Pandemic News/Awareness.

Nurses General Nursing

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I had to close the other panflu thread as it was way too long, and becoming unreadable. I am starting this one with info on the agenda of this meeting tomorrow in Congress. I am linking to Flutrackers because all of the info is right there and easily readable from this post: http://www.flutrackers.com/forum/showpost.php?p=61735&postcount=1

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Taiwan and Thailand working on their own vaccines:

http://afludiary.blogspot.com/2007/01/taiwan-and-thailand-working-on-their.html

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White Washing with the Flu - Effect Measure:

http://scienceblogs.com/effectmeasure/2007/01/whitewashing_with_the_flu.php#more

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Does anyone know if OSHA ever responded to this?

http://spewingforth.blogspot.com/2006/05/pandemic-flu-iom-says-disposable-does.html

Meanwhile, OSHA has not responded to a petition filed last January by the American Federation of State, County and Municipal Employees (AFSCME) and several other labor organizations, calling on OSHA to issue an emergency temporary standard to protect health care workers against pandemic flu. The petition noted that a Congressional Budget Office report had predicted that hospitals, clinics and doctors offices would be overwhelmed and the system would be strained as health care workers became sick or stayed home to take care of sick family members or to protect themselves.

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These are some basic terms used when talking about bird flu. The bird or avian flu that is of most concern recently is H5N1, but there are other avian viruses that can cause illness also:

http://www.usda.gov/wps/portal/usdahome?contentidonly=true&contentid=2006/08/0296.xml

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Bird flu confirmed in England is the virulent Qinghai H5N1 strain:

http://www.inthenews.co.uk/news/news/health/british-bird-flu-outbreak-asian-strain-$1048470.htm

Here is a link at Flutrackers to three BBC videos:

http://www.flutrackers.com/forum/showpost.php?p=62798&postcount=16

Something to think about:

http://afludiary.blogspot.com/2007/02/uk-playing-down-facts.html

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This is a controversial theory that seems to explain the spread of avian flu

throughout the world, and why it should not be a surprise.

Recombination happens when two distinct viruses infect the same host. The result is that they recombine by trading strands of amino acids, part of one homologous gene is copied and then part of the other's homologous gene is copied. This produces a gene with genetic info from both parents, and is called homologous recombination.

This is not the same as the reassortment that can occur with dual infections, by which the mutated virus will have a mixture of complete genes from each parent, and individual genes do not have new sequences, but rather they have exact matches of one of the two parental genes. Please note that reassortment and recombination can both occur, and are not mutually exclusive.

So, the fear is that parts of gene segments can be passed between two influenza viruses co-infecting the same host to create a new airborne H5N1 with the ability of being efficiently transmitted between humans. This is why poultry workers in England who are culling the currently infected poultry found to have H5N1, in its highly pathogenic form, are being given seasonal flu vaccinations.

Does this make sense?

Specializes in Too many to list.

http://www.recombinomics.com/News/02040701/H5N1_England_Surprise.html

The repeated "surprises"... overlook the obvious, which are poor surveillance programs that only detect H5N1 when wild or domestic birds began to die in unexpected numbers or in unexpected places.

...many countries in Europe have only found H5N1 in wild birds.

Those with poor surveillance find H5N1 in domestic poultry after the domestic birds have been infected with H5N1 from the wild birds.

Changes in the sequences dictate the generation of new probes to detect the evolving H5N1. Failure to update probes creates false negatives.

Weybridge has released the HA sequences from two of the H7N3 infected chickens from last year...

These sequences had M230I, which is found in human influenza strains (H1N1, H3N2, influenza B).

Recently, M230I was also found in H5N1 from the Gharbiya cluster in Egypt. These sequences were of interest because they were from the largest human cluster reported to date in Egypt,

...the NA sequences from the cluster members had N294S, which confirms Tamiflu resistance.

...additional H5N1 infected birds in Egypt had M230I, and the coding matched the H7N3 from England.

This association points toward dual infections involving H5N1 and H7N3 and the acquisition of M230I via recombination.

... the WHO consultants continue to describe the evolution of H5N1 as a series of random mutations. Consequently, they are constantly “surprised” by new sequences and migration patterns of H5N1.

A cautionary tale for North America?

i saw a pbs program about 1918 flu, it was a hog/bird comination which was a hemmorgiac in nature and passed from human to human. as in casees of todays flu when it had run its course it disappeared but it left behind millions dead in a world population much smaller than we have today..

todays flu vacine is chosen in a large part by checking in the orient as to what virus is prevalent there..goes around the world from east to west

if any viral disease hits the parts of africa that are already comprimised by aids we will have a disasterous situation

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i saw a pbs program about 1918 flu, it was a hog/bird comination which was a hemmorgiac in nature and passed from human to human. as in casees of todays flu when it had run its course it disappeared but it left behind millions dead in a world population much smaller than we have today..

todays flu vacine is chosen in a large part by checking in the orient as to what virus is prevalent there..goes around the world from east to west

if any viral disease hits the parts of africa that are already comprimised by aids we will have a disasterous situation

Much of the modeling for what a category 5 pandemic would be like, is based on the historical records and recent scientific work with the virus, H1N1 (the so called Spanish Flu) that caused the 1918 pandemic. There was a concurrent pandemic in pigs at about the same time. I have heard that the humans gave the flu to the pigs. I don't know if that is true or not, but if we can get their diseases presumably they can catch ours also.

You have pointed out that millions were left dead, but that the world population was much smaller in 1918. Here is an essay from Avian Flu

Diary with a diagram comparing the severity of the last three pandemics.

The essay makes some pertinent observations about the current case fatality rate of H5N1 (the bird flu of today) with the case fatality rate of H1N1 (the Spanish Flu) in 1918. You get the feeling that things could be very bad despite our advanced medical system if H5N1 goes pandemic.

I am unable to put out of my mind, the extraordinary measures that it took to save those pediatric flu cases in Alabama. How will we do this with large numbers of victims given our current limited resources?

http://afludiary.blogspot.com/2007/02/new-pandemic-severity-index.html

Swine apparently did not have flu until after 1918. So, it seems that us humans gave it to them.

As far as appropriate PPEs, remember Totonto during the SARS outbreak> A friend actually worked there. When they ran out of N95 masks, TPTB convinced the nurses that plain surgical masks were good enough, and nurses dies from the resulting SARS infections that they caught.

Do we really expect that this won`t happen during a Panflu outbreak?

Can`t hurt the bottom line ,now, can we ?

Healthcare used to be about actually caring for people, now it`s all about the money,it`s a business.

I was priviliged to be able to read a blog written by a doc from the Prince of Wales Hospital (some such name) in Singapore (I believe) started to document their trials during the SARS epidemic. They had to resort to extreme measures to prevent the spread amongst staff. Near total isolation; Level III PPE (coveralls, PAPR [Powered Air Purifier Respirators], footies, head coverings and gloves. Even the pen you charted with, once entering the hot zone, remained there. You didn't wipe down your scope after visiting the patients, you used the ones left inside. Nothing carried in was carried out save as sealed trash. Only after such measures were implemented and totally adhered to did they stop nosocomial infections amongst the staff themeselves.

Infection control today is rudimentary in most hospitals. When your patient/nurse ratios are 6, 7 or 8:1 and you are intermingling "regular" patients with infectious cases amongst your mix there are bound to be gaps. The same pen accompanies you into each room, the same 'scope, uncovered footwear, and you are given cheap barrier gowns and unfitted masks that must be reused over and over because you have not the luxery of disposing of them after each use.

Whether we wish to admit it or not we ourselves contribute to the spread of infectious diseases between patients because of our lack of comprehensive infection control practices. Handwashing does nothing to eliminate the MRSA and C. dif, etc that happens to attach to shoes (patients have "accidents after all) that ends up spread down the hall, and occasionally transferred to other patients though there is no direct evidence of the link.

BTW, 1918 is perhaps the earliest period for which we can trace infection strains, and only then because we managed to find some semi-preserved bodies buried in permafrost from which to obtain tissue samples containing viable specimens. We simply do not know what swine, or birds, etc, carried prior to that era. Flu is literally thousands of years old (look for historic records mentioning 'la grippe' for "modern" examples), and is thought to have originated from the Asian steppes, just as most new strains do today.

Ayrman

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Egyptian girl, age 17 has died of H5N1. The case fatality rate in Egypt

for this season remains at 100% unless there are some unacknowledged, but recovered cases that no one has mentioned. Are they still saying that the Egyptian strain is only "moderately" Tamiflu resistant? We won't know until the viral sequences are released.

(hat tip flutrakcers/dutchie)

http://www.alertnet.org/thenews/newsdesk/L05803351.htm

The situation in England, where some are panicking and dumping

poultry on the roadsides. It's a mess:

http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=434074&in_page_id=1770

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They mentioned on news that there is a new scale out sort of like the way they rank hurricaines and earthquakes. This will rank severity of flu outbreaks. I hope to see a link here soon.

Forgot to send this to you, oramar but I did post it in this thread. Sorry this will be a duplicate. Good graph.

http://afludiary.blogspot.com/2007/02/new-pandemic-severity-index.html

Interesting blog, Indigo Girl.

The math on the graph is compelling reason to pay attention to whats happening with H5N1 IMHO.

CDC is essentially saying that if we get a Category 5 pandemic- like 1918- that they project 1,800,000 deaths or more in the United States.

The or more is kinda concerning. Thats with a fatality rate of 2%. H5N1 currently has a case fatality rate of 60%. Unless it moderates greatly when it goes pandemic, the number of deaths would be much, much higher.

I find that very concerning. I do not understand how the officals or anyone can loook at those projections and not encourage longer term preparations thatn 2 weeks!!

I think the point was made earlier in this thread- that if the PPE runs out- which may take days to weeks- then what happens to the hospitals? How will bed shortage, staff shortage and closures affect the fatality rate?

I know I would be scared to do patient care with a 60% fatality rate. I dont think I'd work without PPE and/or a vaccine. I dont know what would happen to us if we didnt come to work, but if that fatality rate holds, nurses will be dropping like flies. So many of the ones that do work will get sick and be out, making the shortages even worse.

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