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The use of good judgement during the discussion of controversial issues would be greatly appreciated.

Pakistan, Dec 15 to Dec. 18

by: DemFromCT

Sat Dec 15, 2007 at 20:37:36 PM EST


This is for news reports on Pakistan (speculation allowed, but please label as such).

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.

DemFromCT :: Pakistan, Dec 15 to Dec. 18
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the clearest stories are from Helen Branswell and Gason Gale
There was some confusion Saturday about how many people had tested positive for the virus, with Pakistan announcing six cases but an official of the World Health Organization suggesting as many as nine people may have tested positive for the virus in that country.

The WHO spokesperson said investigations are still underway to try to determine how the various people became infected, but some human-to-human spread is possible.

"We can't rule it out,'' WHO spokesperson Gregory Hartl said from Geneva.

"There are other plausible explanations.... We don't know enough at this point. And in some of these cases, one never will know enough.''

The cluster of cases involved four brothers and two cousins living in the country's North West Frontier Province. Two of the brothers died, one without having been tested.

A doctor who treated members of the family also has tested positive for H5N1, Hartl said. But she was not tested with the standard diagnostic assay used to detect H5N1 infection and further testing is needed to determine if she is indeed a case.

Three people who are unrelated to the family but who were involved in culling H5N1-infected poultry in the same area have also tested positive.

http://www.newfluwiki2.com/sho...

and http://www.bloomberg.com/apps/...


Pakistan's national laboratory found the lethal H5N1 avian flu strain caused the infections in three brothers and two cousins from the same family, according to information from a WHO statement today and Gregory Hartl, a WHO spokesman in Geneva. Another brother and his son from the U.S., who attended a funeral for one of the victims, tested negative for the virus at a hospital in Nassau County, New York, Hartl said.

Medical teams have been sent to Pakistan to assist local authorities in investigating the cases, in which two people had only mild symptoms, Hartl said. Avian flu has infected at least one person a month in Asia and Africa during the past three years, and doctors are monitoring for signs it may be adapting to humans by killing fewer people, fostering its spread.

``It's too early to make any definitive conclusions'' about the outbreak, Hartl said in a telephone interview today. ``We are still in the middle of it.''



brother and his son from the U.S
Another brother and his son from the U.S., who attended a funeral for one of the victims, tested negative for the virus at a hospital in Nassau County, New York, Hartl said. ...

Five members of a family in Pakistan are among eight people who may be the country's first human cases of bird flu, the World Health Organization said. At least one brother died.

that is from :
http://www.bloomberg.com/apps/...



Be Prepared


pictures of brothers and names
http://www.mysinchew.com/node/...
Pakistani brothers Mohammed Ishtiaq, right, and Mohammed Tariq, left, who were treated for suspected H5N1 bird flu, come out from their house in Sukur village on 15 Dec 2007....

Two brothers died in the northwestern city of Peshawar, but specimens were only gathered from one of them, the Health Ministry said in a statement. Officials were trying to identify how the victims became infected and were monitoring people who had come into contact with the sick.

Myanmar experienced its first human case when a 7-year-old girl from the eastern Shan State became ill 21 Nov in an area where poultry outbreaks had earlier been reported, WHO said. She was hospitalized and has since recovered.......

The father was recovering after taking the antiviral drug Tamiflu, said Hans Troedsson, the WHO representative in China. More than 80 people who came into contact with the family were being monitored.....



Be Prepared


saw an interview on TV
here, of these 2 brothers.  The vet says neither of the brothers who died had any exposure to poultry at all, the only exposure was caring for him in hospital.



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


[ Parent ]
I would tend to take his word for it.
-Rampant Speculation-
I just have a feeling something is going to be made of them being agriculture students for some reason.  

Millions for defense, but not one cent for tribute!

[ Parent ]
here's an additional thought
there is a chance that they are insisting on the 'no contact with poultry' theme because they want to get compensation for the lack of PPE during culling.

That's always a possibility, to put things in perspective.  



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


[ Parent ]
more from the TV interview
took more notes second time round.

The veterinarian said that they were not supplied with any PPE for the culling, no masks or gloves.  Also that he didn't know about the risks before he got sick.

Another brother who recovered was said to have had mild symptoms.  



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


[ Parent ]
brothers of veterinarian
OK, so this is "old news". (Oct and Nov) but it might help clear up some of the uncertainties we have right now.

The deaths of two brothers of a veterinarian, who acquired the deadly H5N1 Avian Influenza virus after coming into contact with infected poultry at a farm in Abbottabad late-October, and the recent hospitalisation of a Mansehra-based poultry handler who has also tested positive for the disease, provide sufficient evidence for the government to institute concrete measures for interruption of human transmission of the disease from birds to poultry handlers and their close contacts.

Of the 40 suspected human samples collected from Peshawar and Abbottabad in the wake of the first-ever confirmed human transmission of H5N1 in Pakistan, 36 have tested negative, while four are positive, investigations conducted by 'The News' have revealed.

It is learnt that both the veterinarian, Dr. Ishtiaq Durrani, who is working as livestock production officer at the Department of Livestock and Dairy Development, NWFP, as well as the poultry handler from Mansehra, did not follow the recommended protective measures while handling infected birds. They may either have come into contact with the saliva, nasal excretions and faeces of the infected birds, or the feed and water that are given to them.

Dr. Ishtiaq was involved in culling of 3,000 birds following the October 21 outbreak of bird flu at a poultry farm in Abbottabad. The other victim from Mansehra happens to be a daily wage labourer who was commissioned for culling without being advised on how he should protect himself. The labourer's daughter, along with another male, is also under observation at a hospital in Abbottabad.....

While Dr. Ishtiaq himself is on the path to recovery, his brothers Mohammad Ilyas Durrani and Mohammad Owais Durrani - both of who were attending him at the Khyber Teaching Hospital during his illness - died on November 19 and November 29, respectively. The symptoms of avian flu infection in humans include muscle aches, fatigue, fever, coughing, sneezing, sore throat and eye infections. In severe cases, infection may lead to fatal pneumonia, blood disorders and multiple organ failure.

Ilyas has been confirmed as being the first casualty of H5N1 in Pakistan. Even though his brother's blood sample could not be collected, health experts talking to 'The News' said clinical evidence suggests that he too succumbed to the deadly virus. The blood samples of two of the three brothers were received by the National Institute of Health on October 28.

http://www.thenews.com.pk/prin...

Be Prepared


Yes, thank you for clearing up the confusion.
I wonder if one of our skilled logistics experts might be willing to create a chart of some sort which will help us track these cases and their connection to one another.

I know everyone is busy, so just asking. I'd do it, but I'm so technologically challenged that it would be a mess.
:oP

Always have a plan B.


[ Parent ]
track cases in wikipage?
at http://www.fluwikie.com I've created http://www.fluwikie.com/pmwiki...

Folks will have to be careful with recent editions, checking who changed what.  Also "no links, no credibility".

I don't know if this would help so feel free to drop the idea if it doesn't help!

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


[ Parent ]
This is significant, good catch.
While Dr. Ishtiaq himself is on the path to recovery, his brothers Mohammad Ilyas Durrani and Mohammad Owais Durrani - both of who were attending him at the Khyber Teaching Hospital during his illness - died on November 19 and November 29, respectively.

Ilyas has been confirmed as being the first casualty of H5N1 in Pakistan. Even though his brother's blood sample could not be collected, health experts talking to 'The News' said clinical evidence suggests that he too succumbed to the deadly virus. The blood samples of two of the three brothers were received by the National Institute of Health on October 28.

The two blood samples would be from Dr Ishtiaq and Mohammad Ilyas Durrani because they say they took no samples from Mohammad Owais Durrani (and thus can't prove he died from H5N1).

This might mean that Mohammad Owais Durrani was the third to be infected but the first to die. He might have caught it from Ilyas and left the hospital before he got sick?


[ Parent ]
October 28th?
The blood samples of two of the three brothers were received by the National Institute of Health on October 28.

Don't know if this is a mistake by the report, because if the poultry outbreak happened on Oct 21st, and the culling happened after that, the vet would have only just started being sick on and around Oct 28th.

IF the vet AND a brother were already tested on October 28th, and they then turn out to be positive, how is it possible that they didn't test the brother who later died on Nov 19th?

Plus there are other reports that suggest the Pakistani authorities got the positive test results some time late in November (can't remember where I read it).

My best guess is this was a misprint, and that their NIH received the blood samples on November 28th.



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


[ Parent ]
More info.
Hat tip AndyM over at PFI.  Looks like there were five brothers.  Please follow the link and read the whole article.

Pakistan Has Eight Suspected Human Cases of Bird Flu (Update4)

By Jason Gale

[snip]

The infections probably began late October in an agriculture ministry official involved in culling diseased poultry on a farm at Abbottabad in North-West Frontier Province, which borders Afghanistan, Hartl said.

The man fell ill and was cared for by two of his brothers, who also became unwell. One of the brothers died about a month ago and was buried before specimens could be taken for a diagnosis. The other died on Nov. 29 and was positive for H5N1 in preliminary tests, Hartl said. Antibody screening on the first man, who recovered, found he'd been infected with H5N1.

U.S. Brother

A third brother was hospitalized for H5N1 infection and also recovered. A fourth brother who lives in the U.S. tested negative for H5N1 after returning to Pakistan for his brother's funeral, Hartl said.

Two cousins, at least one of who is a woman, were positive for H5N1, although they developed only mild symptoms, he said. A man and his niece, who were also involved in culling poultry on either the same or a neighboring farm, have tested positive, Hartl said. The eighth case is a male farm-worker from Mansehra, about 20 kilometers (12 miles) from the other cases, he said.

[snip]

http://www.bloomberg.com/apps/...


Okay, that makes more sense to me.
I was trying to figure it out based on the names in one of the previous articles, plus the ones in the article that shows a picture.  I kept coming up with an extra brother, and I couldn't figure out why!  

Millions for defense, but not one cent for tribute!

[ Parent ]
Here's a list of brothers, as best as I can tell.
Mohammed Ishtiaq - the vet - recovered
Mohammad Ilyas - deceased - no test
Mohammad Owais -deceased - tested positive
Mohammed Tariq - recovered
Unnamed brother - tested neg. in U.S.

Millions for defense, but not one cent for tribute!

[ Parent ]
Do I have the "8 cases" correctly?
The 8 suspected (initial positive tests) cases are:
1: Dr. Ishtiaq Durrania, a veterinarian, became ill late October or early November, recovered
2: The vet's brother, Mohammad Owais Durrani, who became ill after caring for the vet, and died Nov. 29
3: The vet's brother, Mohammed Tariq, who had mild symptoms and recovered
4 & 5: Two cousins (at least 1 of whom is a woman), who had mild symptoms and recovered
6 & 7: A man and his niece, who were involved in culling poultry on the same or a neighborhing farm
8: A male farm-worker from Mansehra

Suspected case (not tested):
The vet's brother, Mohammad Ilyas Durrani, who became ill after caring for the vet, and died Nov. 19

Suspected case (test pending):
A female doctor who treated members of the family

Initially suspected cases, but tested negative:
A fourth (unnamed) brother of the vet, and this brother's son, both of whom live in the U.S.


[ Parent ]
Almost, but I think I had Ilyas and Owais reversed in my list.
Iilyas got sick before Owais, but he is the one authorities are saying was confirmed by lab tests in most of the articles. Other than that, it looks right to me, if we are holding suspect the report of the man who was attending his wife in the vicinity of the brothers' isolation room.  There have been several reports that Tariq died, but since we see a picture of him published on the 15th, I think we have to assume "rumors of [his] death are greatly exaggerated."  

Millions for defense, but not one cent for tribute!

[ Parent ]
This is how we envisioned it to start.
Someone from another country coming over here. Luckily this time, the person was negative. Can we get lucky again?

It's too close for me to be relaxed. I'm roughly 450 miles from N.Y. city. This has rattled me.  

United we stand: Divided we fall
www.flunewsnetwork.com


Pakistan hospitals on alert.
Hat-tip Pixie at PFI

Commentary

Likely Human to Human H5N1 Transmission in Pakistan

Recombinomics Commentary
December 13, 2007

http://www.recombinomics.com/N...

The deaths of two brothers of a veterinarian, who acquired the deadly H5N1 Avian Influenza virus after coming into contact with infected poultry at a farm in Abbottabad late-October, and the recent hospitalisation of a Mansehra-based poultry handler who has also tested positive for the disease, provide sufficient evidence for the government to institute concrete measures for interruption of human transmission of the disease from birds to poultry handlers and their close contacts.

Of the 40 suspected human samples collected from Peshawar and Abbottabad in the wake of the first-ever confirmed human transmission of H5N1 in Pakistan, 36 have tested negative, while four are positive, investigations conducted by 'The News' have revealed.

It is learnt that both the veterinarian, Dr. Ishtiaq Durrani, who is working as livestock production officer at the Department of Livestock and Dairy Development, NWFP, as well as the poultry handler from Mansehra, did not follow the recommended protective measures while handling infected birds.

Dr. Ishtiaq was involved in culling of 3,000 birds following the October 21 outbreak of bird flu at a poultry farm in Abbottabad. The other victim from Mansehra happens to be a daily wage labourer who was commissioned for culling without being advised on how he should protect himself. The labourer's daughter, along with another male, is also under observation at a hospital in Abbottabad.

While Dr. Ishtiaq himself is on the path to recovery, his brothers Mohammad Ilyas Durrani and Mohammad Owais Durrani - both of who were attending him at the Khyber Teaching Hospital during his illness - died on November 19 and November 29, respectively.

The above details suggest H5N1 in Pakistan was transmitted human-to-human in the three family members. Although disease onset dates were not given, the 10 day gap between the date of death strongly suggests one brother infected one or two other brothers. Moreover, the cluster of four positives in the same area, possibly involving five people since one of the dead brothers was not tested, highlight a relatively efficient transmission of H5N1, as do the two hospitalized contacts under observation

Hospitals in Pakistan have gone on alert.

Sequence data on the recent human and poultry cases, as well as earlier outbreaks would be useful.

United we stand: Divided we fall
www.flunewsnetwork.com


heh
Sequence data on the recent human and poultry cases, as well as earlier outbreaks would be useful.

I would say so, as well.


[ Parent ]
this is a problem
both of who were attending him at the Khyber Teaching Hospital during his illness

in many developing countries, patients in hospitals are cared for by family members who often sleep on the floor right next to the bed, as a matter of routine.  Instead of isolating the patients they end up exposing the most vulnerable, ie those who are genetically related.  



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


[ Parent ]
And do they give these caregivers and kind of protective clothing
or even instruction in how to prevent getting infected and/or carrying the infection to others. When these caregivers stay with the ill family member, do they come and go, potentially carrying the disease home to other family members, or perhaps to their workplace?  Yikes. Gives me the willies.

Always have a plan B.

[ Parent ]
you wish
the REASON why such caregiving is the norm is the lack of resources.



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


[ Parent ]
family members often come and go
bringing food, changes of clothing, and other necessities for the patient.  They are also expected to provide the most intimate kinds of patient care, including handling excreta, changing and washing soiled linen, especially when they have diarrhea, etc.

In  addition, Asian cultures are very strong on family values.  It is the expected norm for family and friends to visit, if someone is sick.

All this, of course, can be changed if the hospital is aware enough to impose new restrictions.  But in the absence of firm diagnosis, in places where febrile and respiratory illnesses are common, it's likely that most hospitals will just let family come and go.



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


[ Parent ]
the brother in the US
cross-posted from the news thread  http://www.newfluwiki2.com/sho...

If he tests positive for antibodies, it's likely we are looking at h2h2h.  At least.  Assuming he went to Pakistan for the funeral of the first brother who died on Nov 19th.  

If the index case, the vet, got sick in October, by the time the funeral occurred, chances are the vet would not be excreting as much virus as the other brother who was sick at the time but died afterwards on Nov 29th, who most likely caught it from the index case or from the first brother who died.

If the first cluster ever reported in Pakistan involves h2h2h, and we don't know how much else we are missing, then it's certainly cause for concern.

Which is why it's important to know for sure whether this brother, now in the US, tests positive for antibodies.



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


I read over on PFI that
the US brother tested NEGATIVE.  Do we not have concrete test results for him yet?  I'm not sure which would make me feel better - pos or neg?!  

Time to go decorate our x-mas tree and try not to think about these disturbing developments for a few hours.


[ Parent ]
the US brother was negative by both
state and CDC testing. Definitively negative.

[ Parent ]
So does that mean he simply
had regular flu?  Maybe some of the others did as well?  Very strange.  I can't recall - are there other incidences of anyone who "had" and recovered and tested negative?

[ Parent ]
the two different reports that I read
said "he was not infected" and then he was "negative".

To be very precise, does that exclude the possibility that he HAS NEVER BEEN infected at all?  I know I'm nitpicking at the wording but in terms of timing, there are times when someone has been infected, PCR is negative but then later on you find elevated antibody levels.   It will be good to get that confirmation from the CDC, to know for sure which tests have been done and shown to be negative.



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


[ Parent ]
here's my take
I presume that he had a PCR at CDC (gold standard) and it was negative. The seroprevalence study should be done anyway (was he EVER infected) but unless he was given tamiflu, I don't see that he had it NOW.

And if he had a positive seroprevalence at some other time, less H2H, more point exposure... if we knew where he was and when he was.


"He was negative. There was no doubt about it," Daigle said from Atlanta on Saturday.

Look, there's only so much you can speculate on without data. Making him into a 'possibly suspect' case given negative testing in this case... I don't see it.


[ Parent ]
well, the debate
The discussion of these cases, whether positive or negative, has certainly caused a few ARs. Not a bad thing, all in all since they toughen us up. Even us old time flubies need a wake up call once in a while ;)

Either way, negative/positive, the overall landscape has become a lot bumpier with no level ground in sight...mvho, of course.

Pray for all people and rulers
1Timothy 2:1-4

(Extending the culture of life.)

http://preparedcitizens.wordpr...


[ Parent ]
true
and it's a "teachable moment" re ease to come to the US.

[ Parent ]
except
the information is barely reaching where it is supposed to...the totally unaware. Pakistan and Indonesia are too far away and the subject too easy to deny to really begin to teach the average US citizen.

this is a response from a post that I made at MassLive...I have since been banned and cannot respond to this person
What is the point? People are educated regarding influenza-
"I'm a nurse so I know this. Influenza vaccines are more availble then ever! What is your spin here? That website sounds crackpot to me- no wonder your "word" isn't getting out!" http://www.masslive.com/forums...

If anyone else would like to respond I would appreciate it. In fact, I have invited the people on P4P to actually engage people on this particular board to engage people in conversation. Perhaps "many voices" would have an impact. I would suggest not point to one particular forum board...share the fallout ;)

Just a suggestion....and opinion. It might be a very BAD idea for all I know.

Pray for all people and rulers
1Timothy 2:1-4

(Extending the culture of life.)

http://preparedcitizens.wordpr...


[ Parent ]
standing firm, I'd have to register to post there, wouldn't I? Do posters have to live in Mass.?
Also, where is this post by the nurse?  They are numbered conversations, looks like.  

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

[ Parent ]
rules say anyone can post
http://www.masslive.com/forums... post 1869

http://www.masslive.com/forums...

There is no stipulation that you live in the area.

I think that I did not vary my message enough in some of the forums and that could be what got me banned. Live and learn.

Maybe this is a better way anyway. Many hands make for lighter work and this definitely stimulates conversation!

Flubies can be almost anonymous too ;-)

Pray for all people and rulers
1Timothy 2:1-4

(Extending the culture of life.)

http://preparedcitizens.wordpr...


[ Parent ]
standing firm, I registered and replied to the skeptical nurse.
Wonder if she'll see it.

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

[ Parent ]
she saw it
if you want to combat the idea that it's a 'crackpot' site, that's where CDC and pandemicflu.gov come in, or CIDRAP.

[ Parent ]
i submitted to best practices
Who knows....most people in the general public really don't give a hoot about the CDC or CIDRAP or even pandemicflu.gov at this point in time anyway.

As I said in my local Monson forum...I really don't care what people think of me as long as the word gets out. "Crackpots" can be useful to society too :-). "No skin off my nose" except the peoples lack of preparedness WILL effect us all even if it is on a gut level.

Also, there is an undertone of a class struggle ongoing here---IMVHO. The lower middle class working folks aren't sitting around watching Oprah and some are PC less. What about those who have even less, they have a right to this information...that is my point.

Early morning rant...sorry

Pray for all people and rulers
1Timothy 2:1-4

(Extending the culture of life.)

http://preparedcitizens.wordpr...


[ Parent ]
oops...promising practices n/t


Pray for all people and rulers
1Timothy 2:1-4

(Extending the culture of life.)

http://preparedcitizens.wordpr...


[ Parent ]
but the specific concern expressed
is 'crackpot site'. That's where pandemicflu.gov (or any .gov site, or the American red cross, or a list of similar sites) comes in, as a specific answer to that. especially for those who want to push their nursing credentials at you, use this.

[ Parent ]
got it..thanks
I have resources listed but they need to be featured! Thanks Dem

Pray for all people and rulers
1Timothy 2:1-4

(Extending the culture of life.)

http://preparedcitizens.wordpr...


[ Parent ]
is this what you meant?
http://preparedcitizens.wordpr...

I am working on the actual steps next!


Pray for all people and rulers
1Timothy 2:1-4

(Extending the culture of life.)

http://preparedcitizens.wordpr...


[ Parent ]
CDC can't be dismissed as "crackpot," though, at least by most people.
So others reading may be influenced, even if one particular person chooses to ignore the issue.

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

[ Parent ]
Skeptical Nurse
Sounded more like ignorant nurse than skeptical nurse - and I'm being as kind as I can be, given the level of ignorance and holier-than-thouness I saw displayed.

No problem . . . everybody knows about flu, and vaccines.

D'oh.  


[ Parent ]
Thank you SO much!
Leaving the conversation hanging would have been horrible and you addressed the issue perfectly. Thanks.

Pray for all people and rulers
1Timothy 2:1-4

(Extending the culture of life.)

http://preparedcitizens.wordpr...


[ Parent ]
standing firm, I answered the reply, too,
but maybe got a little testy at the end.  I could be wrong, but it felt like the responders were more interested in finding something to lob back at me than they were in exploring the issue, so I'm done with it now, probably.

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

[ Parent ]
Jane...it is frustrating
...people don't seem to realize that we can reduce the deaths from "other causes".

Thank you Jane. You did great! I am sure that your words had an impact...just getting the words out there has an impact. It will sit there as a record. As people hear more in the news they can refer back.

That was why I wanted to reach out in all the rooms on the board. Eventually....


Pray for all people and rulers
1Timothy 2:1-4

(Extending the culture of life.)

http://preparedcitizens.wordpr...


[ Parent ]
look, I'm only commenting
because there are confusing reports that he was supposed to have been infected in Pakistan and recovered.

I'm not making him into a suspect case, or any case.  But epidemiology involves a meticulous head for details.

So IF he was infected and recovered, AND if the brothers' story, which I saw on a TV interview here (ie interviewing 2 brothers directly, not interviewing officials) is believable, that apart from the vet, no one else was exposed to poultry, the question always is where did he get infected from?

AND if he ONLY went to Pakistan because of the funeral of whichever brother, then the timing suggests he didn't go there before Nov 19th right?

Which means the chance of him getting it from the vet was low (not impossible, but low), then he must have caught it from either one of the other brothers (one dead, one dying),

Which makes it h2h2h.

THAT is why it is important to find out whether he has antibodies!



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


[ Parent ]
I am skeptical of the infected and recovered
and prefer to get the whole story before jumping down that one. One too many IFs for me ;-P.

No question about the need for a filed epidemiological study. This should happen now that WHO is involved... that's what they do...

WHO to Investigate Pakistan Bird Flu

By THE ASSOCIATED PRESS
Filed at 6:22 a.m. ET

ISLAMABAD, Pakistan (AP) -- International health experts have been dispatched to Pakistan to help investigate the cause of South Asia's first outbreak of bird flu in people and determine if the virus could have been transmitted through human contact, officials said Sunday.

Four brothers -- two of whom died -- and two cousins from Abbotabad, a small city about 30 miles north of Islamabad, were suspected of being infected by the H5N1 virus, said WHO spokesman Gregory Hartl in Geneva. A man and his niece from the same area who had slaughtered chickens were also suspected of having the virus.

Another person in a separate case who slaughtered poultry in nearby Mansehra, 15 miles away, also tested positive for the disease, he said.

Details surrounding the cases remained confusing, with Pakistan's Health Ministry issuing a statement Saturday saying six people had initially tested positive for the virus last month, while the WHO said eight had been reported. Hartl said the discrepancy was likely linked to a technicality since six patients had tested positive using an internationally recommended method while a less reliable test was used on the others.

Specimens were never collected from one of the brothers who died, and many of those who tested positive experienced only mild symptoms and were not hospitalized, Hartl said.

He added a team of WHO experts have been sent to Pakistan to help determine the cause. He said all four brothers were believed to have worked on a farm and poultry outbreaks had earlier been reported in the area. But one brothers, Mohammed Tariq, said only one sibling worked on the farm.

Hartl said WHO has not ruled out limited human-to-human transmission.

''We can't answer that yet,'' he said. ''It's possible.''




[ Parent ]
sure ;-)
I am skeptical of the infected and recovered and prefer to get the whole story before jumping down that one.

We all have our preferences.  That's why it's good to have people give different perspectives.

My preference is to make sure we DO get the whole story, by asking questions sooner rather than later.  ;-)



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


[ Parent ]
Bravo Susan EOM


To calm the wife buy cases of chocolate, to calm the husband buy cases of booze, and to calm the children...... heck the booze and chocolate should work.

[ Parent ]
WHO bird flu experts to investigate
if Pakistan outbreak was spread through human contact
ISLAMABAD, Pakistan: International health experts have been dispatched to Pakistan to help investigate the cause of South Asia's first outbreak of bird flu in people and determine if the virus could have been transmitted through human contact, officials said Sunday.

Four brothers - two of whom died - and two cousins from Abbotabad, a small city about 30 miles north of Islamabad, were suspected of being infected by the H5N1 virus, said WHO spokesman Gregory Hartl in Geneva. A man and his niece from the same area who had slaughtered chickens were also suspected of having the virus.

Another person in a separate case who slaughtered poultry in nearby Mansehra, 15 miles away, also tested positive for the disease, he said.

Details surrounding the cases remained confusing, with Pakistan's Health Ministry issuing a statement Saturday saying six people had initially tested positive for the virus last month, while the WHO said eight had been reported. Hartl said the discrepancy was likely linked to a technicality since six patients had tested positive using an internationally recommended method while a less reliable test was used on the others.

Specimens were never collected from one of the brothers who died, and many of those who tested positive experienced only mild symptoms and were not hospitalized, Hartl said.

He added a team of WHO experts have been sent to Pakistan to help determine the cause. He said all four brothers were believed to have worked on a farm and poultry outbreaks had earlier been reported in the area. But one brothers, Mohammed Tariq, said only one sibling worked on the farm.

Hartl said WHO has not ruled out limited human-to-human transmission. "We can't answer that yet," he said. "It's possible." Continued... http://www.iht.com/articles/ap...
 

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

     


All eyes on Pakistan
as H5N1 H2H transmission grows more probable
The confused jumble of media and medical reports coming out of Mansera, Pakistan is beginning to stabilize.  With that stabilization, we are beginning to get a picture of activity that is much more serious than originally assumed.

First, massive tips of the cap: The Flusites are absolutely nuclear with activity on this topic right now, with Flu Wiki and Flutrackers leading the way. Dr. Henry Niman at recombinomics.com is doing his usual excellent job of sorting through the maze and reading between the lines.  Plus, all the A-list flubloggers -- Mike Coston, Crawford Kilian, SophiaZoe and others (just a click away via this site) -- are maintaining excellent lines of communication.

Distilled from all these sites and opinions and translations, here is what apparently has happened:

In one of the numerous Pakistani H5N1-related bird culls of the past few months, a veterinarian appears to have been exposed to the H5N1 avian flu virus last October.  Remember that date. He then, by all appearances, transmitted the virus to one or more of his brothers.  They died ten days apart, strongly suggesting a chain human-to-human transmission, precisely because of the lag times.  If the two sons were infected by, say, eating a diseased chicken at the same dinner table, or even as leftovers, the infection incubation period -- and therefore the deaths -- would have occurred much more closely together.  

But they didn't, and the timetable gets really scary here.  If the vet brother (A) gets infected in October during the cull, and one brother (B) dies on November 19 and the other brother (C) on November 29, there is reason to strongly suspect the infections were passed down like a daisy-chain.  Human to human.  Chain transmission.  

The next wrinkle is really something.  There was another brother (D) of the vet, and who is a resident of -- drum roll, please --  the United States!  He gets the word that brother B died November 19th, and goes home to Mansera, Pakistan.  He then manages to contract bird flu himself and tests positive for the disease.  After hospitalization and confirmed recovery, he returns to the Long Island, New York area.  Immediately upon his arrival at the airport in Nassau County, New York, local health authorities and the CDC immediately place him (D) in quarantine and test him thoroughly until it is determined he tests negative for H5N1 and is now safe to release.  Kudos to the CDC and the authorities in Nassau County, New York.  So the CDC can find people now!  That is a comforting fact.

So to recap: Four brothers (ABCD) are in the first cluster family, one a vet.  And that vet was, by newer media accounts, the sole person to expose himself to poultry during the cull.  Two brothers are now dead, and the remaining two have tested positive for H5N1.

At the same mass bird cull that the veterinarian attended, a day laborer also contracted H5N1.  He is in hospital.  the culler's daughter is either in the hospital with bird flu-like symptoms or simply under observation, depending on the accounts.  Family contacts of all infected are under observation and, one would hope, also under isolation.  .So a second potential cluster develops from the same cull.

All this sounds eerily similar to the outbreak of highly pathogenic H7N7 in the Netherlands in 2003.  As you recall, a veterinarian died in that outbreak, and human-to-human transmission was thoroughly documented by medical researchers (http://www.eurosurveillance.org/em/v10n12/1012-222.asp).  That study's abstract concluded:

Further seroprevalence studies among contacts of asymptomatic H7 cases should be conducted.

So we have as close to a confirmed familial cluster of H5N1 that we have witnessed since May, 2006 in Indonesia.  And we have another potential familial cluster with the culler/laborer.  There may be a third cluster, but I believe we are seeing the "fog of war" syndrome as the Pakistani press tries to sort out some erroneous and conflicting dates and test results. Much more here: http://www.scottmcpherson.net/...


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

     


2003
Carol, the text you have bolded at the bottom of your post is a line from an abstract concerning the 2003 H7N7 outbreak in the Netherlands.  

[ Parent ]
Yes, I know.
The article had that line bolded so I kept it that way.

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

     


[ Parent ]
Ok, thanks Carol n/t


[ Parent ]
we don't know if that is correct

He then manages to contract bird flu himself and tests positive for the disease.

That is not at all clear to me, unless I missed something.


[ Parent ]
Pakistan: the waiting game
Effect Measure- Since this is not a breaking news site, I am waiting to see what is going on in Pakistan. I'll likely sum up tomorrow afternoon what I find by then (I hope with some value added). Here are some places you can keep checking for breaking news. They are the usual suspects:

Helen Branswell's reports (natch). Latest here.
Flu Wiki Forum
Crof's Blog
Avian Flu Diary
Scott McPherson
Sophia Zoe
Flu Trackers
CurEvents
Recombinomics

There are plenty of others, most accessible from one of the above sites. I'll be checking along with you.
Go here for links to the above listed sites: http://scienceblogs.com/effect...
 

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

     


Qinghai
the virus should be similar to the ones in Afghanistan, I assume.
So, it's the Qinghai strain, same as in Turkey, Egypt
with similar CFR

ask experts for their subjective
panflu death expectation values
and report the replies


What I am wondering...and I will bet Niman at recombinomics is working on...
is if there has been a recombination event in Pakistan which has made this virus both more transmissable and a little less virulent.

Okieman has pointed out previously that Pakistan has already been experiencing an early flu season with ILI of a fairly serious nature. Then H5N1 hits poultry farms, infects cullers, and suddenly we have what seems to be H2H2H...but many more than the usual numbers of positive cases with only mild symptoms and spontaneous recoveries, even without medical intervention or tamiflu.  Sounds like something has changed to me. Hope we get sequences soon to find out what.

Always have a plan B.


[ Parent ]
sure, but it really is not necessary
this whole pattern is perfectly consistent with H5N1 so far, only we don't know whether it has gone a little more alarming, or not.

It doesn't need any extra mechanism to explain anything, is what I'm saying.



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


[ Parent ]
So checking the sequences to see if there has been any kind of significant mutation is, in your opinion, unnecessary?
Then when DOES checking the sequences become necessary?

I actually find the number of mild cases that have occured in Pakistan in this short time span (might we say cluster) that resolved themselves without treatment or minimal treatment to be unusual. They didn't get tamiflu, but they did get well, and rather quickly.  I do not recall this kind of thing happening before, yet you say it is "perfectly consistent with H5N1 so far."  Could you please give me examples of where and when this has happened in the past, in these kind of numbers. Thank you.

Always have a plan B.


[ Parent ]
no I meant recombination
is not necessary.  As a hypothesis for why H5N1 is behaving this way.  The virus both mutates and reassorts, and, as far as I understand from conversations with scientists, increasingly research is verifying that recombination is not a significant factor for flu viruses.

So knowing the sequence is important, but changes do not have to be due to recombination to have significance.



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


[ Parent ]
I am with you on this one Mary
I think researching the sequences is always important and is totally called for here because of the changes we are seeing in infection rates and severity of symptoms in this geographical area of Pakistan.

We have heard over and over from WHO, various physicians and scientists how important valid and consistent sequencing is in order to track this virus and to prevent a pandemic. I believe it is especially important now because there appears to be a change in behavior.

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

     


[ Parent ]
to clarify
you can be a "get and openly publish the sequences" fan (we all are) with or without invoking recombination.

we know, alas, there are political headaches to open sequence publishing. who owns the virus? Does it mean admitting your country has H5N1? What happens to the sequences after publishing, etc. and other "science in the 21st C" issues.  


[ Parent ]
WHO secret database
there is also a difference between publishing and publishing,
because there are secret databases with only very limited access.

ask experts for their subjective
panflu death expectation values
and report the replies


[ Parent ]
I didn't mean particularly to "invoke" recombination in my suggestion
re getting the sequences; but it does seem  that those here who are NOT fans of Niman or his theory are particularly ready to dismiss any suggestion that such might have occured.

Mutation, reassortment, recombination...whatever the cause, it does look like this virus is behaving differently - rather significantly differently - in Pakistan than it has in prior cases elsewhere.  I may not be a doctor or PhD, but I am educated enough in science to know that good science looks at all possibilities and dismisses none until and unless they  have been soundly and definitively proven to be false.

Always have a plan B.


[ Parent ]
this is so
and sequence inspection (i.e. gathering data and making it available) is the best way to get there. We all agree. ;-)

[ Parent ]
well the thing is
We are dealing with very hazy information, much of which is likely to be erroneous, and much will probably never be answered to any degree of accuracy to be able to support good conclusions to the level of science that you appear to ascribe to.

but it does seem  that those here who are NOT fans of Niman or his theory are particularly ready to dismiss any suggestion that such might have occured.

Yes, good science is important, which is another reason why I clarified my remark on recombination.  There is no good solid peer-reviewed science to suggest that is an important mechanism for FLU viruses.  It does NOT mean that I'm saying we shouldn't look at sequences, but if you are asking for good scientific approach, then I would suggest with all respect that you reconsider your putting people into boxes, ie whether they are or are not FANS of a particular person or a particular theory, but rather consider that many are capable of making objective judgments based not on WHO espoused the theory, but whether the theory has merit based on SCIENCE.

With all respect.



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


[ Parent ]
sorry typo
aspire to, not ascribe to.



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


[ Parent ]
"ascribe to" vs "aspire to"....a very revealing attitude towards me.
Actually neither term is correct: subscribe (as in endorse)good science would be what I was doing. And I don't care how difficult or impossible it might be to achieve, you still have to hold to that standard or it isn't really science at all.


Always have a plan B.

[ Parent ]
What language is spoken in Pakistan? Arbaric? n/t


United we stand: Divided we fall
www.flunewsnetwork.com


yes, Arabic
and no doubt a large number of ethnic dialects as well.



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


[ Parent ]
Urdu and English as lingua franca
and some 80 other languages. Not much Arabic beyond to an educated minority and for prayers, actually. See
http://en.wikipedia.org/wiki/L...

I couldn't make it out specifically for NWFP, but a friend of mine travelled there extensively and Urdu was what he learned and used.


[ Parent ]
oops I meant Urdu
and Arabic as the written language.  Or at least that's what I've been told, by some Pakistani people that I know.

Sorry, too much multi-tasking!!!



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


[ Parent ]
still wrong!
In the area under discussion, in the North-Western Frontier Province, the main language is Pashto.  http://en.wikipedia.org/wiki/N...

The population consists of 2/3 Pasthtuns, the same ethnic background as those on the Afghan side of the border who were the main supporters of the Taliban.

The central government's reach in this area is weak indeed.  There is correspondingly enormous difficulty for any WHO let along CDC/NAMRU efforts to get accurate epidemiological information, I suspect.



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


[ Parent ]
more context and background
from http://www.travel-earth.com/pa...

Read the traveler's info on Peshawar, and the Khyber pass, like this:

Khyber Pass: The Afghan Connection

Organizing a day-trip from Peshawar to the Khyber Pass can easily be done independently. A taxi is about $15-20 for the whole round-trip. Your driver will first take you to the Office for Tribal Affairs, where you obtain a permit to enter the Khyber Pass (a permit is required). Included in the $3 permit is a gunman for the day. The trip to the Afghan border should take about 1.5-2 hours one way. The gunman will be very happy for a $1-2 tip after the trip.

And this picture of the beautiful and inhospitable landscape, at the Khyber Pass, which is only about an hour away from Peshawar.  http://www.geography.org.uk/do...



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


[ Parent ]
thanks, SusanC...
wow, possible 'enormous difficulty' is so right. Such an interesting history and culture but a tricky place for Western NGO's. I dearly hope the rural families survive this, for their sakes and ours. Understatement of the year.

[ Parent ]
I'm posting these links
for background understanding only.  

In no way am I suggesting we should go into these areas of discussion, rather for us to stay aware that public health does not happen in a vaccuum.  I just thought we can all benefit from a better idea of what the 'situation on the ground' might be like.  Thanks for everyone's understanding!

http://globalpolitician.com/ar...

http://www.theglobeandmail.com...



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


[ Parent ]
Yes
over at PFI there was a small bit of discussion re this. I am worried that tracing contacts may be a bit difficult if the population is not forthcoming with info. I guess it depends on the tribal leaders.

Of all the places for there to be a breakout like this, this is probably one of the worst. I am hoping the WHO is sucessful.It sounds like there is a tamiflu blanket being used which makes me think there is some success in communication.

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


[ Parent ]
languages
Urdu, Punjabi Pashto, Sindhi, Saraiki, Balochi, Gujarati.....and then the dialects

Pray for all people and rulers
1Timothy 2:1-4

(Extending the culture of life.)

http://preparedcitizens.wordpr...


[ Parent ]
From The Chicago Tribune article
I had not seen any dates for tests results posted here so I thought I'd post this part of the CT article. The rest of the article looked pretty familiar and is at the link below if anyone wants to read it. I apologize in advance if this is a repeat of any info.

snip
A team from the U.S. Naval Medical Research Unit in Cairo was being dispatched to Pakistan to help with the investigation, said Dave Daigle, a spokesman for the U.S. Centers for Disease Control and Prevention in Atlanta.

Khalif Bile, WHO representative in Pakistan, told The Associated Press on Saturday that preliminary tests had been carried out. He said the WHO was encouraging the government to carry out confirmation tests in the same government laboratory and the results should be available by Tuesday.

http://tinyurl.com/3dol2e


revere's review
This is from revere
http://scienceblogs.com/effect...
(is He/she/they still mods here???)
It gives a good review- read the whole thing there.
...........

The index case was one of five brothers, an agricultural official who worked on a culling operation on an infected poultry farm and fell ill in October. He has since recovered. Two younger brothers who visited and nursed him in the hospital, however, fell ill and died. Both were students at an agricultural school, so may also have been exposed there. One was said to have been confirmed to be infected with H5N1 by testing at Pakistan's National Laboratory. Specimens are being sent to a WHO reference laboratory for definitive confirmation. The other died and was buried before there was suspicion of H5N1 infection. A third brother, a primary school teacher who also visited the index case, developed mild symptoms and has recovered. Testing on him was not complete. A fourth brother, living in the US, traveled to Pakistan for the funerals of his siblings. There are conflicting reports whether he showed any symptoms. Upon his return to the US (Nassau Country, New York) he notified his doctor of a potential exposure and voluntarily quarantined himself in his home. Subsequent testing by CDC and the New York Health Department showed he had not been infected (his son was also negative for infection). Two cousins of the family are also reported to have had mild symptoms and to have tested positive. We have no exposure information on them at this time. They have since recovered. The three cull workers also have recovered. Finally, a doctor involved in the care of the index case was well but a non-standard diagnostic test (not specified) showed she may have been infected. ................

Be Prepared


I added it to my Daily Kos piece
good summary.

[ Parent ]
Daily Kos post
Dem, thanks for writing this piece.  It's an especially good one to pass along to people who are no longer paying attention.  

[ Parent ]
I should know but
what is a Kos ?

I can't search for it since it only has 3 letters.

Be Prepared


[ Parent ]
heh
Kos is the nickname of the site owner. it's the most active and widely read political blog on the internet. It has upwards of half a million readers a day.

it's an opportunity to reach a broader and larger audience than here, though one which remains skeptical.

http://www.dailykos.com/story/...


[ Parent ]
And some of those skeptics...
...are, shall we say, very vocal! The responses to Dem's posts on DKos make for some very entertaining reading!! Many of them mirror what we've all been confronted with when talking about PanFlu to lesser-informed people...

[ Parent ]
posting timeline here also
I also posted this under the news for the day to help those that haven't yet seen our new Pakistan thread here.

OK, so I got parts from other sites, and it may not be completly correct.
If you know of more info or corrections- make corrections and repost here
Oct. 21-23... culling in Abbotadad.
Oct. 24... 40 people involved with culling tested.
Oct. 25... Ishtiaq D. in hospital, where two brothers visit him.
Oct. 27... first positives found (4 total).
Nov. 19... one brother dies.
Nov. 29... second brother dies.
Dec. 5... last confirmed case found by Pakistani PTB.
Dec. 7... CDC becomes aware of US brother who returned from Pakistan.
Dec. 12... Pakistan finally reports human cases to WHO.
Dec. 16... WHO arrives in Pakistan.

veterinarian, Dr. Ishtiaq Durrani recovered
brothers, Mohammad Ilyas Durrani died untested
Mohammad Owais died tested positive
Mohammed Tariq recovered
one  other brother returned to US (Nassau Country, New York) and tested negative, (his sone also negative)

Notice the time difference between the culling, hospital of vet and brother's (who attended him death).  Sure looks like it was H2H and not the brothers' contact with the same culled birds (notice the two that died worked in the ag department)

OK that is the best I can do for now- make corrections and let's keep a running update


Be Prepared


Intriguing timeline
Pakistan would finally have to report those cases to the WHO, wouldn't they, once the CDC knew about the situation.  The cat was out of the bag then. I wonder when the WHO would have been notified if there had been no brother who reported his possible exposure to his doctor upon his return to the U.S.  

[ Parent ]
Chaotic
Revere's commentary at Effect Measure notes the fact that this region of Pakistan is not particularly stable.  Perhaps that, in part, explains the delay.  Many heads (and significant time) may have been required to piece together the situation.

[ Parent ]
'Not particularly stable' . . .
Now, that's an understatement of the highest order!

[ Parent ]
Great timeline. Thank you, DennisC n/t


[ Parent ]
Please clarify timeline on this one point
The Vet - original case - was hospitalized a few days after the culling on Oct 25. On Oct 27 4 positive cases of H5N1 in humans were confirmed. That would be the vet, the two other cullers, and who?? I wouldn't have been the brother who died on Nov 19, as he was the one they never tested, nor the one on the 29th, as he got sick well after Oct 27th, didn't he?  So who was the 4th positive?

Also, do we have any data on when the two brothers that died first started showing symptoms?
thanks

Always have a plan B.


[ Parent ]
Just guessing here.....
The 2 cousins, Omar (a culler) and a 10 year old girl who lived in that area. Or there could simply be 4 other cases we don't know about.

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

     


[ Parent ]
Frontier seriously considering closing poultry business
PESHAWAR: The Caretaker NWFP Health Minister Syed Kamal Shah expressed his dismay over the "continuous reluctance" of the National Institute of Health (NIH) in providing the provincial government with reports regarding the bird flu victims.

Setting a 24-hour deadline to the NIH for releasing the report, he said that the institute's denial or delay would be taken as they were hiding the report for vested interests. Besides, Syed Kamal said that the NWFP government was seriously considering closing down the poultry business in the Frontier province.

The minister said 70 per cent of Pakistan's poultry industry was based in the two districts of the NWFP, including Abbottabad and Mansehra, which he felt had been posing serious threat to the lives of the local population.

It may be recalled that after the painful deaths of two young brothers, Muhammad Idrees and Muhammad Ilyas, at the Khyber Teaching Hospital (KTH) in Peshawar on October 19 and 29 respectively mainly because of the sheer negligence of the hospital administration as well as by the unresponsive attitude of the NIH authorities, three more patients suffering from bird flu virus were admitted to hospitals in Abbottabad and Peshawar.

In Ayub Medical Complex (AMC), Abbottabad, where two patients, Omar, 38, and a 10-year-old girl were admitted, doctors said their condition was stable and they were sent home.

Medical Superintendent AMC Dr Iftikhar, when reached on telephone, told 'The News' one of them Omar was working at a poultry farm in Abbottabad while the girl was living in the vicinity of the farm.

"Their blood samples had been sent to the NIH but the report is awaited," he said. Another patient Riaz Hussain, who belongs to the nearby Palosai town, was admitted to the KTH.

Dr Mukhtiar Zaman Afridi, who is a noted chest physician and in charge of Pulmonology ward of the hospital, when contacted on telephone said the patient was in a stable condition and his blood samples had been sent to the NIH. (Snip)
He said the patient had been kept in an isolation room and was under his personal observation. However, during a visit to the hospital (KTH) on Sunday, a number of doctors and health workers complained to this correspondent that there was a mechanism to keep them safe from the virus but the ventilator of the isolation room where the patient had been kept was open and the virus could spread around in the entire hospital through air.

(Snip) Majority of doctors, paramedics and nurses were reluctant to go into the isolation room to attend the patient.

However, Dr Mukhtiar's lecture persuaded his staff to continue attending this altogether different patient. (Snip)

It was dismal to note that the two isolation rooms where the two brothers were kept and later died were found locked by the hospital administration. Also, despite the passage of two weeks, the KTH administration has failed to ensure sterilisation of equipment used in attending the two brothers. http://www.thenews.com.pk/top_...

 

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

     


Interesting comments about Abbotobad
from Travelers Digest.  Apparently there is a military academy there.

http://www.travelersdigest.com...

I think two of the deaths have been in Abbotobad (but I'm not sure which two.)


Abbottabad is where the poultry farm culling
took place, according to this prior post by DennisC.  
http://www.newfluwiki2.com/sho...

I found this site that provides a pretty good map showing the surrounding countries. They even had a handy circle drawn around Abbottabad.
http://www.geocities.com/Paris...  


[ Parent ]
WHO to investigate bf cases in Pakistan, Myanmar
BEIJING, Dec. 17 (Xinhuanet) -- The World Health Organisation (WHO) has sent experts to help investigate the cause of first bird flu cases in people in Pakistan and Myanmar and find out if the virus was transmitted through human contact, (Snip) WHO meanwhile praised Pakistan and Myanmar for their swiftly reporting the cases after the outbreak.

Two brothers Mohammad Ilyas and Tariq, who were brought to a hospital from Mansehra in North West Frontier Province on suspicion of carrying H5N1 virus, died of bird flu in Pakistan Thursday.

"The two brothers have been confirmed as bird flu victims and are the first human sufferers of the disease in our country," Dr Siddiqur Rahman, Acting Chief Executive of the Khyber Teaching Hospital in Pakistan.

In Myanmar, the first human infection of bird flu was known to the public on Saturday. A 7-year old girl, Ma Nan Kham Tha, was found infected with bird flu virus among four suspected of carrying the virus last month and was kept in quarantine and given a dosage of timiflu pills since Nov. 27 until her discharge on Dec. 12.

Specimens of the four suspected were first sent to a lab in Yangon which confirmed on Nov. 26 the girl's infection. The human samples of the four were also sent to a lab in Bangkok as well as the WHO lab in Tokyo and those laboratory tests further confirmed the status.

Khalif Bile, WHO representative in Pakistan, said preliminary tests had been carried out, adding the organization was encouraging the governments to carry out confirmation tests and the results should be available by Tuesday. (Snip) http://news.xinhuanet.com/engl...

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

     


WHO team in Pakistan to probe bird flu outbreak
A medical team from the World Health Organisation (WHO) arrived in Pakistan Monday to investigate a possible human-to-human transmission of the bird flu virus in the country's north-west region.

The team, which came from Geneva, was due to travel to the North-West Frontier Province to join other WHO staff in the towns of Manshera and Abbotabad, site of the country's first human cases of the H5N1 avian influenza virus, the WHO officials here said.

At least two people have died and eight others have been infected in the outbreak that prompted Pakistan's health ministry to request the WHO to investigate a possible human-to-human transmission.

Human-to-human transmission of H5N1 strain of avian influenza virus is extremely rare but such cases were found among family members in Indonesia, Cambodia and Vietnam. Continued.... http://www.indiaenews.com/paki...

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

     


WHO Warns Countries to Be on Alert
The World Health Organization warned Monday that countries should be on alert for bird flu because it is again on the move (Snip)

WHO experts arrived in Pakistan to try to sort out cases reported there (Snip). They were expected to visit a hospital and affected areas Tuesday, (Snip)

"They are here to get more information and to provide more support in the case of any potential risk," he said, adding that the Health Ministry, Agriculture Ministry and WHO are now working closely together following a "communication gap" when the government did not immediately report suspected cases to the WHO.

Four brothers and two cousins fell ill last monthin Abbotabad, a small city north of Islamabad, while three others who slaughtered poultry in the same area and a nearby town tested positive for the H5N1 virus earlier this month. (Snip) The cases were positive for H5N1 in initial government testing, but WHO will conduct further analysis to confirm the results.

WHO spokesman Gregory Hartl in Geneva said Sunday human-to-human transmission had not been ruled out, but added that poultry outbreaks had earlier been reported in the area and it was unclear if all patients had links to sick birds or infected surroundings.

A doctor who cared for the brothers also experienced mild flu-like symptoms, but more testing needs to be carried out to determine if she was infected, Hartl said.

Two poultry farms near Abbotabad have been closed and health workers are taking temperatures of those living in the affected area twice a day, but no new suspected cases have been reported, (Snip) "We are on high alert, though we still await any confirmation of human-to-human transmission," he said. (Snip)

With fresh poultry outbreaks reported in a number of countries, including Germany over the weekend, WHO urged nations to be vigilant in identifying and reporting cases in both birds and humans. (Snip)

The H5N1 virus often flares during the winter months. In some countries, like Indonesia, poultry outbreaks and human cases are reported year round, but many countries experience a flurry of activity when temperatures drop. "It starts to pop at this time of the year, not just in this region where it's endemic, but it starts to appear in the West," Cordingley said. "Between now and April is a very dangerous time of the year." http://www.foxnews.com/story/0...

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

     


A reminder
The article linked below was posted on Saturday's news diary.  Out of all the articles which came out that day and since, it is the one which I try to make sure I remember.  No news is not necessarily good news.  Nor is it necessarily bad.  The statements made by the NWFP Health Department minister is fairly stark in my opinion.  

There is a tendency to go two extremes sometimes:  the worst has occurred, or...all is fine and dandy.  I suspect we are somewhere in between, but we just cannot know.  Pakistan is a very volatile place right now, and the Northwest Frontier exceptionally so.  We should not be surprised that there is a bit of a news blackout.  I expect it.  If the virus has changed and is spreading, we will eventually find out, one way or another.  Outside of the government(s), I believe the flublogs will catch first wind of it.  So...we wait and watch...once again.  Patience is a virtue.

http://www.newfluwiki2.com/sho...


More info about Nassau County Resident
Hat-tip Dark Horse over at PFI

Nassau County Resident With Travel History to Pakistan Tests Negative for Bird Flu

ALBANY, N.Y. (Dec. 16, 2007) - Today the New York State Health Department provided the following information concerning a 38-year-old male Nassau County resident who recently returned from Pakistan, where he was exposed to suspected avian influenza or H5N1, also known as bird flu. After consulting with the Centers for Disease Control and Prevention (CDC) and taking appropriate measures, the state and Nassau County Health Departments determined that there was no risk to the public or to individuals that this person came into contact with.

Upon returning from Pakistan, the man landed at JFK International Airport on December 5. He visited his private physician the next day and was referred to a local hospital for observation. The hospital reported the patient to the Nassau County Health Department on December 7. While this individual showed no symptoms, as a precaution the Nassau County Health Department notified the State Health Department on December 7 and had patient specimens sent to the state Wadsworth Laboratories in Albany to test for H5N1. The results of the tests were negative. This negative test result was confirmed by the CDC, which had dispatched its plane to Albany on December 8 to collect the patient's specimens and conduct testing in parallel. Upon confirmation of the negative test results on December 9, the man's quarantine period ended.

As an additional precaution, the Nassau County Health Department arranged for this individual to be voluntarily quarantined in his home and monitored his condition via videophone. Post-exposure prophylaxis (Tamiflu) was prescribed. Because this individual's family was not exposed to avian influenza, they were not prescribed post- exposure prophylaxis. However, one family member who was symptomatic both before and after the man's return was also tested for H5N1 by the state laboratory and CDC and also found negative.

According to the CDC, no human infections with avian influenza H5N1 have been detected in the United States. The state Health Department thanks Nassau County Health Department officials for their teamwork during this process. Preparedness exercises in the past had helped train medical staff to respond to this type of incident. CDC is working with the World Health Organization (WHO) and other international partners closely to monitor the avian influenza situation in humans.

http://www.health.state.ny.us/...



Some past bird flu deaths?
Hat-tip AndyM over at PFI

Pakistan Records H5N1 Influenza Fatalities

[snip]

The case occurred in NW Frontier Province during the last days of October. Five others were also reported infected with the deadly H5N1 virus, according to the Pakistan Health Ministry.

There is also a report of a second death from Bird Flu sources. Health and safety officials in Pakistan are still investigating. The other ten fatalities are believed to be from Avian Bird Flu, but are still being investigated.

"We have found six cases that have shown positive for the H5NI influenza Avian Virus," reported the Pakistan Health Ministry. "We have had complete recovery with five of these patients," stated the Ministry Officials.

[snip]

http://www.dbtechno.com/health...


The vet first got sick in Oct.
I think we're looking at a description of his case and of his brothers'.  This would seem to explain why one of the brothers was not tested.  He died at home, while the tested brother died in the hospital.

Millions for defense, but not one cent for tribute!

[ Parent ]
looks like a mis-translation to me
"10 fatalities" does not fit in the context of the article.  Perhaps what was meant was something closer to "the other ten people who were sick".

[ Parent ]
Changed title
The original title of the article was "12 Dead From Bird Flu".  See this google search page, towards the bottom:  http://news.google.com/news?oe...


[ Parent ]
Interesting
The link no longer works, at least not for me.

[ Parent ]
I mean
The link to the article, not the link to the google search page.

[ Parent ]
I E-mailed the editor about this.
I saw the article this morning that said "12 dead" then read the article, which said 2 dead. I E-mailed the editor and asked for clarification on the story. I think that is when they pulled it. I assume the "12 dead" headline was incorrect.

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

     


[ Parent ]
Thanks Carol. n/t


"I am opposed to any form of tyranny over the mind of man."  Thomas Jefferson

[ Parent ]
H5N1 undetectable after massive Tamiflu?
If he was of concern in Pakistan wouldn't he have been given Tamiflu before he left for NY which would result in a neg. test in the US? And i forget, sorry, would the antibodies show up much later?

if...
If he got tamiflu, PCR would be undetectable in a few days. There's no indication he did. But the antibodies would be positive a month later. Drawing antibodies now and in a month would settle that question.

[ Parent ]
never mind, it's above...n/t


[ Parent ]
Human cases in Pakistan could hint of person-to-person spread.
http://www.nature.com/news/200...
December 17, 2007, Declan Butler
A team of experts from the World Heath Organization (WHO) is making its way north in Pakistan to investigate a cluster of at least eight cases of avian flu in people living near the Afghan border. They will be seeking to establish whether the disease is spreading, and whether the cases were caused by human-to-human transmission.
Cases of bird flu continue to occur worldwide, mostly in Indonesia, and this is the colder time of year when flu is expected to hit hardest in the northern hemisphere. But this latest outbreak is worrying in that it involves the biggest batch of closely related cases since a cluster of eight infected people was reported in Indonesia in May 2006.
"So far, we are not seeing anything different than in previous instances of H5N1 outbreaks," says Gregory Hartl, a spokesman for WHO, whose current information comes from Pakistani authorities.

The Pakistan cases started in mid-November, or possibly earlier, when five family members fell ill in Abbottabad, north of Islamabad. Two of the brothers have died, one of whom was buried before he could be tested for H5N1.  In December, a man and his niece in the same town were found to have H5N1. They are thought to have worked on the same farm as the first family affected. Another man was found to have H5N1 in a nearby town some distance from there. Another case is suspected but not yet confirmed, which would bring the cluster to nine.  Pakistan has had repeated outbreaks of avian flu in poultry over the past two years.

The WHO team will be tracking down, treating and testing people who came into contact with the infected cases. Monitoring for cases in the area will be key to establishing whether the virus has become more virulent or shows signs of spreading.  Meanwhile, Pakistani health authorities are poring over hospital records from the past few months to see, retrospectively, whether there has been any upsurge in the incidence of respiratory illnesses.
Human-to-human transmission cannot be ruled out, says Hartl, as it has occurred on a limited basis on several occasions in the past. Tests of 40 people who have had contact with the patients have so far all turned up negative. Genetic sequencing will help to pin down the mode of transmission and whether any important genetic changes have occurred in the virus.

The Pakistan cluster highlights the obstacles faced by the WHO in containing the spread should a pandemic strain of H5N1 appear. The strategy calls for early diagnosis of cases, in the hope that blanket treatment with antivirals will stamp out an emerging pandemic before it spirals out of control. Computer models suggest that for this to have any chance of succeeding, WHO would have a window of three weeks for this diagnosis at most. But although the first cases occurred in mid-November at the latest, Pakistan only officially informed WHO on 12 December, a day after the first media reports. WHO made the cases public on 15 December.  Last Friday, the WHO also confirmed the first case in Myanmar: a 7-year old girl from Kyaing Tone Township, Shan State, who was hospitalized in late November, and has since recovered. A WHO team has so far found no evidence of infections in any of the case's contacts or in the area.


"I am opposed to any form of tyranny over the mind of man."  Thomas Jefferson


PESHAWAR: Inquiry Ordered Into Bird Flu Death
By Ashfaq Yusufzai
http://www.dawn.com/2007/12/17... December 17, 2007
PESHAWAR, Dec 16: The federal government has expressed concern over the death of a person from bird flu virus in the NWFP and directed the provincial health department to hold an inquiry into the matter, sources said.  In a letter to the NWFP health department, the government expressed dissatisfaction over the measures being taken by the department to control the spread of bird flu virus. The health ministry had directed the provincial government to take concrete measures to prevent transmission of the virus to human, the source added.  The letter said the government had been imparting technical training to the officials concerned on modern lines for the last three years but non-existence of a surveillance system had strengthened fears about the threat posed by bird flu.  The provincial government had also been asked to explain why the health department had failed to develop a referral system to apply brakes to the disease.  According to the sources, the provincial government, on its part, had started holding meetings to fix the responsibility on officials for showing laxity in anti-flu effort.  

Health secretary Abdul Samad Khan said that the provincial government had created special wards for suspected bird flu cases in 14 districts of the province. He said: "The blood samples of the two patients, reportedly died of bird flu, had not been received yet."

He said that an emergency meeting, which took place under the health minister on Friday, issued warning to concerned departments to be alert to cope with the threats posed by the bird flu. The health and livestock departments had decided to develop a surveillance system to monitor the suspected cases, he added.  The secretary said that a state of emergency had been declared in the hospitals of various cities, including Mansehra, Abbottabad, Mardan, Charsadda and Nowshera, besides keeping constant monitoring of poultry farms. He said that trained doctors and health workers would examine the patients.

Mr Khan said that guidelines regarding the culling of poultry suspected of carrying virus had already been provided to the people associated with the poultry industry. He said that availability of diagnostic facilities would also help detect the disease.

"I am opposed to any form of tyranny over the mind of man."  Thomas Jefferson


Editorial out of Pakistan
12-18-07 http://www.nation.com.pk/daily...

Editorials  

Threat to poultry

DISTURBING news of the breakout of bird flu in some parts of the country have been heard during the past few days. And equally distressing is the reported frustration of the NWFP's Health Minister at what has been called the National Institute of Health's apathetic response to the blood samples of the victims sent to it for testing. This has prompted the provincial authorities to take the serious step of closing its poultry business, which is catering for, according to the Minister, 70 percent of the entire country's demand. Acute fears are being expressed about the virus having crossed the species barrier, and the six positive cases reported so far would be investigated from the angle of whether there was human-to-human transmission of the disease. The WHO has sent experts to find out the facts and help Pakistan fight the disease. This is a serious situation that should demand wholehearted coordination between the WHO and local concerned authorities.  

 


And another Editorial
12-18-07 http://www.thenews.com.pk/dail...

Bird business  

Tuesday, December 18, 2007
The confirmation that at least eight people and possibly more have been hit by bird 'flu, and the fears expressed by the NWFP health department that a pandemic could hit the whole province, have immediately stirred panic. The deaths of two victims, and the decision by the WHO to send in a team to help Pakistan tackle the crisis, indicates the gravity of the threat. Indeed one of the aspects the WHO experts will be examining is the possibility of human to human transmission of the virus -- which could lead to a far more rapid spread of the often deadly sickness. During the last two years, the bird 'flu epidemic has taken a big toll on the country's poultry industry -- which employs thousands of people, and indeed is one of the largest job-provision and income generation sectors. The mass culling of birds at farms where the virus had been found and the sudden drop in the sales of poultry with fears of infection running high among consumers were both factors in this.

The government, in situations such as the present one, has a dual responsibility. It must ensure that people at large are safe, while also protecting the poultry industry from unnecessary losses. This can be most effectively achieved by telling the truth, acknowledging the problems that exist and informing people about necessary safety measures, especially for those who are in close contact with hens or other birds. The perception that the government is involved in any way in covering up facts is an immensely damaging one, and in recent years has had an impact on the degree of public panic generated by the surfacing of the virus within the country. The authorities then need to learn from this experience and ensure that the information they convey is reliable and that untruths are not told. At the same time, they need to try and curb the spread of the disease by carrying out organized testing at farms, particularly in NWFP, and by advising farmers on means of prevention. It is necessary, in other words, to build public trust and work along with citizens, to control the disease and the damage caused by it -- some as a consequence of the very real risks it presents, and some due to rumours that circulate swiftly and gain ground all the more quickly when, as has happened in the past, there are questions over the credibility of official voices.

 


Let's hope the government is listening.
The authorities then need to learn from this experience and ensure that the information they convey is reliable and that untruths are not told.


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

     


[ Parent ]
CIDRAP: Possible H5N1 family cluster....
...probed in Pakistan.

(nothing new, really)

Dec 17, 2007 (CIDRAP News) - The World Health Organization (WHO) has sent a team to Pakistan to investigate at least eight suspected human cases of H5N1 avian influenza in the same general area, including cases in four brothers and two of their cousins, according to news services.

WHO spokesman Gregory Hartl said limited human-to-human transmission in the cases is possible, according to an Associated Press (AP) report published yesterday. However, he told Nature that 40 contacts of the suspected case-patients have tested negative.

If confirmed, the cases will mark the first human H5N1 infections in Pakistan. They also appear to constitute the largest cluster of related infections since eight cases (seven confirmed, one probable) occurred among relatives in North Sumatra in May 2006. Transmission of the disease from a 10-year-old boy to his father was confirmed by laboratory testing in that episode.

more...

http://www.cidrap.umn.edu/cidr...


NWFP govt sets up task force to contain bird flu
Staff Report
http://www.dailytimes.com.pk/d...

PESHAWAR: The NWFP government has set up a task force to monitor and contain bird flu or avian influenza in the province, officials said on Saturday.

A Health Department official, requesting anonymity, told Daily Times that a task force had been established at the Chief Minister's Secretariat to monitor the spread of the diseases.

"At present there are no people in quarantine in the province," he said and added that two people belonging to Manshera died recently at the Khyber Teaching Hospital (KTH) and three others were also believed to be infected.

"Two people have been discharged while the third one, a KTH doctor, is suspected to be infected and officials are awaiting his test reports from the National Institute of Health (NIH) Islamabad," he added.

He said there were around 14 centres for the treatment of bird flu in NWFP, with one centre in Mansehra, one in Abbottabad and two in Peshawar.

"We are taking extreme care while treating ordinary flu patients till it is made clear that they are not suffering from the bird flu" he said, and added that World Health Organisation (WHO) experts were also cooperating with them.

NWFP caretaker Health Minister Syed Kamal Shah told Daily Times that so far around six to seven cases of the disease had been reported in the province. He added two of the patients had died in November and that officials were awaiting results of the samples that they had dispatched to the NIH.

"If the results come out to be positive then the samples would be sent to the Centre for Disease Control and Prevention in Atlanta for further confirmation," he said. "I am trying to get the results but poultry is a big industry with many stakeholders, some of whom may want to hush up the issue."

"The strain detected in the Bird Flu-infected people is called H5N1, which is the most dangerous of all other strains," he added.

Shah also said that currently there were three people in the hospitals of Peshawar and Abbottabad. However, he declined to say something about the infected doctor.

He said over 70 percent of the poultry industry was based in NWFP and added that "closure of the industry is under-consideration, as human lives are more precious and important than any industry."


There are 3 suspect patients in the hospital
but it is stated, "At present there are no people in quarantine in the province," They should be!

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

     


CDA Takes Steps Against Bird Flu
Associated Press of Pakistan, December 19, 2007
http://thepost.com.pk/IsbNews....
ISLAMABAD: Following the threat of Bird Flu in the country especially in Islamabad, the Directorate of Health Services of the CDA has taken strict immediate preventive precautionary measures against spread of the disease.  The Eid holidays for the concerned staff has been cancelled and the authority has launched a special spray and fogging campaign in the different areas of the city usually being used for poultry business.  For this purpose, the federal capital has been divided into six zones and poultry shops of all the markets of the Capital City were properly sprayed and fogged with special anti-virus chemical.

A comprehensive awareness campaign has also been launched for the public, especially for the people attached with the poultry business and provided them proper guideline to avoid the spread and to combat the disease efficiently.  The shopkeepers and poultry businessmen have been advised to cover the eatable items properly and must be made their shops complete fly proofs and put the meat inside the shops.   The people concerning poultry, meat and hotels/motels have been advised for proper vaccination from Vaccination Section (DHS).

During the campaign, DHS has issued 58 notices to the poultry shopkeepers in the city markets due to poor hygienic conditions of their premises.  The Senior Director Health Services Dr Saeed Ahmed has constituted a special team to launch a special spray and fogging campaign during Eid holidays especially in the cattle markets to maintain hygienic conditions.

"I am opposed to any form of tyranny over the mind of man."  Thomas Jefferson


CNN Reports on Pakistani Bird Flu Cases
http://www.cnn.com/2007/WORLD/...
December 18, 2007
CNN) -- Eight cases of bird flu among people have been confirmed in Pakistan, the first such cases in the country, the World Health Organization said Tuesday.  The cases of H5N1 avian influenza were confirmed in Pakistan's remote North-West Frontier province, WHO spokesman Greg Hartl told CNN in a telephone interview.
One patient died, six recovered and one remained under medical supervision in the cities of Abbotabad and Mansehra, he said.  Patients were taken to medical facilities after presenting with the flu-like symptoms typical of avian flu. Health officials believe that another person's death was likely caused by bird flu, but has not been confirmed.
Some of the deaths occurred within a single family, raising concern -- but no proof -- that the disease may have spread through human-to-human contact, said officials, who called for further analysis.

"We would be remiss if we didn't investigate further, " said Hartl from the WHO headquarters in Geneva. "Our concern is that once this virus remains in the animal population, it mutates into a more transmissible form. And the more they (the viruses) stay in the animal population, then we have a panic situation."

Public health officials worry that, should the virus gain the ability to transmit easily among humans, a pandemic could occur. Given that the disease is often fatal, the impact could be catastrophic, they contend.  Hartl praised Pakistan's Ministry of Health for investigating the outbreak in hospitals in remote areas.  Though this marks Pakistan's first outbreak of bird flu among people, several outbreaks of H5N1 influenza have occurred among poultry in Pakistan, and it spread to the country's wild birds earlier this year, the WHO said.  Some cases among birds have been reported in the capital city of Islamabad, but most have been reported in Pakistan's "poultry belt" in the North-West Frontier province.

In another part of Asia, Indonesia's Ministry of Health announced Tuesday the death of a 47-year-old man from Banten Province, who died December 13.  Of the 115 confirmed cases in Indonesia, 93 have been fatal, according to WHO.  Since 2003, the health agency has tallied 341 cases among people in 14 countries, 210 of them fatal.  

"I am opposed to any form of tyranny over the mind of man."  Thomas Jefferson


Mods, two favors please.
Could you please fix the side scroll and could you also give us a new thread?  I don't think this situation is going away so we'll continue to post information on it.

I know I'm asking for a lot, but it is Christmas.  

"I am opposed to any form of tyranny over the mind of man."  Thomas Jefferson


I don't see sidescroll, btw... n/t


[ Parent ]
I did for a minute.
But I don't now.  Is that a sign of age or newshound fatigue?

"I am opposed to any form of tyranny over the mind of man."  Thomas Jefferson

[ Parent ]
If this is all History Lover
wants for Christmas then we are getting out cheap! LOL A new thread would be nice. Thanks.

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

     


[ Parent ]
The Philippines Are Also Carrying This Story
WHO Team Begins Investigating Pakistan Bird Flu Outbreak
http://www.philstar.com/index....
Wednesday, December 19, 2007 05:37 AM

ISLAMABAD (AP) - A World Health Organization team began piecing together Pakistan's first human bird flu cases Tuesday to try to determine whether human-to-human transmission may have occurred.  The health experts visited a hospital in the northwestern city Peshawar that treated many of the eight patients suspected of being infected with the H5N1 bird flu virus. They were working with doctors and nurses on how to handle suspected cases and improve infection control measures.

"They want to go through the records in the hospital for the last month or two to see if there's been any upsurge in respiratory cases that weren't identified as H5N1 but which could actually be," said Gregory Hartl, a WHO spokesman in Geneva.  They were expected to visit the other affected areas Wednesday, he said. Pakistan has also requested additional supplies of the antiviral Tamiflu as a precaution.

"I am opposed to any form of tyranny over the mind of man."  Thomas Jefferson


want to inaugurate the new diary ? ;-)


[ Parent ]
Thanks Dem. I'll bake you a cheesecake. n/t


"I am opposed to any form of tyranny over the mind of man."  Thomas Jefferson

[ Parent ]
Please post new Pakistan stories to ...
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