Sludge Watch ==> Where's the Bird Flu Pandemic?

[maureen.reilly at sympatico.ca]

Sludgewatch Admin:

Here is a thoughtful piece by Mae-Wan Ho...looking at the issue of
Bird Flu.

While the world is going through 'preparedness' excersizes, she takes
a critical look at the disease and the hype.

I must note, however, that public health preparedness experts are seldom
aware of the land application of sewage sludge and septage, and are 
generally
unfamiliar with combined sewer overflows and sewage bypasses.  Therefore 
they
tend not to figure in our sanitary sewers and sludge as vehicles of 
contagion.

Indeed, they routinely forget that flushing feces into a toilet can 
aerosolize the viruses
and bacteria into the air and onto the surfaces of the room.

One problem with land application is that where a virulent disease outbreak 
is conveyed
in sludge we generally would not have the
infrastructure to stop land application fast enough to prevent further 
spread of disease.

It wouldn't be just human-to-human transmission that we would need to 
consider, but also animal-
to-animal or animal-to-human, human-to-animal transmission as well.  Such 
outbreaks would not
be easy to detect.  Even urban outbreaks often go undetected for a long 
time.

For instance the crytosporidium outbreak in Milwaukee ... what brought it to 
light was the inabiliity to keep diarhea medication in stock on the shelf... 
it was several days before the city tap was was identified as the source of 
the outbreak and a boil water order was issued.

see post today...13 years ago Milwaukee crypto outbreak
........................................................

The Institute of Science in Society Science Society
Sustainability http://www.i-sis.org.uk

General Enquiries sam at i-sis.org.uk Website/Mailing List
press-release at i-sis.org.uk ISIS Director m.w.ho at i-sis.org.uk

This article can be found on the I-SIS website at
http://www.i-sis.org.uk/
========================================================

Press Release 11/05/06


Where's the Bird Flu Pandemic?

********************************


The hype over bird flu pandemic has greatly profited the
drug industry with little sign of an effective vaccine or
cure

Dr. Mae-Wan Ho


Sources for this report are available in the ISIS members
site. Full details here

Bird flu pandemic could kill up to 150 million and lose
US$800 billion Top UN public health expert Dr. David Nabarro
of World Health Organisation (WHO) warned in September 2005
that a mutated bird flu virus pandemic could kill up to 150
million people [1]. He was just taking up his appointment as
the new UN coordinator to lead a global drive to counter a
human flu pandemic. Nabarro said that with the "almost
certainty" of another influenza pandemic soon, and with
experts saying there is a high likelihood of the H5N1 virus
mutating, it would be "extremely wrong" to ignore the
serious possibility of a global outbreak.

The 1918 influenza pandemic killed more than 40 million; the
range of deaths in the next pandemic could be anything
"between 5 and 150 million, " Nabarro said.

The World Bank issued its own dire warning that economic
losses due to pandemic bird flu could top US $800 billion
[2].

In a letter to the nation, president George W. Bush
announced his National Strategy for Pandemic Influenza
Preparedness and Response [3], which is determined to detect
outbreaks that occur anywhere in the world, to protect the
American People by stockpiling vaccines and antiviral drugs,
and improve the US' ability to rapidly produce new vaccines
against a pandemic strain, and to be ready to respond at the
federal, state and local levels in the event that a pandemic
reaches the USA.

Because a pandemic could strike at any time, President Bush
requested $7.1 billion in emergency funding , which includes
$251 million to detect and contain outbreaks before they
spread around the world; $2.8 billion to accelerate
development of cell-culture technology; $800 million for
development of new treatments and vaccines; $1.519 billion
for the Departments of Health and Human Services and Defense
to purchase influenza vaccines; $1.029 billion to stockpile
antiviral medications; and $644 million to ensure that all
levels of government are prepared to respond to a pandemic
outbreak.

In January 2006, the United States announced in Beijing
China that it would provide $334 million to support the
global campaign against the avian flu virus [4]. This
funding is part of a broader commitment of the United States
that totals £3.98 billion recently appropriated by Congress.

"There is no pandemic flu in Louisiana"

***************************************

But by 15 April 2006, Dr. Julie Gerberding, head of the
Centers for Disease Control and Prevention, told a
conference of 1 200 of mostly health department officials
from across the state of Georgia gathered in Tacoma that [5]
there is no evidence bird flu will be the next pandemic and
there is "no evidence it is evolving in a direction that is
becoming more transmissible to people."

This was in sharp contrast to the November letter from
President Bush, which encouraged the public to prepare the
nation and the world "to fight this potentially devastating
outbreak of infectious disease." The president's letter
created so much anxiety that the audience at the Tacoma
conference wanted to know about buying surgical masks and
stockpiling food at question time.

Gerberding and other federal officials said H5N1 bird flu is
likely to reach the United States; but when that happens,
"it does not signal the start of a pandemic" or a threat to
the food supply, said Richard Raymond, an undersecretary at
the US Department of Agriculture.

Less than a week later, a press release for the 'Louisiana
State Summit' carried the headline: "There Is No Pandemic
Flu in Louisiana" [6]. "Flu season is coming to an end, and
there have not been any widespread outbreaks of the flu in
Louisiana. Nor have there been any confirmed cases of avian
flu in human in the United States. Finally, although there
has been much attention, there has not been a flu epidemic,
much less a flu pandemic."

The flu pandemic is yet to happen. The number of human cases
of bird flu has been rather modest so far - 204 with 113
deaths over three years (see Box 1) - in comparison with the
most recent pandemic SARS, which made 8439 ill and killed
812 in just four months in 2003 [7]. Part of the reason is
that while SARS was transmitted from person-to-person, bird
flu is still transmitted from infected poultry to people.

But we are told that this could change at any time. The H5N1
virus could gain the ability for human transmission by
mutation or by picking up the right genes (see "Fowl play in
bird flu", this series).

------------------------------------------------------------
-

Box 1

Global status of bird flu [8, 9]

Domestic poultry There have been 4253 outbreaks since 2003
in 28 countries in Asia, Europe, and Africa: Topping the
list are: Vietnam (2 312, 54.4 percent), Thailand (1 078,
25.3 percent), Indonesia (209, 4.9 percent), Turkey (176,
4.1 percent) Russia (121, 2.8 percent), and People's
Republic of China (79, 1.9 percent).

Human There have been a total of 204 cases of H5N1 bird flu
resulting in 113 deaths.



Country                        Cases               Deaths

_______________________________________

Vietnam                          93                    42

Indonesia                        32                    24

Thailand                         22                    14

China                            17                    12

Turkey                           12                     4

Egypt                            12                     4

Azerbaijan                        8                     5

Cambodia                          6                     6

Iraq                              2                     2


Total                           204                   113

------------------------------------------------------------
-------



The bird flu hoax

******************

Dr. Joseph Mercola, who runs a popular health website, has
been referring to "the bird flu hoax" [10] ever since Bush
first announced his National Strategy in early October 2005.
The hoax was perpetrated, Mercola and others claim, to
justify the huge sums of money given away to pharmaceutical
corporations to make vaccines and antiviral drugs.

There is currently no effective vaccine against H5N1, or
indeed against any new strain of viruses such as the
influenza virus, which mutates and evolves rapidly. Last
August, the US National Institutes of Health (NIH) announced
preliminary results of a H5N1 vaccine trial [11]. But the
vaccine was only effective at such large doses of the flu
antigen (90 m g compared to the usual 15 m g) that critics
said even if the entire US vaccine production capacity were
employed, it could produce enough only for 15 million
people, or barely 5 percent of the US population .

But the US government had already bought 2 million of the
H5N1 vaccine from the company Sanofi Pasteur based in
Pennsylvania; and intended to buy 20 million more. The test
results meant that would provide protection for 333 000 to
3.4 million people, far short of the original 20 million
goal.

So, it is down to treatments with antiviral drugs such as
ribavirin (action not understood) and inhibitors of the
viral neuraminidase - oseltamivir and zanamivir - sometimes
used in combination with corticosteroids. Other drugs such
as amantadine, which targets the viral protein M2, an ion
channel needed for the viral particle to become uncoated
once it is taken into the cell [12], are often not effective
[13]. The presence of amino acid residue Asp31 in the M2
protein of H5N1 virus invariably confers resistance to
amantadine treatment, so oseltamivir or Tamiflus (brand
name) appears to be about the only treatment (see Box 2). It
does not cure or prevent the disease, however.

Recently, H5N1 viruses with an aminoacid substitution in
neuramindase that confers high-level resistance to
oseltamirvir have been isolated from two of eight Vietnamese
patients, and both died despite early initiation of
treatment in one patient.

Nevertheless, US Defence Secretary Donald Rumsfeld, for one,
has made more than $5 million out of bird flu by selling
shares in the biotech firm that discovered and developed
Tamiflu [14]. Tamiflu is being bought up in massive amounts
by governments all over the world in anticipation of a
pandemic. More than 60 countries have ordered large stocks.

-----------------------------------------------------------
Box 2

What is Tamiflu? Tamiflu is practically the only drug
against bird flu. A website run by Swiss drug giant Roche
describes Tamiflu as "The #1 doctor-prescribed flu
medicine", recommended to be taken within the first two days
from the onset of flu symptoms [15].


Tamiflu is the brand name for oseltamivir, an antiviral that
acts by inhibiting the viral enzyme neuraminidase as an
analogue of it substrate, thereby preventing new viruses
emerging from infected cells [16]. It does not cure or
prevent the disease, but claims to prevent death.

------------------------------------------------------------
-

The drug was developed by a California biotech company,
Gilead Sciences, and is now made and sold by pharmaceutical
giant Roche, which pays a royalty on every tablet sold,
amounting to about a fifth of its price.

Rumsfeld was on the board of Gilead from 1988 to 2001, and
was its chairman from 1997. He left to join the Bush
administration in 2001, but retained a huge shareholding.
The firm made a loss in 2003, the year before concern about
bird flu started. Then revenues from Tamiflu almost
quadrupled to $44.6 million. Sales almost quadrupled again,
to $161 million last year and the share price trebled.

Rumsfeld sold some of his Gilead shares in 2004, resulting
in capital gains or more than $5 million, according to the
financial disclosure report he is obliged to make each year,
which also showed that he still held up at least $25 m worth
of shares.

Roche's sale of Tamiflu was forecast to reach £1 billion by
2007. Patients will need two 75 mg capsules a day for five
days, costing a total of £60-£100 [17].

Britain has ordered 14.6 million courses at £180 m, enough
for a quarter of the population. Germany has ordered 6m
doses. France, New Zealand and Norway planned to purchase
enough to treat 20 to 25 percent of their population.

Indeed, "experts are still predicting that the world will
soon face a flu pandemic," and 'summits' such as the one in
Baton Rouge, Louisiana, are held in each state to ensure the
entire country is ready for a widespread outbreak of the flu
[6].

To reinforce this message, an article was published online
28 April 2006 in Nature , on strategies for mitigating an
influenza pandemic based on simulations with a mathematical
model [18]. The researchers found that border restrictions
and/or internal travel restrictions are unlikely to delay
spread by more than 2-3 weeks unless they are more than 99
percent effective. Closing schools during the peak of a
pandemic can reduce the peak attack rates by up to 40
percent, but it would have little impact on overall attack
rates. Case isolation, or household quarantine could have a
significant impact on reducing overall attack rates.
Treatment of clinical cases can reduce transmission, but
only if antivirals are given within a day of symptoms
starting.

The researchers also found that given enough drugs for 50
percent of the population, household-based prophylaxis
(taking drugs in advance of being ill) coupled with school
closure could reduce clinical attack rates by 40 to 50
percent. Vaccine stockpiled in advance of a pandemic could
significantly reduce attack rates even if the vaccines are
of low (70 percent) efficacy.

Those results are good news for the drug companies; the bird
flu hoax lives on.


Bird flu disease in humans

***************************


Highly pathogenic avian influenza virus subtype H5N1 first
caused disease in 18 patients with 6 deaths in Hong Kong in
1997.

A family of five from Hong Kong visited Fujian province in
Mainland China on 26 January 2003. The two year-old daughter
developed high fever and respiratory symptoms two days after
arriving there and died of a pneumonia-like illness seven
days after the onset of symptoms. The family returned to
Hong Kong on 9 February. The father, a 33 year-old, was
admitted on 11 February after suffering fever and malaise
for four days, as well as sore throat, cough with blood-
stained sputum and bone pain. He had low lymphocyte count
and evidence of consolidation in the right lower-lobe of the
lung. He died six days after admission. Influenza A subtype
H5N1 was identified, and autopsy revealed oedema,
haemorrhage and other evidence of lung disease
characteristic of severe pneumonia. No other organ showed
signs of disease.

On 12 February, the family's previously healthy 8-year-old
son was admitted after three days with an influenza-like
illness and symptoms similar to the father. He said he had
close contact with live chickens during his visit to China.
He recovered.

The patients with H5N1 disease had unusually high serum
levels of chemokines (signalling molecules of the immune
system), and fits in with a previous report that the H5N1
virus induces large amounts of pro-inflammatory cytokines
from macrophage cultures, suggesting that cytokine
dysfunction, a 'cytokine storm' contributes to the H5N1
disease [18, 19].

According to conventional wisdom, avian influenza viruses
generally have little affinity for human respiratory
tissues, because the haemagglutinin (HA) on the surface of
the virus prefers carbohydrate side chains on the cell
surface receptors that end in SA- a -2,3-gal, whereas the HA
of human influenza viruses prefer those terminating in SA- a
-2,6-gal.

Genetic analysis indicates that H5N1 is basically an avian
virus [20], and its HA has affinity for SA- a -2,3-gal,
although isolates from birds and humans show genetic
differences indicating that the virus has changed on
infecting humans.

In mammals including humans, influenza A viruses that can
replicate are generally recovered only from the superficial
epithelium of the respiratory tract, reflecting the
anatomical distribution of trypsin-like proteases that
cleave the viral haemagglutinin, which is an essential step
for making new replicating viruses in the infectious
process. In contrast, cleavage of the H5 haemagglutinin
tends to be independent of the anatomical distribution of
protease, because of the insertion of a run of basic amino
acids at the cleavage site. This is characteristic of the HA
of all highly pathogenic avian influenza viruses, and may
contribute to the tendency of H5N1 viruses to localize to
the brain [19].

It turns out that H5N1 can cause infection of the lower
respiratory tract and severe pneumonia in humans because the
virus binds to several kinds of cells in the human lung and
lower respiratory tract [22]. These cells have surface
receptors with carbohydrate chains ending in SA- a -2,3-gal
instead of SA- a -2,6-gal typical of human cells.

Many scientists consider H5N1 dangerous enough as it is, as
it has killed more than 50 percent of the people infected.
They also believe that if H5N1 should mutate or pick up a HA
gene that enables it to recognize SA- a -2,6-gal instead of
SA- a -2,3-gal, then the virus would replicate rapidly in
human hosts and become transmitted from person to person.
Then, there would be no stopping a flu pandemic reminiscent
of the one in 1918 estimated to have killed 40 million
worldwide.

How dangerous is the H5N1 infecting poultry? Should we worry
about consuming infected poultry products? How likely is the
virus to become the agent of the next flu pandemic? Read the
next article in this series, "What can you believe about
bird flu?"




========================================================
This article can be found on the I-SIS website at
http://www.i-sis.org.uk/

If you like this original article from the Institute of
Science in Society, and would like to continue receiving
articles of this calibre, please consider making a donation
or purchase on our website

http://www.i-sis.org.uk/donations.

ISIS is an independent, not-for-profit organisation
dedicated to providing critical public information on
cutting edge science, and to promoting social accountability
and ecological sustainability in science.

If you would prefer to receive future mailings as HTML
please let us know. If you would like to be removed from our
mailing list unsubscribe at

http://www.i-sis.org.uk/mailinglist/unsubscribe.php
========================================================
CONTACT DETAILS

The Institute of Science in Society, PO Box 32097, London
NW1 OXR

telephone: [44 1994 231623]   [44 20 8452 2729]   [44 20
7272 5636]