Friday, December 29, 2006



With the deaths of three members of the same Egyptian family from avian influenza in the past week, the 2006 bird flu toll has climbed to 79 confirmed deaths.

In 2003, four people died.

In 2004, 32 people died.

In 2005, 42 people died.

The infections and subsequent deaths still focus around children and young people, with the Egyptian deaths involving a 30 year old woman, a 15 year old girl and a 26 year old man.

For every ten people who were confirmed to be infected with the H5N1 virus this year, six of them died. However, the actual number of people infected with the virus but who didn't seek medical help may have been far higher. Some experts still believe the confirmed World Health Organisation infection and death tolls do not tell the full story of the lives claimed by the bird flu virus.

From Bloomberg :
The Egyptian Ministry of Health and Population confirmed that the H5N1 strain of avian influenza had infected the three, who belong to an extended family in Gharbiyah province, 80 kilometers (50 miles), northwest of the capital, Cairo, the World Health Organization said in a statement yesterday.

"While being transferred and cared for at the country's designated avian influenza hospital, a 30-year-old female, a 15- year-old girl and a 26-year-old male died,'' the United Nations health agency said in the statement on its Web site. The most recent death occurred yesterday, the agency said.

The patients had all been in contact with sick ducks, WHO said. Egypt has struggled to control H5N1 outbreaks in poultry, first reported in February, leading to at least 18 human cases, including 10 deaths.

The Egyptian Ministry of Health and Population is further investigating the bird flu cases and has implemented measures to protect public health, WHO said in its statement. The other family members remain healthy and have been placed under close observation, the agency said.

Saturday, December 23, 2006



While other reports have cited a possible death toll of 40-160 million from a bird flu pandemic, this is the first report I've seen that details how and why the vast majority of the deaths would be confined to 'developing world' nations.

The revelations the researchers have come up with from the stats of the 1918-1919 'Spanish Flu' pandemic are particularly interesting.

From the Washington Post :

An influenza pandemic of the type that ravaged the globe in 1918 and 1919 would kill about 62 million people today, with 96 percent of the deaths occurring in developing countries.

That is the conclusion of a study published yesterday in the Lancet medical journal, which uses mortality records kept by governments during the time of "Spanish flu" to predict the effect of a similarly virulent outbreak in the contemporary world.

The analysis, the first of its kind, found a nearly 40-fold difference in death rates between central India, the place with the highest recorded mortality, and Denmark, the country with the lowest.

If a modern Spanish flu killed all its victims in one year, it would more than double global mortality. About 59 million people now die each year.

Historical accounts suggest that what became known as Spanish flu emerged at an Army camp in Kansas in early March 1918. It was carried to Europe by American troops, where it circulated before undergoing a change early the next fall that made it unusually lethal. It spread around the world and was brought back to the United States, where it killed hundreds of thousands of Americans in October and November 1919. It circulated until early 1920, with virtually everyone on Earth eventually exposed to the virus.

The global death toll from the pandemic is unknown. In the 1920s, it was estimated to be about 20 million. A more complete analysis in 1991 raised that to 30 million. One in 2002 said mortality "may fall in the range of 50 to 100 million."

The new study doesn't make a new estimate. Instead, it calculated the death rate in places that had good birth and death records in 1918 and 1919 in order to estimate what would happen in a larger, older and relatively more affluent world population nearly a century later.

The researchers compared the death rates during the 1918-1920 period with those in the three years before and after the pandemic. This gave an estimate of "excess mortality" during the flu years, which was assumed to be caused directly or indirectly by the virus. (Because men in countries fighting in World War I had elevated mortality in 1918, they were excluded from the calculation.) The extra deaths ranged from 0.2 percent of the population in Denmark to 7.8 percent in the Central Provinces and Berar region of India -- a 39-fold difference.

Murray and his colleagues analyzed the death patterns and deduced that about half the variation from region to region was explained by differences in per capita income. For every 10 percent increase in income, a person's risk of dying during the pandemic fell 10 percent.

Why the poor were so vulnerable is unknown. It could have been that many were already ill with parasites or other illnesses or lacked micronutrients such as Vitamin A and zinc that are essential to immunity.

Go Here For The Full Story

Tuesday, December 19, 2006


Some of the last survivors of the world's worst disaster, which killed 50 to 100 million people, remember the very worst of times.

From the Washington Post :

At the height of the flu pandemic in 1918, William H. Sardo Jr. remembers the pine caskets stacked in the living room of his family's house, a funeral home in Washington, D.C.

The city had slowed to a near halt. Schools were closed. Church services were banned. The federal government limited its hours of operation. People were dying -- some who took ill in the morning were dead by night.

''That's how quickly it happened,'' said Sardo, 94, who lives in an assisted living facility just outside the nation's capital. ''They disappeared from the face of the earth.''

Sardo is among the last survivors of the 1918 flu pandemic. Their stories offer a glimpse at the forgotten history of one of the world's worst plagues, when the virus killed at least 50 million people and perhaps as many as 100 million.

More than 600,000 people in the United States died of what was then called ''Spanish Influenza.'' The flu seemed to be particularly lethal for otherwise healthy young adults, many of whom suffocated from the buildup of liquids in their lungs.

In the United States, the first reported cases surfaced at an Army camp in Kansas as World War I began winding down. The virus quickly spread among soldiers at U.S. camps and in the trenches of Europe. It paralyzed many communities as it circled the world.


''They kept me well separated from everybody,'' said Sardo, who lived with his parents, two brothers and three other family members. His family quarantined him in the bedroom he had shared with his brother. Everyone in the family wore masks.

The city began shutting down. The federal government staggered its hours to limit crowding on the streets and on streetcars. Commissioners overseeing the district closed schools in early October, along with playgrounds, theaters, vaudeville houses and ''all places of amusement.'' Dances and other social gatherings were banned.

''There was a feeling that they couldn't turn to God, other than in prayer,'' Sardo said. ''They liked the feeling of going to church, and they were forbidden.''

The flu's spread and the ensuing restrictions ''made everybody afraid to go see anybody,'' he said.

''It changed a lot of society,'' Sardo said. ''We became more individualistic.''

In a list of 12 rules to prevent the disease's spread, the Army's surgeon general wrote that people should ''avoid needless crowding,'' open windows and ''breathe deeply'' when the air is ''pure'' and ''wash your hands before eating.''

At the time, rumors swirled that the Germans had spread the disease -- which Sardo did not believe.


As the death toll started to mount, there was a shortage of coffins. Funeral homes could not keep up. Sardo's father, who owned William H. Sardo & Co., and other funeral-home directors turned to soldiers for help embalming and digging thousands of graves.

Talk of the threat of another pandemic brings back memories for Sardo, who says he has gotten a flu shot every year they are available.

''It scares the hell out of me. It does,'' Sardo said.

Saturday, December 09, 2006



It's time once again for the Hajj pilgrimage in Saudi Arabia, so that means the now standard annual warning of a possible flu pandemic breaking out amongst the millions of Muslim worshippers is being sounded.

The difference this year is the rising call for worshippers to be vaccinated before they arrive in Saudi Arabia. Not only is the call being promoted as a necessity, but some experts are demanding the vaccinations become mandatory.

From The Australian :

Experts have now urged flu vaccination to be made mandatory for worshippers embarking on the pilgrimage, a trip expected of every Muslim who can afford it at least once in their lifetime.

The next Hajj starts on 28 December and lasts for seven days. Between two and three million pilgrims from all over the world are expected to descend on Mecca and other holy sites, staying in extremely crowded conditions.

In terms of public health, “such a gathering makes the possible rampant spread of the influenza virus and a global pandemic... a potentially devastating prospect”, say experts writing in the latest British Medical Journal.

The authors said the crush of people meant it was “not unusual for 50-100 people to share a tent overnight” in desert camps, a degree of overcrowding that “greatly increases the spread of respiratory infections”.

They added the World Health Organisation “must work with the Saudi authorities to minimise the risk of the influenza virus spreading among pilgrims (and the rest of us)”.

Australian flu expert Alan Hampson - a member of the WHO's Pandemic Taskforce set up to counter a global flu outbreak - agreed the risk was real.

“If we were unfortunate enough to see the start of an avian flu outbreak during the Hajj, there's no doubt that would be a great way to spread it to other people quickly, and then spread it around the world when they return home,” he said.

As far as the possibility of a bird flu pandemic breaking out amongst worshippers on the Hajj, experts remain divided whether existing vacinnations would be of any use, as they will not be tailored to fight a virus that has not yet fully shown itself.

While dire predictions late last year and earlier this year about the likelihood of a human bird flu pandemic becoming a reality have proven to be misplaced, avian influenza virus experts are warning the threat is not yet over. While Indonesia is, officially, still clocking up three or four human deaths per month from avian influenza, there have been no more than a handful of deaths elsewhere in the world.

However, experts agree that this does not mean it is time to become complacent about the possible devastating outbreak of a bird flu pandemic amongst humans.

The virus may have gone quiet in recent months, but some experts fear this is because the virus is now "smouldering"; not yet extinguished, and ready to burst back into the human population.

From CNN :
A year ago, headlines were screaming about a looming disaster: the rapid spread of bird flu across two-thirds of the globe. The H5N1 strain of the virus was killing more than half its human victims. Experts were urging the government to stockpile medicine and experimental vaccines.

Dr. Robert Webster, whose vaccine the U.S. government plans to use in case of an outbreak, told CNN at the time, "If this virus learns to transmit human to human and maintains that level of killing, we've got a global catastrophe."

That worldwide pandemic hasn't yet materialized, and bird flu has been out of the headlines for a while. But we may be in for another round of news.

Last week South Korea announced two new outbreaks in poultry.

...Dr. Timothy Uyeki of the U.S. Centers for Disease Control and Prevention said he's bracing for another surge in human infections.

Three recent papers in the New England Journal of Medicine illustrate serious roadblocks to understanding and controlling the virus. The first describes three clusters of cases within families in Indonesia, eight patients in all. In two of the clusters, the authors said it's quite possible one person caught the disease, then passed it to family members.

One of those families was profiled in "Killer Flu," a CNN program last December. Rini Dina, a 37-year-old woman in a Jakarta suburb, died of an H5N1 infection, and her 8-year-old nephew, Firdaus, was hospitalized with fever for 10 days.

Worldwide, about a third of all cases involve family clusters and there are a handful of cases where the virus likely passed from person to person, he said.

As a clinician, Uyeki has also helped to examine bird flu patients in Indonesia and Vietnam, the only U.S. doctor to do so.

As the virus evolves, he said, its symptoms are evolving as well.

"The clinical features in 1997 were different than what they are now. We're seeing less diarrhea, and in Indonesia, it's been much more fatal."

Other, more common symptoms are hard to distinguish from other infections -- fever, aches and coughing, and shortness of breath and pneumonia as the illness progresses.

In a commentary published with the two articles, Webster and another prominent flu expert said efforts to eradicate the virus, through killing infected chicken flocks or by vaccinating poultry, have largely failed.

Worse, they said, many vaccines used in Asia are of poor quality and are pushing the virus to mutate faster, in potentially more dangerous directions.

Go Here For The Full Story

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