Influenza Virus Mashup

Revere at Effect Measure has an excellent post: Flu: Georgia on CDC’s mind. This is the kind of analysis and interpretation you can’t get anywhere else. Excerpt:

The occasion for the briefing was a worrisome increase in hospitalizations and deaths in CDC’s Georgia backyard. Despite housing CDC, Georgia has one of the lower flu vaccination rates in the country and now is experiencing an unexpected recrudescence of H1N1 flu, with numbers of hospitalizations not seen in the state since the height of the pandemic last October.

WHO has published Avian influenza – situation in Viet Nam - update 10.

The Ministry of Health has reported a new confirmed case of human infection with the H5N1 avian influenza virus. 

This case was confirmed at Pasteur Institute, Ho Chi Minh City. The case was a 3 year old girl residing in Thuan An district, Binh Duong province. She developed symptoms on 5 March 2010 and presented to Thuan An District Hospital and a private health facility for investigation and treatment. 

On 10 March, she was presented to the Pediatrics Hospital No. 2 where she was suspected to have influenza A (H5N1). Despite treatment, the case died on 17 March. 

Confirmatory test results for influenza A (H5N1) were also obtained on that day. 

Of the 117 cases confirmed to date in Viet Nam, 59 have been fatal.

WHO has also published a new cumulative total of H5N1 cases worldwide. Among other things, it shows Vietnam has already had five cases this year—as many as it had altogether in 2009. 

On the brighter side, all five cases last year were fatal; only two have been fatal so far this year. And Vietnam’s case fatality ratio, 50.2%, is at least better than the worldwide CFR of 59.1%. Indonesia’s CFR is 81.8%. All these numbers are of course horrendous.

Via the Hong Kong government website: H5 virus suspected in barn swallow. Excerpt:

Preliminary tests on a barn swallow found in Yuen Long indicate suspected H5 avian influenza infection, the Agriculture, Fisheries & Conservation Department says. More tests are being conducted on the carcass.
  

The dead bird was collected on March 26 at the Mai Po Section of Castle Peak Road. As a precautionary measure, the Mai Po Nature Reserve will temporarily close to visitors for 21 days from March 31.
  

There were five chicken farms within three kilometres of where the bird was found. Departmental staff inspected the farms and found no abnormal mortality or symptoms of avian flu among the chicken flocks. These farms will be put under enhanced surveillance.

Via Focus Information Agency: Dead bird in Bulgaria’s Varna expected to test positive for H5N1.

The regional laboratory for influenza diagnosis among birds in the coastal city of Varna has established a positive result for H5N1 flu in a Common Buzzard, the National Veterinary Service announced. 

Veterinary inspectors found the bird dead in Konstantin and Elena resort in the district of Varna while carrying out monitoring on influenza among domestic and wild birds in Bulgaria. 

Samples have been sent to the National Diagnosis and Research Veterinary Institute in Sofia for confirmation. The results are expected at the beginning of next week. DG SANCO has been notified.

Via novinite.com: Bulgaria Health Minister Resigns over Prosecutor’s Charges. Excerpt:

Bulgaria’s Health Minister, Bozhidar Nanev, announced Tuesday he is resigning from his post over official charges from the Sofia City Prosecutor’s Office. 

In a declaration to the media, Nanev states that all charges are unfounded and the two contracts for the supply of anti-viral flu medicine he signed had been the only possibility to timely provide the needed cure during the swine-flu epidemic in the country. 

“I hope that very soon the truth will be revealed and this case will not leave a stain on my name, the name of the GERB party cabinet, and the one of the Prime Minister, who trusted me to take over the Health Ministry,” the declaration reads.

The full story includes a link to earlier coverage of the minister’s controversial Tamiflu purchases.

(Tue, 30 Mar 2010 06:19:02 -0500)

There is a good Canadian Press by Michael Macdonald about the often long time it takes to make a full recovery from flu. A full blown case of classical influenza can really lay you low for days or weeks. People often report never having felt so sick. But once you are “recovered” and back to work or your daily activities you aren’t necessarily fully recovered:

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Via The Star: Swine flu fallout: many suffer nagging symptoms long after H1N1 subsides. Excerpt:

Marga Cugnet thought she knew what she was in for when she came down with swine flu last October. But the health administrator from Weyburn, Sask., said she was annoyed and somewhat dejected when the potent H1N1 virus left her with lingering symptoms that did not let up until earlier this month. 

That’s five months of suffering through a hacking, post-flu cough and bouts of fatigue.

“I never went anywhere without having a bag of cough drops with me because I would just get into a coughing spell that wouldn’t stop,” said Cugnet, the 56-year-old vice-president of primary health with the Sun Country Health Region. 

“I knew it could take months to go away, but I didn’t think it would last that long.” 

Even though the global pandemic ceased making headlines weeks ago, the impact of the virus remains fresh in the minds of many Canadians who are just getting over an ailment that delivered a lasting one-two punch. 

The Public Health Agency of Canada didn’t keep records on the number of Canadians who contracted mild cases of H1N1, mainly because most of them simply stayed home while recovering. 

But Dr. Michael Gardam of the Ontario Agency for Health Protection and Promotion says blood tests on a sample group in that province suggested that just under 10 per cent of the population was infected in the first wave. 

“The second wave was two to three times larger than the first wave, so 30 per cent total is likely reasonable,” said Gardam, the agency’s director of infectious diseases prevention and control.

Via the Latin American Herald Tribune: Mexico Suspects Swine Flu Virus Originated in U.S. Not that it really matters. Excerpt from a long and fascinating article:

One year after Mexico alerted the world about the outbreak of the swine flu epidemic, the country’s health secretary says he suspects that the disease originated in the United States. 

In an interview with Efe, Jose Angel Cordova, at the helm of dealing with the April 2009 outbreak of what was later identified as the AH1N1 virus, acknowledges that “it is very difficult” to know where it started. 

He added, however, that public health officials suspect the bug “came from the United States and that it was returning Mexican emigrants or tourists who brought the virus” into the country. 

“Isolated cases occurred there,” but no one paid them much attention, he said, recalling that among the first cases were two children hospitalized in California for being infected with the unknown virus, which the U.S. Centers for Disease Control later described as an “atypical flu virus.” 

At the same time in Mexico there were other cases of a flu described as atypical, because it occurred in March and April after the December-February flu season was over. 

On April 23, 2009, a Canadian laboratory told Mexico that this was an unknown virus of animal origin with pandemic potential, and that it was the same as had been identified in the kids in California. 

Within hours of the notification, President Felipe Calderon and his Cabinet decided to warn Mexicans of the presence of this new virus and about the necessary precautions to be taken. 

Those measures eventually came to including closing schools nationwide and virtually shutting down Mexico City – home to some 20 million people – for five days. 

Some found the measures exaggerated, but Cordova said that the right decisions were taken, given that health professionals initially feared the AH1N1 outbreak could have been the start of a long-expected global flu pandemic with a high mortality rate. 

“That night and many more I couldn’t sleep. There were at least 15 very difficult days when we didn’t know how (the virus) would develop because the number of cases was increasing. We had to send health convoys all over the place to meet the demand for doctor visits, do testing and get some idea of what we were dealing with,” he said.

Via the Los Angeles Times: New worries about H1N1 influenza. Excerpt:

Continuing activity of pandemic H1N1 influenza in the Southeast, particularly in Georgia, is raising fears of a third wave of swine flu cases, federal officials said Monday. 

They urged people to continue getting vaccinated as a preventive measure in case a new outbreak occurred. 

Although H1N1 flu activity is still low in most of the country, flu-related hospitalizations in Georgia have, since the beginning of February, been higher than they were in October at the height of the second wave of the flu, said Dr. Anne Schuchat, director of the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases. 

A CDC team was sent March 6 to assist state officials investigating the outbreak, but its members have found nothing unusual. 

“There is no evidence the virus has changed in Georgia,” she said. Alabama and South Carolina are also reporting regional activity of the virus, and some unusual activity has been noted in Hawaii and New Mexico. 

The Southeast is where the second wave of the pandemic began last fall, but experts generally attributed that to the earlier start of school in the region. 

Researchers had previously hoped that the continued low activity of swine flu meant that a third wave was less likely than had previously been expected, but Schuchat called the new data from the Southeast a “worrisome trend. . . . The future is hard to predict because there is much we do not know. But we do know that the virus is still around.”

(Mon, 29 Mar 2010 15:41:17 -0500)

A day or two after CDC’s Morbidity and Mortality Weekly Reports (MMWR) released a report about risks to pregnant women from pandemic 2009 flu, CDC held a suddenly announced press briefing about the current H1N1 situation (I listened in but a transcript should be up on the site by the time you read this; check this page). The occasion for the briefing was a worrisome increase in hospitalizations and deaths in CDC’s Georgia backyard. Despite housing CDC, Georgia has one of the lower flu vaccination rates in the country and now is experiencing an unexpected recrudescence of H1N1 flu, with numbers of hospitalizations not seen in the state since the height of the pandemic last October. The cases were described as “adults,” many with pre-existing medical conditions, with a geographic distribution that, on a preliminary view, might be hitting areas less hard hit than the fall wave of cases. Since late February, Georgia was seeing more hospitalizations (in numbers) than any other state in the union and the reason isn’t known. What we know so far is that it is the 2009 H1N1 pandemic, laboratory confirmed and said not to be different than before. What that is based on we don’t know. It is not either of the previous seasonal flu strains, seasonal H1N1 or seasonal H3N2, nor influenza B, which is circulating at many locations at very low levels.

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