H1N1 in Post Pandemic Period

[indigo girl]

WHO | H1N1 in post-pandemic period

As per Director General, Margaret Chan:

The world is no longer in phase 6 of influenza pandemic alert. We are now moving into the post-pandemic period. The new H1N1 virus has largely run its course.

WHO recommendations for the post-pandemic period

These are the views of members of the Emergency Committee, which was convened earlier today by teleconference.

The Committee based its assessment on the global situation, as well as reports from several countries that are now experiencing influenza. I fully agree with the Committee's advice.

As we enter the post-pandemic period, this does not mean that the H1N1 virus has gone away. Based on experience with past pandemics, we expect the H1N1 virus to take on the behaviour of a seasonal influenza virus and continue to circulate for some years to come.

In the post-pandemic period, localized outbreaks of different magnitude may show significant levels of H1N1 transmission. This is the situation we are observing right now in New Zealand, and may see elsewhere.

In fact, the actions of health authorities in New Zealand, and also in India, in terms of vigilance, quick detection and treatment, and recommended vaccination, provide a model of how other countries may need to respond in the immediate post-pandemic period.

Globally, the levels and patterns of H1N1 transmission now being seen differ significantly from what was observed during the pandemic. Out-of-season outbreaks are no longer being reported in either the northern or southern hemisphere. Influenza outbreaks, including those primarily caused by the H1N1 virus, show an intensity similar to that seen during seasonal epidemics.

During the pandemic, the H1N1 virus crowded out other influenza viruses to become the dominant virus. This is no longer the case. Many countries are reporting a mix of influenza viruses, again as is typically seen during seasonal epidemics.

Recently published studies indicate that 20-40% of populations in some areas have been infected by the H1N1 virus and thus have some level of protective immunity. Many countries report good vaccination coverage, especially in high-risk groups, and this coverage further increases community-wide immunity.

Pandemics, like the viruses that cause them, are unpredictable. So is the immediate post-pandemic period. There will be many questions, and we will have clear answers for only some. Continued vigilance is extremely important, and WHO has issued advice on recommended surveillance, vaccination, and clinical management during the post-pandemic period.

Based on available evidence and experience from past pandemics, it is likely that the virus will continue to cause serious disease in younger age groups, at least in the immediate post-pandemic period. Groups identified during the pandemic as at higher risk of severe or fatal illness will probably remain at heightened risk, though hopefully the number of such cases will diminish.

In addition, a small proportion of people infected during the pandemic, including young and healthy people, developed a severe form of primary viral pneumonia that is not typically seen during seasonal epidemics and is especially difficult and demanding to treat. It is not known whether this pattern will change during the post-pandemic period, further emphasizing the need for vigilance.

As I said, pandemics are unpredictable and prone to deliver surprises. No two pandemics are ever alike. This pandemic has turned out to be much more fortunate than what we feared a little over a year ago.

This time around, we have been aided by pure good luck. The virus did not mutate during the pandemic to a more lethal form. Widespread resistance to oseltamivir did not develop. The vaccine proved to be a good match with circulating viruses and showed an excellent safety profile.

Thanks to extensive preparedness and support from the international community, even countries with very weak health systems were able to detect cases and report them promptly.

Had things gone wrong in any of these areas, we would be in a very different situation today.

[indigo girl]

Hazardous WHO Pandemic Hopes and Dreams

Not all agree with WHO's assessment. Dr. Niman comments about his concern that the worst may be yet to come.

The pandemic H1N1 is a swine virus that has jumped to humans, which has not happened in a sustained manner since 1918. The similarities between the current strain, and 1918 pandemic H1N1 or seasonal H1N1 in circulation decades ago has led to a reduced infection rate among the elderly.

However, the H1N1 virus can aggressively target those under 65, the demographic for over 90% of the fatalities. These fatal cases are linked to the ability of the virus to target the lower respiratory tract, which has been linked to receptor binding domain changes such as D225G as well as low reactor alterations at positions 157-159. Recently released 2010 sequence has demonstrated that these genetic changes are on the rise, raising concerns for the emergence of a more virulent H1N1 in the upcoming months or years.

The acquisition of these new markers via recombination has similarities with the fixing of H274Y in seasonal H1N1 in the 2008/2009 season. H274Y confers Tamilfu resistance and began to appear in large numbers in seasonal H1N1 in selective countries in the 2007/2008 season. Although levels approached or exceeded 50% of H1N1 isolates in northern Europe, the level was only 10% in countries like the US and UK, while countries in Asia, like South Korea had no reported cases and the level was only 3% in Japan, where use of Tamiflu in seasonal flu patients was widespread. This distribution surprised and baffled WHO consultants, who maintained that small changes in influenza genes were due to random copy errors which were amplified by selection. However, Tamiflu resistance in Japan was low in H1N1 and there was no reported resistance in H3N2 worldwide. Moreover, all H1N1 resistance targeted the identical genetic change, which was present on multiple H1N1 genetic backgrounds.

In the summer of 2008, H274Y levels rose to 100% in H1N1 sequences in South Africa and Australia. Although the overall levels of H1N1 were low, the fixing of H274Y in the southern hemisphere in the summer of 2008 spread to the northern hemisphere in the 2008/2009 and levels of 100% Tamiflu resistance were reported worldwide, including South Korea where the level was a 0% the previous year.

The potential for dramatic increases in D225G and low reactor changes at positions 157-159 remain and the current pandemic H1N1 continues to fatally infect those under 65, WHO hopes and dreams and associated proclamations notwithstanding.

[indigo girl]

H5N1: H1N1: The war goes on

H1N1: The war goes on

We think of the spring and summer of 1945 as the time when World War II finally ended. In fact, fighting went on and on for years, from Indonesia to Greece.

Similarly, the pandemic is officially over but people are still dying of H1N1. Go over to Arkanoid Legent for his August 11 reports, and see what I mean.

[indigo girl]

New Zealand: Swine Flu Wave Yet to Peak

H5N1: New Zealand: Swine flu wave 'yet to peak'

A second wave of the swine flu pandemic sweeping the country is gaining momentum and is yet to peak.

Despite the World Health Organisation declaring the world to be in a post-pandemic phase, that's not the case in New Zealand.

Some schools are reporting record absences, businesses such as hairdressers and dentists are experiencing more than usual the number of appointment cancellations, and hospitals are having higher than normal admissions, though other areas have so far been relatively untouched by the virus.

Fine One Day, Dead the Next

Fine one day, dead the next: Flu kills boy - National - NZ Herald News

A familiar story, sadly, this case reminds me of many that happened last year here. This is not first case of cardiac arrest associated with this flu.

When Mark Holloway complained to his grandmother of a sore back, he was taken to the family doctor for a routine check.

...'Our boy's not right'. He had a cardiac arrest and by 6pm he was gone."

The next day he was dead.

The 12-year-old, a pupil at Henderson Intermediate, died on Wednesday last week of what doctors have told the family was a strand of the flu.