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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Roche Is Cutting Tamiflu Production.

http://afludiary.blogspot.com/2007/04/roche-cuts-tamiflu-production.html

The wealthier nations of the world have already ordered what they assume will be an adequate supply of Tamiflu.

Recent revelations regarding the number of pills required per dose have called those assumptions into question, but few nations are likely to double their order of antivirals at this late date.

As far as the rest of the world is concerned, the Tamiflu option is too expensive to consider. So Roche must tailor their production to meet the current demand. And that means, should a pandemic erupt, we won't have enough to deal with the threat.

Well, just when you think things might be getting better, and the news has been quiet...

There goes the Rumsfeld's profit argument for the conspiracy minded.

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Another study reaffirming some of what we already knew. Seasonal flu viruses put the elderly most at risk, but pandemic flu viruses prefer the young.

http://www.cdc.gov/eid/content/13/5/694.htm

(hat tip crofsblog)

Age-specific patterns of death from influenza vary, depending on whether the influenza season is epidemic or pandemic. We assessed age patterns and geographic trends in monthly influenza-related deaths in Italy from 1969 through 2001, focusing on differences between epidemic and pandemic seasons. We evaluated age-standardized excess deaths from pneumonia and influenza and from all causes, using a modified version of a cyclical Serfling model. Excess deaths were highest for elderly persons in all seasons except the influenza A (H3N2) pandemic season (1969-70), when rates were greater for younger persons, confirming a shift toward death of younger persons during pandemic seasons...

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Like many communities across the nation, responsible public health authorities in Alabama are discussing the issue of pandemic preparations. One of the CDC's mitigation strategies is the necessary and possibly lengthy closure of schools.

Closing schools is a very difficult decision. Parents then become responsible for child care during the work week. Losing numbers of people in the work force effects the economy. We are all going to be impacted by these decisions.

Despite the doomsday headlines, this is a good article discussing a realistic but unpleasant scenario. This past regular flu season, Alabama was one of the worst hit states for serious pediatric flu cases. Anything that can help prevent this from happening on a larger scale should be a priority, no matter what it costs.

http://afludiary.blogspot.com/2007/04/alabama-officials-discuss-effects-of.html

The scenarios are grim. Most involve multiple deaths and about half the population being ill. A PowerPoint presentation noted the likelihood that "Illness rates [will be] highest among school-aged children."

With kindergarten through 12th grades closed indefinitely, the balance of the community work force and life would come unhinged. Schools, after all, provide a form of day care for working parents.

This is the thread on the seasonal pediatric cases in Alabama, and other localities this past winter:

https://allnurses.com/forums/f8/6-alabama-kids-were-life-support-flu-197370.html

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Autopsy reports of H5N1 victims are rare. Here is a report from cases in Thailand:

http://www.cdc.gov/eid/content/13/5/708.htm

(hat tip crofsblog)

The pathogenesis of avian influenza A (H5N1) virus in humans has not been clearly elucidated. Apoptosis may also play an important role. We studied autopsy specimens from 2 patients who died of infection with this virus. Apoptosis was observed in alveolar epithelial cells, which is the major target cell type for the viral replication. Numerous apoptotic leukocytes were observed in the lung of a patient who died on day 6 of illness. Our data suggest that apoptosis may play a major role in the pathogenesis of influenza (H5N1) virus in humans by destroying alveolar epithelial cells. This pathogenesis causes pneumonia and destroys leukocytes, leading to leukopenia, which is a prominent clinical feature of influenza (H5N1) virus in humans. Whether observed apoptotic cells were a direct result of the viral replication or a consequence of an overactivation of the immune system requires further studies.

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Reseachers create interactive map with google technology to track H5N1

spread.

http://www.eurekalert.org/pub_releases/2007-04/uoca-rci043007.php

As part of the effort, the team looked at two key proteins found on the surface of H5N1 strains known as hemaglutinin, or HA, and neuraminidase, or NA. Scientists think if a virulent strain of H5N1 adapts to succeed at human-to-human transmission, it would likely involve mutations by the two proteins, said Guralnick. No mutations associated with NA and HA were linked to any specific bird or mammal host, he said.

But the team did find a strong association between a specific genotype, Lysine-627, in a segment of the viral genome called the polymerase basic protein, or PB2, and in mammalian hosts in the field. "While this genotype is not exclusive to mammals, we think it is important to track how this PB2 mutation is spreading because it appears to be so infective and deadly in mice," said Janies.

They are talking about this change in the virus:

E627K was never found in birds before. It is a mammalian SNP that allows the virus to exist at the lower body temperature of mammals since birds have a higher body temp.

This marker is now found in virtually all of the virus west of China.

Here is a discussion of changes that H5N1 has made as it morphs from an avian flu into a more mammalian virus:

https://allnurses.com/forums/f8/pandemic-news-awareness-204057-13.html#post2116873

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I came across this document and am not sure if it has been posted here already.. Some of the recommendations I don't *think* I have seen before... was from fall 2006 I believe. U of Pittsburg Medical Center -- Center for Biosecurity

http://www.upmc-biosecurity.org/website/resources/publications/2006_orig-articles/2006-06-15-hospitalprepforpandemiciflu.html

PPEs for 8 weeks

use of volunteers for patient care.

up to 200% surge

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I have never seen this document before either, Cactus. Thanks for posting it.

It is rather amazing in that it does seem to be more realistic about what could actually occur. This was written a year ago, and I believe that the CFR

is even higher now.

Even with all that I have read in the past year, I am still somewhat shocked by this document, although I recognize the need for exactly this kind of planning. If I feel this way, I can imagine how those that are in denial would react. We really do have to get serious about protecting our population.

The care is going to be delivered differently. Yes, volunteers are going to be extremely important. Lots of hands will be needed to care for the many expected cases.

http://www.upmc-biosecurity.org/website/resources/publications/2006_orig-articles/2006-06-15-hospitalprepforpandemiciflu.html

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The possibility of H5N1 in Ghana would not be a surprise as it is surrounded by countries where it has been found.

http://www.recombinomics.com/News/05010702/H5N1_Ghana.html

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A severe pandemic would not only affect the health of the nation's citizens, but also the economic health of the nation, itself.

Wall Street is not ready:

http://afludiary.blogspot.com/2007/05/gao-wall-street-not-ready-for-pandemic.html

The General Accounting Office said in a newly released report that if securities exchanges "fail to produce fully robust plans before an outbreak-which could begin at any time-they may have insufficient time and resources to adequately prepare their staffs and customers for changes in how the organizations will operate during a pandemic."

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CDC Unable to Fill Overseas Posts

This is very bad news considering where the vacancies are occurring.

Very, bad indeed...

http://afludiary.blogspot.com/2007/05/cdc-unable-to-fill-overseas-posts.html

Atlanta Journal-Constitution reporter Alison Young reported last week that only 166 of the agency's 304 positions in overseas assignments are now filled. Of those still vacant, at least 85 are expected to remain unfilled through the remainder of the year because of delays in the hiring process. Several of those key unfilled positions are in China and Indonesia, a hotbed of activity for H5NI avian influenza, the virus that scientists fear may mutate and spark a pandemic.

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Sad news for Ghana. H5N1 is confirmed. They have joined the growing

number of countries with positive avian flu infections in birds.

http://www.flutrackers.com/forum/showpost.php?p=78635&postcount=5

This is interesting. Dr. Niman of Recombinomics is reporting that the U.S. Naval lab,

NAMRU 3 has set up a lab there to provide viral sequences.

http://www.flutrackers.com/forum/showpost.php?p=78639&postcount=6

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Thoughtful commentary on hospitals and keeping the doors open.

Can they do it?

http://afludiary.blogspot.com/2007/05/keeping-doors-open.html

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