[WHO's] Doctor Heymann says H5N1 remains an animal disease. He says there have been only occasional instances where human-to-human infections have occurred.
The World Health Organization reports at least 209 people have died worldwide from the virus, most in Indonesia. Scientists fear the H5N1 or another as yet unidentified virus could mutate into a form that could easily spread the disease among humans.
Doctor Heymann says there were three avian flu pandemics in the last century and other pandemics before then. He says there is a clear understanding in the scientific community that there will be another pandemic of influenza.
"We do not know what virus will cause that, but we know there are avian influenza viruses out there and those viruses could cause a pandemic eventually," he explained. "As long as H5N1 is circulating anywhere in the world, there is a chance that that virus can, either through an adaptive mutation or re-assortment, cause a pandemic. The problem is nobody can quantify that risk."
Doctor Heymann says countries have to be prepared to take action when a pandemic strikes. He says the World Health Organization is stockpiling H5N1 vaccines.
Thailand (2004, .pdf), Indonesia (the Karo cluster in 2006), and now Pakistan represent accepted cases of limited human-to-human transmission (and for those who say it's never gone human to human, yeah, it has, three different countries). Revere (Effect Measure) asks:
Yes, sometimes there is human to human transmission. But it requires very close contact. Casual contact isn't enough. Sounds reasonable. But here's my problem. In a lot of cases there is no history at all of contact with sick poultry. Maybe theses cases came in contact with a virus shedding bird somewhere but was it similarly close contact? Or is casual contact with birds capable of transmitting infection but not from another person? Even more to the point, lots of people have close contact with sick poultry and they don't get infected. Only some people get infected. We don't know why that is, but it would seem more sensible to ask the same question about the rare human to human transmission. Why these people and not others?
As in much of the H5N1 story, many questions, few answers. Any one of those clusters could have been the beginning of the next pandemic. Or maybe, the next pandemic will be some other virus (an H7 or an H9, already known to infect humans). So, it'd be a good thing to continue to beef up surveillance and keep an eye on these emerging viruses, right?
While acknowledging the threats posed by war and global warming, Nabarro insisted that the biggest danger mankind faces today is almost invisibly small. "It's microbes, particularly microbes that come from the animal kingdom, that represent one of the greatest threats to humanity and certainly even to its survival as we know it."
Well, thank goodness, we're on the ball here in the US.
Congress slashes pandemic preparedness funding
Dec 20, 2007 (CIDRAP News) – The 2008 omnibus spending bill passed by Congress this week earmarks only $76 million for influenza pandemic preparedness funding, far below the Bush administration's $870 million request.
The President's advisors have indicated he will sign the bill when it reaches his desk, according to several media reports.
The reduction in pandemic preparedness funding appears to be the most significant cut to President Bush's spending proposals, Government Executive reported yesterday.
The House and Senate appropriations committees said their rationale for cutting the 2008 pandemic preparation budget was based on a $1.2 billion amount remaining from previous appropriations, according Government Executive.
However, Rich Hamburg, director of governmental relations for Trust for America's Health (TFAH), a nonprofit health advocacy group based in Washington, DC, told CIDRAP News that the $1.2 billion represents one-time funding that is mostly intended for buying vaccines and antiviral medications.
The 2008 omnibus bill contains no one-time spending items, he said. "The appropriations committees may have thought that this was a tough budget and that it was hard to make a case that all of the pandemic funding was needed right now," Hamburg said.
To maintain momentum on pandemic preparedness efforts, Congress could fold the funding into the 2009 budget or put budget requests into emergency supplements, Hamburg said.
OK, so this isn't a sexy program like troop funding or earmarks, but it is one of the few remaining bipartisan programs in DC. The funding went the way of SCHIP expansion.
To give you an idea of the importance of surveillance and the ubiquity of the problem, here's this week's bird flu (in birds) run-down (for H5 and H7 infection). Every bird infection is a risk for humans to catch the virus. Every human that gets the virus is a chance for mutation to take place that could enhance H2H spread:
Other Avian Influenza Outbreaks in Animals
- Benin: The H5N1 virus was confirmed on two poultry on farms, one north of the capital Porto Novo and one in the commercial capital Cotonou (Dec. 17).
- Canada: A Saskatchewan poultry farmer whose 50,000 birds were culled after an outbreak of H7N3 bird flu is asking for provincial and federal assistance to pay for the decontamination of his farm (Dec. 19).
- Germany (Brandenburg state): H5N1 was identified on a small poultry farm in Bensdorf in the Potsdam-Mittelmark district, about 85 km west of Berlin (Dec. 20).
- Poland: In the Warmia-Masuria province, the country's seventh outbreak of H5N1 in poultry virus was identified on a farm near the northern city of Olsztyn (Dec. 17). In the Masovian province, the country's eighth outbreak was confirmed on an egg-producing farm in the district of Zuromin (Dec. 22). This farm is within the contamination zone of a Dec. 8 outbreak in the village of Karniszyn, from where the virus is believed to have been transmitted.
- Russia (Southern Federal District): The country's third H5N1 oubreak this year has been reported in Shosseiny, 10 km from the poultry farm where the first case of bird flu was identified in the Rostov region in late November (Dec. 20).
- Saudi Arabia: The sudden death of 20 pigeons in the Al-Hudud ash Shamaliyah province (Northern border province) has raised bird flu fears in the provincial capital, Arar, located on the border with Iraq (Dec. 17). Concerned about a possible spillover of bird flu from poultry and wild birds in Saudi Arabia, Jordan has declared a maximum state of alert (Dec. 22).
- Viet Nam: Ducks in Go Cong Tay district of Tien Giang province that died are being tested for bird flu (Dec. 20).
The integrated and deliberate surveillance and prevention program in the US and overseas is part of the public health infrastructure that needs support, maintenance and (in some cases) rebuilding. Neglecting it is as dangerous as neglecting the levees in New Orleans. All the activity in the world won't help when the hurricane winds begin to blow.
The money cut (see above) would presumably be used for local preparations for humans. So, billions for Iraq, no money for public health. I'm so glad we have our priorities straight.
For other recent 2007 flu stories, see:
Time Cites Bird Flu Vaccine As Top Medical Development Of 2007
WHO says mass bird flu vaccinations not necessary
Pandemic Influenza and Pregnant Women
The Great Pandemic: The United States in 1918-1919
Blogging about Pakistan's bird flu
And, as always, you can check the Week In Review at Flu Wiki Forum.
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