Thursday Morning Roundup

 

# 4950

 

 

After a rainy drive across the state I arrived at St. Augustine late yesterday afternoon.  T.S. Nicole died over Cuba, and the weather has cleared remarkably.

 

Since this is a bit of a working holiday for me, I’ll keep these entries brief until I return.  This morning, some links to stories and events around Flublogia.

 

Ida at BFIC has 3 reports overnight on the continued spread of H5N1 in poultry in South Sulawesi and new outbreaks in West Sulawesi.

 

West Sulawesi ::: Bird flu uprises in 2010

Posted by Ida on September 30, 2010

Mamuju – Avian influenza or bird flu H5N1 prevalence in West Sulawesi province is uprising in September 2010.

Balikpapan, East Kalimantan ::: Chickens death confirmed bird flu

Posted by Ida on September 30, 2010

Balikpapan – The cause of chickens’ death in Kelurahan Manggar, Balikpapan Timur, East Kalimantan province is identified of bird flu H5N1 virus. Diagnosis was done through rapid test by of Agriculture, Marine and Fishery Service. Samples have been sent to Banjar Baru, South Kalimantan for confirmation.

Polman, West Sulawesi ::: Bird flu has spread to Kabupaten Polman

Posted by Ida on September 30, 2010

Polewali Mandar – After hitting three municipals (kabupaten) in South Sulawesi province – Pinrang, Sidrap and Luwu -  bird flu H5N1 is now attacking thousands of chicken in Kecamatan Limboro and Binuang, Kabupaten Polewali Mandar (Polman), West Sulawesi.

 

 

Arkanoid Legent has the latest Australian & New Zealand influenza surveillance data, along with reports on Dengue in Pakistan and the Philippines.

 

 

Australian Influenza Surveillance 2010 - Latest report

The latest report from the Department of Health and Ageing in Australia, excerpt :
Report No. 37
Reporting period 11 to 17 September 2010

• Levels of influenza-like illness (ILI) in the community have continued to increase through most surveillance systems this reporting period. Local, regional and widespread activity was reported within jurisdictions. However, the number of laboratory confirmed notifications continued to decline.

New Zealand : Pandemic Influenza H1N1 2009 (swine flu) - Update 210

The latest H1N1 update from New Zealand's MOH :
" Overall influenza H1N1 activity continues to decrease below baseline levels. While some cases and clusters of influenza are likely to continue, this is much less frequent now and at a national level we are nearing the end of the second wave of pandemic influenza H1N1 in New Zealand. The Ministry's weekly updates will end next week.

 

Crof has reports on  Underreported Dengue in Pakistan, the unintended consequences of mosquito control in Sri Lanka: Killing our enemy's enemy, and a somewhat breathless report out of Sydney Australia: A world without antibiotics.

 

The `big story’ this week continues to be the hospitalization and isolation of several residents of Pinrang, Indonesia who are experiencing flu-like symptoms after exposure to dead or dying chickens.

]

Thus far, we have no announced laboratory results, and so it is unknown whether any of these people are infected with the bird flu virus. 

 

The numbers appear to shift a bit depending upon the news source, but it appears that 26+ people are being monitored in their homes, and 4 or 5 are hospitalized.  

 

FluTrackers is maintaining a forum thread with updated reports that you can check here.

 

The most recent report comes from Treyfish, and is a translation of a  Para Pos article called  5 Warga Suspect Flu Burung, excerpts of which appear below.

 

Thursday, September 30, 2010
3 Referred to Makassar, 2 Isolated

5 Residents Suspect Bird Flu
THURSDAY, 30 SEPTEMBER 2010

PINRANG - Five residents in District Lanrisang Pinrang otherwise suspect (suspect) bird flu. Three out of five residents, each Nawir (42), Andrews (5) citizens Suppang Saddang Hamlet, and Novi (18) Same Ulue Village on Tuesday night, was referred to the Provincial General Hospital Dr M Wahidin Sudirohusodo.

 

<SNIP>

 

Not less than 26 residents who currently monitoring the Health Department. "These data may increase, but we hope diminished," she said. Rusman explained, which distinguishes the common cold sick with bird flu is body temperature. However, if positive for bird flu, 80 percent of patients will experience death.

 

Authorities say it will take roughly 10 days before test results will be known due to the repeat testing that they require to confirm or rule out the disease.

 

FluTrackers also has reports on msny of other disease outbreaks around the world, medical studies recently published, and other humanitarian crises.

 

You could spend a year there, and not read it all.

 

I’ll check back later in the day to survey the scene, but as you can see, these newshounds and bloggers have everything in Flublogia well covered.

A Semi-Hiatus

 

 

 

# 4949

 

 

In a few hours I’ll be leaving for a 4 day semi-hiatus to St. Augustine, Florida where sometime tomorrow morning I should be able to wave to (by then) Tropical Storm Nicole as it passes to our east.

 

I expect the surf will be up at the beach.

 

The latest storm track from the National Hurricane Center has the storm racing northward, making landfall around the North Carolina – South Carolina border tomorrow afternoon.

 

 

Today, it’s south Florida under the gun as this system moves over the Florida straits and sideswipes Miami.

 

It’s track takes it over the warm gulf stream, once it emerges from Florida, so some intensification is possible.  Interests all along the eastern seaboard will want to keep up with this storm’s movements.

 

I’ll have my laptop with me, and will try to update this blog if possible, but until I return on Sunday, my efforts will probably be limited.

 

Of course, with the considerable talents of Crof, Arkanoid Legent, BFIC, Chen Qi, Maryn Mckenna, Ian York and the newshounds on forums like the Flu Wiki and FluTrackers, Flublogia is in excellent hands.

BMJ: Efficacy of Oseltamivir In Mild H1N1

 

 

# 4948

 

 

One of the ongoing debates in the world of influenza has been over the efficacy of administering oseltamivir (Tamiflu) in the treatment of mild influenza in otherwise healthy individuals.

 

You may recall that last December a cluster of articles appeared in the BMJ which seriously questioned the lack of supportive scientific evidence in this matter (see BMJ: A Review Of Tamiflu’s Efficacy Against Seasonal Influenza).

 

Published 8 December 2009, doi:10.1136/bmj.b5106
Cite this as: BMJ 2009;339:b5106
Research

Neuraminidase inhibitors for preventing and treating influenza in healthy adults: systematic review and meta-analysis

 

 

While the entire study is worth reading, the bottom line was there is insufficient evidence, according to the authors, to conclude either for or against Tamiflu for use in healthy adults with seasonal influenza.

In other words, the authors stated that more studies were needed.

 

Although it certainly won’t end the debate, we’ve a new open access retrospective study appearing this week in the BMJ  which suggests that administration of oseltamivir may have significantly reduced the incidence of pneumonia among otherwise healthy pandemic H1N1 patients.

 

BMJ 2010; 341:c4779 doi: 10.1136/bmj.c4779 (Published 28 September 2010)

Cite this as: BMJ 2010; 341:c4779

• Research

Effectiveness of oseltamivir on disease progression and viral RNA shedding in patients with mild pandemic 2009 influenza A H1N1: opportunistic retrospective study of medical charts in China

 

Hongjie Yu, Qiaohong Liao,Yuan Yuan,Lei Zhou, Nijuan Xiang, Yang Huai, Xiuhua Guo, Yingdong Zheng, H Rogier van Doorn, Jeremy Farrar, Zhancheng Gao, Zijian Feng, Yu Wang, Weizhong Yang

Conclusions Chinese patients with 2009 H1N1 infection predominantly presented with features of uncomplicated, self limiting acute respiratory illness. 2009 H1N1 might be shed longer than seasonal influenza virus.

Treatment with oseltamivir was associated with a significantly reduced development of radiographically confirmed pneumonia and a shorter duration of fever and viral RNA shedding.

Though these patients benefited from treatment, the findings should be interpreted with caution as the study was retrospective and not all patients underwent chest radiography.

 

 

For those who would like the short version, there is a press release covering the highlights.  I’ve excerpted a few paragraphs.  Follow the link to read it in its entirety.

 

Swine flu patients benefited from taking Tamiflu, says study

Research: Effectiveness of oseltamivir on disease progression and viral RNA shedding in patients with mild pandemic 2009 influenza A H1N1: opportunistic retrospective study of medical charts in China

Healthy people who caught swine flu during the 2009 pandemic may have been protected against developing radiographically (x-ray) confirmed pneumonia by taking the antiviral drug oseltamivir (Tamiflu), concludes a study of cases in China published on bmj.com today.

 

The researchers also show that oseltamivir treatment was associated with shorter duration of fever and viral RNA shedding (the period when a virus is contagious), although they stress that their findings should be interpreted with caution.

(Continue . . .)

 

While the  lack of peer-reviewed RCTs (Randomized Controlled Trials) on oseltamivir – which can provide genuine ethical dilemmas to mount – will continue to leave some questioning the efficacy of Tamiflu in mild influenza, anecdotal reports and retrospective analysis continues to show the drug to be beneficial, particularly in cases of severe influenza.

 

Today’s study adds a new dimension to the debate, by strongly suggesting that it may reduce morbidity in healthy adults with mild influenza symptoms.

 

Additionally, the researchers reported that:

 

Our study suggests that 2009 H1N1 is shed from one day before the onset of symptoms to eight days after onset for most (91%) patients and can be shed up to 21 days.

The BMJ’s summary reads, in part:

 

What this study adds

• In patients with mild pandemic 2009 H1N1 infection, oseltamivir can protect against subsequent development of radiographic pneumonia, even in those who start treatment more than two days after the onset of symptoms

• Early oseltamivir treatment within two days of symptom onset can reduce the duration of fever and viral RNA shedding

• Pandemic 2009 H1N1 virus is shed from one day before the onset of clinical symptoms to up to eight days after onset for most patients and is shed for longer than seasonal influenza virus

 

There are other concerns when it comes to the routine use of oseltamivir with mild influenza, including the possibility of causing side effects and the (potential, at least) of generating resistant strains of the influenza virus.

 

Both matters to be taken up by other studies and on another day.

Indonesia: 4 Bird Flu Suspects Hospitalized

 

 

 

#4947

 

 

This morning - via Ida at BFIC,  Arkanoid Legent, and Dutchy at FluTrackers  - we have three reports which state that 4 of the 18 people being monitored with flu-like symptoms in the wake of a bird flu outbreak in South Sulawesi (see The Ongoing Bird Flu Flap In Indonesia) are now hospitalized.

 

At this point, laboratory confirmation of H5N1 infection has not been received, and these remain merely `suspect’ cases. 

 

The Indonesian government has displayed continued  reluctance to discuss their country’s bird flu problem  (see Indonesia To Stop Announcing Bird Flu Deaths) – so when or even if - we get official comment on this outbreak is hard to say.

 

We’ll start with a hat tip to Arkanoid Legent - who has developed into a terrific resource and one of the best news gathering sites in Flublogia. 

 

Indonesia : Four Patients Suspected Bird Flu

Another translated report from Liputan 6, bird flu patients in South Sulawesi :

" Makassar: Four suspected bird flu infected patients treated at Wahidin Sudirohusodo Hospital, Makassar, South Sulawesi. The information obtained is SCTV, on Wednesday (29 / 9), four patients consisted of two children and two adults. They are referrals from district hospitals Pinrang.

 

Pediatric patients is Savira origin and Andrian Soppeng District of Pinrang. Two other patients are from Novi and Nawir also Pinrang. Nawir and Andrew are still one family.

 

Although there is no further examination, doctors suspected bird flu because they suffer from high fever after dozens of dead pet chicken."

 

 

Ida at the Bird Flu Information Corner has this translation of a report that appeared in the Indonesian newspaper Tempo Interaktif.   This is just an excerpt, follow the link to read it in its entirety.

 

 

Makassar, South Sulawesi ::: Wahidin Sudirohusodo hospital treats bird flu suspects

Posted by Ida on September 29, 2010

Makassar – Four people are being treated in Inspection Center of Wahidin Sudirohusodo, Makassar, Wednesday 29/09. Those patients are residents of Kabupaten (municipal) Pinrang and Soppeng.

 

Three patients came from Jampue, Kecamatan Lanrisang, Kabupaten Pinrang, identified as Novi (17), Nawir (42) and Adrian (4-year-old). They were admitted to Lanrisang Pinrang hospital at 5,00 am before transferred to Makassar.

 

A 3-year-old girl, Safira, from Kabupaten Soppeng had been admitted to Wahidin Sudirohusodo hospital on the previous day.

 

The four patients are currently having high fever.

 

Director of Wahidin Sudirohusodo hospital, Andi Kalsum Patonangi said those patients were suspected to contract bird flu infection. However, hospital is still waiting laboratory confirmation of bird flu infection.

 

(Continue . . . )

 

And last, but certainly not least, we’ve this translation of a detikNews story by the indefatigable Dutchy  which indicates that the 17 year-old boy may be in the most serious condition, while the three others are slowly improving.

 

This translation is posted on this ongoing FluTrackers Thread.

 

Four Suspects Bird Flu Treated in Hospital Wahidin Sudirohusodo Makassar

Muhammad Nur Abdurrahman - detikNews
Makassar - 4 residents Pinrang and Soppeng District, South Sulawesi, was treated in hospital intensive Wahidin Sudirohusodo DR, Makassar due to high fever.

 

The four were suspected suspect bird flu.

 

Two patients, namely Nawir (42), Adrian (4), derived from Sondra Village, District Jampue. Another patient Novi (17 yrs) from Samaule Village, District Lanrisang Pinrang. While the last patient Sapphire (3), toddlers origin Paroko Village, Sub District Lilirilau Soppeng.

 

All four are now isolated on the first floor space Inpection Center Hospital Wahidin Sudirohusodo. The third patient from the previous Pinrang Lasinrang was treated in hospitals in Pinrang.

 

General & Operations Director RS Wahidin, Kalsum Patonangi, said the four patients had high fever. In the neighborhood around his house, found hundreds of dead birds.

 

"At this time the blood samples of patients still in the examination in the laboratory," said Kalsum.
Kalsum add three patients, in addition to patient Novi, conditions are slowly improving. However the three should still be monitored in a special room Inspection Center.

 

My gratitude goes to these three newshounds - along with dozens of others - who work tirelessly in and around Flublogia to find, translate, and post these stories.  

 

Much of what I do here is dependant upon their fine efforts – which is why I hat tip them at every opportunity.

 

For now, it still isn’t clear whether any of these patients are infected with the H5N1 virus, and if so, how they may have contracted it. Hopefully more details will emerge over the next couple of days. 

 

The newshounds on the Flu forums (see Newshounds: They Cover The Pandemic Front) will keep this under close watch, and you can be sure that Crof, Arkanoid Legent, BFIC, Chen Qi and I will, as well.

 

Stay tuned.

Morens, Taubenberger & Fauci: What’s Next For H1N1

 

 

 

# 4946

 

 

In an open access perspective article appearing in the journal mBio, well known NIH scientists and researchers David M. Morens, Jeffery K. Taubenberger, and Anthony S. Fauci give their take on the future of the novel 2009 H1N1 virus.

 

 

The 2009 H1N1 Pandemic Influenza Virus: What Next?

1. David M. Morens, Jeffery K. Taubenberger, and Anthony S. Fauci

ABSTRACT

History suggests that the 2009 pandemic H1N1 influenza virus faces extinction unless it mutates to avoid already high global population immunity. The immune escape mechanisms potentially at its disposal include antigenic drift, antigenic shift via genetic reassortment, and intrasubtypic reassortment.

 

Going back to the late 19th century, the evolutionary histories of past pandemic viruses are examined in an effort to better understand the nature and extent of the immune pressures faced by the 2009 pandemic virus in the immediate future.

 

While human influenza viruses have often surprised us, available evidence leads to the hope that the current pandemic virus will continue to cause low or moderate mortality rates if it does not become extinct.

 

The FULL TEXT is available here.

 

For those who prefer the Press Release condensed version, we have that as well:

 

NIH scientists consider fate of pandemic H1N1 flu virus

Whither pandemic H1N1 virus? In a new commentary, scientists from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, review the fates of previous pandemic influenza viruses in the years following a pandemic and speculate on possible future courses for the 2009 pandemic H1N1 (pH1N1) virus during the upcoming flu season and beyond.

 

The authors estimate that at least 183 million Americans (about 59 percent of the total U.S. population) have some immunity to pH1N1 because they were exposed to related viruses or vaccines prior to 2009, were immunized against pH1N1 or developed immunity following infection with the pandemic virus.

 

To stay in circulation in the face of such high levels of population immunity, the pH1N1 virus must adapt either through abrupt or gradual changes. The authors briefly examine a number of earlier pandemics and trace paths taken by the causative viruses. Some—for reasons not well understood—died out, while others, like those of 1889 and 1918, returned in an explosive fashion. Such an explosive return of pH1N1 virus is unlikely, note the authors, because global levels of immunity are already high and will increase further through immunization with 2010-2011 seasonal influenza vaccines, which contain the pH1N1 strain.

 

In light of what is known about pH1N1, the NIAID authors express a cautious optimism that unless it disappears entirely the virus will follow a route like that of 1968 pandemic virus, that is, it will persist in a form that causes relatively few deaths.

 

Nevertheless, the authors caution against complacency. As they acknowledge, many gaps remain in understanding how a given pandemic influenza virus adapts to increased immunity in humans. For that reason, influenza vaccination for everyone older than six months is a wise public health measure to maintain high levels of population-wide immunity. Immunization with 2010-2011 seasonal flu vaccine is particularly urged for babies older than six months, children, teens and young adults as the best way to protect individuals in those potentially more susceptible age groups from illness.

Watching The Tropics

 

 

 

UPDATED:  1100hrs 09/28

A Tropical Storm warning has now been issued for South Florida and the Florida Keys.

 

 

 

# 4945

 

 

Although an active Atlantic Hurricane season, the US has thankfully been spared most of the impact from the storms so far in 2010. 

 

That may change over the next 30 days or so, as the western and central Caribbean become bigger players during October and November.

 

 

October Tropical Climatology.

 

 

 

Right now, the NHC is watching an area south and west of Cuba with an excellent chance to form into a Tropical Storm in the next 48 hours.

 

A BROAD AREA OF LOW PRESSURE OVER THE NORTHWESTERN CARIBBEAN SEA CONTINUES TO GENERATE WIDESPREAD THUNDERSTORMS AND STRONG GUSTY WINDS TO NEAR TROPICAL STORM FORCE.  ALTHOUGH THE LOWEST SURFACE PRESSURES ARE LOCATED BETWEEN THE ISLE OF YOUTH CUBA AND GRAND CAYMAN...THE STRONGEST WINDS ARE OCCURRING A COUPLE HUNDRED MILES TO THE EAST AND SOUTH OF THIS LOCATION.  THIS SYSTEM HAS THE POTENTIAL TO BECOME A TROPICAL OR SUBTROPICAL CYCLONE BEFORE MERGING WITH A FRONTAL SYSTEM NEAR THE FLORIDA PENINSULA BY LATE TOMORROW.  AN AIR FORCE RESERVE UNIT HURRICANE HUNTER AIRCRAFT IS SCHEDULED TO INVESTIGATE THIS SYSTEM LATER TODAY.  THERE IS A HIGH  CHANCE  ...80 PERCENT... OF THIS SYSTEM BECOMING A TROPICAL OR SUBTROPICAL CYCLONE DURING THE NEXT 48 HOURS.

 

 

Early models (which can change) suggest this system will move north or north-north-eastward across Cuba and into South Florida over the next couple of days.

 

 

While unlikely to be a major threat, heavy rains and severe weather are certainly a possibility for southern Florida, and portions of the eastern seaboard over the coming days.

 

Besides, you don’t have to worry . . .  you are already prepared . . . aren’t you?

 

Track this budding storm (and any other tropical threats) on the NHC website at:

 

 http://www.nhc.noaa.gov/index.shtml

Also, if you are on Twitter, follow @FEMA and @CraigAtFEMA for timely updates and preparedness advice.

Referral: An Antimicrobial Resistance Primer

 

 

# 4944

 

 

Although geared for health care providers – nurses in particular – this morning I ran across an excellent primer on the growing problem of antimicrobial resistant pathogens on Medscape Today.

 

If you are a health care professional and would like to increase your knowledge of the issue, check out this helpful introduction:

 

From Medscape Nurses > Nursing Perspectives

Antimicrobial Resistance: A Primer

Laura A. Stokowski, RN, MS

Posted: 09/27/2010

 

 

Note: Medscape requires a free registration in order for you to access this article.

The Ongoing Bird Flu Flap In Indonesia

 

 

#4943

 

 

 

The situation in Indonesia over night appears to be evolving, but `into what’ isn’t easy to say.

 

The headline – if it can be trusted – is that the number of people being `monitored’ with flu-like symptoms in the area where thousands of birds have recently died has grown to 18.

 

But exactly what criteria is being used to decide who to monitor, and how seriously ill any-or-all of them are is difficult to determine.

 

And here I confess to a built-in hesitance to place too much credence on machine-translated news stories.

 

The different outputs, the often tortured syntax, and the all-to-frequent double negatives spat out by these software translators tend to induce minor brain bleeds whenever I try to read them.

 

The escalation in persons monitored comes from a report in Pare Pos (h/t Treyfish), which – despite the headline - spends a good deal of time listing the numbers, and locations, of poultry deaths before listing the number of people under observation near the bottom.

 

 

The operative paragraph near the bottom of the story, via ToggleText translator, states:

 

But last September 25, several residents entered observation of the Pinrang Health of the Service, in part in the Suppang Saddang Village 10 people, the Sama Ulue Village of two people, Mallongi-longi five people, and the Amassangan Village of one person. Not not all that 18 people were monitored because of being suspected could tertular the bird flu virus.

 

Google Translator comes up with a more verbose output:

 

While data from the Health Department Pinrang mentioned, until now there has been found that infected people have bird flu, but Sept. 25, a number of residents included in the monitoring of Public Health Pinrang, among others in the village of Suppang Saddang 10 people, Village Ulue Same two people, Mallongi longi-five people, and the Village Amassangan one person. Not less than 18 people can be monitored on suspicion of contracting bird flu virus.

 

 

Same original text – two translation programs – and two similar, but different results.

 

As far as which is more accurate?   Your guess is as good as mine.

 

Meanwhile, Ida at BFIC has yet another (human, this time - thankfully) translation of this story that focuses on the poultry deaths, their locations, and some of the containment efforts underway.

 

 

South Sulawesi ::: Bird flu outbreaks in Kabupaten Pinrang, Sidrap, and Parepare

Posted by Ida on September 28, 2010

Livestock and Fishery Service of Kabupaten (municipal) Sidrap, South Sulawesi strengthened livestock traffic control from Sidrap borders: Pinrang-Sidrap, Parepare-Sidrap, Wajo-Sidrap and Soppeng-Sidrap. This is to prevent disease introduction to Sidrap from other area, mentioned Head of Livestock and Fishery Service of Sidrap, HM Abd Azis. So far, Azis and team are still investigating whether thousands of chickens death in Sidrap was caused by bird flu virus.

 

Livestock and Fishery Service of Sidrap until now recorded about a thousand of chicken which had suddenly died. The most casualty was recorded from Kelurahan Kadidi.

 

Separately from Kabupaten Pinrang, Head of Agriculture and Livestock of Pinrang, H Syamsu Sulaiman stated they had done disinfection in entire sub-districts and depopulation of hundreds of bird flu infected chickens. Livestock service also isolated the infected areas, Sawitto, Tiroang, Paleteang, Mattiro Bulu, and Lanrisang.

(Continue . . . )

 

 

There are certainly other illnesses circulating in Indonesia that could be the cause of `flu-like’ symptoms – and so I’m not particularly keen to jump to the bird flu conclusion.

 

Not just yet, anyway.

 

Given the high mortality rate of H5N1 to date in that country – if any of these people are infected with the bird flu virus – I would expect to start hearing that their condition has deteriorated.

 

For now, the monitoring of these people appears due to an abundance of caution.

 

The newshounds on the Flu Wiki and FluTrackers, along with many of the bloggers in Flublogia are keeping an eye on the situation and will keep you posted.  In time, we’ll hopefully be able to make better sense of it.

 

FluTrackers Thread

FluWiki Thread

2010 Flu Season: A Look Ahead

 

 

 

# 4942

 

 

Tomorrow (Tuesday Sept 28th,2010) the CDC will broadcast a live video event on their Flu.gov website.

 

 

Tuesday, Sept 28 at 12:00 PM EDT

2010 Flu Season: A Look Ahead

Participants:

• Kathleen Sebelius, Secretary, US Dept of Health and Human Services (HHS)
• Howard Koh, M.D., M.P.H., Assistant Secretary for Health, HHS
• Anne Schuchat, M.D., Director, National Center for Immunization and Respiratory Disease, CDC, HHS

 

Dr. Anne Schuchat should be familiar to most of my readers, as she personified the calm voice of reason during many of the CDC’s press conferences last year during the pandemic.

You can read her accompanying blog at the link below:

2010 Flu Season: A Look Ahead

September 24, 2010

By Anne Schuchat, M.D., Director, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention

For many people, fall is a time to tune into sports, tackle new projects, and even plan for the holidays. The Centers for Disease Control and Prevention—CDC—wants to remind you it also means flu season is on its way. Last year’s 2009 H1N1 influenza pandemic hit many hard, and should act as a reminder of just how unpredictable flu can be. It can attack even healthy people, and it can send children and adults to the hospital.  The first and most important step in protecting against the flu is to get a flu vaccine each season, and CDC recommends that everyone 6 months of age and older be vaccinated.

(Continue . . . )

 

 

Australia: Panvax Investigated For Febrile Convulsions

 

 

 

# 4941

 

Late last week Australia’s Therapeutic Goods Administration (TGA) issued an advisory on recent reports of a higher-than-expected number of pediatric febrile convulsions following administration of CSL’s monovalent Panvax  (pandemic) H1N1 flu vaccine

 

CSL’s trivalent seasonal flu shot came under scrutiny last April with similar adverse reactions.

 

The total number of reports were small (several hundred) out of tens of thousands of shots given, but significantly higher than normal.

 

Most of the side effects were related to fever, with some children experiencing febrile convulsions. Others experienced nausea and vomiting, or injection site inflammation (see Australia Investigating Adverse Vaccine Reactions).

 

This latest announcement regarding the Panvax vaccine suggests that the incidence of side effects for this monovalent shot -  while higher than usual – was a fraction of that seen with CSL’s seasonal vaccine.

 

Thus far, we’ve not seen excessive reports like these from other countries or from other manufacturer’s vaccines.

 

Two reports. 

 

First, excerpts from the TGA’s advisory, then a news report from The Sydney Morning Herald that suggests that these side effects may not prove as common as originally stated.

 

 

Suspected adverse reactions to Panvax® reported to the TGA 30 September 2009 to 17 September 2010

22 September 2010

 

The national immunisation program with Panvax® began on 30 September 2009. The TGA has been closely monitoring any side effects from the use of the vaccine.

 

As at 17 September 2010 a total of 1960 suspected side effects had been reported to the TGA following vaccination with Panvax® in Australia. The great majority of reported side effects have been mild and common problems such as headache, gastrointestinal upset, and soreness, swelling, or redness at the injection site. Most of the side effects that have been reported are well recognised and listed in the Panvax® Product Information. Of the suspected side effects reported, only 190 related to Panvax Junior®, and the majority of these reports were of fever (151) and/or vomiting (98).

The TGA's assessment remains that Panvax® is a safe, effective vaccine for prevention of the H1N1 influenza.

As at 17 September 2010 the TGA had received 48 reports of febrile convulsions in children following Panvax/Panvax Jr administration. Nine of these had occurred in children who had also been given other vaccines at the same time as they received Panvax.

 

(Continue . . .)

 

 

 

 

Swine flu jab for children may not be so harmful

Mark Metherell

September 28, 2010

The Commonwealth chief medical officer, Jim Bishop, has sought to play down concerns following the revelation that a second influenza vaccine, Panvax, has been linked to febrile convulsions in infant recipients of the vaccine.

(Continue . . . )

 

 

While often dramatic, febrile convulsions in young children are not uncommon with a fever, and only rarely prove serious.

 

Febrile Seizures Fact Sheet

More Out Of Indonesia

 

 

 

# 4940

 

While the medical status of the 8 Indonesians reporting flu-like symptoms after contact with sick and dying chickens (see Watching Indonesia Again) remains unclear, we continue to see a steady stream of media reports from the region.

 

We are also seeing reports of outbreaks of bird flu (or at least, suspected bird flu) elsewhere across  Indonesia -  I’ve included a couple of these reports at the end of this blog.

 

 

Ida at the Bird Flu Information Corner - a joint project of Kobe University in Japan and the Institute of Tropical Disease, Airlangga University, Indonesia – has translations of 3 short news stories overnight.

 

For now, public health officials have not declared these 8 people as being officially suspected of having H5N1. 

 

Follow the links to read these stories in their entirety.

 

Luwu Utara, South Sulawesi ::: Bird flu attacks chickens

Posted by Ida on September 27, 2010

Luwu Utara – Livestock Service of Kabupaten (municipal) Luwu Utara, South Sulawesi, culled thousands of chickens belong to local farmers. Those birds were infected by bird flu H5N1.

 

 

 

Ponorogo, East Java ::: Chickens die of bird flu

Posted by Ida on September 27, 2010

Ponorogo – Dozens of chicken in Kertosari, Ponorogo suddenly died. The chickens were apparently healthy and found dead on the next day.

Laboratory test of Health Service showed those chickens were positive bird flu H5N1.

 

Eight locals develop illness after bird flu outbreak in Pinrang. Officials ban chickens from South Sulawesi.

Posted by Ida on September 27, 2010

Follow up of Pinrang bird flu outbreak.

Eight locals showed symptoms but officials have not announced them as bird flu suspect. Meanwhile, bird flu infected chickens from South Sulawesi caught and diminished by quarantine officers in Ambon. -adm-

 

 

Historically human H5N1 cases in Indonesia have fared extremely poorly (an > 80% fatality rate). Unless something about the virus has changed, the lack of reported serious illness (so far, anyway) in this group is somewhat reassuring.

 

 

 

Meanwhile, on FluTrackers, the newshounds have been busy overnight.   Treyfish has retrieved and translated several stories, including this one on the containment efforts in Pinrang (available on this FluTrackers Thread).

 

Pinrang KLB Flu Burung
MONDAY, 27 SEPTEMBER 2010 | 11:15 pm | 208 HitsShare |
Pinrang outbreaks of Avian Influenza

Nasri Aboe / DAWN spray. Officers spraying drug to chickens suspected of bird flu in the Hamlet District Paladang Lanrisang, Pinrang, Saturday lalu.

PINRANG - The discovery of thousands of chickens died suddenly, now Pinrang entry status of outbreaks (epidemics) avian influenza (AI) or bird flu . Control of chicken continues to be improved.

 

<SNIP>

Head of Department (Head) Pinrang Health, Dr. Rusman also admitted to having a team monitoring the impact of bird flu on chicken. Monitoring continues. "We remain alert to the possibility of people stricken with bird flu," he said

Note: KLB refers to an `Extraordinary Incident’ and Flu Burung is Indonesian for Bird flu.

 

Again from Treyfish, we get this a `damage control’ statement by a local politician, seeking to reassure residents that eating properly cooked chicken (an important industry in that region) is safe.

Sahabuddin Thoaha: Virus AI Do not be exaggerated

MONDAY, 27 SEPTEMBER 2010

PINRANG - The bird flu virus or Avian Influenza (AI) is now suspected outbreak in some areas has remained a fearsome specter in the midst of society. However, members of parliament Pinrang, Sahabuddin Thoaha requested that suspected cases of AI outbreaks do not need to be exaggerated.

 

The reason, until now, there are no data that prove that bird flu is a major cause of human death. Sahabuddin who met in his office, at the Parliament building Pinrang, Friday, September 24 and then say, so far, I have found no accurate data on human deaths due to Avian Influenza (AI).

 

There was, he said only suspeck (allegedly) only. "I dare to eat the chicken, which is important is cooked above 100 degrees Celsius, because the virus that range," he said.

(Continue  . . . ) – Translated link

Dutchy meanwhile has picked up on another suspicious outbreak of poultry deaths in Kalimantan, with this report:

Today, Team Down To Perform Rapid Test

BALIKPAPAN - The Department of Agriculture, Marine Affairs and Fisheries (DPKP) not remain silent municipal government report found the number of chickens that died suddenly in the area of RT 04 Kelurahan Manggar, Balikpapan East.

 

The plan, on Monday (27 / 9) today, Case Response team will go to the field to take samples of dead chickens and conduct rapid test.

 

(Continue . . . )

 

 

And from the Flu Wiki’s  Indonesian Poultry & Wild Birds thread, we get this report of the return of bird flu to Ponorogo by bgw in MT.

Bird Flu Virus Appears in Ponorogo Back

Sunday, September 26, 2010 11:35:20 AM
Reporter: Raden Chess Cahyo

Ponorogo (beritajatim.com) - After several months of no more rumors about the outbreak of H2N1 virus (bird flu, red) is now the deadly virus reappeared in Ponorogo. At least dozens of chickens owned by residents Kertosari, district of the City died mysteriously.

 

(Continue . . . ) – Translated link

 

 

A lot of activity, a bit unusual for this time of year. 

 

The newshounds on the Flu forums (see Newshounds: They Cover The Pandemic Front) will keep this under close watch, and you can be sure that Crof, Arkanoid Legent, BFIC, Chen Qi and I will, as well.

Watching Indonesia Again

 

 

 

Video capture from MetroTV newscast

 

 

# 4939

 

The newshounds on FluTrackers are watching reports out of Indonesia today on 8 people with flu-like symptoms in the region (Pinrang) where thousands of chickens recently died from the H5N1 bird flu (see A Bad Week For Indonesian Chickens).

 

 

Reports like these usually end up being something other than bird flu – since seasonal flu, along with many other illnesses – can produce similar symptoms.

 

 

Still, human cases and even clusters have occurred in Indonesia in the past, and so reports like these are taken seriously by local health officials and are watched closely by the rest of the world.

 

 

As of this writing Treyfish, along with Dutchy, have posted local media reports on this FluTrackers Thread and others will likely follow.

The following is a translation of a news article that accompanies a video report from MetroTV News, that was posted by Dutchy.

 

 

Eight People Sick After Thousand Chickens Died

Headline News / Archipelago / Sunday, September 26,

Metrotvnews.com, Pinrang:

Eight people reportedly suffered from fever and cough on the location of thousands of chickens died, in Pinrang regency, South Sulawesi.

 

Although there is suspicion of bird flu virus, health department officials have not set the eight citizens as suspect bird flu.

 

From the results of medical examinations, eight residents have a fever and cough, after contact with poultry infected with bird flu virus.

(Continue . . . )

We will obviously be keeping an eye on this story to see if anything develops.

 

In the meantime, you can follow new reports on the FluTrackers Thread.

NPM10: The Rehydration Solution

 

 

 

# 4938

 

 

Note: National Preparedness Month continues, and one part of preparedness is knowing a little first aid.   While no blog essay can replace a first aid course, it is possible to convey a some simple life saving information.

 

Yes, this is a reprint of one of my older blogs.  But it's an important one, and so I try to repost it once a year.

 

While it was written with a severe influenza pandemic in mind, staying hydrated is important, even with seasonal flu.

 

You can follow this month long preparedness campaign on Twitter by searching the #NPM10 hash tag.

 

 

 

Dehydration, and severe diarrheal disease, particularly among children in the third world, is a massive killer. Recognizing this threat, more than 25 years ago the WHO (World Health Organization) came up with what is now called ORS, or an Oral Rehydration Solution.

 

Hundreds of millions of sachets, or packets of this powder, are shipped each year to various third world countries, and there is no doubt that their use has greatly decreased the loss of life due to cholera, dysentery, and other diseases.

 

In a Flu Pandemic, the need for ORS will be great throughout the world. In western societies, where modern medical care is common, IV’s are generally used instead of ORS. There are economic and psychological reasons for this, although many doctors argue that ORS would be just as effective for the majority of patients.

 

Dehydration, from a prolonged bout of flu; with it’s fever, vomiting, and diarrhea, can easily kill patients that might have otherwise survived the virus.

 

As IV’s may well be in short supply, or simply unavailable during a pandemic, the use of ORS may well be the most beneficial treatment that most patients can receive. Certainly, with home care being the most likely venue for most patients, ORS will play a large role in the treatment of pandemic flu.

 

There are, however, conflicting opinions as to what constitutes the proper formula for making your own ORS. All formulas use a base of sugar and salt, in an appropriate ratio. Some formulas, however, add potassium and Sodium Bicarbonate.

 

A little Biochemistry

When the human body becomes dehydrated, it loses both water and essential electrolytes, particularly sodium. This condition can quickly become life threatening.

 

In the human body, fluids tend to move from a less salty environment to the saltier one. As an example, if someone drowns in fresh water, the water in the lungs is less salty than the blood, and so this water is quickly absorbed from the lungs into the surrounding tissues.

 

If a person drowns in salt water, the water in the lungs is saltier than the blood, and so additional fluid is pulled into the lungs to `dilute’ the salt water. In other words, the body tries to balance both sides of the equation.

 

This is an important concept when dealing with rehydration therapy.

 

Ingesting plain water does not help restore the salt content of the body. But ingesting water with too much salt will draw fluids from the body, and make the dehydration worse.

 

While many believe the exact ratios of sugar and salt to be writ in stone, the truth is, if you have to err, err on the side of less salt.

 

Sugar is added to the ORS solution for two reasons. First, it was discovered in the early 1960’s that sugar helped with the transport of fluids across the cellular membranes in the bowel. In 1977, the British Medical Journal Lancet called this `possibly the most important medical discovery of the 20th century’.

 

Sugar also provides needed calories, and as a carbohydrate, can help prevent ketoacidosis from occurring.

 

But, as with salt, too much sugar can be detrimental, it can promote diarrhea, and make the loss of fluids worse.

 

This is one concern regarding the use of sports drinks, such as gatoraid, for rehydration therapy. Many of these commercially available mixtures simply have too much sugar.

 

Making your own ORS

 

The bottom line, of course, is how to make a cheap, safe, and effective ORS powder yourself.

The simplest formula is 3 Tablespoons of sugar, and 1 teaspoon of salt, dissolved in 1 quart of potable water.

 

An alternative simple formula is 8 teaspoons of sugar, and 1 teaspoon of salt, dissolved in 1 quart of potable water.

 

 

This basic formula has been used effectively for more than 30 years by WHO, UNICEF, and other relief agencies and has saved millions of lives.

 

Over the past year, there has been some debate over the amount of salt and sugar in this formula. The old formula certainly works, and is safe. But some doctors have argued that a lower salt and sugar level might reduce fluid loss by curbing diarrhea.

 

I’ve elected to create single-serve packets of ORS powder, with each packet designed to be added to 1 liter of water. Two packets would be used for a 2-liter bottle.

 

I’ve located small, reclosable baggies, called bagettes sold at Michaels Art Supplies. You will find them in the bead section. Snack sized baggies, though lighter gauge plastic, would work as well. The small 2”x3” bagettes are just a little too small for the amount of powder required. You will need to go to the next size up, which are 3”x5”.

 

Along with these baggies, you will need table salt and sugar. I am electing to use non-iodized salt, although I am not aware of any reason why iodized salt would present a problem. The only other things you will need are measuring spoons and a felt tipped marker.

 

Into each baggie I am placing 3 TABLESPOONS of Sugar, and 1 TEASPOON of salt. These do not need to be mixed. I am writing on each Baggie “ORS POWDER- ADD TO 1 LITER OF WATER”.

 

This is the basic formula recommended by Dr. Grattan Woodson in his GOOD HOME TREATMENT OF INFLUENZA guide.

In his home medical guide, Dr. Woodson writes:

 

"Preventing or treating dehydration in people with flu will save more lives than any other intervention during the influenza pandemic."

 

Identification of dehydration

 

When patients have a fever, vomiting, and/or diarrhea, they lose much more water from the body than is commonly appreciated. Symptoms of dehydration include weakness, dizziness, headache, confusion, and fainting. Signs of dehydration include dryness of the mouth, decreased saliva, lack of or very small urine volume that is dark and highly concentrated, sunken eyes, loss of skin elasticity, low blood pressure, especially upon sitting up or rising from the sitting to the standing position, and fast pulse rate, especially when moving from the lying to sitting or standing positions

 

 

Since I make it a practice not to offer specific medical advice in this blog, I would refer you to to Dr. Woodson’s excellent guide for further guidance on the administration (when, how much, etc)  of rehydration fluids.

 

While you are at it, take a look at the rest of the good doctor’s website for more home care information.

 

You may elect to add a flavoring to this mixture. Unsweetened Koolaid would add flavor and color, and make the drink more palatable to some. It might, however, prove to be an intestinal irritant to some people. I intend to leave mine unflavored, and will add koolaid to individual liters of solution if desired.

 

At 15 cents a gallon, the price is right. And for someone who is dehydrated, having this solution on hand can be lifesaving.

 

 

CAVEATS

You should never attempt to force fluids by mouth on anyone who is unconscious. An eye dropper may be used to slowly infuse liquids in semi conscious patients but there is a risk of choking.

 

Better to dilute this powder too much, than too little. DO NOT SKIMP ON THE WATER.

 

For more complete information on oral rehydration fluids visit the Healthlink Worldwide webpage at

 

http://rehydrate.org/dd/su19.htm

Puerto Rico: Dengue Surveillance Week 35

 

 

 

# 4937

 

For the third week in a row the number of new Dengue cases being reported in Puerto Rico is off its highs of early August, albeit still at levels that far exceed the epidemic threshold.

 

 

 

The number of confirmed fatalities has reached 23, exceeding the 19 known deaths from the last big Dengue epidemic on the island in 1998.

 

Another 10 deaths are being investigated.

 

The Dengue epidemic in Puerto Rico this year has often been compared to the 1998 outbreak, and now has exceeded those numbers.

 

1998 Epidemic – MMWR November 13, 1998 / 47(44);952-6 http://tinyurl.com/3ae6vdd

Note: The sudden drop in cases detected in 1998 was due to Hurricane Georges interrupting surveillance efforts.

 

 

Much of Central and South America, along with the islands of the Caribbean, are dealing with unusually high numbers of Dengue cases this year. 

 

Just this past Friday we learned that the Bahamas had issued a Dengue advisory (see Dengue Reports From The Bahamas).

 

PAHO, the Pan American Health Organization, recently issued these year-to-date numbers indicating more than 1 million total infections for the Americas.

 

 

You can find the latest weekly Dengue Surveillance Report HERE and will find more information in the recent MMWR report:

 

Notes from the Field: Dengue Epidemic --- Puerto Rico, January--July 2010

Weekly

July 23, 2010 / 59(28);878

 

 

For an extensive list of my blogs on Dengue and Mosquito Borne Diseases you can select the DENGUE Quick Search here,  on my sidebar.

 

In the meantime, if you live in mosquito territory, be mindful of the 5 D’s.

 

CDC Podcast: ACIP Vaccination Recommendations

 

 

# 4936

 

 

 

The CDC  provides a wide variety of health-related podcasts for the public – and in some cases, for clinicians – on their website.  Some are just audio files (MP3) while others are offered as videos as well.

 

Most are short, running less than 10 minutes. 

 

Recent topics include Recognizing Whooping Cough, Bloodstream Infections with Mycobacterium Tuberculosis among HIV patients, and Type 2 Diabetes Mellitus and Increased Risk for Malaria Infection.

 

An eclectic selection, but just a small sample of hundreds available. To view the latest offerings use THIS LINK.

 

With the flu season just ahead, one of the offerings this week is a 4-minute briefing for clinicians on this years’ ACIP flu vaccination recommendations.

 

While produced for Health Care Providers, these clinician’s podcasts are also available to the general public. 

 

 

Influenza 2010-2011: ACIP Vaccination Recommendations

In this podcast targeted to clinicians, Dr. Joe Bresee discusses who should be vaccinated against seasonal flu during the 2010-2011 season. He explains who is at risk for severe illness from the flu and discusses the benefits of vaccination. Created: 9/22/2010 by National Center for Immunization and Respiratory Diseases (NCIRD). Date Released: 9/23/2010. Series Name: CDC Featured Podcasts.

More info on this topic

 

Running time = 4:41

To save the Podcast, right click the "Save this file" link below and select the "Save Target As..." option.

Save This File (4MB) [right click]

Hong Kong Investigating Suspected Dengue Cases

 

 

# 4935

 

 

Although visitors or returning travelers to Hong Kong have sometimes been diagnosed with Dengue fever, locally acquired cases have been relatively rare over the past few years. 

 

Earlier this month, 3 Hong Kong residents returning from India were diagnosed with the virus.

 

 

3 return from India with Dengue fever

The Centre for Health Protection is investigating three related Dengue fever cases. The three male patients had all stayed in New Delhi before the onset of symptoms.

(Continue . . .)

 

On Wednesday, Xinhua Press reported on the first known locally acquired case of Dengue there since an outbreak in 2002.

 

Hong Kong Reports First Local Case of Dengue Fever in 7 years

September 23, 2010, 12:12am

 

In the 72 hours since that report, several more suspect cases have emerged, and enhanced surveillance and testing has been ordered by the health department.

 

 

3 suspected Dengue fever cases probed

The Centre for Health Protection is investigating three suspected local Dengue fever cases involving the three family members of the 46-year-old man who was earlier confirmed to have the disease.

 

They are the man's 47-year-old wife and his sons, aged 18 and eight. Their blood samples have tested positive for the virus. Confirmatory tests are being conducted. Their domestic helper tested negative for the virus.

 

The centre is arranging further confirmatory tests for a two-year-old girl who is also a suspected local case. Blood tests for her father and two sisters, aged nine months and two years, are also being arranged.

 

Centre staff have visited ESF International Kindergarten (Hillside) and Bradbury School, where the girl and the eight-year-old boy study. So far, none of their classmates reported symptomatic. Blood tests will be arranged with parents' consent.

 

The centre continued its investigation in the area near the patients' home at Island Road, Deep Water Bay and Stubbs Road where the two schools are located. Nobody reported active symptoms. So far, blood samples from 66 people have been taken for analysis. Results are pending.

 

 

Dengue is exceedingly difficult to eradicate, particularly in areas that see a lot of visitors who can continually re-introduce the disease back into the mosquito population.

 

A problem that Northern Australia and Key West, Florida are dealing with this year, as well.