Posted on 05/09/2005 10:18:08 AM PDT by Dog Gone
Some folks suggested that we begin a thread similar to the Marsburg Surveillance Project for monitoring developments regarding Avian Flu.
The purpose is to have an extended thread where those interested can post articles and comments as this story unfolds.
If we're lucky, the story and this thread will fade away.
I hope those Alaska researchers are using the right biolevel gear. Hope someone sends them some of Dr. Niman's info on recombination. They are on the front line. I don't envy them .
That's interesting, how does it work for cytokine storm? Since it is a major tranquilizer does it "calm" down the immune system therefore calming the storm? I doubt that a doctor would hand out a prescription for Haldol for a "just in case" scenario.
"Haldol (yes, the major tranquilizer antipsychotic HALDOL) is useful in treating cytokine storm"
Interesting. I can see it as an adjunct to the prednisone, the respiratory treatments and the antivirals especially when someone is put on a respirator.
I know when my otherwise placid kid had the cytokine storm from that Norovirus there was nothing that could calm her down enough to take the predisone pill (and the prednisolone liquid was as bad as gasoline)- that taste alone was so vile that the treatment seemed to work against itself initially. We tried every flavor at the pharmacy to no avail.
Yes, I recall that. Still there were similarities with ebola enough to raise questions on recombination. I don't think the CDC ever released exactly what they found. I don't think any major org did.
It has taken me quite a while to find the information about Haldol and cytokine storms.
This is the website:
http://72.14.207.104/search?q=cache:M6lrcPV_mV4J:www.medscape.com/viewarticle/491457+cytokine+storm+treatment&hl=en
Here is the article, so it isn't lost forever:
____________________________________________________________
Haloperidol Improves Survival in Mechanically Ventilated, Critically Ill Patients
Yael Waknine
Oct. 15, 2004 — Early use of haloperidol in critically ill patients undergoing mechanical ventilation is associated with significantly reduced hospital mortality, according to the results of a preliminary retrospective cohort study presented at the 17th annual congress of the European Society of Intensive Care Medicine (ESICM) in Berlin, Germany. The paper has also been accepted for publication in Critical Care Medicine.
"Haloperidol has been used for many years to manage agitation in mechanically ventilated intensive care unit (ICU) patients, and it is the recommended drug for treatment of delirium in the ICU," Eric B. Milbrandt, MD, MPH, assistant professor of critical care medicine at the University of Pittsburgh School of Medicine in Pennsylvania, told Medscape in a phone interview. "In addition to reducing agitation and delirium, haloperidol inhibits secretion of pro-inflammatory cytokines and improves survival in an experimental model of sepsis in rats."
To determine whether early treatment with haloperidol would improve survival, the investigators reviewed the records of 1,095 ICU patients during the past year that were mechanically ventilated for a period of longer than 48 hours.
Patients were classified on the basis of whether they had received haloperidol within two days of mechanical ventilation initiation (n = 83) or no haloperidol at all (control subjects, n = 906), on the hypothesis that treatment must be initiated early in the course of mechanical ventilation to affect outcome. Patients administered haloperidol received a mean dose of 11.5 (± 11.6) mg/day for a mean period of 3.5 (± 4.6) days.
The two groups were similar in all respects with the exception of sex — the haloperidol group consisted of a greater proportion of men compared with the control group (67.5% vs 55.2%; P = .03).
The results showed that treatment with haloperidol was associated with significantly lower patient mortality (20.5% vs 36.1%; P = .004) compared with control subjects. An inverse relationship was found between mortality and increasing mean daily haloperidol dose (no haloperidol: 36.1%, 0.5 - 5.0 mg/day: 36.1%, 5.1 - 12.5 mg/day: 15.4%, more than 12.5 mg/day: 7.7%; P for trend = .001).
Logistic and Cox regression analyses showed haloperidol use to be associated with a significantly lower risk of hospital mortality (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.18 - 0.69; P = .0022), and decreased death rate (hazard ratio, 0.39; 95% CI, 0.30 - 0.50; P = .0002) compared with control subjects, even after adjustments for age, comorbidities, race, admission type and diagnosis, ICU type, Simplified Acute Physiology (SAPS) II score, and Sepsis Related Organ Failure (SOFA) score.
Absence of haloperidol therapy was associated with a significantly higher risk of mortality (OR, 2.26; 95% CI, 1.25 - 4.05; P = .006) compared with those administered haloperidol.
"Treatment with haloperidol might avoid excess sedative and analgesic use, which has been associated with prolonged mechanical ventilation and ICU length of stay in other studies," suggested Dr. Milbrandt in explaining the study outcomes, adding that stabilization of cognitive function with haloperidol may have also reduced or reversed the negative effects of central nervous system–mediated anti-inflammatory mechanisms and interrupted central-peripheral signaling that are associated with the pathogenesis of severe illness.
"Haloperidol has anti-inflammatory effects on cytokines," Dr. Milbrandt noted. "Given these effects, treatment with haloperidol may have reduced the cytokine storm associated with critical illness, thereby reducing multi-organ dysfunction and improving survival."
Limitations of the study include its retrospective nature and possible indication bias despite adjustment for potential confounders. "Haloperidol patients may have been agitated but cognitively intact — and therefore healthier, or haloperidol patients may have been delirious and therefore sicker," Dr. Milbrandt observed.
"Treatment with haloperidol during mechanical ventilation was associated with significantly lower hospital mortality for mechanically ventilated ICU patients," Dr. Milbrandt concluded, adding, "Because of the observational nature of this study and the potential risks associated with haloperidol use, these findings should be confirmed in a prospective randomized placebo-controlled trial before being applied to routine patient care."
ESICM 17th Annual Congress: Abstract 251. Presented Oct. 11, 2004.
Reviewed by Gary D. Vogin, MD
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I have a real concern that this very valuable and potentially lifesaving information may be lost or not known about, so I posted the entire article here.
I am not at home, so, somebody please put this on their computer and save it, and let me know, okay? Thanks very much.
Once again, the critical paragraph:
"Haloperidol has anti-inflammatory effects on cytokines," Dr. Milbrandt noted. "Given these effects, treatment with haloperidol may have reduced the cytokine storm associated with critical illness, thereby reducing multi-organ dysfunction and improving survival."
Thank you Judith. I'm saving to my computer.
Bump! Put me on your ping list, if you have one.
I really appreciate that. I have a tendency to lose important stuff like this, and I'm sure it will come up again...
Yes I do, and yes I will. ;-D
Amazing! Anti-inflamatory?! (Who'd a thunk?)
I know. It really stuck in my mind when I first read it, and then I had a heck of a time finding it again tonight. Thank God (literally) that I did...
Thanks
Thanks for the link, this confirms to me that the Chinese government is disseminating false information concerning an as yet unidentified VHF outbreak. I suspect that they will continue to conceal and inhibit research in the regional areas affected so far. This will make identifying any recombinant agents almost impossible.
"1. We have the H5N1 Avian Flu that so far primarily affects birds.."
It is zoonotic and specific to birds hence designated type A influenza, it's ability to infect humans is a result of optimization within an infected porcine host (not necessarily symptomatic) in the main but not eclusively. mechanisms such as antigenic shift and drift, reassortment and recombination events are chiefly responsible for the expression of a genetic factor that allows human transmission and eventually pandemic.
"There is Ebola in China. Moreover, we have multiple strains of Ebola in China. Therefore, there seems to be a lot of it."
We are not sure what we have in China, all we know for sure is that there is a VHF outbreak of unknown type and origin. This could be Marburg which is clinical indisticnt form Ebola. The later is a problem as the most recent outbreak of Marburg shows MUCH higher mortality than any known or previous Ebola outbreak to date. there is also the possibility and likelihood that a recombination event of has taken place there is H5N1 endemic to the region as well as other possibilities
"There is apparently a variant of Avian Flu that has genetic similarity to Ebola"
That is not a good way of describing a recombination event, but essentially this will likely express as an airborne strain of Ebola or whichever VHF agent is responsible.
"There is a somewhat undetermined swine disease that some have called "Streptococcus suis". However, that is in doubt."
Not really as Streptococcus suis is endemic in almost every country. It is proposed by the Chinese that this is a novelStreptococcus suis outbreak. There are problems with their hypothesis as the clinical presentation is inconsistent with Streptococcus suis
"There is also the general concern that any of these variants can be spread either by human to human or by bird/pig to human. If sufficient animals were infected, the human to human transmission might not be necessary for a general pandemic."
It is necessary to determine the transmission mechanisms and vector in order to determine pro active management of the outbreak. Understanding etiology is a vital part of epidemiological analysis. in other words if you promote culling of the porcine and avian populations and the isolated agent is identified as an avian variant then culling is likely method of controlling the outbreak. However if the isolated agent is porcine or a novel variant with human to human characteristics then culling the avian and porcine populations is only part of your management strategy not the whole.
""It might be possible to calculate the probability of the 18 nucleotide pair identity between Ebola and Avian if someone can tell me the total length of the two viral genomes (in base pairs), and the general structural similarity. (I thought they were quite different)."
Your assumptions and metrics are incorrect and not going to be able to resolve the answer you seek.
A sequence variation analysis looking for polymorphisms in both genomes and compared with GenBank references will be the only determination that is sound.
Bird flu may reach Europe but threat limited
04 Aug 2005 10:35:49 GMT
Source: Reuters
http://www.alertnet.org/thenews/newsdesk/L03582512.htm
By David Evans
PARIS, Aug 4 (Reuters) - The discovery of bird flu in Siberia means migratory wildfowl may now carry the deadly virus to Europe, but the region is well set to limit the threat, the world animal health body said on Thursday.
Authorities in Siberia say they have detected the same H5N1 strain of the bird flu virus that has swept large parts of Asia, killing more than 50 people in the region, mostly in Vietnam.
The Paris-based OIE, which draws up global animal health guidelines, has been notified of the presence of an H5 type virus in Siberia by the Russian authorities.
Experts believe migratory wild birds such as geese and ducks may have carried the virus from infected Asian countries to Siberia.
Now it could be Europe's turn.
"The disease probably arrived in Siberia from Asia through wild birds and there's no doubt that birds from there fly to Europe," OIE Director-General Bernard Vallat told Reuters.
H5N1 is a particularly virulent strain of avian influenza, of which there are many types. It has led to the death of 140 million birds in Asia at a cost running to billions of dollars.
But farm structures are far different in Europe.
"It's not definite that even if infected birds arrived in Europe that they would pass the virus onto farm animals, the probability of contact is much less than in Asia," Vallat said.
"Farms here are enclosed and separated from one another."
In Asia, small backyard farms and unregulated local markets have allowed the disease to take hold as well as maximising the contact between people and infected birds.
Russian officials said there was a strong chance that the virus in Siberia would soon spread to the European part of Russia, where the country's poultry industry was concentrated.
Thay are also in contact with authorities in neighbouring Kazakhstan, where poultry deaths were recorded last month.
CONTROLS TIGHTENED
Scientists said last month that the discovery of dead birds at Lake Qinghaihu, a protected nature reserve in western China, meant the virus could soon spread outside Asia.
The virus, which affects ducks with little harm but kills chickens, had very rarely been seen to kill wild birds.
The World Health Organization (WHO) fears the virus would kill millions of people worldwide if it mutated and acquired the ability to pass easily from human to human.
A senior Russian veterinary official said the Netherlands and France were potenial destinations for migratory wildfowl.
The Dutch farm ministry played down the threat, saying after a risk assessment that further measures were unnecessary.
The Netherlands experienced a major outbreak of the less dangerous H7N7 bird flu strain in 2003, when 30 million birds were destroyed at a direct cost of more than 150 million euros.
Vallat said that despite the high density of farms in the Netherlands, which increased the risk of the disease spreading, surveillance and eradication plans had been stepped up.
"Since the last outbreak of bird flu, the authorities have taken new measures, they're much more prepared. We have the veterinary structures in place to act very quickly, to cull potentially infected animals and stop the disease," he said.
"We're not too worried about it," he added.
Swiss firm Roche said this week it was in talks with the WHO on donating substantial quantities of its anti-bird flu drug Tamiflu to the U.N. agency. And Britain's Acambis Plc said it was developing a potentially breakthrough new shot that could offer permanent protection against all types of flu.
Avian Flu Pandemic: Chinese Government's Answer "Make Villages Disappear!"
News Blackout in China and around the World
by Dr. Henry L. Niman
August 4, 2005
Recombinomics.com
Three Villages Razed In Qinghai After H5N1 Bird Flu Riots? By Dr. Henry L. Niman, PhD8-3-5
According to the Qinghai Bulletin Board Service (BBS), the state of emergency imposed on the farming community and its surroundings in the Northwestern Qinghai City / Town of Yushu was lifted on the night of 28th July.
When natives living further from the area made a trip to the farming community, they discovered that it had "vanished" together with 3 of its surrounding villages. Only some ruins, blocks from collapsed walls, remained. Apparently, the farms and villages had been flattened and there were signs that they had been razed.
It is believed that some inhabitants from those 3 villages were workers in the farm. Around 200 people were estimated to have inhabited or worked in those 3 villages and the farm. There whereabouts are, as yet, unknown.
The above translation of a boxun report suggest that three villages were razed in response to unrest linked to a forced bird flu quarantine in Yushu in northwestern Qinghai in China. China has imposed news blackouts and arrested reporters in the past, so verifiable news from the area is difficult to obtain.
News outside of China however, points toward a virulent strain of H5N1 linked to Qinghai Lake has killed ducks and geese in several areas of southern Siberia in Russia as well as the adjacent region in Kazakhstan. There are now reports of five suspected cases of H5N1 in Kazakhstan linked to infected geese, suggesting many similar cases would be possible in Qingahi and Xinjiang provinces in China, where there have been three outbreaks linked to migratory birds and all involved dead geese.
Although it is possible that the ability to infect humans has been recently acquired, boxun reports in May and June described human fatalities in the Qinghai Lake region. In addition, several strains of H5N1 capable of infecting humans were also described.
The news blackout in China as well as additional suspect cases in neighboring Sichuan province which may be spreading further south to Yunnan province has suggested that a raging H5N1 pandemic in China is being covered-up.
http://www.latimes.com/news/health/la-he-birdflu25jul25,0,4494435.story?coll=la-home-headlines
Will we be ready?
Most Americans consider bird flu a distant threat, but U.S. health officials are preparing for a potential pandemic.
By Melissa Healy
Times Staff Writer
July 25, 2005
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Among officials and experts tracking the building force of the H5N1 virus, the anxiety is palpable. Dr. Anthony Fauci, who directs the National Institutes of Health office that oversees preparations for pandemic flu, says the sense of urgency is intense. "I feel it every day, and my staff feels it every day."
Fauci calls pandemic flu "the mother of all emerging infections" and warns that the world is behind in building its defenses.
There is, however, a scramble to get ready. The United Nation's World Health Organization has stepped up its monitoring of H5N1 throughout East Asia. It has brokered cooperation among countries to help stem the spread of the virus — usually by killing flocks of infected birds. And it has exhorted countries to arm themselves with vaccine and antiviral medication.
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"The stakes — in dollars, resources and human lives — are enormous," said Rep. Thomas M. Davis III (R-Va.), who on June 30, presided over the fifth hearing this year that Congress has called on the subject.
Officials also face the uncertainty of not being able to predict how virulent a pandemic flu virus would be. Bird flu victims in Asia have been stricken with typical influenza symptoms at first, but their respiratory distress quickly worsens as their immune systems try to fight the virus. Of those confirmed infected with the bird flu, almost half have died.
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"The arrival of a pandemic influenza would trigger a reaction that would change the world overnight," writes Michael T. Osterholm in an article in the July issue of the journal Foreign Affairs. Trade and travel across foreign and domestic borders would slow or stop, as countries and communities scramble to protect themselves from infection, writes Osterholm, who directs the University of Minnesota's Center for Infectious Disease Research and Policy. "Global, regional and national economies would come to an abrupt halt," he says.
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To thwart entry of a new virus, the CDC this summer will open six quarantine stations in international airports and ports, including San Diego, Anchorage, Boston and Minneapolis. They join 12 existing stations, including quarantine facilities at Los Angeles International, San Francisco International and Seattle airports. Federal health officers staffing these quarantine facilities will have the legal power to hold foreign citizens suspected of being ill with flu for a limited time. Beyond those ports of entry, however, experts say that U.S. and state laws give officials little or no authority to take measures aimed at stopping the spread of a virus.
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