Children's hospital unit quarantined because of swine flu outbreak

Last Updated: Tuesday, July 7, 2009 7:11 PM MT Officials have isolated a unit on the third floor of the Alberta Children's Hospital in Calgary because of three swine flu cases.

The hospital has stopped admitting new patients to the unit, which usually treats children with kidney problems, because one staff member and two children are confirmed to have swine flu, said Don Stewart, a spokesman with Alberta Health Services, on Tuesday.

Patients already there have been isolated, and only their parents or close family are being allowed to visit them.

The unit has been contained, and infection prevention control measures are underway, added Stewart.

Alberta has registered more than 1,000 cases of swine flu since the influenza outbreak began in Mexico in March.

On Monday, health officials confirmed the death of an Edmonton-area woman with chronic pre-existing medical conditions as the second fatality in the province associated with swine flu.

Every year, 4,000 Canadians die from the flu and a high percentage of them have underlying conditions that play a large part in making them susceptible to complications associated with the flu, he said.

New flu virus found in two Sask. hog farm workers

By Angela Halland Joanne Paulson, Saskatchewan News Network
July 7, 2009 7:24 PM




Chief veterinary officer Dr. Greg Douglas (left) and Saskatchewan's chief medical health officer Dr. Moira McKinnon speak to media on Tuesday.

Photograph by: Troy Fleece, Leader-Post




REGINA — A new flu strain not connected to the current H1N1 influenza pandemic has been discovered in two Saskatchewan hog farm workers, health officials said Tuesday.
Testing on the workers — who have since recovered from mild flu cases — revealed that a seasonal human flu strain and components of a pre-existing animal flu strain appear to have formed a novel virus, said Saskatchewan Chief Medical Health Officer Dr. Moira McKinnon.
A possible third case is under investigation.
The detection of a novel influenza virus is rare but does happen occasionally, said McKinnon.
"In the past, most of these events do not end up transmitting from human to human and result in what's called a dead end," said. "Despite this understanding, we are taking aggressive precautionary measures to ensure the health and safety of Saskatchewan residents."
The new strain was found largely because of the increased flu surveillance that's taking place due to the current H1N1 pandemic, McKinnon said.
There is no evidence that the new strain — being referred to as a novel non-pandemic influenza A virus — has transmitted between humans, and there are no signs of the disease in the pigs at the hog operation where the individuals work, agriculture and health officials said.
Big Sky Farms president and CEO John LaClare confirmed that the two affected employees were Big Sky workers at a northeastern Saskatchewan location, but would not reveal the exact site due to privacy concerns. The two employees had flu-like symptoms about the middle of June, said LaClare in an interview. As Big Sky recommended, they did not come to work and sought medical attention.
"They are back at work. There is no evidence that we have the virus circulating in the
herd."
LaClare said Big Sky always operates with very high bio-security standards, including having employees shower in and shower out when they arrive and leave work.
Officials can't say where the virus might have originated, noting there are always flu viruses circulating in the animal and human populations.
"It certainly conceivable that we'll never know where this virus came from," said provincial veterinarian Greg Douglas at a news conference in Regina.
Douglas said the discovery is not a food safety risk.
"Based on sound science and international guidelines this finding should have no bearing on Canadian pork or pork products trade in the world," he said.
Neil Ketilson, general manager of the Saskatchewan Pork Development Board
(Sask Pork), noted the herd is fine, and also emphasized that pork is safe to eat.
"When it comes to type A flu, it's a respiratory disease. It does not flow through into the meat in any way, shape or form," he said.
Saskatchewan residents in the affected area are to be closely monitored for flu symptoms, as will animals at the facility in the northeast, in the weeks ahead. The Ministry of Health said experts believe the new strain will respond to the current seasonal influenza vaccine and all hog farm workers at the affected operation will be vaccinated.

Government of Canada identifies new strain of influenza

July 7, 2009
For Immediate Release


(OTTAWA) – The Government of Canada is working closely with the Province of Saskatchewan to assess the public health risk from a new strain of influenza that has been detected in the province.

The new strain was detected in two workers on a hog farm in Saskatchewan. The workers suffered only mild illness and have recovered fully. A third case is under investigation. Scientists at the Public Health Agency of Canada’s National Microbiology Laboratory in Winnipeg have determined that the new strain is made up of genes from human seasonal flu and swine flu viruses. It is not a new strain of the pandemic H1N1 flu virus currently circulating in Canada.
“We are working closely with the province of Saskatchewan to learn as much as we can about this new flu virus,” said Health Minister Leona Aglukkaq. “Preliminary results indicate the risk to public health is low and that Canadians who have been vaccinated against the regular, seasonal flu should have some immunity to this new flu strain.”
Initial testing of some of the pigs on the farm suggests they were infected with swine influenza A virus, a common flu found in swine herds. There is no evidence that this new human strain of the virus is present in the swine herd.
The Public Health Agency of Canada (PHAC) is collaborating with Saskatchewan public heath officials on further surveillance of workers in Saskatchewan’s hog industry, including those on the affected farm. PHAC is prepared to provide field epidemiological assistance to Saskatchewan. The Canadian Food Inspection Agency (CFIA) is providing advice to the province on swine herd surveillance. CFIA is also providing further diagnostic support to the initial testing performed by the Province at the national reference laboratory in Winnipeg.
“As required under the WHO’s International Health Regulations, Canada has notified the WHO about the detection of this novel influenza virus,” said Dr, David Butler Jones, Canada’s Chief Public Health Officer. “The Government of Canada remains vigilant and we will continue to keep Canadians informed of any new developments.”
Media Inquiries:
Josée Bellemare
Press Secretary
Office of the Minister of Health
613-957-0200
Public Health Agency of Canada
Media Relations
(613) 941-8189

Argentina: CDC, WHO & PAHO Studying Progress of new influenza

Martes 7 de Julio

American professionals studying the progress of the new influenza in Argentina

They are representatives of the Centers for Disease Control and Prevention who came to the country to investigate the impact of influenza H1N1. Pilot tests will be applied to combat the virus

Elizabeth Garrido (Infobae.com)
The Centers for Disease Control and Prevention (CDC) is one of the agencies most internationally recognized under the government of the United States, and continues research on various different diseases and its prevention and fighting.

One such research seeks to influenza A and Argentina was one of the destinations for a comprehensive field work for the relief about the development of viruses as well as the measures implemented by the Argentine Government and its outcomes.

In charge of press affairs for the Hispanic CDC, Arleen Porcell-Pharr, Infobae.com confirmed from his office in Atlanta that there are two epidemiologists who are working since Tuesday on our country, but it is expected that in the next few days add other professional.

"They were invited by the Ministry of Health of the Nation argentina, and aim to improve the surveillance of influenza A. The activities are nationwide but are concentrated in urban sites, those with the largest number of cases," he added the staff member.

The results of the studies would be ready within the next three weeks and would be designed, in the case of Argentina, to extend the protocols for the prevention and fight against the pandemic to be used in the country. "We are studying the deaths, the effects of the flu, among others, then apply for pilot tests and know how to act," he added.

The two professionals are also part of the World Health Organization (WHO) and the Pan American Health Organization (PAHO) and the data collected would be presented in both multilateral and placed on study as emblematic case, especially after the Argentina ranks third in the ranking of fatalities with 72 deaths, preceded by the United States (170) and Mexico (119).

The view from the U.S.
In the United States, the peak of influenza A was at the end of winter so that the American concern in the north of the country did not cease. Thus, on Thursday will be developed in a Maryland summit on influenza, in which the Secretary of Health and Humanitarian Services, Kathleen Sebelius, the representative of Homeland Security, Janet Napolitano, Secretary of Education, Arne Duncan, and Homeland Security Council, John Brennan, to discuss and begin to develop different activities in different parts of the public to prevent further cases.

The order that was issued directly to the White House, Sebelius was justified by asserting that it was necessary to "develop a national campaign to train local officials and federal, as well as the system emergency managers, educators to work with the experts of public health to build a plan according to each state with facilities to combat the pandemic. "

For this purpose, in order that the country still has the north of the traditional hot summers, the Argentine case will be very useful to develop prevention policies and to take some of those test programs that were not to be as effective the pandemic.
hat-tip Shiloh

New non-pandemic influenza virus found in Saskatchewan hog workers

at 19:49 on July 7, 2009, EDT.

Jennifer Graham, THE CANADIAN PRESS

THE CANADIAN PRESS/Ryan Remiorz"

REGINA - A new, never before seen flu virus has been found in Saskatchewan, but health officials were quick point out Tuesday that it's not connected to the current H1N1 pandemic.

Saskatchewan's chief medical health officer, Dr. Moira McKinnon, told a news conference in Regina that the new flu is a mixture of a seasonal human flu and an animal strain that has been circulating in North America for several years.

"I know this is confusing because we've got swine flu H1N1 which is now freely transmitting in humans - it's not that H1N1," said McKinnon.

"We also have seasonal human H1N1 that's been around for many, many years and that is the strain that we vaccinate against every year. That's the virus that's recombined with another virus."

The new strain was found after three hog farm workers in eastern Saskatchewan fell ill in June and were tested for both seasonal and swine flu. The virus was confirmed in two cases and the third is under investigation.

McKinnon said the test results raised more questions.

"Both the tests showed positive and it's unusual to have two flus at once, two different strains of influenza," said McKinnon.

"We sent the samples to the National Microbiology Laboratory in Winnipeg and they looked at it and did the gene sequencing. They looked at the genetic material and that's where they found that two viruses had - the scientific term is - reassorted or mixed their genes," she said.

"Changes in influenza viruses occur frequently in animals and in humans ... the detection of a novel influenza virus is however a rare event."

Health officials could not say how the workers, who all had mild symptoms and have fully recovered, contracted the flu. They have been in Saskatchewan for about a year and have not travelled outside the province, said McKinnon. The 10,000 to 15,000 hogs on the farm are all reportedly healthy.

Saskatchewan chief veterinary officer Dr. Greg Douglas said "it's certainly conceivable that we'll never know where this virus came from."

There is concern because Canada was the first - and is still only one of two places - where the pandemic virus has been found in pigs.

Late Tuesday, Big Sky Farms Inc. issued a news release confirming that the workers were employed at their facilities in Humboldt, Sask.

Big Sky put protocols in place to protect the herd when the H1N1 swine flu came to light a few months ago and it says the workers followed the rules by getting medical attention and isolating themselves.

Douglas said Saskatchewan Agriculture is working with health officials to keep an eye on the herd, but added that so far "this is a human health issue."

"To date there have been no signs of increased illness in this herd and the pigs are under constant veterinary care and monitored by a herd veterinarian," said Douglas.

"Based on sound science and international guidelines, this finding should have no bearing on Canadian pork or pork products trade in the world."

McKinnon said the new flu was likely only detected because of heightened surveillance for swine flu. But she also took pains to emphasize that the new strain of influenza doesn't appear to be spreading and could result in what's called a "dead end."

"It will probably not transmit, it will probably go no further than it's gone already. This happens every now and again with influenza viruses, they do mix. More often than not they don't have the characteristics that enable them to continue," said McKinnon.

"However, it does have the potential possibly of being a new virus that spreads and that's why we have put in all these measures and will be extremely careful and vigilant about what's happening here."

The news about the new flu came the same day another death from H1N1 was announced, this time in Quebec.

There have been 37 deaths from the virus across Canada. Twelve deaths have been reported in Ontario, five in Manitoba, three in Saskatchewan, 15 in Quebec and two in Alberta.

WHO to Recommend Countries Stop Testing All Flu Cases (Update1)

By Phil Serafino and Kristen Hallam

July 7 (Bloomberg) -- The World Health Organization will recommend that countries stop trying to test all suspected cases of swine flu, said Keiji Fukuda, the agency’s assistant director-general of health security and environment.

Nations that have reported pandemic flu cases should focus on diagnosing patients by their symptoms, Fukuda said today on a conference call with reporters. That will free up laboratories to test samples in unusual or severe cases, clusters of illnesses and cases with odd symptoms, he said.

“What countries ought to do is tailor down their testing,” he said. “It will ease the burden on labs and make testing less of a chore. It is very hard to keep up.”

The Geneva-based United Nations health agency will continue recommending testing in countries that haven’t reported any cases of the pandemic H1N1 flu virus, Fukuda said. The WHO will release updated guidance on testing within a few days, he said. More than 98,000 pandemic flu cases have been reported worldwide, Fukuda said.

Swine flu: Scots will be forced to wait 1½ years for full vaccination

Published Date: 08 July 2009

By Tom Peterkin

HEALTH bosses have admitted that the NHS will not be able to vaccinate all of the Scottish population against swine flu until November 2010 – almost 1½ years away.

The admission led to calls for action to ensure that Scotland does not suffer a vaccine shortage as the pandemic intensifies.

Experts have predicted that the number of swine-flu cases in Scotland will soar to 10,000 a day by the end of August

an doctors are anticipating for a rapid increase of the illness over the winter.

The fact that it will be 16 months before there is enough vaccine to cover the entire Scottish population was revealed in a letter from Kevin Woods, the NHS Scotland chief executive, to local NHS board officials.

The letter states: "According to current delivery estimates vaccine for 100 per cent of the population could be received by November 2010."

The letter went on to say that "a significant proportion ... possibly enough to vaccinate half the population" of the vaccine stock would arrive before the end of December this year. The first batches will arrive in August.

The letter added: "Delivery of the H1N1 vaccination programme will be a significant challenge for the NHS in Scotland, unprecedented in scale and scope."

Mary Scanlon, the Conservative health spokeswoman, said: "There was an understanding that there would be sufficient vaccine for all the population over the forthcoming winter months.

"People with asthma and diabetes, and health workers have to be prioritised. I think this is of concern, particularly given that we are told that the swine flu virus is likely to mutate into something more serious."

She added: "Given all the publicity over swine flu, there is likely to be an increase in demand for the vaccine.

"I hope the government will look at all the options to increase the supply of vaccine over the winter months."

The public has been urged not to panic-buy counterfeit swine flu drugs online. The government has also said that the ordered vaccine ought to be more than enough to supply those most at risk of serious illness as a result of contracting the virus.

Richard Simpson, the Labour MSP and former GP, said: "It looks like we are not going to vaccinate 100 per cent for a while, so the question has got to be 'who are the priorities for the injection going to be?'

"Both the UK and the Scottish governments need to start telling us, who is going to be in line for the vaccine? Will it be medical staff? It looks like this virus is not affecting older people. It looks like it is affecting younger people and it is those with underlying health problems, who are dying. So presumably they must be the ones that should be prioritised."

Dr Alan McDevitt, a Clydebank-based GP and the joint vice-chair of the BMA's Scottish GPs committee, said: "Most of us are concerned that the vaccine should be going to those who are most at risk and hopefully 50 per cent should cover that."

Dr McDevitt said doctors would be looking to give the vaccine to those with lung or liver diseases, children and pregnant women.

"The message seems to be that we need enough to cover the at-risk groups and those at risk from complications," Dr McDevitt said. "I think there should be enough for us before Christmas."

So far, seven people in Britain, including two Scots, have died with swine flu.

A Scottish Government spokesman said enough vaccine had been ordered to protect half the British population (30 million people).

"We are not assuming that the whole population is going to get swine flu," the spokesman said. "It would be highly unusual for that to happen. There is no evidence to suggest that swine flu is more virulent than normal seasonal flu."

IMPACT ON SCOTLAND

SOME 1,377 swine flu cases have been identified so far in Scotland.

By the end of August, that figure is expected to rise to 10,000 a day north of the Border and 100,000 across the UK as a whole.

The first UK death was that of Jacqui Fleming, 38, from Glasgow, who contracted the H1N1 virus last month, two weeks after her son Jack was born 11 weeks prematurely. The baby also died, but he did not have the virus.

The second Scottish death was a 73-year-old man from Glasgow.

All of the British swine flu fatalities have suffered from other underlying illnesses.

The World Health Organisation has estimated that 94,000 people around the globe have contracted the disease. The worldwide death toll so far is 431.

Two Canada hog workers hit by new non-pandemic flu

Tue Jul 7, 2009 7:07pm EDT

By Rod Nickel

SASKATOON, Saskatchewan (Reuters) - Two farm workers in Western Canada have become infected with a new flu virus, health officials said on Tuesday, stressing the strain was not related to the H1N1 pandemic.

The two workers, both employees at a hog barn operation in the province of Saskatchewan, have fully recovered. A third case is under investigation.

The new virus contains genes from a seasonal human H1N1 flu strain and a flu virus common in the swine population called triple reassortant H3N2, said Dr. Greg Douglas, Saskatchewan's chief veterinary officer.

The virus is not connected to the H1N1 strain, sometimes referred to as swine flu, that has killed more than 400 people worldwide. That strain is believed to have begun in Mexico and has been labeled a pandemic by the World Health Organization.

There are no signs of increased illness in the hog herd, Douglas added.

"This is a human health issue," he said. "Saskatchewan pork continues to be safe ... This is not a food safety issue at all."

Concern about the issue of pigs becoming infected with the H1N1 flu has been heightened in Canada since a herd in Alberta became infected in April. A human worker who had visited Mexico was initially suspected as the source but was later ruled out.

The Saskatchewan farm is not under quarantine, but the owner has agreed not to move the pigs, said Dr. Frank Plummer, chief science adviser for the Public Health Agency of Canada.

The virus would likely not have been detected at all if not for heightened influenza testing as a result of the pandemic, Plummer said.

"Any time there's a new influenza A strain, we have to be concerned about it, but these events occur and are almost always dead ends," he said.

All workers on the hog farm are being vaccinated. Douglas said he expects the hogs will eventually go to slaughter as they normally would.

The workers have been in Saskatchewan for about one year and had not recently traveled, said Dr. Moira McKinnon, Saskatchewan's chief medical officer.

Plummer said the new virus was likely transmitted from the pigs to the workers, but said the source of transmission of the pandemic H1N1 virus on the Alberta hog farm, which was quarantined in April, was probably human.

More than a dozen countries have banned Canadian hogs or pork since the quarantine.

Bob Harding, executive director of the Canadian Swine Health Board, said there is concern that markets could misinterpret the new virus's connection to swine.

"This is a poorly understood science. It's changing as we speak, but it's not a pig thing," Harding said.

WHO says swine flu situation evolving rapidly

Health 7/7/2009 7:06:00 PM

GENEVA, July 7 (KUNA) -- World Health Organization's (WHO) Assistant Director-General Dr Keiji Fukuda said Tuesday that the situation of A/H1N1 influenza is evolving rapidly. He added, in a news conference, that the pandemic is reported in 137 countries and territories with more than 98,000 confirmed cases and more than 440 deaths. Fukuda explained that the health organization will issue updated surveillance recommendations for countries in the coming days. He added that there are spontaneous mutations of a few cases of a virus which are resistant to Tamivir. The the mutated virus was found in Japan, Denmark and Hong Kong; they are the same mutated virus and they affected three people. "We are monitoring this situation very closely," he said. Fukuda said that discussions were underway to name the pandemic virus, it was decided that the name must be scientifically accurate, and therefore it was suggested to be called A/H1N1 09 virus

Influenza monitoring by the US military

Program provides important data to support worldwide health efforts

San Diego, July 7, 2009 –The recent global swine flu outbreak has underscored the critical need for good surveillance and rapid access to epidemiological data. The US military, starting with early monitoring efforts in the 1970s, has developed a broad-based influenza monitoring system. In an article published in the September 2009 issue of the American Journal of Preventive Medicine, researchers describe this little-known national jewel that has repeatedly made notable contributions to global influenza control through close collaboration with CDC, the Food and Drug Administration (FDA), the WHO, and many other partners.

National concerns about emerging infectious diseases led to the creation of the Department of Defense Global Emerging Infections Surveillance and Response System (DoD-GEIS) in 1997. This program has 6 objectives relevant to influenza: (1) To isolate and identify circulating influenza viruses, (2) To detect new virus variants or subtypes for possible vaccine modification, (3) To identify influenza outbreaks, (4) To determine the incidence of influenza-like illness among sentinel military populations at high risk, such as basic training populations, (5) To prevent or control endemic and pandemic influenza outbreaks, and (6) To conduct global, operationally relevant, laboratory-based influenza surveillance.

According to the Institute of Medicine, "The DoD–Global Emerging Infections System, through its avian influenza/pandemic influenza activities at the [DoD] overseas laboratories and headquarters, has contributed greatly to the development of laboratory and communications infrastructures within partner countries. Beneficial effects can be seen from current DoD-GEIS efforts in 56 countries to assist its public health partners in building capacity through training and support of laboratory and communications infrastructures."

Writing in the article, Col. James Neville, MD, MPH, of the US Air Force School of Aerospace Medicine, Brooks City-Base, Texas, and colleagues state, "During seven complete influenza seasons, the DoD Global Laboratory-Based Influenza Surveillance Program…coordinated and expanded influenza surveillance efforts among the uniformed services and with DoD partner nations overseas, and operated in concert with WHO and CDC programs. As a result, the DoD and other global communities benefited from improved surveillance and expanded influenza laboratory and epidemiologic capability. The generated data and information supported timely, informed decision making in response to threats, expanded the data set used to select the components for seasonal influenza vaccines, and provided candidate seed viruses for possible use in influenza vaccines used worldwide."

In a commentary in the same issue, Dr. Patrick W. Kelley, MD, DrPH, of the Institute of Medicine, The National Academies, notes that, "The somewhat unexpected emergence of novel H1N1 in Mexico, rather than in the anticipated Asian setting, highlights a lesson learned about the need for comprehensive global influenza surveillance. This is a lesson that geographically diverse foreign military health systems may be well-positioned to help address."

He continues, "The success of the US DoD system, and the particular epidemiologic characteristics of military populations and military health systems, suggest that global influenza surveillance and response could be more comprehensive and informative if other military organizations around the world took advantage of their comparative organizational advantages to emulate, extend, and institutionalize the US DoD approach."

Swine flu outbreak during Haj 'inevitable'

Jul 07, 2009 at 14:07


By Peter Harrison

A swine flu outbreak in Saudi Arabia during the pilgrimage season is “inevitable”, but authorities have adequate measures in place for when millions of pilgrims descend on the kingdom later this year, a WHO official said on Tuesday.

"We (WHO) are expecting an outbreak of the illness during pilgrimage season,” Dr John Jappour, medical officer in emerging diseases at the World Health Organization (WHO), told Maktoob Business in an interview.

Jappour said the rapid spread of A(H1N1) globally and the sheer number of people congregating in holy cities of Mecca and Medina for Umrah and Haj meant there would almost certainly be an outbreak of the potentially deadly flu virus.

Around 2 million Muslims are expected to make the journey to Saudi Arabia between August and December for Umrah and Haj.

The Umrah - minor pilgrimage - season picks up in late August, during the fasting month of Ramadan, followed by the Haj - the fifth pillar of Islam - in late November.

With the rapid global spread of swine flu all eyes are on Saudi Arabia to make sure the conservative Muslim country can limit the spread of the virus and cope with any outbreak.

Worldwide, more than 98,000 cases of swine flu, including over 440 deaths, have been reported in some 137 countries, according to the latest WHO figures. Saudi Arabia has recorded 125 cases.

Countries, especially those with large Muslim populations, are very concerns about the prospect of thousands of pilgrims returning home infected with swine flu.

Saudi Arabia and several neighbouring Gulf states have urged old and sick people, as well as pregnant women and children, to skip pilgrimage this year.

Countries are also beefing up airport screening of returning pilgrims - Egypt has said all returning pilgrims will be quarantined.

The WHO, as well as experts from the U.N. and U.S. Centers for Disease Control and Prevention, have all been to Saudi to assess the kingdom’s preparations.

“We are confident that Saudi Arabia now has sufficient contingencies in place,” Jappour said, describing them as "comprehensive, methodical and transparent".

Jappour warned, however, that if a more virulent strain of A(H1N1) emerged contingencies would have to be reassessed.

The current wave of swine flu sweeping the world is seen as relatively mild, killing less than 0.5 percent of those infected, but scientists raised warned subsequent waves may be more virulent.

"If the strain were to mutate we would have to hold further talks to ensure this was dealt with," Jappour said.
hattip Shiloh

Paraguay: Health awaited results of 6 died from suspected H1N1 A

[2 Articles]

07 de Julio de 2009

Dr. Diego Gamarra, Ministry of Public Health and Welfare said today on Radio Primero de Marzo 6 that there are fatalities waiting to be confirmed by suspected influenza A H1N1. The authorities said that the striking new virus affects mostly young adults and pregnant women.

Dr. Diego Gamarra

Dr. Gamarra said also that the authorities are doing everything they can to provide answers and assistance to the people. Further recalled that there was no need for laboratory confirmation to start a treatment for the condition and reagents to confirm any cases in Paraguay arrive this week.

Figures from the Ministry of Health are 114 confirmed cases of influenza A H1N1,
518 suspected cases, which had killed 3 people and 6 A H1N1 confirmed deaths (mostly adults). In addition some 60 people are monitored by severe breathing problems (50% of cases are part of the risk groups).

2nd Article:
And five were confirmed killed by the H1N1 virus
Two more deaths on suspicion of swine flu
This is a couple of 20 years and a boy of 21 years. The first died at the National Hospital and the second incarnation of IPS.

Two other deaths suspected influenza H1N1 occurred yesterday in the country. A 20-year-old who was pregnant and spent several days at the National Hospital, plus a couple of 21 years who died in hospital IPS Incarnation, are the new victims of the dreaded flu swine.

Dr. Felix Ayala, director of the National Hospital Itauguá reported that the couple of 20 years died yesterday at nap time, after being in intensive care since Monday of last week, with a picture of pneumonia severe. "He made the internal and C-section before the baby was saved. It's in neonatal therapy. Hope for tomorrow (today) the results to confirm it is a case of H1N1. Tested positive for influenza A, "he said.

As the youngest of 21 years who died in Encarnación, was transferred from the United Colonies, with a picture of chronic bronchopneumonia. His condition worsened last Saturday, which was derived from the sanatorium to the Adventist Hospital of IPS in this city. He tested negative for common flu, but is not performed the analysis of H1N1 influenza, as reported.

Confirmed cases

Confirmed cases of influenza A H1N1 amount to 114 in Paraguay, as reported yesterday by Dr. Ivan Allende, director of health monitoring of the Ministry of Health. This figure confirms that six other patients contracted the disease.

The doctor reported that 498 cases have been monitored to conform with the definitions of the World Health Organization (WHO), of which 114 were confirmed by laboratory and some, by epidemiological nexus. Meanwhile, 348 remain as suspects. Allende also said that out of all 36 cases reported. He recalled that to date there were 3 deaths due to disease: a sexagenarian, a girl of 8 years and a baby of 11 months. The Director of Health Surveillance said that suspected cases involving all groups, but mostly people between 15 and 40 years, and between 5 and 14 years.

He further indicated that they were working in two distinct stages: mitigation in Asunción and the metropolitan area, where, he said, the response of the services should be good enough to detect cases at risk of serious complications or to decrease the mortality associated to respiratory infections, and the rest of the country, a phase of containment, without any evidence that points to a spread of H1N1 virus in other areas outside of Asuncion and Central.

Situation in Encarnación

Encarnación .- A series of shortcomings and needs to deal with cases of influenza A H1N1 found Encarnación municipal councilors in the various public health centers throughout the city. The lack of financial and human resources, as well as the intensive care unit are more urgent by the spread of the disease. In the Regional Hospital of Encarnación are likely two people interned with swine flu. In this hospital queries increased by respiratory tables 200 to 300%. The councilors Luis Id (Patria Querida) and Rolando Arévalos (Liberal Party) made a tour of verification by the City Pediatric Hospital, Institute of Social Itapúa Regional, Regional Hospital of Encarnación and central border Encarnación-
Posadas.
hat-tip Shiloh [for both articles]
http://www.lanacion.com.py/noticias-255318-2009-07-07.htm

Argentina: Cordoba - 3 Articles to bring you up-to-date

[Shiloh, at FluTrackers, is doing an excellent job of covering all of this, and you can find the specific thread to this area, here: http://www.flutrackers.com/forum/showthread.php?t=114232]

July 5, 2009
Excerpt:
First case in Cordova
Amounting to 56 deaths in the country for the swine flu
The last fatal case occurred in Iturraspe Hospital in Cordoba city of San Francisco. The youngest of 26 years died a few weeks after being placed and give birth to a bebe. "The girl suffered complications after her caesarean section and required mechanical respiration, unfortunately could not escape and died of bilateral pneumonia," said the director of the Hospital Iturraspe Mario Vignolo, told Cadena 3.

Diagnosis of swine influenza in the deceased patient had been confirmed last Tuesday by the Institute Malbrán and for the moment, it is unknown how they are spread.

"This woman was admitted with this pregnancy to term, but with a flu-like box. When subjected to a caesarean section and respiratory complication was a bilateral pneumonia," he said.

The specialist said that "the baby is well, is with his grandparents, was two days in neonatology, but without complications."
*for full article go here: http://tinyurl.com/n5w4gh
hat-tip Shiloh

2nd Article:
06/07/2009
A couple died of influenza A and 6 are suspected cases in Cordova
Excerpt:
Investigating whether a man of 36 years and a boy of 12 died from the virus.
The doctor confirmed that two other suspected cases of pregnant women could be infected with influenza A. Both are being held in hospital in the capital of Córdoba.
*for full article go here: http://tinyurl.com/nbty7q
hat-tip Shiloh

3rd Article: [49 yo is mentioned in article #4]
July 7, 2009
A man who died was among the suspected cases
Excerpt:
Briseño Ruben, aged 49 and originally from Alto Alegre was the first victim in Villa Maria, in the context of pandemic influenza A (H1 N1) that has a health emergency in the country.

Briseño ceased to exist, at 10.30 yesterday, in the Intensive Care Hospital Pasteur was one of "suspected cases", with the samples sent to the Institute Malbrán, but ended without results.

The patient was admitted to hospital in Mendoza street, on Thursday afternoon, presenting a picture of bilateral pneumonia and the symptoms of influenza A, as reported by the doctor in the Intensive Care Unit Sara an exchange.
The man was healthy, non-smoker and had no history that would justify the seriousness of the disease.
For full article go here: http://tinyurl.com/nopd75
hat-tip Shiloh

4th Article:
MAR 7 JUL
Second victim of influenza A in Cordova
Excerpt:
The director of the San Francisco Hospital Iturraspe Mario Vignolo, confirmed this afternoon that the death of a man of 39 years, died on June 28 last, was due to influenza A, which is the second death from the disease in Córdoba province, both in the same city.
Vignolo confirmed in this city east of Cordova, 180 km from this capital, "there are several cases under study, about 6 or 7 patients with suspicion." "We have two confirmed cases and two victims," he added.
Medical authorities Mercy Hospital of Cordova awaiting tests to determine whether a teenager died of influenza A in the hospital, although in principle it could be pneumonia.

Raúl Ré, the hospital director, said the patient died with pneumonic box is not confirmed as influenza A ".

"Either way the studies are in progress, we have no confirmation. The table was made from a pneumonia, is treated as such," the doctor told radio Miter 810.

"This girl came in with respiratory symptoms, its placement was decided, we all studies but had a very fast and died. Pneumonia is a viral table, we must turn to confirm whether there was a virus," he added.

Villa Maria. Investigating the death of a person apparently in Villa Maria with symptoms of influenza A.

In this regard, William Thomas, director of the Pasteur Hospital in that city, stated that the patient suffered from 49 years of bilateral pneumonia and only in 20 days will tell whether his death was due to influenza A.

In San Francisco, meanwhile, there are two pregnant women in serious condition following a strong picture of influenza A.

Children's Hospital. It reserved the health status of a teenager 14 years with suspected influenza A.
For full article go here: http://tinyurl.com/meuguh
hat-tip Shiloh

WHO: New name, but the virus remains deadly: Pandemic H1N1 09

Posted by Tala Dowlatshahi on July 7, 2009

Dr. Keiji Fukuda, WHO’s (World Health Organization) Assistant Director-General for Health Security and Environment provided an update on the newly named: Pandemic H1N1 09. WHO has reported the virus is contagious, spreading easily from one person to another, and from one country to another. “We are now seeing 137 countries, 98,000 cases and over 440 deaths. The situation has evolved quite rapidly. ”

In June 2009, WHO raised the pandemic level from a phase 5 to a phase 6. As defined by WHO:

“Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 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. Phase 6 is pandemic phase, is characterized by community level (wide) outbreaks.

Fukuda added WHO will be issuing updated surveillance data in the next few days and is calling for changes in the surveillance approach in many affected countries. “Building a global system of effective in-country national indicators has been a major area of WHO’s preparedness activity,” he said. Two new national influenza centers were open today in Cameroon and the Ivory Coast.

In the past few weeks, there have been Tamiflu resistant cases reported in Denmark, Japan and Hong Kong. “We are continually monitoring the situation. We don’t want to see the start of widespread viruses,” Fukuda said.

WHO also reported “many, though not all, severe cases have occurred in people with underlying chronic conditions. Based on limited, preliminary data, conditions most frequently seen include respiratory diseases, notably asthma, cardiovascular disease, diabetes, autoimmune disorders, and obesity.”

One third to half of the severe and fatal infections are occurring in previously healthy young and middle-aged people and pregnant women are at increased risk of complications.

For a full audio recording of the press conference go to:

http://terrance.who.int/mediacentre/audio/press_briefings/VPC_07JUL2009_Influenza_A_H1N1.mp3

hat-tip Chuck

Argentina: 1 Conf. death; Another 4 awaiting conf., 3 of which had no underlying conditions

07-07-09
Confirmed the first death from influenza A in Neuquén

The Secretariat of Health announced yesterday that Neuquén, according to the results of a sample sent to the Institute Malbrán, one person died of influenza A in the province.

The victim is not yet on the list of deceased officer of the Ministry of Health of the Nation.

Meanwhile, health authorities are awaiting confirmation of another four deaths, the analysis found in the laboratory Aires, reported the website of The Morning Neuquén.

There are three people who died in the city of Cipolletti, and fourth in the provincial capital, for acute respiratory problems. Of those, two were girls and three had no previous health problems.

Cases of influenza A detected in the province amounted to 56. Meanwhile, this week the number of patients that should be placed with acute respiratory diseases and suspected of having contracted the disease rose from 25 to 102.

The province is one of the already declared health emergency.
hat-tip Shiloh

Argentina: 72 Deaths - 65 Deaths reported yesterday

There would be more than 70 victims of the influenza A
We detected eight new deaths: five in Santa Fe and the remaining three in the City of Buenos Aires, San Juan and Neuquen.

There would be more than 70 victims of the influenza A
Influenza A resulted in eight more deaths in the country, five of them in Santa Fe, and the other three in Buenos Aires, Neuquén and San Juan, according to health authorities reported on Monday. In this way, the total amount of deaths to 72.

Santa Fe The Ministry of Health reported five deaths, bringing the death toll to 18 in the province: 15 in Rosario Node, two in Santa Fe and one in Venado Tuerto.

Moreover, governments of Neuquen and San Juan the first confirmed deaths in these provinces as a result of the influenza A (H1N1), while the Minister of Health of Buenos Aires, Jorge Lemus, the seventh confirmed death in the City of Buenos Aires.

Victims across the country officially joined 60, according to listings released by the Ministry of Health of the Nation on Sunday night. This report refers to Santa Fe with nine cases, however, the health portfolio in the province announced that they are 18. Therefore, the total would reach 72 if account is taken of the 12 cases recorded in Santa Fe, Neuquén, San Juan and Capital.

In San Juan, meanwhile, the first death by influenza A was confirmed Monday by health officials, who said that this is a woman of 38 years, originally from Caucete, located 35 kilometers east of the provincial capital.

The victim, who was not included in any risk group suffered from respiratory complications which could not be replenished, and died in last Saturday night in the sanitarium Almirante Brown.

In addition, the Secretariat of Health of Neuquén informed that the first death in this district was that of a child who had a pre-existing disease.
hat-tip Shiloh

Indo: The patient Suspect Bird Flu began to be restored

Update on this story:

Indo: Patient suspect Avian Flu Died -Nurse that treated, is suspected
Tuesday, July 07, 2009, 12:49:00

A day post the maintenance in the room of the isolation of RSUP M. Djamil Padang, the patient suspect “M” bird flu began to be restored. Nevertheless, the medical team of RSUP M.Djamil Padang continue to broke to treat in the room of the isolation. Because till at this time still menungggu results of the inspection swab the throat and blood from the laboratory Department of Health RI. “Suhu his body has begun to be restored 36 derjat celsius, even so breathlessly began to decrease. However we were still continuing to carry out observation until having the assurance of results of the Department of Health RI,” said Director Umum RSUP M.Djamil Padang Aguswan to Padang Express (Group Padang-Today) in his office, on Tuesday (7/7).

Like beforehand was reported, “M” direct in treated in isolation space, because the fever ended treated, the patient suspect bird flu that died “RK”. “M” was one of the nurses Irna C the Internal Disease of RSUP M.Djamil Padang. A day post the maintenance, "M." underwent several series of the inspection like the taking sample blood and swab the throat. Results of this inspection were sent to the laboratory Department of Health RI. Sesuai the procedure, the assumption patient suspect must continue to undergo the maintenance in isolation space, through to the existence produced by the inspection laboatorium Department of Health RI.
hat-tip Dutchy

Egypt: 4 Suspected Swine Flu in Damanhour

4 suspected cases of bird in the lake pigs

Tuesday, July 7, 2009 - 17:10

Detained Kafr Al-Dawar General Hospital, Lake County, 4 people, including two children after their return from performing Umrah on suspicion of contracting the disease, swine flu.

وقال د.يسرى مبروك وكيل وزارة الصحة بالمحافظة، إن المستشفى احتجز الأربعة المشتبه فى إصابتهم بمرض أنفلونزا الخنازير بعد ظهور أعراض تتشابه مع أعراض المرض عليهم، مضيفاً، أن الحالات المحتجزة هى طفلة تدعى براء أشرف (9 أشهر) وندى شرف (4 أعوام)، وعبد الوهاب السيد (33 عاما)، وإيناس منصور (31 عاما).

A d. Yosri Congratulations, Undersecretary of the Ministry of Health to preserve, said the hospital had been detained four suspected of contracting the disease after an outbreak of swine flu symptoms are similar to the symptoms, he said, adding that the case is retained innocent girl named Ashraf (9 months) and Nada Sharaf (4 years), and Mr. Abdul Wahab (33 years), and Ines Mansour (31 years).

وأوضح، أنه تم عزل المحتجزين عن باقى المرضى وإعطاؤهم عقار التاميفلو بعد أخذ العينات اللازمة منهم لتحليلها وإرسالها إلى المعامل المركزية للتأكد من إصابتهم بالمرض من عدمه.

He explained that the detainees were isolated from the rest of the patients given the drug Tamiflu and after sampling them for analysis and sent to the central laboratory confirmed infection of the disease or not.

Egypt: 8 Suspected Bird Flu in Minya; 2 in Damanhour

The injury of 10 cases of suspected bird flu and queens and the lake

Tuesday, July 7, 2009 - 17:25

احتجز مستشفى حميات المنيا أمس، الاثنين، 8 حالات اشتباه بالإصابة بمرض أنفلونزا الطيور من مراكز: ديرمواس والعدوه والمنيا، بعد ظهور الأعراض عليهم، وتم أخذ عينة منهم وإرسالها إلى معمل التحليل المركزى بالقاهرة.

Minya hospital fevers were held yesterday, Monday, 8 cases of suspected bird flu disease centers: Dermwas and the enemy, Menya, after the onset of symptoms have been taking samples and sending them to laboratory analysis, the central Cairo.

وأكد الدكتور أيمن رجب وكيل وزارة الصحة بالمنيا، أنه تم احتجاز كل من: سيد محمد أحمد عمران (45 سنة)، وأولاده أحمد (12 سنة)، ومحمود (10 سنوات)، وحسين (6 سنوات) من قرية بنى حرام مركز دير مواس أصحاب مزارع دواجن حية، وجلال محمدين إبراهيم (13 سنة) تله مركز المنيا، وشقيقته هدى( 7 سنوات)، وصابرين ماهر صابر (16 سنة)، ونجلاء فتحى السيد (8 سنوات) مركز العدوة.

And Dr. Ayman Al-Rajab, Deputy Minister of Health and queens, was taken into custody by: Syed Imran Ahmed Mohamed (45 years), and his sons, Ahmed (12 years), and Mahmoud (10 years), and Hussein (6 years) from the village of Deir Center was built wrong Moas owners live poultry farms, and of such Jalal Ibrahim (13 years) the status of hill Minya, Huda and his sister (7 years), and Sabrin Maher Saber (16 years), and Mr. Najla Fathi (8 years) the status of the enemy.

وفى البحيرة، صرح الدكتور يسرى مبروك وكيل وزارة الصحة بالبحيرة، أن مستشفى حميات دمنهور قامت باحتجاز شخصين للاشتباه فى إصابتهما بأنفلونزا الطيور، بعد ظهور أعراض تتشابه مع المرض عليهما، من ارتفاع فى درجة الحرارة وألم فى العظام وإجهاد شديد وصعوبة فى التنفس.

In the lake, said Dr. Yusri Congratulations Deputy Minister of Health the lake, the hospital admitted Damanhour detained two people suspected of being infected with bird flu, after the emergence of symptoms of the disease are similar to them, with a high temperature and pain in bones, severe stress and difficulty in breathing.

وتم احتجاز سلمى محمد جمعه خليل (35 سنة) مقيم بالنوبارية، وإسلام صبرى شعبان (27 سنة- مهندس زراعى) مقيم بقرية البيضا بكفر الدوار، وأخذ عينة دم منهما لتحليلها بالمعامل المركزية بالقاهرة.

Were detained Salma Khalil Mohamed Gomaa (35 years) resident owned, and Islam Sabry Shaaban (27 years - agricultural engineer) Beida village resident kaafirs rotor, and the taking of blood samples for analysis of their central labs in Cairo.

وعلى الفور انتقلت لجنة مكافحة المرض لمنازل المريضين لتطهيرها وتطهير المنازل المجاورة، وأخذ عينات من الطيور الموجودة بالمنازل لفحصها وبيان مدى إصابتها

And immediately transferred to the Committee against the disease for patients, clearing houses and clearing houses nearby, and the taking of samples of domestic birds to be tested and indicate the extent of her

WHO: The world's pandemic flu total reached 94,512 cases, 429 of them fatal

Tuesday, 07 July 2009

The world's pandemic flu total reached 94,512 cases, 429 of them fatal, the World Health Organization (WHO) reported today. The number is 4,591 more cases and 47 more deaths than the last report on Jul 3.

Countries reporting their first cases include Cook Island, Croatia, the French overseas territories Guadaloupe and St Martin, Guyana, Libya, and Macedonia. Countries reporting the highest numbers of new cases are Argentina (898), Australia (730), and Thailand (662).

Source : WHO

Recombinomics: Hong Kong Tamiflu Resistant Pandemic Sequence Released

Recombinomics Commentary 06:57
July 7, 2009
The NA sequence from the Hong Kong teenager with oseltamivir Tamiflu resistance, A/Hong Kong/2369/2009, has been released. The sequence is clearly that of pandemic H1N1 and exactly matches (other than H274Y) the sequence of an earlier isolate A/New Jersey/1/2009. Similarly, the HA sequence is also swine and has two recently acquired polymorphisms, one of which is also in New Jersey/1/2009. Thus this sequence is in circulation and as was seen in the isolates in Denmark and Japan, the H274Y is appended onto a swine H1N1 background.

These results mimic that seen in seasonal flu, where H274Y was appended onto multiple seasonal flu background. The polymorphisms jumped from one background to the next, via genetic hitchhiking and recombination. Thus like seasonal flu, the pandemic H1N1 has no evidence of reassortment. The H274Y is on an evolutionarily fit H1N1 that will allow the H274Y to move about through the pandemic H1N1 gene pool. This movement will be facilitated by widespread Tamiflu usage, which will select minor populations as happened in Denmark and Japan, where H274Y was identified in patients receiving a maintenance dose of Tamiflu.

However, in Hong Kong, like the many examples of H274Y in H1N1 seasonal flu, the resistance is in patients not receiving Tamiflu. However, the lessons of H274Y in seasonal flu were not learned. Recent comments have described H274Y acquisitions through random mutation and reassortment. However, there has been no examples of recent seasonal H1N1 flu genes in the pandemic H1N1 sequences, and the H274Y in patients receiving Tamiflu likely represent selection of a minor population with H274Y that is silently spread. The release of the sequences from Denmark and Japan would be useful.

Egypt: The detention of 11 suspected case of bird flu in 5 provinces

7-7 / 2009

Detained in hospital diets 5 provinces of 12 suspected cases of bird flu symptoms.

أكد الدكتور أيمن رجب، وكيل وزارة الصحة فى المنيا، أن مستشفى الحميات احتجز ٥ حالات من مراكز مغاغة وبنى مزار وسمالوط وتم أخذ عينات منهم لتحليلها.

Dr. Ayman Al-Rajab, Under-Secretary, Ministry of Health in Minya, the hospital diets held 5 of the centers of a bell and built a shrine and Samalut been sampling them for analysis.

وصرح الدكتور شريف حمودة، وكيل وزارة الصحة بالغربية، بأن مستشفى حميات طنطا احتجز ٣ حالات ظهر عليها أعراض المرض.

And Dr. Sharif Hammouda, Under-Secretary, Ministry of Health meeting Sunday attended by the hospital admitted Tanta held 3 cases showing symptoms of the disease.

وقال الدكتور محمد صلاح، وكيل وزارة الصحة بأسوان، إن مستشفى الصدر احتجز شقيقين، وتبين مخالطتهما للطيور المنزلية.

Said Dr. Mohammed Salah, the Deputy Minister of Health, Aswan, the Sadr hospital was arrested two brothers, and found Mkhaltthma domestic poultry. واحتجز مستشفى الحميات فى دمياط عيوشة سعد أحمد العربانى «٤٧ سنة» ربة منزل من منطقة الشعراء، مركز دمياط.

He was detained in hospital diets DAMIETTA Ayoshp Saad Ahmed Arabany «47 years» housewife from the poets, the status of Damietta.

وفى البحيرة، صرح الدكتور يسرى مبروك، وكيل وزارة الصحة، بأن مستشفى حميات دمنهور احتجز سلمى محمد جمعة خليل «٣٥ سنة» من النوبارية، للاشتباه فى إصابتها بمرض أنفلونزا الطيور.

In the lake, said Dr. Yusri Congratulations, Under-Secretary, Ministry of Health, admitted that the hospital held a peaceful Damanhour Khalil Mohamed Gomaa «35 years» of Nubaria, on suspicion of being infected with bird flu.

Indo: Patient suspect Avian Flu Died -Nurse that treated, is suspected

---

Tuesday, July 07, 2009, 12:49:00



Padang, Padek - bird flu threat still lurk Sumbar. A patient suspect HIN5 virus, origin Sungaibuluh, District Dharmasraya died.
Victim is known berinisial RK, 7.5, dies after treatment for five hours in space Isolation Irna C RSUP In Diseases Dr M Djamil Padang, Saturday (4 / 7).

The more surprising, a day after RK buried, a nurse in the room RK isolation experienced suspect bird flu. Nurses berinisial M is now in the middle of treatment room isolation Irna C RSUP In Diseases Dr M Djamil Padang. He showed symptoms of bird flu suspect.

"RK has been critical condition when entering RSUP Dr M Djamil Padang, Saturday (6 / 7), pukul 05.00 WIB. Only one five hours later, the patient died at around 10:00 WIB, "said Director General RSUP M Djamil Padang Aguswan, accompanied the Head of room Irna C Diseases In Emi Erawati to Padang Ekspres in space work, yesterday.

RK was undergoing treatment in hospitals Adnaan WD Payakumbuh, since Monday (29 / 6), the chance of being on holiday at her grandmother's house. After that, the RK and then taken to the hospital Yos Sudarso Padang. "From the results of the rays lungs, showed symptoms of bird flu. Patient's body temperature reached 37.5 centigrade accompanied by shortness of breath, "said Aguswan.

When referred to Dr M Djamil RSUP, the condition of the patient is not comfortable with the tool sadarkan bantu oxygen. Until now, Dr M Djamil RSUP Padang can not ensure whether the RK-positive bird flu or not.

"We are still awaiting results of the examination throat swab and a blood test sent to RK Labor MOH RI," said Aguswan. Since 2006, Dr M Djamil RSUP handle the nine patients suspect bird flu from a number of areas in Sumatra, such as Padangpariaman, Limapuluh City, Agam and Dharmasraya. Previously, a patient suspect bird flu died years ago in 2007. (nia

S. Korea's reported H1N1 flu cases come to 286

SEOUL, July 5 (Yonhap) -- South Korea's health authorities said Sunday they have confirmed 27 additional cases of type-A flu, raising the number infections here to 286.

Among the 27 were two men in their 20s employed at the quarantine office of the Incheon International Airport, and who tested positive for the H1N1 virus after showing flu-like symptoms, including fever and throat pain, the Ministry for Health, Welfare and Family Affairs said in a statement

ACEP unveils plan to manage fall pandemic wave

Lisa Schnirring * Staff Writer

Jul 6, 2009 (CIDRAP News) – The American College of Emergency Physicians (ACEP) recently released a plan to help emergency departments, first responders, and public health departments manage a surge in pandemic flu cases that many experts predict will happen this fall.

The 16-page plan was produced under a contract with the US Department of Health and Human Services (HHS) office of the Assistant Secretary for Preparedness and Response (ASPR) and its Emergency Care Coordination Center, ACEP said today in a press release. The document defines critical capabilities and suggests ways to achieve them, ACEP said.

"While H1N1's virulence is not predictable, it is expected to be highly contagious and will place added strains on the emergency care system," said Nicholas Jouriles, MD, president of the ACEP, in the statement.

He added that planning for a second wave will be successful only with cooperation between first responders and public health officials. The plan urges local ACEP chapters to enlist support from state and local health directors, local emergency managers, and political leaders for emergency planning efforts.

The main components of the plan, based on the federal template for managing biological threats, include situational awareness, protecting emergency department infrastructure and personnel, preventing service disruptions, organizing a timely surge response, and recovering to the previous status. Communications with local and state public health officials are crucial, and it's important to have agreements in place for the "triggers" authorities will use to "stand down" the pandemic plan, according to the document.

One of ACEP's key planning assumptions is that large volumes of vaccine against the novel H1N1 virus probably won't be available until mid October at the earliest and that the public won't be protected from infections until 2 weeks after a second injection.

As a result, if the second pandemic wave begins September, health officials may depend heavily on community mitigation strategies to slow the spread of the virus. Emergency departments will still face a surge of patients, but interventions such as school closures will likely strain the department workforces even further, the ACEP plan warns.

Social distancing measures will also affect critical infrastructure businesses and institutions, which may slow the flow of transportation and supplies. Emergency planners shouldn't assume that antiviral medications will be effective for a virus that may have undergone selection pressure between waves, the report notes.

"While the precise effects on emergency departments to function cannot be predicted with confidence, contingency plans should be made for a challenging scenario," the plan states.

The nation's economic problems and the importance of staying on the job may add to the pressures to keep schools open, the planners wrote. News reports of deaths in young people, an age-group currently bearing the brunt of illnesses, might fuel even more parents to seek medical care for their children.

The plan includes 27 capabilities for emergency department response to a severe novel H1N1 outbreak, each with suggested steps and an outline for what level of health or government group is responsible. For example, the plan covers personal protective equipment stockpiling, facility security, crowd management, alternate locations for triage and screening, and configuring waiting rooms for social distancing, if possible.

Stephen Cantrill, MD, an emergency department physician in Denver and a member of ACEP's clinical policy committee, told CIDRAP News that the novel influenza plan is also designed to raise awareness among emergency physicians. The potential burdens will be vast, he said, not only for keeping the workforce functioning during the surge, but also keeping departments adequately supplied.

"There are so many vulnerabilities in the supply chain, where do you start?" he asked, adding that even departments that are well prepared might not able to sustain their supplies.

The impact of the influenza pandemic on emergency departments will be affected greatly by how local public health officials craft their messages to the public, Cantrill said. He said the US Centers for Disease Control and Prevention (CDC) has done a good job communicating flu facts to the public, including details on when to seek medical care.

See also:

ACEP national novel H1N1 influenza strategy

Jul 6 ACEP press release

hattip Shiloh

Patrick talks with flu expert Molecular virologist Dr. Henry L. Niman on the flu pandemic

[Interview was conducted on June 22nd]

Henry L. Niman, Ph.D. - Molecular virologist

Molecular virologist Dr. Henry L. Niman is the founder and president of Recombinomics, Inc., and he tracks emerging diseases around the globe.

WSN/33, a variant of H1N1, is a danger to humans. We can catch viruses from pigs, and this particular virus is one that we have no immunity against. Yet, at the time of the interview, the World Health Organization had only two scientists assigned to work full time tracking emerging diseases like this.

If Dr. Niman hadn’t stumbled onto the genetic sequence of the WSN/33 virus in a public database while doing research for a scientific paper, we might still be in the dark about that potential threat to human health.

Websites:

What's New
http://www.recombinomics.com/whats_new.html
In The News
http://www.recombinomics.com/in_the_news.html
Tracking the progress of H1N1 swine flu - Visual representation including live updated world map
http://flutracker.rhizalabs.com/

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Indonesia-Pig flu Meroket

Sriwijaya Post - 5 July 2009
JAKARTA, SRIPO - Number of swine flu (A HINI) in Indonesia increased rapidly meroket alias. If on Tuesday only eight people, now to 20 people. Penularannya swine flu in Indonesia has been on the stage antarmanusia.

Director General of Disease Prevention and Environmental Penyehatan Department of Health (MOH) Tjandra Yoga Aditama explains, swine flu infection in Indonesia are antarmanusia. "They will be the new home of friends from abroad. The number two person, "specifically in the building meet the press in MOH, Jakarta, Saturday (4 / 7).

According to Tjandra, both of swine flu infection due antarmanusia, occurred in Jakarta. They are contagious from one who has been infected with the virus when to return to Indonesia.

Antarmanusia of swine flu, is spread through direct contact from human to human through coughing, sneezing or objects that have been in contact with the patient.

Overall, the majority of swine flu in Indonesia is imported. Which means, they are contagious swine flu virus when abroad. Namely, among others, Singapore, Canada and Australia. "But they are not severe," he said. Added Tjandra, A H1N1 virus potentially develop in patients aged 20-30 years. "Above the age of virusnya is not too dangerous." He added.

20 Cases

Based on reports from the Directorate General of Disease Control and Penyehatan Environment (P2PL) and the Agency Litbangkes MOH on the development of influenza A H1N1 cases, until Saturday (4 / 7), there are additional new cases of 12 people.

"Indonesia has recorded 20 positive cases of influenza A H1N1. Of 20 positive cases, one person has been declared cured and returned the BM (P, 22 years) WN English, "added Tjandra.

12 of the new swine flu AR (L, 23 TH), RA (L, 10 bln), HR (P, 40 th), IG (L, 33 th), N (P, 34 th), BE (L, 50 th), TD (L, 65 th), F (L, 14 th), RW (L, 23 th), BA (L, 22 th), JO (L, 43 th), and NN.

They were each treated at Pondok Indah Hospital for 6 People, Gatot Subroto Hospital (1.), RS Internasional Bintaro (1) and RS Sanglah Denpasar (3 people).

"They were in better condition," he added. Previously, eight patients treated in the swine flu Sulianti Saroso Hospital (Jakarta) and Bali Sanglah Hospital.

Influenza A (H1N1) - worldwide (84): Tamiflu resistanceINFLUENZA A (H1N1) - WORLDWIDE (84): TAMIFLU RESISTANCE, CHINA (HONG

06-JUL-2009

Date: Sat 4 Jul 2009
Source: 660News, All News Radio, The Canadian Press [edited]
<http://www.660news.com/news/national/more.jsp?content=n034881128>


All cases of Tamiflu resistance are not created equal. So while the 
1st 3 instances of swine flu infection with Tamiflu-resistant viruses 
were reported in the past week, it was Number 3, not Number 1 that put 
influenza experts on edge. Public health authorities in Hong Kong 
announced Friday [3 Jul 2009] they have found a case of Tamiflu 
resistance in a woman who hadn't taken the drug. That means she was 
infected with swine flu viruses that were already resistant to 
Tamiflu, the main weapon in most countries' and companies' pandemic 
drug arsenals.

The 2 earlier cases, reported from Denmark and Japan, involved people 
who had been taking the medication. While always unwelcome, that type 
of resistance is known to occur with seasonal [influenza virus] 
strains and may be less of a threat to the long-term viability of this 
key flu drug. "It was not at all surprising to see resistance in 
patients on treatment, but seeing it in someone who was not treated, 
it certainly is more concerning," says Dr. Malik Peiris, a flu expert 
at the University of Hong Kong.

There is currently no evidence Tamiflu-resistant viruses are spreading 
widely. Still, some experts see the Hong Kong case as a warning that 
Tamiflu's role in this pandemic may not be as long-lived as pandemic 
planners would like. "I think it's too early to judge," says Dr. 
Frederick Hayden, an expert on influenza antivirals who teaches at the 
University of Virginia. "But I think that possibility has existed from 
the beginning, and it's something that needs to be certainly 
considered in making determinations about things like antiviral 
stockpiling, management of patients with more serious illness in 
hospital and how the available drugs will be used."
Some experts say this early sign of resistance should prompt a rethink 
of how often and in which circumstances Tamiflu is used to battle the 
novel H1N1 virus. "It ... probably highlights the importance of not 
using these antiviral drugs indiscriminately, given that the disease 
is relatively mild," says Peiris, whose hospital monitored the woman 
who was found to be carrying the resistant virus. "In people who don't 
have underlying risk factors, they probably should not be treated with 
Tamiflu, basically."

Others suggest countries should limit how often they use the drug to 
prevent infection, a regimen known as prophylaxis. In prophylaxis, 
people who've been exposed to the virus are given one pill a day for 
10 days, compared to the treatment regime of 2 pills a day for 5 days. 
Some countries, including Canada, have been reserving prophylaxis for 
people at high risk from this flu, such as pregnant women. But others 
have taken a different approach, using Tamiflu to try to curb spread 
of the virus. For instance, Britain has made the drug widely available 
to contacts of confirmed cases, though it announced this past week it 
was changing that policy.

The World Health Organization is drafting guidance for countries on 
the use of antivirals. While the WHO advises rather than instructs, it 
has been stressing that saving these drugs for treatment makes the 
most sense, says Dr. Keiji Fukuda, the agency's top flu expert. "In 
general we have been pushing the advice that using these drugs for 
treatment is definitely the priority use of them," says Fukuda, the 
acting assistant director general for health security and environment. 
"And I think this is not just from a theoretical resistance 
perspective but also from the fact that if you have limited amounts of 
antiviral drugs, then you need to make some choices about how you use 
them."

 From their 1st sighting, the new H1N1 viruses have been resistant to 
2 older flu drugs, amantadine and rimantadine. That left the only 2 
other influenza drugs, oseltamivir (Tamiflu) and zanamivir (Relenza), 
as the sole options for treatment and prophylaxis. There is a risk 
inherent in using the drug to prevent illness. If people who are 
already infected but aren't yet experiencing symptoms are put on 
prophylaxis, there won't be enough drug in their systems to kill all 
the viruses they house. Those that survive develop resistance to the 
drug. And that, it appears, may be what happened in the resistance 
cases in Denmark and Japan. In both instances the women involved had 
been given Tamiflu prophylaxis after a contact developed swine flu.

But the Hong Kong case was different. A 16-year-old girl travelling 
from San Francisco was stopped in Hong Kong's airport in mid-June 
[2009] after setting off a fever detection device. She was taken to 
hospital where she tested positive for swine flu. She had not been 
taking antivirals and declined to be treated with the drug. She was 
kept in isolation until she recovered.

Dr. Jennifer McKimm-Breschkin, an influenza expert from Australia and 
a member of the team that developed Relenza, says this case shows 
resistant swine flu viruses can spread. It was previously thought flu 
viruses that developed resistance to the drug would be crippled in the 
process and would not transmit to others. But that belief was 
shattered in 2008 when it was discovered Tamiflu-resistant versions of 
the seasonal H1N1 viruses were spreading rapidly around the globe. 
They have since all but wiped out [replaced] Tamiflu-susceptible 
seasonal H1N1 viruses. "This is a patient that hasn't been treated who 
has gone from San Francisco to Hong Kong. What that means is that she 
has caught a resistant virus in San Francisco," says McKimm- 
Breschkin, virology project leader at the Commonwealth Science and 
Research Organization -- known as CSIRO -- in Melbourne. "So that 
means this virus has been transmitted from somebody who's presumably 
been treated. Which means it's been fit enough to transmit -- and that 
is of a lot more concern than just resistance in a treated patient." 
Experts have worried the seasonal H1N1 viruses might reassort or swap 
genes with the swine H1N1. If swine flu picked up the neuraminidase 
gene -- the N in a flu virus' name -- from the seasonal H1N1, it would 
acquire the resistance its seasonal cousin has developed.

Authorities in Hong Kong have not yet told the WHO whether that is 
what has happened in this case. But whether the Hong Kong resistance 
case is due to reassortment, or from the fact that some swine flu 
viruses have developed resistance on their own, the situation demands 
careful monitoring, Fukuda and others say. "The really big question 
for any finding of antiviral drug resistance with these viruses is 
whether it's an isolated event or whether it's a tip of a larger 
phenomenon," he explains. "The bottom line, as is so often the bottom 
line with influenza, is that the real answer to the current situation 
is monitoring as closely as possible, which in this instance is really 
being done, since an extraordinary number of viruses are being 
collected and looked at."

[Byline: Helen Branswell]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[The identification in Hong Kong (S.A.R.) of a patient arriving from 
the USA harboring Tamiflu-resistant A (H1N1) pandemic influenza virus, 
who had not previously received Tamiflu treatment, is a disturbing but 
not unexpected development in view of the often indiscriminate use of 
the antiviral in some countries. It remains to be seen whether this 
Tamiflu-resistant virus will be transmitted more or less efficiently 
than Tamiflu-sensitive virus. It may be that Tamiflu will become 
largely ineffective in the control and treatment of the A (H1N1) 
pandemic virus sooner rather than later. Restriction in future use of 
Tamiflu should be considered.

Unlike Tamiflu, which is administered orally in tablet form, the 
alternate neuraminidase inhibiter Zanamivir (Relenza) is an antiviral 
that must be administered twice a day in powder form through a special 
inhaler, with treatment continuing for up to 5 days. This may be an 
advantage in reducing the indiscriminate use of the drug. Relenza can 
be used by people over 12 years of age who are known or suspected to 
have influenza A or influenza B virus infection. - Mod.CP]

Chile: Increase to the 21 human deaths from influenza in the country

Monday July 6, 2009
Source: ANSA

SANTIAGO .- The number of deaths in Chile because of the flu AH1N1 increased to 21 according to official figures.

The number of deaths increased after it was confirmed that the deaths of two people, a man and a woman in San Antonio and the city of Tome.

The man of 52 years a native of San Antonio, after suffering a respiratory disease, which complicated their treatment.

"I had a chronic lung disease and was being treated for lymphoma," explained the director of the health service of the cities of Valparaiso and San Antonio, Dagoberto Duarte.

Health Minister Alvaro Erazo, reported that hospital admissions for respiratory diseases in adults increased by 20 percent, while the children had low from week to week.

For its part, the president of the Association of Primary Care Physicians, Camilo Bass, estimated at half a million cases of infection with influenza A in Chile, which contrasts with the official information of 8,000 people confirmed. "We do not have a figure for total cases, but taking into account all that antiviral treatments have been delivered free of charge at clinics and hospitals, and the level of overloading, we believe we have exceeded the 500 thousand cases," said Bass In statements to Radio DNA.

The doctor stressed that primary care was severely overloaded by demand, and because many workers in the system are licensed health.

The president of the Medical College, Pablo Rodriguez, in turn, felt that "it is likely that all the people working today in the health services' becoming infected at some point.
hat-tip Shiloh

Canada: 3 more H1N1 deaths bring national total to 36

Updated Mon. Jul. 6 2009 4:19 PM ET

The Canadian Press

Three new deaths from swine flu were reported Monday -- one in each Prairie province -- increasing the known number of people who have succumbed to the virus in Canada to 36.

Saskatchewan's third fatal flu case involved a child under 10.

Manitoba recorded its fifth death related to swine flu, an adult between 18 and 65.

Dr. Andre Corriveau, Alberta's chief medical health officer, reported that province's second swine flu fatality. The victim was a middle-aged woman who died June 30 in an Edmonton hospital after being transferred from another jurisdiction, which Corriveau refused to identify.

"Influenza causes deaths every year, so this influenza is not different in that way," he said. "And so we can expect to have more deaths."

Each of the three people who died was also suffering from other health problems.

Some news outlets were reporting that Manitoba's fifth victim was Perry Chernesky, 43, the pastor of the Oakbank Baptist Church outside Winnipeg.

Other reported deaths from swine flu include 14 in Quebec and 12 in Ontario.

ICRC hits out at ‘complacency’

Agence France-Presse . Geneva

A Red Cross official has sharply criticised ‘complacency’ towards the impact of communicable diseases on poor countries, contrasting it with responses to flu or heart disease in rich nations.
A report released by the International Federation of Red Cross and Red Crescent Societies on Monday warned that the crippling and growing burden of epidemics like dengue fever, polio, or meningitis was not being sufficiently addressed.
‘We do not see interest, we only see vague, uncoordinated interest in high-profile issues such as influenza — which is in itself a great risk, but not the only one,’ said Tammam Aloudat, the federation’s senior officer for health in emergencies.
Swine flu has ‘killed so far about 150 people, the potential for risk is massive, but what we have today is 14 million people dying mostly unnecessarily from easily preventable diseases that require little resources,’ he told journalists.
Titled ‘The Epidemic Divide’, the Red Cross report said a focus on death rates had helped increase attention and resources to tackle non-communicable diseases such as heart attacks and cancers, now the leading killers worldwide.
But the dominant threat in developing countries remains preventable infectious disease, and their societies were not only ailing due the huge mortality but also the debilitating impact of illness on their development.

Egypt: 4800 Engineer of the veterinary response to avian influenza

Monday, July 6, 2009 - 21:05

Mohamed Abdel-Halim, Chairman of General Union of Workers in agriculture, it is administrative processing for the training of agricultural engineers in all the provinces to combat avian flu.

وأكد محمد عبد الحليم أن التجهيزات لتدريبية ستبدأ فى الفترة من 15 يوليو وحتى 15 أغسطس القادم، وذلك لتدريب المهندسين على المكافحة المستدامة لأنفلونزا الطيور بالتعاون مع الهيئة العامة للخدمات البيطرية، وتهدف التدريبات لتوعية الفلاحين والفلاحات الذين "لا يستطيع العيش بدون تربية الطيور" لأنها تمثل 30% من الحد الأدنى لدخل الأسر فى الريف.

And Mohamed Abdel-Halim, the equipment for the training will begin from July 15 until August 15 next, in order to train engineers for the sustainable control of avian influenza in collaboration with the General Authority for Veterinary Services, and the exercise is aimed to educate farmers and peasant women who "can not live without birds" because they represent 30 % of the minimum income for families in the countryside.

وأضاف عبد الحليم أنه تم اختيار هذه الفترة لتكون بالتزامن مع دخول فصل الشتاء فى أول سبتمبر وسيتواجد 4800 مهندس بيطرى فى 4800 جمعية زراعية منتشرة فى أنحاء الجمهورية، سيكونون متخصصين فى التوعية بالمرض وطرق الوقاية منه.

Abdul Halim said that the choice of this period to be in conjunction with the onset of winter in the beginning of September 4800 the architect to be present in the 4800 General veterinary agricultural scattered throughout the republic, will be specialized in raising awareness of the disease and ways to prevent it.

Indonesia: Abdul Muluk Hospital is treating Bird Flu and Swine Flu Patients

From Lampung, Sumatra. Supect bird flu patient

Abdul Muluk Hospital is treating Bird Flu and Swine Flu Patients

on Monday, July 06 2009 18:13 WIB

the Interactive TIME, Banda Lampung - Abdul's Public Hospital Pompous Banda Lampung treated the patient suspect bird flu berbarengan with the patient suspect pig flu, on Monday (06/07).

A resident, named Nurman, 15 years, must undergo the maintenance in isolation space from this afternoon. “Altough in the same isolation installation both of them were placed in separated rooms ,” Pad Dilangga words, the Deputy Director the hospital.

According to Pad Dilangga, the appointment of two patients in istalasi that was same because the hospital belonging to the government of the Lampung province did not yet have special space for the patient of pig flu. For the time being, said he, two patients with two panyakit different that received the maintenance of the same team.

Both of them were together handled by the team of the control of bird flu, he said. Villagers Mulyo Teak, Lampung Selatan was run off with to the hospital after experiencing the high fever, the cough, and pilek for three days. Before being attacked by the illness, said Slamet, parents of the patient, hundreds of chickens in the village suddenly died suddenly. He was suddenly feverish and coughs after eating chicken, he said.

The temperature of the Nurman body at this time achieved 37.5 levels selsius and complained the crowded breath, the cough, and the fever. The team of the doctor gave tamiflu for the patient. Beforehand the patient got the maintenance in the Mulyo Teak community health centre.
“ they afterwards reconciled the patient to this hospital ,” said Tony Adi Marwan, one of the teams of the doctor.

In the meantime, Conny, 52 years, the patient who it was suspected contracted the illness of pig flu was still undergoing the maintenance. The condition for the resident Street Tamin, Kelurahan Sukajawa, of Tajung Karang Pusat, Banda Lampung began to improve. The temperature of the female body had three children that has been normal.

“We still was waiting for results of the test of the Jakarta Health of the Department's laboratory. Necessarily today results already we received but experienced the delay, ” said Pad Dilangga.
hattip Dutchy