Monday, October 23, 2006

Snippet from Pro Med Mail


Low pathogenic avian influenza commonly occurs in wild birds. It typically causes only minor sickness or no noticeable signs in birds. These strains of the virus include LPAI H5N1, commonly referred to as "North American" H5N1, which is very different from the more severe HPAI H5N1 circulating overseas.There is no known health risk to hunters or hunting dogs from contact with low-pathogenic forms of avian influenza virus. Nevertheless, hunters are always encouraged to use common-sense sanitation practices, such as hand washing and thorough cooking, when handling or preparing wildlife of any kind. DOI has issued guidelines for safe handling and preparation of wild game.For more information about USDA's efforts and research related to avian influenza, go to <http://www.usda.gov/birdflu>.For more information about Interior's efforts and hunter education program, go to <http://www.doi.gov/issues/avianflu.html>.For information about the federal government's overall efforts related to avian influenza and human pandemic preparedness, go to <http://www.avianflu.gov/>.

Sunday, October 22, 2006

Washed your hands lately? Get the habits of health.


Stop the Spread of Germs that Make You and Others Sick!

Serious respiratory illnesses like influenza, respiratory syncytial virus (RSV), whooping cough, and severe acute respiratory syndrome (SARS) are spread by:

  • Coughing or sneezing
  • Unclean hands

To help stop the spread of germs,

  • Cover your mouth and nose with a tissue when you cough or sneeze.
  • If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands.
  • Put your used tissue in the waste basket.

Clean your hands after coughing or sneezing

  • Wash with soap and water.
    or
  • Clean with alcohol-based hand cleaner.


Heard of the Heard Islands? One of the countries reporting no deaths from avian flu. See the countries reporting deaths and their ranking.

Avian Influenza A/(H5N1) Cumulative Number of Confirmed Human Deaths
As of October 16, 2006

This is a long list, but I found just the list of countries reporting to be interesting, so I decided to share. Skip if bored with it!

Rank Table by: Country Name Number
Rank Country Name Number
Global 151

Afghanistan 0
Albania 0
Algeria 0
American Samoa 0
Andorra 0
Angola 0
Anguilla 0
Antigua and Barbuda 0
Argentina 0
Armenia 0
Aruba 0
Australia 0
Austria 0
6 Azerbaijan 5
Bahamas 0
Bahrain 0
Bangladesh 0
Barbados 0
Belarus 0
Belgium 0
Belize 0
Benin 0
Bermuda 0
Bhutan 0
Bolivia 0
Bosnia and Herzegovina 0
Botswana 0
Bouvet Island 0
Brazil 0
British Indian Ocean Territory 0
British Virgin Islands 0
Brunei Darussalam 0
Bulgaria 0
Burkina Faso 0
Burundi 0
5 Cambodia 6
Cameroon 0
Canada 0
Cape Verde 0
Cayman Islands 0
Central African Republic 0
Chad 0
Chile 0
4 China 14
Christmas Island 0
Cocos (Keeling Islands) 0
Colombia 0
Comoros 0
Congo 0
Congo (Dem. Republic of) 0
Cook Islands 0
Costa Rica 0
Cote d'Ivoire 0
Croatia 0
Cuba 0
Cyprus 0
Czech Republic 0
Denmark 0
Djibouti 0
Dominica 0
Dominican Republic 0
Ecuador 0
5 Egypt 6
El Salvador 0
Equatorial Guinea 0
Eritrea 0
Estonia 0
Ethiopia 0
Faeroe Islands 0
Falkland Islands (Malvinas) 0
Fiji 0
Finland 0
France 0
French Guiana 0
French Polynesia 0
French Southern Territories and Antarctic Lands 0
Gabon 0
Gambia 0
Georgia 0
Germany 0
Ghana 0
Gibraltar 0
Greece 0
Greenland 0
Grenada 0
Guadeloupe 0
Guam 0
Guatemala 0
Guinea 0
Guinea-Bissau 0
Guyana 0
Haiti 0
Heard Island and McDonald Islands 0
Honduras 0
Hungary 0
Iceland 0
India 0
1 Indonesia 55
Iran (Islamic Republic of) 0
8 Iraq 2
Ireland 0
Israel 0
Italy 0
Jamaica 0
Japan 0
Johnston Atoll 0
Jordan 0
Kazakhstan 0
Kenya 0
Kiribati 0
Korea (Dem. Peo. Rep. of) 0
Korea (Republic of) 0
Kuwait 0
Kyrgyzstan 0
Lao People's Democratic Rep. 0
Latvia 0
Lebanon 0
Lesotho 0
Liberia 0
Libyan Arab Jamahiriya 0
Liechtenstein 0
Lithuania 0
Luxembourg 0
Macedonia (The former Yugoslav Republic of) 0
Madagascar 0
Malawi 0
Malaysia 0
Maldives 0
Mali 0
Malta 0
Marshall Islands 0
Martinique 0
Mauritania 0
Mauritius 0
Mayotte 0
Mexico 0
Micronesia (Federated States of) 0
Midway 0
Moldova (Republic of) 0
Monaco 0
Mongolia 0
Montserrat 0
Morocco 0
Mozambique 0
Myanmar 0
Namibia 0
Nauru 0
Nepal 0
Netherlands 0
Netherlands Antilles 0
New Caledonia 0
New Zealand 0
Nicaragua 0
Niger 0
Nigeria 0
Niue 0
Norfolk Island 0
Northern Mariana Islands 0
Norway 0
Oman 0
Pakistan 0
Palau 0
Panama 0
Papua New Guinea 0
Paraguay 0
Peru 0
Philippines 0
Pitcairn Island 0
Poland 0
Portugal 0
Puerto Rico 0
Qatar 0
Reunion 0
Romania 0
Russian Federation 0
Rwanda 0
Saint Helena 0
Saint Kitts and Nevis 0
Saint Lucia 0
Saint Vincent and the Grenadines 0
Samoa 0
San Marino 0
Sao Tome and Principe 0
Saudi Arabia 0
Senegal 0
Serbia and Montenegro 0
Seychelles 0
Sierra Leone 0
Singapore 0
Slovakia 0
Slovenia 0
Solomon Islands 0
Somalia 0
South Africa 0
Spain 0
Sri Lanka 0
Sudan 0
Suriname 0
Svalbard and Jan Mayen Islands 0
Swaziland 0
Sweden 0
Switzerland 0
Syrian Arab Republic 0
Tajikistan 0
Tanzania (United Rep. of) 0
3 Thailand 17
Timor Leste 0
Togo 0
Tokelau 0
Tonga 0
Trinidad and Tobago 0
Tunisia 0
7 Turkey 4
Turkmenistan 0
Turks and Caicos Island 0
Tuvalu 0
Uganda 0
Ukraine 0
United Arab Emirates 0
United Kingdom 0
United States of America 0
Uruguay 0
Uzbekistan 0
Vanuatu 0
Venezuela 0
2 Viet Nam 42
Virgin Islands (U.S.) 0
Wake Island 0
Wallis and Futuna Islands 0
West Bank and Gaza 0
Western Sahara 0
Yemen 0
Zambia 0
Zimbabwe 0

Notes: The World Health Organization reports only laboratory-confirmed cases.

Definitions: Avian influenza, or "bird flu" is an infectious disease of animals (usually birds, and less commonly pigs) caused by type A strains of the influenza virus. Transmission to humans is rare, but there is recent cause for concern. In mid-2003, the largest and most severe avian flu outbreak in history began in Southeast Asia, caused by a sub-type of the virus called H5N1 and resulting in widespread transmission to poultry and some documented transmission to humans. Transmission of H5N1 to humans is of particular concern because it mutates rapidly and may therefore change into a form that is highly infectious for humans and more easily spread. In addition, unlike normal seasonal influenza, H5N1 can cause severe disease in humans.

Sources: WHO, 2006, available at: http://www.who.int/csr/disease/avian_influenza/country/en/.

When to use and what type of mask, new interim guidelines from PandemicFlu.gov

Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Health Care Settings during an Influenza Pandemic

October 2006

Complete information available at PandemicFlu.gov




Since the publication of the HHS Pandemic Influenza Plan (www.hhs.gov/pandemicflu/plan/) in November 2005, the U.S. Department of Health and Human Services (HHS) has received numerous comments and inquiries regarding infection control recommendations that relate to surgical mask and respirator use (e.g., N-95 respirator[a]) during an influenza pandemic. Development of authoritative responses is hampered by the lack of definitive data about the relative contributions and importance of short-range inhalational exposure, large droplet mucosal exposure, and direct inoculation via hands or inanimate objects contaminated with virus (i.e., fomites) on influenza transmission There is only limited information on optimal interventions to prevent influenza transmission and the effectiveness of interventions on an individual basis. The lack of scientific consensus has led to conflicting recommendations by public health partners. Moreover, a large amount of incorrect, incomplete, and confusing information about surgical mask and respirator use has been disseminated on the Internet and by other popular media.

The Centers for Disease Control and Prevention (CDC) is aware of no new scientific information related to the transmission of influenza viruses since the drafting of the HHS Pandemic Influenza Plan (www.hhs.gov/pandemicflu/plan/). As stated in the plan, the proportional contribution and clinical importance of the possible modes of transmission of influenza (i.e., droplet, airborne, and contact) remains unclear and may depend on the strain of virus ultimately responsible for a pandemic. Nevertheless, in view of the practical need for clarification, CDC has re-reviewed the existing data, as described below, and has prepared interim recommendations on surgical mask and respirator use. The purpose of this document is to provide a science-based framework to facilitate planning for surgical mask and respirator use in health care settings during an influenza pandemic.

This document synthesizes traditional infection control and industrial hygiene approaches to enhancing protection of health care personnel during an influenza pandemic. It emphasizes that surgical mask and respirator use are components of a system of infection control practices to prevent the spread of infection between infected and non-infected persons. It also reflects concerns that additional precautions are advisable during a pandemic—beyond what is typically recommended during a seasonal influenza outbreak—in view of the lack of pre-existing immunity to a pandemic influenza strain, and the potential for the occurrence of severe disease and a high case-fatality rate. Extra precautions might be especially prudent during the initial stages of a pandemic, when viral transmission and virulence characteristics are uncertain, and medical countermeasures, such as vaccine and antivirals, may not be available.

The prioritization of respirator use during a pandemic remains unchanged: N-95 (or higher) respirators should be worn during medical activities that have a high likelihood of generating infectious respiratory aerosols, for which respirators (not surgical masks) offer the most appropriate protection for health care personnel. Use of N-95 respirators is also prudent for health care personnel during other direct patient care activities (e.g., examination, bathing, feeding) and for support staff who may have direct contact with pandemic influenza patients. If N-95 or other types of respirators are not available, surgical masks provide benefit against large-droplet exposure and should be worn for all health care activities involving patients with confirmed or suspected pandemic influenza. Measures should be employed to minimize the number of personnel required to come in contact with suspected or confirmed pandemic influenza patients.

This document, Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Health Care Settings during an Influenza Pandemic, augments and supersedes recommendations provided in Part 2 of the HHS Pandemic Influenza Plan (www.hhs.gov/pandemicflu/plan/#part2). This interim guidance document will be updated and amended as new information about the epidemiologic characteristics of the pandemic influenza virus becomes available.

Guidance documents on planning for surgical mask and respirator use in non-health care occupations and for the general community setting during an influenza pandemic are in preparation. Infection control recommendations related to seasonal influenza (www.cdc.gov/flu/professionals/infectioncontrol/) and avian influenza A (H5N1) (www.cdc.gov/flu/avian/professional/infect-control.htm) remain unchanged. The use of surgical masks by hospitalized patients and other symptomatic persons ("source control") is covered in the CDC’s Interim Guidance for the Use of Masks to Control Influenza Transmission (www.cdc.gov/flu/professionals/infectioncontrol/maskguidance.htm).

Images of bird flu around the world



















Bird flu killing a person every 4 days this year!




Tests for bird flu are being run on 9 people from a province of Indonesia's
eastern island of Sulawesi, where one of the patients, a 1-year-old boy,
probably died of the virus this week.

The child from the South Sulawesi district of Maros died 17 Oct 2006, hours
after he was admitted to the Wahidin Sudirohusodo Hospital in Makassar with
flu-like symptoms, said Halif Saleh, a doctor who treated the infant.
Samples from the boy are being tested for the H5N1 strain of avian
influenza, Runizar Ruesin, head of the Health Ministry's Avian Flu Center,
said in a phone interview today.

If confirmed, the child would be the 152nd person to die from the virus
since 2003. World health experts say millions could die if H5N1 mutates to
become easily transmissible between humans. Almost half the 109 cases
reported this year have occurred in Indonesia, the world's 4th-most
populous country.

Tests for the H5N1 virus are being run on 8 others being treated in the
Wahidin Sudirohusodo Hospital. They are all from South Sulawesi province,
where the disease is known to have infected poultry, Ruesin said. It wasn't
immediately known whether the patients are related, he said.

A 14-year-old girl died on 24 Jun 2006 of the H5N1 strain in the provincial
capital, Makassar, the World Health Organization said last month.

The virus is reported to have killed a person every 4 days worldwide this
year, more than double the 2005 rate, creating more chances for it to
become more contagious to people. At least 256 people in 10 countries have
caught H5N1 since late 2003, the WHO said on 16 Oct 2006. Almost all human
H5N1 cases have been linked to close contact with sick or dead birds, such
as children playing with them or adults butchering them or plucking
feathers, according to the WHO.


While the virus doesn't spread easily between people, some human-to-human
transmission may have occurred.

Indonesia attracted international attention in May 2006 when 7 members of a
family from the island of Sumatra contracted H5N1, 6 of them fatally. The
cases represented the largest reported cluster of human cases and the 1st
laboratory-proven instance of human-to-human transmission.

[Byline: Karima Anjani]

On the flyway, life may change




Alaska villagers living in bird flu's flight path
What has brought the Eskimos sustenance for generations now may carry the deadly virus into North America

By JIA-RUI CHONG, Times Staff Writer
October 22, 2006

THE 800 YUP'IK ESKIMOS in this wet and lonely village knew the situation was serious when government scientists began swooping in on bush planes.

Except for a few doctors that fly in each year to give villagers checkups, outsiders rarely visited this outpost of scattered gray plywood homes and prefab structures plopped in the middle of the tundra.

Soon, latex gloves appeared on store shelves and Wild West-style posters started popping up around town: "Wanted: Birds of the Delta." Researchers camped out in the town's tribal council offices, preparing for trips to nearby Kwigluk Island with vials, swabs, nets and needles.

They came bearing a warning: The wild birds that the Yup'ik have hunted for millenniums may be carrying the first traces of the deadly bird flu virus from Asia into North America.

"It's kind of scary, you know," said resident Ronnie Peter, 39. "That's like, our food, you know."

The H5N1 avian influenza emerged in China 10 years ago and has since spread into Europe, Africa and the Middle East. Though the virus mainly infects fowl, since 2003 it has sickened 256 people and killed 151 around the world.

Kipnuk lies at the crossroads of an invisible freeway system linking migratory birds that journey along the East Asia-Australia flyway with those from the Pacific Americas flyway.

Tens of millions of birds flock every year to this seemingly endless expanse of soggy land in the Yukon Delta National Wildlife Refuge to feast on insects, grasses, worms and mussels before heading back south in the winter to Asia, Australia and other parts of the Americas.

"If it's going to show up in wild birds, Alaska is the most likely place where it's going to happen," said Brian McCaffery, a federal wildlife biologist who was camped a few miles down the coast from Kipnuk collecting bar-tailed godwit droppings for testing.

Federal officials have identified 29 bird species that are most likely to carry the deadly virus from Asia, and they have enlisted local hunters to help provide birds for testing.

In the old days, the Yup'ik Eskimos felled the uqsuqaq, metraq and kanguq with bows and throw sticks tipped with sharpened walrus ivory.

Now, the men use 12-gauge shotguns and reach remote hunting spots in motorboats.

Little else has changed — until now.

"Oh Lord, what are we going to eat? Store-bought food?" thought Steven Mann, who oversees tribal operations in town, when he first started receiving faxes on bird flu safety in the spring.

The nervousness has waned through the summer, said the 58-year-old ex-Army sergeant, but still, "We don't joke about what we eat here."

Mann's son, Danny, a lanky 27-year-old who used to work as a bilingual parent liaison for the school, took on the job of bird flu testing manager in Kipnuk for the tribal health agency, the Yukon-Kuskokwim Health Corp. He gets $15 for every bird he samples.

At the tribal council offices, he was on the phone, checking in with hunters. "Got any birds?" he asked Peter, who goes hunting just about every day except Sunday.

"How many?" Danny Mann asked. "Can I come over and check them?"

Mann threw on a jacket, grabbed a blue Nike duffel bag and headed out. As a light drizzle enveloped the village, he strode across the boardwalks that lie across the marshiest parts of town. The hollow sound of his steps echoed in the still afternoon.

The residents of Kipnuk, which means "bend in the river" in Yup'ik, are a little bewildered that their speck of a village has been drawn into the battle against the bird flu virus.

No roads lead here. The closest Wal-Mart is nearly 500 miles away. The flatland that spreads out between the Yukon and Kuskokwim rivers is so riddled with lakes and creeks that it looks like Swiss cheese from the air. The slate-gray Bering Sea is only a few miles away.

The coastal location is one reason health officials chose Kipnuk as one of 10 villages for testing. The other main reason is the vigor of its hunters.

Kipnuk villagers hunt intensely through the summer, stocking up on birds, which they usually roast into a crispy meal or boil into a soup made with onions, rice and macaroni. Peter keeps two freezers stuffed with various birds — some plucked, some not.

Mann climbed up the steps to Peter's porch and dug into a pile of common eiders, pintail ducks, a shoveler and a Canada goose.

Mann snapped on a pair of surgical gloves and started filling out a form on the birds.

He peeled the paper packaging around a long swab and inserted it into an eider through its cloaca, a combination genital, intestinal and urinary tract. Mann put the swab, now covered in a greenish-white goop, into a vial.

As Peter's 4-year-old son, Quentin, danced around with a plastic light-saber, Mann repeated the procedure for the other birds.

Mann headed back to his mother's house, where he crept under the front staircase and lifted the lid of a white canister filled with liquid nitrogen. As cold white vapors curled out, he dropped in his handful of vials, which he would send away for analysis.

Mann said he swabbed as many as 300 birds in the first round of sampling in May. In September, he collected about 50 samples. To get more hunters involved, the health agency raffled off a 55-gallon drum of gasoline for each round of testing, which turned out to be one of the highlights of the summer. Villagers got one raffle ticket for each bird they turned in.

So far, government inspectors have taken 18,000 samples from birds all over Alaska. They have found no bird flu.

Still, Mann said, there are so many birds from so many places that pass through this forbidding terrain that detecting the virus is "not a matter of if, but when."

"Whenever I see birds, I always think what birds will be the first to get bird flu around here," he said.

The health corporation began preparing residents in the spring with a newsletter outlining some of the dangers of bird flu.

The newsletter's advice was simple: Don't eat, drink or smoke when cleaning birds, and cook the meat thoroughly.

This has caused some problems.

One of the delicacies of tundra life is half-cooked eider. "The reason why we eat them half-cooked is we won't get hungry for hours and hours," explained Andrew Dock, 39, who won the barrel-of-gas raffle after collecting more than 100 tickets.

He still eats his eider half-cooked.

Steven Mann explained the thinking in Kipnuk this way: "I like to compare the flu to Al Qaeda. They're clear on the other side of the world. We hear about them, but we're not scared."

After thousands of years, it's hard to bend traditions.

Peter, an affable, goateed man who served in the Army National Guard for 19 years, goes hunting in a dark green jacket spotted with droppings, one of the primary carriers of the virus.

He seeks out feces. It is an ancient technique to find birds.

"I've been around it all my life," Peter said, explaining that the elders always told him to "look for more bird poop."

As the wind whipped around him, Peter and his hunting buddy, James Active III, whom everyone calls Big Boy, stalked across a meadow looking for dinner. Peter held his shotgun low in one hand. The only sound was the babbling of geese and Peter's calls to them: "Luk, luk, luk."

He scrambled over spongy tufts of lichen and crowberry and waded through the sedge-lined marsh, the smell of rotten eggs rising from his footprints.

As a chill set in, he disemboweled his birds in the traditional style: hooking one finger into the cloaca and tearing out the intestines with one motion.

He wiped his hand on the damp grass.

Peter said he was worried, but not that worried, yet. "Nobody's gotten sick," he said.

A few minutes later, he dug his fingers into a container of agutak, a dessert known as Eskimo ice cream, made of tundra berries, sugar and Crisco.

Still a bit hungry, he shook a helping of trail mix into his soiled hands and poured it into his mouth.

jia-rui.chong@latimes.com