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.
A few days ago we heard that Egypt is killing all 300 thousand pigs. Obviously, the farmers are not going to be happy. They are in fact fighting back.
Here is also the explanation of who is raising pigs in a predominantly Muslim country.
Egyptian police and armored cars charged into a crowd of a 1,000 irate pig farmers armed with stones and bottles, leaving 12 people injured as residents of a Cairo slum resisted government efforts to slaughter the nation's pigs to guard against swine flu.
Seven police were among the injured in the clashes with largely Christian garbage collectors who raise pigs on the refuse and live in the teeming slums of Manishyet Nasr outside the capital.
Egypt last week ordered the slaughter of all the country's 300,000 pigs even though no cases of swine flu have been reported here.
The World Health Organization has said the move was unnecessary because the virus is being spread through humans.
A total of 454 people have been tested for swine flu in Australia, with 430 cleared including an eight-month-old baby in Tasmania.
The other 24 - 19 in NSW, three in South Australia, one in Tasmania and one in Queensland - are awaiting results.
The federal government announced on Tuesday the temporary rationing of Tamiflu.
The supply of the other anti-viral drug, Relenza, will not be affected.
Tamiflu manufacturer Roche will supply the drug to hospitals for the treatment of confirmed cases of influenza, while GPs will have to contact the company directly.
Supply to pharmacies and wholesalers has temporarily been suspended.
A jet from Mexico that landed in Shanghai today on a mission to bring home dozens of Mexicans quarantined under strict swine flu measures will also pick up 10 people in Hong Kong.
The four-stop trip, which also takes in Beijing and Guangzhou, comes after the mainland at the weekend suspended flights to and from Mexico, the epicenter of the outbreak, leaving tourists at both ends stranded.
Amid frosty ties with Mexico over Beijing's handling of its nationals, a chartered AeroMexico flight collected 43 Mexicans quarantined in Shanghai, before flying to the capital and then heading south later in the day.
China, meanwhile, also sent a plane to Mexico to fetch 200 of its citizens stranded by the flu crisis there, China Southern Airlines said, after the two countries agreed to a repatriation deal.
...25 Quebec students headed on a long-awaited overseas study program to learn Chinese ended up quarantined in a hotel in northeastern China.
Student Anne-Marie Roberge said from the city of Changchun that the group is well-treated and well-fed, and the Quebeckers are free to walk outside in a garden. But they are forbidden from leaving the hotel's grounds and have seen their language course delayed a week.
The students are required to take their temperature three times a day, and write it down on papers provided by authorities.
"Doctors were supposed to come visit us, but we never saw them," she said in an e-mail late Monday night from China, where it was already Tuesday morning. "What's more, while we are quarantined, the staff of the hotel isn't wearing any masks."
The Chinese embassy in Ottawa did not respond to requests for comment.
It's a different tone entirely from the HHS/CDC announcement in the US for today.
Keiji Fukuda, the World Health Organisation assistant director general gave the update for today. He spoke of a clinical call that was going on this afternoon, a virtual science conference of investigators reporting what they were seeing from countries where the virus has spread, and the focus was on the clinical picture of illness.
This is just a summary of what he said. The WHO archives will have a transcript by tomorow. He took questions from the press that were not in this video.
The bulk of the patients is under age 60 with the average age in the twenties. The first cases outside of Mexico were travelers. There was some question of whether or not this was associated with why the victims were younger. Also flu tends to strike younger persons first then spreads to older. Another possible reason for younger cases is that older people may have some pre-existing immunity.
The incubation period is now thought to be from one day to 5 days. Milder illness presents with headache, fever, cough, body ache.
It is clear that we are seeing some severe illness in at least a couple of countries with respiratory distress requiring ventilation and pneumonia. The question is how often is this occurring?
There have been some cases in HCW, but it is unclear if these occurred in the healthcare setting.
The virus is the same strain in all of the countries reporting, and it is still sensitive to Tamiflu and Relenza, but resistant to amantadine and rimantadine.
The number of confirmed cases is expected to increase. From yesterday, that number rose by 405 cases and 4 more deaths.
"So far among the cases being seen everywhere is that the people being infected continue to be relatively younger people," said Fukuda. "There are some exceptions, but in general."
Texas health officials on Tuesday announced the first death of a U.S. resident with swine flu, and said she was a 33-year-old schoolteacher who had recently given birth to a healthy baby.
The woman died early Tuesday and had been hospitalized since April 19, said Leonel Lopez, Cameron County epidemiologist.
Health officials stopped short of saying that swine flu caused the woman's death. State health department spokeswoman Carrie Williams said the woman had "chronic underlying health conditions" but wouldn't give any more details.
Judy Trunnell went to a hospital a few weeks ago complaining of shortness of breath. She was eight months pregnant at the time.
Trunnell slipped into a coma and had been on life-support. Her daughter was delivered by caesarian section. The baby was released from the hospital Tuesday.
This article is talking about the H3N2, Brisbane strain, a seasonal flu strain, first heard of when it caused severe cases of flu in Australia about a year ago. At that time, it was not included in the seasonal flu vaccine. That particular trivalent vaccine was a poor match to all three strains of flu that were circulating at the time. The current vaccine, and the new one for this coming fall does include protection against Type A, H3N2 Brisbane.
Another point to make as they talk about cases that tested negative is that about 50% that test negative for influenza are actually positive cases. Testing is not infallible, unfortunately. It is dependent upon how the specimens were obtained, and how sensitive the test is, and there is room for error. As viruses evolve and change, they also move away from the primer used for the test. This has been a known cause for concern in testing for avian influenza in migratory birds.
I don't know if this researcher is correct or not about this theory, and I have never read about this anywhere else before.
Dr. Robert Brunham, chief of the British Columbia Center for Disease Control, said in an interview that the new variant of H3N2 has turned up in a number of nursing home patients there -- but not so far in the non-institutionalized community.
Brunham says his agency has also found the H3N2 variant in one Canadian traveler who got the flu after returning from Mexico. That raises the possibility, he says, that the traveler became infected in Mexico. If so, the H3N2 circulating in Mexico may have the same two mutations as those being found in British Columbia patients who have not traveled.
"In British Columbia, the H3N2 virus causes more severe cases of flu than H1N1 does," Brunham says. "So we wonder if some of the severe cases in Mexico may have been caused by the variant H3N2 virus."
But it's too soon to say whether the new H3N2 mutant has been circulating widely in Mexico.
British Columbian health officials have tested a number of people who have returned from Mexico recently suffering from cold or flu symptoms, along with hundreds of non-travelers. Most didn't have any sort of flu. Among the 10% who did test positive for flu, they were split 50-50 between H1N1 and H3N2 types.
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.
With all of the coverage on the new Type A H1N1, we have not heard much about highly pathogenic avian influenza (HPAI), and the H5N1 virus. With its horrendous case fatality ratio of over 60%, it continues to be noteworthy with the additional concern of what may happen as well if it reassorts or recombines with the new flu which is much more transmissible.
The lastest case in Egypt is a 34 yr old woman supposedly in stable condition which is rather noteworthy in itself. Most adult cases have been critical whereas the slew of toddlers recently infected this year, all had mild cases. So, are the demographics changing for adults as well? This is case #68 for Egypt.
The case is a 34 year old female from Tanta District, Gharbia Governorate. Her symptoms began on 21 April and she was hospitalized at Tanta Fever Hospital on 21 April where she was started on oseltamivir. She is in a stable condition.
Infection with H5N1 avian influenza was confirmed by the Egyptian Central Public Health Laboratory on 23 April and subsequently confirmed by the U.S. Naval Medical Research Unit No. 3 (NAMRU-3).
Vietnam
This was the 56th case for Vietnam, dead at age 23. She was not hospitalized for 5 days. Tamiflu needs to be started with 48 hours for the best outcome.
The Ministry of Health has reported a new confirmed case of human infection with the H5N1 avian influenza virus. The case has been confirmed at the National Institute of Hygiene and Epidemiology (NIHE).
The case is a 23 year old woman from Quan Hoa District, Thanh Hoa Province. She developed symptoms on 16 April, was hospitalized on 21 April, and died on 22 April.
...The case fatality ratio, worldwide, is now 61 percent...a truly appalling CFR, when the Spanish flu's CFR in most countries was no more than 2.5 percent.
Note that Indonesia still has no cases or deaths in 2009. We're pretty sure that the country has seen a number of cases and deaths, but Jakarta simply isn't officially informing WHO about them.
Even without those cases, the country's CFR is 81.5 percent. That is, out of every five Indonesians who contract H5N1, only one is likely to survive.
Dr Marie-Paule KIENY is the Director of the World Health Organization (WHO) Initiative for Vaccine Research. She led the press conference today. The update was mostly on vaccine development, technology, and capacity.
On 19 May, there is a meeting scheduled with vaccine manufactureres with the Director General of WHO and the UN Secretary General on providing access for developing countries as a corporate responsibility. Seed strains of the virus are being developed by the US CDC and other agencies to be given to all of these manufacturers by the second half of May. It is unknown at this time whether or not one or two injections will be needed to provide enough immunity.
For developing countries, the vaccine will be provided outright as charity or on a tier system where they will pay less than richer countries. Vaccine will be donated to Unicef and PAHO Revolving Fund for these countries.
There is a meeting scheduled on 14 May with regulators and vaccine manufacturers to advise WHO on whether to recommend large scale manufacturing of a new vaccine, and to tell them to put everything into place to begin manufacture. The Director General is seeking advice of the best experts before making her recommendation. They are still watching the situation. Some of these companies are still making seasonal vax.
The virus has not mutated away from the original seed strain at this time and it is expected that it will be a close enough match. Vaccines with adjuvants work best against viral drift. It is not known how much the virus will drift. There is no patent on egg based technology but there is on some of the adjuvants.
There are two ways to make seed strains, reverse genetics and reassortment. With bird flu they had to use reverse genetics because it is a very virulent virus, but with H1N1, they can use the classical reassortment technique.
They will make a profile recommendation of what groups should be vaccinated first. It is unknown if we should vaccinate as we do with seasonal flu the elderly and those with underlying medical conditions first or not.
Capacity of vaccine will depend on many factors. How much of a dose is needed, how much active principle is necessary for each does, whether one or two doses is needed etc. A conservative estimate is that 1 to 2 billion doses could be provided at least.
A US manufacturing plant was mentioned as being built and WHO trusts that it will be.
Some manufacturers already have vaccine orders spoken for by some countries. But, some are so big that they have more capacity to do more.
There are 2 or 3 manufacturers that will be using the new cell based rather than egg based technology but it sounds like their capacity is limited at this time. There are other new technologies that claim to be faster and could provide much more vaccine but they are not tested enough yet. No one wants to repeat what happened with the Swine Flu vaccine in 1976. They will not gamble on safety.
The decision to go forward will be up to the manufacturer with recommendations made by the Director General, Margaret Chan. We will know in about a week.
I may have some of the dates for the meetings wrong along with who will attend but the basic facts are here. I was listening to the audio version of the meeting and writing furiously. Too bad I never continued those stenograhy classes...
In just another one of the those very strange coincidences, the people got sick after the pigs did. Sampling issues? I'll say...
But, kudos to them for saying that they will post the genetic sequences in open data bases that all researchers will have access to.
A number of people living on the unidentified pig farm experienced flu-like symptoms after the pigs fell ill and were tested to see if they too were infected.
But Dr. David Butler-Jones says tests suggest the people were not infected with the H1N1 swine virus.
Butler-Jones says, though, that there may have been "sampling issues" and blood samples from the people will be tested for antibodies to look for a definitive answer on whether they were infected.
He won't say how many people were tested or what he means by sampling issues.
The pigs are thought to have been infected by a worker who had been in Mexico and was ill on his return to work in mid-April. The unidentified carpenter also tested negative for the virus, but it is believed that is because he was too far along in his recovery to be still shedding virus.
A nasal swab from the man was only collected after the pigs started falling sick and that was more than 10 days after his return from Mexico. Officials intend to test his blood too looking for antibodies to the new H1N1 swine flu virus.
Experts will be keen to study the genetic sequences of the viruses isolated from the pigs to determine if there are an mutations that arose when the virus went back into swine.
Butler-Jones says the sequences of those viruses will be posted in open access databases once the work is done.
The fact that the virus can jump from human to swine as well as swine to humans suggests this virus is not going to fade away. It has already moved into the southern hemisphere. Suspect cases have been reported in Brazil, Australia, and New Zealand, where the seasonal flu season is just beginning.
Co-circulation of human and swine H1N1 provide significant opportunities for adaptation to the human host via recombination. Two polymorphisms are already fixed in seasonal flu, H274Y for Tamiflu resistance, and E627K in PB2 which allows the virus to more efficiently replicate at lower temperatures.
These changes can lead to adaptation in humans, as well antiviral resistance. Therefore, the evolution of the H1N1 over the summer will be closely monitored. The current H1N1 has already acquired tandem human H1N1 polymorphism in HA, which may have led to the species jump from swine to human.
Thus, the efficient transmission from swine to human and vice verse, raises concerns that further adaptation to humans can lead to a fall pandemic similar to 1918. The species jump indicates the virus can adapt to a new host, and additional acquisitions over the summer continue to be a cause for concern.
Well, I went to an urgent care clinic this evening, as I've had a severe sore throat, and nasal congestion since yesterday, with some coughing (probably from post nasal discharge). Ordinarily I wouldn't have sought care for those symptoms until respiratory s/s occurred.
Since I read that Tamiflu isn't effective if started more than 48 hours into a flu, I wanted to be tested and on it, if needed. The doctor told me that the swab revealed no H1N1, but commented that they usually don't, until the 3rd or 4th day of the illness. That creates a dilemma........ Have you heard that, Indigo Girl? What do you think?
I realized that I needed to walk my talk as a former IC Nurse, so I asked for a mask when I went into the clinic (which got me into an examining room pretty quickly). The doctor wanted me to remove it, laughing. I understood that since it wasn't an N95 mask, the likelihood of it sparing anyone my germs was low, especially when the moisture formed by the air I breathed out, would project the virus more than without it.
The reason for my heightened concern, is that I'm recovering from a serious upper GI hemorrhage, for which I received 2 units of packed red cells 10 days ago. I may have less resistance to infection now. If you've read any of my rants about the care I got in hospital, you have some idea of the stress I was under.....
This must be the new US vaccine plant mentioned by the WHO in their press conference this afternoon. They may be using this plant for a vax for the new Type A, H1N1 very shortly.
The Sweetwater, Pa., facility is owned and operated by Sanofi Pasteur, which is already the nation's largest seasonal flu vaccine producer and manufactures the only prepandemic H5N1 avian influenza vaccine for the nation's Strategic National Stockpile.
Jesse Goodman, MD, MPH, the FDA's acting chief scientist and deputy commissioner for scientific and medical programs, said in a press release today that increased capacity for influenza vaccines is critical for pandemic preparedness as well as seasonal influenza. "Thanks to strategic investments by the federal government and proactive efforts and engagement by the FDA and the vaccine industry, our nation's preparedness has come a long way over the last 5 years," he said.
Sanofi will use the new facility to make Fluzone, the company's egg-based influenza vaccine. It completed construction of the new $150 million, 140,000-square-foot plant in July 2007 and said it had hoped to bring the facility online by late 2008 or early 2009, according to a company press release in 2007.
In 2007 the US Department of Health and Human Services (HHS) awarded Sanofi a $77.4 million grant to retrofit existing vaccine production facilities and keep them ready for 2 years to produce pandemic flu vaccines, with an option to extend the time to 5 years, according to previous reports. Sanofi had said it hoped to complete the retrofitting by late 2010. The company contributed $25 million toward the renovation of its existing plant.
Construction of Sanofi's new facility was designed to add capacity for 100 million doses of seasonal flu vaccine each year, while the renovation was expected to add production capacity of about 50 million doses each year.
When the HHS awarded the contract to Sanofi, it also awarded a similar retrofitting contract for $55.1 million to MedImmune, Inc. The department's goal in boosting capacity at the two plants was to allow them to produce 100 million doses of a pandemic vaccine within 6 months of the start of a pandemic.
Well, I went to an urgent care clinic this evening, as I've had a severe sore throat, and nasal congestion since yesterday, with some coughing (probably from post nasal discharge). Ordinarily I wouldn't have sought care for those symptoms until respiratory s/s occurred.
Since I read that Tamiflu isn't effective if started more than 48 hours into a flu, I wanted to be tested and on it, if needed. The doctor told me that the swab revealed no H1N1, but commented that they usually don't, until the 3rd or 4th day of the illness. That creates a dilemma........ Have you heard that, Indigo Girl? What do you think?
I realized that I needed to walk my talk as a former IC Nurse, so I asked for a mask when I went into the clinic (which got me into an examining room pretty quickly). The doctor wanted me to remove it, laughing. I understood that since it wasn't an N95 mask, the likelihood of it sparing anyone my germs was low, especially when the moisture formed by the air I breathed out, would project the virus more than without it.
The reason for my heightened concern, is that I'm recovering from a serious upper GI hemorrhage, for which I received 2 units of packed red cells 10 days ago. I may have less resistance to infection now. If you've read any of my rants about the care I got in hospital, you have some idea of the stress I was under.....
I'm sorry that I did not see your post until now.
The data I have is mostly related to H5N1, bird flu with its CFR of over 60%. The first 48 hours is when Tamiflu is most effective for that virus. It is probably the same for H1N1, but since this virus has for the most part been mild, perhaps there is no sense of urgency.
Clinicians working in countries where H5N1 is endemic will frequently put patients on Tamiflu if they present with those s/s associated with it even if the test is negative because they know that there are frequent false negatives. Those public health practioners at Effect Measure are saying that about 50% of the tests here are incorrectly reading negative when the patient actually has the disease, and they are talking about seasonal flu. So, go figure.
indigo girl
5,173 Posts
Egypt: Pig farmers clash with police
http://crofsblogs.typepad.com/h5n1/2009/05/egypt-pig-farmers-clash-with-police.html
A few days ago we heard that Egypt is killing all 300 thousand pigs. Obviously, the farmers are not going to be happy. They are in fact fighting back.
Here is also the explanation of who is raising pigs in a predominantly Muslim country.