My calling

Reuters has a story about how public health experts are realizing that engineers could hold the key to figuring out how to produce enough H5N1 vaccine, should one be developed. I could have told them that.

Avian flu experts appealed on Monday to engineers — a group largely left out of flu preparedness efforts — to come up with potential breakthroughs for speeding vaccine production in case of a deadly pandemic.

The hope is that engineers could use their expertise in areas such as assembly lines and production techniques to help vaccine developers jump hurdles.

Sounds like a job for an industrial engineer with a passion for health care! Give me an internship! 

Relatively large flu outbreak in China?

Yahoo! News has a story about an unknown flu outbreak in Central China over the last couple weeks. This is some seriously scary shit, and hopefully goes to show that my last post is not just fearmongering.

BEIJING (AFP) – Over 400 students at a university in central China's Henan province were hospitalized with high fevers linked to an unknown flu virus, state press and a school official have said.

The outbreak began on March 26 when 22 students were hospitalized with high fevers, Xinhua news agency said.The next day the number of sick students at the Henan University of Science and Technology in Luoyang city rose to 88, and on March 28 there were 208 sick students in the university's infirmary, it said.

"There were over 400 students that became feverish with the flu," a university official who declined to be named told AFP when contacted by phone.

He refused to detail what type of flu it was or how the outbreak had succeeded in infecting so many students.

Local health officials were currently trying to identify the flu strain, Xinhua said.

The temperatures of some of the students reached 39.6 degrees celsius (103.3 degrees Fahrenheit), it said.

The sick students were quarantined while school officials, under directions from provincial health authorities, cancelled classes and began disinfecting the university's 2,000 dormitory rooms, dining halls and classrooms, it said.

Most students were only hospitalized for about three days and released, the report said, adding that only several dozen students remained hospitalized as of Sunday.

If this is H5N1, which of course remains to be seen, the end of the article is *somewhat* encouraging given the extremely high death rate associated with documented cases of H5N1. What worries me, however, is that this happened in China. Like I said in my last post, we cannot necessarily assume that the Chinese government is telling us the whole story.

The threat of H5N1

I just finished writing this primer on avian flu for the April issue of the Michigan Independent. Unfortunately, that issue is cancelled due to lack of funds, and of course I didn't find out until right after I finished this. I suppose I will post it here. It's pretty basic and written for people who haven't a clue what avian flu is. It's not really cited either, although none of this information is hard to come by.

To heed all of the warnings of imminent threats or disasters that one is assaulted with on a daily basis would be to live life cowering in fear of certain death. “Axis of Evil”, terrorists, hurricanes, the crumbling of our society’s moral fabric at the hands of homosexual matrimony and its subsequent plunge into a secular state of nature, etc.

The good news is that meeting your grim demise in that manner is not very likely. The bad news is that when it comes to the latest sign of the apocalypse to receive massive hype, an avian flu pandemic, the media’s frenzy is actually justified, and perhaps not even enough. However, the threat of avian flu is a complicated situation and cannot be understood from sensationalized headlines alone. To appreciate its true nature requires some knowledge of the way flu epidemics work.

Avian flu (also known as HN51, its official name) is a strain of influenza that spreads among and infects almost exclusively birds. It is easily transmitted and migratory birds have propagated the disease from its origin in Southeast Asia throughout the eastern hemisphere, spreading as far west as Spain. While it is true that right now, H5N1 only affects bird populations, we should not let ourselves be lulled into complacency. Humans that have extensive contact with infected birds can in fact, contract H5N1. To date, there are about 200 documented human infections. However, since the virus is most prevalent in predominantly poor countries, it is hard to know how many cases have gone unreported. Frighteningly, 56.5% of reported cases have resulted in death, a remarkably high death rate for an influenza strain.

The number of human cases may seem relatively small compared to the amount of media coverage about avian flu, and many people don’t take it seriously as a result. It its current form, H5N1 is not capable of causing any sort of pandemic because it can’t be spread by human bodily fluids like traditional human influenza. However, many epidemiologists say that all it takes is a simple genetic mutation for H5N1 to jump to humans and spread around the globe. The conditions are ripe and avian flu strains have a history of making this mutation. Most epidemiologists blame the 1918 “Spanish Flu” pandemic on an avian flu strain that made the same jump. That outbreak killed between 50 and 100 million people worldwide, making it one of the worst pandemics in recorded history. H5N1 is considered to be more deadly in humans than the H1N1 strain that is believed to have caused the 1918 pandemic, so the death toll could be catastrophic, particularly in third world countries.

The constantly mutating nature of H5N1 causes more problems than just making human transmission a very real, perhaps even likely, possibility. It also makes it difficult to produce a vaccine with any sort of lasting effectiveness. And even if a vaccine was available, there is virtually no excess production capacity in vaccine manufacturers who are equipped to make flu vaccines. There have been shortages of seasonal flu vaccines in recent years, and the demand for those is virtually nothing compared to what the demand for a pandemic avian flu vaccine would be.

It’s an absolutely terrifying thought, but the fact of the matter is that if a human outbreak of H5N1 is not immediately contained, there is not a great deal that anyone can do to prevent a pandemic. Additionally, just because there have been no infected birds found in the Americas does not exempt us from risk. Researchers think that infected birds could reach the United States as soon as August. The global spread of infected birds increases the risk of the pandemic dramatically because a mutation and uncontrolled outbreak could occur anywhere. A fear of many in the public health community is that an outbreak might occur in a country like China, where the government is not likely to be forthcoming to the global community. If China tried to cover up an outbreak, a lapse of just a few weeks would be time enough for the virus to be everywhere.

There is not a great deal of consensus in the public health community as to exactly how likely an avian flu pandemic is. Some epidemiologists place the chances of a mutation to a human transmissible H5N1 at near 50%, making it an extraordinarily high risk. Others say the risk is far lower, but the fact remains that no matter what numbers you go by, the chances of an avian flu pandemic are astronomical compared to any other crisis facing the planet at the moment.

Scared yet?

The best news I’ve heard in a long time

I just came across this New York Times article that says some new research is making an avian flu epidemic slightly less imminent.

The reason, the researchers propose, is that the cells bearing the type of receptor the avian virus is known to favor are clustered in the deepest branches of the human respiratory tract, keeping it from spreading by coughs and sneezes. Human flu viruses typically infect cells in the upper respiratory tract.

The avian virus would need to accumulate many mutations in its genetic material before it could become a pandemic strain, said Yoshihiro Kawaoka, a virologist at the University of Tokyo and the University of Wisconsin.

According to a University of Wisconsin news release approved by Dr. Kawaoka, “The finding suggests that scientists and public health agencies worldwide may have more time to prepare for an eventual pandemic.”

I’ve been scaring the crap out of everyone I know lately with my bird flu fearmongering. I try to do it in a joking manner, but I’m not really joking. This makes me feel better, but it’s important to note that this is among the first research from respected institutions that suggests that a pandemic isn’t imminent. We still need to be prepared, because it’s still way, way more likely than, like, any other disaster we could possibly anticipate.

Courtesy of Caitlin, the University’s page on flu preparation.

What is UM doing to prepare for avian flu? Together, University Health Service, University Housing, UM Health System, other campus units and the Washtenaw County Health Department plan for contagious disease prevention and response, including pandemic influenza.

I, for one, feel safer knowing that some “planning” is going on.