Monday, January 09, 2006Flu pandemic survival starts and ends at home.
[Visit the Flu Wiki - EXCELLENT source of info]
Bloomberg is reporting that the H5N1 avian flu has spread beyond the initial 2 Turkey cases we heard about in the past few weeks. Now 14 confirmed cases (2 deaths, a third death is still in testing) have been reported and some 45 more hospitalized people are suspected cases.
From that report:
"It seems that the epidemic has been spreading among animals in Turkey for much longer than believed," Klaus Stoehr, who heads the WHO's global influenza program, told German radio, according to AFP.
These cases span Turkey and are not just in one small village.
For now it seems that the H5N1 strain remains B2H (bird to human), we are all just watching with trepidation for when it mutates to a H2H (human to human) strain. When that happens, it could be a matter of hours for it to go global, days for it to be apparent, weeks for it to devastate, years and years for it to settle down into an epidemic that is not so virulent that it kills a huge number of it's hosts (millions instead of billions).
US Gov issues new report for preparedness
So the government has JUST released (January 6th) its latest busy work report. I have linked it to the right on this page and the link is here too.
This report is actually interesting as it is setting the groundwork for the Martial Law that they will institute once the pandemic gets rolling (if or when it does). Take from it what you wish.
They have a small list of things you should have on hand for the "extended period" of flu impacted time we may experience (html, PDF)
There is even a listing of Flu State Plans at this page. And this page has links directly to your state flu page.
I suggest you look at the PDF for your state. More importantly, call up your local health department officials and see if they have any info on how they are going to respond on the local level (it doesn't matter what they will do in Las Vegas if you live in Portsmouth, NH). Our tiny town of 1500 held meetings on smallpox preparedness back in 2001 or 2002. That was instrumental in my realizing that there was NO plan or understanding of communicable diseases (i.e., you do NOT allow people to assemble in a location to get information, you disseminate it so that people remain sheltering in house.)
We may dodge the bullet on this and other diseases, who knows. Its not good for mental health to obsess about it but its also not good to ignore it. I think one huge take home message should be this: In a pandemic or biological attack where we humans are the vectors, YOU WILL BE ON YOUR OWN. You should have a stocked pantry, other house preparedness preparations (do NOT duct tape your house PLEASE) and understand how to keep from infecting yourself and your family.
Tamiflu resistance - evolution of a nightmare
Remember the great promise of Tamiflu, the nasally delivered anti-flu vaccine you could take if you thought you had very recently been exposed to the flu (it's a broad spectrum medicine, not targeted to H5N1). As with other viral organisms, while the H5N1 strain is mutating and possibly picking up the ability to go H2H (human to human) it is also picking up resistance to what we use to try to kill it off (very basic concepts in evolution).
The December 22nd issue of the New England Journal of Medicine reported that resistance to Tamiflu has been detected.
From that freely available report (in PDF, in HTML) we have the following diagram on how the virus picked up the resistance (oseltamivir = Tamiflu):
The neuraminidase active site changes shape to create a pocket for oseltamivir, whereas it accommodates zanamivir without such a change (Panel A). Any of several mutations may prevent the binding of oseltamivir by preventing the formation of this pocket (Panel B); the oseltamivir-resistant viruscan nonetheless bind to the host-cell sialic acid receptor and to zanamivir. The pocket for oseltamivir, illustrated by key amino acids in Panel C, is created by the rotation of E276 and bonding of the amino acid to R224 - events that are prevented by the mutations R292K, N294S, and H274Y and therefore result in resistance to oseltamivir. An E119V mutation may permit the binding of a water molecule in the space created by the smaller valine, also interfering with oseltamivir binding. None of these mutations prevent the binding of zanamivir or of the natural sialic acid substrate.
You can even see a nifty animation of this mechanism at this link. Click the little blue figure on the left side.