World on verge of deadly pandemic, U.S. official says

Washington — The Earth may be on the brink of a worldwide epidemic from a bird flu virus that may mutate to become as deadly and infectious as viruses that killed millions during three influenza pandemics of the 20th century, a federal health official said Monday.

Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention, said scientists expect that a flu virus that has swept through chickens and other poultry in Asia will genetically change into a flu that can be transmitted from person to person.

The genes of the avian flu change rapidly, she said, and experts believe it is highly likely that the virus will evolve into a pathogen deadly for humans.

She made the remarks in a plenary lecture at the national meeting of the American Association for the Advancement of Science.

In Asia, there have already been a number of deaths among people who caught the flu from chickens or ducks. The mortality rate is very high, about 72 per cent of identified patients, said Dr. Gerberding. There also have been documented cases of this strain of flu being transferred from person-to-person, but the outbreak was not sustained, she said.

“We are expecting more human cases over the next few weeks because this is high season for avian influenza in that part of the world,” said Dr. Gerberding. Although cases of human-to-human transmission have been rare, “our assessment is that this is a very high threat.”

The avian flu now spreading in Asia is part of what is called the H1 family of flu viruses. It is a pathogen that is notorious in human history.

“Each time we see a new H1 antigen emerge, we experience a pandemic of influenza,” said Dr. Gerberding. In 1918, H1 appeared and millions died worldwide. In 1957, the Asian flu was an H2, and the Hong Kong flu in 1968 was a H3.

There had been small appearances of the H1-type of avian viruses in other years, but nothing like the H5 now rampaging through the birds of Asia.

“We are seeing a highly pathogenic strain of influenza virus emerge to an extraordinary proportion across the entire western component of Asia,” she said. “The reason this is so ominous is because of the evolution of flu.... You may see the emergence of a new strain to which the human population has no immunity.”

Study already has shown that the virus can infect cats who can then infect other cats, which Dr. Gerberding said was “another harbinger” of the possibility of a human pandemic.

“The science here is all alerting us that we have a great deal to be concerned about,” she said.

The CDC chief said her agency is getting ready for a possible pandemic next year.

A special flu team, organized last year, continues to monitor the spread of the avian flu and to analyze the strains as they appear.

The government has ordered two million doses of vaccine that would protect against the known strains of avian flu. Dr. Gerberding said this would give manufacturers a head start on making the shots that would be needed to combat a full-blown epidemic of an H1-type of flu in this country.

CDC is also plugged into an international communication and monitoring system that, it is hoped, will give an early warning of the emergence of a deadly new flu.

But at the same time, the agency is helping to produce the 180 million or so doses of regular flu that are needed annually. Dr. Gerberding said the timeline for producing the regular vaccine yearly is very tight, with little room for problems. To produce a new vaccine in response to the sudden emergence of an H1-flu bug would require an extraordinary new effort, she said.

The pandemic spread rapidly and affected young healthy people disproportionately. It was not restricted to emerging nations and here in rural Kansas the church registries are quite shocking on the deaths. My wife was helping move records and looked at them. 17, 18 year olds that suddenly died. An older woman remarked about how her parents talked about all the healthy young people that died. They would suddenly get sick and then practically fall apart and die within 48 hours.
The disease was devastating in its quick pathology and quick transmission. It burned through he population quite quick even with the lack of transportation compared to today. For those of us that follow this it is not a laughing matter. The hunt for the 1918 variation led scientists to dig up samples from some sailors that died and were buried in the Greenland permafrost. Those samples are now being studied in a Washington University lab. Influenza mutates rapidly and while hosted in birds, usually goes through a intermediary species that has genetics similar to ours but easier to jump to from birds. Then when it transitions to ours, it is more adapted to our species. As I remember the fear was that pigs were the intermediary species that was the suspect in the 1918 pandemic.
While the death toll was estimated at 50 million, modern estimates indicate a certain western bias in reporting. It is now thought that 50 million died in India and Asia alone. That is quite a statement for a year. Then the disease was gone.
For all of you who think that this is silly alarmist thought, google how many people are killed each year in the US alone by the normal variations of modern influenza that are not well adapted to our species. Now you know the fear that comes from the reports of avian flu in Asia.
So, how lucky are you at not getting the flu? How about your family? The same stuff that makes you sick with a slight change could kill about everyone you know. Every year the strain mutates differently. That is why vaccines change for each year. Who is to say this years won't be the killer one. Imagine your children coming down with the flu and just sickening them to death in 48 hours while you are helplessly standing by. I think there is a whole host of people worried about just that. Many of the reports indicate they come form the CDC centers offices in third world countries. I think we are out there looking to prevent just such a scenario.
As for biological warfare, no, this is natures killer all on its own. Like the plague outbreak in the Congo going on right now it comes down to lethality, transmission, and pathology.
Aids kills with a high lethality but has a low transmission danger(body fluids) Ebola has a high lethality with a medium transmission danger(fluids and airborne). But influenza has a low lethality but a high transmission danger(airborne). It does not have great stability. Should it become a high lethality and high transmission, look out.
Imagine the disruption to the world of a pandemic. We are so interconnected now that our food, financial, energy sources, and economy would be ground to a halt.
Modern disease outbreaks into humans so far have been dealt with. Some by technology and some by luck. It is a fascinating subject. It just doesn't lend itself to be cavalierly dismissed.

I'm not quite clear on your point but for a CDC official to make such an irresponsible conclusion from what has yet to prove to be a widely transmissible pathogen while under the microscope of all the world's epidemiologists strikes me as being a bit self-serving.

First of all, if a new pathogen surfaces with no understood etiology it would be a much more serious threat since we would have no way to track or even identify it; but for a well understood source to rather suddenly show itself to be cross-transmissible we have a clear idea of what to avoid and it is in the avoidance of infection that the greater gains are made prior to a proven treatment or vaccine.

This article has the ring of the Beggar's Bell to me - but then, I'm a cynic.

http://www.cdc.gov/flu/avian/professional/han020405.htm

dated 2/4/05. there are further updates, nothing newer than 2/9/05.

epidemiologists and bacteriologists have been freaked about this for over two years. they don't want more funds, they are trying to tell us what's maybe over the next hill.

Reuters
Avian Flu World's No. 1 Threat, CDC Head Says
Mon Feb 21, 2005 02:07 PM ET

By Maggie Fox, Health and Science Correspondent

WASHINGTON (Reuters) - Avian flu poses the single biggest threat to the world right now and health officials may not yet have all the tools they need to fight it, the head of the Centers for Disease Control and Prevention said on Monday.

Vaccine efforts are still focused on garden-variety influenza, which kills 36,000 Americans every year, and it would be impossible, in case of an avian flu epidemic, to switch gears quickly to make a special avian flu vaccine, CDC Director Dr. Julie Gerberding said.

"This is a very ominous situation for the globe," Gerberding told a meeting of the American Association for the Advancement of Science, calling it the "most important threat that we are facing right now."

"I think we can all recognize a similar pattern probably occurred prior to 1918," she said, referring to the 1918 pandemic of influenza, which also passed from birds to people and killed between 20 million and 40 million people globally.

The H5N1 avian flu, which first appeared in Hong Kong in 1997 and has since popped up twice, is evolving and can jump directly from birds to people, killing an estimated 72 percent of diagnosed victims, Gerberding said. Officials have documented 45 deaths so far from avian flu.

Gerberding said influenza was far more infectious than severe acute respiratory syndrome or SARS, which swept out of China in 2003, killing 800 people and causing global concern before it was stopped.

Health experts have also pointed out influenza kills much faster than diseases such as AIDS, taking tens of millions of lives in the space of weeks or months.

The "high season" for the avian flu was just starting in Asia, Gerberding said.

"We have this highly pathogenic strain circulating widely in poultry and ducks. There are really wonderful opportunities for this virus to either reassort (mix) with human strains of influenza or with other avian species," she said.

Hong Kong authorities stopped H5N1 in 1997 by sacrificing much of the poultry population in the territory. That was harder to do now that it had spread to Thailand, Vietnam, Cambodia and other countries, Gerberding said.

"People depend on poultry for their livelihoods and for feeding their families," she said.

DEPENDING ON THE PRIVATE SECTOR

The U.S. government contracted with two companies that already make flu vaccine -- Chiron Corp. and Sanofi Aventis to make an avian flu vaccine, which will begin testing in people later this year.

But this year's influenza vaccine shortage caused by contamination problems at Chiron's British plant showed how tenuous vaccine-making capability was, Gerberding said. Only three companies make influenza vaccine for the U.S. market.

"There is no wiggle room here," she said. Making an avian flu vaccine in case of an outbreak would be faster than starting from scratch, she said. "But we just don't have the surge capacity to produce both."

So avian flu vaccine would be rationed.

"The very first doses would target the place where the outbreak is occurring," Gerberding told reporters. Health officials would use a "ring vaccination" strategy similar to that used to eradicate smallpox in the 1960s and 1970s, where exposed people and those around them are vaccinated.

People transmit flu before they become ill themselves so it would be almost impossible to stop it by watching or isolating sick people, Gerberding said.

Health experts are working to learn as much as they can about avian flu, such as doing blood surveys of healthy people in avian flu-affected areas.

"Are there people who have been exposed to the avian virus who have not gotten ill so we know what the true denominator is?" she asked.

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