Swine Flu Updates and Issues

Nurses COVID

Published

http://www.washingtonpost.com/wp-dyn/content/article/2009/05/16/AR2009051601850.html?hpid=moreheadlines

The swine-origin influenza A (H1N1) virus that burst into public consciousness a month ago is starting to behave like a mixture of its infamous, pandemic-causing predecessors.

It seems to have a predilection for young adults, as did its notorious ancestor, the 1918 Spanish influenza. Many of the young victims who have become deathly ill turned out to have other medical problems -- a phenomenon first clearly seen with the 1957 Asian flu.

Pandemic flu strains -- and this new H1N1 strain is all but certain to cause the 21st century's first pandemic -- are unpredictable. Any contagious disease that most of the world's 6.8 billion people can catch is inherently dangerous.

"Our message to everybody is, of course, do not over-worry about these things, [but] it is important to know it is serious," the WHO's Keiji Fukuda said last week.

Perhaps the most worrisome features so far are the number and severity of cases in teenagers and young adults. This was noticed early, and the pattern has not changed much now that there are 5,000 laboratory-confirmed infections and probably more than 100,000 overall. The average age of the confirmed and probable cases is 15 years. Two-thirds are younger than 18.

Compared with seasonal outbreaks, all flu pandemics cause a higher percentage of severe cases and deaths in younger groups. Although the overall mortality rate from the current swine flu is low, this trend is already apparent.

Last Thursday, when Fukuda announced that the global death total was 65, he noted that "half of them are healthy people who have no predisposing conditions. This is a pattern different from what we see with normal influenza."

There have been too few deaths in the United States to draw any conclusions. But of the 173 people who have been sick enough to be hospitalized, more than half are in the 5-to-24 age group.

indigo girl

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How Time and Mutations Engineered the New H1N1 Strain

http://www.washingtonpost.com/wp-dyn/content/article/2009/05/10/AR2009051002064.html

The history of H1N1 starting with the 1918 version to today's Swine Flu, and everything you need to know about the language of flu in easy to understand terms.

Once Upon a Time there was a little flu virus. It was probably born in Kansas in late 1917 or 1918, although nobody is really sure. Its name was H1N1. It grew up to be very wicked.

The story of the new strain of swine influenza now circling the world actually starts a lot farther back than the 20th century, but the year the "Spanish influenza" appeared is a good place to start.

From the second week in March 1918, when soldiers at an Army camp in Kansas began to get ill, until the final mini-waves of 1920, the Spanish flu infected about 97 percent of the people on Earth and killed at least 50 million of them.

The virus probably came from waterfowl, which carry dozens of different flu viruses. At some point, either before or after it got into human beings, the virus got into pigs, a species that can be infected by avian and human strains. It has stayed in swines ever since, and in people for almost as long.

indigo girl

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The situation in Japan

http://news.id.msn.com/regional/article.aspx?cp-documentid=3318523

Japan went from a few Swine Flu cases on Saturday to 129 patients by Monday?

Japan said eight high school students had tested positive for swine flu on Saturday amid fears the virus was spreading in schools in at least two cities where scores of students said they felt ill.

The eight confirmed cases were all students at a high school in the western city of Kobe, and another nine school students were considered suspected cases in nearby Osaka city, local officials said.

Prime Minister Taro Aso called on Japan's people to stay level-headed and vowed to take steps to prevent a wider outbreak, speaking after Japan's domestic infection, a 17-year-old boy, was confirmed in the morning.

"Please act calmly while being on alert," Aso said. "The government will carry out thorough inspections on the patients and on the people close to them. We will take action to stop the infection from spreading."

But former World Health Organisation senior official Shigeru Omi, now head of the government's special swine flu task force, warned that "we believe that the infection is beginning to spread in the region."

"It's totally beyond our imagination," said Seiichi Sakurai, of the city's health and welfare bureau. "The virus entered the country undetected. I'm afraid the infection may have already spread further."

http://nz.news.yahoo.com/a/-/world/5573293/japan-confirms-93-swine-flu-cases/

Japan shut more than 1,000 schools and kindergartens as it confirmed that swine flu cases had reached 129 amid warnings the virus was proving difficult to contain.

The number of (A)H1N1 cases has risen rapidly in the urban areas of Kobe and Osaka since the first confirmed domestic infection, a 17-year-old high school student who had not been abroad, was reported on Saturday.

But authorities said the real number of infections could already be in the hundreds with the virus spreading fast in the densely populated island nation.

Experts now believe the virus spread quickly between the two areas after two high schools from Kobe and Osaka met for a volleyball tournament, with some players and coaches feeling feverish after the games.

"Considering the situation, it is possible that the infections spread through volleyball games," Hyogo governor Ido said late Sunday.

indigo girl

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H1N1 Swine Flu Likely Already Infecting 100,000 Americans, Admits CDC

http://news.yahoo.com/s/hsn/20090517/hl_hsn/swineflumayhaveinfectedmorethan100000americans

..."estimates of the confirmed and probable cases in the United States is probably not the best indicator of transmission at this point," the CDC's Jernigan said. "The outbreak is not localized, but is spreading and appears to be expanding throughout the United States. This is an ongoing public health threat."

It's a little hard to estimate the number of people who may be infected with swine flu, Jernigan said, "but if we had to make an estimate, I would say that the amount of activity we are seeing with our influenza-like illness network is probably upwards of 100,000."

Jernigan said there also seems to be more cases of flu generally in the United States -- both the seasonal and the new H1N1 swine flu -- than is usually seen at this time of the year. "There are 22 U.S. states that are reporting widespread or regional influenza activity, which is something that we would not expect at this time," he said.

Swine flu shuts down 2000 Japanese schools

http://www.news.com.au/story/0,23599,25503956-1702,00.html?from=public_rss

Authorities said the real number of infections could already be in the hundreds, with the virus spreading fast in the densely populated island nation.

"We have to act swiftly by assuming the virus is already widespread across the country.''

The Japanese outbreak increases the chance the World Health Organisation may raise its pandemic alert level to six - the top level which would indicate sustained community transmission in a second region outside the Americas.

indigo girl

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Swine flu: jumping the wrong way in New York?

http://scienceblogs.com/effectmeasure/2009/05/swine_flu_jumping_the_wrong_wa.php

Five more schools in the New York City borough of Queens have closed because of suspected swine flu cases. Eleven schools have now been closed there and hundreds of students are down with a flu-like illness. Parents are understandably concerned, the more so because not many days ago Mayor Bloomberg and the city's health commissioner (just named by Obama as the next director of CDC) were reassuring city residents this was pretty much lie seasonal flu.

We thought that was something that might come back to bite them, and now it has:

The city's schools seem to have become both a sentinel and an incubator for the new H1N1 strain of flu, Mayor Michael Bloomberg and his departing health commissioner, Dr. Thomas R. Frieden, acknowledged Friday.

"It appears at this point in schools in New York City in these days to be spreading more rapidly than traditional influenza," Dr. Frieden said. "We don't know why that is, but the fact we have neither a vaccine nor experience being infected with this strain of influenza are likely explanations."

Transmission of Swine H1N1 In Japan Signals Phase 6

http://www.recombinomics.com/News/05180901/Swine_H1N1_Japan_6.html

Swine H1N1 has been transmitting worldwide for over a month. Testing outside of North America was largely limited to travelers from North America, but H1N1 was seeding prior to the enhance surveillance at airports, and transmission would have been largely undetected.

The levels in the United States (see updated map) are approaching the reported levels in Mexico, and travel from the US would increase seeding. However, these increases would also be prior to enhanced surveillance at airports. However, such testing is destined to fail, because travelers infected within a day or two of travel would not be detected. Similarly, as many as 1/3 of cases have no fever.

Although the CDC estimated that the number of true cases in the US was 100,00, that estimate is likely to be 1-2 orders of magnitude too low. Surveillance in the US detects about 0.1% of true cases, so the 1500 cases in the CDC weekly report would represent 1.5 million cases in the US alone, and this estimate may be low because many cases are mild, and those in regions not reported to have high levels are not tested.

...the widespread transmission in North America (Mexico, US, and Canada) insures worldwide transmission. Community transmission has already been reported in Scotland, and now there is confirmed transmission in Japan, leaving no doubt that the spread in North America has been extended to Europe and Asia.

The raising of the pandemic level to 6 is long overdue.

indigo girl

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Swine flu spread in North America may extend into summer, experts say

http://www.google.com/hostednews/canadianpress/article/ALeqM5jDXxBrEwQvOm1dqewmsjcki232nw

Spread of swine flu in North America may not dampen down in coming weeks as was first expected, some health officials and flu experts are now suggesting. Some are now planning for the possibility the new virus may continue to trigger infections into the summer, not petering out in the way seasonal flu strains typically do as temperatures rise in the Northern Hemisphere.

"This is what worries me," says Dr. Arnold Monto, an influenza expert at the University of Michigan's School of Public Health.

"We are seeing a fair amount of circulation of the swine flu virus. And I'm not yet convinced that it's going to go away completely."

"It may dampen down a bit as schools close. But I think we're still seeing increasing transmission in the U.S. And I think in addition you have far more transmission in Canada than some people are saying - it's not just imported cases and circles around imported cases."

Monto's concern is echoed by Dr. Allison McGeer, an influenza expert at Toronto's Mount Sinai Hospital.

McGeer says abnormal flu activity levels for this time of year are making her question "the delusion that this was actually going to quiet down and we weren't going to have a first wave" over the late spring and summer.

http://www.recombinomics.com/News/05120903/Swine_H1N1_Seasonal.html

This movement of swine H1N1 into the human population is cause for concern. The increase over seasonal flu may be driven by the avian PB2 gene in the swine isolate. Position 627 is E, which favors growth at the higher body temperature of birds. Seasonal flu has a K at position 627, which allows for more rapid replication at a lower temperature, which is consistent with the internal temperature of a human nose in the winter.

The presence of avian PB2 may offer a selective advantage over the summer, when seasonal flu falls to barely detectable levels. However, the swine H1N1 that moves south in the upcoming months will be growing under colder conditions, which may favor the acquisition of E627K though reassortment or recombination. This change could create a more virulent H1N1 in the fall in the northern hemisphere.

Thus, the swine H1N1 may be launching a two virus strategy. The H1N1 with avian PB2 will dominate in the northern hemisphere over the summer, while the H1N1 in the southern hemisphere will acquire E627K and establish dominance during the winter months.

indigo girl

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Nations urge WHO to change pandemic assessment

http://www.cbc.ca/world/story/2009/05/18/health-swine-flu-who-meeting-pandemic-severity-virus-spread-deadly.html

A political hot potato is what some are calling this decision. Deciding to do nothing is also a decision...

Britain, Japan and other nations urged the World Health Organization on Monday to change the way it decides to declare a pandemic — saying the agency must consider how deadly the virus is, not just how fast it is spreading.

The debate arose as WHO began its annual meeting, a five-day event in Geneva, Switzerland, attended by hundreds of health experts from the agency's 193 member nations.

Swine flu is expected to dominate this year's conference — and WHO must consider whether it should raise its alert level or tell manufacturers to begin making a specific swine flu vaccine.

'Severity is going to be different in different countries. And within a country, it will be different in different populations.'

— Dick Thompson, WHO

WHO's current system focuses on how widespread the disease has become without regard to its severity. Some member nations are anxious to avoid having the agency declare a swine flu pandemic because the ramifications of that scientific decision could be very costly and politically charged.

WHO says transmission rates in countries outside the Americas is the key factor in whether the agency should raise its pandemic alert scale to the highest level. Right now it is at Phase 5 — out of a possible 6 — meaning a global outbreak is "imminent."

Outbreak 'not winding down' in U.S.: CDC

Dr. Richard Besser, acting director of the U.S. Centers for Disease Control and Prevention, told the WHO meeting that the outbreak is "not winding down" in the United States and "widespread transmission" continues. He also said the epidemic also was not over in Mexico.

Speaking a day after New York school assistant principal Mitchell Wiener died of swine flu, Besser said the world needed to maintain vigilance against the virus.

Sometime during the meeting, Chan is expected to reveal experts' recommendations on whether to produce a swine flu vaccine.

The issue of producing a vaccine is sensitive, particularly for southern hemisphere countries where the annual flu season is about to begin. Seasonal flu can claim as many as 500,000 lives a year globally. But to have enough vaccine to confront a pandemic from a new strain such as swine flu, companies would have to switch from producing vaccine for seasonal flu.

WHO estimates up to two billion doses of swine flu vaccine could be produced yearly, though the first batches would not be available for four to six months.

oramar

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That age distribution for the late teens, early adulthood is the same patter the 1918 epidemic showed isn't it? My grandmother was born in 1900 and was 17 when she got it. She had a older sister that was 22 or 23. Both of them were very ill. My grandmother lived and her sister died. (Of course my grandmother lived, it is perfectly obvious because I wouldn't be sitting here writing this if she didn't) They never received any medical care but they both received last rights. The only care my gran and her sister received was from their parents, who interestingly enough, NEVER became ill. That sounds a lot like what is going on here. I have heard some researchers put forward the idea that their was a earlier pandemic in late 19th century that left a lot of older people immune. However, no one can prove that as far as I know.

oramar

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You got to marvel at it's adaptablity, marvel and cringe at the same time. It could do another mutation at any time and we just got to wait and see.

oramar

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I thought the same thing as the first poster. When Mayor Bloomberg was sort of playing it down I was wondering if it was for economic reasons and also wondered if it would come back and bite him in his political behind.

oramar

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That age distribution for the late teens, early adulthood is the same patter the 1918 epidemic showed isn't it? My grandmother was born in 1900 and was 17 when she got it. She had a older sister that was 22 or 23. Both of them were very ill. My grandmother lived and her sister died. (Of course my grandmother lived, it is perfectly obvious because I wouldn't be sitting here writing this if she didn't) They never received any medical care but they both received last rights. The only care my gran and her sister received was from their parents, who interestingly enough, NEVER became ill. That sounds a lot like what is going on here. I have heard some researchers put forward the idea that their was a earlier pandemic in late 19th century that left a lot of older people immune. However, no one can prove that as far as I know.
Excuse me for reminising but I think a lot of people in their 60s grew up hearing about 4 major events from grandparents. In order of importance 1. the great depression 2. WWII 3.WWI and 4. but not the least THE SPANISH FLU as they called it.

indigo girl

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Catching up on H1N1 swine flu -- a digest of recent events

http://www.scottmcpherson.net/journal/2009/5/18/catching-up-on-h1n1-swine-flu-a-digest-of-recent-events.html

Scott McPherson is the Chief Information Officer for the Florida House of Representatives [CIO]. He is well connected in the world of people interested in influenza, and offers an interesting perspective on the latest events.

It is also kind of futile to simply track the number of cases actually testing positive. As Ian Holm said in The Day After Tomorrow, "That time has come and gone, my friend." In the Internet Age, and with all the powerful real-time surveillance tools at our disposal, we still have no earthly idea how many positive swine H1 cases we have in our own municipalities, let alone the world. So counting is best left to the historians.

Los Alamos in New Mexico specializes in such algorithms and estimates. The CDC has probably been on the horn with them many, many times since the first outbreaks in Mexico, asking what the Big Board would look like in a few weeks.

What is equally clear is that we are now seeing what we did not see three weeks ago:sustained chain human transmission in this country and abroad. A recent Washington Post article showed where the virus is hitting hardest: young people ages 5 to 24.

Last Thursday, when Fukuda announced that the global death total was 65, he noted that "half of them are healthy people who have no predisposing conditions. This is a pattern different from what we see with normal influenza."

There have been too few deaths in the United States to draw any conclusions. But of the 173 people who have been sick enough to be hospitalized, more than half are in the 5-to-24 age group.

We must not be focused on the minutae of positive test results. We need to start looking at, and tabulating,absenteeism in schools and the workplace. That is the indicator of where the virus has gone and the extent of its penetration into our communities.

There has been a lot of hand-wringing over the issue of closing schools and borders and such, both in the US and abroad. Everyone needs to remember that these steps, in the aggregate, are nothing more than delaying actions -- like a rear guard action in combat, which this surely is. We are trying to slow the advance of the virus, not stop it in its tracks. It is flat-out impossible to stop influenza in its tracks. The virus is just too good at what it does. Only influenza can stop influenza.

There is a group of persons who were calling upon the world health community to allow this new virus to burn its way around the globe quickly, hypothetically allowing it to confer immunity while it was still relatively mild. This theory is interesting but ultimately does not hold water. Here's why not:

First, delaying the spread allows us precious time to study the virus, to try and understand its genetic makeup, and to prepare a vaccine candidate.

Second, because seasonal H1N1 holds the dreaded Tamiflu resistance gene, (and you should know from reading my recent and past blogs exactly what that is), the faster swine H1 does its Magellan impression, the more likely it is to pick up that gene more quickly. that would render the world's entire stockpile of Tamiflu useless against a new pandemic.

Already, CDC and WHO are recommending the use of Tamiflu only to treat those in high-risk groups: The immuno-compromised (chemotherapy patients, HIV/AIDS patients, COPD, pregnant women, etc.). And maybe or maybe not the elderly. This is being done in an effort not to over-prescribe Tamiflu, which scientists fear could lead to Tamiflu resistance. But as we know today, the acquisition of the Tamiflu resistance gene has absolutely nothing to do with the overprescription of Tamiflu itself. If it did, Japan would be completely lost, because doctors there (who profit from prescriptions they write) prescribe Tamiflu like American doctors prescribe Motrin. Why do you think the Japanese discovered the possibility that youthful sufferers of influenza, dosed with Tamiflu, might jump off buildings? because they had such a large statistical sample to work with.

Third and finally, hastening the circumnavigation of the world by a new pandemic virus ruins any chance we might have to re-educate the masses on pandemic preparedness. Slowing the spread allows precious time to plan, to educate, to train and to prepare. Of course we should have been doing those things already. But people and organizations procrastinate.

I wanted to return to the topic of Tamiflu-related suicides among Japanese teenagers (Google it if you are unfamiliar). This is why Roche created Childrens Tamiflu, which is available in a smaller dosage than adult Tamiflu. If you have a young child who is diagnosed with swine H1N1, you should ask your doctor about Childrens Tamiflu as an alternative to regular Tamiflu. I am not aware of any Childrens Tamiflu in the Strategic National Stockpile, because the Stockpile began before Roche began the manufacture of the kids' dosage. Again, check with your doctor if you have a child under the age of 16 who is swine H1-positive.

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