Influenza Virus Mashup

Recombinomics Commentary 13:29
June 1, 2009

The latest surveillance report (week 20) from the CDC, clearly indicates that swine H1N1 activity is on the rise in the United States, as seasonal flu levels continue to decline. Consequently the ratio of swine H1N1 to seasonal flu (H1N1, H3N2, influenza B, combined) is greater than 10 to 1. Thus, the vast majority of influenza infections in the United States are now swine flu, which is clear from the latest figures, even though reporting agencies in the United States are limiting testing (see updated map). The latest figures show 1213 (1096+117) swine H1N1 cases compared to a total of 121 for seasonal flu (24+70+27). More importantly however, is the steady increase in the percentage of samples which are positive, (now at 22.41%), which is a frequent characteristic of seasonal flu at the height of flu season.

Although various government agencies had offered optimistic reassurances that the swine flu levels would decline during the summer “off season”, the latest data case serious doubt on that projection. The swine H1N1 has an avian PB2, which has an E at position 627. Consequently, the replication rate for the virus is optimal at 41 C, the body temperature of a bird. This is in marked contrast to seasonal flu, which had E627K, which optimizes replication rates to 33 C. Consequently, the swine H1N1 has increased activity as the weather warms in the northern hemisphere, and seasonal flu has declined as summer months approach.

This increase in H1N1 swine flu has been masked to varying degrees by reporting protocols. In Mexico, the national reports are limited to confirmed cases, and there is a large backlog in confirming probable cases. Thus, the reported numbers in Mexico grossly underestimates cases that have been lab confirmed (considered probable because they are influenza A positive, but not sub-typable with human flu reagents).

In the Unites States, the confirmatory tests have been shifted from the CDC to the 44 states that are certified to run the confirmatory tests. However, the number of confirmatory test kits is limited, so many states have focused on hospitalized patients and have stopped testing mild cases. Similarly, testing of school clusters is also limited to initial cases. The vast majority of infected students and teachers are also not tested. However, in spite of these limitations, the frequency of H1N1 swine positives has risen steadily.

These increases in the United States have begun to affected surveillance programs by countries outside of North America. An increasing number of cases link back to the United States. However, the programs in these other countries also grossly underestimates the number of cases, because the case definition includes travel from an H1N1 infected region, so local cases are not tested unless they link back to imported cases. However, this airport surveillance program misses the vast majority of imported cases because cases infected within a few days of travel are not symptomatic, and a high percentage of cases do not develop a high fever. Moreover, the rapid test used to confirm cases has a low sensitivity. Consequently, most imported cases are not detected, and local infected patients are also not tested because they do not meet the case definition.

This lack of testing is the used to claim that there has been no “evidence” of sustained community transmission, because the local cases are not tested until. However, this limited testing still identifies community cases which happen to be linked to a transmission chain under investigation. Similarly, the local cases lead to school outbreaks, which are not easily ignored, especially in countries in the northern hemisphere, because seasonal flu season has ended, so outbreaks involving students with flu-like symptoms leads to limited swine flu testing.

However, the large number of cases being reported daily, is leading to additional testing and additional examples of community transmission, which will clearly demonstrate that the pandemic is at phase 6. Redefining phase 6 to include severity of disease will just delay the inevitable, because the swine H1N1 will continue to adapt to its new host, which will likely lead to an increase in fatal cases, which involves the same age group (25-44), which was reported in for the initial cases in Mexico.

http://tinyurl.com/mcg7pq

by Alison Gendar
Daily News Staff Writer
Monday, June 1st 2009, 4:00 AM

A Bronx infant has become the fifth New Yorker suffering from swine flu to die, the boy’s family and an official close to his case told the Daily News yesterday.

Eleven-week-old Steven Montañez was already sick with swine flu when his aunt found the boy unconscious on Thursday, an autopsy revealed.

“I went in to check up on him, I turned him around and he was purple,” said his aunt, Jennifer Castellanos, 18. “He was a completely healthy baby.”

“The Health Department told us he died because of swine flu,” she added.

The boy’s father was inconsolable with grief.

“I have nothing to live for anymore,” said the father, Louis Montañez. “You don’t know how painful this is. We’re going through such a bad situation right now.”

A source familiar with the infant’s case confirmed he was sick with swine flu, but the medical examiner had not yet determined if the H1N1 virus caused his death.

Jessica Scaperotti, spokeswoman for the city’s Department of Health and Mental Hygiene, would not confirm or deny the cause of death.

The city has refused to release information about three of the other victims.

[snip]

http://tinyurl.com/m83n9b

An American woman of Vietnamese origin and her 9-year-old son who recently returned from the U.S. have tested positive for swine flu, bringing Vietnam’s total cases to three, doctors said Monday. The two arrived in the southern commercial hub of Ho Chi Minh City last Monday, and test results confirmed they were infected with the H1N1 virus, (Snip)

They were in stable condition, Tu said. He had initially identified the mother and child as Vietnamese citizens, but later said they held American passports. “We are expecting more cases in coming days as many visitors from stricken countries come to Vietnam,” he said by telephone. Tu said he’s confident that Vietnam could keep the virus under control. “We have good experience in fighting SARS and bird flu, and that is very helpful.”

The 40-year-old woman from California and her son were admitted to Pediatric Hospital Number 1 early Sunday morning, said a hospital doctor on condition of anonymity, citing policy.

Continued:

http://tinyurl.com/nvd6jg

The detention of 17 cases in 5 provinces on suspicion of bird flu

And the seizure of more than 4 thousands of birds in Damietta and Port Said

31/May/09
Detained in Mansoura Chest Hospital, yesterday, 7 new cases of suspected bird flu, they are: Abdul Aziz Gad flowers, Magda Mohamed Zeini, the names of Abraham, Mr. Jalal Taher, Mohammad Reza Abdullah, Princess Ashraf Awad Allah and from Hany Ahmed, said doctors at the hospital, 15 out the case of the detainees on suspicion of wounding after confirmation of the negative samples.

In the West, was arrested hospitals admitted Tanta and Mahala 7 new cases, suspected of having avian flu, where he was admitted Mahallah both: Mr. Reza Al-Khattab «years and three months», Abdulrahman Ahmed «4-year», and held both of Tanta fevers: King Amr Salah Muhammad Hamza al-Far «3 years» Behind Nnadif Imad AFAF Abda’er «35 years» and Nagwa Ibrahim Rashad «30 years».

In Qaliubiya detained hospital fevers Banha Mr. Mahmoud Arafa «16 years» called the Institute of the deaf and dumb girl and Mei Ibrahim Hosni «3 and a half years» of suspected bird flu.

In Beni Suef, was held at the Fatima Hamdan «49 years» on suspicion of being infected with the disease, the samples were taken and sent to the laboratories of the Ministry of Health.

In Damietta, the control and execution of the 2098 removal of live birds and 146 shanty home in the city-wide, and 296 birds were seized in the market Friday with the street vendors.

In Port Said, were seized about 2000 birds at dawn yesterday, the market for sale bin Abi Talib flower district, and the liberated 4 minutes of the incident, and issued, Maj. Gen. Salah El Baradei, director of security, the continuing campaign of joint instructions of the police and the supply of education and living in the areas of domestic random and rooftops.

In Sohag, the governor, Major General Mohsen al-Nuamani the execution of all the birds in any spots to prove the existence of the disease in the square kilometer, and the maintenance of the immediate payment of compensation to their owners.

“Dr. Ahmad Badri, Director of Veterinary Medicine, said that during the month of May 31 vaccinated and 985 thousand birds, and the execution of the slaughter of 260 birds and 430 A and the other.

In Damietta, the Teilb Dr. Ashraf, a member of the local town of Damietta, request a briefing to the noble Alqrvs, President of the Council, on the existence of a market place for the birds living within the city during the Thursday and Friday, and the slaughter of birds within the vendor market and the dumping of waste, which threatens an health disaster and the possibility of infection from bird flu.

google translated
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