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Commentary :: International
Bird Flu Breakdown Part I
31 May 2006
Questions and inconsistencies surrounding the bird flu hype
The much anticipated bird-flu plague has yet to emerge, despite much hue and cry. This comes as no surprise to those of us who are familiar with the machinations of the WHO (World Health Organization), CDC and NIH, and their pharmaceutical partners.

But, for those more trusting of public health authorities who wish to know more about the making of public health policy, I thought I’d review some of the bright and shiny inconsistencies that have come into view on the bird flu.

Stray Cats and Chinamen.
In March, 2006, The Associated Press reported: “In Austria, state authorities said Monday that three cats have tested positive for the deadly strain of bird flu in the country’s first reported case of the disease spreading to an animal other than a bird.”

The report quoted the World Health Organization (WHO), which said that “bird flu poses a greater challenge to the world than any infectious disease, including AIDS…”

Really? Bigger than AIDS? Who knew? But why would it be so? Because three cats in Austria tested positive? What does that mean? How many cats, in all of Austria, did they test? What would happen if you tested every cat?

How about every bird? How about every person? Do we know how many people actually have tested positive for bird flu? Maybe a dozen? A couple hundred?

How about millions.


In the November 8, 2005 New York Times’ , Gina Kolata reports1:

“Some experts like Dr. Peter Palese of the Mount Sinai School of Medicine in New York say the A(H5N1) flu viruses are a false alarm. He notes that studies of serum collected in 1992 from people in rural China indicated that millions of people there had antibodies to the A(H5N1) strain. That means that they had been infected with an H5N1 bird virus and recovered, apparently without incident1.”

The 2004 Nature Medicine study2 that Kolata refers to puts it like this:

“It may be possible that infections of humans by avian influenza viruses have been ongoing for decades and it is only the reporting that has improved in recent years. If this were the case, the present emphasis on the imminent pandemic outbreak would not be justified.

In fact, seroepidemiological studies conducted among the rural population in China suggest that millions of people have been infected with influenza viruses of the H4-to-H15 subtypes.

Specifically, seroprevalence levels of 2–7% for H5 viruses alone have been reported, and the seropositivity of human sera for H7, H10 and H11 viruses was estimated to be as high as 38, 17 and 15% respectively.”

Millions of healthy Chinese already exposed, and carrying antibodies to Influenza A? But I’ve been told that the bird flu is fatal to half the people who encounter it. I guess somebody forgot to tell these folks to keel over.

And still, the WHO refers to this flu as the “pandemic strain” of “lethal influenza.” But is it? It is true that some people did die. About 115 in 9 years – that’s number of deaths attributed to the probably-not-so-deadly flu. So what did they die of? Why did bird flu kill them and not millions of others?

Two Children in Vietnam
The February 17, 2005 New England Journal of Medicine3 reviews the cases of two children in southern Vietnam, a brother and sister (aged four and nine), whose deaths are attributed to bird flu.

What are the important questions to ask when looking at illness in a rural, relatively poor country? First, how did the children live? What was their lifestyle, income or poverty level? How was their access to basic medical care, food and water? These things are crucial, but they are the very questions that are ignored when researchers get a fever for an a priori cause.

This NEJM study states in the title that bird flu was to blame: “Fatal Avian Influenza A (H5N1) in a Child Presenting with Diarrhea Followed by Coma”, but a thorough reading reveals that the children lived in a village and region notable for “crowded living conditions and diarrhea,” where there was a high rate of “gastrointestinal infection and acute encephalitis [brain inflammation],” which, the authors note, “alone or in combination are common clinical syndromes in southern Vietnam.”

Why is there so much endemic illness in rural tropical countries? Possibilities: Pesticide use, unsanitary living conditions, lack of sewage treatment and clean water.

How does that play out here? The report describes the daily living conditions: “The family lived in a one-room house…Water from a nearby canal was used for washing and, after boiling, for drinking. Patient 1 swam regularly in this canal, as did other children in the neighborhood.”

These children swam in a canal where people washed, where animals lived, and presumably where people dumped waste – and they also drank (and cooked with) that water too? And they ended up in the hospital with…. diarrhea? Hard to believe!

”[The patient had] a two-day history of fever, headache, vomiting, and severe diarrhea. His stools (daily frequency, 10 times) were watery without blood or mucus. On admission, he was alert, and the results of physical examination were unremarkable….In both siblings, the clinical diagnosis was acute encephalitis.”

Diarrhea, vomiting, and fever. But no lung problems: “Neither patient had respiratory symptoms at presentation…A chest radiograph also was normal”

Which the doctors note was strange, because congested lungs are the hallmark of this avian influenza: ”[W]hy influenza H5N1 presented in this similar atypical manner in these two siblings remains an enigma.”

But both of these children died; the girl within a single day, the boy within five days of entering the hospital. Upon admission, they were both given strong antibiotics: cephalosporins (beta-lactam drugs) and aminoglycosides4.

Aminoglycosides are associated with some potent toxicities, but beta-lactam drugs are the greater concern. Up to 10 percent of people world-wide have toxic shock reactions to these drugs, that can result in severe illness and even death.

A 2000 case report in the journal of Pediatric Dentistry states5:

“The incidence of adverse events triggered by penicillins [beta-lactam drugs] is believed to be between 1% and 10%. Up to one-tenth of these episodes are life-threatening, with the most serious reactions occurring in patients with no history of allergy.”

A 1997 review in the journal Postgraduate Medicine6 reports:

“The most feared adverse events attributed to beta-lactam antibiotics are IgE type I immediate or accelerated reactions. These develop within minutes to hours of drug administration and cause hypotension [abnormally low blood pressure], laryngeal edema [swollen throat – difficulty swallowing and/or breathing] or bronchospasm [lung spasm – difficulty breathing].”

“Unpredictable reactions occur independent of the dose and route of administration…a number of host factors (ie, genetic makeup….[concurrent] medical disorders) affect the frequency and severity of antibiotic-related adverse reactions].”(ibid)

A 2004 study in Clinical & Experimental Allergy7 states:

“The prevalence of self-reported drug allergy was 7.8%, 4.5% to penicillins or other betalactams…The most common manifestations were cutaneous [skin] (63.5%), followed by cardiovascular [heart and blood vessels] symptoms (35.9%). Most of the reactions were immediate, occurring on the first day of treatment (78.5%).”

“Occurring on the first day of treatment.” In this case, a drowsy nine-year-old girl with a four-day history of fever and diarrhea, but no lung problems, died within a day of entering a hospital and being medicated.

The girl’s brother, who entered the hospital alert, but with diarrhea, fever and vomiting, died within five days of being medicated. Siblings and family members often share allergies, including those to drugs. There is no record in the report of testing either child for an allergic reaction to any drug, so it has to be considered as a factor in their demise.

But how would you know if it was really toxic shock? By doing an autopsy, and examining the organs. We can assume that no one was interested in asking those questions, because in both cases: “Acute encephalitis of unknown origin was reported as the cause of death. No autopsy was performed.”

Besides the potential immediate allergic reaction, there are the standard effects of antibiotics – nausea, diarrhea, dehydration, muscular weakness and exhaustion8. Why do these drugs make you weak? Because they kill beneficial bacteria, and damage mitochondria, the energy-producing organelles that drive our cells and bodies. Does any of this help in recovery from weakness, vomiting and severe diarrhea? Not likely. What do antibiotics do for viruses? Nothing. Nothing at all. Presuming a virus was the problem.

The patient progressed predictably:

“As a result of increasing diarrhea and drowsiness, the patient was transferred to a pediatric referral hospital in Ho Chi Minh City on February 15.”

The rest was painful. Lots of drugging, followed by increased weakness, which led the doctors to be more aggressive. Both children were given spinal taps, an invasive and painful procedure in which a syringe needle is pushed through the spinal sheath between two vertebrae, in order to collect fluid for analysis.

The procedure requires patients to be still and relaxed as the needle penetrates their spine, then to lie flat for hours to avoid further trauma. The physical and emotional discomfort to a child could be extreme. But of equal or greater concern is the potential for introducing foreign material into the cerebrospinal fluid – it is a dangerous procedure. But in the case of the younger brother, it was especially so. In his case it was “traumatic”.

“Laboratory analysis of cerebrospinal fluid obtained by means of a slightly traumatic lumbar puncture….the lumbar puncture was traumatic…”

What does this mean, exactly? That the child squirmed, the flesh was torn wider than was intended, it bled a great deal, he was frightened, they did the procedure poorly and went into a nerve or jammed the needle in too far? Who knows? They don’t say, only that it was “traumatic”.

The results of the spinal taps were “zero or one white blood cell per cubic millimeter” – not signaling infection. An unexpected result in children who supposedly died of massive, disseminated viral infection. It does sounds like exposure to a toxin, however. But no toxicological tests were done.

Following that came more drugs, then more weakness, and then, “The patient had a generalized convulsion and became comatose 12 hours after admission.” He began to have trouble breathing, so they intubated (pushed a tube down the throat), ventilated (pushed air into his lungs), added barbiturate sedatives (Phenobarbital) and he perished a day later.

You could be forgiven for thinking that two sick children went into a rural hospital, were over-drugged, poorly cared for, and died as a result.

But we’re asked to exclude every other factor, because one of the children tested positive for influenza A (as do millions of others). And so, we are permitted to believe that it was one thing – the killer flu (and nothing else) – that was responsible for the deaths of these children.

(It should be noted that only one child’s death was attributed to the flu – the younger brother, who died in five days. Why? Because only his sample remained when the WHO came to town, nine months later, scavenging for potential flu cases. The children died in February, 2004; the WHO made the bird-flu diagnosis in November.)

Q: Why would a child test positive for influenza A?

A: Obviously, because he was exposed to sick birds.

As the report indicates:

“The routes of transmission in our patients are unclear. Epidemiologic investigations did not reveal exposure to ill poultry…the family owned apparently healthy fighting cocks. The parents did not handle poultry from markets.”

But it was certainly bird flu, because it was so terribly contagious:

“Before the children were admitted, they were cared for by both parents and several close relatives. No febrile [fever] illnesses were reported in the parents, close relatives, or other residents of the hamlet.”

“Direct transmission from sister to brother appears unlikely, considering the interval between their illnesses. Assuming that the two children died of the same illness, why influenza H5N1 presented in this similar atypical manner in these two siblings remains an enigma.”

So nobody else was sick, it doesn’t look like flu, there are no sick birds. An “enigma!” But it’s still bird flu, according to the WHO. So there’s only one thing left to do.

“Many chickens and ducks were present in the hamlet and canal during early 2004, but none were ill. All were culled in February as part of routine measures to contain the outbreak of influenza H5N1 in poultry.”

Sorry? What outbreak of H5N1 in poultry? But the WHO says it’s so, so a family and village that has lost two children now loses its pets, food supply and livelihood. Bye-bye birdies.

Killed or Culled?
Of all the birds that have died worldwide, how many actually died of illness? No one seems to be bothered by the question:

In October, 2004, ChinaDaily.com reported: “Last week, some 3,000 chickens from three private farms in southern Tien Giang province [Vietnam] died or were culled after they were suspected of contracting the disease….Bird flu has killed or forced the cull of more than 43 million poultry in Vietnam.”

In September, 2005, the PBS investigative program “Wide Angle” reported that “Across Asia, some 200 million chickens and ducks have been killed outright by the disease or culled in an attempt to stave off further deaths, resulting in massive losses for poultry producers large and small9.”

And on May 12, 2006, FoxNews reported that “at least 113 people have died from the [H5N1] strain, which led to the slaughter of more than 200 million animals to prevent what health officials had warned could be a lethal pandemic.”

Two Hundred million animals slaughtered – all for a World Health Organization “could be,” because it could be infectious in humans.

But it was not in the case of the two children: “No febrile [fever] illnesses were reported in the parents, close relatives, or other residents of the hamlet.”

In 1998, the journal Science reported that a 3-year-old in Hong Kong died of bird flu, and yet:

“A clear epidemiologic link was not established between the infected child and infected poultry…there were a few sick chickens at the child’s preschool, but there is no evidence that the chickens were infected with avian influenza or that the child was in close contact with them10.”

Similarly a March, 2004 NEJM report attributes eight deaths to bird flu, but notes that no one exposed to the patients in hospital became ill:

“The absence of any report to date of a similar illness among the health care workers who cared for these patients, despite the lack of full droplet and respiratory infection-control measures early in the outbreak, is reassuring11.”

In December, 2005, MSN-Japan reported: “China has given a clean bill of health to 41 people who came in contact with a woman who died of bird flu….The latest case was in Xinyuan, a county in the far northwestern region of Xinjiang, where 300 birds died on Nov. 24.”

One death, no infectious illness. But, just to be sure: “Authorities culled more than 118,000 poultry within a three-kilometer radius as a precaution.”

A six kilometer-wide area of birds killed, because we believe half of the people who are infected will die, even though millions test positive, because the health authorities and the media repeat it like a mantra: “fatal influenza! fatal influenza! Pandemic strain!”

But it’s not found in evidence. A March, 2004 NEJM study on flu patients cautions: “We cannot rule out the possibility of mild or subclinical infection in persons exposed to either ill poultry or ill persons11.”

“Mild bird flu” can’t be ruled out? I’ve never heard that on the evening news. So what would make a case “mild or subclinical” versus “fatal”?

The report on the brother and sister who died, with no exposure to sick birds, notes that the answer may not be in the virus, but in the patient:

“Further research is needed to determine whether host factors, which may determine a person’s susceptibility to disseminated or central nervous system infection, or a particularly neurologically virulent strain of virus, is involved.”

“Host factors” – a person’s constitution and pre-existing level of health. For example, whether the patient is a child from a poor, rural village with polluted water? That might be worth considering. How about how a patient is medicated? Maybe we should call for “further research” there, too.

But no, say the health authorities. Just because it doesn’t look like influenza, doesn’t mean we can’t call it bird flu:

“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.

These cases emphasize that avian influenza A (H5N1) should be included in the differential diagnosis of a much wider clinical spectrum of disease than previously considered and that clinical surveillance of influenza H5N1 should focus not only on respiratory illnesses, but also on clusters of unexplained deaths or severe illnesses of any kind3.”

“Include a much wider spectrum of disease…..focus on unexplained deaths or severe illnesses of any kind.” If I didn’t know better, I’d say that it sounded like somebody was trying to make it a lot easier to diagnose people with bird flu. Fever and diarrhea in Vietnam used to be “fever and diarrhea” – tropics and poverty and poor sanitation. Something we could do something about, if we wanted to. But now we don’t have to think about that. Because now, it’s “deadly H5N1”.

What does all this add up to – Bird Flu, or Bird Flu Fever? A bad cold, or bad medicine? Whatever it is, it’s certainly business as usual for the World Health Organization, and for the major media, who don’t, can’t or won’t, ask questions of the medical authorities.

Stay tuned for Part Two of the Bird Flu Breakdown…

References:
1 Hazard in Hunt for New Flu The New York Times November 8, 2005.

2 ”Influenza: old and new threats”. Palese, P. Nature Medicine Supplement, December 2004 (v10;n12)

3 “Fatal Avian Influenza A (H5N1) in a Child Presenting with Diarrhea Followed by Coma”. February 17, 2005; ; Volume 352:686-691, Number 7.

4 Drugs given:acetaminophen (tylenol), ceftriaxone and ceftazidime ( beta-lactam antibiotics), amikacin and gentamicin (aminoglycoside antibiotics), phenobarbital (barbituate/sedative/hypnotic) and mannitol (sugar)

5 “Adverse reaction to amoxicillin: a case report”. da Fonseca; American Academy of Pediatric Dentistry. Sep-Oct 2000; 22(5):401-4, 209.

6 Adverse Reactions to Antibiotics: Clues for Recognizing, Understanding, and Avoiding them Gleckman, R., MD; Borrego, F.,MD; Postgraduate Medicine, April 1997,v.101, n.4.

Testing for allergic reactions to antibiotics, from “Adverse Reactions to Antibiotics:

The most reliable way to assess a patient’s risk for a type I IgE-mediated reaction is to measure the skin test response to the “major” and “minor” penicillin determinants. Unfortunately, only the major skin testing determinant (benzylpenicilloyl-polylysine [Pre-Pen]) is commercially available. Testing with major determinant alone would fail to identify a significant number of patients at risk for serious allergic reactions.

Therefore, unless the patient is at a research center where minor determinant can be prepared, the clinician must try to decipher the patient’s drug allergy history, even though such histories are often vague or unreliable.

7 Self-reported drug allergy in a general adult Portuguese population. Gomes, et al. Clinical Experimental Allergy. October 2004;34(10):1597-601.

8 “Gastro-intestinal side effects including diahrroea, nausea and vomiting may occur quite frequently. Pseudomembranous colitis has also been reported.Super-infection is relatively common. Doses should be reduced in severe renal failure.” ( Amoxicillin package insert 2002, Malahyde Information Systems).

“Virtually all antibiotics have been associated with C difficile [bacteria]-related diarrhea and colitis; ampicillin, clindamycin (Cleocin), and the cephalosporins are most commonly implicated.”(Postgraduate Medicine4)

9 WideAngle – H5N1 PBS, September 2005

10 Science; January 16, 1998; Vol 279, Issue 5349, 393-396

11 NEJM, March 18, 2004; V.350:1179-1188; N.12

[bold and italics added throughout by author for emphasis]

Thanks to Jon Rappoport’s “No More Fake News”: for picking up the Kolata NY Times story first, to Dr. A. Maniotis of U. Illinois for research support and assistance, and to Michael Kane of FromTheWilderness.com for his much valued help and encouragement.

This work is in the public domain
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Comments

Re: Bird Flu Breakdown Part I
31 May 2006
I too have followed some of these reports and others and agree there are some -- numerous inconsistencies from the scientific community, government reports here and abroad as well as the media. No doubt that there is way much more that we don't know about bird flu, than what we know, and what we do know we're not sure of. One observation rightly or wrongly is that there is a continual comparison with the AIDS virus. We now know that AIDS was and is not a homosexual diseases as taunted in the early 1980's. We also tracked down AIDS to the late 1950's as well as its origins. And although we took a long time in this country to seriously address it, once we were able to realize there was profitability in it, the mechanisms to contain it, research etc. started flowing. I can only pray that it is not worse than AIDS, note I didn't say when it hits. Not being a scholar, or in medicine I have grave concern when I read and can't verify that the H5N1 virus, unlike other viruses remains alive in your blood, and can possible cause a perfectly healthy person to expire within hours is quite terrifying even to the bravest and most physically fit. I hope Part II can address bird flu and blood facts.
Re: Bird Flu Breakdown Part I
01 Jun 2006
Thanks for taking the time to put all this data about a possible health pandemic in one place.

Could you add a paragraph that simply summarizes whether or not we should be concerned, why and what we can do. thanks.