Influenza Virus Mashup

I’ve just posted an item from Australia that I found on NewsNow: (dengue). But it’s worth noting that the page looks the way swine flu did last spring, with new posts arriving every 5 or 10 minutes. Among those listed at just before 4:30 PST on Wednesday afternoon:

Brazil: 60-year Londrino woman is first dengue fatality in Paraná state. São Paulo considers demolishing some houses to fight dengue. Cuiabá has more than 1,800 cases.

Paraguay: Another 78 confirmed dengue cases bring total to 556.

Malaysia: A group is filing a complaint against a local hospital after two persons died of dengue after being treated there last year. The Subang Jaya Municipal Council reports a total of 263 dengue cases so far this year, a rise of 53 cases over the same period in early 2009.

Argentina: The Buenos Aires ministry of health says it’s confirmed one case of imported dengue and 40 “suspicious” cases, but insists “the dengue virus is not in circulation.”

Via Chicago Press Release Services: Illinois swine flu deaths top 100.

Health officials say swine flu is on its last legs in Illinois, but the virus is still circulating and is still deadly. 

Three new deaths reported last week pushed the state’s swine flu death toll above 100 for the first time. Most who died from the virus were between the ages of 25 and 64, and most had other health problems. 

The Illinois Department of Public Health says 44 of the deaths were in Cook County. Nineteen deaths were in counties surrounding Chicago, 15 were in northwest Illinois, 12 were in central Illinois and 11 were in the southern part of the state. One death was recorded with no information about region. 

Fifty-two of the fatalities were whites, 21 were Latinos, 19 were blacks and one was Asian. The others were unknown or there was no information.

(Wed, 24 Feb 2010 23:07:00 +0000)

# 4381

Lisa Schnirring, in a feature for CIDRAP News tonight, tracks down some anecdotal reports of recent increases in ILIs (Influenza-like Illnesses) being reported in emergency departments around the country.

She also brings us word of the first increase in flu-like illnesses on US college campuses since late November, as reported by the ACHA (American College Health Association).

At this time, it is unknown whether these reports reflect an increase in pandemic H1N1 cases, or whether some other respiratory viruses may be to blame.  

The overall rates of ILI, while increasing in some regions, remain low.   I’ve just reproduced the opening paragraphs to Lisa’s report, follow the link to read it in its entirety.

Emergency departments see rise in flu-like illness

Lisa Schnirring Staff Writer

Feb 24, 2010 (CIDRAP News) – Some of the nation’s emergency departments are noting increases in flu-like illness cases that appear to be pandemic H1N1, and colleges are reporting the first increase in flu-like illness since the end of November, but it’s not clear if these are early signs of a third pandemic flu wave.

 

The American College of Emergency Physicians (ACEP) said today in a Twitter post that some of its members were anecdotally reporting a new wave of pandemic H1N1 patients coming to emergency departments and asked if other physicians were seeing similar patterns.

 

Carl Schultz, MD, professor of emergency medicine at the University of California at Irvine, told CIDRAP News that the increase in the number of influenza-like illnesses appears to be real, but he cautioned that many of the cases have not been confirmed as the pandemic H1N1 strain, because many departments stopped specifically testing for it because of low flu activity. Schultz chairs ACEP’s disaster preparedness and response committee.

(Continue . . . )

(Wed, 24 Feb 2010 20:52:00 +0000)

# 4380

Commonground, posting both on her Pandemic Information News website and on FluTrackers, has picked up media reports of yet another H5N1 case in Egypt. 

This time of a 14 month-old reportedly in stable condition at the Banha Fever Hospital.

This makes the 13th H5N1 case out of Egypt since the beginning of the year.   You’ll find a thread on FluTrackers with several other translated reports of this case.

Aged 14 months and his condition is stable

Last Update: 24/02/2010 18:29 timing of Cairo

Ministry of Health announced Wednesday in the Egyptian case was found 103 bird flu for a child one year old and two months of milk Qalubia.

The history of the illness of the situation that the onset of symptoms was on February 22 and entered the Banha Fever Hospital in the next day suffering from a high temperature and cough, runny nose and shortness of breath, and after being exposed to birds suspected of being infected with bird flu.

 

Have been given Tamiflu, the child immediately in a stable condition.

 

 

It is said that families in rural areas continue to retain the custom of raising poultry at home, leading to mixing for children and women, the Government is making strenuous efforts to contain the deadly virus and limit its spread, and calls through the media to avoid mixing with any birds, but a final After the adoption of precautionary measures.

Meanwhile, in Menoufia, residents are `panicked’ over the sudden deaths of chickens, according to this report (also posted by Commonground) on FluTrackers.

Panic among people fearing an outbreak of avian influenza Menoufia

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Wednesday, February 24th, 2010 - 20:54

Seen some of the villages and the villages of central Quesna Menouf Menofia, the case of mass deaths among domestic birds in the past three days, began the emergence of symptoms peculiar to the presence of chicken blue color known as the chicken and turn to black, followed by the death of birds.

Serious threat is the people’s dumping dead chickens in large quantities in the vicinity of their homes, and on the edge of canals, putting children at risk of bird flu.

 
Dr. Ahmed Fouad, General Manager of Veterinary Medicine Menoufia, it was a medical team to go to the villages which have had cases mortality, to ensure the quality of the disease, whether it is bird flu or not, and in if you are sure will be culling all domestic birds in houses and cleared and then bury the dead them in safe places Sahara, appealing to citizens of the need for the immediate reporting of mortality until they are disposed so as not to return again after the disease have been eliminated.

Via NetIndian.in: 11 more swine flu deaths in India, toll rises to 1357. Excerpt:

Eleven more people have died of influenza A (H1N1) in India, taking the toll in the country so far due to the swine flu pandemic to 1357, an official statement said here today. 

While one death was reported during the day in Rajasthan, information about ten earlier deaths - five each in Maharashtra and Rajasthan - was conveyed by the state authorities concerned to the Union Ministry of Health & Family Welfare today, it said.

Via the Royal Government of Bhutan: Bird flu outbreak in Rinchending, Phuentsholing. Excerpt:

The Ministry of Agriculture and Forest would like to inform the public an HSN1 Birdflu (Avian Flu) outbreak has been declared in Rinchending (Kharbandi), Phuentsholing under Chukha Dzongkhag by the National Incident Common Centre on 23rd February 2010. The source of  the infection is believed to be from the Pasakha area.   

However, the Ministry has asked the public not to be alarmed because the incidence is fully under control and the required control measures are already in place.

(Wed, 24 Feb 2010 13:39:00 +0000)

# 4379

Guangdong Province, which lies adjacent to Hong Kong, has long been the site of suspected bird flu activity – although rarely do we get official acknowledgment of the fact.  

Last year, you may recall, hundreds of dead (and H5N1 infected) chickens were found washed up on the beaches around Hong Kong, after having floated down the Pearl river from mainland China.

For an overview, see More On The Chinese Bird Flu Mystery and for warnings from a leading Chinese scientist that vaccines may mask H5N1 symptoms, see  Zhong Nanshan On Asymptomatic Poultry. 

And every year migratory birds arrive in Hong Kong from the mainland, and they too sometimes carry the H5N1 virus.

Since Hong Kong imports considerable poultry, and other food items, from Guangdong Province there are naturally concerns about the safety of those goods.   Recent food safety scandals coming out of China over the past year or two haven’t helped matters much, either.

So this reassuring Xinhua news article, and accompanying photo – showing a single terrified chicken undergoing scrutiny by no less than 3 hazmat suited inspectors – caught my eye this morning. 

No doubt this level of inspection goes on for each and every chicken headed to the live markets of Hong Kong.  And, doubtless, inspectors can detect asymptomatic H5N1 in poultry, just by looking at them.   

(Actually, they appear to be reading a toe tag.  Probably reads `Inspected by Number 14’  in Cantonese).

Pardon my snark. 

My thanks to Sharon Sanders on FluTrackers for posting this picture which is simply too good not to share.

China - Officials Inspect Poultry Before Shipment from Guangdong Province to Hong Kong

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Guangdong to ensure the safety of fresh agricultural products to Hong Kong

2010-2-24

Figure: inspection and quarantine officers fresh agricultural products to Hong Kong to strengthen inspection to ensure safety

(Newspaper photo)

show on the 23rd Guangzhou, Xinhua Reporters from the Guangdong Entry-Exit Inspection and Quarantine Bureau was informed that, during the Spring Festival in Guangdong for Hong Kong fresh agricultural products, both to ensure the quality and safety of food, but also ensure rapid clearance, customs clearance and smooth.

 

During the Spring Festival, Guangdong Board for Hong Kong and Macao from the 1555 batch, 62476; 216 batches of chicken, 29109; food aquatic animals 2156 batch, 173.4 tons; 1000 batch of vegetables, 7300 tons; milk 20 batches of 224 tons.

 

Guangdong, Hong Kong and Macao fresh agricultural products, a major source of food every day, 450 trucks and ships more than 10 types of fresh agricultural products will be continuously transported to Hong Kong.

(Wed, 24 Feb 2010 12:37:00 +0000)

# 4378

Although the media tends to focus primarily on dramatic events - like pandemics, earthquakes, and terrorist attacks – there are many far-more-common-yet-deadly health threats out there that put us at risk every day.

Nosocomial, or Hospital Acquired Infections (HAIs) are a prime example.  

According to a new study, just published in the Archives of Internal Medicine, just two of these infections (HAI sepsis and pneumonia) claim nearly 50,000 lives a year in the US alone.

The cost goes beyond the tragic loss of life, of course.  There is pain and suffering, and an enormous economic cost as well.   HAIs – many of which are preventable – take a terrible toll each year.

This has been one of the main subjects covered by Maryn McKenna on her terrific Superbug Blog.  Her eagerly anticipated book on MRSA is due out late next month. 

First a few excerpts from the abstract of this study, then on to a press release with more details.

Clinical and Economic Outcomes Attributable to Health Care–Associated Sepsis and Pneumonia

Michael R. Eber, BSE; Ramanan Laxminarayan, PhD, MPH; Eli N. Perencevich, MD, MS; Anup Malani, PhD, JD

Arch Intern Med. 2010;170(4):347-353.

Methods Hospital discharge records from the Nationwide Inpatient Sample database were used to identify sepsis and pneumonia cases among 69 million discharges from hospitals in 40 US states between 1998 and 2006. Community-acquired infections were excluded using criteria adapted from previous studies. Because these criteria may not exclude all community-acquired infections, outcomes were examined separately for cases associated with invasive procedures, which were unlikely to result from preexisting infections.

 

<SNIP>

Results In cases associated with invasive surgery, attributable mean length of stay was 10.9 days, costs were $32 900, and mortality was 19.5% for sepsis; corresponding values for pneumonia were 14.0 days, $46 400, and 11.4%, respectively (P < .001). In cases not associated with invasive surgery, attributable mean length of stay, costs, and mortality were estimated to be 1.9 to 6.0 days, $5800 to $12 700, and 11.7% to 16.0% for sepsis and 3.7 to 9.7 days, $11 100 to $22 300, and 4.6% to 10.3% for pneumonia (P < .001).
 

The press release for this study is below, with more detail.  You can also find more information on the Extending The Cure website.

New study shows sepsis and pneumonia caused by hospital-acquired infections kill 48,000 patients

Cost $8.1 billion to treat

Washington D.C. – Two common conditions caused by hospital-acquired infections (HAIs) killed 48,000 people and ramped up health care costs by $8.1 billion in 2006 alone, according to a study released today in the Archives of Internal Medicine.

 

This is the largest nationally representative study to date of the toll taken by sepsis and pneumonia, two conditions often caused by deadly microbes, including the antibiotic-resistant bacteria MRSA. Such infections can lead to longer hospital stays, serious complications and even death.

 

“In many cases, these conditions could have been avoided with better infection control in hospitals,” said Ramanan Laxminarayan, Ph.D., principal investigator for Extending the Cure, a project examining antibiotic resistance based at the Washington, D.C. think-tank Resources for the Future.

 

“Infections that are acquired during the course of a hospital stay cost the United States a staggering amount in terms of lives lost and health care costs,” he said. “Hospitals and other health care providers must act now to protect patients from this growing menace.”

 

(Continue . . . )

(Wed, 24 Feb 2010 11:07:00 +0000)

# 4376

Trying to second guess the course of a pandemic, particularly when our understanding of how the influenza virus works is (to put it kindly) incomplete, is a quick way to get egg on your face.  

While levels of novel H1N1 influenza in North America and Europe have declined dramatically over the past couple of months, and it looks like the pandemic of 2009 may have run its course, we’ve been fooled before.

NEJM 2009

The 1957 pandemic, for example, appeared to have run out of steam by the spring the following year - but roared back to life two years later, and then again 3 years after that.

Influenza is often full of surprises.

So one can understand why the WHO (World Health Organization) isn’t particularly anxious to declare the pandemic of 2009 as being over.  

With rising levels of immunity in the developed world (from exposure and/or vaccination), it would be a bit surprising to see another major wave of illness in North America or Europe.   

Surprising, but not impossible.

And many parts of the world have no access to vaccine, and immunity levels remain relatively low. 

There also remains the possibility that the virus will pick up antigenic changes that would allow it to evade existing immunity – something that could spark a new round of illness.

So one can understand the reluctance of scientists to declare that this pandemic has peaked.

Although the WHO telegraphed their intentions not to roll back the pandemic phase last night, this morning they’ve released an official statement.     

They will revisit the issue again in a few weeks.

24 February 2010

Director-General statement following the seventh meeting of the Emergency Committee

The Emergency Committee held its seventh meeting by teleconference on 23 February 2010. The Director-General sought the Committee’s views on the determination of the pandemic status.

 

A detailed update was provided to the Committee on the global pandemic situation. After asking additional questions and reviewing the evidence and holding extensive discussion, the Committee was of the view that there was mixed evidence showing declining or low pandemic activity in many countries, but new community level transmission activity in West Africa. Moreover, they expressed concern that the winter months of the Southern Hemisphere had not yet started and there was uncertainty whether additional generalized waves of activity might occur and the need to not undermine preparations. The Committee advised that it was premature to conclude that all parts of the world have experienced peak transmission of the H1N1 pandemic influenza and that additional time and information was needed to provide expert advice on the status of the pandemic. The Committee accordingly suggested that the Committee be re-convened in a few weeks to review intervening developments and related epidemiological information.

 

Having considered these views, the current epidemiological evidence and other relevant information, the Director-General determined that there had been no change in the pandemic phase, and decided to continue to monitor the situation and developments closely and to convene the Committee again within the next several weeks.

 

The WHO Director-General asked the Committee for their views on continuance of the three current temporary IHR recommendations issued for the public health emergency of international concern. The consensus view of the Committee was in favor of continuation but to update the second recommendation by replacing “Intensify” with “Maintain” in recognition of the increased pandemic surveillance already implemented by countries and the need to maintain this activity. Having considered the views of the Emergency Committee, and the ongoing pandemic situation, the Director-General determined to continue the three temporary recommendations, as modified, namely:

• countries should not close borders or restrict international traffic and trade;
• maintain surveillance of unusual flu-like illness & severe pneumonia;
• if ill, it is prudent to delay travel.

Via the Indian government’s Press Information Bureau: Consolidated status of influenza A H1N1 as on 23rd February 2010. The total of confirmed cases is now 29,555, with 1,346 deaths.