Can influenza infectious dose be determinant for disease outcome?

by: Plum

Thu Jul 29, 2010 at 12:40:01 PM EDT

The article can be found at: http://www.plosone.org/article...

Probiotics for influenza treatment and prevention

by: Ruby Murray

Tue Sep 08, 2009 at 12:39:28 PM EDT

I hope lots of people will jump in with experiences, research and argument!

Influenza = Danger + Opportunity for Business

by: Public_Health_Networker

Fri Jul 03, 2009 at 11:01:14 AM EDT

Mexico City / Altitude / Novel Influenza - Recipe For Higher Mortality?

by: Okieman

Wed May 13, 2009 at 16:30:04 PM EDT

Title: The impact of altitude on mortality from tuberculosis and pneumonia.
Personal Authors: Pérez-Padilla, R., Franco-Marina, F.
Author Affiliation: Department of Fisiología Pulmonar, Instituto Nacional de Enfermedades Respiratorias, Tlalpan 4502, C.P. 14080, Mexico DF, Mexico.
Editors: No editors
Document Title: International Journal of Tuberculosis and Lung Disease

Abstract:

Objective: To examine the association between altitude and mortality from tuberculosis (TB) and pneumonia-influenza in Mexico. Design: We analysed specific causes of death in Mexico according to death certificates for the period 1993-1997, totalling over 2 700 000 deaths and including nearly 23 000 attributed to TB and 115 000 to pneumonia and influenza. 30 population subgroups were formed based on altitude of residence (six categories) and level of poverty (five categories). The effect of altitude on mortality was estimated through Poisson regression models, with adjustment for age, gender and socio-economic status. Results: Adjusted death rates for TB decreased with altitude and increased for pneumonia-influenza. Compared to people living below 500 m above sea level, those living between 2000 and 2499 m had a 58% mortality rate for TB and a three-fold increase in mortality due to pneumonia-influenza, despite adjustment for poverty, age and gender. Conclusion: The mortality rate for TB based on death certificates decreases with altitude of residence, whereas the opposite is observed for pneumonia and influenza.

Publisher: International Union Against Tuberculosis and Lung Disease (IUATLD)
http://www.cababstractsplus.or...

PubMed link:  http://www.ncbi.nlm.nih.gov/pu...

Comment:  I do not have access to this paper, but the abstract is very intriguing.  Does anyone here have rights to access PubMed?  If so, let us know what you think.

Mexico City's Altitude
Mexico City is located in the Valley of Mexico, also called the Valley of Anáhuac, a large valley in the high plateaus at the center of Mexico, at an altitude of 2,240 meters (7,349 ft).
http://en.wikipedia.org/wiki/M...

Did altitude contribute to infection and severity of the influenza in Mexico City?  Are tourists on airplanes traveling long distances home at greater risk of infection?  This is from Wikipedia concerning cabin pressure:

The pilot can alter the cabin pressure at will through this valve. Operational considerations typically require it to be set at 6,000 to 8,000ft
http://en.wikipedia.org/wiki/P...

Could Novel A H1N1 be more severe in cities like Denver?  This diary is for discussion of this subject and posting of additional data/studies which address this issue.

actual scientific articles

by: gs

Sat Oct 04, 2008 at 13:15:44 PM EDT

Summary - Misconceptions, Existing and Possible

by: ssal

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

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.

HP-H5N1, feature or bug ?

by: gs

Fri Jun 13, 2008 at 08:43:11 AM EDT

HP could be evolutionary less fit in wild birds.

improve cooperation in flu-research

by: gs

Sat May 10, 2008 at 05:20:01 AM EDT

Fukuda:
> In developing a WHO public health research agenda (on influenza) we are trying to push
> for a paradigm change,
> What we hope to improve is the kind of sharing and flow of information and take it to another level
> Most research is driven by individual researchers but depends on the source of funding,
> so there is also a need to sensitise donors about priorities
> It is really quite secretive until the information is published. It is like a poker game
> SARS showed we can develop a collaborative network to get people who are normally
> competitors sharing information because of a public health need

Hayden:
> Gathering evidence on bird flu through clinical trials and molecular research is vital
>There are a number of key issues where there is insufficiency of evidence to make firm policy
> More research was needed into "genetic risk factors which seem to be real now" for some
> people becoming infected with the bird flu virus while others aren't
> Other areas ripe for in-depth research include the role of asymptomatic people -- who have
> no signs of the disease -- in spreading the virus
> By building the capacity to research we enhance the ability to deal not only with influenza
> but with other emerging infectious disease threats in time

wiki-flu

by: gs

Thu Dec 20, 2007 at 14:53:36 PM EST

there is lots of discussion at wikipedia about influenza
and H5N1 etc. !
e.g. here: http://en.wikipedia.org/wiki/T...

They also have some good and informative pages.
I somehow can't edit,login , but will keep
trying.

We could also merge the wikis !
A mirror of all the wikipedia flu-pages
would be useful.

since when is there influenza in humans ?

by: gs

Thu Aug 30, 2007 at 11:15:24 AM EDT

---------------------------------
In the year 412 BC Hippocrates described an
epidemic that modern doctors believe was influenza,
and history has recorded many influenza epidemics
and pandemics since that time.

In the Middle Ages several widespread outbreaks
that were probably influenza occurred in Europe. But
the first epidemics that can be regarded with confi-
dence as influenza were in 1173. However, the
position of some medical historians that only
epidemics which occurred in 1510 can be considered
as unquestionable influenza epidemics [1]. In 1580
a severe pandemic occurred that was possibly the first
global dissemination of influenza
-----------------------------------

that last one has recently supposed to have been pertussis.
So, no global dissemination of influenza before 1580 ?
Maybe a pandemic needs advanced human travel methods
or high human population.

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

by: wilfriedsoddemann

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

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...

H5N1 bird flu: Spread by drinking water

by: wilfriedsoddemann

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

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...

Presentations Resource List

by: Bronco Bill

Thu Jun 21, 2007 at 15:42:57 PM EDT

Listed below are some of the websites I've found using nothing more than Google and various search words and phrases. Most of the searches include "Spanish Flu, and many of the pages have links to other resources.

Please feel free to add to this list...

do all existing H3N2-viruses descend from one 1968/7-host ?

by: gs

Mon May 28, 2007 at 04:53:34 AM EDT

Influenza

by: gs

Sat May 26, 2007 at 03:19:13 AM EDT

http://www.topleyand...

65 pages , .pdf  file

Orthomyxoviruses: influenza
Nancy J.Cox, Gabriele Neumann,Ruben O.Donis, and Yoshiro Kawaoka
(2005)

St. Louis vs. Philly (are we missing something?)

by: jsanderson

Wed Apr 25, 2007 at 16:30:31 PM EDT

"If St. Louis had waited another week or two, they might have fared the same as Philadelphia," says the lead author of one of the studies, Richard Hatchett, M.D., an associate director for emergency preparedness at NIAID.  But did these two studies miss something when they sought to shed light on this deadly epidemic?  I'm gonna throw this out there: are there some yet to be analyzed factors that made St. Louis less prone to the spread of influenza than other major US cities? 

Flu Science for Dummies

by: SusanC

Tue Jan 09, 2007 at 13:19:39 PM EST