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Welcome to the conversation Forum of Flu Wiki

This is an international website intended to remain accessible to as many people as possible. The opinions expressed here are those of the individual posters who remain solely responsible for the content of their messages.
The use of good judgement during the discussion of controversial issues would be greatly appreciated.
H5N1

H5N1 Cases (Sep 1, 2013 ...)

by: AlohaOR

Sat Oct 19, 2013 at 18:09:10 PM EDT

Last updated April 7, 2014

Previous case tables:
H5N1 cases from Sept. 1, 2012 - Aug. 31, 2013

H5N1 cases from Sept. 1, 2011 - Aug. 31, 2012

There's More... :: (14 Comments, 835 words in story)

H5N1 Case Table (2011-2012 season)

by: AlohaOR

Tue Dec 18, 2012 at 23:23:10 PM EST

This is the table of WHO-confirmed H5N1 cases with symptom onset from Sept. 1, 2011 through Aug. 31, 2012.

The new case table beginning Sept. 2, 2012 is here.

There's More... :: (0 Comments, 549 words in story)

H5N1 Cases (Sep 1, 2012 - Aug. 31, 2013)

by: AlohaOR

Wed Jun 06, 2012 at 23:46:28 PM EDT

Last updated October 7, 2013

The previous H5N1 International diary is here

The table of WHO-confirmed H5N1 cases from Sept. 1, 2011 - Aug. 31, 2012 is here.

Diary for cases from Sept. 1, 2013 on is here.

There's More... :: (102 Comments, 429 words in story)

H5N1 International Diary 2

by: Bronco Bill

Tue Feb 21, 2012 at 15:36:40 PM EST

With recent cases of H5N1 occurring in people in several countries, including China, Cambodia, Vietnam, Indonesia, Zimbabwe, and Egypt, it has been hard to keep track of all the case developments.  This diary will be devoted exclusively to people with H5N1.

The previous H5N1 International diary is here

There's More... :: (101 Comments, 546 words in story)

H5N1 International

by: History Lover

Fri Jan 20, 2012 at 08:06:47 AM EST

With recent cases of H5N1 occurring in people in several countries, including China, Cambodia, Vietnam, Indonesia, Zimbabwe, and Egypt, it has been hard to keep track of all the case developments.  This diary will be devoted exclusively to people with H5N1.

New H5N1 International diary is here

There's More... :: (116 Comments, 255 words in story)

H1N1 Is Mutating, And I Don't Like It?

by: Walrus

Tue Dec 01, 2009 at 14:51:42 PM EST

On 5 November I asked the question "Is H1N1 Mutating?" and posted this thread:

http://www.newfluwiki2.com/dia...

My opening quote asked the rhetorical question whether H1N1 was mutating (which of course it must) and cynically speculated that there appeared to be about a Two week delay between when the authorities knew something was happening, and when they told the public about it.

My speculation was based on a comparison, admittedly with very poor evidence, between the apparently unvarnished news reports of occasional doctors, and the "Official" line from the WHO and/or CDC.

To summarise, the official line Twenty Five days ago (from a Nov 7 post on the original thread by DemfromCT) was:


"Anne Schuchat:Well, influenza viruses change.  That's inevitable.  Mutations with occur.  The key part is will we see something in the near future that makes it change markedly to something more severe than what we are seeing or is there a change that would occur to leave the virus to escape the vaccine?  Both of those changes are possible.  Fortunately, we haven't seen any of those, yet.  We have been testing many of the viruses.  It hasn't changed genetically or the immune characteristics.  The vaccines we are making available are very good matches with the virus. ] It is -- it has been seen with pandemics in the past that over the couple years after a new strain emerges, it starts to change a bit.  It starts to drift and become something that would need a change in vaccine formulation, so that's one of the reasons we make up new vaccines every year for seasonal flu.  Viruses may change from year to year and we may need to modify the vaccine."

Similar pabulum from the WHO, in respect of the Ukraine,  was enough for the revered Reveres of "Effect Measure" to use swear words in their Blog for perhaps the first time.

Since these placid words were uttered about Two weeks ago, we have apparently seen the following events:

1. At least one person reporting "getting the flu twice" which might indicate that the H1N1 virus has mutated in a way that we are no longer immune to it. - Official response: "possible but unlikely,  go back to sleep"

2. The detection of a mutation (D225G?) in several cases that appears to cause severe lung damage. It has been suggested that the 1918 Flu carried this mutation. - Official response: "possible but unlikely,  go back to sleep"

3. More reports of Tamiflu resistant Flu. - Official response: "possible but unlikely,  go back to sleep"

Now those same authorities are suggesting that current H1N1 vaccines might not protect against this mutated H1N1.

And Tamiflu resistant H1N1 might become more prevalent.

And D225G might become more prevalent and might be associated with increased mortality

Being charitable and trying to be measured and in keeping with the august and conservative (in a scientific sense) reputation of this website, the conclusion I draw from this is there seems to be that same Two to Three week lag between when we first hear of something happening and official confirmation.  

I will put that down, assuming for the sake of argument that it's true, to prudent public health professionals preventing public panic. Each time one of these revelations is finally confirmed, the official evaluation seems to  be that the change is unsurprising, of no great importance, and in fact was almost expected anyway.

I think that this appears to be a sensible information management technique, since if I was told in one Twenty four hour period that H1N1 has mutated to a more lethal form that is Tamiflu resistant, and that current vaccines are ineffective, I would be starting to wonder about my Christmas preparations. Instead, since the news was broken to me slowly, in small digestible chunks over a period of weeks, I placidly go on my way, as I suppose I should.

However, that is not my primary concern. I am much more concerned by a rising number of news reports apparently from Health professionals, including one from China on which I commented, discussing the possibility of H5N1 and H1N1 recombining (?) in some way to produce a super flu "slate wiper" with the lethality of H5N1 and the transmissibility and infectiveness of H1N1.

If I make the assumption that my earlier speculation about media management was correct, then this suggests that such a hellish marriage has already been observed somewhere. Should this be true, then I think we can stop worrying about The Global Financial Crisis, Global Warming, and a host of other population related pressures on this planet.

I would welcome your opinions. I apologise for being too lazy to construct an exact timeline showing the relatively consistent gaps between first reports and official denials, followed about Two weeks later by official confirmation.

Discuss :: (10 Comments)

Swine Flu 1976 - Old Vaccines, New Lessons

by: SusanC

Tue Mar 31, 2009 at 20:15:08 PM EDT

A follow-up to this diary has been posted here Guillain-Barre Syndrome after Influenza Vaccination - More Lessons from 1976

Anti-Ganglioside Antibody Induction by Swine (A/NJ/1976/H1N1) and Other Influenza Vaccines: Insights into Vaccine-Associated Guillain-Barré Syndrome

The US army suffered heavy losses during the 1918 pandemic - more men died from flu than from fighting in the War.  When an outbreak of swine flu occurred in 1976 among army recruits in a camp, the US government ordered millions of doses of vaccines against the virus, in anticipation of another pandemic.  But a pandemic didn't happen.  Instead, the massive vaccination campaign resulted in reports of Guillaine-Barre syndrome (or GBS) in some vaccine recipients, eventually causing the vaccination program to be halted.  

Now, decades later, researchers sought to discover how this happened. A paper published last year (link) gives some unexpected and disturbing findings.  

There's More... :: (13 Comments, 736 words in story)

Indonesian Summary

by: cottontop

Fri Sep 19, 2008 at 21:45:54 PM EDT

This diary is for the summary of Indonesia's recent events.
There's More... :: (15 Comments, 82 words in story)

Summary - Misconceptions, Existing and Possible

by: ssal

Sat Sep 13, 2008 at 03:07:35 AM EDT

last update: Oct 23, 2008

Potential number of fatalities: One of the most serious and seemingly widespread misconceptions is that in the "worst case scenario" for an H5N1 pandemic, the number of U.S. human fatalities would be about 1.9 million (e.g., CNN: http://www.cnn.com/2006/HEALTH... ) In truth, it is not possible to rule out that in a worst case pandemic the number of U.S. fatalities could be much greater.

Tara O'Toole, M.D., MPH, and Director of the University of Pittsburgh Medical Center's Center for Biosecurity, has reportedly speculated that 40 million Americans could die (Washington Post: http://www.washingtonpost.com/... ).

And not everyone agrees with him, but one of the world's foremost flu scientists, Robert Webster, has been quoted as saying, "50 percent of the population could die."  He also reportedly said that he had stored a three months supply of food and water at his home in case of an outbreak (ABC News: http://abcnews.go.com/WNT/Avia... ).

According to World Health Organization (WHO) statistics, the overall CFR (case fatality rate -  the percentage who die after coming down with a case of flu) has been over 60% for the laboratory-confirmed H5N1 cases that have occurred so far. In the three previous flu pandemics (1918, 1957, 1968) the AR (attack rate - the percentage of the population that become ill) in the previous three flu pandemics has been roughly 30% (federal government document (Fig 3a): http://www.pandemicflu.gov/pla... ). Assuming an AR of 30%, a CFR of 60%, and a US population of 300,000,000, this would work out to over 50 million deaths.  

The Center for Infectious Disease Research and Policy (CIDRAP) has pointed out that the CFR is  "a single criterion that will likely be known even early in a pandemic when small clusters and outbreaks are occurring" (CIDRAP: http://www.cidrap.umn.edu/cidr... ).

Indonesia is the nation that has so far experienced the most laboratory-confirmed human cases of H5N1 bird flu (130), with a CFR of over 80% (WHO: http://www.who.int/csr/disease... ). One of the best-known clusters of cases was a familial cluster of seven laboratory-confirmed cases in north Sumatra in April-May '06. Six died (U.S. government: http://www.pandemicflu.gov/pla... ; scroll down to Update II and download the pdf; see page 2 of the pdf). --ssal  

Human-to-human transmission: The misconception is that so far, the only human H5N1 cases that have occurred have been the result of bird-to-human  (often abbreviated "B2H") transmission (Crofsblogs: http://crofsblogs.typepad.com/... ). In fact, there is general agreement that beginning in Thailand in 2004 there have been several instances of H2H (human-to-human) transmission, although none yet that has resulted in sustained H2H transmission.  

In the seven-case cluster in north Sumatra (see above), HHS Secretary Michael Leavitt pointed out that there was apparent H2H2H transmission. There are other instances in which the occurrence of H2H2H transmission has been suggested.

A summary of clusters of human cases can be found at Pandemic Flu Information ( http://web.mac.com/monotreme1/... ). --ssal

Age and risk of death: The misconception / possible misconception is that from the standpoint of age, those who would have the greatest risk of death in an H5N1 pandemic would be infants and the elderly (as is the case with seasonal flu). Actually, people who are in the prime of their lives may also face a high death risk.  

In the 1918 flu pandemic, the deadliest flu pandemic of the last century "....most deaths occurred among young, previously healthy adults." (HHS: http://www.hhs.gov/pandemicflu... )

And, as can be seen in a World Health Association graph showing the outcomes of 373 laboratory-confirmed human H5N1 cases, the case fatality rate for people from 20 to 39 years old was 71%. For 10 to 19 years old, 76%. [For readers who have never seen it, the WHO graph is recommended viewing.] http://www.wpro.who.int/NR/rdo... --ssal

Government rescue:  HHS Secretary Michael Leavitt: "If there is one message on pandemic preparedness that I could leave today that you would remember, it would be this: Any community that fails to prepare with the expectation that the federal government or for that matter the state government will be able to step forward and come to their rescue at the final hour will be tragically wrong, not because government will lack a will, not because we lack a collective wallet, but because there is no way that you can respond to every hometown in America at the same time." (U.S. News & World Report:  http://health.usnews.com/usnew... ) --Kobie and ssal

Reliance on family/friends: The misconception / possible misconception is that if a pandemic happens, we can rely on family/friends. But if our family and friends have not prepared, they will not be able to take care of you.

If they have prepared, they may not be able to support you with their preps. -- cottontop

Number of Indonesian cases: Indonesia has arguably been the "hottest" human H5N1 case zone in the world. The misconception / possible misconception is that "officially reported" number of human cases in Indonesia in 2008 is accurate. Actually, the number is almost surely higher.

From the Flu Wiki diary, "Indonesia - September 9, 2008 to ...," a statement just under the "Indonesia Summary" table reads, "Unfortunately, the drastic decrease in suspected cases counted in recent months is attributable mainly to news restrictions in Indonesia.  This table should NOT be used to support the conclusion that suspected viral infections are decreasing in Indonesia." ( http://newfluwiki2.com/showDia... ) --ssal

More items are intended.

Discuss :: (115 Comments)

Indonesia: Tin Foil Hat Time?

by: cottontop

Thu Aug 07, 2008 at 09:16:07 AM EDT

I posted this on my blog last night, and felt that perhaps we need to discuss this situation
further. There are alot of lurkers and poster alike who are probably wondering if this is IT.

What does everyone think? Has this incereased your PPF?  

snip

The first thing I want to say to everyone is stay calm. We have too. I know it isn't easy to do that. If you want to make a prep run in order to settle yourself down, than by all means do so. Sometimes that helps me.

O.K. we first need to know what little facts we have here:

1. a nurse tipped off a reporter.

2. chickens die

3. pidgeons die

4. three people die

5. 13 people are admitted to hospital

6. 2 of the13 are transfered to another hospital (the critical cases)

7. villagers start to flee, getting their children to a safe place

8. Air Batu villagers, Kecamatan Air Batu Kabupaten Asahan fled because they were worried they world be attacked by the bird flu, it they worried it was spreading in the village.

9. Two weeks before three residents in the village died from serious fever.

10. Gradually even more of the villagers were sick.

This is a description of a gradually spreading illness, one which has caused death already so the people are fleeing. The only surprising thing is that the child in critical condition has apparently been ill for one week.

11. Not all the villagers had contact with the poultry.

So this is where we're at. Something is unfolding there, I don't think this is "IT" at the present moment. It certainly makes things that more interesting being the Olympics start Friday.  This situation is so serious that villagers are fleeing in fear. Now this is unusual in a village where chickens have died, at least that we know of. I believe it's happened once or twice before since I've starting tracking this virus going on two years. We have seen this before.

I'm being very cautious. This is the largest possible cluster of H5N1 yet. Perhaps, just perhaps, we'll get the results of these tests after the pandemic!  

This might be overwhelming for some of you, especially if your new to tracking this virus. There is going to be many emotional rollercoasters that you'll going to be on. Heaven knows I've been there to many times.  This is a very tense news development, and we must not get carried away. I'm willing to bet that we will not here much after today. I hope I'm wrong.  If you are feeling "carried away" by this news, take a break and spend sometime with your family, go for a walk, make a prep run, read a book, whatever it is that you do to relax. You don't want to burnout. We can't do anything about this, even if it is "IT." We can only lay in our preps, and watch. That's it. So don't get too worked up about this at the moment.

One last thought here: this is a good time to review your preps, your SIP plan if you have one, if you don't you should think about one.  Doing something constructive like this always helps my anxiety. I suddenly don't feel so helpless, when I've done some pandemic planning.  Hang in there!  

Discuss :: (32 Comments)

Culling Ripple effect

by: Kobie

Mon Jul 14, 2008 at 10:10:02 AM EDT

  Culling is currently one of the best ways to stop the spread of bird flu but it has repercussions.

 While many ignore the clear and present danger of H5N1 at their own peril, the few working on the problem are focused on preparation, education and even recovery. In preparation know there are some H5N1 ripple effects that will be seen long before the end of H5N1 Phase 3.

There's More... :: (0 Comments, 349 words in story)

new vaccine strain suggestion

by: gs

Fri Jul 04, 2008 at 06:36:19 AM EDT

I ask WHO (and Glaxo,Novartis,..) to test antigenicity of
A/Dk/Guangxi/50/2001(H5N1)  (or similar) as a vaccine-candidate in ferrets
and to compare it with the other H5N1-vaccine candidates
and to publish the results !
There's More... :: (0 Comments, 264 words in story)

Medclinician New Avian Flu Diary

by: medclinician

Mon Jun 23, 2008 at 07:00:35 AM EDT

This is a restart of the old Medclinician 3 a.m. Avian Flu Diary. It has been several years now since I began posting seriously online concerning the coming Pandemic when I posted in March 2006 "Not if, but when."

December 14, 2008 Update
First, my thanks to the Admin of Flu Wiki for being able to continue my Flu Diary here. Briefly Bird Flu is sweeping across Asia. Over the last two months it has hit multiple locations, including India, and now Hong Kong and seems to headed for Korea.

We are seeing mutations and recombination which in one recent study published 12/12/08 show 24/25 flu samples resistent to Tamiflu. Considering this is the drug of choice and it has not been withdrawn as a recommended treatment, one finds this a bit strange. Why give a drug that does not work and has been proven to not only not be effective, but also further creates resistant strains.

Well, may the reader form their own conclusions on this. In the drug industry, many is the drug that has been proven totally useless for what it is prescribed for and may even make it worse. Example, the use of steroids in human avian which then creates a cyto storm and death.

Avian Flu and even seasonal flu is serious business - and I think the word business is why antibiotics continue to be given for viral infections creating horrific strains of MRSA and VRSA.

January and February are usually when we go fever pitch with the new strains and already we are seeing wide outbreaks and very little reporting.

If this was a new column I would list links to all of the above, but since it is simply a diary, I will just leave it at that.

Oh, btw, do watch out for the much under reported nasty nasty lung fluish thing which most of the people I know have (me included 103 temp), or have fought for weeks. Bluebird has it as we speak and is battling it in her lower lungs.

Z-Pak seems to be the antibiotic being .. um given out and perhaps IMHO this will keep down the nasty bug bugs in the lungs from creating havoc and death. Z-Paks is pretty hefty but if they keep giving it out like breath mints-it effective life span isn't going to hold out much longer.

Have a great Xmas and I am writing.. that is all I will say here until the critter is born.

Our prayers are with you.. Bluebird, Little Skye, and myself.

Medclinician

Medclinician

Discuss :: (5 Comments)

H3N2+H5N1 reassortment ?

by: gs

Sun May 25, 2008 at 08:39:10 AM EDT

new paper with tests in mice, see here:

http://www.flutrackers.com/for...

Discuss :: (3 Comments)

Media asleep at the wheel on huge international story

by: Snowy Owl

Sat Mar 01, 2008 at 18:21:09 PM EST

The news media, both in the United States and around the world, are "asleep at the switch" when it comes to stories involving some of the biggest threats to human existence ever known, according to a leading American specialist on infectious diseases.

Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a frequent writer on such topics as avian flu and bioterrorism, said the media's failure is that it does not put such topics in context.

While the media have done lots of immediate reporting on Asian bird flu, bioterrorism and other such issues, it has largely failed to understand the terrifying consequences of such matters, he said.

For instance, an avian flu pandemic might claim relatively limited number of lives directly, Osterholm said. But the fallout from a pandemic could well be catastrophic.

"Just because these are small numbers, anyone who shrugs off the seriousness of this is a fool of history," Osterholm said.

The fallout from a flu pandemic, he said, could include massive energy shortages around the world, a surge in other deadly infectious diseases, uncounted associated deaths due to shortage of medical supplies and treatment and more.

The relatively fragile world health system could collapse, he said.

Why the possibility of these catastrophic side-effects of a flu pandemic?

It is, Osterholm said, in part because the world is vastly more interconnected today than it was years ago during previous pandemics. What happens in one place will inevitably impact another.

It is also because the world economy has developed a "just in time" approach to commodities, from medical supplies and food to energy.

Resources are short and they can't be easily moved around, because everyone will be in the same (sick) boat," he said.

"Energy, food, water, transportation, communications, equipment parts, security - all will be in short supply," he said.

Even corpse management will be at risk. "Cremation is a just-in-time industry," he said.

These shortages will have an impact on human life and welfare that far outstrips what the flu itself will accomplish, Osterholm said,.

"Planning is poor. People just assume business will run as normal. Which it won't!" he said.

"And no one, including the media, is paying attention."

Under a pandemic, with people sick and not at work around the world, container shipping will shut down, power plants will close for want of fuel, hospitals will run out of medical supplies and even staff, he said. The human cost of all that will be enormous.

"People just don't understand the implications of a just-in-time economy,"
he said.

One example: Japan is the biggest importer of coal and natural gas (for energy) in the world. If a pandemic causes an interruption in shipping, which is likely will, "the lights are going out in Japan within a matter of days of a pandemic, and that will have a ripple effect around the world."

Osterholm acknowledged that telling such stories is difficult. It takes time, money and space to tell the story in context. That's tough in today's media climate, he admitted.

No one in the current U.S. presidential campaign is talking about these issues, Osterholm said, and "guys like me are too easy to write off."

But he urged journalists at the conference to find ways to make the story happen. One approach might be to note that for all the gloom and doom, there are positive things that can be done and can be reported.

-Use resources now devoted to war to improve health and sanitation conditions in rural villages, Osterholm said. This will improve lives today and have a direct impact on overpopulation as better health conditions translates directly into lower birth rates.

-Focus on better business preparedness, so that critical supplies are produced and readily available.

-Stress conservation as the best response to climate change.

Will the media be up to the task and will the world wake up? Osterholm is not so sure.

"The last time there was a commitment of sufficient time and energy was in World War II," he said. "We don't have that kind of commitment any more."

http://forum.eastwestcenter.or...

Discuss :: (49 Comments)

H5N1 evolution

by: gs

Sat Mar 01, 2008 at 16:22:58 PM EST

There's More... :: (0 Comments, 539 words in story)

H5N1-->swine-->human ?

by: gs

Sat Nov 24, 2007 at 09:03:25 AM EST

url=1: Arch Virol. 2007 Nov 15; [Epub ahead of print Links

(I can delete if you don't want such articles)

There's More... :: (0 Comments, 157 words in story)

Influenza: Spread by the abiotic vehicle "cold drinking water"

by: wilfriedsoddemann

Tue Jul 24, 2007 at 04:20:25 AM EDT

Another one whistleblower:

H5N1 avian flu: Spread by drinking water
Human to human and contact transmission of influenza occur - but are overvalued immense. Influenza epidemics in Germany rarely appear together with recognized clusters (9% of the cases in the season 2004/2005). Recent research must worry: So far the virus had to reach the bronchi and the lungs in order to infect humans. Now in Indonesia it infects the upper respiratory system (mucous membranes of the throat e.g. when drinking and mucous membranes of the nose and probably also the conjunctiva of the eyes as well as the eardrum e.g. at showering). In three cases (Viet Nam, Thailand) stomach and intestine by the H5N1 virus were stricken but not the bronchi and the lungs. The virus must have been thus orally taken up, e.g. when drinking contaminated water.
http://www.cidrap.um...
http://www.who.int/m...
http://www.cidrap.um...
http://www.cdc.gov/n...

Influenza: Initial introduction of influenza viruses to the population via abiotic water supply versus biotic human viral respirated droplet shedding

The primary, initial transmission of the human influenza epidemics by the biotic droplet infection is not proven (BRANKSTON et al. 2007) and extremely improbably as influenza epidemics

- appear only in 9% of the cases (season 2004/2005 in Germany) together with recognized clusters.
- appear virologically locally singularly (influenza-subtypes and precision typing).
- appear geographically locally singularly.
- are not proven with priority in large cities and densely populated areas.
- appear predominantly in the colder regions of Germany.
- regularly reach their maxima in certain districts/cities.
- in temperate climates strictly run parallel to the course of the sum of coldness during the winter.
- can hardly spread via saliva droplets. Saliva contains far less Influenza viruses than the - heavier - droplets from throat and nose.

The facts

Influenza epidemics in Germany rarely appear together with recognized clusters (9% of the cases in the season 2004/2005) (RKI 2006).

Influenza epidemics appear virologically locally singularly (influenza-subtypes and precision typing) (AGI 2007).

Influenza epidemics also run geographically locally singularly. They are not proven with priority in large cities and densely populated areas. They arise predominantly in the colder regions of Germany (in the east with cold continental climate in the winter, southeast, altitudes) (RKI 2007). They reach their maxima regularly in certain districts/cities (RKI 2007).

In temperate climates Influenza epidemics run strictly parallel to the course of the sum of coldness during winter.

In hot climates/tropics the flood-related influenza is typical after extreme weather and natural after a flood. Virulence of influenza virus depends on temperature and time. If young and fresh contaminated water from a local low well, a cistern, tank, rain barrel or rice field is used water temperature may be higher. In the tropics there are often outdoor cisterns, tanks, rain barrels, rice fields or local low wells for water supply. In Germany about 98% inhabitants have a central public water supply with older and better protected water. In Germany therefore coldness is decisive as to virulence of influenza viruses in drinking water.

Influenza epidemics can hardly spread by saliva droplets. Saliva contains far less influenza viruses than the substantially heavier droplets from throat and nose (ANONYMOUS 2003) (GOLDMANN 2001).

Human influenza viruses could be proven in the excretions of mammals such as pigs (faecal and oronasal), wild boar (faecal and oronasal), cattle and goats, so that the transmission path from the environment over waters and the drinking water in principle is possible (BROWN 2004) (GRAVES et al. 1975) (KADEN et al. 2001) (KAWAOKA et al. 1986) (LANDOLT et al. 2003) (MARKOWSKA DANIEL et al. 1999) (RKI 1999) (VICENTE et al. 2002) (WEBSTER 1998) (ZHOU et al. 1996) (CARPENTER 2001). With considerable certainty further animal species that are infected with influenza A will be discovered in the future (WEBSTER 1998).

Elimination and inactivating of viruses during the drinking water treatment

Drinking water is often not or only roughly filtered in Germany. The very small viruses are not definitely removed thereby. For groundwater treatment fast speed filtration plants for the elimination of iron and manganese do not possess any effect regarding the elimination of viruses (WHO 2004). Even the plants in Germany which are known to be particularly efficient regarding the flocculation and filtration can not reach the elimination and inactivating goals demanded from the WHO (WHO 2004); not even under the consideration of the common disinfection procedures, whose efficiency decreases with sinking water temperature [Chlorine and ozone treatment] and that are only of limited efficiency when microorganisms are embedded in particles or in biofilm [Chlorine, ozone treatment and UV irradiation].

"Cooling chain of the public water supply"

Coldness is by far the most important parameter for the preservation of virulent influenza viruses in water. The temperature minimum of the dam water in Germany values in January and February 3-4°C. Every year, river water has its temperature minimum also in January and February. Close to the surface ground water in Germany has its temperature minimum - similar to the soil in 100 cm depth - at the ground water surface of about 3°C in February and March. Ground water taken from wells of larger depth can also be colder than the deeper ground water due to the affection of surface water that infiltrates in the case of unsatisfactory sealing between the fountain and the surrounding rock. River water draining away and reaching wells on short ways can have the same effect. Bank filtrate from wells, which was drilled near the bank from surface water, adopts the temperature of the cold surface water. The same applies to wells, from which ground water enriched with surface water is pumped. The soil temperatures in a meter of depth correspond to the temperatures of the drinking water pipelines that are laid frost-protected in the soils. The temperature minima of the soil temperatures in a 100 cm depth value in Germany during the months February and March 3-5°C (DWD 2007). The temperatures of the drinking water pipelines and the drinking water transported in them adapt themselves to the soil temperatures. In the winter cold raw water remains cold in the drinking water treatment plants and after the treatment to drinking water in the water tanks and water pipelines until the connection to the consumers. The temperature minimum of the drinking water when connecting to the consumers follows in particular the run of the wintry cold sum in the soil and in the water pipelines. It arises in the months February/March. The cold drinking water is first mixed in the dwellings at the taps with warm water from the house installation. Thus the continuous "cooling chain of the public water supply" is described from the water winning up to the consumers with a drinking water temperature of about 4-5°C in the months February/March. Cold, young, freshly by Influenzaviruses contaminated drinking water, taken out from surface water and badly protected surface near ground water as well as out of the ground water from karst can be the abiotic vehicle, which conserves virulent Influenzaviruses in the winter at 4-5°C and transports them over the "cooling chain of the public water supply" to humans.

Transmission paths of the drinking water

Infections by drinking water will not be transmitted alone by drinking the water. Further transmission paths are the inhalation of aerosols and the contact with the drinking water. Access for humans are the conjunctiva, the nose mucous membrane, the mouth mucous membrane, the eardrum, wounds and by catheters affected other mucous membranes.

Conclusions

The primary transmission of the influenza by the biotic "warm" droplet infection from human to human is, already because of the strict dependence on environmental temperatures in temperate climates, extremely improbable. The influenza must be triggered by an abiotic vehicle, which is increasingly efficient regarding the spread of infections with increasingly cold environmental temperatures. Therefore it has to be searched for abiotic vehicles dependent on cold environmental temperatures for the transmission of the influenza in temperate climates. Drinking water is such an abiotic vehicle.

The stated references and indications show that cold drinking water can be that abiotic vehicle, by which virulent human Influenza viruses from the reservoirs reach humans and triggers predominantly the seasonal influenza epidemics.

That applies in particular also to the extremely lethal H5N1 bird flu, whose faecal transmission is indisputable.

Contact:
Bauassessor Dipl.-Ing. Wilfried Soddemann
eMail: soddemann-aachen@t-online.de

Influenza: Primäre Übertragung durch das abiotische Vehikel kaltes Trinkwasser -

Die primäre, initiale Übertragung der Influenza durch die biotische Tröpfcheninfektion ist extrem unwahrscheinlich.


Die primäre Übertragung der Influenza durch die biotische Tröpfcheninfektion ist unbewiesen (BRANKSTON et al. 2007) und extrem unwahrscheinlich, weil Influenza-Endemien

- nur in 9% der Fälle (Saison 2004/2005) zusammen mit erkannten Häufungen auftreten.
- virologisch örtlich singulär auftreten (Influenza-Subtypen und Feintypisierung).
- geografisch örtlich singulär auftreten.
- nicht vorrangig in Großstädten und Ballungsgebieten nachgewiesen werden.
- überwiegend in den kälteren Regionen Deutschlands auftreten.
- ihre Maxima regelmäßig in bestimmten Kreisen/kreisfreien Städten erreichen.
- streng parallel zur Ganglinie der winterlichen Kältesumme verlaufen.
- sich kaum durch Speicheltröpfchen ausbreiten können. Speichel enthält weit weniger Influenzaviren als der - schwerere - Schleim aus Rachen und Nase.

Die Fakten


Influenza-Endemien treten in geringem Umfang zusammen mit erkannten Häufungen auf (9% der Fälle in der Saison 2004/2005) (RKI 2006).


Influenza-Endemien treten virologisch örtlich singulär auf (Influenza-Subtypen und Feintypisierung) (AGI 2007).


Influenza-Endemien verlaufen auch geografisch örtlich singulär. Sie werden nicht vorrangig in Großstädten und Ballungsgebieten nachgewiesen. Sie treten überwiegend in den kälteren Regionen Deutschlands auf (Osten mit im Winter kaltem kontinentalem Klima, Südosten, Höhenlagen) (RKI 2007). Sie erreichen ihre Maxima regelmäßig in bestimmten Kreisen/kreisfreien Städten (absolute Spitzenreiter: Frankenthal, Worms, Landkreis Stollberg) (RKI 2007).


Influenza-Endemien verlaufen streng parallel zur Ganglinie der winterlichen Kältesumme.


Influenza-Endemien können sich kaum durch Speicheltröpfchen ausbreiten. Speichel enthält weit weniger Influenzaviren als der wesentlich schwerere Schleim aus Rachen und Nase (ANONYM 2003) (GOLDMANN 2001).


Humane Influenzaviren konnten in den Ausscheidungen von Säugetieren wie Schweinen (fäkal und oronasal), Wildscheinen (fäkal und oronasal), Rindern und Ziegen nachgewiesen werden, so dass grundsätzlich der Übertragungsweg aus der Umwelt über die Gewässer und das Trinkwasser möglich ist (BROWN 2004) (GRAVES et al. 1975) (KADEN et al. 2001) (KAWAOKA et al. 1986) (LANDOLT et al. 2003) (MARKOWSKA-DANIEL et al. 1999) (RKI 1999) (VICENTE et al. 2002) (WEBSTER 1998) (ZHOU et al. 1996) (ZIMMERMANN 2001). Mit ziemlicher Sicherheit werden zukünftig noch weitere mit Influenza A infizierte Tierarten entdeckt (WEBSTER 1998).

Entfernung und Inaktivierung von Viren bei der Trinkwasseraufbereitung


Trinkwasser wird in Deutschland oft nicht oder nur grob gefiltert. Die sehr kleinen Viren werden dabei nicht sicher entfernt. Zur Grundwasseraufbereitung weit verbreitete Filtrationsanlagen zur Entfernung von Eisen- und Mangan besitzen hinsichtlich der Elimination von Viren keine Wirkung (WHO 2004). Selbst die in Deutschland als besonders leistungsfähig geltenden Anlagen zur Flockung und Filtration können, auch unter Berücksichtigung der gebräuchlichen Desinfektionsverfahren, deren Effizienz mit sinkender Wassertemperatur abnimmt [Chlorung und Ozonbehandlung] und die bei im Wasser verklumpten Mikroorganismen nur eingeschränkt wirksam sind [Chlorung, Ozonbehandlung und UV-Bestrahlung], die von der WHO geforderten Eliminations- und Inaktivierungsleistungen (WHO 2004) nicht erreichen.

Kühlkette der öffentlichen Trinkwasserversorgung


Die Kälte ist mit Abstand der wichtigste Parameter zur Konservierung virulenter Influenzaviren im Wasser. Das Temperaturminimum des Talsperrenwassers in Deutschland beträgt während der Monate Januar und Februar 3-4°C. Flusswasser hat sein Temperaturminimum ebenfalls im Januar und Februar eines jeden Jahres. Oberflächennahes Grundwasser hat in Deutschland an der Grundwasseroberfläche
- analog zum Boden in 100 cm Tiefe - sein Temperaturminimum von etwa 3°C im Februar und März. Auch aus Brunnen größerer Tiefe entnommenes Grundwasser kann bei mangelhafter Abdichtung zwischen den Brunnenrohren und dem umgebenden Gestein durch Zutritte von Oberflächenwasser beeinflusst und deshalb kälter als das tiefere Grundwasser sein. Bachschwinden, aus denen Oberflächenwasser auf kurzen Wegen zu den Brunnen gelangt, können die gleiche Wirkung haben. Uferfiltrat aus Brunnen, die nahe dem Ufer von Oberflächengewässern gebohrt wurden, nimmt die Temperatur des im Winter kalten Oberflächenwassers an. Gleiches gilt für Brunnen, aus denen mit Oberflächenwasser angereichertes Grundwasser gefördert wird. Die Erdbodentemperaturen in einem Meter Tiefe entsprechen den Temperaturen der in den Böden frostfrei verlegten Trinkwasserleitungen. Die Temperaturminima der Erdbodentemperaturen in 100 cm Tiefe betragen in Deutschland während der Monate Februar und März 3-5°C (DWD 2007). Die Temperaturen der Trinkwasserleitungen und des in ihnen transportierten Trinkwassers gleichen sich den Erdbodentemperaturen an. Im Winter kaltes Rohwasser bleibt in den Trinkwasseraufbereitungsanlagen und nach der Aufbereitung zu Trinkwasser in den Wasserbehältern und Wasserleitungen bis zum Hausanschluss der Verbraucher kalt. Das Temperaturminimum des Trinkwassers am Hausanschluss folgt insbesondere dem Verlauf der Kälte im Boden und in den Wasserleitungen. Es stellt sich in den Monaten Februar und März ein. Das kalte Trinkwasser wird erst in den Wohnungen an den Wasserhähnen mit warmem Wasser aus der Hausinstallation gemischt. Damit ist die durchgängige ?Kühlkette der öffentlichen Trinkwasserversorgung? von der Wassergewinnung bis zu den Verbrauchern mit einer Trinkwassertemperatur von etwa 4-5°C in den Monaten Februar und März eines jeden Jahres beschrieben. Kaltes, junges, frisch durch Influenzaviren kontaminiertes Trinkwasser, entnommen aus Oberflächengewässern und schlecht geschützten oberflächennahen Grundwässern sowie aus Karstgrundwasserleitern, kann das abiotische Vehikel sein, das im Winter virulente Influenzaviren bei 4-5°C konserviert und über die durchgängige Kühlkette der öffentlichen Trinkwasserversorgung zu den Menschen transportiert.

Übertragungswege des Trinkwassers


Infektionen durch Trinkwasser werden nicht allein durch das Trinken des Wassers übertragen. Weitere Übertragungswege sind das Einatmen von Aerosolen und der Kontakt mit dem Trinkwasser. Eintrittspforten beim Menschen sind die Augenbindehaut, die Nasenschleimhaut, die Mundschleimhaut, die Ohrtrommelfellmembran, Wunden und durch Katheter berührte sonstige Schleimhäute und Gefäßendothelien.

Schlussfolgerungen


Die primäre Übertragung der Influenza durch die ("warme") biotische Tröpfcheninfektion ist schon wegen der strengen Abhängigkeit von Umwelttemperaturen extrem unwahrscheinlich.


Die Influenza muss durch ein zur Ausbreitung von Infektionen mit zunehmender Kälte zunehmend effizientes abiotisches Vehikel übertragen werden. Deshalb muss für die Übertragung der Influenza nach von der Kälte abhängigen abiotischen Vehikeln gesucht werden. Trinkwasser ist ein solches abiotisches Vehikel.


Die dargelegten Hinweise und Indizien zeigen, dass kaltes Trinkwasser dasjenige abiotische Vehikel sein kann, mit dem virulente humanpathogene Influenzaviren von den Reservoiren zum Menschen gelangen und überwiegend auf diesem Weg die saisonalen Influenza-Endemien auslöst. Das gilt in besonderem Maße auch für die extrem lebensgefährliche H5N1 Vogelgrippe, deren fäkale Übertragung unstreitig ist.

References/Nachweise


AGI (2007): Arbeitsgemeinschaft Influenza http://influenza.rki...
ANONYM (2003): Understanding Sars and other Respiratory Infections May 2003.
http://www.ifh-homeh...
BRANKSTON et al. (2007): Transmission of influenza A in human beings. Lancet Infect Dis. 2007 Apr;7 (4):257-65. http://www.ncbi.nlm....
BROWN (2004): Influenza Virus Infections of Pigs, Part 1: swine, avian & human influenza viruses. http://www.pighealth... ; Part 2: Transmission between pigs and other species. Veterinary Laboratories Agency, UK.
http://www.pighealth...
DWD (2007): Deutscher Wetterdienst (DWD), Wetterstation Erfurt-Bindersleben, Erdbodentemperaturen aus 100 cm Tiefe
GOLDMANN (2001): Epidemiology and Prevention of Pediatric Viral Respiratory Infections in Health-Care Institutions, Children?s Hospital and Harvard Medical School, Boston, Massachusetts, USA, Emerging Infectious Diseases, Special Issue.
http://www.cdc.gov/n...
GRAVES et al. (1975): Human viruses in animals in West Bengal: An ecological analysis, Human Ecology, Volume 3, Number 2 / April, 1975, 105-130. 
http://www.springerl... 
KADEN et al. (2001): Gefährliche Verwandtschaft. Schwarzwild - ein natürliches Reservoir für Infektionserreger und Ansteckungsquelle für Hausschweine? Bundes-forschungsanstalt für Viruskrankheiten der Tiere: Forschungsreport 1/2001: 24-28.
http://ticker-grosst...
KAWAOKA et al. (1986): Intestinal replication of influenza A viruses in two mammalian species, Archives of Virology, Volume 93, Numbers 3-4 / December, 1987, 303-308. 
http://www.springerl...
LANDOLT et al. (2003): Comparison of the Pathogenesis of Two Genetically Different H3N2 Influenza A Viruses in Pigs, J Clin Microbiol. 2003 May; 41(5): 1936?1941. 
http://www.pubmedcen...
MARKOWSKA-DANIEL et al. (1999): Seroprevalence of influenza virus among wild boars in Poland. National Veterinary Research Institute, Swine Diseases Departement, Pulawy, Poland. http://www.medwet.lu...
RKI (1999): Robert Koch-Institut (RKI) Merkblatt für Ärzte Influenza ? Verhütung und Bekämpfung (Stand 1999).
www.gapinfo.de/gesundheitsamt/alle/seuche/infekt/viru/grippe/mba/index.htm
RKI (2006): Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten für 2005, Datenstand: 1. März 2006)
RKI (2007): Robert Koch-Institut Berlin, RKI, Datenbank der nach Infektionsschutzgesetz meldepflichtigen Infektionskrankheiten in Deutschland; http://www3.rki.de/S...
VICENTE et al. (2002): Antibodies to selected viral and bacterial pathogens in European wild boars from southcentral Spain. J Wildl Dis. 38(3): 649-52.
http://www.ncbi.nlm....
WEBSTER (1998): Influenza: An Emerging Disease. Emerging Infectious Diseases 4(3). http://www.cdc.gov/n...
WHO (2004): World Health Organization (WHO), 2004, Guidelines for drinking-water quality, 3rd Ed., http://www.who.int/w...
ZHOU et al. (1996): Influenza infection in humans and pigs in southeastern China, Archives of Virology, Volume 141, Numbers 3-4 / March, 1996, 649-661. http://www.springerl...
ZIMMERMANN (2001): Krankheiten des Schweines. Veterinärmedizinische Fakultät der Universität Bern, Vorlesungsskript: 49-51.
http://www.vetmed.un...

Discuss :: (0 Comments)

H5N1 bird flu: Spread by drinking water

by: wilfriedsoddemann

Tue Jul 24, 2007 at 03:50:21 AM EDT

Risk evaluations of the German authorities BfR/FLI and UBA are fundamentally wrong. The lethal H5N1 bird flu virus will be strong seasonal in the cold transferred to humans via cold drinking water also in Germany, as with the birds.
Recent research results must worry: So far the virus had to reach the bronchi and the lungs of humans in order to infect man. Now in Indonesia it infects the upper respiratory system (mucous membranes of the throat and mucous membranes of the nose e.g. when drinking and probably also the conjunctiva of the eyes as well as the eardrum e.g. at showering).
In three cases (Viet Nam, Thailand) stomach and intestine by the H5N1 Virus were stricken, not however the bronchi and the lungs. The virus must have been thus orally taken up, e.g. when drinking contaminated water.
Ground water in Germany used for drinking water is not free from viruses as the German authorities BfR/FLI and UBA wrong insist. The performance of the drinking water processing plants to eliminate viruses in Germany regularly does not meet the requirements of the WHO and the USA. The performance of flocculation and filtration to eliminate viruses from surface water reaches maximally 99.5%. The WHO Drinking Water Guidelines (2004) demands 99.9999% to 99.999999%. The ventilation and high-speed filtration from groundwater to eliminate iron and manganese do not eliminate any viruses. The US Ground Water Rule requires 99.99%. Conventional disinfection procedures by chlorine are poor, because viruses are chlorine tolerant and occur in the raw water not individually, but clumped and therefore by chlorine cannot be achieved.
Contact: soddemann-aachen@t-online.de

Grippe de l'oiseau H5N1 transmise par l'eau potable.
Les évaluations de risque des administrations allemandes BfR/FLI et UBA sont fondamentalement faux que le virus mortel de grippe de l'oiseau H5N1 sera transféré aux humains également en l'Allemagne exact saisonnier pendant le froid par l'intermédiaire de l'eau froid potable, comme avec les oiseaux.
Les résultats de la recherche récents doivent s'inquiéter: Jusqu'ici le virus a dû atteindre les bronches et le poumon des humains, afin de coller dessus. Maintenant il infecte en Indonésie le système respiratoire supérieur (membranes muqueuses de la gorge par exemple en buvant, les membranes muqueuses du nez également et probable également la peau obligatoire des yeux aussi bien que le diaphragme de peau de tambour d'oreille par exemple à la douche).
Dans trois cas (Vietnam, Thaïlande) l'estomac et l'intestin étaient par le H5N1-Virus frappé, pas cependant les bronches et le poumon. Le virus doit avoir été oralement pris ainsi, par exemple quand l'eau souillée potable.
L'eau du sous-sol en Allemagne utile comme eau potable n'est pas ainsi de quelle pureté et sans virus comme les administrations allemandes BfR/FLI et UBA faux prétendre. La performance d'elimination virus des installations de transformation d'eau potable en Allemagne ne remplit pas régulièrement les conditions de l'OMS et des Etats-Unis. La floculation et la filtration atteint l'elimination virus au maximum de 99.5%, l'OMS exige pour l'eau surface 99.9999% à 99.999999%. La ventilation et la filtration à grande vitesse des eaux souterraines à l'elimination de fer et de manganèse n'apportent pas du tout de performance d'elimination virus. Les Etats-Unis exigent 99.99%. Les procédures conventionnelles de désinfection comme avec chlore apportent peu, parce que virus sont chlore tolérant et se produisent dans l?eau pas individuellement, mais groupé en masse compacte et donc par le chlore ne peut pas être réalisé.
Contact: soddemann-aachen@t-online.de

H5N1 Vogelgrippe durch Trinkwasser übertragbar
Die Risikobewertungen von BfR/FLI und UBA sind grundlegend falsch. Das lebensgefährliche H5N1 Vogelgrippe-Virus wird auch in Deutschland streng saisonal zeitgleich mit dem Maximum der Kältesumme des Winters auf die Menschen via kaltem Trinkwasser übertragen werden, wie bei den Vögeln. Jüngste Forschungsergebnisse müssen beunruhigen: Bisher musste das Virus die Bronchien und die Lunge der Menschen erreichen, um anzustecken. Jetzt infiziert es in Indonesien auch die oberen Atemwege (Schleimhäute des Rachens beim Trinken, Schleimhäute der Nase und vmtl. auch die Bindehaut der Augen sowie die Ohrtrommelfellmembran z.B. beim Duschen). In drei Fällen (Vietnam, Thailand) waren Magen und Darm durch das H5N1-Virus befallen, nicht jedoch die Bronchien und die Lunge. Das Virus muss also oral aufgenommen worden sein, z.B. beim Trinken von kontaminiertem Wasser.
Das in Deutschland als Trinkwasser genutzte Grundwasser ist bei weitem nicht virenfrei, wie BfR/FLI und UBA falsch behaupten. Die Vireneliminationsleistung der Trinkwasseraufbereitungsanlagen in Deutschland erfüllt regelmäßig nicht die Anforderungen der WHO und der USA. Die Flockung und Filtration von Oberflächenwasser erreicht eine Virenelimination von maximal 99,5%, die WHO fordert 99,9999% bis 99,999999%. Die Belüftung und Schnellfiltration von Grundwasser zur Enteisenung und Entmanganung bringt keine Virenelimination. Die USA verlangen 99,99%. Herkömmliche Desinfektionsverfahren wie die Chlorung bringen wenig, weil Viruspartikel chlortolerant sind und im Rohwasser nicht einzeln, sondern verklumpt vorkommen und deshalb vom Chlor nicht erreicht werden können.
Kontakt: soddemann-aachen@t-online.de

http://www.cidrap.um...
CIDRAP
Indonesia suspects ominous H5N1 mutations
...
Wayan Teguh Wibawan, a microbiologist from Indonesia's avian flu commission, told Reuters that the suspicions are based on preliminary results of genetic tests at laboratories in Indonesia. The amino acid structure of poultry H5N1 samples is becoming increasingly similar to that seen in human H5N1 samples, he said.
The similarity in amino acid structure makes it easier for the virus to attach to receptors on cells that line the throat and lungs, Wibawan told Reuters. The virus would have to attach readily to human cell receptors in order to easily pass from birds to humans, he said.

http://www.who.int/m...
WHO, Avian influenza (" bird flu") - Fact sheet
...
THE DISEASE IN HUMANS
...
The second mechanism is a more gradual process of adaptive mutation, whereby the capability of the virus to bind to human cells increases during subsequent infections of humans.
...
Swimming in water bodies where the carcasses of dead infected birds have been discarded or which may have been contaminated by faeces from infected ducks or other birds might be another source of exposure. In some cases, investigations have been unable to identify a plausible exposure source, suggesting that some as yet unknown environmental factor, involving contamination with the virus, may be implicated in a small number of cases.
...
For unknown reasons, most cases have occurred in rural and periurban households. Again for unknown reasons, very few cases have been detected in presumed high-risk groups, such as commercial poultry workers, workers at live poultry markets, cullers, veterinarians, and health staff caring for patients without adequate protective equipment. Also lacking is an explanation for the puzzling concentration of cases in previously healthy children and young adults. Research is urgently needed to better define the exposure circumstances, behaviours, and possible genetic or immunological factors that might enhance the likelihood of human infection.
Assessment of possible cases.
Exposure to an environment that may have been contaminated by faeces from infected birds is a second, though less common, source of human infection. To date, not all human cases have arisen from exposure to dead or visibly ill domestic birds. Research published in 2005 has shown that domestic ducks can excrete large quantities of highly pathogenic virus without showing signs of illness.
...
Clinical features.
Initial symptoms include a high fever, usually with a temperature higher than 38°C, and influenza-like symptoms. Diarrhoea, vomiting, abdominal pain, chest pain, and bleeding from the nose and gums have also been reported as early symptoms in some patients. Watery diarrhoea without blood appears to be more common in H5N1 avian influenza than in normal seasonal influenza. The spectrum of clinical symptoms may, however, be broader, and not all confirmed patients have presented with respiratory symptoms. In two patients from southern Viet Nam, the clinical diagnosis was acute encephalitis; neither patient had respiratory symptoms at presentation. In another case, from Thailand, the patient presented with fever and diarrhoea, but no respiratory symptoms.


H5N1 and Drinking Water - References
Dinh PN, Long HT, Tien NTK, Hien NT, Mai LTQ, Phong LH, et al. Risk factors for human infection with avian influenza A H5N1, Vietnam, 2004. Emerg Infect Dis [serial on the Internet]. 2006 Dec [date cited]. Available from
http://www.cdc.gov/n...
EFFECT MEASURE, Bird flu in water. How big a problem? Available from http://www.agoravox....
Walker K on Webster RG, H5N1 Adapts To Summer Water Heat, TERRA DAILY, Oxford, England (UPI) May 03, 2006. Available from http://www.terradail...
RIVM NL, Schijven FJ, Teunis PFM, Roda Husman AM de, Quantitative Risk Assessment of Avian Influenza Virus Infection via Water. Available from http://www.rivm.nl/b...
BfR/FLI, Zum Risiko der Übertragung des Vogelgrippevirus über Trinkwasser, Gemeinsame Stellungnahme Nr. 017/2006 des Friedrich-Loeffler-Instituts und des BfR vom 22. März 2006. Available from http://www.bfr.bund....
UBA, Keine Gefahr für Trinkwasser aus den öffentlichen Leitungsnetzen durch Vogelgrippe, Hinweise für Trinkwassernutzer, Stand 19. April 2006. Available from http://www.umweltbun...
UBA, Trinkwasser und Aviäre Influenza A/H5N1, Hinweise für Wasserversorger, Stand 19. April 2006. Available from http://www.umweltbun...
WHO, Questions & Answers on potential transmission of avian influenza (H5N1) through water, Sanitation and Hygiene and ways to reduce the risks to human health. Available from http://www.who.int/w...
WHO, Review of latest available evidence on potential transmission of avian influenza (H5N1) through water and sewage and ways to reduce the risks to human health, Last updated 30/05/2006. Available from http://www.who.int/w...
WHO, Guidelines for drinking-water quality, third edition, incorporating first addendum, 7, Microbial aspects, 131-141. Available from
http://www.who.int/w...
U.S. EPA, Ground Water Rule (GWR). EPA published the Ground Water Rule in the Federal Register on November 08, 2006. Available from http://www.epa.gov/s...
SODDEMANN W, Influenza in Deutschland: Als Zoonose durch Trinkwasser übertragbar? Hinweise und Indizien, umwelt-medizin-gesellschaft 18 (1): 49-60. Available from http://www.umg-verla...

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The real lesson from Katrina

by: SusanC

Mon Jun 11, 2007 at 07:37:31 AM EDT

I posted this on Greg's blog today.  But I think this is important enough to deserve a diary all on its own.
There's More... :: (6 Comments, 766 words in story)
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