Pakistan - BF Suspected Human Cases December 18, 2007 to Feb 2, 2008

[AlaskaDenise]

Re: Pakistan: December 18+, WHO Begins Investigations

Commentary at

http://www.recombinomics.com/News/12...n_Overdue.html

Commentary

WHO H5N1 Situation Update on Pakistan Overdue

Recombinomics Commentary
December 24, 2007

"Since there are no symptoms, no new cases or correlation among these people, they say it's not human-to-human bird flu but maybe bird-to-human," said Maqbool Jan Abbasi, a bird-flu spokesman for Pakistan's Health Ministry.

He said 63 people who were in contact with the nine patients tested negative for the virus and that a final report on the findings would be released next week.

The above comments provide more contexts for the Pakistan Health Ministry denial of evidence for human-to-human transmission of H5N1 in Pakistan, which now appears to be a denial of sustained transmission beyond the family members. Thus, the reasons behind the delay in a WHO situation update and additional testing in London remain unclear.

Media reports had indicated that the initial positives had been confirmed by Pakistani labs over a week ago, and independent confirmation by the NAMRU-3 mobile lab was expected last week. However, instead of issuing a report on confirmed cases detailing age, gender, disease onset dates, hospitalization dates, date of death, and relationship to other confirmed or suspect cases in Pakistan, WHO said samples were being sent to London for more information.

The dates of disease onset for the index case, October 25, coupled with the dates of death of two of his brothers, November 19 and 29, plus comments that the most recent case was on December 6, suggested that the transmission chain was among the longest record for H5N1. The likelihood that receptor binding domain changes were present in the sequences from patients in the clusters was likely, and samples in London could be used to see how such changes affected the affinity of the H5N1 for human receptors.

Similarly, samples may have been sent to either get more sequence data, or test contact samples, which may have had lower levels of H5N1 because some or most of the samples were collected after the start of Tamiflu treatment.

The two month delay between disease onset and a report with some specific on the confirmed cases increases pandemic concerns.

A situation update with specifics as well as sequence data, would be useful.


.

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Government still probing deaths from bird flu
ISLAMABAD: The Health Ministry said on Monday that it was still investigating whether there was human transmission in the country?s first death from bird flu. It said initial tests by the World Health Organisation (WHO), which sent a team here last week, had ruled it out, adding that Pakistan had sent blood samples to Geneva ? the WHOO?s headquarters ? for further confirmation.. Health Ministry spokesman Oriya Maqbool Jan said the WHO had ruled out the possibility of human transmission of bird flu but the ministry had forwarded blood samples of the people suspected of being infected to Geneva for further testing. Scientists fear that if the virus were passed from one person to another, rather than from infected birds, it might indicate a mutation that could lead to a global pandemic. Jan said that the WHO team had been sent to the NWFP areas along the Afghanistan border after the death of one of six people infected with the deadly H5N1 strain of the avian influenza virus. He said that a brother of the deceased also died before being tested for the virus. ?Both had worked on a cull of infected poultry,? he said. Separately, Animal Husbandry Commissioner Rafiqal Hasan Usmani said that no new bird flu outbreak had been reported from anywhere in the country. He said that the bird flu-related situation was being closely monitored. Usmani said that the H5N1 strain of bird flu had killed more than 200 people worldwide, mostly in Southeast Asia, since late 2003. staff report

http://www.dailytimes.com.pk/default.asp?page=2007\12\25\story_25-12-2007_pg7_41

[AlaskaDenise]

Re: Pakistan: December 18+, WHO Begins Investigations

<TABLE><TBODY><TR><TD>

H5N1 virus threat | Call to promote frozen chicken markets

</TD></TR><TR><TD>
</TD></TR><TR><TD>Nazia Hameed
</TD></TR><TR><TD>ISLAMABAD: Government should promote frozen chicken market to avoid threats of H5N1 virus, says Dr Alamdar Hussain Malik, secretary/registrar, Pakistan Veterinary Medical Council, the other day.

He said 2,500 poultry farms were without NOC from the Environment Department and without bio-precautionary measures and 90 percent poultry farms were without boundary walls, adding the poultry farms must avoid wild animals and dogs and vaccinators and workers should be in proper safety dress.

Dr Alameda said the government should establish fund for compensation of poultry farm with in 15 days, adding the present scenario of H5N1 virus in poultry and humans was highly infectious and extremely virulent. "When it comes into contact with chickens and the more infected chickens you get, the higher the chances of the virus being passed on to humans."

He said the poultry workers, sellers, buyers were in danger of getting infected without using precautionary measure. "Avian influenza viruses are subdivided into subtypes based on hemagglutinin (H) and neuraminidase (N) protein spikes from the central virus core.

"There are 16H types, each with up to 9N subtypes, yielding a potential for 144 different hemagglutinin and neuraminidase combinations. In addition, all A1 viruses fall into one of two pathotypes: low (LPAI) and high (HPAI) pathogenicity, based on their virulence in poultry population.

"The influenza virus is a masterful quick-change artist. It changes the outer proteins on its shell, known as antigens, easily. The changes occur because the influenza virus lacks the genetic proofreading ability seen in many more stable viruses."When it makes an error in reproducing its own genetic material, influenza virus passes along these errors to progeny viruses. In this way, even a tiny error becomes permanent-or as permanent as a mutable agent like the flu virus.He said that antigenic shift had happened three times in the last century. What's going on now may be the fourth. On the 16H types known, only subtypes H5, H7 and H9 are known to be capable of crossing the species barrier from birds to humans.

"It is feared that if the avian influenza virus undergoes antigenic shift with a human influenza virus, the new subtype created could be both highly contagious and highly lethal in humans."

On the present status of legislation of poultry in Pakistan, he said the stakeholders of the poultry industry claimed that the poultry was the second largest industry after textile but the Ministry of Food, Agriculture and Livestock and the provincial governments had failed to do anything in this regard.

He said the government should give compensation to poultry farms and promote frozen market, as compared to live markets of poultry.


</TD></TR></TBODY></TABLE>
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[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

<TABLE style="TABLE-LAYOUT: auto" cellSpacing=0 cellPadding=0 width="100&#37;" summary="Main Page Table" border=0><TBODY><TR><TD vAlign=top><TABLE cellSpacing=10 cellPadding=0 summary="Main Content Table" border=0><TBODY><TR><TD vAlign=top align=left colSpan=2>Avian flu deaths reported in Egypt, Indonesia, Vietnam

Dec 26, 2007 (CIDRAP News) – A young woman in Egypt and another of almost the same age in Indonesia died of H5N1 avian influenza yesterday, raising the global H5N1 death toll to 211, the World Health Organization (WHO) said today.
Also, a Vietnamese official said a boy who died recently in northern Vietnam had the H5N1 virus, according to an Associated Press (AP) report published today. The WHO has not yet confirmed his case.
The Egyptian victim was a 25-year-old woman from Bany Suwef governorate, south of Cairo, the WHO said in a statement. She was hospitalized Dec 21 and died yesterday.
The WHO said the source of her infection was under investigation, while Egypt's health ministry, according to a Reuters report published today, said she had had contact with birds thought to be infected.
The Indonesian woman who died was a 24-year-old from West Jakarta municipality who fell ill Dec 14 and was hospitalized Dec 19, the WHO said in a statement. The source of her exposure to the virus is under investigation.
An official at Indonesia's avian flu center said the woman had bought a live chicken at a market and slaughtered it there before taking it home, according to a Reuters report published yesterday. But he said the case was still being investigated.
Indonesia has had 116 cases of H5N1 illness with 94 deaths, while Egypt has had 39 cases and 16 deaths, according to the WHO. The global count is 342 cases.
In Vietnam, testing has confirmed avian flu in a 4-year-old boy from Son La province in the north, according to an AP story quoting Nguyen Huy Nga, director of the health ministry's preventative medicine unit. The boy died Dec 16 in Hanoi after a 5-day illness, the story said.
Son La, about 187 miles northwest of Hanoi, has not had any recent H5N1 outbreaks in poultry, the AP reported.
If the WHO confirms the boy's case, he will be listed as Vietnam's 101st case-patient and 47th fatality.
Indonesian cluster ruled out
In other developments, Indonesian officials reported on Dec 22 that testing had ruled out avian flu in a family cluster of illnesses.
Lab tests excluded H5N1 infections in six members of an Indonesian family who were hospitalized Dec 21 with suspected cases, according to a Dec 22 Reuters report. Their cases had raised concern about possible person-to-person transmission of the virus.
Nyoman Kandun, Indonesia's director-general of communicable disease control, said two sets of laboratory tests on the six patients were negative for H5N1, Reuters reported.
The patients are from a village in Banten province. They fell ill with high fevers after more than a dozen ducks died in their backyard, the story said.
Test results pending in Pakistan
In Pakistan, confirmatory testing was not yet complete for a group of eight patients, including five in one extended family, in whom previous preliminary tests indicated H5N1, a WHO official said today.
John Rainford, a WHO spokesman in Geneva, told CIDRAP News he expected confirmatory test results would probably be released tomorrow. But he said the results of genetic sequencing of the viruses will take longer.
"The sequencing is on a different track [from the confirmatory tests], and that can take a week or possibly longer," Rainford said.
He also said there may be a new suspected H5N1 case in Pakistan, but information so far was very sketchy. The local disease surveillance system is "engaged and ramped up," with the result that flu-like illnesses are more likely to be reported, he noted.
According to previous reports, the Pakistan patients who tested positive included a veterinarian who had helped cull infected chickens, three of his brothers, a cousin, and three other people: a man and his niece who were involved in poultry culling in the same vicinity as the veterinarian, and a farm worker from another town nearby. Another brother of the veterinarian died of an H5N1-like illness but was buried without being tested.
The WHO sent a team to investigate the Pakistan situation last week, and US Navy Medical Research Unit 3 in Cairo sent a portable lab. The cases occurred in northern Pakistan, not far from the Afghan border.
The WHO's Keiji Fukuda said last week that the Pakistan cases probably represent a mixture of poultry-to-human cases and human-to-human transmission arising from close contact when people cared for sick relatives. The WHO has said there has been no evidence of sustained transmission.
See also:
WHO statement on Egyptian case
http://www.who.int/csr/don/2007_12_26a/en/index.html
WHO statement on Indonesian case
http://www.who.int/csr/don/2007_12_26/en/index.html
WHO case count


</TD></TR></TBODY></TABLE></TD><!-- end MAIN CONTENT CELL --></TR><!-- FOOTER --><TR><TD colSpan=9><TABLE cellSpacing=0 cellPadding=0 width="100%" summary=Footer border=0><TBODY><TR><TD class=footer width="100%" background=/cidrap/images/footer_stretch.gif height=9>http://www.cidrap.umn.edu/cidrap/con...2607avian.html</TD></TR></TBODY></TABLE>

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[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Commentary at

http://www.recombinomics.com/News/12270701/H5N1_Pakistan_Suspect.html

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

KARACHI: ?No bird flu in Sindh poultry?



<CENTER>By Mukhtar Alam</CENTER>
KARACHI, Dec 26: Bird flu has not been found in poultry in Karachi and Sindh during the current winter but there is a continued need to remain on high alert, said health, agriculture and livestock officials of the Karachi district and the provincial government at a meeting held on Wednesday.

While urging that there was no need for panic, the meeting concluded that efforts must be made to counter the existing communication gap on the H5N1 bird flu virus, said a source privy to the proceedings.

The meeting, convened by the executive district officer (health) of the city district government Karachi (CDGK), came in the wake of Pakistan?s first human death caused by the deadly virus. About a week ago, federal health officials confirmed the death of one of the eight people who had tested positive for the H5N1 bird flu virus in the NWFP since October. It is not yet known whether the latest cases of bird flu in humans were linked to sick birds or were transmitted from human to human.

The CDGK meeting reviewed the city?s preparedness in terms of combating the spread of bird flu, caused by the H5N1 virus and also known as avian influenza or Asian bird flu. Amongst the attendees were EDO health Dr A.D. Sajnani, EDO agriculture Dr Mohan Lal, Director Poultry Ali Akbar Soomro, Dr Aslam Jalali of the provincial livestock department, Dr Aslam Pervez of the CDGK, representatives of the World Health Organisation and the Pakistan Poultry Association, and representatives of poultry farmers.

According to Dr Jalali, poultry samples were being culled and frequently tested in laboratories but no bird flu cases had so far been found in Karachi or Sindh. He said that his department had also conducted tests on backyard poultry and the birds in the big Empress Market shops.

Dr Sajnani pointed out the dearth of communication between the livestock, agriculture and health departments, and the poultry farmers. This was obvious, he said, given that the handlers of public health and hospitals sometimes gained information from the media about a bird flu outbreak. ?Only a timely flow of information can help evolve strategies and effective implementation and counter-measure plans,? he stated.

Some participants also laid emphasis on the need for the CDGK health department to build its capacity in case of the H5N1 virus being transmitted to humans.

Meanwhile, a poultry farmer?s representative said that there was a need to test wild birds, the seasonal migratory birds at Manchar Lake and other water bodies across the province, and the birds housed in zoos and Empress Market.

Mutation fears

The H5N1 virus has been circulating in Asia since 1997 and first appeared in Pakistan around two years ago. Since then, several outbreaks have been reported in various parts of the country, an official told Dawn.

The national poultry disease reference laboratory last confirmed the presence of the virus in Karachi in the first week of April this year. Prior to confirmation from Islamabad, between four and seven thousand birds died of the viral infection while about 28,000 birds were killed at three Gadap town poultry farms, which were then maintained by the farms and provincial livestock department.

At least 208 people have died from the virus. Experts say that in its present form, bird flu is transmitted only through people with some sort of contact with infected birds.

However, scientists are of the opinion that the virus is evolving and could mutate into a form that spreads easily amongst people, which could potentially spark a pandemic. Many countries have stockpiled anti-viral bird flu medicines that could prevent some of the effects of the virus in humans by boosting the body?s immune system.

http://www.dawn.com/2007/12/27/local6.htm

[sharon sanders]

Re: Pakistan: December 18+, WHO Begins Investigations

We are an apolitical site, however, we do follow events as they impact the ability to ascertain disease status. Serious internal turmoil is of interest in this regard.

AP News Service via CNN TV is reporting that she is now dead.


RAWALPINDI. Pakistan (CNN) -- Former Pakistan Prime Minister Benazir Bhutto is said to be critically wounded following a suicide attack on a political rally in Rawalpindi, her husband, Asif Ali Zardari, was quoted as saying on CNN affiliate Geo TV.
<!--startclickprintexclude--> Bhutto is helped from her vehicle following the October 18 suicide attack on her motorcade.




1 of 2






<script type="text/javascript"> var CNN_ArticleChanger = new CNN_imageChanger('cnnImgChngr','/2007/WORLD/asiapcf/12/27/pakistan.sharif/imgChng/p1-0.init.exclude.html',1,1); //CNN.imageChanger.load('cnnImgChngr','imgChng/p1-0.exclude.html'); </script> <!--endclickprintexclude--> The attack has left at least 14 dead and 40 injured, Tariq Azim Khan, former Pakistan information minister, told CNN in a telephone interview.
The bomber is said to have detonated a bomb as he tried to enter the rally where thousands of people gathered to hear Bhutto speak, police said....

http://edition.cnn.com/2007/WORLD/asiapcf/12/27/pakistan.sharif/?iref=hpmostpop

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Location of assasination is about 25 miles from site of October culling.

[sharon sanders]

Re: Pakistan: December 18+, WHO Begins Investigations

One reaction so far.....crude futures up $.70 barrel since killing.

A tough situation for national & international agencies investigating disease.

CORRECTED - US STOCKS-Futures fall after reports Pakistan's Bhutto killed

Thu Dec 27, 2007 8:40am EST
(Corrects prices in second paragraph.) (Updates to show reaction to Bhutto)
NEW YORK, Dec 27 (Reuters) - U.S. stock index futures fell on Thursday, after the Pakistani opposition party said their leader Benazir Bhutto was killed.
S&P 500 futures SPc1 were down 6.10 point, below fair value, a mathematical formula that evaluates pricing by taking into account interest rates, dividends and time to expiration on the contract. Dow Jones industrial average futures DJc1 fell 58 points. Nasdaq 100 NDc1 futures were down 8 points.

http://www.reuters.com/articlePrint?articleId=USN2739328720071227

[Johnny Yuma]

Re: Pakistan: December 18+, WHO Begins Investigations

Here's my reaction:

SORROW, OUTRAGE, AND ACHING FOR PEACE.



This article tells what others are concerned about, a TRUE GREED TRIBUTE:


Gold and bonds rise after Bhutto death
Thu Dec 27, 2007 2:13pm GMT

LONDON (Reuters) - Gold and government bonds rose while U.S. stock futures fell on Thursday after news Pakistani opposition leader Benazir Bhutto was killed in a gun and bomb attack after a rally in the city of Rawalpindi.

Financial market moves accelerated after weaker-than-expected U.S. economic data released shortly after the news. Data showed new orders for long-lasting U.S.-made manufactured goods rose by a much less-than-expected 0.1 percent during November.

Gold rallied to a one-month high, reaching $834.70 an ounce.

Analysts say the shock of the Bhutto news triggered a classic capital flight to assets which are considered as safe havens in times of geopolitical stress.

"(Bhutto) is just a concern. The move to gold is the flight to safety and quality on the headlines on a quiet illiquid day," said Camilla Sutton, currency strategist at Scotia Capital in Toronto.

U.S. government bond prices were up 78 ticks for a yield of 4.1872 percent. Euro zone government bond prices also rose after the Bhutto news and U.S. data, paring earlier losses to standing slightly down on the day.

U.S. stock futures were down around 0.3 percent, indicating a weaker open on Wall Street later.

World stocks, on a MSCI measure, were up a quarter percent on the day.

(Reporting by Natsuko Waki)

http://uk.reuters.com/article/businessNews/idUKL2770807220071227

[Johnny Yuma]

Re: Pakistan: December 18+, WHO Begins Investigations

Here's the winner of the NO BRAINER HEADLINE AWARD for 2007:



Bhutto assassination could bring outbreak of violence

Associated Press - December 27, 2007 9:33 AM ET

RAWALPINDI, Pakistan (AP) - There are fears that Pakistan could erupt in violence, after the assassination of opposition leader Benazir Bhutto.

Aides say she was shot in the neck and chest by an attacker who then blew himself up. The attack took place as Bhutto left a rally where she had addressed thousands of supporters in the city of Rawalpindi.

At least 20 other people were killed in the explosion.

A member of Bhutto's party who was at the hospital where she was taken confirmed her death. Bhutto's supporters exploded in anger, smashing the glass door at the main entrance of the emergency unit. Others burst into tears. Some began chanting that President Pervez Musharraf is a "killer." A few people outside began stoning cars.

The death of the charismatic former prime minister throws the campaign for next month's election into chaos.

Bhutto, who twice served as Pakistan's prime minister, had returned there from an 8-year exile in October. Her homecoming parade was also targeted by a suicide attacker, who killed more than 140 people.

Copyright 2007 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

http://www.whotv.com/Global/story.asp?S=7546739&nav=menu100_2

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

http://www.who.int/csr/don/2007_12_27/en/index.html

Avian influenza ? situation in Pakistan - update

27 December 2007
The first case of human infection with H5N1 avian influenza has been confirmed in Pakistan. Laboratory tests conducted by the WHO H5 Reference Laboratory in Cairo, Egypt and WHO Collaborating Center for Reference and Research on Influenza, in London, United Kingdom have confirmed the presence of avian influenza virus strain A(H5N1) in samples collected from one case in an affected family. Additional laboratory analysis, including gene sequencing, is ongoing.
At the request of the Pakistan Government, a WHO team traveled to Pakistan to participate with national authorities in the ongoing investigations of several suspected cases of human H5N1 infections. The following conclusions have been made accordingly:

• The preliminary risk assessment found no evidence of sustained or community human to human transmission.
• All identified close contacts including the other members of the affected family and involved health care workers remain asymptomatic and have been removed from close medical observation.

The Ministry of Health in Pakistan has taken timely steps to investigate and contain this event including case isolation, contact tracing and monitoring, detailed epidemiological investigations, increasing the availability of personal protective equipment, dedicating hospital facilities for any new suspected cases, and other infection control measures. In addition, agricultural authorities, including the Ministry of Food, Agriculture and Livestock and FAO, have been active technical partners for the effective control of this limited outbreak.

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Commentary at

http://www.recombinomics.com/News/12270704/H5N1_Pakistan_Turmoil.html

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

Commetary at

http://www.recombinomics.com/News/12270705/H5N1_Pakistan_WHO_Vague.html

[HenryN]

Re: Pakistan: December 18+, WHO Begins Investigations

WHO confirms human-to-human birdflu case <!-- END HEADLINE -->
<!-- BEGIN STORY BODY -->22 minutes ago


The World Health Organization (WHO) confirmed on Thursday a single case of human-to-human transmission of the H5N1 bird flu virus in a family in Pakistan but said there was no apparent risk of it spreading wider.
A statement from the U.N. agency said tests in its special laboratories in Cairo and London had established the "human infection" through presence of the virus "collected from one case in an affected family."
But it said a WHO team invited to Pakistan to look into an outbreak involving up to nine people, from late October to December 6 had found no evidence of sustained or community human-to-human transmission.
No identified close contacts of the people infected, including health workers and other members of the affected family, had shown any symptoms and they had all been removed from medical observation, the WHO added.
The outbreak followed a culling of infected chickens in the Peshawar region, in which a veterinary doctor was involved. Subsequently he and three of his brothers developed proven or suspected pneumonia.
The brothers cared for one another and had close personal contact both at home and in the hospital, a WHO spokesman in Geneva said. One of them, who was not involved in the culling, died on November 23.
His was the human-to-human transmission case confirmed by the WHO. The others all recovered.
"All the evidence suggests that the outbreak within this family does not pose a broader risk," the WHO spokesman told Reuters. "But there is already heightened surveillance and there is a need for ongoing vigilance."
It was the first human-to-human case of H5N1 transmission in Pakistan, while others have been confirmed in Indonesia and Thailand in similar circumstances of what the WHO calls close contacts in a very circumscribed area.
Global health experts fear the virus -- which has killed 211 people out of 343 infections reported since 2003 -- could mutate into a form that spreads easily from one person to another, possibly triggering a pandemic that could kill millions.
(Writing by Robert Evans)

http://news.yahoo.com/s/nm/20071227/hl_nm/birdflu_pakistan_dc&printer=1;_ylt=Aojme1yRazdrSNd5O1MSTOsR.3QA