UK: HPA Influenza Update

 

# 5195

 

 

The HPA has released their weekly influenza surveillance report, and once again it shows a significant increase in flu-like illness across that nation. 

 

Consult levels have not reached epidemic proportions, although that could still happen over the next couple of weeks.

 

Links, some excerpts, and a few graphs from this week’s report follow:

 

 

Weekly national influenza report, 30 December 2010

31 December 2010

Latest figures from the Health Protection Agency (HPA) indicate that levels of seasonal flu are continuing to increase across the UK.

 

The two main strains of flu circulating are Influenza A H1N1 (2009) 'swine' flu and Influenza B, with H1N1 being the predominant strain. A small proportion of flu cases are resulting in severe disease, particularly in people under the age of 65. This is due to the fact that H1N1 is more likely to infect young people and, unfortunately, a very small number of these may develop severe disease.

 

In the past week, the HPA has been notified of a further 12 people who have died with confirmed flu, bringing the total number since the flu season began in October this year to 39. 36 of these people died with the H1N1 (2009) strain and 3 with Influenza B. All except one case were under 65 years of age and four were under the age of five.

 

Where information is available on the fatal cases, 23 out of 38 (61 per cent) of those who have died were in a clinical 'at risk' group for vaccination.

Where vaccination status is known for this season's trivalent vaccine, only two people out of 33 had received their jab.  Last year's pandemic vaccine was only received by one person out of 30, where information is available.

(Continue . . . )

 

HPA Weekly National Influenza Graphs (PDF, 678 KB)

HPA Weekly National Influenza Report - week 52 (2010) (PDF, 331 KB)

 

 

Report published 30 December 2010

Summary

Influenza activity continues to increase across the UK.  GP consultation rates are now above baseline levels in all four countries. Influenza A H1N1 (2009) and B are the predominant circulating viruses with few, sporadic A (H3N2) viruses detected.  The H1N1 (2009) virus strain is virologically and epidemiologically similar to that seen during the pandemic.  The virus strains circulating are overall well matched to the current influenza vaccine.  The HPA expects to see continued elevated influenza activity for several weeks.

• In week 51 (ending 26 December), the weekly ILI consultation rates increased across the UK. The weekly influenza/influenza-like illness (ILI) consultation rates remain above baseline levels in England (124.4 per 100,000) and Wales (92.1 per 100,000). The rates have now increased above the baseline in Scotland (58.4 per 100,000) and Northern Ireland (99.4 per 100,000).
• The weekly national proportion of NHS Direct cold/flu calls for week 51 has increased however, the daily proportion has decreased slightly to 10.4% on 28 December, from a peak of 12.9% on 21 December. The proportion of calls for fever in the 5-14 year age group decreased from 21.6% to 16.8%, though this remains above the baseline level of 9%.  This suggests the possiblity that we may be approaching the peak of influenza activity.

(Continue . . . )

 

 

 

The number of ILI (influenza-like-illness) GP consults in the latest reporting week (red line) remain roughly half of what was seen during the 1999-2000 epidemic, but are approaching that seen during the summer peak of the 2009 pandemic.

 

 

The age group most often seen by GPs last week for ILIs was age 1-4, followed by those 5-14 years of age, and then young adults.   Unlike most years, those over 65 years of age were the least commonly seen cohort.

 

While obviously a serious flu outbreak, the overall numbers haven’t come close to those seen during the disastrous 1999-2000 flu season.  What makes this year unique, and distressing, is the burden this particular virus places on young adults and children.

 

The numbers reported – particularly 39 fatalities – should be taken with a large boulder of salt.

 

Most flu-related deaths are not recorded as such, and so `official numbers’ such as these almost always represent a significant undercount of the real toll. 

 

Although this report suggests the outbreak may be close to peaking, the next couple of weeks – with the reopening of most schools on January 4th – will be closely watched.

S. Korea Confirms H5N1 On Two Poultry Farms

 

 

# 5194

 

 

In a story we’ve been following for several days, last night officials announced that two poultry farms located in different parts of South Korea have tested positive for the highly pathogenic H5N1 bird flu virus.

 

Culling is reportedly complete at a duck farm in Cheonan and a poultry farm in Iksan City.  Both farms remain under quarantine, and movements of vehicles and people are restricted.

 

 

In recent weeks there have been more than a half dozen bird flu reports out of South Korea and Japan, involving 3 farms (2 in Korea, 1 in Japan) and a number of wild and/or migratory birds.

 

Both countries have been reported free of the H5N1 virus since 2008.  A few recent reports include:

 

Korea: 2nd Farm Investigated For Bird Flu

South Korea Investigating Cheonan Duck Farm

South Korea Finds 2 H5N1 Infected Owls

Korea: Bird Flu Discovered In Teal Ducks

 

 

Although a number of media sources are now carrying the story of the confirmation, this one (hat tip Shiloh on FluTrackers) comes from Yonhap News.

 

2010/12/31 10:44 KST

S. Korea confirms bird flu outbreak at 2 poultry farms

SEOUL, Dec. 31 (Yonhap) -- South Korea on Friday confirmed its first bird flu outbreak in two years at two poultry farms in the central and southwestern part of the country.

 

The outbreaks at the farms in Cheonan and Iksan, 90 and 230 kilometers south of Seoul, respectively, were first detected on Wednesday after birds started to die off.

 

Both farms have been placed under quarantine with authorities moving to cull and bury their ducks and chickens to prevent further spreading of the disease.

 

(Continue . . . )

 

 

During their last H5N1 outbreak in April-May 2008, South Korea waged a month-long, very expensive battle to contain the virus that resulted in the culling of more than 8 million birds.  

 

Since then, South Korea has conducted year-round monitoring for the bird flu virus (see South Korea To Begin Year-Round Bird Flu Monitoring) in hopes of preventing future outbreaks.

 

In the wake of these latest discoveries, health officials are stepping up inspections, and poultry operations are being urged to increase biosecurity measures.

Referral: McKenna On Flu

 

 

# 5193

 

 

Maryn McKenna has posted a very nice overview of this winter’s influenza season – on both sides of the Atlantic ocean.  As you are probably aware, while things remain quiet here in `the colonies’, the UK is in the midst of a major flu outbreak.

 

Among the many points she makes, Maryn links to Helen Branswell’s recent SciAm podcase on Flu Factories, and the Taubenberger/Morens/Folkers/Fauci paper on Pandemic Influenza’s 500th Anniversary.

 

 

Flu: Still a problem, just not here

• By Maryn McKenna  December 30, 2010  | 
•  

Study: Oseltamivir-Resistant Pandemic Flu Cases In The US

 

 

 

# 5191

 

 

Unlike its seasonal cousin (which has all but vanished), the 2009 novel H1N1 virus remains largely susceptible to the antiviral medication oseltamivir (Tamiflu).

 

During a 14-month period (April 2009-June 2010) 6,740 H1N1 samples were submitted to US surveillance systems for testing, and of those, only 37 (.5%) proved resistant to oseltamivir.

 

That’s the encouraging news from a study, published yesterday, in the CDC’s  EID Journal.

 

The link, and an excerpt describing the patient profile follow.  Go ahead and read it. 

 

I’ll be back with a bit more when you return.

 

 

Characteristics of Patients with Oseltamivir-Resistant Pandemic (H1N1) 2009, United States

Graitcer SB, Gubareva L, Kamimoto L, Doshi S, Vandermeer M, Louie J, et al. Characteristics of patients with oseltamivir-resistant pandemic (H1N1) 2009, United States. Emerg Infect Dis. 2011 Feb; [Epub ahead of print]

 

(EXCERPT)

 

Most patients infected with oseltamivir-resistant pandemic (H1N1) 2009 viruses were hospitalized (81%), had a severe immunocompromising condition (76%), and had been exposed to oseltamivir before collection of the specimen tested for antiviral resistance (89%) (Table); 9 (30%) had received oseltamivir as chemoprophylaxis, and 21 (70%) had received oseltamivir as treatment.

 

Four patients with oseltamivir-resistant pandemic (H1N1) 2009 virus infection had no documented exposure to oseltamivir before collection of the specimen for testing, including exposure to family members receiving oseltamivir.

 

No epidemiologic links were found between the 4 patients.

 

For now, the good news is that the 2009 H1N1 virus remains overwhelmingly sensitive to Tamiflu.

 

But of course, the same could have been said about the old seasonal H1N1 virus back in 2006-2007, when 99% of isolates tested showed good sensitivity to oseltamivir.

 

Resistance is usually caused by a mutation, known as H275Y, where a single amino acid substitution (histidine (H) to tyrosine (Y)) occurs at the neuraminidase position 275

 

(Note: some scientists use 'N2 numbering' (H274Y) and some use 'N1 numbering' (H275Y)).

 

Back in 2007, the belief was that the mutation that made the virus resistant to Tamiflu (H275Y), also reduced its biological fitness – suggesting that mutated versions of the viruses were unlikely to spread widely.

 

 

But those hopes were dimmed when, by the end of the 2007-2008 flu season, nearly 13% of H1N1 isolates tested the United States were resistant to the drug.

 

By December of 2008 nearly all seasonal H1N1 isolates tested around the world carried the H275Y mutation that conferred Tamiflu resistance.

 

Thus far, it appears that most of these resistant 2009 H1N1 strains have developed in immuno-compromised patients as so-called `spontaneous mutations’ – not as the result of contracting a circulating and already-resistant virus.

 

 

Human-to-human transmission of an oseltamivir-resistant novel H1N1 virus has only rarely been demonstrated.  A couple of reports on those include:

 

NEJM: Community Cluster Of Tamiflu Resistant H1N1

WER Review: Oseltamivir Resistance In Pandemic H1N1

 

 

Today, the news is good; resistance in novel H1N1 is rare.  But pharmacological victories over constantly evolving viruses (and bacteria) tend to be fleeting, and so the need for new classes of antivirals is great.  

 

The authors sum of their report this way:

 

Although the number of patients with oseltamivir-resistant pandemic (H1N1) 2009 virus infections was small in the United States during this period, this is the largest case-series published and confirms findings from reports with smaller samples (8–10).

 

Although all patients in our comparison group of patients with oseltamivir-susceptible pandemic (H1N1) 2009 were hospitalized, most patients in the oseltamivir-resistant group were also hospitalized. Finally, we do not have a comparison group of patients with immunocompromising conditions and oseltamivir-susceptible pandemic (H1N1) 2009 virus infections; thus, risk factors for infection with oseltamivir-resistant infection among patients with immunocompromising conditions cannot be determined.

 

The finding of oseltamivir-resistant pandemic (H1N1) 2009 viruses associated with oseltamivir treatment highlights the need for new antiviral agents and new treatment strategies.

UK: On The Cusp Of A Flu Epidemic

 

 

 

# 5190

 

 

While the latest numbers from the HPA haven’t been released yet, British media sources are quoting the Royal College of General Practitioners as stating that influenza cases rose by 50% last week.

 

Assuming those numbers hold true, then the UK remains below the epidemic threshold.

 

But not by much.

 

And among certain age groups, and in some geographic locations, epidemic levels of influenza are probably already being seen (defined as 200 case consults/100K pop.).

 

While the rest of the northern hemisphere lags behind with average (or below average) influenza activity, the UK is being hit hard - and unusually early - with influenza and other winter ailments.

 

With schools back in session after the Christmas Holiday (generally Dec 20th-Jan 3rd) early next week, concerns are that influenza rates may rise even further, meeting or perhaps even exceeding the rates seen in the 1999-2000 flu epidemic.

 

Since all flu viruses aren’t created equal, comparing epidemics based on total numbers infected doesn’t tell us much about the ultimate severity (and death toll) of an outbreak.

 

Unlike most seasonal flu strains, novel H1N1 tends to infect those under the age of 65, who are (on average) stronger and healthier and less likely to succumb to influenza than the elderly.

 

Although H1N1  can cause serious illness in a small percentage of victims – most people recover without incident.  So it remains unclear how heavy the impact from this year’s influenza outbreak will turn out to be.

 

That said, the `official’ number of cases and deaths attributed to the flu virus are widely assumed to be a badly undercounted, and the demands placed on the NHS over the next several weeks are likely to be heavy.

 

A representative round up of some of this morning’s reportage from the UK media includes:

 

Swine flu fears give NHS 24 its busiest four-day period ever The Scottish Herald

 

Number Of Flu Hospital Patients 'Rises Again' Sky News

 

Warning as NHS prepares for flu rush Shields Gazette

 

Doctors urging caution after flu cases rise South Wales Evening Post

 

 

I’ll try to update this story later today,  when the HPA is expected to release their weekly surveillance numbers.

Korea: 2nd Farm Investigated For Bird Flu

 

 

# 5189

 

 

Yesterday we saw a report of suspected bird flu at a duck farm in Cheonan (see South Korea Investigating Cheonan Duck Farm).  Overnight, we’ve several media reports regarding suspected avian flu at a second farm, this time in Iksan, North Jeolla Province.

 

Test results on both of these farms are awaited.

 

Iksan is more than 100 km south of Cheonan, and is in the heart of Korea’s poultry processing region.

 

The past month has seen several H5N1 detections among wild birds and domesticated poultry in both Japan & Korea (Aprox. locations shown below).

 

 

 

This report comes from Xinhau News.

 

 

S. Korea reports suspected case of bird flu

SEOUL, Dec. 30 (Xinhua) -- A suspected case of bird flu has been reported from a chicken farm in a southeastern region of the country, raising concerns over a fresh outbreak of bird flu amid South Korea's struggle with the spread of foot-and-mouth disease, the Ministry for Food, Agriculture, Forestry and Fisheries said Thursday.

 

The ministry said a chicken farm in Iksan, North Jeolla Province, reported a suspected case of bird flu late Wednesday. Another suspected case was reported from a duck farm in Cheonan, South Chungcheong Province.

 

Health officials are testing samples from both farms, the ministry said.

(Continue . . . )

 

 

Additional media reports  (hat tips Shiloh, Arkanoid Legent, Dutchy on this FluTrackers thread) suggest that culling may have begun on at least one farm.

PHAC: Lessons Learned From The 2009 Pandemic

 

 

# 5188

 

Today, the Public Health Agency of Canada (PHAC) and Health Canada released a 106 page report in PDF format, outlining the lessons learned from Canada’s response to the H1N1 pandemic.

 

While stating that – overall, Canada’s response was effective - the authors have identified 34 areas for improvement.

 

You can read the summary, excerpts from the report, or download the entire document at the PHAC website below:

 

 

Lessons Learned Review: Public Health Agency of Canada and Health Canada Response to the 2009 H1N1 Pandemic

 

For readers interested in the full version of this report, the document is available for downloading or viewing:

Lessons Learned Review: Public Health Agency of Canada and Health Canada Response to the 2009 H1N1 Pandemic

 November 2010

The information in this report was obtained by the Public Health Agency of Canada Evaluation Services Directorate through a review of relevant material and a series of interviews. This report does not draw exhaustive or definitive conclusions on all the activities leading up to or taken by various individuals or entities during the H1N1 pandemic response.

 

Rather, the observations in this report are meant to give senior management of the Public Health Agency of Canada and Health Canada a general overview of what worked well in response to this particular event and what needs further refinement to be better prepared for future pandemics and other national public health events.

South Korea Investigating Cheonan Duck Farm

 

 

# 5187

 

 

After three detections of the H5N1 bird flu virus in wild and/or migratory birds this month (see South Korea Finds 2 H5N1 Infected Owls and Korea: Bird Flu Discovered In Teal Ducks), it comes as little surprise that Korean Agriculture authorities are now investigating a duck farm where some of the birds there are showing signs suggestive of avian flu.

 

First the AFP report, appearing on Terra Daily, then some background.

 

S.Korea reports suspected bird flu case

by Staff Writers
Seoul (AFP) Dec 29, 2010

A South Korean duck farm has reported a suspected case of bird flu, the agriculture ministry said Wednesday.

 

A quarantine zone has been declared around a farm in Cheonan, about 90 kilometres (54 miles) south of Seoul, where ducks showed symptoms of avian influenza, the ministry said.

(Continue . . .)

 

Testing is underway, and we should know in a day or so if this is, indeed, H5N1.

 

South Korea has seen three previous major outbreaks of avian influenza in their poultry population.  The first in the winter of 2003-2004, and then a second time in 2006.

The largest, and most costly outbreak occurred in April of 2008, which resulted in the culling of more than 8 million birds.  You can read some of the coverage of that outbreak in these blogs:

 

Korea: Cat Death Attributed To Bird Flu

South Korea Investigating New Outbreak

S. Korea Finds 2 More Suspected Outbreaks

 

At the same time as these Korean outbreaks in 2008, Japan reported the discovery of the H5N1 virus in four swans in Akita Prefecture (see Japan Confirms Swans Infected With H5N1).

 

Similarly, this month Japan and Korea are once again both reporting multiple instances of H5N1 in wild and/or migratory birds.  I’ve plotted the general locations on the map below.

 

All of which has agricultural interests in Japan and Korea on high alert, in hopes of avoiding another widespread outbreak like was seen two years ago.

Carbon Monoxide: A Stealthy Killer

 

 

# 5186

 

In my Kitchen, a few feet away from the only likely source of CO gas in my home (my gas stove), I keep a carbon monoxide detector.

 

I do so because nearly 15  years ago, in another state, my wife and I moved into an older home with a faulty heater, and we very nearly succumbed to CO poisoning that first winter because of it.

 

Luckily for us, the levels of CO were low enough not to be immediately fatal, but rather induced in us a chronic lethargy, constant headaches, and mind-numbing apathy.

 

At first, we simply thought we had the flu, or were having difficulty adjusting to our first mid-western winter,  or were allergic to something in our new home.

 

But the symptoms grew worse, and in desperation we finally installed CO alarms, which immediately began sounding.

 

We were slowly, but insidiously, being poisoned by low levels of Carbon Monoxide from a wood furnace that the previous owner had `modified’.

 

Two cold days later (no heat), repairs to the furnace were completed by a qualified technician at a cost of nearly $1000.

 

An expensive (and almost fatal) lesson.  But the constant headaches, and lethargy, went away with the CO.

 

The CO detector remains, however.

 

 

 

As a former paramedic – one who has seen CO poisoning more than once in the (dim and distant) past – you’d think that I would have been quicker to realize what the problem was. 

 

But that’s the problem with CO poisoning, it slowly robs you of your ability to think critically.  

 

Carbon Monoxide kills by binding to the blood’s hemoglobin at a rate many-fold faster than oxygen can.  It essentially crowds out life-essential oxygen from the blood, causing those exposed to slowly suffocate  . . . often completely unaware of what is happening to them.

 

 

 

Yesterday, the news wires carried the tragic report of 5 teenagers killed in a south Florida motel room from the exhaust of a car left idling in a parking garage below.

 

Florida: Exhaust Fumes Kill 5 Friends at Motel

By THE ASSOCIATED PRESS

Published: December 29, 2010

 

 

The sources of CO are numerous; faulty furnaces, snow blocked car exhaust pipes, attempts to use generators inside the house or garage . . . and the use of CO producing emergency heat sources all contribute to the winter body count.

 

The CDC’s MMWR released a report in 2005 called Unintentional Non--Fire-Related Carbon Monoxide Exposures --- United States, 2001—2003 that stated:

 

During 2001--2003, an estimated 15,200 persons with confirmed or possible non--fire-related CO exposure were treated annually in hospital EDs. In addition, during 2001--2002, an average of 480 persons died annually from non--fire-related CO poisoning. Although males and females were equally likely to visit an ED for CO exposure, males were 2.3 times more likely to die from CO poisoning. Most (64%) of the nonfatal CO exposures occurred in homes. Efforts are needed to educate the public about preventing CO exposure.

 

 

The CDC maintains a webpage on Carbon Monoxide, which you can access here.

 

CDC TV also has an excellent 3 minute video on CO poisoning, which you can watch here (dbl click image to view on Youtube).

 

 

 

 

Carbon Monoxide poisoning is a genuine, but preventable, risk.  If you don’t already have carbon monoxide detectors in your home, getting and installing some would make an excellent New Years resolution. 

 

Believe me, it’s a New Year’s resolution you can live with.

 

 

 

Note: I should mention I also have 2 smoke detectors in my home, as well. - MPC

Ugandan Mystery Disease Identified As Yellow Fever

 

 

# 5185

 

 

More than two months after it began, we now appear to have an official cause of the mystery disease outbreak in northern Uganda; Yellow Fever. 

 

My first blog on this outbreak came in mid-November (see Uganda: Unidentified Hemorrhagic Outbreak), and at that time a hemorrhagic fever like Ebola, Marburg, or Lujo virus was considered the likely cause.

 

Two weeks later, I reported that Health Ministry officials had stated that laboratory tests had come back negative for the usual suspects from that part of the world; Ebola, Marburg, Congo Crimean fever, Rift Valley fever and Typhoid.

 

On December 7th, it was widely reported that Plague (pneumonic and bubonic) had been identified as the cause of the outbreak, which I covered in Uganda Outbreak Identified As Plague: Officials.  

 

Within a few days, the plague diagnoses began to look less and less likely, and in recent days Yellow Fever – a disease not seen in Uganda in nearly 40 years – has come to the forefront.

 

For a detailed history of this outbreak’s progression, FluTrackers has an extensive thread on this story, with more than 150 entries as of this morning.

 

Treyfish has been a particularly close follower of this story, and has posted many of these reports, although he is by no means alone in this effort.  

 

Yesterday afternoon Treyfish posted a U.S. Embassy Warden Message that identifies the outbreak as Yellow Fever.

 

Warden Message

U.S. Embassy Kampala, Uganda
Warden Message - December 28, 2010

Outbreak of Unidentified Illness Now Confirmed as Yellow Fever in Northern Uganda

After discussions with the Ugandan Ministry of Health and WHO, the U.S. Centers for Disease Control and Prevention (CDC) now confirms that the unknown severe illness reported in Mission Kampala’s November 30 Warden Message is an outbreak of Yellow Fever.

 

Although as many as seven districts are now reporting occurrences - including two possible cases from southern Sudan- almost all of the reported severe cases (characterized by fever, vomiting and bleeding) continue to be concentrated in three districts of Northern Uganda, namely Abim (specifically Morulem sub-county), Agago (Omiya P’Chua, Adilang and Paimoi sub-counties) and Kitgum (Orum, Namokora and Kitgum Town Council).

 

In light of these findings, the U.S. Mission in Kampala recommends that U.S. citizens residing and traveling in Uganda avoid travel to Northern Uganda unless they have been vaccinated against Yellow Fever within the past 10 years.  If vaccinated recently, do not travel to Northern Uganda for at least 10 days after receiving the vaccination.  (Yellow Fever vaccinations do not take effect for 10 days.)  Only U.S. government officials with Yellow Fever vaccinations are permitted to travel to the affected areas.

 

(Continue . . . )

 

 

Via newshound Alert we get this update from Uganda’s leading independent daily, The Daily Monitor.

 

 

National

Yellow fever deaths reach 48

By Flavia Nalubega

Posted Wednesday, December 29 2010 at 00:00

Kampala

The number of people killed by yellow fever in northern Uganda has reached 48 and 187 are hospitalised, an official has confirmed. Dr Isa Makumbi, a commissioner in the health ministry, made the revelations last night.

 

Earlier, Junior health minister James Kakooza had told Daily Monitor on phone that the viral disease has been confirmed in Abim, Agago, Lamwo, Kitgum, Pader, Gulu, Arua, Kaabong and Lira districts.

 

“The infection was in place as early as two months ago. Since then, we have been doing investigations to ascertain the disease. It is only two weeks ago that we confirmed the viral infection as yellow fever,” Mr Kakooza said. He said the disease has taken a new string of infection where patients suffer severe vomiting of blood, diarrhoea and swollen eyes.

(Continue . . . )

 

 

Yellow fever is a mosquito borne viral illness, that according to the World Health Organization, infects roughly 200,000 people each year and claims 30,000 lives.

 

Once the scourge of Africa, the Americas and Europe, Yellow fever is now endemic only to the tropical areas of South America and Africa. 

 

(Source link)

 

 

In the 18th and 19th century, Yellow fever caused major epidemics in Europe and in the United States, up the Atlantic seaboard and as far north as New England (Boston was hard hit in 1780, and Philadelphia saw several thousand deaths in 1793).

 

Yellow Fever has been cited as one of the primary reasons why the French abandoned their attempt to build a Panama canal in the late 1800’s, as the combined burden of Yellow Fever and Malaria reportedly claimed the lives of more than 20,000 construction workers.

 

For more on the history of `Yellow Jack’, I would point you to Ian York’s excellent Mystery Rays blog, where he gives us some terrific background in:

 

Yellow fever, stasis, and diversification

The deadliest, most awe-inspiring of the plagues

The good old days

 

 

You can find more information on yellow fever at these websites:

http://www.cdc.gov/ncidod/dvbid/yellowfever/

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/yellow-fever.aspx

http://www.who.int/topics/yellow_fever/en/

Egypt: MOH Reporting Bird Flu Case # 116

 

 

 

# 8184

 

 

 

Twall on FluTrackers, who lives in Egypt and is fluent in Arabic,  has posted a fresh report from the Ministry of Health announcing human infection #116 from the H5N1 virus.

 

 

New cases of bird flu, bringing the number to 116 cases

Tuesday, December 28, 2010 Posted in date

Spokesman of the Ministry of Health - Dr. Abdel Rahman Shahin, on the status of the discovery of new cases of bird flu to a lady at the age of 56 years from the province of East and longer this situation (116) since the onset of illness.

 

Shaheen noted the case had entered a hospital in Eastern Province which is suffering from high fever, cough, difficulty breathing, and that after being exposed to birds suspected of being infected with bird flu have been given the drug Tamiflu as soon as suspicion and took a swab from the throat to the analysis laboratory.

 

The official spokesman that the patient has pneumonia, easier and in stable condition and was transferred to a hospital in Cairo, Abbasid.

 

 

You will also find another report from Youm7 on this case, and any further reports, posted to this  FluTrackers thread.

Korea: Bird Flu Discovered In Teal Ducks

 

 

# 5183

 

 

Each winter, countless thousands of migratory birds make their way south from Mongolia, Siberia, and parts of China to over-winter on the Korean peninsula and in Japan.

 

In recent weeks we’ve been hearing of a small number of migratory birds being discovered in Japan, and to a lesser extent, in Korea (both are part of the East-Asian Flyway) with bird flu.  

 

 

 

Today, via Yonhap News, we learn of 20 teal ducks – found dead in Haenam - that have tested positive for a virulent (probably, but not stated to be H5N1 in this report) bird flu virus.  This is the third such discovery in a month, according to this report.

 

 

2010/12/28 17:04 KST

Dead teal ducks with bird flu strain found in S. Korea

 

SEOUL, Dec. 28 (Yonhap) -- South Korea's farm ministry said Tuesday that it has found 20 dead spectacled teal ducks, apparently affected by the virulent strain of bird flu, and have taken emergency decontamination measures.

The discovery of the dead birds in Haenam 430 kilometers south of Seoul is the third such finding this month and is raising concerns among local poultry farmers.

 

I’ve mapped the three main locations below, which are clustered near the end of the migration path for many of these birds.

 

 

Dutchy on FluTrackers has a thread with a couple of more translated news accounts, that identifies the strain as H5N1. 

 

You can follow that thread here.

UK: 2010 Flu Vaccine Policy Debated

 

 

 

# 5182

 

 

With the UK on the cusp of what may turn into the first major flu epidemic in a decade, difficult questions are being raised about this year’s flu vaccination policies. 

 

The NHS provides free influenza vaccines to groups deemed to be at high risk from the virus, and this year that includes:

 

It is recommended you have a flu jab if you:

• are 65 or over
• are pregnant (see below)
• have a serious medical condition (see box)
• live in a residential or nursing home
• are the main carer for an elderly or disabled person whose welfare may be at risk if you fall ill
• are a healthcare or social care professional directly involved in patient care
• work with poultry (see below)

 

This is essentially a return to the pre-pandemic recommendations, based on the long standing determination that those over-65, and those with chronic health conditions, are most at risk from the influenza virus.

 

Children under the age of 5 were included (a carry over from last year’s pandemic) until The Independent Joint Committee on Vaccination and Immunisation dropped that recommendation last July.

 

Now . . .  with the HPA reporting (as of Dec. 24th) 460 people in intensive care, and 27 flu-related fatalities, this year’s vaccination policy has turned into a heated medical, scientific, and political debate.

 

The novel H1N1 virus – which since it emerged has shown a predilection for those under 65 – is once again the predominant strain of influenza in the UK (but not globally . . . go figure).

 

As a result, 89% of those in Intensive care units are under the age of 65.

 

There are now accusations being made in the media, and by some Shadow Ministers (members of Her Majesty's Loyal Opposition) that the exclusion of otherwise healthy under-5’s from the high-risk list was a cost cutting move, and ill advised.

 

It should be noted that by far, the most heavily impacted age group (based on ICU admissions) are those between the ages of 16-64 (79%).

 

Under-5’s made up about 6% of the total ICU admissions (n=26).

 

Details on how many of each group had pre-existing conditions, and would have been eligible for (or actually received) the jab, have not been made available.

 

 

Health Secretary Andrew Lansley is defending the decision, stating that their vaccination program was based based on age and risk factors and was continually under review.

 

 

This morning, a report from the BBC which includes statements by John Oxford, Professor of Virology at St Bartholomew’s and the Royal London Hospital, on our need to adapt to the changing threat from influenza.

 

 

28 December 2010 Last updated at 05:48 ET

Flu vaccine policy for children defended

Japan: 5 Hooded Cranes Test Positive For H5N1

 

 

 

# 5181

 

 

A brief follow up to a story from Wednesday of last week (see Japan: Hooded Crane Positive For H5N1), we are now learning that a total of 5 hooded cranes have tested positive for H5N1 at the national wildlife reserve in Izumi City, Kagoshima Prefecture Japan.

Roughly 80% of the world’s population of Hooded Cranes (est. pop.  10K) over-winter at Izumi City, after migrating from their summer breeding grounds in Siberia and Mongolia.

(Wikipedia Link)

Today’s report is from Kyodo News International.

No. of bird flu-infected cranes in Kagoshima totals 5

Monday, December 27, 2010 12:16 PM

 

 

According to this report, no new sick or dead cranes have been discovered over the past few days.   The area is being monitored for more signs of the virus, and public access to the reserve has been halted until January 18th.

 

After an absence of two years, the highly pathogenic H5N1 virus has shown up in a couple of locations in Japan this fall, including a poultry farm.  

 

Recent blogs on those events include:

Japan: Detection Of H5N1 In Ducks

Japan: Bird Flu Investigation At Poultry Farm

Japan: Bird Flu Detected In Dead Swan

The Impact Of Mass Gatherings & Travel On Flu Epidemics

 

 

# 5180

 

A timely study this morning, published in BMC Public Health, that looks at and attempts to quantify the impacts of mass gatherings and holiday travel on the spread of an influenza epidemic.

 

With the UK poised on the brink of their epidemic threshold this holiday season, we may well see this effect at work over the next several weeks.

 

Of course, the notion that influenza epidemics can surge in the wake of large gatherings of people is hardly new. During the 1918 Pandemic, most cities instituted strict public health ordinances.   They closed schools, movie houses, pool rooms, restaurants . . even churches.

 

Those cities that took these measures generally saw much lower levels of death and illness.

 

But Philadelphia went ahead with a massive Liberty Loan parade on September 28th of that year, apparently heartened by the low number of flu cases reported in Pennsylvania to that point.

 

Days after Philadelphia’s Liberty Loan parade in September 1918, which was attended by 200,000 people, hundreds of cases of influenza were reported. [Credit: Naval Historical Center]

 

What happened next is best demonstrated by the following graph, which depicts an explosion of pandemic flu cases beginning just days after the parade.

 

 

The chart above, taken from the PNAS journal article entitled Public Health Interventions and Pandemic Intensity During the 1918 Influenza Pandemic , shows the excess mortality in two American cities.

The tall spike represents Philadelphia, while the lower curve represents St. Louis.

 

Over the next three weeks, at least 6,081 deaths from influenza and 2,651 deaths from pneumonia were registered in Pennsylvania, most occurring in Philadelphia (CDC source).

 

A more recent example comes from the 2009 H1N1 pandemic, which appears to have been efficiently disseminated around the world due to the number of Spring Break vacationers returning from Mexico during the initial outbreak.

 

But that was then, this is now.

 

With the exception of the UK (and possibly parts of eastern Europe), influenza appears to be simmering at fairly low levels in most parts of the northern Hemisphere.

 

The next eight weeks, however, will see a number of large public gatherings (i.e. Super Bowl, Carnival in Rio) and the busiest travel holiday of the year – Chinese New Years. 

 

Any of which have the potential to spark a resurgence of the flu. Which brings us to the BMC Journal study, called:

 

The impact of mass gatherings and holiday traveling on the course of an influenza pandemic: a computational model

 

Pengyi Shi, Pinar Keskinocak , Julie L Swann  and Bruce Y Lee

BMC Public Health 2010, 10:778doi:10.1186/1471-2458-10-778

Published:21 December 2010

Abstract (provisional)

Background

During the 2009 H1N1 influenza pandemic, concerns arose about the potential negative effects of mass public gatherings and travel on the course of the pandemic. Better understanding the potential effects of temporal changes in social mixing patterns could help public officials determine if and when to cancel large public gatherings or enforce regional travel restrictions, advisories, or surveillance during an epidemic.

Methods

We develop a computer simulation model using detailed data from the state of Georgia to explore how various changes in social mixing and contact patterns, representing mass gatherings and holiday traveling, may affect the course of an influenza pandemic.  Various scenarios with different combinations of the length of the mass gatherings or traveling period (range: 0.5 to 5 days), the proportion of the population attending the mass gathering events or on travel (range: 1% to 50%), and the initial reproduction numbers R0 (1.3, 1.5, 1.8) are explored.

Results

Mass gatherings that occur within 10 days before the epidemic peak can result in as high as a 10% relative increase in the peak prevalence and the total attack rate, and may have even worse impacts on local communities and travelers' families. Holiday traveling can lead to a second epidemic peak under certain scenarios.

Conversely, mass traveling or gatherings may have little effect when occurring much earlier or later than the epidemic peak, e.g., more than 40 days earlier or 20 days later than the peak when the initial R0 = 1.5.

Conclusions

Our results suggest that monitoring, postponing, or cancelling large public gatherings may be warranted close to the epidemic peak but not earlier or later during the epidemic. Influenza activity should also be closely monitored for a potential second peak if holiday traveling occurs when prevalence is high.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

 

 

Of course, as Professor Emeritus of Statistics at the University of Wisconsin George E. P. Box famously observed:

 

“All models are wrong, but some models are useful.”

 

And the authors of this study readily admit that there are limitations to computational studies such as this. They write:

 

Computer simulations by definition are simplifications of real life. Rather than make decisions, they can identify potentially important factors and relationships for decision makers.

Our model does incorporate a number of assumptions and cannot fully capture every possible factor or effect.

 

Each year, epidemiologists watch Chunyun, or the Spring Festival Travel Season (of which Chinese New Years is a central part) with particular fascination.

 

It is, quite rightfully, billed as the largest annual migration of humans on the planet. Chunyun begins about 15 days before the Lunar New Year and runs for about 40 days total.

 

This year, the Lunar New year falls on February 3rd, and with it comes a cultural ethic for millions who have moved to the big cities to return home to visit with their families.

 

These travelers will spend a few days in their home village or town, and then travel back to the city where they work or attend school. Which can provide ample opportunities for an infectious disease to hitch a ride.

 

 

Of course, it should be pointed out that last year, Chunyun did not precipitate a major resurgence in the H1N1 pandemic virus across Asia. 

 

Nor did we see any feared third wave of influenza following Carnival in Rio, the Super Bowl, or the the World Cup in South Africa.

 

And while there are yearly concerns about bird flu being brought back to the cities from rural locations by Chunyun travelers, that doesn’t appear to have happened (yet) either.

 

All of which means that just because the potential exists, that doesn’t guarantee that something bad will happen.  

 

Of course, the fact that it didn’t happen last year doesn’t preclude it from happening this year . . . or in the future.

 

So we’ll watch for signs that family gatherings and travel during this Holiday season may have exacerbated the the flu epidemic in the UK.  And we’ll keep a watchful eye on influenza activity and spread in the wake of this year’s Super Bowl, Carnival, and Chunyun. 

 

With luck, and over time, with the data we get from computer simulations like the one above - and from observations from the real-life laboratory of the world - we’ll learn a lot more about how, why, and under what conditions influenza is most likely to spread.

 

Valuable information during any influenza season, but of particularly importance should we ever face another virulent pandemic.

Influenza: Predictably Unpredictable

 

 

 

# 5179

 

 

What a difference a few months can make.

 

Back during the summer of 2010, when the H1N1 `swine' flu pandemic was at its lowest ebb, many media outlets, internet pundits, and politicians were bashing the World Health Organization and other health agencies around the world for the `pandemic that wasn’t’, their `scare tactics’, and their `wasteful spending’ on vaccines and antivirals.

 

One such hyperbolic headline from August of 2010 proclaimed:

 

£1.2bn spent to beat swine flu... and just 26 lives saved

Last updated at 9:56 AM on 3rd August 2010

 

The author of this report, in the very first sentence, refers to `the swine flu pandemic that never was’ and tells us of a `study’ that found that all of the antivirals, vaccines, and other pandemic interventions in the UK saved `as few as 26 lives at a cost of up to £46million each’.

 

An unlikely assertion, but terrific fodder - I suppose -  to base a scathing news story on during the dog days of summer. 

 

Now that the much-denigrated pandemic H1N1 virus has returned to the UK with a vengeance, and put hundreds into intensive care, the tone of the reporting from this very same newspaper has changed just a tad:

 

Swine flu epidemic fear as hospital admissions soar by 250 per cent in... Daily Mail 19:14 Sat, 25 Dec 2010

Swine flu: The 24 known victims this winter may be only a fraction... Daily Mail 20:07 Thu, 23 Dec 2010

 

While the above stories all come from the UK’s Daily Mail, I could just as easily have selected offerings from a number of other reputable news publications, cable news channels, or Internet pundits from around the globe.

 

This blowing hot & cold in the media over the flu threat comes about because Influenza is doing exactly what influenza does. 

 

It’s being unpredictable. 

 

It’s not following the the public’s and media’s preconceived notions of how a pandemic virus should act.

 

The flu has frustratingly zigged when many officials and the press have gone on record predicting it would zag.

 

When this happens often enough, we begin to see an inevitable backlash in the press.

 

Hence, over the summer - when the H1N1 virus was all but in remission - we saw a lot of critical stories about the pandemic being `overblown’. 

 

 

Now, somewhat unexpectedly, the UK is seeing unusually heavy flu activity while the rest of the world (with the possible exception of parts of Eastern Europe) is seeing relatively little influenza.

 

Of course, that could easily change over the next few weeks or months.

 

There are now concerns that the epidemic threshold in the UK (200 ILI consults per 100,000 population) may be breached in the next week or so. At last count, there were 460 people in critical care, and 27 `flu-related’ fatalities.

 

In actuality, the number of flu-related deaths is almost certainly far higher.  But, as we’ve discussed before, most flu related fatalities are attributed to other causes; Heart attacks, COPD, pneumonia, etc.

 

At some point in the future, an estimate of the number of deaths will be calculated.  And that number, while no doubt flawed, will be the `best guess’ available.

 

Comparisons are even being made to the devastating 1999-2000 flu season, which is estimated to  have claimed more than 20,000 lives and badly strained the NHS.

 

Will it get that bad?

 

It certainly could, but I’ve been watching flu for too long to be willing to make predictions.

 

Ask me again in about 6 weeks.

 

For now, if you’ve not had your flu shot, it is worth seriously considering.  There are still several months left to the `regular’ influenza season, and flu activity where you live – even if its low right now – could easily pick up later in the season.

 

Because, as the title says: influenza is predictably unpredictable.

Egypt Reports Bird Flu Fatality

 

# 5178

 

 

 

On Thursday of this week we learned of an 11 year-old girl from Luxor, Egypt who was hospitalized with H5N1 (see Egypt: MOH Reports Bird Flu Case #115).  

 

Sadly today, KUNA (Kuwaiti News Agency) is reporting that she lost her battle with the virus.

 

Egypt reports bird flu death case

Health    12/25/2010 6:57:00 PM

CAIRO, Dec 25 (KUNA) -- Egypt's Health Ministry has reported a new bird flu death case, bringing the total number of fatalities this year up to 11.

 

A 11-year-old girl died of bird flu in Luxor Governorate in Upper Egypt on Saturday, Spokesman for the Ministry Abdelrahman Shahin said in news remarks.

 

Egypt has now reported a total of 115 bird flu cases, including 38 fatalities, since the disease broke out in the country in 2006, he added. (end) ez.mt KUNA 251857 Dec 10NNNN

The (Swine) Influenza Reassortment Puzzle

 

 

# 5177

 

 

 

 

With this week’s release of Helen Branswell’s SciAm article called Flu Factories (see Branswell: Podcast On Flu Factories) and a small (but potentially important) change to the CDC’s webpage on recent SOIV (Swine Origin Influenza Viruses) cases, influenza reassortment in pigs is bound to be a hot topic over the next few days.

 

First, the change to the CDC’s webpage (and for spotting this, a big hat tip goes to IronOreHopper):

 

Reported Human Infections with Swine Origin Influenza Viruses (SOIV) in the United States since 2005

As of December 17, 2010, 19 cases of human infection with swine origin influenza viruses (SOIV) have been reported in the United States. These are viruses that normally infect pigs. Like human influenza viruses, there are different subtypes and strains of swine origin influenza viruses. The main swine viruses circulating in U.S. pigs in recent years are swine triple reassortant (tr) H1N1 influenza virus, trH3N2 virus and trH1N2 virus.

 

Of the 19 human cases reported since 2005, 12 have been trH1N1 viruses, six have been trH3N2 viruses and one has been a trH1N2 virus. All 19 persons infected with swine viruses recovered from their illness. Twelve cases occurred in children (persons younger than 19) and 7 cases occurred in adults. In 15 cases, exposure to swine has been identified.

 

Although no person-to-person transmission of swine influenza viruses has been laboratory confirmed in the investigation of these cases to date, some cases reported only exposure to ill persons and no exposure to live pigs.  Thus, limited person-to-person is likely to have occurred.

 

The section in red was added sometime over the past few days, replacing `No person-to-person transmission of these viruses has been documented in the investigation of these cases to date.’

 

Before anyone starts heading down to the bunker, let me state that this change wasn’t completely unexpected, nor is it particularly alarming.

 

We were already aware that there were some cases with no apparent exposure to pigs, and that the CDC was continuing to investigate how these people may have acquired the virus.

 

As I said, I find none of this particularly alarming.  But it is, I believe, worthy of perhaps a modicum of concern.

 

As I’ve pointed out before (including here and here) we occasionally will see a novel swine influenza virus jump to humans. Although the 2009 swine flu pandemic was an exception, most of the time this turns out to be a one-off dead-end transmission, and goes no further. 

 

The key phrase being `most of the time’.

 

Since only a tiny fraction of influenza flu viruses are ever sequenced, we really don’t know how often these types of novel infections occur.

 

It’s probably more often than we think.

 

But surveillance systems must be incredibly lucky, or wait until a novel virus has made sufficient inroads into the population, before they are apt to start picking up cases.

 

The 2009 Swine flu epidemic was undoubtedly spreading stealthily in humans for several months before the folks at the Naval Health Research Center (NHRC) in San Diego first isolated the strain on April 16th of last year.

 

By then, thousands had been infected.  

 

It is likely that limited transmission of novel influenza reassortments occur with some frequency, all over the world.  But only rarely are these novel viruses `biologically fit’ enough to compete with fully human adapted strains.

 

So most turn out to be evolutionary dead-ends, die out of their own accord, and are never detected.   We don’t hear about them, so we don’t tend to worry about them.  

 

But each novel virus that jumps to a human host is another opportunity for the virus to adapt to human physiology.  And as 2009 showed us, once that happens, a virus can spread around the world in a matter of months.

 

If you’ve not already read Helen Branswell’s excellent article on Flu Factories, or listened to the SciAm Podcast, I would invite you to do so.

 

When you return, I’ll have more.

 

Over the past 5 years, we’ve revisited the subject of influenza reassortment dozens of times.   Just a few recent examples include:

 

Virology Journal: Receptor Cells In Minor Poultry Species

mBio: A/H1N1 Potential For Mutation

Study: The Continuing Evolution Of Avian H9N2

EID Journal: Co-Infection By Influenza Strains

EID Journal: Swine Flu Reassortants In Pigs

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

 

Influenza viruses change, evolve, or mutate over time via two well established routes; Antigenic drift and Antigenic Shift (reassortment).

 

Antigenic drift causes small, incremental changes in the virus over time.   Drift is the standard evolutionary process of influenza viruses, and often come about due to replication errors that are common with single-strand RNA viruses.

 

Shift occurs when one virus swap out chunks of their genetic code with gene segments from another virus.  This is known as reassortment. While far less common than drift, shift can produce abrupt, dramatic, and sometimes pandemic inducing changes to the virus.

 

For shift to happen, a host (human, swine, bird) must be infected by two influenza viruses at the same time.  While that is relatively rare, as any virologist will tell you . . . Shift happens.

 

 

 

Although avian influenzas had captured the headlines up until a couple of years ago, since the outbreak of pandemic H1N1 in 2009 - which circulated under-the-radar in pigs for about 10 years – scientists are looking at pigs, and swine influenzas with keener interest today.

 

Source: FAO

 

With global pig production growing rapidly to meet the demands of a hungry world, each year we add millions more `mixing vessels’ to natures laboratory.   And the bulk of the predicted growth in hog farming is expected in developing countries.

 

While limited viral surveillance in pig farms may be found in some parts of the developed world - for much of the globe - that simply doesn’t happen.

 

Unfortunately, some hog farmers here in the US are  reluctant to allow their herds to be tested (see Swine Flu: Don’t Test, Don’t Tell) out of fears that the discovery of a new swine flu virus would depress pork sales.

 

Some will only consent to anonymous testing, which limits the CDC’s ability to investigate cases.

 

 

 

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

 

Photo Credit (Wikipedia)

 

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

 

 

And for even more background, you might want to check out David Brown’s terrific piece in the Washington Post from October of 2009.

 

 

Back where virus started, new scrutiny of pig farming

By David Brown

Washington Post Staff Writer
Sunday, October 25, 2009

 

 

As you can see, concern over reassortment in pigs (and other hosts) is hardly new, although we are learning more about the threat’s potential with each passing day. 

 

And the change in the CDC’s SOIV webpage indicating that `limited person-to-person is likely to have occurred’ isn’t really a surprise.

 

It basically just confirms what many observers have assumed all along.

 

The reality is, Nature’s laboratory is open 24/7, and it performs billions of random genetic experiments each day.   As the supply of `test animals’ increases, so do the opportunities for a new virus to emerge.

 

Another pandemic is all but inevitable.  It could start tomorrow, or it might not happen for decades.

 

Which is why we need better viral surveillance, both among the human population, and on the farm.

 

 

It is, after all, to our advantage to detect any emerging virus as early as possible. 

 

That may allow us to contain or slow its spread using antivirals and other methods, and that would hopefully buy us precious time to develop, manufacture, and distribute a protective vaccine.

 

Because - while the 2009 H1N1 virus turned out to be a less virulent strain than first feared - the next time . . . we may not be nearly so lucky.

UK: Morning Roundup Of Flu Stories

 

 

# 5176

 

 

As stated before in this blog, the UK is in the grips of a not-entirely-unexpected, but nonetheless fairly serious outbreak of H1N1 influenza.

 

Between some truly nasty weather this December, and a low uptake of the influenza vaccine this year, there are concerns that the next few weeks will see a great many more cases of influenza-like illness across the UK.

 

Already hospitals and GPs are under a heavy workload, and the number of serious flu cases continues to rise.

 

Yesterday, it was announced that the National Influenza Hotline would be activated, and that the rules for prescribing Tamiflu were to be relaxed (see UK: Flu Triples In A Week, Puts NHS `Under Growing Strain’ – also look for an update from our UK GP, Chacal in the comments section).

 

 

This morning, we are hearing that the number of flu cases admitted to intensive care units has increased by 50% over the past 3 days, and that some surgeries may have to be postponed due to the flu outbreak.

 

A roundup, therefore, of some this morning’s media coverage of the UK’s flu outbreak (h/t to CopitoSP & Shiloh @ FluTrackers):

 

 

460 flu victims fighting for life as experts admit 24 deaths from swine strain may be only a fraction of the true number

By Sophie Borland
Last updated at 12:26 PM on 24th December 2010

 

 

 

Sharp rise in serious flu cases prompts jab questions

24 December 2010 Last updated at 07:38 ET

By Nick Triggle Health reporter, BBC News

 

 

Flu: intensive care cases 'double in a week' as cases accelerate

The number of people admitted to intensive care with confirmed or suspected cases of flu has doubled in a week, the government said on Friday.

By Andrew Hough, and Rebecca Smith 1:00PM GMT 24 Dec 2010

 

 

Some earlier blogs on this outbreak include:

 

Referral: Fergus Walsh On The UK Flu

The Pandemic Is Ended (But The Malady Lingers On)

Branswell: Podcast On Flu Factories

 

 

 

# 5175

 

 

If you were tasked with finding a medical reporter with a better understanding of influenza than Helen Branswell  . . . well, you’d be searching a long, long time.  Ms. Branswell heads a very short list of truly excellent reporters in that field. 

 

Helen is a long time medical correspondent for the  Canadian Press, and is currently a Nieman Fellow for Global Health Reporting at Harvard University.

 

This week, Helen has a feature article that looks at pig farms as incubators of influenza in the January edition of Scientific American, called  Flu Factories. 

 

If you have a subscription (there is a free synopsis), you can read the article online at:

 

Flu Factories

The next pandemic virus may be circulating on U.S. pig farms, but health officials are struggling to see past the front gate

By Helen Branswell  | December 27, 2011 

 

 

I am very happy to report that SciAm also has a freely available 15 minute audio interview with Helen, as well.

 

 

How You Gonna Keep Flu Down on the Farm?: Pig Farms and Public Health

Journalist Helen Branswell discusses her January Scientific American article, "Flu Factories," about the attempts to monitor new strains of flu that can originate on pig farms and the difficulties of balancing economic and public health constituencies.

 

 

Both the article, and the podcast, are highly recommended.