Pandemic Awareness/Preparation

Nurses COVID

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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.

http://afludiary.blogspot.com/2009/01/hhs-releases-6th-pandemic-planning.html

afludiary.blogspot.com said:

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.

Specializes in Too many to list.

Bird flu in Egyptian children -- it may or may not be "hot air," but it's also something different.

http://www.scottmcpherson.net/journal/2009/4/21/bird-flu-in-egyptian-children-it-may-or-may-not-be-hot-air-b.html

Scott Mcpherson is the CIO of the Florida House of Representatives. He does not post often but when he does he is fun to read, and he does have contact with some very knowledgeable people. As he points out, lots of Tamiflu is being used in Egypt, and we know much more is in use in Indonesia. At this rate, how long will this drug continue to be effective is what I'm wondering...

...the cacophony regarding the possible presence of asymptomatic human carriers was not universal. Far from it: The Pope of Influenza himself, Dr. Robert G. Webster of St. Jude, proclaimed that all this worry was a lot of "hot air." From the New York Times:

"Right now, it's all hot air," said Dr. Robert G. Webster, a flu expert at St. Jude Children's Research Hospital in Memphis. "I hope to hell it's not happening, because it would mean the virus is adapting to humans. But there's not a shred of data."

So, hopefully, Doctor Webster's "hot air" comment will be borne out; because if not, as he says, it would mean the H5N1 virus would have evolved toward H2H transmission. But his tone also suggests he has had the opportunity to personally view samples of the Egyptian virus, as a WHO world-class reference lab. The Egyptian government is refreshingly transparent when it comes to reporting and disclosing bird flu cases and samples.

One thing is absolutely certain: The number of human H5N1 cases in Egypt is double that of the entire year of 2008. It is on track to be the worst year for human H5N1 in Egypt since its introduction in 2006. More than 6,000 Egyptians have been suspected of having H5N1 and were given Tamiflu as a precaution. Egypt is averaging a confirmed human case of H5N1 every six days. At this rate, and even factoring in seasonal fluctuations in the virus' appearance, it will be a long 2009 for the Egyptian government and its people.

Specializes in ER, Labor and Delivery, Infection Contro.

Indigo Girl,

We are out here-paying attention and learning. Your efforts are not wasted! Keep up the good work!!!

alwayslearnin

Mexico Situation

There is currently a serious situation developing in Mexico. Over the past several weeks there has been an increase in influenza-like or respiratory infections. The nature of the infection has not been reported. As many as 30 people may have died of since the beginning of April, most of them have been healthy young people between the ages of 25 and 45. The situation is still fluid but there have been news reports today that as many as 500 health care workers (HCW) in Mexico City may have been sickened, some of them hospitalized and may be on ventilators. There may have even been one death among the HCW.

Translation of local Mexican news reports and discussions can be found at this link at FluTrackers: http://www.flutrackers.com/forum/showthread.php?t=99635

We all need to remember that the next pandemic could start anywhere, not just in some faraway foreign country.

Specializes in Too many to list.

How is your Spanish?

http://www.elmanana.com.mx/notas.asp?id=117125

"Ahorita nos están vacunando y están dando permisos de una semana a los empleados que están enfermos; pero esto ya se volvió una epidemia y creemos que si esto sigue esta semana podríamos tener a más de mil 500 contagiados", manifestó.

As someone over at PFI is saying:

"this could more correctly be translated as "1,500" rather than 500 thousand!" cases if this keeps up.

Looks like they are seriously vaccinating HCW with the current seasonal flu vax which is interesting. They must think it is an influenza after all or why bother? That should give some protection if it is an H1N1 strain, I would hope...

__

Specializes in Clinical Research, Outpt Women's Health.

Wow - if this hits the news people will freak. They are already under the gun economy/tourism wide with the violence from drug cartels.

Almost sounds like the SARS outbreak.

Sure would be nice if they could figure out what is going on for sure.

Specializes in Too many to list.

7 People Mysteriously Contract Swine Flu

http://news.aol.com/health/article/2-kids-mysteriously-contact-swine-Flu/438580

Hat tip to oramar for this update. More cases of swine flu found. Surely some of this are relatives of the two kids? The link does not say. We know that one of the first two cases, was a young that boy travelled with his brother to Texas from California while still sick.

Dr. Anne Schuchat of the CDC said officials believe it can spread human-to-human, which is unusual for a swine flu virus.

The CDC is checking people who have been in contact with the seven confirmed cases, who all became ill between late March and mid-April.

Because of the intensive searching, it's likely health officials will find additional cases, said Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases.

http://www.flutrackers.com/forum/showpost.php?p=220847&postcount=1

The CDC is not making a connection to the cases in Mexico, but then again, they are not saying there is no connection just that they do not have confirmation of a connection. There has not been any organism named yet for what is causing the outbreak in Mexico.

The CDC does not have any confirmation that the illness that has recently caused several deaths in Mexico is swine influenza.

Specializes in Too many to list.

Mexico - Officially, it's an Epidemic

http://crofsblogs.typepad.com/h5n1/2009/04/mexico-flu-is-officially-an-epidemic.html

Too bad my Spanish is so rusty, but crofsblogs has translated this.

[quote=crofsblogs.typepad.com

Via Excelsior, a major Mexico City Daily, a report in Spanish; my rough and ready translation follows between paragraphs. Pide SSA calma ante casos de influenza. [Health department calls for calm in face of influenza.]

[After saying that the influenza is now an epidemic outbreak, but not a pandemic, Health Secretary Jose Angel Cordova admitted that he still doesn't have mortality statistics for the nation, but says this contagious disease has affected at least 7 states in the country.]

Health warning for visitors to Mexico

http://www.thestar.com/News/Canada/article/623074

Meanwhile in Canada, there are ten cases under investigation of folks that had travelled to Mexico, and got sick of a flu like illness.

One of them obviously is Acting City Crown attorney Guy D. Simard noted in my post #104. Remember he ended up on a vent, but did recover. This report says our CDC is helping to investigate the Mexico outbreak so we should hear something eventually about it. Of course, it's not in the US so no hurry, I guess.

Here we have Ontario's acting chief medical officer of health Dr. David Williams being cagey about cases in Canada sort of like the CDC saying that they have no confirmation of the disease in Mexico being related to the swine flu cases in the US. I gather that this means that they don't know enough yet...

"We haven't had any that have been directly tied to it, yet," Williams told reporters this afternoon. "We are heightening our awareness system, and the alertness system and asking our physicians to take any cases seriously."

There is a case in the Cornwall area of a person whose illness is being investigated, Williams said, but added that person has since fully recovered.

"We haven't ruled it out, we haven't ruled it in either, it is under investigation," he said.

Williams said fewer than 10 other cases of illness in Ontario are being investigated for links to the Mexican illness, but would not be more specific. Some of those cases include patients who have already recovered from cold-like symptoms, he said.

The flu-like symptoms that have been reported in young Mexicans from age 25 to 44 start off as severe respiratory problems and become worse as time passes with a high fever that lasts for days, said Williams.

Winnipeg's national microbiology lab and the Centres for Disease Control and Prevention in Atlanta, Georgia, are aiding in the Mexican investigation. "We will get a wide variety of cases reported. That is fine. I would rather have more than less," he said.

Swine flu cases in US, mystery ailment in Mexico have experts scrambling

http://www.google.com/hostednews/canadianpress/article/ALeqM5hKrwlM2yh12pNDe6_7gtuplU31Fw

Genetic sequencing done to date reveals a seemingly unique influenza A virus of the H1N1 subtype made up of a distinctive mix of swine, bird and human flu virus genes. There have been no reports of this virus in pigs, said Dr. Marie Gramer, a swine flu expert with the University of Minnesota's college of veterinary medicine.

"It doesn't seem to be very similar to anything that is currently circulating, from what I have," said Gramer, who has an extensive library of swine flu virus isolates.

The CDC said they expect to confirm more cases in coming days as contacts of the cases are checked and doctors and clinics are put on notice the CDC wants samples of flu viruses that can't be identified by standard methods.

They also cautioned they can't currently tell if the events unfolding represent something new or something that happens occasionally but which has gone unnoticed in the past.

No infections with this virus have been found in Canada, Canadian authorities said.

Nor does it seem that any cases of an unusually severe respiratory illness plaguing parts of Mexico have turned up in this country, said Dr. Danielle Grondin, assistant deputy minister for the Public Health Agency of Canada.

One person from Ontario was ill after returning from Mexico but Grondin said it seemed unlikely the illness was related to the apparent outbreak, which is affecting mainly young, previously healthy adults.

And she said the National Microbiology Laboratory in Winnipeg is testing samples from Mexico looking for the cause or causes of the illnesses. Samples were also en route Thursday to the CDC's labs in Atlanta, Cox said.

Schuchat said there is no evidence yet that what is happening in Mexico is linked to what is happening in California and Texas.

"At this point, we do not have any confirmations of swine influenza in Mexico. We are working with them in terms of understand what they are seeing clinically as well as the virus characteristics of what they're seeing," she said.

A key test will be to see if any of the samples from Mexico contain the unusual swine flu virus being found in the southeastern United States.

"It will be critical to determine whether or not the strains of H1N1 isolated from patients in Mexico are also swine flu," said Dr. Donald Low, an infectious diseases specialist at Toronto's Mount Sinai Hospital.

Specializes in Too many to list.

The Reveres on The evolving Swine Flu story

http://scienceblogs.com/effectmeasure/2009/04/the_evolving_swine_flu_story.php

None of the cases gives a history of contact with pigs, so together with the two "doubles" (the schoolmates and family pair), this strongly suggests active person to person spread. Moreover, the initial two viruses have been completely sequenced and are very similar. Partial information on some of the additional viruses from California are also similar, which reinforces the idea that the virus is in active circulation. How widely we don't yet know. But this isn't all the news.

It turns out this virus is highly unusual, a quadruple reassortant. The genes of a flu virus are packaged in eight discrete segments. When two flu viruses infect the same host cell, the segments of each are copied and repackaged, 8 at a time, in new viral particles which then bud off from the infected cell. They then may infect a new host cell. In this repackaging process the segments of the two different viruses may mix and match, so that new virus particle will have segments from two different viruses. The new virus is, in a sense, not just a swine flu virus. It does have viral segments characteristic of two different families of swine flu, one typical of North America, where swine flu is endemic, and one typical of pig flu viruses from Europe and Asia. But we learned today that it also has viral segments seen in North American birds and in human seasonal influenza. Which of the segments is a bird segment and which is humans wasn't discussed in today's briefing, but the fact that the genetic sources comprise widely different geographies and species is highly unusual -- unusual at least as far as we know. We have little systematic information on swine viruses, so how common this really is we don't know for sure, nor do we know how recent. The virus is resistant to the older adamantane antivirals but sensitive to both oseltamivir (Tamilfu) and zanamivir (Relenza).

Could this be the harbinger of an influenza pandemic? A pandemic is a global sized outbreak from a single strain of influenza. We believe that there are several necessary conditions for this to happen with influenza. One is the ability of the viral strain to infect humans (there are many influenza viruses but most don't infect humans). Another is the ability to be transmitted from person to person. While bird flu can infect humans, it still has not acquired the ability to spread easily from person to person. Yet another is an influenza virus which is sufficiently different that there is little natural immunity in the human population. As far as I can tell, this virus seems to have all of these characteristics. The most important part, though, is what the virulence of the virus is. Virulence doesn't refer to the ability to cause disease, but the ability to cause severe disease it does cause. We don't yet know how virulent infections with this virus are because there aren't enough cases to make that judgment.

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.

Specializes in Too many to list.

Mexico shuts schools around capital in flu scare

http://ca.reuters.com/article/topNews/idCATRE53N11B20090424

Mexico is initiating mitigation strategies at least in Mexico City, in an attempt to limit the spread of the disease outbreak. This is very sensible. Kids are notorious for spreading infection. Do Mexican kids hang out at the mall? No sense in keeping them out of school if they are just going to congregate elsewhere. I wonder what the working parents are doing. Someone has to be home with the kids so this could have a big economic impact if Mexico is like the US where both parents work if the school closures go on for some time.

Mexico is canceling classes for millions of children in the heart of the country on Friday after influenza killed around 20 people in recent weeks.

Mexican Health Minister Jose Angel Cordoba said schools and universities in Mexico City and the surrounding area would be temporarily closed and advised people with flu symptoms to stay home from work.

"We're dealing with a new flu virus that constitutes a respiratory epidemic that so far is controllable," Cordoba said on Thursday.

Canada's government advised doctors to be on the alert for reports of illness from people who recently traveled to Mexico, although it did not advise against visiting the popular beach vacation destination.

Mexico's flu season normally ends in February or March, but it has extended longer this year, the government said.

"We recommend avoiding places or events with a lot of people unless strictly necessary," Cordoba said in an unusual late-night live statement to media.

About 79 people, possibly ill with the flu, are being treated in Mexico and that number has not increased in recent days, the Health Ministry said.

Specializes in Clinical Research, Outpt Women's Health.

Thanks for the update. I am going to Cozumel in 2 weeks so I am definitely following this closely.

I had a flu shot at the usual time and I wonder if that would still be effective?

Specializes in Too many to list.
Thanks for the update. I am going to Cozumel in 2 weeks so I am definitely following this closely.

I had a flu shot at the usual time and I wonder if that would still be effective?

Better to have it than not have it when you consider the situation with the antivirals available. Swine flu is resistant to amantadine and rimantadine but sensitive to Tamiflu which is locked up in the national stockpile. Almost all of the seasonal flu, in the US this year has been H1N1 which is already resistant to Tamiflu, something like 98%. How long do you think it will take swine flu to develop resistance especially if anyone is co-infected with both types of flu? This is why the Mexicans are using the mitigation strategies which we might well be doing soon here also. We cannot give everyone prophylactic Tamiflu.

http://chattahbox.com/health/2009/04/24/deadly-outbreak-of-new-swine-flu-in-southwest-us-and-mexico/

The World Health Organisation (WHO) bas confirmed an outbreak of swine flu in the United States and hundreds of human “influenza-like” cases in Mexico, including about 60 deaths.

The U.S. Centers for Disease Control and Prevention said that the virus ‘A (H1N1) flu strain’ was a never-before-seen mixture of viruses typical among pigs, birds and humans. All 7 American patients had recovered.

Like some human strains, it is resistant to two older flu drugs, amantadine and rimantadine. It is not resistant to Tamiflu or Relenza. However, Tamiflu resistance is common in the H1N1 human flu strain circulating this year, so the swine strain could become resistant to Tamiflu if the viruses mixed in humans or, possibly, in pigs.

Specializes in Too many to list.

Egypt: Another human flu death

http://crofsblogs.typepad.com/h5n1/2009/04/another-human-flu-death.html

Her name was Wafaa Abdel Hamid.

A 34 year-old Egyptian woman died of the H5N1 bird flu virus on Thursday, bringing the number of such deaths to 24 and the total of all cases in the country to 68, Egyptian health ministry spokesman Abdul-Rahman Shaheen said.

The spokesman said in a statement that symptoms on the woman started on April 21st where she was admitted to hospital after high temperature fever, adding that the woman was handling dead birds in her neighborhood. However, she was treated with the drug Tamiflu but remained in critical condition until she died, the spokesman added.

Vietnam: Woman dies of H5N1

I am sorry that we do not even know her name. She was only 23.

http://crofsblogs.typepad.com/h5n1/2009/04/vietnam-woman-dies-of-h5n1.html

A woman in northern Vietnam has died from bird flu - the fourth human case in the country this year - a health official said on Friday.

The 23-year-old woman died Wednesday, two days after being admitted to a hospital in Thanh Hoa province, some 150 kilometres south of Hanoi, said Nguyen Huy Nga, director of the Ministry of Health's Preventive Medicine Department.

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