Bird Flu exploits religious holiday

[Dymanic]

Anybody who's sick of hearing about bird flu might want to take a pill or something, because you're going to be hearing a lot more about it soon. My guess is by this time next week, you won't be hearing about much else.

First, have a look at this:
http://www.recombinomics.com/News/01040606/H5N1_Turkey_26.html
"The above comments suggest that the number of patients hospitalized in Turkey has grown to 26 and come from four provinces."

Some details about what's going on:
http://www.recombinomics.com/News/01050608/H5N1_Turkey_Explosion.html
"The explosion of H5N1 bird flu infections in people and birds in Turkey is cause for concern. The number of suspected cases may have topped 30 with 3 new admissions from Agri and 2 from Ercis. The bird outbreaks have expanded to the south and west in Turkey."

It gets better:
http://www.recombinomics.com/News/01060601/H5N1_Turkey_Van_22.html
"Turkish media indicate that the 22 patients listed above are H5N1 positive."

Now, meet Oric, CurrentEvent's 'man on the ground' in Turkey:
http://www.curevents.com/vb/showthread.php?t=33806&page=16&pp=40
"This was perfect timing (you could say BF is highly intelligent) Because of religious (bayram) holiday the whole population of turkey will mobilize it will be a flow of people from big cities to rural areas and they will come back 1 week later. We lose approx 250 people in car accidents so you can imagine how much relocation is made ... The schools are closing today so the children will be out on the streets for 3 weeks ... (I hope it gets very cold)"


By the way, to anyone still thinking this is all just so much media hype, and eager to go flex his skeptic muscles on that board, I'd advise lurking awhile first; some of the people there are VERY knowledgeable about virology, epidemiology, and the like.

[casebro]

Any confirmed person-to-person infections yet?
Is there an H5N1 antibody test yet?

[ZirconBlue]

Wait! Turkeys carry the bird flu now?! That's going to screw up our Thanksgiving!



(Sorry, couldn't resist the idea of "Bird Flu found in Turkey".)

[alfaniner]

here we go...

:scared:

[Dymanic]

Any confirmed person-to-person infections yet?

No. But the increase in cluster size indicates that the virus has aquired an ability to more easily pass from bird to human. That's not as bad as H2H, but it's BAD.

Niman say:
"Large and frequent familial clusters signal efficient H5N1 transmission, either from a common source or human-to-human transmission. Information on disease onset dates would help distinguish the two possibilities, but the clusters indicate transmission to humans is efficient, regardless of source."
http://www.recombinomics.com/News/01060602/H5N1_Turkey_Clusters.html

Is there an H5N1 antibody test yet?
Yes.

Getting current info on this is tricky, btw, because things appear to be happening fast. As far as I can tell, the current tally is 41 infected, with 3 fatalities. A fourth child from the first family appears to be improving, and has been taken off the ventilator.

[drkitten]

No. But the increase in cluster size indicates that the virus has aquired an ability to more easily pass from bird to human. That's not as bad as H2H, but it's BAD.


My money is on H2H, based on this quote (first source referenced above):


The lack of reported poultry infections in Van, coupled with the large number of patients in Van raise the possibility of transmission to a health care worker in Van.

[MWare]

http://img.timeinc.net/time/cartoons/20051223/3.jpg

[Dymanic]

My money is on H2H, based on this quote (first source referenced above):
We'll know soon. If anybody in those hospitals caught it from any of those patients, the incubation time should be about up; another day or two anyway. One of the things I've learned in the last few days (especially by paying close attention to what Niman is saying) is that the B2H/H2H distinction isn't quite as significant as I'd previously thought. More efficient transmission to humans is a matter of grave concern either way, and this virus has demonstrated and continues to demonstrate an ability to increase that transmissibility.

[casebro]

But isn't it time to do antibody tests on some of the not-so-ill, or healthy, population? I'm still wondering about what percentage of exposed people get the disease so bad that they all end up in the hospital, vs how many get a 'cold' and have no big problem. Hmm... one problem with antibody tests is that once exposed, a patient has antibodies for ever. Could some of those 22 that show + have been exposed last year, and now have a different flu? Time will tell, we hope.

[Dymanic]

But isn't it time to do antibody tests on some of the not-so-ill, or healthy, population?Sounds like a great idea to me. People in Turkey were jamming hospitals once the word got out anyway, asking to be tested, so no shortage of volunteers. I don't think we'd find much by way of antibodies, but that'd be useful information on its own.

I'm still wondering about what percentage of exposed people get the disease so bad that they all end up in the hospital, vs how many get a 'cold' and have no big problem.A thing like this, you have some knowns and some unknowns, and some of the unknowns are known, and some are unknown. The number of mild or asymptomatic cases is one of the known unknowns, and is factored into the models (sure it's possible to do that -- you just have to be ready to accept a range of possible projections).

Another possibility is that the B2H infection rate we're seeing in Turkey is close to what we'd be seeing in China if they were giving up their real numbers. Somehow, that doesn't make me feel any better either.

Hmm... one problem with antibody tests is that once exposed, a patient has antibodies for ever. Could some of those 22 that show + have been exposed last year, and now have a different flu?I think that's a possibility, but it doesn't seem very likely. Since H5N1 is new to the region, it would be hard to explain things that way unless they had all travelled to Southeast Asia or something. There is a lot of discussion going on right now directed to things like gene sequences, cleavage sites, polymorphisms, GenBank entries, etc. Some of the most highly trained people in the relevant fields are spending long hours on this as we speak, and they are tracking specific individual strains. Hard to imagine something like that getting past them -- but the most detailed lab results have yet to come in.

That having been said, the WHO is clearly in a tough situation with regard to trying to deal with a situation like this. Their policy is to take a cautious approach, wait for all the labs, etc. I've been enjoying watching the latest events get reported on forums dedicated to the issue, then seeing how long it takes for the WHO (and the mainstream media) to catch up. But to have any hope of doing any good, a containment/quarantine/antiviral blanket would have to be implemented before it was known for certain that it was needed; by the time the labs are in, it's not only too late, its way too late. Somebody would have to be willing to act on his gut, and be ready to throw a lot of resources at something that might turn out to be nothing. They're just not going to do that. See the problem?

Time will tell, we hope.
I think one of the few absolute guarantees we have is that time will tell. Whatever else, a global pandemic at this time will certainly provide a wealth of infomation about the virology and epidemiology of influenza, the effectiveness of various treatment strategies, etc. Unfortunately, as is so often the case with many other things, the test comes first, and the lesson afterwards.

[CplFerro]

Here's a set of articles on this bird flu business, from a futuristic pro-nuclear, pro-industrial perspective.

Flu Pandemic Coming
http://www.21stcenturysciencetech.com/Articles%202005/Pandemic.pdf

[Soapy Sam]

It's winter.
People catch flu in winter.

What I need to know is this- before I rewire the flat, put a new kitchen in and buy new carpets- am I wasting my money?

[Dymanic]

It's winter.
People catch flu in winter.
Indeed. That fact is a major contributor to the increased level of concern within the epidemiological community. As the number of human cases of the avian flu increases (among both birds and humans) the opportunities for a hybrid version of the virus to emerge as the result of an exchange of genetic information between different strains increases accordingly. But the Turkey affair involves confirmed cases of Avian Flu, and in clusters which appear to be increasing in both size and frequency. This indicates either that such exchanges have already taken place, or that the virus has stumbled upon better combinations through random mutation.

What I need to know is this- before I rewire the flat, put a new kitchen in and buy new carpets- am I wasting my money?
Seriously, I'd hold off on that at least until I had a supply of food and other necessities tucked away; enough for maybe eight weeks would be nice (if one didn't get fancy, but stuck to staples like beans and rice, it could be done for about the price of a good pair of tennis shoes). If I had that much layed away, I'd still spend the carpet money on stretching my supplies to six months, maybe getting a generator, etc -- hey, could come in handy against disasters not yet even anticipated. But then, my carpets are pretty new. Just how bad is your old stuff?

[casebro]

The number of mild or asymptomatic cases is one of the known unknowns, and is factored into the models (sure it's possible to do that -- you just have to be ready to accept a range of possible projections)..

Thats the first I've heard of any mild or asymptomatic cases. All we've heard from the media is that "there is a 50% death rate" of those hospitalised. Nobody has given us any stats on actual "mild or asymptomatic cases" or even mentioned that phrase. I've always felt they were conspicuous by their absence. Therein lies my basis for the doom and glooom prophecy being excessive. Do you have any cites for actual numbers of mild or asymptomatic cases ? Any basis for your mention of models?

[Dymanic]

Thats the first I've heard of any mild or asymptomatic cases. All we've heard from the media is that "there is a 50% death rate" of those hospitalised. Nobody has given us any stats on actual "mild or asymptomatic cases" or even mentioned that phrase. I've always felt they were conspicuous by their absence. Therein lies my basis for the doom and glooom prophecy being excessive.Yes, I remember that from our previous discussions. It seems to me that the basis for your view is the assumption that there are significant numbers of such cases. I don't believe that there are (based on my admittedly rudimentary understanding of the mechanics of influenza virology) but the fact that such a possibility exists leads you to conclude that the "doom and glooom prophecy" is excessive suggests that you have yet to fully appreciate the full significance of what you propose. If a strain of H5N1, with an antigen structure enabling it to infect humans asymptomatically, is silently spreading among either human or avian populations, that would be very bad news. One thing that would mean is that it would be even more difficult than it already is for health agencies to identify potential high-risk areas.

Do you have any cites for actual numbers of mild or asymptomatic cases?
I was afraid that explanation wasn't very clear. What I'm saying is that we don't know if there are any mild or asymptomatic cases, or, if there are, how many. But we KNOW that we don't know this. It's a known unknown. See what I mean now?


Any basis for your mention of models?
No, I just pulled that one out of thin air. (http://www.ccs.lanl.gov/ccs5/projects/episims.shtml)

"EpiSims is a tool for simulating the spread of epidemics at the level of individuals in a large urban region, taking into account realistic contact patterns and disease transmission characteristics. It knits together parameterized models for the progress of a disease within a host, transmission between hosts, and contact patterns of the hosts. It provides estimates of both the geographic and demographic distribution of disease as a function of time."

Just one example.

[casebro]

Dynamic, I did do some googling for <subclinical "bird flu">. Lot's of subclinical cases in birds, I guess that's how it spreads. Yes, there are some proven subclinical cases in humans. And one article mentioned tha Japanese re-testing 30 samples out of 80 that the Vietnamese said showed negative. The Japanese came up with 11 positives of the 30. Outcome of the 80 was not mentioned. Wouldn't 25 more cases in one cluster have a significant effect on the stats? Isn't it about time for the WHO do antibody tests on a whole village - say, Van in Turkey, to get a better indicator of it's mortality rate? Otherwise, it seems their 'models' are using numbers pulled out of their donkeys.

[Dymanic]

I did do some googling for <subclinical "bird flu">. Lot's of subclinical cases in birds, I guess that's how it spreads.
Yep. Affects different bird populations differently. Some places, local populations of some species have been nearly wiped out, while others keep winging their way happily across the sky, shedding virus, but completely asymptomatic themselves. As far as I can tell, the birds that dropped the virus off in Turkey are headed for Africa next. [Shudder].

And one article mentioned that Japanese re-testing 30 samples out of 80 that the Vietnamese said showed negative. The Japanese came up with 11 positives of the 30.
Same thing in Turkey. Some of the first tests were false negatives; subsequent tests performed by specialized WHO labs were positive. I'm not sure if that's an artifact of the testing methods used, or if it has something to do with the stage of the infection at which the tests are performed. I got some meatworld stuff to do today; help me research that, willya?

Isn't it about time for the WHO do antibody tests on a whole village - say, Van in Turkey, to get a better indicator of it's mortality rate?
I'm with you on this 100%.*

*ETA: by the way, the WHO team that was on the way to Turkey? Stuck on the ground due to fog.

[Dymanic]

Same thing in Turkey. Some of the first tests were false negatives; subsequent tests performed by specialized WHO labs were positive. I'm not sure if that's an artifact of the testing methods used, or if it has something to do with the stage of the infection at which the tests are performed. I got some meatworld stuff to do today; help me research that, willya?
Never mind, I got it. (http://www.recombinomics.com/News/12060501/H2H_H5N1_Efficient_Indonesia.html)

"The collection procedure plays are large role in the creation of lab confirmed cases. Indonesia, like most countries in Asia collects samples for testing at an infectious diseases hospital. Cases initially go to primary care facilities were samples are not collected for H5N1 testing. By the time the patient is transferred to the infectious disease hospital, the H5N1 has been cleared from the nose and throat, so the swabs are collected too late. Similarly, antibody levels peak at around 30 days post symptoms, so serum collections at 1-3 weeks are too early for antibody collection. Instead the samples are too late for PCR but too early for antibody. The samples are however "Goldilocks" collections which are just right for false negatives."

Near the bottom of that page is this bit, which makes reference to "milder cases":

"Thus, suggestions that the next pandemic may not involve H5N1 or that the pandemic is years away, fails to address the dramatic increase in efficiency of human-to-human transmission of H5n1, especially in milder cases such as those in Indonesia."

Still digging into that.

Is this the article about false negatives you were looking at? (http://www.recombinomics.com/News/03150502/H5N1_Negative_78.html)

[casebro]

Never mind, I got it. (http://www.recombinomics.com/News/12060501/H2H_H5N1_Efficient_Indonesia.html)

Near the bottom of that page is this bit, which makes reference to "milder cases":

"Thus, suggestions that the next pandemic may not involve H5N1 or that the pandemic is years away, fails to address the dramatic increase in efficiency of human-to-human transmission of H5n1, especially in milder cases such as those in Indonesia."

Still digging into that.

Is this the article about false negatives you were looking at? (http://www.recombinomics.com/News/03150502/H5N1_Negative_78.html)

That's the site I had found, but a different cite.

I like this closing line "The monitoring of bird flu remains scandalously poor."

Couldn't the rising numbers of subclinical cases possibly lower the mortality rate to that of other flus? Making the whole issue yet another "Boy Who Cried Wolf" ? What if every city that has ducks flying over and dropping WMDs, has already achieved some measure of immunity? We wouldnt learn that without better monitoring.

[Dymanic]

Couldn't the rising numbers of subclinical cases possibly lower the mortality rate to that of other flus?
Sure. And results of clinical studies indicating that homeopathic remedies are effective over placebo could raise the practice to the level of real medicine. The problem is, there aren't any. Anyway, do the math. You'd be talking about a LOT of subclinical cases. But it isn't just that; your eagerness to dismiss the threat appears to lead you into attributing a lot of weight to an idea for which there is not only a lack of evidence, but which is also difficult to support from a standpoint of the basic virology. You're taking a statement like: "The monitoring of bird flu remains scandalously poor", and trying to spin that up to sound like good news. It isn't. Frankly, taking optimism to that level strikes me as dangerously irrational. I hope you aren't an airline mechanic or something.

You seem still to be trying to apply what you think you know about seasonal flu to pandemic flu; you are (understandably) applying a top-down, common-sense approach, hoping to obtain an intuitive working understanding that will allow you to make reasonably informed decisions. Unfortunately, unless you are willing to accept the opinions of those who have made these matters their life's work -- and among whom is currently a very strong concensus on this -- then your only real hope lies in getting down with some of the details yourself (the actually relevant details, rather than those you think are the relevant ones).

I'd recommend starting here. (http://www.fluwikie.com/index.php?n=Science.InfluenzaPrimerII) And I'd focus on the part about receptor binding specificities. That is where your best hope lies of grasping the significance of a new subtype (versus a new strain, as with seasonal flu). That's really what all the fuss is about.

Making the whole issue yet another "Boy Who Cried Wolf"?
My response to that hasn't changed. In the first place, in the version of that story that I remember, the boy ended up being eaten by a real, live wolf; the fact that he sounded false alarms didn't change that. In the second place, I think you are still confusing what is coming from mainstream media and other sources outside the scientific community with what is coming from inside the scientific community.

[casebro]

I admit all of that. But without an overall hospitalisation rate, the death rate of those hospitalised is meaningless. Kind of like the "flesh eating bacteria", which is ubiquitous, but does occassionally kill or maim- but no big apocalyptic epidemic.

Without some kind of realistic count of subclinical cases, there can be no realistic estimate of mortality. I don't think there is yet enough stats to base the alarms on. I guess I'm a skeptic.

[Dymanic]

without an overall hospitalisation rate, the death rate of those hospitalised is meaningless
To you.

There are at least two rather different perspectives from which such numbers might be (and are) considered meaningful by those trained in the relevant fields. For a virologist, the high mortality rate -- among not only clinical human cases but among bird populations as well -- is very significant. The comparative pathology of a flu virus begins with the broad classification: "high pathogenicity" (for an avian strain this would be abbreviated: "HPAI", or "highly pathogenic avian influenza) or "low pathogenicity" (LPAI). For an epidemiologist, the clinical mortality rate would play an important role in the development of the models used to project the way a particular infectious agent might spread, and how it might impact healthcare facilities, communities, and populations.

Kind of like the "flesh eating bacteria", which is ubiquitous, but does occassionally kill or maim- but no big apocalyptic epidemic.
Nothing like that at all. Ebola, West Nile, Yellow fever -- name as many as you like; there currently is no pathogen with the same potential to impact humans; not even close. That's precisely what all the fuss is about.

Without some kind of realistic count of subclinical cases, there can be no realistic estimate of mortality.
If, by "realistic estimate" you mean "perfect prediction", then no. Even if there were, there wouldn't be. Until an actual pandemic strain emerges, there is no way to do that. It is possible, however, to make estimates -- in much the same sense that it is possible to make estimates regarding the future strength and path of a hurricane. The models used to make such estimates involve many unknowns, but that doesn't mean that the people who do that work are "using numbers pulled out of their donkeys", either; for one thing, they rely heavily on the assumption that observations from previous hurricanes offer a realistic guideline, and have a proven track record of successes using such methods. Katrina was a good example; NOLA residents were given plenty of time to prepare (evacuate, whatever).

I guess I'm a skeptic.
In the same sense that those who chose to ignore hurricane warnings and remain in New Orleans as Katrina approached were 'skeptics', yes.

[casebro]

"offer a realistic guideline, and have a proven track record of successes using such methods. "

Name some epidemics that these people have successfully predicted, like um Ebola, SARS,anthrax,swine flu,overpopulation, the coming ice age, AGW........

Doesn't "The monitoring of bird flu remains scandalously poor." conflict a little with "It is possible, however, to make estimates" ?

[Dymanic]

Name some epidemics that these people have successfully predicted.
Back up. I've seen your arm-waving, now I'd like to see your argument. We know more about the virology of influenza than at any previous point in history -- but let's continue to ignore that for the moment, and look only at the viability of using data from previous pandemics as a guideline. You obviously feel that past pandemics do NOT offer a realistic guideline; can you offer anything at all to support that, or is it just another feeling you have?

[casebro]

Back up. I've seen your arm-waving, now I'd like to see your argument. We know more about the virology of influenza than at any previous point in history -- but let's continue to ignore that for the moment, and look only at the viability of using data from previous pandemics as a guideline. You obviously feel that past pandemics do NOT offer a realistic guideline; can you offer anything at all to support that, or is it just another feeling you have?

You are the boy crying wolf here. I'm just pointing out deficiencies in your early warning system. And asking about your track record.

I guess you are saying that our knowledge of epidemiology has greatly improved since all those other predictions of gloom? Prove it with some examples, please. Even something as negative as something like " there is an outbreak of sagging armpits in the Jref community, but it is not expected to spread beyond Skeptics.com". Seems every 'epidemic' has to be predicted to have major impact on the whole world.

[Dymanic]

Been watching the news the last week or so by any chance?

New cases of humans infected with avian flu in Turkey are emerging on practically an hourly basis. As I've been saying, there are many unknowns, but one thing that is crystal clear is that we are seeing a sharp increase in both the size and frequency of clusters. The virus has evolved an increased ability to infect humans; it is no longer subject to much dispute. This is perfectly consistent with what the virologists/epidemiologists have been predicting.

[luchog]

Been watching the news the last week or so by any chance?

New cases of humans infected with avian flu in Turkey are emerging on practically an hourly basis. As I've been saying, there are many unknowns, but one thing that is crystal clear is that we are seeing a sharp increase in both the size and frequency of clusters. The virus has evolved an increased ability to infect humans; it is no longer subject to much dispute. This is perfectly consistent with what the virologists/epidemiologists have been predicting.
Do you have a reference for H2H transmissibility? I couldn't find anything recent on Google that verified it.

[Dymanic]

Do you have a reference for H2H transmissibility? I couldn't find anything recent on Google that verified it.
First cases in Turkey were hospitalized on January first. Exact dates those patients first became ill are not clear. There is uncertainty about the incubation time for H5N1; some indications it may be somewhat longer than with seasonal flu, possibly as long as nine days. Hospital personel were not likely to have taken great precautions with the earliest cases, so if the virus is already capable of efficient H2H transmissibility, we should see new cases emerging among those workers by about now.

WHO says no H2H in Turkey (http://mobile.alertnet.org/thenews/newsdesk/IRIN/b10e50a3cd5bbbbd64dfcad1745fab24.htm)
"ANKARA, 9 January (IRIN) - World Health Organization (WHO) officials said on Monday that the 14 people confirmed with avian flu contracted the deadly disease through contact with infected animals rather than infected humans."

As I have stated already, more efficient B2H is bad. Not as bad as H2H, but BAD.

[luchog]

As I have stated already, more efficient B2H is bad. Not as bad as H2H, but BAD.
Bad, yes; but it does mean that communicability is going to be much lower; and epidemics will be limited predominantly to Third-World regions. Transmissibility that is limited to physical contact with infected avians strongly reduces the chance of it becoming a major epidemic even there.

[Dymanic]

Bad, yes; but it does mean that communicability is going to be much lower; and epidemics will be limited predominantly to Third-World regions.Right. Where keeping poultry is an important aspect of daily life for many people, and especially where taking the birds indoors during cold weather is a common practice.

Transmissibility that is limited to physical contact with infected avians strongly reduces the chance of it becoming a major epidemic even there.Right. Even there, it isn't going to reach epidemic level until the virus aquires an ability to pass easily between humans. We don't know all that much about what that consists of. The conventional wisdom for some time has placed considerable emphasis on the 'mixing vessel' model, wherein genes are exhanged between different strains in a co-infected host, in relatively large chunks (it's called "reassortment"). Such an event could result in a hybrid with the potential to erupt in a pandemic almost immediately. For most virologists then, an increase in human cases is a concern primarily because it significantly increases the opportunities for such a reassortment event to occur (especially during the regular flu season, with the accompanying increase in numbers of people infected with seasonal strains of flu).

Niman, however, has been trying to make a case for a somewhat different process: recombination (hence: "recombinomics"). Under this model, viral evolution is made even more efficient through a process of 'recycling' of old mutations, with swapping of genetic information taking place within specific genes. Despite the handy tag: "H5N1", we really aren't dealing with a single virus, but with an expanding tree of related viruses, with branches that can 'grow back together' whenever it suits them. What counts most is the receptor binding specificities. One concern is an exchange of genes between an H5N1 strain and an H9N2 strain, and of particular interest is the S227N polymorphism (http://www.recombinomics.com/News/10220501/H5N1_H9N2_Recombination.html) which would make H5N1 infections of humans more efficient.

Within a few days, the results of genetic sequencing (http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/01/10/nbflu110.xml&sSheet=/news/2006/01/10/ixnewstop.html) being done by a British laboratory are expected; hopefully that will shine some light.

[Dymanic]

Without some kind of realistic count of subclinical cases, there can be no realistic estimate of mortality. I don't think there is yet enough stats to base the alarms on.

http://www.iht.com/articles/2006/01/11/news/flu.php

ANKARA Two young brothers, aged 4 and 5, are being closely watched at the gleaming new Kecioren Hospital here, a police car at the entrance guarding a potential scientific treasure. Though both boys have tested positive for the H5N1 virus after contact with sick birds, neither has any symptoms of the frequently deadly disease.

Freebie. Gonna make me argue both sides of this thing? Too busy, or what?

[Melendwyr]

Does anyone else find it amusing that there's an outbreak of bird flu in _Turkey_?

[Dymanic]

Does anyone else find it amusing that there's an outbreak of bird flu in _Turkey_?
It's been done to death. Wasn't really that funny the first time. I put in the same category as "rings around Uranus".

Sorry.

[Capsid]

Does anyone else find it amusing that there's an outbreak of bird flu in _Turkey_?
Yes it is quirky. But Turkey is just how English speakers pronounce Turkiye which I presume means country of the Turks in Turkish. I don't know what Turk means though.

[Dymanic]

Abstract of journal article referenced in the above linked news item
(http://archinte.ama-assn.org/cgi/content/abstract/166/1/119)
"Background The verified human cases of highly pathogenic avian influenza in Vietnam may represent only a selection of the most severely ill patients. The study objective was to analyze the association between flulike illness, defined as cough and fever, and exposure to sick or dead poultry."

"Conclusions Our epidemiological data are consistent with transmission of mild, highly pathogenic avian influenza to humans and suggest that transmission could be more common than anticipated, though close contact seems required. Further microbiological studies are needed to validate these findings."

[ZirconBlue]

Does anyone else find it amusing that there's an outbreak of bird flu in _Turkey_?

I made an admittedly bad joke about it in post #3 of this very thread. I guess I'm not part of "anyone else".

[casebro]

http://www.iht.com/articles/2006/01/11/news/flu.php

ANKARA Two young brothers, aged 4 and 5, are being closely watched at the gleaming new Kecioren Hospital here, a police car at the entrance guarding a potential scientific treasure. Though both boys have tested positive for the H5N1 virus after contact with sick birds, neither has any symptoms of the frequently deadly disease.

Freebie. Gonna make me argue both sides of this thing? Too busy, or what?


There have been other known positves. One or two more is anecdotal. So, we know there are some. Until a whole bunch of folks are tested, like a whole village where the disease has struck, there is no valid basis for models to make a valid prediction of..virulance? Morbidity? Mortality ? rates. If 98% of the populations get a cold, 2% are hospitalised, 50 % of those die, then we have a 1% death rate. Thats about as bad as 1917. Which will cause an inconvenience to most of us. NOT the collapse of modern society as we know it.

About 1% of the population dies in any given year, without the collapse of civilisation. Whats the big hoo-hoo about doubling that?

There seems to be lots of immunity amoungst birds. How come? How come there are such minimal estimates of immunity amounst humans, when we have had lots of human 'bird flus' ?

[Dymanic]

About 1% of the population dies in any given year, without the collapse of civilisation. Whats the big hoo-hoo about doubling that?
As we've noted, the actual numbers will not be available until such time as a pandemic strain actually emerges. In the absence of those numbers, modelling involves plugging in the numbers seen in seasonal flu epidemics as well as in previous pandemics. It's guesswork, but it's educated guesswork, and not much different from methods used to make lots of decisions that involve uncertainties (they don't call it that, of course, they call it "extrapolation").

By definition, a pandemic involves attack rates (percentage of population infected) of 25%-50% (contrasted with 5%-15% for seasonal flu). In a normal flu season about 200,000 Americans are hospitalized, 36,000 of whom die, with an overall mortality rate of 0.008 percent for those infected. Most of the projections I've seen use attack rates of around 35%, and mortality rates of around 2-3% (Spanish flu was about 2.5%).

So:
Conservatively using an attack rate of .3, and a mortality rate of .02, and 6,500,000,000 as the current world population (http://www.census.gov/ipc/www/popclockworld.html) I get 39 million deaths. That look right to you? Want to see how it comes out using .5 and .05? We have no guarantee it won't be closer to that.

But the mortality rate isn't the only thing to consider. The economic and political repercussions of having such enormous numbers of people sick all at the same time are nothing to sneeze at either (so to speak), even if none of them die. Factor in the numbers of people who won't go to work (or to the movies or the restaurant or the basketball game or shopping for new cars or clothes) for fear of catching the virus -- and then take a look at the overall impact. Fifteen people confirmed in Turkey, and Iran closes part of its border; Russia talking about doing the same. I don't think we're looking at a collapse of civilization, but we're looking at a pretty serious hiccup. Even if I don't get sick, I don't know what I'd do if all those boatloads of cool cheap stuff from China stopped arriving at the docks.


How come there are such minimal estimates of immunity amounst humans, when we have had lots of human 'bird flus' ?
It's because no H5 subtype has ever been known to infect humans before.

[Capsid]

Latest Nature commentary (http://www.nature.com/nature/journal/v439/n7073/full/439124a.html); the experts are divided.

[Eos of the Eons]

siblings who were lobbing chicken heads around in the house died of H5N1

http://yahoo.usatoday.com/news/health/2006-01-06-birdfluturkey_x.htm?csp=1"They played with the heads for days," Sahin said. "They were in very, very close contact with the dead chickens."

You don't see that very often, no wonder the bird flu is getting passed from bird to humans in Turkey.

About 170 people in Asia have been infected; half have died...
There is also some evidence that mammals such as pigs which were originally thought to be resistant to avian flu, have also become infected with the H5N1 virus from birds and subsequently might infect human pig handlers through contact. There are 15 different subtypes of H5 avian influenza that spreads among birds. But H5N1 and H7 are the only avian flu virus strains that kill so effectively.


http://www.earthfiles.com/news/news.cfm?ID=1016&category=Environment

50% death rate there.
the WHO has confirmed 144 human cases of H5N1 avian flu, 76 of them fatal.

http://www.theglobeandmail.com/servlet/story/LAC.20060106.HAVIAN06/TPStory

53% There.
I think I will refrain from playing with dead chickens.