View Full Version : Global SitRep
Reasonable Rascal
05-01-09, 02:47
INFLUENZA A (H1N1) VIRUS, HUMAN: WORLDWIDE
******************************************
A ProMED-mail post
In this update:
[1] WHO declares health emergency
[2] lab biosafety guidelines
[3] WHO update - North America
[4] USA - CDC update (NYC confirmed, Ohio confirmed case)
[5] Canada - Nova Scotia confirmed, British Columbia suspected
[6] Worldwide reports - Spain, New Zealand, France, Israel suspected
******
[1] WHO declares health emergency
Date: Sat 25 Apr 2009
Source: Associated Press [edited]
<http://www.philly.com/philly/wires/ap/news/nation_world/20090425_ap_whodeclaresswineflucrisisahealthemerge ncy.html
>
WHO declares swine flu crisis a health emergency
------------------------------------------------
GENEVA: The World Health Organization has declared the swine flu outbreak in North America a "public health emergency of international concern". The decision means countries around the world will be asked to step up reporting and surveillance of the disease implicated in dozens of human deaths in Mexico and at least 8 non fatal cases in the US. WHO fears the outbreak could spread to other countries and is calling for a coordinated response to contain it.
WHO director-general Margaret Chan made the decision late on Saturday after consulting influenza experts during an emergency meeting. She earlier told reporters the outbreak had "pandemic potential." But her agency held off raising its pandemic alert level, citing the need for more information.
"It would be prudent for health officials within countries to be alert to outbreaks of influenza-like illness or pneumonia, especially if these occur in months outside the usual peak influenza season," Chan told reporters by telephone from Geneva, where she convened an emergency meeting of influenza experts. "Another important signal is excess cases of severe or fatal flu-like illness in groups other than young children and the elderly, who are usually at highest risk during normal seasonal flu," she said. Several Latin American and Asian countries have already started surveillance or screening at airports and other points of entry.
At least 62 people have died from severe pneumonia caused by a flu-like
illness in Mexico, WHO says. Some of those who died are confirmed to have a unique flu type that is a combination of bird, pig, and human viruses. The virus is genetically identical to one found in California. US authorities said 8 people were infected with swine flu in California and Texas, and all recovered. So far, no other countries have reported suspicious cases, according to WHO. But the French government said suspected cases are likely to occur in the coming days because of global air travel. A French government crisis group began operating Saturday. The government has already closed the French school in Mexico City and provided French citizens there with detailed instructions on precautions.
Chilean authorities ordered a sanitary alert that included airport screening of passengers arriving from Mexico. No cases of the disease have been reported so far in the country, deputy health minister Jeanette Vega said, but those showing symptoms will be sent to a hospital for tests. In Peru, authorities will monitor travelers arriving from Mexico and the US and people with flu-like symptoms will be evaluated by health teams, Peru's Health Ministry said. Brazil will "intensify its health surveillance in all points of entry into the country," the Health Ministry's National Health Surveillance Agency said in a statement. Measures will also be put in place to inspect cargo andluggage, and to clean and disinfect aircraft and ships
at ports of entry.
Some Asian nations enforced checks Saturday on passengers from Mexico.
Japan's biggest international airport stepped up health surveillance, while the Philippines said it may quarantine passengers with fevers who have been to Mexico. Health authorities in Thailand and Hong Kong said they were closely monitoring the situation. Asia has fresh memories of an outbreak of severe acute respiratory syndrome, or SARS, which hit countries across the region and severely crippled global air travel. Indonesia, China, Thailand, Vietnam and other countries have also seen a number of human deaths from H5N1 bird flu, the virus that researchers have until now fingered as the most likely cause of a future pandemic.
The Dutch government's Institute for Public Health and Environment has
advised any traveler who returned from Mexico since April 17 and develops a fever over 101.3 degrees Fahrenheit (38.5 Celsius) within four days of arriving in the Netherlands to stay at home. The Polish Foreign Ministry has issued a statement that recommends that Poles postpone any travel plans to regions where the outbreak has occurred until it is totally contained. The Stockholm-based European Center for Disease Prevention and Control said earlier Saturday it shared the concerns about the swine flu cases and stood ready to lend support in any way possible.
WHO's emergency committee, called together Saturday for the first time
since it was created in 2007, draws on experts from around the world. They may decide that the outbreak constitutes an international public health emergency. If so, they will consider whether WHO should recommend travel advisories, trade restrictions or border closures and raise its pandemic alert level.
[byline: Maria Cheng]
******
[2] Lab Biosafety
Date: Fri 24 Apr 2009
Source: CDC. Swine influenza A (H1N1) virus biosafety guidelines for
laboratory workers
<http://www.cdc.gov/swineflu/guidelines_labworkers.htm>
Swine influenza A (H1N1) virus biosafety guidelines for laboratory workers
-----------------------------------------------------------------------
This guidance is for laboratory workers who may be processing or performing diagnostic testing on clinical specimens from patients with suspected swine influenza A (H1N1) virus infection, or performing viral isolation.
Diagnostic laboratory work on clinical samples from patients who are suspected cases of swine influenza A (H1N1) virus infection should be conducted in a BSL2 laboratory. All sample manipulations should be done inside a biosafety cabinet (BSC).
Viral isolation on clinical specimens from patients who are suspected cases of swine influenza A (H1N1) virus infection should be performed in a BSL2 laboratory with BSL3 practices (enhanced BSL2 conditions).
Additional precautions include:
* recommended personal protective equipment (based on site specific risk assessment)
* respiratory protection -- fit-tested N95 respirator or higher level of protection.
* shoe covers
* closed-front gown
* double gloves
* eye protection (goggles or face shields)
Waste
* all waste disposal procedures should be followed as outlined in your facility standard laboratory operating procedures.
Appropriate disinfectants
* 70 per cent ethanol
* 5 per cent Lysol
* 10 per cent bleach
All personnel should self monitor for fever and any symptoms. Symptoms of swine influenza infection include diarrhea, headache, runny nose, and muscle aches. Any illness should be reported to your supervisor immediately.
For personnel who had unprotected exposure or a known breach in personal protective equipment to clinical material or live virus from a confirmed case of swine influenza A (H1N1), antiviral chemoprophylaxis with zanamivir or oseltamivir for 7 days after exposure can be considered. For additional information, please see: antiviral treatment and chemoprophylaxis guidance.
Biosafety in Microbiological and Biomedical Laboratories (BMBL) 5th EditionSection IV Laboratory Biosafety Level Criteria
<http://www.cdc.gov/OD/ohs/biosfty/bmbl5/bmbl5toc.htm>.
Links to non-Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred.
Check these websites for further information and updates:
<http://www.cdc.gov/swineflu> and
<http://www.cdc.gov/swineflu/investigation.htm>.
The Association of Public Health Laboratories (APHL) swine influenza web page can be found at
<http://www.aphl.org/aphlprograms/infectious/outbreak/Pages/swineflu.aspx>.
--
communicated by: ProMED-mail rapporteur Brent Barrett
******
[3] WHO update - North America
Date: 26 Apr 2009
Source: WHO Epidemic and Pandemic Alert and Response (EPR)
<http://www.who.int/csr/don/2009_04_26/en/index.html>
Swine flu illness in the United States and Mexico - update [26 Apr 2009]
-----------------------------------------------------------------------
As of [26 Apr 2009], the United States Government has reported 20 laboratory confirmed human cases of swine influenza A/H1N1 (8 in New York, 7 in California, 2 in Texas, 2 in Kansas, and 1 in Ohio). All 20 cases have had mild influenza-like illness with only one requiring brief hospitalization. No deaths have been reported. All 20 viruses have the same genetic pattern based on preliminary testing. The virus is being described as a new subtype of A/H1N1 not previously detected in swine or humans.
Also as of 26 April, the Government of Mexico has reported 18 laboratory confirmed cases of swine influenza A/H1N1. Investigation is continuing to clarify the spread and severity of the disease in Mexico. Suspected clinical cases have been reported in 19 of the country's 32 states.
WHO and the Global Alert and Response Network (GOARN) are sending experts to Mexico to work with health authorities. WHO and its partners are actively investigating reports of suspect cases in other member states as they occur, and are supporting field epidemiology activities, laboratory diagnosis and clinical management.
On Saturday, [25 Apr 2009], upon the advice of the Emergency Committee
called under the rules of the International Health Regulations, the
director-general declared this event a public health emergency of international concern.
WHO is not recommending any travel or trade restrictions.
Daily updates will we posted on the WHO swine influenza website
<http://www.who.int/csr/disease/swineflu/en/index.html>.
--
communicated by:
ProMED-mail
******
[4] USA - CDC update (NYC confirmed, Ohio confirmed case)
Date: 26 Apr 2009
Source: CDC Swine flu investigation website
<http://www.cdc.gov/swineflu/investigation.htm?s_cid=swineFlu_outbreak_002>
Human cases of swine influenza A (H1N1) virus infection have been
identified in the United States. Human cases of swine influenza A (H1N1) virus infection also have been identified internationally. The current US case count is provided below.
US human cases of swine flu infection
State: No. of laboratory confirmed cases
California: 7 cases
Kansas: 2 cases
New York City: 8 cases
Ohio: 1 case
Texas: 2 cases
Total count: 20 cases
Investigations are ongoing to determine the source of the infection and
whether additional people have been infected with swine influenza viruses.
CDC is working very closely with officials in states where human cases of swine influenza A (H1N1) have been identified, as well as with health officials in Mexico, Canada and the World Health Organization. This includes deploying staff domestically and internationally to provide guidance and technical support. CDC has activated its Emergency Operations Center to coordinate this investigation.
Laboratory testing has found the swine influenza A (H1N1) virus susceptible to the prescription antiviral drugs oseltamivir and zanamivir and has issued interim guidance for the use of these drugs to treat and prevent infection with swine influenza viruses. CDC also has prepared interim guidance on how to care for people who are sick and interim guidance on the use of face masks in a community setting where spread of this swine flu virus has been detected. This is a rapidly evolving situation and CDC will provide new information as it becomes available.
--
communicated by:
ProMED-mail
******
[5] Canada - Nova Scotia confirmed, British Columbia suspected
Date: 26 Apr 2009
Source: CJFW FM
<http://www.cjfw.ca/news/14/918493>
Nova Scotia confirms 4 cases of swine flu in province
-----------------------------------------------------
Health authorities in Nova Scotia are confirming 4 cases of swine flu in the province. The province's public health officer, Dr Robert Strang, says the 4 infected people in the Windsor area are recovering from the illness. All of them had what he describes as "mild" cases of the flu.
Sources say British Columbia has found a pair of cases but it is not yet clear if they have a link to Mexico.
Canadian officials are planning a briefing today in Ottawa on the swine flu situation, which WHO has declared to be a "public health emergency of international concern."
--
communicated by:
ProMED-mail
******
[6] Worldwide reports - Spain, New Zealand, France, Israel suspected
Date: 26 Apr 2009
Source: Yahoo News / Associated Press
<http://news.yahoo.com/s/ap/20090426/ap_on_re_au_an/swine_flu_world>
Canada became the 3rd country to confirm human cases of swine flu Sunday [26 Apr 2009] as global health officials considered whether to raise the global pandemic alert level.
Nations from New Zealand to France also reported suspected cases and some warned citizens against travel to North America while others planned quarantines, tightened rules on pork imports, and tested airline passengers for fevers.
Nova Scotia's chief public health officer, Dr. Robert Strang, said the east coast Canadian province had confirmed 4 "very mild" cases of swine flu in students ranging in age from 12 to 17 or 18. All are recovering, he said. "It was acquired in Mexico, brought home and spread," Strang said.
WHO on Saturday [25 Apr 2009] declared the outbreak first detected in
Mexico and the United States a "public health emergency of international concern". A senior WHO official said the agency's emergency committee will meet for a second time on Tuesday [28 Apr 2009] to examine the extent to which the virus has spread before deciding whether to increase the pandemic alert beyond phase 3. The same strain of the A/H1N1 swine flu virus has been detected in several locations in Mexico and the United States, and it appears to be spreading directly from human to human, said Keiji Fukuda, WHO's assistant director-general in charge of health security.
Mexico's health minister says the disease has killed up to 86 people and likely sickened up to 1400 since [13 Apr 2009]. US officials say the virus has been found in New York, California, Texas, Kansas, and Ohio, but so far no fatalities have been reported.
Governments including China, Russia, and Taiwan began planning to put anyone with symptoms of the deadly virus under quarantine. Others were
increasing their screening of pigs and pork imports from the Americas or banning them outright despite health officials' reassurances that it was safe to eat thoroughly cooked pork. Some nations issued travel warnings for Mexico and the United States.
WHO's emergency committee is still trying to determine exactly how the
virus has spread, Fukuda said. "Right now we have cases occurring in a
couple of different countries and in multiple locations," he said. "But we also know that in the modern world that cases can simply move around from single locations and not really become established."
Raising the pandemic alert phase could entail issuing specific recommendations to countries on how to halt the disease. So far, WHO has only urged governments to step up their surveillance of suspicious outbreaks. WHO director-deneral Margaret Chan called the outbreak a public health emergency of "pandemic potential" because the virus can pass from human to human. Her agency was considering whether to issue nonbinding recommendations on travel and trade restrictions, and even border closures. It is up to governments to decide whether to follow the advice.
"Countries are encouraged to do anything that they feel would be a precautionary measure," WHO spokeswoman Aphaluck Bhatiasevi said. "All
countries need to enhance their monitoring."
New Zealand said that 10 students who took a school trip to Mexico "likely" had swine flu. Israel said a man who had recently visited Mexico had been hospitalized while authorities try to determine whether he had the disease. French Health Ministry officials said 4 possible cases of swine flu in 2 regions are currently under investigation. All recently returned from Mexico.
Spain's Health Ministry said 3 people who just returned from Mexico were under observation in hospitals in the northern Basque region, in south eastern Albacete and the Mediterranean port city of Valencia.
Hong Kong and Taiwan said visitors who came back from flu-affected areas with fevers would be quarantined. China said anyone experiencing flu-like symptoms within 2 weeks of arrival from an affected area had to report to authorities. A Russian health agency said any passenger from North America running a fever would be quarantined until the cause of the fever is determined.
Tokyo's Narita airport installed a device to test the temperatures of passengers arriving from Mexico.
Indonesia increased surveillance at all entry points for travelers with flu-like symptoms -- using devices at airports that were put in place years ago to monitor for severe acute respiratory syndrome, or SARS, and bird flu. It said it was ready to quarantine suspected victims if necessary.
Hong Kong and South Korea warned against travel to the Mexican capital and 3 affected provinces. Italy, Poland, and Venezuela also advised their citizens to postpone travel to affected areas of Mexico and the United States.
The virus is usually contracted through direct contact with pigs, but Joseph Domenech, chief of animal health service at UN Food and Agriculture Agency in Rome, said all indications were that the virus is being spread through human-to-human transmission. No vaccine specifically protects against swine flu, and it is unclear how much protection current human flu vaccines might offer.
Russia banned the import of meat products from Mexico, California, Texas and Kansas. South Korea said it would increase the number of its influenza virus checks on pork products from Mexico and the U.S.
[byline: Frank Jordans]
--
communicated by:
ProMED-mail
[The media feeding frenzy is very reminiscent of the early days of SARS -- an apparently highly contagious novel viral febrile respiratory infection cropping up in multiple locations, with many unknowns as to the origin of the virus and what will happen next.
To summarize the status of confirmed cases and suspected cases as best as one can (given the exponential growth of press releases and press interviews leading to thousands of newswires): There are presently 20 confirmed cases in the United States involving 5 States -- California (7), Kansas (2), New York City (8), Ohio (1) and Texas (2). Of these, only one has been hospitalized and all have been relatively mild and self-limited infections. There have been no fatalities attributable to this novel H1N1 virus infection in the USA reported as of today (26 Apr 2009). In Mexico there have been over 1400 reported cases in 19 of 32 States, with 81 (or 86 depending upon the source) reported fatalities. (This number of fatalities has not altered significantly from the ProMED-mail posting on this outbreak earlier today (see Influenza A (H1N1) virus, swine, human - N America (03) 20090426.1566). There have been 6 cases confirmed in Canada, 4 in Nova Scotia, 2 in British Columbia -- all 6 cases have been mild with self limited illnesses. In addition to the confirmed cases in North America, there are suspected cases reported from New Zealand, Spain, France, Israel -- all involving travellers returning from Mexico. At this point in time, any individual with a history of travel to a location with known confirmed cases of the novel H1N1 virus who develops an influenza like illness (ILI) is considered a suspected cases until results from laboratory testing are available. One would expect the volume of reports of suspected cases to grow, as more and more travellers return to their countries of origin, with a proportion of them having ILIs -- a well observed illness following airline flights.
In an earlier posting, this moderator pointed out that the reported cases in Mexico were hospitalized pneumonia cases, with surveillance data coming from inpatient facilities. In contrast, the information on the reported cases in the USA involved surveillance data coming from outpatient facilities. This difference in sentinel reporting sites biases reported cases in Mexico to be more severe cases as they are cases that were severe enough to merit hospitalization. In turn, the use of outpatient sentinel surveillance sites in the USA leads to a bias selecting milder cases -- those that do not require hospitalization. One suspects that once the countries heighten ILI surveillance to include both inpatient as well as outpatient facilities, these disparities will lessen. One also suspects that the true number of cases in Mexico is significantly higher than the currently reported approximately 1500 cases, which would further lower the calculated case fatality rate (CFR). (Information on the actual number of reported cases in Mexico is not readily available on the Ministry of Health website, so all figures are estimates based on earlier figures provided in CDC and WHO reports and on newswire reports. Hopefully these figures will be available on a regularly updated basis to permit following the course of the outbreak).
Based on the currently available information, the novel H1N1 virus involved in these outbreaks has genetic material from human viruses (permitting human to human transmission), avian influenza viruses, and swine influenza viruses influenza strains might arise when an avian influenza virus infects swine that are also coinfected with human influenza viruses. This coinfection in the same host, along with a possible 3rd coinfection of a swine influenza virus, has been felt to offer the potential for reassortment of the genetic material of the viruses, that might ultimately produce a virus that is novel to humans, and can infect humans and be transmitted between them. - Mod.MPP]
Reasonable Rascal
05-01-09, 03:03
INFLUENZA A (H1N1) "SWINE FLU": WORLDWIDE
*****************************************
A ProMED-mail post
****This is a revised and expanded version of yesterday?s
?Influenza A (H1N1) virus, human: worldwide? ? ProMED****
In this update:
[1] WHO latest information
[2] WHO declares health emergency
[3] Lab biosafety guidelines
[4] WHO update -- North America
[5] USA - CDC update (NYC confirmed, Ohio confirmed case)
[6] Canada -- Nova Scotia confirmed, British Columbia: suspected
[7] New Zealand, France, Israel: suspected
[8] Europe: 1st confirmed case ? Spain
******
[1]: Mon 27 Apr 2009
WHO Epidemic and Pandemic Alert and Response (EPR)
Swine influenza
WHO is coordinating the global response to human cases of swine influenza A (H1N1) and monitoring the corresponding threat of an influenza pandemic. Information on this page tracks the evolving situation and provides access to both technical guidelines and information useful for the general public.
Latest information
Interim WHO guidance for the surveillance of human infection with
swine influenza A(H1N1) virus [pdf 146kb]
27 April 2009
Swine flu illness in the United States and Mexico - update 2
26 April 2009 [see below]
<http://www.who.int/csr/disease/swineflu/en/index.html>
--
Communicated by:
ProMED-mail
*******
[2] Date: Sat 25 Apr 2009
Source: WHO declares health emergency
Date: Associated Press [edited]
<http://www.philly.com/philly/wires/ap/news/nation_world/20090425_ap_whodeclaresswineflucrisisahealthemerge ncy.html>
WHO declares swine flu crisis a health emergency
------------------------------------------------
The World Health Organization has declared the swine flu outbreak in North America a "public health emergency of international concern". The decision means countries around the world will be asked to step up reporting and surveillance of the disease implicated in dozens of human deaths in Mexico and at least 8 non fatal cases in the USA. WHO fears the outbreak could spread to other countries and is calling for a coordinated response to contain it.
WHO director-general Margaret Chan made the decision late on Saturday
after consulting influenza experts during an emergency meeting. She earlier told reporters the outbreak had "pandemic potential." But her agency held off raising its pandemic alert level, citing the need for more information.
"It would be prudent for health officials within countries to be alert to outbreaks of influenza-like illness or pneumonia, especially if these occur in months outside the usual peak influenza season," Chan told reporters by telephone from Geneva, where she convened an emergency meeting of influenza experts. "Another important signal is excess cases of severe or fatal flu-like illness in groups other than young children and the elderly, who are usually at highest risk during normal seasonal flu," she said. Several Latin American and Asian countries have already started surveillance or screening at airports and other points of entry.
At least 62 people have died from severe pneumonia caused by a flu-like illness in Mexico, WHO says. Some of those who died are confirmed to have a unique flu type that is a combination of bird, pig, and human viruses. The virus is genetically identical to one found in California. US authorities said 8 people were infected with swine flu in California and Texas, and all recovered. So far, no other countries have reported suspicious cases, according to WHO [but see below]. But the French government said suspected cases are likely to occur in the coming days because of global air travel. A French government crisis group began operating Saturday. The government has already closed the French school in Mexico City and provided French citizens there with detailed instructions on precautions.
Chile
------
Chilean authorities ordered a sanitary alert that included airport screening of passengers arriving from Mexico. No cases of the disease have been reported so far in the country, deputy health minister Jeanette Vega said, but those showing symptoms will be sent to a hospital for tests.
Peru
------
In Peru, authorities will monitor travelers arriving from Mexico and the USA and people with flu-like symptoms will be evaluated by health teams, Peru's Health Ministry said.
Brazil
-----
Brazil will "intensify its health surveillance in all points of entry into the country," the Health Ministry's National Health Surveillance Agency said in a statement. Measures will also be put in place to inspect cargo and luggage, and to clean and disinfect aircraft and ships at ports of entry.
Asia
-----
Some Asian nations enforced checks Saturday on passengers from Mexico.
Japan's biggest international airport stepped up health surveillance, while the Philippines said it may quarantine passengers with fevers who have been to Mexico. Health authorities in Thailand and Hong Kong said they were closely monitoring the situation. Asia has fresh memories of an outbreak of severe acute respiratory syndrome, or SARS, which hit countries across the region and severely crippled global air travel. Indonesia, China, Thailand, Vietnam and other countries have also seen a number of human deaths from H5N1 bird flu, the virus that researchers have until now fingered as the most likely cause of a future pandemic.
Europe
--------
The Dutch government's Institute for Public Health and Environment has advised any traveler who returned from Mexico since April 17 and develops a fever over 101.3 degrees Fahrenheit (38.5 Celsius) within 4 days of arriving in the Netherlands to stay at home. The Polish Foreign Ministry has issued a statement that recommends that Poles postpone any travel plans to regions where the outbreak has occurred until it is totally contained. The Stockholm-based European Center for Disease Prevention and Control said earlier Saturday it shared the concerns about the swine flu cases and stood ready to lend support in any way possible. [One case now confirmed in Spain ? see below].
WHO's emergency committee, called together Saturday for the first time since it was created in 2007, draws on experts from around the world. They may decide that the outbreak constitutes an international public health emergency. If so, they will consider whether WHO should recommend travel advisories, trade restrictions or border closures and raise its pandemic alert level.
[byline: Maria Cheng]
******
[3] Lab biosafety
Date: Fri 24 Apr 2009
Source: CDC. Swine influenza A (H1N1) virus biosafety guidelines for
laboratory workers
<http://www.cdc.gov/swineflu/guidelines_labworkers.htm>
Swine influenza A (H1N1) virus biosafety guidelines for laboratory workers
-----------------------------------------------------------------------
This guidance is for laboratory workers who may be processing or performing diagnostic testing on clinical specimens from patients with suspected swine influenza A (H1N1) virus infection, or performing viral isolation.
Check these websites for further information and updates:
<http://www.cdc.gov/swineflu> and
<http://www.cdc.gov/swineflu/investigation.htm>.
The Association of Public Health Laboratories (APHL) swine influenza web page can be found at
<http://www.aphl.org/aphlprograms/infectious/outbreak/Pages/swineflu.aspx>.
--
communicated by:
ProMED-mail rapporteur Brent Barrett
******
[4] WHO update - North America
Date: 26 Apr 2009
Source: WHO Epidemic and Pandemic Alert and Response (EPR)
<http://www.who.int/csr/don/2009_04_26/en/index.html>
Swine flu illness in the United States and Mexico - update [26 Apr 2009]
-----------------------------------------------------------------------
As of [26 Apr 2009], the United States Government has reported 20 laboratory confirmed human cases of swine influenza A/H1N1 (8 in New York, 7 in California, 2 in Texas, 2 in Kansas, and 1 in Ohio). All 20 cases have had mild influenza-like illness with only one requiring brief hospitalization. No deaths have been reported. All 20 viruses have the same genetic pattern based on preliminary testing. The virus is being described as a new subtype of A/H1N1 not previously detected in swine or humans.
Also as of 26 April, the Government of Mexico has reported 18 laboratory confirmed cases of swine influenza A/H1N1. Investigation is continuing to clarify the spread and severity of the disease in Mexico. Suspected clinical cases have been reported in 19 of the country's 32 states.
WHO and the Global Alert and Response Network (GOARN) are sending experts to Mexico to work with health authorities. WHO and its partners are actively investigating reports of suspect cases in other member states as they occur, and are supporting field epidemiology activities, laboratory diagnosis and clinical management.
On Saturday, [25 Apr 2009], upon the advice of the Emergency Committee
called under the rules of the International Health Regulations, the
director-general declared this event a public health emergency of
international concern.
WHO is not recommending any travel or trade restrictions.
Daily updates will we posted on the WHO swine influenza website
<http://www.who.int/csr/disease/swineflu/en/index.html>.
--
communicated by:
ProMED-mail
******
[5] USA - CDC update (NYC confirmed, Ohio confirmed case)
Date: 26 Apr 2009
Source: CDC Swine flu investigation website
<http://www.cdc.gov/swineflu/investigation.htm?s_cid=swineFlu_outbreak_002>
Human cases of swine influenza A (H1N1) virus infection have been identified in the United States. Human cases of swine influenza A (H1N1) virus infection also have been identified internationally. The current US case count is provided below.
US human cases of swine flu infection
State: No. of laboratory confirmed cases
California: 7 cases
Kansas: 2 cases
New York City: 8 cases
Ohio: 1 case
Texas: 2 cases
Total count: 20 cases
Investigations are ongoing to determine the source of the infection and whether additional people have been infected with swine influenza viruses.
CDC is working very closely with officials in states where human cases of swine influenza A (H1N1) have been identified, as well as with health officials in Mexico, Canada and the World Health Organization. This includes deploying staff domestically and internationally to provide guidance and technical support. CDC has activated its Emergency Operations Center to coordinate this investigation.
Laboratory testing has found the swine influenza A (H1N1) virus susceptible to the prescription antiviral drugs oseltamivir and zanamivir and has issued interim guidance for the use of these drugs to treat and prevent infection with swine influenza viruses. CDC also has prepared interim guidance on how to care for people who are sick and interim guidance on the use of face masks in a community setting where spread of this swine flu virus has been detected. This is a rapidly evolving situation and CDC will provide new information as it becomes available.
--
communicated by:
ProMED-mail
******
[6] Canada -- Nova Scotia confirmed, British Columbia suspected
Date: 26 Apr 2009
Source: CJFW FM
<http://www.cjfw.ca/news/14/918493>
Nova Scotia confirms 4 cases of swine flu in province
-----------------------------------------------------
Health authorities in Nova Scotia are confirming 4 cases of swine flu in the province. The province's public health officer, Dr Robert Strang, says the 4 infected people in the Windsor area are recovering from the illness. All of them had what he describes as "mild" cases of the flu.
Sources say British Columbia has found a pair of cases but it is not yet clear if they have a link to Mexico.
Canadian officials are planning a briefing today in Ottawa on the swine flu situation, which WHO has declared to be a "public health emergency of international concern."
--
Communicated by:
ProMED-mail
******
[7] Spain, New Zealand, France, Israel: suspected
Date: 26 Apr 2009
Source: Yahoo News / Associated Press
<http://news.yahoo.com/s/ap/20090426/ap_on_re_au_an/swine_flu_world>
Nations from New Zealand to France also reported suspected cases and some warned citizens against travel to North America while others planned quarantines, tightened rules on pork imports, and tested airline passengers for fevers.
A senior WHO official said the agency's emergency committee will meet for a second time on Tuesday [28 Apr 2009] to examine the extent to which the virus has spread before deciding whether to increase the pandemic alert beyond phase 3. The same strain of the A/H1N1 swine flu virus has been detected in several locations in Mexico and the United States, and it appears to be spreading directly from human to human, said Keiji Fukuda, WHO's assistant director-general in charge of health security.
Mexico's health minister says the disease has killed up to 86 people and likely sickened up to 1400 since [13 Apr 2009]. US officials say the virus has been found in New York, California, Texas, Kansas, and Ohio, but so far no fatalities have been reported.
Governments including China, Russia, and Taiwan began planning to put
anyone with symptoms of the deadly virus under quarantine. Others were
increasing their screening of pigs and pork imports from the Americas or banning them outright despite health officials' reassurances that it was safe to eat thoroughly cooked pork. Some nations issued travel warnings for Mexico and the United States.
WHO's emergency committee is still trying to determine exactly how the
virus has spread, Fukuda said. "Right now we have cases occurring in a
couple of different countries and in multiple locations," he said. "But we also know that in the modern world that cases can simply move around from single locations and not really become established."
New Zealand said that 10 students who took a school trip to Mexico "likely" had swine flu.
Israel said a man who had recently visited Mexico had been hospitalized while authorities try to determine whether he had the disease.
French Health Ministry officials said 4 possible cases of swine flu in 2 regions are currently under investigation. All recently returned from Mexico.
Spain's Health Ministry said 3 people who just returned from Mexico were under observation in hospitals in the northern Basque region, in south eastern Albacete and the Mediterranean port city of Valencia. [Now confirmed ? see below].
Hong Kong and Taiwan said visitors who came back from flu-affected areas with fevers would be quarantined. China said anyone experiencing flu-like symptoms within 2 weeks of arrival from an affected area had to report to authorities. A Russian health agency said any passenger from North America running a fever would be quarantined until the cause of the fever is determined.
Tokyo's Narita airport installed a device to test the temperatures of
passengers arriving from Mexico.
Indonesia increased surveillance at all entry points for travelers with flu-like symptoms -- using devices at airports that were put in place years ago to monitor for severe acute respiratory syndrome, or SARS, and bird flu. It said it was ready to quarantine suspected victims if necessary.
Hong Kong and South Korea warned against travel to the Mexican capital and 3 affected provinces. Italy, Poland, and Venezuela also advised their citizens to postpone travel to affected areas of Mexico and the United States.
The virus is usually contracted through direct contact with pigs, but Joseph Domenech, chief of animal health service at UN Food and Agriculture Agency in Rome, said all indications were that the virus is being spread through human-to-human transmission. No vaccine specifically protects against swine flu, and it is unclear how much protection current human flu vaccines might offer.
Russia banned the import of meat products from Mexico, California, Texas and Kansas. South Korea said it would increase the number of its influenza virus checks on pork products from Mexico and the U.S.
[byline: Frank Jordans]
--
communicated by:
ProMED-mail
**********
[8] Europe: 1st confirmed case ? Spain
Date: 27 Apr 2009
Source: CBC Canada
<http://www.cbc.ca/world/story/2009/04/27/swine-flu042709.html?>
Case confirmed in Spain. Returning from Mexico.
--
Communicated by:
ProMED-mail
***********
[The media feeding frenzy is very reminiscent of the early days of SARS -- an apparently highly contagious novel viral febrile respiratory infection cropping up in multiple locations, with many unknowns as to the origin of the virus and what will happen next.
To summarize the status of confirmed cases and suspected cases as best as one can (given the exponential growth of press releases and press interviews leading to thousands of newswires): There are presently 20 confirmed cases in the United States involving 5 States -- California (7), Kansas (2), New York City (8), Ohio (1) and Texas (2). Of these, only one has been hospitalized and all have been relatively mild and self-limited infections. There have been no fatalities attributable to this novel H1N1 virus infection in the USA reported as of today (26 Apr 2009). In Mexico there have been over 1400 reported cases in 19 of 32 States, with 81 (or 86 depending upon the source) reported fatalities. (This number of fatalities has not altered significantly from the ProMED-mail posting on this outbreak earlier today (see Influenza A (H1N1) virus, swine, human - N America (03) 20090426.1566). There have been 6 cases confirmed in Canada, 4 in Nova Scotia, 2 in British Columbia -- all 6 cases have been mild with self limited illnesses. In addition to the confirmed cases in North America, there are suspected cases reported from New Zealand, Spain, France, Israel -- all involving travellers returning from Mexico. At this point in time, any individual with a history of travel to a location with known confirmed cases of the novel H1N1 virus who develops an influenza like illness (ILI) is considered a suspected cases until results from laboratory testing are available. One would expect the volume of reports of suspected cases to grow, as more and more travellers return to their countries of origin, with a proportion of them having ILIs -- a well observed illness following airline flights.
In an earlier posting, this moderator pointed out that the reported cases in Mexico were hospitalized pneumonia cases, with surveillance data coming from inpatient facilities. In contrast, the information on the reported cases in the USA involved surveillance data coming from outpatient facilities. This difference in sentinel reporting sites biases reported cases in Mexico to be more severe cases as they are cases that were severe enough to merit hospitalization. In turn, the use of outpatient sentinel surveillance sites in the USA leads to a bias selecting milder cases -- those that do not require hospitalization. One suspects that once the countries heighten ILI surveillance to include both inpatient as well as outpatient facilities, these disparities will lessen. One also suspects that the true number of cases in Mexico is significantly higher than the currently reported approximately 1500 cases, which would further lower the calculated case fatality rate (CFR). (Information on the actual number of reported cases in Mexico is not readily available on the Ministry of Health website, so all figures are estimates based on earlier figures provided in CDC and WHO reports and on newswire reports. Hopefully these figures will be available on a regularly updated basis to permit following the course of the outbreak).
Based on the currently available information, the novel H1N1 virus involved in these outbreaks has genetic material from human viruses (permitting human to human transmission), avian influenza viruses, and swine influenza viruses. For years the scientific community has been speculating that new influenza strains might arise when an avian influenza virus infects swine that are also coinfected with human influenza viruses. This coinfection in the same host, along with a possible 3rd coinfection of a swine influenza virus, has been felt to offer the potential for reassortment of the genetic material of the viruses, that might ultimately produce a virus that is novel to humans, and can infect humans and be transmitted between them. - Mod.MPP]
Reasonable Rascal
05-01-09, 08:21
INFLUENZA A (H1N1) "SWINE FLU?: WORLDWIDE (02)
**********************************************
A ProMED-mail post
In this update:
[1] WHO statement 27 Apr 2009
[2] WHO update 3
[3] Mexico update
[4] USA (5 states): 40 cases confirmed
[5] UK (Scotland): 2 cases confirmed
[6] BBC news updates: worldwide
*************
[1] WHO statement 27 Apr 2009
Date: 27 Apr 2009
Source: WHO [edited]
<http://www.who.int/mediacentre/news/statements/2009/h1n1_20090427/en/index.html>
Statement by WHO Director-General, Dr Margaret Chan
27 April 2009
Swine influenza
---------------
The Emergency Committee, established in compliance with the International Health Regulations (2005), held its 2nd meeting on 27 April 2009.
The Committee considered available data on confirmed outbreaks of A/H1N1 swine influenza in the United States of America, Mexico, and Canada. The Committee also considered reports of possible spread to additional countries.
Current WHO phase of pandemic alert
-----------------------------------
On the advice of the Committee, the WHO Director-General decided on the following.
The Director-General has raised the level of influenza pandemic alert from the current phase 3 to phase 4 [see explanation in comment at end].
The change to a higher phase of pandemic alert indicates that the likelihood of a pandemic has increased, but not that a pandemic is inevitable.
As further information becomes available, WHO may decide to either revert to phase 3 or raise the level of alert to another phase.
This decision was based primarily on epidemiological data demonstrating human-to-human transmission and the ability of the virus to cause community-level outbreaks.
Given the widespread presence of the virus, the Director-General considered that containment of the outbreak is not feasible. The current focus should be on mitigation measures.
International Health Regulations (IHR)
--------------------------------------
The Director-General recommended NOT to close borders and NOT to restrict international travel. It was considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention.
The Director-General stressed that all measures should conform with the purpose and scope of the International Health Regulations.
Vaccine
-------
The Director-General considered that production of seasonal influenza vaccine should continue at this time, subject to re-evaluation as the situation evolves. WHO will facilitate the process needed to develop a vaccine effective against A/H1N1 virus.
--
Communicated by:
Kunihiko Iizuka
Formerly anonymous source and ProMED award winner 2005
****************
[2] WHO update 3
Date: Mon, 27 Apr 2009
Source: WHO [edited]
<http://www.who.int/csr/don/2009_04_27/en/index.html>
Swine influenza - update 3
--------------------------
The current situation regarding the outbreak of swine influenza A(H1N1) is evolving rapidly. As of 27 April 2009, the United States Government has reported 40 laboratory confirmed human cases of swine influenza A(H1N1), with no deaths. Mexico has reported 26 confirmed human cases of infection with the same virus, including 7 deaths [but see report below], Canada has reported 6 cases, with no deaths, while Spain has reported one case, with no deaths.
Further information on the situation will be available on the WHO website on a regular basis.
WHO advises NO restriction of regular travel or closure of borders. It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities.
There is also no risk of infection from this virus from consumption of well-cooked pork and pork products.
Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.
--
Communicated by
Marianne Hopp, WHO notifications, ProMED
****************
[3] Mexico update
Date: 27 Apr 2009
Source: Washington Post Foreign Service [edited]
<
http://www.washingtonpost.com/wp-dyn/content/article/2009/04/27/AR2009042702017.html>
Mexico Raises Swine Flu Death Toll to 149 [suspected]
-----------------------------------------------------
The suspected death toll from the outbreak of swine flu in Mexico rose Monday [27 Apr 2009] to 149 people as health authorities cancelled all
schools across the country until 6 May 2009.
Mexican cabinet officials led by Health Secretary Jose Angel Cordova gave a press conference today [27 Apr 2009] in Mexico City with the latest information they have gathered about the outbreak of a deadly new strain of swine flu that has halted many aspects of public life here and appears to continue to be spreading.
Since the first case of swine flu was reported, 1995 people have been hospitalized with serious cases of pneumonia, said Cordova, and 1070 of these people have been released. He said 20 of the deaths so far have been confirmed as swine flu, but that just 2 laboratories in the country, one in Mexico City and one in the state of Veracruz, are able to confirm this new strain. [By Joshua Partlow]
--
Communicated by:
ProMED-mail
************
[4] USA (5 states): 40 cases confirmed
Date: 27 Apr 2009
Source: CDC [edited]
<http://www.cdc.gov/swineflu/?s_cid=swineFlu_outbreak_internal_001>
U.S. Human Cases of Swine Flu Infection
(As of April 27, 2009 1:00 PM ET)
California 7 cases
Kansas 2 cases
New York City 28 cases
Ohio 1 case
Texas 2 cases
TOTAL COUNT 40 cases
CDC activated its Emergency Operations Center to coordinate the agency's response to this emerging health threat and yesterday [26 Apr 2009] the Secretary of the Department Homeland Security, Janet Napolitano, declared a public health emergency in the United States.
This will allow funds to be released to support the public health response. CDC's goals during this public health emergency are to reduce transmission and illness severity, and provide information to assist health care providers, public health officials and the public in addressing the challenges posed by this newly identified influenza virus.
To this end, CDC has issued a number of interim guidance documents in the past 24 hours. In addition, CDC's Division of the Strategic National Stockpile (SNS) is releasing one-quarter of its antiviral drugs, personal protective equipment, and respiratory protection devices to help states respond to the outbreak.
Laboratory testing has found the swine influenza A (H1N1) virus susceptible to the prescription antiviral drugs oseltamivir and zanamivir.
This is a rapidly evolving situation and CDC will provide updated guidance and new information as it becomes available.
--
Communicated by:
ProMED-mail
************
[5] UK (Scotland): 2 cases confirmed
Date: Mon 27 Apr 2009
Source: BBC News, Scotland [edited]
<http://news.bbc.co.uk/1/hi/scotland/glasgow_and_west/8020208.stm>
2 people admitted to a Scottish hospital after returning from Mexico have been confirmed as the 1st British cases of swine flu. Scottish Health Secretary Nicola Sturgeon said both patients, a man and a woman, were recovering well. She said 7 other people who had been in contact with them were now displaying mild symptoms. Both the Scottish patients were from the Forth Valley area of central Scotland. The pair, who had been traveling together, returned from Mexico on 21 Apr 2009.
--
Communicated by:
ProMED-mail
********
[6] BBC news updates: worldwide
Date: 27 Apr 2009
Source: BBC news.com [edited]
UK probes '17 swine flu reports'. There have also been cases of swine flu reported in Canada and a suspected case in France. Swine flu is usually found in pigs and contracted only by people in contact with the animals. <news.bbc.co.uk/1/hi/uk/8020222.stm>
Some reports say as many as 149 people may have died from swine flu, but WHO officials put the figure much lower and said only about 20 of the deaths could be definitely attributed to swine flu.
<news.bbc.co.uk/1/hi/world/americas/8021547.stm>
Israel renames unkosher swine flu.
Israel's health minister updates a nervous public about the swine flu epidemic - and starts by renaming it Mexican flu.
<news.bbc.co.uk/1/hi/world/americas/8021301.stm>
Swine flu fears hit travel shares.
Global stock markets fall, with airlines leading the declines on fears over the economic impact of the swine flu outbreak.
<news.bbc.co.uk/1/hi/business/8019912.stm>
--
Communicated by:
ProMED-mail
************
[WHO Phase 4 "is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause 'community-level outbreaks.' ... Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion."
<http://www.who.int/csr/disease/avian_influenza/phase/en/index.html>
A 6th US state, Minnesota, has reported a suspect case.
The pharmaceutical company GSK?s shares have risen as it promises to
produce more of the flu antiviral Relenza.
For a global map of suspected & confirmed cases, see Google maps:
<http://maps.google.com.br/maps?q=swine%20flu&hl=pt-BR&ned=pt-BR_br&tab=nl>
When checking the HealthMap swine flu map at:
<http://www.healthmap.org/swineflu>
be aware that the markers on China, Japan & Hawaii do NOT mean that they are reporting suspect cases, only that they are mentioned in swine flu news stories. - Mod.JW]
Reasonable Rascal
05-01-09, 08:27
INFLUENZA A (H1N1) "SWINE FLU": WORLDWIDE (03)
**********************************************
A ProMED-mail post
In this update:
[1] Some questions
[2] New Zealand
[3] Israel
[4] Comment on seasonality
******
[1] Some questions
Date: Tue 28 Apr 2009
From: Roger Morris <R.S.Morris@massey.ac.nz>
Some questions
--------------
For those of us who are involved in international work on influenza epidemiology and control and responding to the many media enquiries, there is a very large information gap in relation to diagnosis and epidemiology of the Mexican influenza. What is known of the genetic structure of this virus? It has been called a swine flu, but no evidence has been put forward to allow this statement to be evaluated. I have received information that it is a reassortant, which has genetic components from 4 different sources, but nothing official has been released on this. Where does it fit phylogenetically? Is there any genetic variation of significance among the isolates investigated? Would this help to explain the difference in severity of disease between Mexico and other countries?
It is also stated that it should be diagnosed by RT-PCR, without clarifying which PCR. I have received information that the standard PCR for H1 does not reliably detect this virus. Is this true? What is an appropriate series of diagnostic steps for samples from suspect cases? Could we have an authoritative statement on these issues from one of the laboratories, which has been working with the virus?
--
Professor Roger Morris
Emeritus Professor of Animal Health
Massey University EpiCentre, PN623
Institute of Veterinary, Animal and Biomedical Sciences
Massey University, Palmerston North
New Zealand
[The genome sequences of several US isolates are now available at GenBank: see
<http://www.ncbi.nlm.nih.gov/genomes/FLU/SwineFlu.html>. - Mod.CP]
******
[2] New Zealand
Date: Tue 28 Apr 2009
Source: Ministry of Health, New Zealand, Media Release [edited]
<http://www.moh.govt.nz/moh.nsf/indexmh/results-of-h1n1-swine-flu-testing-280409>
Results of H1N1 (swine flu) testing
-----------------------------------
Director of Public Health, Dr Mark Jacobs announced tonight [28 Apr 2009] that results from some of the Rangitoto College party who tested positive to influenza A on Sunday [25 Apr 2009], have also tested positive for swine flu H1N1.
Results from 3 of the samples were received earlier this evening [28 Apr 2009] from the World Health Organization regional laboratory in Melbourne and all tested positive for the same strain of swine flu. Testing continues on a 4th sample.
On the basis of these results, we are assuming that all of the people in the group who had tested positive for influenza A have swine flu. As a result we are continuing with the current treatment, which has been based on this assumption.
We were advised that the lab in Melbourne selected 4 of the best samples of the very delicate genetic material to analyse. They found 3 positive results and one is still to be confirmed.
Staff from Auckland Regional Public Health are getting in touch with those affected and informing them of the results. This is expected to be completed by 10:00 pm tonight [28 Apr 2009]. All 10 are understood to be recovering at home.
There is no need to change the treatment and follow-up of the Rangitoto College group. The Tamiflu treatment will continue and they will remain in home isolation and should complete 72 hours of Tamiflu before they can return to normal activities.
--
Communicated by
Dr Patricia Priest
Senior Lecturer, Epidemiology
Department of Preventive and Social Medicine
University of Otago
Dunedin
New Zealand
[The HealthMap/ProMED-mail interactive map of New Zealand is available at <http://healthmap.org/r/00aG>. - CopyEd.MJ]
******
[3] Israel
Date: Tue 28 Apr 2009
Source: Haaretz News Service [edited]
<http://www.haaretz.com/hasen/spages/1081774.html>
Israel confirms 1st case of swine flu, raises alert level to 4
--------------------------------------------------------------
Israel confirmed its 1st case of swine flu on Tuesday [28 Apr 2009], Israel Radio reported, as the Health Ministry raised its level of alert to 4 out of 6. A 26-year-old man who recently returned from Mexico was diagnosed with the virus, after 2 days of quarantine in a Netanya hospital pending results of his health tests. After the diagnosis, he was listed in good condition at the hospital.
World health officials, racing to extinguish a new flu strain that is jumping borders, raised a global alert to an unprecedented level as the outbreak claimed more lives in Mexico. The US prepared for the worst even as president Barack Obama tried to reassure Americans. With the swine flu having already spread to at least 4 other countries, authorities around the globe are like firefighters battling a blaze without knowing how far it extends. At this time,
containment is not a feasible option, said Keiji Fukuda, assistant director-general of the World Health Organization, which raised its alert level on Monday [27 Apr 2009].
Another Israeli man has also been quarantined until further notice in hospitals in a Kfar Sava, after he too returned from Mexico with fu-like symptoms. The Health Ministry said Monday [27 Apr 2009] that it had embraced the recommendation of the European Commission to postpone nonessential travel to Mexico and recommends that travelers be alert to reports regarding other countries. Health Ministry officials said Monday they were not issuing any special instructions to the public for now, including individuals returning from Mexico. The ministry did recommend that such travelers seek medical
assistance if they develop flu-like symptoms within 7 days after their return. These individuals would be quarantined at local hospitals until their condition is determined.
[Byline: Ran Reznick, Yair Ettinger, Zohar Blumenkrantz]
--
Communicated by:
ProMED-mail
The HealthMap/ProMED-mail interactive map of Israel is available at
<http://healthmap.org/r/00aH>. - CopyEd.MJ]
******
[4] Comment on seasonality
Date: Mon 27 Apr 2009
From: EA Gould <eag@ceh.ac.uk>
Swine influenza and the UK
--------------------------
I haven't been able to read every single ProMED-mail report covering the new "swine" influenza outbreak but it is possible that the reports have missed an important point concerning the UK and the rest of Northern Europe.
I apologise if you or someone have already pointed it out, but for the time being at least, we should have a breathing space in the sense that influenza virus epidemics don't normally occur in Northern Europe during the late spring and summer period.
So it would have to be totally outside precedent if this virus caused significant infections at this time of the year in the UK.
--
Professor EA Gould
CEH Oxford
Mansfield Road
Oxford OX1 3SR
United Kingdom
[Analysis of previous pandemics show that transmission in the Northern hemisphere stops in the beginning of May. The best analysis I have found is this paper: Viboud et al. JID 2005;192:233-48.
Even if the present A/H1N1 has pandemic potential it is therefore highly likely that the outbreak will fade out within the next 2 to 3 weeks, but it will reappear in the autumn.
As pointed out in an earlier posting, the second wave can be more pathogenic than the first wave, and inclusion of the present virus in the vaccine for the autumn therefore should have the highest priority (I am sure it does). - Mod.EP]
Reasonable Rascal
05-01-09, 08:31
INFLUENZA A (H1N1) "SWINE FLU": WORLDWIDE (05)
**********************************************
A ProMED-mail post
[1]
Date: Tue 28 Apr 2009
Source: The New York Times [edited]
<http://www.nytimes.com/2009/04/29/health/29flu.html?hp>
7 Countries Have Confirmed Cases of Swine Flu
---------------------------------------------
A total of 2 new swine flu cases were confirmed in Israel and as many as 11 in New Zealand, bringing the number of countries with confirmed cases to at least 7 on Tuesday [29 Apr 2009]. But all, with the exception of Mexico, said the patients were recovering or had been hospitalized with only mild symptoms, leaving health officials struggling to determine why the disease has killed only in Mexico.
In Mexico, 20 fatalities have been confirmed, and the number of deaths considered likely to have been caused by the flu rose to 152, up from 149 on Monday [28 Apr 2009], according to Mexico's health minister. The number of people believed to be infected surpassed 1600. In the United States, the number of infections stood at 50. Preliminary tests by health officials in New Jersey had identified 5 "probable" cases -- 4 people who were recently in Mexico and one who had been in California, the Associated Press reported. Other cases have been reported in Ohio, Kansas, Texas and California. Most of the cases were concentrated in New York, at a high school in Queens where a group of students had recently traveled to Mexico. At least 28
students at the school tested positive, and another 17 were suspected of having the flu, with testing underway. Investigators were also examining between 10 and 15 possible new cases in 3 counties in upstate New York, all involving people who had recently traveled to Mexico or the southwest United States. "All of our cases continue to be mild, with spontaneous recovery," said Richard F. Daines, the New York state health commissioner.
In Mexico, state health authorities looking for the initial source of the outbreak toured a million-pig hog farm in Perote, in Veracruz State. The plant is half-owned by Smithfield Foods, an American company and the world's largest pork producer. Mexico's 1st known swine flu case, which was later confirmed, was from Perote, according to Health Minister Jose Angel Cordova. The case involved a 5-year-old boy who recovered. But a spokesman for the plant said the boy was not related to a plant worker and that none of its workers were sick. On Tuesday, company officials allowed a reporter to tour their facilities after showering and donning a mask and sanitized clothing.
About 15 000 pigs could be seen in various enclosures, and officials said that at least 3 pig carcasses were on the farm. But they said the pigs had not died of influenza and insisted there had been no spike in deaths. "We're just as worried about this as everyone else," said Mike Hawn, a Smithfield spokesman.
In Europe, Spanish Health Minister Trinidad Jimenez on Tuesday said Spain had confirmed a 2nd case of swine flu, in the eastern province of Valencia, but that the patient was recovering well.
Israel's Ministry of Health on Tuesday reported the 1st case in the country. Smadar Shazo, a Health Ministry spokeswoman, said the man who contracted the illness, a 26-year-old, had recently returned from Mexico. Ms. Shazo said he is in good health now and is likely to be released from hospital Wednesday [29 Apr 2009]. The Health Ministry later reported that a 2nd man had contracted the flu as well, but his condition was unclear.
Hospital authorities in Scotland said 2 people -- the 1st known cases of the virus in Britain -- were recovering after contracting the flu while on honeymoon in Cancun, Mexico.
Officials in Canada said in a statement that 2 new cases had been diagnosed in Alberta as well -- one in Calgary, and another in a northern community -- bringing the number of confirmed cases in Canada to 8. Both patients are men who traveled recently to Mexico, and both had only mild symptoms, said Dr. Andre Corriveau, Alberta's chief medical officer of health.
Given extensive human-to-human transmission, the World Health Organization (WHO) raised its global pandemic flu alert level on Monday [27 Apr 2009], but it recommended that borders not be closed nor travel bans imposed, noting that that the virus had already spread and that infected travelers might not show any symptoms.
However, many countries are tightening border and immigration controls, and on Tuesday Britain advised against any nonessential travel to Mexico. Japan announced that it would no longer allow Mexican travelers to obtain visas upon arrival. The United States, France and Germany have also warned against nonessential travel to Mexico. Canada had done the same, a decision that appeared to contradict the country's campaign for international coordination of health-related travel advisories.
During the SARS outbreak in 2003, recommendations against visiting Canada severely impaired the country's tourism industry. Canada said then that that warnings were unnecessary and has since promoted the idea that the WHO should be the body which issues them.
Another 10 countries are investigating possible cases, including China and Russia, which were set to quarantine passengers suspected of having the flu. At least 9 countries in Asia were checking air passengers arriving from North America, and China was tightening land border checks as well. Hong Kong, Taiwan and Russia were set to quarantine passengers suspected of having the flu.
On Monday, Indonesia banned all pork products coming from Canada, the
United States and Mexico, and said it would destroy any pork products
imported before the ban. International health experts said the flu cannot be transmitted from pigs or from eating properly handled pork.
The increase of the WHO alert to level 4 from level 3 means that there has been sustained human-to-human transmission. The change "indicates that the likelihood of a pandemic has increased, but not that a pandemic is inevitable," Dr. Margaret Chan, the WHO director general, said Monday.
The WHO also recommended that vaccine makers keep making the seasonal
flu vaccine instead of switching over to a new one that matches the swine flu strain, but it urged them to start the process of picking a pandemic strain, weakening it and making large batches of it, which could take 6 months.
American officials said their response to the epidemic was already aggressive, and the WHO's decision to raise its pandemic alert to level 4 from level 3 would not change their plans. The WHO decision offered some official guidance to a world that, at least for the day, seemed swept by confusion that unnerved international travelers and the financial markets. European and Asian markets fell, and stock in airlines and the travel industry fell while those in pharmaceutical companies rose. Pharmacies in New York reported runs on Tamiflu, an anti-flu drug -- something that public health officials badly want to avoid because the drug could eventually be needed for the truly ill.
For now supplies of Tamiflu and Relenza, another anti-flu drug, remain adequate, the manufacturers said, but both were increasing production and expressed anxiety that shortages could develop if governments placed huge orders.
Confirmation of news cases is slow because most nations' laboratories lack the test kit the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is developing for the new virus. The CDC began sending out the new kits on Monday, meaning that soon some states and foreign countries would be able to make their own diagnoses -- a development that could lead to a sharp increase in confirmed cases.
[Byline: Donald G. McNeil Jr.]
--
Communicated by:
ProMED-mail
<promedmail.org>
[The production and distribution of diagnostic reagents and protocols from the CDC will accelerate the diagnosis of cases and facilitate more accurate monitoring of the spread in infection.
In addition to the cases listed above there are reports of suspected cases in numerous countries (see below). - Mod.CP]
*****
[2]
Country by country spread of new flu strain
Date: 28 Apr 2009
Source: Reuters [Edited]
<http://www.alertnet.org/thenews/newsdesk/N28340563.htm>
New Zealand and Israel became the latest countries on Tuesday to be hit by the new strain of swine flu that has caused fatalities in Mexico and also spread to the United States, Europe and the Middle East. Here are the current totals of cases and deaths:
COUNTRY DEATHS CONFIRMED CASES SUSPECTED CASES
MEXICO 159 26 2,500 *
U.S. 0 65 0 **
CANADA 0 13 0
NEW ZEALAND 0 3 8
SPAIN 0 2 32
ISRAEL 0 2 1
BRITAIN 0 2 0
AUSTRALIA 0 0 89
BRAZIL 0 0 20
FRANCE 0 0 20
CHILE 0 0 24
DENMARK 0 0 11
SWITZERLAND 0 0 9
AUSTRIA 0 0 5
COLOMBIA 0 0 4
GERMANY 0 0 3
NORWAY 0 0 1
SOUTH KOREA 0 0 1
GUATEMALA 0 0 1
NOTES:
* Mexico's death toll figure is for deaths that authorities in that country suspect were caused by swine flu. The country's figure for confirmed cases of the disease is the figure given to date by the World Health Organization. The number of suspected cases has been given by the Mexican Health Ministry.
** The U.S. Centers for Disease Control has reported 64 confirmed cases. Authorities in Indiana have reported one additional case.
Sources: Reuters/WHO/CDC/www.hpa.org.uk (Writing by David Cutler,
London Editorial Reference Unit; Editing by Frances Kerry)
--
Communicated by:
ProMED-mail rapporteur Mary Marshall
Reasonable Rascal
05-01-09, 08:42
INFLUENZA A (H1N1) "SWINE FLU": WORLDWIDE (06)
**********************************************
A ProMED-mail post
In this update:
[1, [2] Sequence analysis
[3] Nomenclature
[4] WHO update 4
[5] MMWR dispatch
[6] USA: 1st fatality
[7] Germany: 3 confirmed cases
******
[1] Sequence analysis
Date: Tue 28 Apr 2009
From: Peter Petermann <PPeterman@aol.com>
Concerning the question of the origin of the "novel" H1N1 virus [see ProMED-mail Influenza A (H1N1) "swine flu": worldwide (04) 20090428.1609], may I direct attention to an anonymous statement of CDC on the GISAID [Global Initiative on Sharing Avian Influenza Data] website ("Summary of laboratory sequence data for swine influenza viruses from 2 human cases in CA"), which comes to the same conclusion as Professor Rabadan:
"Nucleotide blast results for the virus A/California/04/2009 isolated from case A (Table 1), show that the HA, PB2, PB1, PA, NP, NS genes contain gene segments from influenza viruses isolated from swine in North America [such as, A/swine/Indiana/P12439/00], while the NA and M genes are most closely related to corresponding genes from influenza viruses isolated in swine population in Eurasia."
However, the NA and M genes from 2 swine virus isolates from America are also closely related to the novel H1N1 virus (A/swine/Virginia/670/1987, A/swine/Virginia/67a/1987), if a reasonable nucleotide substitution rate is accepted. Thus, H1N1 from Mexico may be a swine flu virus strain of entirely American origin, possibly even of relatively ancient origin.
--
Dr Peter Petermann
WAI
[Wissenschaftsforum Aviaere Influenza (Science Forum on Avian Influenza)]
******
[2] Sequence analysis
Date: Tue 28 Apr 2009
From: Joe Rojas-Burke
"The original source of the assertion that the A/H1N1 virus is a reassortment of avian, human, and swine viruses is Dr Anne Schuchat from the [US] Centers for Disease Control and Prevention, who told reporters that very specifically during the [23 Apr 2009] briefing. The CDC transcript reads: "Preliminary testing of viruses from the 1st 2 patients shows that they are very similar. Additional testing is ongoing with the newer isolates. We know so far that the viruses contain genetic pieces from 4 different virus sources. This is unusual. The 1st is our North American swine influenza viruses. North
American avian influenza viruses, human influenza viruses, and swine influenza viruses found in Asia and Europe. That particular genetic combination of swine influenza virus segments has not been recognized before in the US or elsewhere." [The full transcript is available at
<http://www.cdc.gov/media/transcripts/2009/t090423.htm>.
This information contradicts the description in [Morbidity and Mortality Weekly Report] MMWR 21 Apr 2009 / 58 (dispatch) ; 1-3
(<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0421a1.htm>), which
states the following: "Preliminary genetic characterization of the influenza viruses has identified them as swine influenza A (H1N1) viruses. The viruses are similar to each other, and the majority of their genes, including the hemagglutinin (HA) gene, are similar to those of swine influenza viruses that have circulated among US pigs since approximately 1999; however, 2 genes coding for the neuraminidase (NA) and matrix (M) proteins are similar to
corresponding genes of swine influenza viruses of the Eurasian lineage (1). This particular genetic combination of swine influenza virus segments has not been recognized previously among swine or human isolates in the United States, or elsewhere based on analyses of influenza genomic sequences available on GenBank."
--
Joe Rojas-Burke
Staff science writer
The Oregonian
Portland, Oregon
USA
******
[3] Nomenclature
Date: 29 Apr 2009
Source: The New York Times [edited]
<http://www.nytimes.com/2009/04/29/world/asia/29swine.html?hp>
The naming of swine flu, a curious matter
-----------------------------------------
What to call the new strain of flu raising alarms around the world has taken on political, economic and diplomatic overtones.
Pork producers question whether the term "swine flu" is appropriate, given that the new virus has not yet been isolated in samples taken from pigs in Mexico or elsewhere. While the new virus seems to be most heavily composed of genetic sequences from swine influenza virus material, it also has human and avian influenza genetic sequences as well, according to the Centers for Disease Control and Prevention in Atlanta.
Government officials in Thailand, one of the world's largest meat exporters, have started referring to the disease as "Mexican flu." An Israeli deputy health minister - an ultra-Orthodox Jew - said his country would do the same, to keep Jews from having to say the word "swine." However, his call seemed to have been largely ignored.
Janet Napolitano, the secretary for homeland security, and Agriculture Secretary Tom Vilsack went out of their way at a press conference in Washington on Tuesday to refer to the virus by its scientific name, as the "H1N1 virus."
"This is not a food-borne illness, virus -- it is not correct to refer to it as swine flu because really that's not what this is about," Mr. Vilsack said.
The World Organization for Animal Health, which handles veterinary issues around the world, issued a statement late Monday suggesting that the new disease should be labeled "North American influenza," in keeping with a long medical tradition of naming influenza pandemics for the regions where they were first identified. This has included the Spanish flu of 1918 to 1919, the Asian flu of 1957 to 1958 and the Hong Kong flu of 1967 to 1968.
The debate is likely to continue as scientists and health authorities try to trace the disease. While all signs now point to Mexico as the epicenter, the genetic material in the virus there includes part of a swine influenza virus of Eurasian origin. And influenza viruses tend to emerge from Asia.
Prime Minister Wen Jiabao of China called for stepped up measures on Tuesday to prevent and control any possible cases of swine flu that might show up in the country.
Many medical historians believe that the Asian and Hong Kong flus started in southeastern China near Hong Kong, where very high densities of people live in close proximity to hogs and chickens in rural areas and can share their viruses. Some historians also suggest that the Spanish flu also started in southeastern China.
The Mexican ambassador to Beijing, Jorge Guajardo, has been outspoken
this week in suggesting that the disease did not originate in Mexico. He said in a telephone interview on Tuesday that the disease was brought to his country by an infected person from somewhere in "Eurasia," the land mass of Europe and Asia.
Ambassador Guajardo said in a telephone interview that his government had been told by American and Canadian experts that the genetic sequence of the virus pointed to Eurasian origin.
"This did not happen in Mexico," he said, adding, "It was a human who brought this to Mexico."
But flu specialists in Asia said that the new virus probably did not make the jump from animals to people in Asia.
"If that is the case, you would see a lot of infections in Asia by now," said Subash Morzaria, the regional manager for Asia and the Pacific at the Emergency Center for Transboundary Diseases, which is part of the United Nations' Food and Agriculture Organization.
The neuraminidase genetic segment of the virus, which gives the virus its "N1" name and controls the ability of the virus to break out of infected cells, comes from a Eurasian strain of swine flu, said Dr. Yuen Kwok-yung, a microbiologist at Hong Kong University. But he added that enough pigs are moved across national borders that it is impossible to place the location more precisely.
There seems little indication of any outbreak of the new flu in China. There have been no recent surges in illnesses among pigs or pig farmers, according to Ben Boake, the executive vice president of the Henan Zhongpin Food Company Ltd., one of China's largest pork processors.
Millions of pigs died in China two years ago in an epidemic so severe that it pushed pork prices up 90 percent. Veterinarians attributed the deaths at the time mainly to blue-ear disease, which does not affect humans, but also to swine flu. The Chinese government did not issue a public report assessing the outbreak and provided very few details to international organizations.
[Byline: Keith Bradsher]
--
Communicated by:
ProMED-mail
******
[4] WHO update 4
Date: Tue 28 Apr 2009
Source: WHO Epidemic and Pandemic Alert and Response (EPR) Disease
Outbreak News [edited]
<http://www.who.int/csr/don/2009_04_28/en/index.html>
Swine influenza - WHO update 4
------------------------------
The situation continues to evolve rapidly. As of 19:15 GMT, 28 Apr 2009, 7 countries have officially reported cases of swine influenza A/H1N1 infection. The United States Government has reported 64 laboratory confirmed human cases, with no deaths. [but see below. - Mod.JW] Mexico has reported 26 confirmed human cases of infection including 7 deaths.
The following countries have reported laboratory confirmed cases with no deaths: Canada (6), New Zealand (3), the United Kingdom (2), Israel (2) and Spain (2). Further information on the situation will be available on the WHO
website on a regular basis.
WHO advises no restriction of regular travel or closure of borders. It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities.
There is also no risk of infection from this virus from consumption of well-cooked pork and pork products. Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.
--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp
******
[5] MMWR dispatch
Date: Tue 28 Apr 2009
Source: CDC. MMWR Morb Mortal Wkly Rep 2009; 58 (dispatch) [edited]
<http://www.cdc.gov/mmwr/PDF/wk/mm58d0428a2.pdf>
Update: infections with a swine-origin influenza A (H1N1) virus - USA
and other countries, 28 Apr 2009
----------------------------------------------------------------------
Since 21 Apr 2009, CDC has reported cases of respiratory infection with a swine-origin influenza A (H1N1) virus (S-OIV) transmitted through human-to-human contact (1,2). This report updates cases identified in US states and highlights certain control measures taken by CDC. As of [28 Apr 2009], the total number of confirmed cases of S-OIV infection in the United States had increased to 64, with cases in California (10 cases), Kansas (2), New York (45), Ohio (one), and Texas (6). CDC and state and local health departments are investigating all reported US cases to ascertain the clinical
features and epidemiologic characteristics. On [27 Apr 2009], CDC distributed an updated case definition for infection with S-OIV [see original article at URL above for details].
Of the 47 patients reported to CDC with known ages, the median age was 16 years (range: 3-81 years), and 38 (81 percent) were aged less than 18 years; 51 percent of cases were in males. Of the 25 cases with known dates of illness onset, onset ranged from 28 Mar to 25 Apr [2009] (data presented as a figure in the original text). To date, no deaths have been reported among US cases, but 5 patients are known to have been hospitalized. Of 14 patients with known travel histories, 3 had traveled to Mexico; 40 of 47 patients (85 percent) have not been linked to travel or to another confirmed case. Information is being compiled regarding vaccination status of infected patients, but is not yet available. According to the World Health Organization (WHO), as of 27 Apr [2009], a total of 26 confirmed cases of S-OIV infection
had been reported by Mexican authorities. Canada has reported 6 cases
and Spain has reported one case (additional information is available at <http://www.who.int/en/>).
Emergency use authorizations
----------------------------
If an emerging public health threat is identified for which no licensed or approved product exists, the Project BioShield Act of 2004 authorizes the Food and Drug Administration (FDA) commissioner to issue an Emergency Use Authorization (EUA) so that promising countermeasures can be disseminated quickly for the protection and safety of the U.S. population (3).
In response to the current public health emergency involving swine-origin influenza, FDA issued 4 EUAs on 27 Apr [2009] to allow emergency use of: oseltamivir (Tamiflu) and zanamivir (Relenza) for the treatment and prophylaxis of influenza (2 EUAs); disposable N95 respirators for use by the general public; and the rRT-PCR Swine Flu Panel for diagnosis.
Oseltamivir is FDA-approved for treatment and prevention of influenza in adults and children 1 year and older. Zanamivir is FDA-approved for treatment of influenza in adults and children 7 years and older who have been symptomatic for less than 2 days, and for prevention of influenza in adults and children aged 5 years and older. The EUA allows the use of oseltamivir for treatment of influenza in children aged less than 1 year and prevention of influenza in children aged 3 months-1 year. Additionally, traditional prescribing and dispensing requirements might not be met. Under the scope and conditions of current EUAs, mass dispensing of both antiviral medications will be allowed per state and/or local public health authority.
FDA has authorized use of certain N95 respirators to help reduce wearer exposure to pathogenic biological airborne particulates during a public health emergency involving S-OIV. On 27 Apr [2009], CDC published guidelines for the use of N95 respirators. For example, respirators should be considered for use by persons for whom close contact with an infectious person is unavoidable. This can include selected individuals who must care for a sick person (such as, family member with a respiratory infection) at home. Additional information is available at <http://www.cdc.gov/swineflu/masks.htm>.
Currently, no FDA-cleared tests specifically for the S-OIV strain exist in the United States or elsewhere. For this purpose and to meet the significant increase in demand for influenza testing throughout the country, CDC has developed the rRT-PCR Swine Flu Panel to expand and maintain the operational capabilities of public health or other qualified laboratories by providing a detection tool for the presumptive presence of S-OIV.
Control measures at ports of entry and travel warning for Mexico
----------------------------------------------------------------
CDC, in collaboration with industry and federal partners, is continuing to conduct routine illness detection at ports of entry with heightened awareness for travelers who might be infected with S-OIV. During 17-19 Apr [2009], 15 cases of illness in travelers entering the United States from Mexico that were clinically consistent with S-OIV infection were detected. Of these 15 cases, 2
were laboratory confirmed as swine-origin influenza A (H1N1). Nine travelers remain in isolation pending completion of evaluation, and 4 travelers were released to complete travel after influenza virus infection was ruled out.
WHO has declared a Public Health Emergency of International Concern. As part of its responsibilities under the International Health Regulations, CDC is prepared to implement additional screening measures for international flights, if deemed necessary, to prevent exportation of S-OIV. In addition, CDC in collaboration with the US Department of Homeland Security, is distributing travelers health alert notices to all persons traveling to countries with confirmed cases of S-OIV infection.
CDC has recommended that US travelers avoid nonessential travel to
Mexico (<http://wwwn.cdc.gov/travel/contentswineflumexico.aspx>).
However, CDC might revise its travel guidance as the outbreak in Mexico evolves and is characterized more completely. Travelers who cannot delay travel to Mexico should visit <http://www.cdc.gov/travel> and follow the posted recommendations to reduce their risk for infection.
Non pharmaceutical community mitigation
---------------------------------------
CDC has issued interim guidance for non pharmaceutical community mitigation efforts in response to human infections with S-OIV (<http://www.cdc.gov/swineflu/mitigation.htm>). Current recommendations for isolation of patients with cases of S-OIV, household contacts, school dismissal, and other social distancing interventions also are available at
<http://www.cdc.gov/swineflu/mitigation.htm> and will be updated as
the situation evolves.
[The original text is supplemented with a figure of the confirmed human cases of swine-origin influenza A (H1N1) infection with known (25 of 64 cases) dates of illness onset - United States, 27 Apr 2009]
[Reported by: Strategic Science and Program Unit, Coordinating Center for Infectious Diseases; Div of Global Migration and Quarantine, National Center for Preparedness, Detection, and Control of Infectious Diseases; Influenza Div, National Center for Immunization and Respiratory Diseases, CDC Influenza Emergency Response Team, CDC]
References
----------
1. CDC: Swine influenza A (H1N1) infection in two children - Southern
California, March-April 2009. MMWR 2009; 58: 400-2 [available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0421a1.htm>].
2. CDC. Update: swine influenza A (H1N1) infections - California and
Texas, April 2009. MMWR; 58 (in press) [available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0424a1.htm>].
3. Nightingale SL, Prasher JM, Simonson S: Emergency Use
Authorization (EUA) to enable use of needed products in civilian and
military emergencies, United States. Emerg Infect Dis 2007; 13(7):
1046-51 [available at
<http://www.cdc.gov/eid/content/13/7/1046.htm>].
--
Communicated by:
ProMED-mail
******
[6] USA: 1st fatality
Date: Wed 29 Apr 2009
Source: Thomson Reuters Foundation AlertNet [edited]
<http://www.alertnet.org/thenews/newsdesk/N29383699.htm>
Texas child who died of flu recently in Mexico
----------------------------------------------
The Texas baby who became the 1st confirmed US death from the new
H1N1 swine flu had recently traveled to Mexico, a US government source said on Wednesday [29 Apr 2009].
The US Centers for Disease Control and Prevention had earlier confirmed the 23-month-old child as the 1st swine flu death reported outside Mexico, the country hardest hit by the influenza outbreak. US officials have confirmed 65 cases of swine flu, most of them mild but with 5 hospitalizations in California and Texas.
[Byline: Maggie Fox]
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
******
[7] Germany: 3 confirmed cases
Date: Wed 29 Apr 2009
From: Oliver Schmetzer
Three confirmed imported cases of A/H1N1-influenza in Germany.
--------------------------------------------------------------
In the morning of 29 Apr 2009 the Bernhard-Nocht-Institute confirmed in a press release a case of a 22-year-old woman in Hamburg. She came back with flu-symptoms from Mexico.
A 2nd case, a 30-year-old man in Regensburg has been confirmed. He also arrived from Mexico.
The 3rd confirmed case is a 37-year-old woman, confirmed in Kulmbach. She again arrived from Mexico.
The last 2 cases have been confirmed by the laboratory of the University Clinic of Regensburg. There are several suspected cases from different states in Germany (the 1st appeared on 26 Apr 2009). All cases have been isolated and there is no human-to-human transmission [so far]. The confirmed cases reached their hometown via planes from Frankfurt and Stuttgart.
The national pandemic plan was published in 2005 and updated in 2007. The plan contains several measurements and guidelines. The most important suggested measurements until now are: hand washing, hygiene, and prevention of hand to face contact.
On German TV there are many reports now, mainly showing controls of flight passengers by doctors at Frankfurt international airport. According to the Government, Germany has stored large quantities of anti-viral drugs (Tamiflu etc.), which are enough to treat 40 million people (over 50 percent of the population). In case of an epidemic, the drugs are given to the community without charge. They have been shown highly effective against this influenza strain in the US.
The German airline Lufthansa reported that their air-filters remove viral particles and air-quality in their planes is "as good as in a surgery room."
The director of the Bernhard-Nocht-Institute confirmed that in the case of a pandemic alert level 5/6 from the WHO, a vaccine would be available in 3 months. However a virologist in German TV (Prof Alexander Kekul) stated that it will take until January [2010] to prepare a vaccine.
--
Oliver Schmetzer
Reasonable Rascal
05-01-09, 09:07
INFLUENZA A (H1N1) - WORLDWIDE
******************************
A ProMED-mail post
[Note: It is now apparent that the 2009 influenza A (H1N1) virus currently circulating in humans, though genetically linked to swine influenza viruses, has not been found in swine and that swine do not appear to be involved in the ongoing epidemic. For that reason, and in keeping with usage by WHO and other agencies, ProMED will drop the term "swine flu" from our coverage. We expect the term will continue to be used by the media and in common usage for some time. - Mod.LM]
In this update:
[1] Origin
[2] Nomenclature
[3] MMWR Dispatch - Drug susceptibility
[4] Clinical questions
[5] Vaccine production
[6] CDC guidance
******
[1] Origin
Date: Thu 30 Apr 2009
Source: Eurosurveillance, Vol. 14, issue 17 [edited]
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19193>
The origin of the recent swine influenza A(H1N1) virus infecting humans
---------------------------------
By: V Trifonov1, H Khiabanian1, B Greenbaum1,2, R Rabadan 1 At: 1
Department of Biomedical Informatics, Center for Computational Biology and Bioinformatics, Columbia University College of Physicians and Surgeons, New York, United States, and 2 The Simons Center for Systems Biology, Institute for Advanced Study, Princeton, United States.
Preliminary analysis of the genome of the new H1N1 influenza A virus responsible for the current pandemic indicates that all genetic segments are related closest to those of common swine influenza viruses.
A new H1N1 influenza A virus has been identified in Mexico and has spread rapidly to other regions around the world. The World Health Organization in collaboration with many other national and international agencies is working efficiently to evaluate, diagnose and implement measures to contain the spread of this virus. Among the many efforts is the timely release of the genomic sequences from different viral isolates [1]. This is allowing thousands of scientists to participate in the endeavor.
There have been some questions raised about the origin of the new strain. Influenza A is a single stranded RNA virus with 8 different segments. When 2 viruses co-infect the same cell, new viruses can be produced that contain segments from both parental strains.
By using sequences collected in public databases, we can identify the closest relatives of the new strain found in Mexico and construct clusters and phylogenetic trees. Sequence alignment and similarity, cluster analyses by principal component analysis and phylogenetic tree all point to similar results.
Our preliminary analyses show that the closest relatives to this new strain are found in swine, and occasionally in turkeys. Six segments of the virus are related to swine viruses from North America and the other 2 (NA and M) from swine viruses isolated in Europe/Asia. The closest clusters (for the HA segment) in the NCBI data base are North America swine influenza A(H1N2) and H3N2s. The closest relatives of the neuraminidase (NA) gene of the new virus, are influenza A isolates from 1992. As more data becomes accessible, the evolution of this gene could be clarified.
The North American ancestors are related to the multiple reassortants, H1N2 and H3N2 swine viruses isolated in North America since 1998 [2,3]. In particular, the swine H3N2 isolates from 1998 were a triple reassortment of human, swine and avian origin.
Therefore, this preliminary analysis suggests at least 2 swine ancestors to the current H1N1, one of them related to the triple reassortant viruses isolated in North America in 1998. So far, the new strain has not been reported in pigs. It is not clear whether this is due to insufficient surveillance of the swine population or whether this virus has been generated in a very recent reassortment event.
References
(1) World Health Organization. Viral gene sequences to assist update diagnostics for swine influenza A(H1N1). Geneva: WHO; 2009 April 25.
Available from:
<http://www.who.int/csr/disease/swineflu/swineflu_genesequences_20090425.pdf >.
(2) Karasin AI, Schutten MM, Cooper LA, Smith CB, Subbarao K, Anderson GA, et al. Genetic characterization of H3N2 influenza viruses isolated from pigs in North America, 1977-1999: evidence for wholly human and reassortant virus genotypes. Virus Res. 2000;68(1):71-85.
(3) Karasin AI, Landgraf J, Swenson S, Erickson G, Goyal S, Woodruff M, et al. H1N2: Genetic characterization of H1N2 influenza A viruses isolated from pigs throughout the United States. J Clin Microbiol. 2002;40(3):1073-9.
--
Communicated by:
ProMED-mail
******
[2] Nomenclature
Date: Wed 29 Apr 2009
Source: The Bangkok Post, Agence France-Press [edited]
<http://www.bangkokpost.com/breakingnews/141906/us-drops-wine-flu-name>
US drops "swine flu" name
---------------------------
The deadly disease formerly known as "swine flu" is now called the "2009 H1N1 flu," US officials said Wednesday [29 Apr 2009], as they battled against a worldwide clampdown on US pork exports. Bidding to distance the hybrid influenza from pigs, which is responsible for only one part of the strain, US officials again insisted that people could not catch H1N1 from eating pork.
The new designation was in the script at briefings by Health and Human Services Secretary Kathleen Sibelius, Centers for Disease Control and Prevention acting chief Richard Besser and other US officials. "We're calling it the 2009 H1N1 flu. That's now the name for it,'' Besser said.
Pig farmers in the United States, Canada and Mexico -- the disease's epicenter -- are reeling from bans on their exports of live swine and pork meat imposed by several nations including Russia and China. Despite the name swine flu, no pigs in the United States are reported to be suffering from the disease, which also has components from influenza strains afflicting people and birds in 3 continents. [More recent sequence analyses suggest that the 2009 H1N1 influenza virus is comprised of components derived from 3 different strains of swine A (H1N1) influenza virus, See ProMED-mail post: Influenza A (H1N1) "swine flu": worldwide (06). - Mod.CP]
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
******
[3] MMWR Dispatch - Drug susceptibility
Date: Tue 28 Apr 2009
Source: MMWR Dispatch, Vol. 58 [edited]
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0428a1.htm?s_cid=mm58d0428a1_e>
Since 21 Apr 2009, CDC has reported cases of respiratory infection with a swine-origin influenza A (H1N1) virus (S-OIV) that is being spread via human-to-human transmission (1). As of 28 Apr 2009, the total number of confirmed S-OIV cases in the United States was 64; these cases occurred in California (10 cases), Kansas (2), New York (45), Ohio (one), and Texas (6). The viruses contain a unique combination of gene segments that had not been reported previously among swine or human influenza viruses in the United States or elsewhere (1). Viruses from 13 (20 percent) of 64 patients have been tested for resistance to antiviral medications. To date, all tested
viruses are resistant to amantadine and rimantadine but are susceptible to oseltamivir and zanamivir. The purpose of this report is to provide detailed information on the drug susceptibility of the newly detected S-OIVs, which will aid in making recommendations for treatment and prophylaxis for swine influenza A (H1N1) infection. These data also will contribute to antiviral-resistance monitoring and diagnostic test development.
Adamantane susceptibility was assessed by conventional sequencing or
pyrosequencing assay (2) with modifications (3), using viral RNA extracted from original clinical specimens and/or virus isolates. Susceptibility of virus isolates to the neuraminidase inhibitors (NAIs), including oseltamivir and zanamivir and 2 investigative NAIs (peramivir and A-315675), was assessed by chemiluminescent neuraminidase inhibition assay using the NAStar Kit (Applied
Biosystems, Foster City, California) (4). The generated IC50 values (i.e., drug concentration needed to inhibit 50 percent of neuraminidase enzyme activity) of test viruses were compared with those of sensitive seasonal control viruses. In addition, because H274Y is the most commonly detected mutation in oseltamivir-resistant viruses (4,5), a set of new primers for pyrosequencing of the N1 gene was designed to monitor a residue of the neuraminidase protein at 274 (275 in N1 numbering) in viruses of swine origin (6,7) [These data are presented as a Table in the original text].
All 13 specimens tested contained the S31N mutation in the M2 protein, which confers cross-resistance to the adamantane class of anti-influenza drugs [Data presented in a table in the original text]. In addition, a partial sequence deduced from the M2 pyrograms revealed changes characteristic for the M gene of S-OIVs. Existing primers used for the detection of adamantane resistance in seasonal viruses do not work with all tested S-OIVs. Optimized primers have been designed and are currently being validated. All 13 tested virus isolates exhibited IC50 values characteristic of oseltamivir- and
zanamivir-sensitive influenza viruses. A/Georgia/17/2006 (H1N1), which is a seasonal virus, was used as a control. The IC50 for oseltamivir ranged from 0.28 nM to 1.41 nM, whereas those for zanamivir ranged from 0.30 nM to 1.34 nM. All tested viruses also were susceptible to peramivir and A-315675. A subset of viruses (n=2) tested in the fluorescent neuraminidase inhibition assay showed IC50 for oseltamivir and zanamivir ranging from 1.50 nM to 2.40 nM, similar to the sensitive control. Among the 36 specimens tested to date with pyrosequencing for the H274Y mutation in N1, none had mutations at residue 274.
[Reported by: L Gubareva, PhD, M Okomo-Adhiambo, PhD, V Deyde, PhD, AM Fry, MD, TG Sheu, R Garten, PhD, C Smith, J Barnes, A Myrick, M Hillman, M Shaw, PhD, C Bridges, MD, A Klimov, PhD, N Cox, PhD, Influenza Div, National Center for Infectious and Respiratory Diseases, Coordinating Center for Infectious Diseases, CDC]
MMWR Editorial Note:
In the United States, 2 classes of antiviral drugs are approved by the Food and Drug Administration (FDA) for use in treating or preventing influenza virus infections: M2 ion channel blockers and NAIs. The M2 blockers (adamantanes) are effective against influenza A viruses but not influenza B viruses, which lack the M2 protein (8). However, use of the M2 blockers has been associated with the rapid emergence of drug-resistance mutations of the M2 protein among human influenza A viruses of H3N2 subtype, and in H1N1 subtype viruses circulating in certain geographic areas (2,3,9). Adamantane resistance also has been detected in A (H5N1) viruses in Southeast Asia (10,11). In addition, adamantane resistance has been reported for swine viruses in Eurasia (12-14) but not in North America. This rapid increase in resistance has reduced the usefulness of this class of drugs for the management of influenza A infections, and since 2005, CDC has not recommended their use (15), although the emergence of resistance to oseltamivir in seasonal influenza viruses circulating during the 2008-09 season led to changes in CDC
recommendations.*
Two NAIs, oseltamivir (Tamiflu [Hoffman-La Roche, Ltd, Basel, Switzerland]) and zanamivir (Relenza [GlaxoSmithKline, Stevenage, United Kingdom]) are FDA-approved drugs for use against type A and type B influenza infections (16). The 2 drugs differ structurally, resulting in oseltamivir being orally bioavailable, whereas zanamivir is not and must be inhaled (17,18). A 3rd NAI, peramivir (BioCryst, Inc., Birmingham, Alabama), is formulated for intravenous
administration and is undergoing clinical trials, and a 4th, called A-315675 (Abbott Laboratories, Abbott Park, Illinois) has only been investigated in preclinical studies.
Compared with M2 blockers, NAIs previously exhibited lower frequency of antiviral resistance during therapeutic use (16,19). However, during the 2007-08 influenza season, emergence and transmission of oseltamivir-resistant A (H1N1) viruses, with a H274Y mutation in the neuraminidase protein, was simultaneously detected in several countries in the Northern Hemisphere (4,20-22) and spread globally (7,9,23). As of April 2009, similar trends have been observed in the 2008-09 influenza season, with many countries reporting up to 100 percent oseltamivir resistance in A (H1N1) viruses. As a result, the World Health Organization Global Influenza Surveillance Network (GISN) and CDC have emphasized the urgent need for close monitoring of resistance to NAIs. Current interim antiviral recommendations for treatment and chemoprophylaxis of swine influenza A (H1N1) viruses include the use of either zanamivir or oseltamivir and are available at <http://www.cdc.gov/swineflu/recommendations.htm>.
References:
(1) CDC. Swine influenza A (H1N1) infection in 2 children---southern California, March--April 2009. MMWR 2009;58:400--2.
(2) Bright RA, Medina MJ, Xu X, et al. Incidence of adamantane resistance among influenza A (H3N2) viruses isolated worldwide from 1994 to 2005: a cause for concern. Lancet 2005;366:1175--81.
(3) Deyde VM, Xu X, Bright RA, et al. Surveillance of resistance to adamantanes among influenza A (H3N2) and A (H1N1) viruses isolated
worldwide. J Infect Dis 2007;196:249--57.
(4) Sheu TG, Deyde VM, Okomo-Adhiambo M, et al. Surveillance for neuraminidase inhibitor resistance among human influenza A and B viruses circulating worldwide in 2004--2008. Antimicrob Agents Chemother 2008;52:3284--92.
(5) Lackenby A, Hungnes O, Dudman SG, et al. Emergence of resistance
to oseltamivir among influenza A (H1N1) viruses in Europe. Euro Surveill 2008;13(5).
(6) Deyde VM, Okomo-Adhiambo M, Sheu TG, et al. Pyrosequencing as a
tool to detect molecular markers of resistance to neuraminidase inhibitors in seasonal influenza A viruses. Antiviral Res 2009;81:16--24.
(7) Lackenby A, Democratis J, Siqueira MM, Zambon MC. Rapid quantitation of neuraminidase inhibitor drug resistance in influenza virus quasispecies. Antivir Ther 2008;13:809--20.
(8) Hayden FG. Adamantadine and rimantadine---clinical aspects. In: DD Richman, ed. Antiviral drug resistance. San Francisco, CA: John Wiley and Sons Ltd.; 1996:59--77.
(9) CDC. Influenza activity---United States and worldwide, 2007--08 season. MMWR 2008;57:692--7.
(10) He G, Qiao J, Dong C, He C, Zhao L, Tian Y. Amantadine-resistance among H5N1 avian influenza viruses isolated in northern China. Antiviral Res 2008;77:72--6.
(11) Cheung CL, Rayner JM, Smith GJ, et al. Distribution of amantadine- resistant H5N1 avian influenza variants in Asia. J Infect Dis 2006;193:1626--9.
(12) Krumbholz A, Schmidtke M, Bergmann S, et al. High prevalence of
amantadine resistance among circulating European porcine influenza A viruses. J Gen Virol 2009;90(Pt 4):900--8.
(13) Schmidtke M, Zell R, Bauer K, et al. Amantadine resistance among
porcine H1N1, H1N2, and H3N2 influenza A viruses isolated in Germany between 1981 and 2001. Intervirology 2006;49:286--93.
(14) Gregory V, Lim W, Cameron K, et al. Infection of a child in Hong Kong by an influenza A H3N2 virus closely related to viruses circulating in European pigs. J Gen Virol 2001;82(Pt 6):1397--406.
(15) Bright RA, Shay DK, Shu B, Cox NJ, Klimov AI. Adamantane resistance among influenza A viruses isolated early during the 2005--2006 influenza season in the United States. JAMA 2006;295:891--4.
(16) Moscona A. Neuraminidase inhibitors for influenza. N Engl J Med
2005;353:1363--73.
(17) Smith BJ, McKimm-Breshkin JL, McDonald M, Fernley RT, Varghese JN, Colman PM. Structural studies of the resistance of influenza virus neuramindase to inhibitors. J Med Chem 2002;45:2207--12.
(18) Colman PM. Zanamivir: an influenza virus neuraminidase inhibitor. Expert Rev Anti Infect Ther 2005;3:191--9.
(19) Monto AS, McKimm-Breschkin JL, Macken C, et al. Detection of influenza viruses resistant to neuraminidase inhibitors in global surveillance during the 1st 3 years of their use. Antimicrob Agents Chemother 2006;50:2395--402.
(20) Dharan NJ, Gubareva LV, Meyer JJ, et al. Infections with oseltamivir-resistant influenza A (H1N1) virus in the United States. JAMA 2009;301:1034--41.
(21) Hauge SH, Dudman S, Borgen K, Lackenby A, Hungnes O. Oseltamivir- resistant influenza viruses A (H1N1), Norway, 2007--08. Emerg Infect Dis 2009;15:155--62.
(22) Meijer A, Lackenby A, Hungnes O, et al. Oseltamivir-resistant influenza virus A (H1N1), Europe, 2007--08 season. Emerg Infect Dis 2009;15:552--60.
(23) Besselaar TG, Naidoo D, Buys A, et al. Widespread oseltamivir resistance in influenza A viruses (H1N1), South Africa. Emerg Infect Dis 2008;14:1809--10.
--
Communicated by:
ProMED-mail
******
[4] Clinical questions
Date: Wed 29 Apr 2009
From: Andre Dascal
This email is addressed to clinicians or public health physicians who have cared for or have knowledge of the clinical presentation of the present swine influenza cases.
We are interested in age specific frequency of symptoms and signs of patients with confirmed swine flu. In addition, we would like to know whether any in the age range of 16 to 64 have been confirmed and had no fever and/or no cough prior to viral testing.
We are aware that fever is part of the present case definition, thus probably most if not all probably have had fever. However, we wonder whether any were tested even though no fever was present.
We also wonder how many had cough vs. other respiratory manifestations.
--
Andre Dascal MD, FRCPC
Associate Professor of Medicine, Microbiology and Immunology,
McGill University
[Any reader able to provide the information requested by Dr Andre Dascal should contact him directly. - Mod.CP]
******
[5] Vaccine production
Date: Wed 29 Apr 2009
Source: Scientific American, 60 Second Science [edited]
<http://www.sciam.com/blog/60-second-science/post.cfm?id=vaccine-makers-await-critical-swine-2009-04-29>
As the World Health Organization (WHO) today [29 Apr 2009] acknowledged the spreading swine influenza virus by moving the pandemic threat awareness level up one notch to 5, the U.S. Centers for Disease Control (CDC) worked to get drug companies the materials they need to create a vaccine. Meanwhile, the U.S. Department of Health and Human Services (HHS) said it is unlikely that any new swine flu vaccine would be included in the batches of seasonal
influenza vaccines already in production for the typical August vaccine ship date.
CDC and others are working to create the virus reference strain by the end of May 2009 that drug companies need to make a vaccine, says Bruce Gellin, Director of HHS's National Vaccine Program Office and the agency's deputy assistant secretary for health. Once these companies make the necessary adjustments to their facilities and processes (which usually takes 2 or more weeks), he adds, they begin developing a pilot vaccine that the National Institutes of Health (NIH) tests to determine the amount of antigen per dose and number of doses, as well as information on safety.
"For a number of reasons, it is unlikely that [a swine flu vaccine] will be included in the seasonal vaccine," Gellin says. "As the seasonal vaccine is currently in the final phases of production, waiting for this additional strain would delay the availability of seasonal vaccine."
In addition, if the new vaccine requires 2 doses, it would complicate use of the seasonal vaccine, as most (except children vaccinated for the 1st time) require only a single dose each year. "We may learn something from the clinical trials," he adds, "but the assumption going in is that a new virus that's not been seen in people before will require 2 doses."
Pharmaceuticals manufacturer Sanofi Pasteur, based in Lyon, France, agrees that the fastest and safest way to proceed is to maintain 2 separate vaccines for swine flu and for seasonal flu. "Production of the seasonal vaccine is well underway," company spokesperson Donna Cary says, confirming that attempts to combine vaccines would delay the seasonal vaccine.
While the extent of the current swine flu spread is yet to be seen, she adds, "we do know that seasonal influenza hospitalizes 200 000 people annually and resulted in about 36 000 deaths (in the U.S.) this year [2009]." The WHO and CDC meet in January each year to determine which influenza strains to include in that year's vaccine, which drug makers typically begin shipping in August.
Biotech firm Novavax, Inc. in Rockville, Md., is one of the few drug makers not waiting for the CDC to provide a live strain of the H1N1 virus. Instead, the company has begun developing a prototype swine flu vaccine using information the CDC has posted to the Global Initiative on Sharing Avian Influenza Data (GISAID) database, launched in 2006 by a number of science institutes and universities worldwide (including the WHO, CDC and Max-Planck-Institute for Informatics) to encourage data-sharing in response to the global spread of the H5N1 avian flu.
"The clock started last week on Friday [24 Apr 2009]," says Gale Smith, vice president of vaccine development for Novavax, which has seasonal flu vaccines in late-stage clinical testing but no products currently on the market. Novavax claims to have developed a virus-like particle (VLP) technology that allows the company to manufacture a vaccine to match a particular virus strain in about 3 months. The recombinant VLPs, created without the use of any genetic material, contain surface proteins that make the particles look like a virus and can elicit an immune response, even though they lack the genes needed to replicate themselves.
Despite being a relative newcomer with a largely untested technique, Novavax is hoping to create a vaccine that could be given emergency approval for use by first responders, if no other vaccines are available, Smith says. The company plans to have a prototype vaccine to show the CDC or HHS within 3 months. Novavax's seasonal flu vaccine is currently in Phase III trials for efficacy and safety, but it could be years before that vaccine receives FDA approval.
As the vaccine makers await the materials needed get their products off the ground, London-based GlaxoSmithKline is ramping up production of its antiviral drug Relenza (zanamivir). Lab testing on oseltamivir (Tamiflu) and zanamivir indicates they could be up to 90 percent effective in staving off the current swine flu virus, according to the CDC <http://www.cdc.gov/swineflu/antiviral_swine.htm>.
The swine influenza A (H1N1) viruses found in humans over the past week are resistant to the other 2 anti-influenza drugs on the market, amantadine (Symmetrel) and rimantadine (Flumadine).
[Byline: Larry Greenemeier]
--
Communicated by:
ProMED-mail
******
[6] CDC guidance guidance for infection control in healthcare facilities
Date: Wed 29 Apr 2009
Source: CDC
<http://www.cdc.gov/swineflu/guidelines_infection_control.htm>
Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting
This document provides interim guidance for healthcare facilities (e.g., hospitals, long-term care and outpatient facilities, and other settings where healthcare is provided) and will be updated as needed.
[The full guidance can be found at the above URL. - Mod.LM]
--
Communicated by:
ProMED-mail Rapporteur Brent Barrett
******
[7] Interim Guidance for Clinicians
Date: Wed 29 Apr 2009
Source: CDC
<http://www.cdc.gov/swineflu/identifyingpatients.htm>
Interim Guidance for Clinicians on Identifying and Caring for Patients with Swine-origin Influenza A (H1N1) Virus Infection
This document provides interim guidance for clinicians who might provide care for patients with swine-origin influenza A (H1N1) or suspected swine-origin influenza A (H1N1) virus infection. It will be periodically updated as information becomes available.
[The full guidance can be found at the above URL. - Mod.LM]
--
Communicated by:
ProMED-mail Rapporteur Brent Barrett
Reasonable Rascal
05-01-09, 09:20
INFLUENZA A (H1N1) - WORLDWIDE (02): CASE COUNTS
***********************************************
A ProMED-mail post
In this update:
[1] WHO - global update
[2] PAHO - America's region update
[3] CDC - USA update
[4] Mexico - MOH update
[5] Canada - Health Protection Agency
[6] Newly confirmed countries with cases
[7] News briefs
******
[1] WHO - global update
Date: 30 Apr 2009
Source: WHO Epidemic and Pandemic Alert and Response (EPR) [edited]
<http://www.who.int/csr/don/2009_04_30_a/en/index.html>
Influenza A(H1N1) - update 6
---------------------------------
The situation continues to evolve rapidly. As of 17:00 GMT, 30 Apr 2009, 11 countries have officially reported 257 cases of influenza A (H1N1) infection.
The United States Government has reported 109 laboratory confirmed human cases, including one death. Mexico has reported 97 confirmed human cases of infection, including 7 deaths.
The following countries have reported laboratory confirmed cases with no deaths: Austria (1), Canada (19), Germany (3), Israel (2), Netherlands (1), New Zealand (3), Spain (13), Switzerland (1) and the United Kingdom (8).
Further information on the situation will be available on the WHO website on a regular basis.
WHO advises no restriction of regular travel or closure of borders. It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities.
There is also no risk of infection from this virus from consumption of well-cooked pork and pork products. Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.
--
Communicated by:
ProMED-mail
******
[2] PAHO - America's region
Date: 30 Apr 2009
Source: PAHO Epidemiological Alerts Vol. 6, No. 16 [edited]
<http://new.paho.org/hq/index.php?option=com_content&task=view&id=1289&Itemid=569>
Influenza cases by a new sub-type: Regional Update ([30 Apr 2009])
-------------------------------------
On 18 Apr 2009, the National IHR Focal Point of the United States notified the laboratory confirmation of 2 human cases of swine influenza A/H1N1 in 2 children of 9 and 10 years old living in the State of California (one in the County of San Diego and the other one in Imperial County).
To date, the United States has confirmed a total of 109 human cases of swine influenza A H1N1: 1 in Arizona, 14 in California, 1 in Indiana, 2 in Kansas, 2 in Massachusetts, 1 in Michigan, 1 in Nevada, 50 in New York City, 1 in Ohio, 10 in South Carolina and 26 in Texas. Other suspected cases are being investigated. Five hospitalizations and a death have been registered. The dead case is a child of 22 months old from Mexico who died in a hospital of Houston, Texas area.
The most recent cases detected as well as the registered death suggest that more serious cases could appear in the United States.
From [17 to 29 Apr 2009], Mexico has reported 1918 suspected cases of
influenza with severe pneumonia, including 84 deaths. The suspected cases were recorded in all Mexican states, most of them in the Federal District, Guanajuato, State of Mexico, Aguascalientes, Queretaro and San Luis Potosi. The majority of these have occurred in previously healthy young adult people. There have been few cases in individuals under 3 or over 59 years old. 933 of the suspected cases are currently hospitalized.
The number of probable cases of swine influenza A H1N1 remains at 286, and a total of 97 cases has been confirmed. The considerable variation in the number of confirmed cases as of today [30 Apr 2009] is due to the recent laboratory confirmation of samples collected in previous weeks. The number of confirmed dead cases remains at 7. This figure is also subject to variations depending on the new laboratory information.
In Canada to date, 19 human cases of swine influenza A H1N1 have been
confirmed (2 in Alberta, 4 in the province of New Scotland, 6 in British Columbia and 7 in Ontario), some of them with recent trip history to Cancun, Mexico. All the cases developed a mild form of influenza-like illness. Two of the cases presented, in addition, gastrointestinal symptoms. All of them are currently recovered, and none required hospitalization. Laboratory tests were conducted in Winnipeg, Canada. "Indigenous" transmission is not discarded, since not all the confirmed cases have trip history to Mexico.
The press has reported information on suspected cases in several countries of the region; however this information has not been confirmed.
International Health Regulations (IHR):
At the request of the Director-General (DG) of WHO, the IHR Emergence
Committee has been summoned and is advising the DG on the event. On its 1st day of deliberation, [25 Apr 2009], it concluded that the present event constitutes a Public Health Emergency of International Concern.
On [29 Apr 2009], the DG decided to elevate the pandemic alert to Phase 5. In order to come to this urgent decision, the DG considered epidemiological information from the most affected countries, as well as the result of the scientific meeting held that same day. The latter indicated existence of sustained outbreaks of swine influenza A H1N1 at the community level in more countries within the region.
The decision to increase the pandemic level of the alert should permit Member States to provide the required leadership and coordination as well as to consider the possibility of executing their contingency plans.
The DG recommends not closing borders or restricting travel. However, it is prudent for people who are sick to delay travel. Moreover, returning travelers who have become sick should seek medical attention in line with guidance from national authorities.
Production of seasonal vaccine should continue, but at the same time, WHO is making all the efforts to facilitate the process of development of a vaccine against swine influenza A H1N1.
The committee will continue to advise the DG on the basis of the available information.
--
Communicated by:
ProMED-mail
[For a map of distribution of cases in the Americas region, see
<http://new.paho.org/hq/index.php?option=com_content&task=view&id=1289&Itemid=569>.
- Mod.MPP]
******
[3] CDC - USA update
Date: 30 Apr 2009
Source: CDC H1N1 flu website [edited]
<http://www.cdc.gov/swineflu/>
The Swine Flu website, last updated 30 Apr 2009, 10:30 AM ET: U.S.
Human Cases of H1N1 Flu Infection (As of [30 Apr 2009], 10:30 AM ET
[GMT-4])
----------------------------------------
States: No. of lab. confirmed cases / Deaths
Arizona: 1 / 0
California: 14 / 0
Indiana: 1 / 0
Kansas: 2 / 0
Massachusetts: 2 / 0
Michigan: 1 / 0
Nevada: 1 / 0
New York: 50 / 0
Ohio: 1 / 0
South Carolina: 10 / 0
Texas: 26 / 1
Total counts: 109 cases / 1 death
In response to an intensifying outbreak in the United States and internationally caused by a new influenza virus of swine origin, the World Health Organization raised the worldwide pandemic alert level to Phase 5 on [29 Apr 2009]. A Phase 5 alert is a "strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short."
The United States government has declared a public health emergency in the United States. CDC's response goals are to reduce transmission and illness severity and provide information to help health care providers, public health officials and the public address the challenges posed by this emergency. CDC is issuing and updating interim guidance daily in response to the rapidly evolving situation. CDC's Division of the Strategic National Stockpile (SNS) continues to send antiviral drugs, personal protective equipment, and respiratory protection devices to all 50 states and U.S. territories to help them respond to the outbreak. The swine influenza A (H1N1) virus is susceptible to the prescription antiviral drugs oseltamivir and zanamivir. In addition, the federal government and manufacturers have begun the process of developing a vaccine against this new virus.
--
Communicated by:
ProMED-mail
******
[4] Mexico - MOH update
Date: 30 Apr 2009
Source: Secretaria de Salud website (MOH) [trans. Mod.MPP, edited]
<http://portal.salud.gob.mx/contenidos/noticias/influenza/estadisticas.html>
Statistics:
Cumulative number of cases as of 29 Apr 2009
---------------
Cases:
Total Severe Acute Respiratory infection Influenza A(H1N1) suspected: 1918
Total probable cases of Influenza A(H1N1): 286
Total confirmed cases of Influenza A(H1N1): 99
Deaths:
Total deaths Influenza A(H1N1) suspected: 84
Total deaths Influenza A(H1N1) confirmed: 8
--
Communicated by:
ProMED-mail <promed@promedmail.org>
******
[5] Canada - Health Protection Agency
Date: 30 Apr 2009
Source: Health Protection Agency [edited]
<http://www.phac-aspc.gc.ca/alert-alerte/swine-porcine/surveillance-eng.php>
The Public Health Agency is committed to sharing information about the human swine influenza cases with Canadians. This page will be updated as PHAC receives confirmation of human swine influenza cases from provinces and territories.
Province: Confirmed cases of human swine influenza
Alberta: 6
British Columbia: 11
Nova Scotia: 8
Quebec: 1
Ontario: 8
Total: 34
--
Communicated by:
ProMED-mail
******
[6] Newly confirmed countries with cases
a. Netherlands
Date: 30 Apr 2009
From: R.A.M. Fouchier <r.fouchier@erasmusmc.nl>
Mexican influenza virus detected in the Netherlands on [Wed 29 Apr 2009]
------------------------
The National Influenza Centre (NIC) of the Netherlands, a cooperation
between the National Institute for Public Health and the Environment (RIVM) in Bilthoven and Erasmus MC in Rotterdam, detected the 1st case of infection with the Mexican influenza virus in the Netherlands.
The patient is a 3-year-old child that traveled with the family from Mexico to The Netherlands on [27 Apr 2009], arriving in Amsterdam around midday. The child developed fever (greater than 39.5 C) the same evening and respiratory symptoms. In compliance with national advisories, the case was notified to public health authorities, and a nasopharyngeal specimen was collected on [28 Apr 2009] for diagnostic testing.
The clinical specimen arrived for testing on [29 Apr 2009] and was found positive for influenza A virus by real-time quantitative reverse transcription polymerase chain reaction (Q-RT-PCR) with primers specific for the matrix gene. Q-RT-PCR tests performed in parallel with primers specific for the hemagglutinin gene of human A/H3N2 and A/H1N1 viruses were negative, but RT-PCR tests based on avian/swine N1 and the novel influenza virus H1 tested positive. Based on these results, contact tracing and oseltamivir treatment of
the case and contacts were initiated. Additional generic RT-PCR tests with conserved primers against H1 and N1 were done, and sequence analyses of the PCR fragments in both laboratories yielded nearly full-length hemagglutinin (HA) and neuraminidase (NA) gene sequences. The HA gene of A/Netherlands/602/2009 (H1N1) displayed one to a few nucleotide differences as compared to sequences from human cases of infection in Mexico and the USA. The NA gene displayed 3 or more nucleotide differences to sequences from Mexico and the USA. The sequence of the NA gene indicates that the virus is sensitive to neuraminidase inhibitors. The sequences were deposited in the GISAID database (<http://platform.gisaid.org>). Virus isolation in eggs and cell cultures, full genome sequencing, and additional laboratory investigations are ongoing.
The patient is currently doing reasonably well, with only mild symptoms. She is under treatment with oseltamivir. Close contacts of the patient are on prophylactic oseltamivir, after being swabbed for virological evaluation. The contacts in the flight (same row, and 2 rows in either direction) are being approached by the health authorities and will be treated with antivirals and monitored if needed.
For the National Institute for Public Health and the Environment, Bilthoven: M. Koopmans, H. Ruijs, B. Wilbrink, A. Meijer, M. Jonges, M. van der Lubben, J. van Steenbergen, R.A. Coutinho
For Erasmus MC, Rotterdam: R.A.M. Fouchier, C.A.B. Boucher, M. Schutten, G.F. Rimmelzwaan, A.D.M.E. Osterhaus
--
R.A.M. Fouchier
******
b. Germany - 1st human to human transmission
Date: 30 Apr 2009
Source: Bavarian Press release (URL not available) [edited]
Press release from Bavarian health institute (data from 30 Apr 2009
11:00 GMT+2):
-----------------------------------
There are an actual 5 probable cases in addition to the 2 confirmed cases of influenza A/H1N1 in Bavaria, according to the Bavarian health institute. These cases fulfill the clinical picture and had contact with infected persons or have been tested positive, but the test has not been confirmed by a national reference center (RKI).
Statement from the local Rural District Office of Landshut (from 30 Apr 2009): Two of these suspected cases were infected during stay in the regional hospital in Mallersdorf (ICU) with the confirmed case, who is now being treated in the university clinic of Regensburg, and before the case was isolated. One is a patient who shared the room with the confirmed case in the ICU of the regional hospital, and the 2nd patient is a nurse. Both are not severely ill and are staying at home but show the typical clinical symptoms of influenza. They are receiving Tamiflu and are being treated in a daycare setting.
--
Communicated by:
Dr. Oliver Schmetzer
Max-Delbruck-Centrum for molecular medicine
Molecular Immunotherapy
Robert-Roessle-Str. 10
13125 Berlin
Germany
******
[7] News briefs
Date: 30 Apr 2009
[Below are links to newswires with information on suspected cases in
countries and other events of potential interest. The newswires are full of reports of suspected cases in many countries. Reports have been filtered and discarded as more information becomes available during the day. - Mod.MPP]
Americas
Honduras - 1st case confirmed influenza type A, subclassification
pending. Specimens sent to CDC/Atlanta
<http://www.laprensahn.com/Especiales/Ediciones/2009/04/30/Noticias/Confirman-1er.-caso-de-influenza-tipo-A-en-Honduras>
Costa Rica - 2 cases confirmed
<http://insidecostarica.com/dailynews/2009/april/30/nac01.htm>
Europe
Scotland - probable case, contact of cases returning from Mexico (local human to human transmission)
<http://www.guardian.co.uk/world/2009/apr/30/swine-flu-case-probable-scotland>
Pacific
Japan - suspected case, travel to British Columbia, Canada
<http://home.kyodo.co.jp/modules/fstStory/index.php?storyid=436501>
--
Communicated by:
ProMED-mail Rapporteur A-lan Banks
ProMED-mail Rapporteur Kunihiko Iizuka
[To summarize the current situation as of 30 Apr 2009, there have been a total of 257 cases of influenza A (H1N1) infection officially reported coming from 11 countries. The USA has reported 109, laboratory confirmed cases coming from 11 states, and one death in a Mexican child visiting in the USA. This represents an increase of 18 newly confirmed cases in the past 24 hours and a new state reporting cases (South Carolina). Canada has reported 34 cases from 5 provinces with no deaths, representing an increase of 15 newly confirmed cases and a new province reporting cases (Quebec) in the past 24 hours. Mexico has reported 1918 suspected cases of severe pneumonia related to H1N1, 286 cases of probable influenza A(H1N1) infection and 99
confirmed influenza A(H1N1) cases, with 84 suspected deaths and 8 confirmed deaths. The major increase in confirmed cases in Mexico in the past 24 hours represents laboratory result availability and not a major increase in the reported number of new cases.
There are reports of spread to contacts of cases in Germany and Scotland. With the exception of Mexico, there does not appear to be significant community based spread elsewhere as yet. - Mod.MPP]
Reasonable Rascal
05-02-09, 09:19
Number of confirmed H1N1 cases worldwide soars
http://www.cnn.com/2009/HEALTH/05/02/swine.flu/index.html
GENEVA, Switzerland (CNN) -- Confirmed cases of swine flu jumped by more than 65 percent Saturday with the World Health Organization reporting 615 people in 15 countries infected with the virus commonly known as swine flu.
The organization had reported 367 cases on Friday. The jump in cases was due to ongoing testing of a backlog of specimens in Mexico, the WHO said.
The most cases were in Mexico, where 397 people were infected and 16 deaths were attributed to the virus, according to the WHO. Next was the United States, which has 141 cases and one death.
"What the increase reflects is that we are moving forward in confirming many of the cases that have been left untested for some time, so in an way that's reassuring," said WHO spokesman Paul Garwood.
"We know that these cases are being dealt with, these specimens are being looked at and assessed, and we're getting more and more info about this virus.
"So we haven't seen, say, a spike in new cases or new influenza cases appearing in Mexico City, for example," Garwood continued. "It's just the fact that this reporting backlog is bearing fruit and we're seeing the results of that."
The latest developments come as parts of Asia discovered they were not immune to the spread of the virus.
Hundreds of guests and staff were under quarantine in China on Saturday after health officials determined that a hotel guest had contracted the H1N1 virus.
Nearly 200 hotel guests and 100 staff members were ordered to stay in Metro Park Hotel in Hong Kong for seven days to stop the spread of the H1N1 virus, a government spokesman said.
The quarantine was ordered after a 25 -year-old Mexican man stayed in the hotel and became sick, according to the spokesman. The man reportedly flew from Mexico to Shanghai on April 30 and then went to Hong Kong.
The traveler was taken to a hospital and tests confirmed that he had the virus, said York Chow, the secretary for food and health.
Chow said officials would isolate the hotel and that "relevant people" would be quarantined for seven days and treated with an anti-viral medication, commonly known as Tamiflu.
It is the first confirmed case of the virus in Hong Kong, local medical officials said. None of the cases have been confirmed in mainland China.
South Korean officials on Saturday confirmed their first case -- a 51-year-old nun who recently traveled to Mexico for volunteer work.
The other countries with confirmed cases are Canada, with 34; Spain and the United Kingdom, which each have 13; Germany and New Zealand, which each have four; Israel, with two; and Austria, China, Denmark, France, the Netherlands, South Korea, and Switzerland, which each have one.
As the number of swine flu cases across the globe is expected to rise, scientists are racing to develop a vaccine to confront the virus.
The Centers for Disease Control and Prevention in Atlanta, Georgia, hopes to have a vaccine for the virus available to manufacturers within a month, said Michael Shaw, the U.S. agency's lab team leader for the virus response.
"We're doing the best we can as fast as we can," he said.
Still, it would take four to six months from the time the appropriate strain is identified before the first doses become available, said Dr. Marie-Paule Kieny, WHO director of the Initiative for Vaccine Research.
"Of course, we would like to have a vaccine tomorrow. We would have wanted to have it yesterday," she said. "It's a long journey."
Kieny said there is "no doubt" that a vaccine can be made "in a relatively short period of time."
Producing a vaccine involves isolating a strain of the virus, which has already been done, and tweaking it so manufacturers can make a vaccine, Kieny said.
As researchers work, the mayor of Mexico City expressed optimism Friday.
Authorities in Mexico are "beginning to see evidence that the (virus) might be letting up, and the number of people who have been hospitalized has leveled out in regards to people who are contagious, at least as of yesterday," Mayor Marcelo Ebrard told reporters.
"I do not say this so that we lower our guard or so that we think that we do not have a problem anymore," he said.
"We do have a problem, but I say this so that we know where we are as a city after we have done all we have done, and in what direction we are heading and how much we have progressed. And what I can say is that we are heading in the right direction."
One death in the United States has been attributed to swine flu -- a toddler from Mexico whose family brought him to Texas for medical treatment.
At a Cabinet meeting Friday, President Barack Obama praised the "extraordinary" government response to the virus but emphasized that "we also need to prepare for the long term."
"Since we know that these kinds of threats can emerge at any moment, even if it turns out that the H1N1 is relatively mild on the front end, it could come back in a more virulent form during the actual flu season, and that's why we are investing in our public health infrastructure."
Several other countries were investigating hundreds of other probable cases of the virus.
Reasonable Rascal
05-08-09, 00:41
Influenza A (H1N1) - worldwide (05)
***********************************
A ProMED-mail post
in this update:
[1] Vaccine logistics
[2] Surveillance history
[3] H5N1 and H1N1 overlap
******
[1] Vaccine logistics
Date: Fri 1 May 2009
Source: Associated Press report [edited]
<http://www.google.com/hostednews/ap/article/ALeqM5hbKFbEJSbD1GsU3Tw0MMrLIjv3EAD97TKI1O0>
WHO will take vaccine gamble with swine flu
-------------------------------------------
When World Health Organization [WHO] officials ask vaccine manufacturers to start producing vaccine to fight swine flu in a few weeks, they will be taking a calculated risk. Flu vaccine companies can only make one vaccine at a time: either seasonal flu vaccine or pandemic vaccine. Production takes months and it is impossible to switch halfway through if health officials make a mistake. While some countries like the United States may be better prepared than others American officials say production for next year's vaccine batch is so
advanced they're nearly finished, whereas the situation for many other countries is unknown.
About 70 percent of the world's flu vaccines are made in Europe, and the WHO is trying to figure out how many doses of seasonal flu vaccine remain worldwide before asking vaccine manufacturers to start pumping out pandemic vaccine instead. "It's a big decision...We've never done this before," said Marie-Paule Kieny, director of the WHO's Initiative for Vaccine Research. Kieny said the decision would be like guessing which vaccine the world will need most, but that the WHO would try to hedge its bets by tallying existing seasonal flu vaccine stocks. "We are gambling whether or not we will have enough seasonal vaccine, but it will not be an 'either-or' situation," she said.
Vaccine makers can make limited amounts of both seasonal flu vaccine and pandemic vaccine though not at the same time but they cannot make
massive quantities of both because that exceeds capacity. The impending decision to make pandemic vaccine will also complicate matters for countries in the southern hemisphere, where the flu season is just starting. The WHO usually makes recommendations about which seasonal flu strains should go into next year's southern hemisphere flu vaccine in September. But if vaccine manufacturers are already making pandemic vaccine in the fall, that will mean fewer doses of flu vaccine for people in the southern hemisphere.
Regular flu kills between 250 000 to 500 000 people worldwide every year. So far, swine flu appears relatively mild, except in Mexico. Until experts know how contagious and deadly the virus is, they won't know how many people actually need to be vaccinated. If it remains mild, it is possible many people won't need a shot. But if swine flu evolves into a more deadly strain, more shots may be needed to protect wider swathes of the population. Another possible complication is that the pandemic vaccine will be made using the strain available now; whether that will work if the virus mutates isn't certain. At the moment, the WHO has a bit of breathing space. The key component for the pandemic vaccine, the "seed stock" from the swine flu virus, will not be available for a few weeks. The WHO has already put major vaccine makers on alert they may be asked to switch to making pandemic vaccine soon. According to Chris Viehbacher, chief executive of Sanofi-Aventis, Europe's biggest vaccine maker, his scientists are "working around the clock" on preparations for making a swine flu vaccine for when the WHO comes calling.
But they too are waiting for more information. "It is premature to forecast how many doses of swine flu vaccine we could produce," Viehbacher said, noting the company needs to see how much antigen, the active ingredient in a vaccine, is required for each shot. If all goes well, the 1st doses should be available several months after production begins.
In the U.S., the government hasn't yet decided what to order. "It would all depend on how the outbreaks and the emergency unfolds," said Dr. Ruben Donis of the Centers for Disease Control and Prevention, who is heading the U.S. vaccine work. Vaccine makers have a few options when it comes to making pandemic vaccine. They could add the pandemic strain to the regular vaccine, but adding that extra strain reduces the number of shots you can make. Manufacturers might also use adjuvants, components used to stretch a vaccine's active ingredient.
Recent work on H5N1 vaccines, the bird flu strain many thought would ignite the next pandemic, may also help. John Treanor, a vaccines expert at the University of Rochester said that adjuvants developed during H5N1 research may come in handy now. He said public health officials were indeed facing a vaccine dilemma. "There is only a certain amount of capacity for vaccine manufacturing," he said. "One has to make some well-reasoned choices, sometimes based on incomplete information."
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
[A question which has still to be addressed in this debate is the extent to which vaccination with seasonal influenza virus vaccine will provide some degree of immunity or amelioration of symptoms in vaccinees. The symptoms of the illness in those experiencing infection with the novel H5N1 strain with few infections have been mild (the Mexican population apart). It would be interesting to know to what extent this relates to the seasonal influenza virus history of patients. - Mod.CP]
******
[2] Surveillance history
Date: Sat 2 May 2009
Source: The New York Times [edited]
<http://www.nytimes.com/2009/05/02/health/02global.html>
Questions Linger Over the Value of a Global Illness Surveillance System
-----------------------------------------------------------------------
Dr. Scott Dowell was sorting through e-mail messages on 20 Apr 2009 at the Centers for Disease Control and Prevention [CDC] in Atlanta when he decided to cruise through that day's outbreak reports from the agency's Global Disease Detection center.
The agency receives scores of such reports every day, and a team of analysts sorts through them looking for patterns. But Dr. Dowell, the Director of the CDC's division of global disease detection and emergency response, said he liked to puzzle over them himself on occasion. And that day, reports from Mexico caught his attention. Mexican authorities had noticed a worrisome increase in severe pneumonia among young adults. He recalled that just 3 days earlier a colleague had told him about 2 children in California who had contracted a unique form of swine flu. The odd thing was that these
children did not live on a farm. In fact, they had had no known contact with pigs.
Now these Mexican pneumonia cases. Dr. Dowell sent an e-mail message
to a colleague. "Hard to see from these 3 reports whether this is above expected," he wrote, according to an e-mail message provided to The New York Times. "Well worth watching however, in view of the new swine influenza virus in San Diego and the connection with Mexico." Dr. Dowell's intuition would soon pay off when swabs from Mexican flu patients were found to have a flu strain identical to those of the 2 Californians, a finding that would confirm the possibility of the 1st global flu pandemic in more than 40 years.
The discovery resulted from an expensive and evolving illness surveillance system constructed over the past decade. Did the system work? Was it sensitive enough to catch a serious outbreak quickly and save lives? Or was it too sensitive, alerting the world to a virus no more dangerous than the usual seasonal flu bugs? The answers cannot be known for days, if not weeks.
One of the 1st hints that Mexico had a problem came to the World Health Organization (WHO) on 10 Apr 2009 in an unofficial report. The Geneva-based organization has an extensive intelligence network of hundreds of its own offices and thousands of experts. It also uses a sophisticated media and Internet scanning group to uncover reports of strange or unreported illnesses that governments miss. The 10 Apr 2009 report was from its media group, which had found articles reporting a cluster of acute respiratory illnesses in La Gloria, Mexico, a pork-producing town in the state of Veracruz.
"Most of the signals we pick up don't turn out to be anything," said Dr. Michael Ryan, director of the WHO's Global Alert Response. "We can't call up countries 10 times a day and ask what's going on." Dr. Ryan's team decided that this report was serious enough to ask Mexican authorities about. "It was unusual because it was the end of the flu season," he said. On 12 Apr 2009, Mexican authorities responded by saying that they had investigated the outbreak and determined that it had ended on 3 Apr 2009, satisfying Dr. Ryan's team, Dr. Ryan said. That same day, Mexican authorities alerted the
CDC to unexplained cases of severe respiratory illness. On 17 Apr 2009, the multiple surveillance systems at the WHO uncovered a report of an unusual case of a pneumonia death in Mexico that was reported to be similar to those in China during an outbreak of SARS (severe acute respiratory syndrome). "Again, we requested verification from Mexican authorities," Dr. Ryan said. A few hours later, Mexican authorities responded that lab tests had failed to find any connection to a SARS-like virus or even a flu virus. "At that point, we were reassured," Dr. Ryan said.
On 22 Apr 2009, Mexican authorities formally alerted the WHO about a worrisome increase in pneumonia cases among young adults, a report Mexico had sent to the CDC 2 days earlier. On 23 Apr 2009, a CDC test confirmed that the Mexican cases were identical to those in California, and officials realized they had a potential pandemic. Mexico's chief government epidemiologist, Dr. Miguel Angel Lezana, said this week that his center alerted the Pan American Health Organization, a regional arm of the WHO, on April 16 about an unusually late rash of flu and pneumonia cases in Mexico. Officials at the regional group said they received a notification on 18 Apr 2009 that Mexico had declared the alert. Then, 2 days later, on a teleconference call, the CDC, the Pan American Health Organization, and Mexican and Canadian health authorities discussed what measures of cooperation they could take.
The next day, Mexico updated its information, reporting that it had found "atypical behavior of influenza in different cities." By 22 Apr 2009, health authorities from the 3 countries were back at another teleconference call to assess the risk. Although there have been questions about whether information moved back and forth quickly enough across the different agencies, Dr. Lezana said that "there was an intense and fluid exchange between ourselves and our colleagues." Dr. Ryan praised the swift responses from Mexican authorities to queries from the WHO, and he said a few days would hardly have mattered to the global response to the outbreak. Dr. Dowell agreed. Genetic testing suggests that the original swine flu virus, known as
influenza A(H1N1), probably jumped from pigs to humans sometime between late November 2008 and January 2009, and that the virus began infecting large numbers of people sometime in mid-March 2009. [The jump from swine to humans is conjecture and is not supported so far by evidence. - Mod.CP]
If officials could have somehow learned of the initial outbreak in mid-March and blitzed the La Gloria region with antiviral drugs like Tamiflu, the outbreak might have been contained, Dr. Dowell said. But once it began popping up in various regions of Mexico, containment became impossible and mitigation measures like vaccine production, which needs weeks and months, not days, became the next response. "I'm struggling to understand [how] anyone who thinks the public health response would have been different if this was reported globally on 20 or 22 Apr 2009 instead of the 23rd," Dr. Ryan said.
There is little evidence that the swine flu outbreak is any more dangerous than routine infections from the usual strains of seasonal flu viruses. So whether the world's improved surveillance system provided a benefit or simply scared millions of people needlessly is still uncertain. Dr. Dowell said he had no doubts that early warnings of even relatively mild, new flu strains are important. "Seasonal flu viruses cause 36 000 deaths every year, and if this new pathogen causes that much disease and death, that's significant," Dr. Dowell said. "If we have an opportunity to slow the spread, buy ourselves
time and reduce the number of people who get infected, that's definitely worth doing."
[Byline: Gardiner Harris]
--
Communicated by:
ProMED-mail
[Proper evaluation of this outbreak will depend on elucidation of the evolution of the complex genome of this virus and the identity of its swine and non-swine hosts prior to its appearance in humans Mexico. There may not be a quick answer. - Mod.CP]
******
[3] H1N1 and H5N1 range overlap
Date: Sat 2 May 2009
From: Michael Steinle
[B]H5N1 and H5N1
-------------
Perhaps I have just missed it, but I am surprised that no one has talked about the fact that H1N1 and H5N1 are now present simultaneously in at least 2 regions -- Egypt and Southeast Asia. H1N1 is seemingly very transmissible but not very lethal (comparatively) and H5N1 is not readily transmissible but relatively virulent. The possibility of cross-infection and a resulting very transmissible and virulent strain seems more plausible now. Is there any research on this issue?
--
Michael Steinle
[Since 2003 avian A (H5N1) influenza virus has had opportunity to interact with human strains of seasonal (H1N1 and H3N2) influenza virus, but that so far this is not known to have occurred. It may be that the overlap of the ranges of the novel H1N1 strain and H5N1 avian influenza virus has increased the probability of interaction and evolution of a human transmissible H5N1 strain. However it is not apparent yet that the novel H1N1 is more transmissible than the current seasonal influenza viruses, nor that its spread will be sustained during the northern hemisphere summer. - Mod.CP]
Reasonable Rascal
05-08-09, 00:43
WHO: Influenza A(H1N1) - update 12
submited by kickingbird at May, 4, 2009 6:27 AM from WHO
3 May 2009 -- As of 1600 GMT, 3 May 2009, 18 countries have officially reported 898 cases of influenza A(H1N1) infection.
Mexico has reported 506 confirmed human cases of infection, including 19 deaths. The higher number of cases from Mexico in the past 48 hours reflects ongoing testing of previously collected specimens. The United States Government has reported 226 laboratory confirmed human cases, including one death.
The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (85), China, Hong Kong Special Administrative Region (1), Costa Rica (1), Denmark (1), France (2), Germany (8), Ireland (1), Israel (3), Italy (1), Netherlands (1), New Zealand (4), Republic of Korea (1), Spain (40), Switzerland (1) and the United Kingdom (15).
Further information on the situation will be available on the WHO website on a regular basis.
WHO advises no restriction of regular travel or closure of borders.It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities.
Canada on 2 May reported the identification of the A(H1N1) virus in a swine herd in Alberta. It is highly probable that the pigs were exposed to the virus from a Canadian farm worker recently returned from Mexico, who had exhibited flu-like symptoms and had contact with the pigs. There is no indication of virus adaptation through transfer from human to pigs at this time.
There is no risk of infection from this virus from consumption of well-cooked pork and pork products.
Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.
Reasonable Rascal
05-08-09, 00:55
INFLUENZA A (H1N1) - WORLDWIDE (07)
***********************************
A ProMED-mail post
In this update:
[1] Vaccine Logistics: Correction
[2] Multi-drug strategy
[3] Celia Alpuche interview
[4] 'Ground zero' village
[5] H5N1 in swine
******
[1] Vaccine logistics: Correction of "Influenza A (H1N1) - worldwide
(05)" 20090503.1657
The moderator comment from a report discussing the logistics of production of a vaccine for the novel influenza A (H1N1) in the ProMED report "Influenza A (H1N1) - worldwide (05)" 20090503.1657 stated: "infections with the novel H5N1 strain with few infections have been mild" rather than "infections with the novel H1N1 strain with few exceptions have been mild" The corrected full comment is reproduced below. ProMED apologizes for the error. - Mod.LM
[A question which has still to be addressed in this debate is the extent to which vaccination with seasonal influenza virus vaccine will provide some degree of immunity or amelioration of symptoms in vaccinees. The symptoms of the illness in those experiencing infection with the novel H1N1 strain with few exceptions have been mild (the Mexican population apart). It would be interesting to know to what extent this relates to the seasonal influenza virus history of patients. - Mod.CP]
******
[2] Multi-drug strategy
Date: Fri 1 May 2009
Source: The New Scientist [edited]
<http://www.newscientist.com/article/dn17069-multidrug-strategy-could-slow-pandemic-spread.html>
Multi-drug strategy could slow pandemic spread
----------------------------------------------
How individual countries deploy their flu drugs may be key to determining the size of any pandemic that emerges from the current H1N1 outbreak. That's the conclusion of a mathematical model of flu transmission by an international team of researchers. The findings also suggest that countries that stockpile just one of the 2 commonly used flu drugs may have trouble controlling a major pandemic.
"If you can hold off using your primary drug until the cumulative number of cases reaches a sufficiently high number, you reduce the spread of resistance and the final number of cases," says team member Joseph Wu at the University of Hong Kong. "The key is to make sure the source population has good control of antiviral drugs, then all countries downstream benefit. If the source loses control then these strategies won't work," he says.
There are 2 anti-flu drugs that are commonly stockpiled for use in a flu pandemic: oseltamivir, which is sold as Tamiflu, and zanamivir, which is sold as Relenza. Both work by inhibiting an enzyme called neuraminidase that the virus needs to replicate, but they act on different parts of the enzyme and resistance to one drug does not confer resistance to the other. The Mexican H1N1 strain is currently sensitive to both drugs, but no one knows how long that will last.
The Wu team conducted their study after noticing that despite concerns about resistance, many countries stockpile just one drug, usually oseltamivir. There are some exceptions, however, including Australia and the UK, which stockpile both drugs.
Viruses are notorious for their ability to develop resistance to drugs. Last year (2008), an H1N1 flu strain that caused some seasonal flu rapidly developed resistance to oseltamivir. By December, "close to 100 percent of H1N1 in Australia and the US, and many other parts of the world, were resistant to Tamiflu," says Raina MacIntyre, an infectious disease expert at the University of New South Wales in Sydney, Australia.
To work out whether initially treating patients from a smaller stockpile of a secondary anti-flu drug could delay the emergence of resistance, the Wu team ran a mathematical model of a flu outbreak in a theoretical "closed" population of 6.8 million the size of Hong Kong. In the model, doctors either prescribed just one drug, both drugs in combination, or prescribed one, then switched to the other when supplies of the 1st drug ran out.
The 2 strategies that used more than one drug decreased the number of people who finally became infected from 68 to 58 percent. It also reduced the chance of resistance emerging from 38 to just 2 percent, which would translate into a significant number of lives saved, says Wu.
When the model included international travel between the "index" population and 105 large cities to take into account the possibility that people might spread resistant strains, the 2 strategies that used more than one drug reduced the final number of people infected and the emergence of resistance to a similar degree.
As the safety of using 2 drugs together has not been assessed, the most practical strategy would be to use a limited supply of one drug 1st, and then switch to the other, says Wu. Zanamivir, which is less popular because it has to be inhaled, is the obvious drug of choice for the limited-supply drug. However, it has not been approved to treat young children.
"Cross-resistance to both drugs at the same time is highly unlikely, so using the 2 drugs cleverly might be able to delay the emergence of resistance," says epidemiologist Jodie McVernon at Melbourne University, Victoria, Australia, who was not involved in the study. McVernon's team have previously used mathematical modelling to show that resistance can also be delayed by using one of the drugs to treat active flu infections, and the other to prevent infection. "In Australia, where the stock pile is enough for 40 percent of the population, we are keen to use drugs to prevent cases and spread early on, because it's far more effective at limiting the pandemic," she says.
The Wu model only considers drug resistance that is caused by treatment with the drug, and not resistance that emerges from mixing of viruses, or natural mutation. Wu points out that simply avoiding using either drug until numbers of sick people had reached a certain threshold would have the same effect as using 2 drugs in succession. "But medically that would be unethical, so you need to use a 2nd drug," he says. "In a scenario where lots of drugs are being used over a short period of time, drug resistance will probably emerge, and efficacy would be substantially weakened," says Wu.
The modelling study was carried with researchers from Harvard University and the Health Protection Agency in London, as well as the University of Hong Kong. (An account of this research will be published in the journal PLoS Medicine)
[Byline: Rachel Nowak]
******
[3] Celia Alpuche interview
Date: Fri 1 May 2009
Source: ScienceInsider [abbreviated and edited]
<http://blogs.sciencemag.org/scienceinsider/2009/05/exclusive-inter.html>
[An Interview With Head of Mexico's Top Swine Flu Lab Microbiologist. Celia Alpuche, who heads the laboratory in Mexico that has become ground zero for the country's outbreak of swine flu, spoke to Science yesterday from her office at the Instituto de Diagnpstico y Referencia Epidemiologicos (InDRE) in Mexico City.]
Celia Alpuche: Many people have raised questions about whether Mexico could have detected this outbreak earlier and contained it before it spread elsewhere. But as Alpuche explains, InDRE had a confusing situation because the virus surfaced in the middle of flu season -- and it may not have originated in Mexico anyway. Alpuche also sets the record straight about why it took several weeks to link the outbreak to the 1st case with symptoms, a 4-year-old boy from La Gloria in Veracruz state. And she frankly describes the limitations of her own lab.
InDRE has worked closely with the Public Health Agency of Canada and the U.S. Centers for Disease Control and Prevention (CDC) to identify the virus as the cause of the outbreak, and Mexico continues to collaborate to test samples of suspected cases. As of 1 May 2009, Mexico had 156 confirmed cases and 9 deaths, more than any country in the world. Mexico has identified another 1918 suspected cases, as described in the CDC's Morbidity and Mortality Weekly Report (MMWR) yesterday [30 Apr 2009], and InDRE is rushing to sort out how many are actually swine flu.
Influenza is caused by 2 strains, A and B, and several different subtypes that are designated by the 2 proteins that stud the viral surface, hemagglutinin and neuraminidase, followed by a number. The outbreak is caused by an influenza A virus of the subtype H1N1.
Question by ScienceInsider: There have been many questions about the origin and the timing. When was there an indication that there were an unusual number of respiratory cases?
Alpuche: On 7 Apr 2009, we heard that the National Institute of Respiratory Disease was having unusually severe cases of pneumonia in young adults who were previously healthy. Immediately, we started to get the data around this cluster. We also started to do a retrospective analysis of the influenza data we had. We looked at all data that we had regarding influenza detection since January [2009] up to this month and also to compare to the past season of influenza. In addition to the unusual pneumonia, we started to have rumors there were other cases that were not pneumonia, it was like a respiratory disease, an influenza-like illness. The 1st thing that it told us is that we were still detecting influenza in the country, not just in Mexico City. It was pretty much the same as we see every year except it was a prolongation of the flu season. Then we analyzed the subtypes of the strains of influenza, and one of the unusual things we saw was that in this season, we had the 1st peak in the last part of November and December and another one in February. Over the season, we started having more influenza B than we had the year before.
It was very confusing. We found that 37 percent of cases were B and the year before we only found up to 15 percent were B. Then we looked at data that they have in the influenza surveillance system at CDC to see if were having something unusual. We saw also in United States something kind of similar -- a prolonged period of influenza and increases of strain B. So we thought that we were having something related to influenza, and we were still concerned about the pneumonia cases. We went back immediately to look at all the influenza outbreaks we had in the country since the season started to see if this was more related to the prolonged influenza or there was something else we were seeing. We had small outbreaks in some states in the central part of Mexico, Tlaxcala, and then the last outbreak we had was in Veracruz state, in the town of La Gloria, near Perote. That was in the last 2 weeks of March.
ScienceInsider question: Why didn't that trigger concern in the last 2 weeks of March?
Alpuche: It was influenza-like illness, no fatalities and no pneumonia cases. This outbreak was deeply studied with state epidemiologists. The secretary of health of Veracruz did a wonderful job during the outbreak in the last 2 weeks of March.
ScienceOnsider: What capability did they have for typing subtypes?
Alpuche: The influenza, laboratory-based surveillance network in Mexico is using immunofluorescence -- that's the screening test, and it's using antibodies against A and B. So that's what the public health state lab is doing.
ScienceInsider: So they don't have subtype tests and had to refer the
samples to you?
Alpuche: Yes. Not immediately, because if there's nothing unusual, they wait to get accumulated cases and then send to the national referral center. One of the interesting things in this outbreak is they were testing, but the onset of symptoms was after 4 or 5 days. The sensitivity of the immunofluorescence test is low after 72 hours. Most of the tests, which were nasopharyngeal swabs, were negative. In the last part of the outbreak in La Gloria, children started having symptoms 1 Apr 2009. They took the samples 3 Apr 2009. They sent the samples to the public health state lab, and they were processed 4 Apr 2009. These arrived at my lab on 8 Apr 2009. They only identified 3 influenza strains at the end of the period. One turned out be H3N2.
The other was A, but it was not heartening. Here at our lab, we were considering that it could be H1, but it looked indeterminate. To be honest, we were not able to type it. And then we had a B. At that moment, we didn't have any information about the untypeable A's that they saw in the California children.
ScienceInsider: In the surveillance program here in California, if you cannot type it, you send it on to the CDC.
Alpuche: That's what we do. Our collaboration center is the CDC. We have 3 different deadlines to do the accumulation of samples to send to the CDC during the season. When we had that 1st indeterminate strain from La Gloria, we were not worried. By that time, the outbreak was controlled.
ScienceInsider: On 12 Apr 2009, Mexico notified the Pan American Health Organization as per the International Health Regulations about the influenza-like outbreak in Veracruz. Initially, did you think these cases looked like influenza?
Alpuche: No, our initial thinking, as we reported according to the International Health Regulations, was that we were having intensification and prolongation of the influenza period. We thought the outbreaks of Tlaxcala and Perote were nothing unusual in terms of the pneumonia. Those were later on, and then we started to consider that there was something unusual. Then we got a notification of an isolated case, a 37-year-old woman, diabetic, who died because of respiratory disease and pneumonia in Oaxaca. The woman had onset of symptoms 4 Apr 2009. There was no connection at all with Perote. We got samples, and it was a lung biopsy because the relatives didn't allow an autopsy. They intensively investigated the contacts around these deaths. They found some with respiratory diseases but no fatalities. Nothing unusual. They were tested, and all were negative for influenza and other viruses.
ScienceOnsider: When did you 1st contact Frank Plummer, head of the National Microbiology Lab at the Public Health Agency of Canada?
Alpuche: I contacted him 17 Apr 2009 by e-mail, and he answered immediately. He wanted to know more about this, and we had a long conversation on Saturday, 18 Apr 2009.
ScienceInsider: Frank told me that he initially didn't think influenza. He thought it would be an unknown pathogen.
Alpuche: Exactly. And we discussed that with Dr. Plummer. In fact, I was the one who called him because I'm the lab person. I met him through the Global Health Security Action Group. And we've been talking about different collaborations, and immediately when we began discussing this and the epidemiology, we wanted to rule out everything we could. Canada had a lot of experience with the screening of the severe acute respiratory syndrome, SARS, of unknown pathogenesis.
ScienceInsider: When were samples sent to Canada and the CDC?
Alpuche: 21 Apr 2009. We asked for help from both at same time. The CDC is my collaborating center in the WHO network. They always help us, doing quality assessment for us, giving us reagents, doing training, transferring technology. But to do shipping for both of them, it was kind of hard. It was a little delayed to get all the permission from the U.S.
ScienceInsider: Was your decision to send it to Canada also because U.S. authorities were holding up your samples?
Alpuche: No, not at all. I sent these samples to the CDC because they are my collaboration center. That's the way to do it. We get all the help we need from the CDC.
Science Insider: When did you 1st hear back from Frank Plummer about your samples?
Alpuche: We got the preliminary results 22 Apr 2009. Dr. Plummer got the samples at 3:00 in the afternoon, and by midnight he was calling me to say we had influenza A. Some of the samples I sent him, we knew they were influenza A. That week, we started seeing the A's and we started to change our mind about this influenza B prolongation of the seasonal influenza.
ScienceInsider: When did you learn that they were positive for a new swine flu virus?
Alpuche: I 1st learned that it was swine from Frank Plummer; that was in the afternoon of 23 Apr 2009. And later that night Dr. Nancy Cox [of CDC] in a teleconference we had with Mexican experts, we were discussing this and she gave us the preliminary results that we have some swine strains, the ones that just arrived that day at the CDC.
Science: Many laboratories in Mexico City I've visited are very sophisticated. What are the limitations that prevented your lab from identifying the new H1N1? What did the CDC and Canada have that you
didn't have?
Alpuche: The only place in Mexico doing subtyping is this lab here. We are able to sequence and subtype, but we are overwhelmed with samples of influenza and other things from all around the country. It's a ittle bit slower than in the U.S. or Canada. Since this week, we have experts from the CDC and Canada helping us to set up a real-time PCR [polymerase chain reaction] technology to test for swine H1N1 directly.
ScienceInsider: Is your lab the only lab in the country at this point
that can do the confirmatory test with the real-time PCR machines?
Alpuche: At this point, yes, but we're working with the CDC and Canada to train molecular biologists in different institutions in 6 different states in Mexico. We have 2 real-time PCR machines we were able to get immediately -- we borrowed one from the company. And now we bought 10 more machines. We are working full-time to speed up the diagnostics. Right now, we have a backlog of around 1000 tests that we're rushing to do on time. We're having 3 shifts of people working, during the morning, afternoon, and overnight.
ScienceInsider: A lot of Mexican press and now press outside of Mexico has written about La Gloria and the large pig farm in nearby Perote, Granjas Carroll. There are all these allegations and even conspiracy theories. What about the boy in La Gloria who has received so much attention?
Alpuche: It was mild disease, no problem.
ScienceInsider: Is it accurate that he is the index case?
Alpuche: We're not sure about that. By the onset of symptoms, he's the 1st we're seeing in our database, that's all. The date of onset was 1 Apr 2009
ScienceInsider: There have been all these stories of Perote as the epicenter, or the originator. Do you believe that?
Alpuche: We've been asking agriculture authorities, and they ensured us that they didn't detect any problems with outbreaks with animals in these farms near Perote. And the farm is 80 kilometers [50 miles] from La Gloria.
ScienceInsider: One of the theories is that this originated in the United States or elsewhere and a human came to Mexico, possibly a migrant. The assumption that it was a big pig farm could be very misleading.
Alpuche: Could be. That's the same thought we have. We need more data to prove it. One of the interesting thing is, we're seeing these cases isolated in Oaxaca and Perote, they are well-known for migration. And also the other state that we're seeing several cases now during the active epidemic is San Luis Potosi, and it's like the corridor for migration. It's hard to believe that it's going to be associated with this farm, but I know that the authorities are thoroughly investigated it.
ScienceInsider: Do you think if this surfaced somewhere other than Mexico it would have been contained, or does influenza just move too quickly anyway?
Alpuche: Considering it was the end of the season, maybe that confused the fact a little that something else could grow, but probably influenza moves too quickly anyway.
--
Communicated by;
Philip Henika
******
[4] 'Ground zero' village
Date: Sun 3 May 2009
Source: Haaretz newspaper [edited]
<http://www.haaretz.com/hasen/spages/1082555.html>
'Ground zero' swine flu village gets new facilities, but few answers
--------------------------------------------------------------------
At the end of a dirt road leading to the village of La Gloria in Mexico's Veracruz State, 4 hours from Mexico City, the local authorities hung a new sign in broken English welcoming visitors to the village, attesting that it is swine flu-free. It is just one of the changes that has occurred here in the past month.
In his cinder block home, with concrete floor and blue walls, hung with pictures of Jesus and the Virgin of Guadalupe, Edgar Hernandez shows no interest in speaking to any more of the reporters who have been besieging his home for the past week. The 5-year-old, in his Sponge Bob T-shirt, keeps to the other room, watching a video on a broken-down television set. He leaves the reporters to his mother, Maria Carmen. It all started, she says, on 1 Apr 2009. "Edgar had a headache and a sore throat, and soon his whole body was hurting. By night his fever was 40 degrees Celsius [104 degrees F]. I gave him a sponge bath and in the morning I took him to the village clinic." La Gloria, population 2243, has no doctor. The nurse sent Maria and Edgar home with antibiotics and paracetemol. For 3 days, Edgar burned up with fever, but 2 days later his fever was gone. The next day, he returned to kindergarten, his mother says.
Then, 2 weeks ago, representatives of the Mexican Health Ministry came to the village. "They told me that Edgar had been very sick with flu. They took him to the clinic again, they did a biopsy and brought him home. I am so angry; how could it be that I have a child at home with such a serious illness and no one told me about it. Why did our clinic not have the right medicine?" Maria said. Maria attributes the fact that Edgar got better not to to antibiotics, but to the Virgin Mary who she says blessed her and her husband with Edgar and his brother Jonathan after years of trying to conceive.
There is a great deal of confusion in the homes along the unpaved lanes of the poor village about the epidemic that might have visited here. People say that before Edgar got sick, an 8-year-old girl had died, although no one knows whether it was from swine flu. Last month 6 elderly villagers died, but some say they succumbed to a freak cold snap in February. People in the village eke out a living raising corn, and blue agave for tequila, but most work at odd jobs in distant cities.
When the Mexican government released a report 10 days ago indicating that the 1st person to contract swine flu was a boy from La Gloria, health experts, followed by the media, began to try to track the disease. One theory is that the virus spread from a huge industrial pig farm near the village. Villagers who went to work in the big cities spread the virus to the rest of Mexico, it was said.
Some people reported climate changes, strange clouds and odors from one of the farms. The Mexican government hotly denies such a connection, and is doing all it can to protect Granjas Carroll, which operates the farms, 50 percent of which is owned by a large U.S. food producer that is the biggest employer in the region. Granjas Carroll is also conducting tours for journalists at one of its farms to show its attentiveness to sanitation.
In addition to showing the world it is dealing effectively with the disease, the government suddenly paved the 9-kilometer road connecting La Gloria to the nearest town, Perote. Dozens of government vehicles were brought in to build a new clinic, and an abundance of antiviral medications have appeared in the old clinic, which has been freshly painted. A field kitchen, a mobile cafe, an information center and a tent with advanced communications equipment has been put up for press conferences. Signs praising the government's work in developing the area have also been installed. All under the watchful eyes of soldiers armed with M-16s.
Dr. Jonathan Perez, in charge of Health Ministry activities in the village, insists that there was "just one case of H1N1 flu in the village - the boy Edgar." If that is the case, why were hundreds of people been brought in to take care of the village? "We had to check everyone and immunize them. We spread disinfectant powder and checked all the pigs and birds raised here. But I can promise you that we found no additional signs of the virus." Perez also denies that the flu came from nearby pig farms and that the virus spread from La Gloria to the rest of the country, since he says the farms are 8 kilometers [5 miles] away and no signs of the virus were found on it. He also notes that almost immediately after Edgar Hernandez got sick a woman in a town 1000 miles away also contracted the viruses.
[Byline: Anshel Pfeffer]
--
Communicated by;
ProMED-mail
******
[5] H5N1 in swine
Date: Thu 30 Apr 2009
Source: The Daily Shimbun online [edited]
<http://www.asahi.com/special/09015/TKY200905030162.html>
Study shows new H5N1 strain may mutate in pigs
----------------------------------------------
A high proportion of pigs in Indonesia carry the highly infectious H5N1 avian influenza virus -- something that could mutate into a new strain inside the pigs, according to research by the Kobe University Center for Infectious Diseases. It is feared that if the virus mutates inside pigs and becomes transmittable between humans, it could pose a far greater threat to people than the current outbreak of swine flu. The World Health Organization is taking precautions regarding a likely scenario of a new strain that is highly contagious between people being formed in this way.
The center detected the H5N1 virus in 52 pigs -- more than one in ten of the 402 pigs it examined in 4 Indonesian provinces. Pigs are capable of transmitting the virus to birds and people. On further analysis of the H5N1 virus detected in the 52 pigs, the center found a strain of a type of virus that could be transmitted to humans in some cases. "It's a surprising result," said Yoshiyuki Nagai, director of the Center of Research Network for Infectious Diseases. "Perhaps we are looking at the process by which a new strain of influenza becomes infectious [in humans?]. We need to be vigilant."
--
Communicated by:
correspondent Kunihiko Iizuka
[According to our correspondent a similar report published (in Japanese) in the Sun 3 May 2009 issue of Asahi Shimbun (see: <http://www.asahi.com/special/09015/TKY200905030162.html>) states that the research was conducted with Airlannnga University in Indonesia during 2005-07 in 4 states on Indonesia. 52 pigs were infected with H5N1 among 402 pigs. One case [isolate?] was a type able to infect both humans and birds.
An account of these investigations has been posted on ProMED-mail previously; see Avian influenza (30): Indonesia, swine 20090403.1289.
These data need to be analyzed in detail. Further information would be welcomed from anyone familiar with this research. The greater risk will be co-infection of pigs with the 2009 H1N1 virus and the avian H5N1 virus which potentially might accelerate the evolution of a human-transmissible version of the H5N1 virus to which the human population has no inherent immunity. - Mod.CP]
Reasonable Rascal
05-08-09, 01:02
WHO: Influenza A(H1N1) - update 13
submited by kickingbird at May, 4, 2009 14:55 PM from WHO
http://www.flu.org.cn/en/news_detail?action=ql&uid=&pd=&newsId=14893
4 May 2009 -- As of 06:00 GMT, 4 May 2009, 20 countries have officially reported 985 cases of influenza A (H1N1) infection.
Mexico has reported 590 laboratory confirmed human cases of infection, including 25 deaths. The higher number of cases from Mexico reflects ongoing testing of previously collected specimens. The United States has reported 226 laboratory confirmed human cases, including one death.
The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (85), China, Hong Kong Special Administrative Region (1), Costa Rica (1), Colombia (1), Denmark (1), El Salvador (2), France (2), Germany (8), Ireland (1), Israel (3), Italy (1), Netherlands (1), New Zealand (4), Republic of Korea (1), Spain (40), Switzerland (1) and the United Kingdom (15).
There is no risk of infection from this virus from consumption of well-cooked pork and pork products.
It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities. Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.
WHO advises no restriction of regular travel or closure of borders.
Further information on the situation will be available on the WHO website on a regular basis.
Reasonable Rascal
05-08-09, 01:13
INFLUENZA A (H1N1) - WORLDWIDE (12): CASE COUNTS
***************************************
A ProMED-mail post
[Please note that there may be discrepancies between the various
sources of information due to different times of "closure" of daily
figures reported. Times of daily report closures where known are
listed in the table of contents below. Oftentimes a newswire will
mention a confirmed case in a location that has not been on the
official reporting entity list as the confirmation arrived after
closure of the day's report. - Mod.MPP]
******
[1] WHO - global update
Date: 5 May 2009
Source: WHO Epidemic and Pandemic Alert and Response (EPR)
<http://www.who.int/csr/en/>
a. Influenza A(H1N1) - update 15 -- 5 May 2009
<http://www.who.int/csr/don/2009_05_05/en/index.html>
As of 06:00 GMT, 5 May 2009, 21 countries have officially reported
1124 cases of influenza A (H1N1) infection.
Mexico has reported 590 laboratory confirmed human cases of
infection, including 25 deaths. The United States has reported 286 laboratory confirmed human cases, including one death.
The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (140), China, Hong Kong Special Administrative Region (1), Costa Rica (1), Colombia (1), Denmark (1), El Salvador (2), France (4), Germany (8), Ireland (1), Israel (4), Italy (2), Netherlands (1), New Zealand (6), Portugal (1), Republic of Korea (1), Spain (54), Switzerland (1) and the United Kingdom (18).
It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities. Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.
WHO advises no restriction of regular travel or closure of borders.
There is no risk of infection from this virus from consumption of well-cooked pork and pork products.
Reasonable Rascal
05-08-09, 01:35
INFLUENZA A (H1N1) - WORLDWIDE (16): CASE COUNTS
***********************************************
A ProMED-mail post
[Please note that there may be discrepancies between the various sources of information due to different times of "closure" of daily figures reported. Times of daily report closures when known are listed in the table of contents below. Oftentimes, a newswire will mention a confirmed case in a location that has not been on the official reporting entity list, as the confirmation arrived after
closure of the day's report. - Mod.MPP]
******
[1] WHO - global update (16:00 GMT)
Date: 7 May 2009
Source: WHO Epidemic and Pandemic Alert and Response (EPR) [edited]
<http://www.who.int/csr/en/>
a. Influenza A(H1N1) - update 19 - 7 May 2009
<http://www.who.int/csr/don/2009_05_07/en/index.html>
As of 06:00 GMT, 7 May 2009, 23 countries have officially reported 2099 cases of influenza A(H1N1) infection.
Mexico has reported 1112 laboratory confirmed human cases of infection, including 42 deaths. The United States has reported 642 laboratory confirmed human cases, including 2 deaths.
The following countries have reported laboratory confirmed cases with no deaths: Austria (1), Canada (201), China, Hong Kong Special Administrative Region (1), Colombia (1), Costa Rica (1), Denmark (1), El Salvador (2), France (5), Germany (9), Guatemala (1), Ireland (1), Israel (4), Italy (5), Netherlands (1), New Zealand (5), Portugal (1), Republic of Korea (2), Spain (73), Sweden (1), Switzerland (1) and the United Kingdom (28).
Reasonable Rascal
05-10-09, 10:14
WHO: Influenza A(H1N1) - update 22
submited by kickingbird at May, 9, 2009 7:37 AM from WHO
8 May 2009 -- As of 16:00 GMT, 8 May 2009, 25 countries have officially reported 2500 cases of influenza A (H1N1) infection.
Mexico has reported 1204 laboratory confirmed human cases of infection, including 44 deaths. The United States has reported 896 laboratory confirmed human cases, including two deaths.
The following countries have reported laboratory confirmed cases with no deaths - Austria (1), Brazil (4), Canada (214), China, Hong Kong Special Administrative Region (1), Colombia (1), Costa Rica (1), Denmark (1), El Salvador (2), France (12), Germany (11), Guatemala (1), Ireland (1), Israel (7), Italy (6), Netherlands (3), New Zealand (5), Poland (1), Portugal (1), Republic of Korea (3), Spain (88), Sweden (1), Switzerland (1) and the United Kingdom (34).
WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus.
Reasonable Rascal
05-10-09, 10:19
WHO: Influenza A(H1N1) - update 23
submited by kickingbird at May, 9, 2009 20:42 PM from WHO
http://www.flu.org.cn/en/news_detail?action=ql&uid=&pd=&newsId=14913
9 May 2009 -- As of 06:00 GMT, 9 May 2009, 29 countries have officially reported 3440 cases of influenza A(H1N1) infection.
Mexico has reported 1364 laboratory confirmed human cases of infection, including 45 deaths. The United States has reported 1639 laboratory confirmed human cases, including two deaths. Canada has reported 242 laboratory confirmed human cases, including one death.
The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Brazil (6), China, Hong Kong Special Administrative Region (1), Colombia (1), Costa Rica (1), Denmark (1), El Salvador (2), France (12), Germany (11), Guatemala (1), Ireland (1), Israel (7), Italy (6), Japan (3), Netherlands (3), New Zealand (5), Panama (2), Poland (1), Portugal (1), Republic of Korea (3), Spain (88), Sweden (1), Switzerland (1) and the United Kingdom (34).
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