Influenza Virus Mashup

What would ever do without Google? It’s just brought me a site I’d never heard of, Cuba en Fotos, with some fascinating photographs: H1N1 Hospital Nacional, La Habana, Cuba. The blurb at the top says: Treating pregnant women, some possibly carrying H1N1, in Dr. Enrique Cabrera National Hospital, in Boyeros Municipality in the Cuban capital. ¡Muchísimas grácias, Roberto Suarez!

Via Arab News: Pilgrims snub swine flu. Excerpt:

Braving the menace of the swine flu pandemic, thousands of pilgrims from all over the world, especially from countries hit by the H1N1 virus, spent the second day of their stay in the tent city reciting verses from the Holy Qur’an offering prayers to Almighty Allah. 

Pilgrims were undeterred and firm in their resolve to seek Allah’s mercy and rejected any scare due to the H1N1 virus. 

“We never thought even for a second while planning to embark on Haj about the disease. We were firm in our resolve. And if we have to contract this disease it might happen in Mexico, from where we have come and the country that is badly hit by the virus,” said Nabeel Waleed. 

Most of the pilgrims were performing Haj rituals without wearing facemasks. Interestingly the security officials or those involved in Haj management as well as local pilgrims were the ones seen with masks. Pilgrims from Asian countries were rarely seen with masks. 

Even the places, as per the health authorities directives, where they should have worn masks like the crowded Jamrat Bridge and the Grand Mosque in Makkah, many pilgrims were not wearing the masks or taking any precautions. 

“It’s He who gives you pain and misery in the form of disease and we have come to His house to answer His call, so the thought of any fear or scare does not cross our mind,” said Shakil Ahmad from India, who is performing Haj with his wife Shahana Afzal. 

Many pilgrims are regularly drinking Zamzam water known for its divine medicinal properties to avoid contracting diseases, including H1N1.

Via The Independent: France calls in army to meet demand for swine flu jab. Excerpt:

French authorities said Saturday they were calling in the army’s health services to meet a surge in demand for vaccinations against swine flu, which has killed 30 people in the country. 

Mass vaccination centres opened on November 12 but “since last week, the number of people seeking to be vaccinated against the A(H1N1) virus has been sharply increasing,” the health and interior ministries said in a statement. 

“The army’s health services will be called as back-up,” it said. 

Medical students and in-house company doctors will also help meet high demand for the vaccination, the statement added. 

The ministries said local authorities had been told to extend opening hours and increase capacity to cope with the surge in demand. 

Police officials in Paris said Saturday that they would double capacity in each of the French capital’s 12 vaccination centres by “the middle of next week.” 

The number of people receiving the jab each day has risen from an average of 1,000 at the start of the campaign to around 4,000 this week, Paris police said in a statement.

Via YLE.fin: Swine Flu Disrupts Public Health Care services Excerpt:.

The H1N1swine flu epidemic will disrupt basic health care services and specialist hospital care for several months to come. Although the peak of the outbreak has been reached across most of Finland, the number of sufferers remains high. The on-going vaccination programme will also take its toll on health care resources. 

According to Helena Mussalo-Rauhamaa, the Senior Physician for the State Provincial Office of Southern Finland, basic health care services will not return to normal for a long time owing to the vaccination programme for the H1N1 virus. 

She noted that in the third week of November alone, some 10,000 swine flu patients visited health centres. Looking ahead to next year, she says normal seasonal influenza will also add to the burden.

(Sat, 28 Nov 2009 19:09:00 +0000)

# 4094

The Public Health Agency of Canada produces a weekly influenza summary called FluWatch, which is very similar to the US FluView report from the CDC. In it you will find maps, charts, and summaries of the previous week’s influenza surveillance.

As in the United States, while numbers this week are declining, Canada is in the midst of a serious outbreak of influenza. More befitting of what might be expected in January or February than mid November.

 

A few excerpts from this week’s report (ending Nov 21st), but follow the FluWatch link to read it in its entirety.

November 15, 2009 to November 21, 2009 (Week 46)

Summary of FluWatch Findings for the
Week ending November 21, 2009

• Nationally, the activity level reported this week decreased compared to the previous week. All influenza indicators declined during week 46.
• A possible epidemic peak has been reached by all provinces and territories.
• The Pandemic (H1N1) 2009 strain accounted for nearly 100% of the positive influenza A subtyped specimens this week.
• The intensity of Pandemic (H1N1) 2009 in the population was still high with 1,554 hospitalizations, 243 ICU admissions and 61 deaths reported this week. Hospitalized cases occurred in all provinces and territories (P/T) that reported this week while the deaths were from all P/T except PE, NL and NU. From August 30 to November 21, 2009, a total of 5,507 hospitalized cases including 819 (14.9%) cases admitted to an intensive care unit (ICU) as well as 203 deaths had been reported.
• While the number of hospitalized cases, ICU admissions and deaths reported this week decreased, the number of hospitalizations was higher than the overall number of hospitalizations for the first wave.
• The proportion of severe cases (ICU admissions and deaths) among all hospitalized cases was lower in the second wave than in the first wave.

Canadian situation

Antigenic Characterization

Since September 1, 2009, NML has antigenically characterized 310 Pandemic (H1N1) 2009 viruses and four seasonal influenza viruses (two influenza A/H1N1, one influenza A/H3N2 and one B virus) that were received from Canadian laboratories. Of the 310 Pandemic influenza A (H1N1) viruses characterized, 309 (99.7%) were antigenically related to A/California/7/2009, which is the pandemic reference virus selected by WHO as Pandemic (H1N1) 2009 vaccine. One virus (0.3%) tested showed reduced titer with antisera produced against A/California/7/09. Sequence analysis of the HA showed that the virus with reduced titer did not have the mutation at amino acid position 222 as reported by Norway. CDC also reported that of the 348 pandemic H1N1 viruses tested, one virus showed reduced titer with antisera produced against A/California/7/09.

 

Antiviral Resistance

 

NML: Pandemic (H1N1) 2009 viruses tested so far have been sensitive to zanamivir (220 samples) but resistant to amantadine (231 samples). Of the 258 Pandemic (H1N1) 2009 viruses tested, 255 were sensitive to oseltamivir and three viruses were resistant to oseltamivir with the H275Y mutation. The three resistant cases, 2 from Ontario and 1 from Quebec, were associated with oseltamivir treatment.

 

Provinces: Three cases of oseltamivir resistant Pandemic (H1N1) 2009 were reported to date in Canada from the province of Quebec on July 21, 2009, from Alberta on September 15, 2009 and from Ontario on October 13, 2009.

(Sat, 28 Nov 2009 18:31:00 +0000)

# 4093

If you follow the various flu forums, blogs, and websites you are probably aware that there has been a fair amount of discussion in recent days revolving around the `Norwegian’ and `Ukrainian’  mutations, and increased reports of Tamiflu resistant H1N1 viruses.

Don McNeil Jr. of the New York Times has an article about the WHO (World Health Organization’s) attempts to dampen fears over these reports, in a piece called Experts Say Swine Flu Mutations Do Not Warrant New Alarm.

The tone of the message from the World Health Organization is one of reassurance, although they admit there are things they do not yet understand about these mutations.  

I’ll grant that the first inclination of most governments or health agencies - when faced with disturbing news - is to ratchet down public concerns.

It is almost an autonomic reflex, and not always a bad thing. Particularly when there is a good deal of ambiguity about the threat.

My take is simply that mutations happen, and that we shouldn’t be terribly surprised to see them when they do.  As virologists like to say,  `Shift Happens’   (more accurately `drift’ in this case).

 

But I’m not quick to jump on any viral bandwagon. 

 

Which is why I tend not to become too alarmed over these reports.  At least not until we can get some credible data and analysis.

Only time will tell if any of these mutations is `fit’ enough to compete with the existing virus strains and become a `contender’.  Most mutations fail to thrive, and are destined to die out.

The isolation of a single mutation, or even a handful of them around the world, doesn’t automatically make for a public health threat, regardless of what the tabloid papers are saying. 

But of course, every once in awhile . . .  well, let’s face it.  Every viral change started out small somewhere. 

Are the `Norwegian Mutations’ (which actually have been seen in  many places around the world) a big deal?  Or the Tamiflu resistant strains?

 

We don’t know yet.    Maybe.  Stay tuned.

Good science takes time.   You have to collect the data and then analyze it.  And sometimes, the data can be confusing or misleading.

Hopefully we’ll have a better handle on all of this a week or two from now.  But definitive answers could be months away.  

Influenza is constantly fooling us, and the `rules‘ are rarely writ in stone. If any of these mutations end up being less benign than currently advertised, I figure that will become apparent over time. 

For now, I regard these viral changes as worthy of our attention, but not our alarm. 

This from the New York Times.

 

Experts Say Swine Flu Mutations Do Not Warrant New Alarm

by DONALD G. McNEIL Jr.

Published: November 27, 2009

The World Health Organization tried this week to dampen fears about mutations seen in the swine flu virus in several countries, noting that both mutations had been found in very few people.

 

A change that created Tamiflu resistance has been found in about 75 people around the world, said Dr. Keiji Fukuda, chief flu adviser to the W.H.O.’s director general. Two clusters, in cancer units at Duke University Medical Center in North Carolina and a hospital in Wales, were both among patients whose immune systems had been severely suppressed by cancer treatment; some had had their bone marrow, which produces infection-fighting white blood cells, wiped out so that replacement blood stem cells could be injected.

 

Such patients are more likely to develop resistant viruses when on Tamiflu because they can not clear a virus on their own. But the mutant strain appears not to spread easily in people with normal immunity, like hospital workers.

 

“We don’t know the full answer, but it is more likely that we are not seeing a major shift,” Dr. Fukuda said.

 

Widespread Tamiflu resistance is a serious problem in the seasonal H1N1 virus, but it has not crossed over into the swine H1N1.

 

(Continue . . . )

Via allAfrica.com, a report from The Citizen: Tanzania: 142 Contract Swine Flu in Single Village. Excerpt:

Panic has gripped Mwanza as 142 primary school pupils, teachers and villagers have tested positive to swine flu infection at Ilula village in Kwimba District in the region. 

This is the only large sample to be infected at a go since the first case of the disease, that has killed at least one person in Manyara Region, was discovered earlier this year. 

Ilula Primary School, where the disease reportedly first broke out before spreading into the surrounding village, has been closed indefinitely. 

It has since been quarantined to prevent the spread of the virus to other areas, the Mwanza regional medical officer, Dr Meshack Massi, said yesterday. 

However, he was quick to allay fears among Mwanza residents and assured them that steps have been taken to safeguard their lives. He told reporters that sufficient stocks of medicine for treatment of the disease have been distributed by the Government to respective health centres. 

He said a medical team has already been deployed to the village to gather more medical records and test samples in order for the Government to take appropriate measures.

Via the Indian government’s Press Information Bureau: Consolidated status of Influenza A H1N1 for November 28. The country now records 569 H1N1 deaths and 17,868 cases.

(Sat, 28 Nov 2009 13:38:00 +0000)

# 4092

In case you missed it, Maryn McKenna has been blogging up a storm on her Superbug Blog this week, which deals with all things antibiotic resistant.

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

This week Maryn has published a number of important stories on her site, and since this is a holiday week in the States, some of you may have missed them. 

 

Antibiotics - the EU pipeline is empty too

New pig strain in China

Pig MRSA” in the EU - long-awaited survey

CDC warns of deaths from H1N1 flu + bacterial infections

Two good reports published elsewhere

Community MRSA rates rising, and epidemics converging

Antibiotic misuse in animals - one example

If you aren’t visiting the Superbug Blog regularly, you are missing out on one of the best infectious disease resources on the Internet.