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While it doesn't make news here, because it's not American deaths or a change from a simmering baseline, H5N1 still percolates in hot spots like Indonesia's Bali. Several resources help illustrate the problem. This map from Bali, Indonesia, where 1.5 million tourists from all over the world visit each year, tracks suspected cases of H5N1. It's put together by volunteers at Flu Wiki:


While a suspected case is not a proven case, not all samples in Indonesia make it to authorized labs for verification, and some of the suspects might have been placed placed on tamiflu, which is suspected of negating accurate testing. While the total number of cases is likely more than official counts, at this point it's not much more. There's no immediate pandemic happening, but H5N1 remains a candidate for one.

Also, a recent acknowledgment of human to human transmission in Indonesia (one of the human hot spots along with Egypt and Vietnam) highlights the need for vigilance.

A new study by a US university has apparently confirmed for the first time that bird flu has been transmitted from human to human.

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.



The World Health Organization and other international (that's international, including the US) agencies continue to plan and monitor:

The World Health Organisation warned Monday against complacency in the fight against bird flu, saying another human influenza pandemic is inevitable sooner or later.

"I am often asked if the effort invested in pandemic preparedness is a waste of resources," director general Margaret Chan told a regional meeting of the world organisation.

"Has public health cried wolf too often and too loudly?" she said in a speech.

"Not at all. Pandemics are recurring events. We do not know whether the H5N1 (avian influenza) virus will cause the next pandemic. But we do know this: the world will experience another influenza pandemic sooner or later."

WHO regional director Shigeru Omi noted that bird flu deaths in the Western Pacific -- which excludes Indonesia -- had fallen from 19 two years ago to five in the past year.

But he said the virus was still "entrenched" in several countries.

"Because the virus continues to evolve and mutate, we must maintain constant vigilance," he said.

This isn't a front page story, but it's information nonetheless worth posting. H5N1 is not guaranteed to be the next pandemic, but some flu virus out there will be, and there's nothing to say H5N1 won't be.

This fall, the focus will be on community mitigation guidelines and implementation. This means that if a severe pandemic strikes, the public schools in the US may close for up to 12 weeks. Pre-planning is essential for parents and employers. The focus will be on what's called COOP (continuity of operations planning) for individualsand communities.

Expect to hear more in coming weeks. While it's not the number one problem in the world today, it's certainly on the list of potential disasters, and mitigating disasters in advance is certainly a better idea than playing catch-up.

Originally posted to Greg Dworkin on Mon Sep 10, 2007 at 04:07 AM PDT.

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Comment Preferences

  •  at least 2 residents of Bali (25+ / 0-)

    have died from H5N1. The rest are suspect cases. Not all suspect cases (indeed, most suspect cases) are true negatives, but that cannot be determined form the news reports used to build the map.

    This netroots tracking of H5N1 has been an ongoing project since 2005, and is reviewed by the major health agencies to make sure they don't miss cases.

    Daily Indonesian news is here, flu news is here.

    "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

    by Greg Dworkin on Mon Sep 10, 2007 at 04:10:37 AM PDT

    •  Europe (4+ / 0-)

      Not a hot spot, obviously, but there have been discussions about it possibly becoming entrenched/endemic (for example, "Evolution of Highly Pathogenic Avian Influenza type H5N1 in Europe: review of disease ecology, trends and prospects of spread in autumn-winter" [pdf]).

      What do you think?


      As I travel around this big ol' world there's one thing that I most fear/ It's a white man in a golf shirt with a cell phone in his ear...

      by Page van der Linden on Mon Sep 10, 2007 at 04:15:34 AM PDT

      [ Parent ]

      •  it's already entrenched (see germany) (6+ / 0-)

        and we don't do enough wild bird surveillance but poultry trade may be as important or more important than wild birds in the spread of disease.

        One thing to emphasize is how little we know. The flu has been around a long time, but until recently it hasn't been a sexy thing to study (same with TB).

        Rebuilding public health infrastructure includes funding health and basic science studies to be better prepared for whatever nature comes up with.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Mon Sep 10, 2007 at 04:18:41 AM PDT

        [ Parent ]

  •  What's the latest on vaccination? (6+ / 0-)

    Several months ago I read about successful lab tests of vaccinations.  Any new news along that front?  

    I agree all countries should prepare for the worst.  H5N1 or something equally deadly will underscore inherent weaknesses in globalization.  12 weeks is a long time and would cause disruptions anyway - but losing a large section of the global community will wreck havoc on our global driven economy in the long term.  

    Preparedness goes beyond picking up a loaf of bread and box of band-aides at the corner store.  The corner store won't have deliveries for probably a lot longer than 12 weeks.  America (like most countries) isn't ready for such a scenario.  Few of us garden anymore. Hospitals stock enough supplies for a few days, not a few months.  

    H5N1 would bring out the worst in society on a long-term basis.  I hope to Goddess that never happens.

  •  Recommended tag added (2+ / 0-)
    Recommended by:
    DemFromCT, tgray

    Tag scorecard:

    258  avian flu
     81  flu
     79  pandemic preparedness
     70  H5N1
     47  Indonesia
     11  World Health Organization

    The Dutch children's choir Kinderen voor Kinderen (= “children for children”) is a world cultural treasure.

    by lotlizard on Mon Sep 10, 2007 at 05:30:48 AM PDT

  •  Well Dem, I'm wondering . . . (1+ / 0-)
    Recommended by:
    DemFromCT

    I agree that public health emergency preparedness is important, and that preparedness for unpredictable infectious disease epidemics is among the most important components of overall preparedness.  However, I'm really starting to question the tactic of singling out the possibility of an H5N1 influenza pandemic as the McGuffin on this issue.

    As time goes on, I'm actually starting to believe that the probability that this particular strain will evolve into a human pandemic strain decreases.  Meanwhile, as years go by and it just doesn't happen, your audience starts to think of you as the boy who cried "Wolf!"  I really prefer to talk about the issue of emerging infectious diseases in the context of a shrinking planet and highly uneven and deficient health care and public health resources in more general terms.  The focus on this particular virus is unhealthy.

    •  so you've said (0+ / 0-)

      and I continue to respectfully dsagree. As usual. ;-)

      Still, better to debate this vs another health approach (as if they are exclusive... they are not) than this vs Iraq funding.

      And, I would respectfully point out, this is an area where people need to get off their duffs and do something, be it restock their home for family emergencies or prepare to intelligently discuss this at their next school board meeting. ;-P

      That alone justifies the 'extra' discussion and attention.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Mon Sep 10, 2007 at 07:25:57 AM PDT

      [ Parent ]

    •  oh, and by the way (0+ / 0-)

      WHO agrees with my approach. There's nothing inconsistent with what I've writen here, and my focus is on pandemic preparedness as well as H5N1. Dr. Heymann explains further:

      Dr David Heymann has been telling Alison Caldwell that people have been lulled into a false sense of security about the threat posed by infectious diseases.

      ALISON CALDWELL: Last week's confirmation that bird flu was transmitted from human-to-human on the Indonesian island of Sumatra last year, confirmed the fears of many health experts that a global pandemic was and is still possible.

      The World Health Organisation's Dr David Heymann is one of the world's foremost experts on infectious diseases.

      He's visiting Melbourne as a guest of the Nossal Institute for Global Health at the University of Melbourne.

      DAVID HEYMANN: As long as the H5N1 virus is circulating in chicken populations in the world, there will be a threat of a pandemic. So, today what's most important is to get rid of that virus from chicken populations in the world and also from bird populations.

      But there are also other avian viruses, avian influenza virus - H7 viruses, H9 viruses - which also are capable of infecting humans, and which are also thought to be capable of causing a pandemic.

      So, today we have many different viruses that come from avian or bird populations infecting humans, and any one of those could cause a pandemic.

      All of the above is true and completely consistent with what I have written.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Mon Sep 10, 2007 at 07:44:53 AM PDT

      [ Parent ]

      •  It's not inconsistent with what you have written (0+ / 0-)

        My point is to think about what the best strategy is for educating the public and raising awareness.  WHO is concerned about emerging ID, period, they aren't devoting themselves to H5N1 influenza.  I don't think you and my good friend Revere should be either, because I think it's increasingly unpersuasive.  Preparing for a global pandemic of that particular strain of flu virus is no different from preparing for infectious disease emergencies generally.  Even new vaccine production technologies based on bacterial plasmids rather than growing virus in chicken eggs have much broader application.

        I'm just sayin', instead of obsessing on bird flu, let's broaden the obsession.  It would be both more truthful and better marketing.

        •  points to consider (0+ / 0-)

          but I reserve the right to see it differently.

          BTW, this discussion is going on everywhere in various forms... but pandemic preparation is fundamentally different than all hazards, including all infectious disease hazards.

          At the local (school board) and hospital level, pandemic preparedness is being incorporated into planning virtually everywhere, and that will accelerate this year. This is also true at state levels. Multiple examples can be given, with links.

          So, your "unpersuasive" seems a bit, well, therealcervantes-centric and does not reflect what's happening at the local level.  ;-)

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Mon Sep 10, 2007 at 10:56:33 AM PDT

          [ Parent ]

          •  You are not making much sense (0+ / 0-)

            Would you please explain to me why pandemic flu preparation if "fundamentally different" from all other infectious disease hazards?  That statement, I believe, it preposterous and has no basis in reality.  I thought we were having a friendly discussion here, and you're spouting horseshit.

            As for the assertion that "pandemic preparedness is being incorporated into planning virtually everywhere," if that is true, why are you still ringing these alarm bells all the time? It's obviously unnecessary, mission accomplished.

            •  Pandemics are fundamentally different because (0+ / 0-)

              -the scale is different (25 to 40% of workforce ill or caring for others)
              -they happen everywhere (no help from outside) and nearly at the same time
              -they come in waves (potentially)

              Other aspects (no-show rates, societal changing) may apply to other infectious diseases, like SARS, but the world-wide scale makes this different.

              Your definition of "horseshit" seems to be
              anything you don't agree with. Nontheless, WHO, CDC and other health agencies agree with me and not you. That's a hard fact.

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Tue Sep 11, 2007 at 10:30:53 AM PDT

              [ Parent ]

            •  as to the need to continue to discuss this (0+ / 0-)

              As for the assertion that "pandemic preparedness is being incorporated into planning virtually everywhere," if that is true, why are you still ringing these alarm bells all the time? It's obviously unnecessary, mission accomplished.

              much has been done (proof it's being taken seriously) but much is left undoone, including rolling this out past just local officials to the level of ordinary citizens.

              I don't understand why you'd object to that.

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Tue Sep 11, 2007 at 03:13:18 PM PDT

              [ Parent ]

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