Avian flu H5N1 virus

Bird flu virus in sludge/biosolids spread on farmland and home lawns
will make an interesting scientific experiment for health departments.
According to the EPA's Office of Research and Development (ORD) (1999), if sludge with any of
these pathogens (Federal Register (FR), 54, P.5829) in it is applied to land or placed on a
surface disposal site where humans and animals could be exposed, it is probably being illegally
applied. .

There is serious implication here because EPA document references show that since 1986 it has
known bacteria and viruses can survive up to 1 year in soil. The general survival period is 2 to 12
months for bacteria and 3 to 12 months for viruses.

What is perhaps more serious is that of the survival time on food crops and other plants.   According
to EPA ORD, general survival times for bacteria on plants are 1 to 6 months and for viruses it is 1 to
2 months.  For Helminthes ova the survival time on plants is 1 to 5 months -- with a 2 to 7 year
survival time in the soil..

Helane Shields of New Hampshire works with victims of sludge/biosolds and can see the writing on
the wall when the avian flu (Bird flu) virus is introduced into the sludge/biosolids disposal program.
She asks:

Will the purveyors of pathogenic plagues and pestilence next be spreading lethal bird flu on the
fields of  Rural America ?

"The global avian flu pandemic is coming, and it's a case of when, not if. Even as they counsel
people not to panic but to "be prepared", scientists are warning that tens of millions may die."

" . . .  The presence of H5N1 in stool samples offers a new route for human-to-human transmission, .
. . "

Fortunately, no bird or human cases of Avian flu H5N1 virus  have yet been found in US or Canada .
. . but this past week the virus  moved into birds in Europe (Romania and Turkey) . . . so it may be
only a matter of time . . . . .

Bird flu is developing into an intestinal disease . . . some victims suffer diarrhea . . . . . the virus has
been found in human feces . . . . at what point should we question whether Class A and Class B
pathogen reduction methods will inactivate the virus so that land spreading of sewage sludge will not
provide a medium for vectors such as flies, mosquitoes, sea gulls, birds, rats, family pets, etc. to
transport and transmit the disease? Also, if it moves into poultry flocks in US and there is any culling,
safe disposal of carcasses is important so they don't end up in landfills with the leachate going to
local POTWs . . . . . (as has happened with CWD carcasses) . . . . also, can the H5N1 virus be
airborne on dust after the sludge dries  -- is it hydrophobic (in which case it will partition to the
sludge)  or can it survive in sewage effluent discharged to surface waters and reinfect more birds
and ultimately humans  ?   Can the virus survive in  sludge and  leach through soil to groundwater
and/or wells?    Do we wait until after there is an outbreak of Avian flu in humans in US and Canada  
-- or do we ask the questions now  ??


"Although the recurrence of bird flu throughout Vietnam is not unexpected, it is cause for concern.  
The new outbreaks show that controlling H5N1 avian influenza in Vietnam will be difficult and further
human-to-human transmission will be likely.

The report in the New England Journal of Medicine describes three patients who were probably
infected with H5N1, but initially did not present with respiratory symptoms.  The first two patients
formed a cluster last year.  It was the 10th reported H5N1 cluster and was similar to the other 9.  
Samples were not collected from the index case, a relative developed an H5N1 lab confirmed
infection one or two weeks later, and the index case died.

However, in this cluster both cases initially did not have respiratory illness.  Instead gastro-intestinal
and neurological symptoms were seen.  The WHO has indicated that they will expand the case
definition of H5N1 related illnesses, but the extent of spread in Vietnam and elsewhere will not be
known until widespread screening results are analyzed.

In addition to broadening the definition of H5N1 illnesses, the WHO should issue an alert to family
members caring for relatives with symptoms.  The presence of H5N1 in stool samples offers a new
route for human-to-human transmission, and the bimodal distribution of disease onset in all familial
clusters indicates human-to-human transmission of H5N1 is an ongoing problem In Vietnam,
Thailand, and Cambodia.  

The failure to test patients outside of these countries leaves open the extent of worldwide spread of




Are Neurotropic Bird Flu Deaths Complex?

Recombinomics Commentary
February 16, 2005

>> These cases have important clinical, scientific, and public health implications. In both cases, the
clinical presentation led to diagnoses of gastrointestinal infection and acute encephalitis, which
alone or in combination are common clinical syndromes in southern Vietnam. Patient 1 had no
respiratory symptoms and a normal chest radiograph less than 24 hours before she died. Although
Patient 2 showed signs of pneumonia during the last day of his life, a respiratory illness was not
considered his most relevant clinical problem. Recently, another patient with influenza H5N1 was
described with an initial presentation of fever and diarrhea alone.<<

The recent patient with H5N1 that had an initial presentation of fever and diarrhea alone may be
what has been described in recent media reports as "complex" and in a "complicated manner" with
regard to bird flu cases in Vietnam and Cambodia.  

Clearly widespread screening of case clusters in Asia is indicated, including camps for Tsunami
victims.  There have been many reports of high fever and coma in Asia, without any indication that
these patients were tested for H5N1.  In the absence of tests of these patients it seems that H5N1
infections are likely to be more widespread than indicated in official and media reports.

The failure to screen unusual clusters of meningococcemia* cases in the Philippines is a clear
example of a failure to learn the lessons of the 1918 pandemic.  There were several examples of
clusters linked to funerals, with case fatality ratios approaching 100%.

The lack of testing these cases for H5N1 avian influenza represents a clear public health failure.

*   http://www.emedicine.com/derm/topic261.htm   meningococcemia

4-year old Vietnamese child:  "H5N1 influenza A virus was isolated from cerebrospinal fluid, FECAL,
throat, and serum specimens. "


Scientists warn tens of millions may die if more is not done to contain the unpredictable virus.

The global avian flu pandemic is coming, and it's a case of when, not if. Even as they counsel people
not to panic but to "be prepared", scientists are warning that tens of millions may die.

A year ago, the World Health Organisation was playing down the threat to humans of bird flu,
officially influenza A (H5N1) virus, Z strain. But at a bird flu conference last week in Vietnam, Shigeru
Omi, WHO Western Pacific regional director, said: "The world is in the gravest possible danger of a
global pandemic."

Why this fuss for a virus that has killed about 60 people and 1.5 million chickens (with 140 million
more culled)? This compares with the human death toll for the severe acute respiratory syndrome
virus, SARS, which was 774. There are two reasons: confirmation of the first probable human-to-
human transmission of the virus and a mortality rate for infection of 75 per cent. Only ebola (50 per
cent mortality) and rabies, slightly higher, can come close to it. The SARS rate was 9.6 per cent.


"The influenza outbreak of 1918, which is often used as a benchmark for infectious disaster, killed
more than 30 million, but the mortality rate was only 1-2 per cent of those infected.

"With this virus the mortality rate has been 75 per cent. We can't begin to get our heads around it,"
Dr Dowell said.

Other developments that have raised concern include:

· The virus is resistant to most classes of antiviral drugs.

· It is becoming more pathogenic in mammals, such as ferrets that have a similar disease response
to humans.

· The increasing number of human cases.

· Poultry farmers say it is becoming more potent. Previous outbreaks killed 10 per cent of their flock,
now up to 90 per cent are dying.

· Ducks, thought to be benign, are now seen as silent carriers, who can shed the virus for up to 17
days through their stools before they get sick.

After SARS, there was a level of scepticism in the community, a sense that the media had
overplayed the significance of the virus.

WHO Western Pacific region spokesman Peter Cordingley disagrees. "The global community was
very, very lucky with SARS. When people were transmitting the virus they were already showing
signs, so it could be picked up at airports with temperature controls," he said.

"With (bird) flu you can be infectious before you show any signs."


Assessment of Current Situation
The avian influenza A (H5N1) epizootic (animal outbreak) in Asia is not expected to diminish
significantly in the short term. It is likely that H5N1 infection among birds has become endemic to the
region and that human infections resulting from direct contact with infected poultry will continue to
occur. So far, no sustained human-to-human transmission of the H5N1 virus has been identified, and
no evidence for genetic reassortment between human and avian influenza A virus genes has been
found; however, the epizootic in Asia continues to pose an important public health threat.

There is little preexisting natural immunity to H5N1 infection in the human population. If these H5N1
viruses gain the ability for efficient and sustained transmission among humans, an influenza
pandemic could result, with high rates of illness and death. In addition, genetic sequencing of
influenza A (H5N1) viruses from human cases in Vietnam and Thailand shows resistance to the
antiviral medications amantadine and rimantadine, two of the medications commonly used for
treatment of influenza. This would leave two remaining antiviral medications (oseltamivir and
zanamivir) that should still be effective against currently circulating strains of H5N1 virus. Efforts to
produce vaccine candidates that would be effective against avian influenza A (H5N1) virus are under
way. However, it will likely require many months before such vaccines could be mass produced and
made widely available.

Research suggests that currently circulating strains of H5N1 viruses are becoming more capable of
causing disease (pathogenic) in mammals than were earlier H5N1 viruses. H5N1 viruses are
becoming more widespread in birds in the region. One study found that ducks infected with H5N1
virus are now shedding more virus for longer periods without showing symptoms of illness. This
finding has implications for the role of ducks in transmitting disease to other birds and possibly to
humans as well. Additionally, other findings have documented H5N1 infection among pigs in China
and H5N1 infection in felines (experimental infection in housecats in the Netherlands and isolation of
H5N1 viruses in tigers and leopards in Thailand ), suggesting that cats might host or transmit the

Notable findings of epidemiologic investigations of human H5N1 cases in Vietnam during 2005 have
suggested transmission of H5N1 viruses to at least two persons through consumption of uncooked
duck blood. One possible instance of limited person-to-person transmission of H5N1 virus in
Thailand has been reported. This possibility is being further investigated in several clusters of cases
in Vietnam.

The majority of known human H5N1 cases have begun with respiratory symptoms. However, one
atypical fatal case of encephalitis in a child in southern Vietnam in 2004 was identified
retrospectively as H5N1 influenza through testing of cerebrospinal fluid, fecal matter, and throat and
serum samples. Further research is needed to ascertain the implications of such findings.
A recent case report of a 4-year-old Vietnamese child with H5N1 avian influenza who presented in
2004 with encephalitis demonstrated the following features (see References: de Jong 2005):

The child presented with a 2-day history of fever, headache, vomiting, and severe diarrhea
(approximately 10 episodes per day). The stools were watery without blood or mucus.
Laboratory tests on admission were unremarkable and chest x-ray was normal.
On the third day following initial presentation, the child had a generalized convulsion and became
comatose. He developed respiratory failure and died on the fifth day after initial presentation. Acute
encephalitis of unknown origin was reported as the cause of death; no autopsy was performed.
H5N1 influenza A virus was isolated from cerebrospinal fluid, fecal, throat, and serum specimens.
The patient’s 9-year-old sister had died 2 weeks earlier from a similar clinical syndrome.


How the virus is spread
It is thought that water birds such as wild ducks are the carriers of all avian influenza type A viruses.
Indeed, influenza type A viruses of other animals, including humans, may have evolved from avian
influenza strains. The viruses are carried inside the intestines and are distributed into the
environment via faeces.

Migratory birds infected with the virus could potentially spread the bird flu to whichever countries
they visit. Wild birds don't usually get sick, but transmit the virus to domesticated birds, such as
chickens and turkeys, which can be killed by the infection.

Symptoms in birds differ according to the species, but can include diarrhoea, respiratory distress,
swollen head and death. A sick bird sheds the viruses in its feathers, mucous, saliva and faeces.

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