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HEALTH 5/10-5/17/09 Bird, Other Flus Weekly Thread: The lessons of swine flu - TimeBomb 2000
Link to last weeks thread:
5/1/09-5/8/09 Weekly Bird Flu Thread:Mexico Health Chief Slams WHO, Seeks Probe
http://www.timebomb2000.com/vb/showt...highlight=bird
See:
Confirmed cases of Swine Flu and maps
http://www.timebomb2000.com/vb/showthread.php?t=330689
Comprehensive Flu Thread, Latest reports, States, Countries, Closings.
http://www.timebomb2000.com/vb/showthread.php?t=330395
Useful Links:
Avian Influenza (Bird Flu)
http://www.cdc.gov/flu/avian/gen-info/facts.htm
Johns Hopkins on influenza:
http://www.iom.edu/Object.File/Maste...%20Chotani.pdf
National Avian Influenza Surveillance Information:
http://wildlifedisease.nbii.gov/ai/
CDC
http://www.cdc.gov/flu/avian/index.htm
WHO
http://www.who.int/csr/disease/avian.../en/index.html
CIDRAP
http://www.cidrap.umn.edu/
Official U.S.
Government Web site
http://www.pandemicflu.gov/
FAO
http://www.fao.org/ag/againfo/subjec...ial_avian.html
Public Health Agency of Canada
http://www.phac-aspc.gc.ca/influenza/avian_qa_e.html
European Union
http://ec.europa.eu/dgs/health_consu...country_en.htm
The World Bank
http://web.worldbank.org/WBSITE/EXTE...793593,00.html
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The lessons of swine flu
http://www.guardian.co.uk/commentisf...y/10/swine-flu
As the swine flu outbreak backstory seeps out, there are some vitally important lessons that can be learned.
Huge investment in pandemic preparedness and contingency plans, improvements in surveillance and response systems and stockpiling of drugs and vaccines have followed recent avian influenza outbreaks.
But do we have effective global disease surveillance and control systems that can prevent a disaster?
In the face of a potential pandemic, huge numbers of potential deaths are bandied about, based on highly suspect data and assumptions and resulting in wild speculation and panic.
The counter move is to keep quiet, cover up and assure the populace.
Neither approach helps, as we don't know what will happen, when and to whom.
This acceptance of uncertainty and ignorance in a public debate is tough.
But it is also vital.
Otherwise inappropriate public policy arises and misguided signals are given.
Preparing for a pandemic means preparing for surprises and being ready to respond rapidly and flexibly under conditions of uncertainty requires a new set of skills, bureaucratic routines and incentive systems in the public agencies charged with protecting the world from emerging infectious diseases.
As Emery Roe and Paul Schulman argue in their recent book High Reliability Management, reliability must be a feature of any system operating in a complex, uncertain world.
This requires, they argue, high reliability professionals who can track between local understandings of what is happening on the ground and the broader policy situation, liaising between agencies and across scales.
These professionals are currently absent from the international effort creating a vacuum at the heart of the response because authoritative knowledge consists of accepted expertise that does not acknowledge uncertainty, ignorance or complexity.
In a potentially global pandemic situation, global assessments are also based on global statistics, but in reality major structural inequalities affect the likely outcomes of rapid disease spread.
We don't know why disease virulence and mortalities are high in Mexico, but apparently lower elsewhere.
This may have a complex medical, viral cause.
But it also may be to do with access to healthcare and effectiveness of response.
In the UK there is much brash talk of being "the best prepared" country in the world.
But being prepared means having stockpiles of drugs, an effective surveillance system and a functioning national health system.
Such conditions do not exist everywhere;
Other diseases and poverty affect people's health and ability to resist new viruses.
Underdevelopment and inequality play a big part in the dynamics of diseases, and should not be forgotten in the rush to construct a global public response to a potential pandemic.
The swine flu story is also revealing how poor surveillance and reporting systems mean an outbreak can quickly get out of control there were big gaps in detection and reporting that date back to February.
But local people knew of the disease, and have strong hypotheses about its origins.
Anselma Amador from La Gloria, the village where the first known case of swine flu occurred told the Guardian: "We are not doctors, but it is hard for us not to think the pig farms around here don't have something to do with it
The flu has pig material in it and we are humans, not pigs." La Gloria residents say local hills prevent the farm's fetid air from moving on past their village.
These explanations are dismissed by the health minister and pig farming company, but why are such leads not being followed up?
And why are such early-warning approaches, based on local knowledge about disease incidence and its dynamics, not part of the standard surveillance system?
Why is such knowledge of the "not doctors" so easily dismissed?
In south-east Asia local understandings of avian flu and its spread have been vitally important.
Medical doctors, epidemiologists, virologists, veterinarians and other specialists need to work hand in hand with local people for surveillance to be effective.
The naming of "swine flu" is also now being fiercely debated, revealing much about the politics of a disease.
An Israeli health minister and a number of Muslim groups have objected on religious grounds.
World animal health organisation the OIE has also argued that the flu should be relabelled "North American influenza", as the virus had not been isolated in animals, "no current information on influenza-like animal disease in Mexico or the US could support a link between human cases and possible animal cases including swine", it says.
While religious sensibilities might be understandable, what does the OIE's position tell us about a co-ordinated international response?
Made up of chief veterinary officers from around the world, the OIE, as the WTO-recognised body dealing with trade in animals and their products, has enormous influence on and is enormously influenced by the international livestock and meat trade.
Within countries, pressures not to declare an animal disease outbreak can be immense, and slow reporting and a commitment to facilitating certain types of trade, for certain countries and certain business interests, may be part of the political economy of decision-making.
Another strong lesson from the avian flu experience is that attention to the changing structure of the livestock industry is essential to understanding how diseases emerge and spread.
While it is easy to blame big agribusiness and industrial farming techniques, the situation is more complex.
While the "livestock revolution" is celebrated as a source of economic growth in the developing world, rapid restructuring of the livestock sector has major downsides and implications for how industries are regulated and diseases managed.
Backyard production of poultry or pigs can be replaced by poorly regulated industrial units aimed at maximising returns but with little attention to safety, animal welfare, disease control or environmental pollution.
Independence, transparency and effective and timely information flows are essential for international efforts to control emerging diseases.
As the details begin to emerge on the swine flu outbreaks, a more comprehensive assessment of the political economy of agriculture and the pig industry in particular in Mexico will be essential in learning lessons for the future.
Right now, of course, the spotlight is focused on the international public health response.
Preparing for a pandemic means preparing for surprises and being ready to respond rapidly and flexibly under conditions of uncertainty.
As the experience with avian influenza has shown, this may require more than simply the top-down, "active and aggressive" technocratic responses being urged.
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Swine H1N1 Fatality in Washington
http://www.recombinomics.com/News/05..._Fatality.html
The Snohomish County man, who officials said was in his 30s, had an underlying heart condition.
He became sick on April 30 and died Wednesday from what appears to be complications of swine-origin influenza (H1N1), officials with the state Department of Health said.
The above comments describe the first reported H1N1 swine influenza death in Washington state.
The death follows two deaths in Texas and one in Canada.
These deaths highlight concerns that H1N1 deaths in the United States will parallel the deaths in Mexico when the number of cases increase.
The virus is rapidly spreading in the United States (see updated map), but the vast majority of reported cases are in children or young adults and most of these cases have been mild and did not require hospitalization.
However, as the number of deaths in the United States increase, the similarities with Mexico will become clearer.
These similarities are most easily seen in the sequences of the swine H1N1 from patients in Mexico and the United States (see list here), which are virtually identical.
Moreover the same sequences had been identified in isolates worldwide, strongly suggesting that differences in mortality are largely due to testing and detection frequencies.
The H1N1 in Mexico was recently confirmed by labs in the United States and Canada.
Prior to the lab confirmation, the reports out of Mexico were mixed.
It was clear that patients between the ages of 25-44 were dying from atypical pneumonia, but the etiological agent was unclear.
The identification of swine H1N1 that matches the virus circumnavigating the globe provides a tight association between prior events in Mexico and future events in countries with more recent introductions.
However, the timing of these introductions remains uncertain.
The mild nature of the vast majority of case allows for silent spread.
The first two cases in the United States were identified through a border surveillance system.
Other infections would go undiagnosed or misdiagnosed because of similarities with seasonal flu.
Most infected patients would not seek medical attention, and those that did would be positive for influenza A and treated as seasonal flu patients.
This silent spread will likely continue because of decisions to limit testing of patients by state labs.
Many have indicated that they will concentrate on more severe cases.
Although an influenza A positive at this time of the year in the northern hemisphere will be increasingly likely to be H1N1 swine flu, a lab confirmation is the best tracking data.
The deaths of the young adults in Texas and Washington highlights the similarities between the H1N1 swine flu pandemic of 2009 and the 1918 outbreak, which also began with mild influenza due to efficient swine H1N1 transmission in a human population.
The rapid spread in the human population increases the likelihood of co-infrection with H1N1 seasonal flu and the acquisition of key polymorphisms linked to adaptation in human hosts.
Two likely acquisitions are NA H274Y and PB2 E627K, which are fixed in human H1N1.
Close monitoring of sequences, including those from the southern hemisphere in the near term, will allow for detection of key changes that will drive swine H1N1 infections in the northern hemisphere in the fall.
The key acquisitions were recently demonstrated in the fixing of oseltamivir (Tamiflu) fixing in H1N1 seasonal flu, and acquisition of key polymorphisms via homologous recombination remains a cause for concern.
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