Influenza Virus Mashup

Via New Kerala.com: Two more deaths take India’s swine flu toll to 465. Excerpt:

Two more swine flu deaths were reported in India Friday, taking the total toll in the country due to Influenza A (H1N1) virus to 465, health authorities said here. 

Also, 62 new cases were reported in the country, taking the total number of people affected with the flu to 13,784. 

Among those tested positive for the contagious flu Friday is Gujarat Chief Minister Narendra Modi, who returned to the state Wednesday from a visit to Russia. He has been quarantined for a week and officials, businessmen and others who have interacted with him recently have been advised medical caution. 

The 60-year-old Modi’s sample was found positive at the government civil hospital in Ahmedabad, doctor Atul Patel said.

I’ve just posted an item on The Hook, the politics blog of The Tyee: BC downplaying H1N1 vaccine shortage. Excerpt:

In a news conference held Friday morning at the B.C. CDC, Dr. Monika Naus, director of immunization programs, said the federal government had warned deliveries of vaccines would be “lower than anticipated” but that the feds are “making every effort to increase shipments.”

Via Google News, Helen Branswell of The Canadian Press writes: Single H1N1 shot sufficient, pregnant women can use adjuvanted vaccine: WHO. As usual, Branswell helps to clarify some confusing points. Excerpt:

A single dose of H1N1 vaccine should be adequate for all age groups, even very young children, and pregnant women should feel free to use vaccine containing adjuvant, an expert committee that advises the World Health Organization on vaccine issues reported Friday. 

The group, known by the acronym SAGE, said vaccines containing boosting additives called adjuvants and vaccines that are adjuvant-free appear to be equally safe and there is no need to recommend pregnant women get the latter on a preferential basis. 

“This is based on the fact that the safety profiles of adjuvanted vaccine and the non-adjuvanted vaccine are very similar, and the fact that the non-adjuvanted vaccine has been recommended for pregnant women for many, many years,” Dr. Marie-Paule Kieny, director of the WHO’s initiative for vaccine research, said in reporting on the recommendations of the panel.

(Fri, 30 Oct 2009 19:32:00 +0000)

# 3915

SAGE, the Strategic Advisory Group of Experts on Immunizations, advises the WHO (World Health Organization) on policies and strategies for vaccination around the world.  

 

Earlier today, the WHO released a vaccination Briefing note based on SAGE’s latest recommendations.  (see WHO Briefing Note # 14: Vaccine Policies And Strategies)

Helen Branswell, ace medical reporter for The Canadian Press, untangles some of the complexities of this SAGE advice, including a reversal of an earlier recommendation that unadjuvanted vaccines be provided to pregnant women whenever possible.

As always with a Branswell report, it’s worth taking the time to read the whole thing.

Single H1N1 shot sufficient, pregnant women can use adjuvanted vaccine: WHO

 

By Helen Branswell Medical Reporter (CP) 

A single dose of H1N1 vaccine should be adequate for all age groups, even very young children, and pregnant women should feel free to use vaccine containing adjuvant, an expert committee that advises the World Health Organization on vaccine issues reported Friday.

 

The group, known by the acronym SAGE, said vaccines containing boosting additives called adjuvants and vaccines that are adjuvant-free appear to be equally safe and there is no need to recommend pregnant women get the latter on a preferential basis.

 

“This is based on the fact that the safety profiles of adjuvanted vaccine and the non-adjuvanted vaccine are very similar, and the fact that the non-adjuvanted vaccine has been recommended for pregnant women for many, many years,” Dr. Marie-Paule Kieny, director of the WHO’s initiative for vaccine research, said in reporting on the recommendations of the panel.

 

“So there is no reason, in SAGE’s view, to distinguish between both types of vaccines.”

 

(Continue . . . )

(Fri, 30 Oct 2009 18:00:00 +0000)

# 3914

Just posted (1:30pm EDT) on the CDC.gov/h1n1flu  website is this week’s flu situation update.    Later today we’ll get a more detailed FluView report.  This data is for the week of October 18-24th.

As I reported yesterday, 22 pediatric influenza deaths were added last week, 19 laboratory confirmed as being H1N1.

 

2009 H1N1 Flu: Situation Update

October 30, 2009, 1:30 PM ET

U.S. Situation Update

Weekly Flu Activity Estimates

U.S. Patient Visits Reported for Influenza-like Illness (ILI)

U.S. Influenza-like Illness (ILI) Reported by Regions

U.S. Influenza and Pneumonia-Associated Hospitalizations and Deaths from August 30 to October 24, 2009

International
Situation Update

Map of International
Activity Estimates
(Including 2009 H1N1 Flu)

Key Flu Indicators

October 30, 2009, 1:30 PM

Each week CDC analyzes information about influenza disease activity in the United States and publishes findings of key flu indicators in a report called FluView. During the week of October 18-24, 2009, a review of the key indictors found that influenza activity continued to increase in the United States from the previous week. Below is a summary of the most recent key indicators:

• Visits to doctors for influenza-like illness (ILI) increased steeply since last week in the United States, and overall, are much higher than what is expected for this time of the year. ILI activity now is higher than what is seen during the peak of many regular flu seasons.
• Total influenza hospitalization rates for laboratory-confirmed flu are climbing and are higher than expected for this time of year. Hospitalization rates continue to be highest is younger populations with the highest hospitalization rate reported in children 0-4 years old.
• The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report has increased and has been higher than what is expected at this time of year for four weeks now. In addition, 22 flu-related pediatric deaths were reported this week; 19 of these deaths were confirmed 2009 H1N1, and three were influenza A viruses, but were not subtyped. Since April 2009, CDC has received reports of 114 laboratory-confirmed pediatric 2009 H1N1 deaths and another 12 pediatric deaths that were laboratory confirmed as influenza, but where the flu virus subtype was not determined.
• Forty-eight states are reporting widespread influenza activity at this time. They are: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. This many reports of widespread activity are unprecedented during seasonal flu.
• Almost all of the influenza viruses identified so far are 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception.

Via Diario Panorama.com: Buenos Aires: falleció una mujer que padecía el virus H1N1. [Buenos Aires: Woman dies of H1N1] Excerpt, with my translation:

Una mujer de 61 años que padecía gripe A falleció en un centro de salud público de San Fernando. Según confirmaron oficialmente autoridades sanitarias, su caso había sido enviado al laboratorio y este viernes se reveló un resultado positivo. 

A 61-year-old woman with H1N1 has died in a public health centre of San Fernando. Health authorities then confirmed that her case had been sent to the laboratory and this Friday was confirmed positive.

Además, una joven de 18 años, que no fue identificada, se encuentra internada con gripe N1 H1 y asistencia respiratoria en el Hospital Federico Abete, de Malvinas Argentinas. 

As well, a young woman of 18, who was not identified, is in the Frederico Abete Hospital in Malvinas Argentinas with H1N1 and is on a respirator.

 Ayer, el ministerio de Salud bonaerense advirtió que el virus de la pandemia de gripe A H1N1 sigue circulando en la provincia, aunque en menor medida que durante los meses de invierno. 

Yesterday the Buenos Aires health minister warned that the pandemic H1N1 virus is still circulating in the province, though on a minor scale compared to last winter.

 El Instituto Nacional de Epidemiología de Mar del Plata confirmó la existencia de 10 casos de personas infectadas durante octubre y se analizan otros 31 casos posibles. 

The Mar del Plata Institute of Epidemiology has confirmed 10 cases in persons infected during October and is analyzing another 31 possible cases.

“La situación nos está demostrando que las temperaturas elevadas no hacen que el virus deje de circular” indicó el el director de Epidemiología de la cartera sanitaria, Mario Masana Wilson.

“The situation is showing us that higher temperatures don’t prevent the virus from circulating,” said the epidemiology director of the Health ministry, Mario Masana Wilson.

(Fri, 30 Oct 2009 17:45:00 +0000)

# 3913

More evidence, presented at the IDSA (the Infectious Diseases Society of America) in Philadelphia this week, indicating that children shed the influenza virus longer than adults.  

This isn’t the first time we’ve heard this sort of data (see Swine Flu: The Gift That Keeps On Giving).

The guidance from the CDC for staying home, and not going to work or school, has been scaled back from at least 7 days or 24 hours after symptoms disappear – to 24 hours after fever is gone (without using fever reducing drugs).  

Which means that some people may be returning to work or school following an illness while still shedding the virus.

 

Whether this really makes much of a difference is debatable. 

Shedding enough virus to be detectable by today’s modern RT-PCR testing or culture, and being contagious and able to spread the virus, may be two entirely different propositions.  

It it is believed that people can shed the flu virus for to 24 hours before ever showing symptoms – and that some may carry the virus asymptomatically, and spread the virus to others - without ever falling ill themselves (see They Walk Among Us ).

All of which makes it virtually impossible to keep the virus out of the schools and workplace.  Since you can’t tell who is shedding the virus and who isn’t, the only real defense is to get vaccinated, and to practice good flu hygiene. 

This report from Medpage Today.

IDSA: Kids Shed H1N1 Flu Longer than Adults

By Michael Smith, North American Correspondent, MedPage Today
Published: October 30, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.

 

PHILADELPHIA — Children appear to shed particles of the H1N1 pandemic flu virus longer than adults do, which may have implications for how long they stay out of school, a researcher said here.

 

The finding comes from an analysis of an outbreak in a Pennsylvania elementary school in May and June, according to Achuyt Bhattarai, MD, of the CDC.

 

Analysis of a series of specimens from affected children and their household contacts also showed that younger children tended to shed the virus longer than older kids, Bhattarai told attendees at the annual meeting of the Infectious Diseases Society of America.

(Continue . . .)

Via The Star: Long lineups in the rain at H1N1 clinics. Excerpt:

All of the Toronto flu clinics are going to use a number system to manage the thousands of people turning out today for H1N1 shots. 

The clinic at Metro Hall in Toronto started administering the vaccine at 10:17 a.m. and the queue of at least 1,000 people began shuffling forward. Umbrellas snapped out as the rain, on and off since before dawn, came down again. 

At Scarborough Civic Centre the clinic opened shortly after noon. Toronto Public Health nurses walked along the line, handing out slips of paper. 

“We have nurses assessing people and handing out numbers,” said Karen Dowsett, with Public Health. “They will know that they have got a place saved, if you will, and they can leave and grab a coffee or get some food in the mall.” 

The clinic is staffed by about 20 to 28 nurses and Dowsett said they hope to serve between 150 to 200 an hour, up to 300 if things go smoothly. 

By the time the doors opened about 300 to 400 people, many with small children, were waiting in the rain. 

The clinic is scheduled to remain open until 7 p.m., but Dowsett said the line might have to be cut off early if more people than expected show up. About 300 people had started lining up there shortly after 5:30 a.m. 

“I thought, `Better safe than sorry,’” said Nazir Jamal, 32, who works at movie theatres where he comes into contact with people all the time. He was near the front of the line, spurred by reports of people turned away Thursday at two Toronto vaccination clinics. 

“This is insane,” said Kathy DaSilva, who arrived at Scarborough close to 10 a.m. to take over a spot her husband had held since 6 a.m. With her was her 10-year-old son Antonio. 

“These kids should be in school,” said DaSilva gesturing to the long line. 

Her son is asthmatic and DaSilva doesn’t understand why kids, particularly ones with health issues have not been made a priority.

Via Reuters: Ukraine shuts schools, halts campaigning over H1N1. Excerpt:

Ukraine closed schools and banned public meetings including election rallies and restricted travel on Friday for a three-week period after confirming its first death from H1N1 flu. 

Prime Minister Yulia Tymoshenko announced the measures, saying the virus had reached epidemic levels in three parts of western Ukraine, where there has been an outbreak of respiratory illness since mid-October. 

The epidemic coincides with the start of campaigning for a presidential election on January 17. Tymoshenko, herself a front-runner, said the emergency would affect campaign rallies. 

“All our pre-election events have been canceled. They will not be held until the situation has stabilized,” she said in a televised statement. 

President Viktor Yushchenko, a bitter rival of Tymoshenko’s, himself called off a public meeting in Kiev where he had been due to roll out his election program. 

He told journalists that 11 people had died of H1N1, also called swine flu, contradicting a Health Ministry report of only one death. An aide and a ministry official said Yushchenko may have made a mistake.

I have mixed feelings about the Globe and Mail, which in some ways is a fine paper and in some ways seems appallingly thickheaded. But the paper has done very good work in covering H1N1. 

In the paper edition, well-written and factual flu stories get both prominence and space–flu stories have been on the front page all week.Online, the paper’s site offers an excellent page of recent Swine Flu stories and features. (I’m not so keen on the page’s pop-up ads.) 

If you’re interested in how Canada is handling the pandemic, this is the place to go.