Media: Indonesian Bird Flu Fatality

 

 

 

# 4537

 

Indonesian media is reporting the 4 year-old girl who died on Wednesday in the flu isolation unit of Arifin Achmad hospital in Pekan Baru, Indonesia has tested positive for the H5N1 virus.  

 

Meanwhile, three others from the same region remain hospitalized with suspected H5H1 infection.  A 40 year-old mother, her 14-year-old child, and an 8-year-old neighbor. 

 

Their conditions are reported as improving.  

 

 

This machine translation is of an original article from riauterkini.com news.

 

Friday, 30 April 2010 19:40

Positive Joice, Arifin Achmad Hospital Patients Hospitalized third suspect bird flu

 Joice toddlers tested positive Efeline died from bird flu. Sementa currently three residents in the provincial hospital Siak Arifin Achmad for allegedly infected by H5N1 virus.

Riauterkini-Pekanbaru-suspect case of bird flu, Arifin Achmad Hospital has treated this weekend hikes.  After a toddler, child Sidomulyo resident Street, Padang Keluruhan headdress, District Senapelan, named Joice Efeline Pekanbaru City died Wednesday (28/4/10) and ascertained from the virus or the H5N1 strain of avian enfluenza, now there were three patients who origin in Siak Regency should be treated in isolation space suspect bird flu patients.

 

"To Joyce Efeline we can and certainly a positive laboratory result of bird flu," said Chairman of the Bird Flu Prevention Team Arifin Achmad Pekanbaru Hospital Saad Azizman to riauterkini in Pekanbaru, on Friday (30/4/10).

 

While about three patients Siak origin who is now hospitalized in isolation room is a mother named Siti Fatimah (40) and his son, Anggi (14) and neighbor Diva Amandasari (8).

All three residents Apit River, Siak.

All three enter simultaneously at dawn earlier. Initially treated in the emergency room (ER), but because his body temperature reached 38 degrees Celsius, and then referred to were isolated in a special room patients suspect bird flu.

"Now all three conditions began to improve.  His temperature began to decrease and his lung condition is stable, "explained Azizman .***( mad)

A Double Referral On Sheltering In Place

 

 

# 4536

 

 

 

SIP stands for Sheltering In Place, something that the Federal government would like to see more people willing and able to do in the event of a natural or man-made disaster.

 

Whether it be the aftermath of a hurricane, an earthquake, or a terrorist’s dirty bomb . . . people need to be prepared to care for themselves and their loved ones for hours, perhaps even days. 

 

It is for that reason that I’ve stressed the need for individual and community preparedness, and have urged that every household have enough supplies to last a minimum of 72 hours (food and water), a good first aid kit (and knowledge to use it), an emergency radio, and a family emergency plan.

 

As a paramedic, I’ve seen what a lack of preparedness and training can cost, in terms of suffering and even lives.  

 

And as a Floridian who has ridden out more than a few hurricanes, I know what happens to grocery store shelves before, and immediately after a big storm, and what it is like to be without power for an extended period of time.

 

Which is why I prefer to see people maintain a minimum of two-weeks of emergency supplies in their home.

 

John Solomon, writing on his In Case Of Emergency Blog, has two entries that I would refer you to this morning.   Both deal with the need for Sheltering In Place after a terrorist attack, and how that could save thousands of lives.

 

Yesterday, John wrote:

 

New Study Indicates Most Washington, D.C. Area Residents Would Be Willing To Follow Instructions To ‘Shelter In Place’ After ‘Dirty Bomb’

 

Followed today by:

 

“Gimme Shelter: The Need For A Contemporary Civil Defense Program”

 

 

Both essays raise important issues.   Highly recommended.

 

Personally, I prefer to think in terms of `all-threats’ preparedness. But for those who live in New York City, Washington D.C., or other large high-value areas, terrorist attacks certainly have to be considered. 

 

The bottom line, however, is that willingness to follow emergency instructions isn’t enough.  People have to be prepared to shelter in place before a disaster strikes if they hope to comply. 

 

Agencies like FEMA, READY.GOV and the HHS are constantly trying to get the preparedness message out, so that when (not `if') a disaster does occur, human losses can be minimized.

 

For more information on how to prepare for emergencies, up to and including a terrorist attach, the following sites should be of assistance.

 

 

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

 

And a few of my (many) preparedness essays include:

 

An Appropriate Level Of Preparedness

Inside My Bug Out Bag

Red Cross Unveils `Do More Than Cross Your Fingers’ Campaign

The Gift Of Preparedness

MMWR On High Dose Flu Vaccine For Seniors

 

 

# 4535

 

 

Proving that timing is everything, several hours before the CDC released their weekly MMWR which contained information on the new high dose Fluzone vaccine for seniors, I wrote a blog entitled Flu Shots And The Elderly. 

 

In it, I mentioned the new high-dose Fluzone vaccine for seniors, but we’ve a bit more information today.

 

Since not everyone reads the MMWR each week, and this is a new vaccination option available to those over 65, I thought it deserved special mention today.

 

This new high-dose flu vaccine contains 4 times the normal amount of antigen; 60 µg of each of the three recommended strains, instead of the normal  15 µg.  A trivalent shot, like this year’s regular flu shot, it contains antigens from A/California/7/2009 (H1N1)-like, A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like influenza viruses.

 

 

Excerpts follow, but you may wish to follow the link to read the entire article.   I’ve reformatted some of the paragraphs for easier online reading.

 

 

 

Licensure of a High-Dose Inactivated Influenza Vaccine for Persons Aged ≥65 Years (Fluzone High-Dose) and Guidance for Use --- United States, 2010

Weekly

April 30, 2010 / 59(16);485-486

Persons aged ≥65 years are at greater risk for hospitalization and death from seasonal influenza compared with other age groups (1,2), and they respond to vaccination with lower antibody titers to influenza hemagglutinin (an established correlate of protection against influenza) compared with younger adults (3).

 

On December 23, 2009, the Food and Drug Administration (FDA) licensed an injectable inactivated trivalent influenza vaccine (Fluzone High-Dose, Sanofi-Pasteur) that contains an increased amount of influenza virus hemagglutinin antigen compared with other inactivated influenza vaccines such as Fluzone.

 

Fluzone High-Dose is licensed as a single dose for use among persons aged ≥65 years and will be available beginning with the 2010--11 influenza season. The Advisory Committee on Immunization Practices (ACIP) reviewed data from prelicensure clinical trials on the safety and immunogenicity of Fluzone High-Dose and expressed no preference for the new vaccine over other inactivated trivalent influenza vaccines (4).

 

<SNIP>

 

ACIP Guidance for Use of Fluzone High-Dose

 

Fluzone High-Dose may be used for persons aged ≥65 years. All persons aged ≥6 months are recommended for annual influenza vaccination beginning with the 2010--11 influenza season.

 

ACIP has not expressed a preference for any specific licensed inactivated trivalent influenza vaccine, including Fluzone High-Dose, for use in persons aged ≥65 years (4).

 

Data demonstrating greater protection against influenza illness after vaccination with Fluzone High-Dose are needed to evaluate whether Fluzone High-Dose is a more effective vaccine for persons aged ≥65 years.

 

A 3-year postlicensure study of the vaccine effectiveness of Fluzone High-Dose compared with standard dose inactivated influenza vaccine (Fluzone) was begun in 2009 and should be completed in 2012.

As with other inactivated influenza vaccines, Fluzone High-Dose should not be administered to anyone with a known hypersensitivity to egg proteins or influenza vaccine. Adverse events after receipt of any vaccine should be reported to the Vaccine Adverse Event Reporting System at http://vaers.hhs.gov.

Updating Four Earlier Stories

 

 

 

# 4534

 

 

Over the past several days we’ve seen a series of `flu-related’ news reports from places as divergent as Vancouver, Australia, and Indonesia.  

 

All of these stories are still ongoing, but there are bits and pieces of news on each of them. 

 

In an environmentally conscious attempt to conserve our dwindling national supply of electrons, I’ve decided to update all of these stories in a single blog.

 

On Wednesday of this week we learned of an outbreak of an – as yet – unidentified respiratory virus in a long-term care facility in Vancouver, British Columbia  (see Investigating A Viral Outbreak In Vancouver). 

 

H1N1, along with other strains of Influenza A and B, have been ruled out. Nine residents had died, all of whom were described as `elderly and frail’.

 

The virus behind this outbreak remains unidentified, but today we learn that 3 staff members are out sick, and at least one other reported similar illness a month ago.  

 

Without a diagnosis, it is impossible at this time to know if any of these illnesses are related.  Complicating matters, the facility has been plagued with a Norovirus outbreak over the past month.   

 

This from The Times Colonist (hat tip Tetano on FluTrackers)

 

 

3 workers fall sick at Glengarry, where illness claimed 9 lives

By Joanne Hatherly, Times Colonist

April 30, 2010 1:21 AM

The Vancouver Island Health Authority is monitoring three sick staff members at Glengarry Hospital, where nine people have died from an unspecified respiratory illness.

 

VIHA spokeswoman Shannon Marshall said the three staff members reported sick yesterday, but it has not been determined if they are suffering from the illness that broke out in the Chandler Unit at Glengarry Hospital last week.

 

Maureen Donaldson, 50, a care attendant in the unit -- where the nine people died and 11 more were infected -- said she became ill a month ago with the same respiratory and gastrointestinal symptoms that she saw afflict residents.

 

"We are front-line workers and we are in contact with every body fluid," said Donaldson, who is currently undergoing tests.

 

Marshall said no new cases have been reported among the residents. So far, the patients have tested negative for influenza A, B and H1N1. Yesterday, VIHA learned that tests for legionella -- associated with Legionnaires' disease -- were also negative.

(Continue . . . )

 

 

Jumping now to Australia, where their trivalent seasonal flu vaccine is suspected of having triggered an unusual number of fevers and convulsions in children under the age of five (see Australian Vaccine Investigation Widens).

 

Initial examination of the vaccine hasn’t turned up any contaminants, or anything else that officials believe explains these reactions, but the temporary ban on vaccinating children under the age of five remains in place. 

 

 

Flu vaccine for under fives stays on hold

By Pamela Medlen

Federal and state health authorities have agreed to keep seasonal flu vaccines for young children on hold.

 

Hundreds of children under the age of five suffered fever, vomiting and convulsions after receiving the flu vaccine.

 

The Federal Government's chief medical officer, Professor Jim Bishop, says there is no evidence to suggest that faulty batches of flu vaccine are to blame for adverse reactions in children.

 

Professor Bishop says tests of batches of the vaccine show no abnormalities, although further testing is yet to be completed.

 

He says higher numbers of adverse reactions to the vaccine in Western Australia could be explained by the higher rate of vaccination in the state.

 

But Professor Bishop says the ban will remain.

(Continue . . . )

 

 

 

And lastly, we update the two suspected bird flu reports out of Indonesia, which I mentioned yesterday in A Couple Of Bird Flu Reports Out Of Indonesia.

 

First, Dutchy at FluTrackers has a report on the 11 year-old who was being treated at Lubukbasung hospital, and who has now been transferred to Dr M. Djamil Padang Hospital in order to received specialized care. 

 

According to this story, Dr M. Djamil Padang Hospital is currently treating two suspect H5N1 patients.

 

 

Bird Flu Victim in Agam was rushed to the department of internal medicine

 

Harmen - Padang Ekspres

RS (11), bird flu victims in Padang ellipse Bio-Bio, Bawan village, district Ampek  Nagari, Agam regency was rushed to Dr M. Djamil Padang to obtain  special care, Thursday (04/29/2010).

This is done to provide optimal medical help for victims of the virus H5N1 is the worst and anticipate the impact to the victim.

Agency Head Kesbangpol Agam M. Dt.Maruhun and district when Ampek Nagari Welvizar contacted separately mentioned, this week, recorded two original bird flu victims Agam was referred to Dr M. Djamil Padang.

Previously, similar cases occurred in Lapaukonsi, Lubukbasung, where the victim-Budget not her real name (5) also received intensive care. Until now, victims still undergoing treatment.

 

 

And finally, an update from Riau, where 9 members of one village are ill with what authorities fear may be H5N1. All are apparently receiving Tamiflu, but most are refusing to go to the hospital. 

 

 

Ida at BFIC brings us this update from Riau Pos.

 

 

Sungaiapit, Riau ::: Bird flu spreads to other villages

Posted by Ida on April 30, 2010

Sungaiapit, Riau – Bird flu H5N1 had spread to Desa Parit I/II, Desa Harapan and Kelurahan Sungaiapit since it was firstly identified in Desa Lalang. Until now, bird flu infected human suspect has reached nine victims. Two of them are now being treated at Arifin Achmad hospital in Pekanbaru, while others are refused to be hospitalized.

 

Based on the investigation of Health Service and Livestock Service of Kabupaten Siak, so far dead chickens had been tested positive bird flu H5N1. Furthermore, Health Service had collected patient’s liquid samples for further test and treated patients with Tamiflu.

 

Source: Indonesia local newspaper. Riau Pos.

A Couple Of Bird Flu Reports Out Of Indonesia

 

 

# 4533

 

 

The past couple of weeks have seen a few scattered reports of suspected H5N1 infections in Indonesia, something that is pretty common during the winter and spring months of the year. 

 

Details are usually scant, and official confirmation of these reports sometimes takes months.  Sometimes we never hear a follow up on these cases, and are left to wonder exactly what transpired.

 

Over the past few days we’ve seen a spike in Indonesian media reports regarding suspected human infections with the H5N1 virus, including the death of a 4 year-old girl yesterday.  

 

Thus far, we’ve not seen any laboratory confirmation that these recent patients were infected with the H5N1 virus.   So these remain suspect cases.

 

On Monday, Ida at BFIC carried a report of four locals (one adult, 3 toddlers) from Sungaiapit, Riau hospitalized with suspected H5N1 (see Watching Riau Again).

 

Today, based on a machine translation of an Indonesian media report, it appears that the number of suspect cases in this region has climbed to nine.

 

The usual cautions with these translated reports applies;

 

Machine translations can be awkward and difficult to decipher, local reporting may or may not be accurate, and there are a great many diseases in that region that share the same initial symptoms as bird flu.

 

This report was posted by Shiloh on this thread at FluTrackers,

 

Bird Flu Case in Spreads Starting Apit River
29 April 2010
 
Reports Abu Kasim, Sungaiapit abukasim@riaupos.com

CASE Sungaiapit bird flu in the district began to expand, since the unknown Saturday (24 / 4) and then, only one village namely Lalang Village.

In the village of hundreds of birds died suddenly had a positive infected bird flu virus (AI) and until Tuesday (27 / 4), extends to two villages and one village ie village of Parit I / II and Hope Village and Village Sungaiapit.

 

Even human sacrifice which was initially only four people have grown to nine people, two of whom, since Monday (26 / 4) are already in the reconciliations in hospitals Arifin Achmad Pekanbaru.

 

Some of these suspect cases are apparently being treated in their homes with Tamiflu, and are not hospitalized or otherwise isolated.

 

Since `mild cases’ of H5N1 are seldom reported in Indonesia (whether they exist or not is another issue), the fact that not all of these people are ill enough to be hospitalized may serve to lessen the import of these reports a bit. 

 

It isn’t unusual, however, for locals to refuse hospital care in Indonesia, so we’ll simply have to wait for more information.

 

Meanwhile, more than 200 kilometers to the southwest, in Padang we’ve this report  (h/t Shiloh on FluTrackers) of an 11 year-old hospitalized with suspected bird flu.  

 

The boy’s condition is reported as  `still not good’.  Once again, this is a suspect case, and laboratory tests are pending.

 

Padang | Thursday, 4/29/2010 17:37 AM
Dr M. Djamil Back Hospitalized Patient suspect Avian Influenza

Irwan Prayitno

Padang, (AFP) - General Hospital Center Padang M. Djamil, again treating patients suspected of bird flu suspected origin Kanagarian Bawang, Lubuk Basung, Agam District.

 

"The victim is a 11-year-old boy Rz initials," said Dr M. Head of Public Relations Djamil, Gustavianof.

 

According to him, Rz sent to Dr M. Djamil on Thursday (29 / 4) early morning at around 2:00 pm.

 

"Description of the victims parents, three days earlier, Rz suffering from high fever and a little shortness of breath. Then Rz Lubuk brought to health centers in two dozen, but the clinic complaining because of lack of equipment, so refer him to Dr M. Djamil," said Gustavianof.

 

When Rz fever, not far from his home, found 50 chickens that died suddenly.

 

"Based on the description of a local veterinarian, the chickens are attacked by the bird flu virus," he said.

 

This story is being followed on this thread at FluTrackers.

 

 

Again, scattered reports of this type are not unusual this time of year.  The newshounds on the flu forums will continue to watch these cases, and I’ll update them here if and when more information becomes available.

Flu Shots And The Elderly

 

 

# 4532

 

 

Seasonal influenza (as opposed to pandemic flu) traditionally takes its biggest toll among the oldest and frailest members of society. Of the 36,000 estimated deaths flu-related deaths in the United States each year, the vast majority occur in those over the age of 65.

 

According to one recent study, 90% of seasonal flu related deaths “occur in people over 65 years and the mean age of influenza-related deaths is estimated at 76 yrs.”

 

Which is why those over the age of 65 have been routinely urged to get a flu shot every year.  Something I’ve recommended to my (now 85 yr old) father since the 1990s.

 

And since I’m approaching `middle age’ myself (assuming, of course, I manage to live to be 112), I get the flu shot every year as well.

 

The problem is, the elderly - who are most at risk from dying from seasonal influenza - appear to derive the least amount of protection from our current flu shot formulations. 

 

 

While this is hardly a secret, is isn’t exactly advertised on billboards outside of your doctor’s office either.  

 

You’ll find a number of blogs here, going back several years on this topic, including:

 

ACIP Provisional Influenza Vaccine Recommendations

Why Vaccines Matter

Vaccines: Sometimes You Just Need A Bigger Hammer

Another Study: Flu Vaccines Do Not Reduce Mortality Rates In The Elderly

Study: Flu Vaccines And The Elderly

Flu Shots For The Elderly May Have Limited Benefits

 

Since the level of protection induced by the flu shot likely varies widely between elderly recipients, and since a little protection is assumed to be better than none, there is a natural reluctance among some health care providers not to go into a lot detail about the relative degree of protection afforded to the elderly by the vaccine.

 

 

And to be clear here, the evidence doesn’t say there is no benefit to giving those over 65 a flu shot.

 

0nly that those with the weakest immune systems – and therefore most apt to die from the flu – don’t appear to be any less likely to die if they’ve been vaccinated.

 

 

A factoid I’ve shared with my father every fall for several years now, as I dutifully remind him to get the vaccine.  But as they say, a little protection beats none at all . . .

 

Which brings us to an article (hat tip CIDRAP News) which appears on Minnesota public radio’s website, featuring CIDRAP’s director Michael Osterholm.

 

 

Research suggests flu vaccine doesn't prevent deaths among the elderly

by Lorna Benson, Minnesota Public Radio

April 27, 2010

St. Paul, Minn. — If the main point of the nation's influenza vaccination program is to reduce deaths from flu, then the program has failed, at least among people over 65.

 

A growing body of research shows that because our immune systems age, flu vaccines don't work as well in the elderly - the group of people most likely to die from flu-related causes.

 

The revelation has been so unsettling that public health officials have not shared the information widely with the public - even though some of the early findings have been a part of the scientific literature for several years now.

 

Michael Osterholm, who directs the University of Minnesota's Center for Infectious Disease Research and Policy, Tuesday told a national conference on vaccine research that it's time to be more open about the flu vaccine and its lack of protection for the elderly.

 

Osterholm also urged his colleagues to support attempts to create a new, effective vaccine.

(Continue . . . )

 

This is a very good article, with a lot of background on the studies that have been conducted trying to understand the effect and effectiveness of flu vaccination in the elderly.  

 

Last December the FDA approved a new, high-dose Fluzone flu shot for those over 65, that contains 4 times the normal amount of antigen.

 

FDA PRESS RELEASE

For Immediate Release: Dec. 23, 2009

FDA Approves A High Dose Seasonal Influenza Vaccine Specifically Intended for People Ages 65 and Older

Accelerated approval process used in vaccine approval

The U.S. Food and Drug Administration today approved Fluzone High-Dose, an inactivated influenza virus vaccine for people ages 65 years and older to prevent disease caused by influenza virus subtypes A and B.

 

People in this age group are at highest risk for seasonal influenza complications, which may result in hospitalization and death. Annual vaccination remains the best protection from influenza, particularly for people 65 and older.

(Continue . . . )

 

In March, ACIP announced that this new formulation would be available along with standard flu shots this fall, but did not announce a preference for one shot over the other. Those interested should discuss this option with their family physician.

 

While early testing has been promising, it will probably take a year or two of field use before we have any idea of the relative impact of this new flu vaccine.  

 

In the meantime, doctors and public health officials are left in a quandary over how to best present this information without discouraging the uptake of the flu vaccine by the elderly.  

 

Most researchers believe that – at least among those seniors who are reasonably healthy – the flu shot provides some level of protection.

 

How much varies from year-to-year and from person-to-person.

 

Which, ultimately, may be the simplest and most honest way to `sell’ seniors on the idea of getting the shot every year.   

 

It is what I used with my Dad, and he was fine with it.

Indonesia: Suspected Bird Flu Fatality

 

# 4531

 

 

 

Overnight Ida at BFIC posted a report on a 4 year-old from Riau, Indonesia who was hospitalized with suspected H5N1.  Although this child’s symptoms are consistent with bird flu, we’ve not seen any reports of laboratory confirmation of the virus.

 

Since that time, local media has reported her death.

First the report from the Bird Flu Information Corner.

 

Pekanbaru, Riau ::: A four-year-old girl treated as bird flu suspect

Posted by Ida on April 28, 2010

Pekanbaru – A four-year-old girl, Joice Evelyn, a resident of Jalan Sidomulyo RT/RW 1/8 Kecamatan Senapelan, is suspected of contracting bird flu virus. The girl is currently under intensive treatment at bird flu isolation unit of Arifin Achmad hospital in Pekan Baru.

 

Patient had been hospitalized in Arifin Achmad hospital for two days from 21 to 23 April before taken home by her family. Patient had recurrent fever on the next day after she returned home that she was rushed to Santa Maria hospital. Later she was referred to Arifin Achmad hospital.

 

Hospital is still waiting for the laboratory test result.

 

Patient has no direct contact history with birds before the illness.

Source: Indonesia local TV, Riau Televisi

 

Dutchy, posting on FluTrackers has this update from Riauterkini.com.

 

Machine translations from Bahasan oft times confuse genders, but based on Ida’s translation, this victim appears to be a little girl.

 

 

Wednesday, April 28, 2010
Bird flu suspect GIRL died in hospital Arifin Achmadd

 
Arifin Achmad Pekanbaru Hospital could treat a child suspected bird flu Senapelan origin.

 
Her condition worsened and finally died.

Riauterkini-Pekanbaru-A boy berisial Efeline Joyce (4) children Bagarian couples (35) and E Nainggolan (32) the resident Street Sidomulyo, Senapelan, Pekanbaru had undergone treatment
intensive care isolation room patients with suspected bird flu hospitals Arifin Achmad Pekanbaru. Symptom The child suffered clinic leads to attack avian influenza virus.

 
According to the Head of Public Relations Ahcmad Pekanbaru Hospital Arifin Zainal Arifin, the boy suspected bird flu.

The hospital received on Monday (26/4/10) and then, after a referral from the Hospital Santa Maria Pekanbaru. When his condition had worsened referenced. After two days of intensive care, finally, at around 15:00 pm, Wednesday (28/4/10) patients are not spared his soul.

 
"Just now the patient is medically declared dead. But we can not ensure, whether the patient is positive of bird flu. Suspected new limited, "explained when talking with riauterkini in Pekanbaru, Wednesday (28/4/10).

Zainal explained, before the patient's body temperature reached 38.9 degrees celsius koit and conditions lung occurs puddle of liquid. Currently the patient's body still in the hospital and waited for his family to take .

Investigating A Viral Outbreak In Vancouver

 

 

# 4530

 

 

 

In medicine, one always looks first to the most common, or likely, cause of a patient’s chief complaint before considering something exotic.   The old adage, that `When walking in Central Park, if  you hear hoof beats, expect horses, not zebras’ is drummed into every medical student.

 

It is only when you eliminate the simplest explanation that you move to the next most-likely cause of a patient’s illness. 

 

And so, when a series of extremely elderly residents in a long-term nursing facility on Vancouver Island began to fall seriously ill from a respiratory ailment earlier this month, naturally the first thoughts were that it was influenza A or B.

 

But testing has ruled out these two most likely suspects, and doctors and epidemiologists are now looking for a different explanation.

 

Influenza viruses, of course, make up only a small percentage of known respiratory viruses (see ILI’s Aren’t Always The Flu).

 

The list of viral pathogens that can cause ILI's (`influenza-like Illnesses') is a long one, and includes adenoviruses, influenza viruses, human metapneumovirus, parainfluenza viruses, respiratory syncytial viruses, and rhinoviruses.

 

Yesterday the press – particularly in Canada – picked up this story. 

 

A hat tip to RoRo, Alert, Laidback Al, Tetano, and others on FluTrackers for starting this thread to track the progress of this investigation.

 

This report from the Canadian Press, followed by a press release from the local health authority.

 

Virus kills nine at Victoria hospital

 

Influenza-like virus has made 19 ill; H1N1 has been ruled out

Victoria, BC —  Last updated on Tuesday, Apr. 27, 2010 6:26PM EDT

Nine residents have died since April 5 at a Victoria hospital where an influenza-like illness has been detected, says the Vancouver Island Health Authority.

 

Spokeswoman Suzanne Germain said Tuesday that 19 people have become ill since the respiratory outbreak began at Glengarry Hospital, which is home to frail and elderly patients, many with multiple pre-existing conditions.

 

“While we know that nine people who died had the symptoms we don't know if that was what ultimately caused them to die,” she said of the patients, who were in their 80s and 90s.

 

Lab tests have confirmed that the illness is not H1N1 or influenza A and B, but further tests are being conducted to try and find out what kind of illness is involved, she said.

(Continue . . . )

 

 

The Vancouver Island Health Authority (VIHA) has released the following statement:

 

Respiratory Outbreak at Glengarry Hospital

 

April 27, 2010

VICTORIA – The Chandler Unit at Glengarry Hospital in Victoria is experiencing a respiratory outbreak which has affected a total of 19 residents. The Vancouver Island Health Authority (VIHA) is asking family and friends to consider not visiting the facility at this time, especially if they are sick. If they do visit, they will be asked to clean their hands on entering the facility and affected unit as well as follow other precautions as directed by staff.

 

The Chandler Unit at Glengarry has also been experiencing a Norovirus outbreak since April 6. Some patients on the unit began developing respiratory symptoms at the end of March, but these were often mild and not readily distinguished from the Norovirus symptoms in this group of elderly and often cognitively impaired residents. The respiratory outbreak was declared on April 22 after an increase in the number of cases and several deaths occurred.

 

Since April 5, nine residents with the respiratory symptoms have passed away. Each of these residents was elderly and frail with multiple medical challenges. Five of these residents were already receiving palliative care. Medical reviews are underway on all cases to determine what role the respiratory condition may have played – if any – in the deaths.

 

“We take outbreaks in residential care facilities very seriously because the frail, elderly population is more susceptible to serious complications and even death from illnesses,” said Dr. David Forrest, Associate Medical Director, Infection Prevention and Control with VIHA. “The fact that no staff have been affected by this illness would suggest it is a mild illness in most people that is affecting our frail elderly residents more.”

 

Lab tests have not yet confirmed the organism involved in the respiratory condition, but influenza A and B and H1N1 have been ruled out. Further testing is underway at the VIHA laboratory as well as at the BC Centre for Disease Control in Vancouver. Results are expected later this week.

 

“While the cause of the illness is not yet known, residential care facilities reflect the community.  There are many viruses circulating in the community this time of year, including rhino- and noro-viruses.   When they are introduced into the residential care setting they can have a significant impact on residents and staff,” said Dr. Forrest. “We would like to remind people not to visit when they are not feeling well.  In addition, since many infections such as influenza can be prevented by vaccination, immunization is important to prevent the development of such outbreaks and deaths.”

 

VIHA has notified family members of this latest outbreak. Heightened infection control measures are in place to prevent its spread.

These measures include:

• Limiting contact between residents (residents are isolated to their rooms)
• Closing all dining rooms (meals are being served to residents in their rooms)
• Limiting visitors to one family member per resident.
• Requiring visitors to wear protective equipment and to follow strict hand hygiene practices (e.g. mask, gown and gloves when visiting someone with symptoms).
• Restricting visitors to loved one’s room only; no visits in common areas.
• Cancelling special events and restricting movement for residents who smoke.
• Requiring staff to wear protective equipment and to follow strict infection control practices (e.g. mask with visor, gown, gloves).
• Restricting staff who have been working on the Chandler Unit from working in other residential care sites in back-to-back shifts.
• Adding housekeeping staff and enhancing housekeeping with additional infection control cleaning protocols (such as enhanced cleaning of frequent touch areas, changing of privacy curtains).
• Maintaining a previous closure to new admissions that was put in place April 6 due a Norovirus outbreak.

Residents who contract respiratory symptoms are being carefully monitored and treated as appropriate, depending on their care plan, their wishes, or the wishes of their family.  Where requested and appropriate, a resident may be transferred to hospital for additional care such as intravenous antibiotic care.

 

Glengarry has a total of 140 beds. Only the Chandler Unit (70 beds) is affected by the respiratory outbreak.

Vietnam: Worries Over Infectious Diseases

 

 

# 4529

 

 

Although long known as a bird flu hot-spot, when it comes to combating infectious diseases, countries like Vietnam must do battle on many different fronts.  

 

Cholera, measles, Dengue, malaria, respiratory viruses, and a variety of water and/or sanitation related illnesses all exact a heavy toll each year in developing nations.

 

While the number of fatalities attributed to H5N1 last year in this article appears inaccurate (possibly juxtaposed H1N1?), this Voice of Vietnam article does give some sense of the scope of public health challenges that face that nation.

 

The bottom line here – from a bird flu perspective – is that eradication, surveillance, and reporting efforts must compete for limited public health resources that must be shared across a wide array of vexing public health issues.

 

 

Updated : 5:03 PM, 04/27/2010

Epidemics likely to spread

In recent years, many provinces have suffered from epidemics, especially digestive-related diseases such as cholera, said Professor Doctor Nguyen Tran Hien, head of the National Institute of Hygiene and Epidemiology (NIHE).

 

Mr Hien stated this at a conference held in Hanoi on April 27 to put in place measures to combat epidemics in the northern region this year.

 

He warned that the A/H5N1 virus, dengue fever and measles are likely to break out in 2010. Last year, Vietnam had more than 2,000 cases of flu infection, including 15 deaths caused by the A/H5N1 virus, he added.

 

In 2009, more than 9,400 people in the northern region were diagnosed as having measles. The NIHE has planned to vaccinate all children under six against measles by 2012.

 

Since the beginning of this year, the country has confirmed 50 cases of cholera, mostly in Hanoi, Hai Phong, Bac Ninh and Hai Duong. The disease is likely to spread widely due to shortcomings in preventive healthcare and ineffective cooperation between local authorities and functional agencies.

 

According to Professor Hien, it is also essential to introduce preventive measures against respiratory diseases, including A/H1H1 and A/H5N1.

Two Referrals For the Price Of One

 

 

# 4528

 

 

I confess that I am a bit of a science geek, although in truth, my level of understanding of most of these subjects is about a yard wide and only a half an inch deep.  Still, I enjoy reading selected articles from science journals and the works of a number of science bloggers.

 

Two of my favorites are Professor Vincent Racaniello’s Virology Blog and Ian York’s Mystery Rays blog.

 

Today both are dealing with viral mysteries, and if your reading tastes run in that direction, you may find them as fascinating as I did.

 

First, Vincent Racaniello brings us the story of a plant virus that would rather switch than fight, in: 

 

A plant virus that switched to vertebrates

by Vincent Racaniello on 26 April 2010

 

 

And then Ian York delves into a question I’ve had for some time; how many variants (mutations) of a flu virus are produced when a host becomes infected? 

 

Influenza variations

By iayork

 

 

Interesting reading to satisfy the inner science geek in all of us.

CIDRAP’s Lessons Learned: Pt II

 

 

# 4527

 

 

CIDRAP News, on the one year anniversary of the discovery of the novel H1N1 virus, is running a series of `lessons learned’ articles. The first, written by News Editor Robert Roos, appeared last week (see H1N1 LESSONS LEARNED).

 

Today it is contributing writer Maryn McKenna’s turn, and she looks at the vaccine related lessons learned. 

 

Highly recommended.

 

 

H1N1 LESSONS LEARNED
Vaccine production foiled, confirmed experts' predictions

Maryn McKenna Contributing Writer

Second in a series marking the 1-year anniversary of novel H1N1 pandemic influenza. The first, on the virus itself, appeared Apr 23.

Apr 26, 2010 (CIDRAP News) – Among the many surprises of the 2009 H1N1 flu pandemic—its emergence at the end of a flu season, its unexpected toll of mild illness, its almost-complete replacement of circulating seasonal strains—was its reversal of years of received wisdom on how vaccines would be needed to respond.

 

Researchers had predicted, for instance, that to be protected against a novel strain, most members of the population would require two doses of vaccine containing the new pandemic strain. And because that many doses of vaccine would stress the existing vaccine-manufacturing system, other researchers had predicted that the addition of dose-sparing adjuvants to the new vaccine would be crucial to stretch out scarce supplies of newly made antigen.

 

Neither turned out to be true.

(Continue . . .)

 

 

Many of the difficulties encountered with the pandemic vaccine production system were discussed at length in Maryn McKenna’s award winning 7-part series the Pandemic Vaccine Puzzle which she wrote for CIDRAP in 2007.

 

A series that remains just as relevant today as when she wrote it.

 

Part 1: Flu research: a legacy of neglect
Part 2: Vaccine production capacity falls far short
Part 3: H5N1 poses major immunologic challenges
Part 4: The promise and problems of adjuvants
Part 5: What role for prepandemic vaccination?
Part 6: Looking to novel vaccine technologies
Part 7: Time for a vaccine 'Manhattan Project'?
Bibliography

Watching Riau Again

 

 

# 4526

 

Sungaiapit, Riau

 

News stories regarding suspected human bird flu infections in Indonesia are, admittedly, not uncommon.   Getting official confirmation of these cases from the Indonesian government, however, happens rarely.

 

The official stance of the Ministry of Health (MOH) is that they do not comment on individual cases, and only release updates with revised aggregate totals on an intermittent basis. 

 

Confirming individual cases, they decided several years ago, kept the bird flu story on the front pages and wasn’t doing much to enhance their nation’s image or economy.

 

In 2009, the MOH went 11 months between making `official’ announcements, adding 20 cases (19 fatal) to their totals on December 30th of last year. 

 

During that time period, several dozen `suspected’ bird flu cases were mentioned in the local press.   Some were allegedly `confirmed’ by local hospitals or authorities, some reportedly tested `negative’, and others we simply never heard about again.

 

Complicating matters further are the known difficulties in getting accurate H5N1 test results (something that the administration of Tamiflu can help obscure), a plethora of other flu-like illnesses that are common in the region, and a local media that is sometimes quick to identify any such illness as `suspect flu burung’.

 

So it is against this uncertain backdrop that we must view news stories such as the ones appearing overnight in the Riau newspapers identifying four possible bird flu suspects.  

 

For these reasons (and more), while Indonesia media reports have at times provided us with important details on genuine outbreaks, I tend to regard them with a fair degree of caution.

 

 

Dutchy at FluTrackers opened a thread last night with a pair of translated news reports, and Ida at the Bird Flu Information Corner has a translation of a third report this morning.

 

First, from the FluTrackers Thread.

 

Hundreds of chickens died suddenly

Three Toddlers Suspected bird flu

Monday, April 26, 2010 - 21:31:27 AM
We are still conducting observations of the victims who suffered a high fever accompanied by cough and headache and body ache. Is the bird flu virus or not

dr Hartini Head of the River Health Center Apit

RIVER APIT, METRORIAU.COM - Hundreds of chickens owned by citizens of the Village Lalang River District Wedge since the last few days was found dead unexpectedly. This makes residents of chicken deaths panic and reported the incident to the officer Apit River Health Center.

 
Even the death of these chickens had a high fever three toddlers. Three children were allegedly infected bird flu virus.

Health center personnel along with officials from the Department of Animal Husbandry, Fisheries and Agriculture (Distanakan) Siak is down to location, Sunday (25 / 4), had found improprieties against chicken deaths these.

The medical team led, drh Romi from Siak Distanakan have also taken samples of chicken die to do rapid tests. After doing research, the chickens that died suddenly positively infected by avian influenza virus.

 

 

Ida at BFIC has this translation from Metro Riau.

 

Sungaiapit, Riau ::: Four locals possibly contracting bird flu virus

Posted by Ida on April 27, 2010

Sungaiapit, Riau – Hundreds of chickens in Desa Lalang, Kecamatan Sungaiapit, Riau Province found to have suddenly died within these few days. Further rapid test done by Livestock, Fishery and Agriculture Service of Siak  to dead chickens showed positive bird flu (H5N1) infection. Four residents of RT/RW 03/05 Dusun 2 Desa Lalang, were reported to have fever following to the incident.

 

Patients are three children and an adult, named Muhammad Sandika Putra (3.9), Jumiati (3.6), Zurahmah (3.4) and Efriadi (34). Head of Sungaiapit public health center, dr Hartini mentioned patients showed signs such as fever, coughing, headache and muscle pain. They had received intensive treatment in Sugaiapit public health center and had been improved, she said.

 

In mean time, patients are still under observation.

 

For ongoing details, you may wish to monitor the FluTrackers Thread, where their dedicated and talented newshounds will continue to monitor this story.

 

Obviously, should anything of interest come out of these reports, I’ll post it here as well.

Australian Vaccine Investigation Widens

 

 

# 4525

 

 

 

Last Friday (see Australia Investigating Adverse Vaccine Reactions) we started to get word regarding roughly 60 children in Western Australia who were reportedly sickened within hours of receiving that country’s new trivalent flu vaccine.

 

 

Unlike the monovalent pandemic jab rolled out last fall, this vaccine incorporates antigens to protect against three different flu strains; A/California/7/2009 (H1N1); A/Perth/16/2009-like virus(H3N2); and B/Brisbane/60/2008-like virus.

 

Trivalent vaccines such as this are used every year and have an extraordinarily good safety record.

 

This is the first attempt to combine the novel H1N1 antigen with two seasonal strains. This is also the first year for the incorporation of the new Perth strain of H3N2 in the shot.

 

Strain changes such as these are done almost on a yearly basis, however, and are not normally associated with an increase in adverse effects.

 

 

Public Health officials on Friday called for a temporary halt in the vaccination of under-5s with this new vaccine until the cause could be identified and eliminated.

 

In the ensuing 72 hours the investigation has widened and the number of children identified as having been sickened has increased to more than 250.  Of those, 55 are reported to have experienced convulsions and more than 200 suffered fever and vomiting.

 

There has also been a suspected vaccine-related fatality, that of a 2 year-old who received the vaccine roughly two-weeks ago and died the next day.

 

Based on the wide distribution of cases, authorities believe these children received vaccine from more than one batch.  Testing of vaccine lots is underway. 

 

Beyond that, we’ve no word yet on a possible cause.

 

A round up of reports, therefore, from Australian news sources.

 

 

Police investigate girl's death after flu vaccine

By Siobhan Barry

Updated Sun Apr 25, 2010 10:52am AEST

A two-year-old girl from Upper Mount Gravatt died earlier this month, the day after she was immunised.

 

The death of a two-year-old girl from Brisbane who had received the seasonal flu vaccine will be referred to the Queensland coroner.

(Continue . . . )

 

Flu jab sick toll passes 250

 

West Australia's chief health officer says there are now 251 confirmed cases in the state of children aged under five having adverse reactions to flu vaccinations.

 

Last week the Health Department placed a temporary ban on flu shots for children under five after reports of children getting sick after being vaccinated.

 

The Department says 55 children have had convulsions after being vaccinated while nearly 200 others have suffered fever and vomiting.

 

One child is in a serious but stable condition at Princess Margaret Hospital.

(Continue . . .)

 

Flu vax reactions not from single batch: WHO

Dozens of children in Queensland and Western Australia suffered fevers, vomiting and convulsions after being immunised.

 

That has prompted health authorities to temporarily ban the vaccine for those under five.

 

In Brisbane, a two-year-old girl died a day after receiving the seasonal flu shot.

 

Ian Barr from the World Health Organisation (WHO) influenza centre says the cases involved several different batches of the vaccine.

 

"If it was a single batch then you might think that that might be the case," he said.

 

"If multiple batches are involved then that's less likely I think - but again we still need to wait."

 

 

It is always distressing anytime we get reports of vaccine related injury or illness, but doubly so when it involves children.  

 

As a strong supporter of influenza vaccination, I recognize that vaccines have a very good safety record, but that record is not perfect. Last October, in a blog entitled The Double Edged Sword I wrote:

 

It would be the height of irresponsibility for me, or anyone else for that matter, to insist that vaccines are absolutely 100% safe.  While they have an excellent safety record, there is no such thing as a totally benign drug.

 

Over the next few weeks and months, I fully expect that we will hear about adverse reactions . . . perhaps even deaths, that are potentially linked to flu vaccines.

 

Many of these will probably be coincidental occurrences, but some may in fact be caused by the vaccine.

 

The Australian story (at least for now) appears to be one of those genuine cases of vaccine induced side-effects. The good news here is that most (but sadly, not all) of those affected have apparently recovered.

 

Authorities hope to have a better idea of what is behind these adverse reactions later in the week. 

NVAC To Investigate Incidence Of GBS

 

# 2524

 

 

 

From Rob Stein of the Washington Post today we get a story that indicates that researchers are delving deeper into a possible link between the H1N1 pandemic vaccine and a very slight increase in the incidence of GBS (Guillain Barre Syndrome).

 

The data is preliminary, incomplete, and may yet prove to be unsubstantiated.  But a panel at the HHS’s NVAC (National Vaccine Advisory Committee) has voted unanimously to follow up with further research.

 

First the story from the Washington Post, then a few brief comments.

 

Study hints at H1N1 vaccine complications

Officials: Flu perils still outweigh risk

Sunday,  April 25, 2010 2:56 AM

By Rob Stein

THE WASHINGTON POST

Federal health officials are investigating the first hints of possible significant complications from the H1N1 vaccine, but they've stressed that the concerns probably will turn out to be a false alarm.

 

Officials' latest analysis of data has detected what could be a somewhat elevated rate of Guillain-Barre syndrome, which can cause paralysis and death; Bell's palsy, a temporary facial paralysis; and thrombocytopenia, which is a low level of blood platelets.

 

The data are being collected through five of the networks the government is using to monitor people who were inoculated against H1N1, also known as swine flu.

(Continue . . .)

 

 

Because of the problems experienced 34 years ago with the 1976 swine flu vaccine, doctors, researchers, and a small army of statisticians have been on the lookout for any possible spike in vaccine-related side effects with the 2009 H1N1 vaccine.

 

As with any drug, vaccines have the potential to cause adverse side effects.  There is no such thing as a 100% safe drug.

 

A risk-reward calculation must be made to decide if the benefits of a drug trumps any potential down-side to taking it.  Even over-the-counter medications, like Aspirin and NSAIDS, are known to cause thousands of severe medical complications each year.

 

Here in the United States recipients of this year’s flu vaccine have been under close scrutiny by a number of monitoring programs, including the VAERS (Vaccine Adverse Event Reporting System), the military (with over 1 million personnel getting shots, and intense follow up), and the VSD project (Vaccine Safety Datalink).

Their goal is to look for, analyze, and identify any risks from either the pandemic or the seasonal flu shot.  

 

This is the most scrutiny any influenza vaccination campaign has ever received, and so it isn’t terribly surprising that they are seeing hints of what may be very rare adverse reactions.

 

We’ll have to wait to see what is learned here, but even if a link is determined, it is important to keep things in perspective. 

 

Somewhere between 12,000 and 18,000 Americans likely died from the H1N1 virus over the past year, and most of those were under the age of 65.

 

While the vaccine came too late to prevent many of those fatalities, the vaccination of 80 million Americans is probably at least partially responsible for our not seeing a serious third wave this spring.

 

The vaccine, we can assume, probably saved some number of lives.   How many?   

 

Well . . .  I wouldn’t even want to begin to quantify that.  But I suspect it is a significant number.

If the vaccine is eventually linked to some small increase in the rate of GBS, or any other serous side effect for that matter, that risk must be balanced against the benefits it produced.   

 

And based on what we know right now, those benefits appear substantial.

Referral: Superbug Book Review

 

 

 

# 4523

 

 

A little over a month ago I reviewed Maryn McKenna’s terrific book Superbug: The Fatal Menace of MRSA, and since that time a number of other very positive reviews have been published.    

 

The latest of these appears this morning in DemFromCt’s Daily Kos blog.  Dem is one of the founders of the Flu Wiki, a physician, and a strong public health advocate.

 

Dem includes an interview with Maryn in this morning’s blog.  So I’ll step out of the way and direct you to:

 

 

Book review: Staph Infections Gone Wild

by DemFromCT

Sun Apr 25, 2010 at 05:55:13 AM PDT

Superbug: The Fatal Menace of MRSA
Maryn McKenna
Free Press (Simon & Schuster)
Hardcover, 288 pages, $26.00 list
Kindle Edition $12.99
March, 2010

An Unexpected Dividend

 

 

# 4522

 

 

Long ago, and in a galaxy far, far away . . . I was part of a national effort to immunize the country against a feared swine flu pandemic.  The year was 1976, and after a disastrous vaccination campaign that saw 40 million Americans get vaccinated, the pandemic (thankfully) never materialized.

 

I’ve written about those events several times, including Deja Flu, All Over Again.

 

 

Now it seems that the much-maligned swine flu vaccination of 1976 may be responsible for an enhanced immune response in some individuals against the 2009 novel H1N1 virus.

 

This press release from St. Jude Children’s Research Hospital.

 

Study Links 1976 'Swine Flu' Shot to Stronger Immune Response to 21st Century Pandemic Flu

St. Jude Children's Research Hospital staff helps investigators gauge the lingering impact of the 1976 vaccine

MEMPHIS, Tenn., April 23 /PRNewswire-USNewswire/ -- New evidence shows immunization against "swine flu" in 1976 might provide individuals with some protection against the 2009 pandemic H1N1 influenza virus, according to new research from St. Jude investigators.

 

Researchers found that individuals who reported receiving the 1976 vaccine mounted an enhanced immune response against both the 2009 pandemic H1N1 virus and a different H1N1 flu strain that circulated during the 2008-09 flu season. The work appears in the April 23 online issue of the journal Clinical Infectious Diseases.

 

"Our research shows that while immunity among those vaccinated in 1976 has waned somewhat, they mounted a much stronger immune response against the current pandemic H1N1 strain than others who did not receive the 1976 vaccine," said Jonathan A. McCullers, M.D., an associate member of the St. Jude Infectious Diseases Department and the study's lead author.

 

McCullers said it is unclear if the response was enough to protect against the 2009 H1N1 virus, but the study points to a lingering benefit. The findings also raise hope that those vaccinated against the 2009 H1N1 pandemic strain might also enjoy a similar long-term advantage.

(Continue . . . )

CIDRAP: H1N1 Lessons Learned

 

 

 

# 4521

 

 

Last night CIDRAP (The Center For Infectious Disease Research And Policy) published what they promise will be the first in a series of special reports on lessons learned from the H1N1 pandemic. 

 

Penned by News Editor Robert Roos, this first installment covers a lot of territory, and it well worth your time to read.

 

CIDRAP also maintains some of the best - and most up-to-date - information on the H1N1 pandemic in their overview entitled Novel H1N1 Influenza (Swine Flu).  

 

This is a resource I turn to often.

 

Robert Roos interviews Columbia Virology Professor Vincent Racaniello, Dan Jernigan of the CDC’s Influenza Division, chair of the Department of Preventive Medicine at Vanderbilt University, William Schaffner, MD, chair of IDSA’s pandemic flu task force Andrew Pravia, M.D., and Associate Professor of Medicine and chair of ACIP’s influenza working group Kathleen M. Neuzil, MD, MPH for this piece.

Some of the topics addressed include:

 

Geographic expectations

Wave pattern

Impact on the population

Health system stressed

The clinical picture

Obesity emerges as risk factor

Danger for pregnant women

Other lessons learned

Outlook for next season

Highly recommended. 

 

I’ll just reproduce the opening to the CIDRAP article.  Follow the link to read it in its entirety.

 

 

H1N1 LESSONS LEARNED

Pandemic underscored influenza's unpredictability

Robert Roos News Editor

Editor's Note: This is the first of a series of articles reviewing the world's experience with pandemic H1N1 influenza and what we've learned in the past year. Look for further installments in the days to come.

 

Apr 23, 2010 (CIDRAP News) – A year's experience with the 2009 H1N1 influenza virus has underscored the endless unpredictability of flu.

 

The virus and the resulting illness defied expectations on many levels. It was first detected in North America, not Southeast Asia. Unlike the pathogens that caused previous pandemics, the virus was not a new subtype, but rather an H1N1 strain, making it a cousin of a seasonal flu strain that's been around for decades.

 

Unlike seasonal flu, though, the illness hit children and nonelderly adults much more than people over 65. It was relatively mild for most people, unlike the 1918 flu or the devastating disease associated with H5N1 avian flu, which had heavily shaped pandemic preparations. But it killed far more children and young people than seasonal flu typically does, with the vast majority of deaths involving people younger than 60.

(Continue . . .)

Shakes On A Plane

 

 

# 4520

 

 

 

A couple of news reports in USA Today, and a relevant blog post from Jimmy Jazz at Break Glass  (see Quickly Noted: Proposed Quarantine Regulations Dropped), highlight the difficulties involved in trying to keep potentially infectious individuals from boarding commercial airline flights.

 

 

 

The video above, which as been making the rounds for a couple of years, was made by ZHAW (Zürcher Hochschule für Angewandte Wissenschaften) or The Zurich University of Applied Sciences.

 

It is a simulation (using real data) showing 24 hours of air traffic around the world. 

 

Every year there are more than 17,000,000 commercial airline flights (data from year 2000 - it's probably higher now) that carry hundreds of millions of passengers each year.  

 

And on any given day, some percentage of those passengers are likely to be infected with potentially communicable diseases. And not all of them will be symptomatic.

 

During the initial outbreak of novel H1N, there were demands by many that authorities try to identify and interdict sick passengers in the hope of preventing the spread of the virus. 

 

But as many predicted, and as events later proved, doing so was nigh on impossible.

 

Last June, in Vietnam Discovers Passengers Beating Thermal Scanners, we learned that many passengers were taking Tylenol and other fever reducers prior to flying simply so they would not be detected by thermal scanners and detained.

 

And even before the pandemic outbreak began, we saw studies that questioned the effectiveness of airport screening for pandemic flu, such as Can Island Nations Effectively Quarantine Against Pandemic Flu? and Study: U.S. Airport Entry Screening In Response To Pandemic Influenza.

 

Roughly three weeks ago it was quietly announced that the Obama administration was going to drop sweeping quarantine regulations that the CDC had promoted back in 2006.

 

Obama administration scraps quarantine regulations

Posted 4/1/2010 8:53 PM |

By Alison Young, USA TODAY

The Obama administration has quietly scrapped plans to enact sweeping new federal quarantine regulations that the Centers for Disease Control and Prevention touted four years ago as critical to protecting Americans from dangerous diseases spread by travelers.

 

The regulations, proposed in 2005 during the Bush administration amid fears of avian flu, would have given the federal government additional powers to detain sick airline passengers and those exposed to certain diseases. They also would have expanded requirements for airlines to report ill passengers to the CDC and mandated that airlines collect and maintain contact information for fliers in case they later needed to be traced as part of an investigation into an outbreak.

(Continue . .. )

 

The CDC and the HHS are said to be drafting new recommendations based on lessons learned since those proposals were made.

 

In a related report from yesterday, we learn that the reporting requirements currently in place are apparently not identifying all those who fall ill (or even die) on airline flights in the United States.

 

Review: Many sick airline passengers aren't reported

• By Alison Young, USA TODAY

Hundreds of people at major U.S. airports each year are severely ill with symptoms of potentially contagious diseases, yet few are reported to health officials as intended under U.S. regulations and international guidelines, a USA TODAY review of ambulance records and federal data shows.

 

To detect diseases such as pandemic flu, tuberculosis and measles, federal regulations require airlines to notify health officials of passenger illnesses involving diarrhea or fever plus rash, swollen glands or jaundice. The International Civil Aviation Organization, a United Nations agency, also includes persistent vomiting or coughing in its guidelines.

(Continue . . . )

 

 

Obviously nobody would choose to be seated next to someone shaking with chills, a fever, vomiting, diarrhea, or other such symptoms.  And identifying sick passengers, and following up to see if they presented some sort of a public health threat, makes sense.

 

But the simple truth is that unless you are a hermit, you probably come in daily contact with people carrying all manner of potentially infectious diseases.

Rhinoviruses, adenoviruses, noroviruses, influenza  and even more serious pathogens like Tuberculosis.

 

Some of those people will be symptomatic, while others won’t appear to be ill at all. 

 

No screening process is going to catch them all. And no reporting system is going to identify every sick passenger for CDC follow up.

 

While I wish I could be more optimistic about such interventions, I’m resigned to the fact that whatever is devised is going to be an imperfect solution.