03/14/2010 (11:15 am)
HELEN BRANSWELL Articles
Provided by: Canadian Press
Written by: HELEN BRANSWELL
TORONTO (CP) - Think of it as a travelling crash course, Pandemic Influenza 201. Top officials of the Public Health Agency of Canada are about to embark on a cross-country series of seminars aimed at teaching Canadian journalists about the complex science of pandemic influenza and the plans Canadian authorities are putting in place to respond when the next flu pandemic hits.
"Basically it's a recognition of the fact that the level of understanding varies a great deal," the country's chief public health officer, Dr. David Butler-Jones, said of the decision to offer the seminar.
The sessions, which will be hosted jointly with provincial and territorial chief medical officers of health, will be held in 16 centres across the country.
The series kicks off Tuesday with separate sessions in St. John's, N.L., and Halifax. Butler-Jones will lead the former while his deputy, Dr. Paul Gully, will lead the latter. Sessions will be held Wednesday in Fredericton and Charlottetown. It is expected the seminars will be completed by late March.
The aim is to build up an expertise and understanding in newsrooms across the country on a subject that is both challenging to comprehend and to convey in newspaper articles or broadcast media reports.
What's the difference between a flu vaccine and the antiviral drug Tamiflu? Between a virus (which influenza is) and a bacterium (which influenza isn't)? Why is it important to differentiate between avian influenza and pandemic influenza? What are Canada's plans for using the Tamiflu the federal, provincial and territorial government's have stockpiled?
Butler-Jones hopes the government officials won't just be teaching. He expects question-and-answer sessions to give him and his colleagues a better idea of what the media's information needs will be when a pandemic begins to unfold.
"Hopefully we can be as transparent and clear and articulate when we do face something," he said.
Journalism professors at two of Canada's leading journalism schools felt the idea of giving reporters a crash course like this would be useful.
Paul Knox, who heads the journalism program at Toronto's Ryerson University, said in the current media climate, few outlets have reporters assigned full time to a beat like health.
So chances are good that the reporters who are going to be covering pandemic developments may have little background in public health or science, said Knox, a former newspaper reporter. Helping more reporters build a base from which to report accurately and knowledgeably makes sense, he suggests.
"I can't see how there's a downside to it."
Kathryn O'Hara, a former reporter who teaches science and health reporting at Carleton University in Ottawa, said the seminars will give reporters across the country access to experts and the information they have.
"They're charged with the public health of Canada and it pays to see what they have to say," she said.
Influenza and public health experts have feared a pandemic may be looming since late 2003 when a highly virulent avian flu virus, H5N1, ignited a series of outbreaks of avian flu in domestic poultry in a number of countries in Southeast Asia.
But it was largely a back-page story until last fall, when U.S. President George W. Bush started speaking publicly about the pandemic threat. His attention to the issue led to a worldwide explosion of avian and pandemic influenza coverage - and a steep learning curve for journalists the world over.
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In a letter to the president of the Canadian Medical Association, Dr. Jerome Kassirer said he has no confidence the organization intends to respect the editorial autonomy of the embattled journal.
"You have demonstrated unequivocally that the current leaders of the Canadian Medical Association are incapable of allowing a first-class, academically credible journal to flourish, and thus that the CMA is unfit for ownership," Kassirer said in his letter to CMA President Dr. Ruth Collins-Nakai.
"I fully appreciate that a single resignation is unlikely to have a salutary effect. Nonetheless, I can no longer associate with an organization whose leaders are so disrespectful of openness and so committed to hidden agendas."
Kassirer's resignation came just hours after the CMA announced it had restructured the oversight committee meant to serve as an arms-length body between the journal's editorial staff and its owners.
The changes are the latest in a series of moves the association has made to try to get past the controversy that has dogged the CMAJ since editor Dr. John Hoey and senior deputy editor Anne Marie Todkill were fired last month. Three other editors resigned in the wake of the firings.
The dismissals are widely believed to be the culmination of a battle between Hoey and the CMA over control of the contents of the journal, though publisher Graham Morris has insisted it was time for fresh leadership.
The restructured oversight committee will serve on an interim basis, while a panel headed by Antonio Lamer, the retired chief justice of the Supreme Court of Canada, devises recommendations on a new governance structure for the journal. Lamer's panel has 90 days in which to issue a report.
Dr. Larry Erlick, a CMA representative, has left the committee where he served as chair. Replacing him is Dr. Peter Tugwell, director of University of Ottawa's Centre for Global Health, who was already a member.
The journal's editorial board -- which has fought for reinstatement of the fired editors and guarantees of full independence for the journal -- had insisted a representative of the CMA could not serve as chair of the oversight committee.
The editorial board had also demanded no member of the committee be named from the ranks of the CMA leadership. That demand wasn't granted. Dr. Noni MacDonald, a Halifax pediatrician who had served on the committee, was named interim editor last week.
Replacing MacDonald and Erlick are Dr. Jean Gray, a former dean of medicine at Dalhousie University, and Dr. Carol Herbert, dean of medicine at the University of Western Ontario.
Herbert issued a statement of concern after the firings, and said she took the interim post with assurances the CMA intends to respect the editorial autonomy of the journal.
"None of us would be putting our toe in this particular pool if we didn't have the belief we could help make things better and get back on track."
http://lfpress.ca/newsstand/CityandRegion/2006/03/14/1486587-sun.html
Thu, April 6, 2006
By HELEN BRANSWELL, CP
http://lfpress.ca
TORONTO -- Cats may be playing a role in the spread of H5N1 avian flu among poultry flocks and could in theory transmit the virus to people who have close contact with sick felines, a group of European experts warned yesterday.
They also voiced concern the virus might acquire the mutations it would need to easily infect humans by first spreading among cats and urged further study of the role cats might play in the transmission and evolution of H5N1.
"People are really very intimate with their animals," Dr. Ab Osterhaus, head of virology at the Erasmus Medical Centre in Rotterdam, said in an interview from Cambridge, England.
Osterhaus noted that young children in particular can lavish affection on a sick family pet. "Although the risk is not high, definitely it is something to look into and make provisions for."
In a commentary published in the journal Nature, Osterhaus and colleagues from Rotterdam, along with an official of the UN's Food and Agriculture Organization, suggested authorities factor cats into guidelines on how to control H5N1 outbreaks in poultry.
They also urged officials to be on the lookout for sick or dead cats. Given reports of cat deaths in areas where H5N1 has spread, dying felines may serve as early warning of the arrival of the virus, they said.
An American infectious diseases expert agreed that cats are an important piece of the H5N1 puzzle. But Dr. Michael Osterholm said it is not clear whether they might trigger rare human infections or help the virus adapt to humans -- or pose no risk at all to human health.
"This is an area of urgent study," said Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
"This is one of those situations where . . . public health is stuck between a rock and a hard place because we have to take this feline issue very seriously. But the last thing that any of us wants is to go out and see inhuman or hysterical reactions to the cat population."
That concern was echoed the World Health Organization, which has watched with dismay just that type of reaction in the past.
During the SARS crisis in 2003, concerns that dogs and cats might be spreading the virus led to the destruction of large numbers of animals in Beijing.
And when German scientists reported in late February that a cat infected with H5N1 had been found, European animal shelters were inundated with pets abandoned by frightened owners.
Michael Perdue, a scientist with the WHO's global influenza program, pointed out that it has been known for more than two years that this virus can infect cats and that cat-to-cat infection can occur -- but there's been no evidence that cats are spreading the virus to people.
"I'd hate to see statements cause unneeded pain or over-concern on the part of the public," Perdue said.
"Given the current lack of any epidemiologic evidence, I think we need some balance."
Osterhaus's research group has done much of the laboratory work looking at the virus's behaviour in cats. They've shown that cats can become sick from eating infected birds, can infect unexposed cats and shed the virus both in their nasal secretions and their stool.
But the authors note many knowledge gaps remain, including how long cats remain infectious, whether cats can be infectious without showing signs of illness or whether felines can transmit the virus to other species.
Osterhaus said he doesn't believe cats would play a role in reassortment, the mixing of a bird and human virus that could lead to a hybrid strain capable of spreading among people. Cats don't appear to be very susceptible to human flu strains, he said.
Hellen Branswell - The Canadian Press
http://torontosun.com/News/Canada/2006/04/05/1520821-sun.html
Canadian wildlife experts hope to double surveillance of migratory birds this year, looking for evidence of the H5N1 avian flu virus on this continent.
The major focus of testing for avian flu viruses will be on birds travelling on flyways from the eastern Arctic to Central and Eastern Canada.
The surveillance plan still requires government funding approval.
"Due diligence would require that we should be vigilant about the potential arrival of this virus in North America," said Dr. Ted Leighton, executive director of the Canadian Co-operative Wildlife Health Centre, the lead partner on the surveillance program.
"In my opinion, (it's) far more likely by human agency than by wild birds, but one cannot discount the possibility" that the virus could reach Canada that way, said Leighton, who also teaches at the University of Saskatchewan.
While U.S. political figures have deemed it virtually inevitable that migratory birds will bring the virus to North America, avian flu experts are not so certain.
A long-term study suggests there is little intermingling of the viruses carried by birds that travel the Eurasian flyways and those that migrate in the Americas.
The Canadian plan is designed to complement a vastly more ambitious American wild bird surveillance program, which aims to collect samples from between 75,000 and 100,000 migratory birds.
High doses may not be enough
By HELEN BRANSWELL, THE CANADIAN PRESS
Making enough vaccine to protect large numbers of people if the H5N1 avian flu strain sparks a pandemic will be more complex than previously thought, a new study shows.
The study shows that even at extraordinarily high doses -- 12 times the antigen used to protect against seasonal flu strains -- nearly half of vaccinated subjects did not generate the level of antibodies needed for protection.
PATIENT RESPONSE WORRY
Tests showed only 54% to 58% of people who received two doses of 90 micrograms (mcg) each produced the level of antibodies believed needed to protect against infection, the researchers reported in the New England Journal of Medicine.
"These are lower response rates than what one might have expected for regular flu shots in healthy people," said author Dr. John Treanor of the University of Rochester.
VACCINE SHORTAGE
Similar tests for the effectiveness of seasonal flu vaccine vary, depending on the flu strain and the recipient's age and health. Somewhere between 75% and 90% of adults will produce protective levels of antibodies after a shot.
With worldwide flu vaccine capacity, a dosing regime of two shots of 90 mcg apiece would mean about 75 million people around the world -- or just over 1% of the global population -- could be vaccinated in the first year of a pandemic.
http://torontosun.com/News/OtherNews/2006/03/30/1512242-sun.html
By HELEN BRANSWELL
http://cnews.canoe.ca/CNEWS/Canada/2006/04/15/1535656-cp.html
(CP) - The notion is a tempting one, given the potentially dire alternative. And it plays on the minds of some scientists who've been watching the avian influenza virus known as H5N1 since it was first isolated in a Chinese goose a decade ago.
As months and years elapse since this very nasty virus first began to sporadically infect humans, some wonder whether H5N1's failure - to date - to trigger a pandemic signals there is some barrier keeping the virus from becoming an effective human pathogen.
Most leading influenza experts insist we know too little about how pandemic flu strains emerge to bet against the bug. Still, there are scientists who gaze at the growing pile of discarded calendar pages and wonder if a message lies there.
Influenza expert Dr. Peter Palese is one who believes some factor science doesn't yet recognize may be blocking this virus from becoming a flu strain easily sneezed from one human nose to the next.
"I am convinced that pandemics will occur in the future," says Palese, chair of the department of microbiology at Mt. Sinai School of Medicine in New York.
"I'm just not sure it will be H5."
Dr. Jeffery Taubenberger isn't either. But while Palese is
http://bodyandhealth.canada.com/channel_health_news_details.asp?news_id=9582&news_channel_id=139&channel_id=139&rot=11
Provided by: Canadian Press
Written by: HELEN BRANSWELL
Mar. 27, 2006
(CP) - International experts gathered in Geneva this week are trying to tease from the sparse medical literature clues on how best to use antiviral drugs for treatment of human cases of H5N1 avian flu.
They will be combing through case reports of H5N1 patients treated with the few flu drugs in the medical arsenal attempting to see if patterns are coming into focus on what works, at what dose, for what duration and perhaps even in what combination.
Among other issues, the World Health Organization-sponsored meeting will look at whether higher doses of Tamiflu are needed to combat the virulent H5N1 virus. That dosing regimen is based on the way that Tamiflu, from a class of drugs known as neuraminidase inhibitors, works against strains of human influenza.
Infectious disease experts not attending the two-day meeting, which begins Tuesday, outlined a number of issues they hope the session will clarify.
"Clearly we need more information on how the drugs work in the actual prevention and treatment of avian influenza," said Dr. John Treanor, author of a number of scientific papers on neuraminidase inhibitors, and a professor at the University of Rochester, N.Y.
"We've extrapolated everything from what has been done with conventional flu. And it's very likely, or at least possible, that the response to treatment with H5 would be different in several different ways."
While much of the world's attention has centred on Tamiflu, experts are also interested in the role other flu drugs might play.
"To me, a really big question is: What about Relenza? And I really hope that gets talked about a lot," said Dr. Anne Moscona, an infectious diseases specialist at Weill Medical College at Cornell University in New York.
Relenza is the brand name for zanamivir, the only other licensed neuraminidase inhibitor. The drug, administered by inhalation, has taken a back seat to oseltamivir or Tamiflu. But a number of experts, including Moscona, believe its potential has been under-explored.
For one thing, they suggest the drug's design makes it less vulnerable to the emergence of resistant viruses. To date there have been no reported cases of resistance to zanamivir, whereas oseltamivir resistance has been seen in low numbers both with human flu strains and in cases of H5N1 infection.
Also likely to be discussed are older, cheaper drugs known as the adamantanes or M2 inhibitors. The two drugs in this class are amantadine and rimantadine. (Rimantadine has not been brought to market in Canada.) Both are off patent.
The drugs, longtime warriors in the battle against seasonal flu, have recently been shelved after research done at the U.S. Centers for Disease Control showed the overwhelming majority of circulating human flu strains were resistant to them.
For a period, the H5N1 viruses were resistant as well, but a family or clade of viruses that are susceptible to the adamantane drugs has more recently emerged, prompting experts to give them a second thought.
"I think they should be on the table. In a pandemic everything will be on the table," said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
"I think that we would be remiss if we dismissed those offhand without knowing at the time the sensitivity of the virus."
These drugs are attractive because they are far more affordable than Tamiflu or Relenza, are in more abundant supply and can be stored for long periods without losing their potency.
But they have a downside. Resistance to them develops quickly, suggesting that while they might play some role early in the life of a pandemic virus, their efficacy might be limited.
"We know that resistance to these drugs can appear fairly easily . . . So it's going to be a little bit difficult making blanket recommendations that they should or they shouldn't be used," said Dr. Keiji Fukuda, acting director of the WHO's global flu program.
"How's it going to come out in the wash? Not clear. But it is quite possible that in some situations they might be useful."
But the inability to predict whether adamantane drugs will be effective against H5N1 poses real treatment problems, as Dr. Nancy Cox, head of the CDC's flu branch, noted at an infectious diseases conference in Atlanta last week.
Physicians faced with an H5N1 patient won't have time to isolate viruses and run susceptibility tests.
"That really puts a clinician in a dilemma," Cox said.
"It would pose a very difficult problem for a clinician who didn't know if the patient was actually infected with a resistant or a sensitive H5N1 virus to use a drug that could potentially not be effective."
Helen Branswell, Canadian Press
http://www.canada.com
Influenza experts trying to forecast the future path of the worrisome H5N1 avian flu virus do so in the face of an unsettling number of unknowns.
What little is understood about influenza pandemics - and it is by no means sure H5N1 will cause one - has been puzzled out in recent years based on viral and epidemiologic excavations of the three pandemics of the last century.
Even less is known about how the viruses that caused those pandemics emerged from their natural hosts, aquatic birds, and adapted to become efficient human pathogens.
Dr. Jeffery Taubenberger is hoping to add new pieces to the biggest pandemic puzzle of the three, the 1918 Spanish Flu, by tracing how the virus evolved in the years before 1918 and then through the various waves of disease that pandemic provoked.
"There's a lot of work to do," says Taubenberger, the scientist who led the historic project to tease tiny fragments of the 1918 virus from preserved lung tissue of long-dead victims, using those precious traces to chart the full genetic blueprint of a virus believed to have killed upwards of 40 million people worldwide.
"I'm really, in a sense, very tired of this arche-virology, because it's just so slow and painful," admits Taubenberger, who is chair of molecular pathology at the U.S. Armed Forces Institute of Pathology in Rockville, Md.
"But I feel that it's absolutely essential to answer a lot of the questions that we want to know about 1918. And then extend those answers or apply what we learn to the more generalizable rules about how it is pandemics form and how they evolve."
Years of work by Taubenberger and colleagues in his laboratory culminated last fall in the publication of an analysis of the final three genes of the 1918 virus to be sequenced.
Completion of the work allowed researchers from the U.S. Centers for Disease Control in Atlanta and Mt. Sinai School of Medicine in New York to reconstruct each of the eight genes and reassemble the deadly H1N1 virus in a bid to coax from it the secrets of its virulence. That work is progressing at high security labs at the CDC.
But Taubenberger is continuing the search for additional virus samples that could provide strong clues as to how the 1918 H1N1 became so deadly. New findings could help researchers spot emerging pandemic menaces in the future.
He also hopes the process will answer the mystery of whether H1N1 jumped directly from birds to people, or adapted first in some other mammalian host.
The Spanish flu virus that Taubenberger's team sequenced was drawn from the second, most lethal wave of that pandemic, which occurred in North America in the fall of 1918.
Comparing it to viruses from the years preceding the pandemic, the milder first and third waves as well as others from the years immediately after the pandemic could bring into focus mutations that allowed the hyper-virulence to develop and then wane.
If it's really true that its loss was due to a change in the virus, if we find say a 1923 case and sequence across, any differences could be really important," Taubenberger says.
Infectious disease expert Dr. Michael Osterholm thinks pre-pandemic study may be more fruitful as the decrease in virulence may have had more to do with expanding immunity in people than with mutations.
"If I had a choice of knowing the front side or the back side changes (in the virus) I'd want to know the front side," he says. "That would be more powerful (proof)."
Taubenberger expects preserved tissue samples from the Royal London Hospital will offer up some of these viruses for study.
In fact, his lab has already managed to snag a fragment of an influenza A virus - all known pandemics have been caused by influenza A viruses - from a sample preserved in 1915.
"We know for sure that we have a pre-1918 case that has at least a tiny, tiny - underline tiny - fragment of influenza RNA," he says.
It remains to be seen whether Taubenberger's team has enough material to do more in-depth genetic analysis of the virus. "It's a difficult problem. But we're trying that right now. We're working on that."
Even if that effort should fail, Taubenberger has identified another 200 cases from the hospital's preserved tissue bank he thinks were likely influenza deaths.
"And I feel confident that when we screen these 200 cases that we will find (influenza) cases."
In tandem with this work his team will investigate ways to sequence more quickly any viral samples found.
"All of this is incredibly painful. It's not like saying: Oh, I have a viral isolate from a patient's nose today and next week we can have the full genomic sequence," Taubenberger says of the work his team undertakes.
"So we're also trying to look at the possibility of some new approaches to sequencing that might be faster . . . so we don't have to wait another nine years before we know that there's a difference."
© The Canadian Press 2006
| China announces new bird flu death By HELEN BRANSWELL | http://www.canoe.ca/CNEWSImages2003/email_off.gif (javascript:sendit();) | http://www.canoe.ca/CNEWSImages2003/print_off.gif (http://cnews.canoe.ca/CNEWS/World/2006/03/05/pf-1473870.html) | http://www.canoe.ca/CNEWSImages2003/write_off.gif (http://rapids.canoe.ca/cgi-bin/reg/NR-cust_service.pl?MODE=CUSTOMER_SERVICE&LOOK=CNEWS) |
The case came to light amid warnings from the World Health Organization that other human cases may be going undetected in the world's most populous country.
In an interview from Beijing, the WHO's senior person in China paused when asked if he felt there was more human disease in the country than Chinese authorities are admitting.
"It's very conceivable that there are more cases," said Dr. Henk Bekedam, the WHO's representative for China.
"But we do not have the impression, at least from the central ministry, that they are hiding information from the outside world."
Rather, Bekedam said he believes China has a "capacity problem" in terms of its ability to conduct surveillance for infection in birds and detect all human cases, particularly those in which the virus triggers milder disease.
The man's case was reported on Hong Kong's Cable TV by Zhong Nanshan, director of the Guangzhou Institute of Respiratory Diseases and confirmed by China's Ministry of Health in Beijing, according to the Xinhua news agency.
When suspected human cases have cropped up in other countries, the WHO has required testing by a external laboratory before it officially confirms a case. But to date China has not agreed to send out its specimens for independent testing. And the WHO has accepted positive tests from China as confirmation of H5N1 infection.
Many outside the country are skeptical of whether China is reporting the full extent of its H5N1 problem. The country's deeply engrained tradition of secrecy - evidenced by its attempts to cover up the emergence of SARS in 2003 - is fuelling a belief that China's problems are more extensive than the country is willing to admit.
There are also suspicions that Chinese officials choose strategic moments at which to announce new cases. Last weekend, when world media attention was focused on the discovery of Europe's first outbreak of H5N1 in domestic poultry - at a turkey farm in Ain, France - Chinese authorities announced two additional human cases. They became a footnote to the coverage of Europe's spreading H5N1 problem.
"I'm very much aware about the sentiments about China," Bekedam said when asked if he shares the suspicion.
But he said he believes that if the country is under-reporting it is because central authorities don't have a full picture of the problem in China's diverse regions.
"There are some challenges in a big country like China," Bekedam said. "But our sense is when the central Ministry of Health knows about it and when they have done their confirmation test, that we are being informed."
Bekedam said he meets regularly with officials of the Health Ministry, who assure him they are determined to improve the speed at which they detect human cases. "It's a very clear objective of the ministry."
Unlike other jurisdictions, where suspected human cases are quickly reported - and often just as quickly dismissed - Chinese authorities do not report until confirmatory testing is completed.
Bekedam said the WHO doesn't object to that system, so long as there are no hints of human-to-human transmission among the people being investigated.
"As long as you're talking about sporadic cases, we have no problem that you inform us at the moment that they have been properly confirmed," he said he has told Chinese authorities.
"But if there are other close contacts who are also sick, then we would like to be informed. And we need to be informed."
Clusters of cases could signify that the H5N1 virus is mutating in ways that allow it to more easily jump to and between people. If the virus acquires the ability to move readily from person to person, it is believed it would trigger the world's first flu pandemic since the Hong Kong flu of 1968.
Bekedam said a worrisome feature of China's problem is that the massive die-offs of domestic poultry that typically alert authorities to the presence of H5N1 have dwindled off in China.
Widespread use of poultry vaccines may be masking the virus's presence, he said. Vaccinated poultry can acquire and shed the H5N1 virus, perpetuating a sort of low level or invisible spread of virus in a region.
"So somehow the animal surveillance system is not picking up the sick poultry. And that is of concern," Bekedam said.
He noted that none of China's 14 human cases - Sunday's announcement would make that 15 - were from areas where outbreaks in poultry had been reported. Investigation after the fact uncovered evidence of sick birds in at least eight of the cases.
Recent statements from Chinese officials lay the blame for the virus's spread on infected migratory birds. On Friday, the country's Vice-Premier Hui Liangyu warned that when the spring migration begins poultry outbreaks and human cases could soar in China.
Bekedam suggested his Chinese counterparts may be focusing too much attention on the wrong facet of the problem.
"We . . . still feel that there has been a relative over-emphasis on what's happening up in the air," he said. "We do believe that China . . . has also still a major threat on the ground over here, meaning that I think the virus is endemic in many parts of China."
http://cnews.canoe.ca/CNEWS/World/2006/03/05/1473870-cp.html
By HELEN BRANSWEL
(CP) - A year ago, H5N1 avian flu was ripping through Asian poultry flocks and sparking frequent - and too often fatal - human infections in Vietnam. International health authorities worried that a largely oblivious world might be sleepwalking toward disaster.
Few are ignoring the persistent and virulent virus now. But with awareness mounting and fear surging, some of the people who earlier sounded the alarm are wondering if it's time to adjust the volume - or at least fine-tune the channel.
Some express concern that nuances of the actual risk are being lost as the virus continues its flight across Asia, Africa, the Middle East and Europe.
Dick Thompson, the World Health Organization's spokesperson on the issue, worries people have come to - or have been led to - the conclusion that a pandemic arising from this strain of avian influenza is inevitable.
"When we initially started talking about this and to today, we were always saying: We don't know if H5 is going to be the virus, we don't know if it is going to be a bad pandemic, when it will strike, any of that stuff," Thompson says from Geneva.
"All of that seems to me now lost. It seems to me that in everything I'm reading, it's a lock."
Flu virologist Adolfo Garcia-Sastre, who remains skeptical that H5N1 will become a pandemic virus, voices similar concerns. He worries people will become complacent about influenza if this threat subsides.
"This is something I'm a little bit afraid of," Garcia-Sastre says from New York, where he works at Mount Sinai School of Medicine.
"If H5 doesn't make it into a pandemic - and I don't want H5 to make it into a pandemic - but if the virus doesn't make it that somehow people will feel betrayed by all the publicity that was given to the virus."
Thompson's fear is that people will lose faith in public health authorities if the public overlooks the caveats attached to the warning messages.
"We earned a lot of trust during SARS and we could blow it all on H5N1," he says of the WHO.
"But I don't think that that's a big gamble as long as people understand exactly what we're saying. And it's not a bumper-sticker statement. It's a complicated statement. And that is: 'We don't know what the next pandemic is going to look like or how bad it's going to be. But there will be a pandemic and if you prepare for it you can reduce the damage.' "
In many respects, the timing of such qualms seems odd. In recent months, the virus has vastly expanded its geographic range, sparking human infections far beyond its original epicentre of Southeast Asia.
After warning for so long that H5N1 is a significant threat, why get cold feet about that message when the virus seems to be proving your point?
Dr. Jody Lanard, a risk communications expert, isn't surprised by the seeming contradiction.
"There is a kind of seesaw of attention between the public and officials," says Lanard.
"When everyone is ignoring the problem, officials focus on raising the alarm. When people finally pay attention and start worrying, the officials instantly want to calm them down again.
"Everybody in the warning business worries that people will accuse them of crying wolf," she adds. "They forget that in the actual Boy Who Cried Wolf story, the wolf finally showed up."
Dr. Michael Osterholm, a favourite target for those who see the warnings about H5N1 are unwarranted, has some sympathy for Thompson's fears. Up to a point.
"I think it's a very legitimate concern," says Osterholm, who has been one of the most vocal proponents for pandemic preparedness.
"And unfortunately for those of us who have been trying to bring the world to a much higher state of preparedness for pandemic influenza, we have to live often by an eight-word or nine-second sound bite out of a much larger comprehensive message."
Osterholm readily acknowledges there is no way of knowing what strain will cause the next pandemic or whether H5N1 will become a pandemic strain.
But he frequently warns of the parallels between H5N1 and the influenza strain that triggered the 1918 Spanish Flu - earning the disdain of those who insist the severity of that pandemic could not be replicated in the era of modern medicine.
"I worry that too many policy leaders dance around this issue fearful that somehow they will either offend or frighten the public," says Osterholm, the director of the Center for Infectious Disease Policy and Research at the University of Minnesota.
"Our job is not to upset people or to calm people. Our job is to tell the truth."
The job is also to accelerate preparations for a flu pandemic that will come one day, regardless of the H and N numbers on the eventual pandemic strain's name, says Dr. Keiji Fukuda, head of the WHO's global influenza program.
"We are not magicians. We cannot predict what's going to happen tomorrow. But we can say that there are things that we should be concerned about and there are things that we can do because of those concerns."
Fukuda is not worried about expectations.
"If confidence is built on our ability to predict the short-term future, it is confidence which is misplaced. On the other hand, if it is confidence that these are institutions that are analyzing the situation, looking over it and making recommendations, making moves which really are important moves and good moves, that is why trust should be placed in public health."
http://cnews.canoe.ca/CNEWS/Canada/2006/03/19/1495802-cp.html
Helen Branswell, Canadian Press
Published: Monday, February 20, 2006
(CP) - The spread of the H5N1 avian flu virus seems unstoppable, with an ever-lengthening list of countries detecting the virus in dead migratory birds and occasionally in domestic poultry.
But while the geographic expansion of the virus is ringing alarm bells at the political level across Europe and beyond, disease experts insist the finding of H5N1 in a raft of new countries doesn't in itself raise the risk that it will spark a human influenza pandemic.
John Wood, a leading influenza virologist, doesn't believe the recent developments have changed the nature of the pandemic threat posed by this virus.
"I think the risk is still the same as it was a few months ago, before the virus started moving all over Europe and into India and Nigeria," Wood, who's with Britain's National Institute for Biological Standards and Control, said Monday from London.
Given the virus's apparent ability to infect - and travel with - some migratory birds, the spread of the virus to parts of Europe, Africa and eventually North America is to be anticipated, said those tracking the patterns of H5N1.
"It's not fine, but it's not unexpected. And as long as we're dealing only with migratory birds being found here and there, I don't think it's a big deal, frankly," Dr. Guenael Rodier, a leading infectious disease epidemiologist with the World Health Organization's European office, said from Copenhagen.
"It's not the big issue. The big issue is if we start to have domestic poultry infected. Then it would start to be a problem. . . . A higher risk for transmission to humans."
The H5N1 outbreak, having simmered in Southeast Asia for two years, has bubbled over in recent months and weeks.
Evidence of the virus has cropped up recently in Bulgaria, Italy, Azerbaijan, Austria, Germany, Greece and France as well as in Turkey, Iraq, Egypt, Nigeria and India. In most countries, that evidence comes in the form of the carcasses of migratory birds. But poultry outbreaks have been sparked in some of those countries, including Nigeria and India, and human cases have been confirmed in Turkey and Iraq.
Those discoveries, the viral equivalent of sparks flying from a bonfire, may in many cases be easily extinguished. But the rate and range over which they are happening is raising concern that the fire-fighting capacity of the WHO, and its animal counterparts - the International Organization for Animal Health (the OIE) and the Food and Agriculture Organization - is being taxed to a dangerous degree.
Dr. Michael Osterholm, an infectious disease expert at the University of Minnesota, believes the highest risk of H5N1 developing into a pandemic strain remains in Asia, particularly in Indonesia. But he knows those tracking the virus cannot afford to ignore an appearance in Iraq or Romania or Nigeria either.
"How do you keep your eye on the outbreaks while keeping your gaze fixed on Asia?" he asked.
Agriculture ministers from across the European Union met Monday to try to chart ways to combat the influx of the virus, thought to be transmitted by a combination of movement of infected poultry and transmission by one or several as-yet unidentified species of wild birds.
But avian influenza experts believe developed countries like those of the European Union should be able to keep the virus from sparking the more dangerous poultry outbreaks, or tamp them out quickly, should they occur.
"It isn't an absolute, but you certainly can say that the chances of containing spread among bird flocks in developed nations that have good agricultural capabilities and controls, to identify rapidly and cull and eliminate the sick chickens to prevent spread . . . is much better than in some other developing nations," said Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases.
In a statement issued Monday, the WHO called the European appearances of the virus "a public health concern," as they create new opportunities for the virus to spark poultry outbreaks and bring the virus in closer contact to people.
But experts say there is a significant difference between the risk posed by H5N1 brought into France by a migratory bird and the same thing happening in a developing country where people and their chickens live in much closer proximity.
Wherever poultry are raised in a manner similar to that of Asia - with households keeping a clutch of free-range birds and where compensation isn't adequate to entice farmers to cull sick chickens - the risk of what Rodier calls "this too close interface between humans and sick animals" mounts. And with it mounts the risk of human cases.
"I don't think that the resources of the western European countries are going to implode because of this. But you see disaster striking, economically and otherwise, when you get into countries such as in Africa and other developing nations in which they don't have the resources to handle this," Fauci said.
© The Canadian Press 2006
http://www.canada.com/topics/news/agriculture/story.html?id=4ffb13fd-e831-4127-a96c-0028162e55ec&k=68758&p=2
By HELEN BRANSWEL
MINNEAPOLIS (CP) - Businesses hoping to weather a potential influenza pandemic need to plan for myriad knock-on problems that mass illness in society and in their workforces could create, participants at a conference aimed at spurring business continuity planning were told Tuesday.
Planners need to think about such things as whether Internet servers have sufficient capacity and whether workers will be able to access automatically deposited pay cheques if power outages put bank machines out of service.
"One of my biggest concerns is that servers are not large enough to handle all the at-home telecommuting," admitted Sherry Cooper, one of Canada's leading economists. "Servers could go down."
Employees accustomed to having their salaries transferred electronically to their bank could find themselves unable to withdraw funds if bank machines are crippled by lack of power, noted Cooper, chief economist for BMO Nesbitt Burns.
"If people can't get at their money, there could well be significant panic."
Cooper was part of a roster of speakers drawn together to help representatives of more than 200 U.S. and international companies grapple with the complex issue of how to buttress the business sector to get through a flu pandemic.
The two-day meeting is hosted by the University of Minnesota's Center for Infectious Disease Research and Policy.
Dr. Michael Osterholm, director of the centre, had one word of advice for companies that find themselves struggling to come to grips with the complex issue and to anticipate the various ways it could affect their businesses. "Start," he said.
Litigator Cheryl Falvey told the gathering many companies still don't get how a flu pandemic could affect them. But those that make essential products - the makers of medical masks and syringes, for instance - certainly do and they are not alone, she said.
"There's lots of movement in the highest levels of corporate America," Falvey said. "They're taking it very seriously."
For her part, Cooper wasn't convinced much of the business sector has recognized that mass human illness would have unanticipated consequences outside of the health-care sector.
"I do not believe that businesses are prepared. I certainly don't believe the infrastructure is prepared," she said, referring to the vast network of services - garbage removal, electricity, water systems - that keep society functioning.
http://money.canoe.ca/News/Sectors/BiotechnologyHealth/2006/02/14/1442680-cp.html
By HELEN BRANSWELL
http://cnews.canoe.ca/CNEWS/Canada/2006/04/02/1516881-cp.html
TORONTO (CP) - Federal officials want to sharply cut the time it would take to vaccinate all Canadians in the event of a flu pandemic.
Authorities are in talks with pharmaceutical giant GlaxoSmithKline to secure the vaccine production capacity needed to do so.
"We want as much as we can as fast as we can," says Dr. Arlene King, director general of pandemic preparedness with the Public Health Agency of Canada.
Federal pandemic planners are now aiming to provide all Canadians who want vaccine with two doses each within two months, once an effective vaccine can be made. Two rounds of between 25 million and 30 million doses will be needed to do the job, they estimate.
The previous strategy, outlined in the Canadian pandemic plan, calculated it would take four months to vaccinate every Canadian just once.
Research has since shown two shots - a primer and a booster - will likely be needed to protect against a pandemic flu strain.
To meet the new target, the federal government is negotiating with GSK in a bid to lock up more of its expanding Quebec-based vaccine production capacity for Canada.
"We are looking to harness as much capacity as we can to vaccinate the Canadian population - and as fast as possible. And we're still having discussions with GSK around that," King explains.
The Quebec facilities, which GSK bought last year, are currently undergoing large-scale expansion that will bring production capacity to 75 million doses of seasonal flu vaccine a year in 2007 from roughly 12 million last year.
The government wants to ensure Canadians have first dibs on that added capacity.
"We certainly have the assurance, but discussions are ongoing in order to be able to achieve that and harness that production capacity for Canadians specifically," King says.
"We're very optimistic that we'll be able to work out all of the details related to that."
Other countries are currently shopping around looking to secure a piece of the world's limited vaccine production capacity in advance of the next pandemic.
"We've been in discussion with virtually every major government . . . including the U.S.," David Stout, president of GSK's pharmaceutical operations, admitted in a conference call with journalists last week.
"They're talking to us. In some cases, the governments approached us years ago."
Canada is already first in line for pandemic vaccine produced at GSK's Canadian vaccine facilities, based in Laval and Ste-Foy, Que.
In 2001, the federal government signed a 10-year pandemic vaccine contract with Shire Biologics - later bought by ID Biomedical, which was sold to GSK last year. The multimillion-dollar contract required the company to be constantly at the ready to make and sell pandemic flu vaccine to Canada.
The made-at-home aspect of the vaccine is critical. Given current vaccine production methods and capacity, global demand will far outstrip global supply during a pandemic. It is expected countries with vaccine plants within their borders may even block exports until domestic needs have been met, regardless of whose order was placed first.
The Canadian contract is considered visionary by many in the international public health world. But the emerging science on pandemic vaccines suggests the initial Canadian order may have been far too small.
Complicating planning is the fact that as yet, it's unclear how much antigen or vaccine will be needed for each dose, especially if the worrisome H5N1 avian flu strain triggers a pandemic. That's because H5N1 vaccine doesn't provoke a good immune response.
In a study published last week, U.S. researchers reported it took massive doses - two shots of 90 micrograms apiece - to induce what is considered a protective response, and then only in just over half of people who received the largest dose. That's 12 times the vaccine needed to protect against seasonal flu strains.
Additional trials, including by GSK, are trying to find ways to lower the dosing needs by mixing in chemicals called adjuvants that boosts the immune system's reaction to vaccine.
To date vaccine makers Sanofi Pasteur and Australia's CSL have released limited data from trials of H5N1 vaccine using an adjuvant called alum.
Sanofi found two doses of 30 mcg induced protection, though the company has not yet revealed in what portion of its participants that dose worked. CSL said two doses of 15 mcg provoked the required immune response in some of its volunteers.
The original Canadian order envisaged eight million doses of 15 mcg per month over four months. But the clear evidence that two doses would be required would stretch that timeline to eight months.
And if it turns out that each dose must be larger than 15 mcg, that would further add to the time needed to produce sufficient vaccine, as the contract currently stands.
King said the aim of the current negotiations is to guarantee for Canada "with any dose, whatsoever, enough vaccine to vaccinate all Canadians within a two-month time frame."
Mar. 12, 2006. 08:35 PM
HELEN BRANSWELL
CANADIAN PRESS
Limiting who can work on the WHO data isn't just hindering science's ability to crack the mysteries of H5N1's incredible virulence, critics say.
It also hampers efforts by countries outside the WHO network to keep their H5N1 diagnostic tests up to date.
"There are a lot of issues that have to be worked through to come up with a system that is best for everyone involved."
A leading scientist in the field of genetic sequencing is calling on publicly funded U.S. researchers and research organizations to throw open their collections of H5N1 avian flu viruses to allow others to work toward lessening the pandemic threat the virus poses. Steven Salzberg wants the U.S. Centers for Disease Control as well as researchers funded by the National Institutes of Health to place their virus sequence data in open-access databanks on an as-processed basis. He hopes such a move would entice scientists elsewhere, as well as governments in H5N1-afflicted countries, to end a pattern of virus hoarding many believe is undermining the world's ability to battle H5N1.
"I think what ought to happen is that the U.S., starting with people funded by NIH and the CDC itself ought to start releasing all of their data and all of their samples — and lead by example," says Salzberg, director of the Center for Bioinformatics and Computational Biology at the University of Maryland. "Because one complaint I've heard from other scientists in other countries is: `Hey, the CDC in the U.S. doesn't release all their data. So why should we?' And that's a very legitimate complaint." Infectious disease expert Dr. Michael Osterholm sees the logic in Salzberg's appeal.
"I think that's fair. I think they should," says Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "If we don't have timely and comprehensive laboratory analysis and reporting of isolates, then we're in trouble." Salzberg was involved in the historic human genome sequencing effort as well as the teams which sequenced the first plant genome, Arabidopsis (mustard weed) and the parasite that causes malaria. Most recently, he has been working on an NIH-funded project that is sequencing vast numbers of human flu viruses.
He is adding his voice to a campaign started by Dr. Ilaria Capua. An Italian influenza researcher, Capua is challenging the current system which gives a small network of prominent flu labs preferential access to data by virtue of the fact they do testing and surveillance for the World Health Organization. These labs register their findings in a secure database so that they and the WHO can track changes in H5N1 viruses.
But those virus sequences are slow to trickle out to the rest of the research world. (Typically, scientists only post data publicly when they publish findings in a journal, a process that can take months or more.) Capua was offered a chance to join the 15 labs with access to the WHO's secure database after she sequenced H5N1 bird viruses from Nigeria and Italy, according to a recent article in the journal Science.
She turned down the offer, choosing instead to place her sequence data in the open access database Genbank. Canada's National Microbiology Laboratory has no access to the database, notes Scientific Director Dr. Frank Plummer. So if it wanted to update the test it uses to look for H5N1 in Canada, using viruses from the recent human cases in Turkey or Iraq as a model, it could not do so. While Turkey and Iraq allowed human specimens to be sent to a WHO collaborating lab for confirmatory testing, neither country has yet agreed to let WHO release the sequence data for their human cases to scientists outside the secure database. "It limits our ability to make sure we've got the right diagnostic tests. It inhibits research," says Plummer, who is no fan of the system. "I think there needs to be as much openness as possible.
This is information that's to the global public-health good. And it certainly should not be hoarded." Some countries refuse to export viruses or share very few, concerned that foreign scientists will scoop up the publishing glory for studying their problem. Or they may justly fear that foreign drug companies will use their viruses to make a pandemic flu vaccine their citizens won't be able to purchase. China in particular has been slow to share, blocking exports of poultry viruses for more than a year and only recently providing two human isolates to the WHO network.
Salzberg insists that's unlikely to change until Western scientists start sharing, too. "I don't think we're going to get the Chinese to start releasing samples and data until U.S. scientists can do it themselves — before publication, with no restrictions," he says. The WHO is hearing the growing chorus of complaints. But to some degree its hands are tied. The viruses belong to the countries where they were collected. WHO cannot force them to share. And it doesn't own — or pay — its collaborating labs, which are doing huge amounts of science for the global good. "We can't open that database without having permission from the other collaborating centres and member states. That permission hasn't been provided," says WHO spokesperson Maria Cheng. "There are some members of the lab network that balk at sharing data. We can't speak for them and speculate why," adds Cheng, who would not identify the holdouts. "We have to recognize that these collaborating centres are not financed by WHO. So we don't have any authority over them. But they are providing a very valuable public-health service and they're not getting paid explicitly for that."
While that is undeniable, others argue that scientists in these centres are being more than compensated by first — and often exclusive — crack at data in a research field now so white hot that a paper about an interesting change in one virus would be virtually guaranteed publication in a top-flight journal. A spokesperson for the CDC said that agency — one of the world's pre-eminent centres for influenza research — wants to work toward a solution that would allow more open and rapid sharing of data. "We're committed to trying to continue to work on this very issue. We totally understand the importance of quickly sharing this information, especially when it could benefit public health," Tom Skinner says. "We also appreciate the complexity of the issues involved in coming up with a system that takes into account the balances of posting as quickly as possible, working with the host nations where these isolates come from, taking into consideration the importance of scientists being able to publish in peer review journals.
Earl Brown, a University of Ottawa virologist who specializes in influenza evolution, understands the complexity of striking a balance. On the one hand, he believes labs paid by governments to do surveillance and sequencing should not be able to sit on data. "CDC and places like that — once they get a sequence in and once they've checked their errors, it should go out by virtue that they're providing a service to the country," he says. But as a researcher governed by the "publish or perish" rules of academia, Brown can understand the temptation to protect data from bigger labs until publication is secured. "It's a very competitive enterprise," he says ruefully. "Science is a great ideal but it's done by humans who are driven by the standard things. Like glory. Women. The rest of it."
http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&c=Article&pubid=968163964505&cid=1142203809676&col=968705899037&call_page=TS_News&call_pageid=968332188492&call_pagepath=News/News
By HELEN BRANSWELL, CP
German scientists reported yesterday that a cat in that country had been infected with H5N1 avian flu, a discovery experts said reinforces the need to find answers to questions about what role, if any, cats, dogs and other mammals may play in the spread of the worrisome virus.
The cat, found dead on the Baltic Sea island of Ruegen, represents the first reported case of infection in a feline outside of Asia -- although it is not the first time H5N1 infections have been reported in cats and other non-human mammals.
Experts said it was difficult to assess whether cats and other animals could be amplifying the H5N1 problem, though they suggested special attention should be paid to these species in areas with outbreaks in birds.
"I think we should count on the possibility that other carnivores like dogs, perhaps non-domestic ones like foxes, and all kind of other carnivores could (also) be infected," said Ab Osterhaus, a Dutch virologist and leading figure in avian influenza research.
"I think in the management of this whole problem, I think carnivores should be included."
His research group, in conjunction with the Dutch ministries of agriculture and health, has drawn up guidelines for the treatment of cats should H5N1 hit the Netherlands.
"If you have cats present in areas where indeed the virus is present in wild birds or domestic poultry, the advice is to keep cats indoors as much as possible," he said.
"And then eventually, if there is a suspicion of infection or contact, then the best thing is to quarantine the cats."
An avian influenza expert with the World Health Organization said the agency was seeking information from the institute in Germany where the testing was done, but had run into an unexpected snag: Domestic cats don't fall under the responsibility of any of the international agencies working on the H5N1 problem.
"There's no reporting agency responsible for keeping tabs on cats," said Michael Perdue, a scientist in the WHO's global influenza program.
Countries with poultry outbreaks must report them to the World Organization for Animal Health, the OIE. And infected wild animals might also be reportable to that body.
http://lfpress.ca/newsstand/News/International/2006/03/01/1467413-sun.html
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