Influenza Virus Mashup

Via the Hong Kong government website: Info sought on Mainland dog flu reports. The real story is in the last paragraph. Excerpt:

The Centre for Health Protection and the Agriculture, Fisheries & Conservation Department will follow up on the reports that some Mainland dogs tested positive to human swine flu virus, Secretary for Food & Health Dr York Chow says.
  

Speaking to reporters this morning, Dr Chow said it is difficult to judge whether dog owners will face a higher risk at this stage because health officials need to collect more data.
  

“There are always opportunities for the virus to spread from species to species. The occurrence of that might not be that unpredictable. Our concern is what exactly happens to the dogs, and whether it is transmitted from humans to dogs or between dogs.
  

“The other thing is whether the viral genetic structure has changed after the transmission. So there are many questions that need to be answered before we can make a judgement of the implication of these transmissions.”
  

In response to reports that a number of human swine flu patients in Shenzhen have developed encephalitis, Dr Chow said the Government will ask the Mainland authorities for more information.

Via the Medical Journal of Australia: The rational clinician in a pandemic setting. The abstract:

•Pandemic (H1N1) 2009 influenza has generated many controversies in Australia around case definitions, laboratory diagnosis, case management, medical logistics and travel restrictions. 

•Our experience as clinical advisers in the Victorian Department of Human Services Emergency Operations Centre suggests the following: 

•Case definitions may change frequently, and will tend to become more clinically specific over time. 

•Early in a pandemic, laboratory diagnosis plays a critical role in case finding and pathogen identification. 

•Later in the pandemic, standardised case management applied to well crafted case definitions should reduce reliance on the diagnostic laboratory in clinical management. The diagnostic laboratory will remain critical to monitoring disease surveillance, pathogen virulence, and drug susceptibility. 

•Medical logistics will continue to challenge pandemic managers as the health sector struggles to do the most good for the greatest number of people. 

•Travel restrictions remain scientifically controversial public health recommendations. 

•Issues of scalability (escalation and de-escalation of the response) relating to virus lethality need to be resolved in current pandemic planning.

Via India Today.in: Deluge of cases stokes H1N1 second wave fear. Excerpt:

The Capital’s swine flu statistics and the daily temperature have shown an interesting trend: both the figures are inversely proportional to each other. 

The temperature has dipped over the past one week and the number of flu cases shot up, raising fears among Delhiites whether the second wave of the deadly disease is round the bend. Swine flu cases - on the decline in the past few months - have risen sharply in the past week in the Capital. 

On November 24, 42 fresh cases were reported in the Capital. The next day, 68 fresh cases were reported and 82 more the next. On November 27, the number of fresh cases stood at 109. On Saturday, when the city experienced the coldest day of the season so far at 7.9 degrees Celsius, the figure of fresh flu cases rose to an alarming 111. 

The number of confirmed cases of swine flu in Delhi till Saturday was 4,454, the highest in the country followed by 3,973 cases in Maharashtra. 

Health authorities did not discount the possibility of a second wave of swine flu sweeping the Capital. 

“A sudden rise in the number of cases was expected. The World Health Organisation (WHO) had also said that with winter, cases will rise. That is what is happening,” said Dr Anjan Prakash, the additional nodal officer for swine flu.

Here in North America, we are well past the peak of the second wave. I can tell this not only by reports from CDC and PHAC, but from the traffic here: If you look at visits over the past 30 days, you can see the downward trend.

I enjoy attention as much as any other blogger, but that’s not what worries me about the drop in traffic.

Other parts of the world are still struggling with increasing numbers of cases, and we’re not the only countries dealing with aversion to vaccination. But one side effect of a pandemic is short-term public amnesia. 

When the horror stories aren’t dominating the news, people eagerly put H1N1 out of their minds and turn to serious matters like Tiger Woods’s domestic problems. Politicians feel a welcome drop in pressure, and move public health lower on their agendas. And as societies, we lower our guard.

Historically, flu pandemics come in three waves. We in Canada and the US are over the second wave. (I’m not so sure about Mexico.) If everyone decides to forget about getting that vaccination, or stops nagging the kids about washing their hands, the third wave will turn up in the new year and kill people who could and should have lived.

And that’s assuming this flu is more or less like the last three pandemic flus. H1N1 surprised every public-health agency in the world last spring. We should have learned to expect more surprises.

So I offer you a thought from General George S. Patton, in his address to the Third Army on the eve of the Normandy invasion:

“You are ready. A man to continue breathing must be alert at all times. If not, sometime a German son-of-a-bitch will sneak up behind him and beat him to death with a sock full of shit.”

Via Google News, Helen Branswell of The Canadian Press writes: Is there a 3rd wave of H1N1 in the cards for this winter? Who knows? Excerpt:

The current wave of H1N1 activity may have peaked in all provinces and territories, the Public Health Agency of Canada says in its latest assessment on the state of the pandemic. 

But if transmission of the virus is indeed on the downward slope, does that mean the end is in sight for Canada? Or is a third wave of illness sometime this winter in the cards? 

With the notoriously unpredictable influenza, it’s pretty much anyone’s guess. 

“I think if you ask a group of so-called influenza experts, you’re going to get different views,” says Dr. Frederick Hayden, an influenza expert who splits his time between at the University of Virginia and Britain’s Wellcome Trust, a charity that funds biomedical research. 

Hayden is betting on “a bump” of activity after Christmas, because so many people remain susceptible to the virus. Though whether that will be a full wave or just an upswing in cases, he’s not sure. 

Regardless of where the experts come down on the question of a third wave, they say one thing is a safe bet. Whether it’s this winter or next, swine flu will be back. 

That’s something people vacillating over the value of getting vaccinated at this point should keep in mind, says Dr. Danuta Skowronski, an influenza epidemiologist at the British Columbia Centre for Disease Control. 

“The way I see it, basically people have two choices in general: Get immunized or get infected,” she says. “Because this virus isn’t going anywhere. It’s ours now.” 

If this outbreak follows the pattern of previous pandemics - and there’s no reason to believe it won’t - the pandemic virus and its descendants will be among us for some undefined period of time. It could be years, it could be decades.

Via the Budapest Times: Flu-stricken doctor on life support. Excerpt:

A doctor in southern Hungary was on a ventilator in a Szeged hospital last week after contracting swine flu. 

The woman, who worked shifts at a hospital in nearby Makó, had not received an influenza inoculation, the news website Délmagyarorszag.hu reported last Tuesday. 

Meanwhile, the winter flu continued to tighten its grip on the nation. In the week to last Wednesday, 34,000 people presented at their local GP’s surgeries exhibiting the symptoms of influenza. 

Recent figures from the Health Ministry suggest that roughly one in three of those with flu symptoms had contracted the new A(H1N1) viral strain known as swine flu. 

Meanwhile, visiting bans were imposed at more hospitals across the country as influenza spread. Last Tuesday alone, all hospitals in Szeged and Pécs were closed to visitors in a bid to protect high risk patients. 

“Many more people would have got the anti-flu vaccine if certain figures in the medical and political communities had not launched a counter-campaign,” Health Minister Tamás Székely told the right-wing daily Magyar Nemzet last week. 

The opposition has repeatedly blamed the government for failing to ensure widespread inoculation despite Hungary being among the first countries to develop a vaccine to the new virus.

(Sun, 29 Nov 2009 23:51:00 +0000)

# 4098

Helen Branswell, medical correspondent for the Canadian Press, takes us on a tour of public health officials and scientists to ask whether the now declining H1N1 virus will be back later in this flu season as a 3rd wave.

As with any Branswell article, it is worth your time to follow the link to read it in its entirety.

Some health officials predict a third wave of H1N1

November 29, 2009

Helen Branswell

TORONTO — The current wave of H1N1 activity may have peaked in all provinces and territories, the Public Health Agency of Canada says in its latest assessment on the state of the pandemic.

 

But if transmission of the virus is indeed on the downward slope, does that mean the end is in sight for Canada? Or is a third wave of illness sometime this winter in the cards?

 

With the notoriously unpredictable influenza, it’s pretty much anyone’s guess.

 

“I think if you ask a group of so-called influenza experts, you’re going to get different views,” says Dr. Frederick Hayden, an influenza expert who splits his time between at the University of Virginia and Britain’s Wellcome Trust, a charity that funds biomedical research.

 

Hayden is betting on “a bump” of activity after Christmas, because so many people remain susceptible to the virus. Though whether that will be a full wave or just an upswing in cases, he’s not sure.

 

Regardless of where the experts come down on the question of a third wave, they say one thing is a safe bet. Whether it’s this winter or next, the H1N1 flu will be back.

 

(Continue . . . )

(Sun, 29 Nov 2009 23:30:00 +0000)

# 4097

From the eMJA (Medical Journal of Australia) three rapid online publications tonight regarding the southern hemisphere’s recent pandemic flu season. 

The first study falls under the category of `lessons learned’ by clinicians during this past summer’s pandemic wave in Australia, and implications for change in pandemic policies.

The second study looks at the epidemiology and demographics of the pandemic, and clearly indicates the age-shift in hospitalized patients.

The third study looks at the hospitalizations of adult patients and concludes that the severity of illness seen with the novel H1N1 virus was comparable to that seen with seasonal flu.  The primary differences seen were that those patients with novel (H1N1) tended to be younger and less immunocompromised.

Links and excerpts from their abstracts follow:

The rational clinician in a pandemic setting

David A Bradt and Joseph Epstein

Abstract

• Pandemic (H1N1) 2009 influenza has generated many controversies in Australia around case definitions, laboratory diagnosis, case management, medical logistics and travel restrictions.

• Our experience as clinical advisers in the Victorian Department of Human Services Emergency Operations Centre suggests the following:

  • Case definitions may change frequently, and will tend to become more clinically specific over time.

  • Early in a pandemic, laboratory diagnosis plays a critical role in case finding and pathogen identification.

  • Later in the pandemic, standardised case management applied to well crafted case definitions should reduce reliance on the diagnostic laboratory in clinical management. The diagnostic laboratory will remain critical to monitoring disease surveillance, pathogen virulence, and drug susceptibility.

  • Medical logistics will continue to challenge pandemic managers as the health sector struggles to do the most good for the greatest number of people.

  • Travel restrictions remain scientifically controversial public health recommendations.

  • Issues of scalability (escalation and de-escalation of the response) relating to virus lethality need to be resolved in current pandemic planning.

The changing phases of pandemic (H1N1) 2009 in Queensland: an overview of public health actions and epidemiology

 

Ranil D Appuhamy, Frank H Beard, Hai N Phung, Christine E Selvey, Frances A Birrell and Terry H Culleton

Abstract

• A graded public health response was implemented to control the pandemic (H1N1) 2009 outbreak in Queensland.

• Public health measures to contain the outbreak included border control, enhanced surveillance, management of cases and contacts with isolation or quarantine and antivirals, school closures and public education messages.

• The first confirmed case in Australia was notified on 8 May 2009, in a traveller returning to Queensland from the United States.

• In Queensland, 593 laboratory-confirmed cases were notified with a date of onset between 26 April and 22 June 2009, when the Protect phase of the Australian Health Management Plan for Pandemic Influenza was implemented; 16 hospitalisations and no deaths were reported during this time.

• The largest number of confirmed cases was reported in the 10–19-years age group (167, 28% of cases), followed by the 20–29-years age group (153, 26% of cases).

• With ongoing community transmission, the focus has shifted from public health to the clinical domain, with an emphasis on protecting vulnerable groups.

• Considerable resources have been invested to prevent and control the spread of disease in Indigenous communities in Far North Queensland.

• The capacity of clinical services to cope with increased admissions, the potential for widespread antiviral resistance, and rollout of mass vaccination campaigns remain future challenges.

 

Age distribution of Lab confirmed H1N1 cases  clearly showing the age-shift to young adults and children.

Comparison of adult patients hospitalised with pandemic (H1N1) 2009 influenza and seasonal influenza during the “PROTECT” phase of the pandemic response

Ya-Shu Chang, Sebastiaan J van Hal, Peter M Spencer, Iain B Gosbell and Peter W Collett

 

Objective: To compare the patient characteristics, clinical features and outcomes of adult patients hospitalised with pandemic (H1N1) 2009 influenza and seasonal influenza.

 

Design and setting: Retrospective medical record review of all patients admitted to Liverpool Hospital, Sydney, with laboratory-confirmed influenza from the initiation of the “PROTECT” phase of the pandemic response on 17 June until the end of our study period on 31 July 2009.

 

Main outcome measures: Severity of illness; requirement for admission to the intensive care unit (ICU) and/or invasive ventilation; mortality.

 

Results: Sixty-four adults were admitted to Liverpool Hospital with influenza, 48 with pandemic (H1N1) 2009 influenza and 16 with seasonal influenza. Thirteen patients were admitted to the ICU. Seven required invasive ventilation, with 2 patients requiring ongoing extracorporeal membrane oxygenation (ECMO). Five patients died (mortality rate, 8%) with two deaths occurring after the study period. Patients with pandemic (H1N1) 2009 influenza were younger and less likely to be immunocompromised than patients with seasonal influenza. However, the clinical features of pandemic (H1N1) 2009 influenza and seasonal influenza were similar.

 

Conclusions: Our findings show that the clinical course and outcomes of pandemic (H1N1) 2009 influenza virus are comparable to those of the current circulating seasonal influenza in Sydney. The high number of hospital admissions reflects a high incidence of disease in the community rather than an enhanced virulence of the novel pandemic influenza virus.

(Sun, 29 Nov 2009 23:02:55 GMT) This Diary is to report and discuss the situation in Egypt.
The prior Egypt news diary is here.

Map by Okieman (added by DemFromCT):

…Thanks to cottontop for the diligent translation and news-hounding.  

(Sun, 29 Nov 2009 15:00:43 -0500)

We talk so much about the flu virus we thought we’d show you some nice pics that CDC has just put up. This is a review for many of you put reviews are always helpful. In these three pics, only one is the actual swine flu virus, the other two being “cartoon” depictions of a generic influenza virus. The cartoons are quite nice and helpful to see what you are looking at in the electron micrograph of influenza virions (virus particles), probably grown in tissue culture. I say “probably” because there is no other information on the site other than the micrograph was taken in the CDC Influenza Laboratory, but when the virus grows in your lungs it usually isn’t nice and spherical like this but assumes many shapes, often elongated and strand-like. Looking at the photomicrograph, though, you see the essentials. Here it is:

Read the rest of this post… | Read the comments on this post…

Via ANA-MPA.gr, a Greek news source: New flu figures. Excerpt:

The third phase of inoculation against the new flu commences on Monday, director of the National Center for Health Operations (EKEPY) director Dr. Panayiotis Efstathiou announced, adding that the virus was clearly on the rise.     

The third phase of vaccination is addressed to the wider population, encompassing children aged six months up and adults up to 50 years of age, as well as people belonging to the other population groups who were not inoculated during the preceding two stages for healthcare employees and vulnerable groups.     

All the new flu monitoring indicators have doubled, Efstathiou said.

According to official figures, 28 people are currently hospitalised in intensive care units (ICUs), of which 13 are in critical condition. Among them are two minors and a pregnant woman.     

Most of the hospitalised patients have disorder-related obesity, while 21 patients have pneumonia. A total of 17 people have died, 15 of them from complications to existing medical conditions caused by the new flu, while only two were not suffering from any other disease.     

Further, a total of 99 kindergartens, 71 primary schools, 28 junior highschools, 28 highschools and 423 departments of various schools closed on Friday due to a high absentee rate.