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"Highly Pathogenic Avian Influenza H5N1"
aka: "HPAI H5N1", "bird flu", etc.
(In case you're wondering, I do this page on my own time, not on Schreiner's time.)
 WHO fact sheet / CIDRAP ongoing: pandemic & bird flu /  news search  / daily summary / Wall St Jour
complete list of human deaths with considerable case details, as of 6/24/06,
sortable by country, age, or date of death--from the Wall Street Journal (or Excel file version)

Prevention of Avian Influenza- News -- from the government agency in Hong Kong

Development of a triage protocol for critical care during an influenza pandemic -- Christian et al. 175 (11) 1377 -- Canadian Medical Association Journal

Still as of 6/27/2006
The spread of HPAI H5N1 is a major threat to poultry in a rapidly growing number of countries around the world, and therefore to their economy and food supply. It has also infected humans, killing about half of them, and could become a worldwide human pandemic disease--some believe that only a few more changes in it's genetic code would make that happen.
This page is an attempt to provide a background for understanding H5N1, an ongoing look at its status, and a collection of links to relevant web-based resources.

 

News beginning August 2007
  • 2007-08-29 -- Statistical analysis of Sumatra cluster supports belief in human to human transmission
    • "Biostatistician Ira Longini and colleagues at the Fred Hutchinson Cancer Research Center in Seattle looked at two such recent clusters -- one in which eight family members died in Sumatra in 2006, and another in Turkey, in which eight people were infected and four died.
      Experts were almost certain the Sumatra cases were human-to-human transmission, but were eager to see more proof. Longini's team claims they have found that proof, reporting in the journal Emerging Infectious Diseases"
      "The study will be published Sept. 1 in Emerging Infectious Diseases, a journal of the Centers for Disease Control and Prevention"
    • CTV.ca Study confirms human-human spread of bird flu
    • Study confirms 2006 human-human spread of bird flu Science & Health Reuters
    •  

 

 very compressed status summary

H5N1 in "birds"
(includes wild birds and poultry)
As of Sunday 2/19/2006 in about 27 countries

As of Tuesday 2/28/06 in 35 countries
As of Wednesday 3/8/06 in 37 countries

As of Tuesday 3/21/06 in 42 countries

As of Saturday 4/22/06 in 48 countries

As of Thursday 5/18/06 in 56 countries
As of Tuesday 6/27/06 in 57 countries
(adds Djibouti, in Africa)
Jump down to my list of countries reporting H5N1 in birds and poultry
[or follow this link to the list on World Organization for Animal Health "OIE"]

H5N1 in humans since 2003
WHO confirmed Feb 13 '06: 169 cases, 91 deaths, 7 countries [link]
China, Indonesia, Iraq, Turkey
(& w/ none in 2006: Cambodia, Thailand, Viet Nam)
 WHO confirmed Feb 27 '06: 173 cases, 93 deaths, 7 countries [link]
WHO confirmed Mar 10 '06: 176 cases, 97 deaths, 7 countries [link]
 WHO confirmed Mar 21 '06: 184 cases, 103 deaths, 8 countries [link]
adds Azerbaijan
WHO confirmed Apr 21 '06: 204 cases, 113 deaths, 9 countries [link]
adds Egypt

 WHO confirmed May 18 '06: 216 cases, 122 deaths, 10 countries [link]
adds Djibouti
noteworthy=large family cluster in Indonesia

 WHO confirmed June 20 '06: 228 cases, 130 deaths, 10 countries [link]

(WHO confirmed cases omit a large number of probable cases.)

 

 

 

jump down to: Resources for "current" material i.e. frequently updated, as blogs, wikis,  news search, etc.

Resources for "static" material i.e. reference material, general explanation, government websites, etc.

 
  Miscellaneous

 

"Flu Pandemic"  What's the big deal?

NOTE 4/22/06: The country count is 48 as of 4/21/06, a 37% increase in the two months since 2/28/06. [jump down to the list]
NOTE 2/28/06: The country count is 35 as of 2/28/06, more than double the 15 listed directly below on 1/24/06.
NOTE 1/24/06: I wrote the summary below (in this grey box) in mid 2005. Since then, significant developments have occured. [read the WHO "fact sheet"] As of January 2006, the geographical spread of highly pathogenic avian influenza H5N1 "bird flu" has led to outbreaks in domestic and/or wild birds in Korea, Viet Nam, Japan, Thailand, Cambodia, Indonesia, China, Malaysia, Russia, Kazakhstan, Mongolia, Turkey, Romania, Croatia, and Ukraine. Confirmed human cases (most of whom caught it from birds, with some possibility of human-to-human transmission but none confirmed by WHO) are in Cambodia, China, Indonesia, Thailand, Turkey, and Viet Nam. "Stay tuned."
--Searle Crate

What: "Flu Pandemic" refers to an epidemic of flu that sweeps through the worldwide population, infecting large numbers of people--vastly more than the "normal" flu season we see each year. A pandemic occurs when a virulent new strain of flu virus appears that is so different from past varieties that people have no immunity, so it sickens a large percentage of exposed people and spreads rapidly.
 How: Substantially new virus varieties are created when human viruses and animal (particularly avian--"bird flu"--from ducks, geese, chickens, etc.) viruses combine (reassortment). In this event, the virus can have the ability to spread directly between humans, have the high-disease-producing/high-mortality-rates of the animal variety, and the "newness" to evade pre-existing immunity in the human population. The process of reassortment is believed to be likely to happen in pigs, which are capable of "catching" both human flu and bird flu. China has been cited as a likely location, especially because ducks, pigs, and humans all live in close proximity in parts of China. Or, it could happen in humans: the H5N1 bird flu currently being spread around the world by migrating geese etc. can infect humans (and has a high mortality rate)--any humans already infected with a human flu strain who also catch the spreading bird flu create the possiblity of a reassortment between them. [Jan 2006: highly pathogenic avain influenza  H5N1seems to be gradually changing--by recombination rather than reassortment--to transfer more easily from birds to humans, and some think only a couple of mutations away from efficient human-to-human transfer. "Stay tuned."]
 Why care? Lessons from the past: The flu pandemic of 1918-19 ("Spanish Flu") killed 20 to 100 million world-wide (500,000 in the US). The flu pandemic of 1957-58 ("Asian Flu") killed about a million world-wide (60,000 in the US). The flu pandemic of 1968-69 ("Hong Kong Flu") killed 38,00 in the US. Flu pandemics are highly variable in their seriousness, and impossible to predict with accuracy. Production of vaccines would normally have to wait till the pandemic strain emerged and be specifically designed to combat that strain--production by current methods takes 4 to 6 months.
 When? Nobody knows. Recent articles in mainstream medical and scientific journals (Science, Nature, New England Journal of Medicine, etc.) sound the alarm that a new pandemic may be on its way. The World Health Organization (WHO) is on the alert and calling [pdf] for vigilance, planning, etc. Infections of H5N1 bird flu in China have become more widespread and have appeared in wild bird populations, including migratory birds which could rapidly spread the virus geographically. Growing numbers of human cases who presumably caught the disease from birds have a high mortality rate (near 50%). So far, no certain cases of transmission from human to human are known, but a few of the cases look suspiciously like human to human (if true, this would signal a major shift up the ladder of urgency). All together, these increases paint an alarming picture of an avian flu virus undergoing changes that make it more and more likely to undergo the "jump" of reassortment with a human flu virus to produce the next flu pandemic. The Chinese government has a dismal history of non-reporting and/or coverup of infectious diseases, so nobody has confidence that the world will have good information at an early stage if a new pandemic-producing flu variety does appear in China.

 

 

Developments--almost a (reverse) chronology...[top]  A selection of major events along the way, most recent on top
  (This link jumps down to a box of links to official chronology webpages)

 

 

 Possibility of a worldwide flu pandemic [top]
 

 

 

 

H5N1 Chronology Websites [top]
 

 

 

Spreading Epidemic--increase in cases  [top]
 

 

 

  "Bug Blogs" and Speculative reports [top]
  This section is for links to some reports from sources that tend to be overly speculative, or blogs (which can have both great information and pure junk). They may be alarmist and way off base. But, of course, they just could be on target--in that case something spectacular is in the works, and the Chinese government is keeping it secret--a rather sinister scenario.

 

  • From recombinomics.com--the most speculative source. "Dr. Henry Niman, president of the Recombinomics predictive viral change research centre"
  • from the Epoch Times--these people refer to Henry Niman as "known for sometimes speculative commentary", so they report his info along with other stuff, but expressed more in a "what if" tone, and less in a "this is happening" tone.
  • Pandemic Flu Blogs--listed in this very interesting article on the "Bulletin of the Atomic Scientists" website. The quoted descripton the begins each major bullet is pasted from this article.
    • "Among those leading the charge was virologist Henry Niman, whose web site Recombinomics.com is a virtual situation room for bird flu news, boasting color-coded maps tracking confirmed and suspected outbreaks of H5N1 in Indonesia, China, and Europe. A newsfeed on the site, updated daily, offers commentary and background on reports culled from around the world.  Niman is one of the acknowledged grandfathers of the bug blogosphere.
    • "...Agonist.org--a world affairs blog frequented by a mix of amateur bug hunters, seasoned epidemiologists, and public health professionals"
    • "Crawford Kilian, a Canadian professor and science fiction writer, publishes H5N1 (crofsblogs.typepad.com/h5n1), a flu blog mainstay"
      • "H5N1-News and Resources about Avian Flu"
    • "Revere", a prominent public health scientist and academic, maintains the highly regarded web site "Effect Measure" (effectmeasure.blogspot.com)...Anonymity hasn't diminished Revere's credibility, but it does complicate the logistics of blogging.  Revere...has to maintain a secret identity by using a special e-mail address to correspond with readers and sources. "
    • "Melanie Mattson writes the political blog "Just a Bump in the Beltway (node707.com)". Mattson chooses her stories using a simple rubric. She wants "the stuff that ordinary people don't read. Quite frankly the stuff that doctors don't read," including the international media, scientific journals, and fellow bug bloggers. Like many of her colleagues, Mattson worries that the professional health class isn't ready for a flu pandemic because doctors and specialists haven't been following the disease closely."
     
  • New list 1/23/06--needs to be organized into the rest:

 

Placeholder for future expansion  [top]
 

 

 

Countries reporting H5N1 in birds and poultry  [top]
  -Chronological:
 As of Feb 15, 2006, with approximate dates of appearance in each country
  1. Vietnam --this began in 2003
  2. Thailand --this began in 2004
  3. Cambodia --this began in 2005

  4. Indonesia --this began in 2005

  5. Laos

  6. China --this began in 2005

  7. Russia --this began in 2005

  8. Kazakhstan

  9. Mongolia

  10. Turkey --reports in Oct 2005

  11. Romania --reports in Oct 2005

  12. Greece (several swans)

  13. Croatia --reports in Oct 2005

  14. Sweden

  15. Kuwait

  16. Ukraine

  17. Iraq

  18. Cyprus

  19. Saudi Arabia

    Feb  13 update: CIDRAP More countries facing H5N1 flu in birds "The pathogen has been reported in wild birds in five new countries—Azerbaijan, Nigeria, Greece, Italy, and Bulgaria—in the past week."

  20. Italy

  21. Nigeria --reports in Feb 2006 first country in Africa massive die-offs, massive culls: "death toll among poultry exceeds 150,000 birds "

    Feb 16 update: CIDRAP:  Avian flu hits birds in Iran, spreads in Europe

  22. Iran --reports 14 Feb 2006 (swans)

  23. Austria --reports 14 Feb 2006 (swans)

  24. Germany --reports 14 Feb 2006 (swans)

  25. Slovenia --reports 16 Feb 2006 (swans)

  26. Hungary --still testing... (swans-positive for H5 18 Feb, more tests pending)

    Feb 20 update: CIDRAP: H5N1 flu infects birds in Egypt, France, India

  27. Egypt -- report 17 Feb (20 dead birds, plus others)

  28. France -- report 18 Feb (a wild duck) --

  29. India -- report 18 Feb (chickens: "50,000 died last week, and 20,000 were destroyed yesterday")

    Feb 23 update: CIDRAP: Bird flu reaches Slovakia; human tests so far negative in India

  30. Solvakia --  (a duck and a falcon)

    Feb 24 update: CIDRAP: Avian flu found in former Soviet republic of Georgia

  31. Georgia -- (swans)

    Feb 27 update: CIDRAP: Two more countries find H5N1; 3 others probe bird deaths

  32. Bosnia (2 wild swans with H5N1--4,500 poultry culled)

  33. Switzerland (a wild duck in Geneva, positive for H5, waiting to learn about the NA)

    March 6 update: CIDRAP Avian flu infects swans in Poland, cats in Austria

  34. Poland (2 swans, maybe more)
    Austria, cats! (Austria had reported swans 14 Feb)

  35. Serbia (2 swans)

    March 8 update: CIDRAP: Avian flu reaches Albania; US to expand testing

  36. Albania (chickens)

    March 13: CIDRAP Myanmar, Afghanistan, Cameroon may join H5N1 list

  37. Cameroon (a few ducks this date, "hundreds" of wild birds reported by March 21)

    March 15: CIDRAP Denmark suspects, Sweden confirms H5N1 in birds

  38. Sweden (wild ducks)

    March 16: CIDRAP: Avian flu confirmed in Afghanistan, Myanmar -- & says Malaysia "last month"

  39. Myanmar (chickens)

  40. Afghanistan (chickens)

    March 21: CIDRAP H5N1 outbreaks confirmed in Israel, Pakistan

  41. Israel (turkeys--several kibbutz farms--11,800 dead from flu, and culled another 56,700 and plans another 80,00 by the end of the week)

  42. Pakistan (chickens on 2 farms, H5 first detected last month, now confirmed H5N1)

    March 24: CIDRAP Avian flu hits Gaza Strip, West Bank, Jordan

  43. Gaza Strip (chickens)
  44. West Bank (turkeys, culling underway, vaccination planned)
  45. Jordan (three turkeys)

    April 4: CIDRAP Avian flu hits another African nation

  46. Burkina Faso (123 helmeted guinea fowl)

    April 6: CIDRAP Avian flu reaches Scotland as FAO reports progress

  47. Scotland (one swan)

    April 18: CIDRAP China has avian flu case; virus hits poultry in Sudan

  48. Sudan (chickens--"More than 100,000 chickens on 15 farms near Khartoum have been exterminated")

    May 5: CIDRAP Ivory Coast confirms avian flu in birds

  49. Ivory Coast = Côte d'Ivoire (seven chickens, nine ducks, and a sparrow hawk found in Abidjan)--this is the sixth African country...
  50.  

 Processed from http://www.oie.int/downld/AVIAN%20INFLUENZA/A_AI-Asia.htm through 6/27/06
HPAI Avian Influenza in birds and poultry
location virus type start
Korea (Rep. of) H5N1 12/12/03
Vietnam H5N1 01/08/04
Japan H5N1 01/12/04
Taipei China H5N2 01/20/04
Thailand H5N1 01/23/04
Cambodia H5N1 01/24/04
Hong Kong (SARPRC) H5N1 01/26/04
Laos H5 01/27/04
Indonesia H5N1 02/02/04
China H5N1 02/04/04
Malaysia (peninsular) H5N1 08/19/04
Philippines H5 07/12/05
Russia H5N1 07/24/05
Kazakhstan H5N1 08/02/05
Mongolia H5N1 08/10/05
Romania H5N1 10/07/05
Turkey H5N1 10/10/05
Croatia H5N1 10/21/05
Zimbabwe, in Africa H5N2 11/30/05
Ukraine H5N1 12/08/05
France H5N1 02/02/06
Iraq H5 02/02/06
Bulgaria H5N1 02/12/06
Greece H5N1 02/13/06
Italy H5N1 02/14/06
Azerbaijan H5N1 02/15/06
Iran H5N1 02/15/06
Germany H5N1 02/16/06
Egypt H5N1 02/18/06
India H5N1 02/18/06
Austria H5N1 02/20/06
Bosnia and Herzegovina H5N1 02/20/06
Slovakia H5N1 02/24/06
Switzerland H5N1 02/27/06
Niger