Interpandemic Period
Phase 1: No new influenza virus subtypes have been detected in
humans. An
influenza virus subtype that has caused human infection may be
present in
animals. If present in animals, the risk of human infection or
disease is
considered to be low.
Phase 2: No new influenza virus subtypes have been detected in
humans.
However, a circulating animal influenza virus subtype poses a
substantial risk
of human disease.
Pandemic Alert Period
Phase 3: Human infection(s) with a new subtype, but no
human-to-human spread,
or at most rare instances of spread to a close contact.
Phase 4: Small cluster(s) with limited human-to-human
transmission but spread
is highly localized, suggesting that the virus is not well
adapted to humans.
Phase 5: Larger cluster(s) but human-to-human spread still
localized,
suggesting that the virus is becoming increasingly better
adapted to humans,
but may not yet be fully transmissible (substantial pandemic
risk).
Pandemic Period
Phase 6: Pandemic—increased and sustained transmission in
general population.
The pandemic in birds is in Phase 6. Depending on the findings
in
frightening new developments in China, we are either in Stage 4,
5 or even 6.
Here are the important facts:
What IS This Thing? A Primer
As events unfold, a simple understanding of some of the
nomenclature
you will be hearing might help you to see the big picture.
Influenza A viruses
such as this avian influenza, belong to a subfamily of viruses
called
Orthomyxoviridae. They have variable shapes, but most are ovals
or spheres a
mere 80-120 nanometers in diameter. A nanometer is one-one
billionth of a
meter. You need an electron microscope to see them.
How they are constructed is the key to their success (or
failure) at infecting
animals and/or humans. Their genetic material, at the core of
the virus, is
divided into eight segments made of RNA (ribonucleic acid). Each
segment has
a code for producing one of eight different proteins
(polypeptides). Each of
these eight proteins has a role in infection and/or replication
(billions of
copies) of the virus. Two of these proteins form spikes that
stick out of the
fatty (lipid) envelope surrounding the virus’s core. One type of
spike is
called Haemagglutinin or HA, and the other type of spike is
called
Neuraminidase or NA. Scientists use even shorter nicknames for
these proteins:
H and N. To make things even more interesting, there are 15
known H types
(serotypes) and 9 known N serotypes. Now I think you might be
starting to see
the big picture: A virus can have an H spike that is either a
1,2,3,4…..or 15,
and it can have either a 1,2,3,4…..or 9 N spike. The nickname of
the dangerous
form bird flu that you have been hearing about lately has a #5 H
spike and a #1
N spike, or H5N1. These may change as time goes on, but for now,
this is the
beast we are dealing with, though it is a bit more interesting.
There are a
number of H5N1 serotypes with reassortments and recombinations
of genes and
gene segments circulating throughout Asia. Some are more
pathogenic than
others. Some have picked up human influenza gene sequences that
allow them to
more efficiently infect humans. This change is very serious and
has the effect
of increasing the risk of efficient human to human transmission,
the critical
step in the emergence of a great pandemic.
Anatomy of a Pandemic
Here is a brief summary of where we have been and where we are,
according to
virus recombination expert, Dr. Henry Niman, President of
Recombinomics, a
research firm specializing in the molecular evolution of
infectious disease
agents. This information is current up to last night:
1996: H5N1 isolated from a duck. Guangdong Province, China.
Phase 2
1997: H5N1 infects 18 humans, kills 6, in Hong Kong. Phase 3.
According to
Dr. Henry Niman of Recombinomics (www.Recombinomics.com), this
virus was
similar to the 1996 isolate in H and N, but was a new strain
with several
internal genes that matched genes in H9N2 and H6N1 viruses
(caused by
reasortment). Plus, there was evidence of exchanged genetic
material within
genes (recombination) resulting in variations normally found in
mammalian virus
isolates (humanization).
Antibodies to H5N1 found in health care workers with no
symptoms, so
H5N1 transmitted to humans inefficiently. Early Phase 4.
1997-2003: Evolution of H5N1 and re-emergence in a Hong Kong
family visiting
Fujian province in China. Daughter died in China. Father and son
returned to
Hong Kong. Father died. H5N1 isolated from both father and son.
One of the
genes inside the virus had changes that made it resistant to the
anti-viral
medicine, amantadine. The gene was similar to amantadine
resistance genes in
pigs. Early Phase 4.
2004: “Explosion” of H5N1 across Asia: Vietnam, Thailand, China,
Japan, South
Korea, Indonesia and more Asian countries that did not isolate
the viruses.
Human cases only in Vietnam and Thailand. More evolution toward
mammalian
isolates had occurred.
2004: Fatal human-to-human transmission. Several small clusters
occurred within
families. In each case, someone in the family was exposed to
chickens and fell
ill. Then family members became ill 5-10 days later. These
members apparently
became exposed when caring for their sick loved ones. (Bimodal
transmission)
One case was especially clear: A Thai mother who lived and
worked several
hundred miles apart from her 11-year old daughter. Daughter
lived with her
aunt, the mother’s sister. Daughter became ill after exposure to
chickens.
She was hospitalized and mother traveled to see daughter. After
several days,
daughter died. Mother then developed flu and died. Aunt
developed flu and
lived. Fatality rate in Vietnam and Thailand was about 70%.
2005: Pandemic in birds moved to Phase 5 as outbreaks occurred
in Thailand,
Vietnam, Indonesia and Cambodia. Differences between cases in
the north and
south in Vietnam occurred via recombination. In the north, the
case fatality
rates ranged from 10-20%, while those in the south were nearly
100% fatal. For
the first time, health care workers treating patients ill with
flu were
infected, and a cluster of five family members tested positive.
These all
recovered. Human epidemic moving toward Phase 5: larger
clusters, localized,
better adapted to humans, not yet efficiently transmissible.
June 2005: Milder cases in northern and central Vietnam, but
many more: 28 by
June 20th. Importantly, most had no exposure to dead poultry.
Six provinces
show increase in mild H5N1 infections. Virus is moving more
easily into humans
and more likely human-to-human transmission.
June 2005: Qinghai Lake Nature Reserve, northwest China. Serious
new
developments. Bird deaths reported in the 8-10,000 range at the
lake. All H5N1
isolates from Qinghai Lake had almost identical genes indicating
a common
source. All had a mutation in the PB2 gene at position 627, a
trait that
increases virulence in mice and imparts virulence for a large
number of
serotypes. This may explain the large number of bird deaths at
the lake. H, N
and NP genes at Qinghai were closely related to H5N1 isolates
from chickens in
Shantou, China, in 2003. Other genetic traits indicate the
Qinghai virus was a
single introduction. The source could be India where the geese
winter.
TheseH5N1 isolates are very lethal in mammals as well as
efficiently
transmissible to migratory birds.
The birds of Qinghai are in the air.
In the Next Issue
The Pandemic spreads to Russia and is heading for Europe.
Is it already in the U.S.?
Is the “Mystery Pig Disease” in Sichuan Province, China, really
pandemic
influenza? And Ebola? Is this the ultimate doomsday bug?
Doctors and other experts suggest ways for individuals,
businesses, governments
to prepare
Food Supply Update: How this Pandemic will affect U.S. and
global food
supplies. Shortages predicted.
----------------------------------------------------------------------
Geri Guidetti ARK INSTITUTE:
http://www.arkinstitute.org
----------------------------------------------------------------------
Subject: Global Pandemic Alert
Date: Wed, 05 Oct 2005 02:09:45 +0200
From: bird_flu
To: bright_star
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