AFD On Hiatus

 

 

 

The last time I took time away from this blog to make my yearly trek to Missouri to see my Lyme specialist, a pandemic broke out. 

 

I left on April 19th, 2009 and three days later received a phone call just as I was pulling into Springfield alerting me to a pair of swine flu cases detected in San Diego.  Three days later I was back at my computer, desperately trying to catch up with what had turned into a media storm during my absence.   

 

Now . . . 49 weeks and 1440 blogs later, it is with some trepidation that I must make this trip again. 

 

Hopefully, things will stay quiet this time.   

 

As always, you can keep up with the latest flu news by visiting Crofsblog, the Flu Wiki , FluTrackers, or Pandemic Information News.     

 

Effect Measure, the Virology Blog, Mystery Rays and the other sites in my sidebar are all worthy of your attention as well.  

 

I regret that I’ve not time to delve into the following  CDC EID Journal article before I leave.  Maybe when I return.

 

Influenza A Strain-Dependent Pathogenesis in Fatal H1N1 and H5N1 Subtype Infections of Mice
M.-M.. Garigliany et al.

 

My plan is to be back a week from tomorrow (Sunday, April 4th).

 

In the meantime, there are more than 4400 essays archived here to peruse, and of course, Maryn McKenna’s new book Superbug is on the bookstore shelves (hint . . hint).  

 

I trust that you’ll find plenty to occupy yourself until my return

If You’ve Seen One Triple Reassortant Swine Flu Virus . . .

 

 

# 4465

 

You haven’t seen them all.

 

At least, not according to a letter that appears in the latest edition of the CDC’s Journal of Emerging Infectious Diseases.

 

Novel H1N1, as everyone knows by now, is a descendent of a triple reassorted H1N1 swine flu virus that first appeared in American swine herds in 1998.  It apparently bounced around in swine herds for a decade before finding the right genetic mutations to adapt to humans.

 

But H1N1 isn’t the only swine flu virus out there.  Known Swine influenza A viruses include H1N1, H1N2, H3N1, H3N2, and H2N3.

Surveillance and reporting of infected herds is suboptimal in this country and around the world, and many farmers find financial disincentives to testing their herds (see Swine Flu: Don’t Test, Don’t Tell).

 

Today, we’ve news of another triple-reassortant swine flu virus – this time H3N2 – that has been spreading in pigs for more than a decade, that has now shown up in waterfowl in South Dakota.

 

 

 

Volume 16, Number 4–April 2010

Letter

Triple Reassortant Swine Influenza A (H3N2) Virus in Waterfowl

Muthannan A. Ramakrishnan, Ping Wang, Martha Abin, My Yang, Sagar M. Goyal, Marie R. Gramer, Patrick Redig, Monte W. Fuhrman, and Srinand Sreevatsan 

 

To the Editor: In 1998, a new lineage of triple reassortant influenza A (H3N2) virus (TR-H3N2) with genes from humans (hemmaglutinin [HA], neuraminidase [NA], and polymerase basic 1 [PB1]), swine (matrix [M], nonstructural [NS], and nucleoprotein [NP]), and birds (polymerase acidic [PA] and PB2) emerged in the U.S. swine population.

 

Subsequently, similar viruses were isolated from turkeys (1,2), minks, and humans in the United States and Canada (3,4). In 2007, our national influenza surveillance resulted in isolation of 4 swine-like TR-H3N2 viruses from migratory waterfowl (3 from mallards [Anas platyrrhynchos] and 1 from a northern pintail [Anas acuta] of 266 birds sampled) in north-central South Dakota. We report on the characterization of these TR-H3N2 viruses and hypothesize about their potential for interspecies transmission.

(Continue . . . )

 

 

For now, this is mostly a scientific curiosity, not a tangible public health threat.   But of course, one could have said the same thing about the triple reassortant H1N1 in pigs 12 months ago.

 

Which is why many scientists are calling for far more rigorous testing and surveillance of our farm animals. 

 

While one could argue that these viruses have circulated in pigs and other animals for thousands of years without our knowledge, and only rarely have emerged as human health threats, that ignores the recently introduced dynamic of factory farming. 

 

We now put thousands of pigs, and sometimes hundreds of thousands of chickens, in unnaturally close quarters to raise them.  This is believed conducive to promoting the spread, and mutation, of certain bacterial and viral pathogens.

 

Diseases that might never have caught fire fifty years ago, when Old McDonald had a half dozen sows on his farm, have a better opportunity to spread and mutate when introduced into a CAFO (Concentrated Animal Feeding Operation) with thousands of pigs or hundreds of thousands of chickens.

 

For more perspective on this, you might wish to read Dr. Michael Greger’s  Bird Flu: A Virus Of Our Own Hatching (available free, online) and watch his Human Society video on Flu Factories (online here).

 

The significance of this finding, of a swine H3N2 virus in waterfowl in South Dakota, is less than clear.  It may have no public health implications at all, or it could be a harbinger of some future health threat.

 

 

Without good, ongoing animal surveillance, it is impossible to establish a baseline and impossible to determine if something new or unusual is happening.  

 

And if the next virus to jump to man is more virulent than novel H1N1, the price of that ignorance could be very high.

NIH: Rapid Development Of Antiviral Resistance In Two Cases

 

 

# 4464

 

 

Victories over continually evolving pathogens are often fleeting at best.   No sooner do researchers release a new generation of antibiotics or antivirals, than these organisms begin to find ways to work around them.

 

Maryn McKenna’s terrific book Superbug: The Fatal Menace of MRSA goes into great detail about the road to antibiotic resistance, but we are seeing a similar path being followed by antivirals as well.

 

Amantadine managed to remain an effective treatment and/or prophylaxis against influenza A for four decades, although it was used only sparingly for the first 30 years or so.   

 

Overuse of Amantadine, particularly its inclusion into chicken feed during the 1990s to combat bird flu in Asia – has been credited with a dramatic rise in influenza’s resistance to the drug by 2005. 

 

Tamiflu (oseltamivir), released in 1999 proved extremely effective against influenza until 2008, when a resistant version of seasonal H1N1 appeared and quickly spread around the world.   Seasonal H3N2 remained susceptible to the drug. 

 

These two seasonal viruses have been (at least temporarily) replaced by novel H1N1, which fortunately remains sensitive to the drug.   Scientists do worry that over time, novel H1N1 could pick up resistance to Tamiflu as well.

 

Which brings us to a report issued yesterday by the NIH about two patients that developed resistance to Tamiflu, and in one case, to the newly approved peramivir.   

 

FOR IMMEDIATE RELEASE
Friday, March 26, 2010

Media Contact: Anne A. Oplinger
(301) 402-1663
niaidnews@niaid.nih.gov

Rapid Development of Drug-Resistant 2009 H1N1 Influenza Reported in Two Cases

Reevaluation of Treatment Strategies for Prolonged Infection Urged

Two people with compromised immune systems who became ill with 2009 H1N1 influenza developed drug-resistant strains of virus after less than two weeks on therapy, report doctors from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. Doctors who treat prolonged influenza infection should be aware that even a short course of antiviral treatment may lead to drug-resistant virus, say the authors, and clinicians should consider this possibility as they develop initial treatment strategies for their patients who have impaired immune function.

 

Both patients in the new report developed resistance to the key influenza drug oseltamivir (Tamiflu), and one also demonstrated clinical resistance to another antiviral agent, now in experimental testing, intravenous peramivir, note senior authors Matthew J. Memoli, M.D., and Jeffery K. Taubenberger, M.D., Ph.D. This is the first reported case of clinically significant peramivir-resistant 2009 H1N1 illness, say the scientists. The report is scheduled to appear in print on May 1 in Clinical Infectious Diseases and is now online.

 

The people in the current case report had immune limitations due to blood stem cell transplants that occurred several years previously. Both recovered from their influenza infections.

 

“While the emergence of drug-resistant influenza virus is not in itself surprising, these cases demonstrate that resistant strains can emerge after only a brief period of drug therapy,” says NIAID Director Anthony S. Fauci, M.D. “We have a limited number of drugs available for treating influenza and these findings provide additional urgency to efforts to develop antivirals that attack influenza virus in novel ways.”

 

The 2009 H1N1 influenza virus is susceptible to just one of the two available classes of anti-influenza drugs, the neuraminidase inhibitors. Besides oseltamivir, other neuraminidase inhibitors are zanamivir (Relenza), which is inhaled, and the intravenously administered investigational drug peramivir. As the H1N1 influenza pandemic unfolded, laboratory tests of virus strains isolated from patients showed that some strains contained a genetic mutation (the H275Y mutation) that makes the virus less susceptible to some neuraminidase inhibitors.

(Continue . . . )

 

 

Lisa Schnirring at CIDRAP News has more details on this story.

 

 

Researchers report peramivir-resistant H1N1 case

Lisa Schnirring Staff Writer

Mar 26, 2010 (CIDRAP News) – Researchers today sounded two warnings for clinicians who manage pandemic H1N1 patients: that even a short course of oseltamivir (Tamiflu) can lead to antiviral resistance and that patients can develop resistance to peramivir, an alternative to oseltamivir in emergency situations.

 

The warnings come from a case report of two patients published today in an early online edition of Clinical Infectious Diseases (CID). The authors are from the National Institute of Allergy and Infectious Diseases (NIAID) and the US Food and Drug Administration (FDA). The study is scheduled to appear in the May 1 issue of CID.

 

The research team, headed by senior authors Matthew J. Memoli, MD, and Jeffery K. Taubenberger, MD, PhD, said the report details the first clinically significant peramivir-resistant pandemic H1N1 case.

(Continue . . .)

 

These are, admittedly, isolated incidents.  

 

And it should be noted that these two cases involved spontaneous resistance forming in immune compromised patients receiving Tamiflu, and are not due to some new Tamiflu/peramivir  resistant strain circulating in the wild.

 

The takeaway message from this report isn’t that these drugs are losing effectiveness, but that resistance can develop quickly in rare instances in some people receiving these medications.  

 

Which is another good reason why getting a flu shot every year is an exceedingly good idea.

 

While not 100% protective, getting the flu shot can significantly reduce your chances of catching the flu.

 

After all, it is better to try to prevent an illness, than to have to treat one.   

CDC FluView Week 11

 

 

# 4463

 

 

Midday on Friday is when we expect the CDC’s Key Flu Indicators and FluView Report, and today is no exception.

 

Influenza activity remains near the same levels as reported over the past several week; below normal.  

 

There are some signs of increasing activity in 3 of the 10 U.S. Regions (4,7, and 9), and there has been a slight uptick in the P&I mortality rate, but it still remains below the epidemic threshold for this time of year.

 

A few excerpts, then, from today’s FluView report.  Follow the link to read it in its entirety.

 

 

2009-2010 Influenza Season Week 11 ending March 20, 2010

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

Synopsis:

During week 11 (March 14-20, 2010), influenza activity remained at approximately the same levels as last week in the U.S.

• 139 (4.6%) 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.
• Approximately 99% of all subtyped influenza A viruses reported to CDC were 2009 influenza A (H1N1) viruses.
• The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
• One influenza-associated pediatric death was reported and was associated with an influenza A virus for which the subtype was undetermined.
• The proportion of outpatient visits for influenza-like illness (ILI) was 1.8%, which is below the national baseline of 2.3%. Three of 10 regions (Regions 4, 7, and 9) reported ILI at or above region-specific baseline levels.
• No states reported widespread influenza activity. Three states reported regional influenza activity. Puerto Rico and eight states reported local influenza activity. The District of Columbia, Guam and 31 states reported sporadic influenza activity. Eight states reported no influenza activity, and the U.S. Virgin Islands did not report.

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.

Pneumonia and Influenza (P&I) Mortality Surveillance

During week 11, 7.7% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage was below the epidemic threshold of 7.8% for week 11.

 

Influenza-Associated Pediatric Mortality

One influenza-associated pediatric death was reported to CDC during week 11 (Mississippi) and was associated with an influenza A virus for which the subtype was undetermined. This death occurred during week 9 (the week ending March 6, 2010).

Geographic Spread of Influenza as Assessed by State and Territorial Epidemiologists:

The influenza activity reported by state and territorial epidemiologists indicates geographic spread of both seasonal influenza and 2009 influenza A (H1N1) viruses and does not measure the severity of influenza activity.

Study: Efficacy of Facemasks Vs. Respirators

 

 

# 4462

 

 

For decades the assumption by just about everyone – from OSHA to the CDC, to medical professionals – has been that surgical facemasks did little to protect the wearer.   Surgical masks were designed to contain the wearer’s germs and protect those around them, not the other way around.

If you wanted to protect yourself against respiratory viruses, you needed to wear a properly fitted N-95 (or better) respirator.

 

N-95 Respirator               Surgical Facemask

 

Using an N-95 respirator is problematic on a number of fronts, however. 

 

• They are uncomfortable to wear for long periods of time. 
• They saturate with exhaled moisture relatively quickly, and must be changed out every couple of hours. 
• The must be fit tested for each wearer
• The are 10 times more expensive than surgical masks.  
• And our national supply of N-95s is totally inadequate to supply Health Care Workers during a prolonged pandemic wave.

Despite these limitations, many HCWs (Health Care Workers) have demanded that they be afforded the extra protection of N95 respirators when dealing with pandemic flu cases.

 

Indeed, the CDC’s  pandemic infection control guidelines  (updated March 10th) continue to recommend:

For the purposes of this document, close contact is defined as working within 6 feet of the patient or entering into a small enclosed airspace shared with the patient (e.g., average patient room):

 

Respiratory Protection –

Recommendation: CDC continues to recommend the use of respiratory protection that is at least as protective as a fit-tested disposable N95 respirator for healthcare personnel who are in close contact with patients with suspected or confirmed 2009 H1N1 influenza. This recommendation applies uniquely to the special circumstances of the current 2009 H1N1 pandemic during the fall and winter of 2009-2010 and CDC will continue to revisit its guidance as new information becomes available, within this season if necessary.

 

Masks and respirators, the CDC stresses, are the last line of defense in a health care facility.  And they make allowances for supply problems as well, saying that respirators may be prioritized for higher risk aerosol producing procedures.

 

The CDC’s stance, however, isn’t universally accepted or followed.  These are recommendations, after all, not mandates. 

 

Many hospitals have opted to use surgical masks as a matter of routine, except when performing aerosol producing procedures.  And this has caused no small amount of controversy in the healthcare profession.

 

The Respirator Controversy Continues

A Surgical Mask Strike

IOM Recommends N95s For HCWs

 

In a major turnaround, over the past few months we’ve seen a series of studies that suggest that surgical masks may be `non-inferior’ to N95 masks, or that they provide a similar level of protection as the more expensive respirator.

 

Most of these are observational studies, and as such, may be open to some criticism.   Health care workers do not work, and live, in a vacuum.  Controlling (or quantifying) the effects of non-patient (community) exposure to respiratory viruses becomes a real challenge.

 

Today we’ve another such study, that suggests that inexpensive facemasks may be more effective than previously thought in protecting against the H1N1 virus.

 

First the press release, then a link to the study.

 

 

Study finds surgical masks provided effective protection of health-care workers against H1N1

The effectiveness of ordinary surgical masks as opposed to respirators in protecting health care workers against the 2009 H1N1 influenza virus has been the subject of debate. An observational study published in the April 1, 2010 issue of Clinical Infectious Diseases, available online, suggests that surgical masks are just as effective as respirators in this regard.

 

Researchers analyzed the incidence of H1N1 among health care workers from April through August of 2009 at Tan Tock Seng Hospital in Singapore. A small percentage tested positive for H1N1 during this period. None had cared for any patients with H1N1 or worked in H1N1 screening areas of the emergency room. In all cases, transmission was believed to have occurred outside of patient care, when health care workers were in contact with roommates, the general public, and other sources.

 

From June 19 to July 21, health care workers at the hospital wore N95 respirators in the emergency room and an H1N1 isolation area. From July 22 to Aug. 31, surgical masks were used by workers in these areas. The incidence of H1N1 among workers remained low during both periods. Although the study was observational, the findings suggest that surgical masks and respirators did not differ in their effectiveness in preventing hospital staff from acquiring H1N1.

 

"What is more important than using high-filtration or respirator masks for known or suspected cases is to have a uniform policy, such as using surgical masks, when in close contact with all patients," said study author Brenda Sze Peng Ang, MD, of the Tan Tock Seng Hospital in Singapore. "This way, health care workers are protected from getting infected by patients not initially thought to have H1N1."

Here is the link to the journal article, with a few choice excerpts.  If you are in the Health Care field, you will probably want to read this in its entirety.

 

DOI: 10.1086/651159

BRIEF REPORT

Surgical Masks for Protection of Health Care Personnel against Pandemic Novel Swine‐Origin Influenza A (H1N1)–2009: Results from an Observational Study

Brenda Ang,Bee Fong Poh, Mar Kyaw Win, and Angela Chow

There is ongoing debate about the efficacy of surgical masks versus N95 respirators for protection against pandemic novel swine‐origin influenza A (H1N1)–2009. Our hospital, which is designated to manage outbreaks of emerging infection, has robust surveillance systems to detect infection in staff. The incidence of pandemic H1N1‐2009 remained low in staff with use of surgical masks.

 

<SNIP>

 

Discussion. Although this is an observational study, nonetheless our findings show that surgical masks and N95 respirators do not appear to differ in efficacy in the prevention of the acquisition of pH1N1 by staff. Our findings also highlight the importance of a robust HCW surveillance system for the detection of nosocomial transmission of pathogens, including novel pathogens.

 

<SNIP>

Conclusion. Our surveillance systems were effective in detecting infection among HCWs. None of the HCWs who cared for pH1N1 patients acquired infection from them. Those HCWs who did acquire pH1N1 appeared to have been infected from community exposure or in social settings with colleagues. The incidence of pH1N1 remained low in exposed staff, even when staff used surgical masks.

 

We are still some ways off from having a complete understanding of the relative efficacy of surgical masks vs. N95 respirators.

 

Definitive answers are notoriously hard to come by.

 

We were, in retrospect, very lucky that H1N1 proved to have a lower R0 (reproductive number) than originally feared.  That limited transmission. H1N1 also produced lower than expected mortality rates.

 

Again, a stroke of luck. 

 

Had this been a highly lethal H5 avian virus, or even a SARS-like virus, the clamor for the greater perceived protection afforded by N95 masks would have been overwhelming.

 

And our supply would have been exhausted in a matter of weeks.

 

So it would indeed be good news if surgical masks turn out to be equally protective against respiratory viruses as are fit-tested N95 respirators.  

 

They are cheaper, easier to wear, and in far more abundant supply.

 

But for that to be accepted by HCWs – particularly in the face of a dangerous pathogen – more convincing studies are going to be needed. Decades of practice and teaching are not easily swept aside. 

 

Hopefully we’ll get better answers to all this before the next pandemic arrives.

Congratulations In Order

 

 

# 4461

 

 

 

It is always a pleasure to see excellence in blogging acknowledged, and so I’m happy to report that Professor Vincent Racaniello’s terrific Virology Blog has been selected by the Seed Media Group for an award for best clinical research blog.

 

Here’s a link to all of the Winners.   Congratulations to all of the nominees, and to the winners.

 

And here’s Vincent’s announcement on his blog.

 

 

Virology blog receives award at researchblogging.org

 

Those of us who follow Racaniello’s blog, and his TWiV and TWiP podcasts, know that this is a well deserved honor.

The 1918 – 2009 H1N1 Connection

 

 

 

# 4460

 

Maryn McKenna writing for CIDRAP News has the details of two studies released yesterday that show the similarities between the novel H1N1 virus of 2009 and the pandemic virus of 1918.

 

While sharing the same classification (H1N1) as one of the two seasonal influenza `A’ strains that have been in circulation for decades, novel H1N1 was genetically different enough that those under the age of about 50 had little or no immunity.

 

Now, scientists are beginning to fathom why that is so.

 

This from CIDRAP News.

 

Study shows 1918 and 2009 pandemic viruses share key feature

Maryn McKenna Contributing Writer

Mar 24, 2010 (CIDRAP News) – Structural similarities between the pandemic flu viruses of 1918 and 2009 may explain older adults' apparent immunity to the newer virus, two scientific teams report today in two journals. Their results may also explain how pandemic viruses evolve into seasonal viruses, and could point the way toward development of future pandemic vaccines.

 

Writing in Science Express, the online ahead-of-print arm of the journal Science, Ian Wilson and Rui Xu of the Scripps Research Institute and colleagues from Vanderbilt University and Mount Sinai School of Medicine say that the 1918 and 2009 pandemic viruses are antigenically close, with hemagglutinin proteins that share similar crystalline structures. In contrast, the hemagglutinins in 24 seasonal flu strains dating from the 1930s through the 1950s, and 9 seasonal-vaccine strains from 1977 through 2007, differed from the pandemic strains by 30% to 58% of their amino-acid sequences.

 

The similarity between the two pandemic viruses is unusual, not only because they are separated by so many years, but also because genetic evidence has shown that the 2009 pandemic virus was not brand-new, but had already been circulating in humans—two circumstances that would have been expected to cause the viruses to diversify as they adapted.

(Continue . . . )

 

 

Helen Branswell, writing for the Canadian Press, also has terrific coverage of this story.  Both reports are well worth reading in their entirety.

 

 

H1N1 virus more like 1918 flu than modern cousins; explains infection patterns

 

Provided by: Canadian Press
Written by: Helen Branswell, Medical Reporter, THE CANADIAN PRESS
Mar. 24, 2010

TORONTO - The pandemic H1N1 virus more closely resembles the 1918 Spanish flu virus than more modern cousins in the same flu family, new research shows - a finding which helps explain the age pattern of H1N1 infections.

 

Like the Spanish flu virus, the pandemic H1N1 lacks two sugar coats seen on contemporary viruses from the same family, the work reveals.

 

The two studies, released Wednesday, confirm that antibodies which protect against the pandemic virus also fight the virus that caused the 1918 pandemic. But they are not able to neutralize seasonal H1N1 viruses, nor are 2009 H1N1 viruses stopped by antibodies generated in response to those recent viruses.

(Continue . . .)

A Curious Report Out Of Uganda

UPDATED: 12:00 EDT Mar 25

Multiple news sources are now saying that this outbreak is – as expected – not smallpox, but likely chickenpox.  link.

 

# 4459

 

 

 

Roughly 12 hours ago the newshounds at FluTrackers became aware of stories out of Uganda of 4 possible `smallpox’ cases, and began a thread where reports could be posted and reviewed.  Overnight, the story has also been picked up by major news services, and by ProMed Mail.

 

If true, this would be a remarkable and worrisome turn of events.  But there may be less to this story than it first appears.

 

Smallpox is presumed to be eradicated, and has not been seen anywhere in the world in more than 30 years.  Previous reports of suspected smallpox have turned out to be false alarms; Chickenpox, Molluscum Contagiosum, or rarely, Monkeypox.

 

First a report from Reuters, and ProMed.  Then some discussion.

 

WHO says investigating smallpox reports in Uganda

Thu Mar 25, 2010 10:04am GMT

By Kate Kelland, Health and Science Correspondent

LONDON (Reuters) - The World Health Organisation said on Thursday it was investigating reports of suspected cases of the previously eradicated disease smallpox in eastern Uganda.

 

Smallpox is an acute contagious disease and was one of the world's most feared sicknesses until it was officially declared eradicated worldwide in 1979.

 

"WHO takes any report of smallpox seriously," Gregory Hartl, a spokesman for the Geneva-based United Nations health agency, told Reuters via email.

 

"WHO is aware of the reports coming out of Uganda and is taking all the necessary measures to investigate and verify."

 

He added that the WHO had received reports before of smallpox cases, but they had turned out to be false alarms."In the past, these cases have always turned out not to be smallpox and were, usually, either chickenpox or monkeypox cases," he said, stressing that the reports had been of suspected cases.

(Continue. . . )

 

This is an excerpt from the ProMed Mail  RFI (Request For Information) on the story.

 

UNDIAGNOSED ILLNESS, POX VIRUS SUSPECTED - UGANDA (BUDUDA): REQUEST FOR INFORMATION
***********************************************************************
A ProMED-mail post <http://www.promedmail.org>
ProMED-mail is a program of the International Society for Infectious Diseases <http://www.isid.org>

Date: Thurs 25 Mar 2010
From: Daily Monitor (Uganda) online [edited]
<http://www.monitor.co.ug/News/National/-/688334/886256/-/wjtmm9/-/index.html>

Small pox reported in Bududa camps
-------------------------------- 
   

Four children in Internally Displaced People's camps in Bududa District, reportedly suffering from small pox, have been taken to Bukigai and Bulucheke Health Centres III and II, respectively. 

 

Ms Kevin Nabutuwa, Uganda Red Cross' regional programme officer for eastern Uganda, said last evening that the infections were registered on Monday and Tuesday. 

 

Spread contained"

These are cases in the IDP camps but the spread has been contained," she said by phone.In Kampala, Dr Richard Nduhuura, the state minister for Health (general duties), said he is "unaware" of the outbreak of the disease that scientists say can kill three out of every 10 infected persons.

 

He referred this newspaper to the acting Director General of Health Services, Dr Kenya Mugisha, who was unavailable for comment (Continue. . . )

The World Health Organization certified the global eradication of smallpox in December of 1979, a remarkable achievement given that smallpox had killed more than 300 million people in the 20th century.

 

While there are samples of the smallpox virus in laboratories around the world (along with stockpiles of vaccine), the virus has not been seen in the wild in three decades. 

 

Monkeypox, a far less serious illness, is a rare viral disease that is still found in central and western Africa. 

 

It looks remarkably like smallpox, and in fact, is a cousin of that virus.   Close enough that those vaccinated against smallpox have a high level of protection against Monkeypox.

 

 

While named Monkeypox, the virus is  carried by both primates and rodents.   There was an outbreak of Monkeypox in the United States in 2003, after dozens of people were exposed to infected prairie dogs at a pet shop in Illinois.

 

Other possibilities include molluscum, and the most likely suspect, Chickenpox.

 

We’ll just have to wait for more information on this story.  For now, it is a curious report, and while worthy of investigation, probably something other than smallpox.

 

 

Today Is World TB Day

 

 

# 4458

 

 

Almost 40 years ago, when I first entered the EMS arena (1972), Tuberculosis was in decline and most of the TB hospitals around the country were closing.   

 

Antibiotics and education – a least in developed nations – were making a huge impact.

Several times a year, however, I’d be called upon to transport a TB patient to the A. G. Holly TB hospital in Lantana Florida.  A slightly nervous four-hour ride in the back of an ambulance for an 18 year-old EMT, armed with just a surgical mask for protection.

While it seemed during the 1970s that we were on our way to beating tuberculosis (something that had hospitalized my grandmother for months in the 1930s), that victory never materialized.  

 

Instead, we’ve seen the rise of new, drug resistant strains of the TB bacillus, and a resurgence of the disease.

 

Today is World TB day, and the CDC has a webpage devoted to the agencies and activities working to eliminate this deadly scourge.   You’ll also find a number of CDC audio podcasts on Tuberculosis at the end of this post.

 

 

 

World TB Day 2010 TB Elimination: Together We Can!

World TB Day is March 24. This annual event commemorates the date in 1882 when Dr. Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacteria that cause tuberculosis (TB).

World TB Day provides an opportunity to communicate TB-related problems and solutions and to support worldwide TB-control efforts. CDC and our partners are committed to eliminating TB in the United States.

In the United States, the theme for World TB Day 2010 is “TB elimination: Together We Can!”

Eliminating TB: Together We Can!

We can reach the goal of TB elimination by working together and strengthening partnerships.  This country’s progress in controlling TB will only be sustainable if local, state, national, and international partners from all sectors of our society join resources and collaborate together.  Our united effort is needed to reach those at highest risk for TB, and to identify and implement innovative strategies to improve testing and treatment among high-risk populations.

CDC and its domestic and international partners, including the National TB Controllers Association, Stop TB USA, and the global Stop TB Partnership, are taking many steps to prevent further spread of TB and to reduce the overall burden of the disease. Efforts range from developing new treatment regimens and increasing the capacity of health professionals to provide adequate treatment, to issuing new recommendations for improved testing and treatment for U.S. immigrants.

Working Together to Eliminate TB

"Although preventable and treatable, malaria, tuberculosis (TB), and human immunodeficiency virus (HIV) together kill more than 5 million people annually. The burden of these diseases can be reduced—but only with increased governmental and nongovernmental resources, effective public-private partnerships, and strengthened disease-specific and general health systems." 

(Dr. Thomas R. Frieden, Director, Centers for Disease Control and Prevention, Administrator, Agency for Toxic Substances and Disease Registry)

How You Can Become a Partner

• Find out more about TB services in your area.
• Educate your community about TB.
• Ensure that efforts to eliminate TB continue.

Because many people are not aware of the impact of TB, local coalitions in many states and countries are convening educational and awareness activities related to World TB Day. Look to see how you can learn more and get involved.

• World TB Day — Activities
• World TB Day — Resources
• History of World TB Day

Podcasts

Multidrug-Resistant Tuberculosis

In this podcast, Dr. Oeltmann discusses multidrug-resistant tuberculosis. An outbreak occurred in Thailand, which led to 45 cases in the U.S. This serious illness can take up to 2 years to treat. MDR TB is a real threat and a serious condition.

TB Poem: Expressions from Us to You

Regina D. Bess from CDC's Division of Tuberculosis Elimination wrote this poem for World TB Day 2007 to convey messages of commitment and hope in the efforts to eliminate TB. It captures the essence of the TB program's mission and dedication to the communities it serves.

Emergence of Extensively Drug Resistant Tuberculosis

Extensively drug-resistant tuberculosis (XDR TB) outbreaks have been reported in South Africa, and strains have been identified on 6 continents. Dr. Peter Cegielski, team leader for drug-resistant TB with the Division of Tuberculosis Elimination at CDC, comments on a multinational team's report on this emerging global public health threat.

Mantoux Tuberculin Skin Test

Learn how to evaluate people for latent TB infection with the Mantoux tuberculin skin test. This podcast includes sections on administering and reading the Mantoux tuberculin skin test, the standard method for detecting latent TB infection since the 1930s.

Study: Years Of Life Lost Due To 2009 Pandemic

 

 

# 4457

 

 

With the pandemic virus of 2009 (at least temporarily) on the wane in North America and most of Europe, scientists are now trying to quantify its impact. 

 

This is not going to be an easy task, nor shall it be accomplished overnight.  But the first reviews of the data are coming in, and over time a better picture will emerge.

 

One of the big questions is, how shall we calculate the impact?

 

And for that, there is no universally accepted answer.  But one critical measurement would be in years of life lost (YLL).

 

The average (mean) age of a flu-related fatality in a `normal’ flu season here in the United States is about 76 years. Seasonal influenza is primarily seen as a `harvester’ of the aged and infirmed, robbing its victims of the last few months or years of life.

 

Only rarely does it severely impact young adults and children.

When a pandemic strain emerges that pattern can change.  We often see a pronounced age shift, with much younger victims. The pandemic of 2009 followed that pattern, with 85% of its victims under the age of 60. 

 

The mean age of death from the novel H1N1 virus has been calculated to be half that of seasonal flu, or 37.4 years. 

 

 

In terms of years of life lost (YLL), the average pandemic flu death has a many fold greater impact than the average seasonal flu fatality.    

 

This morning, we’ve a preliminary study of these statistics that appears in PLoS Currents Influenza, and an article by Robert Roos at CIDRAP news.  

 

This is a fascinating study, and I heartily recommend that you follow both links to explore further.  It may give you a new perspective on the impact of the pandemic of 2009.

 

 

Preliminary Estimates of Mortality and Years of Life Lost Associated with the 2009 A/H1N1 Pandemic in the US and Comparison with Past Influenza Seasons

By Cecile Viboud, Mark Miller, Don Olson, Michael Osterholm et al (5 authors)

The on-going debate about the health burden of the 2009 influenza pandemic and discussions about the usefulness of vaccine recommendations has been hampered by an absence of directly comparable measures of mortality impact. Here we set out to generate an "apples-to-apples" metric to compare pandemic and epidemic mortality.

 

We estimated the mortality burden of the pandemic in the US using a methodology similar to that used to generate excess mortality burden for inter-pandemic influenza seasons. We also took into account the particularly young age distribution of deaths in the 2009 H1N1 pandemic, using the metric "Years of Life Lost" instead of numbers of deaths. Estimates are based on the timely pneumonia and influenza mortality surveillance data from 122 US cities, and the age distribution of laboratory-confirmed pandemic deaths, which has a mean of 37 years. We estimated that between 7,500 and 44,100 deaths are attributable to the A/H1N1 pandemic virus in the US during May-December 2009, and that between 334,000 and 1,973,000 years of life were lost.

 

The range of years of life lost estimates includes in its lower part the impact of a typical influenza epidemic dominated by the more virulent A/H3N2 subtype, and the impact of the 1968 pandemic in its upper bound. We conclude that the 2009 A/H1N1 pandemic virus had a substantial health burden in the US over the first few months of circulation in terms of years of life lost, justifying the efforts to protect the population with vaccination programs. Analysis of historic records from three other pandemics over the last century suggests that the emerging pandemic virus will continue to circulate and cause excess mortality in unusually young populations for the next few years. Continuing surveillance for indicators of increased mortality is of key importance, as pandemics do not always cause the majority of associated deaths in the first season of circulation.

 

 

(Continue . . . )

 

From CIDRAP, we get this overview.

 

Study: In life-years lost, H1N1 pandemic had sizable impact

Robert Roos News Editor

Mar 23, 2010 (CIDRAP News) – A new study argues that because the H1N1 influenza pandemic cut many young lives short, its real public health impact has been substantially greater than is generally perceived.

 

In the study, a team of government and academic researchers came up with new estimates of deaths in the pandemic. By combining those with data on the age distribution of deaths, they estimated the number of "years of life lost" because of the pandemic. By that measure, its impact was at least as severe as a tough seasonal flu epidemic and possibly greater than the pandemic of 1968-69, they contend.

 

"We conclude that the 2009 A/H1N1 pandemic virus had a substantial health burden in the US over the first few months of circulation in terms of years of life lost, justifying the effort to protect the population with vaccination programs," says the report, published last night by PLoS Currents: Influenza. In the interest of rapid dissemination, the online journal publishes studies that have been screened by experts but have not undergone formal peer review.

 

(Continue. . . )

Vietnam: Worries Over Changes In H5N1

 

# 4456

 

 

Over the past couple of weeks we’ve seen a series of news articles coming out of Vietnam – most  in the Vietnamese language – that seem to indicate that worrisome changes have been detected in the H5N1 bird flu virus. 

For the most part, the machine translations that I’ve seen have been vague, and difficult to decipher.   With the exception of one English language article I blogged on 10 days ago (see Variations On A Bird Flu Theme), I’ve not felt particularly comfortable posting these stories.

 

Today, we’ve another English language report from the Saigon Daily, and while it contains tantalizing tidbits of information, it also contains very little specific data.   

 

A hat tip to Carol@SC on the Flu WIki for posting this article.

 

First the article, then some discussion.

 

 

Concern grows over drug-resistant H5N1 mutations

Medical experts are growing increasingly worried that the bird flu virus (A/H5N1) is showing  signs of transforming into more lethal forms, since the number of cases in Vietnam since the beginning of the year is equal to all those of 2009.

Medical workers advise people to  wear protective clothing and wash their  hands  after coming into contact with poultry

The Department of Preventive Health and Environment, a sub-division of the Ministry of Health, has reported five H5N1 infections in the country since January 1 including two deaths. A 38-year-old woman from southern Tien Giang Province and a three-year-old from Binh Duong Province both succumbed to the illness.

 

Dr. Nguyen Huy Nga, head of the Department of Preventive Health and Environment, said the increase in infections highlights the complexity of the disease’s development.

 

Health workers are also concerned over the critical condition of a 25-year-old female in Hanoi’s Soc Son District who is currently being treated for bird flu at the National Tropical Disease Hospital. Unlike other cases, the woman reportedly had not had contact with diseased or dead waterfowl or eaten poultry before falling ill.

 

Dr. Nguyen Quynh Mai from the National Institute of Hygiene and Epidemiology, said research has revealed seven new A/H5N1 virus strains in Vietnam. Tests show the strains are drug-resistant and potentially lethal.

 

Dr. Nga said that low public awareness could lead to more lethal strains of both bird flu and swine flu (A/H1N1). He warned health agencies to strengthen supervision of flu outbreaks in communities to quickly isolate infected patients from coming into contact with other people.

 

Residents should report to local governments immediately when chickens die or show signs of disease for unclear reasons, he said. In addition, people should wear protective clothing and wash their hands after coming into contact with poultry.

 

Anyone suffering fever, cough or breathing problems is advised to seek immediate medical treatment.

 

 

Obviously, this article is written for a general audience, and is intended more to raise community awareness of their ongoing bird flu threat than it is to impart scientific information.   

 

The claim that they’ve detected `seven new A/H5N1 virus strains in Vietnam’ sounds ominous, but fails to tell us over what time period these variants appeared, and their exact nature.  

 

There are at least 10 well defined clades (and numerous sub-clades) of the virus in circulation around the world, with more expect to develop over time.

 

It would be helpful if we knew if these `seven new’ strains were actually new, or simply discovery of known clades circulating in Vietnam.

 

 

The statement that these new strains are drug-resistant is potentially worrying, but once again, details are lacking.  Presumably this refers to Tamiflu resistance (although Amantadine is also a possibility), and that would be of concern.

 

And lastly, we’ve this report of the 25-year-old from Soc Son District who reportedly had no contact with diseased or dead.  Of course, somewhere around 30% of cases in Indonesia and China over the past few years have reported no contact with birds as well.

 

Is something unusual going on with bird flu in Vietnam?

 

It’s possible.

 

But it is pretty hard to come to any conclusions based on these limited newspaper accounts.    Five cases this year isn’t exactly an avalanche of human infection, even if it equals their count for all of 2009.  

 

Obviously, we’ll keep a close eye on this situation.   Hopefully we’ll get a scientific paper, or letter to a journal, giving us better detail on this story in the coming days or weeks.

FDA Calls For Temporary Halt To Using Rotarix Vaccine

 

 

# 4455

 

 

 

The `big’ news over the past 24 hours has been the  FDA’s recommendation that the use of GSK’s Rotarix rotavirus vaccine be temporarily suspended after it was discovered to be contaminated with DNA from a (probably harmless to humans) pig virus; Porcine circovirus 1 (PCV1)

 

Clinicians are advised to use Merck’s RotaTeq rotavirus vaccine pending a review of the GSK vaccine.

 

This is a complex story, and one that will take some time to sort out.  All of the facts are not in as yet, and the significance of this find are not at all clear.

 

Rotavirus is one of the leading causes of diarrheal illness in infants and young children, and is believed to cause the deaths of a half million children each year, mostly in developing countries.  

 

The vaccine, which became widely available in 2006, has been credited with a reduction in the incidence of rotavirus disease here in the US and in other countries (see MMWR Reduction in Rotavirus After Vaccine Introduction --- United States, 2000—2009).

 

 

Three pieces of information to help clarify the situation: 

 

First, a report by Maggie Fox of Reuters, one of the best science reporters in the business.

 

Second, the FDA  announcement.

 

And lastly, a referral to Vincent Racaniello’s Virology Blog, where he examines the problem.

 

Glaxo's rotavirus vaccine use suspended - US

12:00am EDT

 

* Merck vaccine not affected

* Suspension is temporary - no evidence of harm

* Rotavirus vaccines have troubled history (Adds WHO, European regulator comment)

 

By Maggie Fox, Health and Science Editor

WASHINGTON, March 22 (Reuters) - Doctors should temporarily stop using GlaxoSmithKline Plc's (GSK.L) (GSK.N) Rotarix vaccine against a diarrhea-causing virus called rotavirus because it is contaminated with an apparently harmless pig virus, regulators and the company said on Monday.

 

Doctors should instead give children Merck and Co Inc's (MRK.N) RotaTeq rotavirus vaccine, which is made using a different method and which shows no evidence of the virus, the U.S. Food and Drug Administration said.

 

The FDA and the company both found DNA from the virus in the vaccine. It is not clear whether whole virus is in the vaccine or just pieces of its DNA.

 

"We do believe the product is safe," FDA Commissioner Dr. Margaret Hamburg told reporters in a telephone briefing. Most children in the United States have been vaccinated with Merck's vaccine, which came onto the market sooner than Rotarix, she said.

(Continue . . .)

 

 

FDA NEWS RELEASE

For Immediate Release: March 22, 2010

Media Inquiries: Shelly Burgess, 301-796-4651; shelly.burgess@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA

Components of Extraneous Virus Detected in Rotarix Vaccine; No Known Safety Risk

FDA Recommends Clinicians Temporarily Suspend Use of Vaccine as Agency Learns More

FDA is recommending that healthcare practitioners temporarily suspend use of the Rotarix vaccine for rotavirus immunization in the United States while the agency learns more about components of an extraneous virus detected in the vaccine.  There is no evidence at this time that this finding poses a safety risk.

 

The agency recently became aware that an independent U.S. academic research team, using a novel technique, has found DNA from porcine circovirus 1 (PCV1) in Rotarix, which is manufactured by GlaxoSmithKline.  PCV1 is not known to cause illness in humans or other animals.  In addition, Rotarix has been studied extensively, before and after approval, and found to have an excellent safety record.

(Continue . . . )

 

 

And as a last stop, Vincent Racaniello takes a Virologist’s view of the story in:

 

Porcine circovirus DNA in rotavirus vaccine

Study: Chest X-Rays Help Predict H1N1 Outcomes

 

 

# 4455

 

 

When the ER is getting slammed, as it does during every surge in influenza, Emergency room physicians are faced with having to decide which flu patients are stable enough to go home, and which need to be admitted.

 

It isn’t an easy task.   

 

And as the hospital fills up, and beds become a scarce commodity, the definition of who really needs to be admitted narrows. Since 99% of H1N1 patients do fine at home, the problem becomes one of triage: 

 

How do you spot the 1% at genuine risk of serious complications?

 

In April’s journal Radiology, a study out of Israel the suggests that chest X-rays can provide important clues as to which patients will go on to have adverse outcomes.

  

• Of 97 patients that received chest x-rays upon admission, 40% (n=39) had abnormal findings.  Five of those (13%) went on to see adverse outcomes.
• Of the remainder (n=58) with normal x-rays, only two (3%) went on to see adverse outcomes.

 

While not perfect (nothing ever is in emergency medicine), x-ray findings appear to provide valuable clues in how well patients will fare with the H1N1 virus.

 

The following excerpts are from the study’s abstract.  Follow the link to read it in its entirety.

 

 

H1N1 Influenza: Initial Chest Radiographic Findings in Helping Predict Patient Outcome

1. Galit Aviram, MD, Amir Bar-Shai, MD, Jacob Sosna, MD, Ori Rogowski, MD, Galia Rosen, MD, Iuliana Weinstein, MD, Arie Steinvil, MD and Ofer Zimmerman, MD

Abstract  (Excerpts)

Purpose: To retrospectively evaluate whether findings on initial chest radiographs of influenza A (H1N1) patients can help predict clinical outcome.

 

Results: Of 179 H1N1 influenza patients, 97 (54%) underwent chest radiography at admission; 39 (40%) of these had abnormal radiologic findings likely related to influenza infection and five (13%) of these 39 had adverse outcomes. Fifty-eight (60%) of 97 patients had normal radiographs; two (3%) of these had adverse outcomes (P = .113).

Characteristic imaging findings included the following: ground-glass (69%), consolidation (59%), frequently patchy (41%), and nodular (28%) opacities. Bilateral opacities were common (62%), with involvement of multiple lung zones (72%) . . .

 

Conclusion: Extensive involvement of both lungs, evidenced by the presence of multizonal and bilateral peripheral opacities, is associated with adverse prognosis. Initial chest radiography may have significance in helping predict clinical outcome but normal initial radiographs cannot exclude adverse outcome.

 

FAO: On The Trail Of Avian Influenza

 

# 4454

 

 

The FAO is the UN’s Food and Agriculture Organization, and among its numerous projects, it has taken the lead in helping nations to better detect, report, and contain avian influenza around the world.

 

Today, a status report on efforts to monitor and detect avian influenza in wild birds, and a warning that many people are becoming complacent to the bird flu threat.

 

This from the FAO Newsroom.

 

On the trail of avian influenza

23-03-2010

International task force concerned over declining support for H5N1 monitoring, despite disease persistence and spread

Bar-headed Geese (Anser indicus) in Bharatpur, Rajasthan, India.

 

23 March 2010, Rome - An international team of experts has warned that while more is known today about the role of wild birds in the spread of the highly pathogenic H5N1 avian influenza virus than ever before, significant information gaps remain unfilled as government and public attention is shifting elsewhere.

 

"Waning attention to H5N1 HPAI is reducing surveillance and research opportunities, negatively affecting capacity building and coordination between environmental and agricultural authorities, and impacting efforts to further refine understanding of the epidemiology and the ecology of the virus," the Scientific Task Force on Avian Influenza and Wild Birds said in a statement following a review meeting held at FAO's Rome headquarters.

 

Established in 2005 and jointly led by FAO and the UNEP-Convention on Migratory Species, the task force is a collaborative partnership involving 15 international organizations, including several UN agencies, other intergovernmental groups, and specialist non-governmental organizations (see box at right).

 

"Unfortunately, H5N1 may have slipped off the radar screen for some people, but it continues to be a major problem, especially in Egypt and parts of Asia, where it is having a huge impact on food security and the livelihoods of farmers and local communities," said Juan Lubroth, FAO's Chief Veterinary Officer. H5N1 HPAI is has not been restricted to Asia alone, he added, having also occurred in Europe, Central Asia and parts of Africa.

 

In the past six months, there have been outbreaks of the virus in domestic poultry in Bangladesh, Cambodia, Romania, Israel, Myanmar, Nepal, Egypt, Indonesia, India, and Viet Nam and in wild birds in China, Mongolia, and the Russian Federation. Just this week, Bhutan reported outbreaks for the first time and the virus was detected after a three year absence in Romania in domestic poultry.

 

Poor farm biosecurity and trading of infected poultry are the main causes of disease spread. Wild birds play a much smaller role in the H5N1 HPAI ecology — but understanding their role in this disease, and managing the associated risks, poses particular challenges.

 

The disease has had great and varied conservation implications, including causing thousands of wild birds to die from viral exposure, inappropriate responses including culling of healthy wild birds and destruction of their habitats.

 

No smoking gun

Over the past five years some 750,000 healthy wild birds have been tested for the H5N1 HPAI virus worldwide, either by national authorities, NGO's, and international organizations like FAO.

 

Some expected that "wild reservoir" species — birds that can carry and spread the virus without getting sick — would turn up during this process.

 

So far that hasn't been the case. Only an extremely small number of apparently healthy infected wild birds have been found.

 

FAO has also led efforts to track over 500 migratory wildfowl in various regions with satellite transmitters in order to gather information on their movements and identify possible correlations with avian flu occurrences.

 

No smoking gun emerged from that effort.

 

This suggests that infection of domestic poultry from wild birds is rare and the risk to humans from wild birds is negligible.

 

More testing is needed, however, to firm up this understanding.

"Seven-hundred and fifty thousand is a lot of birds, but when you consider the size of the global bird population, we may need to test even more birds if we are going to find the virus," explained Scott Newman, EMPRES Wildlife Unit Coordinator for FAO. "Is it that there's no wild bird reservoir, or that we have not sampled enough?"

 

"Certainly, wild birds have been involved in transmission in some cases, for example in Mongolia last year — and researchers in China recently reported finding the virus in apparently healthy wildfowl," said Newman.

 

These questions as well as other issues were discussed by the Task Force. Areas highlighted by the group as needing further improvement include:

• Standardisation of reporting and sampling methodologies to current best science-based practices;

• Continued and broader surveillance of wild bird populations, along with improving understanding of migration routes, habitat use, and movements;

• Strengthening of capacity do that those conducting outbreak investigations can evaluate the source of virus introduction;

• Education efforts to reduce indiscriminate blame of wild birds for outbreaks in poultry.

Fringe benefits for wildlife conservation

One of the side benefits of the unprecedented monitoring effort undertaken by FAO and its partners has been a wealth of new information regarding habitat use and migration patterns and routes of some species of wild birds.

"The data were generated so that we could better evaluate possible linkages between wild bird migrations and the occurrence of H5N1, but should prove a tremendous value in terms of identifying and prioritising wetlands of critical importance for conservation and management", said Newman.

Egyptian Media: 17th H5N1 Case of 2010

 

 

# 4453

 

 

Commonground posting on Pandemic Information News and Flutrackers this morning brings us a media report of Egypt’s 107th H5N1 infection.  This time, it is a 4 year-old from Beni Suef.

 

This would make Egypt’s 17th  bird flu infection of 2010.   

 

 

"Health" declares bird flu infection 107

Sunday, March 21st, 2010 - 20:46

 

Minister of Health

Abdul Salam wrote Princess

The Ministry of Health on Sunday evening, the discovery of human cases of bird flu, a child aged 4 years in Beni Suef, bringing the number of cases infected with the disease since it appeared to 107 cases.

 

The ministry's statement into the situation Beni Suef General Hospital on the eighteenth of March, has been suffering from high fever, cough, runny nose and pneumonia after exposure to infected birds, which gave Tamiflu to be transferred to hospital in the capital of the poor condition.

Referral: TWiV on Influenza

 

 

# 4452

 

 

Vincent Racaniello has a special one-on-one interview with Adolfo Garcia-Sastre on the origin and pathogenesis novel H1N1 virus on this week’s TWiV podcast.

 

Dr. García-Sastre is a Professor in the Department of Microbiology at Mount Sinai School of Medicine in New York.

 

While a great many topics are covered, the significance of the D225G mutation is discussed at length.  This week’s TWiV podcast runs about 45 minutes.

 

If you aren’t a regular listener to TWiV (This Week In Virology), and a regular visitor to Racaniello’s Virology Blog,  you really should be. 

 

TWiV #74: Influenza with Professor Adolfo Garcia-Sastre

Review: Superbug: The Fatal Menace of MRSA

 

 

# 4451

 

 

 

In moments of quiet reverie I often find myself wishing I could dance like Astaire, or maybe sing like Sinatra, or perhaps compose like Gershwin.

 

But in truth, I’d happily settle for being able to write about science and medicine as well as does Maryn McKenna.

 

This is not a recent revelation, as I’ve been a avid fan of Maryn’s work for several years. But it was reinforced this past Friday with the arrival of Maryn’s book  Superbug: The Fatal Menace of MRSA, which I’ve been eagerly devouring. 

 

If that title seems a bit over-the-top, trust me . . . it isn’t.  

 

MRSA is a fatal menace, and and as you read this narrative of its spread, you soon realize that calling it a `Superbug’ is totally appropriate. 

 

 

 

While chock full of scientific information, Superbug reads more like a fast-paced medical thriller than a science book.  Maryn writes so vividly, that when she takes you into the ICU (which is often), you can all but smell the antiseptic.

 

Superbug manages to deliver an enormous amount of scientific data almost painlessly by incorporating it into the stories of people (and their families) that MRSA has devastated, or those are trying to understand and stop its spread. 

 

I can think of a great many superlatives to describe this book; engaging, harrowing, fascinating, powerful . . .  even terrifying at times. 

 

But the descriptive term that keeps coming back to me is: 

 

Important.

 

There is probably no graver health threat facing the world today than the rise of antibiotic resistant pathogens.  And it isn’t just MRSA.  There’s VRSA, VRE, VISA, Acinetobacter and others. 

 

The way we use (and misuse) antibiotics in humans, and on the farm, plays a huge role in our ability to deal with infections today and in the future.   As Maryn points out, we need to make changes in hospital procedures, community health care, farming practices, prisons, and antibiotic awareness if we are to combat these emerging superbugs.

 

Much as Upton Sinclair’s The Jungle exposed the meatpacking industry and Rachel Carson’s Silent Spring alerted us to man-made threats to our environment, Maryn McKenna’s Superbug should be viewed as a clarion call for changes we must make if we hope to control this rapidly growing health threat.

 

I am chagrined to confess that even though I’ve been aware of MRSA for years, have read about it often, and even recently lost a relative to MRSA pneumonia  - until I read this book -- I’ve not really appreciated just how profound a threat that antibacterial resistant pathogens pose to mankind.

 

MRSA kills at least 19,000 Americans every year, hospitalizes hundreds of thousands more, and causes millions of visits to doctors and emergency rooms.  It adds tens of billions to our health care costs, and the human costs are incalculable.

 

Yet, incredibly . . . 

 

• 50% of health care workers fail to consistently wash their hands between patients. 
• Hospitals often rely on `passive’ detection instead of active surveillance for MRSA
• MRSA is still not a `notifiable disease’ in many states preventing uniform and accurate surveillance and reporting
• Millions of pounds of antibiotics are used for non-therapeutic use on farms in order to `promote animal growth’. 
• And we ignore the spread of MRSA in fertile breeding grounds like prisons that continually send the pathogen back out into the community.

 

 

MRSA, and other resistant pathogens, are evolving faster than our ability to create new classes of antibiotics to combat them.  As Maryn reports, the only viable solution may be the creation of a vaccine against staph. But developing a vaccine will require time, enormous funding, and the political will to make it happen.  

 

All of which are in short supply.

 

Superbug, quite frankly, should be required reading for every doctor, nurse, and health care professional, if for no other reason than to alert them to the changes they must make in order to help curb the spread of these deadly pathogens.

 

But it should also be on the reading list of parents, students, and teachers who need to be able to recognize the early warning signs of infection. 

 

And just as importantly, read by those who make policy at the local, state, and Federal level.  We either make institutional changes or risk serious peril from these resistant bacteria.

 

 

This is a book I will keep, and I am certain, will re-read and refer to often.  Even if you don’t normally read  `science books’,  you should take the time to read this one.  

 

Superbug is not only a fascinating book, it’s an important one.

 

Highly recommended.

 

Order Superbug From Amazon

Superbug book website

Superbug blog 

Maryn McKenna Interview On Book

 

 

 

Full Disclosure:   While I’ve never met Maryn McKenna in person, we did talk once on the telephone (she interviewed me in 2007 for a CIDRAP News story), and we’ve exchanged a number of emails and twitter communications over the years.

 

So I consider her a friend as well as a blogging colleague.

 

I ordered my copy of SUPERBUG from Amazon in early January . Several days afterward, Maryn offered to send me a publishers advance copy, which arrived in my mailbox on Friday.

 

I will keep my paid-for copy when it arrives, and pass the gratis copy I received on to a Health Care Professional I know to be interested in the subject.