Influenza Virus Mashup

Via the Hong Kong government website, a reported dated October 28: Bird flu outbreak drill held. Excerpt:

The Agriculture, Fisheries & Conservation Department conducted a field simulation exercise today to review its preparedness for an avian influenza outbreak.   

The exercise saw 100 staff familiarise themselves with work procedures and biosecurity measures for conducting the operation and identify areas for response improvement.   

It focused on the overall on-site preparation and implementation of biosecurity measures, such as putting on and removing protective gear, as well as the disinfection and disposal of carcasses.

Hong Kong is of course where H5N1 first infected and killed humans in 1997, and the medical authorities take it very seriously.

Mike Coston at Avian Flu Diary has posted Haiti: Anxiously Watching Tomas. It’s a very good summary of what we know (and don’t know) so far about this late-season hurricane and its implications for Haiti.

(Sun, 31 Oct 2010 12:24:00 +0000)

 

 

# 5022

 

 

With more than a million earthquake displaced individuals scattered across more than 1300 refugee (mostly tent/tarp shelter) centers, relief workers and residents of Haiti have understandably watched the tropics this year with a good deal of apprehension.

 

Not much shelter from the storm.

Flickr Photo Credit  By digital.democracy 

(CC) License Some rights reserved

 

 

There have been a couple of close calls, and one completely unexpected severe summer thunderstorm back on September 24th that killed several, but the island of Hispaniola has - quite remarkably - been spared during this unusually active tropical season.

 

 

All of that could change by the end of this week, however, when an unprecedented late season hurricane is forecast to pass very close to – if not over – the island shared by Haiti and the Dominican Republic.

 

 

The storm is Hurricane Tomas – already at CATEGORY 2 – and forecast to possibly intensify a bit in the near term.

 

This morning’s forecast track map from the NHC, showing a late week northerly turn.  

 

The timing of this turn, and the storm’s forward speed around midweek are still a bit `iffy’, and so confidence in the day 4 & day 5 positions are somewhat less than normal.

 

 

All of this comes, of course, on top of the Cholera epidemic which has sickened thousands and killed hundreds over the past couple of weeks.

 

The latest map of communities affected by the Cholera Outbreak (OCHA) 10-29-10.

 

While it is too early to know for sure if, or how badly,  Haiti will be badly affected by this storm -yesterday the nation’s Centre national de météorologie (CNM) issued a second advisory on Tomas, upgrading their alert from YELLOW to ORANGE.    

 

A concern enhanced, no doubt, by Haiti’s long and tragic history with hurricanes.  A few more recent examples include:

 

• In 2004 Tropical Storm Jeanne passed just north of the island and dumped 13 inches of rain, which caused massive flooding and landslides that claimed 3,000 lives.

• Before that, in 1994  Hurricane Gordon killed in excess of 1,100 people, mostly from flooding.

• In 1963 it was a CAT 4  Hurricane Flora that clipped the southwestern tip of Haiti, and killed more than 8,000.

• Before striking the Carolinas in 1954, Hurricane Hazel swept across Haiti killing more than 1,000.

 

Mountainous terrain, combined with rampant and indiscriminant deforestation over the years, have often produced devastating landslides and floods which greatly exacerbate the losses from these storms.

 

While the eventual track of Tomas is still very much in doubt, there is very little that authorities can do to protect the hundreds of thousands of people still living in tent and tarp cities should a major storm impact the island.

 

Even more substantial structures, still standing but weakened by the earthquake, may not be safe.

 

And even a glancing blow would likely make ongoing attempts to contain the growing cholera epidemic far more complicated.

 

 

First an earthquake, then an epidemic, and now . . potentially, anyway . . . a hurricane.

 

A not-so-gentle reminder that disasters don’t happen in a vacuum.   And that one crisis can quickly compound and escalate into another . . . and then another.

 

Good enough reasons to work towards better preparedness for your family, your neighborhood, and your greater community.

Because it can happen here.

 

 

A good place to learn how is Ready.gov.

Other good places to get started include:

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

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

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

 

Obviously, if you can find a way to help support the relief efforts in Haiti through a donation to one of the NGOs working on the ground there (ie. Red Cross, CARE.ORG, SAVE THE CHILDREN, and others), I’m certain they and the people of Haiti will be grateful for your generosity.

(Sun, 31 Oct 2010 02:28:16 GMT)

Reminder: Please do not post whole articles, just snippets and links, and do not post articles from the Las Vegas Review-Journal. Thanks!!

Cameroon

?  Cameroon Launches Massive Swine Flu Vaccine Campaign (Link)

China

?  Hong Kong holds avian flu outbreak exercise  (Link)

Mexico

?  Temperature drops and increased respiratory disease (translated) (Link)

Zambia

?  MoH to conduct swine flu vaccination exercise this week (Link)

Commentary

?  Recombinomics: 80% of Influenza A in Texas is Seasonal H1 (Link)

?  H (Link)

News for October 30, 2010 is here.

Thanks to all of the newshounds! Special thanks to the newshound volunteers who translate international stories - thanks for keeping us all informed!

Other useful links:

CDC A(H1N1) Site

WHO A(H1N1) Site

WHO H5N1 human case totals, last updated October 18, 2010
Charts and Graphs on H5N1 from WHO
Google Flu Trends (U.S.)
CDC Weekly Influenza Summary
Map of seasonal influenza in the U.S.
CIDPC (Canada) Weekly FluWatch
European CDC Influenza News
UK RCGP Weekly Data on Communicable and Respiratory Diseases
Flu Wiki Main Page

Via The Zimbabwean: Tsholotsho swine flu nightmare. Excerpt:

More than 2 000 suspected cases of the Influenza A (H1N1) or swine flu virus have been reported in Tsholotsho district but officials have to contend with more than just a deadly outbreak – they face the difficult task of breaking deep-seated superstitions and overcoming administrative hurdles. 

At least one person has died since the outbreak, which has affected mostly children, was first detected last month. Health workers fighting the outbreak are however meeting unusual resistance from villagers who believe the virus is caused by witchcraft and are refusing to get treatment. 

The outbreak has even affected the conduct of the 2010 final school examinations. Education officials in the area have been forced to introduce “quarantined exam classes” for infected school children. In one school, more than 95 percent of the children are believed to be infected by the H1N1 virus. 

A previous swine flu outbreak claimed more than 40 lives in 2009 and affected more than 300 people.

(Sat, 30 Oct 2010 11:38:00 +0000)

 

 

 

# 5021

 

 

A couple of stories this morning on NDM-1.

 

In what unfortunately may end up being a case of closing the barn door after the horse got out, India yesterday announced stricter regulations on the over-the-counter sale of antibiotics to the public. 

 

This move comes in response to recent reports of a new form of antibiotic resistance (see NDM-1 Surveillance) strongly associated with medical tourism out of India and Pakistan.

 

Actually, the first response from Indian officials was outrage that this emerging pathogen was named after New Delhi, along with a few ham-handed attempts to `spin’ the news.   

 

 

This move to restrict the sale of antibiotics comes more than two months later.

 

 

NDM-1 or New Delhi metallo-ß-lactamase-1 made headlines in the wake of the release of a Lancet study back in August called:

 

Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study

 

 

Since then, sporadic NDM-1 cases have been identified in countries around the world, with the vast majority of them having had some medical procedure or treatment in India or Pakistan.

 

But I digress . . . here is the first report, from DNA (Daily News & Analysis).

Superbug fallout: Antibiotics ‘on counter sale’ ceased

Published: Saturday, Oct 30, 2010, 9:00 IST
By Akanksha Bafna | Place: Mumbai | Agency: DNA

The drug controller general of India (DCGI) on Friday introduced new rules to buy antibiotics. According to the revised rules, a patient will need two copies of a prescription - one which will be in the chemist’s custody.

 

(Continue . . .)

 

 

Admittedly, India required prescriptions for the purchase of antibiotics before yesterday, but a lack of enforcement meant that this was regarded more as a suggestion than a rule.

 

Indian and Pakistani pharmacies are also prominently featured in online ads hawking the sale of a variety of meds – including antibiotics – without the need for prescriptions. 

 

While these new regulations supposedly add `teeth’ to the law, the unregulated sale of antibiotics has been a lucrative business in India for some time.

 

It remains to be seen how successfully these new rules will be enforced and how effective they will be in curbing the unregulated sale and use of antibiotics.

 

From The Hindu, we get a report on a recent independent investigation conducted by Channel 4 News in the UK, where science correspondent Tom Clarke – with the aid of NDM-1 researcher Professor Timothy Walsh – tested sewage in more than 120 locations across Delhi for the NDM-1 resistant bacteria.

 

The resistant gene was detected in nearly 10% of the samples.

 

“It suggests NDM is spread all over Delhi and people are carrying (these bacteria) as part of their normal flora,” Professor Walsh was quoted as saying.

 

First the article in the Hindu, followed by a link to the Channel 4 News investigative report.

 

News channel claims superbug could be widespread in India

Aarti Dhar

A British television channel has claimed that the New Delhi metallo-B- lactamese (NDM-1) bacteria could be widespread in Indian cities.

(Continue. . . )

 

 

The Channel 4 News story, with more detail, including reports of political interference in the Lancet research:

 

Drug Resistant Superbug Threatens UK Hospitals

Thursday 28 October 2010

Tom Clarke Science Correspondent

Efforts to contain a new strain of superbug threatening the NHS and other health authorities around the world may almost be unachievable, exclusive research by Channel 4 News reveals.

(Continue . . . )

 

 

Unlike a flu pandemic – which can spread very quickly – antibiotic resistance moves at a more glacial pace.  MRSA, after all, was first identified in the early 1960s in the UK, but didn’t really become a huge public health problem for a couple of decades.

 

Today, with global travel and medical `tourism’ far more common, resistant organisms have more opportunities to spread - and so while it may still take awhile – newly emerging resistant bacteria are likely to spread faster than we’ve seen in the past.

 

All of which makes NDM-1 an important long-term story to watch.

 

Like many health bloggers, I’ve written a number of times on this emerging mutated gene. A few of my previous efforts include:

 

NDM-1: A New Acronym To Memorize

Public Health Agencies On NDM-1

Denialism and NDM-1

 

Arguably, some of the best coverage has come from our favorite `scary disease girl’ Maryn McKenna editor of the Superbug blog.

 

And if you’ve not already read Maryn’s 2nd book, Superbug: The Fatal Menace of MRSA, I would invite you to do so.

 

Superbug (MRSA) Book

Although published before the identification of the NDM-1 threat, this book remains a chilling and informative look at the growing problem of emerging antimicrobial resistance.

 

My review of it may be read here.

 

Highly recommended.

Mike Coston at Avian Flu Diary has just updated this morning’s post, Keeping A Wary Eye To The Southeast. It looks as if a late-season hurricane could visit Haiti’s southern coast on Sunday night and Monday. Not good.

Via Scientific American: Finding a Killer’s Achilles’ Heel: Clues from a Pandemic. Excerpt:

It has been five years since a team of scientists resurrected the 1918 influenza virus from the lungs of a long-frozen victim. At the time, the Jurassic Park–like feat was both widely celebrated and sharply criticized. 

Opponents worried about the risk of an accidental (or intentional) release of the revived killer, which claimed between 50 million and 100 million lives in about 15 months and has been dubbed the worst plague in human history. Proponents insisted that the insights gained from a fully reconstructed virus would be instrumental in fighting the next pandemic. 

A paper published in the November issue of the journal Microbe cites a potential new drug target, among other findings, as evidence that the risk was not taken in vain. 

Terrence Tumpey of the Centers for Disease Control and Prevention and his colleagues have closed in on a protein called PB1 that enables the virus to copy itself. 

When researchers substituted the PB1 protein in a normal flu virus with the 1918 version of that same protein, the normal virus morphed into a superkiller: it replicated and spread through its rodent host eight times faster, killing more mice as a result. It turns out that all 20th-century pandemic viruses, among them the 2009 swine flu, have avian flu PB1 genes. Most seasonal flu viruses have human flu PB1 genes. 

Scientists are now working to develop new drugs that target PB1.

(Fri, 29 Oct 2010 16:20:00 +0000)

 

 

UPDATED:  1500hrs EDT  10/29

 

The NHC has upped the odds of this system becoming a T.S. to nearly 100% as of the 2pm advisory.

A recon flight is inside the system right now, and I would not be surprised to see proto-Tomas upgraded and possibly named in the next few hours.

Meanwhile, the Centre national de météorologie (CNM) in Haiti has issued an advisory (in French) here.

 

Translated, it reads in part :

 

Special Bulletin # 1 Friday, October 29, 2010

A rigorous tropical wave associated with a low pressure center was located about 1,000 km east southeast of the West Indies this morning. 

This system could become a hurricane within the next 48 hours.

 

The trajectory models do pass near the southern coast of Haiti on Sunday night and Monday. The passage of this disturbance near the southern coast of Haiti could generate gusty winds, scattered showers and thunderstorms especially for regions south of Haiti from Sunday evening.

 

 

 

# 5020

 

 

It has been an unusual hurricane season, to say the least. 

 

While the United States has been spared the brunt of an unusually active Atlantic tropical season, we are currently up to the year’s 18th named storm (SHARY) and on the cusp of seeing number 19 form.

 

Shary poses a minor threat to Bermuda, but it is the large and well defined (for Late October) disturbance in approaching the Leeward Islands that has captured the most attention.

Frankly, this time of year, we don’t expect to see anything form this far east, or south in the tropics. 

 

September?  Sure.   Late October . . . almost November? 

 

Not in my memory.

 

Conditions are generally favorable for development (although it has to get past the coastline of South America), and the models right now take it in the general direction of Haiti early next week.

 

 

A tropical storm or hurricane is absolutely the last thing that the relief efforts, medical workers fighting a cholera outbreak, and the beleaguered people of Haiti need to deal with right now.

 

Since model forecasts, particularly before a system becomes well developed, tend to shift considerably over time, everyone in the Caribbean – not just Haiti - and the Southeastern United States needs to keep one eye on this late season proto-storm.

 

Of course,  you don’t have much to worry about . . .  as long as you are prepared.

You are already prepared . . . aren’t you?

This weekend would be an excellent time to review your family disaster plan, and make any needed improvements to your emergency kit.

 

Track this budding storm (and any other tropical threats) on the NHC website at:

 

http://www.nhc.noaa.gov/index.shtml

Also, if you are on Twitter, follow @FEMA and @CraigAtFEMA for timely updates and preparedness advice.

Via Eurasia Review: Examining Pandemic Responses In Asia. This is a long article summarizing the way SARS and H1N1 were handled. Excerpt:

SARS played a crucial role in shaping and guiding public health policy learning with regard to pandemic preparedness and handling in three main aspects (Huang, 2010:9). 

Firstly, risk assessment and communication tended to be dominated by worst-case-scenario planning, both at the national and WHO level. WHO Director-General Dr Margaret Chan, for example, noted the ‘notorious’ nature of influenza viruses and declared the H1N1 pandemic a threat to all humanity (WHO, 2009a). 

Secondly, after being criticised for its belated response during the SARS outbreak, China had become sensitive to allegations that it was not reacting responsibly to public health crises. It was therefore predisposed towards a visible, high profile approach such as a strict containment strategy which would present the image of the government being proactive. 

Thirdly, the successful containment of SARS encouraged the use of forceful measures such as quarantine and travel restrictions on H1N1 because ‘SARS and H1N1 were both respiratory infections’ (Xu and Ren, 2009). 

As a result, national and regional authorities may have adhered too strictly to the pandemic preparedness plans developed over 2004–06 to cope with emerging infectious respiratory disease pandemics of the same or similar pathology as SARS in 2003. Consequently, the possibility of an outbreak with varying levels of severity was not taken into serious consideration. 

The response to H1N1, therefore, was shaped by the contingency plan in place as opposed to being tailored to the nature and pathology of the virus itself (Fitzpatrick, forthcoming). 

A review of the 1976 H1N1 outbreak in the US concluded that a public health response to a pandemic should not be premised only on the worst-case scenario and that it would be a mistake to bundle all response measures into a single go or no-go decision, ‘with no provision for the monitoring of the situation and continual reconsideration of policy directions based on new evidence’ (PCAST, 2009:9). 

According to Fitzpatrick (forthcoming), proclaiming a worst-case scenario and reinforcing the ‘prepare for the worst, hope for the best’ doctrine can be detrimental to rational contingency planning, and lead to scaremongering. 

Therefore, it is recommended that policymakers and governments should prepare not for a worst-case-scenario but instead adopt a most-likely-outcome approach based on the pathological and epidemiological nature of the disease while being prepared to monitor and change strategies if need be (Fitzpatrick, forthcoming). 

In other words, a more flexible approach to tackling a potential pandemic outbreak could lead to its more effective management and control.