US: Turkey Farm Reports H1N1

# 4104

 

 

 

It was only last month that that a study in Eurosurveilance sought to reassure us that Turkeys weren’t particularly susceptible to the H1N1 virus.   

 

Below is just an excerpt.

 

Eurosurveillance, Volume 14, Issue 41, 15 October 2009

Rapid communications

Resistance of turkeys to experimental infection with an early 2009 Italian human influenza A(H1N1)v virus isolate

C Terregino¹, R De Nardi¹, R Nisi¹, F Cilloni¹, A Salviato¹, M Fasolato¹, I Capua ()¹

 

Our findings suggest that in its present form, the pandemic H1N1 influenza virus is not likely to be transmitted to meat turkeys and does therefore not represent an animal health or food safety issue for this species.

 

 

Despite this study (which has an excellent pedigree in Ilaria Capuam, noted virologist for the OIE/FAO in Italy), over the past few months we’ve had reports of infected turkeys in Chile (see FAO: Concerns Novel H1N1 May Spread In Poultry  and   Chile: H1N1 Jumps To Turkeys) and Canada  (see Update On Ontario H1N1 Infected Turkeys).

 

Now, a US turkey farm in the the state of Virginia is reporting an H1N1 infection in a flock.   A hat tip goes to Indigo Girl on Allnurses pandemic forum and celvin11 on FluTrackers for the link.

 

This report from Reuters. 

 

U.S. finds pandemic H1N1 virus in turkey flock

 

Mon Nov 30, 2009 5:53pm EST

WASHINGTON (Reuters) - The pandemic H1N1 flu virus was confirmed in a flock of breeder turkeys in Virginia -- the first U.S. case involving turkeys, the U.S. Agriculture Department said on Monday.

 

The virus also has been found in hogs, three house cats, pet ferrets and a cheetah in California. USDA said infections of turkeys have been reported in Canada and Chile.

 

"This is the first detection of 2009 pandemic H1N1 influenza in turkeys in the United States," said a USDA spokesperson.

(Continue . . . )

 

We’ve chronicled a number of species jumps involving the H1N1 virus, and the Reveres at Effect Measure took on the subject of promiscuous flu viruses in their blog today  (see Dogs, cats and swine flu's promiscuity).

 

I confess I’m unaware of the `cheetah story’ alluded to in the above story, and a quick Google search didn’t turn up anything. 

 

We will no doubt be reminded by the USDA that these infections pose no food safety issues, but the ultimate threat of an ever widening host range for the H1N1 virus is less clear. 

There are a couple of trains of thought here.  

 

One is that when the virus broadens its host range, it has more opportunities to mutate or to reassort with other viruses. 

 

One might, after all, reasonably expect that the H1N1 virus has a better chance to meet up and reassort with an H5 or H7 avian virus in a turkey, than in a human host. 

 

There is another theory, however, that states that viruses don’t tend to mutate as long as they have a large number of susceptible hosts.

 

Virologist John Oxford has suggested that mutations in the H1N1 virus are less likely to occur until a certain amount of herd immunity is achieved. There have been studies that indicate that vaccination pressure may actually drive antigenic drift in flu viruses.

 

Avian influenza: genetic evolution under vaccination pressure

Magdalena Escorcia, Lourdes Vázquez, Sara T Méndez, Andrea Rodríguez-Ropón, Eduardo Lucio and Gerardo M Nava

Virology Journal 2008, 5:15doi:10.1186/1743-422X-5-15

 

As a population gains herd immunity (through vaccines or exposure), the virus must either evolve (mutate) away from the established immunity or die off for a lack of suitable hosts.

 

But, if the virus has a wider host range (say humans, pigs, and birds), or a ready natural reservoir, then there is less evolutionary pressure on it to mutate.  

 

Of course this second theory doesn’t help much with relatively rare, but major antigenic shifts (reassortments), but deals mostly with the far more common antigenic drift (minor mutations).

 

Which theory is correct?

 

It’s entirely possible that both are correct, as they are not mutually exclusive. 

 

As to what happens with this promiscuous pandemic H1N1 virus? 

 

That’s the $64 question, and no one has a good answer yet. 

 

Stay tuned.

CDC FluView Week 46

 

# 4103

 

 

 

The CDC has posted FluView for week 46, ending November 21st, 2009. The amount of flu activity we are seeing has decreased from the levels of a couple of weeks ago, but is still much higher than normally seen this time of year.

 

P&I (pneumonia & Influenza) deaths remain above the epidemic level for this time of year, and 35 pediatric influenza-related deaths were added last week.

 

I’ve excerpted some of the data and graphs below, but follow the link to read it in its entirety.  

 

 

 

2009-2010 Influenza Season Week 46 ending November 21, 2009

All data are preliminary and may change as more reports are received.

Synopsis:

During week 46 (November 15-21, 2009), influenza activity continued to decrease in the U.S.

• 1,880 (20.5%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza.
• Over 99% of all subtyped influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses.
• The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold for the eighth consecutive week.
• Thirty-five influenza-associated pediatric deaths were reported. Twenty-seven of these deaths were associated with 2009 influenza A (H1N1) virus infection, seven were associated with an influenza A virus for which the subtype was undetermined, and one was associated with a seasonal influenza A (H1) virus infection that occurred in March.
• The proportion of outpatient visits for influenza-like illness (ILI) was 4.3% which is above the national baseline of 2.3%. All 10 regions reported ILI above region-specific baseline levels.
• Thirty-two states reported geographically widespread influenza activity, Puerto Rico and 17 states reported regional influenza activity, the District of Columbia and one state reported local influenza activity, and Guam and the U.S. Virgin Islands reported sporadic influenza activity.

 

 

U.S. Virologic Surveillance:

WHO and NREVSS collaborating laboratories located in all 50 states and Washington D.C., report to CDC the number of respiratory specimens tested for influenza and the number positive by influenza type and subtype. The results of tests performed during the current week are summarized in the table below.

During week 46, seasonal influenza A (H1N1) and influenza B viruses co-circulated at low levels with 2009 influenza A (H1N1) viruses. Over 99% of all subtyped influenza A viruses reported to CDC this week were 2009 influenza A (H1N1) viruses.

 

 

Pneumonia and Influenza (P&I) Mortality Surveillance

During week 46, 8.2% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 7.0% for week 46. Including week 46, P&I mortality has been above threshold for eight consecutive weeks.

 

 

Influenza-Associated Pediatric Mortality

Thirty-five influenza-associated pediatric deaths were reported to CDC during week 46 (California, Colorado, Florida [3], Illinois [3], Indiana, Kentucky, Massachusetts, Minnesota, Missouri, New Hampshire, New Mexico [8], New York, North Carolina [2], Pennsylvania [2], Rhode Island [2], South Carolina [2], Tennessee, Texas [2], and Washington). Twenty-seven of these deaths were associated with 2009 influenza A (H1N1) virus infection, seven were associated with an influenza A virus for which the subtype is undetermined, and one was associated with a seasonal influenza A (H1) virus infection. The deaths reported during week 46 occurred between March 8 and November 21, 2009.

 

CDC Key Flu Indicators For Week 46

 

 

# 4102

 

Due to the long Thanksgiving holiday weekend, we didn’t get our normal Friday reporting on Flu trends and FluView last week.  

This morning the CDC released their Key Flu Indicators for week 46, which ended November 21st.   Later today the full FluView report should be available.

 

 

 

Key Flu Indicators

November 30, 2009, 11:00 AM

Each week CDC analyzes information about influenza disease activity in the United States and publishes findings of key flu indicators in a report called FluView.

During the week of November 15-21, 2009, influenza activity decreased in some key indicators and increased in others. Overall influenza activity remains high for this time of year. Below is a summary of the most recent key indicators:

 

• Visits to doctors for influenza-like illness (ILI) nationally decreased sharply this week over last week with all regions showing declines in ILI. This is the fourth consecutive week of national decreases in ILI after four consecutive weeks of sharp increases While ILI has declined, visits to doctors for influenza-like illness remain high.
• Influenza hospitalization rates remain higher than expected for this time of year. Hospitalization rates continue to be highest in younger populations with the highest hospitalization rate reported in children 0-4 years old.
• The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report continues to be higher than expected for this time of year. This proportion has remained elevated for eight weeks now. In addition, 35 flu-related pediatric deaths were reported this week: 27 of these deaths were associated with laboratory confirmed 2009 H1N1; 7 were influenza A viruses, but were not subtyped and one death was associated with a seasonal influenza A (H1) virus. The one death associated with seasonal influenza A (H1) virus infection reported this week actually occurred in March, during the 2008-09 season. Since April 2009, CDC has received reports of 234 laboratory-confirmed pediatric deaths:  198 due to 2009 H1N1, 35 pediatric deaths that were laboratory confirmed as influenza, but the flu virus subtype was not determined, and one pediatric death associated with a seasonal influenza virus. (Laboratory-confirmed deaths are thought to represent an undercount of the actual number. CDC has provided estimates about the number of 2009 H1N1 cases and related hospitalizations and deaths.

• Thirty-two states are reporting widespread influenza activity at this time; a decline of 11 states from last week. They are: Alabama, Alaska, Arizona, California, Connecticut, Delaware, Florida, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Virginia, and West Virginia).

• Almost all of the influenza viruses identified so far continue to be 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception.

 

 

Hyperbolic Headlines

 

 

# 4101

 

 

The purveyors of pandemic paranoia are flooding the Internet with scare headlines, speculative (and sometimes nonsensical) stories, and dire predictions about deadly viral mutations `spreading around the world’. 

 

Some of these reports are truly egregious.

 

My favorite, all-encompassing-headline came from The Examiner over the weekend.

 

H1N1 deaths increase as mutations combine - vaccine & antiviral resistant, lung hemorrhaging virus

Scary stuff.  Assuming that it’s true.

 

I’ve received emails this weekend asking what my take is on these mutations, and although I’m not a virologist, I do have an opinion.

 

We all need to slow down, take a deep breath, and wait on the science before we decide it’s time to rush down to the bunkers.

 

Seriously.   

 

The media hysteria generated by stories of `burnt lungs’ coming out of Ukraine earlier this month (with temperature readings of 140 degrees, no less!), virulent hemorrhagic  HA mutations found in Norway, and Tamiflu resistance in the US and Wales is getting out of hand.

 

Of course, everyone knows that all mutations are bad.  That’s why the word has such resonance with the public.   

 

If you aren’t convinced, all you have to do is watch a half dozen 1950’s science fiction movies, and you’ll come away realizing that practically all bad things come from (usually radiation induced) mutations.

 

Giant grasshoppers, tarantulas, sea monsters, and an acting career for John Agar mostly. Admittedly, all horrible things. 

 

The truth is, flu viruses are constantly mutating. 

 

Some of those mutations are actually good for humanity (they make the virus less `fit’, or less virulent, or less transmissible) and some of those mutations can be bad for humanity for exactly the opposite reasons.

 

But most mutations go nowhere.  They prove less than biologically `fit’, and fail to thrive.

 

While it is possible that the mutations being seen in Norway (and other countries) could become a serious threat over time, right now there is more hype than science surrounding these changes.

 

Reports that the mutation is `spreading globally’ are speculative at best.  These mutations could simply be occurring spontaneously in infected individuals. The transmissibility of this mutation has not yet been established.   

 

Maybe in time, that evidence will come. 

 

But even if this strain is transmissible, and can compete with the other H1N1 strains, it still isn’t clear whether this mutation is any more virulent than the other strains of H1N1. 

 

Sure, it’s been found in several fatal cases.  But we tend to look at fatal cases.  Until we know how many mild - or even asymptomatic cases - have been spawned by this mutation, we really don’t know whether it increases virulence or not.

 

The `other’ big story are reports of a `low reactor’ mutation; one that has changed antigenically enough to evade the current vaccine, have also appeared this weekend. 

 

This has always been a concern of scientists, that over time the pandemic virus could mutate away from the vaccine.  After all, that happens with regularity with seasonal flu strains.   There is no reason to believe it won’t happen with this virus.

But once again, speculation is running roughshod over science.  

 

If a `low reactor’ mutation has appeared,  or even multiple instances of it, that doesn’t mean the vaccine is automatically useless or that humanity is doomed.  A new mutation must compete with existing flu strains, and start to crowd them out, in order to become a public health concern.

 

And right now, I’ve seen no evidence of that.  Maybe in time, that will happen.

 

I don’t make pandemic predictions.  There are easier ways for me to publicly make a fool of myself (believe me, I know).

 

None of this is to suggest that I don’t believe that a serious change could occur in the virus, or even that I’m arguing that one hasn’t happened.  

 

I don’t know.  And neither, I suspect, does anyone else.

 

Until I see something more solid than pseudo-scientific supposition, I don’t intend to lose any sleep over these reports. I will continue to watch them with interest, however.   

 

And if there’s anything to them, we’ll know about it soon enough.  

ECDC Weekend Update

 

 

# 4100

 

On Monday morning we get an update from the ECDC on H1N1 pandemic activity in Europe over the previous 72 hours (Friday/Saturday/Sunday).

 

With this report we also get an update on the mutations seen in the HA1 gene of the H1N1 virus.

 

Main developments in past 72 hours

• Influenza activity is high in 27 EU countries and 13 countries report a rising trend
• More  mutations  have  been  reported  by  EU  countries,  with  a  few  in  the  haemagglutinin  gene  at location 222
• A total of 858 fatal cases in Europe and EFTA countries and 7 710 in the rest of the world have been reported up to date.

 

 

Mutations in the haemagglutinin HA1 gene D222G

Following initial reports from Norway, WHO has noted that a spontaneous mutation in the haemagglutinin gene D222G has been observed in at least seven countries world-wide (1). These spontaneous mutations have been detected retrospectively following genetic sequencing. They were first detected in April and were seen in Mexico and the USA and so are not a recent phenomenon (1,2).

Finnish and French virologists reported another three cases last week (3).  As in a number of the cases the viruses were reported from two patients with very severe illness who died. WHO and ECDC are currently assessing the public health significance of this mutation (1,2). It is unclear whether the mutation is especially pathogenic or whether it is somehow selected for in very ill patients. 

However there is no evidence that the virus is transmitting, none of the patients are reported to be connected to each other and the mutation is not spreading in Europe. As further sequencing is undertaken reports of its detection in other European countries can be expected.

 

The Return Of Bird Flu

 

 

# 4099

 

 

While the  H5N1 virus has been off the radar scope for awhile, replaced in our attentions by the H1n1 virus, it is still out there; in the wild, endemic in the domesticated birds of several nations, and occasionally infecting humans.

 

Over the long holiday weekend we learned of Egypt’s 89th known H5N1 human infection.   Today, three new reports: two from Indonesia and one from Vietnam.

First, out of Vietnam, we get this newspaper report of that country’s first known H5N1 fatality since last spring.   Treyfish on Flutrackers has the story from the Vietnam Express, and the complete translated text here.

 

 

In Vietnam The youth died of H5N1

November 30, 2009, 17:27 GMT +7

Patients age 23, in ward Sam Min, the city of Dien Bien, had eaten more duck soup for about a week before has the disease. Especially as the H5N1 ca 5 this year are fatal.

 
Notified by the Department of Preventive Health and Environment (Ministry of Health), patients starting on November 18 patients with sudden high fever, cough, shortness of breath. However, six days after the last patient visit at the medical ward station, then transferred to the Clinic The area of Phu on November 25.

A day later, he continued to be transferred to Hospital Dien Bien province and was diagnosed with severe pneumonia monitor viral, antibiotic treatment, transmission service, antipyretic. Patients to proceed more severe and the patient died on November 28.

As of 29/11, Institute of Hygiene and Epidemiology central results of patients tested positive for H5N1 virus.

 

Officially Vietnam has reported 4 cases of human H5N1, with all four dying.  If officially confirmed, it will probably be a couple of days before news of this case is relayed to the WHO.

 

We next jump to Indonesia, where getting good information on H5N1 has been almost impossible for the past couple of years.  Government silence on outbreaks in poultry and human infections is pretty much standing policy.

 

So while we sometimes see local media accounts of H5N1 infections, we almost never get official confirmation. 

 

Ida at the Bird Flu Information Corner (BFIC) - a  joint venture between Kobe University in Japan and the Institute of Tropical Disease, Airlangga University, Indonesia – remains our best source of information about what is going on in that archipelago nation.

 

Ida translates local media reports and posts them on the BFIC site.  Today we have two such reports, the first involving a suspected human infection in Padang.

 

Padang, West Sumatera ::: Duck farmer suspected to contract bird flu

November 30, 2009

Padang, West Sumatera – A resident of Tanjuang Durian, Nagari Baru Kecamatan Bayang Kabupaten Pesisir Selatan, Dasrizal (37), suspected to contract bird flu virus and admitted to M Djamil hospital.

 

Patient is a duck farmer, and raising hundreds of ducks. He is reported to have found almost of all his ducks suddenly died. Subsequent to the finding, he burried the dead ducks. He developed high fever at noon of the same day, and his family gave him antipyretic drug, a kind of paracetamol.

 

Dafrizal’s fever was getting higher in the afternoon and his family brought him to Pasa Baru public health center in the evening. Public health center was then referred Dafrizal to M Zein Painan hospital, where he was diagnosed as bird flu suspect. Patient was transferred to M Djamil hospital to receive better treatment as bird flu suspect patient.

 

Source: Indonesia local newspaper, Padang Today. http://padang-today.com/?today=news&id=11542

 

 

This second story involves government supplied poultry – a contribution by local governments to their community – that have suddenly died from bird flu.    Other communities received similar contributions, and so the search is on for other outbreaks.

 

 

Lhoksukon, North Aceh ::: Government contributed poultries die of bird flu

November 30, 2009

Lhoksukon – Avian influenza (AI) rapid response team of Livestock Service and Animal Health Service in North Aceh culled number of bird flu infected chickens. Those chickens were contributed by local government for community in Calong, Kecamatan Syamtalira Aron.

 

AI team coordinator, dr Muzakir Anwar on Monday (29/11) said depopulation was done last Wednesday (25/11) after receiving report that 330 of 400 contributed chickens suddenly died. Further check to survived and dead chickens showed positive bird flu infection.

 

Previously, 90 of 400 contributed chickens were reported to have died of bird flu infection in Simpang Empat, Kecamatan Simpang Keuramat. Same incidents occurred in Matang Kuli, Baktiya, dan Muara Batu at the following day.

 

Currently, livestock service is waiting for report from three other sub-district (Kecamatan) which received same contributions; Cot Girek, Langkahan and Saenuddon. So far no report from those three sub-districts, but there is high possibility that same incident may happen.

(Continue . . . )

 

 

The great unknown, of course, is whether the H5N1 virus will ever make the adaptations required to make it an easily transmissible human pathogen.   So far, that hasn’t happened.  

 

And perhaps, there are biological barriers to prevent it from ever happening.  We simply don’t know.

 

Many scientists are concerned over what happens when the H1N1 swine flu virus meets up with the H5N1 bird flu virus in the same host (human, bird, pig).   Again, scientists don’t know if a reassortment will occur.  

 

They just know it’s possible.

 

 

There are some that would argue that since H5N1 hasn’t learned to jump to humans yet, it probably won’t. 

 

That’s possible, of course. 

 

But that ignores the reality that the novel H1N1 virus bounced around in pigs for many years before finding the right genetic combination to make it a human adapted virus.

 

And so we continue to watch warily as influenza evolves on multiple fronts.  The H1N1 pandemic, of course.  But also H5N1 bird flu, and the H7, H9, and H10 avian viruses as well.

 

We cohabitate with a immense, diverse, and ever evolving world of pathogens. 

 

We would ignore them at our considerable peril.

Branswell: Some Scientists Expect A 3rd Wave

 

# 4098

 

 

Helen Branswell, medical correspondent for the Canadian Press, takes us on a tour of public health officials and scientists to ask whether the now declining H1N1 virus will be back later in this flu season as a 3rd wave.

 

As with any Branswell article, it is worth your time to follow the link to read it in its entirety.

 

 

Some health officials predict a third wave of H1N1

November 29, 2009

Helen Branswell

TORONTO — The current wave of H1N1 activity may have peaked in all provinces and territories, the Public Health Agency of Canada says in its latest assessment on the state of the pandemic.

 

But if transmission of the virus is indeed on the downward slope, does that mean the end is in sight for Canada? Or is a third wave of illness sometime this winter in the cards?

 

With the notoriously unpredictable influenza, it’s pretty much anyone’s guess.

 

“I think if you ask a group of so-called influenza experts, you’re going to get different views,” says Dr. Frederick Hayden, an influenza expert who splits his time between at the University of Virginia and Britain’s Wellcome Trust, a charity that funds biomedical research.

 

Hayden is betting on “a bump” of activity after Christmas, because so many people remain susceptible to the virus. Though whether that will be a full wave or just an upswing in cases, he’s not sure.

 

Regardless of where the experts come down on the question of a third wave, they say one thing is a safe bet. Whether it’s this winter or next, the H1N1 flu will be back.

 

(Continue . . . )

Australia: Three eMJA Pandemic Studies

 

 

# 4097

 

From the eMJA (Medical Journal of Australia) three rapid online publications tonight regarding the southern hemisphere’s recent pandemic flu season. 

 

The first study falls under the category of `lessons learned’ by clinicians during this past summer’s pandemic wave in Australia, and implications for change in pandemic policies.

The second study looks at the epidemiology and demographics of the pandemic, and clearly indicates the age-shift in hospitalized patients.

 

The third study looks at the hospitalizations of adult patients and concludes that the severity of illness seen with the novel H1N1 virus was comparable to that seen with seasonal flu.  The primary differences seen were that those patients with novel (H1N1) tended to be younger and less immunocompromised.

 

Links and excerpts from their abstracts follow:

 

 

The rational clinician in a pandemic setting

David A Bradt and Joseph Epstein

Abstract

• Pandemic (H1N1) 2009 influenza has generated many controversies in Australia around case definitions, laboratory diagnosis, case management, medical logistics and travel restrictions.

• Our experience as clinical advisers in the Victorian Department of Human Services Emergency Operations Centre suggests the following:

  • Case definitions may change frequently, and will tend to become more clinically specific over time.

  • Early in a pandemic, laboratory diagnosis plays a critical role in case finding and pathogen identification.

  • Later in the pandemic, standardised case management applied to well crafted case definitions should reduce reliance on the diagnostic laboratory in clinical management. The diagnostic laboratory will remain critical to monitoring disease surveillance, pathogen virulence, and drug susceptibility.

  • Medical logistics will continue to challenge pandemic managers as the health sector struggles to do the most good for the greatest number of people.

  • Travel restrictions remain scientifically controversial public health recommendations.

  • Issues of scalability (escalation and de-escalation of the response) relating to virus lethality need to be resolved in current pandemic planning.

 

 

 

The changing phases of pandemic (H1N1) 2009 in Queensland: an overview of public health actions and epidemiology

 

Ranil D Appuhamy, Frank H Beard, Hai N Phung, Christine E Selvey, Frances A Birrell and Terry H Culleton

Abstract

• A graded public health response was implemented to control the pandemic (H1N1) 2009 outbreak in Queensland.

• Public health measures to contain the outbreak included border control, enhanced surveillance, management of cases and contacts with isolation or quarantine and antivirals, school closures and public education messages.

• The first confirmed case in Australia was notified on 8 May 2009, in a traveller returning to Queensland from the United States.

• In Queensland, 593 laboratory-confirmed cases were notified with a date of onset between 26 April and 22 June 2009, when the Protect phase of the Australian Health Management Plan for Pandemic Influenza was implemented; 16 hospitalisations and no deaths were reported during this time.

• The largest number of confirmed cases was reported in the 10–19-years age group (167, 28% of cases), followed by the 20–29-years age group (153, 26% of cases).

• With ongoing community transmission, the focus has shifted from public health to the clinical domain, with an emphasis on protecting vulnerable groups.

• Considerable resources have been invested to prevent and control the spread of disease in Indigenous communities in Far North Queensland.

• The capacity of clinical services to cope with increased admissions, the potential for widespread antiviral resistance, and rollout of mass vaccination campaigns remain future challenges.

 

Age distribution of Lab confirmed H1N1 cases  clearly showing the age-shift to young adults and children.

 

 

 

Comparison of adult patients hospitalised with pandemic (H1N1) 2009 influenza and seasonal influenza during the “PROTECT” phase of the pandemic response

Ya-Shu Chang, Sebastiaan J van Hal, Peter M Spencer, Iain B Gosbell and Peter W Collett

 

Objective: To compare the patient characteristics, clinical features and outcomes of adult patients hospitalised with pandemic (H1N1) 2009 influenza and seasonal influenza.

 

Design and setting: Retrospective medical record review of all patients admitted to Liverpool Hospital, Sydney, with laboratory-confirmed influenza from the initiation of the “PROTECT” phase of the pandemic response on 17 June until the end of our study period on 31 July 2009.

 

Main outcome measures: Severity of illness; requirement for admission to the intensive care unit (ICU) and/or invasive ventilation; mortality.

 

Results: Sixty-four adults were admitted to Liverpool Hospital with influenza, 48 with pandemic (H1N1) 2009 influenza and 16 with seasonal influenza. Thirteen patients were admitted to the ICU. Seven required invasive ventilation, with 2 patients requiring ongoing extracorporeal membrane oxygenation (ECMO). Five patients died (mortality rate, 8%) with two deaths occurring after the study period. Patients with pandemic (H1N1) 2009 influenza were younger and less likely to be immunocompromised than patients with seasonal influenza. However, the clinical features of pandemic (H1N1) 2009 influenza and seasonal influenza were similar.

 

Conclusions: Our findings show that the clinical course and outcomes of pandemic (H1N1) 2009 influenza virus are comparable to those of the current circulating seasonal influenza in Sydney. The high number of hospital admissions reflects a high incidence of disease in the community rather than an enhanced virulence of the novel pandemic influenza virus.

Some Reliable Pandemic Resources

 

 

# 4096

 

 

I’ve just spent the last 4 hours combing the Internet for something blogable or at least newsworthy regarding the H1N1 virus.

 

It is a relatively quiet Sunday Morning – the end of a long holiday weekend in the US – and the pickings this am are pretty slim.

 

Unless, of course, you’re interests lean towards crazy conspiracy theories, wild speculation, or outright pandemic paranoia.  Those types of stories are always plentiful, regardless of vagaries of the news cycle.  

 

As a `reality-based’ blogger, however, these types of stories don’t do me much good (although they can be useful for killing off weaker brain cells).  Unfortunately, much of what is being reported (or perhaps more accurately, `spewed forth’) on the Internet is of dubious value at best. 

 

Not all of it is dreck, of course.

 

While you can find a lot more mentions in my blog Reliable Sources In Flublogia, some of the real standouts include:

 

My `go to’ science bloggers,  like Vincent Racaniello on Virology Blog, the Reveres on Effect Measure, and Tara Smith on Aetiology. 

 

And `take it to the bank’ reporting by the likes of Helen Branswell of the Canadian Press, Maggie Fox of Reuters, Jason Gale of Bloomberg, and Maryn McKenna, Robert Roos, and Lisa Schnirring of CIDRAP. 

 

But sometimes I’m called upon to do research on my own, and knowing where to go, and what sources I can trust, isn’t easy. 

 

No source can be 100% reliable, of course, and there are admittedly many things we don’t know about influenza (and many others we think we know, but are wrong about).

 

But there are some resources that I’ve learned to trust, and that I go to again and again. So I thought I’d share them with you on this quiet Sunday Morning.

 

First are the CIDRAP overviews.    When it comes to easy to read and understand historical and scientific overviews, these are hard to beat.  I refer to them often.

 

Novel H1N1 Influenza (Swine Flu)

Last updated November 20, 2009

 

Avian Influenza (Bird Flu): Agricultural and Wildlife Considerations
Last updated September 28, 2009

 

Avian Influenza (Bird Flu): Implications for Human Disease

Last updated September 28, 2009

 

While not something I use every day, another resource I’ve found useful is the Thomson Reuters Daily News Briefing on the H1N1 virus.   

 

This is a (currently) 55 page PDF file, updated daily, with background scientific information about the H1N1 virus, with special emphasis on the pharmacology (vaccines, antivirals, diagnostic tests, etc.) and biology of the virus.

While much of this information is specific to the Pharmacology Industry, it provides a good deal of scientific data.

 

 

 

 

Buried in the websites for the CDC, HHS, FDA, NIOSH, FEMA, Ready.gov, Flu.gov  and other governmental agencies are tremendous resources as well. 

 

 

And finally, two Flu Forum resources that I use often.  

 

The `wiki side’ of the Flu Wiki  is a reference site filled with flu information, and maintained by the members of the Flu Wiki.  They describe it this way:

 

The purpose of the Flu Wiki is to help local communities prepare for and perhaps cope with a possible influenza pandemic. This is a task previously ceded to local, state and national governmental public health agencies. Our goal is to be:

• a reliable source of information, as neutral as possible, about important facts useful for a public health approach to pandemic influenza
• a venue for anticipating the vast range of problems that may arise if a pandemic does occur
• a venue for thinking about implementable solutions to foreseeable problems

 

You’ll also find discussion threads, some written by doctors, on the conversation side of the Flu Wiki, that delve (often quite deeply) into the science of influenza.

 

And then there’s FluTrackers which has become one of the largest, and most organized repositories of flu information on the Internet.  Due to its size and scope, navigating FluTrackers can be a bit of a challenge until you get used to it, but it is worth the effort. 

 

Both FluTrackers and the Flu Wiki have hard working and talented newshounds (see Newshounds: They Cover The Pandemic Front) and have collected years worth of news and journal articles, and analysis, on influenza and other emerging infectious diseases.

In many ways, these forums have become living reference libraries.  Sure, you’ll find some speculation on them.  But most of it is either reasonable, or quickly refuted by other forum members.  

 

Like anywhere else, Caveat Lector.

 

On a morning where I’m seeing a discouraging number of conspiracy theories, paranoid rantings, and tabloid stories take center stage, it is worth reminding myself that there are good, solid, and reality-based resources out there.

 

You just have to know where to look.

NIOSH On HCW Work Safety

 

 

# 4095

 

 

One of the groups I tend to hear from via email and/or comments are HCW’s (Health Care Workers), since much of this blog is geared in their direction.  My interest in their welfare runs deep because I have friends who work in that sector, and of course, I used to be a HCW myself.

 

With a largely private Health Care Industry here in the United States, government agencies are somewhat limited in what demands they can place on hospitals, clinics, and doctor’s offices.  

 

Sometimes the best they can do is issue guidelines and make strongly worded recommendations.

 

NIOSH, the National Institute for Occupational Safety & Health, has released Health Care Worker guidelines while it attempts to gather information on HCWs who have been infected with the H1N1 virus on the job.

 

Although this statement was issued more than a month ago (it was updated again earlier this month), it is a good reminder than Hospitals need to follow the CDC recommendations for infection control, they need to inform HCWs about underlying conditions that might make them more prone to serious illness, and they should have flexible and non-punitive sick leave policies.

 

 

 

 

NIOSH Safety and Health Topic:

Occupational Health Issues Associated with H1N1 Influenza Virus (Swine Flu)

Risk of Serious Illness Among Healthcare Personnel Associated With 2009 H1N1 Influenza:  What Is NIOSH Learning?

October 16, 2009

Reports in the news media have associated the deaths of at least four nurses with 2009 H1N1 influenza. Efforts to gain a fuller understanding of the prevalence of serious H1N1 illness and fatalities among nurses, as well as other healthcare personnel, have been limited due to a lack of occupational data in existing healthcare surveillance systems. More efforts are needed in order to fully appreciate the prevalence of severe H1N1 illness among healthcare workers.

 

NIOSH is working with its partners to gather more information about deaths and serious illness among healthcare personnel associated with 2009 H1N1 influenza. These surveillance activities are aimed at better understanding the factors that may heighten the risk of severe work-related 2009 H1N1 infection among healthcare personnel, as well as identifying the factors which affect risk of transmission of 2009 H1N1 influenza to healthcare personnel.

 

Healthcare personnel are at increased risk of occupational exposure to the 2009 H1N1 virus based on their likelihood for encountering patients with 2009 H1N1 illness. In contrast to seasonal influenza virus, 2009 H1N1 influenza virus has caused a greater relative burden of disease in younger people, which includes those in the age range of most healthcare personnel. For some healthcare personnel, this higher risk of exposure and illness may be compounded by the presence of underlying illness which places them at higher risk of serious flu complications, such as asthma, diabetes, or neuromuscular disease. Of particular concern to the healthcare workforce, which is largely female, is the fact that pregnant women are among those groups considered to be at higher risk of severe infection from 2009 H1N1.

 

As NIOSH gathers further information about the prevalence of serious illness among healthcare personnel, it recommends the following precautions, based on known risks of exposure for healthcare personnel and known risk factors for complications from influenza:

• Healthcare facilities should follow U.S. Centers for Disease Control and Prevention (CDC) interim guidance for 2009 H1N1 influenza infection control for healthcare personnel.
• Healthcare personnel should be encouraged to receive both the seasonal influenza vaccine and the 2009 H1N1 vaccine when available.
• Healthcare personnel should be informed about and aware of the types of underlying conditions that may put them at higher risk of complications. In addition to pregnant women, those at higher risk for complications of 2009 H1N1 influenza include the following: those with a variety of chronic medical conditions (examples include asthma, sickle cell disease, and diabetes mellitus); people with immunosuppression caused by medications or disease; those with disorders such as neuromuscular disease that compromise respiratory function or handling of respiratory secretions or increase the risk of aspiration; those younger than 19 years of age who are on chronic aspirin therapy; and those 65 years of age or older.
• Healthcare personnel should be informed about and aware of the symptoms of influenza or influenza-like illness, the emergency warning signs to seek urgent care, including but not limited to difficulty breathing, shortness of breath, or pain or pressure in the chest or abdomen, and the need to seek care aggressively if they have conditions that put them at higher risk of complications of influenza or if they have any concerns about their symptoms.
• Healthcare employers should have flexible, non-punitive, and well-communicated leave policies. They should allow personnel who have the flu to stay home and away from co-workers.

Canada: FluWatch Week 46

 

 

# 4094

 

 

The Public Health Agency of Canada produces a weekly influenza summary called FluWatch, which is very similar to the US FluView report from the CDC. In it you will find maps, charts, and summaries of the previous week’s influenza surveillance.

 

As in the United States, while numbers this week are declining, Canada is in the midst of a serious outbreak of influenza. More befitting of what might be expected in January or February than mid November.

 

A few excerpts from this week’s report (ending Nov 21st), but follow the FluWatch link to read it in its entirety.

 

 

November 15, 2009 to November 21, 2009 (Week 46)

Summary of FluWatch Findings for the
Week ending November 21, 2009

• Nationally, the activity level reported this week decreased compared to the previous week. All influenza indicators declined during week 46.
• A possible epidemic peak has been reached by all provinces and territories.
• The Pandemic (H1N1) 2009 strain accounted for nearly 100% of the positive influenza A subtyped specimens this week.
• The intensity of Pandemic (H1N1) 2009 in the population was still high with 1,554 hospitalizations, 243 ICU admissions and 61 deaths reported this week. Hospitalized cases occurred in all provinces and territories (P/T) that reported this week while the deaths were from all P/T except PE, NL and NU. From August 30 to November 21, 2009, a total of 5,507 hospitalized cases including 819 (14.9%) cases admitted to an intensive care unit (ICU) as well as 203 deaths had been reported.
• While the number of hospitalized cases, ICU admissions and deaths reported this week decreased, the number of hospitalizations was higher than the overall number of hospitalizations for the first wave.
• The proportion of severe cases (ICU admissions and deaths) among all hospitalized cases was lower in the second wave than in the first wave.

 

Canadian situation

Antigenic Characterization

Since September 1, 2009, NML has antigenically characterized 310 Pandemic (H1N1) 2009 viruses and four seasonal influenza viruses (two influenza A/H1N1, one influenza A/H3N2 and one B virus) that were received from Canadian laboratories. Of the 310 Pandemic influenza A (H1N1) viruses characterized, 309 (99.7%) were antigenically related to A/California/7/2009, which is the pandemic reference virus selected by WHO as Pandemic (H1N1) 2009 vaccine. One virus (0.3%) tested showed reduced titer with antisera produced against A/California/7/09. Sequence analysis of the HA showed that the virus with reduced titer did not have the mutation at amino acid position 222 as reported by Norway. CDC also reported that of the 348 pandemic H1N1 viruses tested, one virus showed reduced titer with antisera produced against A/California/7/09.

 

Antiviral Resistance

 

NML: Pandemic (H1N1) 2009 viruses tested so far have been sensitive to zanamivir (220 samples) but resistant to amantadine (231 samples). Of the 258 Pandemic (H1N1) 2009 viruses tested, 255 were sensitive to oseltamivir and three viruses were resistant to oseltamivir with the H275Y mutation. The three resistant cases, 2 from Ontario and 1 from Quebec, were associated with oseltamivir treatment.

 

Provinces: Three cases of oseltamivir resistant Pandemic (H1N1) 2009 were reported to date in Canada from the province of Quebec on July 21, 2009, from Alberta on September 15, 2009 and from Ontario on October 13, 2009.

 

Ambiguous Mutations

 

 

# 4093

 

 

If you follow the various flu forums, blogs, and websites you are probably aware that there has been a fair amount of discussion in recent days revolving around the `Norwegian’ and `Ukrainian’  mutations, and increased reports of Tamiflu resistant H1N1 viruses.

 

Don McNeil Jr. of the New York Times has an article about the WHO (World Health Organization’s) attempts to dampen fears over these reports, in a piece called Experts Say Swine Flu Mutations Do Not Warrant New Alarm.

 

The tone of the message from the World Health Organization is one of reassurance, although they admit there are things they do not yet understand about these mutations.  

 

I’ll grant that the first inclination of most governments or health agencies - when faced with disturbing news - is to ratchet down public concerns.

 

It is almost an autonomic reflex, and not always a bad thing. Particularly when there is a good deal of ambiguity about the threat.

 

My take is simply that mutations happen, and that we shouldn’t be terribly surprised to see them when they do.  As virologists like to say,  `Shift Happens’   (more accurately `drift’ in this case).

 

But I’m not quick to jump on any viral bandwagon. 

 

Which is why I tend not to become too alarmed over these reports.  At least not until we can get some credible data and analysis.

 

Only time will tell if any of these mutations is `fit’ enough to compete with the existing virus strains and become a `contender’.  Most mutations fail to thrive, and are destined to die out.

 

The isolation of a single mutation, or even a handful of them around the world, doesn’t automatically make for a public health threat, regardless of what the tabloid papers are saying. 

 

But of course, every once in awhile . . .  well, let’s face it.  Every viral change started out small somewhere. 

 

Are the `Norwegian Mutations’ (which actually have been seen in  many places around the world) a big deal?  Or the Tamiflu resistant strains?

 

We don’t know yet.    Maybe.  Stay tuned.

 

Good science takes time.   You have to collect the data and then analyze it.  And sometimes, the data can be confusing or misleading.

 

Hopefully we’ll have a better handle on all of this a week or two from now.  But definitive answers could be months away.  

 

Influenza is constantly fooling us, and the `rules‘ are rarely writ in stone. If any of these mutations end up being less benign than currently advertised, I figure that will become apparent over time. 

 

For now, I regard these viral changes as worthy of our attention, but not our alarm. 

 

This from the New York Times.

 

 

 

Experts Say Swine Flu Mutations Do Not Warrant New Alarm

by DONALD G. McNEIL Jr.

Published: November 27, 2009

The World Health Organization tried this week to dampen fears about mutations seen in the swine flu virus in several countries, noting that both mutations had been found in very few people.

 

A change that created Tamiflu resistance has been found in about 75 people around the world, said Dr. Keiji Fukuda, chief flu adviser to the W.H.O.’s director general. Two clusters, in cancer units at Duke University Medical Center in North Carolina and a hospital in Wales, were both among patients whose immune systems had been severely suppressed by cancer treatment; some had had their bone marrow, which produces infection-fighting white blood cells, wiped out so that replacement blood stem cells could be injected.

 

Such patients are more likely to develop resistant viruses when on Tamiflu because they can not clear a virus on their own. But the mutant strain appears not to spread easily in people with normal immunity, like hospital workers.

 

“We don’t know the full answer, but it is more likely that we are not seeing a major shift,” Dr. Fukuda said.

 

Widespread Tamiflu resistance is a serious problem in the seasonal H1N1 virus, but it has not crossed over into the swine H1N1.

 

(Continue . . . )

Hop Aboard The Superbug Express

 

 

# 4092

 

 

In case you missed it, Maryn McKenna has been blogging up a storm on her Superbug Blog this week, which deals with all things antibiotic resistant.

 

Maryn is a contributing writer at CIDRAP, and the author of Beating Back The Devil, the inside story of the CDC’s Epidemic Intelligence Service, and an upcoming book on MRSA.

 

This week Maryn has published a number of important stories on her site, and since this is a holiday week in the States, some of you may have missed them. 

 

 

Antibiotics - the EU pipeline is empty too

New pig strain in China

Pig MRSA" in the EU - long-awaited survey

CDC warns of deaths from H1N1 flu + bacterial infections

Two good reports published elsewhere

Community MRSA rates rising, and epidemics converging

Antibiotic misuse in animals - one example

 

 

If you aren’t visiting the Superbug Blog regularly, you are missing out on one of the best infectious disease resources on the Internet.

China Reports 2 Dogs With H1N1

 

 

# 4091

 

A little over 2-weeks ago we saw a video report from CCTV (China Central Television) news that voiced concerns over the H1N1 virus species jumping to pigs, cats, and according to that report . . . even dogs (see China Worries Over Species Jumping H1N1).

 

Dogs are not normally thought of as able to contract `human flu’ – although if you blog about influenza long enough, you learn not to discount something simply because its never been seen before . . .

 

Cats, after all, we were not thought likely to be susceptible to the novel H1N1 virus  either . . .  until, that is, reports of infected cats began to come in a little over a month ago.

 

Followers of the avian influenza story, of course, know that dogs and cats have both been infected by the H5N1 virus.  

 

Dr. C.A. Nidom demonstrated in 2006 that of 500 cats he tested in and around Jakarta, 20% had antibodies for the bird flu virus.   For an overview of a number of other cases, see Apparently They Didn't Get The Memo.

 

We’ve not heard of dogs being infected by the H1N1 virus before, although there have been reports of dogs being infected by the H5N1 avian flu.   See also Study: Dogs Can Shed H5N1 Virus.

 

Of course, H5N1 is avian flu, with different receptor binding domains than human flu. 

 

Six months ago, many scientists would probably have opined that dogs could not catch this `human flu’.  With the recent discovery of the virus in cats, some veterinarians and scientists have modified that stance to it being `unlikely’ that dogs would be susceptible.

 

Those with a more cautious bent, however, have simply have stated that there’s been `no evidence of human-to-dog transmission of the H1N1 virus’.

 

Well . . . not until now, anyway.

 

Today, at least according to Chinese state run media, we’ve what appears to be confirmation of reports of dogs infected with the novel H1N1 virus, with this story (hat tip Treyfish on FluTrackers) from Xinhua news.

 

Which proves . . . when it comes to influenza, one is wise to never say never.

 

 

 

China urges intensified supervision on A/H1N1 flu in animals

 

www.chinaview.cn  2009-11-28 09:43:42

BEIJING, Nov. 28 (Xinhua) -- China's Ministry of Agriculture has called for intensified monitoring and investigation of A/H1N1 flu in animals after two samples from sick dogs were tested positive for the virus.

 

The veterinary clinic of College of Veterinary Medicine at the China Agricultural University reported Wednesday that two out of 52 samples from sick dogs were tested positive for A/H1N1 flu virus, the ministry said late Friday.

 

Analysis of genetic composition found the virus detected in the samples and those found on human A/H1N1 flu cases were 99 percent homologous, it said.

 

The ministry urged local authorities to further enhance prevention and control, intensify monitoring and investigation in animal cases of A/H1N1 flu and closely watch the virus mutation situation in animals.

Canada: Deciding What To Do With Surplus Vaccine

 

 

# 4090

 

 

Helen Branswell, medical and science correspondent for the Canadian Press, tonight has details on a decision that the Canadian government will soon have to make regarding excess  vaccine they have on order.

 

At some point – relatively soon – Canada will have enough vaccine delivered to accommodate those that are interested in getting the jab right now. 

 

While it sounds like a simple decision – to donate unused vaccine to developing countries – government officials must also decide how much vaccine to keep in reserve in the event of a resurgence of the virus next spring or summer.

Follow the link to read the entire article.

 

 

 

Feds expecting millions of unused H1N1 vaccines

By Helen Branswell - THE CANADIAN PRESS

Last Updated: 27th November 2009, 7:51pm

TORONTO — The federal government will make a decision in the next couple of weeks about what to do with what is expected to be tens of millions of unused doses of H1N1 vaccine, a spokesperson said Friday.

 

The admission came after Health Minister Leona Aglukkaq revealed the Public Health Agency of Canada will provide 5.7 million doses of pandemic vaccine to the provinces next week — a shipment which could in all likelihood fulfil the country’s H1N1 vaccine needs.

 

When that shipment is in place, more than 21.5 million doses of vaccine will have been made available across the country.

 

That’s enough to vaccinate nearly 64 per cent of Canadians — considerably more than have indicated a willingness to be immunized up until now.

(Continue . . .)

WHO Pandemic Update #76

 

 

 

# 4089

 

Although the numbers reported to, and by the WHO (World Health Organization) are - by their own admission - incomplete and represent a significant undercount of cases, this week the WHO is reporting an increase of more than 1000 deaths from the H1N1 virus.

 

This makes the largest single-week uptick thus far in the pandemic and has garnered a good deal of press attention this morning. 

 

Here is how the BBC is reporting the story, including a quote from the WHO’s Keiji Fukuda on the `Norwegian’ mutations.

 

 

Jump in number of global swine flu deaths

 

The global number of swine flu deaths has jumped by more than 1,000 in a week, latest figures from the World Health Organization (WHO) show.

 

At least 7,826 people are now known to have died following infection with the H1N1 virus since it first emerged in Mexico in April.

 

Europe saw an 85% increase in the week, with the total number of deaths rising from at least 350 to at least 650.

 

<SNIP>

 

Keiji Fukuda, WHO's special adviser on pandemic influenza, said: "The question is whether these mutations suggest that there is a fundamental change going on in viruses out there - whether there's a turn for the worse in terms of severity.

 

"The answer right now is that we are not sure."

 

Some excerpts from WHO today’s update, including the latest on the mutations in their virological update.

 

Pandemic (H1N1) 2009 - update 76

Weekly update

27 November 2009 -- As of 22 November 2009, worldwide more than 207 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 7820 deaths.

 

As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual number of cases that have occurred.

 

<SNIP>

 

 

Situation update:

In temperate regions* of the northern hemisphere, the early arriving winter influenza season continues to be intense across parts of North America and much of Europe. In North America, the Caribbean islands and a limited number of European countries there are signs that disease activity peaked.

 

In the United States and Canada, influenza transmission remains very active and geographically widespread. In the United States, disease activity appears to have peaked in all areas of the country. In Canada, influenza activity remains similar but number of hospitalisations and deaths is increasing. Most countries in the Caribbean have ILI and SARI levels coming down.

 

In Europe, widespread and increasing transmission of pandemic influenza virus was observed across much of the continent and most countries that were not yet experiencing elevated ILI activity in the last few weeks, have seen a rapid increase in ILI. Very high activity is seen in Sweden, Norway, Moldova and Italy. Over 99% of subtyped influenza A viruses in Europe were pandemic H1N1 2009. Impact on health care services is severe in Albania and Moldova. Some countries seem to have peaked already: Belgium, Bulgaria, Belarus, Ireland, Luxemburg, Norway, Serbia, Ukraine and Iceland.

 

(Continue . . . )

 

 

Pandemic (H1N1) 2009 - update 76

Weekly update (more data on virological surveillance)

27 November 2009 -- The Global Influenza Surveillance Network (GISN) continues monitoring the global circulation of influenza viruses, including pandemic, seasonal and other influenza viruses infecting, or with the potential to infect, humans including seasonal influenza.

 

<SNIP>

 

A virus mutation at position 222 of the amino acid sequence of the haemagglutinin protein of the pandemic virus was recently reported in a few viruses from Norway. The mutation is D222G (aspartic acid to glycine), which, according to a public accessible gene sequence database "GenBank", has also been detected sporadically in viruses from several other countries since April 2009.

 

This change in the virus has been found in mild as well as severe cases. WHO, through its Global Influenza Surveillance Network (GISN) is monitoring virus mutations that are of potential public health importance.

 

Systematic surveillance conducted by the Global Influenza Surveillance Network (GISN) including WHO Collaborating Centres (WHOCCs) for reference and research on influenza, continues to detect sporadic incidents of H1N1 pandemic viruses that show resistance to the antiviral oseltamivir. To date, 75 oseltamivir resistant pandemic H1N1 influenza viruses have been detected and characterized worldwide. All of these viruses show the same H275Y mutation. All these viruses remain sensitive to zanamivir. Worldwide, more than 10,000 clinical specimens (samples and isolates) of the pandemic H1N1 virus have been tested and found to be sensitive to oseltamivir.

 

All pandemic H1N1 2009 influenza viruses analysed to date were antigenically and genetically closely related to the vaccine virus A/California/7/2009.

Virology data update

Download update (.pdf)

Egypt: WHO Update On 89th H5N1 Infection

 

 

# 4088

 

 

Although FluTrackers had word of an 89th confirmed human H5N1 infection out of Egypt a couple of days ago, the WHO has posted an official update today, along with a new table of cases by country.

 

It should be noted that Indonesia stopped reporting H5N1 cases nearly a year ago, after a couple of years of less than stellar reporting. 

 

Numbers from other countries, where surveillance and reporting may be less than optimal, probably don’t reflect the true picture either.

 

Egypt has seen 38 human infections this year, a nearly 500% increase over 2008.   Remarkably, however, the fatality rate has dropped to just about 10% in 2009.

 

The H5N1 virus remains endemic in poultry in Egypt, despite attempts to eradicate the virus through culling, vaccination, and public education.

 

 

Avian influenza - situation in Egypt - update 25

27 November 2009 -- The Ministry of Health of Egypt has reported a new confirmed human case of avian influenza A(H5N1).

 

The case is a 3 year-old male from Minia Governorate. His symptoms started on 21 November 2009.

 

He was admitted to hospital on 22 November and his condition is stable. Investigations into the source of infection indicated that the case had close contact with dead and/or sick poultry.

 

The cases were confirmed by the Egyptian Central Public Health Laboratories.

 

Of the 89 cases confirmed to date in Egypt, 27 have been fatal.

 

 

 

 

A few of the recent reports of H5N1 in poultry, carried on the SAIDR website, include:

 

• RECENT CASES:
• Date of result: 24 November 2009
  Date of sampling: 23 November 2009
  Governorate: Fayoum
  District: Senouris
  Village: Sanhour el Baharia
  Type of rearing: Household
  Species: Chicken
  Number of birds: 40
  Vaccination status: Unvaccinated
  Purpose of sampling: PDS
  Comments: The village is 500 meters from Lake Qaroun, and the domestic poultry has regular contact with migratory ducks. The outbreak started six months ago and was still circulating among the households around the time of sampling.
  Three weeks ago, the household had sudden deaths with 100 percent mortality associated with cyanosis in comb and wattles for 200 layer chickens. After cleaning and decontamination, the household introduced new 40 young grower chickens bought from a nursery farm via peddler: Three days after introducing new chickens, mortalities started again with cyanosis in comb and wattles. The source of the outbreak is unknown. The newly purchased chickens may have been bought infected from the nursery farm, or may have contracted the infection at the household after contact with contaminated matter from the layer chickens that died in the earlier episode.

• ----------------------------------------------------------

• Date of result: 24 November 2009
  Date of sampling: 23 November 2009
  Governorate: Fayoum
  District: Etsa
  Village: Ahrit
  Type of rearing: Household
  Species: Mixed (chickens, ducks)
  Number of birds: 14
  Vaccination status: Unvaccinated
  Purpose of sampling: PDS
• ----------------------------------------------------------

• Date of result: 18 November 2009
  Date of sampling: 17 November 2009
  Governorate: Dakahlia
  District: Tomay el Amdid
  Village: El Fath el Gedida
  Type of rearing: Household
  Species: Mixed (chickens, ducks, geese)
  Number of birds: 37
  Vaccination status: Unvaccinated
  Purpose of sampling: PDS
  Comments: The outbreak exhibits progressive mortality, clear signs of cyanosis of the head and wattles in chicken, and nervous manifestations in ducks in many households in the village. Signs of an outbreak were first observed two weeks earlier. There was a massive spread of the infection in majority of houses. The source of infection was ducks provided as a gift from Kom el Khalig village, Mansoura district, Dakahlia.