the flu.
-how well does water run w/o electricity or personnel to keep the plant running?
- trench warfare was marked by lousy conditions, poor health, and crowded troop trains - checked the conditions in the slums of mexico city, rio, jo'burg etc. lately?

Bottom line - we are more vulnerable, and more fragile today than we were in 1918. The real enemy is Heineken man and the rest of the grasshoppers who will take what the ant has stored...

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