Today's Mack Attack is dedicated to keeping you abreast of the coming pandemic currently on the wing. Call your congress representatives and drum it home to them that they need to get on the stick.

H5N1 Bird Flu Reported in 3 More Countries

TEHRAN, Feb. 14 -- Iran on Tuesday said 135 wild swans died of bird flu in marshlands near the Caspian Sea in the country's first case of the spreading virus, and officials in Germany and Austria said the virus had apparently come across their borders as well.
The disease's likely spread to three new countries follows the recent deaths of humans from the H5N1 strain of bird flu in Turkey and Iraq, Iran's neighbors, and the march of the disease into the European countries of Greece and Italy.
Olympic officials in Italy said bird flu posed no threat to the Turin Olympics. But an official in Nigeria warned that bird flu was fast spreading in that country, and a U.N. expert said the strain may have surfaced in neighboring Niger.
Bird flu has killed at least 91 people since 2003, according to the World Health Organization. Almost all the human deaths have been linked to contact with infected poultry, but experts fear that the H5N1 virus could mutate into a form that spreads easily among people, possibly sparking a pandemic.
Iran's official Islamic Republic News Agency quoted the country's Veterinary Organization as saying that "international laboratory results" confirmed that the wild swans died from bird flu. It did not name or give the location of the laboratory.
Health Minister Kamaran Bagheri Lankarani said on state-run television that Iranian officials have killed all wild birds in a three-mile radius around where the virus was detected, about 200 miles northwest of the capital, Tehran.
Two dead swans in northern Germany were found on the island of Rugen, and a regional agriculture ministry spokeswoman, Iris Uellendahl, said a preliminary test showed they died of H5N1.
Agriculture Minister Horst Seehofer ordered domestic poultry kept indoors beginning Friday instead of Feb. 20 as previously ordered. Samples from the birds were being taken to an E.U. laboratory in Britain for a definitive test, Uellendahl said.
Two birds found dead in Austria appear to also have been infected with the H5N1 strain.

GENETICS COULD HOLD KEY

BANDUNG, Indonesia -- Buenah's teenage daughter lay sprawled on a hospital bed, under observation for bird flu. In an adjacent room, her haggard husband was sitting wrapped in a gray blanket, also under treatment for the virus.
Her two other children had already died from it.
"I don't know exactly why I'm healthy," Buenah admitted from a cot where she was keeping vigil late last month for her family. "I don't have a fever, a cough or other symptoms. I really don't know why not."
In the weeks before the family became sick, the virus raced through their small flock of chickens. When the last six birds developed symptoms, Buenah's husband helped his brother slit their throats beside a large palm in the front yard. The chickens were plucked and cooked in coconut milk for a family feast.
With four cases confirmed or suspected, her family represents one of the largest clusters of bird flu among humans in the world. It is also notable in sharing a characteristic with nearly all the other family clusters: Those infected by the virus were related to each other by blood and not by marriage. This raises the possibility that genetics play a role in determining who among those exposed contracts the often-lethal disease.
"It's intriguing," said Sonja J. Olsen of the Centers for Disease Control and Prevention in Bangkok, who has studied family clusters of avian influenza. If a biological explanation were ultimately proved, she added, "perhaps we could identify people at genetic risk."
Since bird flu began spreading across Asia in 2003, there have been 25 recorded family clusters involving confirmed or suspected cases. In the overwhelming majority, these have involved blood relations such as siblings, parent and child, children and grandfather, or niece and aunt. In only three instances did both husband and wife test positive.
Worldwide, bird flu has infected at least 165 people and killed 91, according to the World Health Organization. Health experts warn that the notoriously changeable influenza virus could develop into a form more easily transmitted among people and spark a global pandemic.
Outside the isolation ward in Hasan Sadikin hospital, a facility designated to treat bird flu in Bandung, the capital of West Java province, Buenah's relatives were camped on the lobby floor, spending nights on thin woven mats, wondering, like the experts, why she was spared while the rest of the family fell sick.
"It's a mystery. It's really incomprehensible to us," said Surip, her husband's cousin. "Everyone in the family had the same contact with chickens."
There is no evidence that properly cooked poultry or eggs can be a source of infection, according to the CDC. Most cases of bird flu in humans have resulted from direct or close contact with infected live or uncooked poultry or surfaces contaminated with secretions and excretions from infected birds.
The Buenahs live about 100 miles east of Jakarta in the village of Cipedung, in the modest dwelling of a meatball peddler, with dirt floors, flimsy bamboo walls and a ramshackle roof that leaks in the rain. Chickens often wandered inside, sleeping beneath the platform beds.
Health investigators have attributed the outbreak to infected poultry, reporting that bird flu has been identified in chickens across much of the village.
Two days after the family killed and ate the infected birds, Nurochmah, 13, the first to fall sick, began coughing and developed a high fever. By the time she was taken to a district hospital six days later, she was gravely ill. The medical staff recommended she be moved to a better hospital, but she died as the ambulance was coming to transport her.
The day she died, Buenah brought their son, Indrawan, 4, to the district hospital after he came down with the same symptoms. The boy was urgently transferred to the provincial hospital, but he survived for only two days.
Another daughter, Indrawati, 14, was next to become ill, with a slight fever, not enough to keep her out of school. But health workers urged that she too be admitted to the hospital.
Her father, Kadis, joined her three days later after he began complaining of trouble breathing while overseeing the funeral for Nurochmah.
Tests confirmed that Nurochmah and Indrawan died of bird flu. Initial results were inconclusive for the father and older daughter. But international health experts said they expected that further testing would show all four had contracted the disease.
The father and daughter recovered and left the hospital two weeks ago.
The question of how Buenah eluded the virus is part of a puzzle now stumping global influenza experts. Researchers acknowledge that they know little about why some people become ill while others, with even greater exposure to the infection, remain healthy.
For instance, thousands of agricultural workers, officials and soldiers have been culling poultry across Asia in an effort to contain the spread of bird flu, at times lacking even basic protection such as gloves, masks and goggles. Yet according to WHO records, not one has fallen sick. This finding has reinforced the suspicion that some people are more susceptible than others.
"We've discussed how it's always likely there's some genetic component going on," Keiji Fukuda, WHO's influenza chief, said in a telephone interview from Geneva.
He cautioned that it was too soon to conclude that there is genetic susceptibility. Although the family pattern is suggestive, Fukuda said the size and number of clusters remain small. Moreover, even if research proves that some people are more susceptible, he said this information may have little practical benefit if the virus mutates into a form that spreads faster than people can be tested for genetic risk.
Olsen and other researchers have noted that behavior and not genetics might be the determining factor in who in a family gets sick.
Could the rest of Buenah's family have had more contact with sick chickens than she did? That's doubtful, relatives and local agriculture officials said, reporting that as a rural homemaker, she was in daily contact with livestock.
Perhaps the three children contracted the virus by playing with chickens. Could they have then passed it to their father but not their mother? Relatives said Buenah was the parent who usually looked after the children and who carried her ailing son in a sling across her chest for days.
When pressed by a reporter, Buenah suggested she was spared because she did not eat chicken when the rest of the family feasted on the sick birds. She said she had high blood pressure and avoided meat.
But back in the village, next door to Buenah's home, her mother-in-law, Jaonah, dismissed that explanation.
"Many people ate that chicken. I ate the chicken," recalled Jaonah, 70, sitting cross-legged on the porch. Beside her in the rain-soaked yard were the abruptly abandoned reminders of her family: her son's rickety meatball pushcart and her grandson's plastic tricycle. "The rest of us didn't get sick," she continued, eyes reddening. "So that can't be the reason."

OH, GREAT

NEW YORK - The almost certain shortage of mechanical ventilators that will occur in the event of an influenza epidemic dictates that guidelines be established for their appropriate allocation, doctors warn in a report.
Despite improvements in intensive care in recent decades, the overall lack of resources may limit the number of patients that could receive care in a pandemic similar to the influenza pandemic of 1918, they explain in a report published in the journal Academic Emergency Medicine.
Dr. John L. Hick and Dr. Daniel T. O'Laughlin from University of Minnesota in Minneapolis describe the evolution of guidelines for the allocation of scarce resources and for triage of mechanical ventilation in the event of such a pandemic in response to the results of a drill that postulated the occurrence of only around 400 pneumonic plague cases in a region that maintains 4,857 hospital beds, including 480 ICU beds.
The authors recommend, for example, the use of all available resources to minimize stress on the healthcare system, "including patient redistribution, with triage and adjusting standards of care considered as a last resort when no further resources can be obtained."
In these extreme situations, they write, the governor should issue an emergency order recommending standards of care based on the situation and providing legal protection for those who employ such standards while responding to the disaster.
Triage of mechanical ventilation should, in their view, attempt to do the greatest good for the greatest number with the available resources. They recommend implementing a three-tiered criteria system "so that as resources are exhausted, another (stricter) tier of exclusion criteria is implemented in an attempt to provide the best care possible to those with the best chance of survival."
Wherever possible, criteria for allocating scarce resources should be presented to the general public and to specific patients and families upon admission to the hospital.
"It cannot be anticipated that the families will agree with the decisions made," the report notes. "However, their disagreement and anger may be tempered by the fact that they viewed the underlying process as fair and understood it in advance, the so-called 'fair process effect.'"
"As physicians and health care providers, we owe it to ourselves and to our patients to develop thoughtful and fair triage strategies in conjunction with members of the community before a crisis," the authors conclude. "Only in this way can we acknowledge our system limitations and develop contingency plans that can be practiced in advance of an incident, so that we may be trusted to do the greatest good for the greatest number with what we have to offer when disaster strikes."

SOURCE: Academic Emergency Medicine, February 2006.

LAST BUT NOT LEAST

Marie Rose said...

According to the UK Pandemic plan (available with a google search, but I recommend an Adivan and a stiff drink before you read it), the UK has said that a 100% quarantine would only delay the entry of the virus into the country a maximum of 6-8 weeks. The wild bird migration is why.There are several questions I have yet to hear anyone address:Agriculture: If a bird species beneficial (in human terms) for destroying pest insects experiences a high level of infection and death, there will be impacts on crop yields. In sub-Saharan Africa, there simply aren't the surpluses to deal with crop failure. And if you don't think starvation can destabilize nations, I refer you to Marie Antoinette.Public Health: Beyond the obvious of human infection with H5N1, if birds which consume mosquitoes are decimated, there are going be increased rates of mosquito borne illnesses such as malaria.Other Birds/Animals: Raptor populations might be impacted if H5N1 weakened birds are more easily captured and eaten, and the virus transmitted to the raptors and the scavengers which eat the carcasses.