Swine Flu Updates and Issues

[indigo girl]

http://www.washingtonpost.com/wp-dyn/content/article/2009/05/16/AR2009051601850.html?hpid=moreheadlines

The swine-origin influenza A (H1N1) virus that burst into public consciousness a month ago is starting to behave like a mixture of its infamous, pandemic-causing predecessors.

It seems to have a predilection for young adults, as did its notorious ancestor, the 1918 Spanish influenza. Many of the young victims who have become deathly ill turned out to have other medical problems -- a phenomenon first clearly seen with the 1957 Asian flu.

Pandemic flu strains -- and this new H1N1 strain is all but certain to cause the 21st century's first pandemic -- are unpredictable. Any contagious disease that most of the world's 6.8 billion people can catch is inherently dangerous.

"Our message to everybody is, of course, do not over-worry about these things, [but] it is important to know it is serious," the WHO's Keiji Fukuda said last week.

Perhaps the most worrisome features so far are the number and severity of cases in teenagers and young adults. This was noticed early, and the pattern has not changed much now that there are 5,000 laboratory-confirmed infections and probably more than 100,000 overall. The average age of the confirmed and probable cases is 15 years. Two-thirds are younger than 18.

Compared with seasonal outbreaks, all flu pandemics cause a higher percentage of severe cases and deaths in younger groups. Although the overall mortality rate from the current swine flu is low, this trend is already apparent.

Last Thursday, when Fukuda announced that the global death total was 65, he noted that "half of them are healthy people who have no predisposing conditions. This is a pattern different from what we see with normal influenza."

There have been too few deaths in the United States to draw any conclusions. But of the 173 people who have been sick enough to be hospitalized, more than half are in the 5-to-24 age group.

[indigo girl]

Australia Orders Vaccine, Releases Antiviral Stocks

http://afludiary.blogspot.com/2009/05/australia-orders-vaccine-releases.html

With the weather growing colder in the southern hemisphere, and their regular flu season soon to be upon them, concerns over the recent introduction of the H1N1 swine flu virus to Australia are running high.

The number of new cases in Australia have about tripled, to 147, in the past 24 hours.

As a vaccine producing country, Australia is in the position of being able to create their own H1N1 vaccine, and they have now decided to order up 10 million doses.

Until that vaccine can be made available, probably not before late summer or fall, Australia will have to fight a delaying action against the virus using antivirals and other mitigations.

Here is an interesting remark about a threshold needed to contain the spread. I have never heard anyone say anything like this before.

Dr Bishop said the quantity of vaccine ordered would allow mass vaccination of one-third of the population -- the threshold needed to contain the virus's spread -- with the remainder reserved for "priority groups".

[indigo girl]

About Those Prior Existing Conditions - Two Swine Flu Fatalities In El Paso

http://afludiary.blogspot.com/2009/05/two-swine-flu-fatalities-in-el-paso.html

For all that the CDC keeps including people over 65 as a high risk group, I can not remember seeing anyone in that age group as having died yet of swine flu. Have you? Maybe I missed it. But, there have been plenty of younger people even even though they did have something wrong with them that could classify them as being more susceptible. Even the littlest kids under age 5, also considered by CDC as high risk, there have not been many that I have read about with a severe outcome.

At last report, out of nearly 9,000 confirmed cases around the country, over 500 were hospitalized – most of those being in the 5 to 24 age range.

Unlike seasonal influenza, this novel H1N1 virus seems to hit young adults and adolescents the hardest, with (thus far) very few patients over 60.

Today, we learn of two deaths that actually occurred last week due to the H1N1 virus. One was a woman of 24, who was pregnant, a known risk factor for influenza. The other was a 44 year old man.

[Girl Scout]

About the panic thing, my mother unfortunately is one of those that believes that the US government will issue the warning when its time to prepare, and probably come deliver boxes of food and water to everyone if we're being asked to stay home for 4 or 6 or 8 weeks, whatever. She's a very forward-thinking person, and I'm always inspired by her example, but I'm perplexed by things like this. I don't feel like the world is ending, I just feel like I'm grabbing a few extra things in case I'm stuck at home a little while.

Meanwhile, at my house, I've got two metal shelves I bought just to store food and toiletries in. Man... I will be ecstatic if all this blows over and it means I don't have to go grocery shopping for a month or two, though!!

[indigo girl]

...my mother unfortunately is one of those that believes that the US government will issue the warning when its time to prepare, and probably come deliver boxes of food and water to everyone if we're being asked to stay home for 4 or 6 or 8 weeks,

I wonder why she thinks so. Secretary Leavitt warned us 3 years ago that the US Cavalry was not going to rescue us.

Personally, I like the idea of having extra stuff on hand.

http://www.ama-assn.org/amednews/2006/04/03/hlsd0403.htm

Leavitt has been delivering a similar message to states -- he's visited about half so far. Self-sufficiency should be the goal for everyone, he said. Because a pandemic likely would break out almost simultaneously in many parts of the country, the federal government could not be relied upon to send help to everyone in need. States and localities as well as physicians' offices and households will have to be prepared to fend for themselves. "It's a good idea for people to have a couple of weeks of food and water available, not just for a pandemic but for any community emergency," he said. "Personal preparedness is a very solid ethic that makes a community safer."

[indigo girl]

The Invisible Pandemic

http://afludiary.blogspot.com/2009/05/new-scientist-invisible-pandemic.html

More evidence today from an article in the New Scientist Magazine that indicates that overly narrow testing criteria for the H1N1 virus in Europe may be hiding community transmission of the virus.

The UK, along with many other EU countries, have recommended testing people with symptoms only if they have been to affected countries or had contact with a known or suspected case in the past seven days.

The `useful fiction' that community transmission of the H1N1 virus has yet to occur in Europe (or Asia, or Africa . . . .) has been bolstered by the relatively small number of positive H1N1 tests coming out of those regions.

Of course, by failing to demonstrate community transmission in another WHO region, the politically dicey decision to raise the pandemic alert level again can be postponed.

http://www.msnbc.msn.com/id/30485593/

Yes, what about Africa? Does anyone really believe that there are no cases there? How is that possible?

Maybe there aren't many, yet. I suspect that as in the article above, this is more about lack of testing than the true absence of cases.

[indigo girl]

10 Swine Flu Cases on Vents in NYC?

I have to admit that I was somewhat surprised to read this. Makes you wonder what is going on in other cities that we are not hearing about. It's not like the CDC is announcing this or anything.

I keep thinking, this is supposed to be mild, and it's almost June for heaven's sake...What will our regular flu season be like?

http://www.scientificamerican.com/blog/60-second-science/post.cfm?id=swine-flu-strikes-new-york-city-flu-2009-05-29

Swine flu has killed four people in New York State, and hospitalized more than 100, including no more than 10 patients currently on ventilators in the city.* The outbreak seemed to be waning in recent weeks, but yesterday the city closed 6 additional schools, bringing the total to 13.

[indigo girl]

El Paso, Texas

http://www.kfoxtv.com/news/19606453/detail.html

And the prior existing conditions were what?

The initial rapid tests done on both were negative which goes to show you just how reliable these tests are. About 50% maybe...

Negative test results equals no Tamiflu within the 48 hour window necessary for best outcome.

Jessica Avalos was the mother of 4 children. The baby was delivered at 31 weeks by emergency C-section during the mother's hospitalization for influenza, and is doing OK. Jessica died on 5/24, and the other patient died 5/21, and we are just hearing about this now?

The 24-year-old was pregnant when she started showing flu-like symptoms. She was in the hospital for a week, where doctors performed an emergency C-section because of complications. Avalos died on Sunday. She was one of the two people in El Paso who've now also been confirmed with having swine flu.

"What we know is that both individuals that passed away had the infection but they also had other medical conditions that may have caused their death," said Dr. Luis Escobedo.

The city's Public Health Department held a press conference to address the two deaths and answer question about why these two people, one in their 20s and one in their 40s died of complications

Health Department officials explained how tests for both victims were conducted upon arrival to the hospitals, but they initially tested negative for influenza. The Health Department became involved and confirmed both cases as swine flu.

http://www.chron.com/disp/story.mpl/ap/tx/6447348.html

Bates said both had been given rapid flu tests — a nasal swab that is often the first step in determining whether a patient might have the flu — but that results came back negative. After they died at an El Paso hospital, further tests confirmed they had swine flu.

Bates and officials with the Centers for Disease Control and Prevention said rapid tests will sometimes return negative when a patient is actually infected. CDC officials said they did not have data about whether rapid flu tests may have missed, if they were given, in 15 other swine flu deaths nationwide.

Dr. Tim Uyecki, a medical epidemiologist at the CDC, said that there are unfortunately limitations with rapid tests and that it's not as simple an issue as positive versus negative.

"The sensitivity of the test is not as high as you would like," Uyecki said. "The challenge is how to interpret a negative result when there's a lot of influenza going around."

[indigo girl]

Australia: H1N1 now nationwide

http://crofsblogs.typepad.com/h5n1/2009/05/australia-h1n1-now-nationwide.html

Swine flu is now in every state and territory with the Northern Territory recording its first case.

The national tally climbed to 255 overnight, 47 more cases than at the same time yesterday. In Victoria, which has been hardest hit by the virus, there are 173 confirmed cases.

There is growing pressure to upgrade the pandemic alert from the "contain'' phase to the "sustain'' phase with the results of another 262 tests in that state still pending.

One of the Federal Government's top flu advisers, Professor Raina MacIntyre called on health authorities in Victoria to close all schools and childcare centres in a bid to slow the spread of the virus. There are ten schools closed.

The Federal Health Minister, Nicola Roxon has resisted this call so far but said this morning the time would come when it became impossible to keep quarantining people.

There are presently more than 3000 people in voluntary home quarantine.

[indigo girl]

Swine H1N1 Summer Spread Raises Pandemic Concerns

http://www.recombinomics.com/News/06010901/H1N1_Swine_Summer.html

The latest surveillance report (week 20) from the CDC, clearly indicates that swine H1N1 activity is on the rise in the United States, as seasonal flu levels continue to decline. Consequently the ratio of swine H1N1 to seasonal flu (H1N1, H3N2, influenza B, combined) is greater than 10 to 1. Thus, the vast majority of influenza infections in the United States are now swine flu, which is clear from the latest figures, even though reporting agencies in the United States are limiting testing...

...the replication rate for the virus is optimal at 41 C, the body temperature of a bird. This is in marked contrast to seasonal flu, which has E627K, which optimizes replication rates at 33 C. Consequently, the swine H1N1 increased activity as the weather warms in the northern hemisphere, and seasonal flu has declined as summer months approached.

These increases in the United States have begun to affected surveillance programs by countries outside of North America. An increasing number of cases link back to the United States. However, the programs in these other countries also grossly underestimates the number of cases, because the case definition includes travel from an H1N1 infected region, so local cases are not tested unless they link back to imported cases. However, this airport surveillance program misses the vast majority of imported cases because cases infected within a few days of travel are not symptomatic, and a high percentage of cases do not develop a high fever. Moreover, the rapid test used to confirm cases has a low sensitivity. Consequently, most imported cases are not detected, and local infected patients are also not tested because they do not meet the case definition.

[indigo girl]

Bronx School Closes Over High Number Of Flu Absences

http://www.ny1.com/content/top_stories/100063/bronx-school-closes-over-high-number-of-flu-absences/Default.aspx

What I find incredible is that they would wait to close this school until after they had an absentee rate of 88%!

Another Bronx public school is closing down after a high number of flu-related illnesses were reported among students.

The school is set reopen on June 8th.

At this point, there have been no reports of confirmed cases of H1N1 at the school. The absentee rate at the school reached as high as 88 percent last week.

Parents and students say they are relieved the school will be closed for cleaning.

[lamazeteacher]

The initial rapid tests done on both were negative which goes to show you just "how reliable these tests are. About 50% maybe..."

"Negative test results equals no Tamiflu within the 48 hour window necessary for best outcome."

I went to my local "doc-in-a-box" within 48 hours of my flu s/s (severe sore throat, slight recurrent fever). The instant test was negative; and the doctor said that is usually the case before 3-4 days of s/s. However he did prescribe Tamiflu, "in case....."

My URI s/s didn't diminish for 2 weeks! (I'm 70 years old) I'm still coughing flegm up, into the 2nd month following the commencement of that illness......and that's my norm after URIs, since I suffered severe anemia from several GI bleeds over the past 6 years.

I was also diagnosed with asthma following the worst bout of bleeding/anemia (looked that up on the web, and found that sure enough, anemia can cause that!)

[oramar]

Did you see what they are doing in Detroit? One positive case and the whole school closes. At least that is what I get from reading their health dept. statement.