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.
This is from the blog of Dr. Vincent Racaniello, a virologist at Columbia commenting Type A, H1N1:
With the exception of a few countries, the vast majority of confirmed cases have been in the northern hemisphere. I suspect this situation will change rapidly - flu season is winding down in the northern hemisphere, and is about to begin in the south. The fact that there are already confirmed cases in the southern hemisphere means the virus is already there, and likely to spread further.
Infection with the new H1N1 strain might have begun as early as March 11, although the early cases are suspected, not laboratory confirmed. After a period of relatively few infections, the number of cases rapidly climbed to a peak and then quickly declined. Of course, new outbreaks are still possible. If we take the number of deaths in Mexico (42) and divide them by the number of laboratory confirmed cases (949), the mortality rate is 4.4% - higher than the 2.5% observed during the 1918-19 pandemic. However, if we divide the number of deaths by the number of suspected cases (11,932), the fatality rate is more in line with typical seasonal influenza - 0.4%. Which number is correct awaits determination of the actual number of cases.
Just about anyone who studies influenza worries about this happening. Is this a possibility? Yes, it is.
Preventing the swine flu that is spreading across the globe from infecting patients sick with the deadly H5N1 avian flu should be a top priority, especially in Asia, top experts said Thursday.
If both viruses wind up in the same individual, they could mix genes and mutate into a form that is both very pathogenic and easily transmitted among humans, said John Oxford, a virologist at London Queen Mary's School of Medicine and Dentistry.
"We don't want a situation where you have a virus with the spreadibility of the pig virus with an H5 stuck on it. That is something we worry about, to put it mildly," he said in a phone interview.
But while the strain has killed almost 60 percent of those infected, it does not spread easily — virtually all its victims had extensive, direct contact with poultry.
By contrast, the swine flu that erupted in Mexico this spring has moved across the globe much more quickly, but thus far has not proved especially lethal.
The nightmare scenario for virologists is a mutated virus combining high infection potential and virulence.
"The danger of a genetic recombination is real, in animals and in humans — this is something we fear," said Pierre Duplessis, Special Envoy for pandemic influenza at the International Federation of Red Cross and Red Crescent Societies.
Duplessis and other experts caution that it is far too early to "declare victory" against the swine flu, even though its spread appears to have slowed.
All three of the great pandemics of the 20th century, they point out, began with mild "herald waves" in the spring that were followed by far more deadly attacks later in the year. –AFP
Guan Yi is the virologist who discovered where the SARS virus was hiding, tracking it into the wet markets of China. He found it carried by the palm civet cat, considered a delicacy in the Wild Flavor restaurants of China. His research was the key to halting the spread of SARS.
Here are some quotes from him regarding Type A, H1N1 mixing with H5N1.
"In the 1918 pandemic, the first wave was mild, but by fall, the second wave killed many people. So whichever way this virus swings, we can't possibly know," said Guan Yi, a microbiologist at the University of Hong Kong.
"At this point, chances are it will be mild, but we can't rule out it will turn virulent. And even if it turns milder, it can still kill,
Guan Yi said that if it spread to Egypt or Indonesia, where H5N1 bird flu is endemic, it might combine with that virus.
"It could turn into a very powerful H5N1 that is very transmissible among people. Then we will be in trouble, it will be a tragedy."
John Barry is the author of The Great Influenza: The Epic Story of the Deadliest Plague in History. He talks with Steve Inskeep about the lessons learned from how the world responded to that crisis.
I've read Barry's book, I'd recommend it to anyone who wants to learn about the forgotten pandemic. Hopefully we won't repeat the mistakes made last time around.
The Great Influenza: The Epic Story of the Deadliest Plague in History.
Bird flu kills more than 60 per cent of its human victims, but it doesn't easily pass from person to person.
Swine flu can be spread with a sneeze or a handshake, but it kills only a small fraction of the people it infects.
So what happens if they mix?
The scenario is a concern for scientists: The two viruses meet-possibly in Asia, where bird flu is endemic-and combine into a new bug that is both highly contagious and lethal and can spread around the world. Experts are unsure how likely this possibility is, but many note that the new swine flu strain-a never-before-seen mixture of pig, human and bird viruses-has shown itself to be especially adept at snatching evolutionarily advantageous genetic material from other flu viruses.
"This particular virus seems to have this unique ability to pick up other genes," said leading virologist Dr. Robert Webster, whose team discovered an ancestor of the current flu virus at a North Carolina pig farm in 1998.
"Do not drop the ball in monitoring H5N1," WHO Director General Margaret Chan told a meeting of Asia's top health officials in Bangkok today by video link. "We have no idea how H5N1 will behave under the pressure of a pandemic."
Experts have long feared that bird flu could mutate into a form that spreads easily among people. The past three flu pandemics-the 1918 Spanish flu, the 1957-58 Asian flu and the Hong Kong flu of 1968-69-were all linked to birds, though some scientists believe pigs also played a role in 1918.
Dr. Webster, who works at St. Jude's Children's Research Hospital in Memphis, Tenn., said bird flu should be a worry now. Bird flu is endemic in parts of Asia and Africa, and cases of swine flu have already been confirmed in South Korea and Hong Kong.
"My great worry is that when this H1N1 virus gets into the epicentres for H5N1 in Indonesia, Egypt and China, we may have real problems," he said. "We have to watch what's going on very diligently now."
Malik Peiris, a flu expert at Hong Kong University, said the more immediate worry is that swine flu will mix with regular flu viruses as flu season begins in the Southern Hemisphere. It is unclear what such a combination would produce.
But he said there are indications the scenario is possible. Mr. Peiris noted that the swine flu virus jumped from a farm worker in Canada and infected about 220 pigs. The worker and the pigs recovered, but the incident showed how easily the virus can leap to a different species.
Michael Osterholm, an infectious disease specialist at the University of Minnesota who has advised the U.S. government on flu preparations, said while flu experts are discussing the scenario, he has yet to see specific evidence causing him to think it will happen.
"Everything with influenza is a huge guessing game because Mother Nature holds all the rules, and we don't even know what they are, so anything's possible," he said. "We don't have any evidence that this particular re-assortment is that much more likely to pick up H5N1 than any other re-assortment out there."
The H1N1 (swine flu) crisis reminds us that each day, the nation's front-line health care workers are the foundation upon which our health care system is built. As Jordan Barab, the acting head of the Occupational Safety and Health Administration (OSHA), told the U.S. House Education and Labor Committee yesterday:
If they are not able to work due to illness, or unwilling to work due to fears for their health, individual patients and the country's entire health care structure will suffer.
The Centers for Disease Control and Prevention (CDC) says it is currently investigating 26 cases of swine flu in health care workers. The CDC and OSHA have developed guidelines for employers and workers to minimize work-related exposure to the swine flu virus. Click here and here for more information. Also, check out resources for health care workers, educators, firefighters and more at the AFL-CIO's pandemic flu site.
In April, a report by the AFL-CIO and several unions, including the United American Nurses (UAN), revealed that health care workers are at risk because many of the nation's health care facilities are not prepared to deal with a pandemic. The committee's chairman, Rep. George Miller, also said anther recent survey of nearly 200,000 U.S. health care workers found that
57 percent of these workers had not been provided training on pandemic flu. More than half of these workers felt that their facility was not "ready for most things" that could arise in a flu pandemic. And only 33 percent thought that most health care workers would report to work during an actual flu pandemic.
Protecting these workers will preserve our surge capacity to treat the infected.
Last month, the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) issued a pandemic action plan to promote containment and prevent an outbreak of the swine flu.
I found it interesting that another source of information recommended regular face masks for patients with A/H1N1, and respirator/N95 ones for health care workers.
It stands to reason that the face mask acts as a tissue to avoid splatter of microorganisms when coughing or sneezing, and the N95 filters the infectious particles out.
The N95 it said in the description of how to apply it and take it off, is not to be used more than once. The front of it should not be touched when putting it on or taking it off, just the elastic attachments.
It interfers with one's ability to work, oine article said. There was a picture of someone wearing it and trying to work at a desk, who said he felt hot with it on.
I found it interesting that another source of information recommended regular face masks for patients with A/H1N1, and respirator/N95 ones for health care workers.
It stands to reason that the face mask acts as a tissue to avoid splatter of microorganisms when coughing or sneezing, and the N95 filters the infectious particles out.
The N95 it said in the description of how to apply it and take it off, is not to be used more than once. The front of it should not be touched when putting it on or taking it off, just the elastic attachments.
It interfers with one's ability to work, oine article said. There was a picture of someone wearing it and trying to work at a desk, who said he felt hot with it on.
I received a letter from my employer today. The last paragraph said:
Visitors who come to the hospital with fever or other flu s/s will be instructed to wear masks and to wash their hands frequently.
Isolation precautions will be used for those patients wioth suspected or confirmed cases of flu.
Conserve supplies of N-95 mask - when caring for a patient with TB, a mask can be removed and re-used for up to 12 hours. This can't be done for flu patients so conserving our supply now will be helpful.
As more and more countries become able to test for the new A/H1N1 virus, the number of confirmed cases (and countries affected) continues to rise.
This morning, the `confirmed count' is 3440 people in 29 countries. Twenty-four hours ago, those numbers were 2384 cases in 24 countries.
While the virus is still, obviously, spreading - this nearly 50% jump in cases in one day really reflects that many backlogged test results are coming available.
And of course, the number of cases being reported here are just the confirmed cases. If you add in probable and suspected cases, the numbers escalate greatly.
Scott McPherson is the Chief Information Officer of the Florida House of Representatives.
I agree with he is saying here, and I am thinking that maybe the Egyptians are right much as I disliked their plan to slaughter all of these animals. And, what will they do with the 300,000 carcasses?
What I want to talk about now is the situation in Egypt, and why the Egyptian government made the controversial move to slaughter all its pigs virtually overnight. Something feels Biblical in that decision, you know. It was met with hostility and violent demonstrations across the nation. Only Christians eat pork there, and the hogs slaughtered were destined only for Egyptian Christian dinnertables.
But I believe the Egyptian government had its own experience and that of Indonesia on its mind when it made the decision. The Egyptian government has been looking for a reason to wipe out the hog population since 2008, because there was and is growing concern that Egyptian pigs had become reservoirs for H5N1.
...The Egyptian government is scared to death that H1N1 will come around and reassort with H5N1, which they believe to possibly be endemic in their pig population. And if you look at the continuing increase in suspected and confirmed Egyptian H5N1 human bird flu cases, I think you'd agree there is much to be concerned about.
Likewise, the situation in Indonesia and in China also involoves informed speculation on behalf of animal and human influenza researchers that H5N1 may have made a small foothold in the hog populations there. Especially Indonesia, which remains Bird Flu Central for human cases and potential pandemic explosion, despite the competition from ongoing Egyptian human infections. Researchers already know that some 20% of the stray cat population in Indonesia has H5N1 antibodies. Likewise, some hogs in Indonesia have tested positive for H5N! antibodies. From the Website FluWiki, from2006:
Cat H5N1 sequences in Indonesia are apparently more similar to H5N1 sequences from humans than either are to H5N1 sequences from birds. What is the most logical interpretation of these results? I submit that there may be a mammalian reservoir for H5N1 in Indonesia and other countries and that H5N1 is under selection to adapt to mammals in this reservoir. Further, at least some of the human cases may be due to mammal-to-human infections. (See also Dr. Jeremijenko's post at 23:14 in this thread, and here and here). In the recent large cluster of human cases in Indonesia, no infections of poultry were found in close proximity to the village where the outbreak occured. However, pigs with antibodies to H5N1 were found in this region reference. H5N1 infections in pigs would be particularly worrisome as these animals could serve as mixing vessels for the formation of a human-adapted H5N1 strain. (bold mine)
That is what everyone is worried about. That is the Elephant in the Room. That is why no one in Geneva, Atlanta or anywhere else is overreacting about this swH1H1 epidemic.
here it is! from eurosurveillance volume 18 issue 14
there is increasing concern that undetected h5n1 cases may be
occurring in egypt, given the evident anomalies in observed age-
specific and sex-specific case incidence {female}and fatality rates. although there appears to be no compelling evidence for human-to-human transmission of h5n1 in egypt, family clusters have been observed inegypt, and h5n1 clusters involving highly probable human-to-human transmission have been documented in china, thailand, viet nam, indonesia, and pakistan
[7].
with the theory that egyptian pigs have been and are reservoirs for h5n1, their action to kill all their swine is validated and appreciated!
Investigators from the Centers for Disease Control and Prevention (CDC) and state and local public health agencies have released detailed clinical information on the first 642 US cases in the current swine-origin influenza A (H1N1) virus outbreak.
The results, published online May 7 in the New England Journal of Medicine NEJM), show that in addition to the common influenza signs of fever, cough, and sore throat, one fourth of cases present with diarrhea and another one fourth present with vomiting.
Clinicians and patients should therefore be on the lookout for cases bearing both the customary signs of seasonal influenza and atypical gastrointestinal signs, said lead author Fatima S. Dawood, MD, from the Epidemic Intelligence Service at the CDC, during a media briefing.
The investigators note that "both self-limited illness and severe outcomes, including respiratory failure and death, have been observed among identified patients, a wide clinical spectrum similar to that seen among persons infected with earlier strains of swine-origin influenza viruses."
Genetic analysis shows that the current infections are caused by H1 viruses derived from Eurasian rather than North American swine flu lineages, the authors say.
In a related report, also published online in the NEJM, CDC and state and city health authorities describe a small series of sporadic human influenza cases caused by triple-reassortment viruses that occurred before the current outbreak and that appeared to be transmitted from pigs to humans. They advise clinicians to consider animal influenza when patients present with a febrile respiratory illness and recent history of exposure to swine, poultry, or wild birds. They caution that sporadic cases of triple-assortment influenza infections in humans who have had contact with pigs may be sentinels for a larger outbreak.
Although the 2 groups of viruses behave very differently in their infective potential, "both viruses are H1 hemagglutinin viruses, which appeared in humans and swine in 1918 and have subsequently evolved, in both species, into divergent H1 viruses," writes Robert B. Belshe, MD, from the Division of Infectious Diseases and Immunology at Saint Louis University in Missouri, in an accompanying editorial.
"The current situation is not '1918 again,' it is '1918 continued,' in that we are still being infected with remnants of the 1918 pandemic influenza virus," Dr. Belshe writes.
The discussion of the sporadic outbreaks in the article is unnerving. If anyone can't read the entire article, please PM me and I'll send it to you. I don't want to post it here, due to copyright concerns.
indigo girl
5,173 Posts
http://www.virology.ws/2009/05/07/influenza-a-mexico-2009-h1n1-update/
This is from the blog of Dr. Vincent Racaniello, a virologist at Columbia commenting Type A, H1N1:
(hat tip crawford kilian)