Influenza Virus Mashup

In Malaysia, Arkanoid Legent does wonderful work as a flu blogger, and as the old year fades away, he is already far ahead of us North Americans. Click through to see reports on a C. diff outbreak in Canada (scooped on my own turf!), more dengue deaths in Pakistan, and worries about malaria in Zimbabwe. Thank you again, Arkanoid Legent, for your steady, patient coverage.

In Malaysia, Arkanoid Legent does wonderful work as a flu blogger, and as the old year fades away, he is already far ahead of us North Americans. Click through to see reports on a C. diff outbreak in Canada (scooped on my own turf!), more dengue deaths in Pakistan, and worries about malaria in Zimbabwe. Thank you again, Arkanoid Legent, for your steady, patient coverage.

Via USA Today.com, a report from Australia where it's already 2012: Cases of Tamiflu-resistant flu concern experts. Excerpt:

World Health Organization researchers are reporting an apparent spike in Australia in the number of seasonal influenza cases resistant to Tamiflu, the most commonly used antiviral drug. 

The jump in such cases involving the pandemic 2009 A(H1N1) flu strain, also known as swine flu, took place during Australia's most recent winter: May through August of 2011.

"In 2007/2008, a different A(H1N1) influenza virus developed Tamiflu-resistance," explained WHO research scientist Aeron C. Hurt, who reported the spike. "On that occasion, it was first detected in large numbers in Europe. However, within 12 months the virus had spread globally, such that virtually every A(H1N1) virus around the world was resistant to this drug," he explained. 

"This previous situation demonstrated the speed and potential for a Tamiflu-resistant virus to spread worldwide," Hurt added. "Our concern is that this current pandemic 2009 A(H1N1) Tamiflu-resistant virus may also spread globally." 

Hurt, who is based in the Collaborating Centre for Reference and Research on Influenza in North Melbourne, outlined his observations in the Dec. 29 issue of the New England Journal of Medicine. 

To explore the question of H1N1-drug resistance, Hurt and his team obtained viral samples from 182 H1N1 flu patients (aged from one month to 74 years) who were being cared for either in an emergency department or an intensive care unit, or by their general practitioner, during the recent winter in Australia. 

In all, 29 of the patients (or 16 percent) were found to have a form of H1N1 that was resistant to both Tamiflu (oseltamivir) and an older class of adamantine treatments (rimantadine and amantadine). 

Subsequent lab tests revealed that it would take more than 500 times the concentration of Tamiflu usually prescribed for nonresistant flu strains just to cut key aspects of resistant viral activity in half. 

On the plus side, however, the resistant strains remained "fully sensitive" to treatment with another drug, Relenza (zanamivir).

Via USA Today.com, a report from Australia where it's already 2012: Cases of Tamiflu-resistant flu concern experts. Excerpt:

World Health Organization researchers are reporting an apparent spike in Australia in the number of seasonal influenza cases resistant to Tamiflu, the most commonly used antiviral drug. 

The jump in such cases involving the pandemic 2009 A(H1N1) flu strain, also known as swine flu, took place during Australia's most recent winter: May through August of 2011.

"In 2007/2008, a different A(H1N1) influenza virus developed Tamiflu-resistance," explained WHO research scientist Aeron C. Hurt, who reported the spike. "On that occasion, it was first detected in large numbers in Europe. However, within 12 months the virus had spread globally, such that virtually every A(H1N1) virus around the world was resistant to this drug," he explained. 

"This previous situation demonstrated the speed and potential for a Tamiflu-resistant virus to spread worldwide," Hurt added. "Our concern is that this current pandemic 2009 A(H1N1) Tamiflu-resistant virus may also spread globally." 

Hurt, who is based in the Collaborating Centre for Reference and Research on Influenza in North Melbourne, outlined his observations in the Dec. 29 issue of the New England Journal of Medicine. 

To explore the question of H1N1-drug resistance, Hurt and his team obtained viral samples from 182 H1N1 flu patients (aged from one month to 74 years) who were being cared for either in an emergency department or an intensive care unit, or by their general practitioner, during the recent winter in Australia. 

In all, 29 of the patients (or 16 percent) were found to have a form of H1N1 that was resistant to both Tamiflu (oseltamivir) and an older class of adamantine treatments (rimantadine and amantadine). 

Subsequent lab tests revealed that it would take more than 500 times the concentration of Tamiflu usually prescribed for nonresistant flu strains just to cut key aspects of resistant viral activity in half. 

On the plus side, however, the resistant strains remained "fully sensitive" to treatment with another drug, Relenza (zanamivir).

Via the Scientific American blog Observations: What Really Happened in Malta This September When Contagious Bird Flu Was First Announced? Excerpt:

The morning was sunny and warm on September 12 in St. Julian’s. Inside the Intercontinental hotel and conference center, young researchers, jaded veteran scientists and jet-lagged policy makers piled their plates with softly scrambled eggs, American-style sausages and an obligatory piece of fruit or two, shoveling in the offerings and mumbling hellos, in the bright, sky-lit hotel restaurant. 

Just across the hall, however, in the cannily named Eden Arena, the room was dark, as researchers prepared to mount the stage and explain some of the many ways that humanity might soon be threatened by a truly terrifying flu pandemic. 

So maybe it wasn’t quite that dramatic, but perhaps it should have felt more so. Less than an hour later, a suspiciously sniffly Ron Fouchier, a lanky virologist from the Erasmus Medical Center in Rotterdam with a wry smile and reassuringly understated manner, would announce that he and his lab had found a way to make the deadly H5N1 that would likely be just as transmissible from one human to the next as the seasonal flu. 

Circulating seasonal strains, such as H3N2, are adept at attaching to the human nasal cavity and trachea, making them easily transferable among people via a sneeze, cough or sigh. But fortunately for us, H5N1, as it has circulated in bird populations, has not yet developed this capability. Fouchier and his team wanted to see if it was possible to give it that power. 

So they “mutated the hell out of H5N1,” Fouchier said, towering over the podium at the meeting’s Monday morning plenary session. But as it turns out, they hardly needed to. With just a few genetic substitutions, the virus was able to affix to nose and trachea cells—a development “which seemed to be very bad news,” he said. Fortunately for the lab’s test ferrets, a common animal model for human flu transmission, the flu still didn’t seem to pass airborne from animal to animal. 

And that was when “someone finally convinced me to do something really, really stupid,” Fouchier recounted. They put the mutated H5N1 into the nose of one ferret, then took a sample of nasal fluid from that ferret and put it in the nose of another. After 10 ferrets, the virus began spreading from ferret to ferret via the air just about as easily as a seasonal flu virus.

The report goes on to say that Fouchier has really just jumped the gun on H5N1's natural mutation rate. Even if we keep his research secret, H5N1 will go on changing itself. But if we know how it's going to do it, we can monitor the disease much more effectively—and get a head start on a vaccine.

Via the Scientific American blog Observations: What Really Happened in Malta This September When Contagious Bird Flu Was First Announced? Excerpt:

The morning was sunny and warm on September 12 in St. Julian’s. Inside the Intercontinental hotel and conference center, young researchers, jaded veteran scientists and jet-lagged policy makers piled their plates with softly scrambled eggs, American-style sausages and an obligatory piece of fruit or two, shoveling in the offerings and mumbling hellos, in the bright, sky-lit hotel restaurant. 

Just across the hall, however, in the cannily named Eden Arena, the room was dark, as researchers prepared to mount the stage and explain some of the many ways that humanity might soon be threatened by a truly terrifying flu pandemic. 

So maybe it wasn’t quite that dramatic, but perhaps it should have felt more so. Less than an hour later, a suspiciously sniffly Ron Fouchier, a lanky virologist from the Erasmus Medical Center in Rotterdam with a wry smile and reassuringly understated manner, would announce that he and his lab had found a way to make the deadly H5N1 that would likely be just as transmissible from one human to the next as the seasonal flu. 

Circulating seasonal strains, such as H3N2, are adept at attaching to the human nasal cavity and trachea, making them easily transferable among people via a sneeze, cough or sigh. But fortunately for us, H5N1, as it has circulated in bird populations, has not yet developed this capability. Fouchier and his team wanted to see if it was possible to give it that power. 

So they “mutated the hell out of H5N1,” Fouchier said, towering over the podium at the meeting’s Monday morning plenary session. But as it turns out, they hardly needed to. With just a few genetic substitutions, the virus was able to affix to nose and trachea cells—a development “which seemed to be very bad news,” he said. Fortunately for the lab’s test ferrets, a common animal model for human flu transmission, the flu still didn’t seem to pass airborne from animal to animal. 

And that was when “someone finally convinced me to do something really, really stupid,” Fouchier recounted. They put the mutated H5N1 into the nose of one ferret, then took a sample of nasal fluid from that ferret and put it in the nose of another. After 10 ferrets, the virus began spreading from ferret to ferret via the air just about as easily as a seasonal flu virus.

The report goes on to say that Fouchier has really just jumped the gun on H5N1's natural mutation rate. Even if we keep his research secret, H5N1 will go on changing itself. But if we know how it's going to do it, we can monitor the disease much more effectively—and get a head start on a vaccine.

Via the Taipei Times: Man in southern China dies after contracting bird flu. Most of the report is straight from Xinhua, like every other story about this case. But it does offer a local angle:

In Taiwan, the Centers for Disease Control (CDC) yesterday said it notified the Council of Agriculture and the Coast Guard Administration to be on alert. 

The CDC said it plans to conduct fever examinations for travelers at airports and seaports, as well as question travelers about their contact with birds. 

It also called on Taiwanese businesspeople in Guangdong Province, as well as travelers heading to the area, to be mindful of personal sanitation. 

It added that constant hand washing and avoiding picking up or coming into contact with birds would lower the chance of catching the H5N1 virus.

Via The Standard: Madzorera denies bird flu death. Excerpt:

Mystery surrounds the cause of death of MDC-T legislator, Gladys Gombami. 

News reports said she had died of avian influenza or bird flu but health expects deny there any cases of the disease in the country. Health and Child Welfare Minister Henry Madzorera said the government had not raised any alerts of an outbreak of the disease as they had not received reports of a possible epidemic. 

“The Epidemics and Disease Control centre has not informed me about any outbreak, but they are closed and we can only know that after the holidays,” he said. 

Madzorera said he could not comment further as he had not received any news of an outbreak. 

Officials from the health ministry also revealed that there were no known cases of the virus in Zimbabwe or in the region. They said it was highly unlikely that there could have been an outbreak in the country. 

The only recently recorded cases, the officials said, were reported in Hong Kong and a spread to Zimbabwe at this stage was highly improbable. 

But the family of the late senator insist that post-mortem results had indicated that Gombami had been afflicted with the deadly avian virus. 

The Standard could not have access to the post-mortem report. 

To add to the mystery, a Kadoma doctor reportedly declined to carry out a postmortem and instead referred the family to a hospital in Harare. 

“We were told that she had a swelling in her stomach because there was water in her lungs, but this did not make sense to us,” an informed source said. 

The source said before her death, the senator was down with influenza, she however developed an unnamed infection in her chest. 

In the past Zimbabwe’s health systems have been reported to be incapable of handling epidemics such as bird and swine flu. In 2010 it was reported that some children in Tsholotsho were affected by swine flu. However, results on whether it was actually swine flu were inconclusive.

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China

•  Report: Hong Kong suspends poultry imports from some areas in China (Link)

•  Video: Shenzhen confirmed cases of human infection of bird flu deaths - Government to be prepared to combat the epidemic (translated title) (Link)

•  Cause of bird flu death in S China still unclear (Link)

•  First victim of bird flu in China (Link)

•  Bird Flu is China’s First in 18 Months (Link)

•  Bird Flu death man ‘caught virus after jogging in park’ in China (Link)

Malaysia

•  Health D-G: No fear of bird flu spreading from China (Link)

Vietnam

•  CIDRAP: Vietnamese study finds high H1N1 seroprevalence in slaughterhouse pigs (Link)

Zimbabwe

•  Health Minister unaware of Bird Flu outbreak (Link)

•  Madzorera denies bird flu death (Link)

•  Thousands bid farewell to Senator Gombami (Link)

Research

•  CIDRAP: Study - H1N1 transmissibility likely due to constellation of genes (Link)

•  CIDRAP: H1N1 antibody response in kids may correlate with disease severity (Link)

•  H (Link)

News for December 31, 2011 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:

WHO A(H1N1) Site

WHO H5N1 human case totals, last updated December 15, 2011
Charts and Graphs on H5N1 from WHO
Google Flu Trends
CDC Weekly Influenza Summary
Map of seasonal influenza in the U.S.
CIDPC (Canada) Weekly FluWatch
UK RCGP Weekly Data on Communicable and Respiratory Diseases
Flu Wiki Main Page