Is H5N1 flu transitioning to human-to-human transmission?

December 2, 2005 1:30 AM

Is H5N1 flu transitioningto a human-to-human illness? Recent reports of familial clusters suggest that it may be, though there are certainly other possible explanations, such as families living in environments contaminated by virus-laden bird feces. On the other hand, it would seem that epidemiologists are growing increasingly interested in the possibility that these clusters are indicative of human-to-human transmissions. Further, the virus may be inching towards being asymptomatic, which isn't as good as it sounds: if people can carry the virus and transmit it to others without showing symptoms, it will be very difficult to impossible to tell who is a vector and highly difficult to control any emerging epidemic.
posted by chakalakasp (23 comments total)

Well, this is great news to read as you pack for Hong Kong.
posted by [expletive deleted] at 3:49 AM on December 2, 2005

No need to panic.

Ain't no epidemic here.
posted by bwg at 4:06 AM on December 2, 2005

...yet.

Of course, the same can be said for where I am, or anywhere for that matter. I guess that's why it's called a pandemic.
posted by [expletive deleted] at 4:11 AM on December 2, 2005

You forgot the "avian flu" tag.
posted by alumshubby at 4:33 AM on December 2, 2005

Well, this is great news to read as you pack for Hong Kong.

Remember to come back asymptomatic and bring us a present!
posted by rough ashlar at 4:35 AM on December 2, 2005

There are rumours that there is some weak unsubstantiated and uncorroborated evidence that a disease which doesn't yet exist that could possibly be pandemic might be coming.

Be very hypothetically afraid!
posted by srboisvert at 4:56 AM on December 2, 2005

Olsen's letter is here. (EID is public access as it's published by the CDC.)

Further, the virus may be inching towards being asymptomatic, which isn't as good as it sounds: if people can carry the virus and transmit it to others without showing symptoms, it will be very difficult to impossible to tell who is a vector and highly difficult to control any emerging epidemic.

The WHO has just begun a seroprevalence survey of a 'healthy' Indonesian village (IHT). A seroprevalence survey collects blood from a random sample to estimate the number of people with antibodies for a pathogen. In some ways it is a better measure of the spread of an epidemic because it captures both symp and asymp cases. Incredibly, it's not yet been done for bird flu.
posted by docgonzo at 5:01 AM on December 2, 2005

...yet.

True, but the way I see it, if this virus mutates to where it can be transmitted human-to-human, a pandemic is inevitable. If you don't get the flu in Hong Kong, you'll eventually get it somewhere else.

On the other hand, sometimes viruses crossing the species barrier weaken — it could turn out to be less lethal than it is in its current form.

In the meantime, there's no point worrying; we in Hong Kong will deal with developments as they occur.

As such, I have no plans to leave this town.
posted by bwg at 7:05 AM on December 2, 2005

I loved how bird flu coverage on the news dropped to zero during the week of thanksgiving.
posted by benightedly_heedful at 7:12 AM on December 2, 2005

Time to toss that canary to the wolves!
posted by Secret Life of Gravy at 7:13 AM on December 2, 2005

Well, at least the outbreak will occur in a country well-known for being completely honest with the world about the health of its millions of citizens.
posted by odinsdream at 7:36 AM on December 2, 2005

This looks like such weak evidence for human-to-human transmission, I'm suprised anybody even bothered to note it. The fact that the infections are clustering in families seems most easily explained by family members eating birds from the same infected pool.
posted by Coventry at 7:52 AM on December 2, 2005

This looks like such weak evidence for human-to-human transmission, I'm suprised anybody even bothered to note it. The fact that the infections are clustering in families seems most easily explained by family members eating birds from the same infected pool.

Perhaps, but if you RTFA, you'll realize that the researchers who are studying this are taking those sorts of things into consideration. For example, the cluster that was mentioned in the article, in the opinion of the doctor in the article, could not have occured the way that you are describing.
posted by chakalakasp at 9:24 AM on December 2, 2005

"There are rumours that there is some weak unsubstantiated and uncorroborated evidence that a disease which doesn't yet exist that could possibly be pandemic might be coming."

Thank you. When will we stop with the panic inducing hype?
posted by MikeMc at 10:11 AM on December 2, 2005

Thank you. When will we stop with the panic inducing hype?

How much do you really know about the topic? I have found that those who completely discount the possibility of a flu pandemic, despite the fact that three have occured in the last century (one of which brought the world to a standstill) are only trying to give themselves a sense of false intellectual superiority by showing everyone that they're "thinking different". Have you actually done any real research into influenza, epidemics, or H5N1, or are you just parroting what Jon Stewart told you to think about this? There are highly respectable epidemiologists who believe that the H5N1 pandemic danger is overstated, but even they would not be so bold as to declare that it is not something very much worth monitoring and preparing for. Simply laughing everything off as impossible does not make you cleverer than all the sheeple around you. In this case, it just makes you appear ignorant to people who have taken the time to actually research the issue.

This is not shark attacks, terrorism, or African bees. This has happened before in human history with great regularity and will happen again with great regularity. This is similar to, say, living below sea level on a hurricane prone coast: sure, the weather was nice last summer, but sooner or later you're gon' get it, so you may as well be prepared now.
posted by chakalakasp at 10:44 AM on December 2, 2005

You must fear.
posted by Nelson at 11:12 AM on December 2, 2005

"Have you actually done any real research into influenza, epidemics, or H5N1, or are you just parroting what Jon Stewart told you to think about this?"

I don't watch The Daily Show. How many people have actually died from H5N1? How many people died of SARS? What's the next Bug O' The Week? I'm not saying that that influenza should be ignored but damn, look at the coverage of H5N1 compared to the actual impact of the virus. As soon as people stop being afraid of one disease they are very unlikely to get along comes another. Monitoring and preparing is one thing, scaring people without cause is another.
posted by MikeMc at 11:38 AM on December 2, 2005

look at the coverage of H5N1 compared to the actual impact of the virus.

If you study the history of flu epidemics, you'll fund that there's no disparity here. A deadly flu epidemic doesnt just pop out of nowhere. It develops and evolves until it becomes a real problem. The danger isn't what H5N1 is, but what it will eventually become. Just as the Spanish flu took time to develop in the trenches of WWI, the bird flu is still developing now. The casualties will be much higher if we only start worrying once people begin dying at a faster rate; by then the virus will have already spread.
posted by unreason at 12:07 PM on December 2, 2005

We know H5N1 is a killer, as humans have no immunity to it.

Of course researchers are freaked by potential mutation. Of course countries are trying to contain it. If 1918 and subsequent pandemics taught us anything, it's not to take the flu lightly.

All I'm saying is if (and probably when) an outbreak occurs, we should be prepared — but that doesn't mean we all need to be in a constant state of panic.

There's a fine line between dispensing necessary information and hype, and we all know which sells more newspapers.
posted by bwg at 4:49 PM on December 2, 2005

chakalakasp, dont feed the trolls, good post, this is an important new development to keep an eye on, it's new to me anyway.
posted by stbalbach at 5:26 PM on December 2, 2005

"How many people have actually died from H5N1? How many people died of SARS? What's the next Bug O' The Week? I'm not saying that that influenza should be ignored but damn, look at the coverage of H5N1 compared to the actual impact of the virus..."

Considering that yesterday was World AIDS Day, I think it would be appropriate to point out stats from another recent viral pandemic, and how it too started out so very slowly...

Number of known deaths in the US from HIV/AIDS:
up to 1980 -- 31
1981 -- 234
1982 -- 853
1983 -- 2304

(source)

How many lives would have been spared if the health community and the media had paid more attention then? You know, just in case the thing got out of control? As novel virii to which humans have no immunity tend to do?
posted by Asparagirl at 10:28 PM on December 2, 2005

chakalakasp, dont feed the trolls, good post, this is an important new development to keep an eye on, it's new to me anyway.

Except in my opinion you guys are the trolls. The whole mutation argument is problematic because the hysteria will get whipped up and billions will be spent on useless vaccines and then the specific feared mutation probably won't occur.

I have no problem with pushing to develop a plan to deal with flu pandemics or pandemics in general. Despite chakalakasp's ad hominem attacks I am aware and I sure everyone else is that there have been other flu pandemics. I don't doubt that there is a possibilty of another pandemic. I just doubt that it will be this particular one. Why? Because they are trying to predict mutations. That is a big huge if. There is just as good a chance if not better that if it does mutate it mutates into a less serious strain. There are also lots of other disease pools out there festering where the next killer can come from.

We've seen this kind of hysteria hyping before when every rich person in the U.S. bought some Anthrax meds. It isn't just chicken little. It is chicken little with a sky is falling shelter for sale.

Think rationally about protecting yourself from real risks. The emergency planning - civil response - disaster relief - etc is all far more useful than prepping a one disease vaccine response. While everyone freaks out of about the flu and every country buys ridiculous amounts of flu vaccine the next pandemic could be on a plane out of sub-saharan africa courtesy of evolutionary neighbours or maybe ebola carrying fruit bats or it could come from the U.S itself in the form of a mutated tuberculosis or some such.

A smart approach is to look at the SARS response. Figure out how to improve it. Make sure you have plans in place, medical capicity, labs, etc..to respond to any medical contigency.

Vaccination in anticipation of mutation is snake oil.
posted by srboisvert at 2:59 AM on December 3, 2005

Ah, thanks. I read the CIDRAP article, but not the Xinhua article.
posted by Coventry at 9:26 AM on December 3, 2005