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January 13, 2007

Comments

perhaps the world might consider the cessation of the consumption of fowl?
then the bird farms go away, and most of the conditions for the promulgation of a virus would then be eliminated
but no, killing is just too popular, and eating the results are just too hard to give up.

we are a silly lot

Hi. I would like to make a couple of points about this possible family cluster in Indonesia.

First off, just because there's a cluster (if there is a cluster and it looks like there is) that doesn't automatically mean h-2-h spread. The husband supposedly recently slaughtered sick chickens and the wife (now dead) defeathered and prepared them. That means they both would have had exposure and could both be b-2-h cases. We'd really need more info about dates of onset of illnesses to see if there's any chance there was transmission within this family.

And this isn't the first cluster to cross blood lines. In January 2004 there was the Vietnamese wedding party cluster. The groom, his two sisters and the bride all got sick. I read an old Washington Post piece yesterday by Alan Sipress when he was still posted in Asia. He made reference to three or at least three clusters that crossed blood lines in that piece, which I think was from about a year ago.

Cheers.

Thanks, Helen. Very helpful comments (and fact checking). ;-)

H2H is very difficult to prove as many if not all persons in the areas in question will have fowl exposure. A field evaluation by a trained epidemiologist is the only way to know, and that's generally where WHO comes in. It takes a long time to decide. And many 'suspected' cases turn out to be negative. Yet we also know from the medical literature that H5N1 is difficult to accurately test for (see Turkey):

An important observation in this case series is that the results of initial diagnostic testing for H5N1, including real-time PCR assays of nasopharyngeal swabs, were negative in many of the patients.
A 'cluster' (in quotes) with a single point exposure or people in the same family with different (but seemingly similar) illnesses are other possibilities, but similar illnesses with even one positive H5N1 finding are worthy of tracking until definitive answers are available, if they ever are. At Flu Wiki, we track and report what the local media is publishing AND what WHO (and CDC and ECDC) decides. The idea is that if a large number of reported but unconfirmed cases shows up, it is worth knowing about. But we only consider WHO-designated cases as truly positive, whatever our suspicions.

As for bloodline crossing, you are also right that the Vietnam cluster did so, as Alan suggested. Interestingly, the groom was never tested (an example of what I was saying above). The groom's two sisters and his wife were positive for H5N1. Bloodline and familial predisposition remains an active area of review.

More descriptions of the clusters we know about can be found here. The more recent ones (Egypt and Indonesia) are considered 'works in progress'.

There are many clusters reported, 13 in Indonesia alone on the FW page and more from elsewhere. Most are bloodline clusters. What I said was "Should the husband prove positive, that cluster would not only be evidence of H2H transmission, but just about the only cluster case that crosses blood lines" and by that I meant that evidence isn't proff, and that 'just about the only cluster case' should have been described as 'one of the few'. I regret the error.


This is Alan Sipress in the WaPo in Feb 2006:

Genetic Clue Pursued in Families Struck by Bird Flu

...

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.

Preparations for a flu pandemic are quite similiar in odd ways to post "Peak Oil" conditions.

George Monbiot has written a book called: Heat

At it's core he believes environmental contsraints will have to be mandatory government policy, not voluntary action.

In the transportation sector, he says one of the main ways to cut carbon emissions is to have a much smaller fleet of delivery trucks delivering anything and everything to people's houses.

This move would save approx 2/3's of the fuel now wasted having everyone individually drive their cars to the same stores.

The overlap with flu pandemic is that such a delivery system would also be a wise move in a flu pandemic. Far fewer vectors to spreading the disease. Much like what I've heard about closing schools as a preventative measure.

'Energy expenditure' conservation and public health policy intersect in the general sense that the more travel/contact vectors in a given time/space, the more opportunities to spread just about anything, not just the flu.

The Internet would be instrumental in a school closing scenarios with 'distance' learning techniques and also with routing deliveries (food, medicine, etc)to the same houses that those kids are in while not going to school.

As Mr Monbiot would point out, such a system would dramatically reduce carbon emissions in the long run. This kind of emergency planning is also right along the lines of global warming strategies and I believe along similar lines for bird flu.

Yeah why is it that people really just aren't informed about the severity of the situation? I mean this virus has the potential to kill millions. Is that not a good enough reason to take it seriously??

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