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Avian Flu Epidemic

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It could kill a billion people worldwide, make ghost towns out of parts of major cities, and there is not enough medicine to fight it. It is called the avian flu. - ABC News


The World Health Organisation has urged nations to prepare for a bird flu pandemic, saying they should not be caught unawares by an obvious threat.


Outbreaks of highly pathogenic H5N1 avian influenza in poultry are now known to have begun in parts of South-east Asia since mid-2003. These outbreaks have been historically unprecedented in their geographical size and the number of birds affected. So far, around 150 million birds have died during the outbreaks or been destroyed as part of the containment effort.


Symptoms of bird flu in humans have ranged from typical flu-like symptoms (fever, cough, sore throat and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress), and other severe and life-threatening complications. The symptoms of bird flu may depend on which virus caused the infection.


During early August 2005, highly pathogenic H5N1 avian influenza was confirmed in poultry in parts of Siberia, Russia and in adjacent parts of Kazakhstan. Both countries have reported deaths of migratory birds in the vicinity of poultry outbreaks. These events mark the first detection of highly pathogenic H5N1 avian influenza in the two countries. Last week, avian influenza of the H5 subtype was confirmed in dead migratory birds in Mongolia. No human cases have been reported in conjunction with any of these newer outbreaks.


To date, human cases have been confirmed in four countries: Viet Nam, Thailand, Cambodia, and Indonesia.


The Ministry of Health in Viet Nam has retrospectively confirmed an additional fatal case of H5N1 infection that dates back to July. The case, in a 35-year-old male farmer from Ben Tre Province, developed symptoms on 25 July and died on 31 July.


The newly confirmed case brings the total in Viet Nam since mid-December 2004 to 64 cases, of which 21 were fatal


The World Health Organization considers the present risk of a pandemic great, but unpredictable in terms of its timing and severity. All conditions for the start of a pandemic have been met save one: changes in the virus that would make it contagious among humans, thus allowing easy and sustainable human-to-human transmission. The likelihood that this will happen is a matter of opportunity and probability.


Experts anticipate that a virus with improved transmissibility will announce itself in the form of clusters of human cases, closely related in time and space. Surveillance and reporting systems in all countries experiencing outbreaks in birds need to be strong enough to detect such clusters of human cases.


A vaccine probably would not be available in the inital stages of population infection [19]. Once a potential virus is identified, it normally takes at least several months before a vaccine becomes widely available, as it must be developed, tested and authorised. The capability to produce vaccines varies widely from country to country; in fact, only 15 countries are listed as "Influenza vaccine manufacturers" according to the World Health Organisation.


f there was a flu pandemic tomorrow we would not be ready. The clock is ticking and when the pandemic strikes it will be too late," said WHO spokeswoman Christine McNab


The reason I have taken the time to write this article is that I am scared. I have contracted the flu 3 times in the last 4 years. Last year I was scheduled for a flu shot and like most Americans I was not able to get one. Now I find out there is no vaccine being made. Imagine that the mortality for hurricane Katrina was 1000 people. An outbreak of Avian flu could wipe out millions of Americans.


Is there anyone else out there a little scared?

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  • 3 weeks later...

The Ministry of Health in Indonesia has confirmed another human case of H5N1 avian influenza. The patient, a 21-year-old man from Lampung, Sumatra, developed symptoms on 20 September and was hospitalized on 24 September. He remains hospitalized in a stable condition.


Confirmatory testing was conducted at a WHO reference laboratory in Hong Kong.


Initial investigation has revealed that the man had direct exposure to diseased and dying chickens in his household shortly before the onset of illness. Contact tracing and field investigations are under way and samples have been taken to determine whether family members and other close contacts may have been infected.</p>

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Before any international travel to an area affected by H5N1 avian influenza

Visit CDC's Travelers’ Health Web page on Southeast Asia at




to educate yourself and others who may be traveling with you about any disease risks and CDC health recommendations for international travel in areas you plan to visit. For a list of affected areas and other information about avian influenza, see this website:




Be sure you are up to date with all your vaccinations, and see your doctor or health-care provider, ideally 4–6 weeks before travel, to get any additional vaccination medications or information you may need.


Assemble a travel health kit containing basic first aid and medical supplies. Be sure to include a thermometer and alcohol-based hand gel for hand hygiene. See the Travelers Health Kit page in Health Infomation for International Travel for other suggested items.


Identify in-country health-care resources in advance of your trip.

Check your health insurance plan or get additional insurance that covers medical evacuation in case you become sick. Information about medical evacuation services is provided on the U.S. Department of State web page Medical Information for Americans Traveling Abroad, at




During travel to an affected area


Avoid all direct contact with poultry, including touching well-appearing, sick, or dead chickens and ducks. Avoid places such as poultry farms and bird markets where live poultry are raised or kept, and avoid handling surfaces contaminated with poultry feces or secretions.


As with other infectious illnesses, one of the most important preventive practices is careful and frequent handwashing. Cleaning your hands often with soap and water removes potentially infectious material from your skin and helps prevent disease transmission. Waterless alcohol-based hand gels may be used when soap is not available and hands are not visibly soiled.


Influenza viruses are destroyed by heat; therefore, as a precaution, all foods from poultry, including eggs and poultry blood, should be thoroughly cooked.


If you become sick with symptoms such as a fever, difficulty breathing, or cough, or with any illness that requires prompt medical attention, a U.S. consular officer can assist you in locating medical services and informing your family or friends. Inform your health care provider of any possible exposures to avian influenza. See Seeking Health Care Abroad in Health Information for International Travel for more information about what to do if you become ill while abroad. It is advisable that you defer further travel until you are free of symptoms, unless your travel is health-related.


After your return


Monitor your health for 10 days.


If you become ill with fever and develop a cough or difficulty breathing or if you develop any illness during this 10-day period, consult a health-care provider. Before you visit a health-care setting, tell the provider the following:


1) your symptoms,

2) where you traveled

3) if you have had direct contact with poultry.


This way, he or she can be aware that you have traveled to an area reporting avian influenza.

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  • 2 weeks later...

This is a message I received from Dr. Jonathan Hall about Tamiflu




Tamiflu is not a shot. The flu shot is an immunization that anyone

can get (we all try and get it) that decreases your chance of getting

the usual strains of flu. The Avian flu is not covered by the

vaccination however. If a pandemic strikes and people are dying of

influenza that has been confirmed to be the bird flu, then if you get

the flu you start taking the Tamiflu (2 pills a day for 5 days)

within 24 hours. This will lesson the severity of the avian flu and

allow you to survive and develop immunity.


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  • 2 months later...
  • 6 months later...

Indonesia has reported two deaths from avian influenza this week, bringing the country's death toll from the disease to 44.


The island nation now has the dubious honor of being the worst bird flu-hit country in the world.


The World Health Organization confirmed that a 17-year-old girl from Jakarta province and a 6-year-old boy from West Java province had succumbed to the potentially fatal disease, which has killed at least 138 people since it was initially reported to be affecting humans in 2003.


According to WHO, the boy, Megi Saputra, died Monday. He had been in regular contact with sick and dying chickens -- later found to be carrying an H5 strain of avian influenza -- in his home, authorities said.


After falling ill, he was initially told he was sick with typhoid. Avian flu was only raised as a possibility several days after symptoms first appeared, by which point it was too late to save his life.


Members of his family and others with whom he was in close contact have been put under medical surveillance.


CNN.com quoted Megi's mother, Sadiah Saputra, as saying: "I knew about bird flu from the TV and radio, but when my son got sick I had no clue it was bird flu. I had no idea he was going to leave me."


The girl, whose name has not yet been released to the media, died Tuesday. She kept pigeons in her home, and lived in an area where many kept poultry. Local flocks are currently being tested for signs of H5N1 infection.


"Animal health authorities have collected samples from birds in the neighborhood and these will be tested as part of the continuing investigation," the WHO said in a statement.




-- Vietnamese state media reported early Friday that there had been an outbreak of an H5 strain of avian influenza among poultry in the south of the country.


Dong Manh Hoa, head of the Ho Chi Minh City Regional Veterinary Centre, told Saigon Giai Phong newspaper that infected ducks and geese had been found in Tien Giang, Long An and Ben Tre provinces.


It is believed that this outbreak -- which may yet be revealed to be of a different variety than the highly publicized H5N1, although that is doubtful -- is the result of the disease remaining dormant in many waterfowl, which are still being raised by significant numbers of Vietnamese farmers in the Mekong Delta despite official bans in place till early 2007.


Vietnamese Prime Minister Nguyen Tan Dung Thursday urged officials "to focus strongly on instructing and deploying forces to carry out synchronized, preventive measures" in counteracting the spread of avian influenza.


-- Indonesia has culled 5.9 million birds in response to the latest news of avian influenza outbreaks in the country, Agriculture Minister Anton Apriantono has said.


Speaking following a Jakarta meeting for bird flu response coordination at the offices of the Coordinating Minister for People's Welfare earlier this week, he said:


"Besides that, the government has also provided free vaccines for 262 million birds."


Despite routine surveillance being conducted by the government, the minister said, the fact that 30 million Indonesian households kept birds meant that controlling outbreaks and the potential spread of the disease remained an ongoing problem.


"However, there's no guarantee that culling will totally stop the spread of the virus, but it definitely will reduce cases of infection in both poultry and humans," he said. "The key word should be 'bio-security.' People should increase the sanitation of their backyard farms."


-- China this week confirmed earlier suspicions, raised by a letter printed in the New England Journal of Medicine in June, that the country's first case of an avian influenza fatality in a human -- in 2003 -- had originally been attributed to the SARS outbreak which was affecting the country at the time.


According to Chinese Vice Minister of Health Jiang Zuojun, who was speaking at a press conference, the mix-up occurred as a result of communications problems between the scientific and research communities and government agencies.


An investigation into the issue revealed that the man who died, a soldier, had been examined by military scientists upon his death. H5N1 was detected, but government agencies were not informed.


"This issue has exposed problems in our scientific research organizations," he said. "Their communications with disease prevention organizations should be strengthened in future."


Jiang said the military scientists considered the cause of the man's death -- believed by the WHO to be the first case of human avian influenza infection in the world -- as a puzzle to be solved, and added that the H5N1 diagnosis was reached slowly and cautiously.


"At the time, we had incomplete standards for diagnosis. ... From the data we have at hand, which starts from 2003, that was the first case," the minister said.

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  • 2 years later...

Currently, all U.S.-approved influenza vaccines are made in chicken eggs; however, using chicken eggs as the production medium limits scalability in manufacturing and increases the potential risk of manufacturing delays or supply shortages. A severe outbreak of avian influenza could kill the flocks that produce the eggs needed for vaccine production. To address these concerns, MedImmune will be applying advanced cell culture-based manufacturing methods to produce influenza vaccines eliminating the need for chicken eggs. The success of this technology will reduce production times and substantially increase MedImmune’s U.S.-based manufacturing capacity to provide influenza vaccine to the U.S. population. After adding the cell culture-based production capability for its influenza vaccine, MedImmune anticipates having the capacity to produce 300 million monovalent bulk doses of a pandemic vaccine annually by 2012.

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MedImmune Vaccines, Inc.

Gaithersburg, MD 20878


Component No. FLU07-006

U.S. Government License No. 1652


Each of the three influenza virus strains contained in FluMist is a genetic reassortant of a Master Donor Virus (MDV) and a wild-type influenza virus. The MDVs (A/Ann Arbor/6/60 and B/Ann Arbor/1/66) were developed by serial passage at sequentially lower temperatures in specific pathogen-free (SPF) primary chick kidney cells [2]. During this process, the MDVs acquired the ca, ts and att phenotype and multiple mutations in the gene segments that encode viral proteins other than the surface glycoproteins. The individual contribution of the genetic sequences of the six non-glycoprotein MDV genes (“internal gene segments”) to the ca, ts, and att phenotype is not completely understood. However, for the Type A MDV, at least five genetic loci in three different internal gene segments contribute to the ts and att phenotype. For the Type B MDV, at least three genetic loci in two different internal gene segments contribute to both the ts and att properties; five genetic loci in three gene segments control the ca property. No evidence of reversion has been observed in the recovered vaccine strains that have been tested (135 of possible 250 recovered isolates)

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  • 1 month later...

In announcing approval of the seasonal vaccines, the FDA was careful to note that they will not protect against the novel H1N1 virus now circling the globe. The government hopes to have the first doses of vaccine for that virus this fall, possibly in October.


Although the seasonal vaccine will not shield people from the pandemic virus, "it is still important for those Americans for whom it is recommended to receive the seasonal influenza vaccine," the FDA announcement said.


In a question-and-answer bulletin posted yesterday, the Centers for Disease Control and Prevention (CDC) indicated that clinical trials will be conducted to determine if seasonal and novel H1N1 vaccines will be safe and effective if given at the same time, though the seasonal vaccine will be available earlier.


The manufacturers supplying inactivated vaccines this year, and their vaccines, are CSL Limited, Afluria; GlaxoSmithKline (GSK) Biologicals, Fluarix; ID Biomedical Corp. (a dvision of GSK), FluLaval; Novartis Vaccines, Fluvirin; and Sanofi Pasteur, Fluzone. The live vaccine, FluMist, is made by MedImmune Vaccines.


Cary said the B strain this year posed some production problems, but Sanofi was able to meet its production target.


"The new B strain this year is a lower yielding strain," she said. "For Sanofi Pasteur we had taken that into account, and we're bringing to market what we promised we'd bring to market"—50 million doses.

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As a parent I would like to understand why Thimerosal is going to be in the H1N1 vaccine?


The preservative Thimerosal was taken out of childhood vaccines because of a fear of causing autism. Secretary of Health and Human Services Kathleen Sebelius responds to parents' concerns about its use in test batches of the H1N1 vaccine.



Thimerosal in Vaccines


Thimerosal is a mercury-containing organic compound (an organomercurial). Since the 1930s, it has been widely used as a preservative in a number of biological and drug products, including many vaccines, to help prevent potentially life threatening contamination with harmful microbes. Over the past several years, because of an increasing awareness of the theoretical potential for neurotoxicity of even low levels of organomercurials and because of the increased number of thimerosal containing vaccines that had been added to the infant immunization schedule, concerns about the use of thimerosal in vaccines and other products have been raised. Indeed, because of these concerns, the Food and Drug Administration has worked with, and continues to work with, vaccine manufacturers to reduce or eliminate thimerosal from vaccines.

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Organomercury refers to the group of organometallic compounds that contain mercury. Typically the Hg-C bond is stable toward air and moisture but sensitive to light. Important organomercury compounds are the methylmercury cation, CH3Hg+; ethylmercury cation, C2H5Hg+; dimethylmercury, (CH3)2Hg, diethyl mercury and merbromin ("Mercurochrome").


The toxicity of organomercury compounds presents both dangers and benefits. Dimethylmercury in particular, is notoriously toxic, but has found use as an antifungal agent and insecticide. Merbromin and phenylmercuric borate are used as a topical antiseptic.

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Organo mercury compounds cause CNS damage and irritate the eyes, respiratory system, and skin. Symptoms of overexposure may not occur until weeks or even months after the initial exposure. Symptoms of overexposure include numbness and tingling of the l ips, hands and feet. The exposed individual may also experience a staggering walk, joint pain, and emotional abnormalities. Other symptoms include dizziness, increased watering of the mouth and eyes, vomiting, and diarrhea. Organo mercury compounds are a diverse group and specific symptoms of overexposure may vary. Severe overexposure symptoms include jerking movements of the limbs, head or shoulders, groaning, crying, or shouting.


The exact reasons for these overexposure symptoms are not easily identified. However studies suggest that methyl mercury (as well as many other alkyl mercury compounds) affect the proper release of neurotransmitters within the brain. Teratogenic exposure symptoms are manifested by organo mercury compounds ability to cause cellular damage by many different mechanisms. Teratogenic symptoms include constricted vision/blindness, diminished hand usage, quadrapelgia and severe mental retardation.

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