~ Bird Flu or Avian Flu (H5N1) - Fact Finding Trip to Southeast Asia - Facts, the Vaccine and Prevention
By Alex Schauss, PhD, FACN, Director, Natural and Medicinal Products Research, October 16, 2005
- The Vaccine
I just returned from my trip to southeast Asia. In July of this year a death was reported in Jakarta, Indonesia, linked to the avian influenza (bird flu). It was the first confirmed human fatality in Indonesia. The deaths of the man's two children, neither of who were reported to have had close contact with poultry suggested that the virus had mutated into a variant that caused human-to-human transmission. Hence, given that I have traveled to southeast Asia for over two decades it seemed prudent to begin my trip there and learn as much as possible about this potential pandemic. The reason for my interest in these particular Indonesian cases is eloquently found in today’s Wall Street Journal (WSJ):
“The avian flu strain H5N1 already has two of the three characteristics needed to cause a pandemic: It can (1) jump from bird to human and (2) produce an often fatal illness…attributed to the H5N1[viral strain]. If additional genetic evolution makes the virus highly transmissible among humans -- the third characteristic of a pandemic strain -- a worldwide outbreak could become reality.”
The operative term here is “highly transmissible.” A flu virus that spreads as readily as the common cold would spell real trouble and cause contagion world-wide, but a flu that spreads less readily will be more manageable. Which scenario will play out? That’s what I wanted to find out.
Jump for facts
So here is what I learned during my trip:
On July 21st of this year, 109 cases of human infection from the bird flu had been confirmed. Among these cases, 55 deaths were attributed to the flu virus outside of China. That was in mid-July. The total has now reached 65, including five recent cases in Indonesia, 3 of which have already died.
In January of last year, a major new outbreak of avian influenza surfaced in both Vietnam and Thailand's poultry industry. Within just weeks it spread to ten other Asian countries and regions, including China, Indonesia, South Korea and Japan. How many deaths have actually occurred due to the bird flu in China is unknown due to the size of the country, its large population, geography, and lack of transparent record keeping.
Besides how fast H5N1 spreads between migratory birds and domesticated fowl, there is another reason for concern: the mortality rate in humans who have contracted the virus is extraordinary. Not since the influenza pandemic of 1918-19, has such a remarkably high mortality rate been seen in humans. I cannot emphasize enough this point; the H5N1 virus is an extraordinarily deadly variant in birds, and the potential is there to be just as deadly to humans.
The mortality rate for persons infected with the H5N1 bird flu virus to date appears to be between 35% to 50%. By comparison, the annual flu’s that we have become used to each year, which are not bird influenza strains like H5N1, kills less than 1% of those infected. That is a 35 to 50-fold difference!
Just think of how many people you knew last year that had the flu. Now think of one third to one half possibly dying. Sobering, isn’t it. That’s how many in Indonesia perceived the future.
Over the weekend I visited a large regional bookstore in Portland, Oregon, when I came across several historical works on the 1918 influenza pandemic, sometimes called the Spanish Flu. As I handed the books to the clerk at the check out counter, she looked at the titles and said, “I just got over the flu the last 9 days, but I am no longer infectious.” Before leaving the bookstore I made certain I washed my hands.
What if I had walked into that regional book store12 days ago instead of Sunday? Think of how easy it would have been to spread her flu virus to me at which time I would have been wholly reliant upon my immune system to prevent the rapid replication associated with classic flu symptoms. She handled each of my books and gave me a pen to sign my credit card receipt for the books I purchased using her pen, during which time I had one hand face down on the counter she worked at. How many hours would it have been before I returned home not knowing I had been exposed to a flu bug? How long would it take for me to have infected hundreds of others, if I became a vector of the virus?
We are fairly certain the H5N1 strain has not reached the Western hemisphere yet. So the odds are very low that I have anything to worry about. What if this weekend’s experience had occurred a few weeks or months from now and unbeknownst to anyone she was a carrier of the H5N1 variant capable of human-to-human transmission?
When you look at the possibility of a 35-50% mortality rate, it makes one wonder what can be done to protect oneself and their family and friends! Maybe this explains why public health officials are so concerned. Why nearly very country with a functioning bureacracy is developing plans to deal with the bird flu.
Sunday, the Romanian state veterinary authority confirmed that lab tests performed in the UK on 3 ducks found dead in Romania’s Danube River delta near the Black Sea died due to the highly pathogenic H5N1 viral strain found spreading in Asia.
The speed with which the bird flu traveled from Asia to Europe suggests how fast this flu spreads. Elementary school children know that migrating birds can travel from continent to continent and from Anarctica to the Artic. Therefore, it is easy to conclude that there is no way to stop the spread of the H5N1 virus among birds, and from birds to other mammals, including humans.
The big fear is that H5N1 will mutate, acquiring genes from the human influenza virus that would make it highly infectious and lethal, similar to the influenza pandemic of 1918. All that is keeping this virus from killing humans in large numbers right now is that the H5N1 virus does not spread easily from birds to humans. At least not yet. The chances that it will increases exponently every week as it continues to mutate. Today’s WSJ explains why:
“The acquisition of the genetic change(s) needed to become transmissible from human to human is stochastic -- i.e., essentially random, therefore unpredictable. The more viruses there are, the greater the chances that one will acquire the "open-sesame" genetic changes, either by mutation or by exchanging genes during simultaneous infection of a person or animal with H5N1 and another flu virus.”
Dana Milbank with the Washington Post explained the basis for public health official’s fears even more graphically after attending a briefing on Capitol Hill last Monday. One invited presenter described a scenario in which one in eight Americans would die – that’s 40 million Americans – referring to it as “a nation-busting event.” A public health official stated that death rates “approaching this order of magnitude are unprecedented for any epidemic disease.” “We and the entire world remain unprepared for what could be the most horrific disaster in modern history”, warned an expert in infectious diseases. When the subject of quarantine came up, another expert simply said that due to the severity of the virus virulence a “quarantine is not going to work.”
Somewhere between 20 and 100 million people died of the 1918 influenza. Within one year it literally disappeared, but not before it killed more people than the 9.2 million combatants and 15 million civilians who died during the four years it took to end World War. More people died of influenza within a few months in 1918 than all the combatants who lost their lives in WWI, WWII, the Korean War, and the Vietnam War combined! What is known about the 1918 bird influenza, is that it infected 25 percent of the U.S. population, with a mortality rate close to 5 percent. Today, that would equal nearly 15 million lives. The 1918 flu spread to even the most remote areas of the world: in some places the mortality rate was over 50 percent.
In terms of transmissibility, think of the speed with which such a killer influenza virus could spread today. Let’s use my trip to southeast Asia to illustrate the almost insurmountable problem public health officials face.
If I had contracted the virus in Indonesia several days ago it would have begun replicating in my body within hours. After concluding my meetings in Jakarta, I would have headed to the airport to begin my return trip home, with a stop over in Singapore. As I flew to Singapore, I would have infected many of the passengers and flight crew who shared the plane’s cabin with me for nearly two hours. Then think of the people at the airport I would come in contact with once I arrived. If I touched the handle bar on the door of the men’s bathroom, who would touch it after me? After a couple of days of closed meetings with people from Malaysia and Singapore, the virus would have kept replicating. By now the first symptoms might have begun to appear. Misreading my sore throat, fatigue and slightly elevated temperature as possibly due to jet lag, I would have continued my journey by taking another flight to Tokyo. A few hours later after again having exposed even more people on the flight to Tokyo and at the airport, I finally transfer to the final leg of my flight home and board yet another plane, this one a Boeing 767. Due to a strong tail wind I find myself back at Seattle-Tacoma International Airport in a near record seven hours and eighteen minutes. By now I am highly infectious. A majority of passengers have been exposed. Having arrived home early in the morning I stop by the office, visit with staff, and then head home, certain that all I need is a few hours of sleep to recharge my batteries and overcome whatever ails me. Within hours I am vomiting, feel like I am on fire, with every joint arching. I hardly have the energy to call for help. Do I have the “flu” that most people simply overcome, or do I have the dreaded bird flu known as the H5N1 strain?
The H5N1 strain is a highly pathogenic strain of avian (bird) flu that causes severe, even fatal, symptoms in birds. Human cases associated with the H5N1 strain were first seen in 1997. The name “H5N1” refers to the subtypes of the surface antigens present on the virus: hemmagglutinin type 5 and neuraminidase type 1.
In general, influenza viruses are transported in the intestines of wild birds but are usually not lethal. However, the H5N1 strain has now mutated into the most lethal strain of bird influenza ever reported. Since the H5N1 stain was first identified, nearly one hundred fifty million birds have died or been culled (to prevent the spread of the virus). Infected birds pass on the virus through nasal secretions, feces, and saliva. All that needs to happen is for another bird to come in contact with any surfaces contaminated with infected material. Among fowl exposed to H5N1 are migrated birds. Able to fly hundreds of miles a day, it doesn’t take an imagination to realize how fast H5N1 can spread among birds traveling around the world.
Until last week, the bird flu was confined to Asia, Mongolia and eastern Russia. Then without warning it reached Turkey and a few days later Romania. In response, the European Union’s Commission has banned live birds imported from either Turkey or Romania.
To date, outbreaks of the avian flu have originated when crowded conditions exist, such as in duck and chicken farms. Cases involving human infections have involved conditions in which poultry, pigs and humans, live in close proximity to each other. In such tight quarters, the virus can mutate easily to infect humans. This is the reason that once a human case is confirmed, local authorities immediately order the mass slaughter of whatever birds are implicated, be they birds or other mammals. As I learned from my visit to southeast Asia, not all countries are reporting outbreaks, nor are victim’s families reporting flu symptoms or seeking treatment for the flocks for fear that all their birds or pigs will be slaughtered, thereby leaving them without any means to support themselves.
Without culling all birds and/or infected mammals within several miles of the suspected source of a bird or mammal’s death or suspected human H5N1 case, the death toll can rise quickly. This was demonstrated in Vietnam and Thailand in March 2004. Within a few weeks of the first cases of bird deaths being reported to authorities, 23 deaths occurred among humans who had had direct or indirect contact with infected birds. By killing tens of millions of birds, it was thought the virus was contained.
New outbreaks appeared in July, 2004, in Ayutthaya and Pathumthani provinces in Thailand, as well as, Chaohu, Anhui, China. Then in one month later, in August, new cases were found in Kelantin, Malaysia. In response, Singapore immediately imposed a ban on the importation of poultry products. Due to very aggressive attempts to cull all birds within 6.2 miles of the center of the bird infection in Malaysia, not another case of bird flu has been reported for a year. As a result the Singapore government lifted its ban on Malaysian poultry products.
In January 2005, 33 cities and provinces in Vietnam reported outbreaks of the avian flu. This led to the slaughter of 1.2 million birds. The next month, an estimated 140 million birds were culled or had died from the flu.
The human cases are particularly instructive. Take for example one case out of Thailand where human-to-human transmission was suspected. The original carrier who was suspected to have contracted H5N1 from a bird, was held by the mother for several days during which time the young girl died. Very soon afterwards, the mother fell ill and died as well. Not soon afterwards, two nurses who cared for these patients also came down with the same influenza, but managed to survive.
In July 2005, the first confirmed human fatality associated with the bird flu was reported in Indonesia, a country made up of over 18,000 islands. Out of a population of over 215 million, over 100 million of which live on the island of Java, the first outbreak appeared in Java. The landmass of Java covers approximately 50,000 square miles, comparable to the state of Mississippi. Difference is, that Mississippii has less than 3 million residents. The island of Java has over 100 million!
Jakarta, the nation’s capitol, where I spent most of my time, has a population of 15 million, making it one of the most populated cities in the world. What makes the Indonesia cases particularly important to learn about is that neither of the first two children who died had close contact with any poultry. One theory I heard repeatedly was that the children ate undercooked poultry – certainly a possibility. As of August 2005, most reported human cases of the bird flu in Asia have been attributed to consumption of diseased poultry. Human-to-human transmission has not been unequivocally confirmed in any of the Asian outbreaks. What is known is that more than 100 humans have been infected by the influenza H5N1 strain in the past 19 months. Of that number nearly half have died. The cause of death is described as “drowning” from fluids in the lungs.
In August 2005, the U.S. government reported they had successfully tested a “vaccine” they believe can protect against the H5N1 influenza strain spreading in birds. The vaccine known as Tamiflu® is being stockpiled throughout the world. However, there is no H5N1 influenza vaccine. Tamiflu®, known as an antiviral agent and by its generic name, oseltamivir, may protect against human infection, but whether it can protect against a variant of H5N1 capable of human-to-human transmission has yet to be demonstrated. Oseltamivir (Tamiflu®) is a neuraminidase inhibitor that falls in a class of drugs that act on a protein found in all influenza A viruses. But it is not a vaccine that will kill the virus.
Last week a study identified a mutated form of H5N1 bird flu found in one person that is resistant to Tamiflu®. This comes on top of a report in early August 2005, from China that at least 38 people have died and nearly 200 others ill by a swine borne disease associated with H5N1 in Sichuan province. This worries health officials and specialists in infectious diseases because pigs are an ideal species of mammals to accelerate the rate at which a virulent virus could evolve that will lead to a pandemic among humans. These discoveries in 2005 and a report that over 1,000 migratory birds have been found dead in China, is creating considerable concern among health officials that a pandemic is inevitable.
What makes their concerns all the more probable is the knowledge that pigs can carry both the human and bird viruses. If their genetic subunits exchange, the variant could be far worse than the type that killed tens of millions in 1918-1919.
While in Singapore I also learned that H5N1 was found in Thailand in both tigers and leopards, with a high percentage of the cats found to be infected dying. This earlier confirmed speculation that cats could be a vector for the H5N1 strain of avian flu.
H5N1 symptoms in humans include a sore throat, fever, cough and aching muscles. In more severe cases pneumonia and respiratory problems can develop which can lead to death.
No one has tested any nutraceutical ingredient or product for its performance against H5N1. Some candidates have been suggested. One is vitamin C at very high doses (>20 grams/b.i.d) early on when symptoms appear. Dose will vary according to one’s bowel tolerance. In 1980, I was given an IV drip of vitamin C in Sydney, Australia, by a physician after it was determined that I had become infected with a virulent flu strain while doing field research in Guam. I was told that over several hours the physician dripped over 100 grams of vitamin C right into my blood stream. Several hours later I was able to give a four-hour evening lecture at a lecture hall at the University of Sydney in front of an audience of over 500 people. Just six hours earlier I had a fever of 105.2 degrees F. So needless to say, one has to wonder whether vitamin C could be used against the H5N1 strain.
Another approach would be to strengthen one’s immune system by optimizing such immune components as the helper-to-suppressor ratio, natural killer (NK) cells, and T cells that become activated and help secrete cytokines that can activate cytotoxic T-lymphocytes, antibody-secreting B cells, and macrophages.
Will any nutraceutical emerge that can demonstrate such properties? Time will tell. In the interim, the need to contain the virus in whatever way possible may be the only alternative we have at this time.
In the time it took to write this report, a 5th case of fatal bird flu has been reported in Indonesia. To date, 3 out of 5 individuals directly linked to the bird flu have died. As a result, there is considerable fear among many Indonesians that with such a high mortality rate, and with H5N1 infections confirmed in the bird population of 22 of 32 provinces, the virus will soon mutate to a deadly and highly contagious human-to-human variant. Once this happens, given the speed with which humans can travel thousands of miles within hours, it may be too late to prevent a catastrophic repeat of the 1918 Influenza Pandemic. But this one could make the death count pale by comparison. Let’s hope not.
Maintaining a strong immune system is important in these times. Get plenty of rest, exercise regularly, avoid cigarette smoke, keep stress to a minimum, take immune supportive supplements, drink plenty of fluids, and find time to do good things for others, such as volunteer your time rather than be a couch potato. Don’t forget to show love to your family. Laughter and prayer have also been found beneficial to the immune system. Search for balance in your life. Talk with your family and friends about how to prepare for the flu. That inlcudes stocking up on essentials and basic foodstuffs.
Remember, 1918 came and went. It won’t last forever. One year and its gone. It’s all about how you handle that year that could decide your fate and that of others you care about.
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