Thursday, February 09, 2012

CIDRAP: Exploring the CFR Of H5N1

 

 

 

# 6133

 

Since the H5N1 virus reappeared in 2003, the CFR (Case Fatality Rate) of that strain of avian flu has hovered around 60%. Some countries – like Indonesia & Cambodia are well into the 80% fatal range, while Egypt has somewhat lower CFR of about 35%.

 

The 1918 pandemic, by comparison, is believed to have only killed 2.5% of its victims.

 

Over the years a number of researchers have insisted that the true fatality rate must be far lower, and that limited surveillance systems in countries where the virus is endemic are only picking the `sickest of the sick’, who are most apt to die.

 

While long a bone of contention among flu specialists, recently this has become a part of the larger debate over the implied risks of publishing  dual use’ H5N1 research.

 

Robert Roos of CIDRAP takes on this daunting topic today in a lengthy and important article.

 

 

Undetected H5N1 cases seem few, but questions persist

Robert Roos * News Editor

Feb 9, 2012 (CIDRAP News) – The fatality rate for officially confirmed human cases of H5N1 avian influenza infection is a stunningly high 59% (345 deaths in 584 cases). But the current controversy over publishing data about transmissible H5N1 viruses has revived a debate about whether the virus is as lethal as those numbers say.

 

(Continue . . .)

CDC/Medscape Video: Expert Guidance On The H3N2v Virus

 

 

# 6132

 

 

While we’ve heard very little over the past two months regarding the small number H3N3v (formerly called trH3N2) cases detected last fall across five states, the CDC continues update their guidance information, and has taken steps towards developing a seed vaccine.

 

This novel swine-origin virus is a reassortant between swine H3N2 and the 2009 H1N1 virus, and while it does not appear to be transmitting efficiently, some human-to-human transmission is suspected.

 

A sampling of earlier blogs on this emerging virus include:

 

WHO/FAO/OIE: Call It A(H3N2)v

WHO Comment: Testing For Novel Flu Viruses

Branswell On The New trH3N2 Flu Virus

CIDRAP: New Details In The trH3N2 Story

CDC Update On Iowa trH3N2 Cases

 

The CDC, in partnership with Medscape, produces a series of Expert Commentary videos aimed at physicians, nurses, pharmacists, and other healthcare professionals.

 

Earlier this week they posted an Expert Commentary video on the H3N2v virus.  Follow the link below to watch:

 

Variant H3N2 Influenza Virus: What You Should Know

Michael Jhung, MD, MPH

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Vietnam:`New’ H3N2 Swine Flu Virus Reported

 

UPDATED: 1500hrs

Henry Niman has posted this afternoon that after further review, he believes this report to be a badly translated repost of a story from December on 10 Cases in the United States we already knew about. 

Today’s story is ambiguous enough to make that a plausible explanation.   Unless and until we can get some confirmation of this story I would advise that you view the following report with caution.


 


# 6131

 

 

This morning Editor & Senior Moderator Tetano on FluTrackers has picked up a series of news articles coming out of Vietnam talking about 10 human cases of infection by a `new’ H3N2 swine flu virus.

 

Two of these articles are machine translated from Vietnamese, and are therefore a bit garbled, but the third is an English Language report from the VOV (Voice of Vietnam). 

 

Assuming the major points of today’s report are correct (not always a given), there is not enough information provided to know how this virus compares to the A/H3N2v virus which has been detected in a handful of cases in the United States (see CDC Releases Updated H3N2v Interim Guidance).

 

Keeping the usual caveats in mind regarding early media reports, here is the story from the Voice of Vietnam.

 

 

New strain of swine flu detected

Updated : 5:16 PM, 09/02/2012

(VOV) - The Heath Ministry has quoted sources from the Ho Chi Minh City Pasteur Institute confirming that a new kind of porcine flu virus, A/H3N1, has appeared, apparently a combination of the pig-related A/H1N1 and A/H3N2 flu viruses.

 

The medical sector has monitored 10 patients infected with the A/H3N2 virus with porcine origin, and found that three of them had not had direct contact with any diseased pigs.

 

Therefore, the sector has not ruled out the possibility of a mutation in the A/H3N2 strain which could lead to transmission between humans, instead of strictly from pigs to humans as previously.

 

However, the situation has not reached an alarming level because the virus has not changed much; it has low toxicity and has shown no sign of drug resistance.

 

Flu vaccines are able to cope with small changes in this kind of virus, said Le Hoang San, Vice Director of the HCMC Pasteur Institute.

 

 

Swine are highly susceptible to the influenza virus, and are capable of serving as `mixing vessels’, allowing them to reassort into new hybrid strains.

 

Reassortment happens when two different influenza viruses co-infect the same host, swap genetic material, and produce a hybrid virus. 

 

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That is essentially what happened in 2009, when the H1N1 swine flu virus emerged after bouncing around swine herds for a decade or more, picking up genetic changes along the way.

 

And not surprisingly, this recently emergent `humanized’  H1N1 virus has re-entered the swine population and is once again mixing and matching with other circulating swine flu viruses.

 

As a result we now have a Swine H3N2 virus that has reassorted with the 2009 pandemic H1N1 virus, producing a new hybrid that has – in a limited fashion – begun to emerge into the human population.

 

The article above calls the Vietnamese strain a `combination of the pig-related A/H1N1 and A/H3N2 flu viruses’which if we take literally – suggests a different reassortment than the one we’ve seen in the United States.

 

 

As stories in the media often gloss over or confuse crucial scientific details we really need to wait for a more definitive report before we can talk about the origin, genetic makeup, and potential of this new virus.

 

For now, this is simply something new to keep an eye on in the ever changing and always surprising world of influenza.

 

Update:  In a conversation with Sharon Sanders of FluTrackers this morning, she pointed out that this article refers to this new reassortant virus as H3N1 (once) and H3N2 (twice).

I took the first mention (H3N1) as a likely misprint, but until we can get some clarification, I don’t think we can say with any confidence exactly which strain this new virus is.

Wednesday, February 08, 2012

Nature Editorial: Facing Up To Flu

 

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BSL-4 Lab Worker - Photo Credit –USAMRIID

 

 

# 6130

 


Tying in with my last post (see Declan Butler: Lab flu may not aid vaccines), we’ve an editorial appearing today in Nature that calls into question the short-term benefits of so-called  `dual use’ H5N1 research.

 

Follow the link to read:

 

Nature | Editorial

Facing up to flu

Nature 482,131

(09 February 2012) doi:10.1038/482131a

Published online 08 February 2012

The potential for mutant-flu research to improve public health any time soon has been exaggerated. Timely production of sufficient vaccine remains the biggest challenge.

(Continue . . .)

 

 

I expect that we’ll see vigorous counterpunching on this issue in the not too distant future as both sides prepare for the meeting in Geneva next week.

 

Stay tuned.

 

The stakes here are extraordinarily high, the issues are complex, and I expect no shortage of fireworks.

Declan Butler: Lab flu may not aid vaccines

 

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Photo Credit – CDC PHIL

 

# 6129

 

One of the counter arguments offered by researchers when biosecurity experts have warned on the dangers of `dual use’ H5N1 research, is that these experiments put us in a position to create a vaccine faster, should these genetic changes occur in nature.

 

Today Declan Butler, writing for Nature, explores that argument and finds that while the logic behind it is appealing, the reality may fall a bit short. 

 

Lab flu may not aid vaccines

Game-changing vaccine technologies are needed to strengthen global pandemic defences.

08 February 2012

Video: NYAS H5N1 Debate

 

 

# 6128

 

 

Last week (Feb 2nd) the New York Academy of Sciences hosted a 2-hour debate over H5N1 `dual use’ research.

 

The discussion – called  Dual Use Research: H5N1 Influenza Virus and Beyond – was moderated by famed epidemiologist and virus hunter Professor Ian Lipkin, who among his many accomplishments is Director, Center for Infection & Immunity, and John Snow Professor of Epidemiology at Columbia.

The panel members consisted of:

  • Arturo Casadevall, MD, PhD, Albert Einstein College of Medicine, and member, NSABB;
  • Laurie Garrett, PhD, Council on Foreign Relations;
  • Barbara R. Jasny, PhD, Science;
  • Veronique Kiermer, PhD, Nature Publishing Group;
  • Michael T. Osterholm, PhD, MPH, Center for Infectious Disease Research and Policy, University of Minnesota, and member, NSABB;
  • Peter Palese, PhD, Mount Sinai School of Medicine;
  • Vincent Racaniello, PhD, Columbia University;
  • Alan S. Ruldolph, PhD, Defense Threat Reduction Agency.

 

The result was a lively, sometimes heated debate.

 

Today, the NYAS has posted video of that debate (in 2 parts) on their website.

 

"Dual Use Research: H5N1 Influenza Virus and Beyond" Panel Sparks Lively Debate

 

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A hat tip to Vincent Racaniello  & Laurie Garrett for tweeting the announcement.