Influenza Virus Mashup

An editorial in Asahi Shimbun: Swine flu pandemic. Excerpt:

According to an estimate by the National Institute of Infectious Diseases, 20 million people in Japan, mostly children, have been infected so far. 

For those adults who have not acquired immunity to the disease, the situation could become quite dire this autumn if Japan is hit by a second wave of more severe infections. The virus may even mutate into a more virulent strain. 

The government should review its response to the pandemic so far and take steps to ensure the nation will be prepared. The pandemic has claimed the lives of fewer than 200 people in Japan, an amazingly small toll compared with other nations. 

Apparently, early diagnosis and treatment were effective in preventing any deterioration of patients’ conditions. Credit for this must go to the gallant efforts of doctors and medical institutions. 

Many physicians and pediatricians across the nation have been treating patients until late at night. The nation’s first case of swine flu was discovered by a practitioner in Kobe. Citizens also did what they could to prevent the spread of infections. 

In contrast, the health ministry’s response has been less than exemplary. The ministry’s basic plan to deal with new strains of influenza was designed only for bird flu, which was supposed to cause serious symptoms. 

The ministry was slow to revise the plan even after it became clear that most patients only develop relatively mild symptoms. 

The ministry was also slow in setting priorities and making other necessary preparations for the nationwide vaccination campaign, causing confusion among medical institutions and their workers. 

The ministry needs to review the plan to make it more practical and ensure more flexible responses. 

The way the ministry provided information about swine flu to the public was flawed, too. Repeated emergency news conferences held by then health minister Yoichi Masuzoe may have made the public more anxious than necessary. 

The ministry should establish a system to provide timely explanations about the situation by health experts. This is what the WHO and industrialized nations do. Disseminating accurate information is crucial for making sure that people remain cool-headed.

Yesterday the CDC published three “Q&A” documents on its site: 

Underlying Health Conditions among Hospitalized Adults and Children.

Behavioral Risk Factor Surveillance System (BRFSS)2009 H1N1 Flu Modules.

Information on 2009 H1N1 impact by Race and Ethnicity.

Via NetIndian.in: 9 more swine flu deaths in India, toll rises to 1366. Excerpt:

Nine more people have succumbed to influenza A (H1N1) in India, taking the death toll in the country due to the swine flu pandemic to 1366, an official statement said here today. 

While two deaths were reported during the day in Maharashtra, reports of seven earlier deaths - four in Gujarat, two in Karnataka and one in Maharashtra - were received from the state authorities concerned today, it said.

Via Channel NewsAsia: Five-year-old boy dies of H1N1 flu. Excerpt:

A five-year-old boy has become the latest - and one of the youngest - person to die from the Influenza A (H1N1) virus here. 

He was admitted to KK Women’s and Children’s Hospital (KKH) and was said to have caught the virus from his uncle. 

The boy was in critical condition over the Lunar New Year holidays. It is not clear when he died, as KKH was unable to provide details at press time. 

It is also not known if his uncle has recovered. The death is possibly the first since the Ministry of Health (MOH) downgraded its H1N1 flu alert status from yellow to green on February 12. 

Before this, the youngest reported H1N1 victim in Singapore was a two-year-old boy, who died in November last year. 

MOH stopped reporting H1N1 fatalities after the virus was treated as part of the seasonal flu strains circulating in the community. 

As of September, the number of H1N1 deaths stood at 18.

(Thu, 25 Feb 2010 13:56:00 +0000)

# 4384

ACIP, the Advisory Committee on Immunization Practices, yesterday came forth with a long anticipated recommendation that just about all Americans over the age of 6 months should receive a yearly flu vaccination.

Maggie Fox, science and health editor for Reuters, brings us the details in her story.

 

UPDATE 1-Everyone in US should get flu vaccine - experts

Thu Feb 25, 2010 1:44am GMT

(Updates with vote on flu vaccine)

* 97 million H1N1 vaccines administered in U.S.

* Deaths could exceed normal seasonal flu year

* Obese and children at highest risk

By Maggie Fox, Health and Science Editor

WASHINGTON, Feb 24 (Reuters) - Everyone in the United States over the age of six months should get seasonal influenza vaccines every year, federal vaccine advisers said on Wednesday.

 

The Advisory Committee on Immunization Practices made the long-awaited vote to recommend virtually universal flu vaccination — something public health experts have long recommended.

 

“The new recommendation seeks to remove barriers to influenza immunization and signals the importance of preventing influenza across the entire population,” the U.S. Centers for Disease Control and Prevention said in a statement.

 

Earlier, experts told the committee that people who were morbidly obese and school-aged children were much more likely to become seriously ill or to die from H1N1 swine flu, as opposed to seasonal flu, which mostly kills the frail elderly.

(Continue . . .)

Two additional points are  brought out in this article.

First, Maggie reports that H3N2 is on the rise in China, accounting now for about 6% of their influenza cases.  This suggests that reports of seasonal flu’s demise may yet be premature.

Second is that the pandemic death toll in the United States – now estimated at near 17,000 – may be revised upward over the coming months and may exceed the 36,000 deaths we `expect’ from an average flu season.

(36K deaths is the CDC’s yearly estimate of flu deaths.  Not a count)

While many have been quick to latch onto early numbers and jump to conclusions regarding the impact and severity of this pandemic, the simple truth is that it will take months – likely years – before we can analyze most of the data.

Until then, pronouncements regarding this pandemic need to be viewed as preliminary at best.

(Thu, 25 Feb 2010 12:27:00 +0000)

# 4383

The CDC has maintained, and refined over time, a list of those underlying medical conditions they believe predispose some people to more serious complications from the H1N1 pandemic virus.  

Here is their list as of early December:

People at High Risk for Developing Flu-Related Complications

• Children younger than 5, but especially children younger than 2 years old
• Adults 65 years of age and older
• Pregnant women
• People who have medical conditions including:
  • Asthma
  • Neurological and neurodevelopmental conditions [including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability (mental retardation), moderate to severe developmental delay, muscular dystrophy, or spinal cord injury].
  • Chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis
  • Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
  • Blood disorders (such as sickle cell disease)
  • Endocrine disorders (such as diabetes mellitus)
  • Kidney disorders
  • Liver disorders
  • Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
  • Weakened immune system due to disease or medication (such as people with HIV or AIDs, or cancer, or those on chronic steroids)
  • People younger than 19 years of age who are receiving long-term aspirin therapy

Tuesday night the CDC posted an overview and Q&A on the most commonly seen underlying conditions in patients hospitalized from the H1N1 flu over the past 10 months.   

This  update reflects data gather from roughly 60 counties, and 13 metro areas around the country, and is covers the time span April 15, 2009 – February 16, 2010. I’ll not post the whole thing, since you can follow this link to read it in its entirety. 

Since very early in this pandemic it has been apparent that people with certain types of underlying conditions were being hospitalized with serious complications.    Pregnancy and Asthma were both identified very early as potential complicating factors.

According to EIP data collected from April 2009 to February 16, 2010, 85% of hospitalized adults and 58% of hospitalized children with 2009 H1N1 virus infections have had one or more medical conditions. 

The two charts below show the most commonly reported underlying conditions in adults and children.  For both cohorts, Asthma was the number one complicating factor, showing up in more than 30% of each group.

After that, developmental and neurological disorders weighed heavily among children, and chronic metabolic, cardiac, and pulmonary disorders impacted adults the greatest.

Other blogs that have dealt with this subject in the past few months include:

CMAJ: Asthma As A Pandemic Risk Factor In Children

Australian Study: H1N1 Hospitalized Patients

Study: H1N1 Hospitalization Profiles

Study: H1N1 A Threat To All Age Groups

Via Antara: Bird flu kills hundreds of Lampung chickens. Excerpt:

Hundreds of chickens in Kota Metro, Lampung Province, suddenly died this week, causing local chicken breeders to suffer material losses. 

Suyadi, 31-year-old local chicken breeder, said here Wednesday that he did not know the exact causes of his chickens` sudden death but he suspected the bird flu viruses of being the killers. 

“I firstly found that a few chickens suddenly died but the number got increased dramatically from day to day. I have lost a few hundreds,” said the East Metro subdistrict`s resident. 

Suyadi said the local agricultural office`s workers had given disinfectant to his chicken cages but he failed to keep them clean during the rainy season. As a result, his chickens remained vulnerable to the attacks of dangerous diseases, he said. 

Jaelani said hundreds of his chickens also suffered sudden death during this rainy season. The 40-year-old chicken breeder of North Metro subdistrict said the bird flu viruses might have caused the death of his 200 - 300 chickens. 

Therefore, he urged local veterinarians and other related authorities to take immediate actions to halt the spread of bird flu viruses and conduct the awareness campaigns. 

“The awareness campaign is needed because not all people here have well understood about the dangers of bird flu viruses and how to handle them,” he said. 

Jaelani said not all people had known what to do when the viruses attacked their chickens.

If Indonesian chicken farmers still don’t know how to handle outbreaks in their poultry, five or six years after the first appearance of H5N1 in the country, it’s not their fault. It’s their government’s fault.

Earlier today I reported on three new human H5N1 cases in Egypt, making 102 cases altogether. Now Commonground at FluTrackers reports The discovery of bird flu infection # 103 from Banha. 

Don’t bother to check the Egyptian links in the Hot Zone Sources list. They have nothing to say about these cases.

(Thu, 25 Feb 2010 03:54:00 +0000)

# 4382

Ida at The Bird Flu Information Corner tonight has a report out of Pangkalpinang, Indonesia regarding four kids from Kecamatan Simpangkatis who are being treated in a special unit for bird flu patients.

These are suspect cases, based on clinical symptoms and their proximity to recent poultry deaths.   Laboratory results are not expected for several days.

Pangkalpinang, Bangka-Belitung ::: Four bird flu suspect kids

Pangkalpinang – Four kids from Kecamatan Simpangkatis are treated in Depati Hamzah regional hospital, Pangkalpinang. Patients are placed in special unit for bird flu patients.

 

They were suspected of contracting bird flu infection as they exhibited continuous fever, said Supriyadi, Health Service official of Bangka Tengah. Patients’ family confirmed that they experienced many chicken deaths not long before.

 

The suspected kids were found during field investigation on people, which is routinely done by Simpangkatis public health centre officers when birds in the area reported to have suddenly died.

 

To anticipate any possibility of bird flu transmission to human, public health officers referred the four kids of Kecamatan Simpangkatis to Depati Hamzah regional hospital. Medical team of the hospital had collected their blood sample for bird flu test. Laboratory confirmation expected to be issued within a week.

 

Kecamatan Simpangkatis is one of sub-districts under observation of regional health service because of large bird flu H5N1 outbreak in chickens.

Source: Indonesia local newspaper, Bangka Pos.

Ida at Bird Flu Information Corner has a translated report from Bangka Pos: Pangkalpinang, Bangka-Belitung ::: Four bird flu suspect kids. Excerpt:

Four kids from Kecamatan Simpangkatis are treated in Depati Hamzah regional hospital, Pangkalpinang. Patients are placed in special unit for bird flu patients. 

They were suspected of contracting bird flu infection as they exhibited continuous fever, said Supriyadi, Health Service official of Bangka Tengah. Patients’ family confirmed that they experienced many chicken deaths not long before. 

The suspected kids were found during field investigation on people, which is routinely done by Simpangkatis public health centre officers when birds in the area reported to have suddenly died. 

To anticipate any possibility of bird flu transmission to human, public health officers referred the four kids of Kecamatan Simpangkatis to Depati Hamzah regional hospital. Medical team of the hospital had collected their blood sample for bird flu test. Laboratory confirmation expected to be issued within a week.