Re: Pandemic Awareness/Preparation

H1N1 Tamiflu Resistance In China Raises Concerns

http://www.recombinomics.com/News/01...74Y_China.html

This link will be difficult to decipher if you are unfamiliar with the terminology so here is the brief version. H1N1 is one of our regularly recurring seasonal influenzas, the kind that you can get vaccinated for every year. Oseltamivir (Tamiflu) is the antiviral used to treat patients who either have the flu or have been exposed to it. The H1N1 virus has now become resistant to Tamiflu unfortunately, in almost all of its strains by acquiring a piece of genetic material called a SNP, single nucleotide polymorphism (pronounced "snip"). This SNP is H274Y.

A human can be infected with more than one type of influenza. Here is the issue that Dr. Niman is pointing out in this link. As a virologist with an interest in influenza, he reads viral sequences apparently all day. He is seeing flu isolates from China of H1N1, the seasonal flu, and it is showing this resistant trait. Coupled with these new recent cases of bird flu, H5N1 now occurring in China, and asymptomatic birds that are positive for the bird flu, there is the possibility that co-infections of both viruses will take place allowing bird flu to recombine with the seasonal flu, and become resistant to Tamiflu. Tamiflu is just about the only drug we have to treat bird flu. It is being stockpiled by governments across the globe as pandemic preparations continue. We simply can not afford to lose this drug. I hope that this explanation helps because this is a very serious concern.

Originally Posted by www.recombinomics.com

...an isolate from China, A/Jilin-Chaoyang/1191/08, maps with the US isolates, suggesting this same sub-clade has spread to China. Another isolate from China, A/Beijing-Huairou/15/08, is closely related, raising concerns that H274Y levels in H1N1 in China are also near 100%.

The spread of resistant H1N1 to China raises concerns with regard to co-circulating H5N1. China has just reported four confirmed cases of H5N1 and four additional contacts are suspect cases. These patients, as well as contacts, are treated with oseltamivir, raising concerns that patients or contacts infected with H5N1 could also be infected with H1N1 with H274Y, which could lead to the emergence of H5N1 with H274Y.

Re: Pandemic Awareness/Preparation

Japanese Govt plans survey on Tamiflu-resistant flu

http://www.yomiuri.co.jp/dy/national...14TDY02309.htm

It would appear that the Japanese are worried about the new resistant strains of Tamiflu resistant seasonal flu. They use a lot of Tamiflu in Japan to treat seasonal influenza, much more so than does any other country. H1N1 is the seasonal flu that has developed resistance.

Japan has reason to be concerned. They know that some of their wild birds, mostly swans, carry bird flu, H5N1, and they have fought the virus in some not so recent outbreaks in poultry.

They clearly "get" that this could be a hugh problem. Tamiflu is the barrier that has kept bird flu at bay. If bird flu also develops Tamiflu resistance, there will only be the mitigation strategies such as isolation, hand washing, masks, and social distancing to protect humans from the disease. For treatment once infected, there will be only supportive care for most cases.

Tamiflu resistance in H1N1 seasonal flu has appeared just about everywhere across the globe.

Originally Posted by www.yomiuri.co.jp

The Health, Labor and Welfare Ministry plans to conduct a nationwide survey of patients infected with a strain of influenza virus resistant to the major oral drug Tamiflu this winter, it was learned Tuesday.

While an increasing number of cases of the drug-resistant virus have been reported in the United States and Europe, the spread of such a virus in the country likely will disrupt medical institutions because Japan is one of the world's largest users of the drug.

... among foreign patients, including those from Southeast Asia, infected with H5N1 bird flu virus, which some experts fear could mutate into new strains of influenza that can be passed on to humans, those who did not take Tamiflu at an early stage all died. Considering the situation, the government and other organizations have stockpiled Tamiflu for 28 million people, including a supply being distributed as part of efforts to head off an outbreak of new strains of influenza.

However, if the Tamiflu-resistant virus spreads across the country while a new strain of influenza against which human beings have no immunity occurs at the same time, people likely will be infected with both viruses, leading the new strain of influenza to become resistant to Tamiflu. And it will result in an expansion of infection with the new strain as the stockpiled Tamiflu will not work on the patients.

Re: Pandemic Awareness/Preparation

Antiviral Drug Use and Employer Stockpiling Webcast

http://pandemicflu.gov/news/panflu_webinar8.html

This webcast took place in December therefore the information is fairly up to date. Benjamin Schwartz, HHS and Lisa M. Koonin, CDC were interviewed regarding the new federal guidelines for antiviral stockpiling of antivirals by employers for a pandemic.

These are the recommendations for obtaining antivirals:

Anyone who is sick will be given Tamiflu.

The critical employees such as HCW, police, firefighters, EMTs, power plant workers etc. need to be protected with prophylactic antivirals provided by their employers. That means if you are working for a hospital, you are a critical employee if the hospital needs you to be there for patient care or for the functioning of the hospital, for example. Your employer can not expect you to work without providing this protection.

In facilities such as prisons or nursing homes or college dorms where a group has been exposed to an infected person, they will be given antivirals.

They are not going to give meds to the families of any workers.

As an aside, Dr. Benjamin Schwartz from HHS also talked about the recent discovery of Tamiflu resistance in the seasonal flu, H1N1. Initially he starts out dismissing any concerns that the bird flu virus H5N1 might also develop drug resistance but, later in the webcast says it would be "prudent" to use more than one antiviral suggesting that Relenza, the inhalant drug also be stockpiled.

He sounded very reassuring when he said that these drugs would be available. I wondered if he was aware that some states opted out of the federal program that would have helped pay for these antivirals, but maybe he just forgot to mention that when he said that hospitals might be able to acquire antivirals from their states. Or maybe I just misunderstood what he was saying...

Re: Pandemic Awareness/Preparation

China Reports 4th Human H5N1 Fatality This Month

http://afludiary.blogspot.com/2009/0...lity-this.html

Originally Posted by news.yahoo.com

A 31-year-old Chinese woman has died of bird flu, becoming the country's fourth victim of the disease this year, the state Xinhua news agency said on Saturday.

The woman fell ill on January 10 after visiting a poultry market and died early on Friday in northwest China's Xinjiang region, Xinhua said, citing local health authorities.

The woman was China's third avian flu victim in seven days...

Originally Posted by afludiary.blogspot.com

Up until this month, China had only reported 30 human infections. That out of a population of 1.3 billion people. Or roughly 1 for every 43 million people.

Vietnam, with a population of 88 million, has reported 106 infections over roughly the same time period, or 1 in every 800,000 persons.

Why is there a 50 fold difference in reported attack rate between China and Vietnam?

Good question, but nobody really believes that there have not been more cases of bird flu than what the Chinese are admitting to, do they? This is the country that officially denied having any SARS cases until they couldn't hide them anymore...

Re: Pandemic Awareness/Preparation

First Case of Bird Flu Reported in Nepal

http://www.recombinomics.com/News/01...5N1_Damak.html

Awaiting confirmation from one of the WHO affiliated labs to make the official announcement.

Originally Posted by www.recombinomics.com

...comments describe the first lab confirmed H5N1 case in Nepal. The sample has been sent for third party confirmation. Since Weybridge confirmed H5N1 in Nepal poultry, it seems likely that the sample was sent to Mill Hill in England.

This report provides more specifics to reports of human cases in Nepal. An earlier report described 5 patients in critical condition...

If confirmed, the case would cast serious doubt on India’s claim that there are no human H5N1 cases there.

Meanwhile, also in Nepal:

http://crofsblogs.typepad.com/h5n1/2...rom-china.html

Originally Posted by crofsblogs.typepad.com

People living in villages bordering China fear bird flu has made inroads into Sankhuwasabha district as well.

They are panicking ever since chickens started dying from an unidentified disease two months ago. The villagers maintain that the affected birds are exhibiting some symptoms that are common among bird flu-infected chickens.

Over 3,000 chickens have died in bordering VDCs, including Kimathanka, Hatiya and Chaipuwa in course of two months, and the number is increasing, said veterinarian Pushpa Bahadur Budathoki.

Re: Pandemic Awareness/Preparation

Update on the Canadian avian influenza

http://pandemicchronicle.com/

About 300 miles from the US border, I think this is. A low pathogenic avian influenza has been identified though it took them long enough to announce this. Makes you wonder how long they would take if it was highly pathogenic. I still feel uncomfortable with this diagnosis, and may explain why further when I have more time, but the link below addresses this somewhat.

Originally Posted by pandemicchronicle.com/

The agency said tests to date indicate that the strain involved in this case is “low pathogenic.”

Pathogenicity refers to the severity of the illness caused in birds.

Technically a correct statement, however, as may be happening in China recently, birds can be infected with highly pathogenic H5N1 and present only mild, or even no symptoms of illness, known as asymptomatic infections.

Highly pathogenic avian influenza if slightly different at the nucleotide level so an analysis of the hemagglutinin, the HA gene, will provide the definitive answer. That said, it is more likely than not low pathogenic H5N1 since that is what North America has historically dealt with.

Re: Pandemic Awareness/Preparation

Update on Nepal

http://tinyurl.com/c5og3s

Now we are hearing that there has been no human case of bird flu in Nepal, but that they did send viral samples to Weybridge Lab for confirmation. They are claiming that they sent even samples that have already tested negative.

Originally Posted by www.thehimalayantimes.com

Ministry of Agriculture and Cooperatives today clarified that not a single case of bird flu had been detected in Kathmandu valley so far.

“Since we don’t have any reference lab in Nepal, we have been sending samples to London even if they tested negative here,” MoAC spokesperson Hari Dahal told mediapersons at his office today.

Dahal claimed that the government would not conceal the information about bird flu. “Instead, we will inform people and request them to maintain safety measures,” he added.

He, however, admitted that the samples were taken to the central lab for test. “We have sent the samples for further testing in Weybridge Lab of London as a regular procedure even though it tested negative here,” he said.

Re: Pandemic Awareness/Preparation

Egypt Reports New Human Bird Flu Infection

http://afludiary.blogspot.com/2009/0...-bird-flu.html

Unlike Nepal, Egypt has a WHO affiliated reference lab in country which is the US
Naval lab, NAMRU 3. If this case is reported as positive for bird flu, then it is indeed positive.

Originally Posted by afludiary.blogspot.com

A two-year-old Egyptian girl has been infected with the bird flu virus, becoming the country's 53rd case of bird flu in humans, state news agency MENA said on Sunday.

MENA cited a health ministry spokesman as saying the girl, Sherouk Mohammad Said of Menoufia province, contracted the virus through exposure to household poultry, some of which died of the disease. The spokesman said Said began suffering flu-like symptoms on Friday and was hospitalised the same day. She has been treated with the antiviral drug Tamiflu and is in a stable condition, according to MENA.

Re: Pandemic Awareness/Preparation

China: 6th human H5N1 infection reported

http://pandemicchronicle.com/2009/01...5n1-infection/

Originally Posted by pandemicchronicle.com

A 29-year-old man in southwest China is in critical condition after testing positive for bird flu, making him the country’s sixth confirmed case of the virus this month, state media said Sunday.

The man fell ill on January 15 in Guizhou province, and tested positive for the H5N1 virus on Sunday, the Xinhua news agency said.

Authorities are monitoring others who came in contact with the man, but no one else has been found ill, Xinhua said.

Re: Pandemic Awareness/Preparation

More on the Canadian Outbreak of Avian Influenza

http://www.recombinomics.com/News/01...Confirmed.html

Highly pathogenic avian influenza (HPAI) is associated with greater mortality in poultry. Low path (LPAI), in contrast would mean lesser mortality. Virologist Henry Niman is making a case for the possibility of a mix of both types of virus in the same flocks that may have been missed during the testing of the current outbreak in British Colombia.

We do know that the current outbreak of bird flu in Canada is an H5 virus, but which one? And, is it just an LPAI, or both types together as he suggests. Finding the HPAI version of H5N1 in North America would of course, be very bad news since this is the strain causing human fatalities.

Niman is further suggesting that the same type of situation may have occurred already in a 2004 poultry outbreak also in Canada. Low path viruses can evolve into highly pathogenic ones though I don't think that it happens very quickly. But, it did then.

Originally Posted by www.recombinomics.com

Since a biological assay for pathogenicity takes 10 days, it is likely that the low path designation is based on the sequence of the HA cleavage site.

However, low path avian influenza usually does not produce symptoms in the infected birds. Frequently there is a drop in egg production or the influenza is detected through routine surveillance. In this case, the turkeys had respiratory distress and there was a “slight” elevation in mortality, raising concerns that the H5 was a mixture that included high path that was not present in the sequenced isolate(s).

This quarantine zone extends to the Canadian / US border...