Latin America continues to suffer under weight of swine flu H1N1v pandemic

From Scott McPherson's Web Presence [Blog] (link on side-bar)

Thursday, August 6, 2009 at 12:58PM by Scott McPherson in Politics and government, influenza and infectious diseases | 1 Comment

It has been a few days since I was able to sit down and study the latest news coming from South America. A combination of heavy work and helping my wife through her latest round of chemotherapy combined to distract me for over a week.

Once I was able to concentrate on the latest developments, I was shocked but not surprised. Needless to say, the news is quite disconcerting.

I want to take you back to my blog of July 17th, when I predicted that deaths due to confirmed H1N1v in Argentina would exceed those in the United States by the end of July. It took an extra week, but that gap has finally been closed --depending on how you parse your words.

The latest information coming from the CDC indicates a confirmed total of 353 deaths from swine flu. But Argentina just released new, two-week numbers which raise their death toll to 337.

But wait, there's more. According to the Guardian UK newspaper story, the Argentine government is waiting for positive pathology on another 400 deaths. If even a third of these are confirmed H1N1v, that will catapult Argentina to the top of the world's death list. Hat-tip to Cindy of Nerstrand, MN.

So what, you might ask. Well, two things should leap out at you. First, Argentina has just under 41 million people, according to the CIA. That means Argentina has just over one-seventh the population of the United States, yet it now effectively leads the world in deaths. If the United States had, say, 2,600 deaths from swine flu, that would be a comparable ratio relative to population.

Second, recall that this is Argentina's flu season. The Guardian article discusses that 750,000 confirmed cases of swine H1. I am sure that is just an estimate and not actual swabs. But the number of deaths could be double what is being officially reported, if the 400 unknown results become positive.

This strains further an Argentine government that was the textbook example of how NOT to handle risk communication. In my recent Fox News Channel interview, I was asked if all my warnings could incite panic -- especially my instruction to pregnant women that if they feel anything remotely like flu symptoms, they need to get hold of their doctor, pronto.

No, I responded. It is the absence of information that produces panic, not the presence of honest data. I also reminded the reporter of the work of Dr. Peter Sandman and his advice to treat the American people as adults and give them the skinny exactly as it is.

It was also gratifying when, the very next day, the CDC issued the exact same advice/warning.

Anyway, back to the Argentine government. When H1N1v broke out, they acted as if the virus never existed. No, not here. Move along. When it became painfully apparent the virus was in Argentina and people were dying from it, only then did the government do an about-face and started engaging their pandemic plan.

It is absolutely amazing how governments full of well-educated people can make such terribly dumb decisions.

Further, there seems to be quite the debate raging as to whether or not the virus has indeed mutated in South America. Back in June, the Brazilian research facility Instituto Adolfo Lutz has been in existence since 1892, and was renamed to honor the former University of Bern (Switzerland) scientist. Its core competencies include (from its Website):

Currently, the Adolfo Lutz Institute is recognized internationally for its competence to respond to incidents in their area of expertise, having been accredited by the Ministry of Health and National Public Health Laboratory and Reference Laboratory Macroregional. It Collaborating Center of the Joint FAO / WHO for monitoring of contaminants in food. Reference Center for Analytical Quality Control of Mycotoxins and Residues of Pesticides, National Coordinator of the Program for Monitoring of foreign substances in food, the National Reference Center for Laboratory Diagnosis of AIDS; Collaborating Center of the Pan American Health - OPS areas of arbovirus, influenza virus and production of immunobiological and PAHO Collaborating Center for Cell Cultures.

Anyway, this prestigious WHO collaborating center (think if St. Jude had found such a change!) has typed the first known mutation of the virus' hemagglutinin (the "H" in "H1N1"). Hemagglutinin is what sticks the virus to the cell wall in your respiratory tract (think of those velcro ping-pong balls that stuck to felt dartboards from back in the day). An antigenic change in hemagglutinin could make the virus much easier to catch (search umbrellas and coneson this blogsite for a full description of this phenomenon).

The (236 year-old) patient was hospitalized on April 24 at the Institute of Infectious Diseases Emilio Ribas (Brazil) and is fully recovered.

Respiratory secretion sample of this patient was subjected to molecular rt PCR methodology (§ reaÃthe polymerase chain in real time) with probe specific for the new subtype H1N1 by the team of molecular biologist Claudio Sacchi, and the result for the new viral subtype .

Following the research the team of virology Terezinha Maria de Paiva, the Institute Adolfo Lutz, São Paulo, isolated at the end of April that the new strain is now known as A / Paulo/1454/H1N1 are following the rules of the World Health Organization . The virus isolation was performed in cell culture using the MDCK cells successfully in the first passage. In section electron microscopy of the Adolfo Lutz, Marli Ueda and Jonas Kisielius identified several virus particles from the infected culture. also the first observation.

The isolation of the virus provided the sequence of the genetic material of the Brazilian strain, experiments being performed by Dr. Cecília Luiza Simões dos Santos of the Instituto Adolfo Lutz.

The initial molecular characterization of strain A / Paulo/1454/H1N1 are involved the determination of complete sequences of two gene segments, segment 4, which encodes a protein Hemaglutina (HA) responsible for viral infectivity and for which antibodies are produced protectors, and segment 7, which encodes the matrix protein (MP) M1 and M2. The complete sequences of the genes HA and HB, the first determined for strains isolated in Brazil, are available in GenBank, a database that U.S. shared sequences obtained worldwide, which can be consulted by their respective numbers of access: GQ247724 (HA gene) and GQ250156 (MP gene). Molecular analysis indicated that while the virus segment 7 of A / Paulo/1454/H1N1 are shown to be completely conserved when compared to the reference strain A/Califórnia/04/H1N1, segment 4 showed a discrete number of nucleotide changes and of amino acids, with similar rates of around 99, 7% and 99.5% respectively. Detection of amantadine-resistance marker, comprising the amino acid asparagine (N) located at position 31 (N31) of the M2 protein in strain A / San Paulo/1454/H1N1, corroborates the literature that point be the new virus resistant to this class of antiviral compounds.

The debate started just after the sequencing of this new substrain of H1N1v was announced, and it continues to rage on flu sites such as Flutrackers to this very hour. The issue is this: Do these changes have a lot in common with the hemagglutinin from 1918? At first glance, the answer is yes. There was a lot of swine involvement in the 1918 virus, and so it would not be surprising to see this unique virus sort of "run home to Momma" when it comes to picking up mutations. Swine flu is a much closer antigenic descendant to the 1918 pandemic strain than is our seasonal H1N1! The fact that some of these mutations were first typed in the "Brevig Mission, Alaska" trip of Johan Hultin, circa 1997-98, and came conclusively from the 1918 virus, are somewhat unsettling.

It remains to be seen if this Brazilian mutation is responsible for the larger numbers of infected and dead in Latin America relative to population. Sao Paulo is Brazil's southernmost metropolis. It is about 800 miles from Buenos Aires, the capital of Argentina. The area also borders the capitals of Uruguay and Paraguay.

Let us shift to Mexico, which is reporting a new spike in human H1 cases. Are these cases the vanguard, the herald of the Second Wave? Or are these outbreaks simply vestiges of the first wave of the virus? Nobody knows yet, but there are more reports coming from the border region with Texas which indicates more Tamiflu resistance than originally thought.

This can be explained by the sudden and massive insertion of Tamiflu into the region in the Spring. Remember that Tamiflu does not break down in groundwater, nor does it break down in water treatment plants. So it is not surprising that the massive administration of Tamiflu in towns on both sides of the Mexican border might produce NA 274Y Tamiflu resistance.

We have seen this antiviral resistance many times before, both in seasonal H1N1 and in some cases of H5N1 human infection. Of course, the seasonal strain's resistance is far, far more prevalent.

One thing is sure: South America has suffered the most of all the regions of the world in this, the first wave of the H1N1v swine flu pandemic.

Malaysia: Death #15 Reported

posted 9 hrs ago

Malaysia confirms new swine-flu related death

KUALA LUMPUR, Malaysia (AP) — Malaysia's health ministry says a 40-year-old man infected with swine flu has died, raising the country's death toll from the virus to 15.

A ministry statement says the man, who was obese, suffered from fever and cough since July 28 and was hospitalized in Kuala Lumpur on Monday. He died two days later.

The statement Friday said he was confirmed as a swine flu case only on Thursday, a day after his death.

Malaysia has reported 1,525 swine flu cases since May.

Quick Tests for the Flu Found Often Inaccurate

New York Times
August 6, 2009
By ANDREW POLLACK

As the swine flu spreads, many doctors and hospitals are turning to rapid tests that can determine within minutes whether an anxious patient has the flu. Sales of such tests are soaring.

But the tests have a severe limitation: They may fail more than half the time to detect swine flu infections, according to newly published studies and to experts in medical testing.

The low sensitivity of the tests is becoming a concern to health authorities because a false negative reading might prompt a doctor not to prescribe antiflu drugs.

It is also one of the big issues laboratory directors face as they prepare for what is expected to be a crush of flu testing this fall and winter. Numerous diagnostics companies are hoping to capitalize on demand for influenza testing.

The rapid tests “are missing a ton of flu,” said Christine C. Ginocchio, director of the division of microbiology, virology and molecular diagnostics at the North Shore-Long Island Jewish Health System in Lake Success, N.Y.

For seasonal flu, experts have long known about the low detection ability of the rapid tests. The new studies suggest the tests are no better, and possibly worse, at detecting the swine flu strain now spreading around the world, known formally as the novel H1N1 virus.

In a study published recently in The Journal of Clinical Virology, Dr. Ginocchio found that one rapid test detected only 10 percent of the swine flu infections that could be picked up by a more sophisticated laboratory culture. A different rapid test detected 40 percent. (Dr. Ginocchio is a consultant to Luminex, a company that makes a more accurate but slower test.)

The federal Centers for Disease Control and Prevention is expected to publish its own study of the rapid tests soon. Last week, it updated guidance urging doctors to be cautious in relying on the tests.

“We’re saying you need to understand the limitations of these tests,” Dr. Timothy M. Uyeki, an author of the C.D.C. guidance, said in an interview. “The clinician should not base a decision to treat or not treat on the basis of a negative result.”

But some doctors say there is no good substitute for the simplicity, speed and low cost of the rapid tests. Manufacturers of the tests say the products are helpful if used appropriately.

“When these tests are used properly, the performance is very, very good,” said John D. Tamerius, senior vice president for clinical and regulatory affairs at Quidel, which describes itself as the leading maker of such tests.

He said the company’s QuickVue flu test could detect 80 percent of infections if nasal samples were taken correctly and if the test was given early in the course of the disease, when more virus was present.

But in a letter to The New England Journal of Medicine in June, Navy researchers said the Quidel test missed half the swine flu infections detected by a more sensitive technique.

Spurred by flu test sales, Quidel’s revenue from infectious disease testing rose 70 percent in the second quarter from a year earlier, to $16.1 million. Among the big buyers was Mexico, which had an early swine flu outbreak.

Quidel, of San Diego, is now manufacturing tests as fast as it can. The company’s shares, which closed at $15.28 on Wednesday, have doubled since the flu outbreak started in April.

Other rapid tests makers include Inverness Medical Innovations, 3M, Thermo Fisher Scientific, Meridian Bioscience and Becton, Dickinson. With the exception of Meridian, these companies are much larger than Quidel and less dependent on flu tests.

Quidel estimates that about eight million rapid flu tests in total were sold in the United States in the 2007-8 flu season. The number is likely to jump this year.

More accurate tests are available but they generally require sophisticated laboratories. And results might not come for a day or more, making the tests of little use in deciding whether to prescribe drugs like Tamiflu, which are supposed to be started within 48 hours of the appearance of symptoms.

The rapid tests, by contrast, take only a few minutes to half an hour, and most can be done in the doctor’s office or emergency room, without a laboratory. That is appealing to some doctors.

“When parents come in with a kid with fever, they want to know what the fever is from and is there something they can do about it,” said Dr. Dorothy A. Levine, a pediatrician in Connecticut who uses the tests.

The rapid tests also cost only about $10 to $20, though some doctors might charge more, versus about $100 for a test using a sophisticated technique called the polymerase chain reaction, or P.C.R. While a negative result on a rapid test might not be reliable, a positive result, at least during flu season, usually does indicate a person has the flu.

The rapid tests do not tell if a patient has the swine flu. They say only if flu is present, or in some cases whether it is type A or type B influenza. The swine flu is type A, but so are many seasonal flu strains.

So more sophisticated tests, beside being used to double-check a negative rapid test result, are also needed to see if a positive test result is the swine flu.

Demand by patients to know if they had swine flu overwhelmed some public health and hospital laboratories in the spring, and some experts fear a repeat in the fall. “I definitely think there will be another crunch,” said Rosemary Humes, senior adviser for scientific affairs at the Association of Public Health Laboratories.

The C.D.C. has developed and distributed its own test for swine flu that runs on equipment made by Life Technologies. But the agency says it would be costly and unnecessary to determine whether every flu case is swine flu.

Quest Diagnostics, the nation’s largest clinical laboratory company, recently received an emergency authorization from the Food and Drug Administration to distribute a swine flu test to hospitals and other laboratories.

Luminex and Prodesse also sell tests to hospital laboratories that detect flu, though they do not specifically test for the swine flu. Because of the pandemic, “business is extraordinary for us,” said Andrew M. Shrago, chief marketing officer of Prodesse, a privately held company in Waukesha, Wis.

In May, the F.D.A. sent warning letters to Prodesse, Luminex and Becton, Dickinson, saying they were improperly claiming their tests were for swine flu. The companies removed the offending language from their Web sites.

The tests from the C.D.C., Quest, Luminex and Prodesse use the P.C.R. technique, which can amplify minute amounts of the viral genes, making those tests highly sensitive.

The rapid tests are more like pregnancy tests. They use antibodies to detect a protein from the virus. If that protein is present, a colored stripe appears on the test strip. But even a nasal sample from a patient with the flu might not contain enough of the protein to register a positive result.

DxNA, a company in St. George, Utah, says it hopes to have a one-hour P.C.R. swine flu test approved for emergency use this winter. Enigma Diagnostics of Britain hopes to introduce a similar test in 2011.
hat-tip Pixie

Florida A/H1N1 flu deaths double to 41 in 2 weeks

2009-08-07 07:21:41

HOUSTON, Aug. 6 (Xinhua) -- The death toll of the A/H1N1 flu in the southeast U.S. State of Florida had nearly doubled in the past two weeks, the state health officials reported Thursday.

As of Wednesday, Floridians who died of the new virus reached 41, from 22 two weeks ago, according to local health officials.

Miami-Dade County is the hardest-hit with 15 deaths since May. The latest victims reported in Miami-Dade County were 59- and 53-year-old men. No further information about them was released.

Wednesday is seen as a black day when nine new deaths were reported in Miami-Dade, Osceola, Hillsborough, Orange and Lee counties.

Since the pandemic declaration on June 11 by World Health Organization (WHO), the A/H1N1 flu has been spreading rapidly in the state.

The death toll and the conformed cases of the new virus have almost doubled in every two weeks, although most people who have become ill have recovered without requiring medical treatment.

If state health projections hold true, some 160 Lee County residents and 5,000 Floridians will die from the A/H1N1 flu in the next 18 months to two years, the average life cycle of a pandemic, said Jennifer James-Mesloh, the Lee County Health Department spokeswoman.

That's twice as many deaths as Lee County sees in a typical flu season, she added. "I think we do have to be more vigilant than we would in the past," said the spokeswoman. "We don't know if this virus is going to change on us. We don't know if it's going to mutate."

She said she does not want to spark public panic, but to remind people that they can take steps to prevent flu -- frequent handwashing, staying home when sick, getting vaccinated when the inoculations become available this fall.

The rapid increase of fatalities from the A/H1N1 virus seems unpredicted by the health officials and local citizens in the state.

The state surgeon general Viamonte Ros said recently that Florida is preparing for massive A/H1N1 flu immunizations, starting with schoolchildren when they return school later this month.

Vietnam: Alert H1N1 virus risk associated with H5N1

Friday, August 07, 2009

For A/H1N1 flu, WHO representative in Vietnam that, this disease starts spreading in the community. However, Vietnam must particularly note and alert when the virus HPAI H5N1 is still circulating and dangerous combination of H1N1 and H5N1 vaccine virus to create new more dangerous, in the more powerful.

Dr. Jean Marc Olive, head of the WHO representative in Vietnam also said that the ability to combine and H1N1 influenza season is easier. As flu season is also spread from person to person through contact, but H5N1 is spread from poultry to people.

Also in the Ministry of Health have reported that Vietnam has recorded 39 more cases positive for influenza A/H1N1, the total who have this disease to the 1043 positive cases, 1 deaths.

In Hanoi, Health Center, Tu Liem district confirmation 6-8 days, there have been 1 teacher High School Lomonoxop (Urban Area 2 My Dinh, Tu Liem, Hanoi) results positive influenza A / H1N1. Medical Center for Hanoi for Primary School in Nam Thanh Cong, Dong Da district had 1 case of a male grade 2 students are identified with positive influenza A/H1N1.

Starting from today, 7-8, units, schools in the province Hanoi will stop all activities focus students have until the following instructions by the Department of GD-Tel. This is the content of urgent which GD-ĐT Hanoi sent to the unit, through the schools, 6-8. The individual high schools have organized professional competition on 14-8 and preparing for the new school year 2009-2010 is conducted in accordance with the plan was proposed. During this time, schools should work in collaboration with parents of students to understand the health of school students and reported timely when unusual situations occur.

Vietnam: Many patients 3 times still testing positive for A/H1N1

Vietnamnet - 36 minutes ago

The treatment of influenza A/H1N1 in Vietnam has recorded the patient's treatment time longer unusual, then many times the test is positive for influenza virus A/H1N1.
Dak Lak province in a patient is admitted and have positive results for influenza A/H1N1 from 24 / 7. Treated properly exposed it after 5 days, the test on 29 / 7, the result is not negative. 2 days later, patients continue to be tested and continue positive.

"This is the first patient to test the 4 th, after almost 10 days with new negative influenza virus A/H1N1," Mr. Tran Quy Tuong, Deputy Director General Management treatment (Ministry of Health ) said.

In Tien Giang, 5 patients with influenza A/H1N1 also fell into a similar situation.

Mr. Trinh Quan Huan, Deputy Minister of Health explained: "Previously, when other types of flu appear (H5N1, H3N2, influenza B), we have used to treat tamiflu. Frequency use tamiflu more likely resistance tamiflu growing. "

Huan He also suggested the primary treatment should reserve Zanamivir filled rooms where a patient's resistance to flu drug Tamiflu. There is still the drug Tamiflu characteristics of the most popular in the treatment of influenza A/H1N1.

According to Nguyen Tran Hien, Director of Institute of hygiene and epidemiology on the central world has 3 vaccine virus A/H1N1 flu tamiflu resistance. "At the vaccine virus A/H1N1 flu in Vietnam is still stable, no changes dị time. The length of treatment such as mentioned above still negative after continued use of tamiflu, " he said Hien.

2 Chinese workers working in Vietnam and infected with influenza A/H1N1
Hoang Dinh Hoan, Director of the Department of Health Lang Son province, said: "today, we discovered there are 2 workers in China to work in projects international venture, construction of good fun , the golf course (under Hoang Dong commune, City Lang Son) are high fever, cough and nearly 38 degrees. "

Department of Health does Lang Son province has sent samples of 2 patients subject workers down about this and epidemiology central to testing.
2 projects where workers are working there are people working. Mr. Hoan said medical center for Lang Son province has khử trùng spray the entire project area and isolation of people who have close contact with 2 people this, to prevent disease spread and development of new disease.

On 7 / 8, Vietnam has recorded 35 more cases positive for influenza A/H1N1. In the south: 18 ca, north: of 8, Central 4 ca, Environment: 5 ca.
Thus, up to 17h on 7 / 8, Vietnam has recorded 1,078 cases of positive, 1 deaths.

Number of patients was 628 members. 449 remaining cases are being isolation, treatment at hospitals, treatment facilities, monitoring community health status is stable, without serious complication.

Vietnam: 1043 people infected with influenza A/H1N1

Hanoi stop focusing students
On 6-8, Nguyen Huy Nga, Director Department of Health Department of the Environment and Ministry of Health, said that Vietnam has recorded 39 more cases of influenza A/H1N1 infection, in which 20 of the South, North 8 ca, 5 of the Central and Tay Nguyen 6 ca. Up to this time, the country has recorded 1,043 people infected with influenza A/H1N1, 1 in which deaths. There are still 434 people in isolation, treated at health facilities in health status is stable, without serious complication.
The same day, Health Center, Tu Liem District - Hanoi has confirmed an additional secondary school teachers Lomonoxop influenza A/H1N1 infection. This individual teacher contact with students affected by the influenza A/H1N1. Brother of the teacher also has influenza A/H1N1 infection. Department of GD-ĐT Hanoi also has the urgent notice of flu A/H1N1. Accordingly, from 7-8, the school in Hanoi to stop immediately all activities focus students until the Department of GD-ĐT it next.

Vietnam: Tests sponsored by WHO, supply of only 1 more week

Friday, 07 August 2009

At the meeting BCD countries in preventing influenza and influenza A/H1N1 recently, according to Dr. Nguyen Huy Nga, Director Department of Department of Health and the environment in Vietnam and has spread 26 provinces and cities and 4 provinces to have the disease of the large chùm (Hanoi, HCMC, Dong Nai, Khanh Hoa).

Hanoi own continuity patients appear influenza A/H1N1 in schools and residential area on 5 / 8. At the epidemiological hygiene Central (VSDTTU) are in the process of evaluation of the disease. According to the evaluation by experts, this is the beginning of the season on.

Dr. Nguyen Tran Hien, Director of Institute of hygiene and from that beginning of season and to date, Vietnam is using the resources of test and tested by WHO and other sponsoring organizations. Up to now, exhausted and can only enough for 1 more week. Status Pasteur Institute in Nha Trang, Vietnam is also similar. Recently, WHO has also provided 500 additional samples of diagnostic products (testkit) with accuracy to 98.9%, the result after 15 minutes for the test. However, with the number of influenza A/H1N1 BN increases as the current number of samples and this is only enough to use 9 months.

-snip-

Laos-New flu infection reaches 162

(KPL) The number of confirmed cases of type-A (H1N1) flu has reached 162, one of whom died.
The virus spread in eight provinces in Laos, reported the National Coordination Office of Contagious Disease Control and Prevention on 4 August.
While the new type influenza A (H1N1) virus is now erupting in over 160 countries worldwide with 134,503 people infected with the virus and 816 deaths and it seems to further spread seriously, according to the World Health Organisation on 30 July.
As a worsen result, the National Coordination Office of Contagious Disease Control and Prevention, on 5 August, held a lecture on new type influenza A (H1N1) virus and prevention approach to students and teachers of Comcenter College.
Dr Bounlay Phommasak who is responsible for the National Coordination Office of Contagious Disease Control and Prevention, pointed to the adverse effects of new type influenza A (H1N1) pandemic worldwide. This virus led to high rate of casualty worldwide which tends to further rise.

Uncommon Swine Flu Detected In Kansas

Posted: 4:54 PM Aug 6, 2009 Last Updated: 5:08 PM Aug 6, 2009

August 6, 2009 A Riley County child has been infected with a strain of swine influenza not commonly seen in humans, but has fully recovered following a mild illness. No other cases have been identified, but an investigation is underway. The influenza strain that infected the child was identified as an H3N2 virus that commonly circulates in pigs in North America. It is different from the pandemic H1N1 virus, also of swine origin, that was first detected in the United States in mid-April. "It is critical for people to understand that this H3N2 virus is not related to the pandemic H1N1 virus," said Jason Eberhart-Phillips, Kansas State Health Officer and Director of Health at the Kansas Department of Health and Environment (KDHE). "This is not a mutation or a recombination of the pandemic strain, and it does not appear at this time to be a threat to human health." The child was likely exposed to the virus during the Riley County Fair in late July, where the child had direct contact with pigs. The child later developed influenza-like symptoms and sought medical care. The child has fully recovered and no other family members have reported illness. KDHE is working closely with the Centers for Disease Control and Prevention (CDC), the U.S. Department of Agriculture (USDA), the Riley County Health Department and the Kansas Animal Health Department to investigate this case. KDHE and the local health department are working to determine if the Riley County Fair swine exhibitors, or their pigs, have been ill. Swine flu viruses do not normally infect humans, but human infections occur from time to time. Typically CDC has received reports of approximately one human infection with a swine influenza virus each year. That number has risen slightly in the past few years. The increased number of reported cases this year is likely the result of increased influenza testing related to the H1N1 pandemic. So far this year, 14 cases of human infections with swine influenza viruses have been reported in the United States. That number does not include the number of H1N1 cases, as the H1N1 virus has not been detected in swine in the U.S. "Most instances of human infection with animal influenza viruses, like the swine H3N2 virus, do not result in human-to-human transmission," Dr. Eberhart-Phillips said. "However, each case needs to be fully investigated to be sure that the viruses are not spreading among humans." Most commonly, cases of human infection with swine influenza occur in people with direct exposure to pigs, he added.

Thailand tightens border controls against pneumonic plague

BANGKOK, Aug 6 — Thailand has stepped up its border precautions to guard against any possible outbreak after pneumonic plague has led to the deaths of three people in China.

According to the Thailand news agency (TNA), Public Health Minister Witthaya said he had assigned the the Disease Control Department to keep a close watch on measures being implemented in China against the plague, as well as monitor border to prevent animal carriers of the plague entering into Thailand.

“No special measures are being launched against the pneumonic plague. The World Health Organization (WHO) is monitoring the situation and we will follow its measures,” he said, when asked to comment on the pneumonic plague outbreak which killed three people in China’s Ziketan in the northwestern province of Qinghai.

Following the outbreak, the Chinese government has already ordered the town of more than 10,000 people sealed off to prevent the spread of the outbreak to other parts of China.

However, Witthaya added that the pneumonic plague can be spread only in a short period, unlike the influenza A(H1N1) in which the virus stays in human bodies for longer periods and can be transmitted to other persons.

“Untreated patients of pneumonic plague can die within 24 hours after contracting the plague,” said the minister, reports TNA.

Today, Thailand’s Department of Disease Control reported that no pneumonic plague found in rats at the Bangkok’s Klong Toey Port (Thailand’s major port for sea transport of cargo), after closely monitoring the Flea Index in the rats.

Veterinarian Plaiyong Sakaraseranee of the Disease Control Department said the agency laid 35 traps but only seven rats were snared and none of them carried pneumonic plague.

Thailand last recorded pneumonic plague in 1952, Dr Plaiyong said, adding that the department will continue to trap rats at 64 border checkpoints nationwide to evaluate the Flea Index.

He also urged the citizens to clean up their homes and urban living areas to prevent possible outbreak.

Pneumonic plague is caused by the bacteria ‘Yersinia pestis.’ In its spread the plague bacillus enters the skin from the site of the bite and travels through the lymphatic system to the nearest lymph node.

It is usually transmitted between animals and humans by the bite of infected fleas, direct contact, inhalation and only rarely, by eating or drinking infected food. – Bernama

Malaysia: A(H1N1): Death toll increases to 14 (Update)

Updated: Thursday August 6, 2009 MYT 4:02:25 PM

PUTRAJAYA: Health authorities urged the public not to panic and stepped up measures to contain the Influenza A(H1N1) outbreak as the virus claimed its 14th fatality.

Health director-general Tan Sri Dr Ismail Merican said that as of 8am Thursday, the death toll had reached 14, the latest casualty being a 57-year-old pensioner who was a diabetic and suffered from hypertension.

He was warded at the intensive care unit at the Putrajaya Hospital on Aug 4 and succumbed to acute pulmonary oedema on Wednesday.

Health authorities also recorded 16 new cases in the last 24 hours; all were local tranmissions with two new clusters reported. The number of people who have been infected in Malaysia stood at 1,492.

-snip-

White Paper on Novel H1N1 - John M. Barry

[A note on John M. Barry:
John M. Barry is a prize-winning and New York Times best-selling author whose books have won more than twenty awards. In 2005 the National Academies of Science named The Great Influenza, a study of the 1918 pandemic, the year’s outstanding book on science or medicine, and the Center for Biodefense and Emerging Pathogens gave Barry its 2005 “September Eleventh Award” for his contributions to pandemic preparedness.]

White Paper On Novel H1N1
Prepared for the MIT Center for Engineering Systems Fundamentals

John M. Barry
Distinguished Scholar, Tulane University Center for Bioenvironmental Research Member,
Advisory Board, MIT Center for Engineering Systems Fundamentals
jvbarry@aol.com

Note: This paper’s purpose is to provide a relatively in-depth understanding of the problem and the issues, now and as they change. Therefore, it omits an executive summary.

Contents:
1. Background on the Influenza Virus
2. The Epidemiological Picture and Cross-Protection as of Late June 2009
3. Antivirals and Vaccines
4. Recent Non-Pharmaceutical Interventions and International Actions
5. Communication
6. The Past as Prologue: Waves and Patterns from Past Pandemics
7. The Future of Novel H1N1

Egypt did not go beyond the first stage of the swine flu

Thursday, August 6, 2009 - 14:56

Conflict between statements made by the Council of Ministers and the World Health Organization

The statement issued by the central operations room status information and to support decision-making Council of Ministers on Thursday that Egypt is still in the initial phase of any virus (H 1 that 1) is known worldwide as the swine flu.

And is in accordance with the standards set by the Egyptian Ministry of Health with regard to the measurement of the intensity and seriousness of the disease, the number of cases, the proliferation of cases, clinical symptoms of the disease, and mortality disease.

The statement said: "The healing of the case 219 by 69.7% of the total cases of the disease, even yesterday, and there was one death, and enjoy the rest of the 94 cases and the situation in good health."

He added that the number of cases have been found infected with the disease in Egypt amounted to 314 as of yesterday evening, according to the results of the examination and laboratory data of the Ministry of Health, explaining the details of 16 recent cases, which include 12 state of Egyptian nationality, and 3 cases of Saudi nationality, including two coming from Saudi Arabia, and the state and one from Jordan. It also includes cases, one case with Vietnamese nationality, coming from Vietnam, pointing out that the introduction of these 16 recent cases to the hospital and were in stable condition.

The statement pointed out that the examination of 74 suspected case of swine flu in governorates (Cairo, Alexandria, South Sinai, the West, Damietta, Dakahlia, Sohag, the lake, Monoufia, Giza) and the laboratory results were all negative, as was the examination of 8 cases of suspected avian flu from 4 provinces and the laboratory results are negative.

On the deployment of some Internet sites that deal with a glass of anise warm than in the effectiveness of the drug Tamiflu, has denied the Ministry of Health said in a statement today, reports in this regard, stressing that the drug is still used as one of essential medicines for anti swine flu and reduces the severity and complications .

The ministry emphasized the need to consult doctors before taking up any medicine or treatment for swine flu in order to avoid any side effects on the health of citizens.

And questions about public opinion on whether it will be given the drug Tamiflu for bird flu cases to be dealt with domestic pigs during a certain stage in accordance with the plan of the Ministry of Health, the Ministry indicated that, according to the plan, during the third phase will be addressed part of the infected cases in the houses and the rest of the cases in hospitals , according to the criteria in this regard.

The Ministry of Health in accordance with the statement that the majority of cases will be treated at home would not take Tamiflu, which will be given only rare cases of real estate, while the property will be disbursed through the Ministry of Health of the cases treated in hospitals, which will be allocated to it.

It is noteworthy that the Ministry of Health has already said it developed a proposal for measuring the severity of the seriousness of the disease, according to several criteria: the number of cases, the proliferation of cases, clinical symptoms of the disease, disease and mortality rates, based on these criteria have been identified 3 stages of the disease in Egypt.

Egypt: 4 cases of detention on suspicion of being infected with "influenza" meeting Sunday attended by

[I'm not getting a total of 4 in the paragraph below, and the translation is something I have never seen before. In between the comas, may be the 4th case.]

قامت وزارة الصحة بالغربية باحتجاز 4 حالات جديدة بمستشفى حميات طنطا للاشتباه فى إصابتها بمرض أنفلونزا
الطيور بعد ظهور أعراض مشابهة لأعراض المرض عليها، وتم عزلها بالأماكن المخصصة لذلك، حيث تم احتجاز كل من محمد إبراهيم السباغ (عامان) وهو طفل من قرية ميت يزيد مركز السنطة، وحسب الله حسين حسب الله (27 سنة)، أمين شرطة من قرية محلة زياد مركز سمنود، ومحمود هانى محمود الغريب (3 سنوات) من قرية كفرحجازى مركز المحلة، وإيهاب محمد إيهاب (عام ونصف) من عزبة بشارة مركز المحلة.

The Ministry of Health meeting Sunday attended by the detention of 4 new cases of hospital admitted Tanta on suspicion of being infected with bird flu after an outbreak of symptoms similar to symptoms of the disease, and was assigned to isolated places, where both were detained Mohamed Ibrahim Sbag (two), a dead child from the village over the status of Alsentp and, as God, as God's (27 years), the police of the village, Ziad Mahallat Center Smonod, Mahmoud Hany Mahmoud Gharib (3 years) from the village of Mahala Kfrhijazy Center, Ihab Mohamed Ihab (a year and a half) of the Mahalla al-Beshara Center.

تم أخذ عينة دم ومسحة حلق من المرضى، وإرسالها للمعامل المركزية الخاصة بوزارة الصحة لبيان مدى إصابتهم بالمرض من عدمه، وإعطائهم عقار التايمفلو. Blood sample was taken hours, survey of patients, and sent to the central laboratories of the Ministry of Health with the extent of illness or not, and give them the drug Altaymflo.


فيما احتجز مستشفى المنشاوى العام حالتين جديدتين للاشتباه فى إصابتهما بمرض أنفلونزا الخنازير بعد ظهور أعراض المرض عليهما وشعورهما بارتفاع فى درجة الحرارة والآم بالعظام وضيق بالتنفس، حيث احتجز المستشفى كلا من حامد عبد الفتاح عامر (42 سنة) من محلة مرحوم موظف، ومصطفى محمد حسين الشيمى (23 سنة) دون عمل من منطقة بونابرت النحاس بطنطا.

Detained in hospital Minshawi year two new suspected bird flu symptoms after an outbreak of pig disease and of their sense of high fever, bone pain and lack of breathing, the hospital where he was both the Amer-Fattah Abdel-Hamid (42 years) from the locality of the late officer, Mustafa Mohamed Hussein Shimi (23 years) without a working area of the copper Btnta Bonaparte.

تم عزل الحالتين بالأماكن المخصصة لذلك وأخذ عينة دم منهما ومسحة حلق وإرسالها للمعامل المركزية، ووضع المخالطين لهما تحت المراقبة الصحية المستمرة والتنبيه عليهم بالتوجه لأقرب مستشفى حميات أو صدر عند شعورهم بأى أعراض للمرض.

Been isolated cases of places allocated to it and take a blood sample and swab their hours and be sent to the central factor, and the development of contacts are under observation, and the alarm continued to go to the nearest hospital was admitted or when they feel any symptoms of the disease.

كما تم إعطاؤهم عقار التاميفلو لحين ورود نتيجة العينات الخاصة بهم، صرح بذلك الدكتور شريف حمودة وكيل وزارة الصحة بالغربية.

Has also been given the drug Tamiflu, while the result of the receipt of samples of their own, said Dr. Sharif Hammouda Undersecretary of the Ministry of Health meeting Sunday attended.

Egypt: During the last ten days .. The execution of 21 thousand birds nest and the demolition of 309 Menoufi

Thursday, August 6, 2009 - 14:59

The Directorate of Veterinary Medicine Menoufia campaign inspection within ten days all the shops and street vendors, which the 21117 birds culled, and the number of closed down 49 shops and seized a number of vendors, 210 vendors, as well as the demolition of 309 nest cities.

جاءت الحملة فى إطار تكثيف الجهود الخاصة بمكافحة مرض أنفلونزا الطيور وتشديد الرقابة على الأسواق والمزارع ومحاصرة المرض، وبالتعاون بين المحافظة ومديرية الطب البيطرى.

The crackdown came in the context of intensified efforts to combat bird flu and tightening control over markets, farms and surrounded the disease, and the cooperation between the province and the Directorate of Veterinary Medicine.

UK: Flu jabs not tested on children

Thursday, 6 August 2009

By Simon Cox
Radio 4's The Report

A new vaccine for swine flu is most likely to be targeted at vulnerable groups such as young children and pregnant women. But a Radio 4 documentary has discovered that little or no data exists on the safety or effectiveness of flu vaccines on these groups.

Holly Pyke, left, receives a swine flu vaccination by nurse Luiza Duszynski at the Royal Adelaide Hospital in Adelaide, Australia
There have been no trials of swine flu vaccines on pregnant women

In 1976 the US Government vaccinated 45 million people for a swine flu outbreak that never materialised.

But 500 people developed a rare neurological condition called Guillame Barre syndrome which left people in a coma and 25 died.

The reaction still mystifies health officials, including Peter Smith, Professor of tropical epidemiology at the London School of Hygiene and Tropical Medicine.

'Adverse reaction'

"Why that happened has never really been understood - it's not really been observed with subsequent influenza vaccines," said Professor Smith, chairman of the global advisory committee on vaccine safety at the World Health Organisation.

"There's been a lot of seasonal flu vaccines and they've not seen this same adverse effect at all and so that is a sort of lurking shadow in the US experience which I suspect influences the way in which they treat all new vaccines," he added.


Health officials and academics think it is highly unlikely that such an adverse reaction would happen again.

But it is a concern as authorities around the globe stand on the verge of a mass vaccination programme against the current pandemic.

Pregnant women and children are expected to be among the groups targeted for vaccination, especially in countries likely to ration their vaccines.

Yet paradoxically the hard scientific evidence about the efficacy or dangers of these vaccines on pregnant women and young children does not exist.

"There is no study of the vaccines on pregnant women - no randomised clinical trials," said epidemiologist Tom Jefferson, who reviews influenza prevention and treatment for The Cochrane Collaboration, the voluntary global database provided by healthcare professionals which monitors the effects of healthcare worldwide.

No trials

He added: "Under the age of two there is only one trial and it shows inactivate vaccines [vaccines based on killed organisms] don't actually work."

Dr Jefferson said the best effect of influenza vaccines was on healthy adults.

A further problem, he explained, was that flu vaccines are unique in that they are registered and approved before full scale clinical trials have taken place.

Neither will the possible side effects be known on pregnant women or young children as Dr Marie Paul Kieny, director of vaccine research at the WHO explained. "It's not to say they would not be safe, they may be very safe but there is no data for the time being to demonstrate safety."


Adam Finn, professor of paediatrics at Bristol University is waiting for the go-ahead to commence a study the UK"

"We urgently need to get some evidence from children because young children, particularly under five, do seem to be at risk of serious illness," says Professor Finn.

"And secondly there is clear evidence that flu epidemics and pandemics are spread very efficiently by children. Children simply infect each other and their parents very efficiently and for that reason a hugely effective strategy to controlling epidemics of this kind is to immunise children."

Priority patients

Professor Finn predicted that the vaccines would probably be more effective in older children although he said that is not to say deploying the vaccines in younger children has no value.

"A vaccine that works, albeit not so well, is still better than no vaccine at all," he added.

The results of these trials will not be ready for a few months, probably mid-October.

This poses a potential dilemma for the Dept of Health - whether to start vaccination before the trial's results are known. Officials declined to tell The Report whether they will wait for the end of the trial.

The US has already issued its priorities: adults under 24, pregnant women, healthcare workers and people with underlying conditions like asthma. The over 65s are at the end of the queue.

Find out more from The Report on BBC Radio 4, Thursday 6 August 2009 at 2000 BST. You can also listen via the BBC iPlayer after broadcast or download the podcast.

hat-tip Shiloh

Malaysia: Influenza A H1N1 Deaths Leap To 14

PUTRAJAYA, Aug 6 (Bernama) -- Another death related to Influenza A (H1N1), that of a 57-year old male pensioner at the Putrajaya Hospital Wednesday, has raised the number of deaths due to the pandemic to 14 since this morning.

Director-General of Health Tan Sri Dr Mohd Ismail Merican said the victim who had diabetes and hypertension was admitted to the hospital's intensive care unit (ICU) with symptoms of fever, cough and difficulty in breathing.

"He was confirmed having the virus yesterday. He died yesterday of Acute Pulmonary Oedema secondary to H1N1," he told reporters here Thursday.

In that regard, Dr Mohd Ismail again stressed that people with high risk like pregnant women, those with lung disease, obesity, diabetes, asthma, low immunity, heart disease and breathing difficulty to seek immediate treatment at the nearest clinic or hospital as treatment for Influenza A (H1N1) was very effective if treatment was started within 48 hours of onset of symptoms.

He said for those who have normal influenza symptoms and not in the high risk groups they are advised to not panic and rush to get themselves tested.

He said this was because many H1N1 cases in Malaysia, and the rest of the world, would show light symptoms and 98 per cent would recover even without specific medicine.

"Patients with light symptoms are asked to rest and God Willing will recover in three or four days. After recovering they will have the anti-body, so it is not necessary for all cases with light symptoms to undergo H1N1 testing," he said.

Dr Mohd Ismail said H1N1 testing would only be done for cases admitted to ward and those with high risk.

He said this was because the Institute of Medical Research (IMR) which is responsible for testing is swamped with 500 tests a day and that 80-90 per cent were tested negative

hat-tip Kiwibird

Think About It

We are accustomed to flu season. We are not too bothered with the 36,000 people that die each year. Why? Because they are mostly the elderly.

Think about it. We are going to have a probable 70,000 deaths instead of the number we are used to. We are going to be replacing the deaths with young people and children.



Homeland Security Secretary Janet Napolitano on August 4th:


• “it's more likely that the pandemic would mirror 1957, when flu killed about 70,000 people in the USA...”


• One difference between swine flu and the 1957 version is that the new virus strikes a higher proportion of children and young people than the elderly.


• “pandemic flu probably will flare up soon after schools open in the fall, before vaccine is available.”


• there would not be enough pandemic flu vaccine for everyone, at least in the early stages of the flu season. "There will be prioritization of vaccinations,"


• The first batches of the vaccine are due in mid-October.


• About 36,000 people in the USA die and 200,000 are hospitalized in typical flu seaons.

INFLUENZA PANDEMIC (H1N1) 2009 (24): GLOBAL UPDATE

05-AUG-2009
Subject	PRO/AH/EDR> Influenza pandemic (H1N1) 2009 (24): global update

Date: Tue 4 Aug 2009
Source: Arab Times, Kuwait [edited]
<http://www.arabtimesonline.com/client/pagesdetails.asp?nid=35535&ccid=11>

WHO holds 2 billion people could catch H1N1
-------------------------------------------
Health officials raised the alarm about a strain of swine flu that is
resistant to the Tamiflu treatment as the virus claimed more lives on
Tuesday [4 Aug 2009], with Viet Nam reporting its 1st fatal case.
India and South Africa both reported their 1st deadly cases of the
A(H1N1) virus late Monday [3 Aug 2009].

 Maria Teresa Cerqueira, head
of the Pan-American Health Organization office in La Jolla,
California, said a Tamiflu-resistant mutation of A(H1N1) [the
Influenza pandemic (H1N1) 2009 virus] had been found around the
US-Mexico border in El Paso and close to McAllen, Texas. Experts had
gathered in La Jolla, California, on Monday to discuss responses to
the outbreak, and warned that resistant strains were likely emerging
because of overuse of antivirals like Tamiflu. "In the United States
Tamiflu is sold with a prescription, but in Mexico and Canada it is
sold freely and taken at the 1st sneeze. Then, when it is really
needed, it doesn't work," said Cerqueira late Monday. Cases of
A(H1N1) that were resistant to the anti-viral medicine have now been
found in the United States, Canada, Denmark, Hong Kong and Japan.

As the northern hemisphere autumn approaches, and with it the onset
of seasonal flu, the WHO is working with drug companies to ensure
vaccines to cope both with H1N1 and seasonal flu will be available.
WHO spokeswoman Fadela Chaib said the agency hoped to give an update
on its vaccine plans later this week. Leading flu vaccine makers
include Sanofi-Aventis, Novartis , Baxter, GlaxoSmithKline and Solvay.

Novartis has started human testing of H1N1 swine flu vaccine
candidates while Sanofi-Aventis, the world leader in flu shots, will
commence within days, company officials said on Tuesday [4 Aug 2009].
The launch of clinical trials is a key part of a widening programme
of work being undertaken by big pharmaceutical companies as they
prepare for mass vaccination from next month.

 GlaxoSmithKline, the
other "big 3" flu vaccine supplier, said it would initiate clinical
studies later this month. Healthcare officials are relying on a
vaccine to contain the spread of disease, providing a potential sales
windfall for those companies that are able to deliver quickly and in
large volume.

Australia's CSL has so far been the fastest commercial operator,
after starting its 1st clinical trials in Australia 2 weeks ago. Now
others are catching up. "We started a little over a week ago,"
Novartis spokesman Eric Althoff said by telephone from Basel. Benoit
Rungeard, product communications director for Sanofi Pasteur, the
vaccines division of the French drugmaker, told Reuters his company
would start "in the coming days or next week." 

Althoff said
Swiss-based Novartis was conducting its clinical trials in a number
of countries, including the United States, Britain and Germany, and
was testing both single and booster, or repeat, doses of vaccines.
Novartis, in common with other manufacturers, will also compare
vaccines with and without adjuvants -- ingredients that boost the
immune system response. AstraZeneca, whose MedImmune unit makes
smaller amounts of a flu vaccine that is sprayed into the nose rather
than injected, said it would start clinical trials in the United!
  States around 17 Aug 2009.

Meanwhile, a Taiwanese biotech company on Tuesday [4 Aug 2009]
started mass production of a swine flu vaccine before even completing
clinical trials, in a bid to get a jump before the start of the
winter flu season. Adimmune Corp, the island's only human vaccine
manufacturer, said it was starting production at its plant in central
Taichung. The company is due to deliver 5 million doses of A(H1N1)
influenza vaccine before the end of October [2009], according to the
purchase contract it has signed with the government, said deputy CEO
and president Ignatius Wei. The company says it has completed some
animal trials of the vaccine, but will only begin human trials in
September -- sparking criticism about the risks of manufacturing an
as-yet unproven product. But Huang Li-min, a doctor at National
Taiwan University Hospital who will oversee the human trials, says
Adimmune is taking a calculated risk. "They have to do so... they are
racing against time," Huang told AFP, referring to the upcoming start
of flu season. "There may be a risk for the company, but the risk is
small to an experienced company," he said.

Vietnam 5 H1N1 patients still test positive after 10 days

Translation

5 influenza A/H1N1 patients over 10 days still positive
5 influenza A/H1N1 patients over 10 days still positive
Updated: Today at 00:25 - Source: DanTri.com.vn



(Dân trí) - After several days of treatment, 5 patients of influenza A/H1N1 in Tien Giang still positive with the flu virus this, though treatment has been exposed as chart of the Ministry of Health.
"Treated isolation through first 11 days and tested 3 times but patients Tran Van Chuong (50 years old, Viet Kieu My, staying My Tho City) still have positive results A/H1N1 flu" - Uncle doctor Tran Thanh Thao, Deputy Director of the Department of Health Tien Giang province for.



Patients Tran Van Chuong hospitalized protected Center Tien Giang Province on the 26 / 7 but after 10 days of treatment, up to today (5 / 8) still testing positive for influenza A/H1N1 virus.



Today, a family would have moved patients to the Hospital for Tropical TPHCM continue treatment.



The Tien Giang, 4 patients had left treatment is 8-10 days from the test 2 times still positive influenza A/H1N1.



Doctors Health Department to Tien Giang: The influenza A/H1N1 of this place are complex. While no hot fever germs but still, so Hospital Center province will continue to keep treating it as exposed by the Ministry of Health. When tested again, if the patient has negative results for discharge.

hattip Windwaker

India-Swine flu death triggers panic

Now, outbreak of panic over swine flu

TNN 6 August 2009, 02:00am IST

PUNE: Women cradling babies, schoolchildren tagging along with parents, college-going teens, senior citizens and even pregnant women - more than a thousand people thronged Pune's government-run Naidu Hospital on Wednesday as panic deepened two days after the country's first fatality from swine flu was reported from the city.

Men, women and children with the slightest hint of cough and cold, anxious to get tested for the flu virus, began gathering from early morning and doctors and hospital staff soon found themselves swamped by a jostling crowd.

What made things worse was private general physicians, who normally are the first point of consultation, turning back patients who came to them with cold and fever symptoms, telling them to get checked at Naidu Hospital.

Pune municipal commissioner Mahesh Zagade said 20 patients suspected of having the virus were admitted to the hospital on Wednesday. Nine positive cases were reported as more people reported for testing, following the death of 14-year-old Rida Shaikh. The city planned 15 more screening centres for the H1N1 flu from Thursday. The civic administration also decided to increase the number of doctors at the hospital to clear the rush.

As the crowd at the hospital grew larger, tempers rose. Around 11am, a scuffle broke out between members in the crowd and the hospital staff following confusion regarding entry into the medical officer's cabin. However, policemen deputed at the hospital brought the situation under control.

No sooner than he came to the hospital for an inspection, municipal commissioner Zagade was surrounded by concerned parents. Parents of students from St Anne's School, where Rida Shaikh studied, demanded that their children be tested first.

``One doctor can handle 40-45 cases in a day. With more and more people pouring in here, we need more experts to deal with the situation,'' Zagade said.

On Wednesday, as many as 100 throat swab samples were sent for testing to the National Institute of Virology (NIV).

The institute usually receives an average of 40 samples every day. In view of the large number of samples, the NIV has doubled its workforce and machinery.

Taking note of complaints that private practitioners were directing patients to Naidu Hospital with minor ailments, district collector Chandrakant Dalvi warned that it would be considered a ``serious offence'' if any doctor avoided his duty of initially screening flu patients.

However, Dilip Sarda, president of the Pune unit of the Indian Medical Association, told TOI that the developments following Rida's death had created a panic in the medical fraternity. ``Doctors are reluctant to check patients suffering from cold and fever as they fear action may be taken against them if any of the patients test positive for H1N1 later. However, the IMA is appealing to the doctors not to refuse patients,'' he said.

With more than 70 confirmed cases of H1N1 flu coming from various city schools so far, the Pune Municipal Corporation

(PMC) held an emergency meeting of school representatives on Wednesday and instructed principals and headmasters of all private and municipal schools to raise awareness about the flu among students and their parents and submit a report about the steps taken to the civic body on August 7.

Meanwhile, worried parents at Naidu Hospital, many of whom waited for over two hours, seemed far from satisfied with the doctors.

``All the doctor did was counsel us. He refused to do the swab test even though my son has been suffering from fever, diahorrea and vomiting since the last six days. The doctor says unless they are sure that he has come in contact with an infected person, they will not do the test. But since my son goes to school, it is difficult to say whether he has come in contact with a positive case,'' said an angry father.

Another parent, also unhappy with the testing, said, ``In the past few days, we have been to the railway station, banks and other public places. How can we possibly know whether anybody there was infected or not?”

Defending their stand of not testing every person who showed symptoms, Narendra Thakur, medical officer at the Naidu hospital, said, ``The government has set criteria for us to conduct the tests. The swab test will be done only if a person has been abroad recently or has come in contact with a positive case. We have to work according to the guidelines of the government. Due to panic, even those suffering from ordinary flu are coming to us and we cannot test everyone.''

The Pimpri Chinchwad Municipal Corporation (PCMC) also held a meeting of school representatives on Wednesday. PCMC medical officer R R Iyer told TOI that the civic body has appointed 42 medical officers to keep a watch on schools in the municipal limits. The relatives of two H1N1-positive cases in the PCMC limits have been quarantined at home.

Aundh civil hospital, which is the other centre for treating and admitting H1N1 cases, took in 17 new suspected cases on Wednesday. The hospital has seen 18 positive cases so far. Of these, 15 have recovered.

In Satara district, the Krantisinh Nana Patil hospital opened a special screening cell on Wednesday. Twenty-five positive cases have been detected in the district over the past two weeks. The hospital presently has six confirmed and two suspected cases. Seventeen patients have recovered.

The U.S. Senate agreed to resume imports of Chinese chicken

Author: Washington, Reuters Published: August 5, 2009

The U.S. Senate voted Tuesday, to take special measures to ensure that if it is safe for human consumption, will allow chicken imports from China. This may help end a trade dispute.

北京方面表示,美国在长达两年的时间里禁止进口中国加工的鸡肉,违反了国际贸易准则.这是全球第一大进口国美国和出口大国中国之间在贸易问题上的数个争执之一.

Beijing has said that the United States for up to two years in China banned the import of processed chicken, in violation of international trade. This is the world's largest import and export of the United States, major powers of trade between China on the issue of a number of disputes one.

美国贸易组织表示,中国已经停止美国的鸡肉进口.中国是美国鸡肉的主要出口市场,年成交额接近7亿美元.

Trade Organization, the United States that China has stopped imports of U.S. chicken. China is a major exporter of the U.S. chicken market, the annual turnover of close to 700 million U.S. dollars.

尽管参议院为中国鸡肉进口打开了通道,但却将对中国施加较其他国家更为严格的监管.向美国出口的厂家需要获得美国批准,以後要进行年检,在美国的港口亦将加强检验

Although the Senate chicken imports to China and opened the channel, but to China than other countries to exert more stringent control. The factory to the United States need to ratify the United States, after the annual inspection should be carried out in the United States will also step up inspection of the port

China’s Plague-Affected Town Gets Handbooks to Stem Outbreak

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By Jason Gale

Aug. 5 (Bloomberg) -- Chinese officials trying to stop pneumonic plague spreading in northwestern Qinghai province have distributed more than 40,000 handbooks and other material to educate residents and prevent panic.

Authorities also quarantined a 3,500-square-kilometer (1,350-square-mile) area to contain the pneumonia-causing disease in the remote town of Ziketan, the provincial health department said in a statement today. Three people have died of the disease in the past week, one is in serious condition, one is recovering and seven others are stable, the department said.

Pneumonic plague, the most serious of three forms of the disease caused by Yersinia pestis bacteria, infects the lungs and can spread through coughing and sneezing. While improved hygiene has reduced its occurrence in China in the past decade, the germ has persisted in some areas including Qinghai, said P.L. Ho, associate professor of microbiology at Hong Kong University.

“The exact mode of transmission and why small clusters have occurred in recent years is still under investigation,” Ho, who has studied bacteria for 20 years, said in a telephone interview.

While plague can be fatal in all untreated cases, early diagnosis and treatment with generic antibiotics such as streptomycin and tetracycline cuts patients’ mortality rate to less than 15 percent, the World Health Organization said. The Geneva-based agency said it’s monitoring the situation.

Lives Are ‘Normal’

The Qinghai health department reiterated that the plague- affected area, situated northeast of Tibet, is adequately supplied with medicines and daily necessities and people’s lives are “normal.” Authorities also ordered the area to be fumigated and for all animal carcasses to be burned to prevent the spread of the disease, it said.

Residents of the farming town say people have been seeking to flee, mostly by foot, in defiance of a lockdown by authorities, the Associated Press reported yesterday.

Anyone who has visited Ziketan and the surrounding areas after July 15 and has developed a fever or a cough should seek treatment at a hospital, the health department said.

Ziketan, which has a population of about 10,000, is 144 kilometers southwest of the Qinghai provincial capital of Xining, which in turn is about a 2 1/2-hour flight west of Beijing.

Pneumonic plague is caused by the same bacterium that cause bubonic plague -- the Black Death that killed an estimated 25 million people in Europe during the Middle Ages. In the mid- 1800s, plague killed 12 million people in China.

Yersinia pestis bacteria are found mainly in rodents, particularly rats, and in the fleas that feed on them.

“In many parts of the world, the infection is still endemic and occurs sporadically where resources and systematic treatment is limited,” Ho said. “Attention is required because of international travel and the possibility of travelers visiting remote villages and being exposed.”

Brazil: Family of couple who died in flight open action, says aunt

5/8/2009

The family of Jacqueline Street, who died during the flight back from a trip of 12 days at Disney on Sunday, will sue the agency responsible for tourism throughout the death of the girl, according to today's aunt Magda Santos. "We're still absorbing this. We see our lawyers because it is clear that there were failures. If the Jacqueline went wrong, why no one warned us? A child of 15 years is not responsible for their actions. These guides are not prepared for anything, but nothing will bring her back. It was a great misfortune, "said Magda, in an interview with the" More You, "from TV Globo.

According to the aunt, at any time the family was informed by Aunt Augusta that the teenager was with pneumonia. "They called me and said I need not be concerned, that was okay. The Jacques also spoke with my sister from inside the plane," he said. In a note, the agency Aunt Augusta said that all medical procedures were taken and the company regrets the death of Jacqueline.

The couple had symptoms of influenza after another kid who participated in the tour have the same symptoms. According to the company of tourism, she took first in the antiviral Tamiflu July 29. The next day, when complaining of shortness of breath, Jacqueline, age 15, was taken to a North American hospital. There has been answered, conducted a test for swine flu, then a doctor, was released for the return flight. The results for Influenza A (H1N1) was negative and she was diagnosed with pneumonia. The teenager died on the trip, an hour before arriving in Sao Paulo.

As reported, the agency says tourism is "deeply dismayed by the death of the young" and said that research has already asked both the Brazilian government when the United States. "We are asking the Brazilian embassy in the United States, the U.S. Embassy in Brazil and the Minister of Health to make representations to the U.S. authorities so that they process their medical procedures adopted in the Orlando case, informed the text.

Disney/Brazil Flight: Surveillance will be tracking 18 people who were in flight when Jacqueline Ruas Died

05/08/2009

The State Health Secretariat of São Paulo reported that the Health Surveillance is monitoring 18 people who were on the flight in which the teenager Jacqueline Streets, 15, died last Sunday (2).

The teenager returned from a trip to Disney and still showed symptoms of influenza in the United States. She was referred to a hospital where he was subjected to an examination to diagnose it was swine flu - the so-called influenza A (H1N1) - but the result was negative.

The couple returned to go wrong during the flight and was attended by two doctors who were on board, they did CPR procedures for it, but had no success. According to SSP (Department of Public Safety), the IML diagnosed pneumonia as the cause of death.

According to Secretary of Health of São Paulo, they were sitting in the row next to Jacqueline during the flight that landed at the international airport of São Paulo, at Guarulhos (metropolitan area). The list of passengers was made by Anvisa (National Health Surveillance Agency).

According to the Secretariat, among the 18 passengers selected people from different states and even from other countries. The monitoring will be done by the Epidemiological Monitoring of each site.

On Monday (3), the tourism agency of Aunt Augusta, reported that a boy who traveled on the same flight of the adolescent, was confirmed with the swine flu. A child traveling with parents and showed symptoms of flu yet in the United States.

Case
The family of the student decided to sue the operator of tourism Aunt Augusta. The teenager's aunt, Magda Peace Santos, 39, says the goal is to get information on what happened during the U.S. tour before the teenager go wrong and die.

East an area hospital 1 year-old girl dyes the Type A flu to be perilous

2009-08-05 19:47

The health protection center, public and the privately operated hospital implementation's child supervises the arrangement, today receives a new report, involves a 1 year-old girl. The girl appears in the 1st of the month has a fever, symptoms and so on cough, class snot and vomit, moves in area Madame Youde east on the 2nd of the month that dozen of element hospital. She presents encephalitis's complication, at present in the sincere treatment department, the situation is perilous. Girl's nasopharyngeal secretion sample's lab results showed that assumes the positive reaction to the Type A flu. The girl passes the health to be good, has not wandered abroad the record. Her mother has a fever on July 30, seeks medical help to private doctor, at present has been restored to health. Other family member not any similar symptom.

Some measures won't help prevent flu pandemic - report

By Maggie Fox, Health and Science Editor Maggie Fox, Health And Science Editor – 12 mins ago
WASHINGTON (Reuters) – Closing schools, stopping large gatherings and other such measures are unlikely to do much to prevent the spread of the H1N1 swine flu pandemic, a team of experts predicted on Wednesday.

They said pandemic closely resembles the pandemic of H2N2 influenza in 1957 when it quickly became apparent that there was little officials could do to stop it.

"Efforts to mitigate it were futile," Brooke Courtney Center for Biosecurity at the University of Pittsburgh Medical Center said in a telephone interview.

Federal officials are expected to announce their recommendations for school closures on Friday. Local school districts and states usually make the decision to close schools, but they look to the federal government for advice.

At the height of the epidemic in May, more than 700 schools closed in the United States, according to the Department of Education.

In Mexico, where the pandemic started, officials closed government offices and schools for around two weeks in April and May, and encouraged businesses to close.

H1N1 is still circulating and, just as influenza did in 1957, it is dominating the mixture of viruses in the southern hemisphere's flu season going on now.

In its latest update last week the World Health Organization reported 162,230 confirmed cases and 1,154 deaths. But flu experts said this probably reflected only a fraction of the true count as not every patient can be diagnosed with a lab test.

Experts expect the flu will pick up activity in the northern hemisphere's autumn and the WHO predicted one third of the world's population -- two billion people -- will eventually be infected.

TOO WIDESPREAD

Governments are taking different approaches to slowing the spread of the virus. Last month, British experts on the spread of disease said closing schools at the first sign of a new pandemic might delay the worst so health officials can prepare, but cannot prevent the spread of the disease.

Writing in the journal Biosecurity and Bioterrorism, Courtney, Dr. D. A. Henderson and colleagues said it appears that the new H1N1 is now too widespread to try to stop.

"In 1957 it was decided pretty early on that efforts to quarantine or isolate people would not be effective," Courtney said.

As happened this year, the virus first appeared in the northern hemisphere's spring. It worsened in the fall. "The opening of schools in September appeared to be a major factor in initiating community epidemics," the researchers wrote.

"Schools were not closed for the purpose of trying to control the spread of disease. They were closed because too many teachers or administrators or students were out," Courtney said.

In 1957, 25 percent of the U.S. population became ill. Global health experts estimate two million people died.

"What we saw was that the federal government took very practical steps to deal with the expected pandemic in the fall in 1957," Courtney said. "They understood that, yes, it was expected that there would be a lot of people who got sick."

In 1957 it took months to make a vaccine and then it was not very effective, the researchers found.

Drug companies have started making vaccine against H1N1 swine flu. But the recommended population of 160 million people, including healthcare workers and pregnant women, cannot be fully immunized until December, experts estimate. Two doses are needed for full protection.

Argentina: 53% of the 337 people killed by this virus was not a risk factor or disease basis

Half of those killed by the influenza A patients were not at risk or have other disease-based

05-08-2009
According to a report issued by the Ministry of Health of the Nation, 53% of the 337 people killed by this virus was not a risk factor or disease basis. Furthermore, it was concluded that the age group most affected by the deaths, is composed of adults 50 to 59 years.

The Ministry of Health issued a report on influenza A.
47 per cent of the 337 people killed by influenza A in the country had any risk factor or disease and, while the age group most affected by the deaths, is composed of adults 50 to 59 years.This is indicated by a report allowed the Ministry of Health of the Nation.

The statistical survey of cases of influenza A show that the deceased persons in the country, does not differ by sex. In addition, it clarifies that the most important risk factors for both men and women are obese (18 percent), heart disease (8 percent) and chronic obstructive pulmonary disease (7 percent).

A total of 82 deceased women with risk factors, pregnancy and puerperium accounted for 19.5 percent. At week 29 of the epidemic (19 to July 25) influenza A accounted for 93.8 percent of all respiratory viruses circulating in over 5 years.

In children 1 to 4 years this proportion drops to 22 percent, while raising the proportion of respiratory syncytial virus, accounting for 70.6 percent. According to the ministry, there were 6384 cases of Severe Acute Respiratory Infection (IRAG), which required hospitalization.

The age groups most affected with this disease were younger than 5 years and 15 to 24. Confirmation of the cases were performed in 18 laboratories, provincial, public and private.

These laboratories are located in City of Buenos Aires, Buenos Aires Province (La Plata, Malvinas Argentinas, Bahía Blanca, February 3, General Pueyrredón) Santa Fe (Rosario, Venado Tuerto), Cordoba and Mendoza.

The health portfolio recalled, too, according to new recommendations from the World Health Organization (WHO) conducted the monitoring of influenza A on 4 indicators: trend, intensity, geographic dispersion and impact on health care .

In that sense, he argued that Argentina is in the 30 weeks of the epidemic of influenza A (July 26 to August 1) with a wide geographical dispersion, ie the disease is present in all cases the country's provinces.

He also said that there is a tendency of decreasing the activity of respiratory illness and stated that there is high intensity of activity of TSI (Influenza Type Disease).

"In other words, there is still a higher proportion of population affected as expected for this time of year," the party. The health portfolio stressed that the disease has a moderate impact on health services and that "the health system is capable of absorbing the demand generated by the epidemic.
hat-tip Shiloh

Minnesota quarantines turkey flock due to bird flu

08/05/2009 02:35:51 PM

A commercial turkey flock in central Minnesota has been quarantined after routine testing discovered the avian flu virus.

The state Bureau of Animal Health says the birds appeared healthy and showed no signs of infection and there’s no sign of illness among farm workers.

The board is following the state’s containment plan by quarantining the flock and all other flocks within three miles. They will be repeatedly tested for the virus for six weeks.

Dr. Dale Lauer is the assistant director of the board. He says it’s not uncommon to find the bird flu virus in domestic poultry flocks, and Minnesota turkey remains safe.

However, if the virus is left unchecked it can change into a form that’s lethal to domestic poultry.

Minnesota is the nation’s top turkey producing state.