Sandman And Lanard On Pandemic Credibility and Communication

 

 

# 4688

 

 

My thanks and a big hat tip to Crof at Crofsblog  for posting a link to what he rightfully calls the ` absolute must read’ of the day; an in-depth analysis of the World Health Organization’s pandemic communications and the charges of a `fake pandemic’.

 

The “Fake Pandemic” Charge Goes Mainstream and WHO’s Credibility Nosedives

by Peter M. Sandman and Jody Lanard

The extremely long assessment that follows advances an argument we can summarize in a single sentence:

The absurd charge that the World Health Organization (WHO) hyped a fake pandemic in order to enrich Big Pharma has gained undeserved mainstream credibility mostly because WHO has badly mishandled its risk communication about three issues: (a) the mildness of the pandemic (so far); (b) the debatable meaning of the term “influenza pandemic”; and (c) the inevitable – but not culpable – structural conflicts of interest of WHO advisors.

 

(Continue reading . . . )

 

Dr. Peter Sandman is an internationally recognized expert on effective crisis communications, and he along with his wife and colleague  Dr. Jody Lanard produce a wealth of invaluable risk management advice on their website:

 

I’ve highlighted their work on numerous occasions, including:

 

Referral: Risk Communication and Disasters

Peter Sandman: Swine Flu For Grownups

Experts: `Mild’ Is A Misleading Term For This Pandemic

Peter Sandman On Pandemic Risk Communication

Medpedia Launches Rare Disease Community

 

 

 

# 4687

 

Medpedia is an open platform connecting people and information to advance medicine. Medpedia is created in association with Harvard Medical School, the Stanford School of Medicine, The University of Michigan Medical School, the UC Berkeley School of Public Health, and leading health organizations around the world.

For more information, visit Medpedia.com.

 

For nearly a year now my blog (along with many others) have been syndicated through the Medpedia family of news and analysis sites that are mirrored on the Medpedia web portal. 

 

Over the past year the site has been continually expanding its offerings. 

 

In A Medpedia Family Way

Medpedia Unveils 3 New Resources

 

Visitors to the site can browse the various blog feeds by category. You’ll find Avian Flu Diary under the Public Health listings.

 

Browse News & Analysis by Channel

• General Medicine

• Health News

• Health Technology

• Diseases and Conditions

• Science and Research

• Medical Specialties

• Public Health

 

Yesterday Medpedia announced the opening of a new Rare Childhood Disease community.  Since this is something that would be of interest to some of my readers, I’ve reproduced portions of the press release below.

 

By all means, check it out.  And if you haven’t perused Medpedia recently, give it a look.

 

 

 

MEDPEDIA PLATFORM EXPANDS WITH ADDITION OF RARE DISEASE COMMUNITY

RareSpace Leverages Medpedia’s Technology Platform

SAN FRANCISCO, CA (June 29, 2010) –Medpedia today announces RareSpace, an online knowledge sharing platform designed in partnership with the R.A.R.E. Project and the Children’s Rare Disease Network to advance research and share information about the rare childhood diseases that affect 22.5 million American families. This resource is available now on Medpedia at http://www.medpedia.com/communities/274-RareSpace.

 

"RareSpace is a unique and valuable tool for families caring for children with rare diseases," says Jonathan Jacoby, CEO of the R.A.R.E Project. "With the help of Medpedia.com, RareSpace will become a safe place to share important information aggregated from the rare disease community at large, which is vital to finding hope for children."

 

Parents, physicians, medical researchers, patients, advocates and others interested in rare diseases are encouraged to participate in discussions and share information about genetic diseases, innovations in research, standards of care, and best practices in treating rare diseases and disorders. RareSpace also includes translational research and discussions of possible cures for diseases. Medical professionals in RareSpace will answer questions about treatment, best practices, and how to best help these children and their families. Anyone with an interest in rare diseases is invited to join at http://www.medpedia.com/communities/274-RareSpace.

(Continue . . . )

A Side By Side Comparison Of Rapid Influenza Tests

 

 

# 4686

 

 

Of primary interest to clinicians, I suppose, but we’ve a new study showing the wide divergence of sensitivity of RIDTs (Rapid Influenza Detection Tests) sometimes called IRDTs to various strains of influenza A and B – including avian strains.

 

These tests are generally used in doctor’s offices, clinics, and ERs to quickly (less than 30 minutes) test for the influenza virus.  

 

Their accuracy has come under increasing fire over the past couple of years, however.

A few blogs on the subject include:

 

A Tale of Two Headlines

PLoS Currents: Improving Diagnostic Efficiency Of H1N1

No Doesn’t Always Mean No

 

According to the CDC:

The rapid tests vary in terms of sensitivity and specificity when compared with viral culture or RT-PCR. Product insert information and research publications indicate that:

• Sensitivities are approximately 50-70%
• Specificities are approximately 90-95%

 

The two main measures of the accuracy of a diagnostic test are sensitivity and specificity.

• Sensitivity is defined as the ability of a test to correctly identify individuals who have a given disease or condition.

• Specificity is defined as the ability of a test to exclude someone from having a disease or illness.

 

The various RIDTs are designed to show if someone tests positive for the Influenza A or B virus, but not the strain of flu.

 

Today from the Journal of Microbiology, we look at a side-by-side comparison of 20 different IRDTs available in Japan.  

 

Sensitivity of influenza rapid diagnostic tests to H5N1 and 2009 pandemic H1N1 viruses

Yuko Sakai-Tagawa, Makoto Ozawa, Daisuke Tamura, Quynh Mai Le, Chairul A. Nidom, Norio Sugaya, and Yoshihiro Kawaoka

J. Clin. Microbiol. published ahead of print on 16 June 2010, doi:10.1128/JCM.00439-10

 

Abstract

Simple and rapid diagnosis of influenza is useful to treatment decision-making in the clinical setting. Although many influenza rapid diagnostic tests (IRDTs) are available for the detection of seasonal influenza virus infections, their sensitivity for other viruses, such as H5N1 viruses and the recently emerged swine-origin pandemic (H1N1) 2009 virus, remains largely unknown.

Here, we examined the sensitivity of 20 IRDTs to various influenza virus strains, including H5N1 and 2009 pandemic H1N1 viruses. Our results indicate that the detection sensitivity to swine-origin H1N1 viruses varies widely among IRDTs, with some tests lacking sufficient sensitivity to detect the early stages of infection when the virus load is low.

 

 

Viruses tested include seasonal H1N1, seasonal H3N2, seasonal Type B, 16 different (human and avian) H5N1 viruses, H5N2, H5N3, H9N2, H7N7, and 3 clades of pandemic H1N1.

 

You’ll find that that these tests all are not created equally, and that it is important to match the test to the virus you are testing for.   As stated in the report:

 

Our findings emphasize the importance of selecting the right IRDT for rapid diagnosis of non-seasonal
influenza viruses, since the sensitivity of the IRDTs we tested varied by as much as 100-fold.

 

 

Obviously, we are in need of better, more accurate, rapid influenza tests – particularly when it comes to picking up novel or avian strains of the virus.

 

This is a detailed report and well worth reading, particularly if you are involved in the selection of RIDTs for your practice.

Two Reports From Indonesia

 

 

# 4685

 

 

Ida at BFIC – a joint effort between Kobe University in Japan and the Institute of Tropical Disease, Airlangga University, Indonesia – has translations of a couple of recent articles from the Indonesian press regarding two suspected incidents of bird flu.

 

As stated often in this blog, the Indonesian government is less than anxious to discuss their bird flu situation (see Indonesia To Stop Announcing Bird Flu Deaths), and rarely confirms or comments on these media reports.

 

Suspected cases, however, are simply that.   There are a number of diseases to be found in Indonesia that can produce `bird flu-like’ symptoms. 

 

Laboratory confirmation is required before a case can be attributed to the H5N1 virus.   Lab tests for bird flu, however, are not always reliable and multiple tests are required.

 

With that preface in place, the two translated reports from the Bird Flu Information Corner.

 

Boyolali, Central Java ::: A man possibly dies of bird flu

Posted by Ida on June 30, 2010

Boyolali – Syamsudin (27), a resident of Desa Paras, Kecamatan Cepogo, Kabupaten Boyolali allegedly died of bird flu/avian influenza H5N1 infection.

 

Head of Boyolali Health Service, dr Yulianto Prabowo, mentioned patient had been treated in Pandan Arang Boyolali regional public hospital before the death.

 

Patient was diagnosed as bird flu suspect, and  in critical condition that must be referred to Dr. Moewardi hospital in Solo.

 

He died during treatment in Dr Moewardi hospital and diagnosed to have respiratory infection.

 

Previously, hundreds of chickens died in Dukuh Bandung, Desa Beji, Kecamatan Andong, Boyolali. However, officials faced difficulty in diagnosing the cause of death because no dead chickens left for sample.

 

So far, no report of bird flu signs in human, but area monitoring is still ongoing.

Source: Indonesia news office, ANTARA-JATENG.

 

 

This next report concerns the isolation of 4 children who are exhibiting flu-like symptoms after exposure to sick and dying chickens in West Kalimantan.

This province is one of the few in Indonesia that has been certified as bird flu free.  In recent weeks, however, they’ve begun reporting poultry deaths.

 

 

West Kalimantan Province, Indonesia

A week ago we had a report of a 4 year-old hospitalized from this region with suspected H5N1 (see Indonesia: Bird Flu Suspect).  That child, according to this report, tested negative and has been released from the hospital.

 

Pontianak, West Kalimantan ::: 4-year-old negative bird flu. Four other children under isolation

Posted by Ida on June 30, 2010

Pontianak – Following to avian influenza (AI) outbreak in chickens, four people from different areas in Pontianak are under intensive treatment of alleged bird flu infection. Patients were reported to develop fever and flu symptoms after chickens suddenly died around their neighborhood.

 

Patients are being treated in dr Soedarso hospital, Pontianak. A patient has recovered and discharged from hospital, while four patients are still isolated, Ad (10), Ap (15), Da (10) and Wt (9). Da and Wt are cousins, and neighbors of Ap residing in Karya Bhakti street. Ad is resident of Pak Benceng of Pontianak city.

 

Head of Medic and Non-Medic Service Division, Dr Soedarso hospital, Dr Hj Tita Selati said patients had been taken care according standard procedure (protap). “They are isolated and given Tamiflu”, said Tita.

 

In the meantime, patients’ swab samples have been sent to research and development laboratory of Ministry of Health (Litbangkes) in Jakarta for bird flu confirmation.

 

Ap was referred from Gang Sehat public health center and Wt was from Purnama public health center.

 

Previously, Dd (4.5), a bird flu suspect patient in dr Soedarso had been confirmed negative by Litbangkes, and discharged from hospital.

Source: Indonesia local newspaper, Equator News

 

 

Reports such as these come out of Indonesia, and other bird-flu endemic regions, sporadically.  Some will turn out to be H5N1, while others will not.   And it is likely that some cases are never detected.

 

H2H (Human to Human) transmission of the virus remains exceedingly rare, and most of the cases still appear to be due to contract with infected birds.

Still, these reports are a valuable reminder that the H5N1 virus remains active in some parts of the world, and its potential for causing a pandemic sometime in the future has not diminished.

 

My thanks to Ida at the BFIC , and the other newshounds around the world who diligently pour through hundreds of news sources every day looking for obscure items of interest, and then translating and posting them.

USDA: Food Safety When The Power Goes Out

 

 

 

# 4684

 

 

With hurricane conditions possible along the south Texas coast in roughly 36 hours, a lot of people may find themselves without electrical power for hours or possibly even days.  

 

And when that happens some of the food that people have in their homes can go bad quickly.   Particularly during the heat of summer.

 

The USDA maintains a Food Safety and Inspection website with a great deal of consumer information about how to protect your food supplies during an emergency, and how to tell when to discard food that may no longer be safe to consume.

 

 

First, an audio podcast (5 minutes).

 

Surviving a Power Outage: Don't Be in the Dark When it Comes to Food Safety (Jun 2, 2010; 4:45) | Script
FSIS Food Safety staff discusses tips on how to be food safe during a power outage.

 

 

Next, an extensive fact sheet on food safety during an emergency, such as a hurricane, flood, or earthquake.

 

Keeping Food Safe During an Emergency

Did you know that a flood, fire, national disaster, or the loss of power from high winds, snow, or ice could jeopardize the safety of your food? Knowing how to determine if food is safe and how to keep food safe will help minimize the potential loss of food and reduce the risk of foodborne illness. This fact sheet will help you make the right decisions for keeping your family safe during an emergency.

 

ABCD’s of Keeping Food Safe in an Emergency

Always keep meat, poultry, fish, and eggs refrigerated at or below 40 °F and frozen food at or below 0 °F. This may be difficult when the power is out.

Keep the refrigerator and freezer doors closed as much as possible to maintain the cold temperature. The refrigerator will keep food safely cold for about 4 hours if it is unopened. A full freezer will hold the temperature for approximately 48 hours (24 hours if it is half full) if the door remains closed. Obtain dry or block ice to keep your refrigerator as cold as possible if the power is going to be out for a prolonged period of time. Fifty pounds of dry ice should hold an 18-cubic foot full freezer for 2 days. Plan ahead and know where dry ice and block ice can be purchased.

(Continue . . . )

 

You’ll also find numerous charts (like the one below) showing different food items, and how to know when they must be discarded.

 

 

 

It doesn’t require a major disaster like a Hurricane to knock out the power to your home for 24 hours or longer.  A strong thunderstorm is perfectly capable of taking down power lines.

 

So whether you are in the path of a storm or not, it’s not such a bad idea to visit this site and glean what you can while the power is still on.

It’s In The Bag

 

 

 

# 4683

 

 

About a year ago I bought a few of those light weight reusable grocery bags and I’ve tried to to get in the habit of taking them to the store with me.   

 

Admittedly, I haven’t always remembered.

 

Although I liked the concept, my ardor dimmed somewhat early on when a package of raw chicken `leaked’ into the bag on the way home.  Since then, I’ve mainly used these reusable bags for canned or boxed goods.

 

Today we’ve a report on studies conducted by two universities suggesting that these reusable bags – while eco-friendly – may harbor dangerous bacteria.

 

First this report from The University of Arizona News, then the abstract and a link to the study.

 

Reusable Grocery Bags Contaminated With E. Coli, Other Bacteria

These are some of the dozens of grocery bags that were tested for contamination during the study.

These bags may be friendly to the environment, but not necessarily to you, according to a new report by researchers at two universities.

By University Communications June 24, 2010

Reusable grocery bags can be a breeding ground for dangerous food-borne bacteria and pose a serious risk to public health, according to a joint food-safety research report issued today by the University of Arizona and Loma Linda University in California.

 

The research study – which randomly tested reusable grocery bags carried by shoppers in Tucson, Los Angeles and San Francisco – also found consumers were almost completely unaware of the need to regularly wash their bags.

 

"Our findings suggest a serious threat to public health, especially from coliform bacteria including E. coli, which were detected in half of the bags sampled," said Charles Gerba, a UA professor of soil, water and environmental science and co-author of the study. "Furthermore, consumers are alarmingly unaware of these risks and the critical need to sanitize their bags on a weekly basis."

 

Bacteria levels found in reusable bags were significant enough to cause a wide range of serious health problems and even death. They are a particular danger for young children, who are especially vulnerable to food-borne illnesses, Gerba said.

(Continue . . .)

 

The report is titled:

 

Assessment of the Potential for Cross Contamination of Food Products by Reusable Shopping Bags

Charles P. Gerba, David Williams and Ryan G. Sinclair

 

Abstract (Reparagraphed for readability)

Most foodborne illnesses are believed to originate in the home. Reuse of bags creates an opportunity for cross contamination of foods. The purpose of this study was to assess the potential for cross contamination of food products from reusable bags used to carry groceries.

 
Reusable bags were collected at random from consumers as they entered grocery stores in California and Arizona. In interviews it was found that reusable bags are seldom if ever washed and often used for multiple purposes. Large numbers of bacteria were found in almost all bags and coliform bacteria in half. 

Escherichia coli were identified in 12% of the bags and a wide range of enteric bacteria, including several opportunistic pathogens. When meat juices were added to bags and stored in the trunks of cars for two hours the number of bacteria increased 10-fold indicating the potential for bacterial growth in the bags.

Hand or machine washing was found to reduce the bacteria in bags by >99.9%. These results indicate that reusable bags can play a significant role in the cross contamination of foods if not properly washed on a regular basis. It is recommended that the public needs to be educated about the proper care of reusable bags by printed instructions on the bags or through public service announcements

WAHID Notification Of Russian H5N1

 

 

# 4682

 

 

Eleven days ago I wrote about the discovery of wild bird deaths from an unspecified (but likely H5N1) avian flu, along the Russian-Mongolian border at Uvs Nuur lake.

 

 

Over the past couple of days Russian authorities have submitted two reports to the OIE’s  WAHID (World Animal Health Information Database) Interface.

 

• Immediate notification (25/06/2010)
• Follow-up report No. 1 (28/06/2010)

 

As expected, the laboratory testing has come back positive for highly pathogenic H5N1  and the total number of dead birds recovered is now 367.

 

Species affected included Great Crested Grebe (Podiceps cristatus), Goosander (Mergus merganser), Grey Heron (Ardea cinerea), Gadwall (Anas strepera), Eurasian Spoonbill (Platalea leucorodia).

 

This is the third die off of birds due to H5N1 in this region since 2006. 

 

A reminder that, while we don’t often read about it, avian flu continues to circulate in the wild. 

Tripura Follow Up

 

 

# 4681

 

 

We’ve a little more information  this morning about the events in Tripura, India where 20 or more people have recently died from a `mysterious illness’ (see Newshounds Watching Tripura).

 

According to a news report today, Tripura’s Health Minister Tapan Chakraborty is describing this as an ARI (Acute Respiratory Infection), and giving the number of deaths as approximately 24 (with 17 of them children).

 

The cause of the respiratory infection isn’t stated, although an investigation is promised. 

 

For now, the debate seems to have centered around political infighting and affixing blame for the spread of the illness. 

 

Which leaves us – for the time being - not knowing whether this outbreak is due to a pneumonia, an influenza, or perhaps some other respiratory pathogen (RSV, Parainfluenza, metapneumovirus, etc.).

 

These reports come via Alert on FluTrackers.

 

ARI claims 24 lives in Tripura

Agartala | Tuesday, Jun 29 2010 IST

At least 24 people have lost their lives since the past fortnight following sudden spread of acute respiratory infection (ARI) in remote Kangrai hamlet under North Tripura along Tripura-Mizoram border.

 

Health Minister Tapan Chakraborty said according to hospital records, 24 people had died so far and 50 others were admitted with ARI complications, adding that there was a possibility of few more unrecorded deaths outside the hospital. Unofficial reports said 28 people, including 17 children, had died.

 

The minister said initial investigation revealed that the deaths occurred due to failure of the health officials to contain the disease in the area and village panchayats were also to be blamed for their careless attitude.

 

''We are giving our best efforts to control the situation and we have launched investigation into the cause of spread of the disease and all the accused authorities will be dealt with as per law,'' Mr Chakraborty said.

 

(Continue . . .)

 

And this from the Tripura Times.

 

Health Minister holds meeting with officials
Kangrai incident to rock Assembly today
Times News

(EXCERPT)

Mr. Nath has already demanded resignation of Health Minister for his alleged failure to check the outbreak of the mysterious disease.The outbreak of mysterious disease that has so far claimed 26 lives has pushed the government in an awaked situation keeping in view of the Assembly session.

 

The deaths of mysterious disease have exposed the poor health service in the rural areas like Kangrai. Sources said, the treasury bench has also envisaged strategy on how the tackle the opposition members in the Assembly tomorrow.It has been learnt that Health Minister held a meeting with senior Health department officials where he was briefed about the steps taken by the department to tackle the situation.The steps include setting up of a special sub-centre, engagement of a paediatrician at Kanchanpur hospital and house to house surveillance in the entire subdivision.

 

The government today formally informed the Ministry of Health and Family Welfare about the outbreak of Respiratory Tract Infection (RTI) at Kangrai in Kanchanpur subdivision. The outbreak of RTI has claimed 14 lives, according to an official of Health department.

 

Obviously, we’ll watch with interest to see what is determined to be the infectious agent in this case.

That Uncertain Feeling

 

 

 

 UPDATED 10:00 hrs EDT

 

The NHC has issued a Hurricane WATCH in effect for the Gulf coast of Texas from Baffin Bay south to the Rio Grande.  Mexico has issued a hurricane watch extending south from the Rio Grande.

 

The forecast track has been moved slightly further north with this latest advisory.

 

 

 

# 4680

 

Tropical Storm Alex, has cleared the Yucatan and is back out over open (and very warm) water.   His projected path at this hour is less than certain, with some fairly wide divergence among the computer models.

For now, as of 5am EDT, this is the forecast track. 

 

Pay attention to the entire `cone’, as landfall could occur late this week in either Mexico or south/central Texas.

 

 

A few minutes ago Craig Fugate (@CraigatFema), director of FEMA, tweeted:

 

Alex could become a Hurricane today or Tuesday Residents along the South Texas Coast should monitor the storm's progress. www.hurricanes.gov 

 

Good advice, as Alex stayed remarkably intact as it passed over Yucatan, and regained tropical storm status very quickly once it emerged. Conditions are favorable for intensification, and Alex could potentially become a major hurricane over the next couple of days.

The computer models are inconsistent right now, and so the confidence in this projected track is less than 100%. 

 

A few snippets from this morning’s 5am EDT (4am CDT) NHC discussion include:

 

...THERE IS STILL CONSIDERABLE DIVERGENCE IN THE FORECAST TRACKS...ESPECIALLY AFTER 48 HOURS.

FOR THE NEXT 2 DAYS OR SO...THE MODELS ARE IN GENERAL AGREEMENT ON A SLOW  NORTHWESTWARD MOTION. AFTER THAT...THE GFS...GFS-PARALLEL... CMC...HWRF...AND GFDL MODEL KEEP ALEX ON A NORTHWESTWARD TRACK AND BRING THE CYCLONE INLAND ALONG THE LOWER OR CENTRAL TEXAS COAST. IN CONTRAST ...THE ECMWF...UKMET...AND NOGAPS MODELS TAKE ALEX WESTWARD INTO THE NORTHEASTERN COAST OF MEXICO...

GIVEN THAT ALEX IS EXPECTED TO BE A RELATIVELY LARGE HURRICANE BY 72 HOURS ... GREATER WEIGHT WAS PLACED ON THE OTHER MODEL SOLUTIONS...

 

Hurricane warnings will go up about 48 hours before the storm is expected, but this isn’t too soon for Gulf Coast residents from Mexico to Texas to be reviewing their hurricane plans and getting ready.

 

Some essential hurricane resources to get you started include:

 

http://www.fema.gov/hazard/hurricane/index.shtm

http://www.ready.gov/america/beinformed/hurricanes.html

You may wish to revisit my blog entitled Hurricane Resources On The Net for links to storm resources online.

Newshounds Watching Tripura

 

 

# 4779

 

 

 

Three days ago Shiloh on FluTrackers posted an article from The Hindustan Times on a deadly outbreak of a `mystery disease’ in the northeastern Indian state of Tripura that had reportedly claimed the lives of 20 children.

 

 

Unknown diseases kill 20 kids in Tripura
Indo-Asian News Service
Agartala, June 25, 2010
 
Last Updated: 16:15 IST(25/6/2010)

At least 20 children have died in the past 10 days following the outbreak of various unknown viral and tropical diseases in a remote tribal-dominated village in Tripura, officials in Agartala said on Friday.

 

"The children mostly died at their homes in remote Kangrai tribal village along the Tripura-Mizoram border in northern Tripura," doctors and officials who visited the affected areas told reporters at divisional headquarters Kanchanpur.

 

Many other children and elders also fell ill. Some were admitted to the sub-divisional hospital.

(Continue . . .)

 

 

Reports of `mystery fevers’ and illness are common out of India and surrounding countries as many villages are remote, and without adequate medical care.  

 

Often, assuming we do get a diagnosis, these outbreaks are attributed to Japanese Encephalitis, Malaria or some other vector borne disease that is endemic in the region. Sometimes food poisoning or a tainted water source is blamed.

 

Occasionally, in this part of the world, outbreaks of something more exotic occur, such as the Nipah virus. And while no human cases have been recorded in India as yet, this is also an area that has seen H5N1 in poultry.

 

So naturally, the newshounds are paying attention to reports of any `mystery disease’ out of that region.

 

Over the last 72 hours Alert, Treyfish, Ironorehopper, and RoRo have all added to this ongoing thread on Flutrackers, with more than a dozen additional reports from various news outlets.

 

The reports are somewhat confused and conflicting, with various estimates of deaths ranging from 24 to nearly 100.  The symptoms described are too vague to allow much speculation as to the cause.

 

ProMed Mail  was notified, and they’ve printed several of these reports and issued an RFI (Request for Information) as well.   I’ve excerpted their comment below.

 

 

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

<SNIP>

 

The description of the symptoms of the illness is not sufficiently precise to indicate whether this outbreak has been caused by a novel pathogen such as Nipah virus or a more familiar agent such as avian (H5N1) or pandemic (H1N1) influenza virus, Japanese encephalitis virus, or malaria which may be prevalent in the area, or a combination of agents. ProMED-mail would welcome any additional information from the region.

 

Regardless of what ends up being the cause of this outbreak, this is illustrative of the terrific work being done by the volunteer newshounds on the flu forums.

 

They spend countless hours searching hundreds of newsfeeds every day, looking for any hint of an unusual outbreak of a disease in humans or animals.  And they do this not only in English, but in dozens of other languages as well. 

 

I’ve written often of my gratitude to these tireless troops.  I literally couldn’t do half what I do without their efforts.

 

For more on how they go about their formidable task, you might wish to read Newshounds: They Cover The Pandemic Front.

 

When we get more information, I’ll try to update it here.  But to follow in real time, you may wish to check on this FluTrackers thread.

EID Journal: Transmission Of Bird Flu In Egypt

 

 

# 4678

 

 

In terms of total numbers of reported human H5N1 infections, Egypt ranks 3rd in the world with 109 cases, led by Indonesia (n=165) and Vietnam (n=119).

 

 

With a current CFR (case fatality ratio) of 31%, Egypt’s fatality rates substantially lower than that seen in Vietnam (50%) and Indonesia (82%).

 

While there may be some subtle differences in the virus circulating in Egypt, much of the credit for this lower fatality rate has been given to earlier hospitalization and treatment.

 

This month’s CDC’s EID journal has an in depth look at the epidemiology of H5N1 transmission in Egypt through March of 2009.   This covers the first 63 human cases. 

 

Since that time, there have been more than 40 additional cases, so some of the statistics have changed a bit.

 

First the link and abstract, then a little discussion.

 

 

Volume 16, Number 7–July 2010

Research

Zoonotic Transmission of Avian Influenza Virus (H5N1), Egypt, 2006–2009

 

Amr Kandeel, Serge Manoncourt, Eman Abd el Kareem, Abdel-Nasser Mohamed Ahmed, Samir El-Refaie, Hala Essmat, Jeffrey Tjaden, Cecilia C. de Mattos, Kenneth C. Earhart, Anthony A. Marfin, and Nasr El-Sayed

Abstract

During March 2006–March 2009, a total of 6,355 suspected cases of avian influenza (H5N1) were reported to the Ministry of Health in Egypt. Sixty-three (1%) patients had confirmed infections; 24 (38%) died.

 

Risk factors for death included female sex, age >15 years, and receiving the first dose of oseltamivir >2 days after illness onset. All but 2 case-patients reported exposure to domestic poultry probably infected with avian influenza virus (H5N1). No cases of human-to-human transmission were found.

 

Greatest risks for infection and death were reported among women >15 years of age, who accounted for 38% of infections and 83% of deaths. The lower case-fatality rate in Egypt could be caused by a less virulent virus clade. However, the lower mortality rate seems to be caused by the large number of infected children who were identified early, received prompt treatment, and had less severe clinical disease.

 

 

As the title of this report indicates, the transmission of the virus in Egypt thus far has been solely attributed to infected poultry.  

 

No H2H (Human-to-Human) transmission has been identified.

 

The virus has become endemic in Egyptian poultry since its arrival in 2006.  Many households raise chickens for food, and as  an income source, and tending the birds is usually a job for young females in the family.

 
A demographic breakdown of victims shows that females outnumber males, and 97% of victims are under the age of 50.

 

Most telling is that 87% of the fatal cases were among females.

 

(Click to enlarge)

 

The `seasonality’ of infection is clearly shown in the chart below, with the winter and spring seeing the greatest number of cases.

 

 

 

While this distribution map shows that the bulk of the infections have occurred in northern Egypt.

 

The early administration of Tamiflu has been credited with better outcomes in Egyptian cases, and this report provides some compelling observational data as to its efficacy.

 

Of 58 patients for whom complete data for oseltamivir was available, 25 (43%) received their first dose <48 hours after illness onset; all but 1 survived.

 

Median duration of treatment was 8 days (range 1–37 days). The first dose of oseltamivir was more likely to be delayed for adults. Twenty (80%) of 25 adults had a delay before receiving oseltamivir compared with 13 (39%) of 33 children (p = 0.005).

 

Conversely, late hospitalization and the administration of Tamiflu was associated with greater mortality.

 

Eighteen (90%) of 20 adults whose first oseltamivir dose was delayed died compared with 1 (20%) of 5 adults whose first oseltamivir dose was not delayed (p = 0.005). None of 20 children who received oseltamivir <48 hours of illness onset died compared with 1 (8%) of 13 children whose first dose was delayed.

 

(Click to enlarge)

It should be noted that early hospitalization provides other benefits besides Tamiflu (i.e. antibiotics, rehydration, antipyretics, nursing care, etc), and so some of these better outcomes may be due to factors other than just the early administration of antivirals. 

 

Even with the faster, more modern medical care available in Egypt, a CFR of over 30% for influenza is still appalling. 

 

The great pandemic of 1918 was estimated to have a CFR of between 2.5% and 5.0%.

 

Since the cut off date of this report (Mar 2009), the percentage of younger victims has gone up, while the CFR has decreased from 38% down to about 31%.

 

And once again we appear to be in the summer lull of human infections, with no new reports since April.

 

This is an excellent overview of the progression of H5N1 infection in Egypt, and well worth reading in its entirety.

HPA Conference: Pandemic Lessons Learned

 

 

# 4677

 

 

Last week the UK’s Health Protection Agency convened a two-day conference in London where scientists, academics and clinicians gathered to examine lessons learned from the pandemic of 2009.

 

You can view the program  for the conference, along with bios of the presenters, here.

 

From the Emerging Health Threats Forum we get the following report, with extensive comments and reactions from Angus Nicoll of the European Centre for Disease Prevention and Control (ECDC).

 

 

 

 

Pandemics: Europe looks ahead

Friday 25 June 2010

ECDC expert evaluates flu response, identifies weaknesses that need to be tackled for next time

 

From a European perspective “it’s hard to think of a better pandemic”, says Angus Nicoll of the European Centre for Disease Prevention and Control (ECDC). Many features of the 2009 pandemic were in Europe’s favour, he says, but adds there are still lessons to be learned about the public health responses countries planned and how well they worked.

 

Speaking at a UK Health Protection Agency conference about the public health response this week, Nicoll says that on balance, Europe managed the pandemic “moderately” well, but that countries were “lucky it was the pandemic it was.”

 

He described the advantages Europe had in tackling the pandemic — that the pandemic virus emerged in Central America from pigs, and was not a variant of the deadly Asian bird flu virus that many had feared, he explained.

(Continue . . .)

CDC: International Flu Trends

 

# 4676

 

 

While overall reporting of influenza around the world is low, there remain areas where pandemic H1N1 and/or seasonal flu strains are still circulating.   

 

The CDC  doesn’t normally publish their FluView report during the summer months, but they do keep track of the International flu situation using data provided by the World Health Organization.  

 

Perhaps the most interesting facet is the continuing persistence of H3N2 in some African and South American reports.

 

First a graphic showing selected global trends for the 1st half of June, then some excerpts from this week’s update follow:

 

 

2009 H1N1 continues to actively circulate in the Caribbean, West Africa, and South and Southeast Asia. In the Southern Hemisphere, the proportion of influenza A (H3N2) viruses detected continues to increase and has exceeded reports of 2009 H1N1. In the Northern Hemisphere, the number of influenza B viruses detected has exceeded reports of 2009 H1N1.

 

Low levels of 2009 H1N1 influenza activity continue to be reported from Cuba and Colombia. 2009 H1N1 activity is increasing in Southern regions of India and circulating at low levels in several countries in Southeast Asia. Influenza type B is actively circulating in Central and Southern regions of Africa and is currently co-circulating with 2009 H1N1 in Bangladesh.

 

Influenza A (H3N2) and influenza type B viruses have been reported in South Africa, and influenza A (H3N2) viruses continue to be reported in East Africa. Sporadic seasonal and 2009 H1N1 influenza viruses have been detected in Australia and New Zealand. 

Selected Highlights

• According to WHO, the majority of 2009 H1N1 virus isolates tested worldwide remains sensitive to oseltamivir, an antiviral medicine used to treat flu. Among 2009 H1N1 isolates tested worldwide, 298 have been found to be resistant to oseltamivir – as of May 28, 2010, 67 of these isolates were detected in the United States. Approximately 1% of U.S. 2009 H1N1 viruses tested by CDC since September 1, 2009, have been resistant to oseltamivir.
• Influenza B continues to predominate in many countries of the Northern Hemisphere, including China (69.8% of all influenza detections) and the Russian Federation (93.7%).
• Influenza A (H3N2) activity persists and continues to increase in several countries of East Africa.
• On February 18, 2010, WHO published recommendations for the following viruses to be used for influenza vaccines in the 2010-2011 influenza season of the Northern Hemisphere:
  • an A/California/7/2009 (H1N1)-like virus;
  • an A/Perth/16/2009 (H3N2)-like virus*;
  • a B/Brisbane/60/2008-like virus.

Birds Of A Feather . . . .

 

 

 

# 4675

 

 

Yesterday Scott McPherson took a fascinating look at the role of of terrestrial wild birds (as opposed to waterfowl) in the spreading of various avian influenzas across the United States (see Songbirds, not just fowl, represent avian flu threat to US).

 

This morning, we’ve new research (that appeared yesterday) in PLoS One, suggesting that waterfowl may be acquiring and spreading avian flu viruses because their preening oils bind the virus to their feathers.

 

The persistence of avian flu viruses in bodies of water has been demonstrated in the past (Persistence of H5 and H7 avian influenza viruses in water  and  Persistence of avian influenza viruses in water).

 

Under the right conditions, the virus can remain viable for days or even weeks.

 

While avian influenza surveillance efforts among wild birds have concentrated on cloacal and tracheal samples, this research suggests that the additional step of sampling bird’s feathers might yield additional positives.

 

First, excerpts from the press release (slightly reparagraphed for readability), then a link to the PLoS One  Article.

 

 

 

Bird flu: In the plumage the secret of virus spread success

Today in PLoS ONE

International team of Italy-US scientists reports discovery of a new mechanism of avian influenza virus circulation and transmission in nature

 

A team of scientists, led by Mauro Delogu, virologist from the Veterinary Faculty of the Bologna University and researchers from the Istituto Superiore di Sanità, Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia and St. Jude Children's Research Hospital (Memphis, Tennessee) have discovered a new way of avian influenza transmission.

 

<SNIP>

The scientists actually discovered that the preen oil gland secretions, by which all aquatic birds make their feathers waterproof, support a natural mechanism that concentrates AIVs from water onto birds' bodies. They found that a progressive virus "sticking" on feathers occurs because AIV-contaminated waters interact with the preen oil gland secretion.

 

Since waterbirds use to spread preen oil over their own (self-preening) or other birds' (allo-preening) plumage, it is easily understandable how these preening activities could facilitate the diffusion of the viruses in nature.

 

The discovery, adds Delogu, has also important implications in the surveillance of avian influenza viruses.

 

In fact, virus on feathers could escape detection by the current surveillance strategies which assay the virus secreted in the cloacal and tracheal samples only. Lack of detection of these viruses may greatly complicate surveillance and rapid responses to new virus emergence and spread. For this reason, Delogu said, in routine surveillance programs, additional sampling methods could be necessary to detect AIVs on birds' bodies.

(Continue . . . )

 

 

The PLoS One  link and abstract follow:

 

Can Preening Contribute to Influenza A Virus Infection in Wild Waterbirds?

 

Mauro Delogu, Maria A. De Marco, Livia Di Trani, Elisabetta Raffini, Claudia Cotti, Simona Puzelli, Fabio Ostanello, Robert G. Webster, Antonio Cassone, Isabella Donatelli

Abstract

Wild aquatic birds in the Orders Anseriformes and Charadriiformes are the main reservoir hosts perpetuating the genetic pool of all influenza A viruses, including pandemic viruses. High viral loads in feces of infected birds permit a fecal-oral route of transmission.

 

Numerous studies have reported the isolation of avian influenza viruses (AIVs) from surface water at aquatic bird habitats. These isolations indicate aquatic environments have an important role in the transmission of AIV among wild aquatic birds.

 

However, the progressive dilution of infectious feces in water could decrease the likelihood of virus/host interactions. To evaluate whether alternate mechanisms facilitate AIV transmission in aquatic bird populations, we investigated whether the preen oil gland secretions by which all aquatic birds make their feathers waterproof could support a natural mechanism that concentrates AIVs from water onto birds' bodies, thus, representing a possible source of infection by preening activity.

 

We consistently detected both viral RNA and infectious AIVs on swabs of preened feathers of 345 wild mallards by using reverse transcription–polymerase chain reaction (RT-PCR) and virus-isolation (VI) assays. Additionally, in two laboratory experiments using a quantitative real-time (qR) RT-PCR assay, we demonstrated that feather samples (n = 5) and cotton swabs (n = 24) experimentally impregnated with preen oil, when soaked in AIV-contaminated waters, attracted and concentrated AIVs on their surfaces. The data presented herein provide information that expands our understanding of AIV ecology in the wild bird reservoir system.

ACIP Adjusts Pediatric Flu Vaccine Recommendations

 

 

# 4674

 

 

Yesterday ACIP  (the CDC’s Advisory Committee on Immunization Practices) made a small adjustment to this fall’s seasonal flu vaccine recommendations for children under the age of 10.

 

In a non-unanimous decision (10-5), the panel voted that children who didn’t receive at least one dose of the H1N1 pandemic vaccine last year should receive two doses of the trivalent seasonal vaccine this year.

 

Those that already received the monovalent H1N1 vaccine would only need one shot. 

 

Lisa Schnirring of CIDRAP has the details, along with some information on studies being conducted by the CDC  on CSL’s trivalent vaccine which produced an unusually high number of side effects (mostly fever) in Australian children under the age of five.

 

CDC advisors tweak seasonal flu vaccine advice for young kids

Lisa Schnirring Staff Writer

Jun 24, 2010 (CIDRAP News) – Aiming to close some of the gaps in protection against the pandemic H1N1 virus expected to circulate this fall, a federal vaccine advisory group today recommended that children aged 6 months to 9 years who haven't received at least one dose of monovalent pandemic vaccine receive two doses of the upcoming season's trivalent vaccine.

 

The Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) made the recommendation at its meeting today after seeing the most recent immunogenicity data for the pandemic vaccine. Though it was 62% protective among all age-groups after one dose, rates were lower in younger children. Some CDC experts said this supports the recommendation for a 2-dose, prime-boost pandemic immunization strategy for children 6 months to 9 years old.

(Continue . . .)

EID Journal: Swine Flu Reassortants In Pigs

 

 

 

# 4673

 

 

Most scientists believe that the two main ways that flu viruses mutate, change, or evolve are by either antigenic drift or by antigenic shift.

 

Drift occurs when when flu viruses make replication errors.  

 

When a flu virus invades a host cell, it makes numerous of copies of itself, and after a few hours, those thousands of `offspring’ then burst out of the cell and move on to infect other cells.

 

Sometimes, however, errors creep into the duplication process.

 

If these errors result in a biologically fit virus that can compete successfully against the parent strain, we see a viable mutation.

 

Antigenic Drift is an incremental change and happens more or less continually.

 

It explains why the flu vaccine we used last year may not be protective against the same virus this year.  And why immunity you gained from your last bout with flu may not protect you today.

 

Bigger, more abrupt changes come about through antigenic shift, which can occur when a novel virus makes a direct jump from another species to humans or (more likely) a reassortment of two flu viruses occurs in a host animal resulting in a new hybrid virus.

 

While rare, as any virologist will tell you.   Shift Happens.

 

 

 

This is the process that, after having been compounded several times over a number of years in host pigs, resulted in the H1N1 `swine’ flu pandemic virus of 2009.

 

And while any susceptible host has the potential to serve as a `mixing vessel’ for influenza viruses, pigs appear particularly well adapted for this role.

 

Pigs are susceptible to many human, swine, and avian strains of flu and are in frequent contact with humans, which increased their chances of acquiring and passing on infection.

 

 

While reassortment is a frequent topic in this blog, a few notable stories from the past six months include:

 

• Last week the big news was a study out of Hong Kong on the reassorted 2009 H1N1 virus detected in a Chinese pig  (see H1N1 Reassortment In Swine).

• In February we saw research that showed that the H3N2 seasonal virus could reassort with the H5N1 `bird flu’ virus, and produce virulent hybrids (see PNAS: H3N2 And H5N1 Reassortment) under laboratory conditions.

• In January we learned (via Helen Branswell) of a single human infection by a novel H3N2 swine flu virus in Iowa (see H3N2 Swine Flu)

 

All of which lays some foundation for a study which appears in the latest issue of the CDC’s EID Journal titled:

 

Novel Swine Influenza Virus Reassortants in Pigs, China

DOI: 10.3201/eid1607.091881

Yuhai Bi, Guanghua Fu, Jing Chen, Jinshan Peng, Yipeng Sun, Jingjing Wang, Juan Pu, Yi Zhang, Huijie Gao, Guangpeng Ma, Fulin Tian, Ian H. Brown, and Jinhua Liu

 

 

The abstract is disarmingly short.

 

Abstract

During swine influenza virus surveillance in pigs in China during 2006–2009, we isolated subtypes H1N1, H1N2, and H3N2 and found novel reassortment between contemporary swine and avian panzootic viruses. These reassortment events raise concern about generation of novel viruses in pigs, which could have pandemic potential.

 

 

A few excerpts flesh this out a little better. First, this is how the research was conducted.

 

During December 2006–February 2009 in the People's Republic of China, 3,546 samples from 3 main swine industry provinces—Fujian (765 samples), Guangdong (1,276 samples), and Shandong (1,505 samples)—were collected for influenza surveillance. Nasal and tracheal swab samples were collected from apparently healthy domestic pigs at abattoirs. Virus isolation and identification were performed as described (3).

 

Of 29 strains of influenza A virus obtained, 19 were subtype H1N1, 1 subtype H1N2, and 9 subtype H3N2. Subtype H1N2 was isolated from diseased pigs in Guangdong Province in 2006; the others were isolated from healthy pigs. Isolation rates for subtypes H1N1 and H3N2 were 0.54% and 0.25%, respectively, indicating that subtype H1N1 viruses were predominant in the sampled pig population.

 

And here are the author’s conclusions (slightly reformatted for readability).

 

Conclusions

Influenza A subtypes H1N1, H1N2, and H3N2 viruses co-circulate in China. Genetic analysis showed that the single subtype H1N2 virus and all subtype H3N2 viruses examined were either double- or triple-reassortant viruses, which have been rarely documented in China.

 

Finding a gene fragment ostensibly of highly pathogenic avian influenza (H5N1) virus in a subtype H3N2 virus implies that subtype H5N1 viruses may be able to contribute genes to virus pathogenic processes in pigs. Moreover, European avian-like swine (H1N1) virus undergoes reassortment with avian (H9N2) viruses.

 

Some researchers have hypothesized that pigs may serve as hosts for genetic reassortment between human and avian influenza viruses (4). Our results show that subtypes H3N2 and H1N2 and 1 European avian-like swine (H1N1) virus were all derived from relatively recent reassortment events.

 

The gene fragments of the subtype H3N2 viruses comprised those of human subtype H3N2 (A/Victoria/75-like and A/Moscow/99-like) and the strains H1N1 classical swine, Eurasian H5N1, and H9N2 avian.

 

Infection of pigs with avian H5N1 and H9N2 viruses in China has been reported, and swine H1 and H3 viruses appear widely established in the pig population in China and elsewhere in Southeast Asia (5–9). These findings raise more questions about the generation of novel viruses, which may have zoonotic potential, in pigs.

 

Pandemic (H1N1) 2009 virus probably resulted from reassortment of recent North American influenza subtypes H3N2 and/or H1N2 swine viruses with Eurasian avian-like swine viruses (2).

 

The current situation, therefore, presents continued risk for further reassortment of swine influenza virus in pig populations and continued spread of pandemic (H1N1) 2009 virus to pigs worldwide. Systematic influenza virus surveillance in pigs is needed in China.

 

Obviously, the detection of 29 strains of influenza A – including numerous double and triple reassortant viruses – is a worrisome finding, and discovery of fragments of avian flu viruses in some of these strains only compounds the concern.

 

Nature’s laboratory is open 24/7 - and unlike public health, scientific research, and surveillance programs - operates without budgetary constraints.

 

Which is why better surveillance (and funding) is needed if we hope to detect, and possibly head off, the next influenza pandemic before it jumps to humans.

California: Pertussis Epidemic

 

# 4672

 

 

Pertussis, or `Whooping Cough’ is a highly contagious bacterial infection that can cause serious illness and even death.  Although it is thought of as a `childhood’ disease, anyone of any age can catch it.

 

It is caused by either Bordetella pertussis or Bordetella parapertussis bacteria, which are easily spread through the air by the characteristic violent coughing spasms it induces.

 

Infection can last for 6 weeks or longer.  Any anyone who has had it can tell you it is miserable.

 

Prevention is by vaccination.  

 

 

The DTaP vaccine is one of the recommended childhood immunizations that protects against Diphtheria, Tetanus, and Pertussis. 

 

The CDC has a simple, 2-page pamphlet on the DTaP vaccine.

 

Adults, and children over the age of 10, should get the Tdap booster vaccine every 10 years.

 

 

Unfortunately, some people have either refused vaccines for themselves or for their children (or failed to get them) - or in the case of a lot of adults - simply don’t think about the necessity to keep up on the Tdap vaccine.

 

And so portions of the public are unprotected. 

 

Right now California is seeing a 4-fold jump in Whooping Cough cases this year, and public health officials are calling it an epidemic. 

 

Thus far, at least five children have died.

 

This from the California Department of Public Health.

 

 

WHOOPING COUGH EPIDEMIC MAY BE WORST IN 50 YEARS 

Date: 6/23/2010

Number: 10-041

Contact: Al Lundeen (916) 440-7259

SACRAMENTO

Urging Californians to get vaccinated now, Dr. Mark Horton, director of the California Department of Public Health (CDPH), warned today that the state is on pace to suffer the most illnesses and deaths due to pertussis, also known as whooping cough, in 50 years.

 

“Whooping cough is now an epidemic in California,” Horton said. “Children should be vaccinated against the disease and parents, family members and caregivers of infants need a booster shot.”

 

As of June 15, California had recorded 910 cases of pertussis, a four-fold increase from the same period last year when 219 cases were recorded. Five infants — all under three months of age — have died from the disease this year. In addition, 600 more possible cases of pertussis are being investigated by local health departments.

 

Pertussis is cyclical. Cases tend to peak every two to five years. In 2005, California recorded 3,182 cases and eight deaths.

 

Pertussis is a highly contagious disease. Unimmunized or incompletely immunized young infants are particularly vulnerable. Since 1998, more than 80 percent of the infants in California who have died from pertussis have been Hispanic.

 

The pertussis vaccine is safe for children and adults. Pertussis vaccination begins at two months of age, but young infants are not adequately protected until the initial series of three shots is complete at 6 months of age. The series of shots that most children receive wears off by the time they finish middle school. Neither vaccination nor illness from pertussis provides lifetime immunity.

 

Pregnant women may be vaccinated against pertussis before pregnancy, during pregnancy or after giving birth. Fathers may be vaccinated at any time, but preferably before the birth of their baby. CDPH encourages birthing hospitals to implement policies to vaccinate new mothers and fathers before sending newborns home. CDPH is providing vaccine free of charge to hospitals.

 

Others who may have contact with infants, including family members, healthcare workers, and childcare workers, should also be vaccinated. Individuals should contact their regular health care provider or local health department to inquire about pertussis vaccination.

 

A typical case of pertussis in children and adults starts with a cough and runny nose for one-to-two weeks, followed by weeks to months of rapid coughing fits that sometimes end with a whooping sound. Fever is rare.

Dial M For Mutation

 

 

 

#4771

 

 

Once again we’ve a story out of India claiming that the novel H1N1 `swine flu’ virus has `mutated’, but as in earlier media reports, we’re given very little solid information to go on.

 

First the article from the Hindustan Times, then a bit of discussion.

 

 

H1N1 virus has mutated

Mumbai: , June 24, 2010

Neha Bhayana , Hindustan Times

The H1N1 virus has undergone a slight genetic mutation and its effect on patients has also changed. But patients are still responding to anti-viral drug Tamiflu.

 

“Unlike last year, swine flu patients don’t have high fever these days. Severe sore throat and backache are the most prominent symptoms now,” said Dr G.T. Ambe, Brihanmumbai Municipal Corporation’s executive health officer.

 

He added that Tamiflu and the vaccine are still “very effective.”

 

The state Directorate of Health Services had called for a meeting of experts and officials involved in tackling swine flu on Wednesday.

 

Dr A.C. Mishra, director of the National Institute of Virology, who attended the meeting in Mumbai, shared insights about the change in antigenicity of the virus (ability to cause production of antibodies), according to sources.

 

Infectious disease specialist Dr Om Srivastav has also observed changes in the clinical manifestation of swine flu. “Fever is not a predominant feature anymore,” he said.

 

“There is a small change in the virus. But this is not surprising. We expect it to change further,” said Dr Srivastav, who is part of the state government’s H1N1 advisory committee.

(Continue . . . )

 

 

Although the word `mutation’ has an ominous connotation, changes in the influenza virus happen often and only rarely result in a more aggressive or dangerous flu strain.

 

Most of these mutations result in evolutionary dead ends; flawed viruses unable to compete against the existing strain.

 

In order for a mutation to become a pathogenic `player’, it has to be biologically fit, and capable of replicating reliably and efficiently. 

 

And even when that happens, the end result isn’t necessarily bad. A virus can certainly mutate into a less virulent strain.

 

This isn’t the first media story about suspected mutations in the H1N1 virus to come out of India since the pandemic started.  

 

Last March (see PB2 Mutation Detected In India) there was a brief flurry of reports about the detection of an (unspecified) change in the PB2 segment of the virus.

 

It was reported that this mutation had little clinical significance.

 

Although details were not provided, this change is thought to be similar to that which  Dutch scientists isolated last September; the E627K mutation (see ProMed Mail  INFLUENZA PANDEMIC (H1N1) 2009 (58): THE NETHERLANDS, PB2 MUTATION). 

 

The E627K mutation in novel H1N1 was widely expected to expedite viral replication in humans. The fact that it apparently doesn’t was of considerable surprise to scientists around the world.

 

And last September The Hindu printed this somewhat hyperbolic report:

 

A(H1N1) gets more virulent

Tuesday, Sep 15, 2009

HYDERABAD: The A(H1N1) virus is showing signs of getting ‘mutated’ into a more virulent form.

 

Clinical observation of experts in the State capital indicate that the genetic make up of A(H1N1) virus has ‘changed’ and is now more ‘potent’ after coming into contact with the local existing viral forms.

(Continue . . . )

 

 

Inferring a `mutation’ based on a change in clinical presentation is an `iffy’ proposition.   And despite the warnings of a `more virulent’ result, we’ve seen little evidence to support that prediction.

 

Small, often incremental changes to the H1N1 virus are to be expected.   After all, that’s what influenza viruses do. 

 

They mutate.  They evolve.

 

The significance of this most recent report is difficult to gauge, given the lack of specifics provided.

 

More information regarding the location and type of mutation and the transmissibility (and incidence) of this `mutated virus’ would be helpful.

 

For now, I consider this report interesting, but not terribly illuminating.