Influenza Virus Mashup

Via CIDRAP: NEWS SCAN: Benefit of H1N1 vaccine, flu deaths in Asia, E coli treatment lessons, local dengue in Miami, HEV68 respiratory illness. Excerpt:

German clinicians who treated patients with hemolytic uremic syndrome (HUS) during Europe's sprout-related Escherichia coli O104:H4 outbreak recently shared several lessons they learned, according to an overview of a Sep 9 event in Berlin that appears in Eurosurveillance today. 

In one unusual finding, 14 HUS patients treated at Hamburg-Expender University who were assessed as having severe kidney damage based on histopathological images recovered better than expected, and none will need regular dialysis. The researcher, Dr Udo Helmchen, said initial histopathological ratings may have been misleading. 

The presentations did not help resolve unanswered questions about monoclonal antibody (Eculizumab) treatment for patients not responding to other treatments such as plasma exchange therapy or the use of antibiotics for enterohemorrhagic E coli (EHEC) infections, according to the report. 

However, other clinicians reiterated the benefits they found for the use of immunoabsorption for patients who went on to experience neurologic symptoms about 5 to 12 days after the onset of gastrointestinal symptoms.  

So far the E coli O104:H4 strain doesn't appear to have become established as an endemic strain in Germany. A German EHEC-HUS registry has data from 589 patients; the overall mortality rate was 4.4%.

(Thu, 29 Sep 2011 19:29:00 +0000)

 

 

 

# 5871

 

 

There is probably no more nebulous disease description than that of `ILI’ or an influenza-like-illness.  It ranks up there with `malaise’ and `fatigue’ among the most common of human complaints, and is just about as specific.

Nearly all viral (and a fair number of bacterial, parasitic, and fungal) infections present – at least in their prodromal stage – with flu-like symptoms.

The public tends to categorize mild respiratory infections as `colds’ and more severe illnesses as `the flu’, but doctors know there is a whole galaxy of pathogens out there that can mimic influenza.

 

Which is why doctors usually refer to `picking up a virus’, or having an ILI (Influenza-like Illness or sometimes ARI Acute Respiratory Infection), when rendering a diagnosis. 

 

Elaborate testing isn’t usually done because of the costs involved, and because knowing the etiology doesn’t really affect treatment. Bed rest, fever reducers, and plenty of fluids is the usual regimen.

 

Consequently, there are probably still a number of as-yet unidentified respiratory viruses running around out there.

 

All of which serves as prelude to a report in today’s MMWR on the detection of  HEV68 – or Human Enterovirus 68 – that has produced a number of clusters of respiratory illness around the world over the past couple of years.

 

Enteroviruses encompass a large family of small RNA viruses that include the three Polioviruses, along with myriad non-polio serotypes of Human Rhinovirus, Coxsackievirus, echovirus, and human, porcine, and simian enteroviruses. 

 

The few excerpts from today’s MMWR report (follow the link to read it in its entirety):

 

Clusters of Acute Respiratory Illness Associated with Human Enterovirus 68 — Asia, Europe, and United States, 2008–2010

Weekly

September 30, 2011 / 60(38);1301-1304

In the past 2 years, CDC has learned of several clusters of respiratory illness associated with human enterovirus 68 (HEV68), including severe disease. HEV68 is a unique enterovirus that shares epidemiologic and biologic features with human rhinoviruses (HRV) (1).

 

First isolated in California in 1962 from four children with bronchiolitis and pneumonia (2), HEV68 has been reported rarely since that time and the full spectrum of illness that it can cause is unknown. The six clusters of respiratory illness associated with HEV68 described in this report occurred in Asia, Europe, and the United States during 2008–2010.

 

HEV68 infection was associated with respiratory illness ranging from relatively mild illness that did not require hospitalization to severe illness requiring intensive care and mechanical ventilation. Three cases, two in the Philippines and one in Japan, were fatal. In these six clusters, HEV68 disproportionately occurred among children.

 

CDC learned of clusters of HEV68 from public health agencies requesting consultation or diagnostic assistance and from reports presented at scientific conferences. In each cluster, HEV68 was diagnosed by reverse transcription–polymerase chain reaction (RT-PCR) testing targeting the 5′-nontranslated region, followed by partial sequencing of the structural protein genes, VP4-VP2, VP1, or both, to give definitive, enterovirus type-specific information.

 

This report highlights HEV68 as an increasingly recognized cause of respiratory illness. Clinicians should be aware of HEV68 as one of many causes of viral respiratory disease and should report clusters of unexplained respiratory illness to the appropriate public health agency.

(Continue . . . )

 

Occurrence of human enterovirus 68, by month, duration, and geographic location — Asia, Europe, and United States, 2008—2010

 

In recent years, with advances in microbiology and sequence-independent amplification of viral genomes, the ability of scientists to identify new viruses has improved greatly and so they are adding new names to the `suspect list’.

 

About a decade ago the human metapneumovirus (HMPV) was identified in Dutch children with bronchiolitis.  Since then, it has been found to be ubiquitous around the world, and responsible for a significant percentage of childhood respiratory infections . . . yet until 2001, no one knew it existed.

 

Human Bocavirus-infection (HBoV) wasn’t identified until 2005, when it was detected in 48 (9.1%) of 527 children with gastroenteritis in Spain (cite).  

 

And the list grows longer every year.

 

While discovered 40 years ago, according to this MMWR report, testing for HEV68 remains problematic. So we probably don’t have a good handle on how common it really is. 

 

The summary provided for this release reads:

 

What is already known on this topic?

Human enterovirus 68 (HEV68) is a unique enterovirus that shares epidemiologic and biologic features with human rhinoviruses.

 

What is added by this report?

Although isolated cases of HEV68 have been reported since the virus was described in 1962, clusters of cases have been recognized only recently. The clusters described in this report occurred late in the typical enterovirus season and included severe cases, three of which were fatal.

 

What are the implications for public health practice?

Clinicians should be aware of HEV68 as one of many possible causes of viral respiratory disease. Some diagnostic tests might not detect HEV68 or might misidentify it as a human rhinovirus.

 

For more on the expanding universe of non-influenza respiratory viruses, you might wish to revisit these earlier blogs:

 

BMC Study: A Crowded Viral Field

ILI’s Aren’t Always The Flu

Via Ida's Bird Flu Information Corner, a translated report from Makassar TV: Masamba, South Sulawesi ::: Chickens die of bird flu.

Masamba – Chicken farmers in Mappedeceng and Masamba, in Luwu Utara regency burned dozens of suddenly died chickens to prevent disease spreading to other farm animals. Additionally, farmers also disinfected the surviving chickens. 

Further test conducted by Veterinary Disease Investigating Center laboratory, in Maros, showed the chickens died of bird flu H5N1. 

Due to the high prevalence of bird flu in chicken, local livestock service stated extraordinary event status. Officials are now isolating the infected area, dispatching officers to the field for helping farmers to control diseased chickens.

(Thu, 29 Sep 2011 12:10:00 +0000)

 

 

# 5870

 

 

Everyone’s favorite `scary disease girl’, Maryn McKenna updates us on the ongoing outbreak of listeriosis reported in 18 states due to contaminated cantaloupes.

 

This outbreak is unique, in that Listeria has never been found in cantaloupe before, and exactly how this contamination occurred is still unknown.

 

I’ll just step out of the way, and direct you to:

 

Cantaloupe Outbreak: 13 Dead, 18 States, More To Come

• By Maryn McKenna
• September 28, 2011

(Thu, 29 Sep 2011 11:36:00 +0000)

 

 

# 5869

 

Since the recommendations for seasonal flu vaccines have changed in recent years, and there are some new options available as well, there’s some confusion out there as to what the CDC is currently recommending.

 

Many people mistakenly believe that since the vaccine formula is unchanged since last year, they don’t need a shot this year. Or that since they had `the flu’ last year, they are already immune.

 

But the flu shot’s immunity can wear off over time, and the `flu’ you had last year – assuming it was the flu – was only one strain.  The seasonal flu shot has antigens against three different strains (H1N1, H3N2, B).

 

So yes, if you want to be protected you still need a flu shot.

 

The general public can get a lot of their questions answered at FLU.GOV, but the CDC also provides information geared for doctors, nurses, and other health care providers.

 

Their Expert Commentary Series is a collaboration between CDC and Medscape and is `designed to deliver CDC’s authoritative guidance directly to Medscape’s physicians, nurses, pharmacists, and other healthcare professionals.’

(Note: Free registration required to access)

While aimed primarily at Health Care Professionals, these concise briefings can also prove valuable to those of us who follow public health issues.

 

Last Friday, the CDC released a 7 minute video expert briefing on this year’s flu vaccination recommendations, presented by Dr. Tim Uyeki, Deputy Chief for Science in the Epidemiology and Prevention Branch of the CDC’s Influenza Division.

 

You can view the video, and read the transcript at:

From CDC Expert Commentary

Influenza Vaccination 2011-2012: Recommendations

Tim Uyeki, MD, MPH, MPP

 

 

You can find additional information on this year’s flu vaccine at:

 

MMWR: ACIP Updated Flu Vaccination Recommendations

FDA Approves 2011-2012 Seasonal Influenza Vaccines

 

And in a personal note, yesterday I popped into my local CVS pharmacy and in less than 10 minutes, got my yearly flu shot.  

 

It was quick, easy, and relatively painless.

 

I know some people are still reluctant to get the shot every year, but you’ll find my reasoning on why I consider it worth getting in:

 

NPM11: Giving Preparedness A Shot In The Arm

Flu Shot Ethics

Via Vaccine News Daily: Upper airway infections the source of narcolepsy, not H1N1 vaccinations. Excerpt:

Contrary to reports that narcolepsy resulted following H1N1 vaccinations in northern Europe and other areas, the onset of narcolepsy was highly correlated with seasonal and annual patterns of upper airway infections.   

Self-reported data on the month and year of narcolepsy onset between September 1998 and February 2011 indicate that onset is most frequent in April and least frequent in November in China. Only eight out 142 narcolepsy patients reported having been vaccinated and 85 percent reported symptoms of upper airway infection, Internal Medicine News reports.   

The findings show that the onset of narcolepsy in China is strongly seasonal and suggest that it is not related to H1N1 vaccination. While the occurrence of narcolepsy onset was over threefold greater than expected following the 2009-2010 H1N1 pandemic, 96 percent of new narcolepsy patients in 2010 did not report being vaccinated. 

This is in contrast with reports of narcolepsy in Canada, France, the United States and Finland following H1N1 vaccination with an adjuvanted vaccine, which caused alarm.

(Wed, 28 Sep 2011 14:04:00 +0000)

 

 

# 5868

 

 

Today, a fascinating study  that associates viremia, and a specific mutation (D222G/N) in the 2009 H1N1 virus, to more severe disease presentation.

 

Viremia simply refers to the presence of viruses in the blood stream.

 

While many viruses cause viremia (ie. Dengue, Chikungunya, WNV) – seasonal influenza, being primarily a respiratory disease, isn’t usually one of them.

 

But as we’ve seen demonstrated over the past several years, the pathogenesis of the 2009 H1N1 virus sometimes deviated from what one normally sees with seasonal flu.

 

Recently, in mBio: Lethal Synergism of H1N1 Pandemic Influenza & Bacterial Pneumonia we saw how novel H1N1 infection exacerbated lung damage due to bacterial co-infection, when seasonal flu did not.

 

In April of 2010, in There’s No Flu Like A New Flu, I listed many of the other differences observed between seasonal flu and the novel H1N1 virus, including:

 

• The Age shift to under-65s seeing the greatest number of fatalities (see Study: Years Of Life Lost Due To 2009 Pandemic).

 

• Research out of Hong Kong that discovered that the novel H1N1 virus – unlike seasonal flu – easily infect and replicate in the conjunctival tissues of the eye  (see I Only Have Eyes For Flu).

 

• Novel H1N1’s unusually high rate of gastro-intestinal symptoms (see The Lancet study Clinical characteristics of paediatric H1N1 admissions in Birmingham, UK).

 

• And reports of patients that presented with neurological symptoms including unexplained seizures and altered mental status (see Japan: Influenza Related Encephalopathy).

 

 

Although the H1N1 pandemic virus of 2009 proved to be relatively mild for the vast majority of those infected, for a very small percentage, it produced serious and sometimes life-threatening illness.

 

Add to this the fact that this flu, unlike seasonal flu, was also frequently detected in companion animals, and it certainly appears that something was inherently different about the 2009 H1N1 virus.

 

Today, a new study appears in PLoS One that adds more weight to that argument. The open access study is called:

 

 

Clinical and Virological Factors Associated with Viremia in Pandemic Influenza A/H1N1/2009 Virus Infection

 

Herman Tse, Kelvin K. W. To, Xi Wen, Honglin Chen, Kwok-Hung Chan, Hoi-Wah Tsoi, Iris W. S. Li, Kwok-Yung Yuen

Positive detection of viral RNA in blood and other non-respiratory specimens occurs in severe human influenza A/H5N1 viral infection but is not known to occur commonly in seasonal human influenza infection.

Recently, viral RNA was detected in the blood of patients suffering from severe pandemic influenza A/H1N1/2009 viral infection, although the significance of viremia had not been previously studied. Our study aims to explore the clinical and virological factors associated with pandemic influenza A/H1N1/2009 viremia and to determine its clinical significance.

Methodology/Principal Findings

Clinical data of patients admitted to hospitals in Hong Kong between May 2009 and April 2010 and tested positive for pandemic influenza A/H1N1/2009 was collected. Viral RNA was detected by reverse-transcription polymerase chain reactions (RT-PCR) targeting the matrix (M) and HA genes of pandemic influenza A/H1N1/2009 virus from the following specimens: nasopharyngeal aspirate (NPA), endotracheal aspirate (ETA), blood, stool and rectal swab.

Stool and/ or rectal swab was obtained only if the patient complained of any gastrointestinal symptoms. A total of 139 patients were included in the study, with viral RNA being detected in the blood of 14 patients by RT-PCR.

The occurrence of viremia was strongly associated with a severe clinical presentation and a higher mortality rate, although the latter association was not statistically significant. D222G/N quasispecies were observed in 90% of the blood samples.

Conclusion

Presence of pandemic influenza A/H1N1/2009 viremia is an indicator of disease severity and strongly associated with D222G/N mutation in the viral hemagglutinin protein.

 

The authors propose several theories as to why the virus was detected in the bloodstream, and gastrointestinal tract.

 

The detected viral RNA in blood could either reflect extensive pulmonary damage with phagocytic uptake of virus-infected cells or true infection of monocyte-derived dendritic cells and macrophages [26].

On the contrary, viruses in the stool may originate from swallowed respiratory secretions, although viral replication in the epithelial tissue along the gastrointestinal tract cannot be ruled out entirely.

 

 

The significance of the H222G/N mutation in the 2009 H1N1 virus has been vigorously debated for nearly two years.

 

The `Norway’ or D222G/N (D225G/N in influenza H3 Numbering) mutation cited in this study was first linked to more severe disease by Norwegian Scientists in November 2009, although patients carrying these strains can have mild illness as well. 

 

While we’ve covered this territory a number of times over the past year, a brief (and hopefully simple) review is in order. If you are up to speed on receptor binding, and the history of the D222G/N variant, feel free to skip the next section.

 

This mutation involves a single amino acid change in the HA1 gene at position 222 from aspartic acid (D) to glycine (G) (or asparagine (N)).

 

The pdmH1N1 virus carrying this mutation appears to bind more readily to receptor cells (α2-3) found deeper in the lungs, whereas unmutated seasonal flu strains bind preferentially to the (α2-6) receptor cells found in the upper airway.

 

A virus’s ability to bind to specific cells is controlled by its RBD or Receptor Binding Domain; an area of its genetic code that allows it to attach to, and infect, specific types of host cells.

(A Very Simplified Illustration of RBDs)

Like a key into a padlock, the RBD must `fit’ in order to open the cell to infection.

 

The evidence for the D222G/N  amino acid substitution driving increased virulence has been mixed, with the World Health Organization, the CDC, and the HPA continuing to investigate. 

 

Complicating matters - viruses can have multiple amino acid changes – and it may be the combination of these changes can unpredictably (at least for now) alter the virus’s behavior. 

 

Since the D222G/N mutation has been found in patients showing mild disease, it may be that a second (or third) mutation elsewhere in the virus – in concert with D222G/N – is required to produce greater virulence.

 

There is simply a lot we don’t know yet.

 

During the first week of January, Eurosurveillance  printed a study looking at fatal and non-fatal cases of influenza in the UK (see Eurosurveillance: Analysis Of Fatal H1N1 Cases In The UK). 

 

Ellis et al. reported that almost all of the virus samples tested in fatal and non-fatal cases during the early wave of the 2010/11 influenza season showed aspartic acid (D) at position 222.

 

In other words, no `Norway’ mutation.

Towards the end of January 2011, Eurosurveillance published a letter from an Italian researcher who had found a high percentage of D222G/N mutations in severely ill patients (43%)  – particularly when taking virus samples from the lower respiratory tract (lungs).

 

In a reply, the authors of the original study concede that in many cases, only upper respiratory swabs were available for this analysis, and that when possible, samples from the lower respiratory system would be useful.

 

This scholarly debate wasn’t over, as Ellis et al. state in their reply:

 

The selection and emergence of the D222G mutation as a cause or consequence of more severe lower respiratory tract infection is still to be resolved.

 

Emergence of this mutant is likely to exacerbate severity of disease, but by itself, may be neither necessary nor sufficient to account for a severe disease outcome, which is invariably a balance between virus virulence factors and host immune response capability.

 

And so the debate has continued, with some scientists believing the `Norway’ mutation causes more severe illness, while others are less certain.

 

It will take more samples, more research, and more time to determine the truth in the matter.

 

Still, this study is another step forward in our understanding of the unusual pathogenesis, and genetic evolution, of the pandemic H1N1 virus.

 

And since we’ve seen similar severe lung damage, and scattered reports of viremia, among the small number of H5N1 `bird flu’ cases that have been examined, what we can learn about the 2009 H1N1 virus may provide clues on how to tackle a more severe pandemic in the future.

(Wed, 28 Sep 2011 12:04:00 +0000)

 

 

# 5866

 

 

Note: This is day 28 of National Preparedness Month.  Follow this year’s campaign on Twitter by searching for the #NPM11 hash tag. As a member of the NPM11 coalition, I’ve been running preparedness articles all month.

 

The blog that follows is a reprint (slightly edited) of a 2007 essay that has easily proven to be the most downloaded blog the nearly 6 year history of AFD.

 

While it was written with a severe influenza pandemic in mind, emergency hydration can be lifesaving in a variety of situations including heat stroke and severe vomiting or diarrhea. 

 

# 5867

 

Dehydration, and severe diarrheal disease, particularly among children in the third world, is a massive killer. Recognizing this threat, more than 25 years ago the WHO (World Health Organization) came up with what is now called ORS, or an Oral Rehydration Solution.

 

Hundreds of millions of sachets, or packets of this powder, are shipped each year to various third world countries, and there is no doubt that their use has greatly decreased the loss of life due to cholera, dysentery, and other diseases.

 

In a Flu Pandemic, the need for ORS will be great throughout the world. In western societies, where modern medical care is common, IV’s are generally used instead of ORS. There are economic and psychological reasons for this, although many doctors argue that ORS would be just as effective for the majority of patients.

 

Dehydration, from a prolonged bout of flu; with it’s fever, vomiting, and diarrhea, can easily kill patients that might have otherwise survived the virus.

 

As IV’s may well be in short supply, or simply unavailable during a pandemic, the use of ORS may well be the most beneficial treatment that most patients can receive. Certainly, with home care being the most likely venue for most patients, ORS will play a large role in the treatment of pandemic flu.

 

There are, however, conflicting opinions as to what constitutes the proper formula for making your own ORS. All formulas use a base of sugar and salt, in an appropriate ratio. Some formulas, however, add potassium and Sodium Bicarbonate.

 

A little Biochemistry

 

When the human body becomes dehydrated, it loses both water and essential electrolytes, particularly sodium. This condition can quickly become life threatening.

 

In the human body, fluids tend to move from a less salty environment to the saltier one. As an example, if someone drowns in fresh water, the water in the lungs is less salty than the blood, and so this water is quickly absorbed from the lungs into the surrounding tissues.

 

If a person drowns in salt water, the water in the lungs is saltier than the blood, and so additional fluid is pulled into the lungs to `dilute’ the salt water. In other words, the body tries to balance both sides of the equation.

 

This is an important concept when dealing with rehydration therapy.

 

Ingesting plain water does not help restore the salt content of the body. But ingesting water with too much salt will draw fluids from the body, and make the dehydration worse.

 

 

While many believe the exact ratios of sugar and salt to be writ in stone, the truth is, if you have to err, err on the side of less salt.

 

Sugar is added to the ORS solution for two reasons. First, it was discovered in the early 1960’s that sugar helped with the transport of fluids across the cellular membranes in the bowel. In 1977, the British Medical Journal Lancet called this `possibly the most important medical discovery of the 20th century’.

 

Sugar also provides needed calories, and as a carbohydrate, can help prevent ketoacidosis from occurring.

 

But, as with salt, too much sugar can be detrimental, it can promote diarrhea, and make the loss of fluids worse.

 

This is one concern regarding the use of commercial sports drinks for rehydration therapy. Many of these commercially available mixtures simply have too much sugar.

Making your own ORS

The bottom line, of course, is how to make a cheap, safe, and effective ORS powder yourself.

 

 

The simplest formula is 3 Tablespoons of sugar, and 1 teaspoon of salt, dissolved in 1 quart of potable water.

 

An alternative simple formula is 8 teaspoons of sugar, and 1 teaspoon of salt, dissolved in 1 quart of potable water.

 

This basic formula has been used effectively for more than 30 years by WHO, UNICEF, and other relief agencies and has saved millions of lives.

 

Over the past year, there has been some debate over the amount of salt and sugar in this formula. The old formula certainly works, and is safe. But some doctors have argued that a lower salt and sugar level might reduce fluid loss by curbing diarrhea.

 

I’ve elected to create single-serve packets of ORS powder, with each packet designed to be added to 1 liter of water. Two packets would be used for a 2-liter bottle.

 

I’ve located small plastic baggies, called bagettes sold at Michaels Art Supplies. You will find them in the bead section. Snack sized baggies, though lighter gauge plastic, would work as well. The small 2”x3” bagettes are just a little too small for the amount of powder required. You will need to go to the next size up, which are 3”x5”.

 

Along with these baggies, you will need table salt and sugar. I am electing to use non-iodized salt, although I am not aware of any reason why iodized salt would present a problem. The only other things you will need are measuring spoons and a felt tipped marker.

 

Into each baggie I am placing 3 TABLESPOONS of Sugar, and 1 TEASPOON of salt. These do not need to be mixed. I am writing on each Baggie “ORS POWDER- ADD TO 1 LITER OF WATER”.

 

This is the basic formula recommended by Dr. Grattan Woodson in his GOOD HOME TREATMENT OF INFLUENZA guide.

In his home medical guide, Dr. Woodson writes:

 

"Preventing or treating dehydration in people with flu will save more lives than any other intervention during the influenza pandemic."

 

Identification of dehydration

 

When patients have a fever, vomiting, and/or diarrhea, they lose much more water from the body than is commonly appreciated. Symptoms of dehydration include weakness, dizziness, headache, confusion, and fainting. Signs of dehydration include dryness of the mouth, decreased saliva, lack of or very small urine volume that is dark and highly concentrated, sunken eyes, loss of skin elasticity, low blood pressure, especially upon sitting up or rising from the sitting to the standing position, and fast pulse rate, especially when moving from the lying to sitting or standing positions

 

Since I make it a practice not to offer specific medical advice in this blog, I would refer you to to Dr. Woodson’s excellent guide for further guidance on the administration (when, how much, etc)  of rehydration fluids.

 

While you are at it, take a look at the rest of the good doctor’s website for more home care information.

 

You may elect to add a flavoring to this mixture. Unsweetened Koolaid would add flavor and color, and make the drink more palatable to some. It might, however, prove to be an intestinal irritant to some people. I intend to leave mine unflavored, and will add koolaid to individual liters of solution if desired.

 

At 15 cents a gallon, the price is right. And for someone who is dehydrated, having this solution on hand can be lifesaving.

 

CAVEATS

 

You should never attempt to force fluids by mouth on anyone who is unconscious. An eye dropper may be used to slowly infuse liquids in semi conscious patients but there is a risk of choking.

 

Better to dilute this powder too much, than too little. DO NOT SKIMP ON THE WATER.

 

For more complete information on oral rehydration fluids visit the Healthlink Worldwide webpage at

http://rehydrate.org/dd/su19.htm

 

 

For more on National Preparedness Month visit:

 

Via Nature News.com, a report by Declan Butler—a founding Flublogian and a fine science journalist: Vaccine campaign to target deadly childhood diarrhoea. Excerpt:

Every year, more than one million children under the age of five die as a result of diarrhoea. It is the second-biggest killer in this age group, after pneumonia, and 40% of diarrhoea deaths are caused by rotavirus. 

That horrific toll could soon fall, thanks to the first major roll-out of rotavirus vaccines in Africa, where half of rotavirus deaths occur. The programme was unveiled this week by the GAVI Alliance — formerly the Global Alliance for Vaccines and Immunisation — based in Geneva, Switzerland. 

The group hopes to immunize 50 million children against rotavirus in 40 of the world's poorest countries by 2015. Although rotavirus gastro­enteritis is common worldwide, it kills very few children in richer countries, where hospitalization and intravenous rehydration are readily available, and where vaccination is becoming more common. 

GAVI has already funded successful rotavirus-vaccination programmes in Nicaragua, Bolivia, Guyana and Honduras, but the effort is now ramping up to cover 13 countries in Africa and a further 4 elsewhere (see 'Rotavirus roll-out'). 

"It's an incredibly exciting time, to see this vaccine finally reaching the children in Africa," says John Wecker, head of vaccine access and delivery at the Program for Appropriate Technology in Health (PATH), an international organization based in Seattle, Washington, that runs the Rotavirus Vaccine Program (RVP) in partnership with the World Health Organization (WHO) and the US Centers for Disease Control and Prevention. 

In the past it has often taken 15–20 years for a vaccine approved in rich countries to reach poorer ones, but GAVI funding has sharply reduced that lag for rotavirus and some other vaccines. The current rota­virus vaccines were first approved by the WHO and the US Food and Drug Administration just five years ago, on the basis of clinical trials in rich and middle-income countries. 

The RVP's trials of the vaccines in poorer countries were crucial for a wider roll-out, even though they showed that the vaccines are not quite as effective in those areas, where children are often malnourished and have other infectious diseases. 

The trials have proved, however, that the vaccines do reduce case numbers and, more importantly, substantially prevent serious disease and deaths. 

Unexpectedly, the vaccines also protect against multiple, fast-mutating strains of rotavirus, alleviating concerns among scientists that many different rotavirus vaccines might have been needed, with frequent reformulations.

Minister of Health appoint two hospitals in North Sulawesi tackle bird flu

Saturday, September 24, 2011 10:50 pm
Manado (AFP) – Health Minister (Menkes), Endang Rahayu Sedyaningsih, pointed to two hospitals (Hospital) in North Sulawesi (Sulawesi), RS and RS Kandouw Sam Ratulangi as a reference in the handling of bird flu. “In North Sulawesi there are two hospitals designated as referral hospital that could handle this case, each RS and RS Kandouw in Manado Sam Ratulangi in Tondano, “said Head of Controlling Health Problems of North Sulawesi Provincial Health Office, Dr. Jemmy Lampus, in Manado on Saturday.

He explains, when these two hospitals designated as referral bird flu patients, its facilities have been improved.Among other things, provided a special isolation room patients, medical equipment and health personnel who provided special. “So in case of bird flu cases in North Sulawesi, such as, the case that just happened in the City Kotamobagu, patients suspected of bird flu should not be brought to Jakarta for get special treatment, “he said.Kandouw Hospitals and Sam Ratulangi will be a special isolation rooms for patients, said Jemmy.

Even so, he said, until now the two hospitals could not be directly examined blood samples of suspected bird flu. Things like this do not only occur in two hospitals, but occurs also in all hospitals in Indonesia. “blood samples are sent and checked Agency for Health Research and Development, Ministry of Health Republic of Indonesia. This is done because of the limitations of existing technology in two this hospital, “he said.

Kandouw Special hospital, said Jemmy, had also become one of the referral hospital for patients with swine influenza (swine flu) and Severe Acute Respiratory Syndrome (SARS). Earlier, 11 people Gogagoman Village, District of West Kotamobagu , Kotamobagu City, North Sulawesi, was treated at General Hospital (RSU) Kandou Manado for allegedly contracted the bird flu virus. blood samples were then taken and sent to Jakarta. After the blood samples examined 11 suspected bird flu negative. They’ve returned to the City Kotamobagu.

translated

http://www.antaranews.com/berita/276815/menkes-tunjuk-dua-rs-di-sulut-tangani-flu-burung

Anticipation of Bird Flu Spreads
September 27, 2011

JAKARTA: More than half of Indonesian people obtain food and daily necessities from traditional markets. Meanwhile, Indonesia’s traditional markets are identically so dirty that they are breeding animal-borne diseases. Traditional markets that are also a place for trade in poultry are the host for bird flu virus. To that end, Health Minister Endang Rahayu Sedyaningsih has asked the city district government to make the traditional markets into healthy markets.
Endang explained that since 2005 been reported from several countries of Asia bird flu cases in humans are highly pathogenic. It has the potential to cause outbreaks or outbreaks with high mortality. Healthy markets ”become the prevention of disease transmission and prevention of bird flu transmission potential disease outbreaks,” she said in the ‘National Workshop on Traditional Market Revitalization into Healthy Market’ in Jakarta.

To give support to the regents and mayors, the government has already developed a healthy market town pilot in 10 districts in nine provinces. This pilot program has been implemented since 2007 in cooperation with the European Union and the WHO. Operation of a healthy market has also been regulated in Decree No. 519/2008 of the Minister of Health Guidelines for Implementation of Market Competition. Recorded at this time, there are 13,650 traditional markets in Indonesia that are entirely managed by local governments. Health authorities inform that more than 250 kinds of diseases are transmitted through unsafe foods.

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http://www.republika.co.id/berita/nasional/lingkungan/11/09/27/ls5t5f-antisipasi-penyebaran-flu-burung-pasar-tradisional-disulap-jadi-pasar-sehat

Ward Off Bird Flu – In October “Rapid Test” Will Be Carried Out Simultaneously [Bali]

September 28 2011

Denpasar (Bali Post) – Beginning this coming October, Livestock Service (Disnak) the Balinese Province coordinating with Disnak all the regency/the city of Bali will carry out rapid test or the fast test simultaneously in the traditional markets that sold the poultry, including the birds market. This step to guard against increasingly expanded the spreading of the virus H5N1 the cause of the very potential bird flu illness threatened the spirit of humankind.

The head of Disnak Provinsi Bali I Putu Sumantra, on last Tuesday (27/9) said, his side also asked for the community that bought the chicken and the other poultry to isolate the poultry that just was bought. For preventive efforts, the community was also appealed to to destroy or burn the remnants of the waste of the poultry after being cut up.

“If being found had the poultry that died suddenly or it was suspected infected bird flu, we asked for the community as soon as possible reported to Disnak local,” he said.

According to Sumantra, the case of last bird flu was found in three locations in the Jembrana Regency just recently namely the Satria Hamlet in Pande Village, Air Anakan Hamlet in Banyubiru Village, and Menega Hamlet in Dauh Waru Village. The number of chickens that died suddenly in the three villages covered 103 tails in the Satria Hamlet, 14 tails in the Air Anakan Hamlet and 3 tails in the Menega Hamlet.

In the three same locations was carried out by the extermination of the poultry namely 25 tails in the Satria Hamlet, 25 tails in the Air Anakan Hamlet and 14 tails in the Menega Hamlet. Sumantra added, his side has coordinated with Disnak the regency/the city in order to increase vigilance for ward off expanding the spread of the case of bird flu. Moreover, his side also ask for to the quarantine side and KP3 to increase the supervision of the entry of the poultry from outside Bali.

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http://www.balipost.com/mediadetail.php?module=detailberitaindex&kid=10&id=56886