AVIAN INFLUENZA, HUMAN - MBDS REGION (16):) WHO VIET NAM (THANH HOA

Date: Wed 6 May 2009
Source: WHO Epidemic and Pandemic Alert and Response (EPR) disease
outbreak news [edited]
<http://www.who.int/csr/don/2009_05_06c/en/index.html>


Avian influenza situation in Viet Nam - update 6
------------------------------------------------
The Ministry of Health has reported a new confirmed case of human
infection with the H5N1 avian influenza virus. The case has been
confirmed at the National Institute of Hygiene and Epidemiology (NIHE).

The case is a 23 year old woman from Quan Hoa District, Thanh Hoa
Province. She developed symptoms on [16 Apr 2009], was hospitalized
on [21 Apr 2009], and died on [22 Apr 2009].

Investigation into the source of infection indicated poultry died of
influenza A/(H5N1) around her household.

Of the 111 cases confirmed to date in Viet Nam, 56 have been fatal.

--
Communicated by:
ProMED-MBDS
<promed-mbds@promedmail.org>

[The death of a 23 year old female from Thanh Hoa province (see prior
PRO/MBDS posting Avian influenza, human - MBDS region (15): Viet Nam
(Thanh Hoa) 20090426.1573) has been confirmed by WHO to be due to
H5N1 avian influenza infection.

A concurrent H5N1 outbreak in poultry was reported from Quan Hoa
district, Thanh Hoa province, and confirmed by the Department of
Animal Health in Viet Nam (see prior PRO/MBDS posting Avian influenza
- MBDS region (22): Viet Nam (Quang Ngai, Thanh Hoa) 20090430.1627).

The cumulative number of confirmed human cases of avian influenza A
(H5N1) reported to WHO and dated 6 May 2009, is available at
<http://www.who.int/csr/disease/avian_influenza/country/cases_table_2009_05_06/en/index.html>.
Viet Nam has reported 4 cases and 4 deaths of H5N1 infection during
2009, and a total of 111 cases and 56 deaths since the beginning of 2003.

For maps of Viet Nam with provinces, see
<http://www.lib.utexas.edu/maps/middle_east_and_asia/vietnam_admin01.jpg>
and <http://www.angelfire.com/co/hongnam/vnmap.html>. The interactive
HealthMap/ProMED-mail with direct links to other outbreaks in Viet
Nam and surrounding countries reported on ProMED-mail and PRO/MBDS
can be accessed at <http://healthmap.org/r/00bm>. - Mod.YMA]

AVIAN INFLUENZA, HUMAN (86): EGYPT, AGE-SPECIFIC RATES

Date: Thu 7 May 2009
Source: Eurosurveillance, Volume 14, Issue 18 [edited]
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=1919>


Age-specific infection and death rates for human A(H5N1) avian
influenza in Egypt. By J. P. Dudley, Science Applications
International Corporation, Modeling and Analysis Division, Rockville,
Maryland, United States
-----------------------------------------------
The age-specific infection and death profiles among confirmed human
cases of influenza A(H5N1) infection in Egypt differ markedly from
those recorded in other countries. The case fatality rate among human
H5N1 cases in Egypt is 34 percent, versus an average of 66 percent in
other countries. In Egypt, children younger than 10 years comprise 48
percent of reported cases, nearly twice the global average of
approximately 25 percent, and no H5N1 fatalities have been confirmed
among individuals in this age group as of 23 Apr 2009. Females
outnumber males among confirmed H5N1 cases by a factor of nearly 2:1,
and 90 percent of reported fatalities in Egypt have been females. The
evident age and sex biases in morbidity and mortality among H5N1
cases in Egypt are phenomena that warrant further investigation and analysis.

Introduction:
The 1st cases of human infection with avian influenza type A(H5N1)
were reported from Egypt in March 2006, and a cumulative total of 67
confirmed cases including 23 fatalities have been reported as of 23
Apr 2009 [1]. There are evident anomalies in the age distribution and
sex ratio of human mortality from influenza A(H5N1) in Egypt relative
to those reported from other countries that warrant detailed
investigation and analysis.

Methods:
Published information on human H5N1 cases in Egypt was analysed to
develop a 1st order comparative analysis of age-specific and
sex-specific infection and mortality patterns between human H5N1
cases in Egypt and those in other areas of the world. The age and
case history data of patients with confirmed influenza A(H5N1)
infection in Egypt used in this analysis were derived from reports
published by the United States Naval Medical Research Unit No. 3 in
Cairo, Egypt [2] and the World Health Organization (WHO), available
as of 23 Apr 2009 [1].

Results:
Human H5N1 cases in Egypt are most frequently reported among children
younger than 10 years, and approximately 80 percent of all reported
cases have occurred among individuals under the age of 30 years. In
Egypt, children under the age of 10 years comprise 48 percent of all
reported cases, nearly double the current global average of
approximately 25 percent [3]. A median age of 8 years has been
reported for human H5N1 cases in Egypt between March 2006 and March
2009 [2], versus a median age of 18 years for WHO-confirmed human
cases globally between November 2003 and November 2006 [4].

The age-specific infection and death profiles among confirmed human
A(H5N1) cases in Egypt differ markedly from those recorded in Asia
and Indonesia when compared to cumulative data for countries
worldwide other than Egypt, Nigeria, and Turkey [These data are
illustrated by 2 figures in the original text.]. The case fatality
rate from human H5N1 cases in Egypt confirmed as of 23 Apr 2009 is
only 34 percent (23 of 67), versus an average of 66 percent among
WHO-confirmed cases from all countries other than Egypt (234 of 354
cases as of 23 Apr 2009) [5].

Human mortality from H5N1 in Egypt is highly biased towards females
(90 percent: 21 females, 2 males), with confirmed mortality only
reported among individuals older than 9 years. Although the sex ratio
of cases in most countries is approximately 1:1, females outnumber
males among confirmed cases in Egypt by a factor of nearly 2:1 (43
females: 24 males). Although the average case fatality rate from H5N1
among children aged 0-9 years from all countries other than Egypt and
Turkey is 59 percent, no confirmed fatalities among 33 children in
this age cohort have been reported from Egypt as of 23 Apr 2009. A
similar pattern is evident for H5N1 cases in Turkey during January
2006; although 11 of 21 confirmed H5N1 cases in Turkey were children
in the age group 0-9 years, no confirmed fatalities were reported in
this age cohort [6].

Discussion:
There is increasing concern that undetected H5N1 cases may be
occurring in Egypt, given the evident anomalies in observed age-
specific and sex-specific case incidence and fatality rates. Although
there appears to be no compelling evidence for human-to-human
transmission of H5N1 in Egypt, family clusters have been observed in
Egypt, and H5N1 clusters involving highly probable human-to-human
transmission have been documented in China, Thailand, Viet Nam,
Indonesia, and Pakistan [7].

The most characteristic presentation of humans with fatal H5N1 virus
infections is severe lower respiratory disease accompanied by
hypercytokinaemia of the alveolar tissues. The pathology of most
fatal H5N1 cases resembles those of fatal human severe acute
respiratory syndrome (SARS) infections, and a suspected SARS case in
China during November 2003 was subsequently confirmed as a fatal H5N1 case [8].

The existing anomalies with regard to age and sex may be attributable
in part to the existence of undetected fatal or non-fatal atypical or
asymptomatic human H5N1 infections. Although human infections with
the H5N1 virus are typically associated with respiratory symptoms,
the clinical spectrum of H5N1 infections in humans is extremely
broad, and H5N1 virus has been recovered from lung, brain, large
intestine, small intestine, cerebrospinal fluid, kidney, spleen,
liver, pharynx, blood, and placental tissues [9]. Fatal atypical
human H5N1 infections involving only gastrointestinal and
neurological symptoms have been documented from patients in Viet Nam
and Thailand [10]. Asymptomatic human infections with H5N1 have been
reported from China, Viet Nam, Japan, Thailand, and Korea [11].

Clinically mild illness from highly pathogenic avian influenza (HPAI)
H5N1 virus infection has been reported from children in most
countries, but the early detection and treatment of possible cases
may be a factor in the overall lower case fatality rate reported for
H5N1 cases in Egypt. Although a median time of 4 days from symptom
onset to hospitalization has been reported for H5N1 cases worldwide
[4], nearly 50 percent of confirmed cases in Egypt are admitted to
hospitals within 24 hours after the 1st onset of symptoms, and
approximately 70 percent are hospitalized within 72 hours after
symptom onset [2].

Conclusions:
The evident age and sex biases in the incidence of infection and
mortality among H5N1 cases from Egypt are phenomena that have not
been fully explained and merit further in-depth investigation and
analysis. Further research is needed to understand the immediate and
long-term health risks of avian influenzas for human populations and
to identify those members of exposed populations who are at greatest
risk of infection and serious disease from avian influenza viruses.
Although most cases in Egypt can be linked to contact with diseased
poultry, increasing numbers of confirmed human H5N1 cases with no
evident history of direct exposure to diseased poultry or birds are
being reported from China and Indonesia. Efforts need to be made to
evaluate potential background rates of asymptomatic and mild cases of
human avian influenza in communities where human H5N1 clusters have
been documented and to evaluate potential instances of human-to-human
transmission of H5N1 in Egypt.

References:
(1) World Health Organization. Epidemic and Pandemic Alert and
Response (EPR). Disease outbreaks by country. Egypt. Geneva: World
Health Organization; 2009 Apr 23. Available from:
<http://www.who.int/csr/don/2009_04_23a/en/index.html>.
(2) United States Naval Medical Research Unit No. 3. Influenza
Activities Report. February-March 2009. Egypt. Available from:
<http://www.geis.fhp.osd.mil/GEIS/SurveillanceActivities/Influenza/Reports/NAMRU3_March_2009.pdf>.
(3) World Health Organization Western Pacific Regional Office. Avian
Influenza A(H5N1) Cases by Age Group and Outcome. Geneva: World
Health Organization Western Pacific Regional Office; 2009 Mar 23.
Available from:
<http://www.wpro.who.int/NR/rdonlyres/FD4AC2FD-B7C8-4A13-A32C-6CF328A0C036/0/Slide4.jpg>.
(4) Peiris JSM, de Jong MD, Guan Y. Avian influenza virus (H5N1): a
threat to human health. Clin Microbiol Rev. 2007;20(2):243-67. Available from:
<http://cmr.asm.org/cgi/content/full/20/2/243#Transmission_and_Epidemiology>.
(5) Epidemic and Pandemic Alert and Response (EPR). Cumulative Number
of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO.
Geneva: World Health Organization; 2009 Apr 23. Available from:
<http://www.who.int/csr/disease/avian_influenza/country/cases_table_2009_04_23/en/index.html>.
(6) World Health Organization. Epidemic and Pandemic Alert and
Response (EPR). Disease outbreaks by country. Turkey. Available from:
<http://www.who.int/csr/don/2006_01_18/en/index.html>.
(7) Nicoll A. (Yet) another human A/H5N1 influenza case and cluster -
when should Europe be concerned? Euro Surveill.
2008;13(15):pii=18833. Available from:
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18833>.
(8) Zhu QY, Qin ED, Wang W, Yu J, Liu BH, Hu Y, et al. Fatal
infection with influenza A (H5N1) virus in China. New Engl J Med.
2006;354(25): 2731-2. Available from:
<http://content.nejm.org/cgi/content/full/354/25/2731>.
(9) Ng WF, To KF. Pathology of human H5N1 infection: new findings.
Lancet 2007;370(9593):1106-8.
(10) de Jong MD, Hien TT. Avian influenza A (H5N1). J Clin Virol.
2006;35(1):2-13. Available from:
<http://www.prbo.org/cms/docs/birdflu/deJong_and_Hien_2006_J%5B1%5D._Clinical_Virology.pdf>.
(11) Dudley JP. Public health and epidemiological considerations for
avian influenza risk mapping and risk assessment. Ecology and Society
2008;13(2):21. Available from:
<http://www.ecologyandsociety.org/vol13/iss2/art21/>.

Reports suggest elderly Alberta woman with swine flu has died

hursday, May 7, 2009 6:11 PM MT Comments8Recommended14

CBC News

Reports emerged Thursday night that an elderly woman who had swine flu has died in northern Alberta.

It's not clear whether she had any other underlying conditions.

CBC News put the question to Alberta's health minister at 2:30 p.m. MT, and he stated at that time that he had no information about the case.

Vical shares rise on U.S. Navy deal for H1N1 flu vaccine

Last Updated: 2009-05-07 14:00:34 -0400 (Reuters Health)

By Vidya L Nathan

BANGALORE (Reuters) - Shares of Vical Inc surged 31 percent, after the biotechnology company said it was in pact with the U.S. Navy for the development of a vaccine against the H1N1 strain of influenza virus and posted a narrower quarterly loss.

On Wednesday, the company said the development program aims to advance a Vaxfectin-formulated H1N1 DNA vaccine into clinical testing as quickly as possible. [ID:nBNG448760]

Vaxfectin is the company's experimental influenza product. Vical did not disclose the terms of the agreement.

The deal will help Vical get partners for its influenza vaccine in its early-stage study, Rodman & Renshaw analyst Reni Benjamin said.

"(Vical) will clearly need more funding to develop this, going forward, but with the U.S. Navy willing to have a co-development deal with the company, chances are better in securing funding," Benjamin said.

If the vaccine is successful, it would translate into recurring revenue for the company through government contracts, the analyst said.

"It really depends on the government and how severe this (swine flu) scare is, whether this becomes a full blown pandemic. But if (the vaccine) is successful, then it could become part of the stockpiling effort."

However, Needham & Co analyst Alan Carr said it is too early for the company to say whether these recent events would help its strategy in the influenza area.

On Thursday, Vical posted a net loss of $8.2 million, or 20 cents per share, for the first quarter, compared with a net loss of $9.6 million, or 24 cents a share, a year ago.

Shares of the company touched a high of $2.75 before paring some gains to trade up 13 percent at $2.38 in morning trade, making them one of the top percentage gainers on Nasdaq.

Swine Flu Cases Widen Reach With ‘Epidemic Curve’ (Update2)

By Tom Randall and Lisa Rapaport

May 7 (Bloomberg) -- Swine flu may spread to at least one- third of the world’s population within the next year and a full- fledged pandemic remains possible, the World Health Organization said.

In two weeks, the flu jumped from isolated reports in the U.S. and Mexico to a widening circle of infections in Central America, South America, Europe, the Middle East, Asia and New Zealand. The disease has been confirmed in 2,371 people in 24 countries, with 44 deaths, the WHO reported today.

A panel of the Geneva-based agency will meet May 14 to decide whether drugmakers should begin producing hundreds of millions of doses of a vaccine against the new illness, a form of H1N1 influenza. Keiji Fukuda, the WHO’s assistant director- general of health, security and environment, said in a video broadcast from Geneva to Asian ministers in Bangkok today that more of the world’s 6 billion people will fall ill.

“Even if the illnesses appear relatively mild at the individual level, the global population level adds up to enormous numbers,” Fukuda said.

Fukuda declined to say how many deaths there might be in a full pandemic.

In the U.S., an outbreak in Illinois led to a jump in the number of confirmed cases to at least 896, the U.S. Centers for Disease Control and Prevention said today on its Web site. The cases include two U.S. deaths and may represent a fraction of those infected, officials said.

Not ‘Petering Out’

Illinois cases totaled 204, the agency said. Most of the surge is attributable to the state’s new testing capability, Illinois officials said. Before this week, only the CDC lab in Atlanta could definitively identify U.S. cases of swine flu. Test kits were delivered May 5 to laboratories in all 50 states.

“As we look at the data so far, we’re not seeing any sign that this is petering out,” Richard Besser, the acting director of the CDC, said today on a conference call. “We’re still in the upswing of what we call the epidemic curve. We see ongoing transmission and we expect that to continue.”

Hong Kong, which confirmed its first case of swine flu on May 1, and China are today releasing some people who were isolated after they were found to be on the same flight as an infected patient.

A 58-year-old Polish woman, that country’s first confirmed swine flu case, is recovering and the passengers on her May 2 flight from New York to Warsaw are being monitored for symptoms, Pawel Wierdak, a spokesman for the Polish mission to the United Nations in New York, said yesterday in an interview.

World Impact

Disease trackers are monitoring 88 cases in Spain and 34 in the U.K. to determine whether the virus has established itself outside North America. Such a finding would prompt the WHO to declare a pandemic, the first since 1968, the agency said.

The WHO panel next week will determine whether to go ahead with production of a swine flu shot and may later ask companies to stop making seasonal flu vaccines in order to free manufacturing capacity, said Marie-Paule Kieny, director of WHO’s initiative on vaccine research, at a news conference in Geneva yesterday.

“We are very early in the epidemic,” Kieny said. “We have recommended for all manufacturers to put everything into place to be able to start manufacturing the vaccines.”

Younger Patients

Data so far suggest that the virus affects youth more than seasonal influenza, and that younger patients are entering hospitals, Besser said yesterday. Few with swine flu are older than 60, and the median age is 16. It’s possible that older people have greater immunity or that younger people spread the disease on spring break vacation trips to Mexico, he said.

The CDC reversed U.S. school-closure recommendations that shut 468,000 students out of classes this week, saying schools should reopen and sick children should stay home. About 103,000 students returned to school yesterday, and it will take several days for most schools to reopen, the U.S. Education Department said.

The virus is milder than originally thought and has already rooted itself in communities across the country, making containment impossible, Besser said, explaining the school policy reversal. Even if symptoms remain mild, the ease with which the new virus spreads makes it a threat, he said.

The three main seasonal flu strains -- H3N2, another form of H1N1, and type B -- cause 250,000 to 500,000 deaths a year globally, according to the WHO. The new flu’s symptoms are similar: aches, coughing and fever.

Mexico City

Mexico City’s government planned to reduce its emergency alert level for swine flu today to “yellow,” or medium alert, from “orange,” or elevated warning, said Carolina Pavon, a spokeswoman for the city. The change could allow businesses such as bars, gymnasiums and theaters to reopen under the city’s sanitary guidelines.

Hong Kong has isolated 386 people under a seven-day quarantine imposed after they had contact with a 25-year-old man who flew in from Mexico by way of Shanghai and was tested positive for swine flu. The city released 28 people with no swine flu-like symptoms from the Lady MacLehose Holiday Village, Thomas Tsang, controller at Hong Kong’s Centre for Health Protection, said today.

China started allowing about 110 passengers on the same flight as the Mexican man to leave their hotels today after holding them under quarantine for seven days, the official Xinhua News Agency said, citing some of the people.

South Korea today confirmed its third case of swine flu.

Affected Countries

In addition to the U.S. and Mexico, swine flu has been confirmed in Austria, Canada, Colombia, Costa Rica, Denmark, El Salvador, France, Germany, Guatemala, Hong Kong, Ireland, Israel, Italy, the Netherlands, New Zealand, Poland, Portugal, South Korea, Spain, Sweden, Switzerland and the U.K.

The virulence of the swine flu may reveal itself when the Southern Hemisphere faces its influenza season beginning this month through September, Besser said. Scientists will watch the virus to see whether it becomes the dominant flu strain or mutates into a deadlier illness.

WHO determined that a swine flu shot would have to be made in separate plants from the seasonal flu version. The swine flu vaccine may also require a follow-up booster shot to be effective because it is an entirely new strain, Kieny said. The single-shot seasonal flu vaccine itself acts as a booster, reinforcing natural antibodies from previous flu exposures, health authorities said.

Vaccine Makers

Sanofi-Aventis SA of Paris, Baxter International Inc. of Deerfield, Illinois, and GlaxoSmithKline Plc of London are talking with world health authorities about producing shots, the agency said.

Baxter received a sample of the virus from the WHO and is taking steps to produce a vaccine, Chris Bona, a company spokesman, said today in an interview.

The U.S. Food and Drug Administration yesterday licensed Sanofi’s new vaccine plant in Swiftwater, Pennsylvania, the agency and the company said in separate statements. Sanofi said the new plant can produce 100 million doses of seasonal flu vaccine when it is operating at full capacity and the company’s Sanofi-Pasteur unit can produce another 50 million doses at its older Swiftwater facility.

Authorities advised hand washing, hygiene and staying home if sick as the most effective ways to control the outbreak. The WHO and CDC said closing borders or killing animals are costly steps that wouldn’t slow the spread of flu.

Australia: Travel Advice

United States of America overall
This Advice is current for Friday, 08 May 2009.

Exercise caution
This advice has been reviewed and reissued. It contains new information in the Summary and under Health Issues (new quarantine measures in New Zealand for passengers who have visited the United States). The overall level of the advice has not changed.

MSF forced to reduce its emergency activities in north-western Pakistan

07 May 2009 Press Release

Civilians trapped in crossfire with little chance to get food, water or medical care

Islamabad/Brussels - Islamabad/Brussels - Medecins Sans Frontieres/Doctors Without Borders (MSF) has had to halt its emergency medical care in the Swat region of Pakistan and reduce activities in other areas affected by the current warfare. The international humanitarian organisation was the only one supporting the hospital in Mingora and providing ambulance services in Swat. The reduction of MSF’s activities is a result of the generalised insecurity in addition to a number direct incidents against MSF itself.

“Even before this new offensive, civilians in north-western Pakistan were already struggling to survive a terrible situation,” says Brice de le Vingne, Brussels-based coordinator for MSF’s work in Pakistan and Afghanistan. “Today, curfews, roadblocks and intensely fierce warfare make it virtually impossible for them to reach hospitals and clinics. They are literally locked into this situation of extreme violence. On top of that, it is largely impossible for our medical teams to assist them.”

Unknown numbers of people cannot escape the warfare. Trapped in their homes, they cannot go out to buy food, get clean water, visit a doctor if they need to.

MSF calls on all parties to respect the rights of injured civilians to medical treatment and to provide space for MSF to assist them without being subjected to further violence, threats and intimidation. As a priority, MSF needs to be able to evacuate wounded people and replenish Saidu Sharif hospital with urgently needed medical supplies.

“This is a completely untenable situation,” says De le Vingne. “It has gone from dire to absolutely desperate. And there is every chance that things will get even worse. Right now, exactly when the risks facing people are radically increasing, we are simply not able to set up much of the necessary lifesaving activities,.”

Hundreds of thousands are seeking refuge in less insecure parts of Pakistan. They often stay with host families, putting extra strain on local resources including health care, or in improvised camps.

In Lower Dir, MSF continues to provide clean water and basic health care to displaced people in two camps. And in Peshawar, MSF prepares for a possible arrival of more displaced, including injured civilians who cannot find treatment closer to home. MSF has a team on standby in Dargai to assist all those who need surgery.

From December 2007 to December 2008, during curfew hours MSF ambulances transferred around 1,300 war-wounded patients and other emergencies from various parts of Swat towards Saidu Sharif and hospitals in Peshawar and Islamabad. In September, MSF treated almost 4,000 cholera patients during an outbreak of the disease. Such lifesaving assistance is no longer possible.

Other activities of MSF in Pakistan- in Baluchistan, Kurram agency, and in the Peshawar area - continue uninterrupted. MSF works in three basic health units in the Peshawar neighbourhoods that are hosting families displaced by the war, has supported a camp in Charsadda and distributed essential non-food items to over 30,000 displaced people in Peshawar, Charsadda and Mardan since August.

Update -Flu from animals an ongoing threat - reports

* New virus has many genetic mutations

* Infection causes unusual symptoms in some people

* New mixtures likely inevitable

(Recasts with quotes from news conference)

By Maggie Fox, Health and Science Editor

WASHINGTON, May 7 (Reuters) - The first batch of formal reports looking at the current outbreak of a new kind of swine flu virus shows it is a Frankenstein-like mixture of viruses, researchers reported on Thursday.

It includes a so-called "triple reassortent" virus with swine, human and bird elements that has been circulating since at least 1998.

And such mixtures are likely to occur and infect people in the future, the researchers reported in the New England Journal of Medicine.

The new strain of H1N1 swine flu has spread globally although North American countries are the hardest-hit. The World Health Organization is watching for signs it could tip over into a pandemic.

Dr. Lyn Finelli of the U.S. Centers for Disease Control and Prevention and colleagues reported on 11 people infected with the triple reassortent virus -- apparently one ancestor of the new strain -- since 2005.

"As recent events suggest, the generation of novel influenza viruses through the reassortment of swine influenza viruses with other human and animal influenza viruses may be inevitable," they wrote in one report.

The new virus includes genes from this strain, but two genes are from swine viruses that had only been seen in Europe.

MYSTERIOUS ORIGIN

A gene called "M" carried mutations that made the virus resist the effects of older antiviral drugs but not the newer drugs Tamiflu and Relenza, they said.

The other genes were of clear North American origin.

The neuraminidase, or the "N" of a flu's name, most closely resembles a swine flu first identified in Belgium, they said. "Those genes had never been seen in the United States before," the CDC's Dr. Michael Shaw told reporters. "We have no idea whether they came to this hemisphere by human or animal."

He said it appeared the virus had been circulating unseen somewhere, either in humans or animals.

"It was already well adapted for transmission in humans before it popped up," Shaw added.

"In this context, the possibility of novel influenza viruses causing epidemic and pandemic disease ... remains a major ongoing public health threat," the report reads.

Among the 11 patients infected with the older swine virus, symptoms were slightly different from those of seasonal flu, but 100 percent of the patients had typical symptoms such as cough and nine of out 10 had fever. A third had diarrhea, which is not usually seen with seasonal flu. Some were very sick but all recovered.

A similar pattern is seen with the new virus, said Dr. Fatimah Dawood of CDC's Epidemic Intelligence Service, which indicates it may spread through the fecal-oral route as well as traditional influenza routes such as sneezing or coughing.

"This is a new virus and we still learning how transmission occurs," Dawood said.

The two U.S. patients who died were the Mexican toddler who had been born with an autoimmune disease called myasthenia gravis and a pregnant woman in her 30s, Dawood and colleagues said in another report.

Both also had several other conditions that put people at greater risk of dying from influenza.

The first person to be identified with the flu was a 9-year-old girl from Imperial County, California, on the border with Mexico, who developed a cough and fever on March 28.

Egypt: A secret agreement between health and Aini Palace to receive the flu suspected to be infected pigs

Thursday, May 7, 2009 - 15:24

Fears of the spread of swine flu patients Aini Palace

Hospital, medical sources said minors in kind, that there is an agreement between the medical and the Ministry of Health and Hospital minors in kind, two days ago about the allocation of a special room for suspected cases of swine flu in the Section of Sadr hospital in secret, so as not to raise the terror patients.

وأكد المصدر خطورة ذلك على المرضى المترددين على المستشفى والمحتجزين به، مشيرا إلى أن مثل هذه الحالات المشتبه فى أصابتها بأنفلونزا الخنازير لابد أن يكون لها مكان بعيد عن التجمعات، خاصة وأن القصر العينى يستقبل الآلاف يوميا، قائلا "الحالة عقبال لما تدخل من باب المستشفى حتى تصل إلى المكان المخصص لها تكون نشرت العدوى بين الكثيرين".

The source confirmed the seriousness of the patients visiting the hospital and detained him, pointing out that such cases of suspected bird flu pigs must be located away from communities, especially minors and Aini receives thousands a day, saying "The situation Akbal to interference from the door of the hospital until up to the place allotted to them to be published infection among the many. "

ونفى مصدر طبى آخر من داخل قسم رعاية الصدر وجود أى حالات مشتبه فى إصابتها بأنفلونزا الخنازير داخل القصر العينى، مؤكد أن الحالة التى وردت إلى المستشفى مشتبه بإصابتها بأنفلونزا الطيور وليس الخنازير، وأن التقديرات الأولية تستبعد حتى إصابتها بأنفلونزا الطيور.

And denied medical source from within another Section of the chest and there are no cases of suspected bird flu in pigs within the palace in kind, which assured that the situation has been communicated to the hospital suspected bird flu, not the pigs, and the initial estimates exclude even bird flu.

Influenza A (H1N1): Generic production must be part of solution for access to influenza medicines

07 May 2009 Article

While uncertainty still prevails over the severity of a possible influenza pandemic, many developing countries do not have stockpiles of medicines or advanced purchase commitments with manufacturers to ensure access to protect their populations if the pandemic does take hold.

“If a pandemic were to occur, the test of global solidarity will be whether there is a focus on developing countries who would likely be hit worst, since they would be the least prepared. The production of generic versions of influenza medicines will be crucial to ensure these countries can not only get hold of these drugs but also at an affordable price,” said Michelle Childs, Director of Policy and Advocacy at Médecins Sans Frontières’ Campaign for Access to Essential Medicines. “Rich countries cannot just buy their way out at the expense of developing countries.”

Populations in many developing countries will be far more vulnerable to the Influenza A (H1N1) virus because they are already affected by malnutrition and high burdens of other diseases such as tuberculosis, HIV, and malaria.

But focusing solely on negotiations to boost supply and reduce prices with the current manufacturers won’t solve the problem. Generic producers will have a crucial role to play. Generic production of oseltamivir in India can be scaled up as the patent on this drug has already been rejected there and there is no patent in several other developing countries.

“As part of its mandate for pandemic preparedness, the World Health Organization needs to take action to increase generic drug supply for the treatments that it is recommending,” warned Childs. “Only WHO can determine global stockpile needs and coordinate the fair allocation of the supply of flu drugs.”

In countries where recommended treatments are patented governments and/or patent holders need to assure generic companies that patents will not be a barrier. Governments can do this by issuing compulsory licenses whereby the patent holder receives royalties.

So far, patent holders have been issuing voluntary licenses with several manufacturers, but these can come with conditions attached.

“Patent holders could make the whole process easier by publicly declaring that they will not assert their patent rights to prevent access to generic products,” said Childs.

Alternatively companies could agree to place their patents into a ‘patent pool’ – a mechanism that allows generic manufacturers to produce medicines on equitable licensing terms.

It is also important to remember that while a flu pandemic is a threat, thousands die of HIV/AIDS and other diseases every day in developing countries.

“Patents should not stand in the way of access to essential drugs: not with influenza, and not with HIV/AIDS or any other illness,” emphasised Childs. “We need to see the same level of attention that is now paid to influenza for diseases that already kill millions of people in the developing world.”

8 Bhmyat students detained on suspicion of Suez in the swine flu

3 Thursday, May 7, 2009 - 15:33

Hospitals receive cases of suspected influenza

8 injured students living in University City Branch of the Suez Canal University Bnzlat response resulted in severe injury of the high temperature, severe vomiting, due to strong mixing within the chambers, including the university city.

Immediately to Dr. Moses and Undersecretary of the Ministry of Health the Gulf of Suez, by transferring them to a hospital diets to detect them, and after making sure that cases are not beyond the cold, were taken to Suez General Hospital for treatment and left, four students were discharged from hospital upon recovery, while the other four remained in the hospital to complete the treatment.

Dr. Fahim Ahmed Khalifa, Vice-President of the University branch of Suez, that the minor injuries of students denied rumors that they were on over twenty students, where the suspect was caught a cold and is not suspected of bird flu or avian influenza as the most common pig

Egypt-12 new suspected case of bird flu

In the West ..

الThursday, May 7, 2009 - 20:40

Avian influenza is still out of control

12 new cases were admitted within the area and Tanta and Kafr el-Sheikh had been arrested on suspicion of bird flu infected. Hospital admitted Tanta held, Hoveyda Fawzi SNOUSSI clinical facility of the Center for Qtor housewife (30 years) and Fayza Zeinhom (3 years) from the village of stone Borreg Center Qtor Yahia and Mary A. (10 months) from the village of Shin Qtor Center Bhmyat Kafr el-Sheikh.

While detained fevers Nada Abdallah Ghazi al-Mahalla (6 years) from the village of Kafr El-Mahalla Dkhamis Center, and Norhan Sameh (3 and a half years) from the village of Mahala dead Sarraj Center, and Alaeddin Sameh (two years) Mahallat cane Mahallah Center, Abdullah Hussam Shahawi (two years) of the Village Center Jabriya place.
Fevers and detained two of Kafr Al-Zayat, the names of Mr. Safaa Hamid Repetty house.

Detainees were given the drug Altaymflo and blood sampling, survey hours and sent to labs central Ministry of Health confirmed infection of the disease or not.

The samples were the result of the special cases Iman Mohamed cane (26 years old), Kafr El-Khader Besion Center, Fatima Mohamed Farid (5 years) from Kafr Hegazy Center Mahallah negative result, and was discharged from hospital after stabilization of their condition.

From Effects measure

« Swine flu: what does "so far, so good" mean? Main

Swine flu: why we are party poopers

Posted on: May 7, 2009 5:49 PM, by revere

It seems a conversation on one of the comment threads about "swine flu parties" at Effect Measure has made the New York Times:

One of the first open debates of the idea of intentional self-infection was on Effect Measure, a public health blog with many posts by thoughtful people who say they are clinicians, epidemiologists, veterinarians and other professionals, sometimes in government, but who post under pseudonyms to speak freely.

On April 28, a user calling herself OmegaMom posted: “Just a quick note — I just got a Tweet from a mom suggesting ‘swine flu parties’ because the U.S. version seems to be a mild version. Can you speak to the utter insanity of doing this, please?”

Several posters weighed in to say it would be foolish given the number of deaths in Mexico, the lack of information on the virus and the unpredictability of flu. (Donald McNeil, New York Times)

The report is accurate regarding the question and answers in the comments. I was going to post on this topic anyway, but now Mr. MacNeil has given me a good excuse to do it sooner rather than later (my grant proposal deadlines took no notice of this outbreak, alas).

Like other scientists quoted in the article, I also think deliberately self-infecting yourself or your family is a very bad idea, something I also expressed strongly in the aforementioned comment thread. I understand completely why this would be an attractive idea, and I have been asked about it by reporters and at least two colleagues, both of them smart and well informed. Given how this is being portrayed in the media and occasionally by public health officials the logic seems ironclad: the virus might return with a vengeance next flu season in a more severe form, it currently is a mild disease, and there is no protective vaccine for it at the moment and uncertainty as to when there might be or its availability. So why not take advantage of a naturally circulating "live virus vaccine"?

I can think of a number of reasons:

• While clinically the virus seems to be resulting in a "mild" flu, even a mild flu is not most people's idea of a mild illness. Even mild cases of the flu can be very uncomfortable: high fever, wracking muscles aches and pains and a hacking cough that goes on for weeks after other symptoms subside, not to mention easy fatigue and tiredness. This version also has an unusual prevalence of nausea, vomiting and diarrhea
• Of course you could get a milder or even asymptomatic case, too. On the other hand, you could get seriously ill. Last I looked there were 35 people hospitalized in the US and as the disease spreads there will be more. The hospitalization rate is somewhat higher than for seasonal flu, especially the relative number of healthy young adults and children. The hospitalized cases seem to have roughly the same age distribution as the cases in general, that is, half of them are 15 years old and younger. Few parents would consider something that sent their child to the hospital a mild illness
• All this is predicated on the virus continuing to act as it does now -- or as we think it is acting now. As we pointed out in this post, we still are not confident we know how severe it is
• It may not continue to act as it does now. Flu viruses are notoriously unpredictable. It could just disappear, it could become more severe or it could change in ways that make a subsequent infection possible, as with the changes we see from year to year in seasonal flu
• Given all this, you may still choose to voluntarily and knowlingly infect yourself or your family. But unless you and all your fellow party-goers are also willing to isolate yourselves for 14 days, you also may infect others. You could be spreading the disease in your community to others who have not consented to take the risks you have

At the moment this is likely moot, as confirmed cases are being isolated. But as the disease spreads more widely, some people may decide to do this with friends or family.

So let me be crystal clear. We think it would be a very foolish and irresponsible thing to do.

The trouble with Tamiflu

The companies behind the two leading anti-flu drugs are making millions out of the crisis. But just how effective are their products? Sarah Boseley reports

• Sarah Boseley
• The Guardian, Thursday 7 May 2009
• Article history

Tamiflu pills. Photograph: Michael Probst/Associated Press

It was a sight that would have gladdened the heart of Dr Severin Shwan, chief executive of Roche, one of the biggest drug companies in the world. A long line of well-heeled parents assembled on a bank holiday weekend at a British private school, Alleyn's in south London, patiently waiting their turn to receive a packet of Roche's drug Tamiflu from staff. Five pupils had been diagnosed with swine flu and the school had been closed. The pills were intended to stave off infection among the children who had been sent home.

The board of Roche, a Swiss-based company which has globalised the name it inherited from its founder, Fritz Hoffmann-La Roche in 1896, must be laughing. It has a drug which has become a household name and been stockpiled by the millions of boxes all over the world, against a potential pandemic that the World Health Organisation (WHO) warns is almost upon us. Roche has supplied governments with 220m courses worldwide. The UK has stored enough to treat half the population. And yet Tamiflu is of limited use.

There are two drug contenders to reduce the impact of a flu pandemic - Tamiflu (oseltamivir) and the GlaxoSmithKline (GSK) drug Relenza (zanamivir), which is similar but more complicated to use because it must be inhaled - not easy if people have breathing problems. But Relenza, too, is being stockpiled around the world, to the delight of a small Australian company called Biota Holdings - the company that developed Relenza and licensed it to GSK. Biota's share price leapt 16% last week when GSK announced it had sold $46m-worth of the flu drug, giving Biota $32.3m in licensing fees.

Relenza and Tamiflu are known as neuraminidase inhibitors (NIs). Two other, older flu drugs, amantadine and rimantadine, are now of little use because flu viruses have become resistant to them over the years. Nobody claims Tamiflu and Relenza cure flu, but they were licensed after trials that showed they mitigated its severity and reduced the length of the illness by about a day. Unfortunately, you have to take them within 48 hours of symptoms starting.

The government's contingency plan envisages that any of us who start to cough and splutter would ring a flu hotline, where a nurse would give us a diagnosis over the phone and then prescribe the drugs which our nominated "flu buddy" will pick up from the chemist. But the most important element of this arrangement, some will say, is that it keeps the flu sufferer out of the way of the rest of us. Dr Tom Jefferson, of the Cochrane Collaboration in Rome, headed the most authoritative, non drug-company conducted (and therefore without the vested interests) review yet done on the flu drugs. He is appalled that such drugs could be widely used and relied on as the solution to a flu pandemic at the expense of things that really work - like washing your hands dozens of times a day.

The Cochrane review, carried out in 2006 but regularly updated, most recently this year, says the NIs do not stop people becoming infected, although they do decrease the amount of virus sprayed from people's noses when they sneeze all over you in the bus or office. They can also reduce the complications of flu, such as bronchitis and pneumonia. The review concluded that they might be of some help in a pandemic, but strongly recommended they should not be handed out routinely or used for normal winter flu outbreaks.

To Jefferson's horror, however, the WHO has recommended that the drugs should be used against seasonal flu - the usual forms of flu that hit us every winter - so that doctors get used to giving them, and patients to taking them, ahead of a pandemic. "Wide-scale use of antivirals and vaccines during a pandemic will depend on familiarity with their effective application during the inter-pandemic period," it reasons.

"It is more than madness," says Jefferson. "Especially as we don't know what the real reasons for that recommendation are." Doctors who work for the drug companies, carrying out their studies or sometimes simply allowing their name to be attached to the paper, also advise the WHO, he points out.

He argues that there is a very real possibility of resistance developing to the drugs if they are handed out like Smarties. Viruses are clever organisms, and evolve super-fast and efficiently. Treat a virus with drugs and you must hit it hard enough and for long enough to eliminate it. If the dose is not strong enough, or the patient stops taking the drugs mid-course, the virus will evolve into a form that can overcome the drug. It is then a resistant strain. This is a major problem with the Aids virus, HIV, for which many new drugs have had to be developed. Bacteria behave the same way - penicillin, once a wonder drug, is now of little use.

Jefferson points out that although Tamiflu is only eight years old, resistance has already set in. Last year a strain of winter flu was circulating in the US that was found to be resistant to Tamiflu. In the South East Asia bird flu outbreak, there was resistance among 16% of children given the drug and among two out of eight Vietnamese people aged between 8 and 35, according to the Cochrane review.

This resistance is inevitable, says Jefferson, if you believe in the theory of natural selection, in which organisms evolve to overcome threats to their survival. "We know that has already happened with Tamiflu. It has happened with amantadine, which has been around since the 60s." Of course, governments and the public want magic bullets. There is a belief that where there is an illness, there must be a cure. Handing out drugs reduces panic. People are more likely to stay put at home where they cannot infect too many people if they feel they are being treated.

And there is is a role for Tamiflu in severe and complicated cases caught early. But Jefferson balks at the idea of drug hand-outs at schools. "The spread will stop, but only because the children have been sent home," he says.

The most important trial in disease prevention of the last 50 years was carried out in 2005 by a US doctor called Stephen Luby. "For that he should receive a Nobel prize," says Jefferson. Luby carried out a randomised trial in squatter settlements in Karachi, promoting hand-washing in half the families. Children under five who regularly washed their hands had half as many episodes of diarrhoea, impetigo and acute respiratory infection. It saved lives. If the big pandemic hits, washing hands will save more lives than Tamiflu, he predicts.

Meanwhile Tamiflu is sought everywhere. In 2005, Roche asked for help in manufacturing enough of the stuff to satisfy world demand and it got 300 offers from other manufacturers. It has now established 19 partners to produce the drug in 10 locations on three continents. It has also given licences to Indian and Chinese generic companies to make it for the developing world. If only it really was a miracle cure ·

Egypt-35 citizen of the West put under observation due to swine flu

After their return from abroad ..

ا Thursday, May 7, 2009 - 20:40

Ministry of Health to the crisis by all standards

The Directorate of Health meeting Sunday attended by the development of 35 Egyptian citizens from abroad, from different countries under strict observation, and the fear of disease swine flu.

Was signed by a medical examination on 35% of citizens, as they are coming from France, Italy and the European Union countries and African countries, has been placed under constant observation and their families for fear that they are infected with the disease and put them under observation for 10 days.

For the names of suspected to be infected, click here

http://tinyurl.com/ck7egq

Swine Flu Spreads, Fall Flu Season Looms

Health Officials Warn About Swine Flu's Potential in Fall Even as Some Guidelines Are Eased

By Daniel J. DeNoon
WebMD Health News

Reviewed by Louise Chang, MD

May 7, 2009 -- H1N1 swine flu is spreading faster and wider in the U.S. That's worrisome -- but more and more, health officials are fretting about what might happen this fall.

So far, H1N1 swine flu disease has been milder than originally feared. That's led the CDC to relax some of its original guidelines.

Schools and day care centers need no longer close if a few kids get the new flu. And in communities with known H1N1 outbreaks, the CDC no longer recommends confirmatory H1N1 lab tests for otherwise healthy people with mild flu symptoms.

But that doesn't mean anybody should relax, acting CDC Director Richard Besser, MD, said at today's H1N1 swine flu briefing.

"We are not seeing any sign of this petering out. We are still on the upswing of the epidemic curve," Besser said.

The number of cases is expected to rise as the new flu spreads across the country. But the hope and expectation is that, aided by the warm summer weather that flu bugs don't like, the rate of spread will slow.

That may only be the lull before the storm, Besser warned. What worries health officials is what will happen this fall when traditional flu season begins.

"We don't know what the fall will bring," Besser said. "What has been seen with previous outbreaks is flu goes away in the summer. But during the winter flu spreads better, so the virus could go away and come back."

Besser urged Americans to take advantage of this breathing room. True, H1N1 swine flu could just go away for a number of reasons. On the other hand, it could just as easily become more severe as it picks up elements from seasonal flu bugs.

"This period of time before the fall is critically important for community preparedness should this virus come back in a severe form," Besser said.

There's a lot that governments, communities, and businesses can do. But Besser strongly urged individuals to prepare at the family level. He stressed hand washing, staying home when sick, and covering coughs. He also pointed families to the CDC's pandemic flu web site.

That web site advises families to make preparations for a flu pandemic:

• Store a two-week supply of water and food. During a pandemic, if you cannot get to a store, or if stores are out of supplies, it will be important for you to have extra supplies on hand. This can be useful in other types of emergencies, such as power outages and disasters.

• Periodically check your regular prescription drugs to ensure a continuous supply in your home.

• Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.

A suspected case of avian influenza in Port Said

A suspected case of avian influenza in Port Said

Thursday, May 7, 2009 - 18:12

Ministry of Health faced successive crises

Port Said - Mohamed Farag

management of civil protection (police fire brigade) on suspicion of being infected with bird flu.

Private complained of high fever and chest congestion, go to the hospital Diwan in Port Said, which had to convert it into a fever, where he was suffering from high temperature, sore throat and lack of breathing, and was immediately withdrawn from the blood samples and throat and sent to labs central Ministry of Health for analysis .

Reservation and has been isolated and preventive pending receipt of the result of analysis, where the fever came under No. 1027. The recruit, through his statements that he is, raising chickens in his village, province, Zagazig and upon his return from leave hair with symptoms of the disease, the Department of Preventive Medicine in Port Said on the disclosure of his colleagues, found that their health was sound.

National Committee Formed to Combat Swine Flu

8 May 2009

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ABU DHABI — Deputy Prime Minister Shaikh Hamdan bin Zayed Al Nahyan, Chairman of the National Emergency Committee for Anti-Bird Flu, said the UAE from the day one has given priority to the preventive measures of swine flu to safeguard the health of nationals and expatriates alike.

“This preparedness was exhibited in tightening preventive precautionary measures taken immediately to keep the disease at bay,” he added.

Addressing the launch of the UAE National Emergency Response Committee to combat Swine Flu, here on Thursday, Shaikh Hamdan said, in a speech delivered on his behalf by Shaikh Zayed bin Hamdan bin Zayed Al Nahyan, that the UAE has in place the world-class emergency plans, which were maximised amid apprehensions of swine flu outbreak at world level.

He reiterated in the event held at Emirates Centre for Strategic Studies and Research that the procedures taken by the UAE since appearance of swine flu have saved time and energy. He thanked the UAE leadership for the implementation of the preventive and precautionary measures against swine flu and sustained follow up.

Dr Ali Ahmed bin Shakr, Director-General of the Ministry of Health (MoH), underlined that the UAE is swine flu free, indicating that upon the instructions from the leadership all the measures were taken to curb the spread of the disease.

He added that the MoH was keen to adopt serious initiatives proposed by the mobile Emirates Humanitarian World Hospital.

UAE bans dairy imports from Egypt

By Kate Dannies
First Published: May 7, 2009

AFP PHOTO/KHALED DESOUKI An Egyptian farmer milks a cow at her farm in Beni Suef, 200 km south of Cairo.

CAIRO: The United Arab Emirates announced a ban on imports of milk and cheese products from Egypt on Tuesday, citing “health concerns,” the local press reported.

This decision comes on the heels of a March ban on the import of all cloven-hoofed animals and animal products from Egypt due to concerns about the transmission of foot and mouth disease from infected imported food products.

The UAE banned the import of animals and animal products from Lebanon, China and Taiwan in late February for similar reasons.

Foot and mouth disease is a highly contagious viral disease that afflicts cloven-hoofed animals. While humans are rarely affected, recent outbreaks have caused concern about the disease’s transmission to humans through contact with infected animals or animal products.

Although Egypt’s exports of meat are negligible, annual dairy exports are worth LE 2.8 billion, with LE 35 million in revenue coming from exports to the UAE, Reuters reported Tuesday.

“LE 35 million does not constitute a large part of Egypt’s economy, so the ban won’t have a serious effect,” said Magdy Sobhy, an economics expert at the Al-Ahram Center for Strategic Studies.

“Actually, Egypt is a net importer of dairy products, so there’s plenty of demand for these products at home if the UAE ban continues,” he added.

The UAE also banned the import of pork products at the end of April due to fears about the recent international outbreak of swine flu. This ban comes despite statements issued by the World Health Organization asserting that swine flu cannot be transmitted to humans by live pigs or pork products and instead is being passed from human to human.

Reuters quoted the chairman of Egypt’s Chamber of Food Industries, Tarek Tawfik, saying that the ban might have simply been a misunderstanding of the earlier ban on animal products, and that he hoped the issue could be resolved through talks between the ministers of agriculture and trade in both countries.

The Ministry of Trade and Industry could not be reached for comment.

Keeping swine and bird flus apart top priority, say experts

By AFP
First Published: May 7, 2009

PARIS: Preventing the swine flu that is spreading across the globe from infecting patients sick with the deadly H5N1 avian flu should be a top priority, especially in Asia, top experts said Thursday.

If both viruses wind up in the same individual, they could mix genes and mutate into a form that is both very pathogenic and easily transmitted among humans, said John Oxford, a virologist at London Queen Mary's School of Medicine and Dentistry.

"We don't want a situation where you have a virus with the spreadibility of the pig virus with an H5 stuck on it. That is something we worry about, to put it mildly," he said in a phone interview.

On an influenza "Richter scale" of concern, if an ordinary seasonal flu rates a level three and the swine flu a level five, then bird flu on its own would be a six and "an H5N1 virus swapping genes with a pig virus would be the highest of all, at least a seven," Oxford said.

Since 2003, the H5N1 strain of bird flu has killed more than 250 people in a dozen countries, according to the World Health Organization (WHO).

More than 80 percent of the deaths were in East and Southeast Asia, with 115 in Indonesia, 56 in Vietnam, 25 in China and 17 in Thailand. There have also been 26 fatal cases in Egypt, the most recent two weeks ago.

But while the strain has killed almost 60 percent of those infected, it does not spread easily — virtually all its victims had extensive, direct contact with poultry.

By contrast, the swine flu that erupted in Mexico this spring has moved across the globe much more quickly, but thus far has not proved especially lethal. Mexican officials report 42 deaths, with two more registered in the United States.

All told, the WHO has verified some 1,900 cases in 23 countries.

The nightmare scenario for virologists is a mutated virus combining high infection potential and virulence.

"The danger of a genetic recombination is real, in animals and in humans — this is something we fear," said Pierre Duplessis, Special Envoy for pandemic influenza at the International Federation of Red Cross and Red Crescent Societies.

"We know that in the current genome of the [swine] flu, there is a sequence that comes from birds, so it is possible that the virus could take on more aggressive attributes and become more virulent," he told AFP.

Duplessis and other experts caution that it is far too early to "declare victory" against the swine flu, even though its spread appears to have slowed.

All three of the great pandemics of the 20th century, they point out, began with mild "herald waves" in the spring that were followed by far more deadly attacks later in the year. –AFP

Arlington report pushes swine-flu cases in Virginia to 14

The Virginian-Pilot
© May 7, 2009

The number of swine flu cases in Virginia increased to 14 on Thursday, with the Arlington health district confirming its first case.

Two more cases turned up in the Central Shenandoah region, which is where the cases at Washington and Lee University were confirmed earlier this week. That district now has nine cases, the most in the state.

Other cases had already been confirmed in the following health districts: one in Norfolk, two in Chesterfield, one in Three Rivers.

The Virginia Department of Health began posting the count of H1N1 virus cases, more commonly known as the swine flu, on its Web site on Thursday. The cases will be listed by health district and be updated by 5 p.m. each day.

The Web site is www.vdh.virginia.gov.

WHO considers flu alert overhaul

By Andrew Jack in London , Financial Times, 7 May 2009

The World Health Organisation is considering an overhaul of its pandemic ratings system amid growing criticism that it provoked unnecessary alarm by rapidly escalating its warnings over swine flu.

Officials at the agency's headquarters in Geneva said they were discussing changes to the six-point scale to make clear in the future the gravity of the threat posed by a new virus.

The move comes against a backdrop of intensifying attacks on the WHO, which has been accused of "crying wolf" over its decisions to raise its pandemic alert from level three to an unprecedented five. This comes amid indications it may even go to the maximum level six.

Media organisations initially seized on the raising of the alerts in front page headlines around the world, but as it has emerged that the death toll has stayed relatively low, so the criticism has mounted. As of Thursday morning the WHO had confirmed 2,099 cases in 23 countries, including 44 deaths.

While designed to identify and classify the spread of a new flu virus between humans around the world, the WHO's system of pandemic alerts provides no indication of the danger of the virus.

Even if the A (H1N1) virus in Mexico proves no more lethal than a typical seasonal flu, it could still soon trigger the highest level six WHO pandemic alert once it has been identified as spreading widely between humans in different parts of the world.

Margaret Chan, WHO director general, has stressed that an increase to level six is a technical change which does not mean that people around the world are at serious threat.

In an interview with the FT earlier this week Ms Chan defended the organisation's public statements. "I am not predicting the pandemic will blow up but if I miss it and we don't prepare, I fail. I'd rather over-prepare than not prepare," she said.

But her reassurances clash with a widely-held public understanding of a pandemic as a serious infectious disease.

Only two weeks after the Mexican virus was first decoded, health officials are still struggling to understand which age groups and what overall proportion of a population are infected by the flu, and how many are at risk of dying or becoming seriously ill as a result.

With such limited data, they still want to be able to alert health authorities around the world to the potential risks so that they can step up their response while gathering more information.

Scientists also warn that even if outside Mexico the virus has so far proved relatively mild, there is a significant danger that it could mutate on mixing with some of the seasonal flu viruses now starting to circulate in the southern hemisphere. These are widely resistant to antiviral treatments such as Tamiflu.

The "Armageddon" scenario is that it might mix with the H5N1 bird flu virus, which is highly lethal in humans but so far has not proved to be easily transmitted between humans.

The WHO had already sparked concerns from a number of health authorities for changing its pandemic alert scale last month, just after the Mexican virus was identified. This had the effect of speeding up the escalation from level 3 and was out of step with many national pandemic plans.

Anthony Kessel, from the UK's Health Protection Agency, said the current arrangements were "a necessary alert system" but added: "It will be important for the WHO's member states and advisory bodies to determine whether in the future a link with the severity of the infection is feasible, and whether it would add value to our current system."

Governments Prepare for Possible Flu Pandemic

By Melinda Smith Washington 07 May 2009

The World Health Organization reported Wednesday that 22 countries have officially reported a total of more than 1500 cases of Influenza A H1N1 infection. Mexico continues to report the greatest number of cases (822), with more than 400 confirmed in the United States. The WHO has so far refrained from calling this a level six global pandemic, but one U.S. health official said he would not be surprised if that does not happen eventually.

From left: Paul Jarris, executive director of the Association of State and Territorial Health Officials, Rear Admiral Anne Schuchat of CDC and Dr.Anthony Fauci of NIH on Capitol Hill, 28 Apr 2009

You may have heard the newest influenza virus referred to as H1N1. Finally we hear what the "H" and "N" mean from Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

"We identify influenza by two proteins on its surface called Hemagglutinin and Neuraminidase and hence the terminology 'H' and 'N'," Dr. Fauci said.

Influenza viruses generally affect a population in seasons. Sometimes, according to Dr. Fauci, they can modify slightly in what's called a drift. Researchers often adjust the influenza vaccine for that drift.

But in the 20th century, there was a major shift in the influenza virus and scientists and the public were unprepared for it.

In 1918, the H1N1 virus, known then as the Spanish flu, killed 50 million people in a global pandemic.

Two other pandemics occurred in 1957 and 1968. The Asian Flu in 1957 killed at least one million and the Hong Kong Flu in 1968 killed 700-thousand.

With the spread of avian flu in 2004, health experts had practice in preparing for a possible pandemic on the scale of the current H1N1 flu.

Scientists in the United States and elsewhere are now in developmental stages of a vaccine for this H1N1 virus

They are not saying this virus is as deadly as the 1918 flu. But they warn that poorer countries need help to prepare.

Dr. Dennis Carroll, an influenza specialist with the U.S. Agency for International Development, says exercises have already begun in parts of Africa.

"Country representatives from seven east African countries were able to draw from their experiences developing national pandemic plans to test them in real time context of a possible H1N1 pandemic," Dr. Carroll said. "Similar exercises already planned for south African countries in June and Asian countries in August.

Scientists in the United States and elsewhere are now in developmental stages of a vaccine for this H1N1 virus.

They say the virus could gather strength as the flu season begins in the southern hemisphere and as it sets in some months from now in in the northern hemisphere.

Health experts predict that the earliest date a vaccine would be available is in September.

Hong Kong: Situation report on human swine influenza

A spokesman for the Department of Health said in the 24 hours to 12 noon today (May 7), two people fulfilling human swine influenza (Influenza A H1N1) reporting criteria were reported to the Centre for Health Protection (CHP).

"They are in stable condition and laboratory results of their specimens are pending," the spokesman said.

So far, a total of 46 cases fulfilling reporting criteria were received. Forty-three of them were tested negative.

Up to 4pm today, the CHP's hotline 2125 1111 has received 1,625 calls since it was set up on April 30.

A daily update on swine influenza in humans is now available on the CHP website (www.chp.gov.hk).

Ends/Thursday, May 7, 2009
Issued at HKT 20:51

3 injured in suspected cases of bird flu meeting Sunday attended by

Thursday, May 7, 2009

احتجز مستشفى حميات طنطا وكفر الشيخ، 3 حالات جديدة للاشتباه بإصابتها بأنفلونزا الطيور، حيث احتجزت حميات طنطا نبيلة مرسى( 26 سنة) طالبة ومقيمة بطنطا، وعبير حسن (3 سنوات) من قرية بوريج مركز قطور، بينما احتجز مستشفى حميات كفر الشيخ طفلة (10 شهور) وتدعى مريم يحيى عوض من قرية الشين مركز قطور بالغربية. Detained hospital admitted Tanta and Kafr el-Sheikh, 3 new cases of suspected bird flu, with fevers detained Tanta noble Marina (26 years) student and resident Btnta and Abeer Hassan (3 years) from the village of Borreg Qtor Center, while the hospital held a child fevers Kafr el-Sheikh (10 months) are invited Yahya Mariam Awad from the village of Shin Qtor meeting Sunday attended by the Center.

Three cases have been registered and allocated to the premises, and took a blood sample and melancholy hours, and was sent to central laboratories to ensure that the disease infected or not.

صرح بذلك الدكتور شريف حمودة وكيل وزارة الصحة بالغربية، والذى أكد أن جميع الحالات التى احتجزت مؤخرا للاشتباه بإصابتها بالمرض جميعها حالات سلبية. This was stated by Dr. Sharif Hammouda Undersecretary of the Ministry of Health meeting Sunday attended, which emphasized that all cases in which detained recently on suspicion of bird flu cases of the disease, all negative.

China warns of growing domestic flu risk despite declining global new cases

08:08, May 07, 2009

China faces a growing risk of the influenza A/H1N1 spreading into its mainland although the worldwide increase of new cases is in decline, Vice Health Minister Zhang Mao said here Wednesday. "Chinese medical experts believe the epidemic will continue to spread across the globe and China must remain vigilant," Zhang told a video conference on the prevention and control of the disease. A 25-year-old male Mexican was confirmed on Friday in Hong Kong to be infected with influenza A/H1N1, and those who were in close contact with him have been put under quarantine in 19 mainland provinces, municipalities and autonomous regions as well as Hong Kong and Macao. PREVENTION "EFFECTIVE" SO FAR In the past week, China has initiated a joint prevention and control mechanism, adopted strict quarantine of people, goods and vehicles entering its border, stepped up epidemic monitoring and made active medical preparations for emergencies. "The measures are proved to be timely, forceful and effective, as no A/H1N1 cases have been reported on the mainland and those in close contact with the confirmed Hong Kong case are under effective control," he said. Zhang said the slowed increase of new cases might be due to the active prevention measures most countries have taken. Although no international travel warning has been issued, countries have all beefed up customs quarantine and other virus containing efforts. "Autumn and winter might see the second wave of outbreak and the virus might mutate into a more fierce variety, so we must be fully prepared," he said. He urged health authorities to beef up epidemic surveillance, reporting, treatment and research, and called for better preparation work including medicine storage and vaccine research and production. He also underlined the role of traditional Chinese medicine in combating the virus. "WORST SCENARIO" ALERT SOUNDED Zeng Guang, chief epidemiologist of China's Center for Disease Control, said China has to be prepared for the "worst scenario" as it faces direr challenges of a possible flu epidemic, given its high population density, an enormous migrating population and uneven disease control capacities in different regions. "The results could be more disastrous in China than in other parts of the world. That's why China is on the alert against the A/H1N1 flu," he told Xinhua on Wednesday. "We should never be caught off guard, because currently we still do not know much about the disease, and what will happen in the future," he said. Zeng said one important lesson learnt by the World Health Organization and China following the SARS outbreak in 2003 was to use drastic measures to stem the spread of the virus. "The spread of the A/H1N1 flu is slower than it should be after the world has acted to monitor and contain it. But if we lower our vigilance, it will spread more quickly," he warned. QUARANTINE DEFENDED Zeng defended China's move to put under quarantine some foreigners from countries where the A/H1N1 flu cases were reported, saying that was to protect the health of the Chinese public. "We should always prepare for the worst scenario while working towards the best results," he said. A leading administrative law expert, Ma Huaide, vice president of the China University of Political Science and Law, also defended the government's measures to prevent an epidemic outbreak. He told Xinhua on Wednesday that the laws allow administrative authorities to quarantine those who have, or were suspected to have, highly infectious diseases. Ma was interviewed hours after a Mexican jet flew scores of its nationals home from cities across China early Wednesday, after they were quarantined for taking the same flight with the confirmed Hong Kong case. The measures triggered Mexican claims of discrimination, although China took the position that this was a case equivalent to the country's Class A, or most dangerous, infectious diseases, such as plague and cholera. China learned from its experience during the outbreak of severe acute respiratory syndrome in 2003, Ma said. "The country has improved its legal system to deal with such public health emergencies," he said. "The system has provided a legal basis for the government to carry out its disease prevention measures." Under the Law on the Prevention and Control of Infectious Diseases, medical authorities are entitled to isolate patients who have contracted Class A infectious diseases and disease carriers for treatment, and to treat suspected patients individually in isolation at designated places until a definite diagnosis is made. Those in close contact with patients, disease carriers or suspected patients should be kept under medical observation at designated places, it stipulates. The Border Quarantine Law also empowered border inspection authorities to quarantine people coming from countries where infectious diseases were epidemic, Ma added. "Both laws apply to foreigners while they are in Chinese territory ... it is absolutely legal for Chinese health authorities to put the Mexican crew and passengers into quarantine," Ma said. Ma stressed that during an epidemic, the government had even greater rights. Under the Emergency Regulations on Public Health Contingencies and Measures for the Prevention issued by the State Council, or the cabinet, in 2003 following the outbreak of SARS, authorities could even force patients into quarantine, seal off workplaces and schools and summarily incinerate or entomb the bodies of deceased patients, to prevent an epidemic from spreading. The A/H1N1 virus is confirmed to be responsible for at least 29deaths in Mexico and two in the United States, and the World Health Organization has counted 1,490 people infected around the globe so far. WHO PRAISE A World Health Organization (WHO) officer on Wednesday praised China's efforts to prevent a possible pandemic of the virus. "Overall, WHO feels that China has handled the situation with influenza A/H1N1 quite well," said Vivian Tan, communications officer with the WHO China, in a written reply to Xinhua. "China's experiences with SARS and avian influenza have prepared it well for the current situation with influenza A/H1N1,"she said. However, the officer warned that "if it turns into a pandemic, China will probably not be spared." What's important is to mitigate the impact of the pandemic by focusing on early detection, public information, social distancing and treatment, she said. The 1.3 billion-populated country has mobilized several governmental sectors including Ministries of Health, Agriculture, Foreign Affairs and China Center for Disease Control to be engaged in prevention of the influenza's outbreak. The State Council, China's Cabinet, has added 5 billion yuan (725 million U.S. dollars) for flu prevention and control work to nationwide health education campaigns about the virus. The WHO officer said China's proactive response and multi-sectoral approach are crucial to ensuring a well-coordinated response. STRANDED NATIONALS BACK IN CHINA A plane sent to fetch 98 Chinese citizens from Mexico arrived in Shanghai Wednesday afternoon. All on board were in normal condition, the city's quarantine bureau said. The plane landed at Pudong International Airport at 4:32 p.m. The passengers, along with a Shanghai-based infectious disease specialist who accompanied them, were sent to a hotel for quarantine. China sent the flight under an agreement with Mexico, which has been battling an A/H1N1 flu outbreak, to send back each other's nationals. The Shanghai Quarantine Bureau checked the health of all the people on the plane on its arrival, and sterilized the aircraft, luggage and waste. China suspended direct flights from Mexico to Shanghai starting Saturday after the 25-year-old Mexican was diagnosed with A/H1N1 flu in Hong Kong. QUARANTINE BEING LIFTED FOR SOME Those passengers who have been under quarantine since May 1 for taking the same flight with the Mexican young man will be free to go by 6 a.m. Thursday if they show no flu-like symptoms, the health ministry said. The passengers are now scattered in 19 provinces, autonomous regions and municipalities on the Chinese mainland. None of them had yet showed any flu-like symptoms as of 12 a.m. Wednesday, according to the ministry. In anther development, 25 Canadian students were released Wednesday from medical surveillance in northeast China's Jilin Province. The overseas students at Northeast Normal University were put under observation at a hotel immediately after flying to Changchun, capital of Jilin, on May 2, from Canada via Beijing. The students have displayed no influenza A/H1N1-like symptoms, including fever and sore throat, the Jilin Provincial Publicity Department said late Wednesday.