Wednesday, May 31, 2006

More Measles in Boston

The Boston Metro reports a new case of measles in an employee of Investors Bank & Trust Co. at the John Hancock Tower. The outbreak, which health officials have traced to a visitor from India, is still confined to IBT. The Mass. Dept. of Public Health Measles Alert [PDF] has not been updated.

Thursday, May 25, 2006

Patient 7 Died on the Lam

Bloomberg reports on the ominous details of the seventh case from the bird flu cluster in Sumatra:

It's less clear how [Patient 7] Ginting's son was infected, Dick Thompson, leader of the WHO's pandemic and outbreak communications team, said by phone yesterday from the Indonesian capital, Jakarta. Based on neighbors' accounts, it's possible the boy entered his aunt's house during her illness, he said.
Ginting helped care for his 10-year-old son at the Adam Malik Hospital in Medan up until the boy's death on May 13, the WHO said. Two days later, after returning to his home in Kubu Sembelang, Ginting began coughing.
Ginting was examined three days later by local health-care workers, who observed avian flu-like symptoms. The WHO's Grein recommended on May 18 that he be isolated and treated in the hospital with the Roche Holding AG antiviral drug, Tamiflu.
Instead Ginting fled local health authorities and sought care from a witch doctor, I Nyoman Kandun, director general of disease control with the Indonesian Health Ministry, told reporters in Jakarta on May 22.
Disease trackers located Ginting late on May 21 in a nearby village. Blood samples and swabs of his nose and throat for viral particles were taken that day and flown to a laboratory in Jakarta. Ginting died the following day after tests confirmed he had H5N1, the WHO said on May 23.

For the difficult choice between Tamiflu and Ting Tang Walla Walla Bing Bang, PlagueBlog endorses the Tamiflu. But wait, it gets so much worse:

Dozens of poultry farmers and sellers from the deceased man's district slaughtered chickens and drank the blood in Medan on 22 May in a demonstration of their frustration at being branded by authorities as having been infected with avian flu. Footage of the protests was broadcast on Trans TV television.
The Sumatra experience shows the government and international health authorities need to do a better job educating communities and garnering their trust, said Cheng. The deceased man's wife highlighted the family's suspicion and lack of understanding when she said in a 17 May interview that she believed Tamiflu poisoned her son.

PlagueBlog recommends cooking chicken blood thoroughly before drinking it, especially in areas where avian influenza is endemic.

Measles in Boston

The Boston Metro reports that measles has broken out in the Hancock Tower:

Three people who work in the John Hancock Tower have been stricken with the highly-contagious measles, according to the Boston Public Health Commission.
All of the employess work for the same company and public health authorities have been working with officials there to try to identify co-workers who have been exposed to the measles. A second round of vaccinations are being offered to employees who are uncertain whether or not they were vaccinated in the past.

Tuesday, May 23, 2006

The Family Cluster Expands

The World Health Organization reports that a seventh case, and sixth fatality, has been added to the family cluster of avian influenza in North Sumatra, Indonesia. The evidence points toward person-to-person transmission. On the bright side:

Full genetic sequencing of two viruses isolated from cases in this cluster has been completed by WHO H5 reference laboratories in Hong Kong and the USA. Sequencing of all eight gene segments found no evidence of genetic reassortment with human or pig influenza viruses and no evidence of significant mutations. The viruses showed no mutations associated with resistance to the neuraminidase inhibitors, including oseltamivir (Tamiflu).

Sunday, May 21, 2006

Renu MoistureLoc Permanently Recalled

The American Academy of Ophthalmology reports on the permanent recall of Renu's MoistureLoc brand contact lens solution, following a study that found a positive correlation between MoistureLoc and Fusarium keratitis, a fungal infection of the cornea. No other Renu products or similar competing brands were implicated.

In a letter to the Academy, Bausch & Lomb specifically mentions alexidine, a disinfecting agent added to MoistureLoc. MultiPlus and Multi-Purpose do not include alexidine.
The letter states that alexidine is safe and effective, but under certain extreme conditions - such as the solution is allowed to evaporate, the solution is not regularly replaced in the lens case, when the bottle is kept open in between uses or when the case is not cleaned properly or changed regularly - "the concentration of polymers included in the formula to enhance comfort may make the solution more likely to be contaminated with Fusarium in the environment."

Thursday, May 18, 2006

Bird Flu on the Move

Via ProMED-mail: Although the suspected Romanian case has been disproved, avian influenza has recently been confirmed in Djibouti, the first human case in the Horn of Africa, and in 5 members out of eight suspected cases in one family in Indonesia.

The WHO has sent a team to the area near Medan. The agency said it was on alert for signs the virus is mutating into one that can be easily transmitted between people, a development that could signal the start of a pandemic in which millions could die.
Such a mutation could occur anywhere there is bird flu, the WHO says.
Mr Kandun said authorities were still trying to identify the source of the virus in the cluster case in Kubu Simbelang village in Karo regency, about 50km south of Medan.
But an Indonesian agriculture official who declined to be named told Reuters tests had shed no light on the case.
"There is a big question mark. Blood samples from all kinds of animals from chickens, ducks, geese, birds, pigs, cats and dogs turned out negative so far. Manure has also been checked.
The result is negative," the Jakarta-based official said.

Monday, May 15, 2006

Playing Lifeboat

Via GeekPress: National Geographic News rethinks who should be vaccinated against pandemic influenza.

Under the current plan, the ill elderly top the list, while healthy people age 2 to 64 are last in line.
This plan was based on recommendations from the National Vaccine Advisory Committee and the Advisory Committee on Immunization Policy.
It operates under several assumptions, including a prediction of how the virus will kill.
"The greatest risk of hospitalization and death—as during the 1957 and 1968 pandemics and annual influenza—will be in infants, the elderly, and those with underlying health conditions," the authors write.
Now Ezekiel Emanuel and Alan Wertheimer of the National Institutes of Health's Department of Clinical Bioethics in Bethesda, Maryland, have proposed an alternative scheme.

Thursday, May 04, 2006

Human Genetics of Bird Flu

Reuters reports on the genetics of human bird flu cases:

Kida explained that people infected with H5N1 have a carbohydrate receptor on cells lining their throats. The receptor — called alpha 2,3 — is predominantly found in birds and avian influenza viruses like to bind to this class of receptors to replicate and cause disease.
Human influenza viruses, however, prefer to bind to another receptor called alpha 2,6, which is dominant in humans.
“I think people who are infected with avian strains are special. They must have alpha 2,3 receptors,” Kida said.
Although humans have some amount of alpha 2,3, Kida said alpha 2,6 was by far more “dominant” in most people.

Tuesday, May 02, 2006

Veterinary Vaccines for Humans

Via ProMED-mail: The New York Times reports on the possibility of using bird flu vaccine intended for domestic chickens on human beings:

Presumably, if the A(H5N1) avian flu turns into a pandemic, modern medicine will show more common sense. But at the moment, the common-sense response — an avian flu vaccine for humans — is in very short supply. A few million doses exist, earmarked for clinical trials and protection of the vaccine workers needed to make more.
Meanwhile, billions of doses, using crude versions of the same technology, exist for chickens. In desperation, could chicken vaccine be used on humans?
Several experts asked about it were aghast at the idea.

The article goes on to discuss nasty impurites, nastier adjuvants, and the low dosage and limited protection of bird vaccines compared to human vaccines.

Monday, May 01, 2006

State of the Flu

Last week's Science was a special issue on Influenza: The State of Our Ignorance.