On the sixteenth I made mention of my curiosity about the underlying cause of the new outbreak in China: mutated strain or ineffective vaccine. Today officials announced finding no meaningful mutation of the virus.

Dead chickens get H5N1 mutation all-clear
Adele Wong
Friday, December 19, 2008

The H5N1 virus found in dead chickens in a Yuen Long farm had not mutated, Undersecretary for Food and Health Gabriel Leung told the Legislative Council’s panel on food safety and environmental hygiene yesterday.

The genetic sequencing of the bird flu virus detected in the farm on December 9 did not contain obvious differences from previous viruses, Leung told the panel.

Leung also said more tests were needed to find out how the chickens contracted the virus.

[snip]

Meanwhile, an Agriculture Fisheries and Conservation Department spokeswoman yesterday explained why the government has been using an H5N2 vaccine manufactured in the Netherlands to protect local chickens from the flu since 2003, even though recent outbreaks showed the virus strain to be subtype H5N1. She said when vaccines were first introduced to local chicken farms, tests had shown the H5N2 vaccine to be effective against the viruses found in South China.

“The H5N2 vaccine is also effective against H5N1 viruses,” the spokeswoman said, adding that in 2006, the government had let US authorities test the vaccine, which also showed it is effective for use in southern China.

“However, no vaccine is 100 percent effective. The government has set up an investigation group on avian influenza to look into the matter,” she said.

Vaccinating poultry is an imperfect means of preventing infection with avian influenza virus; however, it is our best means of protecting a food source much of the world has grown dependent. Fortunately, vaccination programs work far more often than not.

I am still curious as to whether the vaccine was administered in the strength and the formula specified by vaccination protocols. I may have to remain forever curious however because vaccine from the batch(s) used may no longer exist to be analyzed.

I have confidence in China’s willingness to search out any answers that may be gleaned as to the cause or source of the outbreak, but willingness to search and investigate does not always yield answers, or at least answers of the definitive sort.

For the time being, it’s probably wise to accept the premise of imperfect vaccines and imperfect vaccine programs.

SZ

My thanks to Medical Operations Collaboration and Communications (C2) blog for alerting me to the UN’s plea for a “human rescue” package.

UN agency urges nations to fund ‘human rescue’ package needed to feed millions

16 December 2008 – Without a “human rescue” package, costing a mere fraction of the financial bailout and economic stimulus initiatives tabled in Western Europe and the United States, millions of people around the world will go hungry early next year, warned the United Nations World Food Programme (WFP) today.

WFP, which aims to feed nearly 100 million of the world’s hungriest people in 2009, announced that it will start the New Year needing $5.2 billion to urgently support its programmes combating global hunger.

Unless donors provide a rapid injection of funds, the agency’s warehouse stocks will run out by the end of March, condemning millions of people in Haiti, the Democratic Republic of the Congo (DRC), Ethiopia, Kenya and other hunger hot spots to live without essential food assistance.

“As we take care of Wall Street and Main Street, we can’t forget the places that have no streets,” stressed WFP Executive Director Josette Sheeran, speaking during a visit to India, which has the single largest undernourished population in the world.

With just one per cent of the money proposed for bailout packages across the developed world, Ms. Sheeran said that WFP could fully fund its work, and make a mark toward meeting other urgent hunger needs. Feeding all 59 million hungry school children worldwide, for example, would only cost $3 billion per year.

“The world is poised to produce trillions for financial rescue packages. What will they produce for the human rescue?” asked Ms. Sheeran.

“World leaders need to be confronted with the values implicit in the policy choices they are making,” she noted.

WFP’s urgent call comes off the back of historically high food prices and market volatility, which is compounded by the financial meltdown in the developed world, spilling into the developing world as incomes are affected, and trade, capital flows and remittances slow.

This month alone, the Kyrgyz Government asked WFP to help feed 600,000 people pushed into desperate hunger following a sharp decline in the remittances which account for 20 per cent of the country’s gross domestic product (GDP).

Ms. Sheeran noted that hunger can lead to civil unrest as witnessed in Haiti, where people were killed and a prime minister was driven from office when food prices soared earlier this year.

“We are at a critical juncture where we risk watching hunger spiral out of control as the world’s population is set to climb toward 9 billion [by] mid-century,” she said, adding “We can’t afford to lose the next generation.”

From the World Food Programme’s news release:

As we each suffer our personal financial anxieties and losses it is easy to forget that to 2 billion people around the world we are unimaginably rich and blessed. Yes, even residents of G8 countries are struggling, but that struggle is nothing like the struggle to survive of the 100 million anticipated in the program against global hunger.

No country can support these needs alone, even in good economic times, but as Washington contemplates ways to rescue failed industries, I hope that my government finds a way to continue to support the WFP. After all, it’s sobering to think about the fact that one of the listed countries is an immediate neighbor [Haiti].

SZ

It is not unusual to have an uptick in areas experiencing outbreaks of H5N1 [in poultry] when temperatures trend to the colder end of the thermometer. Today Mainland China announces a significantly sized chicken cull.

Via The Wall Street Journal
[Excerpt]

DECEMBER 17, 2008

By GORDON FAIRCLOUGH

SHANGHAI — Chinese agriculture officials ordered the slaughter of more than 300,000 chickens after they found poultry infected with a lethal form of avian influenza — the first such outbreak publicly reported in mainland China since June.

The discovery of the H5N1 form of the bird-flu virus in two areas of Jiangsu province northwest of Shanghai follows recent outbreaks in India, Hong Kong and Southeast Asia, raising the risk of human infections during the winter.

After routine testing turned up signs of the H5N1 virus in chicken eggs on farms in two locales, the agriculture ministry said it moved to kill 377,000 chickens and ban the transport of poultry in or out of the affected areas.

China has a “robust” vaccination program for poultry, both chicken and duck. China pioneered a successful vaccination program in domestic ducks, something not previously managed, so when I say their program is “robust” I mean it is well developed and well deployed.

That said however, there have been problems with efficacy of substandard batches of vaccine, some reported little more, or actually, plain water. It is not the production of substandard vaccine, rather a few unscrupulous distributers, reminiscent of the melamine adulterated milk products scandal of late.

I am wondering if the circulating strain has shifted away from the strain used to produce the vaccine, suggested in the Hong Kong outbreak, or if we are seeing the result of a substandard vaccine. Either one seems to be a reasonable possibility at this time, and neither one would bode well for this winter’s resurgence of H5N1.

As usual, we will just have to wait to see how everything unfolds, or even if it unfolds.

SZ

Egypt announced today that a 16-year-old girl, Samiyah Salem, died of H5N1.

Via Reuters:

CAIRO, Dec 15 A 16-year-old girl died of the deadly H5N1 strain of bird flu on Monday, the 23rd fatality and 51st case of the disease among humans in Egypt, state news agency MENA said.

[snip]

The official said Salem began suffering symptoms a week ago, after two of the household ducks died and the remainder of the flock was slaughtered in the house.

Salem was subsequently admitted to hospital with a high fever, vomiting and diarrhea, and then transferred to intensive care. She was treated with the antiviral drug tamiflu, but suffered a pulmonary infection and respiratory failure, and died on Monday.

There are no further details about the course of her illness, or if there were preexisting health issues. Egypt has a better survival rate than most countries that have suffered human infections. We do not yet know if that is a function of the circulating strain, a function of the medical treatment(s) received, the timing of the treatments, or some combination.

Given that young Samiyah presented with high fever, vomiting, and diarrhea, severe dehydration could have been a contributor. Severe dehydration is a very serious condition in and of itself, and then to develop what seems to be pneumonia, a healthy young person, healthy in every other way, could rapidly succumb, even with antiviral treatment.

I say all of that because it might be all too easy to assume that Tamiflu was wholly ineffective. We should be cautious with our assumptions however, as we simply don’t have enough details.

Since Egypt has a laudable record of transparency and international collaborations, I am hopeful that details will be made available to those who might benefit in a “broader picture” way.

SZ