Influenza Virus Mashup

(Mon, 28 Dec 2009 06:40:42 -0500)

It’s the end of the calendar year and the traditional time the media looks back on “the biggest stories of the year.” There are websites about almost any subject (even one on a particular model of running shoe, I am told), but those of us who write specialized blogs (as opposed to ones about politics or current events) rarely expect our subject matter to show up on one of those lists. We’ve been writing about flu for over five years, here, and while re recognized the possibility our subject would come into vogue — that’s indeed why we were writing about it — it still took us and everyone else by surprise.

Now, just about everyone’s choice as one of the top flu reporters in the world, Helen Branswell of Canadian Press, confirms that for Canada, and likely for the US and much of Europe as well, the swine flu pandemic was the newsroom choice for biggest story:

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Via China Daily: Hospital chief says poor treatment upped cases. Excerpt:

The president of one of Beijing’s top hospitals has said that improper medical treatment has caused a severe increase of A/H1N1 cases. 

An overuse of hormone therapies to treat A/H1N1 has weakened patients’ immune systems, making them more susceptible to the illness, Li Ning, president of Beijing You’an Hospital, said at an H1N1 flu control and prevention meeting. 

As one of Beijing’s leading infectious disease centers, You’an Hospital has been responsible for the treatment of critically ill swine flu patients. It has diagnosed more than 400 infected with the virus, 80 of who were diagnosed with severe cases. 

There have been 15 deaths from A/H1N1 at You’an. 

“All the cases that have been transferred [to You'an] from other hospitals received hormone therapy doses ranging from 320 mg to 800 mg,” Li said. “A patient from Daxing Hospital was even given 1,500 mg.” 

A 1,000 mg dose of hormones can cause an adult to lose immune system activity for 72 hours, Li said. Li did not specify the exact nature of the hormone therapies. 

Some patients from other hospitals were not immediately administered Oseltamivir, an antiviral drug sold under the name Tamiflu, when they came for treatment, he said. 

“Oseltamivir should be used for A/H1N1 patients within 48 hours,” Li said. “The severe patients who came to our hospital were given the drug three to four days after they started running fever.” 

Li said his team is still researching whether delayed use of Tamiflu worsens the effect of the virus. 

“A/H1N1 was not as normal as we expected,” Li said, noting the virus was also traced in urine. “Actually it is more dangerous than SARS.” 

A deadly outbreak of Severe Acute Respiratory Syndrom, or SARS, sickened more than 8,000 people, killing nearly 800, in China in 2003.

I’m not sure what to make of this story. If H1N1 is more dangerous than SARS, does it mean that it’s killed more than 10 percent of its victims, or just that it’s more contagious than SARS, or what?

And can anyone enlighten me about the hormone therapy Dr. Li is so unhappy about?

(Sun, 27 Dec 2009 23:35:00 +0000)

# 4193

The CDC has posted FluView for week 50, ending December 19th , 2009. The amount of ILI (Influenza-like-illness) activity we are seeing has decreased again for the eight straight week after four consecutive weeks of sharp gains, but is still slightly higher than normally seen this time of year.

P&I (pneumonia & Influenza) deaths decreased over the last week and has dropped below the epidemic threshold for the first time in eleven weeks.  

 

There were nine pediatric flu-related fatalities added to this year’s count during the past week.

While the numbers here in the US, and also in Canada, reflect a winding down of the fall pandemic wave,  what lies ahead is less clear.  There are more than 4 more months remaining in flu season, and there are a number of possible scenarios (see Waiting For The Other Flu To Drop).

We’ll just have to wait to see.  In the meantime, we’ll take any respite we can get.    It should be noted that of the samples submitted for analysis, just under 7% tested positive for influenza.

Which means there are apparently a lot of flu-like illnesses in circulation right now, and having had one doesn’t guarantee you’ve developed immunity to the H1N1 virus.

 

I’ve excerpted some of the data and graphs below, but follow the link to read it in its entirety.  

2009-2010 Influenza Season Week 50 ending December 19, 2009

All data are preliminary and may change as more reports are received.

Synopsis:

During week 50 (December 13-19, 2009), influenza activity continued to decrease in the U.S.

• 306 (6.9%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza.
• All subtyped influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses.
• The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
• Nine influenza-associated pediatric deaths were reported. Eight of these deaths were associated with 2009 influenza A (H1N1) virus infection and one was associated with an influenza A virus for which the subtype was undetermined.
• The proportion of outpatient visits for influenza-like illness (ILI) was 2.3% which is at the national baseline of 2.3%. Seven of the 10 regions (1, 3, 5, 6, 7, 8 and 10) reported ILI below region-specific baseline levels.
• Seven states reported geographically widespread influenza activity, 18 states reported regional influenza activity, the District of Columbia, Puerto Rico, and 13 states reported local influenza activity, the U.S. Virgin Islands and 11 states reported sporadic influenza activity, Guam and one state reported no influenza activity.

 

Pneumonia and Influenza (P&I) Mortality Surveillance

During week 50, 7.2% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage was below the epidemic threshold of 7.3% for week 50.

 

 

 

 

Influenza-Associated Pediatric Mortality

Nine influenza-associated pediatric deaths were reported to CDC during week 50 (Iowa [3], New Jersey, New York [2], Ohio, South Carolina, and West Virginia). Eight of these deaths were associated with 2009 influenza A (H1N1) virus infection and one was associated with an influenza A virus for which the subtype is undetermined. The deaths reported during week 50 occurred between October 11 and December 12, 2009.

 

(Sun, 27 Dec 2009 22:54:00 +0000)

# 4192

Helen Branswell, medical writer for the Canadian Press, has been providing some of the best and most authoritative reporting on pandemic issues for years. So it is fitting that she brings us this story tonight that news editors in Canada have selected the H1N1 pandemic as the biggest news story of the year.

H1N1 flu virus voted top news story of 2009 in Canadian Press survey

By Helen Branswell (CP) – 3 hours ago

TORONTO — An influenza virus that scientists believe migrated from pigs to people before touching off a global pandemic was the runaway selection for the top Canadian news story of 2009.

 

The H1N1 virus was chosen by 70 per cent of the newspaper editors and broadcast news directors in the annual year-end survey of newsrooms conducted by The Canadian Press.

 

“There isn’t a Canadian out there who isn’t affected by or interested in the virus and how it may affect their families,” said Sandy Heimlich-Hall, assistant news director at CFJC-TV in Kamloops, B.C.

 

“It was a coast-to-coast story that people followed with interest no matter where they lived in Canada,” agreed Lesley Sheppard, managing editor of the Moose Jaw Times-Herald, in Moose Jaw, Sask.

 

H1N1, also known as swine flu, was the runaway pick as the issue that made the most headlines over the last year. The inquiry into the tragic death of Robert Dziekanski, who died after being Tasered by RCMP officers at Vancouver International Airport, came a distant second with just nine per cent of the vote.

 

For better or worse, the first flu pandemic of the 21st century was the story on the minds of the nation’s editors. A number, though, felt it received more play than it deserved.

 

(Continue . . . )

Via Google News, Helen Branswell of The Canadian Press reports: H1N1 flu virus voted top news story of 2009 in Canadian Press survey. Of course, it’s been Branswell’s brilliant reporting, based on years of tracking SARS, H5N1, and other health stories, that helped to make it so. Excerpt:

An influenza virus that scientists believe migrated from pigs to people before touching off a global pandemic was the runaway selection for the top Canadian news story of 2009. 

The H1N1 virus was chosen by 70 per cent of the newspaper editors and broadcast news directors in the annual year-end survey of newsrooms conducted by The Canadian Press. 

“There isn’t a Canadian out there who isn’t affected by or interested in the virus and how it may affect their families,” said Sandy Heimlich-Hall, assistant news director at CFJC-TV in Kamloops, B.C. 

“It was a coast-to-coast story that people followed with interest no matter where they lived in Canada,” agreed Lesley Sheppard, managing editor of the Moose Jaw Times-Herald, in Moose Jaw, Sask. 

H1N1, also known as swine flu, was the runaway pick as the issue that made the most headlines over the last year. The inquiry into the tragic death of Robert Dziekanski, who died after being Tasered by RCMP officers at Vancouver International Airport, came a distant second with just nine per cent of the vote. 

For better or worse, the first flu pandemic of the 21st century was the story on the minds of the nation’s editors. A number, though, felt it received more play than it deserved. 

“The H1N1 flu scare is almost more famous for the way it was handled by the media than how it spread wildly across the country,” said Victor Krasowski, news director of radio station CJUK in Thunder Bay, Ont. 

Rocco Frangione, Krasowski’s counterpart at CFXN Radio in North Bay, Ont., agreed H1N1 was more hype than threat. 

“The way health organizations spun this issue, I expected people to be falling dead in the street,” Frangione said. “It didn’t happen and once again the so-called experts got it wrong when it comes to a new virus hitting people.” 

But there was no way of knowing what was in store in mid-April, when flu scientists at the U.S. Centers for Disease Control discovered two children in California had been infected with the same type of swine influenza virus.

Via TabascoHOY.com, a Notimex report datelined Santiago de Chile: Más de 3 mil muertos en Sudamérica por influenza. [More than 3,000 deaths in South American from influenza] Excerpt, with my translation:

La influenza humana que estalló en abril pasado en Norteamérica y que en junio se convirtió en una pandemia que se expandió con rapidez por todo el continente americano, dejó más de tres mil muertos en Sudamérica. 

The H1N1 flu that appeared last April in North America, and that became a pandemic in June spreading rapidly throughout the American continent, has left more than 3,000 dead in South America.

El virus A/H1N1 atacó a más de 72 mil personas en esta región del sur del continente, tres mil 129 de las cuales murieron, de acuerdo con cifras de organismos de salud que siguieron semana a semana la evolución de la pandemia en la región. 

H1N1 attacked over 72,000 persons in this region, 3,129 of whom died, according to health authorities tracking the pandemic’s spread in the region.

La “nueva gripe”, que hasta el 18 de diciembre había cobrado la vida de seis mil 670 personas en el continente americano, puso a prueba los sistemas de salud de los países sudamericanos, donde la llegada del verano austral ha reducido al mínimo los nuevos casos. 

The “new flu,” which as of December 18 had taken the lives of 6,670 persons in the Americas, put to the test the health systems of the South American nations, where the arrival of the austral summer has reduced the number of new cases.

Brasil, el gigante sudamericano, registró al menos 27 mil 850 casos de influenza humana, los cuales resultaron fatales para mil 632 personas, seguido por Chile, que tuvo 12 mil 276, con 150 muertos.

Brazil, the South American giant, recorded at least 27,850 cases of H1N1, resulting in 1,632 deaths, followed by Chile, with 12,276 cases and 150 deaths.

(Sun, 27 Dec 2009 14:34:59 -0500)

The natural home for influenza viruses is aquatic waterfowl, including ducks and geese (anseriformes). So I’ve read a fair amount about swabbing the claocae (rectums) of these animals as part of avian influenza surveillance. Recently it has been suggested that avian influenza is actually a sexually transmitted disease, so the question of anseriform sex is now on the agenda. It’s not just consensual sex. It turns out that male ducks and geese haven’t heard that rape (aka forced copulation) is frowned up in civilized society and, unusual among birds, they go in for it in a big way. Big in lots of ways. Because ducks seem to have prodigiously large penises. I was reading about a just published paper on duck penises and vaginas and decided to Google the subject and came upon a great post from scibling, Darren Naish at Tetropod Zoology:

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Via The Times of India, a report from Rajkot, Gujarat state: Treating swine flu patients made mandatory for pvt docs. The entire story, with comments after:

All private clinics and doctors in the city will have to provide primary health treatment to any patient approaching them with swine flu  symptoms. Failing to do so, the medicos will be booked under Nursing Act and liable for prosecution. 

This was decreed on Saturday by Rajkot Municipal Corporation commissioner Dinesh Brahmabhatt. “RMC commissioner has taken this decision with a view to curb the swine flu epidemic, which has assumed dangerous proportions,” said a senior official from RMC health department. 

Intensifying its fight against the H1N1 virus, RMC has roped in 95 paediatricians, 105 general practitioners, 200 government hospitals and 27 private clinics in the drive. 

In order to reach out to more patients, RMC has also authorised three private hospitals Ashirwad Hospital behind Mavadi Circle, Mile Stone Hospital on Vidhyanagar Road and H J Doshi Hospital behind PDM College to provide swine flu treatment and medicines. 

Following this, special wards for H1N1 positive patients have been created in these hospitals. 

That apart, RMC health department has made it mandatory for all education institutions in the city to grant holidays to students with fever. 

“In order to check the inflow of swine flu patients in the city, managers of ST depots and officials at railway station have been ordered to keep an eye on passengers with swine flu-like symptoms and report them to the health department immediately,” the official said. 

So far, Rajkot city and adjoining areas have reported 88 H1N1 positive cases, of which 20 patients have died. Total of 747 suspected cases, who are feared to have contracted infection after coming in contact with swine flu patients, have been quarantined for treatment.

I don’t understand the details of India’s healthcare system, but this is not the first report I’ve seen about private doctors and hospitals. They can evidently charge more for their services, and pick and choose whom to serve. “Roping in” the private system to deal with serious outbreaks ought to be automatic.

The proportion of confirmed H1N1 cases to deaths is far too low. I assume the vast majority of flu victims in Rajkot aren’t bothering to seek medical help, and that most of those who do are not being tested. If only the critically ill are tested for H1N1, it would follow that many of those cases would end in death.

Via Kuwait News Agency: Algeria announces 3 fatalities, 54 new A/H1N1 cases.

Algerian authorities announced here on Sunday three fatalities and 54 new cases of swine flu epidemic, bringing the total number of fatalities [to] 42 and 687 infected cases with A(H1N1). 

A statement issued by the Algerian Ministry of Health said the three victims included were a woman aged 24, a 28-year-old pregnant woman and a 51-year-old man who was suffering from a severe difficulty in breathing.