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

[HenryN]

AVIAN INFLUENZA, HUMAN (172): CHINA, PAKISTAN
*********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Fri 21 Dec 2007
Source: EARTHtimes.org, DPA report [edited]
<http://www.earthtimes.org/articles/show/162668.html>


The World Health Organization (WHO) said on Friday [21 Dec 2007] that it
was impossible to say whether a case of bird flu in China in a 52 year old
man was due to human-to-human transmission, but, even if it was, it was
down to very close contact between the victims. The assistant
director-general for health security at WHO, Dr David Heymann, said the
only proven transmission of this nature so far, in Indonesia and Thailand,
had been as a result of very "close contact" in a "very circumscribed area".

WHO was still awaiting final tests results for a recent cluster of cases in
the north west region of Pakistan. The team of WHO experts, who traveled to
the area earlier this week, believed though that the 1st ever human cases
in the country were again a result of intimate contact. Heymann said the
virus could, on "occasional instances, be transmitted" between humans but
that it was not transmittable like influenza with a sneeze. "It's not that
kind of transmission".

In China, both the man and his 24 year old son, who died on 2 Dec 2007, had
been exposed to the same common source. Infection had also occurred during
the incubation period. There had also been close contact with another 600
people, but blood tests had confirmed they were free from the virus.
Heymann said: "Even if there had been human-to-human transmission, it was
limited and did not continue. It was not sustained, and it's that which is
very important."

However, though the H5N1 strain of bird flu has not jumped the species
barrier in a way that would cause a major outbreak so far, the scientific
community remains convinced there is a real possibility of an influenza
pandemic in the future, but it cannot say whether H5N1 will be the source
or another flu variant.

--
communicated by:
ProMED-mail rapporteur Mary Marshall

******
[2]
Date: Fri 21 Dec 2007
Source: Associated Press report [edited]
<http://malaysia.news.yahoo.com/ap/20071221/tap-as-gen-pakistan-bird-flu-1st-
ld-writ-d3b07b8.html>


Limited human-to-human bird flu transmission may have occurred in Pakistan,
but no new infections have been reported for 2 weeks, and there appears to
be no threat of further spread, a top World Health Organization official
said on Fri 21 Dec 2007. A WHO team has finished its initial investigation
in Pakistan after up to 9 patients, including several family members, were
suspected of being infected with the H5N1 bird flu virus in areas north of
Islamabad. They were the country's 1st reported human cases.

The experts were expected back in Geneva to begin piecing together how the
virus may have spread, but they found no evidence of anyone currently
sickened by the virus, Dr David Heymann, WHO's top flu official in Geneva,
told The Associated Press by telephone. "I think the team right now feels
on initial analysis that this might be a small chain of human-to-human,
non-sustained transmission," he said, stressing that there was no cause for
alarm. He said the last reported case was on 6 Dec 2007. Pakistani health
officials have conducted initial testing on the samples and found them to
be positive, but WHO has sent the specimens to one of its collaborating
laboratories for confirmation.

At least 209 people have died worldwide from the virus, which began
plaguing Asian poultry stocks in late 2003. It remains hard for people to
catch, but scientists worry it could mutate into a form that spreads easily
among people, potentially sparking a pandemic. Most cases have been linked
to contact with infected birds, but scientists believe limited
human-to-human transmission has occurred a few times before among blood
relatives who had close contact.

Five brothers were sickened last month [November 2007] in the small city of
Abbotabad, about 50 km (30 miles) north of Islamabad. One was a
veterinarian who was involved in slaughtering sick poultry infected with
bird flu. Two of his brothers fell ill and died, one of whom was buried
before tests were conducted. The veterinarian and his other 2 brothers
recovered. Up to 5 other people in the same area also tested positive for
the virus in preliminary tests.

Heymann said no one knows when a pandemic will occur or what virus will
start it, but countries need to be prepared to take action. "The more it
reproduces, whether it's in humans or chickens, the more likely it is that
there will be an event that will occur that causes it," he said. "We just
have to wait to see what's going to happen."

Meanwhile, Indonesia, which is the world's hardest-hit country with 93
human deaths, also reported on Friday [21 Dec 2007] that 5 people from an
extended family had been hospitalized with flu-like symptoms in an area
where bird flu was earlier reported in poultry. Specimens have been taken
to determine whether any of the relatives were infected with the H5N1
virus. Myanmar reported its 1st human case last week, and a number of other
countries have recently reported poultry outbreaks during the winter
months, when the virus typically flares.

[byline: Margie Mason]

--
communicated by:
ProMED-mail rapporteur Mary Marshall

[These 2 reports indicate that the recent outbreaks in China and Pakistan
have not spread. Limited human-to-human transmission cannot be excluded in
either of these recent incidents, but if it occurs, it appears to be
restricted to blood relatives, suggesting that innate genetic
susceptibility is still the main predisposing factor.

As yet, none of the H5N1-positive cases in Pakistan has been confirmed by
an independent WHO reference laboratory. A significant factor in the
Pakistan outbreak may be that the index case has been identified as a
veterinarian (and one of the group of 5 brothers) employed in the culling
of infected poultry. - Mod.CP]

[see also:
Avian influenza, human (159): China (Jiangsu), WHO 20071211.3987
Avian influenza, human (171): Pakistan 20071220.4089
Avian influenza, human (169): Pakistan 20071218.4072
Avian influenza, human (168): Pakistan 20071217.4059
Avian influenza, human (167): Pakistan 20071216.4049
Avian influenza, human (166): Pakistan, WHO 20071215.4038
Avian influenza, human (165): Pakistan 20071214.4023
Avian influenza, human (163): Pakistan 1st report 20071213.4008]

................cp/msp/sh

[Commonground]

So this is etched in stone, as the "word" from WHO. Right?
@ 11:44:

Nine people, including five brothers, became infected with the H5N1 bird flu virus in a small town north of Islamabad. One was a veterinarian involved in culling sick poultry. Two of his brothers fell ill and died. The veterinarian and his other two brothers subsequently recovered.

Edit: Sorry didn't see the following post:

WHO was still awaiting final tests results for a recent cluster of cases in
the north west region of Pakistan.

[HenryN]

ISLAMABAD: World Health Organization (WHO) has said that there was no threat of further spreading of bird flu virus in Pakistan, presently, as no new case came to the fore during the past two weeks. WHO team has completed its initial investigation about the bird flu in Pakistan. This team was dispatched to Pakistan on the information of the existence of nine persons infected by bird flu. This is for the first time in Pakistan that the human bird flu case has come to the fore. WHO high official in Geneva, Dr. David told that the team after the initial investigation was of the view that there might have been few cases of human-to-human bird flu transmission incidents in Pakistan, but no new case during the previous two weeks came to the fore and, therefore, there was no threat of further spreading of bird flu virus in Pakistan, presently. He said that the last bird flu case was reported on December 6. The officials had got the suspected patients laboratory tested, which were found positive, but the WHO has sent the samples for test in its laboratory for certification.

http://www.pakistanlink.com/Headlines/Dec07/22/05.htm

[HenryN]

Commentary at

http://www.recombinomics.com/News/12...H2H_Comps.html

[AlaskaDenise]

Originally Posted by niman

Commentary at

http://www.recombinomics.com/News/12...H2H_Comps.html

Commentary

H5N1 Human to Human Transmission Comparison

Recombinomics Commentary
December 22, 2007

Doctor Heymann says an analysis of the information is not yet complete. But preliminary results indicate there was human-to-human transmission of the virus. He says there could have been a common source of the infection.
"The team feels, we have not seen all their evidence yet, but they feel that this could be an instance of close contact of human-to-human transmission in a very circumscribed area and not sustained," he explained. "Just like happened in Indonesia and in Thailand."

The above comments reference the clusters in Indonesia and Thailand, which have been called proven human to human transmission (H2H) in other media reports, but really are only slightly more "proven" than the dozens of other H5N1 H2H clusters.

The cluster in Thailand was somewhat unusual because the mother of the index case was an office worker and did not have exposure to poultry. She had close contact with her daughter after hospitalization, and then developed symptoms after her daughter died. The index case's aunt also was infected, and the cluster might have been H2H2H, but the New England Journal of Medicine report focused on transmissions from the index case, and discounted the scenario where the index case infected her mother and her mother infected her aunt. The index case was never tested for H5N1 because she was misdiagnosed as having dengue fever, but the cluster was characterized as the first proven case of H5N1 H2H transmission.

The cluster in Karo, Indonesia was larger and had two time gaps indicating H2H2H. The source of the infection of the index case was unknown, but her condition deteriorated just the day before a family barbeque and many blood relatives slept in the same small room with the index case. They developed symptoms within a day or two of each other, and the final case was the son of one of the family members infected by the index case. Once again the index case wasn't tested before she died, but the family members were H5N1 positive and all but one died.

However, the differences between these clusters and the dozens of other clusters were minor. Other clusters did not involve an obvious source, had significant time gaps between the disease onset dates, and had contact between the index case and infected family members.

Thus, the evidence for H2H in most of the other clusters was similar to that for the two cited clusters. The cited clusters did not have obvious genetic changes in the H5N1 sequences.

However, many of the clusters associated with the Qinghai strain did have receptor binding domain changes, and the Pakistan cluster almost certainly involves the Qinghai strain. Thus, a comparison with those clusters would be more appropropriate. In Turkey and Azerbaijan there were multiple clusters that developed at the same time, as was seen in media reports of the Pakistan outbreak. These Qinghai outbreaks also had receptor binding domain changes in the H5N1 isolates from the cluster members. Therefore comparison with those clusters would seem to be more appropriate.

In Turkey, the locations of the clusters was concentrated in eastern Turkey, but was not limited to one geographic location. The same pattern was seen in the Azerbaijan clusters. In Iraq, there was only one official cluster, but media reports raised questions about additional clusters. Sample collection in Iraq was less than ideal, and the one cluster may have not have been unique.

Media reports indicate that new infections in Pakistan have not been found since December 6. However, there is no situation update with specifics, and comments have already been made about infections being mild. Detection of mild cases has been difficult because of similarities with other respiratory diseases, coupled with limited testing and application of Tamiflu blankets.

Media reports indicate this outbreak has been sustained for the longest period reported to date, and the delay in release in a situation update following confirmed H5N1 clusters is without precedent.

The first case was reported have been exposed two months ago, lab confirmed almost two months ago, and reconfirmed a week ago.

These extensive delays remain cause for concern.

.

[HenryN]

Commentary at

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

[HenryN]

Pakistan still probing human transmission in bird flu: ministry
1 hour, 1 minute ago


Pakistan's health ministry said it was still investigating whether there was human transmission in the country's first death from bird flu.
It said initials tests by the World Health Organisation (WHO), which sent a team here last week, had ruled it out but that Pakistan had sent samples to Geneva -- the WHO's headquarters -- for further confirmation.
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 with the potential to kill millions.
"In their preliminary tests the WHO team excluded suspected human-to-human transmission, but we have sent the samples to Geneva for further confirmation," health ministry spokesman Oriya Maqbool Jan told AFP.
The WHO team was sent after the ministry announced the death of a man who was one of six people infected with the deadly H5N1 strain of the avian influenza virus in North West Frontier Province along the Afghanistan border.
A brother of the victim also died before being tested for the virus. Both had worked on a cull of infected poultry.
"We have been very closely monitoring the situation," said Rafiqal Hasan Usmani, the animal husbandry commissioner. "There has been no new outbreak."
The H5N1 strain of bird flu has killed more than 200 people worldwide, mostly in Southeast Asia, since late 2003.

http://news.yahoo.com/s/afp/20071224...4DUVbLZnnuOrgF

[HenryN]

Commentary at

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

[HenryN]

WHO says human-to-human bird-flu transmission unlikely in Pakistan Posted on : 2007-12-24 | Author : DPA News Category : Health Islamabad - The World Health Organization (WHO) has all but ruled out human-to-human transmission of avian influenza among nine Pakistanis who contracted the virus last month, one of whom became the country's first bird-flu fatality, a health official said Monday. While retests of blood samples were still to be conducted at a WHO laboratory in Geneva, investigators who were in Islamabad last week said they did not believe H5N1, the strain of avian influenza that can be deadly in humans, was passed among the nine people in the North-West Frontier Province, six of whom are blood relatives. "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 cases began in late November when a man involved in the culling of suspected sick birds outside the city of Peshawar contracted bird flu, followed by one of his brothers who later died from the virus. http://www.earthtimes.org/articles/show/163757.html# Human-to-human transmission is extremely rare but has occurred among family members in Indonesia and Thailand. Last week, WHO said it could not confirm a feared human-to-human transmission involving a 52-year-old man in China. There have been multiple bird-flu outbreaks among Pakistan's poultry population since 2006, but there had never been a human case until last month. Globally, bird flu has killed at least 210 people worldwide since 2003. Most human cases of H5N1 are linked to contact with infected birds, but experts fear the virus might mutate into a form that spreads easily among humans, potentially sparking a pandemic that could kill millions of people.

[HenryN]

Commentary at

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

[sharon sanders]

Originally Posted by niman

Commentary at

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

This is the last situation update by WHO dated Dec. 15th 2007:

Avian influenza – situation in Pakistan


15 December 2007
The Ministry of Health in Pakistan has informed WHO of 8 suspected human cases of H5N1 avian influenza infection in the Peshawar area of the country. These cases were detected following a series of culling operations in response to outbreaks of H5N1 in poultry. One of the cases has now recovered and a further two suspected cases have since died.
Samples taken from the suspected cases have tested positive for H5N1 in the national laboratory and are being forwarded to a WHO H5 Reference Laboratory for confirmation and further analysis. The MoH is taking steps to investigate and contain this event, including case isolation and contact tracing and monitoring, detailed epidemiological investigations, providing oseltamivir for case management and prophylaxis, reviewing hospital infection control measures and enhancing health care-based and community-based surveillance for acute respiratory infections.
WHO is providing technical support to the MoH in epidemiological investigations, reviewing the surveillance, prevention and control measures that have been implemented and carrying out viral sequencing of avian and human isolates.
Multiple poultry outbreaks of H5N1 influenza have been occurring in Pakistan since 2006. In 2007, there have also been outbreaks in wild birds. A majority of the outbreaks discovered have been in the ‘poultry belt’ of North-West Frontier Province, particularly in the Abbottabad and Mansehra area and cases of infection in wild birds have been identified in the Islamabad Capital Territory.

http://www.who.int/csr/don/2007_12_15/en/index.html

[sharon sanders]

Do we know if they have tested beyond the contacts of the cluster? Fellow poultry workers? Extended family? Neighbors? Those who have not taken tamiflu but were in contact with the cluster individuals? Also, any antibody testing?

[HenryN]

Originally Posted by Florida1

Do we know if they have tested beyond the contacts of the cluster? Fellow poultry workers? Extended family? Neighbors? Those who have not taken tamiflu but were in contact with the cluster individuals? Also, any antibody testing?

Usually most contacts are health care workers.

[AlaskaDenise]

Originally Posted by niman

Commentary at

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

Commentary

H5N1 Genetic Predisposition Media Myth

Recombinomics Commentary
December 23, 2007

Some experts believe that a sick person is more likely to pass the infection on to a blood relative rather than an in law if both are in close and continuous physical contact with him/her.

The above comment is another widely circulated media myth. It shows up in wire service stories, and well as ProMed commentaries. However, the speculation has little scientific basis.

The speculation became more widespread after the Indonesia cluster in Karo. In that cluster, there were 8 family members who died or were H5N1 confirmed. Since all infected were blood relatives, and genetic predisposition was postulated and the lack of clusters involving a husband and wife was cited in support.

However, the Karo cluster is easily explained by close contact with patients who are fatally infected with a high H5N1 viral load Data supporting close contact comes from the WHO update:

The newly confirmed case is a brother of the initial case. Specimens were taken on 21 May and flown the same day to Jakarta. Tests run overnight confirmed his infection. His 10-year-old son died of H5N1 infection on 13 May. The father was closely involved in caring for his son, and this contact is considered a possible source of infection.

Although the investigation is continuing, preliminary findings indicate that three of the confirmed cases spent the night of 29 April in a small room together with the initial case at a time when she was symptomatic and coughing frequently. These cases include the woman’s two sons and a second brother, aged 25 years, who is the sole surviving case among infected members of this family. Other infected family members lived in adjacent homes.

All confirmed cases in the cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness. Although human-to-human transmission cannot be ruled out, the search for a possible alternative source of exposure is continuing.

The index case had developed symptoms May 24 from an unknown source. A family gathering was planned for May 30. As noted in the update, four of the eight members of the cluster slept in the same small room on May 29. They developed symptoms a few days later, as did the index case’s daughter, niece, and nephew. The family gathering and the location of their housing allowed for additional close contact on or about May 30, which is the approximate date of exposure based on symptoms a few days later. Another brother developed symptoms after his son (who was the nephew of the index case) died.

The development of symptoms close to the date of death of the index case is common. Just prior to death the viral load is usually at a peak. Most H5N1 isolates come from samples collect just prior to or on the date of death. Thus, the infection of family members, including blood relatives who cared for the infected relative, is not unexpected.

The number of large H5N1 clusters is relatively small. The index case frequently is a child or teenager, which is likely due to an increased exposure risk. A requirement of infection of three family members or more is required for infection of husband and wife.

However, a cluster of five in Haiphong did involve a husband, wife, and three daughters. Similarly, there have been clusters that involved a health care worker in Vietnam, and a friend in Azerbaijan. Thus, although the number of larger clusters is limited, they contain clear examples of infections in contacts that are not blood relatives.

Similarly, media reports suggest that one or two health care workers were infected through contact with the larger familial cluster in Pakistan, and health care workers linked to patients infected in 1997 in Hong Kong had antibodies, indicating the were infected with H5N1 by patients who were not blood relatives.

Moreover, many of the outbreaks are multi-focal. In Pakistan in addition to the large familial cluster, there was a smaller familial cluster, as well as at least one additional patient who did not appear to be a blood relative of any of the cluster members. The relationships in the Pakistan outbreak will be clearer when the situation update is released.

However, earlier clusters do not support the genetic predisposition that is cited in media reports.


.

[AlaskaDenise]

Originally Posted by niman

Commentary at

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

Commentary

H5N1 False Negatives in Pakistan?

Recombinomics Commentary
December 24, 2007

“In their preliminary tests the WHO team excluded suspected human-to-human transmission, but we have sent the samples to Geneva for further confirmation,” health ministry spokesman Oriya Maqbool Jan told AFP.

The above comments suggest that the shipment of samples from patients in Pakistan to London was due to false negatives at the NAMRU-3 mobile lab. Media reports had indicated that the positive results obtained in October by labs in Pakistan were confirmed in Pakistan over a week ago. Moreover, the sustained transmission in H5N1 lab confirmed contacts strongly supports human-to-human transmission.

False negatives by the NAMRU-3 mobile lab could be due to a number of factors including sample degradation due to multiple tests, viral RNA depression due to collection of samples after the start of Tamiflu treatment, or primer mismatches due to sequence differences between the H5N1 in Pakistan compared to Egypt, lack of fine tuning in the testing by the mobile lab.

Unfortunately, there is precedent for all of the above. Media quotes from the Pakistan Health Minister indicated samples from patients were collected one to two after the start of Tamiflu treatment. Since Tamiflu inhibits the release of H5N1 from an infected cell, treatment can cause to drop in RNA levels, resulting in a false negative result. Sequence differences between the H5N1 in Pakistan and Egypt are likely because the isolates in Pakistan are likely to be related to the Uva Lake strain, which is currently widespread in Europe and was previously detected in Kuwait in early 2007, but has not been reported in human H5N1 sequences generated by NAMRU-3 in Egypt.

However, there is also evidence of detection failures at the regional centers also. A year ago, 21 patients were H5N1 confirmed by labs in Turkey. However, only 12 of the 21 were confirmed by Weybridge in England. These failures were almost certainly false negatives because the samples in Turkey formed clusters, and the likelihood of pairing up false negatives is remote. These failures extended to the fourth sibling from the index cluster. Moreover, sequences from only four patients have been released, suggesting that there were significant isolation failures at Weybridge. These failures extended to mixtures because the index case from Turkey had S227N, while the isolate from the sister of the index case did not. H5N1 false negatives in Egypt were also seen in the Gharbiya cluster. Although three family members died with bird flu symptoms, sequence data was not obtained for one of the three fatalities.

Some or all of these failures may also be linked to use of a Tamiflu blanket. In addition to failures in detecting clade 2.2 in the above examples, the Tamiflu blanket may have led to the lab confirmation failures for the recent suspect cluster in Indonesia.

Details on collections histories relative to the start of Tamiflu treatment would be useful.


.

[AlaskaDenise]

Originally Posted by niman

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]

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...12-2007_pg7_41

[AlaskaDenise]

H5N1 virus threat | Call to promote frozen chicken markets

Nazia Hameed

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.

.

[HenryN]

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

http://www.cidrap.umn.edu/cidrap/con...2607avian.html

[HenryN]

Commentary at

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

[HenryN]

KARACHI: ‘No bird flu in Sindh poultry’



By Mukhtar Alam
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]

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.
Bhutto is helped from her vehicle following the October 18 suicide attack on her motorcade.




1 of 2






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/as...iref=hpmostpop

[HenryN]

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

[sharon sanders]

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?...39328720071227

[Johnny Yuma]

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/busine...70807220071227

[Johnny Yuma]

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.as...&nav=menu100_2

[HenryN]

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]

Commentary at

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

[HenryN]

Commetary at

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

[HenryN]

WHO confirms human-to-human birdflu case
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/...d5O1MSTOsR.3QA