Influenza Virus Mashup

I’ve just posted an item on The Hook, the blog connected with The Tyee: Agencies report on ‘lessons learned’ from H1N1 pandemic. Excerpt:

The Public Health Agency of Canada and Health Canada have issued a “Lessons Learned Review” of their response to the 2009 H1N1 pandemic. While the report describes many successes in fighting the pandemic, the recommendations for improvement indicate that Ottawa and the provinces were often communicating poorly to one another, to healthcare professionals, and to the public.

Via CIDRAP: NEWS SCAN: Flu in France and Egypt, cholera and crop losses, Salmonella sprout cases, brucellosis standards. Excerpt:

Influenza in France has reached epidemic levels, with 176,000 cases and 2 deaths this season, according to an Agence France-Presse (AFP) story today. Cases reached 280 per 100,000 population, well past the epidemic threshold of 174 per 100,000. Epidemiologic networks have identified “three viral strains” as causing illness, including 2009 pandemic H1N1. Officials are urging at-risk groups to get vaccinated. 

In Egypt, pandemic H1N1 has infected 1,172 people and killed 56 since Oct 8, Reuters reported. Overall, since the beginning of the pandemic in that country last June, the virus has infected at least 16,373 people and killed at least 281.

(Wed, 29 Dec 2010 19:07:00 +0000)

# 5188

Today, the Public Health Agency of Canada (PHAC) and Health Canada released a 106 page report in PDF format, outlining the lessons learned from Canada’s response to the H1N1 pandemic.

While stating that – overall, Canada’s response was effective - the authors have identified 34 areas for improvement.

You can read the summary, excerpts from the report, or download the entire document at the PHAC website below:

Lessons Learned Review: Public Health Agency of Canada and Health Canada Response to the 2009 H1N1 Pandemic

 

For readers interested in the full version of this report, the document is available for downloading or viewing:

Lessons Learned Review: Public Health Agency of Canada and Health Canada Response to the 2009 H1N1 Pandemic

 November 2010

The information in this report was obtained by the Public Health Agency of Canada Evaluation Services Directorate through a review of relevant material and a series of interviews. This report does not draw exhaustive or definitive conclusions on all the activities leading up to or taken by various individuals or entities during the H1N1 pandemic response.

 

Rather, the observations in this report are meant to give senior management of the Public Health Agency of Canada and Health Canada a general overview of what worked well in response to this particular event and what needs further refinement to be better prepared for future pandemics and other national public health events.

After a Christmas hiatus, Arkanoid Legent is back. Today’s posts include a lot of information about both bird flu in Asia and H1N1 in the UK. As always, a good source of disease news.

(Wed, 29 Dec 2010 13:28:00 +0000)

# 5187

After three detections of the H5N1 bird flu virus in wild and/or migratory birds this month (see South Korea Finds 2 H5N1 Infected Owls and Korea: Bird Flu Discovered In Teal Ducks), it comes as little surprise that Korean Agriculture authorities are now investigating a duck farm where some of the birds there are showing signs suggestive of avian flu.

First the AFP report, appearing on Terra Daily, then some background.

S.Korea reports suspected bird flu case

by Staff Writers
Seoul (AFP) Dec 29, 2010

A South Korean duck farm has reported a suspected case of bird flu, the agriculture ministry said Wednesday.

 

A quarantine zone has been declared around a farm in Cheonan, about 90 kilometres (54 miles) south of Seoul, where ducks showed symptoms of avian influenza, the ministry said.

(Continue . . .)

Testing is underway, and we should know in a day or so if this is, indeed, H5N1.

South Korea has seen three previous major outbreaks of avian influenza in their poultry population.  The first in the winter of 2003-2004, and then a second time in 2006.

The largest, and most costly outbreak occurred in April of 2008, which resulted in the culling of more than 8 million birds.  You can read some of the coverage of that outbreak in these blogs:

Korea: Cat Death Attributed To Bird Flu

South Korea Investigating New Outbreak

S. Korea Finds 2 More Suspected Outbreaks

At the same time as these Korean outbreaks in 2008, Japan reported the discovery of the H5N1 virus in four swans in Akita Prefecture (see Japan Confirms Swans Infected With H5N1).

Similarly, this month Japan and Korea are once again both reporting multiple instances of H5N1 in wild and/or migratory birds.  I’ve plotted the general locations on the map below.

All of which has agricultural interests in Japan and Korea on high alert, in hopes of avoiding another widespread outbreak like was seen two years ago.

(Wed, 29 Dec 2010 12:08:00 +0000)

# 5186

In my Kitchen, a few feet away from the only likely source of CO gas in my home (my gas stove), I keep a carbon monoxide detector.

I do so because nearly 15  years ago, in another state, my wife and I moved into an older home with a faulty heater, and we very nearly succumbed to CO poisoning that first winter because of it.

Luckily for us, the levels of CO were low enough not to be immediately fatal, but rather induced in us a chronic lethargy, constant headaches, and mind-numbing apathy.

At first, we simply thought we had the flu, or were having difficulty adjusting to our first mid-western winter,  or were allergic to something in our new home.

But the symptoms grew worse, and in desperation we finally installed CO alarms, which immediately began sounding.

We were slowly, but insidiously, being poisoned by low levels of Carbon Monoxide from a wood furnace that the previous owner had `modified’.

 

Two cold days later (no heat), repairs to the furnace were completed by a qualified technician at a cost of nearly $1000.

 

An expensive (and almost fatal) lesson.  But the constant headaches, and lethargy, went away with the CO.

 

The CO detector remains, however.

 

 

As a former paramedic – one who has seen CO poisoning more than once in the (dim and distant) past – you’d think that I would have been quicker to realize what the problem was. 

But that’s the problem with CO poisoning, it slowly robs you of your ability to think critically.  

Carbon Monoxide kills by binding to the blood’s hemoglobin at a rate many-fold faster than oxygen can.  It essentially crowds out life-essential oxygen from the blood, causing those exposed to slowly suffocate  . . . often completely unaware of what is happening to them.

Yesterday, the news wires carried the tragic report of 5 teenagers killed in a south Florida motel room from the exhaust of a car left idling in a parking garage below.

Florida: Exhaust Fumes Kill 5 Friends at Motel

By THE ASSOCIATED PRESS

Published: December 29, 2010

The sources of CO are numerous; faulty furnaces, snow blocked car exhaust pipes, attempts to use generators inside the house or garage . . . and the use of CO producing emergency heat sources all contribute to the winter body count.

The CDC’s MMWR released a report in 2005 called Unintentional Non–Fire-Related Carbon Monoxide Exposures — United States, 2001—2003 that stated:

During 2001–2003, an estimated 15,200 persons with confirmed or possible non–fire-related CO exposure were treated annually in hospital EDs. In addition, during 2001–2002, an average of 480 persons died annually from non–fire-related CO poisoning. Although males and females were equally likely to visit an ED for CO exposure, males were 2.3 times more likely to die from CO poisoning. Most (64%) of the nonfatal CO exposures occurred in homes. Efforts are needed to educate the public about preventing CO exposure.

The CDC maintains a webpage on Carbon Monoxide, which you can access here.

CDC TV also has an excellent 3 minute video on CO poisoning, which you can watch here (dbl click image to view on Youtube).

Carbon Monoxide poisoning is a genuine, but preventable, risk.  If you don’t already have carbon monoxide detectors in your home, getting and installing some would make an excellent New Years resolution. 

Believe me, it’s a New Year’s resolution you can live with.

Note: I should mention I also have 2 smoke detectors in my home, as well. - MPC

(Wed, 29 Dec 2010 11:13:00 +0000)

# 5185

More than two months after it began, we now appear to have an official cause of the mystery disease outbreak in northern Uganda; Yellow Fever. 

My first blog on this outbreak came in mid-November (see Uganda: Unidentified Hemorrhagic Outbreak), and at that time a hemorrhagic fever like Ebola, Marburg, or Lujo virus was considered the likely cause.

Two weeks later, I reported that Health Ministry officials had stated that laboratory tests had come back negative for the usual suspects from that part of the world; Ebola, Marburg, Congo Crimean fever, Rift Valley fever and Typhoid.

On December 7th, it was widely reported that Plague (pneumonic and bubonic) had been identified as the cause of the outbreak, which I covered in Uganda Outbreak Identified As Plague: Officials.  

Within a few days, the plague diagnoses began to look less and less likely, and in recent days Yellow Fever – a disease not seen in Uganda in nearly 40 years – has come to the forefront.

For a detailed history of this outbreak’s progression, FluTrackers has an extensive thread on this story, with more than 150 entries as of this morning.

Treyfish has been a particularly close follower of this story, and has posted many of these reports, although he is by no means alone in this effort.  

Yesterday afternoon Treyfish posted a U.S. Embassy Warden Message that identifies the outbreak as Yellow Fever.

Warden Message

U.S. Embassy Kampala, Uganda
Warden Message - December 28, 2010

Outbreak of Unidentified Illness Now Confirmed as Yellow Fever in Northern Uganda

After discussions with the Ugandan Ministry of Health and WHO, the U.S. Centers for Disease Control and Prevention (CDC) now confirms that the unknown severe illness reported in Mission Kampala’s November 30 Warden Message is an outbreak of Yellow Fever.

 

Although as many as seven districts are now reporting occurrences - including two possible cases from southern Sudan- almost all of the reported severe cases (characterized by fever, vomiting and bleeding) continue to be concentrated in three districts of Northern Uganda, namely Abim (specifically Morulem sub-county), Agago (Omiya P’Chua, Adilang and Paimoi sub-counties) and Kitgum (Orum, Namokora and Kitgum Town Council).

 

In light of these findings, the U.S. Mission in Kampala recommends that U.S. citizens residing and traveling in Uganda avoid travel to Northern Uganda unless they have been vaccinated against Yellow Fever within the past 10 years.  If vaccinated recently, do not travel to Northern Uganda for at least 10 days after receiving the vaccination.  (Yellow Fever vaccinations do not take effect for 10 days.)  Only U.S. government officials with Yellow Fever vaccinations are permitted to travel to the affected areas.

 

(Continue . . . )

Via newshound Alert we get this update from Uganda’s leading independent daily, The Daily Monitor.

National

Yellow fever deaths reach 48

By Flavia Nalubega

Posted Wednesday, December 29 2010 at 00:00

Kampala

The number of people killed by yellow fever in northern Uganda has reached 48 and 187 are hospitalised, an official has confirmed. Dr Isa Makumbi, a commissioner in the health ministry, made the revelations last night.

 

Earlier, Junior health minister James Kakooza had told Daily Monitor on phone that the viral disease has been confirmed in Abim, Agago, Lamwo, Kitgum, Pader, Gulu, Arua, Kaabong and Lira districts.

 

“The infection was in place as early as two months ago. Since then, we have been doing investigations to ascertain the disease. It is only two weeks ago that we confirmed the viral infection as yellow fever,” Mr Kakooza said. He said the disease has taken a new string of infection where patients suffer severe vomiting of blood, diarrhoea and swollen eyes.

(Continue . . . )

Yellow fever is a mosquito borne viral illness, that according to the World Health Organization, infects roughly 200,000 people each year and claims 30,000 lives.

Once the scourge of Africa, the Americas and Europe, Yellow fever is now endemic only to the tropical areas of South America and Africa. 

(Source link)

In the 18th and 19th century, Yellow fever caused major epidemics in Europe and in the United States, up the Atlantic seaboard and as far north as New England (Boston was hard hit in 1780, and Philadelphia saw several thousand deaths in 1793).

Yellow Fever has been cited as one of the primary reasons why the French abandoned their attempt to build a Panama canal in the late 1800’s, as the combined burden of Yellow Fever and Malaria reportedly claimed the lives of more than 20,000 construction workers.

For more on the history of `Yellow Jack’, I would point you to Ian York’s excellent Mystery Rays blog, where he gives us some terrific background in:

 

Yellow fever, stasis, and diversification

The deadliest, most awe-inspiring of the plagues

The good old days

You can find more information on yellow fever at these websites:

http://www.cdc.gov/ncidod/dvbid/yellowfever/

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/yellow-fever.aspx

http://www.who.int/topics/yellow_fever/en/

Via CIDRAP: NEWS SCAN: Swine flu surveillance, Salmonella source, cholera update, UK flu-shot debate, H5N1 in Egypt. Excerpt:

An article published yesterday in Scientific American explores what experts see as the vastly inadequate global efforts to monitor influenza viruses in swine, in the wake of a pandemic caused by a swine flu virus that jumped to humans. 

Reporter Helen Branswell writes that most pork-producing countries don’t test their swine herds for flu at all. In the United States, pork producers generally test their animals, but they don’t usually share the results with public health officials, since they know that any news about swine flu scares people away from eating pork. 

The Centers for Disease Control and Prevention (CDC) recently worked with the US Department of Agriculture to launch a program to share animal testing results with the public health sector, Branswell reports. 

But the program has limitations, in that swine flu surveillance data are stripped of identifying information, so health officials know what state a sample came from but not what county or farm. And when a human case of swine flu occurs, the herd suspected as the source can be tested only with the owner’s permission. 

Flu experts are planning a February meeting in Italy to try to find ways to overcome the barriers to better surveillance, the article says.

Via The Guardian: Winter flu outbreak has not yet reached its peak, doctors warn. Excerpt:

The seasonal flu that has killed dozens and left hundreds in hospital will worsen over the next few days and not peak until later this week or early next week, infection experts are warning. 

And the outbreak of winter flu, which mainly involves an increasing prevalence of H1N1 swine flu infection, is likely to continue causing sometimes serious sickness until the end of January. 

“We are still on the upward trajectory. We probably haven’t quite reached the peak yet,” said Dr Meirion Evans, of the UK Faculty of Public Health, which represents public health doctors working in the NHS, local councils and academia. 

“My guess is that it will reach a peak either this week or early next week, and will then start coming down. But we will continue to see seasonal flu around for most of January. So it’s still got four to five weeks to run.” 

Evans, a public health consultant and consultant epidemiologist in Cardiff, is also a member of the scientific advisory committee on pandemic flu, which advises the government on how to prevent outbreaks. 

The number of people affected has been increasing for about three weeks, he added. But he said the next seven days should bring the high point of the winter flu season, which usually lasts for six to eight weeks. While seasonal flu usually begins in earnest at the start of January, this year it struck in early December, although experts cannot explain why. 

Hospitals are preparing for worse to come and senior doctors insist last year’s major outbreak of swine flu has left them ready. 

“The NHS is well-placed to manage what may well yet prove to be an unprecedented demand for critical care as a result of seasonal flu,” said Dr Bob Winter, the president of the Intensive Care Society. 

“The public should be reassured that there are [critical care] beds available at the moment and, should it be required, there are well-rehearsed plans to double critical care capacity if needed.” 

Winter added: “At the moment seasonal flu is a pressure but not yet a problem.” 

Last week brought a doubling in those receiving critical care in hospitals to 460, and a jump from 10 to 27 deaths attributed to flu – 24 of which involved H1N1. Those figures go up to last Thursday. The latest batch of statistics from the Health Protection Agency (HPA), due tomorrow, are likely to show a jump.

Via The Guardian: Flu jab plan has Conservatives and Labour trading accusations. Excerpt:

The health minister, Simon Burns, accused Labour of stooping to a new low of political opportunism today after it claimed the government had cut a routine flu vaccination for under-fives. 

John Healey, the shadow health secretary, said the cut had been against scientific advice and was driven by the need to make financial savings. 

He said: “The serious problem lies with the groups that are most at risk, like children. That has come because the government axed the annual advertising campaign and they cancelled the flu jab plan for the under-fives.” 

But an angry Burns said: “Labour have stooped to a new low of political opportunism today. By calling on the government to reject independent scientific advice, they risk undermining the public confidence in immunisation programmes which is so crucial to their success. 

“The government is legally obliged to implement the recommendations made by the experts in the joint committee on vaccination and immunisation [JCVI]. We have no intention of repealing these laws to allow us to override experts in the manner which Labour suggest. 

“John Healey is either spectacularly ill-informed or playing politics with people’s health. He should either apologise or be ashamed.” 

The rate of flu cases in England almost doubled in a week earlier this month, from 34 people in every 100,000 to 87 in every 100,000 – a faster rise than in 1999, the last time England suffered a flu epidemic. 

Labour had criticised the government over the lack of dedicated protection for young children and the decision to axe the annual flu jab awareness campaign. 

The health secretary, Andrew Lansley, said he had acted on the advice of the independent JCVI. The committee issues seasonal vaccine advice and said on 23 July that healthy children under five were not at risk, officials said. During the 2009 swine flu outbreak, it had recommended that healthy under-fives be vaccinated. 

The Department of Health said the vaccine remained available to under-fives in at-risk groups. The government is advising parents of unimmunised children aged between six months and five years in at-risk groups to get them vaccinated if their GP recommends it.