Click the links for previous Sunday Kos Essays on pandemic preparedness and the National Response Framework.
While we've been writing about H5N1 and the threat of a pandemic for three years on Daily Kos, passage of time doesn't make the threat any less. Today we'll touch on surveillance. The combination of a domestic turkey outbreak in the UK (possibly from wild birds and still under investigation), along with the suggestion of another human to human (H2H) cluster in Riau, Indonesia, tells us that the threat of a flu pandemic is still out there and very real, but without robust surveillance, how would we know that?
David Heymann from the World Health Organization writes:
"As long as the H5N1 virus is circulating in chicken populations in the world, there will be a threat of a pandemic." September 7, 2007
Dr. David Heymann
WHO's Assistant Director-General for Communicable Diseases
Global pandemic a real threat: WHO
Well, it's not just chickens these days and it's not just third world countries that are affected. The most recent H5N1 outbreak [yes, it's confirmed] in birds is in turkeys in the UK.
Bird flu virus contained, says farm
A cull of 28,000 poultry on five farms linked to a bird flu outbreak in East Anglia will be completed today. The owners of Redgrave Poultry in Diss, Norfolk, the farm at the centre of the outbreak, are optimistic that the virus has been contained. Government advisers are baffled, however, about the outbreak’s source.
For the second time in a year, the UK has to deal with H5N1 infections in poultry. In the first case, Bernard Matthews, the largest poultry dealer in the country, was faced with an H5N1 infection likely spread from infected poultry from Hungary. This time, a free range turkey farm in Suffolk reported the deadly virus, which sparked an exclusion zone within which the poultry cull took place.
The source of the infection is unknown, but it is identical to the strain found in recent outbreaks in southern Germany and the Czech Republic (see FW summary).
Interestingly, DEFRA (the British agency that oversees poultry surveillance and testing, is threatened with budget cuts in a scenario where they can barely keep up with the threat.
POULTRY producers last night called for increased surveillance of wild birds after an outbreak of avian flu in East Anglia was confirmed as the feared H5N1 strain.
More than 6,500 birds, including some 5,000 free-range turkeys, were slaughtered yesterday at the farm in Redgrave, Suffolk. The farm is near a large pond used by wild birds and government scientists said initial tests "suggest a possible wild-bird source" for the disease.
As David Heymann notes, if H5N1 is in the environment, it is a threat to humans. This is a lesson the Indonesians are learning the hard way. These maps, produced by Flu Wiki volunteers, show recent Indonesian cases, including suspect cases that may suggest a human H2H cluster:
click pics for bigger versions; more after the break
More from Flu Wiki:
After a lull in July, the following human H5N1 cases have been confirmed in Indonesia (dates are from the onset of symptoms):
Banten:
1 case (fatal) in August
1 case (fatal) in September
3 cases (2 of which were fatal) in October
The 1st October case was a neighbor of the September case
Riau:
1 case (fatal) in August
2 cases (both fatal) in October
There are 2 more suspect cases in November which are linked to the last fatal case (they are the wife and nephew of the last October case). These two suspect cases look like H2H spread if they end up testing positive.
Bali:
2 cases (both fatal) in August
West Java:
1 case (fatal) in September
The above list was created by Flu Wiki volunteers scouring Indonesian media for reports of positive testing. The liberal use of tamiflu in Indonesia, an antiviral agent used to treat influenza, interferes with testing results, so accurate testing information remains difficult to come by. In addition, Indonesia is still not freely sharing viral samples (for fear of "exploitatioin' by western countries using the sample to produce expensive vaccine which is then sold back to Indonesia). WHO is working to resolve these issues, but as of this writing, there's still limited viral sharing.
THE world's ability to track the evolution of flu and develop vaccines against it hangs in the balance. Governments will meet next week at the World Health Organization (WHO) in Geneva, Switzerland, to try and rebuild the global system for sharing flu viruses after protests by Indonesia earlier this year. The country has sent only five H5N1 samples from infected people to WHO labs in 2007. Virologists say this is not enough to track H5N1 evolution.
Indonesia and its allies complain that the samples they send to the WHO-run Global Influenza Surveillance Network (GISN) are being turned into patented diagnostic tests and vaccines that they can't afford. "There has been a huge spike in H5N1-related patents recently," says Ed Hammond of pressure group the Sunshine Project.
Surveillance is a key component of pandemic preparedness, and whether it's DEFRA in the UK or WHO in Indonesia, the idea that surveillance agencies are being hamstrung by budget cuts and politics is a terrible development, one with real world consequences.
This recent Daily Kos diary about Obama's 2005 leadership on pandemic preparedness is welcomed, but what the candidates are saying and doing in 2007 seems more relevant. This issue is likely not going to be the focus of any of the debates, nor the issue that decides the election, but leadership when and where it exists should be recognized and applauded. Given the proven ability of this virus to mutate and spread, and the potential ability to be the cause of a worldwide pandemic, humans need all the help we can get.