Bird flu 'could mutate to cause deadly human pandemic'

[Kassy]

The Fouchier article is finally published in Science and generating a lot of stories in the press.

Bird flu 'could mutate to cause deadly human pandemic'

http://www.bbc.co.uk/news/science-environment-18534676


Mutant-Bird-Flu Study Fuels Fears of Airborne H5N1

http://www.wired.com/wiredscience/20...red+Science%29

And many others have been published.


Thread with events before the publication:
http://thisbluemarble.com/showthread.php?t=41749

[sandyd]

Are we sitting ducks waiting for this?

any hope on a vax?

[NowVoyager]

Granted I just glanced at the articles and I seem to recall the first study using the ferrets regarding H5N1 garnered a fair amount of dismissal from some in the field.

What's your take on this latest study?

It seems to still be a question of whether such mutations could occur in nature (outside a closed study environment), but it seems to me that this latest round adds weight to the likelihood of H5N1 becoming airborne and more easily transmitted.

JMO but with worsening economic times globally, less money for preventative care, less access for many to medical care and in some cases (likely to increase?) medical providers having dwindling access to basic medications; plus more people living either in less healthy conditions or in closer quarters (families / people moving in together to share - pool, resources / expenses), that a 'perfect storm' of conditions is potentially being created.

I've noticed, based on the rather numerous health care providers I deal with, that many have noted they're seeing fewer patients in their private practice ( fewer snowbirds, less need to seasonal hiring) and more of their regular patients are losing health care benefits. Also the VA system is greatly overwhelmed with veterans who would other wise have access to other healthcare options, and now use the VA as their sole health care resource for all their non service connected health issues.

Can't personally speak to local / community based health care clinics that offer very limited and very basic health care to those without any other recourse; however, from what I've heard from others, is that funding cutbacks are making it difficult for them to handle an increasing number who qualify for their services.

[Kassy]

Not really. It's just nice to get this confirmation after many years of flubeeing. It started out at Qinghai lake which was in 2005 or so. There had been many human cases in Asia before that.

So we know that it could infect humans through animals.

Later on we have seen chains of transmission but never long ones. The H5N1 virus wasn't efficient enough in airbourne transmission. The chains/clusters would be family members with a lot of close contact (kids/parents or vice versa).

Still there never was a reason to think it could not develop into a human pandemic but a virus does so at it's own timing.

It is present in a number of countries where cases pop up occasionally. They are reported if patients die but we only hear about the severe cases that end up in hospitals and get tested. There could be many undetected mild cases.

The last pandemic, the H1N1 swine flu popped up out of nothing.

H5N1 could do the same.

We are not sitting ducks.

There are at least 2 or 3 human H5N1 vaccines.

There's more in the development pipelines like a more universal flu vaccine and DRACO might work too.

When H5N1 goes fully H2H it will be more like your normal flu.

Mostly people think about that "big CFR" but that's just an artifact of selection.

[penguinzee]

Bloomberg picked it up too...

http://www.bloomberg.com/news/2012-0...udy-finds.html

Apparently, the US Biosecurity panel wanted to censor the paper, fearing that this info "could fall into the wrong hands"... like al-Queda has a level 3 lab handy...

The question now is: Is there enough pressure on the virus for it to move on to another host (us)? I know that we're likely going to be a lot more stressed (look at the economy!) here over the next few years, leaving us more vulnerable to something like this spreading undetected...

Franc (penguinzee)

[Oric]

If i remeber correctly this was being discussed in old current events back in 2004, it took 8 years for scientists to publish a paper on this ?

[Samen]

Mhh, i do not think al-Qaeda has the same bio-security standards enforced as say in the US.
Level 2 works just fine. And building a lvl 2 is no biggie if you don't follow all the regulations, apart from the structure some easily obtainable containment equipment and and a ton of 20 year old lab gear floating around the markets for peanuts, you set.

[Sysiphus]

Apparently, the US Biosecurity panel wanted to censor the paper, fearing that this info "could fall into the wrong hands"... like al-Queda has a level 3 lab handy...

But, would a level 3 lab be necessary? I seem to recall some dead AQ members in a Libyan or Tunisian desert a while back, and it being pinned on plague or something like that. Was never much follow up on that story, was there?

I'm with Osterholm on this one. I don't think they should have published it. This stuff is really easy to do now, and someone is probably going to take a shot at it. These are not the most brilliant folks, and they would not know how to do it on their own. They are engineers, maybe a doc or two, but not virologists, pathologists or microbiologists. Now these technicians have an instruction manual. Yippee!

[gsgs]

http://www.virology.ws/2012/06/21/in...ets-round-two/
http://www.sciencemag.org/content/336/6088/1534.full
http://www.cidrap.umn.edu/cidrap/con...2fouchier.html

http://www.virology.ws/2012/06/21/in...ets-round-two/
http://www.virology.ws/2012/05/02/ka...us-in-ferrets/


Fouchier:IDN/5/2005(H5N1) + Q222L(4),G224S(4),E627K(1),T156A(4),H103Y(4)
http://www.sciencemag.org/content/336/6088/1534.full

Kawaoka:VNM/1203/2004(H5N1)(4)+Mx(1,2,3,5,6,7,8) + N224K(4),Q226L(4),N158D(4),T318I(4),
http://www.nature.com/nature/journal...ture10831.html


that was with H3-numbering, but H5 hardly aligns to H3,
so here with H5-numbering : (coding region, amino acids)


Kawaoka : N170D,N236K,Q238L,T331I (?) LIKKnSTY,TRSKVnGqSG,YVKSNRLVLAtGLRNS
Fouchier : Q238L,G240S,T172A,H119Y -- FNDYEELKhLLSRIN,RNVVWLIKKNStYPTI,TRSKVNGqSgRME

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

170  1081   -:253 B:2 D:1051 E:2 G:20 K:1 N:3040 S:3 T:1 X:1 
236    22   -:255 D:3 H:15 K:2 N:4097 X:2 
238     6   -:256 K:1 P:1 Q:4112 R:2 X:2 
331     9   -:48 I:1 K:3 L:1 P:1 T:4317 X:3 
-----------------------------------------------------
119     5   -:269 H:4100 P:2 R:1 X:1 Y:1 
172 2141   -:253 A:2066 I:5 K:3 S:62 T:1980 V:3 X:2 
238    6   -:256 K:1 P:1 Q:4112 R:2 X:2 
240    4   -:256 A:1 E:1 G:4114 X:2 
-----------------------------------------------

[NowVoyager]

Originally Posted by Sysiphus

But, would a level 3 lab be necessary? I seem to recall some dead AQ members in a Libyan or Tunisian desert a while back, and it being pinned on plague or something like that. Was never much follow up on that story, was there?

I'm with Osterholm on this one. I don't think they should have published it. This stuff is really easy to do now, and someone is probably going to take a shot at it. These are not the most brilliant folks, and they would not know how to do it on their own. They are engineers, maybe a doc or two, but not virologists, pathologists or microbiologists. Now these technicians have an instruction manual. Yippee!

I too recall that story about the AQ members dying of a type of plague. And yes, the MSM quickly dropped the story.

They are plenty of those nations sympathetic to AQ and others, who would have both money and resources to provide the equipment and individuals needed to set up a clandestine lab.

[Justathought]

Originally Posted by Kassy

We are not sitting ducks.

There are at least 2 or 3 human H5N1 vaccines.

There's more in the development pipelines like a more universal flu vaccine and DRACO might work too.

When H5N1 goes fully H2H it will be more like your normal flu.

Mostly people think about that "big CFR" but that's just an artifact of selection.

Totally Agree!!

There is nothing new in the news that we are just a few mutations away from airborne transmission of H5N1. The CDC, WHO, and virologists around the world (see Dr. Niman), have been closely watching the evolution of the H5N1 virus for just such a nasty turn of events.

So far the H5N1 virus that appeared from the Qinghai lake recombination/mutational event has evolved into a number of new and different stains of H5N1. Some of these strains are Tamiflu resistant, others more or less lethal to humans, and/or infect humans more efficiently.

No doubt, in some corner of the world, H5N1 will find a compatible common flu virus to swap bits with to acquire airborne qualities. That could happen tomorrow or 5-10 years down the road.

With this probability in mind, it is imperative to stockpile essential medications and a month or two of food and water for family and pets (there could be several months of chaos).

In the last 5 years, vaccine technology has been revolutionized. Production facilities have been built and rebuilt, and regional and federal vaccine distribution plans updated (the H1N1 Pandemic was a good trial run).

When an airborne H5N1 virus shows up, the U.S. will make a seed vaccine and send it to other countries and vaccine manufacturers for production. Within 3-6 months we should have enough vaccine to start localized distribution. How much vaccine we can make without using egg-based technology will determine how fast vaccine can be made.

H5N1 is a very deadly virus and as Tamiflue Resistance becomes more common among the H5N1 strains, death becomes more certain for the infected. Already the fatality rate (CFR) among people infected with H5N1 is 50%-85%.

The CFR of an airborne H5N1 could be lower or higher than this depending on the qualities of the final infecting virus, the heredity of the populations involved, and the availability of ventilators and high quality medical care.

Before a vaccine is available, the first wave of infection/fatalities could be stunning. It is interesting to note, however, prior experience with H5N1 outbreaks indicate it seldom infects folks over 60 years of age. Apparently prior HN type common flu infections (and vaccines?) provide some cross-over protection.

Until a vaccine is available, the best protection is home quarantine. Many of the people who survived the 1919 Pandemic lived on isolated home farms at the time or had parents who did not let them (as then children) leave the house.

[Old Lurker]

Once H5N1 is airborne why would it stop mutating? The reason you need a flu shot every year is flu mutates rapidly.

I was hoping there was some sort of natural barrier and H5N1 could never go airborne. That seems to be out the window now and its a matter of time. A high CFR flu that would change a bit each year is a very scary thing.

Maybe our society will realize and direct the money going to sports and reality TV towards getting ready!!

Who am I kidding. We are all on our own......

[gsgs]

there could still be that barrier. But shifted a bit.
The new strain, could it compete with other flu ?
Can it get high R0 ? They might figure it out,
but would it be published ? We may have to watch
when they increase preparation ...

[Justathought]

Not on our own.

As we chronicled on the old Curevent Flu Blog website, the U.S. alone has spent Billions of dollars on H5N1 vaccine, local and federal preparedness, and vastly improved vaccine technology. Billions more have been spent by other governments around the world. The CDC and the WHO have beefed up their surveillance and technical capacity, and cooperative networks between nations and scientists have been developed (where do you think Dr. Niman gets the information he so voluminously publishes online?).

After about 5 years, we are in pretty good shape (as a world) to combat an airborne H5N1 Pandemic. I remember Dr. Fauci saying in 2007 that we needed 4 years to be ready to survive a H5N1 Pandemic. He was saying it would take that long to build and re-build vaccine production facilities around the world and improve vaccine technology so vaccine could be made in large batches in vats instead of in short supply chickern eggs. Last year I saw a picture of a happy Dr. Osterholm standing next to several huge metal vats (cell technology) which were on "standby" ready to be used in a vaccine production emergency.

So things are looking up. Could be better of course, but will become so if the need arises. In such tight economic times I have been surprised at the willingness of the U.S. and other governments to spend money on vaccine stockpiles and other readiness initiatives (and the work goes on to improve vaccine technology and production facilities).

The recent H1N1 Pandemic scare was such a good ""test run" for a deadly Pandemic that it could be considered a happy accident, or the Hand of God.

[gsgs]

influenza vaccine capacity:

2006:1050M doses monovalent per year
2011:2400M doses monovalent per year
(2014:5000M)

worldwide

[Old Lurker]

Excellent points Justathought. I agree, a lot has been done and most western countries are way more prepared which is a good thing. A lot of people on this board are also preparing (for this and other possibilities).

I think social networking will also play a large part in tracking and isoaltion if the worst happens.

My real concern is the third world which is not prepared and will act as a breeding ground for strain after strain of H5N1 that can bypass last years vaccine.

Will there be one vaccine that can cover all strains?

To me it seems nature is looking for the key to Pandora's box. I hope the key is never found or does not exist.

[Kassy]

My real concern is the third world which is not prepared and will act as a breeding ground for strain after strain of H5N1 that can bypass last years vaccine.

I don't think it will change that much after it reaching the 'final human form' when it accumulates all missing changes it needs. The recipe is pretty stable every pandemic.

We put a lot of effort in and there's more the enough vaccine.

Will there be one vaccine that can cover all strains?

I think so. Eventually.

There are some lines of research aimed at flu.

Using a different , a more common & unchanging target in Ha...our seasonal vaccines are teaching the immune system to recognize the tips of the parts that make it a H1 or H3 or a H1oldschool seasonal/H1swineflu. The new approach would be like teaching the immune system to look for lower parts, like using trunks to identify the trees instead of the surface of the foliage.

And there's another research project aiming at different parts of the flu genome for a vaccine, forgot which (M1 or/and M2?).

Then there's DRACO. Different but useful.

[Kassy]

Published Date: 2012-06-25 16:11:52
Subject: PRO/AH/EDR> Avian influenza, human (57): seroprevalence debate
Archive Number: 20120625.1179950

AVIAN INFLUENZA, HUMAN (57): SEROPREVALENCE DEBATE
**************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Fri 22 Jun 2012

Source: CIDRAP (Center for Infectious Disease Research & Policy) News [edited]

http://www.cidrap.umn.edu/cidrap/con...un2212cfr.html





Debate over H5N1 fatality rate flares again


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


In the latest chapter in an ongoing debate over the true case-fatality ratio (CFR) for human H5N1 influenza infections, a group of leading flu experts has written a Science article rejecting the idea that millions of H5N1 infections have gone undetected.



The debate was sparked by the controversy over publication of 2 studies involving lab-created H5N1 viruses with airborne transmissibility (both of which have now been published in full [see ProMED-mail report Avian influenza, human (56): airborne spread mutations 20120622.1177785]). Some proponents of publishing the full details of the studies argued that the true H5N1 case-fatality ratio (CFR) is probably much lower than the nearly 60 percent observed in confirmed cases, because in their view many mild or asymptomatic cases have likely been missed.



In February [2012], Science published a meta-analysis by a team from Mount Sinai School of Medicine in New York City who said that on the basis of seroprevalence studies, the infection rate in populations exposed to H5N1 could be 1 to 2 percent, which would probably translate into millions of infections globally. The authors were Taia T Wang, PhD, Michael K Parides, PhD, and Peter Palese, PhD.



In the article published today [22 Jun 2012], flu experts write that Wang and colleagues "overinterpret the results of seroprevalence studies and take too little account of underlying uncertainties. Although the true risk of death from H5N1 infection will likely be lower than the 60 percent of reported laboratory-confirmed cases, there is little evidence of millions of missed infections."



The article is accompanied by a response from the Mount Sinai group, who observe that the combined rural population of countries where H5N1 outbreaks occur is about 1 billion and assert that the tests used in seroprevalence studies probably miss many cases.



The 1st author of the article published today is Maria D Van Kerkhove, PhD, and the senior author is Neil M Ferguson, D Phil, both of the Medical Research Council Centre for Outbreak Analysis and Modeling at Imperial College London. Several other widely known flu experts are co-authors.



The main way to detect asymptomatic or subclinical cases is to conduct seroprevalence studies, looking for H5N1 antibodies in people who weren't sick but may have been exposed to the virus, such as contacts of confirmed case-patients, poultry cullers, or residents of an area where poultry outbreaks occurred. In nearly all such studies conducted since 2003, few people tested positive, if any.



The Van Kerkhove article says that H5N1 cases in both the numerator and denominator of the CFR are undoubtedly being missed, since in some disease-related deaths the cause remains undetermined and some sick people never seek medical care. But it notes that in a recent systematic review by Van Kerkhove and others, most studies found no seropositive individuals, and the seropositive rate in the rest was less than 3 percent.



That review and others have pointed up the limitations of seroprevalence studies and cautioned against overinterpreting low levels of seroprevalence as signaling actual infection, the authors write. They note that findings are clouded by a lack of standardized serologic assays, variable criteria for seropositivity, and cross-reactions in people who have been exposed to seasonal flu or vaccines.



"Populations with no known exposure to highly pathogenic H5N1 viruses also manifest low, but detectable, levels of seroprevalence, and it is unwise to infer asymptomatic H5N1 infection on the basis of such low levels of seroprevalence," Van Kerkhove and colleagues write.



For these reasons and others, the article says, the suggestion by the Mount Sinai group that millions of H5N1 infections may have gone undetected "represents an incautious overinterpretation of limited and uncertain data."



Even if the true number of infections were 60 times as great as the official number, the authors add, "natural H5N1 viruses would still be 100 times as lethal as the 2009 H1N1 pandemic virus. The precautionary principle dictates that we continue to assume that natural H5N1 infection in humans carries a high risk of death."



In a short response to the Van Kerkhove article, Wang and Palese of Mount Sinai write that 4 of the countries that have H5N1 outbreaks --Viet Nam, Indonesia, Egypt, and China -- have a total rural population of about 1 billion, and each year, "some fraction of those people is exposed to H5N1," with studies suggesting 1 to 3 percent have been infected.



"Recent reports of human antibodies or of T cells specific for H5N1 viruses support the 1 to 3 percent rate of infection or provide evidence for infections without detectable antibodies," Wang and Palese write. "Over the many decades that H5N1 viruses have been circulating in poultry, millions of people have likely been infected."



Further, they assert that serologic tests used in seroprevalence studies are more likely to underestimate than overestimate the number of positives: "The lack of sensitivity of H5N1 seroassays is well documented, as is the short period in which serum H5N1 antibodies can be detected in infected individuals. The high rate of false negative results from serum-based assays is exemplified by the rate of only about 70 percent seropositive findings from patients with polymerase chain reaction-confirmed H5N1 disease -- and this is under the best of circumstances, when the time of infection is known."



Finally, Wang and Palese dismiss as "arbitrary" the statement that if H5N1 infections were underestimated by a factor of 60, the virus would still be 100 times as lethal as the 2009 H1N1 virus.



References


----------


1. Van Kerkhove MD, Riley S, Lipsitch M, et al: Comment on "Seroprevalence for H5N1 influenza virus infections in humans: meta-analysis." Science 2012; 336(6088): 1506; available at http://www.sciencemag.org/content/336/6088/1506.2.full

2. Wang TT, Palese P: Response to comment on "Seroprevalence for H5N1 influenza infections in humans: meta-analysis." Science 2012; 336(6088): 1506; available at http://www.sciencemag.org/content/336/6088/1506.3.full

3. Wang TT, Parides M, Palese P: Seroevidence for H5N1 influenza infections in humans: meta-analysis. Science 2012; 335(6075): 1463; available at http://www.sciencemag.org/content/335/6075/1463.full



[Byline: Robert Roos]



--

Communicated by:

ProMED-mail

<promed@promedmail.org>

[The outcomes of investigation of the seroprevalence of H5N1 influenza virus infection in the human population seem finely balanced. It may be that the question of the true case-fatality ratio for human A/H5N1 influenza virus infection will not be resolved in the immediate future.



It might be more productive to turn attention to the genetic, physiological, and other characteristics of the 357 individuals (as of 7 Jun 2012) who have succumbed to avian A/H5N1 virus infection among the approximately 1 billion individuals presumed to have been exposed to infection. - Mod.CP]


http://www.promedmail.org/direct.php...120625.1179950

To that last promed comment: i think it would be good to do a very thorough seroprevalence study in some area we know had bird flu and at least some human cases.

There's an annoyingly wide margin to guess in (as todays news on the H1N1 swine flu shows).

[gsgs]

Sensenbrenner not happy how this was handled:
http://globalhealth.kff.org/Home/Dai...+Policy+Report)

[Justathought]

Originally Posted by Old Lurker

To me it seems nature is looking for the key to Pandora's box. I hope the key is never found or does not exist.

Even if found, it has to survive to infect and spread among susceptible humans to do us deadly "Pandemic "damage.

Several years ago someone at our old flu blog site speculated that the "key" had been found.....and lost again.

The hypothesis was something like; a chicken was infected with H5N1, eaten by a dog, which was snacked on by a bird. The deadly mutation was created in the bird who flew over a road and was hit by a truck!!

We should be so lucky, and maybe we have been...

[Kassy]

The question is: what will be unlocked.

H5N1 will be as transmissable as all human flu's but will it be as deadly as it looked in 2005? Not quite because the picture we get is from a selection of cases anyway. Only the top of the iceberg & only the more severe cases.

We have tons of vaccine too so we're sort of ready now or at least we are in a much better position then in 2005.

H5N1 will get there at some time it just doesn't care about our attention spans or our expectations.

[gsgs]

You can’t put a number on it,” said Fauci

if Fauci "can't", others can and hopefully will.
That just means, we will not so much consider
Fauci's opinion on this issue, sigh.

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

Derek Smith said :
> But asking whether a five-mutation strain could evolve in human hosts,
> was like asking if it could ever snow in the Sahara — unlikely, but not inconceivable.

comparing it with weather events means that experts "can"
and will put numbers to it.

January 20, 2012 – BECHAR, Algeria - Snow fell Tuesday in the Sahara Desert in western Algeria.

-----------------------------------------------
> Asked if a rogue researcher could now try to duplicate Dr. Fouchier’s
> work, Dr. Fauci said it was possible. But he argued that open discussion
> was still better than restriction to a few government-cleared flu
> researchers, because experts in unrelated fields, like X-ray
> crystallography or viral epidemiology, might take interest
> and eventually make important contributions, he said.

sure, but what is more likely ? I don't count on the X-ray people
to save us. 80 years of flu research didn't achieve a lot so far.
Best achieved is presumably antibiotics against bacterial pneumonia.
And how shall knowing these special mutations help flu-research ?
The only thing that comes to mind is surveillance and watching
and concentrating on the dangerous strains.
But that doesn't need publishing.

----------------------------------------------------------------------
> The only groups who might logically consider using such
> a weapon are those for whom humans are the problem,
> such as environmental extremists and animal-rights activists,
> or apocalyptic sects, such as the Japanese terrorist cult
> Aum Shinrikyo, which released sarin gas in the Tokyo underground
> in 1995. Then there are those who do not care about casualties,
> such as a state or a regime that believes it faces imminent
> existential threat, or suicide fighters.

or any group who is desperate enough. E.g. in a war, when the
world knows that the country/dictator has H5N1 panflu weapons, they
will not allow it to become desperate enough to use it.
So it makes sense to have such weapons, and that bares the risk
of lab escapes.
And normal terrorists can also well make use of it.
They can threaten to use it so to press the world to
fulfill conditions. They don't want to use, but will make
it almost automatical if the conditions aren't met.
So they can be realatively sure that the conditions are met.
--------------------------------------------------------------------
Tim Trevan:
> Precise calculation is not possible, but the evidence strongly suggests that the
> increase in risk is quite small.
-------------------------------------------------------------------
> “There is always a risk,” Dr. Anthony S. Fauci, the director of the National Institute
> for Allergy and Infectious Diseases, said in a telephone news conference held by
> Science. “But I believe the benefits are greater than the risks.”

I think it will turn out in the next years, that he overestimated the benefits ...
----------------------------------------------------------------
> “done something really, really stupid” and had “mutated the hell out of H5N1”
someone suggested this was maybe incorrectly translated. Any Dutch-speakers here ?
------------------------------------------------------------------
> up to three in a single human is “a possibility,” said Derek J. Smith,
> “Five mutations is pretty difficult, but we don’t yet know how difficult it is

reminds me to Fujian H3 in 2002. Suddenly 11 mutations in HA out of nowhere.
T31C,C121A,G156T,T273G,C511A,A512C,G648A,G1011A,C1 044T,T1149C,C1642T
only 3 nonsynonymous, though.
We've seen multiple mutations in prolonged infection in immunodeficient people
-------------------------------------------
has someone read the paper ? 6 ferret sequences at genbank with many common
mutations, I haven't yet found which viruses went to which ferrets, can't be that
all these 14 multi-mutations developed independently ?!?!
Also, they started with a different,special variant of A/IDN/5/2005(H5N1) , why ?
-------------------------------------------------------------------------
“It’s possible that the chances are one in a thousand, and we’ve just gotten lucky,”
Dr. Smith said. “Or it’s possible that the chance is one in a million and it might not
happen for a long time.”
--------------------------------------------------------------------
> No one knows the probability that H5N1 would reassort with a human flu.
everyone has a subjective probability
-----------------------------------------------------------------------
> “We really don’t talk about it, because so little is known about the probability of it,” said Dr. Smith.
we should.
---------------------------------------------------------------------------
Fauci ,
> hopes scientists will be able to amass a longer list of potential mutations,
> and even find a common denominator in how they alter H5N1. It might then be
> possible to monitor emerging strains for signs that they are about to cross over into humans.
> That may be the real home run for surveillance,
OK, but we could vaccinate people in countries with more dangerous strains and concentrate on those.
If e.g. it turns out that Indonesia is dangerous, but -Qinghai,Fujian,Vietnam are not,
then we could concentrate on IDN. ~Half of efforts saved
Or we could even increase our efforts to eradicate that one strain.
Or even introduce another H5N1 to that country hoping that it will
replace the more dangerous one
We needn't make the mutations public now, though.
---------------------------------------------------------------------------
Fouchier adds.
> Very little has gone wrong so far, so why would that be different now?”
because things have changed. Now we have reverse genetic
---------------------------------------------------------------------
> In 2002, for reasons that are still unclear, the viruses started hopping back into wild birds
ahh, wasn't it in wild birds all the time ? AFAIK it didn't go from poultry to wild birds ((?))
except occasional, e.g. one of the Qinghai strain components afair
----------------------------------------------------------------
2.3.2.1, is of great concern to Webster.
--------------------------------------------------------------------
Palese suspects that the severe cases have simply inhaled high doses of the virus.
But Peiris says that this cannot be the sole explanation.
-------------------------------------------------------
Wendy Barclay,
> not quantify the odds or reassortment. If you force the event, it'll happen, but I haven't seen
> anyone do the experiment in a more natural way,
nature does. We have much data to estimate the likelyhood of double infection
and reassortment.
-------------------------------------------------------------
Farrar:
I think the great worry is that a purely avian virus somehow crosses over to us,
H5N1 tops the list of concerns
-----------------------------------------------------------

[Kassy]

I moved the posts about Cambodia & Sydney into a seperate thread:

http://thisbluemarble.com/showthread.php?t=47535

[Old Lurker]

I remember at the end of the movie Twelve Monkeys when the female scientist went back in time to find the original virus strain. I think in the movie they were looking for the same thing. A part of the virus that stays common through multiple mutations.

It would be great if we can find the same in H5N1 and get a vaccine before H5N1 finds a way to go airborne between humans.