Sunday, September 02, 2007

Bird Flu Pandemic : How Close Did We Come?

Another story covering the US research that claims human to human transmission of the bird flu virus did occur in Indonesia in 2006, when eight members of the same family caught the virus, killing seven.

From ABC News Australia :

It is the nightmare possibility that health authorities have been fearing ever since the disease first appeared.

It happened in Indonesia last year and reveals the world only narrowly avoided a global bird flu pandemic.

Researchers from the University of Washington have studied the case of a woman on the Indonesian island of Sumatra who caught the H5N1 bird flu virus from poultry in May last year.

Professor Ira Longini, who led the research, says they have confirmed that not only did she pass the virus on to her 10-year-old nephew, it was then transmitted to other relatives.

Seven of eight family members who caught the disease were soon dead.

"This proves there is person-to-person transmission in this case, in that setting, in Indonesia, northern Sumatra," he said.

Professor Longini says this shows there is a serious threat of a bird flu pandemic.

"It could happen and will happen eventually, and this simply confirms this particular H5N1 virus is capable of person-to-person transmission," he said.

"The other thing it says is that we need to be very vigilant to find these clusters, to assess whether there's transmission and to stop transmission as quickly as we can each time they arise.

"We're going to see strains of influenza that are capable of causing pandemics arising, probably avian strains, and that will happen for sure, there's no doubt about it."

Professor Longini says in this case, a pandemic may have been averted because of the quick action of health authorities or, statistically at least, it could have been luck.

He said because the sample group was so small, it was impossible to say how fast the disease could have spread in the workplace or the street.

But he says that in the home, it was a fast mover.

"It had about a one-third chance of transmitting from person to person due to close contact in that household setting," he said.

Other scientists say the research confirms their suspicions about the disease.

Dr Alan Hampson is a member of the World Health Organisation's (WHO) Pandemic Taskforce and an adviser to the Australian Government on influenza.

"This study has looked at the dynamics of the spread of the virus in the family environment in Sumatra and has come down with the conclusion that it clearly does show person-to-person transmission," he said.

"We had already believed that that was probably the case and we haven't had confirmation through analysis of the viruses.

"The information relating to those viruses is information that's held in Indonesia, so we haven't seen that, but what we do believe, from people who have seen the information, is that that too indicated that it was person-to-person spread and that the virus was changing as it spread from one person to another, as we would expect it to do."

Dr Hampson says the Sumatra case could have become a pandemic.

"If it had gone further, we do know that the virus is very good at adapting, so while on the one hand it may have to go through a number of steps, if its passage is from one person to another, then that chance is there," he said

4 comments:

Frederick Pottinger said...

dazza: if you can get access to Nature papers, you might be interested in the 2005 Oct 20;437(7062):1108 paper which reports "the isolation of an H5N1 virus from a Vietnamese girl that is resistant to the drug oseltamivir", doubly interesting because of the circumstances surrounding her infection:

"Kawaoka and colleagues say that, as far as they could tell, the Vietnamese patient had no direct contact with poultry. She had, however, taken care of her 21-year-old brother while he was infected with H5N1."

IE human to human infection with concomitant tamiflu resistence, the nightmare scenario.

Dipl.-Ing. Wilfried Soddemann said...

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.umn.edu/cidrap/content/influenza/avianflu/news/jun0607indonesia.html
http://www.who.int/mediacentre/factsheets/avian_influenza/en/index.html#history
http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/mar1307transmit.html
http://www.cdc.gov/ncidod/EID/vol12no12/06-0829.htm?s_cid=eid06_0829_x

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.


References

AGI (2007): Arbeitsgemeinschaft Influenza http://influenza.rki.de/agi
ANONYM (2003): Understanding Sars and other Respiratory Infections May 2003.
http://www.ifh-homehygiene.org/2003/2downloadabledoc/SARS.pdf
BRANKSTON et al. (2007): Transmission of influenza A in human beings. Lancet Infect Dis. 2007 Apr;7 (4):257-65. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17376383&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
BROWN (2004): Influenza Virus Infections of Pigs, Part 1: swine, avian & human influenza viruses. http://www.pighealth.com/influenza.htm ; Part 2: Transmission between pigs and other species. Veterinary Laboratories Agency, UK.
http://www.pighealth.com/influenzaB.htm
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/ncidod/eid/vol7no2/goldmann.htm
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.springerlink.com/content/u5408wx5t622ll82/
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-grosstiere.animal-health-online.de/20010902-00002/
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.springerlink.com/content/g352726672xj5703/
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.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstract&artid=154671
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.lublin.pl/Year%201999/vol99-05/art222-98.htm
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/SurvStat/
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.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12238391&dopt=Abstract
WEBSTER (1998): Influenza: An Emerging Disease. Emerging Infectious Diseases 4(3). http://www.cdc.gov/ncidod/eid/vol4no3/webster.htm
WHO (2004): World Health Organization (WHO), 2004, Guidelines for drinking-water quality, 3rd Ed., http://www.who.int/water_sanitation_health/dwq/gdwq3/en/print.html
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.springerlink.com/content/p220471r1r337521/
ZIMMERMANN (2001): Krankheiten des Schweines. Veterinärmedizinische Fakultät der Universität Bern, Vorlesungsskript: 49-51.
http://www.vetmed.unibe.ch/studvet/download/year4/Erkr%20der%20Schweine_Skript_WZimmermann_234JK_WS0102_081101.pdf

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

Sparrow said...

Sodderman,

Bird flu transmission (in part) through drinking water?

Good Christ almighty. First I've heard of this anywhere. I thought I had been keeping track but this is news to me.

I will feel stupid boiling water for my bottle in the fridge but it's going to be hard to stop myself from doing it now.

Anonymous said...

Wilfried Soddemann has been trotting out these claims for months on just about every available forum on the Internet and beyond (just try a Google search on his name). I run a photo blog and he even posted his diatribe there!

Viruses need a living host to replicate (FACT) and must be delivered at the minimal infective dose (MID) to cause infection. What is that flu viruses in water Wilfied? In addition, what is the titre of flu in drinking water? If it cannot be detected is then very likely below the MID threshold.

I think that you be better to start worrying about being struck by lightning!