Influenza Virus Mashup

Via The Brisbane Times: Govt alarmed over flu shot drop. Excerpt:

Queensland Health Minister Paul Lucas is alarmed over a big reported drop in the number of people asking their family doctor to vaccinate them against seasonal and swine flu. 

The Australian Medical Association Queensland (AMAQ) fears the flu season could be disastrous with anecdotal evidence from doctors showing there had been a 50 per cent drop in vaccination requests. 

Mr Lucas said today that the figure was “extremely concerning”. 

“The federal notification is only in relation to the seasonal flu vaccination for under fives,” Mr Lucas said in Brisbane. 

“It’s not in relation to other vaccinations, it’s not in relation to the swine flu vaccination, it’s not in relation to seasonal flu vaccination for adults.” 

Mr Lucas advised people to check advice carefully to help avoid a terrible flu season. 

“We do know that Queenslanders died last year as a result of getting swine flu,” he said. 

“We do know that children with swine flu are very, very significant carriers of it and what they can do is infect other people who are elderly … or someone else in a vulnerable group.”

Via Ida at Bird Flu Information Corner, an Antara report: Pekanbaru, Riau ::: Four-year-old bird flu suspect girl dies. Excerpt:

A four-year-old girl bird flu suspect patient, Joice Evelyn, died on Wednesday afternoon after had been treated for two days in Arifin Achmad hospital, Pekanbaru, Riau. 

Joice, a resident of Sidomulyo, Pekanbaru, had been treated in isolation unit of Arifin Achmad hospital since Monday (26/4) after previously treated in Santa Maria hospital. 

Joice had high fever up to 39℃ and breathing rate 90 per minute before the decease. 

“Joice never had any contact with birds. We don’t rear any birds at home,” said Harapan Bagariang, Joice’s father. 

Previously, Joice developed fever for a week and hospitalized in Arifin Achmad hospital. Because of insufficient medical service, family brought the girl to Santa Maria hospital. 

“After a day, Santa Maria hospital’s doctor said that Joice had virus. She was then referred back to Arifin Achmad hospital as it is the only bird flu referral hospital (in Riau).

(Thu, 29 Apr 2010 12:32:00 +0000)

# 4532

Seasonal influenza (as opposed to pandemic flu) traditionally takes its biggest toll among the oldest and frailest members of society. Of the 36,000 estimated deaths flu-related deaths in the United States each year, the vast majority occur in those over the age of 65.

According to one recent study, 90% of seasonal flu related deaths “occur in people over 65 years and the mean age of influenza-related deaths is estimated at 76 yrs.”

Which is why those over the age of 65 have been routinely urged to get a flu shot every year.  Something I’ve recommended to my (now 85 yr old) father since the 1990s.

And since I’m approaching `middle age’ myself (assuming, of course, I manage to live to be 112), I get the flu shot every year as well.

The problem is, the elderly - who are most at risk from dying from seasonal influenza - appear to derive the least amount of protection from our current flu shot formulations. 

 

 

While this is hardly a secret, is isn’t exactly advertised on billboards outside of your doctor’s office either.  

You’ll find a number of blogs here, going back several years on this topic, including:

ACIP Provisional Influenza Vaccine Recommendations

Why Vaccines Matter

Vaccines: Sometimes You Just Need A Bigger Hammer

Another Study: Flu Vaccines Do Not Reduce Mortality Rates In The Elderly

Study: Flu Vaccines And The Elderly

Flu Shots For The Elderly May Have Limited Benefits

Since the level of protection induced by the flu shot likely varies widely between elderly recipients, and since a little protection is assumed to be better than none, there is a natural reluctance among some health care providers not to go into a lot detail about the relative degree of protection afforded to the elderly by the vaccine.

And to be clear here, the evidence doesn’t say there is no benefit to giving those over 65 a flu shot.

 

0nly that those with the weakest immune systems – and therefore most apt to die from the flu – don’t appear to be any less likely to die if they’ve been vaccinated.

A factoid I’ve shared with my father every fall for several years now, as I dutifully remind him to get the vaccine.  But as they say, a little protection beats none at all . . .

Which brings us to an article (hat tip CIDRAP News) which appears on Minnesota public radio’s website, featuring CIDRAP’s director Michael Osterholm.

Research suggests flu vaccine doesn’t prevent deaths among the elderly

by Lorna Benson, Minnesota Public Radio

April 27, 2010

St. Paul, Minn. — If the main point of the nation’s influenza vaccination program is to reduce deaths from flu, then the program has failed, at least among people over 65.

 

A growing body of research shows that because our immune systems age, flu vaccines don’t work as well in the elderly - the group of people most likely to die from flu-related causes.

 

The revelation has been so unsettling that public health officials have not shared the information widely with the public - even though some of the early findings have been a part of the scientific literature for several years now.

 

Michael Osterholm, who directs the University of Minnesota’s Center for Infectious Disease Research and Policy, Tuesday told a national conference on vaccine research that it’s time to be more open about the flu vaccine and its lack of protection for the elderly.

 

Osterholm also urged his colleagues to support attempts to create a new, effective vaccine.

(Continue . . . )

This is a very good article, with a lot of background on the studies that have been conducted trying to understand the effect and effectiveness of flu vaccination in the elderly.  

Last December the FDA approved a new, high-dose Fluzone flu shot for those over 65, that contains 4 times the normal amount of antigen.

FDA PRESS RELEASE

For Immediate Release: Dec. 23, 2009

FDA Approves A High Dose Seasonal Influenza Vaccine Specifically Intended for People Ages 65 and Older

Accelerated approval process used in vaccine approval

The U.S. Food and Drug Administration today approved Fluzone High-Dose, an inactivated influenza virus vaccine for people ages 65 years and older to prevent disease caused by influenza virus subtypes A and B.

 

People in this age group are at highest risk for seasonal influenza complications, which may result in hospitalization and death. Annual vaccination remains the best protection from influenza, particularly for people 65 and older.

(Continue . . . )

 

In March, ACIP announced that this new formulation would be available along with standard flu shots this fall, but did not announce a preference for one shot over the other. Those interested should discuss this option with their family physician.

While early testing has been promising, it will probably take a year or two of field use before we have any idea of the relative impact of this new flu vaccine.  

In the meantime, doctors and public health officials are left in a quandary over how to best present this information without discouraging the uptake of the flu vaccine by the elderly.  

Most researchers believe that – at least among those seniors who are reasonably healthy – the flu shot provides some level of protection.

 

How much varies from year-to-year and from person-to-person.

Which, ultimately, may be the simplest and most honest way to `sell’ seniors on the idea of getting the shot every year.   

It is what I used with my Dad, and he was fine with it.

Via Precavido.com.br, a report from Jornal da Tarde: SP, capital, has the first outbreak of H1N1, in a primary school. Excerpt, with my translation:

A capital registrou este mês o primeiro surto precoce de H1N1 entre alunos de uma mesma escola. Cinco estudantes de duas classes da Escola Paulistinha de Educação infantil, ligada à Universidade Federal de São Paulo (Unifesp), na Vila Clementino, zona sul - com idades entre 6 e 8 anos - foram afastados das aulas por apresentar os sintomas da gripe A.

The capital this month recorded the first early outbreak of H1N1 among pupils in a single school. Five students in two classes of the Paulinista School of Primary Education, linked to the Federal University of São Paulo (Unifesp), in Vila Clementino, south zone, aged between 6 and 8, were isolated from their classes after presenting with symptoms of H1N1.

Via Folha Online: Pernambuco confirma primeira morte do ano por gripe suína no Estado. [Pernambuco confirms first H1N1 death of the year in the state] Excerpt, with my translation:

A Secretaria de Saúde de Pernambuco confirmou nesta quarta-feira a primeira morte provocada pela influenza A (H1N1) –a gripe suína– neste ano no Estado. 

The Pernambuco Secretariat of Health this Wednesday confirms this year’s first H1N1 death in the state.

A vítima é um jovem que morava no interior e que estava internado no Hospital Universitário Oswaldo Cruz. 

The victim was a young man from the interior who was in Oswaldo Cruz University Hospital.

De acordo com a secretaria, ele chegou à unidade em estado grave e permaneceu internado por 20 dias, mas não resistiu. 

According to the secretariat, he arrived there in grave condition and remains hospitalized for 20 days before dying.

Este ano, Pernambuco registra sete casos confirmados da doença, além de 18 em investigação. Em 2009, 154 casos foram confirmados e seis pessoas morreram no Estado.

This year Pernambuco has recorded seven confirmed cases of the illness, with another 18 under investigation. In 2009, 154 cases were confirmed and 6 persons died in the state.

Mike Coston at Avian Flu Diary has the story: Indonesia: Suspected Bird Flu Fatality. Excerpt:

Overnight Ida at BFIC posted a report on a 4 year-old from Riau, Indonesia who was hospitalized with suspected H5N1.  Although this child’s symptoms are consistent with bird flu, we’ve not seen any reports of laboratory confirmation of the virus.   

Since that time, local media has reported her death.

(Wed, 28 Apr 2010 12:26:00 +0000)

# 4531

Overnight Ida at BFIC posted a report on a 4 year-old from Riau, Indonesia who was hospitalized with suspected H5N1.  Although this child’s symptoms are consistent with bird flu, we’ve not seen any reports of laboratory confirmation of the virus.

Since that time, local media has reported her death.

First the report from the Bird Flu Information Corner.

 

Pekanbaru, Riau ::: A four-year-old girl treated as bird flu suspect

Posted by Ida on April 28, 2010

Pekanbaru – A four-year-old girl, Joice Evelyn, a resident of Jalan Sidomulyo RT/RW 1/8 Kecamatan Senapelan, is suspected of contracting bird flu virus. The girl is currently under intensive treatment at bird flu isolation unit of Arifin Achmad hospital in Pekan Baru.

 

Patient had been hospitalized in Arifin Achmad hospital for two days from 21 to 23 April before taken home by her family. Patient had recurrent fever on the next day after she returned home that she was rushed to Santa Maria hospital. Later she was referred to Arifin Achmad hospital.

 

Hospital is still waiting for the laboratory test result.

 

Patient has no direct contact history with birds before the illness.

Source: Indonesia local TV, Riau Televisi

Dutchy, posting on FluTrackers has this update from Riauterkini.com.

Machine translations from Bahasan oft times confuse genders, but based on Ida’s translation, this victim appears to be a little girl.

Wednesday, April 28, 2010
Bird flu suspect GIRL died in hospital Arifin Achmadd

 
Arifin Achmad Pekanbaru Hospital could treat a child suspected bird flu Senapelan origin.

 
Her condition worsened and finally died.

Riauterkini-Pekanbaru-A boy berisial Efeline Joyce (4) children Bagarian couples (35) and E Nainggolan (32) the resident Street Sidomulyo, Senapelan, Pekanbaru had undergone treatment
intensive care isolation room patients with suspected bird flu hospitals Arifin Achmad Pekanbaru. Symptom The child suffered clinic leads to attack avian influenza virus.

 
According to the Head of Public Relations Ahcmad Pekanbaru Hospital Arifin Zainal Arifin, the boy suspected bird flu.

The hospital received on Monday (26/4/10) and then, after a referral from the Hospital Santa Maria Pekanbaru. When his condition had worsened referenced. After two days of intensive care, finally, at around 15:00 pm, Wednesday (28/4/10) patients are not spared his soul.

 
“Just now the patient is medically declared dead. But we can not ensure, whether the patient is positive of bird flu. Suspected new limited, “explained when talking with riauterkini in Pekanbaru, Wednesday (28/4/10).

Zainal explained, before the patient’s body temperature reached 38.9 degrees celsius koit and conditions lung occurs puddle of liquid. Currently the patient’s body still in the hospital and waited for his family to take .

(Wed, 28 Apr 2010 10:46:00 +0000)

# 4530

In medicine, one always looks first to the most common, or likely, cause of a patient’s chief complaint before considering something exotic.   The old adage, that `When walking in Central Park, if  you hear hoof beats, expect horses, not zebras’ is drummed into every medical student.

It is only when you eliminate the simplest explanation that you move to the next most-likely cause of a patient’s illness. 

And so, when a series of extremely elderly residents in a long-term nursing facility on Vancouver Island began to fall seriously ill from a respiratory ailment earlier this month, naturally the first thoughts were that it was influenza A or B.

 

But testing has ruled out these two most likely suspects, and doctors and epidemiologists are now looking for a different explanation.

Influenza viruses, of course, make up only a small percentage of known respiratory viruses (see ILI’s Aren’t Always The Flu).

The list of viral pathogens that can cause ILI’s (`influenza-like Illnesses’) is a long one, and includes adenoviruses, influenza viruses, human metapneumovirus, parainfluenza viruses, respiratory syncytial viruses, and rhinoviruses.

Yesterday the press – particularly in Canada – picked up this story. 

A hat tip to RoRo, Alert, Laidback Al, Tetano, and others on FluTrackers for starting this thread to track the progress of this investigation.

This report from the Canadian Press, followed by a press release from the local health authority.

Virus kills nine at Victoria hospital

 

Influenza-like virus has made 19 ill; H1N1 has been ruled out

Victoria, BC —  Last updated on Tuesday, Apr. 27, 2010 6:26PM EDT

Nine residents have died since April 5 at a Victoria hospital where an influenza-like illness has been detected, says the Vancouver Island Health Authority.

 

Spokeswoman Suzanne Germain said Tuesday that 19 people have become ill since the respiratory outbreak began at Glengarry Hospital, which is home to frail and elderly patients, many with multiple pre-existing conditions.

 

“While we know that nine people who died had the symptoms we don’t know if that was what ultimately caused them to die,” she said of the patients, who were in their 80s and 90s.

 

Lab tests have confirmed that the illness is not H1N1 or influenza A and B, but further tests are being conducted to try and find out what kind of illness is involved, she said.

(Continue . . . )

The Vancouver Island Health Authority (VIHA) has released the following statement:

Respiratory Outbreak at Glengarry Hospital

 

April 27, 2010

VICTORIA – The Chandler Unit at Glengarry Hospital in Victoria is experiencing a respiratory outbreak which has affected a total of 19 residents. The Vancouver Island Health Authority (VIHA) is asking family and friends to consider not visiting the facility at this time, especially if they are sick. If they do visit, they will be asked to clean their hands on entering the facility and affected unit as well as follow other precautions as directed by staff.

 

The Chandler Unit at Glengarry has also been experiencing a Norovirus outbreak since April 6. Some patients on the unit began developing respiratory symptoms at the end of March, but these were often mild and not readily distinguished from the Norovirus symptoms in this group of elderly and often cognitively impaired residents. The respiratory outbreak was declared on April 22 after an increase in the number of cases and several deaths occurred.

 

Since April 5, nine residents with the respiratory symptoms have passed away. Each of these residents was elderly and frail with multiple medical challenges. Five of these residents were already receiving palliative care. Medical reviews are underway on all cases to determine what role the respiratory condition may have played – if any – in the deaths.

 

“We take outbreaks in residential care facilities very seriously because the frail, elderly population is more susceptible to serious complications and even death from illnesses,” said Dr. David Forrest, Associate Medical Director, Infection Prevention and Control with VIHA. “The fact that no staff have been affected by this illness would suggest it is a mild illness in most people that is affecting our frail elderly residents more.”

 

Lab tests have not yet confirmed the organism involved in the respiratory condition, but influenza A and B and H1N1 have been ruled out. Further testing is underway at the VIHA laboratory as well as at the BC Centre for Disease Control in Vancouver. Results are expected later this week.

 

“While the cause of the illness is not yet known, residential care facilities reflect the community.  There are many viruses circulating in the community this time of year, including rhino- and noro-viruses.   When they are introduced into the residential care setting they can have a significant impact on residents and staff,” said Dr. Forrest. “We would like to remind people not to visit when they are not feeling well.  In addition, since many infections such as influenza can be prevented by vaccination, immunization is important to prevent the development of such outbreaks and deaths.”

 

VIHA has notified family members of this latest outbreak. Heightened infection control measures are in place to prevent its spread.

These measures include:

• Limiting contact between residents (residents are isolated to their rooms)
• Closing all dining rooms (meals are being served to residents in their rooms)
• Limiting visitors to one family member per resident.
• Requiring visitors to wear protective equipment and to follow strict hand hygiene practices (e.g. mask, gown and gloves when visiting someone with symptoms).
• Restricting visitors to loved one’s room only; no visits in common areas.
• Cancelling special events and restricting movement for residents who smoke.
• Requiring staff to wear protective equipment and to follow strict infection control practices (e.g. mask with visor, gown, gloves).
• Restricting staff who have been working on the Chandler Unit from working in other residential care sites in back-to-back shifts.
• Adding housekeeping staff and enhancing housekeeping with additional infection control cleaning protocols (such as enhanced cleaning of frequent touch areas, changing of privacy curtains).
• Maintaining a previous closure to new admissions that was put in place April 6 due a Norovirus outbreak.

Residents who contract respiratory symptoms are being carefully monitored and treated as appropriate, depending on their care plan, their wishes, or the wishes of their family.  Where requested and appropriate, a resident may be transferred to hospital for additional care such as intravenous antibiotic care.

 

Glengarry has a total of 140 beds. Only the Chandler Unit (70 beds) is affected by the respiratory outbreak.

Via Xinhua: ASEAN embarks on roadmap on control of avian influenza. Excerpt:

Animal health experts, public health experts, the private sector and development partners from ASEAN members ended a two-day meeting to draft the roadmap which will be finalized for submission to relevant ASEAN sectoral bodies in late 2010, according to a statement released by the ASEAN Secretariat here on Tuesday. 

The concept and work plan in the development of the roadmap was discussed at the First Technical Working Group Meeting on Highly Pathogenic Avian Influenza (HPAI) Roadmap held at the ASEAN Secretariat. 

Regional cooperation in the control and eradication of highly pathogenic avian influenza (HPAI) will receive a boost when a roadmap to ensure the attainment of HPAI-free ASEAN by 2020 is finalized this year. The two-day meeting comprised experts from the animal health and public health departments and agencies of ASEAN Member State.

The Roadmap incorporates several progressive phases and approaches based on lessons learned and ongoing initiatives in the broader context of trans boundary animal disease control, multi- sectoral cooperation for health, and One World, One Health frameworks. 

“The Roadmap would contribute to regional economic integration towards a single market and production base by 2015 with free flow of animal and livestock products as well as alleviating poverty and enhancing food security in the region,” said the Deputy Secretary-General of ASEAN for ASEAN Economic Community, S. Pushpanathan, in his welcome remarks. 

“Such a contribution is indeed a key ASEAN contribution to the World Veterinary Day which is annually celebrated on the last Saturday of April,”he said.

Via The Daily Star: 19 poultry markets up for upgrade to avert bird flu risk. Excerpt:

Some 19 Live Bird Markets (LBMs) will be upgraded in major cities in a couple of months to provide hygienic poultry products to consumers, minimising the risk of spread of avian influenza or bird flu. 

Of the 19 LBMs, eight will be upgraded in Dhaka and 11 in other major cities, including five divisional cities and Bogra and Cox’s Bazar. 

The renovation works of five LBMs in Dhaka have already been completed. 

The move, symbolic in nature, is expected to yield positive benefits by creating awareness among poultry traders and consumers about advantages of maintaining bio-security in LBMs. 

It also calls for government initiative to replicate models of these upgraded LBMs in all over the country to provide people access to safe food and minimise the risk of spread of avian influenza from the LBMs, a major source of spreading bird flu. 

This was shared at a programme organised to inaugurate an upgraded LBM market at New Market in the capital yesterday. 

“This is about healthy life that we can try to provide to consumers,” said Ad Spijkers, FAO representative in Bangladesh, adding that clean markets would help reduce the chance of spreading disease to customers, other markets and poultry farms. 

Sunil Chandra Gain, director general of the Department of Livestock Services, and Denise Rollins, USAID mission director in Bangladesh, were also present. 

LBMs are being renovated under a USAID funded project on improved bio-security and hygiene production. FAO in collaboration with the Department of Livestock Services run the project. 

Under the $575,000 project, infrastructure of the newly opened market has been developed, while cleaning and disinfections equipment and commodities have also been provided to reduce any chance of spreading disease to consumers, other market and poultry farms. 

LBM workers such as cleaners have also been provided training to wash, clean and disinfect the markets regularly, organisers said.