News Reports for February 26

Laos announces first suspected human case of bird flu

(Note: I posted this story yesterday and the facts were much different. That article said she had not played with chickens and this one says she worked at a chicken farm.)

Sunday February 25, 2007 
Bangkok- Laos' Public Health Ministry on Monday confirmed
that the country's first suspected human case of avian influenza has been detected, following an outbreak of the virus at a poultry farm on the outskirts of Vientiane earlier this month.

The health ministry identified the suspected case as a 15-year-old girl who had been working on a chicken farm in Srirattana district Vientiane, where an outbreak of H5N1 occurred in late January and was confirmed to be bird flu two weeks ago, said Radio Vientiane in a broadcast monitored in Bangkok.

Foreign Ministry spokesman Yong Chanhthalousy confirmed that
authorities have received a confirmation from the Mahidol Institute in Bangkok that the girl, who has been moved to Nong Khai Hospital in north-eastern Thailand, has tested positive for H5 but not yet for N1. (Snip)

The health of the girl, who was first hospitalized in Vientiane on February 15 and later transferred to Nong Khai Hospital on February 24, was improving, according to Yong.

Yong said Laos had taken all the appropriate measures to prevent the spread of the virus from the infected farm, including culling all poultry in the area and 20 surrounding villages and spraying vehicles entering and leaving the "red zone."

Laos, which neighbours Thailand, has reported small outbreaks of bird flu in the past, but has yet to confirm a case of a human contracting the virus. (Snip)
http://rawstory.com/...

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     

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by: Carol@SC @ Mon Feb 26, 2007 at 05:02:57 AM UTC

2,000 Influenza Virus Genomes Now Completed And Publicly Accessible

The Influenza Genome Sequencing Project, funded by the National Institute of Allergy and Infectious Diseases (NIAID), one of the National Institutes of Health (NIH), has announced that it has achieved a major milestone. The entire genetic blueprints of more than 2,000 human and avian influenza viruses taken from samples around the world have been completed and the sequence data made available in a public database.

"This information will help scientists understand how influenza viruses evolve and spread," says NIH Director Elias A. Zerhouni, M.D., "and it will aid in the development of new flu vaccines, therapies and diagnostics."

"Scientists around the world can use the sequence data to compare different strains of the virus, identify the genetic factors that determine their virulence, and look for new therapeutic, vaccine and diagnostic targets," says NIAID Director Anthony S. Fauci, M.D.

(snip)

http://www.medicalne...

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by: Kelly Phan @ Mon Feb 26, 2007 at 05:20:34 AM UTC

BF Hoax in UK Links to Fake BBC Webpage

Hoax bird flu email sparks panic
A spoof email claiming bird flu is killing people across Sussex has causd panic.

The hoax contains a link to a fake BBC News internet page, with the headline "Government denies human outbreak of bird flu in Sussex".

...

It reads: "There have already been 15 deaths in as little as three weeks that are directly associated with this killer bug and, while most of them have been elderly people, at least three were otherwise fit and healthy professionals in their 20s and 30s."

Julie Boucher, 30, of Baden Road, Brighton, contacted The Argus after receiving the email.

...

The man behind the site is Larry Pickleman, a fictional character created by Brighton online animator Dave Watson, 37. Mr Watson told The Argus: "I've had several people coming back to me, some in tears."

He said the hoax, the second he has based on the BBC News site, was a way of making people take a "second look", citing the internet film Loose Change, which claims 9/11 was a Government conspiracy, as an example of people being drawn into believing things that are not true.
...

A BBC spokeswoman said the corporation took copyright infringement seriously and would be contacting the site's owner.

10:15pm Sunday 25th February 2007

By Richard Gurner

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 

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by: Into The Woods @ Mon Feb 26, 2007 at 07:46:45 AM UTC

Link

http://www.theargus....

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 

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by: Into The Woods @ Mon Feb 26, 2007 at 07:47:30 AM UTC

[ Parent ]

hmmm

Sounds alot like what this guy did.

http://www.youtube.c...

This is a link to the first video, click on other videos by this user, and watch them all.  I think there are 6.

Our children change our lives, whether they live or not.
www.misschildren.org

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by: Carrey in VA @ Mon Feb 26, 2007 at 12:13:18 PM UTC

[ Parent ]

Bird flu detected in southeastern Turkey

http://www.dunyagaze...

Turkish authorities discovered Monday (H5N1) Bird Flu cases in Batman city southeast of Turkey.

Medical official at the Turkish Ministry of Health, Erdal Uzer, revealed that the cases were found in a town near Batman city, indicating that authorities were taking the proper procedures to prevent the disease from spreading.

About 8,000 birds would be exterminated in the process, said the official.

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by: Nimbus @ Mon Feb 26, 2007 at 13:40:38 PM UTC

Two dead Hong Kong birds had H5N1 virus - test results

http://www.forbes.co...

HONG KONG (XFN-ASIA) - Two birds found dead in densely populated parts of Hong Kong had the H5N1 bird flu virus, according to test results revealed by government researchers.

They were the ninth and 10th wild birds found in Hong Kong this year to have been infected with the virus, which has decimated poultry flocks throughout the world and killed more than 160 people since 2003.

Biologists believe local species of wild birds found dead with the virus could have picked it up from contact with infected flocks in mainland China, where it is believed the strain first mutated into a form deadly to humans.

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by: Nimbus @ Mon Feb 26, 2007 at 13:43:10 PM UTC

Is it me

or does Hong Kong keep finding birds in pairs?

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by: UK - Bird @ Mon Feb 26, 2007 at 18:35:06 PM UTC

[ Parent ]

Maybe there are more than 2 found dead but

they take only two for sampling???

Eat pudding first - who know's what might happen next! - Anon

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by: AnnieB @ Mon Feb 26, 2007 at 19:21:03 PM UTC

[ Parent ]

Could be.

This type of report has happened a few times now and I was waiting for it to happen again before commenting.

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by: UK - Bird @ Mon Feb 26, 2007 at 19:31:01 PM UTC

[ Parent ]

single birds

a single dead bird does not attract much attention.  Multiple dead birds do.

Be Prepared

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by: DennisC @ Mon Feb 26, 2007 at 19:34:47 PM UTC

[ Parent ]

Afghan officials quarantine poultry after bird flu outbreak 2/26/07

Kabul -(Snip) The veterinary department of the Afghan government has quarantined and disinfected the contaminated areas and enforced a ban on poultry trade from the region.

Edwards said that an awareness campaign has also been carried out in the area and that a total of 60,000 vaccinations will be performed while an additional 140,000 would be available for Kunar province.

The Afghan government and the UN have intensified their surveillance and the outbreaks are believed to be geographically confined to the eastern region, and should be controllable, Edwards said.
(Snip)
Meanwhile, Edwards also said that health workers had detected the outbreak of viral Hepatitis E in the eastern Laghman province, where 33 cases have so far been reported.
Hepatitis E is caused by faecal contamination of drinking water and and affects both adults and children.
http://www.earthtime...


Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     

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by: Carol@SC @ Mon Feb 26, 2007 at 14:41:39 PM UTC

Bird flu confirmed in chickens in northern Vietnam

HANOI, Feb 26 (Reuters) - Vietnam confirmed a bird flu outbreak in chickens in a northern province only two weeks after it announced the disease had been contained, state media reported on Monday.

The online newspaper VnExpress (www.vnexpress.net) quoted the director of the northern province of Hai Duong's animal health department, Dong Van Chuc, as saying tests on a flock of about 10,500 chickens confirmed the presence of a bird flu virus.

Around 70 chickens died from bird flu a week ago, Chuc said.
The entire flock was immediately culled last Sunday and no new infection had been detected since then, he said.
Continued....http://www.alertnet....

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     

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by: Carol@SC @ Mon Feb 26, 2007 at 14:51:14 PM UTC

First Glimpse Of Influenza Replication Machine

http://www.scienceda...

[snip]

Researchers from the European Molecular Biology Laboratory [EMBL] in Grenoble and Heidelberg, the Institut de Biologie Structurale [IBS] and the Unit of Virus Host Cell Interactions [UVHCI]*, both in Grenoble, have now produced the first 3-dimensional image of part of this key protein. The study, which is published in the current issue of Nature Structural and Molecular Biology, investigates the structure and function of the protein and sheds light on how polymerase mutations contribute to transmission of avian flu to humans.

Upon infection the influenza virus starts multiplying in the cells of an infected host. The polymerase is crucial in this process because it copies the viral genome and directs the production of its proteins. Interfering with polymerase function would prevent the virus replicating, thereby reducing the spread of the virus and the severity of the infection.

"For many years scientists have tried to understand the flu polymerase and to look for weak points that could be targeted by drugs," says Darren Hart, whose team participated in the research at EMBL Grenoble. "But no one could get enough protein to analyse its structure. We developed a way to use robots to screen tens of thousands of experimental conditions and discovered a piece of the influenza polymerase that we could work with. It is a small part of the entire protein, but it provides interesting insights into how the protein works and how mutations may affect host range."

Together with scientists at the IBS they visualized the atomic structure of the protein and discovered a previously overlooked signal that labels it for transport to the human nucleus where the genetic material of the virus is replicated. Cell microscopy studies at EMBL Heidelberg revealed that the human nuclear transport protein, importin alpha, recognises this signal and shuttles the polymerase into the nucleus.

To find out how the polymerase and importin interact, Stephen Cusack, head of EMBL Grenoble, and collaborators at the UVHCI, used the high intensity X-ray source of the European Synchrotron Radiation Facility to generate a high-resolution image of the two proteins interacting with each other. The image revealed that mutations known to play a role in the transmission of avian influenza virus to mammals were located within, or close to, this site of interaction. This suggests that mutations may affect the efficiency of nuclear transport and through this the ability of the virus to replicate in different species.

"Interfering with polymerase function could provide new ways to treat or prevent flu," says Cusack, "but this will require a detailed picture of the rest of the polymerase. This is what we are aiming for in our new FLUPOL project. In a joint effort with other European laboratories, and with financial support by the European Commission, we will explore both structure and function of this key drug target and try to characterise other mutations implicated in bird-to-human transmission."

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by: Nimbus @ Mon Feb 26, 2007 at 16:50:50 PM UTC

FDA staff questions Sanofi bird flu vaccine

http://investing.reu...

WASHINGTON (Reuters) - Data on Sanofi-Aventis's (SNY.N: Quote, Profile , Research) (SASY.PA: Quote, Profile , Research) experimental bird flu vaccine shows higher doses worked better, but it is unclear whether those results prove the product's effectiveness, U.S. regulatory staff said in documents released on Monday.

Food and Drug Administration staff also said studies of the vaccine, which targets the potentially pandemic H5N1 strain of the influenza virus, showed "no significant safety signals."

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by: Nimbus @ Mon Feb 26, 2007 at 16:53:10 PM UTC

Kuwait discovers 12 more cases of bird flu in birds, raising number of confirmed cases to 32

http://www.iht.com/a...

KUWAIT CITY: Kuwait confirmed Monday 12 more cases of the deadly strain of bird flu in chicken and turkeys, raising the number of recent cases to 32. But there was still no sign of human infection.

"Bird flu was discovered in three turkeys and nine chickens in home pens," said Ahmed al-Shatti, a spokesman for the Health Ministry. He said tests in local labs on samples from the birds showed they were infected with the H5N1 strain.

The turkeys and the chicken came from small farm houses in Wafra, south of Kuwait City, and the northern district of Doha, he said.

All poultry in these farm houses have been culled, and people who came in contact with the birds were given precautionary medication, al-Shatti added.

The Health Ministry closed Kuwait Zoo and the bird markets on Sunday, and banned all imports and exports of birds, after tests confirmed 20 cases of bird flu in falcons, chickens and turkeys.

[snip]

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by: Nimbus @ Mon Feb 26, 2007 at 16:55:07 PM UTC

IRAN - Minister of Health denies bf outbreak in northern Iran

Machine-translated from Arabic:

General / Minister of Health Iranian / denied
Tehran 8 0 1428 AH February 26, 2007 WAS

Iranian Minister of Health Kamran Baqri denied today the news that spoke about the Incharmrd of the influenza of Amal City Al Tiorfi in the north of Iran.  And some Iranian media have reported by officials in the enterprise of the Iranian veterinary medicine news about Incharmrd the influenza of this city Al Tiorfi.

And he said for my denial according to what the Iranian News Agency reported that any case did not declare the injury of animals or the human being by this disease in Amal City.  And he added that Iran was still free from the presence of injuries by the bird flu disease in the time that it suffers many neighboring countries from the spread of this disease.

And he added that says that its ministry put on its agenda plans for the resistance to this disease and its fighting as sending the health groups and especially in the border regions, the closure of the border commercial markets and training an Al Kadralshi and the citizens in the recognition of the bird flu symptoms.

http://www.spa.gov.s...

Proud FAF-er.

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by: Theresa42 @ Mon Feb 26, 2007 at 17:31:00 PM UTC

Unprepared for a Pandemic

http://www.foreignaf...
Michael T. Osterholm
From Foreign Affairs, March/April 2007

SOUNDING THE ALARM, AGAIN
More than a year and a half ago, Foreign Affairs published three articles that sounded a clarion call to prepare for the next pandemic. They warned that another pandemic could occur at any time and at a staggering cost to human health and the world economy. These facts remain incontrovertible. At the time, many public health scientists believed that recent outbreaks of the H5N1 influenza virus in birds in Asia, Europe, and Africa, with occasional infections in humans, were precursors to the next pandemic. They still do today.

[snip]

Although it is impossible to know for sure whether H5N1 will ever evolve into the next human pandemic virus, more and more of the genetic changes documented in the 1918-19 virus have also been found to have occurred in recent H5N1 strains affecting both birds and people. Meanwhile, the spread of H5N1 infections to more avian species and to more humans continues to point to H5N1 as a likely strain of the next pandemic.

No one can predict when the next pandemic will occur or how severe it will be. But it will occur for sure, and because of the interdependence of the global economy today, its implications will reach far beyond its toll on human health. A recent study by the Lowy Institute for International Policy, which provides the most comprehensive estimate yet, found that a mild pandemic similar to that of 1968 would kill 1.4 million people and cost approximately $330 billion (or 0.8 percent of global GDP) in lost economic output. Were a pandemic as severe as that of 1918-19 to occur, [rest of article requires purchase or subscription]
 

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by: Nimbus @ Mon Feb 26, 2007 at 17:35:08 PM UTC

Foreign Affairs Article Download?

Has anybody else tried to download this article? I was going to purchase a copy but I can't get the doc to stay in my shopping cart.

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by: banshee @ Mon Feb 26, 2007 at 18:20:04 PM UTC

note the comment when trying to purchase...

Our server encountered a problem displaying this page. Our support staff has been notified. Please try again using the left hand navigation or try our Search function or Site Map.

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by: DemFromCT @ Mon Feb 26, 2007 at 20:46:37 PM UTC

[ Parent ]

Got it

Thanks. After some tinkering I managed to download a copy. I'll write up a more comprehensive synopsis if I see anything interesting.

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by: banshee @ Mon Feb 26, 2007 at 22:34:12 PM UTC

[ Parent ]

Read Osterholm's Foreign Affairs article

Unfortunately, I won't have time to write anything up until later tonight or tomorrow morning. But, ahhhh, there really is no good news here. To sum it up, we're still screwed.

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by: banshee @ Mon Feb 26, 2007 at 22:56:22 PM UTC

[ Parent ]

bird-flu vaccine even less effective than thought

Government says first bird-flu vaccine even less effective than thought

WASHINGTON (AP) - The nation's first vaccine against bird flu is even less effective than previously thought, according to Food and Drug Administration documents released Monday.  In clinical trials, the two-shot series appears to provide protection to just 45 percent of adults who received the highest dose of the Sanofi Aventis SA vaccine.

An earlier, interim analysis of the same study of the vaccine suggested it sparked a protective immune response in 54 percent of patients, when measured 28 days after getting the second shot. The New England Journal of Medicine published those results in March 2006. The FDA released the more recent results, contained in company and agency documents, ahead of a Tuesday meeting where it will ask a panel of outside experts to review the vaccine. The agency isn't required to follow the advice of its advisory committees, but usually does. The vaccine is the first against the H5N1 influenza strain to seek FDA approval.

The FDA said the 452-person study showed the vaccine against the deadly bird-flu strain called H5N1 is safe, but it remained unclear whether it would be effective. Seasonal flu vaccines, for example, protect 75 percent to 90 percent of vaccinated adults younger than 65......

http://www.newspress...

Be Prepared

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by: DennisC @ Mon Feb 26, 2007 at 18:29:47 PM UTC

poor results

check out the FDA documents from this link http://www.fda.gov/o...

MEMORANDUM
To:  Committee Members, VRBPAC
From:  Office of Vaccine Research and Review and the Division of Vaccines and Related Product Applications
Re:  February 27, 2007 Meeting Topic 1: Safety and Immunogenicity of H5N1 Influenza Virus Vaccine, A/Vietnam/1203/2004 (clade 1), 90µg/mL, Manufactured by Sanofi Pasteur

Several things of note:

1. The data included in this BLA is different from that published previously in NEJM http://content.nejm.... due to resolutions in the test end points with CBER officials
   
2. The microneurtralization assay data were not validated.  "The FDA received an assay validation package for HAI antibody; however, despite requests no such assay validation package was received for the microneutralization assay.  Therefore, the FDA reviewed the HAI antibody assay data as presented in the BLA and not the data derived from the unvalidated microneutralization assay."
   
3. Data on the development of serum antibody responses against antigenically drifted variants of H5N1 influenza virus (required as secondary endpoint of the protocol) were not included in the BLA submission.
   
4. GMT (geometric mean titer) for was 30.6 28 days after 2nd dose (56.3 in NEJM) and 11.8 6 months after.
   
5. 4-fold rise in HAI titer 45.1% at 28 days after 2nd dose (57% in NEJM) and 17.6% at 6 months.
   
6. HAI > 1:40 at 28 days after 2nd dose 46%, 6 month, 18.7%

All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

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by: SusanC @ Mon Feb 26, 2007 at 21:29:44 PM UTC

[ Parent ]

can you clarify how they test its effectiveness?

(I am presuming they didn't infect the vaccinated people with H5N1 to see who got sick and who were immune, so just how do they check its effectiveness?)

Always have a plan B.

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by: maryinhawaii @ Tue Feb 27, 2007 at 04:40:35 AM UTC

[ Parent ]

they didn't

they only checked antibody responses, and the results were not very good even at 90ug.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...

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by: SusanC @ Tue Feb 27, 2007 at 05:26:34 AM UTC

[ Parent ]

Egyptian Woman Tests Positive for Bird Flu

http://today.reuters...

There is no article there!!

nothing left to do but :) :) :)

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by: SarahS @ Mon Feb 26, 2007 at 21:50:52 PM UTC

try this link

I think it might be the same as:

CAIRO, Feb 26 (Reuters) - An Egyptian woman from the Nile Delta town of Beheira has tested positive for the bird flu virus, Egypt's state news agency MENA said on Monday.

MENA identified the woman as Samia Mansour Hashem, a housewife who raised chickens in her home.
http://www.alertnet....

Be Prepared

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by: DennisC @ Mon Feb 26, 2007 at 22:31:52 PM UTC

[ Parent ]

Egyptian health official denies new bird flu case

Mon 26 Feb 2007 22:31:40 GMT
CAIRO, Feb 26 (Reuters) - An Egyptian Health Ministry official denied on Monday a report by the state news agency that a woman from the Nile Delta had tested positive for the deadly bird flu virus.

"It's not true," said Amr Qandil, director of communicable diseases at the ministry. "I do not know where they got this information."

State news agency MENA reported that a 31-year-old housewife from the Nile Delta province of Beheira, Samia Mansour Hashem, had tested positive for the bird flu virus. It said that the woman raised chickens in her home.

She had been taken to hospital in the town of Damanhour but was transferred to Alexandria Fever Hospital when her condition deteriorated, MENA said. Veterinary workers had also been sent to her home to test birds there, the agency said.

World Health Organisation officials, who normally confirm human bird flu cases, were not immediately available for comment, nor were doctors at the Alexandria Fever Hospital.
Continued....http://today.reuters...

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     

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by: Carol@SC @ Mon Feb 26, 2007 at 22:47:51 PM UTC

9 Bird Flu Sites Confirmed

Authorities on Monday confirmed cases of bird flu at nine locations in the Moscow region, a source in the Agriculture Ministry told Interfax.

The source of the bird flu outbreak has been eliminated, and affected areas remain under quarantine, the source said.

Also Monday, authorities in the Kaluga region confirmed that 17 chickens in the village of Kolodkino had died of bird flu. The village is under quarantine, Interfax reported. (MT)
http://www.themoscow...


Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     

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by: Carol@SC @ Mon Feb 26, 2007 at 23:06:30 PM UTC

UAE geared to block bird flu

Abu Dhabi/Dubai: Steps to prevent the deadly bird flu from entering the UAE are in place, with officials advising calm following reports of an outbreak in neighbouring Kuwait.
(Snip)
Dr Mohammad Saeed Al Kindi, UAE Minister of Environment and Water, told Gulf News that the UAE was fully prepared to prevent the deadly virus from crossing over.
(Snip)

Spring migration (Snip)
Spring migration of birds is set to begin, with more than 200 known species of birds expected to pass through the UAE, including the dunlin and redshank, on their way north.
(Snip)
Dr Kayan Jaff, UN Food and Agriculture Organisation (FAO) representative in the UAE, told Gulf News that the organisation regarded the cases in Kuwait as suspected cases, rather than confirmed until another test confirmed the results.

"The Kuwaiti government may have confirmed the cases based on its appearance. Testing does not take a day. It takes 10 to 14 days to get full results," he said.

"There is no reason for alarm at this stage, because as we understand it, the cases are isolated and contained."
http://www.gulf-news...


Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     

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by: Carol@SC @ Mon Feb 26, 2007 at 23:14:20 PM UTC

aerosol transmission

On the one hand... and on the other...

http://www.cdc.gov/n...

Abstract

In theory, influenza viruses can be transmitted through aerosols, large droplets, or direct contact with secretions (or fomites). These 3 modes are not mutually exclusive. Published findings that support the occurrence of aerosol transmission were reviewed to assess the importance of this mode of transmission. Published evidence indicates that aerosol transmission of influenza can be an important mode of transmission, which has obvious implications for pandemic influenza planning and in particular for recommendations about the use of N95 respirators as part of personal protective equipment.

but see Lancet article (requires free registration for summary):

Scientific Review Finds Little Evidence that Influenza is Spread via Airborne Transmission

Brankston G, Gitterman L, Hirji Z, Lemieux C, Gardam M. Transmission of influenza A in human beings. The Lancet Infectious Disease. Published online February 19, 2007. Free Summary Available at: http://www.thelancet.... Accessed February 23, 2007.

We have found that the existing data are limited with respect to the identification of specific modes of transmission in the natural setting. However, we are able to conclude that transmission occurs at close range rather than over long distances, suggesting that airborne transmission, as traditionally defi ned, is unlikely to be of significance in most clinical settings. Further research is required to better define conditions under which the infl uenza virus may transmit via the airborne route.

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by: DemFromCT @ Mon Feb 26, 2007 at 23:14:44 PM UTC

my heart skipped a beat...or two....with your subject line...but I've recovered. n/t

I am not like other birds of prey....

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by: Commonground @ Mon Feb 26, 2007 at 23:43:52 PM UTC

[ Parent ]

oops...

can't edit comments, alas

Seasonal Flu: Theory

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by: DemFromCT @ Mon Feb 26, 2007 at 23:46:28 PM UTC

[ Parent ]

Floating like a vapor on the soft summer air.

CDC Abstract:
The discussion of the Livermore Veterans Administration Hospital during the 1957-58 pandemic seems to go well beyond 'theory' in showing the potential of aerosal transmission.

Whereas UV irradiation is highly effective in inactivating viruses in small-particle aerosols, it is ineffective for surface decontamination because of poor surface penetrations. It is also ineffective for large droplets because the germicidal activity sharply decreases as the relative humidity increases (28). Furthermore, because the installation of UV lights was set up in such a way as to decontaminate the upper air of rooms only, large droplets would not have been exposed to UV, whereas aerosols, carried by thermal air mixing, would have been exposed (27,28). So in effect in this study only the aerosol route of infection was blocked, and this step alone achieved near complete protection.

The article also goes beyond theory in discussion of both avian transmission and the analysis of H5N1 infections in humans.

Even though efficient human-to-human transmission of the A (H5N1) virus has not yet been observed (by any mode), transmission of influenza A (H5N1) by aerosols from geese to quails has been demonstrated in the laboratory (33).  Thus, even in the current incarnation of A (H5N1), infection by the virus can generate aerosols that are infectious for highly susceptible hosts.
...
Thus, in the respiratory system the current strains of A (H5N1) appear to infect mostly (perhaps exclusively) the lower respiratory tract. If that is indeed the case, it in turn suggests that human cases of avian influenza were acquired by exposure to an aerosol, since large droplets would not have delivered the virus to the lower respiratory tract.
...
Given the strong evidence for aerosol transmission of influenza viruses in general, and the high lethality of the current strains of avian influenza A (H5N1) (37), recommending the use of N95 respirators, not surgical masks, as part of the protective equipment seems rational.

Lancet Article:
Short distances would be 3-6 feet?
Long distances?
Anything in between?

How is airborne transmission "traditionally defined"?  Is it the same definition used in the CDC article?

Is there some other non-traditional definition discussed in the Lancet article that would be suggested to occur?

How does it limit affect statement to limit it to "clinical settings"?

The last sentence of this Lancet article summary seems less certain in its conclusions than all the carefully parsed prior text. 

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 

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by: Into The Woods @ Tue Feb 27, 2007 at 00:30:43 AM UTC

[ Parent ]

the latest review by the experts

presented at the seasonal and pandemic 2007 conference did not dismiss the possibility of aerosols.

Animal model experiments with ferrets and guinea pigs are ongoing but not published yet.

Guidelines for HCW from OSHA divide people into highest, high, moderate, and low groups of risk based on exposure and aerosol-generating procedures like sticking something down a patient's throat or nose.

Still unclear, though fomite and contact seems lowert, and large droplet highest.

my conclusion is that simple masks help some, but are hardly foolproof.

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by: DemFromCT @ Tue Feb 27, 2007 at 00:38:46 AM UTC

[ Parent ]

definitions from the lancet article

Panel: Possible modes of respiratory virus transmission6,7

Direct contact
Transmission occurs when the transfer of microorganisms results from direct physical contact between an infected or colonised individual and a susceptible host.

Indirect contact
Transmission occurs by the passive transfer of microorganisms to a susceptible host via an intermediate object such as contaminated hands that are not washed between patients, or contaminated instruments or other inanimate objects in the patient's immediate environment.

Droplet
Transmission occurs via large droplets (?5 ?m diameter) generated from the respiratory tract of the infected individual during coughing or sneezing, talking, or during procedures such as suctioning or bronchoscopy. These droplets are propelled a distance of less than 1 m through the air and are deposited on the nasal or oral mucosa of the new host or in their immediate environment. These large droplets do not remain suspended in the air; therefore, special ventilation is not required since true aerosolisation does not occur.

Airborne
Transmission occurs via the dissemination of microorganisms by aerosolisation. Organisms are contained in droplet nuclei (airborne particles less than 5 ?m that result from the evaporation of large droplets) or in dust particles containing skin squamous cells and other debris that remain suspended in the air for long periods of time. Such microorganisms are widely dispersed by air currents and inhaled by susceptible hosts who may be some distance away from the source patients or individuals, even in diff erent rooms or hospital wards. Control of airborne transmission is the most diffi cult because it requires control of airfl ow through special ventilation systems.

Contact transmission includes direct contact, indirect contact, and droplet (large droplet) transmission.

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by: DemFromCT @ Tue Feb 27, 2007 at 00:42:32 AM UTC

[ Parent ]

The "5?m" in your article is 5 micron.

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     

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by: Carol@SC @ Tue Feb 27, 2007 at 01:45:58 AM UTC

[ Parent ]

yeah and ?5?m

is <5µm. Couldn't handle the little µ thingie.

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by: DemFromCT @ Tue Feb 27, 2007 at 02:06:51 AM UTC

[ Parent ]

specific responses within the article

short distance = 1 meter, or 3 feet

and as for the study in the VA with UV light:

Neither of the studies that compared influenza infection in different buildings or sections of the same facility appropriately accounted for all potential confounding factors such as the number of infectious index patients, patient allocation and characteristics, bed layout, presence of open windows, handwashing by staff and patients, length of stay, number of procedures, infl uenza immunisation status, and use of antiviral medications.38 One study was further confounded by the fact that patients on the ward with the lowest attack rate also had more space allocated per patient (which would decrease transmission rates for diseases spread via contact or droplet routes), in addition to the most fresh air ventilation.38 Individually, each of these factors has the potential to substantially infl uence the risk of exposure. Interestingly, the authors comment that the attack rates for the following influenza season were essentially identical between the four buildings. Furthermore, observation bias may have influenced the differences seen in the proportions of individuals infected between buildings or sections: of 15 refusals to provide a laboratory sample in one study, eight came from the building (one of four) with the lowest proportion infected. Finally, neither study reported the air exchange rates for the buildings or wings studied. We therefore believe that no conclusions about specific modes of influenza transmission can be made from the epidemiological studies cited above. 

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by: DemFromCT @ Tue Feb 27, 2007 at 00:49:35 AM UTC

[ Parent ]

and see big critter's comment...

"A recent review by public health physician ERIC TONER, MD, at the University of Pittsburgh Center for Biosecurity, suggests that surgical masks may  provide almost as good a protection against aerosolized infection as N95 masks.  In one study, the N95 masks filtered 97% of an experimental aerosol, while standard surgical masks filtered about 95%.  The difference between the two masks matters -- but, in a community-wide emergency, there won't be enough N95 masks to go around."

http://www.upmc-cbn....

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by: DemFromCT @ Tue Feb 27, 2007 at 01:18:14 AM UTC

[ Parent ]

In and Out

Most of these studies seem focussed almost entirely on use of these PPE to keep infection out.

As I read through the Interim Guidance and wrestled with the realities of keeping young people from seeing their chums or romantic interests for 3 months, I wondered whether use of surgical masks to keep infection in might be worth considering.

They propose a plan that suggests your kids would need to choose 3 friends that would be their only contacts while the school closures were in effect.  This small thing could be a nighmare for kids of a given age and would put huge pressure on compliance.

I wondered whether the use of surgical masks (appropriately tricked out) would help to keep the kids from coughing or breathing infection out onto their friends.  If so, it would be worth finding out if printing or designs on the masks reduce that protection. 

If what Dr Toner says is correct, a properly fitted surgical mask would do quite a bit to help in both directions.  As with the N-95, poor fit compromises effectiveness, but not near as much as no mask at all. 

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 

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by: Into The Woods @ Tue Feb 27, 2007 at 01:36:40 AM UTC

[ Parent ]

There are lots of issues with assumed compliance for kids

A few issues that I've thought about:

1.  A lot of teenagers significantly contribute their home's economic income by working a job.  I personally know several homes that would not be able to pay their electric and taxes without the added income from their teens.  Now, whether those jobs they hold would still exist is a different question.

2.  There is a significant issue with social behaviors such as smoking ... legal or illegal substances ... that will cause the use of masks impossible in the minds' of the kids in question.

3.  There are other social behaviors ... like gangs, runaways, etc. ... that will interfere with compliance.

My understanding is that while compliance is only 30% for the general population in any given area, for the plan to work as close to 100% compliance as possible is required for those under say 18 or 20 years.

I'm not too concerned with reaching the 30% compliance rate ... but anyone that has ever worked with teenagers, your own or others, knows that 100% compliance for certain groups of kids is going to be next to impossible.

And, shouldn't the requirements actually be 100% compliance for those homes that contain kids or have contacts with kids and 30% for non-child households.  By households that means that more than just kids will need to have 100% compliance.

Never doubt that a small group of thoughtful, committed citizens can change the world, indeed it is the only thing that ever has. -- Margaret Mead

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by: KathyinFL @ Tue Feb 27, 2007 at 01:55:39 AM UTC

[ Parent ]

Teen Health Care Workers

The number of teen health care workers is not insignificant, especially in rural long term care. 

Wonder what that percentage is and whether it has been taken into account.

I had not been thinking of how this would impact working teens, many of whom are providing critical support to their family's resources.

One more part of the puzzle.

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 

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by: Into The Woods @ Tue Feb 27, 2007 at 05:26:21 AM UTC

[ Parent ]

Into The Woods....

This site has printed mask if you are interested.
http://www.breathehe...

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     

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by: Carol@SC @ Tue Feb 27, 2007 at 01:58:59 AM UTC

[ Parent ]

Printed masks.

What about putting a printed silk scarf over the mask (need to be disinfected by bleach later) as a fashion statement?

Some one said use a panty hose over a regular mask to ensure tight fit. What about using that material to manufacture a printed scarf. There should be plenty of manufacturing capacity. If some celebrity make this a new trendy look, when the pandemic arrives, just wear the surgical mask underneath. Well, I know nothing about fashion psychology. Just a thought.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

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by: anon.yyz @ Tue Feb 27, 2007 at 03:20:14 AM UTC

[ Parent ]

...

not sure about scarves, but i bet ski masks would work well...  especially for bank employees.. 

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by: c3jmp @ Tue Feb 27, 2007 at 07:14:17 AM UTC

[ Parent ]

Heh! You're funny.

On a serious side note...

A sister bank near where I work got robbed last Saturday.  It was a 'jump over the counter' armed robbery.  Gunmen were wearing ski masks, I think. 

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by: Kelly Phan @ Tue Feb 27, 2007 at 07:19:53 AM UTC

[ Parent ]

...

no doubt.. it really is a cliche.  practically a hollywood tradition..  of course, some wear panty hose, too.  might slow criminal activities down slightly - the bad guys can pick each other out at a glance if they're the only ones wearing them.

apologies to anyone offended..

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by: c3jmp @ Tue Feb 27, 2007 at 07:30:24 AM UTC

[ Parent ]

why would anybody get offended? You're a funny person. LOL n/t

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by: Kelly Phan @ Tue Feb 27, 2007 at 07:36:43 AM UTC

[ Parent ]

...

it really was well intended..  i was reading thru the thread, and was thinking about scarves and alternatives..  ski masks came to mind, then what the public's reaction would be to business folk in ski masks, then which business would have the more interesting reactions...  if i were a customer walking into a bank, and everyone behind the counter was wearing a ski mask...  social distancing would not be a problem.. 

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by: c3jmp @ Tue Feb 27, 2007 at 08:00:13 AM UTC

[ Parent ]

LOL

This was my first chuckle of the day ;)

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by: LurkerMartha @ Tue Feb 27, 2007 at 12:21:07 PM UTC

[ Parent ]

Ski masks hard to wash and dry, and won't work in the summer.

Silk scarves may be easier, if some idol makes a fashion statement.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

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by: anon.yyz @ Tue Feb 27, 2007 at 16:13:57 PM UTC

[ Parent ]

LOL!!!!!!!!!!!!!!!!! n/t

Meteorologist in Florida!?!  Now we're talkin'!!!

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by: Tempest @ Tue Feb 27, 2007 at 07:25:34 AM UTC

[ Parent ]

A cotton bandana would work better; silk may be destroyed by bleach. n/t

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

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by: Jane @ Tue Feb 27, 2007 at 20:53:06 PM UTC

[ Parent ]

Thanks. New to me.

Interesting claims about their fabric and related products.  Any experience with the vendor or product?

Wonder if any other vendor has a bit more of an edge - youth market in mind.

Think of the clothes and t-shirts you see kids wearing. 

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 

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by: Into The Woods @ Tue Feb 27, 2007 at 05:29:27 AM UTC

[ Parent ]

Printed Masks looke like panties to me n/t

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by: Kobie @ Tue Feb 27, 2007 at 16:20:40 PM UTC

[ Parent ]

Some of the patterns are the same as on scrubs. n/t

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

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by: Jane @ Tue Feb 27, 2007 at 20:54:00 PM UTC

[ Parent ]

They didn't send the product.

I ordered 1 mask from this company over half a year ago.It was charged to my credit card account. I never recieved the product. I wrote twice and never received a reply. I don't recommend them. I wish there were a reputable dealer because I would like to try one.

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by: bgw in MT @ Tue Feb 27, 2007 at 21:36:58 PM UTC

[ Parent ]

97/95% mask effectiveness translates into 80/50% hcw protection

Similar results were found in Toronto during the SARS outbreak, where consistent use of surgical masks reduced the risk of infection by 50% among 32 critical care nurses who entered the room of a SARS patient. Consistent use of an N95 resulted in an 80% risk reduction.

So it is not an insignificant difference for HCW.

See my post here:

http://www.newfluwik...

Here's the problem I see. If there are 3 waves as in 1918. For each wave, if it is only 50% effective, we will only have 12.5% of HCW left when it is all over. That will kill more people after the pandemic for several years, in addition to those killed during the pandemic waves.  At 80% HCW protection, after 3 waves, we will have 51.2% no infected i.e. 4 times as good as the surgical mask scenario.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

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by: anon.yyz @ Tue Feb 27, 2007 at 02:11:55 AM UTC

[ Parent ]

97/95 is not 80/50

and similar isn't the same.

N95s are better, but simple masks are useful. Handwashing, 3 feet distance, etc also matter, and masks are not a substitute... nor a guarantee, especially when most non-HCW will not have been fit tested.

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by: DemFromCT @ Tue Feb 27, 2007 at 02:15:39 AM UTC

[ Parent ]

Those numbers are for HCW.

For the public, the main issue is education, training, practice, simple guidelines and compliance. The easiest, cheapest guideline is to double the distance to 6 ft or 2 meters where possible (since most won't be fit tested), while wearing regular surgical masks and recommend fit tested N95 if there is a need to be as close as 3 ft or 1 meter. The problem with the current recommendation of 3 ft or 1 meter is that there is no margin for error, accident or compliance.  The social distancing is a social behavior or norm.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

---

by: anon.yyz @ Tue Feb 27, 2007 at 02:26:33 AM UTC

[ Parent ]

I'm thinking of caring for flu sick at home

not just going out and about (oot and aboot?).

---

by: DemFromCT @ Tue Feb 27, 2007 at 02:33:47 AM UTC

[ Parent ]

80/50 protection was an unshakable factual record (no spin),

in real world situation, certainly more accurate than a controlled experiment. The numbers from controlled experiments are suspect, as they don't represent stressful working conditions during an outbreak. The HCW have to move around from one patient to another, with a lot on their minds, not standing on a treadmill focused on the experiment. Remember those numbers were from HCW, trained professionals, not the public.  The public won't do as well, because even more mistakes will be made.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

---

by: anon.yyz @ Tue Feb 27, 2007 at 02:39:33 AM UTC

[ Parent ]

I understand that (and accept it)

but also remember HCW don't wash their hands as well as they should and only 40% get a flu shot.  ;-(

they are closer to the population as a whole than they'd like to think.

And as SusanC has pointed out, bad pandemic means increased coompliance across the board.

OTOH, re Hong Kong and not Toronto, I saw a presentation that said that 100% handwashing and no mask led to 0% staff infection with SARS. The hospital with 7 infection control nurses did much better than the hospitals with one. So, that too, is a real life observation.

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by: DemFromCT @ Tue Feb 27, 2007 at 02:44:07 AM UTC

[ Parent ]

Washing hands compliance.

That may be a function of HCW education, motivation (how scared, yes scared to respect the threat but not hopeless), practice and case load.  Easy access to hand wash is important. If the CFR gets real bad, the scare factor is higher, but so are the work load, stress and fatigue.  So I do agree that NPI to reduce the AR is very critical, but then NPI won't work if people don't stockpile.

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

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by: anon.yyz @ Tue Feb 27, 2007 at 02:56:06 AM UTC

[ Parent ]

I hope that is true

When I was head nurse of an oncology unit I did a quality assurance study of handwashing compliance of physicians on my floor during rounds and most did poorly.

The results were posted without the physicians names and they pestered me to no end to find out who Doc A, B, C, and D etc was. I would not tell. Their performance improved as they then thought they were being watched.

There was a sink in each room but they did not use it as they should. I think most docs in a pandemic situation would not enter a room without gloves.

Life is not so short but that there is always time enough for courtesy. Ralph Waldo Emerson

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by: mojo @ Tue Feb 27, 2007 at 03:08:04 AM UTC

[ Parent ]

put it this way...

if I have an N95 and I am around a coughing/sneezing patient, I am using it. if all i have is a simple mask, I am using that and standing back. ;-0

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by: DemFromCT @ Tue Feb 27, 2007 at 02:18:03 AM UTC

[ Parent ]

You forgot Hand Hygiene :) n/t

Never believe that a few caring people can't change the world. For, indeed, that's all who ever have. ~ Margaret Mead

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by: FloridaGirl @ Tue Feb 27, 2007 at 02:44:55 AM UTC

[ Parent ]

see comment above ;-)

re SARS and Hong Kong, and HCW who do not wash their hands.

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by: DemFromCT @ Tue Feb 27, 2007 at 02:48:12 AM UTC

[ Parent ]

If you run across that presentation about 0% with HH

then I would love to have a copy of it. 

Never believe that a few caring people can't change the world. For, indeed, that's all who ever have. ~ Margaret Mead

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by: FloridaGirl @ Tue Feb 27, 2007 at 03:37:46 AM UTC

[ Parent ]

he said 0% in the presentation I heard, though in this

reference there were 2 "possibles." The summary is from a Medscape article by Mike Tapper. The presentation, in Arlington VA, cited his hospital as having significantly less staff infections than surrounding hospitals.

Control of Emerging Infectious Diseases, Including SARS

In a highly personal and entertaining lecture, Professor Seto called for a "back-to-basics" strategy for infection control to prepare for the challenges of emerging infectious diseases. In contrast to many other facilities in Hong Kong at the time of the initial SARS outbreak in Asia, Queen Mary Hospital had a full complement of trained infection control personnel. They were able, therefore, to quickly mobilize professional resources to handle an influx of SARS and suspected SARS cases in Hong Kong. Unlike other facilities during the outbreak in Hong Kong, Queen Mary Hospital experienced only 2 cases of probable nosocomial transmission of SARS to healthcare workers.[3]

Resources from other infection control priorities, such as control of methicillin-resistant Staphylococcus aureus (MRSA) transmission, had to be diverted during the SARS outbreak in Hong Kong. Despite this diversion, Professor Seto noted that the transmission of other nosocomial pathogens did not increase during the SARS outbreak. He attributed this phenomenon to the continuous training offered by his staff. To achieve these and other similar successes, such as a decrease in catheter-associated bloodstream infections, Professor Seto described the unique features of the infection control program at Queen Mary, namely, a broadly based and adequately staffed infection control infrastructure that addresses ongoing endemic infection control. This is in contrast to an overemphasis on preparedness for specific diseases, such as SARS or avian influenza. Professor Seto urged facilities in both developing and developed countries to invest in this more general, yet very successful approach.

Seto WH, Ying RWH, Ching TY, et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of Severe Acquired Respiratory Syndrome (SARS). Lancet. 2003;361:1519-1520.

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by: DemFromCT @ Tue Feb 27, 2007 at 03:52:07 AM UTC

[ Parent ]

I'll try to locate this article tomorrow.... I would

be curious to whether they used (emphaised) foam or Hand washing... Thanks, Dem.

Never believe that a few caring people can't change the world. For, indeed, that's all who ever have. ~ Margaret Mead

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by: FloridaGirl @ Tue Feb 27, 2007 at 03:59:08 AM UTC

[ Parent ]

link is below

free after registration.

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by: DemFromCT @ Tue Feb 27, 2007 at 04:01:40 AM UTC

[ Parent ]

so what we learned is...

... SARS is droplet spread, and therefore simple mask is nearly as good as N95. Paper masks, which get wet, do not work. That all follows from what we know about droplet spread.

If the SARS analogy is to be followed, simple masks were effective, at least in Hong Kong. And, to the extent that flu is droplet spread, there's a role for simple masks. Where aerosol is expected (like in instrumenting the throat), N95 are wiser to use.

Handwashing and gowns have more of a role than gloves.

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by: DemFromCT @ Tue Feb 27, 2007 at 04:10:38 AM UTC

[ Parent ]

i got that wrong

following the Lancet reference, masks (either simple or N95) were the most important factor.

Staff who used masks, gowns, and handwashing were less likely to develop SARS than those who did not use them, but the association for gloves was not significant (table 2). None of the 69 staff reporting use of all four measures became infected. By contrast, all 13 infected staff had omitted at least one of the measures (p=0·0224). However logistic regression of the four measures with forward stepwise selection showed that only use of masks was significant in the final model (table 2)...

The staff who wore surgical masks and N95 masks were significantly associated with non-infection (table 2), but this was not seen for paper masks.

http://www.thelancet...

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by: DemFromCT @ Tue Feb 27, 2007 at 04:00:31 AM UTC

[ Parent ]

Would patients wear masks?

If not, I'm imagining a patient lying in bed with a sneeze guard over his face.  Like the mesh cover with a domed frame sold for picnics to keep off yellowjackets and flies.  One portion could be less porous and be positioned over his mouth and nose, and the rest could be airier for breathing purposes.  It's hard to imagine a 6-foot distance between patient and doctor or nurse.  It's reassuring to be touched, for one thing, but we should be reasonable about how much risk we expect HCWs to take.

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

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by: Jane @ Tue Feb 27, 2007 at 03:36:12 AM UTC

[ Parent ]

6 ft distance was my thought about the public, not for health care setting n/t

You want perspective. I want perspective. Let's talk. We don't have to agree on every thing. If we do, one of us is redundant.

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by: anon.yyz @ Tue Feb 27, 2007 at 03:40:45 AM UTC

[ Parent ]

Double Bag

Especially if using less that N-95, one for the patient and one for you. 

Two lines of defense. 

Half as good means twice as much.

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 

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by: Into The Woods @ Tue Feb 27, 2007 at 05:33:06 AM UTC

[ Parent ]

Bird Flu Spreading In Central Russia

Recent cases of avian flu in dead poultry have been registered in the Russian capital and two adjacent regions, the emergencies ministry said Monday. "Since February 10, dead poultry have been found in Moscow, eight districts of the Moscow Region and a district in the Kaluga Region," the ministry said. "Traces of the deadly H5N1 virus have been confirmed at private farms at 10 locations in these areas."...

http://www.terradail...

Be Prepared

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by: DennisC @ Tue Feb 27, 2007 at 02:22:24 AM UTC