Wednesday, November 30, 2011

NOAA: The 2011 Atlantic Hurricane Season in 4.5 Minutes

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2011 Tropical Storm Tracks – Source Wikipedia

#5985

 

Today – November 30th - marks the official end of the 2011 Atlantic Hurricane season.

 

NOAA has released a 4 minute video that compresses the 6 month Altantic Hurricane season into 4 minutes and 41 seconds. It comes from the NOAA Environmental Visualization Laboratory, and requires Adobe Flash Player to view.

 

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(Click image to view)

 

This description from the NOAA webpage. A hat tip to  @JustinNOAA for tweeting this link.

 

 

 

The 2011 Atlantic Hurricane Season in 4.5 minutes

The 2011 Atlantic hurricane season officially ends on Nov. 30 and produced a total of 19 tropical storms of which seven became hurricanes, including three major hurricanes. This level of activity matched NOAA’s predictions and continues the trend of active hurricane seasons that began in 1995.

 

From Arlene to Sean, Hurricane Season 2011 has been very active, leading to 120 fatalities and causing more than $11 billion in property and infrastructure damage. Surprisingly, none of the first eight tropical storms reached hurricane status, a record since reliable reports started in 1851.

 

(Continue .  .  . )

 

 

Once again, despite an unusually busy tropical season, the United States was largely spared due to favorable steering currents which kept most of these storms out to sea.

 

Only two named storms made landfall in the United States during the 2011 season; Tropical Storm Lee in Louisiana and Hurricane Irene in New England.

 

But every hurricane season is different, and what happened this year, or the year before, doesn’t tell us much about what lies in store for 2012.

 

Even with this relatively mild hurricane season, the United States has sustained a record number of Billion Dollar Plus weather-related disasters this year, proving the need for year-round preparedness, and in all areas of the nation.

 


(See Weathering Heights: Billion-Dollar-Plus Weather Disasters)

 

Like death and taxes, disasters are inevitable. A few of my general preparedness blogs include:

 

When 72 Hours Isn’t Enough

In An Emergency, Who Has Your Back?

An Appropriate Level Of Preparedness

 

To become better prepared as an individual, family, business owner, or community to deal with hurricanes, tornadoes, floods, or any other type of disaster: visit the following preparedness sites.

 

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

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

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

CIDRAP: New Details In The trH3N2 Story

 

 

 

# 5984

 

 

When it comes to flu and/or infectious disease-related reporting, CIDRAP NEWS is high up on my (admittedly) short list of media sources that I consider to be sane, credible, and reliable.

 

Eschewing hyperbole and unsubstantiated speculation, News Editor Robert Roos & staff writer Lisa Schnirring do a terrific job cutting to the chase, without leaving out important details.

 

Last night Lisa put together an overview of the emerging trH3N2 story, including some news we’d not seen before; that USDA sponsored surveillance has detected a number of reassortant H3N2 viruses in swine recently, including 8 that display the 2009 H1N1 matrix (M) gene.

 

This M gene is the same one shared by the trH3N2 virus that has – at last count – infected at least 10 people across four states over the past few months.

 

At this point I’ll simply step aside and direct you to:

 

New details emerge in novel H3N2 reports

Lisa Schnirring * Staff Writer

Nov 29, 2011 (CIDRAP News) – New details about the three most recent human infections with a novel swine-origin influenza virus have emerged over the past few days, along with a preliminary report of similar viruses in a few pigs.

(Continue . . .)

 

 

If you have not already done so, I would invite you to read Helen Branswell’s terrific SciAm feature from last December called Flu Factories which looks at the potential for novel flu viruses to emerge from the farm. 

 

It is an absolute must read.

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, 2010 |

Tuesday, November 29, 2011

ECDC Risk Assessment On trH3N2 Cases In North America

 

 

# 5983

 


My thanks to Helen Branswell for tweeting the link to this new risk assessment from the ECDC on the recent trH3N2 cases detected in a handful of people (mostly children) across four states here in the US (see MMWR Dispatch: Limited H-2-H Transmission Of Novel A(H3N2) Virus.)

 

The 7-page PDF document considers the current threat these reassorted swine viruses pose to public health in Europe to be low.

 

They concede, however, that `It is possible that these triple reassortant infections will appear in Europe, particularly if there is more human-to- human  transmission, which could lead to imported cases.’

 

 

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ECDC rapid risk assessment: Swine-origin triple Reassortant influenza A(H3N2) viruses in North America

29 Nov 2011

Centers for Disease Control and Prevention (CDC) has reported recent infections in children in North America with a swine-origin triple reassortant influenza A(H3N2) virus that includes a genetic component from the pandemic 2009 virus, and with probable human-to-human transmission with these viruses.

 

ECDC has conducted a rapid risk assessment to evaluate the implications for public health in Europe.

ECDC rapid risk assessment: Swine-origin triple reassortant influenza A(H3N2) viruses in North America (29 November 2011)

A few excerpts from the summary follow, but the entire document is worth reading:

 

Conclusions and recommendations


Following recent infections in children in North America with a swine-origin triple reassortant influenza A(H3N2) virus that includes a genetic component from the pandemic 2009 virus, and with probable human-to-human transmission of these viruses, ECDC has come to the following preliminary opinion:


•  These viruses are known to be found in pigs in North America but they have not been found in pigs in Europe (EU/EEA countries). However, surveillance for influenza in pigs is weak in both North America and Europe, and surveillance for infections in humans in close contact with pigs is notably weak in Europe. Hence all such statements on the epidemiology of swine influenzas must be treated with caution.   

 

•  Most of the US cases experienced only mild disease. Those hospitalised had underlying conditions and all patients recovered completely.


•  These viruses are susceptible to the neuraminidase inhibitors (oseltamivir and zanamivir) though the current A(H3N2) component of seasonal influenza vaccines is unlikely to provide protection. Older people are likely to have some protection from exposure to earlier vaccines.


•  It is considered by the United States Centers for Disease Control (CDC) that there had already been some very limited human-to-human transmission of these and similar viruses in the US. 


•  Unlike in March 2009 (the start of the pandemic) there are no reports of numbers of unexplained influenza infections elsewhere in the Americas. Hence it is unlikely that these US cases represent outliers for a larger phenomenon. 


•  Overall, therefore, the immediate direct threat to human health in Europe is low.


•  ECDC staff are following the situation closely and are in direct contact with the WHO, the US CDC and relevant experts in EU Member States.


•  There is a need to ensure that these infections could be detected through  diagnostic testing in European national influenza laboratories. 


•  There are strong public health arguments for more active virological surveillance of pig herds in Europe (and North America) including active surveillance of infections in humans that are in direct or indirect contact with pigs.  

 
•  Equally justified are more formal approaches to assessing emerging influenza viruses for their pandemic potential and such virological risk assessments should continue to be developed. 

 

•  Unusual influenza viruses should continue to be referred to National Influenza Centres and on to the WHO Collaborating Centre in Europe, along with relevant clinical and epidemiological data.   

 

 

For more on this emerging  story, you wish to revisit some of these earlier blogs:

 

Pseudo Pandemics And Viral Interlopers
CDC Update On trH3N2 Swine Infections
CDC Update On trH3N2 Cases
CDC Update On Recent Novel Swine Flu Cases
MMWR: Swine-Origin Influenza A (H3N2) Virus Infection in Two Children

WHO H5N1 Update On Egypt

 

 


# 5982

 

 

My thanks to Lisa for the head’s up this morning on this World Health Organization Global Alert and Response (GAR)  update from Egypt.

 

 

Avian influenza - situation in Egypt - update 57

29 November 2011 - The Ministry of Health and Population of Egypt has notified WHO of one case of human infection with avian influenza A (H5N1) virus.

 

The case is a 31 year-old female from Meet Salseel district, Dakahlia governorate. She developed symptoms on 10 November 2011 and was hospitalized on 16 November 2011. She is in critical condition and is provided with ventilation support.

 

Investigations into the source of infection revealed that the case had exposure to sick and dead poultry in her backyard.

 

The case was confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network on 21 November 2011.

 

Of the 153 cases confirmed to date in Egypt, 52 have been fatal.

The Bird Flu Research Debate Continues

 

 


# 5981

 

 

The hyperbolic headlines of the past few days would have the casual observer believing that the world’s bird flu researchers are a bunch of crazed scientists about to unleash a plague upon all of humanity.

 

A few examples taken from the NewsNow feed of the past 72 hours include:

 

Engineered Avian Flu Could Kill Half the World's Humans [Science] Gizmodo

 

Man-made deadly flu virus could wipe out humanity New Kerala

 

Mad Scientists Create H5N1 GM BioTerrorism Virus Conspiracy Planet

 

Based on the first two headlines, there is apparently some dispute over whether this research will be the death of all of us, or just half of the worlds population.

 

A minor technical point, I admit. But of interest, I would think, to at least 3.5 billion people.

 

There are legitimate questions to be asked regarding the safety and wisdom of many avenues of scientific research, but the truth is far less Strangelovian than some in the media would have us believe.

 

There is frankly little incentive for scientists to unleash a species killing plague, as it would make getting future research grants nearly impossible.

 

 

Since some in the media seem intent on pillorying bird flu researchers in general, and Ron Fouchier in particular, I thought it was only fair – for balance, if for no other reason - if I directed my readers to `the other side’ of this story.

 

My thanks to Gert van der Hoek on FluTrackers for posting the following link to Erasmus University’s Bird Flu Research FAQ.

 

 

FAQ Birdflu

Why does Erasmus MC carry out this type of research?

Erasmus MC carries out research to improve public health which is precisely why it is essential to conduct research on these viruses. A pandemic could cost many lives. Only by conducting these studies can we determine the risks caused by viruses and devise strategies to mitigate the risks, for example, by developing vaccines and medication to curtail the spread of the virus and by developing diagnostic tests. If these studies are not carried out as a precaution but once the virus has started to spread, it is too late. Research and the development of tests, vaccines and medication are very time consuming. The outcomes of this study will also be benficial in earlier recognition of dangerous variants of the virus in outbreaks.

You’ll also find their answers to the following questions on this webpage.

 

 

How big is the risk that the virus will spread among humans?

Could this dangerous virus escape from a laboratory or fall into the hands of people intending to cause harm, such as bioterrorists?

Can researchers become infected with the virus and then spread it?

Would it not be better to stop this type of research?

 

 

 

While some aspects of the media are unfairly painting bird flu researchers as a bunch of `mad scientists’ with a Gilbert Chemistry set, a sick chicken, and a dream - the reality is that nature continues to work 24/7 to develop more efficient pathogens. 

 

Researchers are trying to stay one step ahead of this process, in order to mitigate, or perhaps even avert, the next pandemic.

 

There are risks involved, of course. 

 

But those risks are also present in dozens of BSL-3 and BSL-4 labs all over the world, where scores of deadly pathogens are stored and experimented with every day. 

 

According to a CIDRAP report from last night (see Biosecurity panel said to be reviewing another H5N1 transmissions study) another well respected researcher’s work is under scrutiny by the US National Science Advisory Board for Biosecurity (NSABB), and there are discussions over how (or even whether) to publish the results.

 

Granted, genuine concerns exist over the wisdom of releasing the full details on these experiments, and some compromise regarding the publication of key elements to this research may well be needed.

 

But censoring the scientific community is a bad idea in principle, and as history has shown, rarely works in the long run. 

 

Knowledge is a difficult genie, no matter how closely held, to coax back into the bottle.

Monday, November 28, 2011

Study: Flu Hygiene Reduces Respiratory Infections In School Setting

 

 

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# 5980

 

 

We’ve another study that – despite returning somewhat mixed results – once again suggests the importance of maintaining good `flu hygiene’ during cold & flu season.

 

During the 2007-2008 flu season 10 Pittsburg elementary schools (grades K- 5) took part in a study where half of the schools served as controls, and half (5) were selected as `intervention’ schools.

 

Children in the intervention schools watched a special video on flu prevention, and were introduced to the `WHACK the Flu’ concepts.

 

WHACK stood for:

 

(W)ash or sanitize your hands often;

(H)ome is where you stay when you are sick;

(A)void touching your eyes, nose, and mouth;

(C)over your coughs and sneezes; and

(K)eep your distance from sick people.

 

This message was reinforced continually over the study period, and hand sanitizer dispensers were installed in each classroom and in major common areas of the intervention schools.

 

The goal was to encourage a minimum of 4 uses a day; upon arrival, before and after lunch, and prior to departure. Students were also encouraged to wash their hands and/or use the hand sanitizer as needed during the day.

 

Teachers were surveyed during the year regarding compliance rates among the students. Parents of students who were absent for more than one day received a phone call, and those who reported their child to have an ILI (influenza-like-Illness) received a home health visit where nasal swabs were obtained and tested for both influenza A & B.

 

The bottom line: at the intervention schools total student absences were reduced by 26% and lab confirmed influenza A infections were reduced by 52%.

 

Curiously, rates of influenza B were not reduced in this study, although the reasons why are less than clear.  In their discussion, the authors suggest several possible reasons, including:

 

The observation of no effect on influenza B could be attributed to differences in the basic biology and epidemiology of influenza B compared with A or to the fact that influenza B infections occurred late in the season, after compliance with the intervention possibly had waned.

 

A quick Google search returned a pdf of the full study online at this link.

 

Below you’ll find some excerpts from the abstract which may be read at the following link:

 

Pediatr Infect Dis J. 2011 Nov;30(11):921-6.

Reduction in the incidence of influenza A but not influenza B associated with use of hand sanitizer and cough hygiene in schools: a randomized controlled trial.

Stebbins S, Cummings DA, Stark JH, Vukotich C, Mitruka K, Thompson W, Rinaldo C, Roth L, Wagner M, Wisniewski SR, Dato V, Eng H, Burke DS.

(EXCERPT)
RESULTS:

A total of 3360 children participated in this study. Using reverse-transcriptase polymerase chain reaction, 54 cases of influenza A and 50 cases of influenza B were detected. We found no significant effect of the intervention on the primary study outcome of all laboratory-confirmed influenza cases (incidence rate ratio [IRR]: 0.81; 95% confidence interval [CI]: 0.54, 1.23). However, we did find statistically significant differences in protocol-specified ancillary outcomes.

Children in intervention schools had significantly fewer laboratory-confirmed influenza A infections than children in control schools, with an adjusted IRR of 0.48 (95% CI: 0.26, 0.87). Total absent episodes were also significantly lower among the intervention group than among the control group; adjusted IRR 0.74 (95% CI: 0.56, 0.97).

CONCLUSIONS:

NPIs (respiratory hygiene education and the regular use of hand sanitizer) did not reduce total laboratory-confirmed influenza. However, the interventions did reduce school total absence episodes by 26% and laboratory-confirmed influenza A infections by 52%. Our results suggest that NPIs can be an important adjunct to influenza vaccination programs to reduce the number of influenza A infections among children.

In the full paper, the authors conclude:

 

This study demonstrated that a set of NPIs can be implemented successfully on a large scale within urban schools to reduce absenteeism and the incidence of influenza A.

 

Furthermore, the results provide support for currently recommended respiratory hygiene behaviors during seasonal and pandemic influenza outbreaks and should be included as part of an overall prevention strategy to reduce the burden of influenza among school-aged children.

 

 

While useful interventions during any flu season, these techniques are even more important during an outbreak of a novel virus – such as we saw in 2009.  

 

Since vaccines typically take months to develop and even longer to deploy, simple, easy to implement NPIs (Non-pharmaceutical Interventions) such as these – while not a panacea - will undoubtedly form an important part of our initial response to any influenza epidemic.

Saturday, November 26, 2011

Branswell On The WHO Response To trH3N2

 

 

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H3N2 influenza virions responsible for casing illness in Indiana and Pennsylvania in 2011 Source – CDC Phil

# 5979

 

 

We’ve a terrific behind-the-scenes look via Helen Branswell on the World Health Organization’s thinking, and initial response to the recent trH3N2 swine-origin flu cases detected across four US states.

 

Helen is not only one of the best health and science writers on the planet, she also arguably has the best rolodex in the business (ok, with that archaic reference, I’m showing my age). 

 

You’ll find quotes from a `dream team’ of flu experts including Dr. Keiji Fukuda of the WHO, Dr. Arnold Monto of the University of Michigan, Dr. Nancy Cox of the CDC,  and renown virologist Dr. Malik Peiris of the University of Hong Kong.

 

At issue is what is the appropriate early response to the recent emergence of this new trH3N2 virus?

 

First, Helen’s article.  By all means, follow the link and read it in its entirety. When you come back, I’ll have a little more.

 

WHO trying to hit the sweet spot in responding to puzzling new flu virus

By: Helen Branswell, The Canadian Press

The spread of an odd new flu virus that has been jumping from pigs to people in parts of the United States has the World Health Organization gearing up its response planning, a senior official of the agency says.

 

The UN health body is figuring out what needs to be done if the virus continues to spread and a global response is required, Dr. Keiji Fukuda, assistant director-general for health security and environment said in an interview from Geneva.

 

(Continue . . . )

 

 

As I wrote yesterday in Pseudo Pandemics And Viral Interlopers, the appearance of a new virus – even one that demonstrates the ability to transmit among humans – isn’t a guarantee of a pandemic.

 

It didn’t happen in 1951 with the Liverpool flu or in 1976 with the swine flu, and it very well may not happen with this new trH3N2.

 

But you can’t just assume this virus will go away either.  It could adapt further to humans as it circulates, and in time, it could become a larger public health threat.

 

After the pillorying that the WHO took during the summer of 2009 over their declaration of a pandemic, they are understandably cautious today.

 

Call it a public relations lesson learned . . .  even though the 2009 H1N1 virus was a pandemic. It just didn’t fit the public’s perception of what a pandemic should look like.

 

Constant readers are no doubt aware that I’ve adopted a `wait and see’ attitude on this virus. While I’ve devoted more than a dozen blogs to its recent arrival, I’m not altogether convinced that it will spark the next pandemic.

 

I only accept that it could.

 

But then, so could H5N1, H9N2, or any of a handful of other viruses circulating around the world.

 

Given the uncertainty over the timing of the next public health crisis, and the potential for seeing many other types of disasters and emergencies, it only makes sense to make individual, business, and community preparedness a priority.

 

After all, if you are well prepared for an earthquake or a hurricane, you are probably reasonably well prepared to deal with a pandemic.

 


To learn how to prepare as an individual, family, business owner, or community I would invite you to visit the following sites and use THIS LINK to access some of my preparedness blogs.

 

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

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

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

 

I discovered long ago the secret to sleeping soundly at night; that preparing is easy.

 

It’s worrying that’s hard

Friday, November 25, 2011

Pseudo Pandemics And Viral Interlopers

 

 

# 5978

 

 

With the recent detections of a novel trH3N2 virus (see MMWR dispatch) among a handful of people across four states, today seems like a opportune time to look back at some viral contenders that threatened . . . but failed to produce a full blown pandemic.

 

Given that surveillance and testing methods have improved over the years, it is possible (perhaps even likely) that similar novel influenza viruses have briefly emerged in the past and simply gone undetected.

 

 

image

 

But interspersed between the pandemics of 1918, 1957, 1968 and 2009 we are aware of at least four other influenza strains that could have sparked a pandemic, but didn’t.

 

One was extremely mild and widespread, another extremely virulent but geographically limited and short lived, the third disappeared mysteriously, and the fourth affected mostly children and adolescents.

 

 

The first example comes from shortly after the end of WWII with what would become known as the `pseudo-pandemic’ or vaccine failure of 1947.

 

In 1943, the US military – fearing that crowded ships and barracks could give rise to a reprise of the 1918 pandemic – commissioned Dr. Thomas Francis of the University of Michigan and his protégé Jonas Salk to come up with a viable influenza vaccine.  

 

Within a year a vaccine based on the 1934 and 1943 flu strains was in wide use in the military, and for several years the Francis/Salk vaccine worked well. 

 

But in 1947, a new variant of the H1N1 virus appeared on military bases – first in Japan – and quickly spread from there infecting hundreds of millions around the globe (see 2002 PNAS article).

 

While it produced a generally mild illness, and few excess deaths, this new strain apparently had drifted enough antigenically to evade both the vaccine and community immunity acquired from earlier strains.

 

1947 is little remembered today, except for the lesson it taught us; that vaccines must be updated each year to take into account antigenic drift (or newly emerging flu strains).

 

Four years later, a far more ominous viral strain made an appearance on the global stage, during what was an otherwise mild and unremarkable 1950-51 flu season. 

 

This outbreak is commonly called the Liverpool Flu.

 

For about six weeks, a highly virulent influenza erupted in Liverpool, England and then spread across the UK and to Canada – that for a time was as deadly as the 1918 pandemic.

 

image

 

This startling graphic comes from the March 16th, 1951 Proceedings of The Royal Society of Medicinepage 19 – and shows in detail the tremendous spike in influenza deaths in early 1951 over the (admittedly, unusually mild) 1948 flu season. 

 

The CDC's EID Journal  has a stellar account of this 1951 event, and is very much worth reading.

 

Viboud C, Tam T, Fleming D, Miller MA, Simonsen L. 1951 influenza epidemic, England and Wales, Canada, and the United States. Emerg Infect Dis [serial on the Internet]. 2006 Apr [date cited].

 

 

This aberrant strain never spread much beyond the UK and eastern Canada, and died out as the flu season came to a close. Thankfully, it did not return the following year. 

 

What made it so virulent, and why it failed to return the following year, remains a medical mystery.

 

The 1957 and 1968 pandemics – while mild in comparison to the Spanish Flu of 1918 – followed.

 

In February of 1976, a young recruit at Ft. Dix, New Jersey fell ill and died within 24 hours. The virus went on to infect more than 200 soldiers and caused severe respiratory disease in 13 of them. It circulated on the base for nearly a month.

 

The virus was isolated and dubbed A/New Jersey/76 (Hsw1N1). How it arrived on the base was unknown. While the death rate was very low, this virus appeared to easily transmissible among humans.

 

And the fear was, it might develop a higher mortality rate as it mutated.

 

This led to the swine flu pandemic scare of 1976, which I chronicled several years ago in Deja Flu, All Over Again

 

The feared swine flu pandemic never materialized, and for reasons we cannot explain, the virus simply disappeared.

 

But a year later, we did see an epidemic, at least among children, with the return of the H1N1 virus after a 20 year absence.

 

The 1918 H1N1 virus, and its descendents, monopolized the world’s influenza scene for nearly 40 years until the H2N2 strain appeared in 1957, and replaced it. Another replacement occurred in 1968, when the H3N2 strain supplanted H2N2.

 

It appeared that in the normal scheme of things, only one major Influenza A strain could circulate at a time.

 

But that theory was turned on its head when, in 1977, H1N1 resurfaced. How and why it returned is a mystery, although many believe it was the result of an accidental release from a Russian or Chinese research laboratory (see Vince Racaniello’s  Origin of current influenza H1N1 virus).

 

It was dubbed the `Russian Flu’, and quickly spread among the under-20-somethings who had no immunity. 

 

But this time things were different. It didn’t replace or drive out the existing (H3N2) virus.

 

The two strains (H3N2 and H1N1) co-circulated, and since then having two main `A’ strains in circulation (along with some `B’ viruses) has become the norm.

 

The reason most commonly given is that older people were less affected by the returning H1N1 virus – since those born before 1957 had previous exposure – and so they remained a reservoir of the H3N2 virus.

 

The seasonal H1N1 virus was supplanted in 2009 by the arrival of the  pandemic H1N1 virus, which, while no longer a pandemic strain, co-circulates today with H3N2.

 

None of this tells us what will become of the trH3N2 virus we are currently watching, or any of the other novel strains that we’ve seen jump to humans over the past few years.

 


But it does provide some perspective.

 


It shows that new, emerging influenza viruses can appear - and even transmit efficiently among humans –and still fail to spark a global pandemic. These viral interlopers can sometimes simply run out of steam and die out, for no discernable reason. 

 

And even if one spreads globally – as we saw in 1947 – it can turn out to be exceedingly mild.

 

Of course, the opposite can be true. The pandemics of 1918, 1957, 1968, and 2009 show us that.

 

The bottom line is that influenza viruses are notoriously unpredictable. They certainly deserve our attention and respect.

 

Whether trH3N2 becomes a contender, or ends up a footnote in the history of influenza, is something we will have to wait to see.

 

But with a wide constellation of viruses out there, constantly evolving, looking for new hosts and an evolutionary advantage, the smart money is on being prepared.


Because, regardless of its source, pandemics happen.

 

It’s just a matter of time.

Thursday, November 24, 2011

WHO Statement On Novel trH3N2 Cases In The US

 

 

# 5977

 

The World Health Organization has posted a statement regarding the ongoing detection of sporadic infections by a novel swine-origin triple reassorted H3N2 virus in the United States.

 

You’ll find the CDC’s Statement from yesterday HERE, and the MMWR dispatch with details on the three latest cases HERE.

 

 

Influenza like illness in the United States of America

24 November 2011 - The United States Government has reported three cases of human infection with swine origin triple reassortant Influenza A H3N2. Between 10 and 13 November 2011, three children (aged 11 months, 2 years and 3 years) experienced onset of febrile respiratory illness. All three children had visited the same health care provider in Iowa State. None of them were hospitalized and all three have recovered.

 

Laboratory testing conducted on 18 November 2011 in the State Hygienic Laboratory at the University of Iowa showed a swine-origin triple reassortant influenza A (H3N2) (S-OtrH3N2) virus. This was confirmed by sequencing at the Centers for Disease Control and Prevention (CDC) on 20 November.

 

The three children attend the same daycare facility. There is an ongoing investigation and to date, no epidemiological link to swine has been identified in any of the three children. Additional investigation is currently underway to identify and characterize the illness in other daycare attendees, family members, or other contacts, and to determine any exposure to swine.

 

These are 16th, 17th and 18th cases of human infection with swine origin triple reassortant influenza A (H3N2) detected in the United States since 2009, and the 8th, 9th, and 10th cases reported this year.

 

WHO is closely following the situation with the US Government, CDC and other partners.

 

MMWR Dispatch: Limited H-2-H Transmission Of Novel A(H3N2) Virus

 

 

# 5976

 

 

For the past several months we’ve been watching an evolving story involving a newly identified swine flu variant (S-OtrH3N2) that has now been detected in 10 people (mostly children) across 4 states.

 

For more on those earlier cases see:

 

CDC Update On trH3N2 Swine Infections
Maine Confirms A 2nd trH3N2 Case
CDC Update On trH3N2 Cases
A 5th trH3N2 SOIV Report
CDC Update On Recent Novel Swine Flu Cases
MMWR: Swine-Origin Influenza A (H3N2) Virus Infection in Two Children

 

Although the majority of these cases have had recent potential contact with swine, the latest three cases out of Iowa appear to be the result of Human-to-Human (H-2-H) transmission.

 

Late yesterday the CDC released a special MMWR  dispatch that provides details on these three new cases, some background on earlier SOIV (swine origin influenza viruses) cases, and some analysis. 

 

A few excerpts follow (underscores & bolding mine), but follow the link to read the entire dispatch.

 

Limited Human-to-Human Transmission of Novel Influenza A (H3N2) Virus — Iowa, November 2011

Dispatch

November 23, 2011 / 60(Dispatch);1-3

On November 20, 2011, CDC confirmed three cases of swine-origin triple reassortant influenza A (H3N2) (S-OtrH3N2) virus infection in children in two counties in Iowa. None of the children were hospitalized, and each has recovered from a mild episode of febrile respiratory illness. All three were in contact with one another, and none had a known recent exposure to swine. No additional human infections with this virus have been detected in Iowa, and no evidence of sustained human-to-human transmission of this S-OtrH3N2 virus exists; surveillance is ongoing.

 

Eighteen human infections with swine-origin influenza A (H3N2) viruses have been identified since 2009 (1,2). The most recent 10 cases, including the three Iowa cases described in this report, were infections with S-OtrH3N2 viruses containing the matrix (M) gene from the pandemic 2009 influenza A (H1N1) virus (pH1N1). These viruses are considered reassortant viruses between a swine-origin influenza A (H3N2) virus circulating in North American swine and a pH1N1 virus. All cases of human infection with S-OtrH3N2 virus containing the M gene from the pH1N1 virus have occurred in 2011 and have been reported from four states: Pennsylvania (three cases), Maine (two), Indiana (two), and Iowa (three) (3).

Case Reports

Patient A. In the second week of November 2011, patient A, a previously healthy female child, experienced acute onset of influenza-like illness (ILI). Three days after her illness onset (illness day four), she was seen by a health-care provider, who obtained a respiratory specimen and performed a rapid influenza diagnostic test, which was positive.

As part of routine influenza surveillance, the respiratory specimen was forwarded to the University of Iowa State Hygienic Laboratory (SHL) for further evaluation. Patient A's brother experienced onset of ILI 1 day before patient A's date of illness onset. Patient A's brother was not tested for influenza but was treated with oseltamivir by a health-care provider and has recovered. During her illness days two and three, patient A was in contact with her father, who subsequently developed ILI 2 days after his most recent contact with patient A. He was not tested for influenza. No other household member has reported respiratory illness. No family member reported exposure to swine before their illness onset. On her illness day one, patient A attended a small gathering of children.

Patients B and C. Patient B is a previously healthy male child who developed ILI 2 days after patient A's first day of illness. He is the sibling of patient C, a previously healthy male child who developed ILI 1 day after patient B's illness onset. Both children were seen by a health-care provider 2 days after patient B's illness onset; rapid influenza diagnostic testing was positive for both patients. As part of routine influenza surveillance, respiratory specimens were forwarded to SHL for further evaluation. The mother of patients B and C reported that no other household member had a respiratory illness and none had been exposed to swine before patient B became ill. On patient A's illness day one, patients B and C attended the same small gathering of children as patient A.

Epidemiologic and Laboratory Investigations

An investigation by the Iowa Department of Public Health (IDPH) determined that the families of patients A, B, and C reported no recent travel or attendance at community events. To date, the only epidemiologic link among patients A, B, and C that has been identified is attendance at a gathering of children on patient A's illness day one. No illnesses were reported among adults or among the five other children who were present at this gathering on that day. No swine exposures have been identified among adults or children attending this gathering. IDPH has detected no increase in absenteeism or reports of respiratory illness in the community where patients A, B, and C reside or in the schools in the community.

Enhanced surveillance for ILI has been implemented in health-care facilities in the communities where patients A, B, and C reside. IDPH has instructed health-care providers to obtain respiratory specimens from patients with ILI for influenza diagnostic testing at SHL. Thus far, no additional cases of S-OtrH3N2 infection have been identified, and surveillance data from the state have shown low levels of influenza activity currently and at the time of all these patients' illnesses.

(Continue . . . )

 

 

Swine are highly susceptible to the influenza virus, and are capable of serving as `mixing vessels’, allowing them to reassort into new hybrid strains.

 

Reassortment happens when two different influenza viruses co-infect the same host, swap genetic material, and produce a hybrid virus. 

 

image

 

That is essentially what happened in 2009, when the H1N1 swine flu virus emerged after bouncing around swine herds for a decade or more, picking up genetic changes along the way.

 

And not surprisingly, this recently emergent `humanized’  H1N1 virus has re-entered the swine population and is once again mixing and matching with other circulating swine flu viruses.

 

As a result we now have a Swine H3N2 virus that has reassorted with the 2009 pandemic H1N1 virus, producing a new hybrid that has – in a limited fashion – begun to emerge into the human population.

 

Whether this virus has `legs’, and can sustain itself in the human population, is something we’ll simply have to wait to see. 

 

Regardless of what this virus does - with our regular flu season nearly upon us - the best advice from the CDC is to maintain good flu hygiene this winter (cover your coughs, wash your hands, stay home if you are sick), and to get the seasonal flu shot.

 

While the public health threat from this emerging swine virus appears low for now, this is obviously a story we’ll continue to follow with considerable interest.

Wednesday, November 23, 2011

CDC Update On Iowa trH3N2 Cases

 

 

# 5975

 

 

The CDC has posted an update on their Have you heard? webpage on the recent detection of 3 additional trH3N2 cases, this time in Iowa.

 

You’ll find earlier blogs on these latest cases here and here.

 

The CDC is currently characterizing these latest cases as `unsustained human-to-human transmission’. I’ve reproduced the entire statement below.

 

 

Iowa Reports Novel Influenza Infections in Three Children

November 22, 2011

The Iowa Department of Public Health today reported that a “novel strain of the influenza virus has been detected in three children.” All three of the children were reportedly mildly ill and have recovered. Iowa has increased surveillance for influenza-like-illness to detect any additional cases of infection with this novel virus.

 

All three patients are young children who were in contact with one another. All cases were detected at the state public health laboratory through virologic surveillance. An investigation is ongoing but no additional cases have been identified.

 

Testing at CDC has confirmed that these viruses are similar to the swine-origin influenza A (H3N2) viruses identified in three other states. These viruses contain the “matrix (M) gene segment” from the pandemic 2009 H1N1 virus. This combination of genes was first identified in a person in July. Since then, several additional human infections with this virus have been detected, bringing the total number of human infections to 10 (Indiana 2, Pennsylvania 3, Maine 2, and Iowa 3). All 10 patients have recovered and the majority of cases had relatively mild illness, although 3 patients were hospitalized.

 

CDC has reported on the previous infections on its website, in the FluView activity report, and in the Morbidity and Mortality Weekly Report. Links to all previous reports related to this virus are available on the CDC swine influenza website at http://www.cdc.gov/flu/swineflu/index.htm.

 

These viruses are substantially different from human influenza A (H3N2) viruses, so the seasonal vaccine is expected to provide limited cross-protection among adults and no protection to children. However, laboratory testing so far indicates these viruses are susceptible to the antiviral drugs oseltamivir (Tamiflu®) and zanamivir (Relenza®). CDC recommends these drugs for treatment of seasonal and these swine-origin influenza viruses.

 

Prior to the three cases in Iowa, most human infections with this virus were associated with exposure to swine. In Iowa, however, no swine exposure has been identified. At this time, it appears that unsustained human-to-human transmission may have occurred. These viruses have been reported in swine in several states in the United States. Swine influenza viruses do not spread through contact with pork or pork products. Eating properly handled and cooked pork is safe.

 

As part of routine preparedness measures to counter possible pandemic threats posed by novel influenza viruses in the event that they gain the ability to spread easily from person-to-person, CDC has developed a candidate vaccine virus and provided it to manufacturers.

 

These cases will be officially reported in the MMWR and FluView.

More Details On The trH3N2 Story

 

 

 

# 5974

 

 

The announcement yesterday out of Iowa that 3 more children have contracted a rare emerging swine flu strain (see Iowa DPH Reports 3 Novel trH3N2 Cases) has produced a number of headlines over the past 18 hours.

 

The most significant piece of new information since then is that all three children had contact with one another, and that it appears that one child transmitted the virus to the other two.

 

No additional transmission has thus far been detected, and the the mystery of how and where the first child acquired the virus remains.

 

As might be expected, Helen Branswell of the Canadian Press has some of the best and most complete coverage of this story.  

 

A link to her story (which I encourage you to read in its entirety), then I’ll be back with a little more.

 

U.S. sees 3 new infections with new flu virus

The Canadian Press

Date: Tuesday Nov. 22, 2011 8:59 PM ET

U.S. health officials have spotted three more children infected with a new swine-origin flu virus, this time in Iowa.

 

And while earlier cases of infection with this virus are believed to have been cause by exposure to pigs, this time the evidence points to person-to-person spread.

(Continue . . . )

 

 

Occasionally we’ll see a novel swine influenza virus (usually an H1N1 or H3N2 variant) 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’

 

While it is a rare event, as we saw in 2009 it is possible for one of these viruses to adapt well enough to human physiology to spark an extended outbreak, or even a pandemic.

 

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 infected a sufficient percentage of the population, before they are likely to start picking up cases.

 

In these ten most recently reported cases, the virus has been a swine H3N2 virus with the M segment gene borrowed from the 2009 H1N1 virus. Essentially a hybrid – a new reassortant virus - that until this summer had not been seen before.

 

Reassorted viruses can result when two different flu strains inhabit the same host (human or otherwise) at the same time. Under the right conditions, they can swap one or more gene segments and produce a hybrid virus.

 

reshuffle

 

Where this virus goes from here is anyone’s guess.

 

Its appearance across four states, and in some humans without direct animal contact, certainly suggests low-level human transmission.

 

But the ability to transmit from one human to another isn’t enough to ensure its survival. In order to thrive, it must have an R0 number (basic reproductive number) sufficient to sustain an outbreak.

 

The R0  number signifies the average number of secondary infections caused by one infectious person entering a totally susceptible population. 

 

If less than 1.0, outbreaks are likely to sputter and die out.  If greater than 1.0, the outbreak is more capable of spreading. 

 

 

And as we’ve seen with roughly two dozen other reported novel swine infections since 2005, and with a significant number of H5, H7, and H9 avian flu infections, it is possible to have limited outbreaks of a novel flu virus without it sparking an epidemic.

 

For now, this virus doesn’t appear to be sufficiently well adapted to human physiology to spread in an efficient and sustained manner.

 

This virus may simply simmer at low levels in the human population for a spell, then die out. Or it may further adapt to humans, and produce a larger public health threat down the road.

 

We’ll simply have to keep our eyes on this story, to see where it goes.

 

In the meantime, maintaining good flu hygiene this winter, and getting your flu shot, remain the best strategies to avoid getting sick during this flu season.

Tuesday, November 22, 2011

Iowa DPH Reports 3 Novel trH3N2 Cases

 

Note: This story is updated at  More Details On The trH3N2 Story

 

# 5973

 

image

Reassortant H3N2 virus detected in Pennsylvania,Indiana & Maine – Source CDC

The Iowa Department of Public Health announced today in a brief press release that they have detected three cases of a novel trH3N2 SOIV (Swine Origin Influenza Virus) described as being similar to the ones reported recently in Indiana, Pennsylvania, and Maine.

 

For more on those earlier cases see:

 

CDC Update On trH3N2 Swine Infections
Maine Confirms A 2nd trH3N2 Case
CDC Update On trH3N2 Cases
A 5th trH3N2 SOIV Report
CDC Update On Recent Novel Swine Flu Cases
MMWR: Swine-Origin Influenza A (H3N2) Virus Infection in Two Children

 

Unlike the majority of cases reported over the past few months, these three cases report no animal exposure, and so limited Human-to-Human spread is suspected.

 

My thanks to Carol@SC on the Flu Wiki for posting a news item that led me on a search to find this news release from the Iowa DPH.

 

 

Flu Activity in Iowa Includes Novel Strain

Posted: Tue, 22 Nov 2011 15:09 CST

Important to cover your cough and stay home when sick

Routine surveillance by the Iowa Department of Public Health (IDPH), the State Hygienic Lab and other partners across the state indicate that a novel strain of the influenza virus has been detected in three children in Webster and Hamilton Counties.

This virus, an influenza A/H3N2 recombinant virus, has also been detected in other states in recent months. Symptoms are similar to the regular seasonal flu and include fever, cough, tiredness, body aches and loss of appetite.This influenza A/H3N2 virus contains components of human, avian, H1N1, and swine influenza.

All spread has been human to human, and spread appears to be limited; no further cases have been identified in the last week. None of the cases have had any animal exposure. Because the virus is unique, IDPH has increased surveillance for this strain at clinics and emergency rooms.

 

“It appears the seasonal influenza vaccine currently available may offer some protection against this novel strain,” said IDPH Medical Director, Dr. Patricia Quinlisk. “However, we continue to stress the importance of personal protective actions. Remember the three Cs: Clean you hands frequently; Cover your coughs and sneezes; and Contain germs by staying home when ill.”

 

No serious illness or death has been reported in connection with this novel influenza A/H3N2 virus, and all cases have recovered. For more information on the virus, visit www.idph.state.ia.us/Cade/Influenza.aspx?pg=FluHome .

 

While unusual, human infections by novel swine viruses are not unheard of.  Over the past 5 years more than 2 dozen (trH1N1 & trH3N2) cases have been detected.  Most are a result of direct exposure to swine, although limited human-to-human transmission appears to have occurred.

 

Since these novel H3N2 infections continue to appear in low levels across the upper Midwest,this is obviously a story we will continue to follow.

Thanksgiving Roll Call 2011

 

 

# 5973  

 

 

This is my sixth Thanksgiving blogging at AFD.

 

During Thanksgiving week of 2006 I began what has turned out to be a joyous tradition for me - taking the time to publicly acknowledge and thank those working to prevent, or mitigate, global health threats.

 

Each year I update this essay to include some new people, and to mention some of the friends I've met along the way on this remarkable journey through Flublogia.

 

While I pen AFD alone, this is by no means a solitary effort.  I rely (heavily) on the the advice, expertise, hard work, and generosity of dozens of others in Flublogia, without whom, this blog would not be possible.

 

This is my once-a-year chance to thank them. You’ll find earlier editions of this roll call at:

Thanksgiving Roll Call - 2010

Thanksgiving Roll Call 2009

Thanksgiving Roll Call - 2008

Thanksgiving Roll Call, Redux

AVIAN FLU THANKSGIVING ROLL CALL

 

Our regular coverage of Emerging Infectious Diseases and public health threats will continue shortly.

 

In the meantime, I invite you to take a moment to reflect on those who are out there doing good work (including some, who sadly, are no longer with us) to try to reduce disease morbidity and mortality around the world.

 

 

You may know some of these people by name, and some by the organizations they represent, while others you may not be aware of at all.

 

This is, in no way, a complete list.

 

There are far too many good people, agencies, and organizations doing good work out there to mention.

 

But it’s a start.

 

So, in no particular order, a tip of the hat and a world of thanks go to:

 

Kudos first to the career members of the HHS, CDC, and FDA who during the spring of 2009 were faced with an emerging pandemic during a time of political transition. The kind of work they do in the face of an outbreak was nicely dramatized this past year in the movie Contagion (see  The `Contagion’ Conversation Continues).

 

Readers of this blog no doubt have noticed that I’ve referenced the work of CIDRAP  often over the years. 

 

The reason is simple: They are extremely good at what they do.

 

 

The reporting from CIDRAP  News is always first rate, with most of the heavy lifting done by Editor Robert Roos, and Lisa Schnirring.

 

Dr. Michael Osterholm, Director of CIDRAP, is a bit of a legend in the flu world, and rightfully so. Before devoting his attentions to CIDRAP, Dr. Osterholm served for 24 years (1975-1999) in various roles at the Minnesota Department of Health (MDH), the last 15 as state epidemiologist and chief of the Acute Disease Epidemiology Section.

 

I consider myself fortunate indeed to have had the opportunity to meet and become friends with Lisa, Robert, Nick Kelley – CIDRAPs Preparedness Program Coordinator - and Dr. Osterholm.

 

CIDRAP, of course, is made up of more than just the handful of people I've mentioned. A more complete list is available here along with their mission statement.

 

Other notables include:

 

Dr. David Nabarro, Senior United Nations system Coordinator for Avian and Human Influenza and now, also coordinator of the UN’s High-Level Task Force on the Global Food Security Crisis.

 

Dr. Robert G. Webster, perhaps the world’s most famous virologist, and the head of the virology department of St. Jude’s Research Hospital. In addition to his life long study of viral pathogens, and the numerous papers he has produced, Dr. Webster was one of the first scientists to recognize the threat of the H5N1 virus in Hong Kong more than a dozen years ago.

 

The list of doctors and researchers is extensive, and there are many unsung heroes among them. People like Greg Poland of the Mayo Clinic, and John Oxford, Professor of Virology at St Bartholomew’s and the Royal London Hospital, Professor Peter Doherty, and Richard Webby of St. Judes, Ab Osterhaus and  Ron Fouchier Erasmus Medical Center in Rotterdam, and Chairul A. Nidom, a virologist with the Tropical Disease Centre at Airlangga University.

 

Names you may never have heard of, unless you follow virology closely.

 

There are countless people at the CDC, the NIH, the WHO, FAO, and OIE who are working, mostly anonymously and often in less than optimal conditions, to mitigate this pandemic and hopefully prevent the next one.

 

And there are universities and medical centers around the world; places like the University of Minnesota, St. Judes Research Hospital, UPMC Center For Biosecurity, Australian National University, and Baylor College of Medicine in Houston which are major sponsors of influenza and emerging infectious disease research - along with others too numerous to mention.

Moving beyond researchers and scientists, there are those who bring us their stories and keep us informed on disease threats and the steps being taken to combat them.

 

John M. Barry, author of the quintessential book on the 1918 pandemic, The Great Influenza: The Epic Story of the Deadliest Plague in History,  almost single handedly has reminded us of the horrors of our last great pandemic. If you haven’t read this book, you should. Period.

 

Dr. Michael Greger, author of Bird Flu: A Virus of Our Own Hatching has provided us with a compelling, and all too often disturbing look at the factory farming business, and how it contributes to the threat of a pandemic.

 

The entire text is available online, without charge (thank you Dr. Greger!).

 

Helen Branswell, health reporter for the Canadian Press. If anyone in the field of journalism deserves the Paul Revere Award, it is Helen. She has produced some of the finest reportage on the emergence of the H5N1 virus (and now H1N1) as exists anywhere in the world, and she started back when few had heard of the threat.

 

Her writing is clear, concise, and absent of the breathless prose that many lesser journalists rely upon.  Whenever I find a Branswell article, I know in advance it is going to be well worth reading.

 

Maggie Fox, now Managing Editor, Technology and Healthcare at the National Journal, is another standout in the world of journalism.   Her reporting on the pandemic threat (along with a myriad of other topics) has been consistently excellent.

 

Maggie has an advantage over many other news reporters in that she understands the science, having completed fellowships at the National Institutes of Health on Genomics, at Harvard Medical School on infectious disease, and at the University of Maryland on child and family health policy.

 

And it shows.

 

Declan Butler, senior reporter for Nature, and blogger, who very early on called the attention of the world to the pandemic threat, and who has used Google Earth to great effect mapping avian flu outbreaks around the world.

 

Other notable names would include Jason Gale of BloombergPatrick Thibodeau of ComputerWorld, Betsy McKay at the Wall Street JournalRobin McDowell of the AP, and Emmy Fitri of the Jakarta Post.  There are others of course.

 

Thank you all. We could use a hundred more, just like you.

 

On the Internet we have a number of dedicated and astute bloggers, and they too deserve special mention.  Among them:

 

Crawford Kilian, author of Crofsblog, was one of the first to devote his blog to pandemic flu – but has branched out to cover many of the neglected diseases and disasters - like Dengue, Malaria, Chikungunya, and the Cholera epidemic in Haiti.

 

His site is resource rich, his comments are invariably on target, and he has a genuine nose for news.

 

Writer and blogger Maryn McKenna lends considerable talent and expertise to Flublogia, particularly on the antimicrobial resistance front.

 

Last year her second book, SUPERBUG: The Fatal Menace of MRSA was published to sterling reviews (you can read my review here).  Her Superbug Blog continues to be one the best resources on antibiotic resistance issues available online.

 

Maryn is also the author of Beating Back The Devil, the inside story of the CDC’s Epidemic Intelligence Service, and an upcoming book on MRSA.

 

Ian York, who now works at the CDC, also pens the  wonderful Mystery Rays blog (although his work schedule has limited his blogging this year). His eclectic meanderings through the world (and history) of infectious diseases are a delight for disease geeks and highly recommended.

 

A couple of years ago, after several years of email correspondence, I finally got to meet the irrepressible (and now zombified!) Scott McPherson .

 

We were both part of the CIDRAP summit in September 2009, and I got to spend two glorious days hanging out with him and Indigo Girl (of the AllNurses forum), forming what we called The Flu Amigos.

 

A fellow Floridian, Scott is the CIO of the Florida House of Representatives, and rubs elbows with State and Federal officials every day.  His insights, often sprinkled with a dash of healthy whimsy, are always a pleasure to read.

 

 

Indigo Girl of Allnurses.com has been a major force behind their pandemic forum for several years.  Her long-running analysis of avian and H1N1 flu news has brought a keener awareness and understanding of pandemic issues to her fellow nurses.

 

I consider myself very fortunate to be able to call both of these flubies good and dear friends. 

 

Another blogger I've had the great fortune to meet, and work with on several occasions, is Dr. Greg Dworkin (DemFromCt), editor of the Flu Wiki and a blogger on the Daily Kos.

 

We've worked together on four projects so far; The 2007 HHS Pandemic Leadership Blog, the 2008 HHS Pandemic Tabletop Exercise, the 2009 HHS Pandemic Tabletop Exercise, and are both contributors to GetPandemicReady.Org.

 

Distance makes face-to-face meetings between bloggers rare-but-happy events, but we often share information and ideas via Skype, email, and other backchannels.

 

Integral to the blogging scene are Arkanoid Legent out of Malaysia, who very efficiently covers `the night shift’ in Flublogia - and of course, Ida at the Bird Flu Information Corner provides some of our best views of what is really going on in Indonesia.

 

You’ll find even more flu and emerging disease information at Giuseppe Michieli’s eclectic A Time’s Memory and Cottontop’s Flu News Network.

 

We’ve also lost some bloggers in Flublogia over the past year or so, some by intent, and one whose was claimed by an insidious disease at a tragically young age.

 

John Solomon (1963-2010)  – who waged a courageous battle against Leukemia, passed away in the fall of 2010.  While we never met face-to-face, John and I highlighted each other’s work in our blogs, and frequently exchanged emails.

 

His In Case of Emergency Blog was a favorite of mine.  He, and his dedication to the cause of personal, community, and national preparedness will be long remembered and missed by many.

 

Jimmy Jazz, the pseudonym of the Editor of Break Glass, outed himself in the wake of John Solomon’s death, and has reincarnated his web presence in a new (and excellent) blog called The Face of The Matter.

 

We also said Farewell To Chen Qi last April, when Paul decided to shutter the site in order to concentrate on other projects.

 

While not necessarily flu-centric, some other bloggers of note that I follow, and recommend include:

 

Vincent Racaniello’s always excellent Virology Blog, which devotes a good deal of time to influenza.   His TWiV and TWiP  podcasts are also highly recommended.

 

Assistant Professor of Epidemiology, Tara Smith’s blog Aetiology and Celeste Monforton and Liz Borkowski of The Pump Handle are highly recommended as well.

 

Joel at Preparedness and Response.  

 

And then there’s David Dobbs of Neuron Culture and Nedra Weinreich at Spare Change.

 

 

And last, but hardly least, there’s Dr. Peter Sandman who, along with his wife and colleague  Dr. Jody Lanard, produce a wealth of invaluable risk management and pandemic communications advice on their Risk Communication Website.

 

 

Relatively new are the Twitter generated daily newspapers, like Cesar Sanchez’s Microbiology Daily, Liz Ditz’s ScienceMob Daily, and All Hands’s Emergency Management Daily and Business Continuity Daily, and Dave Walker’s Healthcare Daily.

 

In a special category I mention author, journalist, filmmaker, and friend  Peter Christian Hall (see  A Recurrent Fever) – who in the wake of the release of the movie `Contagion’ - recently interviewed a number of flu bloggers for the  The Huffington Post (see Contagion Grips 'Flublogia').

 

His pandemic novel, American Fever is due out after the first of the year.  Good luck Peter.

 

While most of them don’t maintain formal blogs, many of most active (and most astute) infectious disease news analysts in Flublogia are the volunteer newshounds on the flu forums.

 

Every day, dozens of hardworking flubies scour foreign language news reports, using search engines, text-finding software, and translating programs to bring us the latest tidbits of news from around the world.

 

They do an awesome job.  

 

If the CIA and the NSA aren't envious, they should be.  I’ve written numerous times about the work they do, but if you want to know how they do it, check out Newshounds: They Cover The Pandemic Front.

 

It would be impossible to mention them all, and I fear insulting those I miss. But a partial list (in no particular order) of some of the most active newshounds – now and in the past -  includes :

 

Dutchy,  Ironorehopper,  Treyfish, Commonground, Florida1, DemFromCt, SusanC, Kobie, Carol@SC, Pixie, mojo, bgw in MT, Readymom, pugmom, Frenchiegirl, AlohaOr, UK-Bird, Rick, Canada Sue, Theresa42, Mosaic, Cottontop, Influentia2, Mojo, Michelle in OK, Mary In Hawaii,  dbg, flubergasted, Laidback Al, Alaska Denise, Siam, InKy, History Lover  . . .

 

To those I missed (and there are many), mea culpa.

 

Some of these newshounds can be found on multiple flu forums, while others stick with one particular home base.  Regardless, the information is freely shared between all of the flu forums, and dissected by knowledgeable and interested parties.

 

The work they do is remarkable. And I couldn't do much of what I do without them.  Thank you all.

 

The owners and moderators of the flu forums deserve mention, too. 

 

Labors of love, and devourer's of both time and money, flu forums provide a place for laymen and professionals to gather to discuss the various aspects of pandemic planning, and quite often, the science behind influenza and epidemiology.   

 

The founders and moderators do a terrific job keeping things on track, and do so without compensation.  Most of the time, the costs (which can run into the hundreds of dollars each month) are borne by the owners.

 

There are a number of flu forums out there, but the two where I hang my hat are the Flu Wiki and  Flutrackers. Each has their own style and personality, and in many cases, members of one forum belong to several other forums as well.

 

The Flu Wiki, the first of the dedicated flu forums, was founded by DemFromCt, Pogge, and Melanie Matson.  In 2008, we lost Melanie after a long illness.  She was a pioneer, and an activist, and is greatly missed.

 

You can read more about her, and her legacy, here.

 

FluTrackers, founded by Sharon Sanders (but run with the aid of dozens of tireless volunteer moderators), boasts nearly 2,000 members and prides themselves on maintaining an impressive library of scientific literature on pandemic influenza and other emerging infectious diseases.

 

Sharon is also a dear friend, fellow Floridian, confidant, and unindicted co-conspirator.  

 

There is also Francophones des FluTrackers,  which is a French language section of Flutrackers, moderated by Muscade, Éditeur et Directeur.

 

And then there are the flubies, which number in the thousands. 

 

Some are active posters on the flu forums, while others take a more passive role.  Many have become activists in their communities.

 

Readymom, whom I've highlighted before in these pages, runs her own website Emergency Home Preparation.

 

Starting in mid-2007, more than a dozen volunteers worked to put together the GetPandemicReady.Org website.   There you will find more than 3 dozen easy-to-follow preparedness guides, written by some pretty familiar names from the Flu Forums.

 

This site is hosted by the Lewiston-Nez Perce County Board of Commissioners, and came about in large part due the hard work of Mel Johnson, Director of Emergency Management.

 

And StudentsPrepAmerica.Org was created by Justin Kamen and others at Columbia University, and is designed to get the preparedness word out to College and University Students.

 

Behold the power for the flu forums. 

 

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

They could use your support.

 

These NGO’s do a great deal with very little, and even small donations can help make a difference.

 

Often forgotten, I also send out thanks to all who wear the uniform of our country, and who will are often called upon to be on the front lines during any crisis, including a pandemic.

 

This includes our military and national guard troops, both at home and abroad. You guys and gals do a tough, often thankless job, 365 days a year; and are deserving of both our respect and our nation's gratitude.

 

Please know, you have mine.

 

There are hundreds of thousands of doctors, nurses, technicians, EMT's, paramedics, firefighters, and law enforcement officers out there who put it on the line each and every day. I'm proud to have been able to be a part of that universe. And my thanks, and fervent best wishes go out to each of you.

 

And of course, thanks go to the readers of these forums and blogs. There are far more of you out there than you imagine. Those that post on flu forums, or comment on blog sites are just the tip of the iceberg. Ninety percent of our visitors read and absorb the information here, and say nothing. We know you are out there because our web counter software logs every visit.

 

No, I’m not going to `out' anyone. Your secret is safe with me.

 

But even this humble blog gets visits every day from hundreds of corporations, government agencies, financial institutions, and even medical research facilities. Names that you would readily recognize. And that is both extremely gratifying and humbling at the same time.

 

It has been an amazing journey, these past six years blogging on influenza and emerging infectious diseases.  I've been fortunate enough to meet scores of people, either in person, or via email or chat, from around the world due to this blog.

 

I've collected more than a few good friends along the way. To all of those who have written me, thank you.  And keep them coming.   I appreciate each and every email.

 

Even the ones with suggestions as to what I can do with my blog.

And lastly, a special thank you (in no particular order) to just some of the people in the Flu Community who have gone out of their way to extend kindness, friendship, and counsel to this old medic. 

 

To Sharon and Crof, Scott and Camille, Maryn, Chacal & Family, the Revere's, Anne, Phytosleuth, Eric in Atlanta, Rolf, MTO at CIDRAP  Lisa & Nick & Robert at CIDRAP , Dr. Michael Greger, DemFromCt, Stephanie, Eric,  Sally, Emmy, Maggie, Helen, Jackie, Karen, Cheryl, Cliff, Susan, Anne, Blitzen, Snick, Corky, BlueskyRedwolf, GR, hoggie, Seazar, Paul, Joel, AnnieRn, Caroldn,and Bonnie  (and many more I've no doubt  left out) a special holiday thanks to you and your families.  

 

You guys, whether you know it or not, help light the path for me every day.

 

And to everyone else, a safe and happy Holiday.

 

Postscript:   I’ll keep a link to this roll call at the top of my sidebar for a couple of weeks, so people away from the holidays can find it.

 

 

And for those interested in something a little less stressful than emerging infectious diseases, I also write a blog on public domain radio/TV/and film that can be freely (and legally) viewed or downloaded from the Internet.

 

http://masterofmypublicdomain.blogspot.com/