NoCarrier

Long article, but it's serious enough to read it.

http://www.canada.com/health/story.h...6-FEDFB5F57AFE

Ingredients in place for pandemic influenza outbreak, WHO official warns

TORONTO (CP) - An outbreak of deadly avian flu in Vietnam which may have killed as many as 12 people could be the precursor to an influenza pandemic, experts admitted Tuesday.

"The ingredients are there that the pandemic can occur," Klaus Stohr, project leader of the World Health Organization's global influenza program, said in an interview from Geneva. "We can hope for the best but we are preparing for the worst."

Public health authorities have been predicting for some time that the world is overdue for a new pandemic, which would sweep the globe, killing millions and causing far-reaching social and economic disruption.

The most deadly example of an influenza pandemic was the Spanish Flu of 1918-19, which killed between 20 million and 40 million people worldwide.

Recent outbreaks of avian influenza of the H5N1 subtype in South Korea, Japan and now Vietnam - and repeated transmission of the virus to humans - may be laying the groundwork for that dreaded event, influenza experts warned.

"The more times that there are outbreaks amongst poultry and the more times that there are human exposures and human cases of H5N1, the more opportunities there are for this influenza virus to mutate to the point where it is well adapted for human-to-human transmission," noted Dr. Danuta Skowronski, an influenza specialist at the British Columbia Centre for Disease Control.

Health Canada is maintaining a high level of vigilance, monitoring the situation on a constant basis, said Dr. Arlene King, director of the immunization and respiratory infections division.

"Certainly it represents a concern and a health threat. And that's why we take these things very seriously."

Two southern provinces in Vietnam are in the grips of an H5N1 influenza outbreak among poultry stock. The virus, which is fatal in virtually all chickens it infects, has killed about 40,000 chickens so far, WHO says. The Vietnamese government is culling an additional 30,000 birds in a bid to contain the outbreak.

But in other parts of Vietnam, the virus has attacked humans. Laboratory testing has confirmed H5N1 infection in two children and an adult in the capital, Hanoi.

WHO spokesman Dick Thompson said the organization is investigating a total of 14 suspected cases of bird flu in humans in Hanoi and surrounding provinces. All but one of the cases were children. Twelve of the 14 cases - including 11 children - have died.

Officially, the WHO says there is no evidence of human-to-human transmission of this strain of influenza, though Stohr admitted there may have been "some very inefficient transmission from human-to-humans."

But some of the infections date back to late October, a worrisome sign. The longer bird flu is in contact with humans, the greater the chance it will acquire the ability to spread among them.

And WHO is aware that these 14 cases may not be the entire iceberg.

"There is a concern that there could be more cases out there, both in humans and in chickens," Thompson admitted, saying the WHO has asked other countries in the region to be on the lookout for "any unusual patterns of death in chickens or humans, influenza-related."

For a pandemic to occur, a strain of influenza which has never before circulated among humans has to break out of nature and develop the ability to spread not just from animals to humans, but from human to human as well. Virtually no one would have any real immunity to such a virus, meaning it would spread like wildfire around the globe, rendering huge numbers of people sick.

Most people recuperate from influenza. But some go on to develop pneumonia and die, as Canadians have been reminded this severe flu season. Health Canada estimates between 9,000 and 51,000 Canadians could die in the next pandemic, if a vaccine is not available.

Such widespread illness and death would cause massive disruption to the health-care system and would tax the ability of governments around the globe to maintain essential services, experts predict.

"A pandemic of influenza will make SARS look like a cakewalk in comparison," Skowronski said.

There are two ways an animal influenza virus can acquire the ability to spread within the human population - through a chance mutation that would give it that skill, or by what's called reassortment. If a person who was sick with a human influenza virus also became infected with the H5N1 virus, the two could swap some genetic material, and a new and deadly human virus could be formed.

Given that it is currently influenza season, that second option is particularly worrisome.

"It's a bad time for this to be happening," said Richard Webby, a leading influenza virologist based at St. Judes Children's Hospital in Memphis, Tenn.

"It's very, very concerning."

Stohr said the WHO has alerted its influenza network to the situation and will begin work on vaccine development within days. That process automatically kicks in when two or more human cases of avian influenza are discovered.

Some facts about pandemic influenza:

What is it? Flu pandemics occur when a new influenza virus arises and acquires the ability to spread within the human population. The entire global population could be susceptible. Huge numbers of people fall ill and millions die.

How often do they happen? Pandemics are unpredictable. But experts estimate about three per century.

When was the last? 1968-69.

When was the worst? The notorious Spanish Flu of 1918-19, which is believed to have killed 20-40 million people worldwide.

When is the next due? No one knows. But experts believe one could occur anytime.

What will it mean? Huge portions of the population will be sick, virtually at once. Hospitals will be swamped. Staffing essential services will be a serious challenge. It's estimated between 9,000 and 51,000 Canadians could die, if a vaccine is not developed in time.

Quote: "My view is that in the course of the last few years we have seen an acceleration of events with pandemic potential. And with this H5N1 virus, which has a high propensity of mutating, spreading relatively rapidly in an unprecedented way in Asia and which has been causing death and disease in humans in the course of the last few years . . . there is good reason to be concerned." - Klaus Stohr, project leader of the World Health Organization's global influenza program.
? Copyright 2004 The Canadian Press

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boneprone

We had a pandemic outbreak of the flu at Internext so it seems.....

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Industry Hall Of Fame Legend Mike Jones
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Learn about it kids.

NoCarrier

Probe launched amid flu pandemic fears

http://www.reuters.co.uk/newsPackage...3&section=news

SINGAPORE (Reuters) - Flu outbreaks have killed tens of millions of people around the globe over the past century, and scientists are investigating if the deaths of three people in Vietnam from bird flu could be the start of a new pandemic.

In most pandemics, animals such as chickens, pigs or even cows have played a role in creating deadly new strains of influenza viruses for which humans have no immunity.

That is what is alarming scientists in Asia after an outbreak of bird flu has killed millions of poultry in Vietnam, South Korea and Japan. The World Health Organisation says 18 people in Vietnam are suspected to have been infected with bird flu, including the three confirmed infections.

But the WHO stresses there is a lack of evidence of human-to-human transmission in Vietnam. The case resembles an outbreak of bird flu in Hong Kong in 1997 when 18 people were infected with avian influenza virus A (H5N1), six of whom died.

That outbreak did not spread because the virus could not pass from one human to another. The slaughter of 1.5 million chickens in the crowded city also prevented more deaths of people.

The danger is when a new virus can cross from person to person. Animals play a key role here because they become breeding grounds for new strains of flu that contain changes in the genetic structure that the human immune system cannot recognise.

According to the science journal Nature, flu viruses originate in wild birds and are thought to become lethal when they cross into poultry or pigs. In cells infected with another flu variety, the viruses pick up genes that enable them to infect humans.

This can also happen, it is thought, in cows.

COUGHING PIGS

According to the U.S. Centres for Disease Control and Prevention, pigs can be infected with human and avian influenza viruses in addition to swine influenza viruses. Infected pigs get symptoms similar to humans, such as cough, fever and runny nose.

Because pigs are susceptible to a variety of flu viruses, they potentially may be infected with viruses from different species, such as ducks and humans, at the same time. If this happens, it is possible for the genes of these viruses to mix and create a new virus.

In Vietnam, hundreds of pigs have also died of flu.

Dr Veronica Chan, head of the microbiology and parasitology department at the University of the Philippines' College of Medicine, said on Wednesday humans would have no protection against a new strain of flu.

"We should worry. It kills. It kills," she told Reuters.

Scientists say major flu pandemics occur every 30-35 years. The deadliest in the past century was the Spanish Flu pandemic of 1918-19 that killed between 20 million and 50 million people worldwide, including 500,000 in the United States. The exact source of this virulent strain is unknown but is thought to have been wild birds.

The virus behind the last major flu outbreak, the Hong Kong flu pandemic of 1968, is thought to have originated with wild aquatic birds such as ducks. Nature journal reported last year that the next killer influenza strain might leap directly from ducks to humans.

Influenza strains in domestic ducks have already acquired genes from poultry viruses, researchers found, and may have the potential to invade human cells.

"It's getting closer to one that can spread," said influenza expert Robert Lamb of Northwestern University in Evanston, Illinois, in a June 5, 2003, report in Nature.

The viruses, known as H9N2, probably jumped from wild birds into poultry, swapped genes with influenza strains there, and then migrated back into ducks, Nature said.

The WHO and other major health bodies have sent experts to Vietnam to investigate the latest outbreak and how it is spreading. They will be looking closely at whether wild birds have spread the avian flu virus around the region.

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NoCarrier

Yeah.. well at least you guys recovered.

If this virus mutates like the spanish influenza, you could die from the flu in 6 hours.

"As their lungs filled ? the patients became short of breath and increasingly cyanotic. After gasping for several hours they became delirious and incontinent, and many died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth. It was a dreadful business."

Not only was the Spanish Flu strikingly virulent, but it displayed an unusual preference in its choice of victims---tending to select young healthy adults over those with weakened immune systems, as in the very young, the very old, and the infirm. The normal age distribution for flu mortality was completely reversed.

We're at Phase 0, PL 2: 2 or more human infections with a novel virus have been confirmed. The ability of the virus to spread between people or to cause serious disease is still questionable.

They report that pigs and ducks have been infected.

The 1918 spanish flu originated from pigs.

Yikes.

http://www.ksu.edu/biology/pob/pandemic.htm

"One speculation was that the Spanish flu virus passed from birds to pigs and then onto humans, a mode of transmission thought to produce the most dangerous strains of influenza. It was not until recently, however, that Taubenberger's genetic analysis concretely supported the antibody evidence that the virus had in fact come from pigs. "


"There's an enormous amount of influenza carried by birds," said Webster. "The pigs act as 're-assorters,' where the influenza viruses from humans and birds rearrange their genes and are then let loose upon the world again." The Asian and Hong Kong flu's were the result of this type of reassembling.

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NoCarrier

What exactly makes for a pandemic?

The CDC lists 5 phases with the first phase having several stages. The complete explanation is here - I'm just posting the URL, then precising the essentials:

http://www.cdc.gov/od/nvpo/pandemics/flu2.htm

1) Phase 0, Prep Level 0: Nothing happening during a current flu
season except for illness due to
known flu strains.

2) Phase 0, PL 1: Isolation of a novel virus in humans with no
evidence of person to person transmission or
outbreak. Each report of a novel virus in
humans is investigated & the next level may be
initiated if warranted.

3) Phase 0, PL 2: 2 or more human infections with a novel virus
have been confirmed. The ability of the virus to
spread between people or to cause serious
disease is still questionable.

4) Phase 0, PL 3: Human transmission has been confirmed
through clear evidence of person to person
spread in the GENERAL POPULATION in the
COMMUNITY, with at least 1 outbreak lasting a
minimum of 2 weeks in 1 country.

5) Phase 1: Status changed from 'Novel Virus Alert' to 'Pandemic
Imminent' as the virus clearly spread efficiently from
person to person. Several outbreaks are seen in at
least one country. There is significant illness &
significant death in at least 1 segment of the
population.

6) Phase 2: The novel virus is causing outbreaks & epidemics in
several countries around the world. Getting to this
stage is rare - it hasn't happened since 1968 HK flu.

7) Phase 3: Flu activity in initially affected countries has ended
but outbreaks of the new virus are occuring
elsewhere in the world. It represents the end of the
first wave & if vax is available, gives us a chance to
'catch up' with the virus & stop the pandemic.

8) Phase 4: Consists of subsequent waves - there may be more
than 1 & they typically occur in 3 - 9 month time
intervals.

9) Phase 5: The end of the pandemic. Illness rates return to pre- pandemic levels around the world. This can take up
to 2 years.


With this crisis, we're at Phase 0, PL 2.

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Pornwolf

Cool. I don't drink Evian anyway.

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