Swine Flu Updates and Issues - page 3
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May 21, '09When I've read about the world's preparations for a global H5N1 pandemic in the past, I always wondered this: how in the world do you get everything, and everyone, on the whole planet, working and communicating smoothly and effectively? And take out all the things that divide us and obfuscate our true priorities, like politics and business? You just don't. That, in itself, creates the disaster.
May 21, '09When is a pandemic not a pandemic?
Africa has poor surveillance systems and many health challenges. We already know that swine flu hits those with co-existing conditions the hardest. What will happen if there is large scale transmission in the countries with large numbers of HIV and TB cases? There are already some reports coming out of Africa, but not much news yet.
Quote from www.nature.comAmen to that.
...Margaret Chan, director-general of the WHO, came under pressure from member states-including the United Kingdom and Japan-to move the goalposts to delay or prevent a move to phase 6, by redefining it to include an assessment of the severity of the disease, and not only its geographical spread.
Adding that requirement of severity may sound like common sense. But it is not, because the severity of a pandemic is unpredictable. The flu might fizzle out; or it could go away for months only to come back with a vengeance, creating as much devastation as the 1918 flu outbreak, which caused an estimated 50 to 100 million deaths worldwide.
Moreover, the WHO has pointed out that adding that criterion at a global level would be largely meaningless-what might be deemed a mild disease in a rich country with many doctors, drugs and intensive-care units might be more severe and cause considerable mortality in a poor country with little health infrastructure, and where underlying diseases may worsen outcomes of a flu infection.
So what's the big hang-up with calling a pandemic a pandemic? Those fretting over the term include news pundits in denial about the scale of the threat, along with politicians and scientists who fear that using the word may induce public panic.
The importance of the phase 6 designation is overrated. It is not some alert threshold that, when passed, triggers an automatic and unstoppable series of draconian measures. As Chan says, "Level 6 does not mean that we are facing the end of the world."
The WHO revised its pandemic preparation guidelines in April to make it clear that the organization's role is limited to the following: defining the extent of the virus's spread; coordinating the international public-health response; selecting the pandemic vaccine strains and recommending when large-scale vaccine production should start; and coordinating the gathering of scientific data on the outbreak.
Individual nations then take responsibility for deciding an appropriate course of action.
Indeed, the WHO's expectations of national response are the same for phases 5 and 6. Both call for "each country to implement actions as called for in their national plans", and to be ready for an "imminent response".
...the move to phase 5 had already activated several preparedness measures, and had helped to put public-health services, labs and industry on alert. She reiterated the definition of a pandemic: "A defining characteristic of a pandemic is the almost-universal vulnerability of the world's population to infection. Not all people become infected, but nearly all people are at risk."
Heavy surveillance teamed with rapid isolation and treatment of individual cases only makes sense at the very earliest stage of an outbreak in a region, when there is a possibility of slowing the initial spread. It becomes irrelevant once the virus is spreading widely within the community, as it is in the United States.
As Chan implied in her address, there are more pressing issues at hand than quibbling over phase definitions, such as helping poorer countries to prepare for the pandemic.
"This virus may have given us a grace period, but we do not know how long this will last," says Chan. "I strongly urge the international community to use this grace period wisely. I strongly urge you to look closely at anything and everything we can do, collectively, to protect developing countries from, once again, bearing the brunt of a global contagion."
May 21, '09Suspected cases of Swine Flu in Africa
Quote from www.hararetribune.com
"The WHO in Africa has so far 12 suspected cases in the region. Five of them are waiting now for results and are currently under investigation," Luis Sambo said at a meeting of the continent's health ministers in Addis Ababa.
"We've been discussing with pharmaceutical companies to make Tamiflu, the only effective medicine we have, available. For Africa, we have already dispatched thousands of doses to the countries," Sambo said.
"If the epidemic hits Africa, the impact would be more serious than in other parts of the world as the surveillance systems are weaker, and the resources insufficient," the WHO chief said.
"That is why we are now making the assessment of the needs to be sure we can respond to any outbreak," he added.
Sambo nevertheless pointed out that the continent was grappling with graver epidemics -- such as AIDS, malaria and tuberculosis -- and noted that swine flu's mortality rate was low.
The African Union Commissioner for Social Affairs Bience Gawanas said it was critical for the continent to initiate concerted action in the face of an H1N1 pandemic threat.
"Africa needs to take immediate and concrete actions to meet the emerging threat of H1N1 and related epidemics, the cost which will be too huge for individual member states to bear," he said.
May 21, '09http://www.nytimes.com/2009/05/21/ny...rssnyt&emc=rss
What a surprise! Kids being kids are not going to stay home unsupervised so now they will bringing swine flu to the mall.
Quote from www.nytimes.com
Marlene Telalyan, 14, spent an afternoon swanning around the Queens Center Mall with a pack of her girlfriends.
"My mom told me not to go out," she proclaimed, giggling. "Too bad she's at work and can't see me."
With swine flu still shuttering and more than 15,000 students granted an unexpected week off, they are scattering across Queens this week like new visitors to a planet called Weekday, somewhere between a snow day and a full summer vacation. Students have popped up among adults in stores, parks and libraries, places they are often forbidden to visit unsupervised.
May 21, '09Quote from indigo girlThe kids out from school in Japan are taking the same approach: shopping, going out to parties, clubbing. If any are carrying the virus (and I suppose many are), closing the didn't really actually serve its purpose. But what are you going to do, keep the schools open?http://www.nytimes.com/2009/05/21/ny...rssnyt&emc=rss
What a surprise! Kids being kids are not going to stay home unsupervised so now they will bringing swine flu to the mall.
Besides... they're teenagers! Teenagers rarely follow instructions or have good rationale even on the best of days. Telling them not to do something is almost the same as daring them not to do it, and with a pack of 10 of their buddies!
May 22, '09W.H.O. Plans to Rewrite Its Rules for Declaring a Pandemic
There are some interesting things of note in this article. First, that the WHO has bowed to pressure to redefine what a pandemic is or is not. But, btw, this is not the first time that they have done so.
The other, at least to me, startling point is that 300 people in the US have been hospitalized. I had no idea that 300 people were sick enough to be in the hospital This is reportedly a mild flu. And, we are only a month into this "epidemic" or whatever we are now calling it.
Quote from www.nytimes.comRight, but what they don't say are that these underlying conditions are not necessarily so terrible that they would interfere with anyone most of the time. You know conditions such as mild asthma, or gout, or even sleep apnea not requiring CPAP. And, let us not forget obesity is also being noted as a co-exising condition.
Bowing to pressure, the World Health Organization announced Friday that it would rewrite its rules for alerting the world to new diseases, meaning the swine flu circling the globe will probably never be declared a full-fledged pandemic.
Dr. Keiji Fukuda, the deputy director general making the W.H.O. announcement, said that he could not predict exactly what the new rules would be but that criteria would include a “substantial risk of harm to people,” not just the geographic spread of a relatively benign virus.
The six-point system was created in 2005 when the threat was H5N1 avian flu, which has a fatality rate of about 60 percent. But the system does not take into account a virus’s lethality, and in the current outbreak, some countries have complained that the warning system created panic and pressure for border closings, even though the strain was less deadly.
Asked if the W.H.O. could damage its credibility by changing the rules in mid-outbreak, Dr. Fukuda said: “There’s nothing like reality for telling you whether something is working or not. Rigidly adhering to something that is not working would not be very helpful.”
Separately, federal health officials said a study of flu genes released Friday showed that the virus could have been circulating undetected in pigs for years, and called for better surveillance.
The study, published online by Science magazine, was a collaboration between virologists from the Centers for Disease Control and Prevention and the W.H.O., along with others from Mexico, Britain, the Netherlands and the health departments of several American states and New York City.
The closest match, surprisingly, was found in Thailand in 2005 — a pig with both North American and Eurasian flu genes.
Now that the mixed genes have been found in Asia, it is possible that they came from a North American pig that was taken there. There is little flu surveillance of pigs in much of the world, and even in the United States it is “not very systematic,” Dr. Cox said.
Henry L. Niman, who runs a Web site tracking flu mutations, complained that many swine sequences are posted by American universities and in Mexico only on private databases. “Those sequences would be very useful for figuring out how the H1N1 emerged,” he said.
The flu could also be in an intermediate host, said Dr. Cox, as the 2002 SARS virus passed from bats to humans through palm civets. But she said scientists “don’t have a hypothesis for alternative hosts.” Not enough is known about how many species carry flu, Dr. Cox said. For example, virologists were surprised to learn in 2004 that bird flu could kill zoo tigers and house cats.
Dr. Fukuda also said the new virus has been confirmed in 42 countries and had killed 86 people. About half of those hospitalized are young and healthy with no underlying conditions, he said. In the United States, such conditions are more common among the 300 now hospitalized.
It is not a surprise that pregnancy always puts women at risk as this is true even with seasonal influenza.
Health Department: 56 hospitalized with swine flu in city
Quote from www.nydailynews.com
A health department spokeswoman says 56 people are hospitalized with confirmed cases of swine flu around New York City.
Spokeswoman Jessica Scaperotti had no information Thursday on the patients’ conditions or ages, or how the number of hospitalizations compares with recent days or weeks.Last edit by indigo girl on May 23, '09
May 22, '09US directs $1 billion for new swine flu vaccine
Quote from www.reuters.com
The U.S. government said on Friday that it was setting aside $1 billion to help companies develop a vaccine against the new strain of H1N1 influenza that is sweeping the world.
Health and Human Services Secretary Kathleen Sebelius said the money would be used for clinical studies over the summer and for commercial-scale production of two potential vaccine ingredients for the pre-pandemic influenza stockpile.Last edit by indigo girl on May 22, '09
May 23, '09One man came in (21) with a fever and was vomiting blood, with multiple organ failure. That happened in 1918. See the info at Stanford.edu I think. Also look up on Wikipedia. This is getting scary. We aren't being told the final symptoms....pneumonia vs vomiting blood is a big difference.
May 23, '09Also the pregnant woman who died, her husband said she had no real underlying medical problems....so who is trying to calm us by upping the chronic health conditions of the victims. I want the truth, if it is hitting, and killing healthy people, I want to know....we have a right to know...not personal details, but I would like to be well informed, not 'calmed'
May 23, '09I will have to find the actual email, but the cdc just changed the criteria for testing, didn't it? Well, our hospital still says...anyone in contact with someone from Mexico, or travelled there. Are they idiots? Or they say, if anyone has a sore throat AND cough with fever, in absence of other possible causes, well, then you can test them. I think our actual numbers in the country and state are way below what they actually are....
May 23, '09Genome analysis sheds light on swine flu origins - and high-speed science
Quote from blogs.nature.comThe posting of analyses of the flu genome is the very best thing to come out of the appearance of the novel swine flu virus. If only they would do this for the H5N1 bird flu virus as well. Having access to those hidden sequences would be very helpful in predicting what bird flu is doing, how it is changing, and what the future might hold for us from this very virulent virus.
An unpredecented aspect of the reaction of the scientific community to the current pandemic threat is the sheer speed with which researchers are making data publicly available. Within hours of the genomes of virus isolates having been analyzed, researchers from every corner of the globe have uploaded their sequences to the GISAID flu database, or Genbank, for anyone to compute.
Meanwhile, some journals have moved to warp speed, getting papers peer reviewed and published in days instead of months. Neil Ferguson's group at Imperial College London, for example, published an initial report on the epidemiology of the outbreak in Science on 11 May (see 'Swine flu spread matches previous flu pandemics') . It used some sophisticated modelling to describe the evolution of the outbreak, even if the underlying epidemiological data available at that point to feed into the models was so scant that one leading public health blogger described the paper as "computer-aided tea-leaf reading".
The New England Journal of Medicine (NEJM) also published a somewhat meatier paper on 7 May by scientists at the US Disease Control and Prevention (CDC) providing a useful summary of the clinical symptons and age distributions of the earliest cases (see 'US swine flu cases dissected').
But another group of leading evolutionary biologists, including Oliver Pybus at the University of Oxford, and Andrew Rambaut at the University of Edinburgh, have taken a completely different tack. While preparing papers for peer-reviewed publication, they have put online on a public Wiki sophisticated analyses of the flu genome, including detailed phylogenetic trees, as soon as they got their results. They argue that it is in the interest of the public and the scientific community to make data relevant to the pandemic threat publicly available as fast as possible.
May 23, '09Swine flu: planning for the bogeyman
Quote from scienceblogs.com
It's a simple fact that the surge in demand by those not sick enough to warrant the use of scarce medical resources (the time of emergency room personnel) is unavoidable and has to be part of any planning. Hartocollis reports that visits to the Schneider Children's Hospital ER in Queens quadrupled since last Friday. Most city ERs are running at capacity during normal times and this constitutes an overwhelming demand. Because of this, the onerous trip to the emergency room brings nothing tangible. Unless the patient has an underlying medical condition and signs of an influenza-like illness, they aren't being tested nor usually given medication.
But medication and testing aren't the real objectives for most parents. The real objective is some peace of mind. That's not the same thing as panic and it won't be cured by trying to reassure the public with hopes of "avoiding panic." Instead we should look for better ways to allow people to meet the objective, for example, by temporary flu clinics to triage cases and reassure the non cases.
Hartocollis has it exactly right. A trip to the ER is the equivalent of checking under the bed for the bogeyman. It can't be prevented. It can only be planned for.
May 23, '09Update on the Novel Influenza A H1N1 Virus and New Findings
This is the transcript of the CDC update for Friday, May 22nd. There is quite a bit of information about the origins of the swine flu virus. Clearly there is a need for increased surveillance for viruses coming from the animal health sector. The cooperation of scientists from both human and animal health is necessary.
Quote from www.cdc.gov
Is the goal here primarily to figure out where the virus emerged or is that the primary goal? Is the primary goal to determine, you know, our capability to combat it with a vaccine?
Anne Schuchat: ...our primary responsibility is to respond. And so, our analysis attempts to do two things, two inform our public health response, that is by helping us understand how we can make a vaccine and make the most effective vaccine possible, to inform our recommendations on use of antivirals for treatment and prophylaxis, but it's very important also to understand the origin of these viruses, because if we can determine the origin, we also then can take measures to make sure that the virus doesn't re-emerge in a slightly different form, and so, our first goal is to prepare for response, but understanding the origin is a part of that response, but it's a secondary part.
You can also think about the new tools that we have at our disposal in the scientific community. With the type of genetic and antigenic characterization that the scientists did, they can look backwards in history and try to understand where these parts of the virus emerged from, and that can help us really try to prevent those types of reassortments or emergences in the future. And so, this is little bit like medical or sort of scientific detective work, understanding the sources of this virus through the genetic characterization but also looking forward, preventive, so that the more we understand how these new strains come into human populations, the easier it will be for us to counter them in the future.
Donald McNeil: Hi, thank you. This is in part a call for more surveillance of swine influenza. I know that the chicken industry stepped forward very quickly a couple of years ago when there was a need for more surveillance of Avian influenza. Does this mean that the pork industry needs to step forward and pig farmers around the world need to, or submit more samples, or what needs to be done now that this problem has emerged?
Anne Schuchat: Yeah, you know, I think that this really hits home how important it is for animal and human health to cooperate and collaborate. We're pleased with the improved collaboration of the two disciplines, but for many infectious diseases that have emerged over the past few decades, we see that what happens is that the animal-human interface is very important. And so, part of our strategies now involve joint investigations and shared information. And I think this does point to the need for that going forward.
...a triple reassortment virus that contained genes that had originated in -- of course, let me preface this remark by saying that all influenza viruses are present in the Avian reservoir. And so, the ultimate origin of all influenza viruses is from birds. And so, what had happened was in swine, there had been introduction of the 1918 virus, and that virus evolved and continued to circulate in pigs without interruption, as far as we can tell, between 1918 and the current time.In addition, human influenza viruses have been introduced into pigs because pigs are susceptible to human influenza viruses. In addition, another Avian influenza virus was introduced into pigs in North America. These viruses interacted in such a way as to reassort, essentially, swap genes, and thus, we had a triple reassortment virus that's been circulating fairly widely in pigs in the United States and occasionally causing human infections. So, we were very well aware of this triple reassortment, both because it caused infections in pigs and because it caused occasional sporadic infections in humans. This triple reassortant virus, which had originated in North America, was then later detected in pigs in Europe and Asia. And this triple reassortant virus that originated in North America co-circulated with Eurasian swine viruses. Now, those Eurasian swine viruses, as I mentioned, originated in birds, the ultimate source of all influenza viruses.But once they enter a new host, they evolve in a way that you can distinguish the genes from those from the original Avian source. So, the reassortant event that occurred was between this triple reassortant and the Eurasian swine influenza virus. Now, if you look very closely at the gene sequences that are present in the databases that exist, such as GenBank, you will see that reassortants between the North American viruses that have been very well described in the literature and the Eurasian swine lineage viruses have been detected in people and in pigs. However, the exact gene combination that we've seen for the viruses that are spreading in humans had not been detected previously either in North America or in Asia. So, we know that the reassortment had occurred and there were reassortants, but they didn't have exactly the same gene constellation. In the United States, surveillance in pigs for influenza viruses does occur when there is an outbreak that causes disease and it comes to the attention of veterinary authorities, but the surveillance is not very systemic. Sometimes farmers don't report that they have outbreaks in pigs. Often these outbreaks don't cause serious disease and so on. And while we have some surveillance in the United States, the surveillance in other parts of the world is much more limited than that that we have in the United States. And I think that's where we can see the greatest gaps in surveillance in pigs. I hope that's answered part of your question.