It has been my own personal project to follow H5N1 for the last 3 years simply because it interests me. Attracted to this type of information like a magnet, I've been watching this relatively new influenza virus to see where it will go, how it will change itself, and possibly change our world. I have followed its country by country outbreaks, and watched for the important viral mutations such drug resistance or changes that allowed it to more specifically target mammals.
Keeping in mind at all times that we will be cleared impacted as HCW, as well as being members of our communities, and having families of our own to care for, I wanted to start the new year by opening a single focused pandemic thread that would also look at what we are doing nationally to prepare for a future pandemic. Is this the virus to spark the next pandemic? No one can answer that question. We can look back at the past to the last few pandemics, and in particular to the most devastating one in 1918, and extrapolate useful information about them, but we can not predict the future. We can only make comparisons with our situation now, and learn what worked to lessen morbidity and mortality in those past events. And, we can look at those other viruses, and compare them with what we are seeing now. For example, H5N1 is a Type A virus. We know that all pandemics are caused by Type A viruses. It is also an avian virus. The deadly 1918 virus, H1N1 was also an avian virus.
For this thread, as in the previous threads, I will be making use of news sources, scientific studies, govt bulletins such as the MMR, as well as flu forums and blogs devoted to this subject for my sources. Because press information, particularly the foreign press, is not always available for later access when I am looking back to check recent historical information, the use of these blogs and forums are important because archived information quoting the media and all other sources is always fully and easily available there with no worries about information disappearing or no longer being available. They also fully document their sources or I would not be using them.
With this link from Avian Flu Diary, a well researched source that I highly recommend, we can read the words of outgoing HHS Secretary Leavitt on our state of preparedness. Leavitt has done an admirable job during his tenure, but admits that there is much left to do.
A scant 33 months ago, I sent my first message about a race that HHS had just begun. As I said then, it was a race against a fast-moving virulent virus with the potential to cause an influenza pandemic. Since then, we have mobilized experts and resources across the country and around the world. I now send you this final message, as I look back at the unprecedented progress we have made in energizing a national pandemic influenza preparedness movement in those 33 months.
Today, many people mistakenly think influenza pandemics are a thing of the past, but influenza has struck hard in the era of modern medicine – much harder than most people realize. And it will strike again. Pandemics are hard things to talk about. When one discusses them in advance, it sounds alarmist. After a pandemic starts, no matter how much preparation has been done, it will be inadequate.
The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.
...we are witnessing a medical science landmark. Never before have we watched a flu outbreak of global dimensions unfold in real time. Nor have we ever had the opportunity to alter the course of such an outbreak.
I have been critical of WHO for being late to the party, but they are fully on board now and by raising the pandemic threat level to phase 5 have done something very important: served notice that it's time to mobilize resources in the event this virus shows sustained transmission in several countries. The severity of the disease it produces doesn't have to be extremely serious or lethal for a widespread outbreak of flu in a community to do a lot of damage in productivity, economic loss and quality of life. It's the job of public health agencies to warn communities this might happen and so they can prepare to manage the consequences. WHO has done the right thing, however this evolves from now on. And CDC's proactive and aggressive approach is also right on target. Meanwhile we are compiling extremely valuable information about the dynamics of influenza disease spread, information that will pay off in future planning and preparedness activities.
Want to know more about this version of H1N? It really is a swine virus, but it is now politically incorrect to call it Swine Flu.
You might have some difficulty following this interview so just skim the science if you don't understand it, and you will still get the gist of what is being said here.
This is an interview with virologist Ruben Donis, chief of the molecular virology and vaccines branch at the U.S. Centers for Disease Control and Prevention. He suggests that the first infected human may not have been in North America, and that it had not been spreading in Mexico for long.
R.D.: Where does all this talk about avian and human genes come from? I was describing a fully swine virus. For [the] last 10 years, this has been a fully swine virus. Can you tell I have an accent? I'm a U.S. citizen but I have the roots in Argentina. It's like me. I've been in the U.S. since 1980. I'm a U.S. citizen but I have an accent.
Q: It's not as though human and avian just got there in this strain.
R.D.: It's part of the swine virus.
Q: What's the newest part of this strain?
R.D.: Neuraminidase and the matrix are the newest to be seen in North America. They were not part of the team--I talk about flu virus as teams of genes. There are eight players. They have these two new players from Asia.
Q: It suggests a mixing of pigs from North America and Asia.
R.D.: One little detail we haven't discussed is [that] these Midwestern viruses were exported to Asia. Korea and many countries import from the U.S. Swine flu is economically not such a big deal that many countries don't check for it.
Q: How do you get Europe in there?
R.D.: There are some parts of the puzzle I don't have the answer to. The genetic lineages of Asia and Europe mix quite a bit.
Q: How does the pig get back here?
R.D.: Who said it was a pig that came from Asia? Did I say that? It could be a person.
Q: So the origin might trace back to Europe or Asia.
R.D.: I didn't say that. I don't want to point the finger at anyone.
Q: It does suggest that mixing didn't happen in Mexico.
R.D.: Probably not. The amazing thing is the hemagglutinins we are seeing in this strain are a lonely branch that have been evolving somewhere and we didn't know about it.
Q: Does this one scare you?
R.D.: I saw figures that do scare you. We've received 300 samples from Mexico, and these cover the span of February, March, and April. And you look at flu A, traditionally it's A/H1 or A/H3 or it's B up until the end of March. There are two or three cases up to [the] last days of March that are swine. Then in April they skyrocket. So all the cases in the D.F. areas, where most samples came from, it really transmits very efficiently.
Q: What is the date of first sample?
R.D.: I think it's the end of March, the first positive specimen.
Q: Did Mexico react quickly enough?
R.D.: They didn't know. They probably thought it was regular flu.
Q: Flu is a seasonal disease that peaks in winter. Maybe this will end in the United States with the end of the flu season.
R.D.: We're in a good position. The folks in Buenos Aires are in trouble. They're entering winter now.
Have you noticed? The govt agencies and the WHO, no longer call it Swine Flu.
To quell the notion that pigs are to blame for the swine influenza H1N1 epidemic, three international agencies said today they would take the "swine" out of the virus's name and call it "influenza A/H1N1" instead.
The United Nations Food and Agriculture Organization (FAO) said today it has agreed with the World Health Organization (WHO) and the World Organization for Animal Health (OIE) "to no longer refer to 'swine flu' but instead to 'influenza A/H1N1.'"
Joseph Domenech, the FAO's chief veterinary officer, said in the FAO statement that there is no evidence that the new virus is circulating in pigs in Mexico or anywhere else and that pork consumption poses no increased risk of contracting the virus.
The move comes in the wake of reports that Egypt began slaughtering pigs yesterday out of the mistaken concern that they could spread the new virus to people. Some countries have banned pork from Mexico and the United States for the same reason.
The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.
Of course, not everyone will have a mild clinical presentation. Influenza can make you very ill, even this virus that has been mostly described as mild outside of Mexico.
Rachel Mele, Age 16
[she] saw her fever break yesterday for the first time in five days. It had been hovering around 101F since the terrifying night when her parents rushed her to the hospital. "I could barely even catch my breath. I've never felt a pain like that before," Mele said. "My throat, it was burning, like, it was the worst burning sensation I ever got before. I couldn't even swallow. I couldn't even let up air. I could barely breathe through my mouth." http://www.nzherald.co.nz/world/news...0569363&pnum=2
We forget that influenza can be very serious, and the more cases we see of this new flu, the more likely it is that some people will be very sick. This woman is 30 years old. They do not say anything about any pre-existing conditions like diabetes that could have made her more at risk. They would probably say if she was on a vent, so I am thinking that she is not.
I would include pregnancy also as a possible risk factor for more serious disease. I have read that there may be a pregnant woman in south Texas who is gravely ill, and on a vent but that is an unsubstantiated rumor at this time.
The woman is in the ICU at West GA Medical in LaGrange, GA showing modest signs and considered seriously ill.
Timeline:
She traveled from Kentucky to Georgia with her 5-year-old daughter by way of car.
Prior to her trip to Georgia she took a leisure trip to Cancun, Mexico with a travel companion from April 17- April 21.
She began to fell ill on April 18th, but she thought it was due to the sun.
April 23: She arrived in Atlanta, GA by way of car.
April 24: She went shopping in Atlanta, GA.
April 25: She went to a wedding rehearsal dinner in LaGrange, GA.
April 26: She attended a wedding and later that day went to the ER voluntarily with family to West Georgia Medical in LaGrange, GA. She was immediately isolated. Officials performed a rapid specimen test , which the CDC received on April 28.
The family and those in her close circle were given anti-viral medications as a precaution.
Have many of you have been forced to go to work while sick? I've been there myself. The guilt feeling of leaving co-workers short, the need of that pay check for folks who don't have sick time, and the fear of losing your job, force many to do this. Is this going to change during a national emergency, I wonder...
One of the things we are told is not the responsibility of government but an "individual responsibility" is not working sick or sending our kids to school when they are sick. I pointed out that the ability to do this may depend on others, particularly employers. Employers also have a responsibility, not just employees.
The US has some of the worst sick leave and child care policies among industrialized nations. It is nothing short of a scandal. And now these non-policies have the potential to have major public health consequences. The US labor movement is querying its workers about this.
The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.
This is a fascinating article from the Wall Street Journal giving some detail about how the medical community in Mexico, and the US first discovered that people were becoming ill with a virus that no one had ever seen before. This is highly recommended reading.
The voice on the conference call last week was Frank Plummer, a Canadian scientist who had just spent 24 hours analyzing virus samples from 51 seriously ill people in Mexico.
The news: Seventeen people carried a completely new type of flu virus, one which had its origin in pigs. Flu from swine, which can be fatal, has rarely made the jump to humans -- much less appeared in so many people at once. Within minutes, Mexico's health minister grabbed a red-telephone hotline to President Felipe Calderón. "Mr. President, I need to see you urgently. It's a matter of national security."
The more serious illnesses in Mexico are said to be due to their less integrated swine. That is, no foreign animals have thinned their swine's lines. In Asia and the USA more exchanges of the animals have occurred, therefore making the strains dissimilar and their virus less virulent.
I forget in which of the many sites I've been referred by Indigo Girl, that I saw that........
Roughly a year ago, when the pandemic threat seemed distant to all but public health officials and a few disease geeks blogging on the subject, the CDC began to recommend that Americans consider stockpiling a small quantity of facemasks and respirators in the event they might be needed during an outbreak.
In an Interim guidance on the use and purchase of facemasks and respirators by individuals and families for pandemic influenza preparedness the American public was given a much stronger recommendation for the home stockpiling, and use, of facemasks and respirators than we'd seen before.
Some excerpts from this guidance:
Although not all households will have someone who becomes ill with influenza during a pandemic, because one cannot predict in which households an infection will occur, it would be reasonable for each household to stockpile some respirators that can be used, if needed, when caring for an ill family member.
With proper precautions, a single caregiver can use the same respirator several times over a day for brief care visits with the same ill person in the household,[2] so a stockpile of 20 respirators per household would be reasonable.
Just a brief note to remind everyone about the case definitions CDC is using for reporting on swine flu (or whatever name we collectively settle on). In order to make sure numbers are comparable from day to day and place to place we have to decide on criteria for knowing we have something to count. Is someone with flu-like symptoms to be counted as a case? Or do we confine it to someone with laboratory proved infection with the virus? Should there be different categories of diagnostic certainty?
...the person must first have an acute febrile respiratory illness. The fever has to be at least 100 degrees F. (that's the febrile part) and accompanied by recent onset (the acute part) of at last one of these respiratory tract symptoms: rhinorrhea (runny nose) or nasal congestion, sore throat, cough (these, obviously, are the respiratory illness components of the definition).
Having an acute febrile illness at this juncture is not enough to put you into the biggest category, "suspect case." You also have to have been in close contact with a confirmed cases within the last 7 days (the upper range of the incubation period) or have traveled in the last 7 days (in the US or internationally) someplace where there have been confirmed cases, or now, live in a US community that has cases.
The index of suspicion gets ratcheted up when a suspect case is shown to be shedding influenza A virus through one of the rapid antigen tests available in a doctor's office. These tests don't detect all flu A, however. They are said to be about 50% sensitive, meaning they miss about half of true flu A infections. Their main use was as a way to detect the presence of flu A (or flu B) in the community. Using it as a test for an individual, as here, is not the best way to make a diagnosis, but the number of errors that will be made will be a function of the prevalence of flu A among those with acute febrile respiratory illnesses at any point in time. If they are positive by this test, the swab is supposed to be sent to a state-level public health laboratory for subtyping. If it cannot be subtyped at this level, it is sent to CDC for a specific test for the current swine flu virus involved in the outbreak.
Probable cases are popping up all over and I wouldn't be surprised if CDC's lab started to back up. That will mean that decisions about closing schools or businesses will be waiting for final confirmation. The decision makers are in a difficult position, because shutting schools at the end of a school year, with proms, SAT and final exams and who knows what else creates extremely difficult and painful problems.
The CDC has spoken, and this is what they have to say about pregnant HCW. Healthcare facilites should take notice, and I am wondering if they will just say that PPE is adequate protection for everyone. If the CDC has written this guidance, they must not be certain that it is enough. I find these guidelines to be serious cause for concern.
Health care workers treating patients with suspected or known illness easily transmitted by contact, droplet, or airborne transmission (e.g. influenza viruses) should do a risk assessment to determine the type of transmission-based precautions needed. Contact, droplet, or airborne precautions may be indicated (OSHA_pandemic_health.pdf, pages 16-17).
Pregnant women who will likely be in direct contact with patients with confirmed, probable, or suspected influenza A (H1N1) (e.g., a nurse, physician, or respiratory therapist caring for hospitalized patients), should consider reassignment to lower-risk activities, such as telephone triage.
If reassignment is not possible, pregnant women should avoid participating in procedures that may generate increased small-particle aerosols of respiratory secretions in patients with known or suspected influenza, including the following procedures:
* Endotracheal intubation
* Aerosolized or nebulized medication administration
* Diagnostic sputum induction
* Bronchoscopy
* Airway suctioning
* Positive pressure ventilation via face mask (e.g., BiPAP and CPAP)
indigo girl
5,173 Posts
Thursday night in Mexico
http://crofsblogs.typepad.com/h5n1/2009/04/thursday-night-in-mexico.html