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.
laboratory-confirmed cases of new influenza a(h1n1) as officially reported to who by states parties to the international health regulations (2005)
{the following is a different format from the one in the article i copied. the 4 figures following the names of the countries surveyed, represent: 1st, # of cases, 2nd,# of deaths in past. the next 2 numbers are: 3rd, # of additional cases since the first 2 figures were reported; and 4th, # of additional deaths. for example, argentina had 5 cases, 0 deaths and then updated data showed an additional 3 cases were reported, with 0 deaths. it's important to take those numbers with "a grain of salt", as not all people who become ill are tested, or they're tested too soon for a positive result.}
country cumulative total newly confirmed since the last reporting period cases deaths cases deaths argentina 5 0 3 0 australia 19 0 3 0 austria 1 0 0 0 belgium 7 0 0 0 brazil 9 0 0 0 canada 921 1 116 0 chile 74 0 30 0 china 20 0 5 0 colombia 16 0 3 0 costa rica 33 1 5 0 cuba 4 0 0 0 denmark 1 0 0 0 ecuador 24 0 14 0 el salvador 6 0 0 0 finland 2 0 0 0 france 16 0 0 0 germany 17 0 0 0 greece 1 0 0 0 guatemala 4 0 0 0 honduras 1 0 0 0 iceland 1 0 0 0 india 1 0 0 0 ireland 1 0 0 0 israel 8 0 0 0 italy 19 0 0 0 japan 350 0 5 0 korea, republic of 21 0 18 0 kuwait 18 0 0 0 malaysia 2 0 0 0 mexico 4174 80 0 0 netherlands 3 0 0 0 new zealand 9 0 0 0 norway 4 0 0 0 panama 76 0 0 0 peru 27 0 2 0 philippines 2 0 1 0 poland 3 0 0 0 portugal 1 0 0 0 russia 2 0 1 0 spain 136 0 3 0 sweden 3 0 0 0 switzerland 3 0 0 0 thailand 2 0 0 0 turkey 2 0 0 0 united kingdom 137 0 15 0 united states of america 6764 10 212 1 grand total 12954 92 439 1
chinese taipei has reported 4 confirmed cases of influenza a (h1n1) with 0 deaths. cases from chinese taipei are included in the cumulative totals provided in the table above.
cumulative and new figures are subject to revision
[color=gray][color=gray]govdelivery, inc. sending on behalf of the u.s. department of health & human services - 200 independence avenue sw - washington dc 20201 - 1-877-696-6775
estimates of emergency department capacity: united states, 2007
by linda f. mccaig, m.p.h., jianmin xu, m.s., and richard w. niska, m.d., m.p.h., f.a.c.e.p., division of health care statistics
in 2006, the institute of medicine (iom) released a report titled "hospital-based emergency care: at the breaking point," which identified weaknesses in the nation’s ability to respond to large-scale emergency situations, whether disease outbreaks such as pandemic influenza, naturally occurring disasters, or acts of terrorism (1). over the last several decades, the role of emergency departments (eds) has expanded from treating seriously ill and injured patients to providing urgent unscheduled care to patients unable to gain access to their providers in a timely fashion and to providing primary care to medicaid beneficiaries and persons without insurance. eds are now frequently overloaded. one of the most common factors related to ed crowding is the inability to transfer ed patients to an inpatient bed once a decision has been made to admit them (2). as the ed begins to "board" patients, the space, the staff, and the resources available to treat new patients are further reduced. a consequence of overcrowded eds is ambulance diversion, in which eds close their doors to incoming ambulances. the resulting treatment delay can be catastrophic for the patient. approximately 500,000 ambulances are diverted annually in the united states (i.e., one ambulance diversion per minute) (3).
the national hospital ambulatory medical care survey (nhamcs), inaugurated in 1992, is the longest continuously running nationally representative survey of hospital ed utilization. the nhamcs is conducted by the centers for disease control and prevention’s national center for health statistics (nchs). this health e-stat provides ed level estimates for items that were added to the 2007 nhamcs hospital induction interview in response to the iom report (1).
although large eds (annual visit volume greater than 50,000) in metropolitan statistical areas (msas) comprised 17.7 percent of eds (data not shown), they accounted for 43.8 percent of all ed visits (figure). the implication is that small eds (annual visit volume less than 20,000) may not experience crowding and, therefore, have little need for some of the techniques suggested in the iom report. the iom recommendations are particularly important for large, urban eds, which experience higher visit volumes.
about one-half of all hospitals with eds had a bed coordinator or bed czar, 58.2 percent had elective surgeries scheduled 5 days a week, and 66.1 percent had bed census data available instantaneously (table). electronic medical records (emrs), either all electronic or part paper and part electronic, were used in 61.6 percent of eds. emr systems have also been defined as basic (patient demographics, problem lists, clinical notes, orders for prescription, and viewing laboratory and imaging results) or fully functional (prescription orders sent electronically, warnings of drug interactions or contraindications, orders for tests, out-of-range test levels highlighted, medical history and followup, and reminders for guideline-based interventions in addition to the basic elements) (4). basic emr systems were reported by 14.9% of eds (data not shown); however, the estimate for fully functional emr systems was unreliable.
more than one-third of eds had an observation or clinical decision unit. admitted ed patients were "boarded" for more than 2 hours in the ed while waiting for an inpatient bed in 62.5 percent of eds. among eds that "boarded" patients, 14.8 percent used inpatient hallways or another space outside the ed when it was critically overloaded. in the previous 2 years, 24.3 percent of eds increased the number of standard treatment spaces. although 19.5 percent of eds expanded their physical space in the last 2 years, 31.5 percent of those that did not expand their physical space plan to do so within the next 2 years. the frequency of use of ed patient care techniques was as follows: bedside registration (66.1%), computer-assisted triage (40.0%), zone nursing (35.3%), electronic dashboard (35.2%), separate fast track unit for nonurgent care (33.8%), "pool" nurses (33.2%), full capacity protocol (21.1%), and radio frequency identification tracking (9.8%).
the table presents estimates of ed characteristics by ed visit volume and msa status. when compared with small eds, large eds were more likely to have a bed coordinator in their hospitals (71.2% compared with 33.8%); have an observation or clinical decision unit (53.5% compared with 32.5%); "board" patients for more than 2 hours in the ed while waiting for an inpatient bed (86.5% compared with 39.0%); and use bedside registration (89.0% compared with 54.2%), computer-assisted triage (62.2% compared with 24.3%), and zone nursing (61.9% compared with 19.0%).
eds with over 20,000 annual visits comprised 70.5 percent of eds in msas. when compared to eds in non-msas, eds in msas were more likely to have a bed coordinator or bed czar in their hospital (60.7% compared with 30.0%) and "board" patients for more than 2 hours in the ed while waiting for an inpatient bed (77.4% compared with 32.8%).
institute of medicine. hospital-based emergency care: at the breaking point. washington, dc: national academy press. 2006.
general accounting office. hospital emergency departments: crowded conditions vary among hospitals and communities. washington, dc: general accounting office. 2003.
burt cw, mccaig lf, valverde rh. analysis of ambulance transports and diversions among u.s. emergency departments. ann emerg med 47(4):317-326. 2006.
desroches cm, campbell eg, rao sr, donelan k, ferris tg, jha a, et al. electronic health records in ambulatory care -- a national survey of physicians. n engl j med 359:50-60. 2008.
Usually the outcome is better for toddlers which these kids are not. No one knows why but some older kids and the majority of adults do not do well.
Despite, and maybe because of the swine flu pandemic (dare I call it that?), bird flu is important to watch. There is a definite possibility of the two flu viruses exchanging genetic material in a host co-infected with both. That scenario could result in a very transmissible, and very deadly virus, at least to young adults though maybe not to toddlers...
Two four-year-old Egyptian children have contracted the highly pathogenic H5N1 bird flu virus, raising to 76 the number of cases reported in Egypt, the state news agency MENA reported on Tuesday.
Egypt has been hit harder by bird flu than any other country outside Asia and has seen a surge of cases in recent weeks.
The children, a boy and girl, were from different areas of Sharkiya province in the Nile Delta region. Both fell ill after coming into contact with birds with the virus.
Bird flu is alarming enough, but now to find that this virus can survive in the carcasses in landfills for almost 2 years is too much.
I am wondering how are the Egyptians going to dispose of those 400,000 swine that they insist on slaughtering? H5N1 is endemic in Egypt. Is it possible that at least some of the swine were carrying bird flu? We will never know...
Hundreds of millions of chickens and ducks infected with the virus have died or been culled from flocks worldwide in efforts to control the disease. More than 4 million poultry died or were culled in a 2002 outbreak in Virginia, and the carcasses were disposed of in municipal landfills. Until now, few studies have directly assessed the safety of landfill disposal.
"The objectives of this study were to assess the survival of avian influenza in landfill leachate and the influence of environmental factors," says the report. The data showed that the virus survived in landfill leachate-liquid that drains or "leaches" from a landfill-for at least 30 days and up to 600 days. The two factors that most reduced influenza survival times were elevated temperature and acidic or alkaline pH.
"Data obtained from this study indicate that landfilling is an appropriate method for disposal of carcasses infected with avian influenza," says the study, noting that landfills are designed to hold material for much longer periods of time.
I am wondering how are the Egyptians going to dispose of those 400,000 swine that they insist on slaughtering? H5N1 is endemic in Egypt. Is it possible that at least some of the swine were carrying bird flu? We will never know...
It was my understanding that the slaughter was carried out to 'keep the peace', as it were, since the non-Christian community views pigs as unclean, thus a path of disease. The meat was to be frozen and preserved, and later sold back to the Christian community so that the pig farmers would not have complete losses.
It was my understanding that the slaughter was carried out to 'keep the peace', as it were, since the non-Christian community views pigs as unclean, thus a path of disease. The meat was to be frozen and preserved, and later sold back to the Christian community so that the pig farmers would not have complete losses.
I have heard that also, but obviously we are talking lots and lots of animals. And, the following link seems to be saying that many are being buried sometimes alive in pits. It's a very sad, sad story. I am not going to highlight this article. It's too gruesome.
It's very painful. I hate feeling helpless to stop suffering, especially in animals. I'd say more, but it's a very emotional topic for me.
On the subject of these "underlying conditions" that we're seeing so much talk of, apparently a Dr. Thomas Frieden gave a list of conditions that are considered when reporting possible swine flu deaths. Here's the NYT article that discusses that:
The article lists health problems that are common, such as asthma, diabetes, heart disease, obesity, high blood pressure, and lung disease, liver disease, or kidney disease. HIV is an underlying condition, as is pregnancy, and being younger than 2 or older than 65. Others: sickle-cell anemia, severe mental problems, seizure disorders, and neuromuscular disease.
The chief underlying conditions, though, are 1) decreased lung capacity (or decreased capacity for oxygen in the blood) and 2) suppressed immune system. Apparently, what they're saying is that if these two conditions are present, a death from swine flu could be called a death complicated or even caused by an underlying condition.
And, as I was telling someone a week or two ago, I don't know anyone who is 100% healthy 100% of the time. That person would be an anomaly and would probably be studied in a lab somewhere. The thing is, I don't know anyone who doesn't have some problem, or hasn't had some problem. It's kind of sad, really, but it's a fact of life.
And, as I was telling someone a week or two ago, I don't know anyone who is 100% healthy 100% of the time. That person would be an anomaly and would probably be studied in a lab somewhere. The thing is, I don't know anyone who doesn't have some problem, or hasn't had some problem. It's kind of sad, really, but it's a fact of life.
Influenza could be almost anywhere, I guess. Crazy...
The natural reservoir for most influenza viruses is birds, especially aquatic birds, but some versions of the virus have also become adapted to the host cells of other species, among them sea mammals, horses, dogs and of course pigs and humans (among others). How long is the list? We really don't know, as there has been little systematic inquiry into influenza hosts in the natural world. While human influenza is seasonal in the northern and southern hemispheres, where it goes in the "off season" is a matter of debate. Most flu experts think it remains at low levels in the community, spiking to outbreak levels during "flu season" for reasons that are yet to be agreed upon. Another possibility is that it remains in some unidentified non-human reservoir. And there is surprisingly little information about influenza in tropical climes (see this interesting piece by Declan Butler in Nature).
A paper just published in Emerging Infectious Diseases is a stark example that the virus could exist almost anywhere. The paper describes an outbreak with a human seasonal H1N1 virus in a colony of Myrmecophaga tridactyla, more popularly known as The Giant Anteater:
In announcing this week that swine flu had been implicated in the deaths of two more New Yorkers, the city's health commissioner, Dr. Thomas R. Frieden, added a by-now familiar caveat: Both of them, he said, had "underlying conditions."
He went on to enumerate a list of conditions that could aggravate the effects of swine flu and that characterize a large portion of New York's population: diabetes, asthma, heart disease, lung disease, a weakened immune system and, possibly, obesity.
He did not even mention three other risk factors that alone apply to more than 1.2 million New Yorkers and 50 million Americans: pregnancy, being younger than 2, or being older than 65.
About 50 percent of swine flu hospitalizations globally and about 70 percent of those in the United States seem to involve underlying conditions. Besides Dr. Frieden's list, they include anything that makes it difficult for patients to clear their lungs, which can include some severe mental problems, seizure disorders or neuromuscular disease.
They include chronic heart, liver and kidney disease; suppressed immunity, whether caused by H.I.V. or drugs taken by cancer or transplant patients; and blood diseases like sickle-cell anemia, which lowers the blood's ability to carry oxygen.
About 400,000 New Yorkers have asthma, the city's most common chronic childhood illness; about 700,000, or 12.5 percent of adults, have diabetes; about 100,000 have H.I.V.; about 17,000 women are pregnant at any time, a conservative estimate, and about 900 people have tuberculosis, another risk factor, according to 2008 city statistics.
There are about 1 million New Yorkers older than 65 (although there is some evidence that people born before 1957 may have antibodies to H1N1) and 228,000 younger than 2. Obesity-which the federal Centers for Disease Control and Prevention suspect may play a role because it can impede lung functioning and immune responses-is practically epidemic. One-third of adult Americans and more than 1 million adults and teenagers in New York City are considered obese, but those with severe obesity are considered more at risk.
"We were surprised by the frequency of obesity among the severe cases that we've been tracking," Dr. Anne Shuchat, the centers' director of immunization and respiratory disease, said at a May 19 press conference.
The centers' officials have said that pregnancy is a risk factor because it suppresses the immune system to protect the fetus and can decrease lung capacity.
Compounding the anxiety is that public health officials, citing medical confidentiality, have refused to disclose not just the identities of those who have died but even the most basic information about their health conditions.
Judy Trunnell, 33, a teacher from South Texas, was the first American citizen to die of swine flu, in early May, after delivering a healthy baby girl by Caesarean section. A Texas Health Department spokeswoman said she had "chronic underlying health conditions," which her husband, Steven, later denied on CNN.
More details came to light a week later through a routine scientific study, a weekly "Morbidity and Mortality" report by the federal disease centers. Without using her name, it said she had a history of psoriasis (not considered an underlying condition) and mild asthma, in addition to her pregnancy.
Warnings about underlying conditions appeared to be propelling people toward bursting emergency rooms.
Such anxiety has been a headache for doctors. They say that people with underlying conditions who have flu symptoms should consult their doctors, but that visiting an emergency room full of sick people may actually put them in more danger.
"Like the asthmatics, we'd really prefer that pregnant women would stay away from the emergency departments," said Dr. Steven J. Davidson, the chairman of the hospital's emergency medicine department.
The Egyptian Health Ministry confirmed on Saturday the 77th infection case with H5N1 virus.
A female baby, aged one year and two months, contracted the highly pathogenic virus because she got in contact with domestic birds in a village located in Daqahliya, north Cairo, the ministry's spokesman Dr. Abdulrahman Shahin said in a press briefing.
The baby was hospitalized five days ago, suffering from bird flu-like symptoms including high temperature, running nose, and respiratory disorder.
She was diagnosed as H5N1 positive so she has been treated with the antiviral drug Tamiflu, Dr. Shahin revealed.
The victim is being relocated to Manshiyat Al-Bakri Hospital, Cairo, for further medication, he added.
The case pushed to 77 Egypt's national tally of the fatal disease with the death toll amounting to 27 since the outbreak of the highly contagious virus in February, 2006.
![map of the spread of influenza a(h1n1): number of laboratory confirmed cases and deaths [jpg 1.35mb]](http://links.govdelivery.com/track?type=click&enid=bwfpbgluz2lkptq4odmxmcztzxnzywdlawq9ufjelujvtc00odgzmtamzgf0ywjhc2vpzd0xmdaxjnnlcmlhbd0xmje1ndk5mtyzjmvtywlsawq9bg9pc19rbgvpbkb5ywhvby5jb20mdxnlcmlkpwxvaxnfa2xlaw5aewfob28uy29tjmv4dhjhpsymjg==&&&101&&&http://www.who.int/entity/csr/don/globalsubnationalmaster_20090526_0800.jpg){kind=link}
CrunchRN, ADN, RN
4,556 Posts
I do wonder if now people will be to complacent.....................