The Ministry of Health confirms that the arrival of the swine flu virus resistant to Tamiflu, to Egypt

Saturday, December 5th, 2009

The announcement of WHO on the transmission of swine influenza virus resistant to treatment with Altammivloa for the first time since the discovery of the virus, to open the door to a new wave of evolution of the virus, which experts said was a new virus that no one knows the nature of the prevalence or Thorath and resistance to treatment.
-snip-
The Ministry of Health formed a committee to examine the death of the tenth case, due to the injury of swine flu, which was suspected of resistance to treatment Baltammivloa, but it has not yet been proved.

The WHO has indicated in published urgent this morning, it had registered for the first time two cases of infection caused by H1N1 viruses resistant to oseltamivir, the scientific name of the property wizard to swine influenza virus to "Altammivloa."

The first group launched by [snip] "and Wales" which was recorded in England, which was unveiled in late October last eight patients, was the introduction of all these patients to the hospital because of bloody unrest and tent. Has not been recorded any deaths among them so far, note that being treated and one of them in the intensive care ward.

The second group is a United States of America, which included four patients with a general shortage of Immunology, The cases occurred over two weeks in the period between mid-October and early November of last November, has resulted in three cases of a total of four cases of death, but that uncertainty does not continues to control the extent to which the H1N1 virus in the occurrence of such deaths.

Included all viruses H275Y resistance mutation itself, which refers to the resistance to the drug oseltamivir treatment of influenza first mutated and sensitivity about zanamivir, a drug the second anti-virus software.

The World Health Organization, once receiving reports, to organize a telephone conference with officials of the hospitals and their staff and experts in the fields of clinical medicine, epidemiology and virology to discuss the outbreaks mentioned, calling attention therapeutic options that can be made available to the immunocompromised patients who are infected with HIV pandemic.

UK: Change in swine flu virus is my biggest fear: Liam Donaldson

By Rebecca Smith, Medical Editor
Published: 6:17PM GMT 03 Dec 2009

Sir Liam Donaldson, the Chief Medical Officer: "My biggest fear is swine flu mutation." Photo: GEOFF PUGH

Cases of the H1N1 pandemic virus are dropping but the risk remains that the strain could change into something more virulent, he said.

Sir Liam revealed so-called 'drift' of the virus, where it changes slightly over time, was his biggest worry.

Experts have warned that although the virus is causing only mild illness in the majority of people currently, it could still change into a more dangerous disease.

Flu viruses have shown they can mutate easily and they can also mix with other strains raising the concern that swine flu could mix with the more deadly bird flu.

It comes after Tamiflu-resistant swine flu emerged in Wales and spread between very sick patients in a hospital ward. The strain does not appear to have escaped from the hospital and there have been no further cases.

Resistant forms have been found in other countries around the world.

Sir Liam revealed his 'worry list' for the first time, and said: "The biggest worry of all is the fear of mutation. We hear people saying something funny has happened (to the virus) in Norway or France but fortunately we have not seen any change in the virus so far.

"We are not claiming victory, there are still too many things to worry about, particularly at the severe end of the disease spectrum and it is still early days as far as the NHS winter is concerned."

Prof David Salisbury, head of immunisation at the Department of Health, said the vaccines with adjuvants, substances which boost the immune system and allow less active ingredient to be used in each dose, offer good protection even if the virus does change.

The GlaxoSmithKline vaccine, Pandemrix, which forms the bulk of the government programme, contains an adjuvant.

Prof Salisbury said: "One of the advantages with adjuvanted vaccines is their ability to protect against drifted strains. It opens the door for a whole new strategy in dealing with flu."

Sir Liam said his other major concerns were that the NHS could still face severe pressure this winter with ordinary seasonal flu coming after waves of swine flu, other respiratory infections and bad weather combining to stretch the service to it's limits.

And he is worried that there is a 'continuing stream' of children under five in hospital with severe swine flu and complications and that people are still dying from it.

Overall it is estimated there were just 22,000 new cases of swine flu last week, the lowest since the last week of September - near the start of wave two.

There have been 178 deaths in England linked to swine flu and 270 in the UK as a whole, Sir Liam said.

However, despite the drop in new cases, there are still high numbers in hospital, with over 700 patients in wards on Wednesday and 161 of them in critical care, which is only a slight drop on the previous week.

There are now more children under five with swine flu in hospital and in critical care that at any time and they remain the age group hardest hit by the virus.

Sir Liam said the numbers of children in hospital were for suspected swine flu and another virus called respiratory syncytial virus (RSV) which affects children at this time of year annually and has very similar symptoms.

A spokesman for the Health Protection Agency said their data was showing that RSV rates were 'in-line with previous years'.

The vaccination programme is due to be rolled out to children between six months and five years-old once the risk groups have been completed.

So far 11.2 million doses of Pandemrix, the GlaxoSmithKline vaccine, have been sent out to health services, along with 500,000 doses of Celvapan, made by Baxter.

It is estimated 1.6 million doses have been administered to people in the risk groups, including people with long-term conditions and pregnant women.

So far 275,000 doses have been administered to front line health workers in England, more than twice the number of doses of ordinary seasonal flu that were given in the whole of last year.

The figures suggest that front line health workers are not shunning the vaccine as some had feared.

2 Drug-Resistant H1N1 Cases Reported In Pa.

Dec 4, 2009 8:21 pm US/Eastern

PITTSBURGH (KDKA) -The standard treatment for H1N1 is anti-flu drug Tamiflu, so when cases of Tamiflu-resistant H1N1 turn up, it is concerning.

There are two cases in our state. Public health officials and hospitals have a plan, if they're faced with a local case.

"Tamiflu has been our mainstay of therapy. And yes, as we get more and more resistance, we do have some concerns about that," says Dr. Bruce Dixon, of the Allegheny County Health Department.

The state lab has been testing whether the virus samples it receives would respond to this drug.

"They've detected two cases in the state, in the eastern part of the state, and I don't think that's unexpected. We're seeing growing numbers in the country of resistant viruses showing up, and we know flu mutates quite readily," Dr. Dixon continues.

A series of steps would be taken should there be a local patient with drug-resistant virus.

In the hospital, some aspects would be the same as if they were dealing with a regular strain.

"The isolation we would use for any influenza case would be the same, people wearing gloves, and surgical masks when they're seeing the patients, everybody would already be in a private room," explains Dr. Amesh Adalja, a critical care medicine fellow at UPMC.

The treatment, though, would be different with an alternate anti-flu drug -- Relenza. It is typically inhaled, but when a patient is very ill, it has to be given by vein and that requires special permission from the hospital and the drug company.

"There's no evidence that this virus causes any more damage than the regular one. The prognosis may be a little worse because it's harder to get effective antiviral treatment to this patient," says Dr Adalja.

The health department would also take action.

"We look carefully to see if there are other family members that are ill, if there are other friends in their immediate circle of acquaintances who have gotten infected," Dixon said. "We do that regularly with the severe cases of H1N1."

The health department is reminding people that they will be holding an H1N1 vaccine clinic again this weekend. The vaccine will help prevent Tamiflu resistant cases in general, by cutting down on the number of people with H1N1 all together.

Variant of swine influenza specifically attack the lung with young children

Variant of swine influenza specifically attack the lung with young children
2009-12-05

Has emerged the world's 40 drug-resistant swine influenza viruses, University of Hong Kong Li Ka-shing (related) such as Harvard University School of Medicine in conjunction with the United States to conduct the study.

(Roundup) (Sing Tao Daily reported) the number of pick-up in swine influenza infection, there are visits to Hong Kong virus, experts believe that Hong Kong may have entered the swine flu, the second wave, although the epidemic is expected to moderate, but found the world's emerging 200 Nianer were variants of swine influenza virus, lethal for children under ten or stronger, the virus will go into the lungs; Experts urge people to fight swine influenza vaccine as soon as possible, but also proposes that the Government will be free for children vaccination of swine influenza vaccine policy and consists of six extended to the age of ten or below for children.

Visit to the United States is Hong Kong's Research Hospital in St. Zhu De, Department of infectious diseases, virologists Weishi Bo (Webster), Professor said that the U.S. is now the second wave of swine influenza in the fall period, but since the outbreak of swine influenza throughout the country since there are eight million 16 children under the age of infection, 36000 were hospitalized, 540 children died from swine flu, compared with an annual average of only 80 children die from seasonal influenza, a difference of nearly seven times the number of deaths.

Weishi Bo also said that Norway discovered variant of swine flu, the global Nianer 200 cases have been found, because of its viral proteins, the regional variations in the H22, so that variants of swine influenza on children under ten or highly lethal, the virus can penetrate the lungs in patients with , resulting in two deaths in Norway, the deceased black lung, such as coke.

He was worried that the United States when the third wave of swine flu, would be led by a variant of swine influenza virus, when more children will be subject to attack, but also worried that swine influenza virus and up to five percent of the deadly H5N1 bird flu virus reshuffle, will be more lethal severe.

Weishi Bo added that the U.S. is now a trial drug Peramivir, intensive care for children with severe swine influenza treatment, the drug directly into the blood vessels, a considerable effect, but each time you use are subject to prior approval of the U.S. Centers for Disease Control and Prevention (CDC) approval.

Hong Kong people infected with swine flu, the number rebounded Wei Shibo that, there are likely to have entered the second wave of swine flu, it is estimated that the overall epidemic in other countries or regions are similar, are considered moderate.

As concerns the virus variants influence, he worried that children under ten or infections as severe as with the United States, so that Hong Kong free of charge for children under six plan to fight flu shot, might consider extending to the old, "even if the virus mutates, the vaccine and drugs are still effective. "

In addition, the global drug resistance has emerged 40 of swine influenza virus, in conjunction with the University of Hong Kong Li Ka Shing School of Medicine at Harvard University and other mathematical model of the relevant research shows that in an influenza pandemic, the early use of a single antiviral drugs, such as Tamiflu, infection rates of up to Qi Cheng.

However, if at an early stage (community population, lower than the percentage rate of infection 1:00), restraint and medication, only the use of Relenza or amantadine, or mix them and Tamiflu can reduce the resistance, and also would reduce the transmission rate less than 5 into 7.

Participated in the study of Hong Kong School of Public Health assistant professor of beard-kei said: "This response is the nature of the insurance, but the Government has implemented, is still considering a number of factors, it is necessary to see the public would accept."
hat-tip Treyfish

CDC MMWR: Safety of Influenza A (H1N1) 2009 Monovalent Vaccines --- United States, October 1--November 24, 2009

December 4, 2009 / 58(Early Release);1-6
Excerpt:

CDC and FDA staff members searched the VAERS database to identify all U.S. reports of adverse events after vaccination with H1N1 vaccines and 2009--10 seasonal influenza vaccines during July 1--November 24. The first doses of H1N1 LAMV became available to the public in the United States on October 5, and H1N1 MIV became available the following week. VAERS reports were coded as fatal or nonfatal serious adverse events (defined by federal regulation as those resulting in death, life-threatening illness, hospitalization, prolongation of hospitalization, persistent or significant disability, or congenital anomaly) or as nonserious,^† and reporting rates per 1 million doses distributed as of November 20 were calculated.^§

VAERS reports coded as serious adverse events are reviewed by medical officers and assigned to predetermined broad diagnostic categories. To verify the reported event, medical records are requested and reviewed for all serious adverse event reports and for any reports (both serious and nonserious) that describe patients with possible Guillain-Barré syndrome or anaphylaxis. Cause of death is determined as stated in medical or autopsy records. Reports to VAERS indicate only that health events occurred after vaccination; causality generally cannot be determined solely by reports to VAERS. Excluded were 62 reports with insufficient information.

Through November 24, VAERS received 3,783 reports of adverse events after receipt of H1N1 vaccine, of which 204 were categorized as serious, and 4,672 reports after receipt of seasonal influenza vaccines, of which 283 were serious. During October 5--November 20, a total of 46.2 million doses of H1N1 vaccines (11.3 million LAMV and 34.9 million MIV doses) and 98.9 million doses of seasonal influenza vaccines were distributed to U.S states and territories. The overall VAERS adverse event reporting rates were 82 per 1 million H1N1 vaccine doses distributed and 47 per 1 million seasonal influenza vaccine doses distributed. The serious adverse event reporting rates were 4.4 and 2.9 serious adverse events per 1 million doses distributed for H1N1 vaccines and seasonal influenza vaccines, respectively. However, the percentage of serious adverse events among all adverse events reported after receipt of seasonal influenza vaccines was slightly higher (6.1%), compared with the percentage of serious adverse events after receipt of H1N1 vaccines (5.4%), and this finding was consistent for inactivated (5.8% versus 5.5%) and live attenuated (7.3% versus 4.7%) vaccines (Table 1).

VAERS received 13 reports of deaths occurring after receipt of H1N1 vaccine; three deaths occurred after receipt of LAMV and 10 after receipt of MIV (Table 2). In nine of these deaths, significant underlying illness (including illness that might be indication for vaccination) was present; one death resulted from a motor vehicle crash, and the remaining three deaths await review of final autopsy results or death certificates by CDC.

As of November 24, VAERS had received 10 reports of Guillain-Barré syndrome, and two additional reports of possible Guillain-Barré syndrome were identified by medical officers reviewing other reports to VAERS describing neurologic events. After chart review, four of these 12 reports (all after receipt of MIV) met Brighton Collaboration criteria^¶ for Guillain-Barré syndrome, four did not meet the criteria, and four are under review. VAERS also received 11 reports of anaphylaxis, and an additional eight reports of possible anaphylaxis were identified by medical officers reviewing reports to VAERS of serious allergic events. Of these 19 cases, 13 met Brighton Collaboration criteria, five had an anaphylaxis diagnosis on medical record review, and one has not been confirmed. Three of the Guillain-Barré syndrome cases and 15 of the anaphylaxis cases were coded as serious adverse events, in accordance with federal regulation.

The remaining 173 nonfatal serious adverse events after vaccination with H1N1 vaccines are under chart review. These reports fall into the following diagnostic categories: neurologic or muscular condition other than Guillain-Barré syndrome (49 [28%]); pneumonia or influenza-like illness (27 [16%]); other noninfectious conditions, including multiple medical symptoms (19 [11%]); respiratory or ear, nose, and throat condition (17 [10%]); allergic conditions other than anaphylaxis (16 [9%]); pregnancy complications** (15 [9%]); other infectious symptoms (10 [6%]); gastrointestinal (eight [5%]); cardiovascular (six [3%]); and psychiatric (six [3%]). Each category includes a variety of diagnoses; no patterns were identified.

CDC FluView: 2009-2010 Influenza Season Week 47 ending November 28, 2009

Excerpts:

U.S. Virologic Surveillance:

WHO and NREVSS collaborating laboratories located in all 50 states and Washington D.C., report to CDC the number of respiratory specimens tested for influenza and the number positive by influenza type and subtype. The results of tests performed during the current week are summarized in the table below.
Click on image:

*Subtyping results for the majority of specimens in this category were inconclusive because of low virus titers.

During week 47, seasonal influenza A (H3N2) and influenza B viruses co-circulated at low levels with 2009 influenza A (H1N1) viruses. Over 99% of all subtyped influenza A viruses reported to CDC this week were 2009 influenza A (H1N1) viruses.

Click on image:

Maryland: Mutated swine flu in city raises concerns

By Kelly Brewington
December 3, 2009
A mutated strain resistant to the most commonly prescribed drug used to treat swine flu has surfaced in Baltimore, raising concern among experts that the virus could become harder to treat.

The cases of two cancer patients at Johns Hopkins Hospital who contracted the mutated strain are the first involving Tamiflu-resistant H1N1 in Maryland and are among 75 worldwide.

Health officials, noting that the Hopkins patients recovered, say there is no cause for alarm because the cases are isolated and have not spread. But the local cases, diagnosed in October and November, come on the heels of similar mutations found last week in four cancer patients at Duke University Medical Center in North Carolina - three of whom died - and in another cluster of patients at a hospital in Wales.

Dr. Trish Perl, a Hopkins epidemiologist, said hospitals need to be careful about hygiene and watch for new strains, that doctors should prescribe Tamiflu only when necessary, and that the public should get vaccinated against swine flu to avoid transmission.

"Probably, this mutation is out there, so what we want to do is to engage everyone in thinking about this more, particularly the medical community," Perl said. "This is a big wake up call for us. We are going to be more vigilant."

The Hopkins patients were two men who have since been discharged. One was admitted to the hospital after complaining of fever. Doctors tested him for influenza and the sample was sent to the state Department of Health and Mental Hygiene, which has been testing for virus mutations since summer. The other patient was being treated at the hospital and did not get better after taking Tamiflu. Samples sent to the state lab confirmed a mutated strain.

Officials at Hopkins and at the state health department would not disclose more information on the men's conditions, ages or hometowns. Officials said the patients were not likely to spread the virus. The men, who had weakened immune systems which made them more susceptible, were cared for in private rooms by medical staff wearing masks.

-snip-

British officials said they have found 24 swine flu viruses with a mutation associated with Tamiflu resistance

Britain: Swine flu cases fall by more than half, WHO says it's too soon to say it's peaked

By THE ASSOCIATED PRESS (CP) – 7 hours ago

LONDON — British officials say swine flu cases in England fell by more than half last week, with about 22,000 new cases.

The week before, the government guessed there were 46,000 new infections, though the numbers have a big margin of error. The number of cases has been falling for weeks, but World Health Organization officials say it's too soon to say whether this wave of swine flu has peaked.

In a statement Thursday, British officials said they have found 24 swine flu viruses with a mutation associated with Tamiflu resistance. Contrary to WHO guidance, Britain gives out Tamiflu liberally, and does not require a doctor's advice to get the antiviral. Critics warn that could speed up the development of resistant viruses.

Netherlands reports mutant swine flu death

THE HAGUE — Dutch authorities said Thursday a patient infected by a mutant strain of the swine flu virus had died, but added that this was not the cause of death.

Harald Wychgel, spokesman for the Dutch Institute for Health and the Environment, told AFP that there had been a "minor change in the virus to make it resistant to Tamiflu," a key treatment for influenza.

"He died not because the virus was resistant but because he was seriously ill and caught the Mexican (swine) flu," Wychgel said.

The man, whose age had not been given, died Sunday in the northern city of Groningen, local health official Hans Coenraads said.

"We have carried out tests on the patient's associates to see if the mutation had spread but we found no such indications", he said.

Reports said that two more patients in the Netherlands had shown resistance to Tamiflu.

It is the fifth fatal case of mutated A(H1N1) flu in Europe, after two in France and two in Norway.

The World Health Organisation said last month that mutations had been observed in Brazil, China, Japan, Mexico, where the swine flu pandemic began, Ukraine, and the United States, as early as April.

Italy also reported a non-fatal case on Monday.

"The mutations appear to occur sporadically and spontaneously. To date, no links between the small number of patients infected with the mutated virus have been found and the mutation does not appear to spread," a WHO statement said on November 20.

The WHO also underlined that there was no evidence of more infections or more deaths as a result, while the mutated virus detected up to that point remained sensitive to antiviral drugs used to treat severe flu, oseltamivir (Tamiflu) and zanamivir (Relenza).

Scientists fear that mutations in flu viruses could cause more virulent and deadly pandemic flu. The global health watchdog reiterated a call for close monitoring.

"Although further investigation is under way, no evidence currently suggests that these mutations are leading to an unusual increase in the number of H1N1 infections or a greater number of severe or fatal cases," it added.

WHO: It's too early to say pandemic has peaked

Robert Roos News Editor

Dec 3, 2009 (CIDRAP News)

The World Health Organization's (WHO's) top influenza expert said today it's too soon to judge whether the H1N1 influenza pandemic has passed its peak, though he acknowledged that cases are dropping in the United States and Canada.

"It's too early to say whether activity is peaking in the Northern Hemisphere, and it's not possible to predict what will happen in the spring," said Dr. Keiji Fukuda, special adviser to the WHO director-general on pandemic flu.



In response to questions, Fukuda said it's premature for the WHO to start formal discussions on whether the pandemic has crested. "In some countries there are still increasing infections, even though there are some countries, such as the United States and Canada, where infections are going down," he said.

Formal discussions on whether the pandemic is waning won't come until "sometime in 2010," he said.

Recent reports indicate that that the second wave of pandemic is ebbing in the United States and Canada. The latest report from the US Centers for Disease Control and Prevention (CDC), covering the third week in November, said physician visits for flu-like illness dropped for the fourth straight week.



And the Public Health Agency of Canada said on Nov 27 that all provinces and territories had reached "a possible epidemic peak."



The evidence from Europe is less clear. Today's update from the European Centre for Disease Prevention and Control (ECDC) said H1N1 deaths increased by 6% last week, signaling a slower rise in mortality, as the toll had been nearly doubling every 2 weeks over the preceding 6 weeks.



In other comments today, Fukuda said the WHO has not calculated a case-fatality rate (CFR) for the pandemic, after a reporter noted that the CDC recently estimated the US CFR to be .018%.

Fukuda said CFR estimates depend today, as in past pandemics, mainly on gathering data on all deaths and then using modeling techniques to estimate how many were flu-related. "People don't count flu deaths on a one-to-one basis," he said.



"It's much too soon to have the kind of vital record health data that's typically used to model estimates of overall [flu] deaths," he added. "I think it'll take another 1 to 2 years after the pandemic to collect this kind of data and come up with estimates."

The WHO estimates that 150 million doses of H1N1 vaccine have been distributed in about 40 countries so far, Fukuda said.

Meanwhile, the WHO released a statement today to allay concerns it said have been voiced in the news media that experts on some of the agency's advisory committees have pharmaceutical industry ties that influence policy decisions related to the pandemic.



The statement says the WHO has historically collaborated with the pharmaceutical industry because efforts to improve health depend on access to effective and affordable medicines, vaccines, and diagnostics. The agency said it has many safeguards to identify and deal with potential conflicts of interest.



The statement also says public perceptions of the H1N1 pandemic have been strongly influenced by the 5-year history of worry about the deadly H5N1 avian influenza virus. "Adjusting public perceptions to suit a far less lethal virus has been problematic," the agency said. "Given the discrepancy between what was expected and what has happened, a search for ulterior motives on the part of WHO and its scientific advisers is understandable, though without justification."

In the briefing, Fukuda emphasized the necessity of WHO's collaboration with many partners, including private companies, though he didn't mention media criticisms.

"It's the private sector that makes vaccine," he said. "Most vaccine is not made by governments, but by companies in the private sector, both in developed and developing countries. It's this group which has unique knowledge of vaccines because they manufacture them. It's essential for public health to access this knowledge."
hat-tip Harfang

Transplant infectious disease experts provide pandemic guidance

Public release date: 3-Dec-2009

Swine flu has major implications for solid organ transplants

Surgeons and other healthcare professionals specialising in solid organ transplants have been issued with expert advice to guide them through the complex clinical issues posed by the global H1N1 (swine flu) pandemic.

The paper, published online by the American Journal of Transplantation, also urges them to stay alert to the significant concerns that swine flu could combine with seasonal flu, and possibly even bird flu (H5N1), to develop into a strain with unpredictable virulence.

"The current virus pandemic can cause severe disease in transplant patients and could be transmitted from donors" explains assistant professor Dr Deepali Kumar, an expert in transplant-related infectious diseases from the University of Alberta, Canada. "This has major implications for donor selection and transplant management and care."

Dr Kumar has teamed up with infectious disease experts from across Canada and the USA to discuss the solid organ transplant guidance issued as part of the wider H1N1 guidelines produced by the American Society of Transplantation (AST) and The Transplantation Society (TTS), which are updated online as new information emerges.

The article, fast-tracked for online publication, has been produced on behalf of both societies and carries the additional endorsement of the Canadian Society of Transplantation.

It includes discussions about clinical presentation, diagnosis, therapy and prevention, specifically addressing areas such as chemoprophylaxis, immunization and donor-derived infection.

"Reaction to this novel respiratory virus in the transplant community has been swift, as clinicians have real concerns about the prevention, diagnosis and treatment of the flu virus as public health data mounts and the course of the pandemic evolves" says Dr Kumar.

"The International Society for Heart and Lung Transplantation has already developed guidelines for heart and lung transplant recipients in the pandemic setting, raising concerns about transmission from donors to recipients.

"However, autopsy studies suggest that other organs, such as the brain, kidney, pancreas, spleen, liver and heart, can also become infected. This pandemic has important clinical implications for all stages of the solid organ transplant process."

Key points raised by the discussion document include:

• All patients with influenza-like illnesses, and milder symptoms such as a persistent runny nose, should be tested for the virus and empiric antiviral therapy considered.
• Some experts recommend continuing antiviral therapy until viral replication has ceased and clinicians should base their therapy decisions on current advice from the Centers for Disease Control (CDC) and individual patient assessments.
• Some experts also recommend that the oseltamivir (Tamiflu) dose may be doubled in critically ill patients and a significant reduction of immunosuppression is recommended in patients with significant disease.
• However it should be noted that a CDC study (August 2009) reported oseltamivir resistance in two immunocompromised patients.
• Transplant patients and donors should receive at least one dose of H1N1 vaccine. Recent studies show that in healthy adults a single dose of inactive split-virus 2009 H1N1 vaccine had a seroconversion (antibody production) rate of 96.7 per cent, while a single dose of a vaccine containing adjuvant MF59 achieved 76 per cent.
• People who receive a Live Attenuated Influenza Vaccine may shed the virus for up to 21 days after immunization.
• There is currently no data on the duration of antiviral therapy that donors with H1N1 must undergo before organs can be safely used. If the donor has not completed a course of treatment, the current recommendation is to give the recipient five to ten days of antiviral therapy, at therapeutic not prophylaxis doses.

"As new information emerges about novel H1N1, updates will be made to the electronic guidance document posted on the AST and TTS websites so regular visits are recommended" stresses Dr Kumar.

###

The paper is available free online at: http://www3.interscience.wiley.com/cgi-bin/fulltext/123198716/HTMLSTART

Notes to editors

Guidance on Novel Influenza A/H1N1 in Solid Organ Transplant Recipients. Kumar et al on behalf of the AST Infectious Diseases Community of Practice and Transplant Infections Diseases Section of TTS. American Journal of Transplantation. Online publication ahead of print (December 2009). doi: 10.1111/j.1600-6143.2009.02960.x Available free online at: http://www3.interscience.wiley.com/cgi-bin/fulltext/123198716/HTMLSTART

American Journal of Transplantation is the leading, most authoritative source for current clinical and research results on all aspects of transplantation. As the official publication of the American Society of Transplantation and the American Society of Transplant Surgeons, the American Journal of Transplantation serves as a forum for debate and reassessment, an agent of change, and a major new platform for promoting understanding, improving results, and advancing science in organ and tissue transplantation. For more information, please visit www.amjtrans.com.

Wiley-Blackwell is the international scientific, technical, medical, and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world's leading societies. Wiley-Blackwell publishes nearly 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols. For more information, please visit www.wileyblackwell.com or www.interscience.wiley.com

WHO alert/update entitled "Oseltamivir resistance in immunocompromised hospital patients" Is Misleading

In the post below this one, entitled:

"WHO: Oseltamivir resistance in immunocompromised hospital patients"

The article clearly states that one third of all cases were immunocompromised. I believe they should have put "one third" in the title. It is misleading. All cases were not from immunocompromised patients.

Within the past two weeks, the number of documented cases of oseltamivir resistance in H1N1 viruses has risen from 57 to 96.

Around one third of these cases occurred in patients whose immune systems were severely suppressed by haematological malignancy, aggressive chemotherapy for cancer, or post-transplant treatment.

WHO: Oseltamivir resistance in immunocompromised hospital patients

2 DECEMBER 2009 | GENEVA --

WHO has been informed of two recent clusters of patients infected with oseltamivir-resistant H1N1 viruses. Both clusters, detected in Wales, UK and North Carolina, USA, occurred in a single ward in a hospital, and both involved patients whose immune systems were severely compromised or suppressed. Transmission of resistant virus from one patient to another is suspected in both outbreaks.

The emergence of drug-resistant influenza viruses in severely immunosuppressed or immunocompromised patients undergoing antiviral treatment is not unexpected and has been well documented during seasonal influenza. Virus replication can persist in such patients for prolonged periods of time despite antiviral treatment, creating an environment in which drug-resistant viruses can readily be selected. This phenomenon has also been observed for the pandemic (H1N1) 2009.

Upon receipt of the reports, WHO organized a telephone conference with officials and staff from the hospitals and experts in clinical medicine, epidemiology, and virology to discuss the two outbreaks. Particular attention is being given to the best treatment options for immunocompromised patients who become infected with the pandemic virus.

The outbreaks

The Wales outbreak, which was detected in late October, involved eight patients. All of these patients were hospitalized because of severe haematological disorders. No deaths occurred. Three of these patients remain in hospital, with one being treated in intensive care.

In the USA outbreak, which involved four severely immunocompromised patients, cases occurred in a two-week period between mid-October and early November. Three of the four cases were fatal, but the role of H1N1 infection in contributing to these deaths is uncertain.

All of the resistant viruses carried the same H275Y mutation, indicating resistance to oseltamivir but susceptibility to the second antiviral drug, zanamivir.

Ongoing investigation

The outbreaks are being further investigated to determine the mode of transmission within the wards and to ensure that resistant viruses have not spread to staff, other patients in the hospitals, or into the wider community. Results to date are reassuring.

No illness in staff caring for these patients has been detected, suggesting that the resistant virus does not spread easily to otherwise healthy people, especially when good measures for infection control are in place. Moreover, intensified surveillance has found no spread to other wards within the two hospitals or into the wider community.

Modified treatment recommendations

The experts agreed that severely immunocompromised patients need to be regarded as an especially vulnerable group. These patients are highly susceptible to infection, particularly difficult to treat, and especially likely to develop resistance.

As early signs of influenza may be masked by symptoms associated with underlying disorders or their treatment, the experts further agreed that doctors treating such patients should operate with a high level of suspicion for influenza virus infection and be especially vigilant for the rapid development of oseltamivir resistance.

In these patients, standard treatment doses and duration for treatment with oseltamivir are unlikely to be sufficient. Though clinical judgement is important, doses may need to be increased and continued, without interruption, for the duration of acute illness. Zanamivir should be considered as the treatment of choice for patients who develop prolonged influenza illness despite treatment with oseltamivir.

Once oseltamivir resistant virus has been detected in a ward treating severely immunocompromised patients, doctors should consider switching to zanamivir as the antiviral drug of first choice for treatment and when considering post exposure prophylactic treatment of other patients on the ward.

The experts were emphatic in their recommendation that health care staff, carers and family contacts of patients be vaccinated against pandemic influenza.

Vigilant monitoring needed

WHO recommends vigilant monitoring for the development of oseltamivir-resistant viruses and for any changes in the transmissibility or pathogenicity of these viruses. Experience with seasonal influenza viruses shows that resistant viruses can quickly spread within the general population and become established, rendering one or more antiviral drugs ineffective.

Experience acquired since the initial characterization of the H1N1 pandemic virus in March shows that the neuraminidase inhibitors, oseltamivir and zanamivir, when administered early, reduce the risk of complications and may also improve the clinical outcome in patients with severe disease. This experience underscores the need to protect the effectiveness of these drugs by minimizing the occurrence and impact of drug resistance.

WHO received the first report of an oseltamivir-resistant pandemic virus in July. In general, cases of oseltamivir resistance have been geographically dispersed, sporadic and not linked to one another. The number of these events has been steadily increasing, in line with recent increases in influenza activity in many parts of the world and a corresponding increase in the administration of antiviral drugs.

Within the past two weeks, the number of documented cases of oseltamivir resistance in H1N1 viruses has risen from 57 to 96.

Around one third of these cases occurred in patients whose immune systems were severely suppressed by haematological malignancy, aggressive chemotherapy for cancer, or post-transplant treatment. The clusters in the two hospital wards should be viewed in the context of these overall trends. Although all incidents of oseltamivir resistance merit investigation, no evidence suggests that events to date constitute a public health threat.

Patients in Md., Va. treated for Tamiflu-resistant swine flu

By Michael Laris

Washington Post Staff Writer
Wednesday, December 2, 2009; 3:55 PM

Two swine flu patients in Maryland and one in Virginia were hospitalized with a form of the virus resistant to a commonly used medicine, prompting infectious disease specialists to call for renewed caution even as the intensity of the pandemic nationwide has declined.

Tamiflu is one of the key drugs used on the sickest patients, and the number of cases where it can no longer kill the H1N1 virus is tiny. But epidemiologists say experience with other flu strains shows that resistance can take over quickly, making monitoring and prevention crucial.

"I don't want to scare the public, but I do want people to be responsible in what they need to be doing, not only for their patients but also for public health," said Trish Perl, a professor at Johns Hopkins University Hospital.

"It's been reported in Seattle, it's been reported at Duke, it's been reported in our place. All of the sudden we're starting to see . . . more resistance than we saw earlier this spring," she said. "What it calls for is increased vigilance."

Diane Helentjaris, head of Virginia's office of H1N1 response, said two state residents have been treated for Tamiflu-resistant swine flu, one at a hospital in Virginia and one in another state.

"It's not unexpected at all, when you have many, many people taking an antiviral medication," she said. Extended treatment for those with immune problems is another issue. "The longer you're on something the more likely you might develop some resistance," she said.

Both Hopkins patients had weakened immune systems and were being treated under protocols consistent with leukemia patients. Staff had been vaccinated and wore masks, hospital officials said. Perl said initial virus samples responded to Tamiflu, but that changed during the onslaught of the treatment itself, leading to a mutated, resistant form. "Under the pressure it can emerge," she said. Doctors can try a different drug in such cases. Both patients were eventually discharged.

Perl said Tamiflu should not be over-prescribed, because that can lead to more chances for mutations. And people should avoid complacency and get vaccinated, she said.

In the District, officials confirmed the city's first swine flu-related death, of an adult male with a preexisting medical condition, Health Department spokeswoman Dena Iverson said.

Cases Of Tamiflu Resistant Swine Flu In Md

Wednesday, December 02, 2009
Scott Wykoff

The Maryland Department of Health and Mental Hygiene has reported the first two cases of Tamiflu resistant Swine Flu in Maryland to the Centers for Disease Control and Prevention.

Molecular testing by the DHMH Laboratory confirmed that each case had the Tamiflu resistant virus strain.

Notification is underway to the state's acute-care hospitals, physicians and other health care providers to remain on the lookout for other possible cases.

The resistant strain is presumed preventable by the Swine Flu vaccine and can be treated by alternative antiviral medication. "This kind of mutation of the flu virus has been expected and that is why we've tested over 500 H1N1 samples from across the state for resistance to Tamiflu as a part of our flu monitoring and surveillance effort," said John M. Colmers, DHMH Secretary. "These two resistant cases are of concern because although infections such as this can be prevented with vaccine, we also want to retain all of our options for treating those with serious influenza complications."

Routine testing at the state Public Health Laboratory discovered the first Maryland case. Astute clinicians suspected and reported the second case after a patient continued to test positive for flu despite antiviral treatment.

Tamiflu (oseltamivir) is the most frequently prescribed flu medicine for flu treatment of adults and children aged 1 year and older. When properly prescribed, antivirals such as Tamiflu can slow the rate at which a flu virus infects cells in the body, thus reducing the spread and the severity of the illness. A Tamiflu resistant strain of Swine Flu makes it more difficult for physicians to treat patients. "There is no indication that any Tamiflu resistant strain of the Swine Flu virus has spread broadly through the general population," said Frances Phillips, DHMH Deputy Secretary for Public Health Services. "Both of these patients have recovered from influenza. However, DHMH is working closely with local hospitals and health departments to be sure the virus has not spread to others."

These cases were diagnosed with flu during October and November hospitalizations at The Johns Hopkins Hospital and both have recovered from influenza. While there does not appear to be any link between the two cases, both had immunosuppression, which is an identified risk factor for the development of antiviral resistance.

Worldwide, there have been a small number of Tamiflu resistant H1N1 influenza cases identified by public health authorities. The majority of these cases have occurred among immunosuppressed patients undergoing treatment for influenza. Nationally, there are several cases of these resistant viruses transmitted in the healthcare environment or in group settings. It is common for strains of seasonal influenza to become resistant to antiviral medications as well, which is another reason why seasonal influenza vaccination is highly recommended among those at high risk for influenza complications. "Vaccination remains the best protection against the flu," added Secretary Colmers. "While we continue to see flu activity on a downward slope in Maryland for now, more H1N1 vaccine arrives each day and we urge everyone, especially members of the five target populations, to contact their doctors, health care providers or local health departments to get vaccinated."
hat-tip Treyfish

China H1N1 (2 articles)

By THE ASSOCIATED PRESS (CP) – 2 hours ago
China death toll from swine flu triples in 2 weeks

BEIJING — The number of swine flu deaths in China has more than tripled in two weeks with the onset of winter, the Health Ministry said late Tuesday.

By Sunday, the Chinese mainland had recorded 178 deaths from the H1N1 virus - a threefold-plus jump from the 53 deaths announced Nov. 15, according to the ministry's Web site.

The ministry also said three of four recent deaths reported after people received swine flu vaccinations have been determined to have no link to the inoculations themselves, the official Xinhua News Agency said.

The three deaths were "coincidental," Liang Wannian, director of the ministry's emergency response office, was quoted as saying. Results for the fourth death are still pending.

Of the 26 million people inoculated so far nationwide, a tiny fraction - 2,867 - reported adverse reactions, Liang said. Most of those reactions were fever or swelling, he said.

"Clinical tests and practices in China and other countries have shown the A/H1N1 flu vaccines are safe," Liang said.

More than 90,000 people in China have been infected with swine flu and nearly 80 per cent have recovered, Xinhua reported.

By comparison, China's figures are much smaller than in the United States. Since it was first identified in April, swine flu has sickened an estimated 22 million Americans, hospitalized about 98,000 and killed 4,000.

The flu situation in China is still "severe" as the number of cases and fatalities grows with the onset of winter, Liang said.

Swine flu made up about 90 per cent of all flu cases in recent weeks. Schools are still the main venue for prevention, with nationwide vaccinations continuing.

Dec 1, 2009
In China, Real Statistics of H1N1 Infection Kept Secret

Hospitals told to diagnose ordinary flu, pneumonia

The official H1N1 death toll in China’s northwestern province of Jilin was two as of Nov. 15, according to the province’s Health Bureau. The real death toll far exceeds that number, according to information from staff workers at the local Center for Disease Control and Prevention (CDC).

One staff worker who did not wish to be identified told The Epoch Times that “estimates of the H1N1 death toll cannot possibly be very accurate.”

“As far as we are concerned, the statistics of H1N1 infection are a secret. We have an obligation to keep it secret. We cannot even tell our parents about it,” said the staff worker, who is based at the CDC in Jilin Province’s Changchun City.

The staff worker further explained that, "Hospitals only test for H1N1 on critically ill patients to monitor changes in the H1N1 virus. Routine testing for H1N1 on less severely ill patients is almost non-existent: Most cases were just treated like ordinary flu, as required by the government. When there is a cluster infection, tests are only run on a few patients, and we don’t do it based on individual requests."

The staff worker also admitted that some of the deaths due to H1N1 infection were not included in the H1N1 death toll since tests were only conducted on critically ill patients. Changchun City’s CDC has also reported cases like this to the Health Bureau, according to the staff worker, adding that, “Whether the Health Bureau will publish the true data or not, we don’t have the right to intervene.”

This staff member’s information corroborates evidence given to The Epoch Times by another CDC staff member a few days ago—that many students have recently contracted the H1N1 virus. Many schools were shut down because of the disease at the time, although some chose not to report the situation, and thus the CDC does not know the exact figure.

An official from the Jilin Province Health Bureau, when contacted by The Epoch Times, said that patients now have to spend their own money to be treated for the H1N1 infection, as the regime has stopped providing coverage since August or September. He refused to comment further.

Zhong Nansha, an academic of the Chinese Academy of Engineering and a noted Chinese medical expert expressed his doubt of the official estimate of the H1N1 death toll in a report published by Guangzhou Daily on Nov. 19.
Jilin Authorities’ Coverup Guarantees Report of Zero Fatalities

A Chinese blogger posted an article on China’s famous Baidu Tieba (the Chinese equivalent of Google), stating he suspected that some critically ill patients, including one of his own family members in the Intensive Care Unit (ICU) in Jilin City Hospital had H1N1 infection.

Although the official diagnosis for this blogger’s relative was severe pneumonia, judging from the medication prescribed by the hospital, he suspects his relative has H1N1 infection. The high medical cost, which ran over 10,000 yuan (US$1,500) per day for 12 days, was a huge financial burden for the blogger’s family. After treatment, the patient still did not show any signs of improvement.

The blogger also said that there were patients with similar symptoms who were admitted to the ICU, and five of them were in a coma. There were also patients with similar symptoms in the nearby Railroad Hospital.

“There were clearly cases of H1N1 infection, yet they do not confirm or explain the cases. They only stated that these were severe cases of pneumonia. Covering up and avoiding reporting H1N1 infection is now a fact of public health,” according to the blogger.

He also indicated that the Jilin provincial government had promised the State Council that there will not be any fatalities recorded due to H1N1 infection in Jilin Province, and the promise was kept at the cost of blocking reports on H1N1 infection and going so far as stopping testing for H1N1 in elementary/middle schools and various medical facilities.

A 25-year woman who was seven months pregnant was admitted to the ICU ward of the Jilin City Hospital for H1N1 infection. The woman had a normal delivery, but the baby was already stillborn, according to the blogger.

Although 80 percent of flu cases in Jilin City were H1N1 infections, hospitals were instructed to not to give an H1N1 diagnosis, but instead to diagnose suspected cases as regular flu or pneumonia, according to another blogger who said he was given this information by a relative who is a nurse.

Yet another blogger stated that although nearly 400 students in his school had developed fever, not a single H1N1 diagnosis was given, and nobody showed any concern.

Vaccine No Longer Reliable Due to H1N1 Mutation

Major foreign media have reported the H1N1 mutation in China, a fact that Chinese authorities can no longer deny. As a result, many Chinese have started questioning the efficacy of the H1N1 vaccine.

“It is not our time to give students the H1N1 vaccine shots yet. But I think [they will not necessarily] develop immunity even if they are given the shots, due to the mutation of the virus,” an employee of the Changchun University of Science and Technology said when contacted by The Epoch Times, adding that, “The school is under lockdown. Students have to show their student ID’s to go in and out. The weather is unstable and many people have come down with the flu.”

When The Epoch Times contacted Jilin University, the reporter was told that classes were suspended in September and many students were infected with H1N1 when they returned to school after the Oct. 1 National Day. “Now students basically just stay in the school and wear masks when they are in public places.”

http://www.theepochtimes.com/n2/content/view/25896/99999999/1/1/

No more drug-resistant H1N1 found at Duke

Updated: Today at 1:22 p.m.

Durham, N.C. — Extensive testing has found no more cases of drug-resistant H1N1 flu at Duke University Hospital, officials said Tuesday.

The hospital reported on Nov. 20 that two men and two women had contracted a strain of the virus that was resistant to the drug Tamiflu, one of two medicines used to fight H1N1. Both men and one woman died.

The patients had been treated in an isolated unit of the hospital in the six weeks prior to the Nov. 20 announcement, and all had underlying compromised immune systems and other complex medical conditions at the time, officials said.

The U.S. Centers for Disease Control and Prevention and the state Division of Public Health worked with Duke Hospital to test all other patients in the isolated unit several times in recent days. Other people being treated for H1N1 at the hospital also were tested.

"Much work is still being done to better understand the nature of the four cases that were reported previously," Dr. Daniel Sexton, an infectious disease specialist and director of the Duke Infection Control Outreach Network, said in a statement.

-snip-

Vietnam: Difficult to distinguish influenza A/H5N1 and influenza A/H1N1

January 12, 2009 [translates bad..means 12/1/2009]

Excerpt:

Due to the difficulty to distinguish between patients of these two influenza A, so Dr. Nguyen Huy Nga, Director of Department of Preventive Health and Environment (Ministry of Health), said, the medical establishments and establishments that treatment and the patient must clearly understand the patient's history.

Patients if exposed to eating meat and poultry at risk (infected birds, dead) before the disease or is considered the most basic elements to distinguish influenza A/H1N1 and H5N1 influenza A for patients / H5N1 mainly transmitted from infected poultry, influenza A/H1N1 spread from person to person.

Dr. Nguyen Huy Nga adds, Central Institute of Hygiene and Epidemiology has studied and showed that influenza A/H5N1 virus in Vietnam does not have the gene variation.

Indonesia: The Deadly mutation of the Virus of Pig Flu with Bird Flu [Infeksi.com]

The community was appealed to anticipate the new virus attack that was formed from the combination two genetic the virus namely pig flu (H1N1) and bird flu (H5N1) with the level of the spread and the death was very high.

That was revealed by the Section Head the Dan Pengamatan Prevention of the Illness, Dinas Kesehatan of the Regency Lampung Selatan Kristi Endarwati SKM, on Monday (30/11).

He said, be based on pengamataan and the Department's research of the Health, naturally the two viruses were enabled bermutasi in a short time. "We received intruksi to guard against and anticipate him in accordance with the procedure continue to (Protap) clearly from the centre to handle him if terjangkit to humankind," he said.

He said, uptil now the community only learned the existence of the bird flu virus and pig flu separately, in fact was based on results of the scientific research, the virus could have a mutation and spread to humankind simultaneously in the form of the very deadly new virus.

Further, he explained, the bird flu virus uptil now the characteristics of his spread tended slower but the mortality rate that was resulted in by him very high. Whereas the flu virus of the spread pig was very fast antarmanusia but the mortality rate was classified as low. After having a mutation, continued he, the two viruses had finally become a new virus that was perfect with the characteristics was faster fast between humans was increased by the mortality rate was very high. The indication of the spread even more dasyat because of the combination of the sign of the two viruses.

He added, the mutation of this virus by the Department of the Health was not yet given by the name because of not yet having the case that happened because of that the community diintruksikan was on the alert and menyosialisasikan to that did not yet know him.

The "mutation" of "this virus happened naturally started from the virus H5N1 spread to the pig body that has infected H1N1 afterwards spread between humans in accordance with the original characteristics" of the "virus H1N1," said he. He said, was based on the research, the bird flu virus was really enabled to spread to the pig that already infected flu or humankind because of the structure of the pig body had the similarity with the human body, or H5N1 spread direct to humankind that has infected H1N1.

"One of the viruses till at this time still was difficult to be prevented in fact immune with antivirus, moreover if until the two viruses has bermutasi became the crueller new virus," explained he. He explained, after the virus was combined bermutasi became the virus just had speed perfection of the spread and height perfection of the death for that tertular.

To melaukan the early detection of the case, the Kesehatan Service make an effort with empowerment of the health service, and memebentuk 40 people surveilans (the observer) to berkerja be the same as gave the edication to the community. The important matter that must be done by the community to anticipate him that is guarding the pattern of the healthy life by maintaining the cleanliness as washing the hands before eating, maintained ethics when sneezing and the cough. (Ant/MI)

Swine flu mutation reported in Italy

AFP - The Italian Health Ministry reported the country's first case of a mutant form of swine flu on Monday.

The ministry said the variation of the A(H1N1) virus was identical to one reported in Norway on November 20. On Friday, France reported the death of two people infected by the same mutation.

The A(H1N1) variation was found three or four months ago in a patient in Monza, near Milan, Italian Deputy Health Minister Ferruccio Fazio said in comments reported by ANSA news agency.

"The Higher Institute of Health has examined around 100 strains (of the virus) found in recent months in patients from all over Italy and up to now the mutation has only been found in one patient," the ministry said in a statement.

"Italian data suggest that at the moment the mutation in question is not dominating serious and fatal cases of the virus. Furthermore, the mutation seems to be sporadic and does not appear to be spreading," the ministry said.

-snip-

Italy reports first case of A/H1N1 mutation

Comment: This statement in the article below appears to be inaccurate:

"According to the country's Higher Institute of Health, the variant found in Italy is unrelated to the one blamed for three deaths in Norway and two others in France last week."

I will post a few stories that claim otherwise.

Previously posted here, it is a separate issue from this "mutation" being reported:

Saturday, November 21, 2009

Tamiflu Resistance Found In Italy

hat-tip Florida1

November 20, 2009, 1 submitted by Fondazione IRCCS Policlinico San Matteo, Italy:

	PB2	PB1	PA	HA	NP	NA	MP	NS
Influenza A virus (A/Pavia/21/2009(H1N1))						GU216651*

* This sequence has the H274Y mutation that confers resistance to Oseltamivir.

2009-12-01
ROME, Nov. 30 (Xinhua) -- The Italian Health Ministry on Monday reported the first case of mutation of the A/H1N1 flu string.

The ministry said the mutation was identified in a patient with a serious case of pneumonia, who has recovered after treatment with antiviral drugs.

According to the country's Higher Institute of Health, the variant found in Italy is unrelated to the one blamed for three deaths in Norway and two others in France last week.

Italian authorities have attributed 91 deaths to the new flu out of an estimated 3 million infections and the government has vaccinated nearly half a million of its citizens.

Deputy Health Minister Ferruccio Fazio said the single mutation of the A/H1N1 flu virus reported in Italy so far was of no particular concern.

"This variant is limited to a single patient that we know of ... (it) was kept from spreading," Fazio said.

Vaccination and antiviral treatments were still effective against the mutation, according to the Health Ministry.

Fazio said the government would likely extend the vaccination campaign this week to children between six months and 17 years of age, in addition to seniors over 65 suffering from chronic illnesses.

Though the mutations have stirred fears about potentially dangerous new strains, the World Health Organization said over the weekend that none of them were resistant to the vaccine or antiviral drugs.

Four-week decline in flu-like cases, officials say

[I was so excited when I read the title of this article. By the time I was done reading it, I .....was no longer excited....]

Posted 17m ago
By Steve Sternberg, USA TODAY

Federal health officials reported Monday that cases of flu-like illness in the USA have declined for four weeks in a row, though hospitalization rates remain high, especially for children younger than 4.

The steady decline in the USA and elsewhere prompted the World Health Organization to propose Friday that swine flu may have peaked in North America, the Caribbean and parts of Europe, though the "winter influenza season continues to be intense."

U.S. officials challenged WHO's hopeful assessment, saying it is too soon to declare that swine flu is tapering off.

"We are certainly nowhere near the end," says Daniel Jernigan of the Centers for Disease Control and Prevention, noting that, even after the month long decline, "we're still above the peak we had last winter."

Jernigan says there also was a drop in cases at this stage of the 1957 pandemic, which appears to offer the closest parallel to today's outbreak. But flu cases and deaths rebounded after the Christmas and New Year's holidays. "The conditions that influenza likes – winter with people crowding together – haven't even come yet," he says.

Deaths of children continue to mount, the CDC reported, with a record 27 during the week ending Nov. 21. That's the highest one-week total since swine flu, also known as H1N1, was identified in April. Doctors have reported about 200 pediatric swine flu deaths to the CDC, which says many more deaths probably have gone unreported.

As of Monday, 66 million doses of swine flu vaccine were available for states to order, and more were on the way, the CDC's Thomas Skinner says.

Finland confirms human-to-pig transmission of A/H1N1 flu

My comments earlier today.....did I mention Finland??

So far, there has been Swine Flu (H1N1) found in pigs in China, Indonesia, America, Norway, Iceland..it goes on and on.

2009-12-01
HELSINKI, Nov. 30 (Xinhua) -- Finland has confirmed the country's first known human-to-pig transmission of A/H1N1 influenza, said Finnish Food Safety Authority and Finnish National Institute for Health and Welfare in a statement on Monday.

According to the agencies, samples taken from some pigs of a pig farm in Southern Pohjanmaa region, west in the country tested positive for the A/H1N1 flu viruses.

Finland has confirmed a total of 7,038 cases of A/H1N1 flu by Monday, reporting 16 fatalities related to the disease. The epidemic of A/H1N1 flu has peaked in all parts of the Finland, with signs to subside in northern part of the country. A massive vaccination plan against A/H1N1 flu covering the entire population is under way in the country.

Indonesian case of H1N1 in pigs

We heard back in April that H5N1 was adapting to pigs in Indonesia. We know it is endemic in their poultry. From April:

H5N1 Avian Virus Adapting to Pigs, Closer to Human Variation
Apr 4, 2009

The deadly H5N1 virus, a scourge among avian species in Asia, appears to have adapted to operate in swine populations, a report in the Archives of Virology finds.
The H5N1 virus - a headline-producing species that regularly ravages avian populations throughout Asia - appears to have successfully mutated toward residence in pigs. While the pig variety may be less virulent than its avian-oriented cousins, it is acknowledged among virologists that the transference to the swine environment is a precursor to human infection.
The H5N1 viruses were isolated from pigs in Indonesia and were tested on mice. The pig-oriented variation was considerably less devastating to the exposed mice than the avian H5N1 species.
"The finding suggests that in growing in pigs, the virus may have become less harmful to mammals in general, the authors report. That sounds reassuring, but the authors say it may mean the virus is one step closer to turning into a human pandemic strain," writes Robert Roos in a report for the Center for Infectious Disease Research & Policy.

And now we have H1N1 also in pigs....

27 Nov 2009
The Indonesian Ministry of Agriculture has officially declared that on 23 November 2009 an outbreak of pandemic influenza A/H1N1 in pigs occurred.

An outbreak investigation has been conducted by the Disease Investigation Center, Region II, Bukittinggi. 180 nasal swabs and serum samples were collected in pigs in the breeder, weaner and farrow/finishing units.

33 samples were positive for influenza A and divided on 11 pool samples, which were sent to the Indonesian Research Center for Veterinary Sciences and to the Australian Animal Health Laboratory for advanced tests. 6 samples were positive for pandemic influenza A/H1N1.

ISU: H1N1 vaccine used on US swine

30 Nov 2009

The only swine vaccine available for the H1N1 virus has been sent to vaccinate a swine herd infected with the virus. The vaccination marks the first time vaccine has been sent to a swine herd diagnosed with the pandemic flu.

Iowa State University's Hank Harris, professor of animal science, developed the vaccine this summer and has been shipping preventive doses to swine producers in Iowa, Kansas and Illinois for several weeks.

The latest vaccines were shipped to a swine producer in Indiana that had H1N1 diagnosed in the herd. "This is the first time we've had a confirmed diagnosis and the farmer wanted to vaccinate," said Harris. "We shipped about 20,000 with about another 11,000 doses to go out to them later."

Vaccinating a herd that has already been infected should have some effect on the spread, but Harris isn't sure how much. Harris' vaccinations have recently been reviewed and published by the online journal PLoS Current Influenza.

"It isn't uncommon for vaccinations to be used in what we call 'the face of an outbreak,'" he said. "They (producers) may think the virus is spreading slowly in the herd, and they want to vaccinate the entire herd."

Harris thinks the Indiana vaccinations may indicate swine producers around the country are eager to vaccinate. "Since these pigs got sick and had a confirmed diagnosis, I think more farmers are going to want to vaccinate," he said.

Harris says that the virus may have gotten into the Indiana swine herd from humans who had flu-like symptoms while working with the pigs. "It's one of those things we'll probably never know for sure. The history is that the virus can go from people to pigs and from pigs to people just as easily," he said.

The vaccine is being manufactured through Iowa State University and Harris' startup company Harrisvaccines, Inc. d/b/a SirrahBios, Inc.

Source: Iowa State University

Pigs with Swine Flu (H1N1)

Feng Zijian, Dir. of Emerg. Response for the Chinese Ctr. of Disease Control & Prevention has it exactly right. Pigs do provide a better environment for virus mutation. So, while this article was printed to dull the anxiety of H1N1 found in dogs....it is the very last sentence that is important. So far, there has been Swine Flu (H1N1) found in pigs in China, Indonesia, America, Norway, Iceland..it goes on and on.

Chinese experts say H1N1 infected dogs 'no threat to humans'

Monday 30th November, 2009 (ANI)

New Delhi, November 30 : Health experts in China are urging people not to panic after recent cases of two dogs infected with the deadly H1N1 virus emerged.

Feng Zijian, director of emergency response for the Chinese Center for Disease Control and Prevention, said while it was possible for pets to transfer viruses to their owners there was no evidence to suggest pets were already spreading the illness, reports the China Daily.

Feng said: "If animals can get infected from humans, then the reverse is also true. But there is no need to panic in this case."

Feng added: "Only when the virus mutates within dogs will it be a new threat to humans."

The animals were diagnosed in Beijing and the virus discovered was said to be a 99-percent match for the flu currently infecting humans, according to the Ministry of Agriculture.

Feng said: "The role of dogs in the virus' mutation is still unknown. However, pigs provide a better environment for virus mutation."

http://www.humanitas-international.org/newstran/newsdesk-news-search.htm

Malaysia: GLC set up to research, create vaccines

KUALA LUMPUR, Nov 30 — The government has set up a government-linked company (GLC) to do research and produce vaccines for contagious diseases like Influenza A (H1N1), said deputy Health Minister Datuk Rosnah Abdul Rashid Shirlin.

Realising the importance of vaccines for the prevention of contagious diseases, the government has set up the company, 9BIO, under the Ministry of Finance.

“The company will carry out research and produce vaccines, not only for Malaysia but also other countries in the region,” Rosnah told the Dewan Rakyat here today.

Rosnah added that Malaysia has yet to produce vaccines because the Institute of Medical Research was still carrying out studies and research to identify the genetics of the H1N1 virus.

“The study and research is important to identify any mutation so that the process can be used to produce vaccines,” said Rosnah when answering a question by Datuk Seri Dr Fong Chan Onn (BN-Alor Gajah).

Fong had wanted to know if there was any country that had succeeded in producing vaccines for H1N1 and whether the ministry was carrying out any research to produce vaccines.

Rosnah said the ministry was working with London-based international pharmaceutical company GlaxoSmithKline that produces vaccines.

The government had placed orders for 400,000 doses of the H1N1 vaccine at a cost of RM14 million, and the first consignment of 46,000 doses had been received in November and another 78,000 doses are expected by year end while the remainder, by January 2010, said Rosnah.

She added that additional orders would be placed if the 400,000 was not enough.

“The vaccines will be given to the frontliners working at the country’s 53 entry and exit points because they are the high risk group due to their direct involvement in the control of the disease,” said Rosnah. — Bernama

S. Korea: Student dies after receiving H1N1 vaccine

SEOUL, Nov 30 — A South Korean student had died of cerebral hemorrhage after receiving A/H1N1 vaccine, while health authorities said the death case is not associated with the vaccine, China’s Xinhua news agency said citing a local media report today.

According to the Ministry for Health, Welfare and Family Affairs, a student, whose identity has not been revealed, died of cerebral hemorrhage two days ago, four days after being inoculated with the A/H1N1 vaccine.

Investigation jointly carried out by experts, the health ministry, the Korea Food and Drug Administration and the National Institute of Scientific Investigation showed that there is no direct causality between the vaccine and the victim’s cerebral hemorrhage, the ministry said.

Computer tomography showed serious bleeding in the brain that could indicate a prior dangerous medical condition, so the death may have been caused by an aneurysm, or an extreme swelling on the wall of an artery, in the brain, local media quoted experts who took part in the investigation as saying.

The health authorities also conducted an investigation to 516 students out of a total of 966 students who received the vaccine from the same production batch, and only 70 cases reported with minor side-effects, and the symptoms had vanished in a short period, the ministry said. — Bernama

Vietnam: Bird Flu (H5N1) Death

Patients age 23, in ward Sam Min, the city of Dien Bien, had eaten more duck soup for about a week before has the disease. Especially as the H5N1 ca 5 this year are fatal.

Notified by the Department of Preventive Health and Environment (Ministry of Health), patients starting on November 18 patients with sudden high fever, cough, shortness of breath. However, six days after the last patient visit at the medical ward station, then transferred to the Clinic The area of Phu on November 25.

A day later, he continued to be transferred to Hospital Dien Bien province and was diagnosed with severe pneumonia monitor viral, antibiotic treatment, transmission service, antipyretic. Patients to proceed more severe and the patient died on November 28.

As of 29/11, Institute of Hygiene and Epidemiology central results of patients tested positive for H5N1 virus.

This is the first fatality recorded by H5N1 in Dien Bien province since this local message with avian influenza in Do Luong commune and Yen Thanh, Dien Bien on October 21.

So, after nearly seven months since the ca H5N1 4th death in Thanh Hoa in late April, Vietnam recorded a new cases of H5N1. Especially, all five ca H5N1 this year are fatal. Apart from the two localities, Quang Ninh, Ninh Binh, Dong Thap province has recorded the ca H5N1 infected.

Department of Preventive Health and Environment strongly recommends people successful implementation of preventive measures such as detecting birds sick or dead absolutely not slaughter and use that to immediately notify local authorities timely processing, ensuring food cooked, boiled drinking, washing hands with soap before eating and after using the toilet ...

S.Korea reports first Tamiflu-resistant flu case

SEOUL — Health authorities Monday reported South Korea's first case of swine flu that was resistant to the anti-viral drug Tamiflu, and called for extra precautions against any future cases.


The health ministry said in a statement that it found a Tamiflu-resistant strain of the (A)H1N1 virus in a five-year-old boy, who needed repeated and doubled doses of Tamiflu to recover.


Another anti-viral drug, Relenza, proved effective in specimens taken from the child but he was too young to take the drug, it added.


The ministry urged people to report immediately to hospitals or health authorities if Tamiflu had no effect five straight days after the first dose.

It said the World Health Organization has reported 75 Tamiflu-resistant cases globally since the first such case in North America in April.
South Korea's swine flu death toll has reached 104 but the spread of the disease is waning, according to the ministry.

Some health officials predict a third wave of H1N1

November 29, 2009
Helen Branswell

TORONTO — The current wave of H1N1 activity may have peaked in all provinces and territories, the Public Health Agency of Canada says in its latest assessment on the state of the pandemic.

But if transmission of the virus is indeed on the downward slope, does that mean the end is in sight for Canada? Or is a third wave of illness sometime this winter in the cards?

With the notoriously unpredictable influenza, it’s pretty much anyone’s guess.

“I think if you ask a group of so-called influenza experts, you’re going to get different views,” says Dr. Frederick Hayden, an influenza expert who splits his time between at the University of Virginia and Britain’s Wellcome Trust, a charity that funds biomedical research.

Hayden is betting on “a bump” of activity after Christmas, because so many people remain susceptible to the virus. Though whether that will be a full wave or just an upswing in cases, he’s not sure.

Regardless of where the experts come down on the question of a third wave, they say one thing is a safe bet. Whether it’s this winter or next, the H1N1 flu will be back.

That’s something people vacillating over the value of getting vaccinated at this point should keep in mind, says Dr. Danuta Skowronski, an influenza epidemiologist at the British Columbia Centre for Disease Control.

“The way I see it, basically people have two choices in general: Get immunized or get infected,” she says. “Because this virus isn’t going anywhere. It’s ours now.”

If this outbreak follows the pattern of previous pandemics — and there’s no reason to believe it won’t — the pandemic virus and its descendents will be among us for some undefined period of time. It could be years, it could be decades.

In past pandemics, a new influenza A virus replaced the previous virus, making it the seasonal flu A strain until the next pandemic occurred. (Influenza B viruses also cause human illness but they don’t trigger pandemics and aren’t affected by the interplay between influenza A viruses.)

Going into this pandemic there were two seasonal A viruses, H3N2 and a seasonal H1N1 virus and it’s too soon to say whether the pandemic H1N1 will replace both. But there is every reason to believe the pandemic H1N1 will cause illness next winter and the winter after that.

The burning question at this point, though, is what will pandemic H1N1 do over the next few months?

Flu season doesn’t usually start in our neck of the woods until late November or December at the earliest, with activity generally spiking in January or February. Is it possible we could face a winter where we got most of our flu activity out of the way before Christmas?

“There’s a lot of winter left to go, and I think that’s the big unknown,” says Dr. Anthony Mounts, a flu expert with the World Health Organization.

Pandemics don’t follow a single pattern so there’s really no way to predict. But experts are looking to the most recent pandemics, 1957 and 1968, to try to get a sense of how this winter will play out.

Dr. Walter Dowdle worked on influenza at the U.S. Centers for Disease Control during the former and ran the CDC’s virology division during the latter. He expects to see some ongoing transmission of the new virus, but not the sharp spike of activity seen in some places in the spring or early summer and seen in most places this fall.

Dowdle says we could even see “a peak here and there after Christmas.” Places that didn’t have as much illness as others likely have more “susceptibles” — people still vulnerable to the disease. “And for places that haven’t had a lot of transmission you could very well see some uptick,” he says.

How many susceptibles there are out there is a question without an answer at this point. Some people estimate, however, that between the people who have already had H1N1, have been vaccinated or had pre-existing immunity (seen in some people over age 60), Canada is nearing the point where about half of the population is likely protected against the virus.

That still leaves a lot of people, says Dr. Allison McGeer, who believes we face a third wave this winter.

“I don’t think the pandemic strain is finished. I think there are too many susceptibles. I think it’s coming back,” says McGeer, head of infection control at Toronto’s Mount Sinai Hospital.

Dr. Arlene King, Ontario’s chief medical officer of health, frankly wishes people would stop spending so much time debating whether we’ll have another wave of H1N1 flu this winter.

“I’m concerned that the fixation on waves is distracting from the task at hand, which is to try to get as many people immunized as possible as quickly as possible,” says King, who was the Public Health Agency of Canada’s point person for pandemic preparedness for years until she took the Ontario job last spring.

“The more people we get immunized and clearly the more quickly we get them immunized, the more cases we’re going to prevent overall,” she adds. “Maybe we can stop talking about a third wave if we get enough vaccine into the population.”

The Canadian Press

hat-tip VA_MOM