Avian influenza has spread and, while it has not reached pandemic proportions, constant vigilance is still crucial.

Avian flu is in the news so much nowadays that some of us may have become desensitised to the urgency of the matter.

When news about avian flu first broke in 1997, there was much concern when it revealed that the virus, having transmitted from chickens to humans, had infected 18 people and killed six. Then, things quieted down for a few years, until 2003 when avian flu made an appearance again and never went away.
A health worker injecting a chicken with the bird flu vaccine in a poultry farm in China. The H5N1 (virus) may never become pandemic but, if it does, the catastrophic situation could be more than we can even imagine.

According to Prof Malik Peiris, the avian flu problem has been progressively increasing. Peiris is the virologist who discovered the aetiological agent that causes Severe Acute Respiratory Syndrome (SARS), and has been involved with avian flu research. He is based in Hong Kong, but was in Kuala Lumpur recently to receive the Mahathir Science Award 2007, Malaysia’s most prestigious science award named in honour of former prime minister Tun Dr Mahathir Mohamad.

During the SARS outbreak, Peiris led a team of researchers from the University of Hong Kong and Queen Mary’s Hospital who managed to identify the SARS coronavirus within weeks. That breakthrough, along with other measures, led to the successful control and containment of the outbreak.

After the avian flu outbreak in 1997, Peiris subsequently became more interested in avian and animal influenza viruses and their danger to humans.

“If you look at the geographical area that is affected, it is now bigger than it was two or three years ago,” said Peiris. “So if you look at that scale, at the poultry level, it is increasing. It is certainly not going to disappear. This is going to be entrenched, and we are not going to be able to get rid of it in the short term.”

Fortunately for us, the efficiency of the virus infecting humans is still very low. Most of the time, people who are exposed to the virus are not infected. But Peiris identifies two levels to the problem. First, the huge poultry industry would mean that people’s livelihood, the country’s economy and human health would be affected. Second, the occasional transmission of the virus from poultry to humans, where the real danger is, if the transmissions are not monitored and controlled, and the virus is allowed to adapt and transfer between humans.

“There are people who say, well, this virus has been here for 10 years, and it has not really done this, so it won’t happen,” said Peiris. “I think that is extremely dangerous. That was exactly the same situation with SARS. That virus was also probably in the animal reservoir for quite a long time.”
Prof Malik Peiris: ‘We really have to take it (bird flu) seriously, and take measures to see what can be done.’

But Peiris pointed out that this doesn’t mean we should start panicking, nor should we be complacent about it.

“On a risk-assessment basis, the H5N1 (virus) may never become pandemic,” said Peiris. “But the point is, if it does, the catastrophic situation could be more than we can even imagine. It definitely could be much worse than any of the past pandemics. We really have to take it seriously, and take measures to see what can be done.”

Mutation

While there are claims that the virus is two mutations away from human-to-human transmission, and that it has learnt to infect humans more easily, Peiris dismissed these as “simplistic”.

“It obviously requires a lot of adaptations, not just one or two,” Peiris explained. “A number of studies have shown that mixing the genes alone doesn’t do it. It requires a multi-step process. That’s probably why it hasn’t happened so far. But I think these rare events do happen, and we’d be very stupid not to take precautions.”

Peiris warned that the problem is currently “grossly underestimated”. In countries where the virus is endemic, he said, much more poultry carry the virus than people imagine. Poultry enter the markets and are slaughtered, so it doesn’t seem as though they are dying from the virus. But the virus continues to circulate as farmers bring their cages to the markets, leave the poultry there, and return to their farms with the cages, unaware that those cages may have come into contact with the virus.

“Once the virus gets in a market, it remains there almost forever,” said Peiris.

He said countries such as Malaysia, Japan, North Korea and India have been successful in detecting the virus early and eradicating it, demonstrating the need to be alert at all times.

Even during the lull between 1997 and 2003, virologists and researchers continued their surveillance and published papers on their findings, all the while aware that the virus was still lurking somewhere and was adapting.

Defence

While the capacity for producing vaccines has increased, Peiris said the real challenge is in creating a vaccine that would protect against more than one strain of the H5 virus which is now diverse. The fact that we do not know which strain will become pandemic means there needs to be broad protection. Peiris said the newer vaccines that have come to clinical trials look promising, but there is also the problem of trying to produce enough in an emergency.

This raises some tricky issues. We could wait for a pandemic before producing the vaccine, but chances are there would not be enough time because it takes months to scale up production. The second option, said Peiris, is to stockpile the vaccine in advance, but money could be wasted if a pandemic never happens.

This would mean that an ideal situation where one could walk into a store and purchase the vaccine in an emergency would never be viable.

“You can’t have a vaccine that is not regularly used sitting in the stores,” said Peiris. “For the next five years, it might not be used, and it will be out of date. I think the real possibility is to stockpile it in bulk at governmental level. So if the emergency comes, it can be quickly distributed.”

Asked if there is a beacon of light in this seemingly hopeless situation, Peiris pointed to how SARS was successfully controlled, and that it was a great achievement of global collaboration.

“I think the control of SARS was probably one of the greatest triumphs for global public health,” he said. “So things can be done, for sure. But we can’t sit back and assume that things will happen. It is actually planning, intervention, collaboration and all these things that made it happen.”

Is lack of sleep bad for the brain?

I need sleep

Is lack of sleep bad for the brain? Both nightshift work and chronic sleep deprivation increasingly are implicated in mental and cognitive problems.

AIzheimer's risk: Abnormal insulin levels (common in shift workers and sleep-deprived people) might increase the risk for certain neurodegenerative disorders, such as Alzheimer's disease, scientists at the University of Washington have found.
Normally, insulin acts on the brain to promote learning and memory. Insulin resistance, however, might cause inflammation in
the brain, a key process in the development of Alzheimer's.

learning: Proper alignment between sleep times and internal circadian time is crucial for optimal cognitive performance.

And numerous recent studies show learning is enhanced if it's followed followed by restorative sleep.

In other words, students who pull all-nighters studying for an exam are doing themselves more harm than good.

Mood: Even moderate changes in sleep times can have a big effect on mood. Diane Boivin of the Centre for Study and Treatment of Circadian Rhythms at Douglas Mental Health University Institute in Montreal published research last year in the journal Sleep showing that serotonin levels - a key sub-stance for mood stability - are lower in shift workers than day workers.

Other studies have found that exposure to bright light in the morning can lift the moods of people with depression, and that prescribed periods of sleep deprivation can interrupt a bout of depression.

Bipolar disorder: Flawed circadian rhythms might be to blame for bipolar disorder. In a study published last year in the Proceedings of the National Academy of Sciences, scientists from the University of Texas Southwestern Medical Center identified a gene that, if disrnpted, causes mice to behave as if they have bipolar disorder. Correcting the geue mutation could lead to a therapy for the illness, the scientists said.

Does circumcision help protect a man from developing a sexually transmitted disease ?

Circumcision against STDs?

DOES circumcision help protect a man from developing a sexually transmitted disease (STD)?

A study analysed data on 499 men; 201 had been circumcised before age three. By age 32, 117 of the men reported that they'd had a sexually transmitted infection, most often genital warts, chlamydia or genital herpes. The infection rate was virtually the same - about 23%; - whether men had or had not been circumcised as a child.

Who may be affected? Men. In the United States, about 65% of all boy babies are circumcised, meaning the skin that covers the tip of the penis is surgically removed. The decision often is based on cultural or religious views or personal preference rather than medical necessity.

Caveats: Data on STDs came from questionnaires completed by the men. The authors wrote that other research has provided "compelling evidence" that circumcision lowers the risk of men's contracting H1V infectionm through sex with women.

You can find this study in the March issue of theJournal of Pediatrics. Learn more about circumcision at www.familydoctor.org and www.kidshealth.org (click "For Parents").

BABIES born before they've been in the womb 37 weeks face a higher risk of complications very early in life

Being premature

BABIES born before they've been in the womb 37 weeks face a higher risk of complications very early in life. as they grow up, though, do people born prematurely continue to exhibit differences from those carried full-term?

A study analysed data on more than a million people born in Norway during a 20-year period; about 5% were premature births.

The more premature the infants had been, the more likely they were to have died before turning one year old. Survival rates improved through late childhood but remained lower, by comparison, for those born prematurely.

As teens and young adults, those who'd been premature were more likely to have attained less than a high school education and less likely to have gone to college than those who'd been full-term babies.

Adults wbo'd been premature infants also were less likely to have had children of their own. And women who'd been premature were more likely, once pregnant, to have given birth prematurely than were women born at full term; prematurity did not affect men's chances of fathering a premature infant.

Who may be affected? People born prematurely. In the United States, more than 12% of babies are premature, a rate that has been steadily increasing over the past two decades.

Caveats: The cause of the premature births was not indicated. The findings might be different for babies born today, given medical and technological advances in the 40 years since the study began.

You can find this study in the March 26 issue of the Journal of the American Medical Association. Learn more about premature births at www.nichd.nih.gov/womenshealth (search for "preterm") and www.marchofdimes.com.