Most Recent Flu in the News - 2011:
81 Mexicans die of swine flu
Mexico City, Feb 12 (IANS/EFE) Eighty-one people have so far died of swine flu in Mexico this year, while at least 3,522 have been infected with the virus, health officials said.
From Jan 1 till Feb 9, there have been 3,882 confirmed flu cases, the health secretariat said in a statement.
Three seasonal viruses are currently active in Mexico -- AH1N1, AH3N2 and influenza B. The AH1N1 -- or swine flu -- has been the predominant one, with 91 percent of the infections.
The AH1N1 virus broke out in Mexico in March-April 2009. By June 2010, around 1,300 deaths had occurred and more than 70,000 people had contracted the disease.
Costa Rica Facing Increase In "Flu" Cases
The number of people attending medical centres with influenza and acute respiratory infections is higher than expected by health authorities.
According to the Caja Costarricense de Seguro Social (CCSS) the behaviour of these diseases has been "unusual in recent weeks".
Most of the cases are in the provinces of Cartago and San José.
Those most affected, according to the CCSS, are infants under one year of age and teens and adults between 15 and 39.
Up to January 28, the CCSS reports 419 people were hospitalized with respiratory complications.
Although there are no clear figures, the increase in cases include AH3N2 and AH1N1. In the case H1N1, the ministerio de Salud reports up 12 confirmed cases.
In January Salud reported five deaths - three from AH1N1, one from the seasonal virus and a 73 year old woman from San Carlos with Adenovirus, which infections most commonly cause illness of the respiratory system.
Seven people remain hospitalized to control the progress of these viral conditions.
Due the increase in cases the Ministerio de Salud and the CCSS recommend washing hands frequently and using alcohol gel and avoid contact with sick people.
Trial of Korean red ginseng extract for preventing Influenza-like illness
Standardized Korean red ginseng extract has become the best-selling influenza-like illness (ILI) remedy in Korea, yet much controversy regarding the efficacy of the Korean red ginseng (KRG) in reducing ILI incidence remains. The aim of the study is to assess the efficacy of the KRG extract on the ILI incidence in healthy adults.
Methods: We will conduct a randomized, double-blind, placebo-controlled study at the onset of the influenza seasons.
A total of 100 subjects 30-70 years of age will be recruited from the general populations. The subjects will be instructed to take 9 capsules per day of either the KRG extract or a placebo for a period of 3 months.
The primary outcome measure is to assess the frequency of ILI onset in participated subjects. Secondary variable measures will be included severity and duration of ILI symptoms.
The ILI symptoms will be scored by subjects using a 4-point scale.DiscussionThis study is a randomized placebo controlled trial to evaluate the efficacy of the KRG extract compared to placebo and will be provided valuable new information about the clinical and physiological effects of the KRG extract on reduction of ILI incidence including flu and upper respiratory tract infections. The study has been pragmatically designed to ensure that the study findings can be implemented into clinical practice if KRG extract can be shown to be an effective reduction strategy in ILI incidence.
Trial Registration: NCT01478009.
Author: Ki-Chan HaMin-Gul KimMi-Ra OhEun-Kyung ChoiHyang-Im BackSun-Young KimEun-Ok ParkDae-Young KwonHye-Jeong YangMin-Jeong KimHee-Joo KangJu-Hyung LeeKyung-Min ChoiSoo-Wan ChaeChang-Seop Lee
Credits/Source: BMC Complementary and Alternative Medicine
Published on: 2012-02-08
Forty-two people killed by B-type flu: CDC
Taipei, Feb. 7 (CNA) Four more people in Taiwan died from flu complications Tuesday, raising the total number of flu-related deaths in the country since last July to 54, the Centers for Disease Control (CDC) reported that day.
Of the 54 fatalities, 42 were from complications of the Yamagata Influenza B strain, while 12 people died of the Type A flu virus, the CDC said.
Seven of the 42 people who succumbed had been vaccinated, according to CDC Deputy Director-General Chou Jih-haw.
The vaccine recommended by the World Health Organization (WHO) for the 2011-2012 flu season was supposed to protect against the same three viruses that last year's flu vaccine did, but no recommendations were made against Yamagata Influenza B, according to Chou, who noted that regardless of WHO or local directives, there could be misfires or miscalculations wherever predictions are involved.
He said the CDC might alter its next assessment when it places new orders for flu vaccine for the 2012-2013 flu season.
(By Chen Chin-fang and Deborah Kuo)
Mysterious deaths investigated
MIMS, Fla. (WOFL FOX 35) - The Brevard County Sheriff's Office and county health officials are investigating the death of two Titusville women, a mother and daughter, who were both complaining of flu-like symptoms prior to their death.
The ex-husband of the woman in her 60s, and the father of the younger woman, in her 40s, called 911 after he couldn't awaken the women from their beds in separate bedrooms.
When investigators arrived, they insisted the man living go to the hospital after observing his flu-like symptoms. Then, they put on full body suits and masks and searched each bedroom.
"There’s no signs of trauma, no signs of foul play. It is suspicious only because we've located two deceased within the same residence."
Little was learned after a search of the home, so investigators questioned neighbors about the last time they had seen the two women.
"She seemed like she was in good spirits. We talked, she laughed a little bit. It's weird. Gonna miss her."
Investigators have ruled out carbon monoxide and any other deadly gases as a possible cause. Some pharmaceutical drugs were found, but each had a prescription for the medicine, leaving those who live in the neighborhood what could have killed their neighbors.
"It concerns me. If it was drugs, or something else, whatever, that concerns me. I live in this neighborhood."
The man has been transported to Parrish Medical Center for an evaluation.
58 People Die of Flu in Mexico So Far This Year
MEXICO CITY – A total of 58 people have died of the flu in Mexico so far this year, with 2,815 living patients confirmed to have the infection, the latest report by the Health Secretariat said.
From Jan. 1 to Feb. 2, according to the epidemiological report, the 58 deaths were caused by different strains of flu virus, the predominant one being the AH1N1 swine flu with 93 percent.
The Health Secretariat said in a communique Friday that the deaths make up 2 percent of the total number of confirmed cases of the illness.
Of the 2,815 cases of infection, 90 percent have been due to the AH1N1 virus, “the seasonal virus that has predominated since the beginning of 2012.”
Three seasonal flu viruses are currently active in Mexico: AH1N1, AH3N2 and influenza B.
Up to now, the average incidence of doctor’s visits for seasonal flu has been 15 out of every 1,000. During the 2009-2010 pandemic, doctor’s visits for the same illness surged to an average of 35 per thousand.
The AH1N1 virus broke out in Mexico between March and April 2009, and, at a local level, the alert for the disease was maintained until June 29, 2010, by which time there had been some 1,300 deaths and more than 70,000 cases of the infection.
This year, according to health authorities, the virus has come from the south, erupting strongly during the Southern Hemisphere winter and progressing northward through the Andean region, Central America and reaching Mexico in the last few weeks of 2011.
This year between 5,000 and 11,000 cases of flu are expected in the country, so authorities say that the number registered up to now is within the amount forecast for the season.
Costa Rica: AH1N1 Claims Fourth Victim
A 30 year old man, who was hospitalized in serious condition in the San Juan de Dios hospital, has become the fourth victim AH1N1 flu victim of the year.
So far this year, one person has died from the seasonal influenza and three by the AH1N1 strain, as the ministerio de Salud prepares to increase measures to prevent further infections and deaths.
Roberto Castro, member of the la Vigilancia del Ministerio de Salud, states that there have been advertisements the media, emphasizing the need to take necessary precautionary measures, with the intent to alert the population to the problem.
Confirmed are five more cases of the AH1N1, one of them in delicate condition at the San Juan de Dios.
In 2011, six people died from the virus, so it is worrisome than the year begins with four in the first month.
Dr. Castro, categorizes this year as "very special" and ensures that health authorities will be on the lookout.
Hand washing, covering your mouth when sneezing and coughing and vaccination is the key to preventing the spreading of the virus. And more deaths.
Mexico Reports a Rise of H1N1 Flu Cases
BROWNSVILLE - According to reports, there is a rise in the H1N1flu in Mexico, but Texas State Health Regional Director Dr. Brian Smith says there is no need to worry here locally.
Mexico has reported a few hundred cases of the H1N1flu throughout Mexico and Dr. Smith those numbers are usual for this time of the year, "We are in regular communication in Tamaulipas and we get weekly reports of any unusual activity to let us know what's going on and we haven't gotten any unusual reports in Tamaulipas."
Dr. Smith says there's also been an increase of influenza like illnesses in the State of Texas.
Mexican swine flu outbreak kills 29, infects nearly 1,500
MEXICO CITY (BNO NEWS) -- An ongoing swine flu outbreak in Mexico has left at least 29 people dead and nearly 1,500 others infected, health officials confirmed on Saturday. Thousands more are also ill as the country faces several types of flu this season.
Since the start of the ongoing winter season, at least 7,069 people have reported suffering from symptoms similar to those of swine flu. Lab tests are still underway and have so far confirmed 1,456 cases of the disease, which is officially known as A/H1N1.
According to Mexico's Health Ministry (SSA), at least twenty-nine people have died of swine flu so far this season. While no health emergency has been declared, officials expect the death toll will rise in the coming weeks as Mexico also faces A/H3N2 and B influenza.
The H1N1 influenza virus emerged in the Mexican state of Veracruz in April 2009 and quickly spread around the world, causing the World Health Organization (WHO) to declare a global flu pandemic in June 2009. At least 18,000 people have died of the disease since, although the actual number is believed to be far higher.
In August 2010, the WHO declared that the swine flu pandemic was over. "In the post-pandemic period, influenza disease activity will have returned to levels normally seen for seasonal influenza," the WHO said at the time. "It is expected that the pandemic virus will behave as a seasonal influenza A virus."
(Copyright 2012 by BNO News B.V. All rights reserved. Info: sales@bnonews.com.)
Swine Influenza Death Toll Reaches Nine in Mexico
The swine influenza outbreak in Mexico claimed its ninth life Tuesday as H1N1 continues to account for 90 percent of detected cases of flu in the country. According to Big Pond News, the total confirmed number of swine flu cases in the country currently totals 573.
That’s up by more than 200 cases since last Thursday, when the total reached 333. Still, Mexican health authorities are denying that the situation constitutes an emergency. They have been tracking the outbreak’s progress since December.
The Associated Press reported that the federal education ministry was planning to screen elementary school children for H1N1 Wednesday, but later retracted and said it would only screen children who exhibited symptoms of the virus. A few schools in Mexico City have closed due to the threat, but the government emphasized that they were private schools and the closures were not the result of government action.
The outbreak is a resurgence of the H1N1 virus that first hit Mexico and the United States in April 2009. In that strain, more than 1,250 Mexicans died before the World Health Organization declared the pandemic over in 2010.
In the United States, a different strain of swine flu is taking root. While H1N1 is now considered a seasonal flu, the U.S. Centers for Disease Control and Prevention are preparing for a strain known as H3N2.
Older adults may be vulnerable to new swine flu virus
TORONTO — There may be a lot more vulnerability in the population to a new swine influenza virus than was first thought, new Canadian research suggests.
It has been believed that while children and teens are probably vulnerable to the new H3N2 variant, people over the age of 20 or so would have antibodies that would either block infection or protect against severe disease caused by the viruses.
But the new study suggests that while young adults do have antibodies that recognize the viruses, antibody levels start to drop sharply in middle-aged adults. When plotted on a graph, the decline is striking and suggests that the elderly may also be unprotected against this new flu virus.
Whether that's true or not remains to be shown. The study, published Thursday in the journal Eurosurveillance, only looked at blood samples from children 17 months to 10 years and adults aged 20 to 59.
But lead author Dr. Danuta Skowronski said the results suggest that if this new virus gets a foothold in humankind, it could sicken a lot more people than H1N1 viruses -- which also came from swine -- did during the 2009 pandemic.
Skowronski, an influenza expert with the British Columbia Centre for Disease Control in Vancouver, admitted the findings were a surprise.
"We had predicted that most adults would have some cross-reactive antibodies to the virus. But what we found was that young adults -- those in the range 20 to 30 -- did have antibodies to this swine H3N2. ... But we saw a decrease with increasing age in adults -- which for me is a concern," she said in an interview.
The swine H3N2 viruses were once human viruses that entered pig populations sometime in the early to mid-1990s. Studies suggest the contemporary pig viruses are most similar to a human H3N2 that circulated around 1995.
So the thought has been that people born before then probably would have had exposure to ancestors of the swine H3N2 and would have some protection from it.
Skowronski said it would be important to do similar work looking for antibodies in seniors to verify whether, as she fears, they are also susceptible to the new virus. Her group is doing a study, but she hopes others will as well. Patterns of protection against this virus may vary by geographic areas, she suggested.
Her concern relates to two factors, one specific to H3N2 viruses and the other which is a feature of flu in general.
After decades of experience with H3N2 viruses -- the human versions have been circulating since 1968 -- public health officials know this flu subtype takes a harsh toll on seniors. "The elderly ... don't handle H3N2 viruses well at all," Skowronski said.
And the notion of vulnerability in both children and seniors is a particular concern. It's recognized that children ramp up flu activity in a community, and that activity generally makes its way to the elderly.
"If we have a mix of broad susceptibility to an emerging swine H3N2 virus in children -- which our results suggest -- and we have a susceptibility because of lack of pre-existing antibody in the elderly, who don't handle H3N2 viruses well, that's not a good mix," Skowronski said.
"Children can propagate it and the elderly suffer the most severe consequences of H3N2 viruses."
Dr. Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota, said it is important to pursue this line of study to assess the risk these new H3N2 viruses might pose.
"This really deserves further study," he said.
To date there have only been 12 reported human infections with the viruses, all in the United States. All but one of the cases have been children under the age of 10. About half had some exposure to pigs, but for the remainder the evidence suggests they probably caught the virus from another person.
Several of the people who have been infected have been hospitalized, but all have recovered. So far it appears the virus causes a regular and relatively mild flu in people, though experts suggest it is unwise to draw too many conclusions from so few cases.
Scientists have no way of predicting whether the virus will seed itself in the human population, like the 2009 H1N1 virus did, continue to cause sporadic cases or hit a dead end.
This study was done using stored blood samples taken before and after people were vaccinated with the seasonal flu shot in 2010.
The researchers also looked to see whether levels of cross-reactive antibodies rose in the samples taken between 21 to 28 days after the participants received their flu shot.
The aim of that was to see whether the H3N2 component in the shot, which is meant to protect against contemporary human strains of the virus, would trigger a rise in antibodies to the swine H3N2. It did not.
Natural cures for the common cold
Cold season is here. Between the sniffles, the coughs, and the runny noses, everyone is catching something; however, many have mixed feelings over the side effects from over-the-counter cold medicines, and some would rather take the natural route.
Dr. Roberta Lee, Medical Director of the Continuum Center for Health and Healing, talked with Dr. Manny Alvarez, senior managing health editor of FoxNews.com, about an assortment of natural remedies.
One new herb that is turning heads is called the Elderberry (Sambucus).
“It comes in liquid and tablet form, and it’s one of the few that has scientific studies showing it’s very effective against Influenza A,” Lee said of the herb.
As soon as people have even a hint of getting sick, Lee advised that’s the best time to reach for the Elderberry.
Another known healer are medicinal mushrooms, which come in pill form. While eating mushrooms with your meal is also beneficial for your health, Lee said to stick to the pills first.
“You can do that,” Lee said of eating typical shiitake mushrooms. “It’s helpful, but not as useful for viruses and colds as taking a capsule.”
Two die of H1N1 in Mexico: Official
MEXICO CITY (AFP) - An outbreak of A(H1N1) claimed the lives of two people - 19 and 21 years old - in Mexico's capital in the first weeks of the year, health authorities said on Saturday.
The health secretary of Mexico's Federal District, Armando Ahued, said there were 138 confirmed cases of the flu, including 110 cases of A(H1N1), a novel strain of the disease that was first detected in 2009.
Nationwide, 333 cases of the virus have been confirmed, the federal government's health secretary said earlier in the week, without saying how many deaths had been attributed to it.
The latest victims were a 19-year-old and a 21-year-old who died in separate hospitals. 'The tendency toward an increase in flu cases is normal because January is the month with the lowest temperatures,' said Ahued adding that the incidence of flu should begin to subside in February.
Three countries report H5N1 cases, deaths
Jan 19, 2012 (CIDRAP News) – The World Health Organization (WHO) today confirmed three new H5N1 avian influenza cases from Indonesia and Egypt, one of them fatal, a day after Vietnam's health ministry announced a death from the disease, its first in nearly 2 years.
Indonesia's newest case-patient is a 5-year-old girl from Jakarta province who died from her infection and is a family contact of a man who died from H5N1 on Jan 7, the WHO reported. The girl's illness was detected on Jan 7 during surveillance as part of the investigation into the man's infection.
She was referred to a hospital and began having breathing difficulties on Jan 13. The girl's condition worsened, and she died on Jan 16. The WHO said the girl had been exposed to the same pigeons implicated in the man's death and shared the same household environment. Surveillance of the patients' contacts hasn't found any more H5N1 infections.
The girl's illness and death raise Indonesia's H5N1 total to 184 cases, including 152 fatalities. The country leads the world in both categories.
One of Egypt's cases is in a 2-year-old girl from Cairo governorate who was treated for flulike symptoms as an outpatient at a hospital on Oct 30, according to a WHO statement. Her H5N1 infection was detected by Egypt's Central Public Health Laboratory during periodic screening of respiratory samples collected from outpatient surveillance sites.
An investigation into the source of her infection found she had been exposed to backyard poultry. The WHO said samples have been sent to the US Naval Medical Research Unit 3 (NAMRU 3) for further sequencing.
Egypt's other case is a 31-year-old man from Fayoum governorates who got sick on Jan 1, was treated with oseltamivir (Tamiflu) on Jan 14 and is still hospitalized in critical condition, the WHO said. He also had been exposed to backyard poultry.
The two new infections push Egypt's H5N1 total to 159 cases, which include 55 deaths. Egypt has the world's second-highest H5N1 case count and third-highest fatality total, behind Vietnam.
Meanwhile, a provincial health official in Vietnam said an 18-year-old man from Kien Giang province has died of an H5N1 infection, the Associated Press (AP) reported today. The official told the AP that the man, a worker on a duck farm, died on Jan 16, a day after he was hospitalized for fever and breathing difficulties.
Kein Giang province is in southern Vietnam's Mekong Delta region.
Neither of the two farms where the man worked had recently reported sick or dead poultry, according to the AP. Authorities are monitoring the man's contacts and collecting poultry samples. Vietnam's last H5N1 death was reported in April 2010, according to previous WHO reports.
If the WHO confirms this case, the global H5N1 tally would rise to 582 cases and 343 deaths.
Bird flu-infected Cambodian boy died
PHNOM PENH (Xinhua) -- A 2-year-and-7 month-old boy from northwestern province of Banteay Meanchey had died early Wednesday from avian influenza A (H5N1) virus after being admitted to hospital for about a week, said a senior health official.
"The boy passed away at 2:00 a.m. early Wednesday due to critical condition," Sok Touch, director of the Health Ministry' s anti-communicable disease department, told Xinhua over telephone on Wednesday.
He said the boy was the nineteenth person in Cambodia to become infected with H5N1 virus, and the first person died this year. "To date, 17 persons had died from H5N1 in Cambodia," he said.
According to a joint statement of Cambodia's Ministry of Health and the World Health Organization last Friday, the boy became sick on Jan. 3, 2012 suffering with fever, cough, runny nose, and vomiting.
He was initially treated by local private practitioners, but his conditions worsened and he was admitted to Angkor Hospital for Children on Jan. 9, where he died.
"The diagnosis of the clinical samples on Jan. 12 found that the boy had contact with sick or dead poultry prior to becoming sick," it said.
Banteay Meanchey is situated in northwest of Cambodia about 400 kilometers from capital Phnom Penh.
It's only natural that mother knows best
If I ever needed evidence to support the claim that "mother knows best", I certainly got it this week. Having suffered from a lingering sore throat and unsuccessfully self-medicated a cold for the past 10 days - it was somewhat fortuitous that I should be commissioned to write a piece about alternative flu remedies.
Interviewee after interviewee extolled the virtues of herbal medicine, an organic diet and plenty of exercise for a long and healthy life. They also claimed an abstinence from antibiotics ensured their swift recovery from illness and maintained a robust immune system.
I remained a sceptic, struggling to rationalise how a gnarled root of ginger and diced onion were able to trump the mighty force of Amoxycillin. Nevertheless, in the name of research, I gave it a go and duly stocked up on honey, herbal teas, probiotics, local veggies and an entire alphabet of supplements.
With my regime underway and my morning kick-started with a mug of hot water and lemon, the dots started to connect. Long have female members of my family been drinking this breakfast brew and raising eyebrows in restaurants by ordering fresh mint tea rather than coffee after a meal. Could there really be something in it?
More pennies dropped throughout the week as updating my food diary became something of a 20km run down memory lane. And tucking into a packets of nuts and dried fruit (instead of my habitual afternoon chocolate bar) suddenly took me back to prep-school.
Lunch time was never something I looked forward to as a child, for I knew only too well what my bright yellow tuck box contained. Precisely no tuck at all.
Lentils, rice and brown bread sandwiches made up the weekly menu and, "as a treat", sachets of sunflower seed and raisins would often be hiding inside a piece of kitchen roll. Far from taste being the problem, it was the giggles from my fellow diners who chomped merrily on Cheesy Wotsits and ruler-long Curly Wurly bars that made my cheeks flush.
How I longed for an additive-packed box of Um Bungo juice or a humble Proustian madeleine. But alas, it was not to be. Now, of course, I think my mother was light years ahead of her time and I can't thank her enough for force feeding me all the goodness the health-food chain Holland & Barrett had to offer. She's rarely ill so I guess there's a lot to be said for feeding your body the right fuel. Shame it took me 30 years to come around to her way of thinking. So look out for me in the organic section of your local supermarket. I'll be the flu-free evangelist eager to compare notes on the perfect sprouted adzuki-bean and kale salad. Sounds delicious, doesn't it?
rduane@thenational.ae
New Analysis Challenges Tamiflu Efficacy
A new review of the influenza drug oseltamivir (Tamiflu) has raised questions about both the efficacy of the medication and the commitment of its maker to supply enough data for claims about the drug to be evaluated by independent experts.
It also raises questions about the entire process of systematic review.
Researchers led by Tom Jefferson, MD, of the Cochrane Collaboration, pored over 15 published studies and nearly 30,000 pages of "clinical study reports."
But, they reported, the clinical study information – data previously shared only with regulators – was only a part of what internal evidence suggested was available.
And many published studies had to be excluded because of missing or contradictory data, Jefferson and colleagues reported. Action Points
Explain that a new review of an important flu drug has raised questions about the medication and the entire process of systematic review.
Point out that the review of oseltamivir showed that there was no evidence of effect on hospital admissions.
The drug's maker, Switzerland-based Roche, had promised after a previous Cochrane review to make all of its data available for "legitimate analyses." After a request for the data, Jefferson and colleagues reported, the company sent them 3,195 pages covering 10 treatment trials of the drug.
But, three of the reviewers noted in a parallel report in BMJ, the tables of contents suggested that the data were incomplete.
"What we're seeing is largely Chapter One and Chapter Two of reports that usually have four or five chapters," according to the BMJ article's lead author, Peter Doshi, PhD, of Johns Hopkins University.
Roche did not immediately respond to a telephoned request for comment.
Requests for More Data
The researchers then asked the European Medicines Agency (EMA) for the data, under a Freedom of Information request, and obtained a further 25,453 pages, covering 19 trials.
But that data, too, was incomplete, they said, although the agency said it was all that was available.
The FDA is thought to have the complete reports, but has not yet responded to requests for them, the researchers reported.
Regulatory agencies such as the EMA and FDA routinely see the large clinical study reports, Jefferson and colleagues said in BMJ, but systematic reviewers and the general medical public do not.
"While regulators and systematic reviewers may assess the same clinical trials, the data they look at differs substantially," they said.
The Cochrane group has been trying for several years to put together a clear-cut systematic review of the evidence on antivirals aimed at flu.
In 2006, the group concluded that the evidence showed that oseltamivir reduced the complications of the flu. But that conclusion was challenged on the basis that a key piece of data was flawed.
An updated review in 2009 – throwing out the flawed study -- concluded there wasn't enough evidence to show that the drug had any effect on complications.
For this analysis, the Cochrane reviewers had originally intended to perform a systematic review on both of the approved neuraminidase inhibitors – oseltamivir and zanamivir (Relenza), using the clinical study reports to supplement published trials.
In the end, they decided that for oseltamivir, they needed more detail in order to perform the review in its entirety. But, they reported, some conclusions could be drawn from published data on the 15 trials and from 16,000 pages of clinical study reports that were available before their deadline.
They also decided to postpone analysis of zanamivir (for which they had 10 trials) because the drug's maker, GlaxoSmithKline, offered individual patient data which they wanted time to analyze.
The oseltamivir analysis showed:
The time to first alleviation of symptoms in people with influenza-like illness was a median of 160 hours in the placebo groups and about 21 hours shorter in those treated with oseltamivir. The difference, evaluated in five studies, was significant at P<0.001.
There was no evidence of effect on hospital admissions: In seven studies, the odds ratio was 0.95, with a 95% confidence interval from 0.57 to 1.61, which was nonsignificant at P=0.86.
A post-protocol analysis of eight studies showed that oseltamivir patients were less likely to be diagnosed with influenza.
The data "lacked sufficient detail to credibly assess" any effect on influenza complications and viral transmission.
Data Discrepancies Found
But discrepancies between the published trial data and the clinical study reports "led us to lose confidence in the journal reports," Doshi and colleagues wrote in BMJ.
For example, they noted that one journal report clearly said there were no drug-related serious adverse events, but the clinical study report listed three that were possibly related to oseltamivir.
As well, the sheer scope of the clinical study reports meant that much was left out of journal reports. One 2010 study, on safety and pharmacokinetics of oseltamivir at standard and high dosages, took up seven journal pages and 8,545 pages of the clinical study report.
But the researchers were also shaken, they said, by the "fragility" of some of their assumptions.
For instance, they found that the clinical study reports showed that in many trials, the placebo contained two chemicals not found in the oseltamivir capsules.
"We could find no explanation for why these ingredients were only in the placebo," they wrote in BMJ, "and Roche did not answer our request for more information on the placebo content."
Jefferson and colleagues also reported they found disparities in the numbers of influenza-infected people reported to be present in the treatment versus control groups of oseltamivir trials.
One possible explanation, they noted, is that oseltamivir affects antibody production – even though the manufacturer says it does not.
Gaps in Knowledge Remain
That question is profoundly important, Doshi told MedPage Today, because it may offer clues to how the drug works – one of the gaps in knowledge about oseltamivir.
"You can't make good therapeutic decisions if you don't know how the drugs works," he said – information that he and his colleagues suspect may be buried in the mass of missing data.
It's also important, he said, because public health agencies have been making decisions to stockpile oseltamivir without a clear understanding of the facts.
Essentially, he said, those decisions have been based on the flawed study – a Roche-supported meta-analysis – that was thrown out of the 2009 Cochrane review.
"They're taking the drug manufacturer's word at face value," he said.
The results seem unlikely to resolve conflicts over the medical value of the drug, which is a major cash cow for Roche, adding some $3.4 billion to the company's bottom line in 2009 alone, according to Deborah Cohen, investigations editor of BMJ.
In an accompanying article, Cohen said that "clinicians can be forgiven for being confused about what the evidence on oseltamivir says."
She noted that the European Centre for Disease Prevention and Control, the CDC, and the World Health Organization "differ in their conclusions about what the drug does."
As well, those conclusions are often contradicted by claims on the drug labels – themselves allowed by regulators, Cohen argued.
The Cochrane reviewers reported grant support from the U.K. National Institute for Health Research and Jefferson and Doshi reported they had no recent financial links with industry.
Cohen is employed by BMJ.
Primary source: Cochrane Database of Systematic Reviews
Source reference: Jefferson T, et al "Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children" Cochrane Database of Systematic Reviews 2011; 12. Art. No.: CD008965.
By Michael Smith, North American Correspondent, MedPage Today - Published: January 17, 2012 - Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.
Man dies of swine flu in city
HYDERABAD: Swine flu claimed its first victim this year in city on Friday evening. A 60-year-old resident of Secunderabad succumbed to the virus at a private hospital in the city.
Sources said the victim had travelled to Bangalore a few days back and had returned with high fever. He was admitted to Apollo Hospital on Wednesday and the tests confirmed that he was suffering from H1N1 Influenza (swine flu).
His condition turned critical and was moved to intensive care unit and put on ventilator. He died of respiratory distress on Friday evening.
The district medical and health officer Dr Uma Maheshwari pleaded ignorance of the swine flu death case and refused to provide any information.
Little Egret tests positive for H5 virus
Hong Kong (HKSAR) - Preliminary testing of a dead Little Egret found in Yuen Long has tested positive for the H5 avian influenza virus, a spokesman for the Agriculture, Fisheries and Conservation Department (AFCD) said today (January 14), adding that further confirmatory tests are being conducted.
The bird carcass was found and collected beside a tree outside Yuen Long Office, Wetland and Fauna Conservation (Enforcement) Section of AFCD, Lot 1520RP, DD123, Nam Sang Wai, Yuen Long on January 12.The Little Egret is a common resident bird in Hong Kong.
The AFCD has stepped up cleansing and disinfection of the office.
The spokesman said that two chicken farms are within 3 kilometres of where the dead bird was found. AFCD staff inspected the farms and found no abnormal mortality or symptoms of avian influenza among the chicken flocks. These farms will be put under enhanced surveillance.
In view of the case, the AFCD has phoned poultry farmers to remind them to strengthen precautionary and biosecurity measures against avian influenza. Letters have been issued to farmers, pet bird shop owners and licence holders of pet poultry and racing pigeons reminding them that proper precautions must be taken.
The spokesman said the department would conduct frequent inspections of poultry farms and the wholesale market to ensure that proper precautions against avian influenza have been implemented.
The department will continue its wild bird monitoring and surveillance.
"People should avoid personal contact with wild birds and live poultry and their droppings. They should clean their hands thoroughly after coming into contact with them. The public can call 1823 for follow-up if they come across suspicious sick or dead birds, including the carcasses of wild birds and poultry," the spokesman said.
The Food and Environmental Hygiene Department (FEHD) will continue to be vigilant over imported live poultry as well as live poultry stalls. It will also remind stall operators to maintain good hygiene.
The Department of Health will keep up with its health education to remind the public to maintain strict personal and environmental hygiene to prevent avian influenza.
The AFCD, the FEHD, the Customs and Excise Department and the Police will strive to deter the illegal import of poultry and birds into Hong Kong to minimise the risk of avian influenza outbreaks caused by imported poultry and birds that have not gone through inspection and quarantine.
All relevant government departments will continue to remain highly vigilant and strictly enforce preventive measures against avian influenza.
Why I'm Anti-Antibacterial Soaps, Even in Flu Season
It started right after Thanksgiving -- a stomach flu that first hit Alden, my two-year-old. Then it got me, and then Graham (the baby), and finally my husband Chris. After the stomach flu completed its cycle, next up was this awful cold with a barking cough, which made the full round of our family twice and cut short our recent Christmas vacation.
The second time it hit Graham was the worst. My normally social and smiley baby didn't smile for almost a week. He could barely keep any food down and was hacking like a pack-a-day smoker with a 20-year habit.
With all this suffering, I'm sure you can understand why I've become obsessed with washing hands. My kids' hands, my hands, and your hands, too. Anyone who sets foot in my apartment will be politely requested to wash their hands thoroughly before touching anything, especially the baby.
But hand-washing obsessive though I might be, I won't use antibacterial soaps or antibacterial hand sanitizers as an extra precaution. They're not any better than washing with regular soap and water, and they contain something normal soap doesn't -- hormone-disrupting chemicals called triclosan and triclocarban.
Having had trouble becoming pregnant, I am only too aware of the studies demonstrating that triclosan interferes with thyroid hormone, and triclocarban can enhance the activity of male and female sex hormones. This is especially consequential for the growing bodies of children -- amplified hormonal effects at the wrong time may increase the risk of breast and prostate cancers as well as infertility. Scientists are also concerned that the overuse of antimicrobial chemicals like these could promote antibiotic resistance, leading to the creation of superbugs that are difficult to vanquish with today's antibiotics.
Am I putting my family at risk by not using a more "powerful" soap? Not at all. Scientific studies have shown, and the FDA agrees, that antibacterial soaps are no more effective than washing with regular soap and water. All that stuff you read on the label is marketing hype.
Why are these unnecessary chemicals in our soap in the first place? Because for more than 33 years, the FDA has been looking into antimicrobials like triclosan without coming to any conclusions, despite growing scientific evidence that there is cause for concern. NRDC filed a lawsuit in 2010 to pressure the FDA to complete its review. The agency was supposed to finally announce its findings on the safety of triclosan and triclocarban in the spring of 2011, but has since delayed the release of the findings to later this year.
NRDC is continuing to push the case in court, and meanwhile, in the absence of action by the FDA, consumer groups and some members of Congress have taken up the call. At their urging, some companies, such as Colgate-Palmolive and Reckitt-Benckiser, have voluntarily removed triclosan from some of their products, including dish soap, hand soap, and some face washes.
While the FDA continues to delay, these chemicals are finding their way into more and more products, like yoga mats, towels, footwear, and cutting boards. I steer clear of any product labeled "antibacterial" or "antimicrobial," or that has triclosan listed as an ingredient (because it is classed as a pesticide, triclosan must be listed on labels; triclocarban, however, does not have to be listed). For my family, good old soap and water and a thorough scrubbing do the trick.
Thorough scrubbing is key. A proper hand-washing should take a full 20 seconds and include the webbing of your fingers, the base of your wrists, and around your fingernails. Dr. Gina Solomon has recommended teaching your children to sing "Row Your Boat" while handwashing to ensure they do so long enough. If you're on the go and just can't get to a sink, use alcohol-based hand sanitizers or hand wipes. I carry Giovanni Organic Recharge or Herban Essentials brand wipes, which use plant-based essential oils for germ-killing power. (They smell good, too.)
Flu Shot or Not? Reaction to Young Girl's Death
Nicole and Justin Matten of Barton have lived every parent’s worst nightmare. On December 2 their 7-year-old daughter, Kaylynne, visited her physician for an annual checkup. She got a flu shot. The next day, she developed a bad headache and fever. On December 6, the normally happy and healthy girl, who had no previous history of chronic health problems or adverse reactions to vaccines, turned blue, stopped breathing and died in her mother’s arms.
“They worked on her for about three hours and did everything they could, but they just couldn’t get her back,” Nicole Matten says of her second child, who was a first-grader at Barton Graded School.
The state medical examiner has yet to determine the girl’s exact cause of death; the autopsy report is due within a few weeks. State health officials are also investigating the tragedy. Any child’s death “puts a hole in everyone’s gut, and when one dies, we all have to ask a lot of questions,” says Vermont Health Commissioner Dr. Harry Chen.
“We’re just waiting for an answer,” says Kaylynne’s mom, “but we believe in our hearts that it was the flu shot.”
Chen is not convinced. He points out that serious adverse reactions to vaccines, including deaths, are “extremely rare” — so rare, in fact, that none associated with the flu shot has ever been reported in Vermont. Since last fall, more than 130 million people nationwide have received the annual flu vaccine.
Chen and other state health officials are more worried about the effects of news reports prematurely linking the Barton girl’s death to the flu shot: specifically, that more parents will opt out of immunizing their children, or themselves, against seasonal influenza.
“Of course, it’s important for parents to understand the risks and benefits, and I have absolute respect for their right to make their own decisions,” Chen says. “But I don’t think that being alarmist contributes to overall public health. Vaccines have saved countless lives.”
Each year, seasonal influenza causes more than 200,000 hospitalizations nationwide, as well as 3000 to 49,000 deaths, according to data from the Centers for Disease Control and Prevention. The majority of those severe illnesses and deaths occur among infants, young children, pregnant women, seniors and people with chronic medical conditions.
Part of Chen’s concern stems from what he calls Vermont’s “mediocre” vaccination rate. Once among the highest in the nation, Vermont’s childhood vaccination rate has plummeted in the last decade to one of the lowest levels in the nation. The reasons are numerous and complex, health officials say, as more parents are questioning the safety and efficacy of vaccines and expressing concern that adverse reactions to vaccines are worse than the diseases they prevent.
Even the CDC acknowledges that there’s some educated guesswork involved in creating the flu shot each year. Vaccine strains are chosen based on international surveillance and scientists’ estimations about which types and strains of the virus will circulate that year. One result is that the influenza vaccine is only about 65 to 75 percent effective, compared to other vaccines, which are more than 90 percent effective.
In Vermont, the shot is not a prerequisite for admission to school or daycare.
The flu vaccine became a hotly contentious issue two months ago, when the American Academy of Pediatrics asked Delta Airlines to pull an in-flight video endorsing more parental choice and independent testing of vaccines. Made by the Virginia-based National Vaccine Information Center, the film gave tips on staying well during flu season without getting vaccinated.
AAP president Robert Block accused Delta of “putting children’s lives at risk” with a video containing “harmful messages.” The video was subsequently removed.
Chen won’t reveal any details about the specific vaccine administered to Kaylynne Matten — except to say that the health department has determined the manufacturer and lot number of the vaccine and reported it to the CDC, which has received no other reports of adverse reactions to that particular batch.
For her part, Nicole Matten admits she’s conflicted about the flu vaccine. Her three other children, who range in age from 1 to 12, all received them this year without incident. Matten is also pregnant and expecting her fifth child in May, which puts her at higher risk for contracting the virus.
When asked what advice she’d offer other parents, Matten says, “If you do get the flu shot, keep a close eye on your child afterward. If you even suspect something’s going wrong, get your child checked right away.”
12 Infected With New Swine Flu Strain
The days of medical masks at airports and widespread panic may be coming back—that's because at least 12 humans are believed to have been infected with a new strain of swine flu that's not covered by this season's vaccine.
The new swine flu strain, H3N2v, has shown at least some potential for human-to-human transmission in those 12 individuals, which makes it especially dangerous. Between 2009 and mid-2010, more than 17,000 people died worldwide from the highly contagious H1N1 swine flu strain, leading the World Health Organization to call the strain a pandemic.
The 12 people with the new swine flu strain live in Indiana, Iowa, Maine, Pennsylvania, and West Virginia. Officials for the Centers for Disease Control say the sample size of H3N2 infections is too small to know whether it will pose a threat to the population at large.
"It's a very small sample and it's geographically spread, which makes it more difficult to get a handle on it," says Jeffrey Dimond, a CDC spokesman. "Most of the cases have come through direct contact with the animals, through the 4H Club and that sort of thing."
In order to have a true threat of causing an epidemic or pandemic, Dimond says the virus needs to spread easily between humans.
"If you're in close contact with someone who's ill, that's one thing," he says. "To make it like the pandemic flu of a few years ago, it has to be highly contagious from human to human."
H3N2v or another new flu strain could disrupt what CDC officials expected to be a relatively quiet flu season. Each year's flu vaccine protects against specific strains of the virus that researchers expect to circulate. In October, Joe Bresee, chief of CDC's influenza epidemiology and prevention branch, said he was confident this year's vaccine would protect against the most dangerous flu strains.
"The flu viruses this year's vaccine will protect against are very well-matched to those flu viruses that [were] circulating [in October]," he said. "We will have a vaccine that provides good protection this season to help keep influenza illness and serious complications down."
While it's too early to tell if the new H3N2 strain (or another unexpected strain) will develop into a larger threat, the CDC admits the current vaccine will do little to help stop the virus.
"These viruses are substantially different from human influenza A (H3N2) viruses, so the seasonal vaccine is expected to provide limited cross-protection among adults and no protection to children," the CDC wrote in a report released in late November.
Third Man Dies From Bird Flu in Indonesia
A 24-year-old Indonesian man infected with bird flu died in the capital Jakarta, the health ministry said Tuesday, in the country's third fatal case in three months.
"Test results from the man who died confirmed that he was infected with bird flu," health ministry head of communicable diseases Tjandra Yoga Aditama said.
The man likely contracted the H5N1 avian influenza virus from birds living around his house, Aditama said.
"We have taken samples from birds around his home and are waiting for lab results to determine if they were infected with the virus," he said.
The Jakarta Post reported that the man died Saturday after being rejected by a hospital specializing in bird flu, and had on New Year's Eve been misdiagnosed by two other hospitals with a gastric infection and dengue fever.
The man reportedly died on his way to another hospital on the capital's northeastern outskirts.
The Post quoted a neighbor as saying the man's family kept pet pigeons in their property.
Indonesia has been the hardest-hit by bird flu, with 150 deaths reported between 2003 and 2011, according to the World Health Organization.
Nine Indonesians died from the virus last year, including two children on the resort island of Bali in October.
Vietnam culled more than 2,500 chickens this week on bird flu fears after several animals were found dead on a farm in the Mekong Delta, and China reported its first human fatality from the disease in 18 months late December.
The virus typically spreads from birds to humans through direct contact, but experts fear it could mutate into a form easily transmissible between humans, with the potential to kill millions in a pandemic.
Odisha on high alert to tackle bird flu in Khurda villages
Maintaining high preparedness to deal with the bird flu scare in Khurda district, the Odisha government on Tuesday kept rapid action teams and groups of veterinarians ready.
Nineteen villages, within a three-km radius of Keranga, where A(H5N1) virus was first detected in hen and duck, have been declared a restricted zone.
Experts from Kolkata and New Delhi visited the Keranga village to take stock of the situation.
“We are keeping a close watch on the situation. Samples of dead birds are being sent to different laboratories. The Centre is seriously going through the reports. Whatever appropriate direction the Centre gives to control the situation will be followed,” said Fisheries and Animal Resources Development (ARD) Secretary Satyabrata Sahu.
Khurda Collector Roopa Mishra said 30 veterinarians and 60 livestock inspectors, besides forest and police department personnel, were asked to stay prepared. Vaccination has already been launched. Tara Charan Pan, an expert from the Regional Disease Diagnostic Laboratory (RDDL), Kolkata, said that based on the ground situation, all possible measures would be considered. The ARD Department started orienting veterinarians and livestock inspectors to the issue of killing and burying infected birds.
Meanwhile, the Animal Disease Research Institute (ADRI) at Phulnakhara, Cuttack, continued to send samples of dead crows to the High Security Animal Disease Laboratory in Bhopal. About 300 samples have already been despatched.
The ADRI also found dead crows at Betanati in Mayurbhanj district, an indication of disturbing times ahead.
Boy dies of Type B influenza in Taoyuan: CDC
Taipei, Jan. 4 (CNA) The death of a five-year-old boy in Taoyuan on Tuesday is believed to have been caused by Type B influenza, the first such case in the northern county, the Centers for Disease Control (CDC) said Wednesday.
The child developed flu symptoms, including a fever, on Jan. 1 and was immediately taken to hospital where he tested positive for Type B influenza, said Luo Yi-chun, a doctor at the CDC.
However, the patient failed to respond to medical treatment and died of multiple organ failure within three days, Luo said.
He urged the people to get vaccinated against flu as soon as possible, as the peak season for flu usually falls between the start of the year and the Chinese New Year holiday.
Since July 1, Taiwan has recorded 221 cases of Type B flu with complications, 14 of which were fatal. (By Chen Ching-fang and Hanna Liu)
Should We Fear Avian H5N1 Influenza?
The only thing we have to fear is fear itself -- Franklin D. Roosevelt
Why is there such widespread fear of avian H5N1 influenza virus?
Why did Paul Keim, chair of the National Science Advisory Board for Biosecurity (NSABB) say "I can't think of another pathogenic organism that is as scary as this one". What lead Donald McNeil, writing about H5N1 in the New York Times, to conclude that "In its natural form, it is known to have infected only about 600 people since its discovery in 1997, but it killed more than half of them."
McNeil's statement is incorrect. Yet it summarizes why Paul Keim, the NSABB, and many others fear the virus.
The problem is that we cannot say with any certainty that the virus has infected only about 600 people. What we do know is that among the 600 seriously ill individuals infected with influenza H5N1 who are admitted to hospital, over half of them die.
To know the fatality rate of avian H5N1 influenza virus in humans, we need to divide the number of fatalities by the number of infections. We do not know that last number -- but there are hints that it could be quite large. In a recent study of rural Thai villagers, sera from 800 individuals were collected and analyzed for antibodies against several avian influenza viruses, including H5N1, by hemagglutination-inhibition and neutralization assays. The results indicate that 73 participants (9.1%) had antibody titers against one of two different H5N1 strains. The authors conclude that ‘people in rural central Thailand may have experienced subclinical avian influenza virus infections'. A subclinical infection is one without apparent signs of illness.
If 9% of the rural Asian population has been subclinically infected with avian H5N1 influenza virus strains, it would dramatically change our view of the pathogenicity of the virus. Extensive serological studies must be done to determine the extent of human infection with avian H5N1 influenza viruses.
Until we know how many individuals are infected with avian influenza H5N1, we must refrain from making dire conclusions about the pathogenicity of the virus. Doing so has only lead us down a dangerous path of fearing that H5N1 influenza virus might be used as a weapon of bioterrorism, and restricting the publication of scientific papers on the virus.
Khuntirat, B., Yoon, I., Blair, P., Krueger, W., Chittaganpitch, M., Putnam, S., Supawat, K., Gibbons, R., Pattamadilok, S., Sawanpanyalert, P., Heil, G., Friary, J., Capuano, A., & Gray, G. (2011). Evidence for Subclinical Avian Influenza Virus Infections Among Rural Thai Villagers Clinical Infectious Diseases, 53 (8) DOI: 10.1093/cid/cir525
Man dies of bird flu in Shenzhen
GUANGZHOU, Dec. 31 (Xinhua) -- A bus driver died in hospital Saturday after being infected with the H5N1 avian influenza virus in the southern city of Shenzhen in Guangdong province, local authorities said.
The 39-year-old man surnamed Chen died of multiple organ failures at 1 p.m., the Department of Health of Guangdong said in a statement.
Another 120 people who had contact with the driver have not reported any symptoms, the department said.
Chen was hospitalized for fever on Dec. 21 and tested positive for the H5N1 avian influenza virus in the Bao'an district of Shenzhen, which borders Hong Kong, the department said.
The department also said that during the month prior to his fever, he had no direct contact with poultry and had not traveled out of the city.
The General Administration of Quality Supervision, Inspection and Quarantine (AQSIQ) on Dec. 22 suspended supplies of live poultry to Hong Kong after a dead chicken tested positive in Hong Kong for the H5N1 avian influenza virus.
The discovery of the infected bird prompted Hong Kong's health authorities to raise the city's response level for bird flu from "alert" to "serious" and to cull more than 17,000 chickens at a poultry market where the infected carcass was found.
Avian influenza, commonly known as bird flu, is a contagious disease caused by viruses that normally infect birds and, less commonly, pigs. It can be fatal to humans.
According to data released by the WHO, the virus has infected 573 people around the world, killing 336 as of December this year.
HK finds 2nd dead bird in a week with H5N1 bird flu
Hong Kong authorities say a second dead bird in a week has tested positive for a dangerous strain of bird flu, raising health concerns in the city.
The agricultural department said Friday that lab tests confirmed an Oriental magpie robin found dead on Dec. 17 was infected with H5N1 avian influenza.
On Wednesday, workers slaughtered more than 19,000 birds at a Hong Kong market and banned the import and sale of live poultry for three weeks after a chicken carcass tested positive for H5N1.
H5N1 occasionally infects people who have close contact with infected poultry, particularly in parts of Asia. Globally, 331 people have died from bird flu since it was first detected in 2003.
The Oriental magpie robin is commonly found in Hong Kong. (AP)
100,000 Italians in bed with flu for Christmas
(AGI) Rome - With fever, cold symptoms and joint pain 100,000 Italians will be in bed over Christmas with the seasonal flu.
According to the Influnet bulletin from the Superior Health Institute, 1.63 cases have been reported for every 1000 visited in the last week, coming to a total of 97,800 cases. Those feeling the effects of the cold weather are mainly the youngest, from 0-4 years a rate of 4.57 cases per 1,000 are reported. This drops to 2.15 for the group between 5 and 14 years old, to 1.55 for the 15-65 year old group and barely 0.62 for those over 65.
Details of lab-made bird flu won't be revealed
WASHINGTON (AP) -- The U.S. government paid scientists to figure out how the deadly bird flu virus might mutate to become a bigger threat to people — and two labs succeeded in creating new strains that are easier to spread.
On Tuesday, federal officials took the unprecedented step of asking those scientists not to publicize all the details of how they did it.
The worry: That this research with lots of potential to help the public might also be hijacked by would-be bioterrorists. The labs found that it appears easier than scientists had thought for the so-called H5N1 bird flu to evolve in a way that lets it spread easily between at least some mammals.
"It wasn't an easy decision," said Dr. Anthony Fauci, infectious diseases chief at the National Institutes of Health, which funded the original research.
The scary-sounding viruses are locked in high-security labs as researchers at the Erasmus University Medical Center in the Netherlands and the University of Wisconsin-Madison prepare to publish their findings in leading scientific journals. That's the way scientists share their work so that their colleagues can build on it, perhaps creating better ways to monitor bird flu in the wild, for example.
But biosecurity advisers to the government recommended that the journals Science and Nature publish only the general discoveries, not the full blueprint for these man-made strains. Tuesday, the government announced that it agreed and made the request.
In statements, the two research teams say they're making some changes, if reluctantly. The journals are mulling what to do, and the government didn't say precisely what should be left out.
But Science editor-in-chief Dr. Bruce Alberts said his journal pushed the U.S. government to set up a system where certain international researchers will be able to get the full genetic recipe for these lab-bred strains — especially those in bird flu-prone countries like China and Indonesia.
"This is a sort of watershed moment," said Alberts, noting it's believed to be the first time this kind of secrecy has been sought from legitimate public health research.
He doesn't want to publish an abbreviated version of the findings unless he can direct scientists how to get the full, if confidential, details.
"It's very important to get this information out to all the people around the world who are living with this virus and are working on it," Alberts said.
NIH's Fauci said the system should be working very soon, so that international public health officials, scientists and drug companies with "a legitimate need to know can have access to that information."
Nature's editor-in-chief, Dr. Philip Campbell, also called the recommendations unprecedented.
"It is essential for public health that the full details of any scientific analysis of flu viruses be available to researchers, he said in a statement. The journal is discussing how "appropriate access to the scientific methods and data could be enabled."
H5N1 has caused outbreaks in wild birds and poultry in a number of countries around the world. But it only occasionally infects people who have close contact with infected poultry, particularly in parts of Southeast Asia. It's known to have sickened nearly 600 people over the past decade. But it's highly deadly, killing about 60 percent of the time.
The concern is that one day, bird flu might begin spreading easily between people and cause a pandemic. The NIH wanted to know what genetic changes it should monitor for, as a warning.
In surprise findings, the two teams of researchers separately re-engineered bird flu to create strains that can spread easily between ferrets. That animal mimics how humans respond to influenza.
That doesn't necessarily mean the new lab-bred flu strains could infect people, Fauci cautioned.
Still, the viruses are being kept under special conditions along with other so-called "select agents" for security and to guard against a lab accident, as researchers try to learn more about just how risky the H5N1 that circulates in the wild really could become.
"There is clearly a public health threat that has been lingering and smoldering with regard to H5N1 for several years," said Fauci, who adds that a naturally occurring flu pandemic is much more likely than any man-made one.
"Nature is the worst bioterrorist. We know that through history," he said.
More information on the two research projects isn't being released until the journals decide what to publish.
But in a statement last month, Dutch lead researcher Dr. Ron Fouchier said his discovery showed what mutations to watch for so "we can then stop the outbreak before it is too late."
Tuesday, Erasmus Medical Center said researchers were complying with the U.S. request to change their scientific report. But, "academic and press freedom will be at stake as a result of the recommendation. This has never happened before," the statement said.
The University of Wisconsin said virologist Yoshihiro Kawaoka's team likewise would comply.
"While recognizing the potential for misuse of scientific discovery, the research described by UW-Madison researchers is essential for public health, global influenza surveillance activities and the development of vaccines and drugs to counter any potential pandemic," said a university statement.
An independent biosecurity expert called Tuesday's announcement a good middle-ground but said scientists should think twice about re-engineering influenza given the potential global consequences of an accident. The two labs involved are highly regarded, but more and more labs around the world can try similar work, noted Dr. D.A. Henderson of the Center for Biosecurity of the University of Pittsburgh Medical Center.
"Influenza is certainly a unique beast in its capability to spread," said Henderson, who played a key role in the eradication of a different killer, smallpox. "The question is how can we assure experiments like this really aren't done in ways that the organism is apt to escape."
Vitamin D-The Sunshine Vitamin
An important part of Dr. Christopher's Incurables Program is the sunbath. He recommended that you "take a sunbath each day in the nude and not through glass but in the direct sun." There are two types of ultraviolet light from the sun, UVA and UVB rays. UVA rays are longer and penetrate deep into the skin to produce a dark tan. When in the sun too long they cause wrinkles and sun spots. UVB rays are shorter and cause the skin to burn. They are also the only rays that make vitamin D. Vitamin D is actually a steroid and is a powerful antioxidant. It is an important nutrient in preventing cancer including skin cancers. It is important for proper immune function and to prevent autoimmune diseases. It helps with proper brain function, diabetes prevention and is needed for absorption of calcium and phosphorus.
"Only allow two minutes on the front and two minutes on the back the first day. Then add two minutes front and back each day, but no more." You should never stay in the sun long enough to get burned. The body stops making vitamin D once the skin starts to turn pink. When SPF sunscreen is applied it stops vitamin D production and may make you more susceptible to some skin cancers.
"The sun is the world's greatest doctor but must be used by building up the exposed time in the sun gradually so as to not burn." The best time for vitamin D production from the sun is 11:00 am until 1:00 pm or when the sun is the brightest. That is when the UVBs are most direct. They are not as effective when they come in at an angle and they are easily filtered out by smog, pollution, fog, clouds and windows.
"If it is a cloudy or cold day, use a sunlamp, but do not allow a burn." The best source for vitamin D is from natural sunlight, but in the winter, it is not possible to get adequate amounts of vitamin D from the sun. Sunlamps or tanning beds are another option and some provide
both UVA and UVB rays for vitamin D production.
Most salon tanning beds are calibrated to produce about 95% UVA light, but there are some that will produce both UVA and UVB rays. The same caution should be used with a tanning bed as with sun exposure and they can safely produce vitamin D in the winter months. Dr. Michael Holick of Boston University has shown that vitamin D produced by UVB radiation from a tanning bed maintains longer lasting and more consistent levels of vitamin D than taking vitamin D supplements.
Dermatologists have found that tanning makes the skin give off endorphin's which improve feelings of well-being and make you feel happier.
Sources: Herbal Home Health Care by Dr. John R. Christopher
Primal Body, Primal Mind by Nora T. Gedgaudas, CNS, CNT
Baby Boomer Diet by Donna Gates
Mercola.com/Tanning-Bed
Hiding data won't stop flu weapon: expert
The Government should not back US attempts to suppress details in scientific reports about how a killer birdflu mutated to become highly contagious, says an Auckland scientist.
US regulators are concerned the details might be used by terrorists to create a bio-weapon.
The virus is an H5N1 avian influenza strain that was genetically altered in Rotterdam's Erasmus Medical Centre, so it can pass easily between ferrets.
It is estimated it could have a catastrophic 60 percent mortality rate among humans.
The reports are due to be published in the prestigious journals Science and Nature, but the editors are considering the suppression request.
Auckland University microbiologist Dr Siouxsie Wiles says the government should help the public understand why such research was important.
"I do not believe the New Zealand Government should support the suppression of the Erasmus study," she said on the Science Media Centre's website today.
The United States National Science Advisory Board for Biosecurity (USABB) has requested the two journals to delete details regarding both scientific methodology and specific viral mutations before publishing articles on the research.
"The greatest risk was that such mutations could occur naturally where people and animals such as poultry lived together, and it was absolutely crucial scientists monitoring the viruses in the environment knew what mutations to look out for," Dr Wiles said.
"While there may be little risk to New Zealand of H5N1 from infected migratory birds, our proximity to Asia and the ever increasing popularity of air travel, make this a far more likely route for the virus onto our shores.
"It is important for everyone, policy makers and the public alike, to understand that a weaponised form of H5N1 may already be brewing in nature.
"In fact, this scenario is more likely than some so called rogue-state acting on the data in the two manuscripts submitted to Nature and Science."
38,400 ostriches culled to deal with avian flu
South Africa had culled 38 400 ostriches since an outbreak of avian flu in the Western Cape in April that halted exports to Europe, threatening an industry that employs 20 000 people, the provincial Agricultural Department said yesterday. Tests were being conducted on the birds in the Oudtshoorn area to determine whether they were clear of influenza so that an eight-month export ban to the EU could be lifted, said Wouter Kriel, a spokesman for the department. The industry was losing about R108 million a month because of the flu outbreak. In 2005 South Africa lost R600m in ostrich exports because of an avian flu outbreak, resulting in the slaughter of about 26 000 birds and costing the industry 4 000 jobs. – Bloomberg
Health Notes: Some answers to cold/flu questions
Is it a cold, or is it the flu? And what can you do to prevent either? New York otolaryngologist Dr. Sezelle Gereau Haddon MD, Continuum Center for Health and Healing, offers answers to frequently asked questions about cold and flu.
1. When do cold symptoms typically occur for kids and adults? Is there a difference between the two groups? Answer: Cold symptoms usually occur within 2 or 3 days after you came in contact with the virus, although it could take up to a week. You are contagious for this same period of time. There is no difference between kids and adults.
2. Is there a reason why women are more likely to catch a cold than men? Answer:Women, especially those 20 to 30 years old, have more colds than men, possibly because of their closer contact with children. Many things cause you to be more prone to upper respiratory illness, including stress, fatigue and allergies. Being female in and of itself does not predispose you to it.
3. Would you recommend Zinc for kids? If so, how would a kid take it? (Lozenge? Zicam?) How much should kids take? Also, how does zinc help the cold and flu? Does it decrease the duration or symptoms? Answer: Zicam should not be used in the nose, as it causes a loss of sense of smell. Dosages as published by the Mayo Clinic are: "For the common cold, the following doses of zinc have been taken by mouth: 10 milligrams of zinc lozenges 5-6 times daily, based on age; one-half of a zinc lozenge (23 milligrams) (Truett Laboratories, TX), for children under 27 kilograms, every two hours, not to exceed six daily; and zinc gluconate glycine lozenges (Cold-EEZE®) four times daily for the duration of the cold"
4. What are some of the best ways to fight off a cold before it gets to you? Answer: Many things can be done to prevent full development of cold symptoms, but they have to be instituted early on. These include rest, stress reduction, increased fluid intake and certain supplements. We are not sure why all of them work, but they support normal function of the immune system in various ways.
5. There is an old wives' tale that says to 'feed a fever and starve a cold' but research has shown that's probably not true. Instead, what can parents do to help their kids feel better when they have the cold or flu? Studies show that chicken soup helps. Why? How much rest and fluids do children need and why do these things seem to help? Answer: Chicken soup has both anti-inflammatory and antiviral effects. Fluids prevent dehydration, so help one feel better. Saline sprays are helpful with moving nasal secretions and with facilitating breathing. Products with Elderberry and Astragalus are made in formulations for children, and can be soothing and help the immune system as well. Rest helps the body recharge, and lessening stress can be beneficial for the innate immune system.
6. How do viruses typically enter the body? Is there a way to prevent it entering these passages? Answer: Yes, viruses enter the body through the nose, or mouth. A daily nasal wash can be useful to prevent development of these illnesses, or actually used for treatment once they develop.
7. Do hand sanitizers work? Answer: Hand sanitizers are wonderful ways to keep from spreading and contracting viral illnesses, and can be used to prevent getting sick, particularly with those in close quarters. They should not be used to replace handwashing.
Hong Kong raises bird flu alert level, bans imports
HONG KONG — Hong Kong raised its bird flu alert level to "serious" on Tuesday and announced it is to cull 17,000 chickens after three birds tested positive for the deadly H5N1 strain of the virus.
The city's health chief York Chow announced the measures after a dead chicken at a wholesale market and two other wild birds tested positive for the deadly H5N1 strain of the disease.
Authorities banned all live poultry imports with immediate effect while they trace the source of the dead chicken, whether it was imported or from local poultry farms.
Public broadcaster RTHK reported that around 20 students from a girls' school, aged between six and seven, have developed flu-like symptoms including fever, cough and sore throat, but none has been taken to hospital.
Hong Kong was the site of the world's first major outbreak of bird flu among humans in 1997, when six people died from a mutated form of the virus, which is normally confined to poultry. Millions of birds were then culled.
The cull at the poultry wholesale market where the infected chicken was found will be held on Wednesday, Chow told a late night press conference.
"With a heavy heart, I announce that the dead chicken has been tested positive for the H5N1 strain of virus after a routine check by the agriculture, fisheries and conservation department today," Chow said.
"We are now raising the bird flu response level from alert to serious."
Earlier on Tuesday, the agriculture authorities confirmed an Oriental magpie robin found dead in a secondary school on Saturday had tested positive for H5N1, the second such case in a week.
Another secondary school was ordered to close for a day for disinfection last Friday after a dead black-headed gull was found with the virus.
A school clerk, who picked up the bird, and her son developed flu-like symptoms and were taken to hospital but both were cleared later.
A 59-year-old woman tested positive for bird flu in 2010 in Hong Kong's first human case of the illness since 2003.
The city is particularly nervous about infectious diseases after an outbreak of deadly respiratory disease SARS in 2003 killed 300 people in Hong Kong and a further 500 worldwide.
Copyright © 2011 AFP. All rights reserved
Flu virus linked to seal deaths off New England coast
A flu virus similar to one found in birds but not previously detected in harbor seals was the cause of five of 162 recent deaths of the marine animals off the New England coast, federal and state officials announced today.
The influenza virus, known as H3N8, appears to have a low risk for transmission to humans, they said. But the officials are urging the public to be cautious about approaching stranded seals to reduce the potential risk of spreading the infection to people or their unleashed dogs.
“Influenza that poses a risk to people are human strains of influenza....but there have been documented cases in people of transmission from other species,” said Dr. Catherine M. Brown, public health veterinarian for the Massachusetts Department of Public Health.
Brown noted that other viruses that caused global disease outbreaks in years past, such as avian and swine flu, jumped from birds and pigs to humans, usually through the animals’ caretakers.
Federal scientists have been working with researchers from the New England Aquarium and various centers around the country to investigate the string of seal deaths since September.
The specialists said today in a news conference that they believe the influenza type A virus that infected the seals left them vulnerable to a bacterial pneumonia that killed five of them. They said that most land-based animals, such as wild birds, who have been infected with this virus suffered upper respiratory infections and most recovered.
“We don’t undertand at the moment what is making this virus more deadly,” said Dr. Hon Ip, a researcher at the US Geological Survey Wildlife Health Center.
Ip said there have been earlier deaths of seals traced to an influenza virus but that they were few and far between.
The scientists said they will continue to study the strandings, and to test tissue samples taken from some of the dead seals to determine how many others may have been infected by the virus. They also said that because marine mammals are known to travel, they will be working with scientists in Canada to monitor the health of harbor seals in Canadian waters.
Types of Immune System Supplements
We live in an environment that is full of pollutants and poisonous substances. Our bodies fight thousands of bacteria and viruses that enter our body through our mouth and nose without us even being aware of it. It is only when our body starts losing the battle with these tiny microorganisms that we become aware of their presence. Minor diseases like the cold and flu can turn into something far more complicated, if our immune system is unable to fight it. In the struggle against germs, our immune system plays a vital role. The spleen, skin, white blood cells and the lymphatic system each play their role in protecting the body from harmful viruses and bacteria. But if the immune system is weak for some reason, the results can be catastrophic. This is particularly so among older people and those suffering from a deadly disease for a long period of time. Frequent use of antibiotics to fight the outside agents can damage the body in more ways than one. So, it’s far better to concentrate on making the immune system stronger; enabling it to work independently, without any outside help to eradicate harmful germs.
There are many types of immune system supplements. First in the list are herbal immune system supplements. Herbs like goldenseal, echinea, grape seed extract and probiotics are on top of the immune system supplement list. Goldenseal can be used for short periods of time only but grape seeds extract is safe to use for longer periods without any negative effect. Probiotics are contained in many everyday foods such as yogurt and do wonders for strengthening the immune system. The advantage of using these herbal immune system supplements is the lack of side effects and damaging consequences for the body.
Anti-Aging Cereal boosts immunity
Oats and Barley cereal is a great way to start your morning. These grains contain beta-glucan, a type of fibre with antimicrobial and antioxidant capabilities more potent than echinacea, reports a Norwegian study. When animals eat this compound, they're less likely to contract influenza, herpes, even anthrax; in humans, it boosts immunity, speeds wound healing, and may help antibiotics work better.
These grains contain beta-glucan, a type of fibre with antimicrobial and antioxidant capacity higher than echinacea, says a recent Norwegian study.
When animals consume these compounds are protected from cold, herpes and anthrax. In humans, oats and barley improve the immune system and help speed up wound healing.
Hong Kong school closed in bird flu scare
HONG KONG (AFP) - A Hong Kong school was closed on Friday after a dead bird found in the southern Chinese city was tested positive for the deadly H5 strain of the bird flu virus, health officials said.
The closure came after the school clerk, a 48-year-old woman, picked up a sick black-headed gull at the school on Tuesday, which died the next day and was tested positive for the H5 strain, a health department spokesman told AFP.
She picked up the bird - a common winter visitor - without any protection and developed a fever, sore throat and diarrhoea but has tested negative for Influenza A (H5), a variant of bird flu.
'She has been cleared in the medical results we received today but tests on her 11-year-old son are still ongoing, with results expected to be released later Friday,' said the spokesman.
Bird tests positive for H5 avian flu
A woman is undergoing tests after a black-headed gull she'd handled tested positive for the H5 avian flu virus. The bird was found three days ago at the Chiu Lut Sau Memorial Secondary School in Yuen Long. The woman developed fever, diarrhoea and sore throat yesterday. Test results are due later today.
The Centre for Health Protection said no abnormalities had so far been reported from the school's students. Its Controller, Thomas Tsang, said it was unlikely the woman has got the H5 virus.
New Facility to Advance Public Health, Zoonoses Research
Guelph - The University of Guelph today opened a new research facility to help prevent and control emerging animal-related diseases that threaten public health.
Based at the Ontario Veterinary College (OVC), the new laboratories will support investigations by researchers in U of G’s Centre for Public Health and Zoonoses (CPHAZ). Scientists will use state-of-the-art equipment to address new or re-emerging zoonotic diseases (those that can jump between animals and humans) such as the H1N1 flu virus, bird flu, E. coli O157:H7 and West Nile virus.
“Scientists and public health experts are increasingly working together to protect the health of both animals and people, ” said OVC dean Elizabeth Stone.
“This new facility allows us to provide focus and leadership in solving important problems with zoonotic diseases and to disseminate this knowledge to inform policy decision-makers, animal industries and the public.”
Newly-created laboratories and equipment in the facility were funded in part by a $1-million grant from the Canada Foundation for Innovation and the Ontario Research Fund.
“We are grateful to CFI and to the Ontario Ministry of Economic Development and Innovation,” said Rich Moccia, associate vice-president (research).
“Their investment will allow the University to continue its strong tradition of research and education in animal-related aspects of public health and collaborative partnerships.”
The Centre for Public Health and Zoonoses involves more than 40 U of G scientists, as well as government and industry collaborators. They investigate a variety of infectious diseases, including food-borne diseases and diseases affecting companion animals, food animals and wildlife.
The centre is directed by Jan Sargeant, a professor in OVC’s Department of Population Medicine and the holder of a $1-million Applied Public Health Chair funded by the Canadian Institutes of Health Research.
Zoonotic diseases are a major public health threat worldwide, said Sargeant, and veterinarians are uniquely equipped to investigate and find solutions.
“Up to 75 per cent of emerging diseases that pose a threat to human health originate in animal populations, whether it’s avian flu or new strains of antibiotic-resistant ‘superbugs,’” she said.
“We have an important role to play in developing knowledge and expertise in this area and integrating them in the public health system.”
Sargeant said the centre will expand its research in the new facilities, including laboratories for studying bacteria and molecules and “supercomputer” facilities for disease monitoring and surveillance which is a joint effort with the Department of Math and Statistics in the College of Physical and Engineering Sciences.
Integrating research and surveillance efforts will help predict problems and understand and control infectious diseases, she said.
A cryo-storage facility will allow veterinarians to store collected samples which can then be used in the future to develop and validate diagnostic tests, vaccines and virulence factors.
“It will build even stronger collaborations between researchers in different disciplines and allow us to conduct cutting-edge research that would not be possible without this resource,” Sargeant said.
The Bioterrorist Next Door
Man-made killer bird flu is here. Can -- should -- governments try to stop it? In September, an amiable Dutchman stepped up to the podium at a scientific meeting convened on the island of Malta and announced that he had created a form of influenza that could well be the deadliest contagious disease humanity has ever faced. The bombshell announcement, by virologist Ron Fouchier of Erasmus Medical Center, sparked weeks of vigorous debate among the world's experts on bioterrorism, influenza, virology, and national security over whether the research should have been performed or announced and whether it should ever be published.
Meanwhile, a joint Japanese-American research team led by the University of Wisconsin's Yoshihiro Kawaoka says that it, too, has manufactured a superflu. Additionally, a team at the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta has acknowledged doing similar research, without successfully making the über flu. The U.S. National Science Advisory Board for Biosecurity is now deliberating whether to censor publication of the Fouchier and Kawaoka papers, though it lacks any actual power to do so: It could so advise scientific journals, but editors would still decide. The advisory board is expected to release its decision on Dec. 15.
The interest in this brave new world of biology is not limited to the scientific community. U.S. Secretary of State Hillary Clinton made a surprise visit to Geneva on Dec. 7, addressing the Biological Weapons Convention review conference. The highest-ranking U.S. official to speak to the biological weapons group in decades, Clinton warned, "The emerging gene-synthesis industry is making genetic material widely available. This obviously has many benefits for research, but it could also potentially be used to assemble the components of a deadly organism."
"A crude but effective terrorist weapon can be made by using a small sample of any number of widely available pathogens, inexpensive equipment, and college-level chemistry and biology," Clinton also stated. "Less than a year ago, al Qaeda in the Arabian Peninsula made a call to arms for, and I quote, 'brothers with degrees in microbiology or chemistry to develop a weapon of mass destruction.'"
Noting that "It is not possible, in our opinion, to create a verification regime" for biological weapons compliance under the convention, Clinton called for voluntary transparency on biological experimentation among the 165 countries that have signed the agreement.
Officials throughout the U.S. government are declining to comment on the influenza experiments or elaborate on Clinton's comments and appearance in Geneva. The influenza scientists were politely but firmly instructed recently by U.S. officials to keep their mouths shut and provide no data or details regarding their experiments to anybody. Sources inside the Dutch, German, and French governments say that discreet agreement was reached among Western leaders to greet the influenza pronouncements with a wall of silence, pending the advisory board's decision and detailed analysis of the experiments by classified intelligence and scientific bodies.
Should we worry? If these scientists have indeed used the techniques that they have verbally described (but not yet published) to produce a highly contagious and virulent form of the so-called "bird flu," the feat can at least theoretically be performed by lesser-skilled individuals with nefarious intentions. Perhaps more significantly, the evolutionary leaps might be made naturally, via flu-infected birds, pigs, even humans. In other words, the research has implications for both terrorism and a catastrophic pandemic. Moreover, several experimental antecedents involving smallpox-like viruses and polio lend credence to the idea that concocting or radically altering viruses to create more lethal or transmissible germs is becoming an easier feat and an accidental byproduct of legitimate research.
The advisory board is debating whether the work, as well as details on how the flu viruses were deliberately mutated, should be published. That is the wrong question. As a practical matter, experimental results are now shared with lightning speed between laboratories, and I know that several leading scientists outside Fouchier's and Kawaoka's labs already recognize exactly how these experiments were executed. The genie is out of the bottle: Eager graduate students in virology departments from Boston to Bangkok have convened journal-review debates reckoning exactly how these viral Frankenstein efforts were carried out.
The list of attempts by governments to stifle scientific information is lengthy and marked by failure. I was at a 1982 optical engineering meeting in San Diego that was disrupted by a censorship order handed down by the Ronald Reagan administration's security chief, Adm. Bobby Ray Inman, compelling seizure of about 100 papers. The administration claimed the findings in those mathematics papers would, in Soviet hands, pose an existential threat to the United States -- an assertion that proved laughable when the studies soon saw the light of day. In 2006, George W. Bush's administration tried to block climate change–related presentations by NASA scientist James Hansen; every single one of Hansen's data points swiftly appeared on the Internet.
Rather than trying to censor research because its inevitable release might be harmful, we ought to be having a frank, open discussion about its implications. The correct questions that scientists, national security and political leaders, and the public ought to be asking are: How difficult was it to perform these experiments? Could they be replicated in the hands of criminals or would-be terrorists? What have these experiments shown us about the likelihood that the H5N1 "bird flu" virus will naturally evolve into this terrifying form? Are we safer, or less secure, today due to the post-2001 anthrax-inspired proliferation of high-security biological laboratories?
What Genie Has Popped from Which Bottle?
In 1997, the form of influenza now dubbed H5N1, or avian flu, emerged in Hong Kong, killing six people and forcing the destruction of every chicken in the protectorate. The virus had been circulating in aquatic migratory birds and domestic poultry flocks within mainland China for at least two years, but it was not recognized as a unique entity until the Hong Kong outbreak. The spread of H5N1 was temporarily halted by Hong Kong health official Margaret Chan, who ordered the mass culling of the area's poultry. Chan now serves as director general of the World Health Organization (WHO).
The virus reappeared in Thailand in 2003, killing flocks of chickens and ducks that November and infecting humans in January 2004 in Thailand and Vietnam. The H5N1 virus mutated in 2005 as it spread among various species of birds migrating through northern China, giving avian flu the capacity to infect a far greater range of bird species, as well as mammals -- including human beings. That year, human and animal outbreaks of H5N1 appeared across a vast expanse of the globe, from the southernmost Indonesian islands, up to central Siberia, and as far west as Germany.
By mid-2011, H5N1 had become a seasonal occurrence in a swath of the world spanning 63 countries of Asia, the Pacific Islands, Eastern and Western Europe, the Middle East, and North and West Africa. Since its 2004 reappearance, H5N1 has sickened at least 565 people, killing 331, for an overall mortality rate of 59 percent. The Ebola virus can be more lethal -- as high as 90 percent -- but is not terribly contagious. Rabies, in the absence of vaccination, is 100 percent lethal, but it can only be transmitted through the bite of an animal. It is estimated that in pre-vaccine days, the smallpox virus killed about a third of the people it infected.
Only influenza holds the potential of both severe contagion and, in the case of H5N1, astounding mortality rates, ranging from about 35 percent in Egypt (where the virus circulates widely) to more than 80 percent in parts of Indonesia (where 178 confirmed cases have resulted in 146 deaths). The virulence of H5N1 is far higher than that seen with any other influenza, including the notorious 1918 flu that killed an estimated 62 million people in less than two years. (Some reckonings of 1918 death tolls in poor countries that lacked epidemic reporting systems, such as China, India, and all of Africa, put the final mortality at 100 million, when the world population was just 1.8 billion and commercial air travel did not exist.) Six years ago, the spread of H5N1 sparked concern in the Executive Office of the Secretary-General of the United Nations, the White House, and many of its counterpart centers of government worldwide. Tremendous efforts ensued to kill infected domestic poultry, rapidly identify outbreaks, and pool scientific resources to track and scrutinize various H5N1 strains as they emerged. Some 400 million domestic birds were killed between 2004 and 2010, at an estimated global cost of $20 billion. It all seemed to work: By the end of 2008 the annual number of poultry outbreaks of H5N1 had shrunk from 4,000 down to 300.
In fearful anticipation, health and virus experts also watched for signs that the virus was spreading from one person to another. Although there were clusters of victims, infected families, and isolated person-to-person possible infections, the dreaded emergence of a form of humanly contagious H5N1 never occurred. By 2010, many leading virologists concluded that H5N1 was a terrifying germ -- for birds. The confident consensus, however, was that the mutations that avian flu would have to undergo to be able to spread easily from one human lung to another's were so complex as to approach evolutionary impossibility.
By mid-2011 the global response to avian flu had grown lethargic and complacent. Predictably, in the absence of vigilant bird-culling and vaccination efforts, trouble emerged as outbreaks mounted across Asia. Between January 2010 and the spring of 2011 more than 800 outbreaks were dutifully logged by government officials worldwide. In late July, a 4-year-old girl died of H5N1 in Cambodia, making her the seventh avian flu mortality in a country that had been free of the microbe for a long time.
On Aug. 29, the Food and Agriculture Organization sounded a mutation alarm, noting a new strain of the virus, dubbed H5N1-2.3.2.1, had surfaced in wild and domestic bird populations in Vietnam. Vietnam was one of six countries (including Bangladesh, Egypt, Indonesia, China, and India) in which avian flu had become endemic, meaning it permanently circulated among local and migratory birds. A week later, a Boston biotech company called Replikins announced the discovery of a mutant combination of the avian H5N1 flu and the so-called "swine flu" that spread swiftly among people during the 2009 global pandemic. Replikins's claim implied that the highly virulent bird flu could gain the capacity to spread rapidly between people by absorbing infection genes from the contagious-but-wimpy H1N1 swine influenza.
Although these announcements sparked a minor panic in Asia, further scrutiny of both the 2.3.2.1 and Replikins's claim left the WHO convinced that no new human threat loomed. In early September, a collective sigh of public-health relief was expelled.
Three days later, the conference of the European Scientists Fighting Influenza (ESWI, the Romance-language acronym) convened in Malta, opening with scientific evidence of current pandemic potentials. The stage was set by renowned University of Hong Kong flu scientist Malik Peiris, who described with exquisite precision which genetic factors made the "swine flu," H1N1, highly contagious between pigs, ferrets, humans, and other mammals. Peiris offered evidence that the 2009 H1N1 pandemic started among American pigs but had been circulating in swine populations throughout North America and China for decades before making the mutational steps that sparked global spread.
Fouchier, the Dutch scientist, who has tracked H5N1 avian flu outbreaks in Indonesia for years, then suggested that vaccines used for years on chicken farms are now failing. Perhaps under selective evolutionary pressure, forms of vaccine-resistant H5N1 have appeared, Fouchier told the Malta meeting, adding, "We discovered that only one to three substitutions are sufficient to cause large changes in antigenic drift." In other words, naturally occurring, infinitesimal changes in the flu's genetic material are sufficient to render vaccines useless.
Fouchier went on to describe what he dubbed his "stupid" experiment of infecting ferrets in his lab sequentially with H5N1. One set of the animals would be infected, and then Fouchier would withdraw nasal fluid from the ferrets and use it to inoculation-infect a second set of animals. After 10 repeats, the superkiller H5N1 emerged, spreading through the air rapidly, killing 75 percent of the exposed animals. (Because Fouchier's work has not been published, accounts of the experiment vary, based on reporting from those who were present to hear his Malta speech. In some accounts the superlethal bird flu resulted from only five serial passages in ferrets -- a number far more likely to occur randomly in nature.)
"This virus is airborne and as efficiently transmitted as the seasonal virus," Fouchier told the Malta crowd, adding that he had identified which specific five mutations were necessary. Only five minute switches in RNA nucleotides -- the most basic elements of genetics -- were needed.
"This is very bad news, indeed," a sober Fouchier concluded.
The five dire mutations (technically, single nucleotide changes occurring inside two genes) have been separately found in influenza viruses circulating in the world. The actual mutations are not, therefore, unique. Fouchier's only innovation was in making all five occur inside the same virus at once. The more famous flu researcher from Erasmus, Albert Osterhaus, told reporters that what is done in the lab can happen in nature, adding, "Expect the unexpected.… The mutations are out there, but they have not gotten together yet."
Under questioning in Malta, Fouchier said his ferret form of H5N1 would certainly spread among humans and is "one of the most dangerous viruses you can make."
Shortly after Fouchier's announcement, Kawaoka, the University of Wisconsin scientist, let it be known that he, too, has made an airborne-transmissible H5N1 that readily spreads among mammals. Kawaoka's efforts were jointly executed by teams he heads at the University of Wisconsin and the University of Tokyo. No further details regarding this effort are publicly available, though Kawaoka has submitted a paper detailing his techniques and discoveries for review by the U.S. National Science Advisory Board for Biosecurity, as has Fouchier. Both scientists wish to publish their work in major scientific journals.
Scientists are deeply divided regarding publication. "If I were a journal editor and I received an article that said how to make a bioweapon, I'd never publish it, but that would be based on self-regulation, not any government restriction," anthrax expert and retired Harvard University professor Matt Meselson told an interviewer. "I've never heard of a case where the government has restricted publication. I don't think it would work." But fellow anthrax researcher Paul Keim, who chairs the advisory board, told reporters, "I can't think of another pathogenic organism that is as scary as this one. I don't think anthrax is scary at all compared to this."
Perhaps the most intriguing comments came from Australian scientist Ian Ramshaw, who suggested that the Fouchier or Kawaoka papers could serve as bioterrorism blueprints: "As a researcher you do the good thing, but in the wrong hands it could be used for evil. In this case I'm not so worried about bioterrorism. It's the disgruntled researcher who is dangerous -- the rogue scientist," Ramshaw warned, according to the Canberra Times. Ten years ago Ramshaw accidentally made a superkiller form of mousepox, the rodent version of smallpox, in his Australian National University laboratory. He injected lab mice with the pox virus to test out a completely unrelated contraceptive vaccine, but the experiment transformed the virus into a deadly monster with a 100 percent fatality rate. In 2001 Ramshaw's work spurred high-level concern about the use of genetically modified smallpox by a rogue nation or terrorist group, launching the vigorous, multibillion-dollar post-9/11 American smallpox vaccine effort, as detailed in my new book, I Heard the Sirens Scream.
Within two years of Ramshaw's accidental mousepox creation, separate labs deliberately created viruses. In 2002, researchers at the State University of New York in Stony Brook built a polio virus from its genetic blueprint. This constituted a proof of principle, demonstrating that in a sufficiently skilled laboratory, all that is required to make a deadly virus is its nucleotide sequence -- details of which are now routinely published for everything from anthrax to the Ebola virus. At the time, Eckard Wimmer, the lead scientist on the project, warned: "The world had better be prepared. This shows you can re-create a virus from written information."
The following year another scientific team deliberately mimicked Ramshaw's mousepox accident, not only with the rodent form of pox but also with pox viruses that infect rabbits and cows. And in 2005 the CDC famously joined fragments of RNA from thawed tissue of victims of the 1918 flu, re-creating the original superkiller.
The Genie Is Out of the Bioterrorism and Pandemic Bottles: How Scared Should We Be?
This April, a team of CDC scientists published word that it had tried to manipulate H5N1 genes to render the avian virus a human-to-human spreader, but could not make it work. The team used a different method from the one apparently deployed by Fouchier and Kawaoka's team: The CDC group directly altered the genes of viruses, rather than sequentially infecting ferret after ferret. The CDC concluded, "An improvement in transmission efficiency was not observed with any of the mutants compared to the parental viruses, indicating that alternative molecular changes are required for H5N1 viruses to fully adapt to humans and to acquire pandemic capability."
That seemed comforting.
But in 2007 a different CDC team did to the SARS virus what Fouchier apparently has done to H5N1, with lethal results. Just as Fouchier produced highly infectious bird flu in ferrets by sequentially infecting one group of animals after another, the CDC group passed the SARS virus through one group of mice after another. Mice are normally harmlessly infected by SARS, which cannot cause disease in the rodents. But after 15 such passages, the team got a 100 percent fatal form of the virus. Moreover, it was an airborne killer, sniffed out the air. (SARS, or severe acute respiratory syndrome, killed more than 900 people worldwide in 2002 and 2003, mostly in China.)
The University of Minnesota's Michael Osterholm, an expert on both bioterrorism and pandemics, thinks that understanding how animals might pass a virus like SARS or H5N1 among themselves, in a fashion in nature that mimics the laboratory experiments, may hold a vital key to predicting future epidemics. "We don't want to give bad guys a road map on how to make bad bugs really bad," he recently told Science reporter Martin Enserink. Health experts, however, do applaud the controversial research because it shows which mutations are necessary and at least one way they might arise.
There is no way to put a number on the probability of such natural mutational events. Are the odds 50-50 that a deadly, contagious form of H5N1 will wreak havoc across the world in the next 10 years? Anybody who claims to answer such a question, or pooh-pooh the asking of it, is a fool or a charlatan. It is an unknown.
What About the Proliferation of High-Security Biology Labs: Good or Dangerous?
Before the anthrax mailings terrorized America in 2001, there were only a handful of top security Biosafety Level 4 (BSL-4) labs in the world and a few dozen of the next-level BSL-3 facilities. The CDC and U.S. Army had the two largest pre-2001 BSL-4 labs, which nested like matryoshka dolls, with one layer of security inside another and another. The innermost labs required identity clearance, scientists wore protective space suits, and all air and water were specially cleansed and filtered to prevent accidental escape of Ebola, smallpox, and dozens of other superlethal organisms. The world's most dangerous known microbes were carefully kept under lock and key in a clearly identified handful of BSL-4 labs.
Even the less-secure BSL-3 labs required that scientists undergo security checks, wear spacesuits, and breathe through special respirators. Their numbers were finite and known, and researchers working on influenza, anthrax, or other deadly-but-treatable microbes represented a fairly small pool of scientists.
Since the 9/11 terrorist attacks, however, the number of such laboratories has proliferated spectacularly, not only inside the United States, but all over the world. In 2001 the United States had five "centers of excellence," as they were called, devoted to bioterrorism. By the end of 2002, more than 100 such centers were named, amid a record-breaking expansion in the numbers of laboratories and scientists studying anthrax, smallpox, Ebola, botulism, and every other germ somebody thought could be weaponized. After 9/11, the European Union saw the number of BSL-4 labs grow from six to 15. In the United States: from seven to 13. Canada built a BSL-4 complex in Winnipeg. Just as possession of rockets in the 1950s or nuclear power plants in the 1960s seemed the marks of a serious state power, so having BSL-3 and BSL-4 labs suddenly became a mark of national significance in the world -- an achievement to which countries should aspire. This year India opened its first BSL-4 facility, and it is rumored that Pakistan is now building one.
The proliferation of high-security labs means a great deal more than the mere construction of physical buildings. Where 10 years ago a finite pool of predominantly senior scientists toiled in such facilities, today thousands of graduate students, postdoctoral fellows, technicians, and senior researchers work in facilities stocked with humankind's worst microbial foes. Accidents have occurred with alarming regularity since the lab proliferation commenced, as I have detailed in my book. The facilities also constitute locations wherein individuals could theoretically execute experiments to produce supergerms without risking harm to themselves or others, regardless of whether the intent were noble, as appears to be the case for Fouchier and Kawaoka, or whether the intent were evil, as was the case with those responsible for the anthrax mailings.
Since 2005, several flu experiments conducted under BSL-3 conditions have raised eyebrows, as critics have charged the work should have been done inside the far more difficult but secure BSL-4 conditions. The original 1918 virus was "revived" from a long-frozen human body and grown inside a BSL-3 lab. Experiments were done on the 1918 virus in an effort to discover what genes made it so lethal. And the research that the CDC team, Fouchier, and Kawaoka performed on the H5N1 virus was all done in BSL-3 labs.
In September, when news of the Fouchier work started to appear in science magazines, Thomas Inglesby of the Center for Biosecurity at the University of Pittsburgh told New Scientist, "Small mistakes in biosafety could have terrible global consequences." His Pittsburgh colleague D.A. Henderson concurred: "The potential for escape of that virus is staggering."
According to the FBI, the culprit behind the 2001 anthrax mailings was Bruce Ivins, who worked in the U.S. Army's BSL-3 and BSL-4 labs in Maryland. Whether or not the FBI caught the right man -- a point of controversy among scientists -- it remains extraordinary that the response to what the agency calls "Amerithrax" is the creation of more such facilities in which more "Ivins" might toil.
The questions that arise from these H5N1 experiments have nothing to do with publication of the Fouchier and Kawaoka papers. We should be asking what we can do to ensure that such terrible man-made viruses never accidentally escape their laboratory confines or are deliberately released. And we should heed the question posed in the recently released Hollywood thriller Contagion when a Homeland Security character queries a CDC scientist:
"Is there any way someone could weaponize the bird flu? Is that what we're looking at?"
"Someone doesn't have to weaponize the bird flu," the CDC scientist responds, "The birds are doing that."
Study suggests statins reduce deaths in severe flu infections
Dec 15, 2011 (CIDRAP News) – The use of statins—widely used lipid-control drugs—was associated with a 41% lower death rate in patients who were hospitalized with influenza, according to a surveillance study from the 2007-08 flu season that spanned 10 states.
Over the past several years, researchers have identified possible statin benefits for other diseases. For flu, the drugs have the potential to inhibit the release of cytokines, pro-inflammatory chemicals that are thought to play a role in the type of severe pathophysiologic changes in seen in human H5N1 avian flu infections.
Studies to gauge the effect of statins on flu have produced mixed results. But the latest study, published yesterday in the Journal of Infectious Diseases (JID), is the first to limit the analysis to lab-confirmed flu cases.
The analysis is based on data from the influenza hospitalization surveillance system of the US Center for Disease Control and Prevention's Emerging Infections Program, which encompasses 59 counties in 10 states. Demographic and clinical data were collected from each patient's medical record, and the researchers obtained flu vaccination information from charts, registries, physicians, or patients.
The researchers recorded any statin use before or during hospitalization, but they did not collect the dose or frequency.
Surveillance subjects included adults who were hospitalized between Oct 1, 2007, and Apr 30, 2008, within 14 days of a positive influenza test. Testing methods included viral culture, immunofluorescence antibody staining, reverse-transcriptase polymerase chain reaction (PCR), a commercial rapid flu test, serologic testing, or an unspecified test noted in the patient's records.
With 3,043 patients included in the analysis, the average age was 70.4 years, and 56% were women. More than half (57.1%) had been vaccinated, and 33.3% (1,013) were given statins before or during hospitalization. Of that group, 76% were on statins before and during hospitalization. Those who used statins were more likely to be male and white, to have a cardiac or other underlying medical condition, and to have been vaccinated against flu.
Of the study group, 151 (5%) died within 30 days after their flu diagnosis, the majority of them shortly after hospital discharge.
After controlling for age, race, underlying medical conditions, vaccination status, and antiviral use, the researchers reported a 41% reduction (adjusted odds ratio, 0.59; 95% confidence interval, 0.38-0.92) in mortality in patients who took statins before or during hospitalization.
The results agree with the findings of two other studies that explored links between statins and flu mortality, but those studies used broader disease classifications that included pneumonia, rather than lab-confirmed flu, according to the authors.
However, they said a 2010 study found no benefits from statin use for acute respiratory infections in a primary care setting. That study didn't assess prescription adherence and used different disease end points that didn't include more severe outcomes. "Statins may be more beneficial at preventing disease outcomes, such as death, but may not play a role in reducing the incidence of infection or minor illness," the authors wrote.
Several limitations cited
The researchers detailed three main limitations of their findings: testing issues, limitations of chart data, and the possibility of a "healthy user bias" in people who take statins.
They noted that the study cohort may not reflect all patients hospitalized with flu, including those who weren't tested for the disease. Also, the limited sensitivity of the rapid tests could lead to underestimation of the number of cases.
According to the CDC, the sensitivity of rapid flu tests ranges from 50% to 70%, and their accuracy is influenced by the level of flu in the community. False-negatives are more likely when disease prevalence is high.
Ann Thomas, MD, MPH, the study's corresponding author and a public health physician with the Oregon Public Health Division, in an e-mail detailed the percentages for the flu confirmation methods: 75% rapid test, 11% direct immunofluorescent assay (DFA), 11% cell culture, and 6% PCR. She said the total exceeds 100% because some patients with positive rapid tests likely had other confirmatory tests.
She said that, since the 2009 H1N1 pandemic, clinicians have become more interested in knowing the subtype, and PCR has now become the dominant test to identify flu cases for the Emerging Infections Program surveillance system. However, before that time, including the 2007-08 flu season, about 75% of the surveillance systems cases were diagnosed by rapid test.
She noted that most of the cases during the study were identified during peak flu season, when the positive predictive value of rapid testing is higher, which Thomas said makes the study group hopeful that the test results are accurate.
It's unlikely that statin use would be associated with false-positive rapid test results or that death is more or less likely in subjects with false-positive results, she wrote. "My guess would be that inclusion of patients who did not really have influenza would bias us towards the null," she said
Exploring statin use in patients who had negative rapid tests would require the investigators to do chart abstractions, which they weren't able to do because they didn't collect information on that group, Thomas noted.
Another challenge the researchers had was determining the true number of deaths. Since the study relied mainly on chart data, they attempted to clarify the number of deaths by reviewing local vital statistics records to see if any of the hospitalized patients died within 30 days of hospital discharge.
The reliance on chart data also made it difficult for the researchers to assess the underlying functional health status of the patients, which they wrote could influence the relationship between statins and flu severity, introducing a possible "healthy user" bias. However, they noted that the statin users were older, had more underlying conditions, and had longer hospital stays, suggesting that their baseline health was no better than that of patients not taking the drugs.
The researchers concluded that their findings suggest that statins are a promising area for further study and could be a useful adjunct to antiviral medication and vaccines, especially when viruses aren't susceptible to medication or when the flu vaccine is in short supply or not well matched to the circulating strains.
Future studies—ideally randomized controlled trials—exploring a possible role for statins in treating influenza should include analysis of functional status, dose and duration of therapy, statin use in younger patients, and identification of the most effective class of statins, they wrote.
Slowly mounting evidence
In an editorial in JID yesterday, Dr Edward Walsh, with the Infectious Diseases Division at the University of Rochester School of Medicine in New York, wrote that the findings are a significant addition to the slowly mounting evidence that statins may reduce annual flu burden and deaths, because the study links deaths to lab-confirmed flu.
As in many observational studies, unrecognized factors, such as the "healthy user" bias, may affect the results and conclusion, Walsh wrote, noting that similar concerns have been raised about flu vaccine efficacy in older people.
The analysis did not find that the influenza vaccine and antivirals reduced the number of deaths, though it did show a nonsignificant benefit for antivirals, he pointed out.
Walsh said the findings raise several key questions about the relationship between statins and flu deaths, such as what mechanism is responsible. For example, he said it's unclear if statins are more effective in flu complicated by bacterial infection or if the main benefit is due to anti-inflammatory effects that help prevent heart attacks and strokes during flu epidemics. It's often difficult to assess the cause of deaths in chart review studies, so scientists can only speculate about what statin mechanisms might provide a benefit, he wrote.
More high-quality prospective observational studies are needed to confirm the findings, but a randomized trial of the effects of long-term statin use on flu outcomes would be logistically difficult, and clinicians probably wouldn't administer statins solely to reduce flu severity, Walsh said.
However, he said such studies could support the use of statins in a pandemic setting, a strategy suggested in 2006 by David Fedson, MD, an internationally known vaccine expert. Fedson has said that if research confirms the benefits of statins for flu patients, they may offer hope for patients in countries where antiviral and vaccine supplies are scarce.
Vandermeer ML, Thomas AR, Kamimoto L, et al. Association between use of statins and mortality among patients hospitalized with laboratory-confirmed influenza virus infections: a multistate study. J Infect Dis 2011 Dec 14 [Abstract]
Walsh E. Statins and influenza: can we move forward? (Editorial) J Infect Dis 2011 Dec 14 [Extract]
See also: Jun 30, 2006, CIDRAP News story "Paris meeting airs avian flu impacts, possible treatment"
“When in doubt, tell the truth.”
- Mark Twain
“Falsehood is easy, truth so difficult.”
- George Eliot
“Who is more foolish, the child afraid of the dark or the adult afraid of the light?”
- Maurice Freehill
“I know God will not give me anything I can't handle. I just wish He didn't trust me so much.”
- Mother Teresa
“A popular government without popular information, or the means of acquiring it, is but a prologue to a farce or a tragedy, or perhaps both.”
- James Madison
“The United States is unusual among the industrial democracies in the rigidity of the system of ideological control — 'indoctrination,' we might say — 'exercised through the mass media.'”
- Noam Chomsky
“Truth, like gold, is to be obtained not by its growth, but by washing away from it all that is not gold. ”
- Leo Tolstoy
“A newspaper, as I'm sure you know, is a collection of supposedly true stories written down by writers who either saw them happen or talked to people who did. These writers are called journalists, and like telephone operators, butchers, ballerinas, and people who clean up after horses, journalists can sometimes make mistakes.”
- Lemony Snicket
“Knowledge is the antidote to fear.”
- Ralph Waldo Emerson
“What the caterpillar calls the end of the world, the master calls a butterfly.”
- Richard Bach
“Fear is not in the habit of speaking truth; when perfect sincerity is expected, perfect freedom must be allowed; nor has anyone who is apt to be angry when he hears the truth any cause to wonder that he does not hear it.”
- Publius Cornelius Tacitus
“The man who fears no truth has nothing to fear from lies.”
- Thomas Jefferson
“Truthfulness has never been counted among the political virtues, and lies have always been regarded as justifiable tools in political dealings.”
- Hannah Arendt
“If Thomas Edison invented electric light today, Dan Rather would report it on CBS News as: 'Candle making industry threatened.'”
- Newt Gingrich
“Truth has no fear; Untruth shivers at every shadow.”
- Sri Sathya Sai Baba
“In spite of your fear, do what you have to do.”
- Chin-Ning Chu
“Fear grows in darkness; if you think there's a bogeyman around, turn on the light.”
- Dorothy Thompson
“Whenever the people are well-informed, they can be trusted with their own government.”
- Thomas Jefferson
“The man who fears no truths has nothing to fear from lies.”
- Francis Bacon
“A man goes to knowledge as he goes to war, wide awake, with fear, with respect, and with absolute assurance. Going to knowledge or going to war in any other manner is a mistake, and whoever makes it will live to regret his steps.”
- Carlos Castaneda
“Get your facts first, and then you can distort 'em as much as you please.”
- Mark Twain
“Don't waste life in doubts and fears; spend yourself on the work before you, well assured that the right performance of this hour's duties will be the best preparation for the hours and ages that will follow it.”
- Ralph Waldo Emerson
“The world is for thousands a freak show; the images flicker past and vanish; the impressions remain flat and unconnected in the soul. Thus they are easily led by the opinions of others, are content to let their impressions be shuffled and rearranged and evaluated differently.”
- Johann Wolfgang Von Goethe
“I learned that courage was not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear.”
- Nelson Mandela
“We are taught to understand, correctly, that courage is not the absence of fear, but the capacity for action despite our fears.”
- John McCain
“You can conquer almost any fear if you will only make up your mind to do so. For remember, fear doesn't exist anywhere except in the mind.”
- Dale Carnegie
“Courage is a special kind of knowledge: the knowledge of how to fear what ought to be feared and how not to fear what ought no to be feared.”
- David Ben-Gurion
“Fear is the path to the dark side. Fear leads to anger. Anger leads to hate. Hate leads to suffering.”
- Yoda
“The only sure bulwark of continuing liberty is a government strong enough to protect the interests of the people, and a people strong enough and well enough informed to maintain its sovereign control over the government.”
- Franklin D. Roosevelt
“How very little can be done under the spirit of fear. ”
- Florence Nightingale
“Listen to what you know instead of what you fear. ”
- Richard Bach
“To fear to face an issue is to believe the worst is true.”
- Ayn Rand
“A nation that is afraid to let its people judge the truth and falsehood in an open market is a nation that is afraid of its people.”
- John F. Kennedy
“It may well be that our means are fairly limited and our possibilities restricted when it comes to applying pressure on our government. But is this a reason to do nothing? Despair is nor an answer. Neither is resignation. Resignation only leads to indifference, which is not merely a sin but a punishment.”
- Elie Wiesel
“It would be difficult to dispel ignorance unless there is freedom to pursue the truth unfettered by fear. With so close a relationship between fear and corruption it is little wonder that in any society where fear is rife corruption in all forms becomes deeply entrenched.”
- Aung San Suu Kyi
“Fear is the main source of superstition, and one of the main sources of cruelty. To conquer fear is the beginning of wisdom, in the pursuit of truth as in the endeavour after a worthy manner of life.”
- Bertrand Russell
“If it's called the USA Today, why is all the news from yesterday? BAM. Busted!”
- Stephen Colbert
“Nothing in life is to be feared. It is only to be understood.”
- Marie Curie
“When even one American - who has done nothing wrong -- is forced by fear to shut his mind and close his mouth, then all of Americans are in peril.”
- Harry S. Truman
“A lie gets halfway around the world before the truth has a chance to get its pants on.”
- Winston Churchill
“When the people fear their government, there is tyranny; when the government fears the people, there is liberty.”
- Thomas Jefferson
“I do not mean to be the slightest bit critical of TV newspeople, who do a superb job, considering that they operate under severe time constraints and have the intellectual depth of hamsters. But TV news can only present the 'bare bones' of a story; it takes a newspaper, with its capability to present vast amounts of information, to render the story truly boring.”
- Dave Barry
“The truth is more important than the facts.”
- Frank Lloyd Wright
“Truth is tough. It will not break, like a bubble, at a touch, nay, you may kick it all about all day like a football, and it will be round and full at evening.”
- Oliver Wendell Holmes
“For my part, whatever anguish of spirit it may cost, I am willing to know the whole truth; to know the worst and provide for it.”
- Patrick Henry
“It is a puzzling thing. The truth knocks on the door and you say, 'Go away, I'm looking for the truth,' and so it goes away. Puzzling.”
- Robert M. Pirsig
“It is error alone which needs the support of government. Truth can stand by itself.”
- Thomas Jefferson
“When I tell any truth, it is not for the sake of convincing those who do not know it, but for the sake of defending those that do.”
- William Blake
“If I had my choice I would kill every reporter in the world, but I am sure we would be getting reports from Hell before breakfast.”
- William Tecumseh Sherman
“A nation of sheep will beget a government of wolves.”
- Edward R. Murrow
“If you tell a lie big enough and keep repeating it, people will eventually come to believe it. The lie can be maintained only for such time as the State can shield the people from the political, economic and/or military consequences of the lie. It thus becomes vitally important for the State to use all of its powers to repress dissent, for the truth is the mortal enemy of the lie, and thus by extension, the truth is the greatest enemy of the State.”
- Joseph Goebbels
“Newspapers are unable, seemingly, to discriminate between a bicycle accident and the collapse of civilisation.”
- George Bernard Shaw
“The truth is found when men are free to pursue it.”
- Franklin D. Roosevelt
“Hastiness and superficiality are the psychic diseases of the twentieth century, and more than anywhere else this disease is reflected in the press.”
- Alexander Solzhenitsyn
“I am a firm believer in the people. If given the truth, they can be depended upon to meet any national crisis. The great point is to bring them the real facts.”
- Abraham Lincoln
“A wave of panic passed over the vessel, and these rough and hardy men, who feared no mortal foe, shook with terror at the shadows of their own minds.”
- Arthur Conan Doyle
“Fear cannot be banished, but it can be calm and without panic; it can be mitigated by reason and evaluation.”
- Vannevar Bush
“Cowardice, as distinguished from panic, is almost always simply a lack of ability to suspend the functioning of the imagination.”
- Ernest Hemingway
“Courage is not the absence of fear but the ability to carry on with dignity in spite of it.”
- Scott Turow
“The media's the most powerful entity on earth. They have the power to make the innocent guilty and to make the guilty innocent, and that's power. Because they control the minds of the masses.”
- Malcom X
“If you once forfeit the confidence of your fellow citizens, you can never regain their respect and esteem. It is true that you may fool all of the people some of the time; you can even fool some of the people all of the time; but you can't fool all of the people all of the time.”
- Abraham Lincoln
“We hang the petty thieves and appoint the great ones to public office.”
- Aesop
“Media is just a word that has come to mean bad journalism.”
- Graham Greene
“By definition, a government has no conscience. Sometimes it has a policy, but nothing more.”
- Albert Camus
“Those who seek absolute power, even though they seek it to do what they regard as good, are simply demanding the right to enforce their own version of heaven on earth. And let me remind you, they are the very ones who always create the most hellish tyrannies. Absolute power does corrupt, and those who seek it must be suspect and must be opposed.”
- Barry Goldwater
“We are not afraid to entrust the American people with unpleasant facts, foreign ideas, alien philosophies, and competitive values. For a nation that is afraid to let its people judge the truth and falsehood in an open market is a nation that is afraid of its people.”
- John F. Kennedy
“I know of no safe repository of the ultimate power of society but people. And if we think them not enlightened enough, the remedy is not to take the power from them, but to inform them by education.”
- Thomas Jefferson
“Where large sums of money are concerned, it is advisable to trust nobody.”
- Agatha Christie
“Love all, trust a few.”
- William Shakespeare
“One of the saddest lessons of history is this: If we've been bamboozled long enough, we tend to reject any evidence of the bamboozle. The bamboozle has captured us. Once you give a charlatan power over you, you almost never get it back.”
- Carl Sagan
“All of us who professionally use the mass media are the shapers of society. We can vulgerize that society. We can brutalize it. Or we can help lift it onto a higher level.”
- William Bernbach
“I'm not upset that you lied to me, I'm upset that from now on I can't believe you.”
- Friedrich Nietzsche
“If one morning I walked on top of the water across the Potomac River, the headline that afternoon would read: 'President Can't Swim.'”
- Lyndon B. Johnson
“Lies are often much more plausible, more appealing to reason, than reality, since the liar has the great advantage of knowing beforehand what the audience wishes or expects to hear.”
- Hannah Arendt
“The public have an insatiable curiosity to know everything. Except what is worth knowing. Journalism, conscious of this, and having tradesman-like habits, supplies their demands.”
- Oscar Wilde
“When in doubt, tell the truth.”
- Mark Twain
“When distant and unfamiliar and complex things are communicated to great masses of people, the truth suffers a considerable and often a radical distortion. The complex is made over into the simple, the hypothetical into the dogmatic, and the relative into an absolute.”
- Walter Lippmann
“If such a plague came today, killing a similar fraction of the U.S. population, 1.5 million Americans would die, which is more than the number felled in a single year by heart disease, cancers, strokes, chronic pulmonary disease, AIDS, and Alzheimer’s disease combined.”
- Gina Kolata
