FluView Week 51

 

# 4207

 

 

The CDC has posted FluView for week 51, ending December 26th , 2009. Unlike the past few weeks where we’ve seen declines in most indicators across the board, this week is a mixed bag. 

 

During the last reporting week certain indicators went up, while others went down or remained the same.

 

Visits to doctors for ILI increased slightly over last week, while hospitalizations remained the same.

 

P&I (pneumonia & Influenza) deaths increased over the last week and has moved above the epidemic threshold this week, after dropping below last week.

 

There were four pediatric flu-related fatalities added to this year’s count during the past week.

 

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

 

2009-2010 Influenza Season Week 51 ending December 26, 2009

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

Synopsis:

During week 51 (December 20-26, 2009), influenza activity decreased slightly in the U.S.

• 154 (3.9%) 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.
• 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 above the epidemic threshold.
• Four influenza-associated pediatric deaths were reported. Two of these deaths were associated with 2009 influenza A (H1N1) virus infection and two were associated with an influenza A virus for which the subtype was undetermined.
• The proportion of outpatient visits for influenza-like illness (ILI) was 3.2% which is above the national baseline of 2.3%. Two of the 10 regions (1 and 10) reported ILI below region-specific baseline levels.
• Four states reported geographically widespread influenza activity, 13 states reported regional influenza activity, the District of Columbia, Puerto Rico, and 19 states reported local influenza activity, Guam and 13 states reported sporadic influenza activity, and one state reported no influenza activity, 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 51, 7.7% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 7.4% for week 51.

Influenza-Associated Pediatric Mortality

Four influenza-associated pediatric deaths were reported to CDC during week 51 (Florida [2], Massachusetts, and Texas). Two of these deaths were associated with 2009 influenza A (H1N1) virus infection and two were associated with an influenza A virus for which the subtype is undetermined. The deaths reported during week 51 occurred between August 30 and December 19, 2009.

Outpatient Illness Surveillance:

Nationwide during week 51, 3.2% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is above the national baseline of 2.3%.

On A Cold January Morning 364 days ago . . .

 

 

# 4206

 

 

. . . in a blog entitled Looking Forward On This First Morning Of The Last Year Of The First Decade Of the 21st Century, I wrote . . .

 

 

Looking forward, 2009 may or may not be the year that we see a pandemic.   No one really knows.   All we know is that the conditions appear to remain conducive to seeing one sometime `soon'.

 

`Soon' could mean this year, five years from now, or perhaps even further off.   But history tells us that pandemics happen, with frightening regularity.  Roughly every 30 to 40 years.

 

And they generally strike with little warning.

 

We have a choice, of course.

 

We can prepare for something we know is coming, and in doing so also be better prepared to handle less catastrophic events like hurricanes, floods, and earthquakes . . .  or we can pretend that it will never happen to our family, or our business, and go on our merry way with blinders on, hoping that this year isn't the year our luck runs out.

 

Disasters are going to happen.  We can't predict, or control, where earthquakes are going to occur, or hurricanes are going to make landfall, or epidemics are going to erupt.

 

All we can do is be ready for them.

 

We aren't helpless in a pandemic.  But in order to weather one, we need to prepare for it before it happens.

 

Like I say, we have a choice.

 

We just have to be willing to make it.

 

 

As luck would have it, we did see the first pandemic in 40 years strike . . .with little warning. 

 

It came from out of left field, sparked by of all things, an H1N1 virus circulating among swine in our own backyard.  Not from the dreaded bird flu, which continues to threaten in Asia and the Middle East.

 

There can be little doubt, we got very lucky this time.

 

Our level of preparation has improved over the past five years, but the experience of 2009 has shown that we are nowhere near ready for a 1918-style pandemic. 

 

Everything from vaccine production, emergency room and ICU capacities, our public health infrastructure, to personal and community preparedness must be improved.

 

Had we been struck by a high CFR (Case Fatality Ratio) virus like H5N1, our response would have been woefully inadequate. Millions could have died, and the social and economic costs would have been staggering.

 

There is absolutely nothing that says we couldn’t see another pandemic virus arise, or a serious mutation to the novel H1N1 virus, in the next few years.  

 

Nothing at all.

 

As we slide into 2010, we should indeed be thankful that the novel H1N1 pandemic has not been any worse than it has been. But we’d be absolute fools to ignore the very real possibility that something far worse lies somewhere in our future.

 

I can’t tell you what global health crisis will next come down the pike. But I can assure you that nature’s laboratory is open 24/7, and it is quite capable of serving up something quite nasty with very little warning.

 

It’s worth repeating.

 

We aren't helpless in a pandemic.  But in order to weather one, we need to prepare for it before it happens.

 

Like I say, we have a choice.

 

We just have to be willing to make it.

UK: HPA Weekly Pandemic Flu Update

 

 

# 4205

 

 

The HPA (Health Protection Agency) of the UK releases surveillance data not unlike that we get from the CDC’s FluView and Canada’s FluWatch reports.

 

Like the US, Canada, and much of western Europe, the numbers in the UK (consultations, illnesses, hospitalizations) are all decreasing.

 

 

 

Weekly pandemic flu media update

31 December 2009

KEY POINTS

• Most indicators show that flu activity is continuing to decrease across the UK. Some caution must be exercised, however, as the indicators may be influenced by the holiday period.
• The consultation rate for flu-like illness in England from the Royal College of General Practitioners (RCGP) scheme has decreased to 12.7 per 100,000 in week 52 compared to 24.7 in week 51. This is below the English baseline threshold of 30/100,000.
• The estimated cases self referring to the National Pandemic Flu Service have shown decreases in all areas of assessments, authorisations and collections. This is across all regions and all age groups. 

 

VIRAL CHARACTERISTICS

To date (as of 30 December 2009) 4,563 viruses have been analysed by the HPA Centre for Infections for the genetic marker commonly associated with resistance to oseltamivir in seasonal H1N1 flu (H274Y). 31 viruses have been found to carry this marker in the UK with three of these, through additional testing, showing evidence of resistance when viral growth is tested in the presence of oseltamivir. These viruses are still sensitive to zanamivir. In addition, 293 specimens have been fully tested for susceptibility to antivirals.

 

Information on medical history was available for 17 cases, all of whom had an underlying medical condition: 14 were immunosuppressed and three had chronic respiratory or neurological illnesses.

 

Testing of samples, taken before and after treatment with oseltamivir, show that the antiviral resistance in 14 of the cases was treatment-induced, four are probably acquired through person to person transmission, and in four cases the origin of the resistant virus is still under investigation.

 

The agency is continually assessing its advice to government on health protection policies such as antiviral use. Currently there is no requirement to change existing guidance.

 

There have been no significant changes in the virus.

Study: Streptococcus Pneumoniae In Fatal H1N1 Cases In Argentina

 

# 4204

 

 

Readers with long memories may remember that last July I reported in this blog that researchers from Columbia University’s Mailman School of Public Health were to travel to Argentina to investigate the perceived high CFR (Case Fatality Ratio) among H1N1 cases there.

 

Jason Gale and Eliana Raszewski, writing for Bloomberg news, described the project in a story entitled: Argentina Flu Death Mystery Sparks Probe for Virus Mutation.

 

Scientists from Columbia University and Argentina’s National Institute of Infectious Diseases now plan to decode the complete genomic sequences of at least 150 virus samples over the next 10 days to gauge the frequency of the changes and whether they are linked to more severe illness. Major changes in the pandemic virus could erode the effectiveness of vaccines being prepared to fight the scourge.

 

You’ll find further details on these deaths, and the planned investigation, in the following blogs.

 

Argentina Working To Release Viral Sequences

Follow Up On Yesterday’s Report On Argentina Sequences

 

Since that report in July, we’ve heard very little other than the fact that no unusual viral mutations had been discovered in Argentina that could account for the higher CFR.   

 

That is, until November of last month, when two of the authors of the following PLoS One  study appeared on Vincent Racaniello’s excellent podcast, TWiV  (This week In Virology) to discuss their upcoming paper.

 

TWiV 59: Dog bites virus

by Vincent Racaniello on 22 November 2009

Hosts: Vincent Racaniello, Alan Dove, Rich Condit, Gustavo Palacios, and Mady Hornig

A TWiV panel of five considers the finding of Streptococcus pneumoniae in fatal H1N1 cases in Argentina, hysteria in the Ukraine over pandemic influenza, and human vaccinia infection after contact with a raccoon rabies vaccine bait.

 

TWiV is both entertaining and informative, and I highly recommend it to anyone with curiosity about the field of virology.   While sometimes it can’t avoid being a bit technical, the panel does a great job making the information accessible and understandable to the general public.

 

In this episode, Gustavo Palacios, and Mady Hornig reveal that it was the presence of S. pneumoniae in those infected with H1N1 that often led to the heightened severity of their illness.

 

Excerpts from the PLoS One  study are posted below. 

 

In it, the authors suggest that testing for the presence of S. pneumoniae may accurately predict who will develop severe disease.  They write:

 

In our study of Argentinean victims of H1N1pdm, the presence of S. pneumoniae in NPS predicts severe disease outcome. The risk associated with S. pneumoniae is particularly prominent in 6-to-55 year-old individuals.

 

Indeed, severity of disease in this low risk group can be predicted with 90.97% accuracy via a multivariable logistic regression model that considers the presence of S. pneumoniae together with viruses other than influenza and a risk-associated medical condition.

 

But before we go there, a reminder:

 

I have suggested on numerous occasions that people should consult with their health care provider about the advisability of taking the Pneumococcal polysaccharide vaccine (PPSV) – even if you aren’t sure you fall into a recommended category.

Along the way, a few of my blogs on the subject include:

 

CDC Promoting Better Uptake Of PPSV in Adults

An Appropriate Level Of Concern (Revisited)

Referral: Effect Measure On Pneumococcal Vaccines

CDC Issues Pneumococcal Vaccine Recommendations

 

The PPSV is designed to help protect against many (but not all) strains of S. pneumoniae.  

Something to bear in mind as you read this report.

 

 

 

Streptococcus pneumoniae Coinfection Is Correlated with the Severity of H1N1 Pandemic Influenza

Initial reports in May 2009 of the novel influenza strain H1N1pdm estimated a case fatality rate (CFR) of 0.6%, similar to that of seasonal influenza. In July 2009, however, Argentina reported 3056 cases with 137 deaths, representing a CFR of 4.5%. Potential explanations for increased CFR included virus reassortment or genetic drift, or infection of a more vulnerable population.

 

Virus genomic sequencing of 26 Argentinian samples representing both severe and mild disease indicated no evidence of reassortment, mutations associated with resistance to antiviral drugs, or genetic drift that might contribute to virulence. Furthermore, no evidence was found for increased frequency of risk factors for H1N1pdm disease.

 

We examined nasopharyngeal swab samples (NPS) from 199 cases of H1N1pdm infection from Argentina with MassTag PCR, testing for 33 additional microbial agents. The study population consisted of 199 H1N1pdm-infected subjects sampled between 23 June and 4 July 2009. Thirty-nine had severe disease defined as death (n = 20) or hospitalization (n = 19); 160 had mild disease.

 

At least one additional agent of potential pathogenic importance was identified in 152 samples (76%), including Streptococcus pneumoniae (n = 62); Haemophilus influenzae (n = 104); human respiratory syncytial virus A (n = 11) and B (n = 1); human rhinovirus A (n = 1) and B (n = 4); human coronaviruses 229E (n = 1) and OC43 (n = 2); Klebsiella pneumoniae (n = 2); Acinetobacter baumannii (n = 2); Serratia marcescens (n = 1); and Staphylococcus aureus (n = 35) and methicillin-resistant S. aureus (MRSA, n = 6).

 

The presence of S. pneumoniae was strongly correlated with severe disease. S. pneumoniae was present in 56.4% of severe cases versus 25% of mild cases; more than one-third of H1N1pdm NPS with S. pneumoniae were from subjects with severe disease (22 of 62 S. pneumoniae-positive NPS, p = 0.0004). In subjects 6 to 55 years of age, the adjusted odds ratio (OR) of severe disease in the presence of S. pneumoniae was 125.5 (95% confidence interval [CI], 16.95, 928.72; p<0.0001).

 

The association of S. pneumoniae with morbidity and mortality is established in the current and previous influenza pandemics. However, this study is the first to demonstrate the prognostic significance of non-invasive antemortem diagnosis of S. pneumoniae infection and may provide insights into clinical management.

Gustavo Palacios1#*, Mady Hornig1#, Daniel Cisterna2, Nazir Savji1, Ana Valeria Bussetti1, Vishal Kapoor1, Jeffrey Hui1, Rafal Tokarz1, Thomas Briese1, Elsa Baumeister2, W. Ian Lipkin1*

(Continue. . . )

NEJM: Household Transmission Of The H1N1 Virus

 

 

# 4203

 

A study today from the NEJM which suggests the novel H1N1 virus isn’t as easily transmissible as other novel pandemic viruses of the past. 

 

In a study of 216 households where an index case of H1N1 infection was identified, only about 13% of household contacts (about 1 in 8) came down with the infection.

 

Looked at another way, in roughly 72% of the households where a case was identified, no one else came down with the virus.   In 21% of the households, only one additional member acquired the infection.  And in only 6% of households did more than one other family member fall ill.

 

Children and teens under the age of 18 were twice as likely to catch the virus than those aged 19 to 50.  Those over the age of 50 were even less likely to fall ill.

 

For reasons that are less than clear, the rate of viral transmission in households with just two members was much higher than in households with four or more members.  

 

Excerpts from the abstract are below, but follow the link to read the entire study.

 

 

Household Transmission of 2009 Pandemic Influenza A (H1N1) Virus in the United States

Simon Cauchemez, Ph.D., Christl A. Donnelly, Sc.D., Carrie Reed, D.Sc., Azra C. Ghani, Ph.D., Christophe Fraser, Ph.D., Charlotte K. Kent, Ph.D., Lyn Finelli, Dr.P.H., and Neil M. Ferguson, D.Phil.

ABSTRACT

 
Background As of June 11, 2009, a total of 17,855 probable or confirmed cases of 2009 pandemic influenza A (H1N1) had been reported in the United States. Risk factors for transmission remain largely uncharacterized. We characterize the risk factors and describe the transmission of the virus within households.

 
Methods Probable and confirmed cases of infection with the 2009 H1N1 virus in the United States were reported to the Centers for Disease Control and Prevention with the use of a standardized case form. We investigated transmission of infection in 216 households — including 216 index patients and their 600 household contacts — in which the index patient was the first case patient and complete information on symptoms and age was available for all household members.

 

Results An acute respiratory illness developed in 78 of 600 household contacts (13%). In 156 households (72% of the 216 households), an acute respiratory illness developed in none of the household contacts; in 46 households (21%), illness developed in one contact; and in 14 households (6%), illness developed in more than one contact.

The proportion of household contacts in whom acute respiratory illness developed decreased with the size of the household, from 28% in two-member households to 9% in six-member households. Household contacts 18 years of age or younger were twice as susceptible as those 19 to 50 years of age (relative susceptibility, 1.96; Bayesian 95% credible interval, 1.05 to 3.78; P=0.005), and household contacts older than 50 years of age were less susceptible than those who were 19 to 50 years of age (relative susceptibility, 0.17; 95% credible interval, 0.02 to 0.92; P=0.03).

Infectivity did not vary with age. The mean time between the onset of symptoms in a case patient and the onset of symptoms in the household contacts infected by that patient was 2.6 days (95% credible interval, 2.2 to 3.5).

 

Conclusions The transmissibility of the 2009 H1N1 influenza virus in households is lower than that seen in past pandemics. Most transmissions occur soon before or after the onset of symptoms in a case patient.

 

 

A few caveats to this study are in order.

 

First, this study took place very early in the outbreak, essentially during the first 3 weeks of May.  

 

While it may not have appreciably changed, this is a snapshot of the transmissibility of the virus at that time.

 

Second, the data was collected by interviewing (telephone or face-to-face) family members within 7 days of an index case having been identified in their household. 

 

Illnesses that fell outside of that 7 day follow up period were not directly identified.

 

Third, reports of ILI (influenza-like illness) among family members or contacts within 7 days were assumed to have been due to exposure to the index case.

 

Testing for H1N1 wasn’t always done, and the actual chain of infection may have been other than from the index case.

 

None of which is mentioned to negate the findings of this study, but simply stated to illustrate that these sorts of studies have limitations, and those must be considered when you view the data.

 

This study does seem to suggest that compared to teenagers and children, those over the age of 18 may have some limited immunity to the virus. And that immunity appears to increase with age, becoming more prevalent in those over the age of 50.

 

The authors put it this way :

 

. . .  our findings are consistent with serologic analyses of the 2009 H1N1 virus suggesting that there are some preexisting pandemic H1N1 immune responses in the elderly; these are present to a lesser extent in younger adults but are rarely present in children.

 

Just as I was about to post this entry, I noticed that Maryn McKenna, writing for CIDRAP, has posted her summary of the report.   You’ll find it at the link below.

 

Study: H1N1 not highly contagious in households

Indonesia: 19 H5N1 Deaths In 2009

 

 

# 4202

 

 

Via Ida at BFIC (Bird Flu Information Corner)  –a  joint venture between Kobe University in Japan and the Institute of Tropical Disease, Airlangga University, Indonesia – we get this translation of the first confirmation of human H5N1 infections and deaths out of Indonesia for 2009.

 

Indonesia has adopted a policy of only rarely providing updates (the last was in January) of the total number of Human infections from bird flu.   

 

According to this report, 19 of 20 known cases died.

 

 

Indonesia ::: H5N1 situation update 2009

December 30, 2009

Since 1 January to 28 December 2009, a total 20 H5N1 cases reported in Indonesia. Of those confirmed cases, 19 have been fatal. First H5N1 case was reported from Bogor on 9 January, and latest was reported from South Jakarta on 23 September 2009.

 

Total cumulative number of H5N1 in Indonesia since 2005 to 2009 is 161 with 134 deaths.

 

This information is broadcasted by Public Communication Center, General Secretary Ministry of Health. Further information is available at: phone 021-52907416-9, fax 52921669, call center 021-30413700, or e-mail puskom.publik@yahoo.co.id, info@puskom.depkes.go.id, kontak@puskom.depkes.go.id.

 

Source: Ministry of Health Republic of Indonesia.

http://www.depkes.go.id/index.php?option=news&task=viewarticle&sid=3663

South Jakarta and Bogor, Java, Indonesia

===AvianInfluenzaIndonesia===

 

 

 

The World Health Organization continues to show no cases out of Indonesia for 2009, with its last update on December 21st.  Of course, they can report only what Indonesia reports to them.

 

 

How close this newly admitted number is to reality is unknown. 

 

Despite the news blackout, we’ve seen dozens of unconfirmed reports over the past year of `suspected’ human H5N1 infections in the Indonesian press.

 

A 95% CFR – even in Indonesia – is an astoundingly high number. 

 

One has to assume there are probably other, unreported cases out there, that hopefully would bring down that CFR. 

Report: North Korea Struggling With Pandemic Virus

 

# 4201

 

 

Although the North Korean government has had very little to say about it, reports continue to filter out of that closed, impoverished country that suggest the pandemic virus is having a serious impact.

 

Earlier this month, in a humanitarian gesture, South Korea offered emergency supplies (including Tamiflu) to the north, to help them fight the pandemic (South Korea Offers Pandemic Humanitarian Aid To The North).

 

Today, the Wall Street Journal has a report – gleaned from information provided by the Good Friends aid group working in North Korea – that suggests the situation in that country may be more serious than previously thought.

 

 

 

     DECEMBER 30, 2009, 6:50 A.M. ET

North Korea Fights H1N1

By JAEYEON WOO

North Korea sent out a nationwide alert in recent days about the apparent worsening spread of H1N1 flu there, according to an aid group with contacts in the country.

 

The notice by the Seoul-based Buddhist aid group Good Friends follows the South Korean government's shipment of 400,000 doses of the flu treatment Tamiflu and 100,000 doses of the treatment Relenza to its impoverished neighbor earlier this month amid fears that a delayed response to the disease in the North could lead to serious consequences for the South.

 

Good Friends said this week that North Korean officials had issued a statement that said patients suffering from the disease should be given priority. The group said the statement was of a type issued only twice before, for seriously wounded soldiers during the 1950-1953 Korean War and for a deadly skirmish with South Korea in 2002.

 

The true picture within highly restrictive North Korea is difficult to determine. Officials there couldn't be reached.

(Continue . . . )

Hong Kong: More Pigs Test Positive For H1N1

 

 

 

# 4200

 

 

Were it not for concerns over the potential for the pandemic H1N1 virus to acquire additional genetic changes via reassortment, the discovery of the virus in swine would be a non-story by now.

 

After all, as a swine-origin influenza virus, novel H1N1 is understandably pretty comfortable in a swine host.

 

Just yesterday we saw a report of a 16th pig farm in South Korea reporting the infection.  In recent months farms in Europe, North and South America, and Asia have all reported livestock infections.  

 

Pigs are susceptible to a variety of human, avian, and swine influenza viruses.  They can even be infected by two different flu viruses at the same time.  

 

As such, they are considered to be good `mixing vessels’ for viruses, and could help produce a hybrid `reassorted’ virus.  One that could potentially have pandemic potential.

 

 

Of course, that’s a pretty rare occurrence.  

 

You not only need two compatible flu viruses to inhabit the same cell at the same time, it needs to produce a `fit’ hybrid.  One that replicates well, is adapted to human receptor cells, and is easily transmitted.

 

It appears that our 2009 pandemic virus bounced around in pigs for many years, picking up multiple mutations (via reassortment), before it found the right combination to jump to humans.

 

It could take years, perhaps decades, before we see that sort of thing happen again.  

 

Or it could happen tomorrow.

 

The infected swine detected in this report from Hong Kong came from the Chinese mainland where little or no testing occurs, and bio security on farms often leaves much to be desired.

 

Other influenza viruses, including the H5 and H9 avian viruses, are also known to circulate among domesticated livestock in that region, and that has some scientists concerned.

 

The good news here is that testing so far has shown no gene reassortment to have occurred, and the virus detected remains genetically similar to the H1N1 pandemic virus.

 

This from News.gov.hk.

 

 

 

 

 

Pigs test positive for human swine flu

December 30, 2009

The University of Hong Kong's influenza virus surveillance programme found five samples taken from pigs at the Sheung Shui Slaughterhouse on December 17 tested positive for the human swine influenza virus, the Food & Environmental Hygiene Department said today.

 

This is the third time the programme uncovered positive samples. No gene reassortment has occurred and the virus remained genetically similar to the human swine flu viruses regularly found in people. The flu virus is believed to have been transmitted from people to pigs.

 

The concerned samples were taken from pigs imported from the Mainland. The department informed the Mainland authorities, and they have strengthened monitoring of registered farms that supply live pigs to Hong Kong.

 

The World Health Organisation, World Organisation for Animal Health, Food & Agriculture Organisation of the United Nations and World Trade Organisation state that pork and pork products which are handled properly and thoroughly cooked are not a source of human swine flu infection.

(Continue . . .)

 

Why They Call It A Medium

 

 

# 4199

 

 

A recurring theme of this blog has been the lack of responsibility shown by a great many Internet (and sometime mainstream) media outlets when it comes to `reporting’ on influenza, emerging infectious diseases, pandemics, or just science in general.

 

Controversy sells.  And on the Internet, there is little accountability.  

 

You can say just about anything, and get away with it. 

 

What you often end up with are thousands of P.T. Barnum wannabes, selling junk science, conspiracy theories, and thinly veiled agenda’s to a gullible and receptive public.

 

In September, the big story promoted by many of these fringe sites was the `untested and dangerous vaccine’  that we would soon all be forced to take.   Of course, we’ve not seen the predicted carnage from the vaccine, and last time I checked, no one has been strapped down and forcibly injected with deadly nano-particles.

 

No matter, there’s always next time.

 

There are websites devoted to the idea that the WHO, the UN, the Bilderbergers, Big Pharma, and others are behind the `release’ of H1N1, and that bird flu is next on their list.  

 

Pandemic paranoia has practically become a cottage industry on the Internet.

 

In late October and early November, hundreds of websites carried lurid reports of `pneumonic plague’ in Ukraine. Facebook, Youtube, and Twitter were alive with stories, videos, and tweets of patients dying from `burnt lungs’, and the of aerial spraying of biological agents  (see Ukraine And The Internet Rumor Mill).

 

The only problem is . . .  these (and other) stories were about 10% fact liberally mixed with about 90% fiction.

 

Once these stories had run their course, they were replaced by the dreaded Norway Mutation story, which was played to full effect by many of these same sites.  

Was there a story in Ukraine?  

 

Sure. 

 

But the truth wasn’t nearly as prurient or exciting to the general public as the fictionalize version being peddled by certain factions of the `new media’. And so the tabloid version of events blotted out most of the serious coverage.  

 

The Norway Mutation story is of considerable scientific interest, and may yet turn out to be important in this pandemic.  But right now the science doesn’t support the wilder assertions of a `killer mutation’ on the loose around the world.

 

You wouldn’t know that by much of the coverage online.

 

 

Of course, it would be unfair to paint the entire Internet with the same brush.

 

While badly outnumbered by purveyors of pseudoscientific poppycock, there are a great many serious, science-rooted, and sane web sites devoted to accurate reporting and reasonable commentary.

 

 

You’ll find a large number of reliable flu sources listed in my essay, Reliable Sources In Flublogia.

 

 

Today,  Helen Branswell of the Canadian Press has an interview with Director General Margaret Chan of the WHO about the communications challenges they have faced when dealing with the media, new and otherwise.

 

 

H1N1 pandemic poses big communications challenge for global health agency: Chan

 

By: Helen Branswell, Medical Reporter, THE CANADIAN PRESS

OTTAWA - For the director general of the World Health Organization, the best news of the decade is the fact that the first influenza pandemic of the 21st century is a moderate - some would even call it mild - one.

 

Still, that lucky break, disease-wise, has created a communications challenge for those in public health in general and the WHO in particular, Dr. Margaret Chan acknowledged Monday in an interview with The Canadian Press.

 

For years, the WHO and health officials around the world had worried about and planned for the possibility the dangerous H5N1 avian flu virus might trigger the next pandemic. (Many still worry humankind may have a future date with the so-called bird flu.)

 

Instead, two swine flu viruses swapped genes, giving rise to a new variant that started spreading among people. It was new enough to cause disease and occasionally death. But it was sufficiently similar to viruses that have spread among people in the past that its impact hasn't been the crisis many feared.

 

(Continue . . .)

 

 

As a `serious’ blogger I accepted long ago that I’ll never be able to compete with the numbers garnered by websites that promote `wild and wacky’ conspiracy theories.   The audience for that sort of claptrap is simply greater than the audience for sensible reporting and commentary.

 

I know how a museum operator must feel in a town filled with strip joints.

 

Fred Allen, acerbic star of radio during the 1930’s and 1940’s, never really embraced the upstart medium of television (he did appear on it with some frequency, however).

 

He famously quipped that `Television is a new medium. It's called a medium because nothing is well-done.’

 

 

The same could be said, with a few notable exceptions, for much of the Internet today.

Farm Flu In Korea

 

 

# 4198

 

Two unrelated stories, except that they involve farm animals in South Korea infected with two very different influenza viruses; one human adapted, and one low-path avian.

 

While neither story is particularly alarming, they do illustrate how difficult it is to keep human and avian flu strains out of domesticated livestock.   

 

South Korea tests livestock more rigorously than many other nations, and understandably reports these sorts of infections more often than many other countries.   It is pretty safe to assume that similar infections are going unreported in many places around the world.

 

 

Number of H1N1 Infections Growing on Pig Farms

SEOUL, SOUTH KOREA - South Korea reported today another case of H1N1 infection at a local swine farm, adding to a growing list of pigs infected with the flu, local media reported.

 

The latest outbreak occurred in a pig farm in Jeungup, Jeolla Province, marking the sixteenth confirmed case of H1N1 infection since mid-December when five farms reported infection for the first time in the country, according to local media.

 

Authorities are suspecting pigs in the latest case might have contracted the virus through human contacts and expecting them to be naturally cured, according to media reports.

 

The country's farm ministry plans to take quarantine measures and vaccinate hog industry and health workers in an effort to stem further spread, local media said.

 

 

Low path H5 and H7 viruses are reportable animal diseases, even though they pose little health hazards to humans.   Low pathogenic viruses have the potential to mutate into highly pathogenic viruses, therefore their appearance is taken seriously.

 

 

S. Korea: Low pathogenic H5N2 in ducks

29 Dec 2009

On a duck farm in South Korea low pathogenic bird flu type H5N2 has been diagnosed.

 

The duck farm in Chung Chong-Namdo (Gobuk-myeon, Seo-san city) holds 26,800 duck of which 40 birds were found to be positive for H5N2. The source of the infection could not be established.

 

As part of the yearly surveillance programme, a member of the Livestock Health Control Association collected samples from a duck raising farm in Seo-san city and requested the test for avian influenza to the Chungchong-namdo Veterinary Research Institute (VRI) on 7 December 2009.

 

<SNIP>

26,800 ducks raised in the affected farm were culled and 176,000 eggs kept in the farm were destroyed.

Chan: Too Soon To Declare Pandemic Is Over

 

 

# 4197

 

 

Given that none of the pandemics of the 20th century were over in less than a year, it is hardly surprising that the Director-General of the WHO (World Health Organization) - Margaret Chan - is unwilling to declare victory now that the virus appears to be receding in North America and and parts of Europe.

 

It isn’t lost on scientists that in 1957, the Asian Flu pandemic seemed to disappear completely for more than a year, only to return in 1959 and again after a two year lull during the 1962-63 flu season.  

 

 

NEJM 2009

 

Today, Director General Chan stated that it will take another 6 months to a year to know if this pandemic is truly on the wane, and she reminds us that we are not ready for a more severe H5N1 pandemic.

 

This report from AFP.

 

 

 

WHO chief says too early to declare flu victory

December 29, 2009 - 8:59PM

World Health Organisation chief Margaret Chan said Tuesday it was too early to declare victory over swine flu and insisted that measures taken to deal with the pandemic were justified.

 

"I think that we must remain prudent and observe the evolution of the pandemic over the next six to 12 months before declaring victory," she told Swiss newspaper Le Temps in an interview.

 

Even though the peak of the flu has passed in some countries of the northern hemisphere, such as Canada and the United States, others countries were far from seeing the end, she noted.

 

"Winter is still long," said the WHO director-general, adding that a precise picture of the flu's impact would not be seen before two years.

 

 

(Continue . . . )

ECDC Monday Update

 

 

 

# 4196

 

 

The ECDC (European Centre For Disease Prevention & Control) like many agencies, took some time off last week and did not issue any daily reports on Thursday and Friday.  So today’s update covers the events of the past 5 days.

 

 

Main developments in the past 5 days

Weekly Influenza Surveillance Overview published December 24th and covering Week 51 (Dec 14th  to 20th) found that most reporting countries were observing declining trends with the most reported influenza activity being in South Eastern Europe

 

A total of 1 803 fatal cases in Europe and EFTA countries and 10 879 in the rest of the world have been reported up to date. 

 

ECDC published a summary on the D222G/D222N mutations in the pandemic virus

 

 

Perhaps of most interest is the latest report on the D222G/D222N mutations in the pandemic virus.

 

While the ECDC believes that further study of these mutations and surveillance is warranted, they believe that as of right now, they should have a minimal impact on public health and pandemic response.

 

They find no direct evidence that these mutations are responsible for an increase in virulence (although they leave that door open a bit), or that they are being transmitted easily.

Here is the ECDC summary, and a more complete report is available here.

 

(slightly reformatted for readability).

ECDC Summary on Pandemic 2009 Virus Mutation D222G/D222N published in its Public Health Developments Series 

December 23rd

Recently, several countries have reported finding mutations of the 2009 pandemic virus. One particular mutation has come to attention, especially following a formal notification by Norway through the International Health Regulations and  Early Warning and Response System  reporting mechanisms.(1)

 

The particular  change a substitutions in a specific codon of the Haemagglutinin (HA) gene and is called either D222G and D222N depending on the precise change. The variants have been especially found in a number of severe cases of pandemic influenza including deaths and it has been suggested that the variants could cause more efficient infection of deeper airways resulting in a more serious disease profile.

 

No direct evidence for this exists and cases have also been found in mild infections. The D222G and D222N variants, and sometimes mixtures thereof have been described in viruses and sequences derived directly from clinical specimens of 2009 pandemic influenza A(H1N1)  cases in at least 20 countries, including Brazil, China, France, Italy, Japan, Mexico, Norway, Spain, the Ukraine and the USA.

 

These mutations are not new in this pandemic, they have been found in cased going back to April 2009.

 

To date no connection between cases, suggestive of transmission, has been found and it seems that the appearance in various countries is more the result of routine sequencing rather than spread of the mutation.  It is also unclear if the association with severe cases is coincidental or not, perhaps resulting from preferred sequencing of specimens and viruses from severe cases/deaths.

 

After considering the current available virological, epidemiological and clinical findings and following discussions on an earlier draft with WHO and its European-based Collaborating Centre ECDC has come to a preliminary formulation namely that the G222D/N variants exist in a small proportion of  sporadic severe, as well as mild cases of 2009 pandemic  influenza A(H1N1) infection and that these represents natural variation of the virus with no special association with severity of the disease course.

 

As such and while they do not transmit they should have a minimal impact on public health and pandemic response. Current data suggests that the cases involving variant viruses in different parts of the world are unrelated and the underlying mutation events probably occurred independently from each other in the infected individuals as a consequence of the natural variability of influenza viruses and their inability to correct random coding errors.

 

However because of that inherent variability and  ability to surprise the 2009 A(H1N1) will need on-going combined virological, epidemiological and clinical surveillance and study.(2)

1.  WHO Pandemic (H1N1) 2009 briefing note 17.
http://www.who.int/csr/disease/swineflu/notes/briefing_20091120/en/index.html

2.  ECDC 2009 pandemic influenza A(H1N1) virus mutations reported to be associated with severe disease ECDC Public Health development December 23rd  2009

Scanning The Horizon

 

 

 

# 4195

 

 

Even though the pandemic of 2009 continues, and we don’t yet know how it will turn out, there are other infectious disease threats on the horizon. 

 

Some are flu-related, and others stem from other pathogens.   Some have pandemic potential, while others (right now) are only capable of localized outbreaks.

 

Either way, infectious diseases – once believed on the way to eradication – are on the comeback trail.

 

TB (Tuberculosis) was a scourge here in the US 60 years ago.  My Grandmother had it – and was in a sanitarium for months – back in the 1930s. 

 

When I was a young paramedic, we often saw TB patients.  In fact, I transported TB patients to the Lantana TB hospital mentioned in the article below, back in the 1970s.

 

Gradually, though, TB here in the US receded in the face of new antibiotics, and improved treatment regimens.   By the late 1970s, most of the TB hospitals had been shuttered, and many believed the disease would soon be eliminated – at least in the developed world.

Of course, that didn’t happen.  TB has learned to evade our first line antibiotics, and in some cases, is becoming to resistant to our higher tier treatments as well.

 

Yesterday the AP (Associated Press) ran a detailed story about the discovery, and treatment of the first known case of XXDR-TB (Extremely Drug Resistant TB) here in the US.  

 

The story, by Martha Mendoza and Margie Mason is well worth reading.

 

 

Danger at home: Rare form of TB comes to U.S.

First U.S. case of extremely drug-resistant strain of tuberculosis diagnosed

 

While still incredibly rare, many scientists fear this is the future of TB; increasingly drug resistant and difficult to treat.

 

An excerpt from the AP report.  But follow the link above to read it in its entirety.

 

Forty years ago, the world thought it had conquered TB and any number of other diseases through the new wonder drugs: antibiotics. U.S. Surgeon General William H. Stewart announced it was "time to close the book on infectious diseases and declare the war against pestilence won."

 

Today, all the leading killer infectious diseases on the planet — TB, malaria and HIV among them — are mutating at an alarming rate, hitchhiking their way in and out of countries. The reason: overuse and misuse of the very drugs that were supposed to save us.

 

Just as the drugs were a manmade solution to dangerous illness, the problem with them is also manmade. It is fueled worldwide by everything from counterfeit drugmakers to the unintended consequences of giving drugs to the poor without properly monitoring their treatment. Here's what the AP found:

• In Cambodia, scientists have confirmed the emergence of a new drug-resistant form of malaria, threatening the only treatment left to fight a disease that already kills 1 million people a year.
• In Africa, new and harder to treat strains of HIV are being detected in about 5 percent of new patients. HIV drug resistance rates have shot up to as high as 30 percent worldwide.
• In the U.S., drug-resistant infections killed more than 65,000 people last year — more than prostate and breast cancer combined. More than 19,000 people died from a staph infection alone that has been eliminated in Norway, where antibiotics are stringently limited.

"Drug resistance is starting to be a very big problem. In the past, people stopped worrying about TB and it came roaring back. We need to make sure that doesn't happen again," said Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, who was himself infected with tuberculosis while caring for drug-resistant patients at a New York clinic in the early '90s. "We are all connected by the air we breathe, and that is why this must be everyone's problem."

 

 

More than 2 1/2 years ago I wrote a blog entitled It Isn't Just Bird Flu, where I wrote about a number of possible pandemic and epidemic threats.   I opened with:

 

In this increasingly crowded world of ours, where there are large areas of poverty and poor medical care, there are literally scores of deadly pathogens that could spark the next epidemic, or pandemic.    Bird flu, or the H5N1 virus, is high on the list of diseases we watch, but it is by no means the only one out there.

 

When we prepare for a bird flu pandemic, we are also preparing for any other disease outbreak.

 

Recently I updated that blog with another called It Isn’t Just Swine Flu.   The message remains the same.  We live in a world teeming with pathogens, many of which are continually changing and evolving to become more efficient at infecting their hosts.

 

In  October of 2008  Lloyd's issued a pandemic impact report for the Insurance industry, which can be downloaded here.

 

The Lloyds report takes pains to point out that while we worry about an influenza pandemic the most, there are other candidates out there that could spark a pandemic (or at least an epidemic).

They list:

• Hendra Virus
• Nipah Virus
• Cholera
• Small Pox
• HIV/AIDS
• Bubonic Plague
• Tuberculosis
• Lassa fever
• Rift Valley fever
• Marburg virus
• Ebola virus
• Bolivian hemorrhagic fever
• MRSA
• SARS

I could add Dengue, Chikungunya, and of course Pathogen X, the one we don't know about yet, to this list.

 

While I can’t tell you which of these threats will end up being the big disease story of 2010, I can assure you there will be plenty of pathogen related news to write about and discuss in the upcoming year.

 

That’s the thing about blogging about emerging infectious diseases.

Despite the premature proclamation of U.S. Surgeon General William H. Stewart back in 1969.  

 

It’s a growth industry.

Weekly Roundup Of FluBlogia

 

 

# 4194

 

 

Continuing an experiment today.

 

Since the holidays are upon us and the number of news stories is relatively low, for the next few weeks I will attempt to do a weekly recap of some of the biggest stories, the best blog posts, and most interesting information from Flublogia each Sunday or Monday Morning.

 

This will be a subjective list of things that caught my eye, and is by no means intended to recap all of the news reports or mention every worthy blog post out there.  It is more of a sampling.

 

My apologies for the good stories I may miss.  In no particularly order . . .

 

 

On Vincent Racaniello’s  Virology Blog we get an assessment of the efficacy of Tamiflu in the wake of a BMJ article (see BMJ: A Review Of Tamiflu’s Efficacy Against Seasonal Influenza) questioning its usefulness. 

 

In Influenza neuraminidase inhibitors work, Professor Racaniello gives us the results of a human study published nearly a decade ago that support the usefulness of the drug against influenza.

Also from Vincent Racaniello, the 63rd installment of TWiV (This week in Virology) Podcast.  A fascinating stroll through the world of virology each week.  Highly recommended for disease geeks everywhere.

 

From the Reveres at Effect Measure a pair of flu-related blogs to note.   First, an excellent overview of the the experimental antiviral being tested in Japan called T-705 – which while still a long way from being on your pharmacy shelves – shows serious promise.

 

In  A new front line drug for flu in the offing?  Revere gives us a good deal of background information on drug which is about to begin human trials.

 

Also, in CDC's 2009 flu wrap up presser  Revere takes a look at the CDC’s last flu press conference, and looks ahead to what might happen this spring.

 

Maryn McKenna, on her Superbug Blog, makes an important appeal to her readers to help support ProMed Mail, something I heartily endorse as well.   In  A plea, and not for me: Support ProMED she reminds us of the important – donation supported – work done 24/7 by the editors of ProMail Med.

 

We are all eagerly awaiting the publication of Maryn’s new book Superbug: The Fatal Menace of MRSA (Hardcover) in March.  In the meantime, her excellent MRSA blog  Superbug is now available on Kindle.

 

CIDRAP News provides excellent coverage and analysis of H1N1 and other disease news, and Mayrn McKenna’s report H1N1 poses grave risk to pregnant women, new moms is a perfect example.   You’ll find additional terrific reporting from CIDRAP by Lisa Schnirring and Robert Roos.

 

Crof over at Crofsblog, not only keeps the best tabs on the daily news of the pandemic (along with other flu issues), but also writes terrific commentary from time to time as well.   His Blogging H1N1: Lessons so far is a prime example.

 

Crof may be the hardest working blogger in FluBlogia, and his translations of Spanish Language articles from Mexico and South America are our best window into what is going on in that part of the world.

 

Chen Qi continues to provide a terrific newspaper-style blog of Flu and Emerging Infectious disease news.  One of the most readable sources of information – gleaned from all over the world – on the next.

 

As a blogger, I am highly dependent upon journalists who cover the `flu beat’, and while there are many excellent reporters out there, two probably show up on these pages more than any others.

 

Helen Branswell of the Canadian Press and Maggie Fox of Reuters.

 

Why?   Because they understand the science, and I trust them to get the story right.

A few examples of the reports these two reporters have recently filed, all of which I used as fodder for this blog.

 

H1N1 flu virus voted top news story of 2009 in Canadian Press survey  - Branswell

Experts say pandemic could have a silver lining if it knocks out other viruses – Branswell

Other viruses abound in U.S. flu season, tests show - Fox

New Japanese flu drug protects mice from avian flu – Fox

 

My thanks to both of you, and to many of your colleagues, for the hard work you are doing getting the latest pandemic information out. 

 

Now is a good time to remind my readers that agencies like the Red Cross, Red Crescent, CARE, Save The Children, The H2P Project, UNICEF, and others are working around the world every day to combat poverty and disease, and are on the front lines every day.

 

They could use your support.

 

These NGO’s do a great deal with very little, and even small donations can help make a difference.   You can find their websites and blogs in my sidebar.

 

I am somewhat chagrined to admit that it has only been recently that I’ve become a regular visitor to  Mystery Rays From Outer Space, a fascinating blog by assistant professor of immunology and virology at Michigan State University, Ian York, Ph. D.

 

I am thoroughly enjoying going through the Mystery Rays archives, while wondering how I could have gone this long without discovering this resource.

 

As always, I am heavily reliant on the newshounds on the flu forums (I frequent Flu Wiki and FluTrackers) which continue to provide the best stream of raw news and information on emerging infectious diseases from around the world.  

 

As for my own blogging over this past short holiday week, in addition to covering influenza and disease news, a few of my more in-depth blogs included:

 

Another H9 Report From Hong Kong

Cytokine Storm Warnings

Enough To Make You ILI

US: Dog Tests Positive For H1N1

 

All of this represents just a sampling of this week in Flublogia.  As you can see, this is a collaborative effort. No one reporter, blogger, or flu forum could cover it all. 

 

Hopefully this recap will highlight some of the stories you may have missed over the past week.

 

There are a lot of terrific bloggers, flu forums, agencies, and organizations from around the world who contribute to Flublogia each and every week. 

 

You can find a lot of them in my sidebar.

 

It is worth the time to explore these resources, and go back through their archives, looking for dusty, but no-less-valuable gems of writing.

FluView Week 50

 

 

# 4193

 

 

The CDC has posted FluView for week 50, ending December 19th , 2009. The amount of ILI (Influenza-like-illness) activity we are seeing has decreased again for the eight straight week after four consecutive weeks of sharp gains, but is still slightly higher than normally seen this time of year.

 

P&I (pneumonia & Influenza) deaths decreased over the last week and has dropped below the epidemic threshold for the first time in eleven weeks.  

 

There were nine pediatric flu-related fatalities added to this year’s count during the past week.

 

While the numbers here in the US, and also in Canada, reflect a winding down of the fall pandemic wave,  what lies ahead is less clear.  There are more than 4 more months remaining in flu season, and there are a number of possible scenarios (see Waiting For The Other Flu To Drop).

 

We’ll just have to wait to see.  In the meantime, we’ll take any respite we can get.    It should be noted that of the samples submitted for analysis, just under 7% tested positive for influenza.

 

Which means there are apparently a lot of flu-like illnesses in circulation right now, and having had one doesn’t guarantee you’ve developed immunity to the H1N1 virus.

 

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

 

2009-2010 Influenza Season Week 50 ending December 19, 2009

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

Synopsis:

During week 50 (December 13-19, 2009), influenza activity continued to decrease in the U.S.

• 306 (6.9%) 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.
• All subtyped influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses.
• The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
• Nine influenza-associated pediatric deaths were reported. Eight of these deaths were associated with 2009 influenza A (H1N1) virus infection and one was associated with an influenza A virus for which the subtype was undetermined.
• The proportion of outpatient visits for influenza-like illness (ILI) was 2.3% which is at the national baseline of 2.3%. Seven of the 10 regions (1, 3, 5, 6, 7, 8 and 10) reported ILI below region-specific baseline levels.
• Seven states reported geographically widespread influenza activity, 18 states reported regional influenza activity, the District of Columbia, Puerto Rico, and 13 states reported local influenza activity, the U.S. Virgin Islands and 11 states reported sporadic influenza activity, Guam and one state reported no influenza activity.

 

Pneumonia and Influenza (P&I) Mortality Surveillance

During week 50, 7.2% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage was below the epidemic threshold of 7.3% for week 50.

 

 

 

 

Influenza-Associated Pediatric Mortality

Nine influenza-associated pediatric deaths were reported to CDC during week 50 (Iowa [3], New Jersey, New York [2], Ohio, South Carolina, and West Virginia). Eight of these deaths were associated with 2009 influenza A (H1N1) virus infection and one was associated with an influenza A virus for which the subtype is undetermined. The deaths reported during week 50 occurred between October 11 and December 12, 2009.

 

Branswell: H1N1 Voted Top Story of 2009

 

 

# 4192

 

Helen Branswell, medical writer for the Canadian Press, has been providing some of the best and most authoritative reporting on pandemic issues for years. So it is fitting that she brings us this story tonight that news editors in Canada have selected the H1N1 pandemic as the biggest news story of the year.

 

 

H1N1 flu virus voted top news story of 2009 in Canadian Press survey

By Helen Branswell (CP) – 3 hours ago

TORONTO — An influenza virus that scientists believe migrated from pigs to people before touching off a global pandemic was the runaway selection for the top Canadian news story of 2009.

 

The H1N1 virus was chosen by 70 per cent of the newspaper editors and broadcast news directors in the annual year-end survey of newsrooms conducted by The Canadian Press.

 

"There isn't a Canadian out there who isn't affected by or interested in the virus and how it may affect their families," said Sandy Heimlich-Hall, assistant news director at CFJC-TV in Kamloops, B.C.

 

"It was a coast-to-coast story that people followed with interest no matter where they lived in Canada," agreed Lesley Sheppard, managing editor of the Moose Jaw Times-Herald, in Moose Jaw, Sask.

 

H1N1, also known as swine flu, was the runaway pick as the issue that made the most headlines over the last year. The inquiry into the tragic death of Robert Dziekanski, who died after being Tasered by RCMP officers at Vancouver International Airport, came a distant second with just nine per cent of the vote.

 

For better or worse, the first flu pandemic of the 21st century was the story on the minds of the nation's editors. A number, though, felt it received more play than it deserved.

 

(Continue . . . )

A Holiday Hiatus

 

 

Due to Holiday travel plans, this blog probably won’t be updated again until sometime on Sunday, December 27th.   

 

To all of my readers around the world, I wish you a joyous, safe and happy holiday celebration.

 

And to all of the scientists, researchers, doctors, journalists, bloggers, flu forum newshounds, and other contributors to Flublogia who make this blog a pleasure to produce . . .  my deepest thanks and sincerest holiday wishes.

 

You’ll find I name names in Thanksgiving Roll Call 2009 and Reliable Sources In Flublogia. 

 

It is an honor for me to be a small part of all of this.

NEJM: Pediatric H1N1 Hospitalizations & Deaths In Argentina

 

 

# 4191

 

 

The next time someone tries to tell you how mild, how insignificant, and how overhyped by health officials the pandemic of 2009 has been – refer them to this study which appears in the NEJM (New England Journal of Medicine) which analyses the rate of hospitalization and death among pediatric H1N1 patients in Argentina over their recent flu season.

 

While novel H1N1 has not proven to be a huge killer of elderly adults, its impact on younger age groups has been substantially greater than normally seen with seasonal influenza.

 

 

The CDC’s tracking of pediatric deaths in the US for the year 2009 shows a huge increase in pediatric mortality.    The actual number of pediatric deaths has been estimated to exceed 1,000 this year.

 

 

These numbers are estimated as of mid-November, and are no doubt quite a bit higher today.

 

So it is of little surprise that an analysis of pediatric cases from Argentina would show double the normal (seasonal flu-related) pediatric hospitalizations  and a 10 fold increase in pediatric deaths.

 

 

Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1) in Argentina
Romina Libster, M.D., et al.

ABSTRACT

 
Background While the Northern Hemisphere experiences the effects of the 2009 pandemic influenza A (H1N1) virus, data from the recent influenza season in the Southern Hemisphere can provide important information on the burden of disease in children.

 

Methods We conducted a retrospective case series involving children with acute infection of the lower respiratory tract or fever in whom 2009 H1N1 influenza was diagnosed on reverse-transcriptase polymerase-chain-reaction assay and who were admitted to one of six pediatric hospitals serving a catchment area of 1.2 million children. We compared rates of admission and death with those among age-matched children who had been infected with seasonal influenza strains in previous years.

 

Results Between May and July 2009, a total of 251 children were hospitalized with 2009 H1N1 influenza. Rates of hospitalization were double those for seasonal influenza in 2008. Of the children who were hospitalized, 47 (19%) were admitted to an intensive care unit, 42 (17%) required mechanical ventilation, and 13 (5%) died. The overall rate of death was 1.1 per 100,000 children, as compared with 0.1 per 100,000 children for seasonal influenza in 2007. (No pediatric deaths associated with seasonal influenza were reported in 2008.) Most deaths were caused by refractory hypoxemia in infants under 1 year of age (death rate, 7.6 per 100,000).

 

Conclusions Pandemic 2009 H1N1 influenza was associated with pediatric death rates that were 10 times the rates for seasonal influenza in previous years.