Pigeon Droppings

 

Bihar State – Credit Wikipedia

 

# 6696

 

 

Last winter India was plagued with numerous stories of wild bird die offs that were largely blamed on the avian flu virus (see Media Report: H5N1 Killing Crows In Jharkhand).

 

By mid-December the Indian Veterinary Research Institute (IVRI), Bhopal, confirmed that the H5N1 virus was behind at least some of these deaths. (see EpiSouth eweb_195_15_12__11.pdf).

 

Over the next few months, more reports came in, involving thousands of dead birds (see The Kolkata Crow Mystery & H5N1: A Murder Of Crows) that spread across several northern states.

 

While it is fair to say that the H5N1 virus was widely suspected, it is not clear how many were actually confirmed by laboratory testing.

 

On February  6th,2012 official notification was made to the OIE of H5N1 virus detections in crows from four states; Jharkhand, Maharashtra, Orissa, and Bihar.

 

By the end of spring, reports of fresh H5N1 outbreaks in poultry - and wild bird die offs - came to a close in India, and the subject of bird flu dropped off the front pages.  With the return of fall weather, however, the bird flu virus is back in the news (see Bangalore, India: H5N1 in Turkeys).

 

And today we’ve  a report – once again from Bihar – of a fresh bird die-off, although this time the victims are not crows, but pigeons.

 

At this point, no testing has been done, so the cause of this die off is not known.  H5N1 is a possibility, but by no means is it the only one.

 

Pigeons are generally regarded as being far less susceptible to the H5N1 virus than many other bird species (see Role of Terrestrial Wild Birds in Ecology of Influenza A Virus (H5N1), but they are not completely immune.

 

Earlier this year (see WHO Updates H5N1 In Egypt & Indonesia), two human H5N1 deaths in Indonesia were linked to direct contact with pigeons. Other pigeon-related cases from the past include:

 

•  In February of 2006, a 14 year-old pigeon handler in Iraq reportedly died from H5N1
• The April 2006 CDC's EID Journal Avian Influenza H5N1 in Naturally Infected Domestic Cats, describes a domestic cat that died after eating an infected pigeon. 
• In May of 2006, a 39 year-old man died after reportedly cleaning pigeon feces from blocked roof gutters at his home.

 

 

Any mass bird die off in an area where the H5N1 virus is endemic is worthy of investigation, but there are many other diseases that can kill pigeons. The Paramyxovirus (PMV) which has recently caused such a stir among pigeon fanciers in Australia and Newcastle virus are just two.

 

And pigeons (along with other terrestrial birds) may be affected by environmental factors, such as pesticides, and contaminated feed.

 

With all of these caveats, here is the report from the Times of India, which includes the somewhat unusual speculation from a veterinarian that faulty `mobile phone towers’ may be responsible for these deaths.

 

 

Over 500 pigeons drop dead in Bihar village

IANS | Nov 5, 2012, 05.41PM IST

PATNA: More than five hundred pigeons suddenly dropped dead at a village in Bihar's Bhagalpur district over the last four days, causing residents, some of them pigeon-keepers, to fear that something was amiss.

District officials are still to visit the site and conduct an inquiry.

Over 500 pigeons died mysteriously in Bath village near Sultanganj in Bhagalpur, about 250 km from the state capital.

(Continue . . . )

 

 

The history in India has been that officials are often slow to investigate reports of bird deaths, in poultry, and in the wild. Often, by the time an investigation is launched, the birds have been incinerated or are too decomposed, to examine.

 

So we’ll have to wait to see what, if any, answers are forthcoming on this event.

»» Read More

India: The H5N1 & Migratory Birds Debate

Credit U.S. Fish and Wildlife Service

 

# 6686

 

One of ongoing debates in the world of avian influenza is over exactly how much of a role migratory birds play in the spread of highly pathogenic H5N1.  

 

Bird enthusiasts tend to point to the poorly managed poultry trade as being the main source of the spread of bird flu while those in the poultry industry are often quick to blame migratory birds.

 

Over the years we’ve studies that either implicate migratory birds in the spread of the virus, or minimizes their role (see  India: The Role Of Migratory Birds In Spreading Bird Flu).

 

Personally, I see no reason why these positions should be mutually exclusive.  As far as I can tell, both are important factors in the spread of the virus.

 

But the debate goes on, often heatedly.

 

The recent outbreak of H5N1 in India (see  Bangalore: More Poultry Culled Due To H5N1) at a government poultry farm is very near Hesaragatta lake - a man-make reservoir and winter nesting ground for migratory birds that has fallen into disrepair in recent years from a lack of water. 

 

Reportedly, the number of birds that now visit every year is greatly reduced.

 

Nevertheless, several thousand birds continue to stop over at Hesaragatta lake each winter, and that has prompted local officials to suggest that migratory birds are to blame for the current outbreak.

 

A position that local ornithologists are taking serious umbrage over.

 

First a link to the article from DNA (Daily News & Analysis) that attempts to exonerate wild birds as carriers of the H5N1 virus, then I’ll return with some comments of my own.

 

Experts debunk migratory birds theory

Published: Thursday, Nov 1, 2012, 15:50 IST
By Aishhwariya Subramanian | Place: Bangalore | Agency: DNA

The hunt for the elusive cause of the avian influenza outbreak at Central Poultry Development Organisation & Training Institute (CPDOTI) on Tuesday saw officials of animal husbandry department blaming migratory birds for carrying the virus. But ornithologists have debunked the theory despite animal husbandry officials stating that the Hesaraghatta Lake close to CPDOTI facility which attracts migratory birds was the culprit for the outbreak.

(Continue . . . )

 

The arguments being made by the experts interviewed in this article are basically two pronged. 

 

• The first seems to be the old canard that `sick birds don’t fly’
• The second is the reduced number of migratory birds arriving at the reservoir in recent years.

 

While it’s true that wild birds that acquire the virus, sicken, and die are less likely to transfer the virus across long distances, the `sick birds don’t fly’  stance ignores the fact that in migratory waterfowl, the H5N1 is often an asymptomatic infection.

We’ve looked at asymptomatic waterfowl as reservoirs of the virus a number of times in the past, including:

Reservoir Ducks

Webster On China's `Silent' Bird Flu Infections

Mallard Ducks Found To Be Asymptomatic To Bird Flu Virus

We’ve also witnessed the geographic spread of new clades of the H5N1 virus in migratory waterfowl, and the apparent importation of H5N1 into Hong Kong, Japan, and South Korea by the arrival of migratory birds in the past.

 

EID Journal: H5N1 Branching Out

Study: The Role Of Migratory Birds In Spreading Bird Flu

Egrets, They’ve Had A Few . . .

Japan: Hooded Crane Positive For H5N1

Wild Birds Eyed As Likely Source Of Hong Kong Bird Flu Outbreak

FAO: On The Trail Of Avian Influenza

 

 

The second argument, that the number of migratory birds arriving each year at Hesaragatta lake has recently dropped may reduce the odds that birds brought the virus to Bangalore, but it certainly doesn’t eliminate the possibility.

 

The bottom line - it just takes one infected bird to arrive and introduce the virus to the environment.

 

None of which tells us how the H5N1 virus made it to a government poultry operation in Bangalore, but it does help put migratory birds as carriers of avian flu into better perspective.

 

Lest bird lovers cry `fowl’, the role of poultry producers in the spread of avian flu – including, but not limited to: poor biosecurity, overcrowded conditions, covering up reports of illnesses or deaths among birds, and smuggling – are well documented in this blog, and elsewhere.

 

While migratory birds appear to have a role in introducing avian flu viruses to new regions, poorly run poultry operations obviously help to amplify and spread these viruses further.

 

The fact that this debate is unresolved nearly a decade after the re-emergence of H5N1 in 2003 underscores the need for better research and surveillance, both in migratory birds and in poultry operations.

 

 

Until we can clearly understand the various mechanisms by which this virus is spread, the prospects of halting outbreaks in the future remain slim.

»» Read More

Bangalore: More Poultry Culled Due To H5N1

 

Photo Credit – FAO

# 6678

 

 

Last Friday in Bangalore, India: H5N1 in Turkeys, I reported on the discovery of H5N1 at a government-run poultry operation on the outskirts of Bangalore, that had resulted in the deaths and culling of more than 3,300 birds.

 

Today, we are learning that the culling operation has been increased nearly 10-fold, with roughly 33,000 birds now culled.  This from the IBT.

 

Bird Flu Outbreak in Karnataka: Over 33,000 Poultry Birds Culled at CPDO

 

By Ankita Mehta | October 30, 2012 10:39 AM GMT

Fear of avian influenza continued to create panic in Karnataka after more than 33,000 poultry birds -19,235 chicken, 13,673 ducks and 369 emus - were culled at Central Poultry Development Organization (CPDO) in Hesaraghatta, 40 km from Bangalore.

(Continue . . )

 

 

The freewheeling Indian media is rarely shy about criticizing the government’s response to bird flu (or any other crisis). Today we get an example from DNA.

 

Bird flu is on, so is passing-the-buck

Published: Tuesday, Oct 30, 2012, 16:43 IST
By Nirad Mudur & Deepthi MR | Place: Bangalore | Agency: DNA

The Centre on October 25 notified its confirmation that avian influenza has indeed struck the Central Poultry Development Organisation & Training Institute (CPDOTI) located in Byatha village in Hesaraghatta on the outskirts of Bangalore.

 

But despite the confirmation that 4,265 turkeys had died due to avian influenza and 206 chicken and 17 ducks died due to suspected infection from the same disease, the state health department and the Bruhat Bengaluru Mahanagara Palike (BBMP)’s health department are engaged in a bureaucratic passing-the-buck. Each is stating that the responsibility of checking the disease spread lies solely with the state department of animal husbandry.

(Continue . . .)

 

 

Of particular concern, the story above goes on to state that several poultry farms close to the affected farm had already moved their flocks in order to avoid culling them.

 

Since that can spread the virus to other regions, neighboring states are now taking steps to prevent entry of birds from Karnataka.

This from the Deccan Herald.

 

Bird flu in Karnataka: Kerala bans poultry from outside

Thiruvananthapuram, Oct 30, 2012 (PTI)

Kerala has banned entry of poultry from other states following detection of avian influenza (bird flu) in a central government farm at Hesserghatt in southern Karnataka.

Following an intimation in this regard from the Karnataka Government, the state Animal Husbandry Department has banned movement of poultry from both Karnataka and Tamil Nadu since last evening, official sources said today.

(Continue . . .)

 

For now, H5N1 remains primarily a threat to poultry and wild birds.  India has yet to report a human infection from the virus. 

But elsewhere around the world more than 600 widely scattered human infections have been reported, and the mortality rate has been a horrendously high 60% among known cases.

 

And so we watch outbreaks such as this with keen interest.

»» Read More

India: Still Looking For A Policy On Antibiotics

 

Inoculated MacConkey agar culture plate cultivated colonial growth of Gram-negative, small rod-shaped and facultatively anaerobic Klebsiella pneumoniae bacteria. – CDC PHIL.

# 6502

 

Although the antibiotic resistance enzyme now known as NDM-1 (New Delhi metallo-ß-lactamase-1) was first detected in a patient in Sweden (albeit with Indian origins) four years ago, it didn’t capture much attention until the publication of an eye-opening research paper in The Lancet in August of 2010.

 

Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study

Dr David Livermore, Prof Timothy Walsh, et al.

doi:10.1016/S1473-3099(10)70143-2

Published Online: 11 August 2010

 

This study linked the recent importation of a handful of NDM-1 infections into the UK, US, and other countries  to `medical tourism’ on the Indian Sub-continent (see NDM-1: A New Acronym To Memorize).

 

NDM-1 is an enzyme confers resistance to certain gram negative bacteria like E.coli and Klebsiella against a class of antibiotics called carbapenems. Carbapenems are often our drug of last resort against a variety of bacterial infections.

 

Of particular concern, this enzyme is carried by a plasmid – a snippet of portable DNA  - that can be transferred to other types of bacteria (see Study: Adaptation Of Plasmids To New Bacterial Species).

 

 

The rise of antibiotic resistance has long been linked to the overuse and misuse of antibiotics.

 

Citing a lack of doctors and low family incomes, the Indian government allows the unfettered sale of antibiotics to the public without a doctor’s prescription.

 

Indian officials swiftly reacted to the Lancet paper, but rather than taking immediate action against a growing public health menace, they took umbrage instead.

 

They condemned of the use of `New Delhi’ in the naming of this resistance gene and called the paper a `conspiracy theory’.  They issued broad denials of its prevalence in India or that medical tourism to their nation was responsible for its spread.

 

It is worth noting that the naming convention for pathogens that invoked India’s ire has long used the pathogen’s place of discovery or emergence. India was certainly not singled out.

 

After intense pressure from the International community and scathing editorializing in Indian newspapers, the Indian Health Ministry announced in October 2010 that they would impose new restrictions on the sale of 90 antibiotics that were currently sold over-the-counter.

 

But that plan was eventually abandoned. Two years later, the sale of antibiotics remains rampant and unregulated in India.

 

This article appeared last week in The Hindu.

 

 

Wanted: a policy on antibiotics

R. Sujatha

It needed a scare like NDM-1 for the country to wake up to a policy to regulate antibiotics. But after announcing with much fanfare that a policy would be in place, the government withdrew the decision. We have arrived at a crossroads and there is no solution to the crisis yet.

(Continue . . .)

 

 

The story goes on to say that next week doctors from around the country will meet in Chennai to try to come up some kind of  `road map’ for the government to use to implement an antibiotic policy. 

 

Whether they will succeed, and whether the government will follow through, remains to be seen.

 

Meanwhile, as policy makers dither, the NDM-1 enzyme continues its evolution and spread.

 

Six months after the first Lancet article in April, 2011, the same researchers published a another study that found the NDM-1 enzyme in 4% of New Delhi’s sampled drinking water sources, and 30 per cent of the sewage tested.

 

The Lancet Infectious Diseases, Early Online Publication, 7 April 2011

doi:10.1016/S1473-3099(11)70059-7

Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study

Prof Timothy R Walsh PhD , Janis Weeks BS, David M Livermore PhD , Mark A Toleman PhD

 

And most alarmingly, the researchers also identified 11 new species of bacteria carrying the NDM-1 gene, including strains which cause cholera and dysentery.

 

Once again the reaction out of India was one of denial (see Hopefully, It’s Just A Stage They Are Going Through). 

 

Last fall, despite ongoing denials from the Indian government, we saw a number of stories that helped to corroborate the findings of these two much-maligned-in-India Lancet studies.

 

First stop, the The Economic Times.

Ganga Ram study finds high levels of superbug NDM1

5 Oct, 2011, 1114 hrs IST, Durgesh Nandan Jha, TNN

NEW DELHI: India might have vehemently opposed an antibiotic-resistant superbug being named New Delhi Metallo-beta-lactamase 1 (NDM1), but a study in a leading city hospital has found a worryingly high prevalence of the deadly gene.

(Continue . . . )

 

 

The study, conducted over a 5-month period, examined 10,889 samples from patients. The NDM1 resistance gene was found in 8.1% of E. coli samples and 38.02% of samples of K. pneumoniae.

 

In the article, Dr S P Byotra, chairperson of medicine at the Ganga Ram Hospital, is quoted as saying:

 

"The idea behind this study is to stop denying the crisis NDM1 poses and work out strategies to check its spread. Antibiotic usage needs to be monitored strictly and good infection-control methods should be put in place at hospitals."

 

Another related article, that appeared in the International Business Times, quotes Former Indian Council of Medical Research chief and chairman N.K. Ganguly as saying that the multi-drug resistant New Delhi metallo-beta-lactamase-1 or NDM-1 comes from hospital waste that goes into Delhi's sewage water.

 

Presence of Antibiotic-Resistant Bacteria in Delhi Confirmed

October 5, 2011 1:26 PM EST

 

 

Last March (see Chan: World Faces A `Post-Antibiotic Era’), World Health Organization Director-General Margaret Chan – delivering the  keynote address to the Conference on Combating Antimicrobial Resistance in Copenhagen, Denmark - painted a bleak picture of the future of antibiotic availability if action is not taken.

 

The D-G’s entire remarks may be viewed on the WHO’s website at Antimicrobial resistance in the European Union and the world, but I’ve excerpted a few choice statements below, after which you’ll find a link to the World Health Organization’s latest publication on antibiotic resistance.

 

Excerpts from D-G Chan’s March 14th, 2012 speech.

 

Antimicrobial resistance is on the rise in Europe, and elsewhere in the world. We are losing our first-line antimicrobials. Replacement treatments are more costly, more toxic, need much longer durations of treatment, and may require treatment in intensive care units.

 

<SNIP>

 

If current trends continue unabated, the future is easy to predict. Some experts say we are moving back to the pre-antibiotic era. No. This will be a post-antibiotic era. In terms of new replacement antibiotics, the pipeline is virtually dry, especially for gram-negative bacteria. The cupboard is nearly bare.

 

<SNIP>

 

A post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.

The evolving threat of antimicrobial resistance - Options for action

Authors:
World Health Organization

 

 

To be fair, India isn’t the only country with NDM-1 cases or growing carbapenem resistance. But the Indian sub-continent does appear to be a focal point – a situation often linked to their lax controls on the sale and use of antibiotics.

 

Short of seeing a hyper-virulent pandemic someday, I can think of no public health crisis with a bigger potential impact than the growth of antibiotic resistant pathogens.

 

While I dabble in the subject from time to time, without a doubt  the `go to’ blogger on all things antibiotic resistant is Maryn McKenna, author of Superbug: The Fatal Menace of MRSA. 

 

 

If you aren’t a regular visitor to her Superbug Blog, you should be.

 

If and when the Indian government imposes meaningful restrictions on the sale of antibiotics, I’ll report it. 

 

One just hopes that happens before the point becomes moot.

»» Read More

Indian Government Responds To Concerns Over H1N1

 

 

# 6274

 

 

A couple of days ago I wrote about aggressive reporting in the Indian media over the number of H1N1 `swine flu’ cases being reported in many parts of India (see Indian Expert: `Nothing Scary About Outbreak’).

 

Media speculation has included the mention of `possible mutations’ in the virus, prompting considerable alarm.

 

 

The Indian government, which has had made little comment until now, has released a statement indicating that nothing unusual is going on regarding influenza activity in India.

 

Specifically they deny any signs of unusual mutation in the virus. Here is the text of their statement (slightly reformatted for readability):

 

No Cause for panic about Pandemic Influenza A H1N1

Ministry of Health and Family Welfare

 

11-April, 2012 13:53 IST

The situation with respect to instances of H1N1 is well under control and is being monitored. As reported in some section of the press, the virus has not mutated to a more virulent form or changed its character.

 

Director, National Institute of Virology, Pune has clarified that the presently circulating strain of H1N1 pandemic virus belongs to clade 6 and 7. (Clade is the medical terminology used to describe related organisms descended from a common ancestor). These clades are circulating in many countries. All are treatable with Oseltamivir (an antiviral drug which slows the spread of influenza (flu) virus). The currently available vaccine can be used, as antigenic (antigen is a substance that when introduced into the body stimulates the production of an antibody. Antigens include toxins, bacteria, foreign blood cells, and the cells of transplanted organs) differences are not significant. There is no mutation to suggest change of virus to 'dangerous form'.

 

World Health Organisation while declaring the Pandemic to be over in August 2010, had conveyed that the influenza H1N1 pandemic virus would take on the behaviour of seasonal influenza virus and continue to circulate for some years to come. Hence, in the post-pandemic period, localized outbreaks of varying magnitude with significant level of H1N1 transmission are expected.

 

Subsequent to this declaration, our country had experienced major outbreaks during the period August to October, 2010 and again from May, 2011 to July 2011. Now, in March-April, 2012, there is increased number of cases of Pandemic Influenza A H1N1 reported from the State of Andhra Pradesh, Maharashtra, Rajasthan, Karnataka and Tamil Nadu. Small pockets of population who remained unexposed to the pandemic and susceptible would be affected. In first week of March almost 30% of referred samples were positive for H1N1 in Pune which has come down to approx. 10% now.

 

A large number of these cases would be presenting with mild influenza like illness and as such requires no testing or anti viral drug treatment. However, it is important to get oneself examined at the nearest hospital in the initial part of illness to detect moderate illness and other associated risk factors/ diseases that require hospitalization. The anti viral drug Oseltamivir is available free of cost through the State public health system. They are also available with retail chemists licensed to keep Schedule X drugs. A central stockpile of about 8 million doses of Oseltamivir is also maintained. As the virus is circulating with in the country, there is no need to impose any travel restrictions or screening at inter-state point of entry, railway stations etc.
SBS

 

 

While a public statement from the Indian Government is certainly welcome, one does wonder what took them so long to respond.

»» Read More

Indian Expert: `Nothing Scary About Outbreak’

 

 

 

# 6268

 

For several weeks newspaper headlines in India have been warning about the spread and rising death toll from the H1N1 `Swine flu’ virus. This story has been covered with the kind of exuberance typical of the Indian Press; a few headlines from this past weekend serve to illustrate the point:

 

Swine flu cases spark alarm in Vizag The New Indian Express

Swine flu redux: is this a mutated summer strain?-First Post.India

 

Swine flu panic goes viral in Chennai The New Indian Express

Tamil Nadu sitting on swine flu tinderbox The Asian Age

Fear of H1N1 outbreak puts Kerala on alert Gulf News

Officials try to hush up flu toll Deccan Herald

DMO cautions against spread of H1N1 The New Indian Express

 

To spare you from having to read all of these reports, they contain rumors of government cover ups, stories of crowded clinics, a mounting death toll interspersed with almost obligatory speculation over the possibility that some (as yet unidentified) `mutation’ in the H1N1 virus has revived its ferocity.

 

The reason why I’ve not devoted blog space to these media reports is that - while it is always possible that something unusual is going on with the virus in India - thus far I’ve seen nothing to lead me to that conclusion.

 

Today the New Indian Express has printed an opinion piece by T. Jacob John - a vaccine expert and Professor Emeritus of Virology at CMC (Christian Medical College) in Vellore – that attempts to calm some of the public’s fears and put all of this media generated sound and fury over the swine flu into perspective.

 

 

Nothing scary about outbreak

T Jacob John

Express News Service

Last Updated : 09 Apr 2012

CHENNAI: Why this panic over pandemic flu? The pandemic is long over; it was declared on 11 June 2009 – and declared ended on 10 August 2010.

 

Like in the past, the new virus strain continues to circulate and is qualified “seasonal” (in cold countries) and “endemic” in warm countries. The virus is no longer swine flu, but human influenza virus A/pandemic 2009/H1N1, which is endemic in India. It is no surprise that it is found when specifically looked for, but it will be found only where it is looked for. The pre-pandemic endemic virus A/ H3N2 also continues to circulate.

(Continue . . . )

 

 

In addition to dispelling some of the worries over the (not unexpected) outbreaks of influenza (H1N1, H3N2, & B) across India, Professor John also touches briefly on H5N1, concerns over India’s growing threat from antibiotic resistant bacteria, and deficits in India’s disease surveillance and reporting systems.

 

While it doesn’t happen often, it is always possible that the H1N1 virus (or any other flu virus) could abruptly mutate in India – or elsewhere – and spark a new wave of serious disease.

 

That appears to be what happened in the winter of 1950-51 when a new, and quite deadly flu emerged during an otherwise mild flu season out of Liverpool, England and for a few weeks caused a higher death toll in that region than did the 1918 pandemic (see Pseudo Pandemics And Viral Interlopers for the full story)

 

Influenza viruses mutate.  It’s what they do.

 

Most of the time, these mutations are benign, or even detrimental to the virus.  But rarely a mutation will crop up that makes the virus more `fit’, and enhances its ability to spread.

Sometimes it can increase its virulence as well.

 

And so we watch news accounts of influenza activity around the world with interest, even if we must take some of the reporting with a sizable grain of salt.

 

But the flu doesn’t have to mutate in order to cause severe disease and even death. Influenza claims hundreds of thousands of lives every year around the globe, and can be particularly dangerous for those with pre-existing risk factors.

 

Which is why the smart move is to get the seasonal flu vaccine each year, and to practice good flu hygiene all year round (washing your hands, covering your coughs, staying home when sick).

 

For while the pandemic is ended, the malady lingers on.

»» Read More

NDTV: Video Report On India’s Crow Deaths

 

 

 

# 6190

 

NDTV or New Delhi Television, is a commercial broadcast network in India that features a good deal of English language programming.

 

Today they’ve uploaded a news video to their YouTube channel reporting on fresh concerns over the deaths of thousands of crows across several Indian states (see H5N1: A Murder Of Crows).

 

`Science reporting’ via the mass media often suffers from a lack of scientific specificity, and occasionally indulges in a bit of speculation as well. 

 

I think it’s fair to say that this media report contains a bit of both. The opening monologue reads:

 

After remaining clean for five years, India saw an outbreak of avian influenza or bird flu in the eastern states early this year. But this time there is the threat of a possible new virus circulating in the environment. Over 6000 crows have died across several states. Only 20 samples have shown up positive for bird flu. The rest have died of unidentified causes. After ignoring the problem, the government is now moving quickly to work out an emergency outbreak plan to identify the virus and contain the epidemic.

 

You will find a short interview with FAO  representative John Weaver, calling for an epidemiological investigation into these bird deaths and the testing for pathogens other than H5N1 that may be contributing to these crow deaths.

 

Bird flu virus changing DNA, 6000 crows dead

 

 

While an interesting report, a few caveats to consider:

 

The opening statement that `After remaining clean for five years, India saw an outbreak of avian influenza or bird flu in the eastern states early this year’ seems a dubious start, since India has reported outbreaks of the H5N1 virus to the OIE every year since 2006.

 

Similarly, the claim `Over 6000 crows have died across several states. Only 20 samples have shown up positive for bird flu. The rest have died of unidentified causes.’ gives the impression that all 6000 crows were tested for bird flu.  Something I’ve not seen reported.

 

And lastly, the headline Bird flu virus changing DNA,  6000 crows dead - in the absence of genetic tests  showing mutations -  appears to be highly speculative (not to mention the fact that influenza is an RNA virus).

 

 

Despite these limitations, this report illustrates that more than three months after thousands of crows began dying mysteriously across several Indian states, we still know surprisingly little about the cause or causes.

»» Read More

H5N1: A Murder Of Crows

 

Indian House Crow – Photo Credit Wikipedia

 

# 6154

 

Over the past three months, and across several states in northern India, we’ve seen numerous reports of mass deaths of crows (see The Kolkata Crow Mystery & Media Report: H5N1 Killing Crows In Jharkhand).

 

By mid-December the Indian Veterinary Research Institute (IVRI), Bhopal, confirmed that it was the H5N1 virus that was behind these deaths. (see EpiSouth Bulletin eweb_195_15_12__11.pdf).

 

Still, there has remained some debate over whether the H5N1 virus is truly responsible for these crow deaths. As recently as January 20th, the Calcutta Telegraph reported that FAO officials were expressing doubts on the cause (see UN experts sceptical of H5N1 attack on crows).

 

Their reasoning, according to this report: `the FAO team currently touring Jharkhand, insisted that if the virus were indeed H5N1, it would have spread to other animals and also human beings.’

 

Meanwhile, the media has accused local governments of being slow to react, as in this report from late January that appeared in the  Times of India.

Govt gets cracking on crow deaths

TNN | Jan 29, 2012, 07.36AM IST

KOLKATA: After ignoring the mysterious crow deaths in the city for nearly two months, the state government flew into action mode on Saturday and sent scientists to Rabindra Sarovar to gather carcasses and blood samples.

(Continue . . . )

 

 

Doubts over the cause of these crow deaths would seem to have been erased on February 6th, when official notification was made to the OIE of H5N1 virus detections in crows from four states; Jharkhand, Maharashtra, Orissa, and Bihar.

 

 

 

 

Today, somewhat belatedly, we get a media report from the northeastern Indian state of Bihar announcing the cause of these crow deaths.

 

 

Crows are dying in Bihar from bird flu

IANS | Feb 18, 2012, 02.01PM IST

PATNA: It is official now. Crows are dying in Bihar because of bird flu. This was revealed in the report of the Bhopal-based High Security Animal Disease Laboratory (HSADL), officials Saturday said.

 

The HSADL has confirmed in its report that avian influenza was killing the crows in Gaya district.

 

After the confirmation, the Bihar government has directed the animal husbandary department officials to begin necessary measures to deal with the situation.

(Continue . . .)

 

 

Curiously, no explanation (or even mention) is made of the 12-day delay between OIE’s notification, and the results apparently made public today from India’s High Security Animal Disease Laboratory (HSADL).

 

The public are now being warned to stay away from crows (living or dead), and non-specific assurances are being offered by local officials that,`Some measures have been taken to control the situation and check possible spread of any kind of infection.’

 

Despite IVRI reports in mid-December finding the Jharkhand crow deaths were due to the H5N1 virus, on December 29th the media reported India declares itself bird flu-free; notifies OIE).

 

That coveted status didn’t last long.

 

Since then, India has filed 6 reports of H5N1, in poultry and in wild birds, with the OIE.

India H5N1  11/01/12 Immediate notification 49326

                 13/01/12 Follow-up report No. 1 49359

                 18/01/12 Follow-up report No. 2 49405

                 28/01/12 Follow-up report No. 3 49504

                 04/02/12 Follow-up report No. 4 49573

                 06/02/12 Immediate notification 

 

 

Demonstrating once more, just how difficult it is for countries where the H5N1 virus has become entrenched to successfully eradicate it from the environment.

»» Read More

The Kolkata Crow Mystery

 

Indian House Crow – Photo Credit Wikipedia

# 6107

 

Roughly two months ago crows by the hundreds (some say thousands) began falling from their perches and dying in Jharkhand, India. 

 

By mid-December the Indian Veterinary Research Institute (IVRI), Bhopal, confirmed that it was the H5N1 virus that was behind these deaths. (see EpiSouth Bulletin eweb_195_15_12__11.pdf).

 

You can find additional AFD coverage of this event in Media Report: H5N1 Killing Crows In Jharkhand  and several from Crofsblog, including India: ‘New bird flu strain killed Jharkhand crows’.

 

Today the Times of India is reporting (h/t Emily on FluTrackers) that after ignoring dying crows in the capital city of Kolkata for weeks, West Bengal authorities are finally launching an investigation.

 

Govt gets cracking on crow deaths

TNN | Jan 29, 2012, 07.36AM IST

 

KOLKATA: After ignoring the mysterious crow deaths in the city for nearly two months, the state government flew into action mode on Saturday and sent scientists to Rabindra Sarovar to gather carcasses and blood samples.

TOI on Friday first reported on crows dropping dead all over the city.

(Continue . . . )

 

 

Somewhat remarkably, two weeks after the discovery of H5N1 in Jharkhand crows, India declared itself to be bird flu free, leading to some highly critical media coverage (see Dying crows deny India is bird flu free).

 

There are other possible causes of the crow deaths in Kolkata; insecticides, accidental poisoning, and Newcastle disease to name a few.

 

But with the recent positive test results in neighboring Jharkhand positive for H5N1, concerns are running high that the virus may be behind these deaths as well.

»» Read More

Media Report: H5N1 Killing Crows In Jharkhand

 

Photo Credit – Wikipedia

 

# 6011

 

More than two weeks after the first reports started coming in that hundreds of dead crows have been found in the eastern Indian state of Jharkhand, we now have a report that lab tests have finally confirmed the presence of the H5N1 virus.

 

Initial reports raised concerns over the possibility of avian flu, as in this November 29th report from the Deccan Herald.

 

Dead crows in Jharkhand raise fears of avian virus

Ranchi, Nov 29, (IANS):

Crows are dropping dead in cities and towns across Jharkhand since the last fortnight due to a mysterious disease. The state authorities have warned people not to touch the dead birds as they could be carrying a contagious avian virus.

(continue . . . )

 

The following day, the Times of India carried this report.

 

Bird flu-like virus killing Jharkhand crows

Jaideep Deogharia, TNN Dec 1, 2011, 12.48AM IST

RANCHI: The Centre has sent an alert to the Jharkhand government to remain cautious about a possible poultry infection, after a mysterious bird flu-like virus is believed to have killed between 500 and 1,000 crows in Jamshedpur, Bokaro and parts of Hazaribagh. Though an official intimation from the Union animal husbandry department is still to reach the state, a study on the crow deaths conducted at the animal disease laboratory in Bhopal found a virus resembling that of bird flu. However, the study allays fears about cattle, poultry and humans being infected because the virus was detected only in the brain of the dead crows.

(Continue . . . )

 

 

This is a story that flublogia, including FluTrackers, has been following for several weeks. You’ll find more than 30 posts on FT regarding this story in this thread.

 

Over the past 10 days we’ve seen conflicting reports, with some attributing these bird deaths to bird flu, and others saying the cause was still undetermined.

 

Today it is being widely reported in the media (see here, and here) that laboratory testing in Bhopal has apparently detected the H5N1 virus in some of these dead birds.

 

 

Bird Flu killing crows in Jharkhand

Dec 15, 2011 |

In a worrying development, hundreds of crows have died in Jharkhand due to bird flu, a government official said Thursday.

 

The crows first started dying mysteriously last month in Jamshedpur district. This was followed by their deaths in Ranchi, Bokaro, Khuti, Sahebganj and other districts of the state.

(Continue. . . .)

 

 

I’ve looked for, but have not yet found, any official announcement from the Indian Government or on the Jharkhand government website.

»» Read More

Referral: McKenna On NDM-1 In India

 

 

# 5903

 

 

Maryn McKenna, author of Superbug: The Fatal Menace of MRSA, has details on the political and scientific wrangling surrounding the recent international conference on antibiotic resistance held last week in New Delhi (see my posts here, and here).

 

Follow the link below to go to Maryn’s Superbug Blog.

 

NDM-1 in India: Drug Resistance, Political Resistance

• By Maryn McKenna
• October 16, 2011  | 
• 10:14 am  | 
•  

»» Read More

India: The NDM-1 Story Continues

 

 

# 5880

 

 

In a follow up to Monday’s blog on the failure of the Indian government to restrict the over-the-counter sale of antibiotics, we’ve several news stories this morning that emphasize just how quickly NDM-1 and other forms of antibiotic resistance are spreading on the Indian subcontinent.

 

Many of these stories, no doubt, are inspired by this week’s global summit on antibiotic resistance being held in New Delhi. 

 

NDM-1, or New Delhi metallo-ß-lactamase-1, is an enzyme that confers antibiotic resistance to several common types of bacteria. This emerging form of antimicrobial resistance made huge headlines in a Lancet study in August of last year:

 

Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study

 

Of particular concern, this enzyme is carried by a plasmid – a snippet of portable DNA  - that can be transferred to other types of bacteria (see Study: Adaptation Of Plasmids To New Bacterial Species).

 

Since then, sporadic NDM-1 cases have been identified in countries around the world, with the vast majority of them having some link to a previous medical procedure or treatment in India or Pakistan.

 

The Indian government’s response was first to deny that a problem with NDM-1 existed and to take serious umbrage over the naming of the pathogen. 

 

Under pressure to act, promises to restrict the sale of antibiotics were made in October of last year, but have yet to be implemented.

 

Again in April of this year, The Lancet published another study by Timothy Walsh, Janis Weeks , David M Livermore, and Mark A Toleman that looked for – and found – bacteria carrying the NDM-1 enzyme in New Delhi's drinking water supply.

 

Lancet Study: NDM-1 In New Delhi Water Supply

 

A snippet from the press release stated ominously (emphasis mine):

 

Resistant bacteria were found in 4 per cent of the water supplies and 30 per cent of the seepage sites. The researchers identified 11 new species of bacteria carrying the NDM-1 gene, including strains which cause cholera and dysentery.

 

In an interview for Reuters, co-author Mark Toleman of Britain’s Cardiff University School of Medicine stated that as many as 500,000 residents of New Delhi may be carrying the NDM-1 resistance gene in their gut flora.

 

The response from the Indian government, again, was one of denial (see Hopefully, It’s Just A Stage They Are Going Through).

 

Indian officials claimed that the researchers `illegally transferred’ samples of tap water out of the country, stated that the research was `unscientific’ and insist that the researchers were intentionally biased.

 

 

Which brings us to several stories this morning that go a long ways towards confirming many of the findings of these two much-maligned-in-India Lancet studies.

 

First stop, the The Economic Times.

 

Ganga Ram study finds high levels of superbug NDM1

5 Oct, 2011, 1114 hrs IST, Durgesh Nandan Jha, TNN

NEW DELHI: India might have vehemently opposed an antibiotic-resistant superbug being named New Delhi Metallo-beta-lactamase 1 (NDM1), but a study in a leading city hospital has found a worryingly high prevalence of the deadly gene.

(Continue . . . )

 

The study, conducted over a 5-month period, examined 10,889 samples from patients. The NDM1 resistance gene was found in 8.1% of E. coli samples and 38.02% of samples of K. pneumoniae.

 

In the article, Dr S P Byotra, chairperson of medicine at the Ganga Ram Hospital, is quoted as saying:

 

"The idea behind this study is to stop denying the crisis NDM1 poses and work out strategies to check its spread. Antibiotic usage needs to be monitored strictly and good infection-control methods should be put in place at hospitals."

 

Next, a related article in the International Business Times, that quotes Former Indian Council of Medical Research chief and chairman N.K. Ganguly saying that the multi-drug resistant New Delhi metallo-beta-lactamase-1 or NDM-1 comes from hospital waste that goes into Delhi's sewage water.

 

Presence of Antibiotic-Resistant Bacteria in Delhi Confirmed

October 5, 2011 1:26 PM EST

 

Another story, this time from IBN-Live, states that 60,000 newborns die each year in India due to various types of antibiotic resistant sepsis (including NDM-1).

 

Health | Updated Oct 05, 2011 at 11:48am IST

NDM-1 superbug hits neonatal ICUs, kills infants

 

 

And lastly, filed under the category of no-good-deed-goes-unpunished, two of the authors of the original Lancet study – Dr Timothy R. Walsh and Dr Mark Toleman – report a decidedly cool reception at this week’s global summit in New Delhi.

 

Savita Verma  New Delhi, October 5, 2011 | 

UK 'superbug' scientist-duo alleges boycott by Indian counterparts

 

Despite hosting a global summit this week, India still appears to be treating NDM-1 and antibiotic resistance as a public relations problem instead of a public health threat.

 

To be fair, India isn’t the only country with NDM-1 cases or growing carbapenem resistance. But the Indian sub-continent does appear to be a focal point – a situation often blamed on their longstanding lax controls on the use of antibiotics.

 

 

Short of seeing an extremely high mortality influenza pandemic, I can think of no looming medical crisis more dire than the growing threat of antimicrobial resistance.

 

The World Health Organization (WHO) and the CDC - along with other public health organizations around the world – used this year’s World Health Day – 7 April 2011 to promote sane antibiotic usage and awareness of antimicrobial resistance.

 

 

Given the these reports (and many others), increased surveillance, openness, and international cooperation – not indignation, intimidation, and denial – are the responses needed if we are to have any hope of stemming the rise of antibiotic resistance around the globe.

 

And we need these things now, as time is not exactly on our side.

»» Read More

India Puts Antibiotic Regulations On Hold

 

Inoculated MacConkey agar culture plate cultivated colonial growth of Gram-negative, small rod-shaped and facultatively anaerobic Klebsiella pneumoniae bacteria. – CDC PHIL.

 

# 5877

 

 

In August of 2010 a research article was published in The Lancet on the emergence on the Indian sub-continent (and its recent importation into the UK, US, and other countries) of a particularly worrisome enzyme that confers antibiotic resistance to common bacteria (see NDM-1: A New Acronym To Memorize).

 

This enzyme was dubbed NMD-1 or New Delhi metallo-ß-lactamase-1, using a long-standing convention for naming pathogens that often incorporates its place of discovery or emergence.

 

The reaction from officials out of India was both swift and disappointing. 

 

Rather than taking steps against a growing public health threat, they condemned of the use of `New Delhi’ in the naming of this enzyme, dismissed the findings, and called the paper a `conspiracy theory’.

 

The first `action’ that many scientists hoped the Indian government would take would be to end the unrestricted sale of antibiotics at local pharmacies. 

 

Over the following two months a chorus of international calls for action, along with highly critical Indian press coverage, finally resulted in a grudging agreement to regulate the sale of dozens of common antibiotics.

 

In NDM-1 Updates From India, I carried the following news report from the Indian news service DNA (Daily News & Analysis).

 

Superbug fallout: Antibiotics ‘on counter sale’ ceased

Published: Saturday, Oct 30, 2010, 9:00 IST

By Akanksha Bafna | Place: Mumbai | Agency: DNA

The drug controller general of India (DCGI) on Friday introduced new rules to buy antibiotics. According to the revised rules, a patient will need two copies of a prescription - one which will be in the chemist's custody.

(Continue . . .)

 

 

While this headline made these rules look like a fait accompli, in fact, they were not immediately enforced.

 

Over the next 10 months we saw a long list of reports out of India on the detection of NDM-1 and other resistant bacteria, yet as of mid-August of 2011 (see NDM-1: One Year Later) these new restrictions on the sale of antibiotics were still to be enforced.

 

Today, we’ve news that India’s Health Ministry continues to consider the impact of such regulations, and has not decided whether, and how, they will enforce them.

 

First stop, a press release from the Government of India’s Press Information Bureau on a forum being held in New Delhi on bacterial resistance.

 

 

Antimicrobial Resistance A Global Problem – Our Solutions Need to be Sensitive to Local Constraints: Azad

The Union Minister for Health & Family Welfare, Shri Ghulam Nabi Azad inaugurated today the “1st Global Forum on Bacterial Infections: Balancing Treatment, Access and Antibiotic Resistance” organized in New Delhi.

 

Speaking on the occasion, Shri Azad said “Antimicrobial Resistance poses a growing threat to the treatment and control of infectious diseases. It is now time to look into this problem more holistically. Resistance to micro-organisms leads to loss of lives, productivity and earnings, and also threatens to undermine the effectiveness of health delivery programmes in all Member States”. He said there is an urgent need to formulate and implement effective strategies to prevent and contain antimicrobial resistance and preserve the efficacy of antimicrobial drugs.

 

The Minister noted that “For a large country like India where a significant fraction lacks access to basic healthcare and antibiotics, we have an urgent need to protect the effectiveness of our most affordable drugs”. He informed that India has created an antibiotics policy that will restrict access to new generation antibiotics over the counter, restrict use for sub-therapeutic purposes in the animal feed sector and will focus on various measures to reduce the need for antibiotics.

 

Shri Azad asked the forum to debate the feasibility of a separate schedule H1 under the Drugs and Cosmetics Rules to rationalize and regulate antibiotics in the market, keeping in view the ground realities of particularly the rural India. The Minister acknowledged that the Ministry of Health and Family Welfare has received representations from various stakeholders and a balanced view in the matter would be taken. Shri Azad said “although resistance is global problem, shared by developing and developed countries, our solutions must be local and sensitive to constraints of respective health systems”.

 

Not explicitly stated in this press release is that while `India has created an antibiotics policy that will restrict access to new generation antibiotics over the counter’ . . . these regulations are not being enforced.

 

From DNA (Daily News & Analysis) we get a bit more clarification, with this report:

 

Govt holds antibiotic policy, not to restrict access to drugs

Published: Monday, Oct 3, 2011, 

 

 

The DNA report states that the government has put enforcement of their new antibiotics policy on hold until a way can be found to provide access to antibiotics for rural populations who may not have access to doctors.

 

And this is, no doubt, a legitimate concern. Access to doctors, and the ability to pay to see one, often elude the rural poor in India.

 

One proposal being considered involves training chemists and non-physician healthcare providers in rural areas so that they can prescribe antibiotics.

 

But lobbying and protests by pharmaceutical companies, drugstore retailers, online pharmacies, and agricultural interests also appear to be part of the delay.

 

For now, massive amounts of antibiotics continue to be sold freely over the counter across India, and we’ve no word of when these issues are expected to be resolved.

 

 

 

While the end of the antibiotic era is not yet at hand, many experts fear we may be drawing closer to that day.

 

In April of this year, Margaret Chan – Director General of the World Health Organization – in a speech for World Health Day 2011, issued this stark warning:

 

In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated.

 

The implications go beyond a resurgence of deadly infections to threaten many other life-saving and life-prolonging interventions, like cancer treatments, sophisticated surgical operations, and organ transplantations. With hospitals now the hotbeds for highly-resistant pathogens, such procedures become hazardous.

 

While there are legitimate concerns over the impact that enforcing India’s new antibiotic rules might have, we are literally in a race against a rising tide of rising antibiotic resistance, and delays in curbing inappropriate antibiotic use endangers all of us. 

 

For a far more complete (and eye-opening) discussion of antimicrobial resistance issues, I can think of no better primer than Maryn McKenna’s book SUPERBUG: The Fatal Menace of MRSA.

 

And Maryn’s SUPERBUG Blog, now part of Wired Science Blogs, continues to provide the best day-to-day coverage of these issues.

»» Read More

Bird Flu In West Bengal

 

 

# 5854

 

After battling the H5N1 virus in Tripura during the Spring, India declared itself free of bird flu this past July. But, as we’ve seen before in India, Vietnam, Cambodia, and many other countries .  .  .  such declarations are often short lived.

 

In early August India notified the OIE of a fresh outbreak of H5N1 among poultry in Assam (see Immediate notification ) and yesterday provided a follow up report indicating another outbreak in West Bengal (see Follow-up report No. 1).

 

This morning, the Indian newspapers are full of stories about this latest outbreak, which reportedly began in Nadia, West Bengal on September 14th. 

 

Culling of all poultry within 3km of the reported outbreak been ordered as well as increased surveillance and restrictions on the sale and transport of poultry within 10 Km. 

 

Typical of the reporting this morning is this story from the Economic Times:

 

20 Sep, 2011, 02.50PM IST, PTI

Bird flu, Avian influenza, detected in poultry samples in Nadia, West Bengal

 

India has been battling sporadic outbreaks of the H5N1 virus in poultry since 2008, although no human cases have been documented. 

 

Concerns run high since India is one of six countries where the virus is believed well entrenched (along with Bangladesh, China, Egypt, Indonesia and Vietnam).

 

Today The Hindu carries a long, cautionary editorial on the threat of bird flu.

 

This threat is not just for the birds

N. Gopal Raj

 

Earlier this month the FAO made headlines when it warned of a `mutated’ strain of bird flu spreading in China and Vietnam (see FAO Warns On Bird Flu). 

 

This new clade 2.3.2.1 has been around for at least a year, and is a variant of the 2.3.2 clade which has been circulating for several years.  

 

In response the World Health Organization (see WHO Statement On New Bird Flu Clade) stated that based on the available evidence `this evolution of the H5N1 virus poses no increased risk to public health.

 

But it is further evidence that the virus continues to mutate and evolve.

 

For now H5N1 is primarily a threat to poultry.

 

The virus remains poorly adapted to human physiology, and despite ample opportunities in places like Egypt and Indonesia, only causes rare, sporadic infections.

 

The concern, of course, is that over time that may change.  And so the world remains at Pre-pandemic Phase III for the H5N1 virus, and we continue to watch for signs that the virus is adapting to humans.

»» Read More