Swine Flu Updates and Issues

[indigo girl]

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]

http://crofsblogs.typepad.com/h5n1/2009/06/who-worries-about-h1n1-in-aboriginal-peoples.html

A little ethnic education from crofsblog:

I'm a little uncertain about the use of the term "Inuit." The Inuit are an Arctic people, quite distinct from First Nations peoples. (Our current health minister, Leona Aglukkaq, is an Inuk--that's the singular of "Inuit.")

According to PHAC's June 8 update, Nunavut (with an 85% Inuit population) has 25 cases (19 confirmed since June 5), and the Northwest Territories have two.

These numbers are already out of date: CBCnews.ca says today's count in Nunavut is 53, with six hospitalized. The same report also cites Fukuda's worries about Inuit cases.

So something about the Nunavut outbreak may be notably serious. But I'm surprised that Fukuda didn't use a term like "aboriginal." That would include the First Nations cases like those at St. Theresa Point in Manitoba--which are indeed serious, with many band members in hospital on respirators.

Serious H1N1 cases in Canadian Inuits raise concern

http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/jun0909firstnation.html

An official from the World Health Organization (WHO) said today that health experts are closely monitoring novel H1N1 influenza infections in Canada's Inuit populations, following reports that the communities are seeing more than their share of severe cases.

...WHO doesn't know if the trend is linked to socioeconomic factors, genetic factors, or chronic underlying diseases, and commented that Inuit groups were hit hard in some earlier pandemics. Fukuda is the WHO's assistant director-general for health security and the environment.

...health officials in Canada's Nunavut territory today said the number of confirmed novel flu cases has jumped from 25 to 53, with six patients in the hospital, the CBC reported. Nunavut's population is primarily Inuit.

Donald R. Olson, MPH, research director for the International Society for Disease Surveillance, based in New York City, told CIDRAP News that the severe cases in Canada's Inuit populations are puzzling. However, he added that among remote populations, the 1918 pandemic influenza was more severe and didn't follow the age patterns seen in the rest of the world.

"Inuit groups didn't show the same apparent sparing of the elderly, so possibly the older proportion of the population had not been exposed" to previous viruses related to the pandemic strain, he said.

The medical literature tells of "flu orphans" from remote Alaskan villages who survived the 1918-19 pandemic, though their parents and grandparents died, presumably because they had not been exposed to earlier H1-like viruses.

In 2006 at a state summit in Alaska, former US Health and Human Services Secretary Mike Leavitt described the impact of the 1918 pandemic virus on Alaska's native populations. "The Alaska native population in Nome was decimated--176 of the 300 Alaska Natives in the region died," he said in comments posted on the HHS pandemic flu Web site. "The pandemic swept through communities, killing whole villages."

Officials don't know if higher rates of chronic illnesses in today's Inuit populations are playing a role in the high number of severe cases. However, Health Canada reports that when compared to the rest of the nation, First Nations and Inuit people have 1.5 times the rate of heart disease, 3 to 5 times the rate of type 2 diabetes, and 8 to 10 times the rate of tuberculosis infection.

Yesterday, an Australian health expert from Darwin warned that the country's indigenous populations might be at greater risk for novel H1N1 infections.

Besides citing lack of exposure to similar virus and underlying conditions as possible risk factors, experts have also theorized that remote populations might have a genetic predisposition that makes them more susceptible to the virus, Olson said. But he expressed doubt that the factor is playing a role in Canada's current outbreak.

The signals coming out of Canada are worrying, he said. "The less developed world may have a terrible experience with this, though there is a lot of coughing and sneezing in the rest of the world," Olson said.

Danuta Skowronski, MD, a physician and epidemiologist at the University of British Columbia, told CIDRAP News that over the past few years, circulation of seasonal H1N1 viruses in North America has been patchy, and people in remote communities are likely to have had less exposure to the viruses than have people living in urban settings.

There's still much that researchers don't know about possible cross-protection against the novel H1N1 virus from exposure to previous H1N1 strains, she said. Though researchers have identified antibody markers and determined that seasonal vaccination offers little protection, they still haven't gauged the cell-mediated response--which can offer protection during severe infections--afforded by exposure to previous H1N1 strains, Skowronski added.

Public health officials will also be looking for environmental factors that might be contributing to the infections in the First Nations and Inuit groups, she said. For example, large numbers of people living in one household may have greater exposure to the virus. "This all needs to be assessed, because we're picking up possible signals of concern," Skowronski said.

[lamazeteacher]

"Two hospital doctors are among the latest people confirmed as having swine flu.

Both are doctors at the RAH and are thought to have caught it from patients being treated there, the Scottish Government said." quote from indigogirl's quote in her post.

I wonder if those doctors wore masks and/or had the patients wear their "respirator" type masks.......

[indigo girl]

mexico

http://crofsblogs.typepad.com/h5n1/2009/06/mexico-will-host-international-h1n1-conference.html

health ministers from 40 nations and senior officials from the world health organization (who) will gather in mexico's caribbean resort of cancun early next month to discuss influenza a/h1n1, the health ministry said on tuesday.

the meeting, slated for july 1-3, aims to share the best practice in tackling the disease, which has infected 26,563 people across 73 nations, including 140 deaths, the ministry said in a statement.

who director-general margaret chan and pan-american health organization director mirta roses are expected to attend the gathering.

participating countries will be those which have been suffering from a/h1n1 flu in recent weeks, though the meeting is also open to other nations that are interested in the outbreak, the ministry said.

if i were running any country on the planet, however poor, i'd find the money to send my best people to cancun.

http://crofsblogs.typepad.com/h5n1/2009/06/tuesday-night-in-mexico.html

interesting. the cfr of the 1918 pandemic was supposedly 2%. what are they saying here?

h1n1 is still a problem in mexico:

two schools closed in tabasco state due to h1n1.

new outbreak of flu in a jalisco state school.

mexico announces an international meeting on influenza.

a school in gustavo a. madero district has reopened after an outbreak has come under control.

as of monday night, the health secretariat announced that since april 29 when the epidemic began, it has recorded 6,241 cases of h1n1, with 108 deaths. those deaths represent 1.7% of all cases, of whom 51.9% were females and 48.1% males, and 71.3% were between 20 and 54 years old.

as well, 37% of the fatal cases also suffered metabolic diseases such as obesity and diabetes mellitus, 18.5% cardiovascular diseases, 13% "tabaquismo" (tobacco addiction?), 8.3% respiratory problems, and the rest suffered from infectious diseases, autoimmune diseases, and cancers.

that sounds as if no one died outright of h1n1, and it calls into question the theory that mexicans of aboriginal ancestry may have been genetically vulnerable to this new virus. but i may not have translated the report properly, and it may not be accurate in any case.

a very detailed study of mexico's cases and deaths should be a major priority for the immediate future.

[indigo girl]

Swine flu: are we there, yet?

http://scienceblogs.com/effectmeasure/2009/06/the_swine_flu_pandemic_has_arr.php#more

Yes, let's gone on with it.

Listening to yesterday's press briefing with WHO's Dr. Keiji Fukuda...several things seemed clear to me. The first is that everyone, WHO included, thinks a pandemic is well underway. Second, WHO's efforts to explain why they are not making it "official" by going to phase 6 are becoming increasingly awkward and the explanations manifestly tortured. Essentially what Fukuda said was that WHO was waiting for its member nations to signal they knew it was a pandemic and then WHO would say it was a pandemic. It was reminiscent of the cries of one of the principals of the revolution of 1848 as he chased the mob into Paris's Jardin du Luxembourg: "I'm their leader! I must follow them!" Third, despite Fukuda's calm and measured tone, there was an undercurrent of worry. The severity of the not-yet-called-a-pandemic pandemic is now being termed "moderate" (which seems accurate to me). Fukuda explicitly declined to characterize it as "mild." He also called attention to reports of "disproportionate numbers of serious cases occurring" in Canada's First Nation (indigenous) community.

As Fukuda points out, influenza took a heavy toll in isolated and disadvantaged communities in earlier pandemics. This is part of a picture of a well transmitted novel influenza virus, circulating out of season and hitting younger age groups differentially, just what one expects from a pandemic strain based on past experience.

The on-again-now-off-again inclusion of severity as a criterion for a pandemic is currently being spun as a descriptor to give member nation's the best information on the nature of the pandemic they are dealing with. I think that's a sensible attitude, and I don't fault WHO. The politics of any intergovernmental agency, especially in the UN system, produce a difficult and treacherous landscape to negotiate. If you've never seen it close up, it's hard to appreciate the labyrinthine and counter-to-common sense ways of the international community. This is not the UN's fault and certainly not WHO's. It is the system they (and we) are forced to work within, as mandated by the nations of the world. If the space program becomes robust enough, someday you may be able to opt out for another planet. Until then, it's no use complaining.

Meanwhile we now have the long predicted influenza pandemic. It's neither so scary nor so benign that we can afford to either hide under the bed or ignore it. What we must do is roll up our sleeves and manage the consequences.

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.

[lamazeteacher]

The only thing that I find surprising about the demographic BELOW, is the absence of a large number of cases in African countries. There may be under reporting there, in India, and Sweden, and in Russia and its subsidiaries. New Zealand nurses have reported many more cases, at allnurses.com THIS IS THE PICTURE OF A PANDEMIC!

[indigo girl]

Bingo! You have made an excellent point, lamaze. The African cases are conspicuous by their absence, aren't they?

No doubt the cases are there. The reasons why we are not seeing them? Lack of resources for testing, and lack of motivation for testing ILI most likely. Most of those countries are not going to isolate mild illnesses, assuming that it stays mild, that is.

The First Nation experience in northern Canada might be repeated in Africa as well. Cases are being reported in Egypt, btw but you probably mean the rest of the continent, I am guessing.

The Egyptians are clearly motivated to test. Remember this is the country where in an excess of caution and misguided zeal, they slaughtered thousands of pigs. Fear is a great motivator. Why are they so afraid?

Egypt is the one country with the most cases of bird flu, H5N1 outside of Indonesia. There have been this year alone, 29 cases of H5N1 since January, mostly in kids. Does it mean that only kids are catching it? Probably not! It is endemic in the bird population and the humans are likely passing it around quietly. Kids get diagnosed because parents have been taught to report symptoms, and they want to safeguard their kids. Most recent cases have been mild. It is not always mild as we well know. Most adults with bird flu have died, and that is a fact.

Now, with two different type A influenzas circulating in the same country, Egypt may be a potential breeding ground for a future more virulent form of swine/bird flu if these two viruses co-infect the same hosts, and exchange genetic material. Egypt is well aware of this threat. They are considering all sorts of ways to stop swine flu from spreading. Will they be successful? That will be interesting to see.

http://www.google.com/hostednews/canadianpress/article/ALeqM5hDSoQdC8McMMC7Q-L9VtC0gC5Hwg

...Two more people in Egypt have tested positive for swine flu bringing the total number of those infected in the country to 10, the spokesman for the Health Ministry said Wednesday.

Abdel Rahman Shahine said that the two new cases had recently returned from the United States. One is an Egyptian citizen who has now been hospitalized in Alexandria, while the other - a foreigner-is in a hospital in Cairo.

He did not disclose the nationality of the foreigner.

A student dorm of the American University in Cairo has been placed under quarantine through June 15 after seven Americans, six students and one faculty member, were diagnosed with swine flu on Saturday.

A 12-year Egyptian-American girl returning from the United States was diagnosed with flu on June 2. She has since recovered.

Travellers arriving in Egypt are photographed, their body temperature scanned and addresses taken in case there is a need to follow up with them.

http://crofsblogs.typepad.com/h5n1/2009/06/egypt-two-new-h1n1-cases.html

I see from translations at flutrackers.com that the Gulf of Suez Petroleum Company has just announced 9 cases as well. Really, there are probably many that are not diagnosed yet. Yes, this is going to be one country to watch in the next month.

They are considering closing the subway or limiting its use to slow down spread. I did not even know that they had a subway. They must mean in Cairo.

[indigo girl]

China

http://news.xinhuanet.com/english/2009-06/11/content_11522818.htm

Yes, that would be 111 confirmed cases which probably means ten times that suspected. And, if anyone really believes that there are only 111 cases in all of China, I have a bridge to sell you in Brooklyn...

The Chinese mainland reported 10 new confirmed A/H1N1 flu cases Wednesday, bringing the total number to 111.

There have been no reports of deaths from A/H1N1 flu on the Chinese mainland, the Ministry of Health said.

According to the Ministry of Health, 29 confirmed A/H1N1 flu cases have been reported in Beijing, 27 in Guangdong, 18 in Fujian,13 in Shanghai, 10 in Sichuan, four in Hubei, three in Shandong, two each in Zhejiang and Hunan, and one each in Shanxi, Henan and Tianjin.

Of the 111 cases, 58 have been discharged from hospital, the ministry said.

[indigo girl]

By Thursday evening, we'll be in first official flu pandemic in 41 years

http://www.scottmcpherson.net/journal/2009/6/10/by-thursday-evening-well-be-in-first-official-flu-pandemic-i.html

Scott, such an optimist, you are. Well, just maybe they will get around to it by tomorrow night. As for panic, that you are right about. No whisper of concern from most places as most people do not get that the WHO has now decided that what was first called "mild" is not so mild anymore. Their description is now "moderate" and that could change as we go along.

How the disease progresses through the developing world may well shape the way history will decribe what happened in 2009.

WHO set to declare Phase Six at emergency meeting in Geneva.

Finally. Tomorrow, Thursday, June 11, 2009, the World Health Organization is expected to relent and finally declare what the world already knows; namely, that we are in the beginning of the first honest-to-God flu pandemic since the 1968 Hong Kong H3N2 influenza pandemic.

Dr. Margaret Chan, the head of the WHO, has been working with nations to make sure a move to Phase Six does not create some sort of bureaucratic nightmare. Also, there has been concern that a move to officially declare a pandemic would provoke some sort of panic.

I think the WHO is seriously underestimating the ability of the world's population to filter that news and absorb it quietly, without panic and without fanfare. The world already suspects that we are in panflu status; telling them they are correct will do far more to reassure people there is no coverup going on than to maintain a Phase Five status that is clearly obsolete.

There have been numerous articles regarding the collective inability of the world's animal health and public health professionals to look for the obvious (hogs) when doing their disease surveillance, and instead become preoccupied with avian flu that is still a threat, just not THE threat right now.

I mention Wisconsin because that state has been a veritable incubator of swine flu. At last count, some 2,200 cases of human swine H1 infection were reported to the CDC. This outpaces California, Texas, Illinois, New York and Florida.

What is fascinating is when you look back at the dispersion of the 1946-49 maybe-pandemic of H1N1. the first big area to be impacted by that epidemic was: The western and central Great Lakes states. That would include Wisconsin and Illinois. If you add up their swine H1 exposure, those two states account for nearly one-third of all US confirmed swine H1 cases. One-third. And the last time I looked, neither state borders Mexico, previously considered to be Ground Zero in all this.

I say "previously considered" because someone needs to formulate a theory as to why Wisconsin is the nation's swine flu capital, while not producing a single human death (so far) from the virus. Why is 2009's flu pattern mimicking that of 1946-48's? Somebody get a study going on that one, pronto.

I'll have more on that later. For now, rest assured that by evening drive tomorrow, and thus on the network news shows, we will be at Phase Six. And Americans, at least, will go on about their business.

Scott MacPherson is the Chief Information Officer of the Florida House of Representatives.

[indigo girl]

Swine Flu Nations Briefed in Preparation for WHO Pandemic Call

http://www.bloomberg.com/apps/news?pid=20601081&sid=a1nkBJwRxffw

Leaders of six swine flu-infected countries have been briefed by the World Health Organization in preparation for a "probable change" in the agency's level of pandemic alert, Chile's health ministry said.

Officials in Australia, Chile, Japan, Mexico, the U.K. and the U.S. were asked for information on cases and measures taken to mitigate the disease, known as H1N1, before the WHO moves to the top of its six-stage pandemic warning scale, Chile's Health Minister Alvaro Erazo said in a statement yesterday.

"This is to date a less-severe illness than had been planned for," Australia's Health Minister Nicola Roxon told reporters in Melbourne today. "This is presenting somewhat of a challenge to the health communities and public health officials around the world because much of the pandemic planning was done on the assumption that the disease would have more virulence."

An emergency committee of experts advising the Geneva-based agency will discuss the current swine flu threat at a meeting starting at noon Geneva time today, spokesman Dick Thompson said by telephone.

"WHO will be discussing their alert level," Roxon said. Chan discussed late yesterday the swine flu situation with government leaders in Australia, the country with the most reported cases outside the Americas, she said.

Australia has 1,275 confirmed cases, with Victoria the worst-hit state with 1,011 infections, she said. The southeastern state upgraded its response to the outbreak earlier this month, acknowledging the spread of the virus is beyond prevention.

"Most of the cases in Australia have still been fairly mild, but the virus is not harmless," Roxon said. Since last month, 25 people have had to be hospitalized, including four who are being treated in an intensive care ward in Victoria, she said.

Six schools and one childcare center in Australia have been closed to help stem transmission, Roxon said, adding that "school-age children seem to be the super-spreaders."

Hong Kong suspended classes at all primary schools, kindergartens and childcare centers for 14 days from tomorrow because of swine flu, Chief Executive Donald Tsang said today.

Those who have been hospitalized in Australia have generally had other pre-existing medical conditions such as morbid obesity or chronic respiratory disease, Roxon said. Almost 28,000 cases of swine flu have been confirmed worldwide, including 141 deaths.

"As this becomes more widespread across the world, not just in Australia, we will see people who have negative outcomes from this flu," Roxon said. "Any type of flu can be dangerous if not treated properly."

Chile, the country with the most infections outside North America, had 1,694 cases of swine flu as of June 9, up from 890 reported on June 5, the ministry said.

Two people have died from the disease in the country, where the number of cases has jumped fourfold since the weekend as officials began including cases reported by private clinics.

[indigo girl]

Leaders of affected communities say health resources inadequate

http://www.winnipegfreepress.com/local/were-in-a-war-zone-chief-47760982.html

The World Health Organization is concerned about the surge of H1N1 influenza cases in two isolated Manitoba First Nations communities, even as the chief of Garden Hill First Nation said his community lacks basic medical resources to cope with the crisis.

They don't have a full-time doctor or antivirals. They also don't have enough masks, medical gloves or sanitization equipment.

Manitoba Health is working to find an extra doctor to send to Garden Hill, but that may not happen until next week. It was only on Wednesday that First Nations Inuit Health decided to send hand sanitizers to First Nations communities, many of which don't have access to running water.

Dozens of First Nations residents have been medevaced to hospitals in Winnipeg with severe flu-like symptoms.

"We need to set up a temporary hospital base right within the region, that is what's urgently needed," Garden Hill Chief David Harper said Wednesday, referring to the Island Lake region that includes three other First Nations communities, including St. Theresa Point. Garden Hill has only a nursing station that shares a doctor with a neighbouring community.

"The amount of medevacs that we've had in one month would almost pay for a hospital. It would definitely pay for a hospital."

Harper said medical equipment such as masks, antivirals and sanitization equipment was ordered last week through the local nursing station but has not arrived.

Harper's pleas for a temporary hospital in the Island Lake region were echoed in the House of Commons Wednesday by Churchill MP Niki Ashton. "Chief (David) McDougall of St. Theresa Point has called for a field hospital to deal with the situation that is so bad," she said during question period in Ottawa. "If we can do this in war zones, why can we not do it on the front lines of a coming pandemic?"

[oramar]

Leaders of affected communities say health resources inadequate

http://www.winnipegfreepress.com/local/were-in-a-war-zone-chief-47760982.html

I have said that myself, "why can't they drop field hospitals into these high flu areas that are very poor and have few resources". These people are citizens of whatever country they live in and deserve attention also.

[indigo girl]

Chan: Mexico should prepare for a new outbreak

http://crofsblogs.typepad.com/h5n1/2009/06/chan-mexico-should-prepare-for-a-new-outbreak.html

Like everywhere else, a second wave is expected. Dr. Chan of WHO warns Mexico in this translated message:

Mexico, the country where the influenza epidemic began, should be prepared for a second wave of cases, said Margaret Chan, director-general of WHO, today.

"Mexico should prepare for the future even though it has controlled the epidemic. A/H1N1 can return in a second wave," Chan warned, in a press conference at which she announced pandemic status for this new virus, raising the alert level to the maximum 6.