Aetiology

Background The verified human cases of highly pathogenic avian influenza in Vietnam may represent only a selection of the most severely ill patients. The study objective was to analyze the association between flulike illness, defined as cough and fever, and exposure to sick or dead poultry.

Methods A population-based study was performed from April 1 to June 30, 2004, in FilaBavi, a rural Vietnamese demographic surveillance site with confirmed outbreaks of highly pathogenic avian influenza among poultry. We included 45 478 randomly selected (cluster sampling) inhabitants. Household representatives were asked screening questions about exposure to poultry and flulike illness during the preceding months; individuals with a history of disease and/or exposure were interviewed in person.

Results A total of 8149 individuals (17.9%) reported flulike illness, 38 373 persons (84.4%) lived in households keeping poultry, and 11 755 (25.9%) resided in households reporting sick or dead poultry. A dose-response relationship between poultry exposure and flulike illness was noted: poultry in the household (odds ratio, 1.04; 95% confidence interval, 0.96-1.12), sick or dead poultry in the household but with no direct contact (odds ratio, 1.14; 95% confidence interval, 1.06-1.23), and direct contact with sick poultry (odds ratio, 1.73; 95% confidence interval, 1.58-1.89). The flulike illness attributed to direct contact with sick or dead poultry was estimated to be 650 to 750 cases.

Conclusions Our epidemiological data are consistent with transmission of mild, highly pathogenic avian influenza to humans and suggest that transmission could be more common than anticipated, though close contact seems required. Further microbiological studies are needed to validate these findings.

"I would call this the smoking gun," said Dr. Gregory Poland, a Mayo Clinic flu specialist. "All of us have been concerned and have guessed that the data we have so far has been the tip of the iceberg."

The human cases counted so far likely have been the most severely ill patients treated at major hospitals, Poland said.

"In the really rural areas, we know that this had to be occurring" too, and the study suggests that the prevalence "is pretty high," he said. "The data lines up biologically the way we would have expected it to."

Two young brothers, ages 4 and 5, who have tested positive for the dreaded H5N1 avian virus but shown no symptoms of the disease were being closely watched at Kecioren Hospital here Tuesday. Doctors are unsure whether they are for the first time seeing human bird flu in its earliest stages or if they are discovering that infection with the H5N1 virus does not always lead to illness.

In any case, the highly unusual cluster of five cases detected in Turkey's capital over the last three days -- all traceable to contact with sick birds -- is challenging some of the doctors' assumptions about bird flu and giving them new insights into how it spreads and causes disease. Since none of the five has died, it is raising the possibility that human bird flu is not as deadly as currently thought and that many mild cases in Asian countries may have gone unreported.

Diamond Pet Food has discovered aflatoxin in a product manufactured at our facility in Gaston, South Carolina. Aflatoxin is a naturally occurring toxic chemical by-product from the growth of the fungus Aspergillus flavus,, on corn and other crops.

Out of an abundance of caution, we have notified our distributors and recommended they hold the sale of all Diamond Pet Food products formulated with corn that were produced out of our Gaston facility (see complete list below). Please note that products manufactured at our facilities in Meta, Missouri and Lathrop, California are not affected. The Gaston facility date codes are unique from other Diamond facility codes in that either the eleventh or twelfth character in the date code will be a capital "G" (in reference to Gaston). The range of date codes being reviewed are "Best By 01-March-07" through Best By " 11-June-07". Diamond's quantitative analysis records substantiate that Diamond's corn shipments were definitively clear of aflatoxin after December 10. As such, "Best By 11-June-07" date codes or later are not affected by this notice.

States serviced by our Gaston facility include Alabama, Connecticut, Delaware, Florida, Georgia, Kentucky (eastern), Maine, Maryland, Massachusetts, Mississippi, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, West Virginia, Vermont, and Virginia.

We are rapidly analyzing retained samples of all products produced in Gaston so we can isolate specific lot numbers impacted and provide this information to our distributors, retailers and customers as quickly as possible.

Meanwhile, if your pet is showing any symptoms of illness, including sluggishness or lethargy combined with a reluctance to eat, yellowish tint to the eyes and/or gums, and severe or bloody diarrhea, please consult your veterinarian immediately.

Doctors and AIDS activists in South Africa have filed a joint lawsuit against the country's health minister and controversial vitamin supplier Matthias Rath as concerns mount over the government's lack of leadership amidst the country's worsening AIDS crisis.

The South African Medical Association (SAMA) and the prominent activist group Treatment Action Campaign (TAC), which together filed the lawsuit, say they aim to end the climate of what the TAC calls "politically-supported denialism" afflicting the country's fight against AIDS.

A key element of the lawsuit is the allegation that in at least two townships, Rath is running illegal medical trials for his multivitamins, which he markets to AIDS sufferers as an alternative to 'poisonous' antiretroviral drugs.

A spokesman for Rath declined to speak to Nature Medicine about the case, saying he is convinced the journal is "funded to the hilt with drug money."

They don't agree with everything I say -- in particular, I suspect my anti-religious stance might give a few of our administrators' ulcers -- but they're also committed to the principles of academic freedom.

Organisms like the sea slug Elysia chlorotica. This animal not only looks like a leaf, but it also acts like one, making energy from the sun. Its secret? When it eats algae, it extracts the chloroplasts, the tiny entities that plants and algae use to manufacture energy from sunlight, and shunts them into special cells beneath its skin. The chloroplasts continue to function; the slug thus becomes able to live on a diet composed only of sunbeams.

Still more fabulous is the bacterium Brocadia anammoxidans. It blithely makes a substance that to most organisms is a lethal poison - namely, hydrazine. That's rocket fuel.

And then there's the wasp Cotesia congregata. She injects her eggs into the bodies of caterpillars. As she does so, she also injects a virus that disables the caterpillar's immune system and prevents it from attacking the eggs. When the eggs hatch, the larvae eat the caterpillar alive.

It's hard not to have an insatiable interest in organisms like these, to be enthralled by the strangeness, the complexity, the breathtaking variety of nature.

It's that small facts add up to big pictures. For although Mother Nature's infinite variety seems incomprehensible at first, it is not. The forces of nature are not random; often, they are strongly predictable.

For example, if you were to discover a new species and you told me that the male is much bigger than the female, I would tell you what the mating system is likely to be: males fight each other for access to females. Or if you discover that the male's testicles make up a large part of his weight, I can tell you that the females in his species consort with several males at a time.

Suppose you find that a particular bacterium lives exclusively in the gullets of leeches and helps them digest blood. Then I can tell you how that bacterium's genome is likely to differ from those of its free-living cousins; among other changes, the genome will be smaller, and it will have lost sets of genes that are helpful for living free but useless for living inside another being.

When I was in school, I learned none of this. Biology was a subject that seemed as exciting as a clump of cotton wool. It was a dreary exercise in the memorization and regurgitation of apparently unconnected facts. Only later did I learn about evolution and how it transforms biology from that mass of cotton wool into a magnificent tapestry, a tapestry we can contemplate and begin to understand.

Some people want to think of humans as the product of a special creation, separate from other living things. I am not among them; I am glad it is not so. I am proud to be part of the riot of nature, to know that the same forces that produced me also produced bees, giant ferns and microbes that live at the bottom of the sea.

For me, the knowledge that we evolved is a source of solace and hope. I find it a relief that plagues and cancers and wasp larvae that eat caterpillars alive are the result of the impartial - and comprehensible - forces of evolution rather than the caprices of a deity.

More than that, I find that in viewing ourselves as one species out of hundreds of millions, we become more remarkable, not less so. No other animal that I have heard of can live so peaceably in such close quarters with so many individuals that are unrelated. No other animal routinely bothers to help the sick and the dying, or tries to save those hurt in an earthquake or flood.

And for me, there is something deeply spiritual about that idea, of connectedness to all of the planet on some level. I don't find that evolution challenges my spirit; rather, learning more about how nature interconnects allows me to find more footing with my own life and walk with God.