Influenza Virus Mashup

(Wed, 01 Jun 2011 17:25:00 +0000)

# 5592

While the Robert Koch Institute (RKI) in Germany has the lead on the investigation of the large outbreak of Shiga toxin-producing E. coli  STEC O104, the CDC is naturally following the events there closely. 

Earlier today the CDC released a statement outlining what is currently known about the outbreak, along with a brief Q&A section that addresses some common questions the public may have.

 

I’ll not reprint the entire statement, but you are encouraged to follow the link to read it in its entirety. 

For Immediate Release: June 1, 2011
Contact: CDC Media Relations
(404) 639-3286

CDC Statement on Outbreak of STEC O104:H4 infections in Germany

CDC is following a large outbreak of Shiga toxin-producing E. coli O104, or STEC O104, infections currently going on in Germany. As of May 31, 2011, the Robert Koch Institute (RKI), Germany’s disease control and prevention agency, has confirmed six deaths and 373 patients with hemolytic uremic syndrome, or (HUS) (kidney failure), a life-threatening complication of E. coli infections.

 

To date, no confirmed cases of STEC O104 infections have been reported in U.S. travelers to Europe. Two cases of HUS in the United States have been reported in persons with recent travel to Hamburg, Germany. CDC is working with state health departments to learn more about these two cases and to identify others. CDC has been in contact with the German public health authorities at RKI. We have alerted state health departments in the United States of the ongoing outbreak. We have also requested that they report to CDC any cases in which people have either HUS or Shiga toxin-positive diarrheal illness, with illness onset during or after travel to Germany since April 1, 2011.

 

The strain of STEC causing illness, STEC O104:H4, is very rare. CDC is not aware of any cases of STEC O104:H4 infection ever being reported in United States. Any person with recent travel to Germany with signs or symptoms of STEC infection or HUS, should seek medical care and let the medical provider know about the outbreak of STEC infections in Germany and the importance of being tested. Symptoms of STEC infection include severe stomach cramps, diarrhea, which is often bloody, and vomiting. If there is fever, it usually is not very high. Most people get better within 5–7 days, but some patients go on to develop HUS—usually about a week after the diarrhea starts. Symptoms of HUS include decreased frequency of urination, feeling very tired, and losing pink color to skin and membranes due to anemia.

(Continue . . . )

For some of the best day-to-day coverage of this story, I would direct my readers to Crof at Crofsblog, who has been spending a lot of time finding and translating news items from the German Press.

For now, the source of this rare form of E. coli remains a mystery, and the number of cases continues to grow.

(Wed, 01 Jun 2011 12:52:00 +0000)

# 5591

Two reports today.

First, the World Health Organization has details of a fresh bird flu case in Egypt.

Avian influenza - situation in Egypt - update 52

1 June 2011 - The Ministry of Health of Egypt has announced a new confirmed case of human infection with avian influenza A (H5N1) virus.

 

The case is a 30 year old female from Amria District, Alexandria Governorate. She developed symptoms on 26 April and was hospitalized on 3 May.

 

She was in a critical condition under artificial ventilation and died on 9 May. She received oseltamivir treatment at the time of hospitalization.

 

Investigations into the source of infection indicate that the case had exposure to sick poultry suspected to have avian influenza.

 

The case was confirmed by the Egyptian Central Public Health Laboratory, a National Influenza Center of the WHO Global Influenza Surveillance Network.

 

Of the 144 cases confirmed to date in Egypt, 48 have been fatal.

This marks the 25th case and 8th fatality in Egypt from the H5N1 virus in 2011.

Next we get a report from Indonesia, a country where more than 8 out of 10 people treated for H5N1 infection have died.

Happy endings there are few and far between, nevertheless, we appear to have one today with this announcement by Depkes (The Indonesian Ministry of Health).

A big hat tip goes to Arkanoid Legent, one of the hardest working newshounds in Flublogia, for posting this report his site, along with the Flu Wiki and FluTrackers.

BIRD FLU PATIENT Heal

 

Indonesia : Bird Flu Patient Heals

KN (P, 1.2 years), North Jakarta residents who tested positive for H5N1 virus (bird flu) based on the results of Laboratory Research and Development Agency Ministry of Health, declared cured after being treated intensively in AI referral hospitals in North Jakarta. Until now KN conditions remain healthy.

 

KN started getting ill on 3 April 2011 with symptoms of fever, cough, diarrhea and shortness. The patient recovered from surveillance activities SARI (Severe acute Respiratory Infection), which is coordinated Balitbangkes. He referred to the hospital on 8 April 2011 and is getting treatment at the referral hospital care with a diagnosis Bronkhopneumoni.

 

To identify risk factors, we conducted an epidemiological investigation into the patient’s house and surrounding environment. The strongest risk factor, a week before the ill patients were invited his father to the market near his house to buy free-range chicken and KN participated holding the chicken.

 

Tjandra Yoga Aditama as the focal point of IHR (International Health Reagulation) has informed also about the case to the WHO.

Today’s announcement from Depkes should put Indonesia’s confirmed totals to 178 cases and 146 fatalities (82% mortality rate).

Surveillance being sporadic, and laboratory test results sometimes unreliable, these numbers are subject to some debate.

Although we continue to see isolated human infections in Indonesia, Egypt, and around the world - for now H5N1 is primarily a threat to poultry.

The virus remains poorly adapted to human physiology, and despite ample opportunities to cause illness in humans, only causes rare, sporadic infections.

The concern, of course, is that over time that may change.  That the virus will mutate into a form that is easily acquired and passed on by humans.

And so the world remains at Pre-pandemic Phase III on the H5N1 virus, and we continue to watch for signs that the virus is adapting to humans.

(Wed, 01 Jun 2011 12:15:00 +0000)

# 5590

Today, June 1st, marks the start of this year’s Atlantic Hurricane season, although hurricanes in June are a fairly rare event.  Over the past 50 years 9 Hurricanes have formed during the first month of Hurricane season.

As you can see by the NOAA chart below, early season tropical storms are a bit more common, but the season doesn’t usually pick up steam until August.

Mariner’s Poem On Hurricanes

June too soon.
July stand by.
August look out you must.
September remember.
October all over.

- Published in “Weather Lore” by R. Inwards in 1898

Of course, some years are exceptions. 

In 2010 Hurricane Alex – a strong CAT 2 hurricane – slammed into Mexican state of Tamaulipas after intensifying to hurricane strength on June 29th.

 

Hurricane Audrey in 1957 was the only June storm in modern history known to reach CAT 4 strength, and it claimed 550 lives after it made landfall in eastern Texas and western Louisiana.

Below are a few notable June Hurricane tracks, including 1957’s notorious Audrey.

When hurricanes and tropical storms do form in June, they tend to form in the warmer, comparatively shallower waters of the the Gulf of Mexico.

June Climatology

All of which means that while it is very early in the Hurricane season, it isn’t too early to be prepared.

Last March NOAA, FEMA, and the American Red Cross released an updated preparedness guide for the 2011 tropical season.

To become better prepared as an individual, family, business owner, or community to deal with hurricanes, or any other type of disaster: visit the following preparedness sites.

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

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

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

 

And lastly, you may wish to revisit some of my preparedness essays, including:

 

In An Emergency, Who Has Your Back?

An Appropriate Level Of Preparedness

(Wed, 01 Jun 2011 11:28:00 +0000)

# 5589

Last week IAEA nuclear experts from 12 countries (Argentina, China, France, Hungary, India, Indonesia, Russia, South Korea, Spain, Turkey, United Kingdom and the United States) arrived in Fukushima, Japan to conduct interviews with local officials and to visit nuclear facilities, including the earthquake and tsunami damaged Fukushima Daiichi power plant.

They have produced a brief (3-page) preliminary assessment of the safety issues related to the Fukushima nuclear crisis. A full report will be delivered to the Ministerial Conference on Nuclear Safety at IAEA headquarters in Vienna in about 3 weeks.

They describe the level of cooperation, and access, their expert mission received as being `excellent’, and the response of the workers at the stricken plant as `exemplary’ and `brave’. 

They also reassure that: To date no health effects have been reported in any person as a result of radiation exposure from the nuclear accident.

From today’s  UPDATE: IAEA Fact-Finding Team Completes Visit to Japan (1 June 2011) on the IAEA website, we get an overview of the expert mission, and a synopsis of their findings:

The expert team made several preliminary findings and lessons learned, including:

• Japan’s response to the nuclear accident has been exemplary, particularly illustrated by the dedicated, determined and expert staff working under exceptional circumstances;
• Japan’s long-term response, including the evacuation of the area around stricken reactors, has been impressive and well organized. A suitable and timely follow-up programme on public and worker exposures and health monitoring would be beneficial;
• The tsunami hazard for several sites was underestimated. Nuclear plant designers and operators should appropriately evaluate and protect against the risks of all natural hazards, and should periodically update those assessments and assessment methodologies;
• Nuclear regulatory systems should address extreme events adequately, including their periodic review, and should ensure that regulatory independence and clarity of roles are preserved; and
• The Japanese accident demonstrates the value of hardened on-site Emergency Response Centres with adequate provisions for handling all necessary emergency roles, including communications.

While cloaked in the polite language of diplomacy, the bottom line is that what disaster planners and nuclear regulatory agencies assumed to be a `worst-case scenario’, and planned for  – a 5.7 meter tsunami – turned out to completely inadequate on March 11, 2011 when a series of 14+ meter tsunamis slammed into the Fukushima nuclear power facility.

It has recently emerged that this wildly optimistic worst-case disaster scenario’ came from a 1-page, decade-old memo generated by Fukushima plant operators, and that it provided little in the way of scientific data to back up their assessment (see AP article AP Exclusive: Fukushima tsunami plan a single page).

Those expecting any sort of critical exposé here will find this report lacking. Given Japan’s level of social, political, and economic uncertainty in the wake of this three-pronged disaster, the IAEA is obviously (and understandably) treading carefully here.

Prime Minister Naoto Kan faces a no-confidence vote this week, the Japanese economy is reeling, public confidence in TEPCO and the Japanese government’s disaster response is waning, and the Japanese people are enduring a collective tragedy almost beyond comprehension.

So diplomatically, this report avoids assigning blame or directing criticism, so as not to aggravate what is obviously a precarious situation.

A full post-mortem analysis of what happened - and what continues to transpire as crews attempt to contain this nuclear crisis - will no doubt have to wait until the emergency has passed.

And given the size and scope of this disaster, that could be months or even years from now.

Via Austria’s derStandard.at: A quarter of all patients suffering from HUS -suffer consequences. Excerpt from a computer translation, with my editing:

Those who survive HUS are not automatically healthy again: “It’s not like a flu that is easily got over,” says Reinhard Würzner of the University Hospital of Innsbruck. 

The hemolytic-uremic syndrome, HUS for short, is the worst complication that can occur during infection with EHEC bacteria. About a quarter of all patients suffer this long-term sequelae. 

Normally up to three quarters of all HUS patients are children and only a quarter adults; but in the current outbreak the proportions are just the opposite. But because children have better recovery ability than adults, this time more HUS cases could suffer permanent damage, Würzner fears. 

The most common long-term consequences for HUS patients are renal damage. Although patients do not always need dialysis, kidney function can be reduced permanently. 

Another outcome can be brain damage that can lead to symptoms similar symptoms to a stroke: stuttering, trembling, and epileptic seizures.

On Ärzte Zeitung, where I was looking for EHEC news, I found this: Avian influenza in East Westphalia is expanding. Excerpt from a computer translation, with my editing:

Avian influenza has spread to Paderborn in East Westphalia. On a farm in the Delbrück area, where the virus has been detected, around 12,000 animals have been killed as a precautionary measure. 

This was announced by the Paderborn district on Tuesday. It was not clear initially whether this was a high-or low-infectious variant of the influenza virus. 

Laboratory results are expected by the end of the week. A one-kilometer restricted zone has been set up around the farm. 

So far in the East Westphalia Gütersloh four farms have been affected with a total of five sites of the poultry disease. More than 64,000 animals have been killed.

(Tue, 31 May 2011 19:25:00 +0000)

# 5588

It was just over a year ago that the the World Health Organization’s International Agency for Research on Cancer (IARC) released their long-delayed INTERPHONE report, which was unable to establish a link between cell phone use and brain tumors (see The IARC Cell Phone Report) .

For a number of years some scientists have expressed concerns that prolonged exposure to cell phone RF (radiofrequency) electromagnetic fields might cause certain types of head and neck cancers.

 

And researchers worried that children, teenagers, and young adults, who rank among the most fervent users of cell phones, could be at particular risk.

While reassuring, the 2010 INTERPHONE report wasn’t exactly an `All Clear’ on cell phone dangers. The study, the authors admitted, had limitations. And some scientists were less than mollified by their findings.

At the time, Dr Christopher Wild, Director of IARC warned that additional studies were warranted.  From the IARC press release of May, 2010:

“An increased risk of brain cancer is not established from the data from Interphone.

 

However, observations at the highest level of cumulative call time and the changing patterns of mobile phone use since the period studied by Interphone, particularly in young people, mean that further investigation of mobile phone use and brain cancer risk is merited.”

Earlier this year we also saw a major report in the Journal of the American Medical Association that looked at the effects of RF signal exposure on brain activity (see JAMA: Cell Phone Use Stimulates Brain Activity).

Using PET scans researchers were able to prove that areas of the brain in close proximity to the antennas of activated cell phones demonstrated increased glucose uptake, indicating increased localized brain activity in response to the RF (radio frequency) emissions.

 

This study indicates that the prolonged use of a cell phone does affect brain activity. What all this might mean in regards to human health remains unknown for now.

Fast forward to today, and the IARC has released a new statement (IARC Press Release N° 208) that lists mobile phone use in same carcinogenic hazard category as exposure to gasoline, engine exhaust and lead.

Given the popularity of (and our societal reliance upon) cell phones, this report – which classifies radio-frequency electromagnetic fields as possibly carcinogenic to humans (Group 2B) - is likely to spur a good deal of news coverage.

Group 1 carcinogens are those that are most strongly associated with cancer, like smoking and asbestos, and are considered the most dangerous.

 

Group 2a carcinogens are considered probably carcinogenic based on limited evidence of carcinogenicity in humans and sufficient evidence of carcinogenicity in experimental animals.

 

Group 2b carcinogens – where cell phones have now been ranked – are considered possibly carcinogenic, but evidence is limited in both humans and experimental animals.

For now, the evidence supporting a link between cell phones and certain types of brain cancer is limited. However, Dr Jonathan Samet, the overall chairman of the working group  states :

“ . . . the  evidence, while still accumulating, is  strong enough to support a conclusion and the 2B classification. The conclusion means that there could be some risk, and therefore we need to keep a close watch for a link between cell phones and cancer risk.” 

None of this proves that cell phones cause brain cancer.  Only that there is enough evidence to suggest a link to a specific type of cancer (glioma), and that more studies must be done.

Since it can take years – or even decades – for brain cancers to develop, the true health impacts from the stratospheric rise in cell phone use over the past decade may be difficult to accurately gauge for some time.

A full report on the IARC’s findings will be published over the next few days in The Lancet Oncology.

(Tue, 31 May 2011 11:47:00 +0000)

# 5587

Today, May 31st, is designated by the World Health Organization as  World No Tobacco Day.

This year’s focus is on WHO Framework Convention on Tobacco Control (WHO FCTC) in the fight against the global use of Tobacco.

Tobacco products are blamed for six million deaths each year, including hundreds of thousands due to 2nd-hand exposure.  You can read more about the WHO’s Tobacco Free Initiative including the World No Tobacco Day press release.

Today is also – coincidentally – the 4th anniversary of my smoking my last cigarette.

I was solidly hooked, smoking 2+ packs a day, and had been doing so for years.  It was expensive and disgusting habit, and was a danger to my health.

But all of my previous attempts to stop had failed.

I asked my doctor for advice, and he prescribed a medicine that helped me quit.  It wasn’t exactly easy . . . but it turned out not to be as difficult as I feared.

The point is, there are new and better ways to help you kick the habit.  Your doctor can help you find one that will work for you.

Believe me, if I can quit, you can too.

(Tue, 31 May 2011 10:20:00 +0000)

# 5586

In November of 2008 Google – the 800 lb gorilla of Internet search engines – announced the opening of their Flu Tracking website (see Google Unveils Flu Tracking System).

The idea was intriguingly simple, really. 

Since people tend to perform internet searches on health topics of concern, it stood to reason that more people would Google `flu’ or `influenza’ when the flu was circulating in their communities.

By tracking the number of searches of flu-related terms by geographical region – and comparing them to baselines established over a period of years – it should be possible to get an early warning of influenza-like illness (ILI) activity.

The rub, of course, is that not all ILIs are the flu.

In October of 2009, during the height of the fall wave of the H1N1 pandemic, I posted the following graphic on my blog.

Of the more than 10,000 samples submitted for testing during the 1st week of October 2009, more than 72% – almost 3/4ths –  came back negative for influenza.

About a year ago a researchers at the University of Washington found that Google Flu Trends was somewhat less accurate than the CDC in predicting laboratory confirmed influenza, but was a robust tool for detecting less specific influenza-like illnesses.

While separating influenza from other ILIs remains a challenge, and intense media attention can spur search spikes and skew results, the data being provided by Google’s Flu Trends has proven to be both timely and valuable.

Since the early results from Flu Trends has proved so promising, Google is now setting their sights on the fastest growing mosquito-borne illness in the world; Dengue.

As with influenza-like illnesses, aggregated search totals for Dengue in a number of countries correspond closely with outbreaks. Below you’ll see the correlation between Dengue activity and Dengue-related queries in Brazil since 2003.

The Dengue Trends project is small right now, with just 5 countries being tracked (Bolivia, Brazil, India, Indonesia, and Singapore). 

Not all dengue-endemic countries have enough detailed historical dengue surveillance and enough Internet access and activity to monitor right now, but more countries are expected to be added over time.

This is what the Dengue Trends front page looks like. 

Google provides this service, and data, free of charge and as a public service. 

They also continue to release a number of free data mining tools, including one last week called Google Correlate that works like Google Trends in reverse.

Rather than inputting a search term and seeing the trend, Google Correlate allows you to upload your own data series, and see what search terms are a trending match. 

For more on how all of this works, check out the Google Labs announcement.  Statistical data geeks will find a White Paper on all of this, but for those of us who are arithmetically challenged, Google was kind enough to present the basics in the form of an 8-page comic book.

 

 

Google Flu Trends and Dengue Trends won’t supplant traditional surveillance systems, of course.

But they can serve as a novel and innovative real-time adjunct to conventional surveillance systems, and over time will likely improve in both geographic coverage and accuracy.

It should be fascinating to watch them evolve.