Influenza Virus Mashup

WHO has published Pandemic (H1N1) 2009 - update 98. Excerpt:

As of 25th of April, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17919 deaths. 

WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and Member States and through monitoring of multiple sources of information. 

Situation update: 

The current situation is largely unchanged since the last update. The most active areas of transmission of pandemic influenza H1N1 virus continue to be parts of West and Central Africa with some focal areas of activity in South and Southeast Asia. 

Pandemic influenza activity H1N1 remains low in much of the temperate areas of both the northern and southern hemispheres. 

Seasonal influenza type B virus is the predominant influenza virus, though also at low levels of circulation, across East Asia, Northern and Eastern Europe. Influenza type B viruses have also been detected in Central Africa and this week in West Africa. 

Seasonal influenza H3N2 viruses have continued to be detected in South and Southeast Asia, as well as sporadically in some countries of West and Central Africa, and Eastern Europe.

Via the Courier Mail: Doctors bracing for flu epidemic. Excerpt:

Health authorities are increasingly worried that Queensland is heading for a horror flu season. 

Doctors were already expecting a “double whammy” flu threat, with the return of swine flu and two more conventional strains expected to circulate. 

Now the number of people requesting flu vaccinations has plummeted after the shots were banned for children aged five and under. 

GPs are reporting a 50 per cent drop in requests for the seasonal flu vaccine, which is safe for those over the age of five and protects against swine flu, or H1N1, influenza B and A:Perth. 

The swine flu vaccination remains safe for all ages. 

The Therapeutic Goods Association is investigating whether the flu vaccine may have caused the death of Brisbane two-year-old Ashley Epapara, and authorities are yet to get to the bottom of a vaccine scare in Western Australia, with tests so far showing no signs of abnormalities. 

There have been hundreds of cases of children suffering adverse reactions to vaccines, including febrile convulsions, fevers and vomiting. 

Australia’s chief medical officer Jim Bishop said it was possible a spike in cases of fever and convulsions among young children in WA could simply be linked to the higher number of vaccinations performed there. 

Australian Medical Association Queensland president Mason Stevenson said ongoing “unnecessary paranoia” about flu vaccinations could result in an “abysmally low” vaccination rate this year. 

“This has come at the worst time when we anticipate the second wave of the human swine flu pandemic to hit Australia,” he said. 

“We have 230 intensive care beds in Queensland, and it would only take an epidemic not much worse than last year’s to max out our ICU beds.” Dr Stevenson said a “double whammy” flu threat would hit all age groups this year. 

“Vaccination rates remain low, and there are as many as three circulating strains in the same year, with swine flu a grave risk to the young and middle-aged, and the two seasonal flu strains the greatest risk to the elderly,” he said.

Via Ida at Bird Flu Information Corner, a report from Riau Pos: Sungaiapit, Riau ::: Bird flu spreads to other villages. Excerpt:

Bird flu H5N1 had spread to Desa Parit I/II, Desa Harapan and Kelurahan Sungaiapit since it was firstly identified in Desa Lalang. Until now, bird flu infected human suspect has reached nine victims. Two of them are now being treated at Arifin Achmad hospital in Pekanbaru, while others are refused to be hospitalized.  

Based on the investigation of Health Service and Livestock Service of Kabupaten Siak, so far dead chickens had been tested positive bird flu H5N1. Furthermore, Health Service had collected patient’s liquid samples for further test and treated patients with Tamiflu.

Ida has another report, from West Sumatera, about a widespread outbreak of B2B H5N1 and one suspected human case, an 11-year-old boy.

(Fri, 30 Apr 2010 12:58:00 +0000)

# 4536

SIP stands for Sheltering In Place, something that the Federal government would like to see more people willing and able to do in the event of a natural or man-made disaster.

Whether it be the aftermath of a hurricane, an earthquake, or a terrorist’s dirty bomb . . . people need to be prepared to care for themselves and their loved ones for hours, perhaps even days. 

It is for that reason that I’ve stressed the need for individual and community preparedness, and have urged that every household have enough supplies to last a minimum of 72 hours (food and water), a good first aid kit (and knowledge to use it), an emergency radio, and a family emergency plan.

As a paramedic, I’ve seen what a lack of preparedness and training can cost, in terms of suffering and even lives.  

And as a Floridian who has ridden out more than a few hurricanes, I know what happens to grocery store shelves before, and immediately after a big storm, and what it is like to be without power for an extended period of time.

Which is why I prefer to see people maintain a minimum of two-weeks of emergency supplies in their home.

John Solomon, writing on his In Case Of Emergency Blog, has two entries that I would refer you to this morning.   Both deal with the need for Sheltering In Place after a terrorist attack, and how that could save thousands of lives.

Yesterday, John wrote:

New Study Indicates Most Washington, D.C. Area Residents Would Be Willing To Follow Instructions To ‘Shelter In Place’ After ‘Dirty Bomb’

Followed today by:

“Gimme Shelter: The Need For A Contemporary Civil Defense Program”

Both essays raise important issues.   Highly recommended.

Personally, I prefer to think in terms of `all-threats’ preparedness. But for those who live in New York City, Washington D.C., or other large high-value areas, terrorist attacks certainly have to be considered. 

The bottom line, however, is that willingness to follow emergency instructions isn’t enough.  People have to be prepared to shelter in place before a disaster strikes if they hope to comply. 

Agencies like FEMA, READY.GOV and the HHS are constantly trying to get the preparedness message out, so that when (not `if’) a disaster does occur, human losses can be minimized.

For more information on how to prepare for emergencies, up to and including a terrorist attach, the following sites should be of assistance.

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

And a few of my (many) preparedness essays include:

An Appropriate Level Of Preparedness

Inside My Bug Out Bag

Red Cross Unveils `Do More Than Cross Your Fingers’ Campaign

The Gift Of Preparedness

(Fri, 30 Apr 2010 12:10:00 +0000)

# 4535

Proving that timing is everything, several hours before the CDC released their weekly MMWR which contained information on the new high dose Fluzone vaccine for seniors, I wrote a blog entitled Flu Shots And The Elderly. 

In it, I mentioned the new high-dose Fluzone vaccine for seniors, but we’ve a bit more information today.

Since not everyone reads the MMWR each week, and this is a new vaccination option available to those over 65, I thought it deserved special mention today.

This new high-dose flu vaccine contains 4 times the normal amount of antigen; 60 µg of each of the three recommended strains, instead of the normal  15 µg.  A trivalent shot, like this year’s regular flu shot, it contains antigens from A/California/7/2009 (H1N1)-like, A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like influenza viruses.

Excerpts follow, but you may wish to follow the link to read the entire article.   I’ve reformatted some of the paragraphs for easier online reading.

 

Licensure of a High-Dose Inactivated Influenza Vaccine for Persons Aged ≥65 Years (Fluzone High-Dose) and Guidance for Use — United States, 2010

Weekly

April 30, 2010 / 59(16);485-486

Persons aged ≥65 years are at greater risk for hospitalization and death from seasonal influenza compared with other age groups (1,2), and they respond to vaccination with lower antibody titers to influenza hemagglutinin (an established correlate of protection against influenza) compared with younger adults (3).

 

On December 23, 2009, the Food and Drug Administration (FDA) licensed an injectable inactivated trivalent influenza vaccine (Fluzone High-Dose, Sanofi-Pasteur) that contains an increased amount of influenza virus hemagglutinin antigen compared with other inactivated influenza vaccines such as Fluzone.

 

Fluzone High-Dose is licensed as a single dose for use among persons aged ≥65 years and will be available beginning with the 2010–11 influenza season. The Advisory Committee on Immunization Practices (ACIP) reviewed data from prelicensure clinical trials on the safety and immunogenicity of Fluzone High-Dose and expressed no preference for the new vaccine over other inactivated trivalent influenza vaccines (4).

 

<SNIP>

 

ACIP Guidance for Use of Fluzone High-Dose

 

Fluzone High-Dose may be used for persons aged ≥65 years. All persons aged ≥6 months are recommended for annual influenza vaccination beginning with the 2010–11 influenza season.

 

ACIP has not expressed a preference for any specific licensed inactivated trivalent influenza vaccine, including Fluzone High-Dose, for use in persons aged ≥65 years (4).

 

Data demonstrating greater protection against influenza illness after vaccination with Fluzone High-Dose are needed to evaluate whether Fluzone High-Dose is a more effective vaccine for persons aged ≥65 years.

 

A 3-year postlicensure study of the vaccine effectiveness of Fluzone High-Dose compared with standard dose inactivated influenza vaccine (Fluzone) was begun in 2009 and should be completed in 2012.

As with other inactivated influenza vaccines, Fluzone High-Dose should not be administered to anyone with a known hypersensitivity to egg proteins or influenza vaccine. Adverse events after receipt of any vaccine should be reported to the Vaccine Adverse Event Reporting System at http://vaers.hhs.gov.

(Fri, 30 Apr 2010 06:31:43 -0500)

On the surface the story in Wired made perfect sense: Twin Study Deepens Multiple Sclerosis Mystery. It is about a new study from the National Center for Genome Resources that compared the genetic endowments of three sets of identical twins, one each of which contracted multiple sclerosis (MS), the other didn’t. This was a full bore effort that wound up costing $1.5 million over a year and a half to sequence 2.8 billion base pairs in each twin, determine if they come from the mother or father and then — and this is the amazing part — determine the entire epigenome of the CD4 cell, one of the white cells in the immune system that plays a central part in MS. MS is thought to be an autoimmune disease where the patient aberrantly makes antibodies to his or her own nerve tissues. The epigenome consists in additional modifications to the genome that are acquired throughout life that don’t involve the underlying sequence. They often involve attaching other small molecular groups, like the methyl group, onto the basic sequence without altering it. Twins have identical genomes but their epigenomes might diverge as they age and they encounter different environmental influences. So looking for the answer in the epigenome made a lot of sense. But the answer wasn’t there. There was no difference in either the genomes (expected) or the epigenomes, or, for that matter, in the transcriptomes, the repertoire of what genes are actually expressed. Each twin looked the same but only one had MS.

As I say, that this surprise made sense on one level. It was a reasonable place to look. But I found another aspect of the story quite striking:

Read the rest of this post… | Read the comments on this post…

(Fri, 30 Apr 2010 11:21:00 +0000)

# 4534

Over the past several days we’ve seen a series of `flu-related’ news reports from places as divergent as Vancouver, Australia, and Indonesia.  

All of these stories are still ongoing, but there are bits and pieces of news on each of them. 

 

In an environmentally conscious attempt to conserve our dwindling national supply of electrons, I’ve decided to update all of these stories in a single blog.

On Wednesday of this week we learned of an outbreak of an – as yet – unidentified respiratory virus in a long-term care facility in Vancouver, British Columbia  (see Investigating A Viral Outbreak In Vancouver). 

H1N1, along with other strains of Influenza A and B, have been ruled out. Nine residents had died, all of whom were described as `elderly and frail’.

The virus behind this outbreak remains unidentified, but today we learn that 3 staff members are out sick, and at least one other reported similar illness a month ago.  

Without a diagnosis, it is impossible at this time to know if any of these illnesses are related.  Complicating matters, the facility has been plagued with a Norovirus outbreak over the past month.   

This from The Times Colonist (hat tip Tetano on FluTrackers)

3 workers fall sick at Glengarry, where illness claimed 9 lives

By Joanne Hatherly, Times Colonist

April 30, 2010 1:21 AM

The Vancouver Island Health Authority is monitoring three sick staff members at Glengarry Hospital, where nine people have died from an unspecified respiratory illness.

 

VIHA spokeswoman Shannon Marshall said the three staff members reported sick yesterday, but it has not been determined if they are suffering from the illness that broke out in the Chandler Unit at Glengarry Hospital last week.

 

Maureen Donaldson, 50, a care attendant in the unit — where the nine people died and 11 more were infected — said she became ill a month ago with the same respiratory and gastrointestinal symptoms that she saw afflict residents.

 

“We are front-line workers and we are in contact with every body fluid,” said Donaldson, who is currently undergoing tests.

 

Marshall said no new cases have been reported among the residents. So far, the patients have tested negative for influenza A, B and H1N1. Yesterday, VIHA learned that tests for legionella — associated with Legionnaires’ disease — were also negative.

(Continue . . . )

Jumping now to Australia, where their trivalent seasonal flu vaccine is suspected of having triggered an unusual number of fevers and convulsions in children under the age of five (see Australian Vaccine Investigation Widens).

Initial examination of the vaccine hasn’t turned up any contaminants, or anything else that officials believe explains these reactions, but the temporary ban on vaccinating children under the age of five remains in place. 

Flu vaccine for under fives stays on hold

By Pamela Medlen

Federal and state health authorities have agreed to keep seasonal flu vaccines for young children on hold.

 

Hundreds of children under the age of five suffered fever, vomiting and convulsions after receiving the flu vaccine.

 

The Federal Government’s chief medical officer, Professor Jim Bishop, says there is no evidence to suggest that faulty batches of flu vaccine are to blame for adverse reactions in children.

 

Professor Bishop says tests of batches of the vaccine show no abnormalities, although further testing is yet to be completed.

 

He says higher numbers of adverse reactions to the vaccine in Western Australia could be explained by the higher rate of vaccination in the state.

 

But Professor Bishop says the ban will remain.

(Continue . . . )

And lastly, we update the two suspected bird flu reports out of Indonesia, which I mentioned yesterday in A Couple Of Bird Flu Reports Out Of Indonesia.

First, Dutchy at FluTrackers has a report on the 11 year-old who was being treated at Lubukbasung hospital, and who has now been transferred to Dr M. Djamil Padang Hospital in order to received specialized care. 

According to this story, Dr M. Djamil Padang Hospital is currently treating two suspect H5N1 patients.

Bird Flu Victim in Agam was rushed to the department of internal medicine

 

Harmen - Padang Ekspres

RS (11), bird flu victims in Padang ellipse Bio-Bio, Bawan village, district Ampek  Nagari, Agam regency was rushed to Dr M. Djamil Padang to obtain  special care, Thursday (04/29/2010).

This is done to provide optimal medical help for victims of the virus H5N1 is the worst and anticipate the impact to the victim.

Agency Head Kesbangpol Agam M. Dt.Maruhun and district when Ampek Nagari Welvizar contacted separately mentioned, this week, recorded two original bird flu victims Agam was referred to Dr M. Djamil Padang.

Previously, similar cases occurred in Lapaukonsi, Lubukbasung, where the victim-Budget not her real name (5) also received intensive care. Until now, victims still undergoing treatment.

And finally, an update from Riau, where 9 members of one village are ill with what authorities fear may be H5N1. All are apparently receiving Tamiflu, but most are refusing to go to the hospital. 

Ida at BFIC brings us this update from Riau Pos.

Sungaiapit, Riau ::: Bird flu spreads to other villages

Posted by Ida on April 30, 2010

Sungaiapit, Riau – Bird flu H5N1 had spread to Desa Parit I/II, Desa Harapan and Kelurahan Sungaiapit since it was firstly identified in Desa Lalang. Until now, bird flu infected human suspect has reached nine victims. Two of them are now being treated at Arifin Achmad hospital in Pekanbaru, while others are refused to be hospitalized.

 

Based on the investigation of Health Service and Livestock Service of Kabupaten Siak, so far dead chickens had been tested positive bird flu H5N1. Furthermore, Health Service had collected patient’s liquid samples for further test and treated patients with Tamiflu.

 

Source: Indonesia local newspaper. Riau Pos.

Via The Jakarta Post: Public told to stay alert despite declining threat. Excerpt:

Efforts to reduce the transmission of avian influenza (bird flu) in Indonesia should not stop despite the significant decrease in H5N1 cases. 

“Bird flu cases in poultry and humans are decreasing. The last case found in a human was in Jakarta in January,” Emil Agustiono from the Coordinating Public Welfare Ministry said Wednesday. 

“The H5N1 virus, which is pathogenic and deadly, is endemic in Indonesia,” he said. “But we should not be afraid. We just need to be aware of it.” 

According to the World Health Organization, the number of deaths due to H5N1 in Indonesia decreased steadily from 45 in 2006, to 37 in 2007 and to 19 in 2009. 

To help Indonesia reduce the risk of bird flu, the US Agency for International Development (USAID), through the Community-Based Avian Influenza Control Project (CBAIC) conducted a 4-year program. 

“The focus has been to work at the community, government, local government, health and husbandry agency level, as well as with commercial farms,” Maria Isabel Busquets of CBAIC said. 

“This is all to reduce the risk of avian influenza transmission.”

I would be delighted to think that no one in Indonesia had died of H5N1 since January, but we do have some suspected H5N1 deaths, including that of a four-year-old girl named Joice Evelyn, reported here this morning.

H5N1 has been a huge and embarrassing political issue in Indonesia since 2005. The official numbers of confirmed cases and deaths may have declined, but Jakarta has deliberately failed to report those cases promptly and accurately as it’s supposed to as a signatory to the International Health Regulations. 

The threat may be declining, but we’re entitled to be skeptical about the numbers Jakarta gives us.

Via the Indian government’s Press Information Bureau: Consolidated status of influenza A H1N1 as on 28th April 2010. It reports 30,554 confirmed cases and 1,494 deaths.

On March 28, the confirmed cases totalled 30,154 and 1,443 had died.

On January 1, India reported 26,039 cases and 967 deaths. So 527 Indians have died of H1N1 so far this year, a third of the total. India’s first H1N1 death was reported on August 4, 2009.

(Thu, 29 Apr 2010 13:55:00 +0000)

# 4533

The past couple of weeks have seen a few scattered reports of suspected H5N1 infections in Indonesia, something that is pretty common during the winter and spring months of the year. 

Details are usually scant, and official confirmation of these reports sometimes takes months.  Sometimes we never hear a follow up on these cases, and are left to wonder exactly what transpired.

Over the past few days we’ve seen a spike in Indonesian media reports regarding suspected human infections with the H5N1 virus, including the death of a 4 year-old girl yesterday.  

Thus far, we’ve not seen any laboratory confirmation that these recent patients were infected with the H5N1 virus.   So these remain suspect cases.

On Monday, Ida at BFIC carried a report of four locals (one adult, 3 toddlers) from Sungaiapit, Riau hospitalized with suspected H5N1 (see Watching Riau Again).

Today, based on a machine translation of an Indonesian media report, it appears that the number of suspect cases in this region has climbed to nine.

The usual cautions with these translated reports applies;

 

Machine translations can be awkward and difficult to decipher, local reporting may or may not be accurate, and there are a great many diseases in that region that share the same initial symptoms as bird flu.

This report was posted by Shiloh on this thread at FluTrackers,

Bird Flu Case in Spreads Starting Apit River
29 April 2010
 
Reports Abu Kasim, Sungaiapit abukasim@riaupos.com

CASE Sungaiapit bird flu in the district began to expand, since the unknown Saturday (24 / 4) and then, only one village namely Lalang Village.

In the village of hundreds of birds died suddenly had a positive infected bird flu virus (AI) and until Tuesday (27 / 4), extends to two villages and one village ie village of Parit I / II and Hope Village and Village Sungaiapit.

 

Even human sacrifice which was initially only four people have grown to nine people, two of whom, since Monday (26 / 4) are already in the reconciliations in hospitals Arifin Achmad Pekanbaru.

Some of these suspect cases are apparently being treated in their homes with Tamiflu, and are not hospitalized or otherwise isolated.

Since `mild cases’ of H5N1 are seldom reported in Indonesia (whether they exist or not is another issue), the fact that not all of these people are ill enough to be hospitalized may serve to lessen the import of these reports a bit. 

It isn’t unusual, however, for locals to refuse hospital care in Indonesia, so we’ll simply have to wait for more information.

Meanwhile, more than 200 kilometers to the southwest, in Padang we’ve this report  (h/t Shiloh on FluTrackers) of an 11 year-old hospitalized with suspected bird flu.  

The boy’s condition is reported as  `still not good’.  Once again, this is a suspect case, and laboratory tests are pending.

Padang | Thursday, 4/29/2010 17:37 AM
Dr M. Djamil Back Hospitalized Patient suspect Avian Influenza

Irwan Prayitno

Padang, (AFP) - General Hospital Center Padang M. Djamil, again treating patients suspected of bird flu suspected origin Kanagarian Bawang, Lubuk Basung, Agam District.

 

“The victim is a 11-year-old boy Rz initials,” said Dr M. Head of Public Relations Djamil, Gustavianof.

 

According to him, Rz sent to Dr M. Djamil on Thursday (29 / 4) early morning at around 2:00 pm.

 

“Description of the victims parents, three days earlier, Rz suffering from high fever and a little shortness of breath. Then Rz Lubuk brought to health centers in two dozen, but the clinic complaining because of lack of equipment, so refer him to Dr M. Djamil,” said Gustavianof.

 

When Rz fever, not far from his home, found 50 chickens that died suddenly.

 

“Based on the description of a local veterinarian, the chickens are attacked by the bird flu virus,” he said.

This story is being followed on this thread at FluTrackers.

Again, scattered reports of this type are not unusual this time of year.  The newshounds on the flu forums will continue to watch these cases, and I’ll update them here if and when more information becomes available.