November 2009
Introduction
A novel influenza A (H1N1) virus of swine origin emerged among people in Mexico
during the spring of 2009 and spread with travellers worldwide, resulting in the first
influenza pandemic since 1968. As of October 2009, 195 countries have reported
confirmed human cases of pandemic (H1N1) 2009. While the majority of illnesses caused by pandemic (H1N1) 2009 virus infection have been self-limited mild-to-moderate uncomplicated disease, severe complications including fatal outcomes have been reported.
The pandemic (H1N1) 2009 influenza virus differs in its pathogenicity from seasonal
influenza in two key aspects. First, as the majority of human population has little or no pre-existing immunity to the virus, the impact of the infection has been in a wider age range, in particular among children and young adults. Secondly, the virus can infect the lower respiratory tract and cause rapidly progressive pneumonia especially in children and young to middle-aged adults.
In October 2009, WHO convened an international consultation represented by all WHO Regions, in Washington, DC, USA, to revise the guidance on clinical management of patients with pandemic (H1N1) 2009 virus infection. Experts in public health, laboratory science, pathology, and clinical care came together to review the published evidence to date and to share unpublished data. This document incorporates the knowledge made available to WHO and updates previous WHO guidance. Additional WHO guidance on pharmacological management, as well as infection control recommendations for health care facilities, are available separately. We anticipate commissioning full evidence reviews in preparation for another international consultation in 2010. This clinical guidance will then be revised accordingly, based upon new information. The purpose of this document is to provide information for clinicians managing patients with suspected or confirmed pandemic (H1N1) 2009 virus infection.
-snip-
Signs and symptoms of progressive disease
Patients who present initially with uncomplicated influenza may progress to more severe disease. Progression can be rapid (i.e. within 24 hours). The following are some of the indicators of progression, which would necessitate an urgent review of patient management:
• Symptoms and signs suggesting oxygen impairment or cardiopulmonary insufficiency:
- Shortness of breath (with activity or at rest), difficulty in breathing2, turning
blue, bloody or coloured sputum, chest pain, and low blood pressure;
- In children, fast or laboured breathing; and
- Hypoxia, as indicated by pulse oximetry.
• Symptoms and signs suggesting CNS complications:
- Altered mental status, unconsciousness, drowsiness, or difficult to awaken and
recurring or persistent convulsions (seizures), confusion, severe weakness, or
paralysis.
• Evidence of sustained virus replication or invasive secondary bacterial infection
based on laboratory testing or clinical signs (e.g. persistent high fever and other
symptoms beyond 3 days).
• Severe dehydration, manifested as decreased activity, dizziness, decreased urine
output, and lethargy.
-snip- [click on title for full document]
Wednesday, November 11, 2009
Monday, November 9, 2009
When No Number Is Right
Avian Flu Diary Blog:
UPDATED (see bottom)
# 3971
It sounds like it ought to be a simple request.
How many people died last week (or in the last month, or YTD) from the pandemic H1N1 virus in the United States?
But it is anything but simple to try to come up with a number. And the CDC, to whom most people look to for this sort of information, is obviously struggling to find some way to represent incomplete and inaccurate numbers responsibly.
Which is why the CDC stopped `counting’ H1N1 deaths months ago.
Instead, they’ve made an attempt to report P&I related hospitalizations and deaths from specific localities around the nation.
Some people have chosen to regard those as a kind of official H1N1 death toll, but as far as I know, it has never been represented as such by the CDC.
Yesterday, the CDC changed the way they report on P&I (pneumonia & Influenza) deaths on their pandemic surveillance pages. Something that has raised eyebrows, and some concerns, around Flublogia.
But before we look at the new representation, let’s look at the old one. On August 31st, they `reset the count’ to zero, and for the next two months reported two numbers.
Laboratory confirmed H1N1 deaths, and P&I Syndrome deaths.
P&I Syndrome hospitalizations and deaths can be based on syndromic, admission or discharge data, or a combination of data elements that could include laboratory-confirmed and influenza-like illness hospitalizations.
This is the chart from 2 weeks ago, where total of more than 2400 were listed as having died in the previous 6 weeks from P&I Syndrome.
In yesterday’s US update, we got the following chart showing 672 laboratory confirmed influenza deaths since August 31st, but the P&I Syndrome hospitalizations and deaths were missing.
This change in reporting was made without fanfare or explanation (see UPDATE at bottom), leaving some to wonder just what is going on? We’ve gone from well over 2,000 deaths on this page last week to under 700 this week.
Confusing matters further, CDC Director Frieden stated last week that there have been `more than 1,000 deaths’ from the H1N1 virus in the US.
This is no doubt true, but it is kind of like saying that Bill Gates has more than 1 million dollars. Technically true, but not very revealing.
So what is going on here?
Since I’m not privy to what goes on behind closed doors at the CDC, I can only speculate. But I think they’ve got themselves a first class dilemma, and they aren’t sure how to best handle it.
Consider: What do you do when you know all of your numbers are wrong?
The press and the American people expect some number, some quantification of the severity of this pandemic. And yet, the surveillance and reporting systems in this country (or any country) are inadequate to provide an accurate case or fatality count.
What do you do?
It’s the same with every disease, but we don’t worry about it as much when we don’t call it a pandemic.
Whether it’s Lyme Disease, West Nile Virus, Salmonella poisoning, Heart Attacks, or influenza . . . the CDC only has estimates of the number of cases, and deaths.
Even when it is a reportable disease – like Lyme – they understand that not every case gets diagnosed, and not everyone diagnosed gets reported.
Those cases that end up reported to the CDC usually represent only the tip of the iceberg – or in this case, a pyramid – of the actual number of cases.
When someone dies, there isn’t some sign on their chest that says “I died of an influenza-related complication”.
There isn’t even a good definition of what an influenza-related complication is.
If I get the flu and get dehydrated and weak, and then a few days from now get up out of my sick bed - and while walking to my mailbox - keel over with a heart attack . . . did the flu contribute to my death?
Maybe.
How do we count that? Does the flu body count go up a full point? Or should 55 years of fast food restaurants get half a point, and the flu the other half? What about a family history of coronary artery disease?
1/3rd . . .1/3rd . . . 1/3rd?
What if a week after I got the `flu’, instead of a massive coronary, I developed a bacterial pneumonia and ended dying after a few days in the hospital?
After a week, any influenza tests would come back negative.
How do you count that? Would I have caught pneumonia without having had the flu first? Probably not.
But . . . did I really have the flu?
It could have been some other respiratory virus. Perhaps metapneumovirus, parainfluenzavirus, respiratory syncytial virus (RSV), one of the myriad Rhinoviruses (Common cold), or adenovirus.
Even during the height of flu season, at least half of all ILI’s (influenza-like-illnesses) are probably caused by something other than influenza.
This chart (see ILI’s Aren’t Always The Flu) from early October show more than 70% of samples tested by the CDC came back negative for influenza.
There is no requirement to report adult influenza and pneumonia deaths in the United States, only pediatric deaths. And even all of those aren’t reported.
Mortality is monitored using the 122 MRS system, which tracks P&I related deaths in 122 cities around the nation . .. but that covers only about 25% to 30% of the nation.
And it most certainly doesn’t catch all P&I related deaths in those localities. It is a benchmark, something we can compare one year to the next, but not an accurate measurement of cases.
Here’s how the CDC describes it (highlights & reparagraphing mine):
Exact numbers of how many people died from flu this season cannot be determined.
Flu-associated deaths (which have laboratory confirmed influenza), are only a nationally notifiable condition among children; however not all pediatric influenza deaths may be detected and reported and there is no requirement to report adult deaths from influenza.
In addition, many people who die from flu complications are not tested, or they seek medical care later in their illness when flu can no longer be detected from respiratory samples.
However, CDC tracks pneumonia and influenza (P&I) deaths through the 122 Cities Mortality Reporting System. This system collects information each week on the total number of death certificates filed in each of the 122 participating cities and the number of death certificates with pneumonia or influenza listed as a cause of death.
The 122 Cities Mortality Reporting system helps gauge the severity of a flu season compared with other years. However, only a proportion of all P&I deaths are influenza-related and, as noted, most flu deaths are not lab confirmed.
Thus, this system does not allow for an estimation of the number of deaths, only the relative severity among different influenza seasons. For the 2007-08 season, the proportion of deaths due to pneumonia and influenza was higher than the previous two years, but was similar to the 2004-05 season.
I’ve only scratched the surface on the complexities involved here.
Every day, about 6,000 people die in the United States. Most never get a post mortem exam, and of those that do, only a very small percentage might be tested for the H1N1 virus.
Essentially, unless someone is under the age of 18 (we scrutinize child deaths pretty closely), or is an adult who dies while in the hospital and under treatment for the H1N1 virus, the odds are pretty good that their death will go uncounted.
That’s simply a limitation of our surveillance and reporting system.
And you will find huge differences in the scope and quality of surveillance across the country. There are many places that still use locally elected coroners – usually the local funeral home director – instead of a medical examiner system.
You’ll also find different communities (or at least their officials) have varying ideas over how this data should be collected and released. Some places seem intent on downplaying deaths and cases, out of what I view as misplaced concern over panic.
Crof over at Crofsblog has been covering some excellent reporting from the University of Southern California's Annenberg School of Communications and Journalism. L.A. County's Swine Flu Victims: Death Certificates Tell the Stories Of A Ravaging Virus shows how cases aren’t always identified or publicly acknowledged.
The 57 deaths attributed to H1N1 in the Los Angeles area are undoubtedly an undercount.
Yes, it is an imperfect system – one saddled by fifty years of underfunding and neglect.
So you can understand the quandary. What is the responsible number for the CDC to report?
Do you lump all P&I hospitalizations and deaths reported, and call that the right number? (Note: The CDC never said those were all H1N1 related)
Of course, those numbers don’t represent the whole country. And maybe half . . . or some weeks maybe even more, may have stemmed from something other than influenza.
Or do we go with the new system, that reports only laboratory confirmed influenza deaths?
It has the advantage of only counting confirmed influenza cases, but we know this is a gross undercounting of actual flu cases.
While there are other metrics they could use, there is really no good solution here. Any number you can come up with is going to be wrong – or at the very least, grossly incomplete.
And so I understand their dilemma.
What is the responsible number to report?
I don’t honestly know. Believe me, I’m frustrated by this, and want a number just as badly as you do.
I want to know just how bad this pandemic really is. I want to know if we are over-reacting, under-reacting, or acting just about right when it comes to the threat.
And I’d like some ammunition to use against the pandemic deniers who are using the CDC’s and WHO’s numbers to `prove’ their contention that this pandemic is a non-event.
A little over a week ago a study was published in the EID Journal (see Adjusting The Numbers) that attempts to estimate the impact of the H1N1 virus over the first 3 months. This was still at a time when the CDC was attempting to count cases.
Estimates of the Prevalence of Pandemic (H1N1) 2009, United States, April–July 2009
C. Reed et al. (364 KB, 7 pages)
Over a time period (April-July 23rd) when the official numbers were:
43,677 confirmed cases
5009 hospitalizations
302 deaths
The newly estimated numbers are:
1.8 – 5.7 Million cases
9,000-21,000 Hospitalizations
800 (range 550-1300) deaths
In other words, the best guess was that even at a time when they were trying to count all deaths, the most likely number was 250% higher, and might have been as much as 500% higher.
For months the CDC has been intentionally vague when asked about the number of deaths due to this virus, and while I don’t like that, I can’t really blame them.
It is impossible to calculate . . . and the moment you do attempt to put a number to it, some bright guy or gal with a sharp pencil is going to challenge your methodology and publically rip it to shreds.
Supposedly, the CDC is working on better `real time estimates’, that will hopefully give us a better idea of the impact of this pandemic. When those will ready for prime time, is hard to say.
But they won’t be `counts’, they will be estimates. Like the ones above. And frankly, that’s as good as we are ever likely to get.
Where the CDC has erred, in my opinion, is in not explaining the challenges of counting cases and fatalities to the press, and the public, better than they have.
They’ve also confused the issue by changing – without comment or explanation – the way they track P&I cases. If the reporting system needs to change (no quibble there), for goodness sakes, explain why. (Note: see the update at the bottom of this blog)
They need to understand that people are watching, and scrutinizing (and yes – even comparing week to week) the data they put out.
When there are changes in format, or inconsistencies in the numbers, people will notice.
Sure . . . I’d like to be able to jump up and down, scream, and vent over the lack of good, solid numbers . . . but I understand, at least a little, the scope of the problem. Even if I were in charge, and were given all the resources the CDC has, I don’t know how I’d go about coming up with an accurate count of pandemic flu deaths.
At least not without the aid of a magic wand.
* * * * * * * * * *
UPDATE: Buried near the bottom of another CDC webpage - Monitoring Influenza Activity, Including 2009 H1N1 dated September 11, 2009, 6:00 PM ET are 3 updates (which do not show up in the What’s New listing on the site) made sometime yesterday (Nov 6th).
How accurate a representation are these numbers?
Updated Nov 06
Laboratory-confirmed data is thought to be an underestimation of the true number of cases because most people will not be tested for influenza. However, influenza and pneumonia syndrome hospitalizations and deaths may be an overestimate of actual number of flu-related hospitalizations and deaths because that diagnostic category includes other illnesses. Influenza and pneumonia syndromic reports are less specific to influenza, but are helpful in following disease trends.
Will the old 2009 H1N1 counts prior to August 30, 2009 remain available?
Yes, the cumulative number of 2009 H1N1-related hospitalizations and deaths reported to CDC from April through August 2009 will be archived and available for future reference.
What hospitalizations and death information will CDC report publicly?
Added Nov 06
From August 30-October 24, 2009 CDC publicly posted reports of both laboratory-confirmed influenza for all types of influenza AND syndromic cases, i.e., cases of presumed influenza and/or pneumonia based on ICD-9 coded hospitalizations or death reports each week. From the week beginning October 25-31, 2009; however, CDC will only publicly report laboratory-confirmed influenza-associated hospitalizations and deaths. The reason for this change in public reporting is that the interpretation of syndromic data (most of which is not laboratory-confirmed) relative to laboratory-confirmed data has been challenging. CDC will continue to collect and analyze both laboratory-confirmed and syndromic data reported to CDC by states.
How many states are reporting laboratory-confirmed hospitalizations and deaths?
Added Nov 06
The number of states reporting laboroatory-confirmed hospitalizations and deaths varies each week, however, for the week of October 25-31, 2009, more than 30 U.S. states were continuing to report laboratory-confirmed data.
So it seems the CDC did offer some explanation for the change (Interpretation of the data was `challenging’ ), but managed to put it someplace where it wasn’t going to be terribly easy to find.
There is – btw – a link on the surveillance page where the new chart is located called Questions and Answers: Monitoring Influenza Activity, Including 2009 H1N1 – but as of this writing, it is a dead link.
The proper link is http://www.cdc.gov/h1n1flu/reportingqa.htm
My thanks to Cathy M on the Flu Wiki for finding and posting this notice.
* * * * * * * * * *
Note: If anyone from the CDC is reading this, and finds that I’ve gotten any of it wrong, let me know. I’d appreciate the opportunity to make any corrections.
Can cheap drugs help save H1N1 patients? Studies aim to find out
TORONTO — Can cheap and readily available treatments like steroids and cholesterol-lowering statin drugs help save the sickest of H1N1 patients? New efforts by researchers in Canada, the United States and France could help answer this pressing question.
Randomized controlled studies looking at whether corticosteroids, statins or a combination of the two could contribute to improved survival rates in gravely ill pandemic flu patients are being organized in the three countries by linked networks of intensive care specialists, according to Dr. John Marshall, chair of the Canadian Critical Care Trials Group.
The aim is to try to gather data fast enough to answer the questions in real time, a goal that eluded researchers during SARS.
Toronto physicians treating SARS cases tried to mount a clinical trial to see whether the antiviral drug ribavirin - which was routinely given to SARS patients for lack of other options - was actually helping. But before the trial could be approved, the disease disappeared.
The same could happen with this effort, admits Marshall, a trauma surgeon and critical-care specialist at Toronto's St. Michael's Hospital, who says it will take quick work and international collaborations to generate enough data to clarify the role steroids and statins might play in treating H1N1 cases.
"What are the chances that we will have 1,400 Canadian patients enrolled in the study by the middle of January? Pretty small. But what are the chances that we will have made a good inroad into being able to run the study and pool some data with France and the United States? I think the chances are relatively good that we can do that," he says.
"And what are the chances that we're going to have an extraordinarily rich understanding of how one optimally does these studies under pandemic conditions? I think the chances are 100 per cent of that."
In recent years as the influenza world prepared for a feared pandemic, the scarcity of weapons with which to fight flu weighed heavily on the minds of planners.
Vaccine would take months to make. And because of the limited global production capacity, it would be in short supply and available mostly in wealthy countries. Antiviral drugs might be more readily available, but the best ones aren't cheap and all are vulnerable to the development of drug resistance. (As it turns out, the cheap flu drugs don't work against this virus, which has been resistant to them from the start.)
So were there drugs already in existence, preferably off-patent, that might help?
Spurred in large measure by the relentless commentary writing of retired American virologist Dr. David Fedson - who believes statins could play a major role in combating pandemic influenza - others have started to look at the question.
A study presented at the recent meeting of the Infectious Diseases Society of America suggested that people on statins for cholesterol control who were hospitalized with seasonal flu were half as likely to die as hospitalized flu patients who were not on the drugs.
While tantalizing, that doesn't prove statins - which reduce inflammation and may have mild antiviral properties - are useful as treatment for severe H1N1 infection.
For one thing the two groups of patients were not randomized, so there could have been key differences between them that contributed to the different outcomes. And for another, the people who are hospitalized for seasonal flu are generally a lot older than the severely ill H1N1 patients. The way the drugs act in people with waning immune systems might not be the same as they would act in younger adults who were reasonably healthy before contracting H1N1.
Marshall says the trials to be done will compare patients who got a statin versus a placebo (the United States) or corticosteroids versus a placebo (France). The Canadian team hopes to run a four-armed study randomly assigning patients to get neither of these drugs, one of the drugs or the drugs in combination.
The World Health Organization recommended against use of corticosteroids in care of patients with H5N1 avian flu virus, and the experience in SARS was that patients who received heavy doses of steroids suffered a number of side-effects, including bone loss.
"There's no questions that steroids can have real downsides," says Dr. Frederick Hayden, an antiviral expert who splits his time between the University of Virginia and Britain's Wellcome Trust.
Hayden notes a recent study from Hong Kong suggested steroid use in the treatment of seasonal flu prolonged the period in which the virus replicated. Still, he suggested there is evidence that low-dose steroids might be beneficial, but said much depends on when they are used and for how long.
Marshall says the steroid question is an open one and the reality is that a substantial portion of severely ill H1N1 patients are probably getting steroid therapy, as their doctors struggle to find anything that might help.
The statins and steroids would be used in addition to standard treatment for severe H1N1 patients, which includes the antivirals Tamiflu or Relenza and use of mechanical breathing techniques if needed.
Because the drugs will be used in addition to standard care, these trials won't tell researchers whether statins and steroids on their own would help H1N1 patients in resource-poor countries survive severe infection, Hayden says. "I don't think one can generalize those findings to other patient populations or other settings."
Still, he says it would be good to have some data based on randomized controlled trials, the gold standard of medical evidence.
"Given the uncertainty in these circumstances, having controlled data from a prospective trial will be very useful," Hayden says. "And they will hopefully make us smarter in terms of our management of seriously ill patients in the future."
H1N1 anxiety fed by increased scrutiny
EL PASO -- Health department statistics say no one in El Paso died from seasonal flu in the past three years but 10 people died from swine flu in just the past seven months.
The numbers are both startling and inaccurate.
Michael Hill, director of the city's Department of Public Health, said hundreds of deaths in El Paso during the past three years could have been linked to seasonal flu, but they were likely attributed to other causes, such as pneumonia. The condition often develops in people with the flu.
People also may have died from other chronic illnesses that were worsened by the flu.
Hill said public concern this year over H1N1 influenza, or swine flu, caused doctors, hospital staffs and other health officials to more closely monitor deaths that could be attributed to the flu. These were further scrutinized to determine whether seasonal flu or swine flu played a role.
"This year with all this attention, we're probably getting most of the flu deaths reported," he said.
The federal Centers for Disease Control and Prevention estimates there are about 36,000 seasonal flu-related deaths in the United States each year.
Hill said when the figure is calculated to reflect El Paso's population, the annual number of local flu-related deaths should be much higher than reported.
"Ballpark estimate is 120 to 130 El Pasoans die directly or indirectly from influenza" each year, Hill said.
Many of these deaths occur in people under the care of doctors who list more
"There's no coordinated network of determining whether there is an influ-enza-associated death or not," Hill said. "Pathologists may suspect that and may include that as cause of death, but that information is not coordinated, is not compiled and is not integrated."
A new system of compiling and tracking the information is on the horizon with a collaboration of the health department, the county medical examiner's staff and the Texas Tech University Health Sciences Center Paul L. Foster School of Medicine.
"Just because there were none reported last year doesn't mean there were none," Hill said. "Since there hasn't been any surveillance in the past to really get good numbers, I don't know what the real number was last year. Was it zero or 120?"
The health department soon will hire a person responsible for educating medical providers about the need to report any deaths that might be tied to flu, whether they be swine flu or seasonal flu. This person will be housed at the medical examiner's office and will compile the information.
"If we can get better surveillance, we understand what the virus is doing and we can maybe counteract it better," said Dr. Paul Shrode, the county medical examiner. "The information is out there. We just need to collate it. We need better communication between all the health entities."
Experts from the medical school in pathology and infectious disease will assist in creating the system. They will include Dr. Gary Simpson, professor of medicine and infectious diseases in the departments of Medical Education and Internal Medicine.
He formerly was medical director of infectious diseases in the Public Health Division of New Mexico's Department of Health. Simpson helped establish a similar surveillance program there that focused on many infectious diseases.
"It has been profoundly valuable to public health," he said. "We're trying to see if we can extend that kind of experience to the county, and we're rapidly doing that."
Staff members of the health department, medical examiner's office and medical school meet weekly to discuss their progress toward establishing the program. Hill said it should be off the ground in December.
Simpson said it will help health officials identify trends of infectious diseases and allow them to develop ways to combat the illness, such as targeting groups for vaccination.
In addition, he said, he would not be surprised to learn if there were additional swine flu-related deaths beyond the 10 already reported.
"We haven't had a surveillance network up and going, so you can assume there may have been more deaths than we know about," he said.
These could have been in groups such as elderly people who were being treated for other health conditions when they contracted the flu.
Simpson said the collaboration will begin with a focus on influenza, but he would like to see it expand to include surveillance of other infectious disease-related deaths.
"Most of the country has been slow to embrace the importance of this kind of surveillance," he said.
Hill also wants to enhance its focus once the program is established.
"There are a lot of communicable diseases people die of that we don't know about because a physician finds something that's a valid cause of death and puts it down, and nobody is scrutinizing that," he said.
He anticipates the community will have a better picture of the true flu situation after several months of monitoring.
"A year from now when you come and ask me is it better or worse, I'll have something to compare it to," Hill said. "Right now there's not been that kind of surveillance."
Erica Molina Johnson may be reached at emolina@elpasotimes.com; 546-6132.
Saturday, November 7, 2009
Weekly Laboratory-Confirmed Influenza-Associated Hospitalizations and Deaths
Here is the chart posted here at the blog on October 30th.
It is up to Week #42.
This is the chart for this past week. Week #43.
If you look at last weeks bar, it is different in both hospitalizations and deaths, than was reported last week. Notice the numbers along the left side, in the Hospitalizations chart, are different.....On week #42, the bar graph showed approx. 3,100 hospitalizations, and approx. 90 deaths. Now, this week, week #43, it shows week #42 as having 4,400 hospitalizations and 110 deaths. That is a 1,300 difference in hospitalizations, and 20 deaths, for Week #42.
It is up to Week #42.
This is the chart for this past week. Week #43.
If you look at last weeks bar, it is different in both hospitalizations and deaths, than was reported last week. Notice the numbers along the left side, in the Hospitalizations chart, are different.....On week #42, the bar graph showed approx. 3,100 hospitalizations, and approx. 90 deaths. Now, this week, week #43, it shows week #42 as having 4,400 hospitalizations and 110 deaths. That is a 1,300 difference in hospitalizations, and 20 deaths, for Week #42.
CDC Reporting Change To Exclude Influenza and Pneumonia Syndrome
The last report has excluded the Influenza & Pneumonia Syndrome. Which reduces the total numbers considerably. Without the Influenza & Pneumonia counts, there is no accurate picture of the progress of the pandemic, and therefore, we are not getting the true picture. You can click on the screen shots below to open them.
The previous week's report is here:
http://www.cdc.gov/h1n1flu/updates/us/#totalcases
http://www.cdc.gov/h1n1flu/updates/us/102309.htm
The previous week's report is here:
http://www.cdc.gov/h1n1flu/updates/us/#totalcases
http://www.cdc.gov/h1n1flu/updates/us/102309.htm
Friday, November 6, 2009
NexBio(R) Publishes Two Articles Showing DAS181 (Fludase(R)*) Potently Inhibits Pandemic Influenza A(H1N1) and NAI-Resistant Influenza Viruses
SAN DIEGO, Nov. 6 /PRNewswire/ -- NexBio Inc., in collaboration with scientists at the Centers for Disease Control and Prevention (CDC), St. Louis University, and the University of Hong Kong, announced today the publication of two articles in the peer-reviewed journal PLoS ONE. These two published studies suggest that DAS181 (Fludase®) may play a potentially important role for the treatment and prevention of the Pandemic Influenza A(H1N1) and drug-resistant influenza.
DAS181 is a broad spectrum drug candidate being studied in human clinical trials for treatment and prevention of Influenza-Like Illness (ILI) caused by any strain of influenza and parainfluenza viruses. Unlike neuraminidase inhibitors (NAI), e.g. Tamiflu® (oseltamivir), as well as vaccines, which target the influenza virus ("pathogen target"), DAS181 works by inactivating the human receptors ("host target") for these viruses; thus, it may be less likely to cause drug resistance compared with currently-available antiviral drugs.
One published paper entitled "Novel Pandemic Influenza A(H1N1) Viruses are Potently Inhibited by DAS181, a Sialidase Fusion Protein" evaluated the antiviral activity of DAS181 against multiple Pandemic Influenza A(H1N1) viral clinical isolates in a number of preclinical models. DAS181 inhibited all of the pandemic viral strains in each study model. It demonstrates significant antiviral activity against the H1N1 viruses in primary human respiratory cells as well as in fresh human bronchial tissue. In studies performed at the CDC, DAS181 treatment given after infection by a Pandemic Influenza A(H1N1) virus completely prevented animal death. It also successfully prevented viral replication and weight loss in these animals.
In the second published paper entitled "Inhibition of Neuraminidase Inhibitor-Resistant Influenza Virus by DAS181, a Novel Sialidase Fusion Protein", the activity of DAS181 against clinical isolates of seasonal H1N1 influenza virus collected from influenza patients during 2004, 2007, and 2009 was studied. The isolates from 2007 and 2009 are all resistant to Tamiflu® as all contain the H274Y mutation known to cause such resistance. Notably, all isolates were strongly inhibited by DAS181. Additionally, NexBio has data to demonstrate that a laboratory strain of influenza which is resistant to all three NAIs (oseltamivir, zanamivir, peramivir) in vitro was inhibited by DAS181 in cell culture and in animals in the study.
"These results are particularly important because of the current H1N1 pandemic and the urgent need for new antiviral drugs with different approaches from currently available NAIs. Neuraminidase inhibitor drug resistance is already a significant problem for seasonal influenza. Tamiflu® drug resistance caused by the same mutation in Pandemic Influenza A(H1N1) is now being seen worldwide" commented Dr. Fang Fang, NexBio's President of Research & Development. "Unique among licensed influenza drugs and those in clinical development, DAS181 uses a Host-Oriented Therapeutic (HOT) strategy. Our goal for the continued advanced clinical development of DAS181 is to bring a potentially important new medicine to the treatment and prevention of this worldwide problem," Dr. Fang added
ABOUT NEXBIO
NexBio, Inc. is a privately held clinical-stage biopharmaceutical company located in San Diego. NexBio's mission is to save lives and to improve the quality of life by creating and commercializing novel, broad-spectrum biopharmaceuticals to prevent and treat current and emerging life-threatening diseases. DAS181 (Fludase®), is an investigational drug that consists of an inhaled recombinant fusion protein. It inactivates viral receptors on the cells of the human respiratory tract, thereby preventing and treating infection by influenza, including potential pandemic strains, and by parainfluenza viruses (which may cause serious respiratory illness similar to influenza and for which there is no approved vaccine or therapeutic). The DAS181 development program is funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, under BAA Contract HHSN266200600015C and grant U01-AI070281. ViradinTM, invented and developed by NexBio, is a parenteral protein under development, currently at lead optimization stage, directed to the treatment of viral hemorrhagic fevers and bacterial biothreat sepsis. TOSAP® is a technology invented and developed by NexBio and is used to formulate DAS181 for inhalation, as well as to make nano/microparticles from virtually any type of molecule. TOSAP® is offered for the formulation of compounds of partners, under license.
Thursday, November 5, 2009
Hospitalization, Death From H1N1 Influenza Can Occur at Any Age
November 5, 2009 — H1N1 influenza is emerging as an equal-opportunity threat, seriously affecting people of all ages — not just younger people, as had been thought — according to the results of a surveillance study from California published in the November 4 issue of the Journal of the American Medical Association.
"Pandemic influenza A(H1N1) emerged rapidly in California in April 2009," write Janice K. Louie, MD, MPH, from the California Department of Public Health, Richmond, and colleagues. "Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A(H1N1) disproportionately affects younger ages and causes generally mild disease."
However, data on the clinical features and populations at risk for complications from H1N1 influenza infection are still emerging, the authors add.
The aim of the study was to describe the clinical and epidemiologic features of H1N1 influenza cases that led to hospitalization or death.
The investigators studied all cases of California residents who were hospitalized or died with laboratory evidence of H1N1 infection that were reported to the California Department of Public Health between April 23 and August 11, 2009.
During that time, 1088 cases that led to hospitalization or death were reported in 41 of 61 local health departments, with most occurring in June and July. Of these, 344 (32%) were children younger than 18 years.
The median age of all cases was 27 years (range, <1>. The overall rate of hospitalization or fatality per 100,000 for all age groups was 2.8 and ranged from 11.9 in infants younger than 1 year to 1.5 in those aged 70 years or older.
The highest hospitalization rates per 100,000 were in infants 1 month old (35.8) and 2 months old (21.1). These rates were lower in infants aged between 3 and 12 months, ranging from 4.2 to 12.6 per 100,000.
The median length of stay in hospital was 4 days.
Although infants were hospitalized at greater rates than adults, individuals aged 50 years or older had the highest rate of death once hospitalized, the authors report.
The overall fatality rate was 11%. In children younger than 18 years, the death rate was 7%, and in persons older than 50 years, it was 18% to 20%. The median time from onset of symptoms to death was 12 days, and the most common causes of death were viral pneumonia and acute respiratory distress syndrome.
Sixty-eight percent (741/1088) of patients had risk factors for seasonal influenza complications.
Obesity a Risk Factor for Hospitalization
The study also found that a high number of hospitalized adult patients were obese. Of the 268 adults aged 20 years or older with a known body mass index (BMI), 156 (58%) were obese, as defined by a BMI 30 kg/m2 or higher. Of these, 67 patients (43%) were morbidly obese (BMI ≥ 40 kg/m2).
Sixty-three percent of obese patients had comorbidities associated with influenza complications such as diabetes, asthma, and renal disease.
"We found a surprising number of obese persons in this study," Dr. Louie commented to Medscape Infectious Diseases. "Our proportion of morbidly obese persons was much higher than in the general population. Others are reporting similar findings. We need to study further to find out if obese persons were also more likely to have other risk factors not yet diagnosed, like asthma or diabetes."
The study findings emphasize the importance of vaccinating children, as well as caregivers of infants younger than 6 months of age and pregnant women, she added.
"H1N1 has a reputation as a mild illness, but we found that almost one third of our hospitalized cases became severely ill and required mechanical ventilation. Over 10% died," she said. "Also, there is a perception that the elderly have some immunity. However, we found that if elderly persons were admitted to a hospital, they tended to be more likely to die from their H1N1 infection."
She emphasized that clinicians should be thinking about H1N1 infection, as well as seasonal influenza, when a person presents with fever and respiratory symptoms.
Rapid Influenza Tests Not Reliable
She added, "Clinicians should not rely on the rapid tests for influenza done in the clinic, because these can be unreliable, especially in adults. If a patient is not looking well or has risk factors like pregnancy, antiviral treatment should be started right away while awaiting test results with [polymerase chain reaction]. Many studies have shown that early treatment can make a big difference as far as hospitalization and death for influenza."
Commenting on the study for Medscape Infectious Diseases, John Bartlett, MD, professor of medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland, said the authors did everybody a big favor by doing the study.
The big surprise here, he said, was the severity of H1N1 infection in older individuals.
"We've all emphasized the fact that this is a disease of young people and elderly people are relatively spared. A lot of people, including myself, have told older people not to worry about H1N1, that it's not their problem. I think we have to think twice about that now," he said.
This does not mean that all older people need to be vaccinated, he added. Rather, it means that clinicians need to be more cautious in advising them of their risk.
Dr. Bartlett also noted the finding that obesity appears to be a risk factor for hospitalization. "Everybody has been talking about this, but the CDC has never really recognized that as a risk per se. But it just keeps coming up. It came up in Canada, it came up in Mexico, and it came up in California. I think we are going to have to try to figure out why people who are morbidly obese tend to handle this flu less well. A lot of them in this series had comorbidities, but a lot of them did not."
Dr. Louie and Dr. Bartlett have disclosed no relevant financial relationships.
JAMA. 2009;302:1896–1902.
Swine flu now in virtually every country, as WHO braces for winter season
November 5, 2009
Pandemic H1N1 influenza is now in virtually every country in the world, and health officials are bracing for an upsurge in cases as winter sets in, World Health Organization officials said this morning.
Pandemic H1N1 influenza is now in virtually every country in the world, and health officials are bracing for an upsurge in cases as winter sets in, World Health Organization officials said this morning.
"At WHO, we remain concerned about the pattern we are seeing, particularly because a sizable number of people do develop serious complications and death," Dr. Keiji Fukuda, a special advisor to the WHO director-general on pandemic influenza, said at a news conference. "We anticipate seeing continued or increased activity during the winter period in the Northern Hemisphere. This also means we expect to see continued reports of serious cases and deaths."
The most recent figures available show that at least 5,700 people worldwide have died from swine flu, with 4,175 of those in the Americas.
Fukuda said that vaccinations against swine flu have started in 20 countries and that millions of doses have been delivered safely, with no adverse events. He complained, however, that the agency has yet to receive most of the 200 million doses of vaccine that were to be donated by 11 countries. Delays in production of the vaccine have led to shortages, and most countries, like the United States, have chosen to vaccinate their high-priority groups before making good on their pledges.
In other flu news:
-- Swine flu has struck the remote Yanomami tribe in Venezuela, showing that no one is safe from the virus. Seven people have died from the flu, out of a population of only 28,000. Several of the victims were babies, and one was a pregnant woman. Fukuda said the virus has also struck aboriginal populations in Australia severely, and it is not clear yet whether the high rate of infection is related to a genetic susceptibility or to poor healthcare.
-- Cold weather has brought an outbreak of swine flu in Mongolia, and the country has been requesting additonal doses of the antiviral drug Tamiflu to combat its spread. The country has confirmed 859 cases of swine flu and six deaths, but healthcare facilities have been struggling to cope with the surge in unconfirmed cases. Mongolia previously had a stockpile of 11,000 doses of Tamiflu, half provided by the WHO in May. The agency is now sending an additional 45,000 doses.
-- In an effort to ease the burden on its healthcare system caused by swine flu, Norway has decided to allow sale of Tamiflu without a prescription. Health officials have feared that such sales would lead to indiscriminate use of the drug, increasing the risk of the virus developing resistance to what is currently the most valuable tool to fight infections. Fukuda, however, called the decision to allow over-the-counter sales "innovative and prudent."
-- An intense outbreak is occurring in Ukraine, with 500,000 cases of acute respiratory distress and 85 deaths, according to the European Centre for Disease Prevention and Control. Both the WHO and European officials have been sending in teams to help out.
-- As if Wall Street weren't already hated enough, recent news reports have said that at least 13 major companies, including Citigroup, Goldman Sachs and JP Morgan Chase, have received allocations of swine flu vaccine. Such allocations are approved by state health officials, in this case New York, who generally approve shipments for use in high-risk groups. Critics charge that the companies are getting favorable treatment. "It seems safe to assume the vast majority of their employees are not pregnant women, infants and children, young adults up to 24 years old, and healthcare workers," said Melanie Sloan, executive director of Citizens for Responsibility and Ethics in Washington.
-- A new McClatchy-Ipsos poll found that almost half of Americans are rejecting the swine flu vaccine. Only 52% said they were likely to get it, and only 33% said they are very likely to get it. The poll apparently did not ask why they were rejecting it, but many people have been concerned about the safety of the vaccine, despite repeated assurances that it is made exactly like the seasonal flu vaccine, which has proved safe in hundreds of millions of people.
-- Thomas H. Maugh IIFlu dogma being rewritten by a strange virus no one pegged to trigger a pandemic
By Helen Branswell Medical Reporter (CP) – 4 hours ago
TORONTO — The World Health Organization's top flu scientist often describes the virus he's studied for years as "humbling."
And Dr. Keiji Fukuda isn't alone in marvelling at the mercurial nature of influenza. Flu scientists repeat almost as a mantra that the only thing predictable about flu is its unpredictability.
Yet despite decades of evidence that influenza will repeatedly rewrite the rules, flu dogma emerges and takes hold. Scientists keen to sift patterns from chaos agree X is true about Y - until the virus sets them straight yet again.
In the late '60s it was held that pandemic viruses emerged in 11-year cycles, after the closely spaced 1957 Asian flu and 1968 Hong Kong flu outbreaks.
It used to be accepted that only H1, H2 and H3 viruses could infect humans. And then viruses from the H5, H7 and H9 subtypes jumped from birds to infect people. Wrong again.
Though the world is not quite seven months into this pandemic, a number of widely held assumptions about flu and pandemics seem destined for the redrawing board when the dust from this outbreak settles.
Here are some:
-Pandemic viruses emerge from Asia, the cradle of flu viruses.
Years of focus on H5N1 avian influenza viruses left experts convinced Asia was the birthplace of new flu viruses and would be the source of the next pandemic. Despite the fact that there's good evidence the 1918 Spanish flu virus may have emerged in Kansas, no one was looking to North America as ground zero for the first pandemic of the 21st century.
It's a valuable lesson, says Dr. Nancy Cox, who has been pushing for a number of years for more flu surveillance in Latin America.
"You can't take your eye off the other possible threats. You can't focus too much on one area of the world because influenza - a new virus - can emerge from anywhere," says Cox, head of the influenza division at the U.S. Centers for Disease Control.
-Pandemics are triggered by "antigenic shift."
Flu viruses evolve constantly via small mutations, a process called antigenic drift. But once in a blue moon an entirely new virus bursts out of nature, an event known as antigenic shift. Because most people are vulnerable to the new virus, it ignites a pandemic.
It used to be thought pandemics could only be started by a virus with a new hemagglutinin - the H number in the virus's name - or a virus with a hemagglutinin that hadn't spread recently among people, such as the H2N2 viruses that circulated from 1957 to 1968.
The current pandemic is caused by an H1N1 virus, which is startling because almost everyone alive has antibodies to H1 viruses. They've been circulating among people since 1918, except for a 20-year gap between 1957 and 1977.
So few scientists would have predicted a new H1 virus could cause a pandemic at this point in history.
Some, in fact, still question whether this outbreak is a pandemic, at least by the definition science currently applies. The retired head of virology for the U.S. Centers for Disease Control is one of the doubters.
"There's no precedence for this," says Dr. Walter Dowdle, who now works for the non-profit Task Force on Global Health, based at Emory University in Atlanta. "Nobody had really thought that . . . the virus would re-emerge with this much background immunity."
But Dowdle cautions about dismissing the potential of this virus just because it defies our assumptions.
"We're the ones that make the definitions. And if the virus doesn't behave according to the definitions, well, it's our fault, not the virus's fault. So I think we have to be very careful about forcing the viruses into our definition, which can only be made based on what we've seen in the past.
Now we've seen something different. And so therefore we've got to go back and rethink this."
-Emerging pandemics can be extinguished with quick use of antiviral drugs.
Landmark modelling studies published in August 2005 suggested that with good surveillance, rapid response capacity and enough Tamiflu, a flu virus that was just starting to spread person-to-person could be snuffed out.
The late Dr. J.W. Lee, then director general of the WHO, committed the agency to try. Experts at the agency and elsewhere spent untold person-hours honing a plan for trying to stop a pandemic at source.
And while flu experts were watching the spread of H5N1 avian flu viruses from Asia, pigs got infected with some viruses that swapped genes and created the H1N1 virus we call swine flu. By the time we knew it was spreading, containment was out of the question.
"This cat was not only out of the bag, but this cat had nine litters before we realized what had happened," says Dr. Michael Osterholm, director of the University of Minnesota's Center for Infectious Diseases Research and Policy.
-We'd know it when we saw it.
Pandemics are rare. And before this one, only two had occurred in the era of virology. So what would a pandemic look like? Experts insisted it was a bit like pornography - we'd know it when we saw it.
And then a new virus of swine-avian-and-human genes started to spread.
It wasn't from a new subtype (see above). And but for the fact it was spreading in the off season and causing severe illness in younger people, it might have been mistaken for plain old flu.
Confusion ensued.
-There would be little time between the spotting of an emerging pandemic virus and the declaration of a pandemic.
The WHO's pandemic alert scale goes from Phase 1 (no threat) to Phase 6 (pandemic). For years the world had been at Phase 3, which means a non-human virus (H5N1) posed a pandemic threat and was triggering occasional cases, but person-to-person transmission was rare and limited.
Most experts assumed when a pandemic virus started to take off, the world would race through Phases 4 and 5 to 6.
Within 10 days of the first announcement that human swine flu infections had been found, the WHO raised the alert level from 3 to 4 and then to 5.
And then the world waited.
The virus spread as expected. What wasn't anticipated was political resistance to the declaration of a pandemic caused by such a mild strain.
The gap between Phase 5 and Phase 6 stretched for six weeks - not because of the virus, but because of political wrangling and perceived need to ease the world into the first pandemic in 41 years.
-A mutation at position 627 on the PB2 gene means trouble.
After years of study, flu scientists believe they've found a number of signature motifs in viruses that can predict characteristics like disease severity or transmissibility. One is a mutation at the 627 position on a gene called PB2.
For as far back as molecular biology can see, all flu viruses known to have spread among humans had the mutation. That has led flu scientists to peg it as essential to transmission in humans. But this virus doesn't have that mutation.
Flu virologists have been on the lookout for pandemic H1N1 viruses with this change, believing it would confer greater transmissibility and maybe greater severity of disease. But when it was found in a few cases in the Netherlands, there were no nightmare changes in the illness pattern.
-People would clamour for pandemic vaccine.
Much of the recent pandemic planning was done with H5N1 flu in mind.
The virus is a monster in humans, killing around 60 per cent of those infected. Planners assumed people would be desperate for pandemic vaccine.
But until recently, it seemed H1N1 wouldn't scare many people into vaccine queues. Instead, polls showed a surprising number were more nervous about the vaccine than the virus.
And even after the recent death of 13-year-old Evan Frustaglio of Toronto received widespread attention, a Canadian Press Harris-Decima poll showed only 55 per cent of Canadians want this vaccine.
Meanwhile in Europe, response to vaccination efforts has been indifferent.
"It's funny because I would not have predicted us to be in this situation a year ago. Because it's a no-brainer that you'll get the vaccine out and you'll want to vaccinate as many people as possible," says Dr. Michael Gardam, of the Ontario Agency for Health Protection and Promotion.
-People would need two shots of vaccine to be protected against a pandemic virus.
The assumption was that a pandemic virus would be so new our immune systems wouldn't be able to protect us against it with just one shot. One jab would be needed to "prime" our immune systems and a second to "boost."
Those assumptions were based on the idea a pandemic virus would be a new virus subtype, foreign to our immune systems.
Clinical trials of H1N1 vaccine show most people respond to a single shot of vaccine as if it's a booster, not a primer.
-Vaccine would be ready in time to combat the second wave of infections.
Planners expected more time between the emergence of the virus and a proper first wave of activity. And they thought there would be enough time before the second wave to make and deploy vaccine.
This virus has followed a different timetable, with a rapid and heavy first wave in the spring, continued activity over the summer and an early start to the flu season in the fall.
In Canada, the first supplies of vaccine have arrived as activity is really taking off in many parts of the country. Public health officials are in a race with the virus, trying to get vaccine into people before they can catch the bug. But it takes about 10 days for an immune response to develop after vaccination and in some cases, the virus is winning the race.
"I think most of us were hoping that there was going to be a longer gap between the initial identification and even a first wave," says Dr. Allison McGeer, head of infection control at Toronto's Mount Sinai Hospital.
The head of the CDC has been surprisingly blunt in his assessment of the existing system's capacity to make pandemic vaccine in a timely way.
"The technology we are using, although tried and true, is not well suited for pandemics," Dr. Tom Frieden has said.
-Hospitals would be crippled.
Pandemic planners thought hospitals would be overwhelmed. Emergency departments would be swamped. Overflow facilities might be needed. Surgeries would be cancelled.
No one knows what this winter has in store and that scenario could still materialize. Certainly after high profile cases like the Frustaglio death, emergency departments have reported heavy use.
But so far, hospitals haven't been overwhelmed - except intensive care units.
Severe cases of H1N1 are rare, but people who develop bad disease are profoundly ill. ICU staff have to take extraordinary measures to oxygenate the blood of these people because their embattled lungs cannot do the work for them.
ICUs in a number of hard hit places during the spring wave reported nearing the point of overflow. If they reach that point, experts say, death rates will rise and other hospital services will need to be rationed. But that hasn't been the case to date.
Follow Canadian Press Medical Writer Helen Branswell's flu updates on Twitter at CP-Branswell
Copyright © 2009 The Canadian Press. All rights reserved.
TORONTO — The World Health Organization's top flu scientist often describes the virus he's studied for years as "humbling."
And Dr. Keiji Fukuda isn't alone in marvelling at the mercurial nature of influenza. Flu scientists repeat almost as a mantra that the only thing predictable about flu is its unpredictability.
Yet despite decades of evidence that influenza will repeatedly rewrite the rules, flu dogma emerges and takes hold. Scientists keen to sift patterns from chaos agree X is true about Y - until the virus sets them straight yet again.
In the late '60s it was held that pandemic viruses emerged in 11-year cycles, after the closely spaced 1957 Asian flu and 1968 Hong Kong flu outbreaks.
It used to be accepted that only H1, H2 and H3 viruses could infect humans. And then viruses from the H5, H7 and H9 subtypes jumped from birds to infect people. Wrong again.
Though the world is not quite seven months into this pandemic, a number of widely held assumptions about flu and pandemics seem destined for the redrawing board when the dust from this outbreak settles.
Here are some:
-Pandemic viruses emerge from Asia, the cradle of flu viruses.
Years of focus on H5N1 avian influenza viruses left experts convinced Asia was the birthplace of new flu viruses and would be the source of the next pandemic. Despite the fact that there's good evidence the 1918 Spanish flu virus may have emerged in Kansas, no one was looking to North America as ground zero for the first pandemic of the 21st century.
It's a valuable lesson, says Dr. Nancy Cox, who has been pushing for a number of years for more flu surveillance in Latin America.
"You can't take your eye off the other possible threats. You can't focus too much on one area of the world because influenza - a new virus - can emerge from anywhere," says Cox, head of the influenza division at the U.S. Centers for Disease Control.
-Pandemics are triggered by "antigenic shift."
Flu viruses evolve constantly via small mutations, a process called antigenic drift. But once in a blue moon an entirely new virus bursts out of nature, an event known as antigenic shift. Because most people are vulnerable to the new virus, it ignites a pandemic.
It used to be thought pandemics could only be started by a virus with a new hemagglutinin - the H number in the virus's name - or a virus with a hemagglutinin that hadn't spread recently among people, such as the H2N2 viruses that circulated from 1957 to 1968.
The current pandemic is caused by an H1N1 virus, which is startling because almost everyone alive has antibodies to H1 viruses. They've been circulating among people since 1918, except for a 20-year gap between 1957 and 1977.
So few scientists would have predicted a new H1 virus could cause a pandemic at this point in history.
Some, in fact, still question whether this outbreak is a pandemic, at least by the definition science currently applies. The retired head of virology for the U.S. Centers for Disease Control is one of the doubters.
"There's no precedence for this," says Dr. Walter Dowdle, who now works for the non-profit Task Force on Global Health, based at Emory University in Atlanta. "Nobody had really thought that . . . the virus would re-emerge with this much background immunity."
But Dowdle cautions about dismissing the potential of this virus just because it defies our assumptions.
"We're the ones that make the definitions. And if the virus doesn't behave according to the definitions, well, it's our fault, not the virus's fault. So I think we have to be very careful about forcing the viruses into our definition, which can only be made based on what we've seen in the past.
Now we've seen something different. And so therefore we've got to go back and rethink this."
-Emerging pandemics can be extinguished with quick use of antiviral drugs.
Landmark modelling studies published in August 2005 suggested that with good surveillance, rapid response capacity and enough Tamiflu, a flu virus that was just starting to spread person-to-person could be snuffed out.
The late Dr. J.W. Lee, then director general of the WHO, committed the agency to try. Experts at the agency and elsewhere spent untold person-hours honing a plan for trying to stop a pandemic at source.
And while flu experts were watching the spread of H5N1 avian flu viruses from Asia, pigs got infected with some viruses that swapped genes and created the H1N1 virus we call swine flu. By the time we knew it was spreading, containment was out of the question.
"This cat was not only out of the bag, but this cat had nine litters before we realized what had happened," says Dr. Michael Osterholm, director of the University of Minnesota's Center for Infectious Diseases Research and Policy.
-We'd know it when we saw it.
Pandemics are rare. And before this one, only two had occurred in the era of virology. So what would a pandemic look like? Experts insisted it was a bit like pornography - we'd know it when we saw it.
And then a new virus of swine-avian-and-human genes started to spread.
It wasn't from a new subtype (see above). And but for the fact it was spreading in the off season and causing severe illness in younger people, it might have been mistaken for plain old flu.
Confusion ensued.
-There would be little time between the spotting of an emerging pandemic virus and the declaration of a pandemic.
The WHO's pandemic alert scale goes from Phase 1 (no threat) to Phase 6 (pandemic). For years the world had been at Phase 3, which means a non-human virus (H5N1) posed a pandemic threat and was triggering occasional cases, but person-to-person transmission was rare and limited.
Most experts assumed when a pandemic virus started to take off, the world would race through Phases 4 and 5 to 6.
Within 10 days of the first announcement that human swine flu infections had been found, the WHO raised the alert level from 3 to 4 and then to 5.
And then the world waited.
The virus spread as expected. What wasn't anticipated was political resistance to the declaration of a pandemic caused by such a mild strain.
The gap between Phase 5 and Phase 6 stretched for six weeks - not because of the virus, but because of political wrangling and perceived need to ease the world into the first pandemic in 41 years.
-A mutation at position 627 on the PB2 gene means trouble.
After years of study, flu scientists believe they've found a number of signature motifs in viruses that can predict characteristics like disease severity or transmissibility. One is a mutation at the 627 position on a gene called PB2.
For as far back as molecular biology can see, all flu viruses known to have spread among humans had the mutation. That has led flu scientists to peg it as essential to transmission in humans. But this virus doesn't have that mutation.
Flu virologists have been on the lookout for pandemic H1N1 viruses with this change, believing it would confer greater transmissibility and maybe greater severity of disease. But when it was found in a few cases in the Netherlands, there were no nightmare changes in the illness pattern.
-People would clamour for pandemic vaccine.
Much of the recent pandemic planning was done with H5N1 flu in mind.
The virus is a monster in humans, killing around 60 per cent of those infected. Planners assumed people would be desperate for pandemic vaccine.
But until recently, it seemed H1N1 wouldn't scare many people into vaccine queues. Instead, polls showed a surprising number were more nervous about the vaccine than the virus.
And even after the recent death of 13-year-old Evan Frustaglio of Toronto received widespread attention, a Canadian Press Harris-Decima poll showed only 55 per cent of Canadians want this vaccine.
Meanwhile in Europe, response to vaccination efforts has been indifferent.
"It's funny because I would not have predicted us to be in this situation a year ago. Because it's a no-brainer that you'll get the vaccine out and you'll want to vaccinate as many people as possible," says Dr. Michael Gardam, of the Ontario Agency for Health Protection and Promotion.
-People would need two shots of vaccine to be protected against a pandemic virus.
The assumption was that a pandemic virus would be so new our immune systems wouldn't be able to protect us against it with just one shot. One jab would be needed to "prime" our immune systems and a second to "boost."
Those assumptions were based on the idea a pandemic virus would be a new virus subtype, foreign to our immune systems.
Clinical trials of H1N1 vaccine show most people respond to a single shot of vaccine as if it's a booster, not a primer.
-Vaccine would be ready in time to combat the second wave of infections.
Planners expected more time between the emergence of the virus and a proper first wave of activity. And they thought there would be enough time before the second wave to make and deploy vaccine.
This virus has followed a different timetable, with a rapid and heavy first wave in the spring, continued activity over the summer and an early start to the flu season in the fall.
In Canada, the first supplies of vaccine have arrived as activity is really taking off in many parts of the country. Public health officials are in a race with the virus, trying to get vaccine into people before they can catch the bug. But it takes about 10 days for an immune response to develop after vaccination and in some cases, the virus is winning the race.
"I think most of us were hoping that there was going to be a longer gap between the initial identification and even a first wave," says Dr. Allison McGeer, head of infection control at Toronto's Mount Sinai Hospital.
The head of the CDC has been surprisingly blunt in his assessment of the existing system's capacity to make pandemic vaccine in a timely way.
"The technology we are using, although tried and true, is not well suited for pandemics," Dr. Tom Frieden has said.
-Hospitals would be crippled.
Pandemic planners thought hospitals would be overwhelmed. Emergency departments would be swamped. Overflow facilities might be needed. Surgeries would be cancelled.
No one knows what this winter has in store and that scenario could still materialize. Certainly after high profile cases like the Frustaglio death, emergency departments have reported heavy use.
But so far, hospitals haven't been overwhelmed - except intensive care units.
Severe cases of H1N1 are rare, but people who develop bad disease are profoundly ill. ICU staff have to take extraordinary measures to oxygenate the blood of these people because their embattled lungs cannot do the work for them.
ICUs in a number of hard hit places during the spring wave reported nearing the point of overflow. If they reach that point, experts say, death rates will rise and other hospital services will need to be rationed. But that hasn't been the case to date.
Follow Canadian Press Medical Writer Helen Branswell's flu updates on Twitter at CP-Branswell
Copyright © 2009 The Canadian Press. All rights reserved.
Wednesday, November 4, 2009
CDC: Monovalent Influenza Vaccine Dosage, Administration, and Storage
Page last updated Noverber 3, 2009 3:30 PM ET
Inactivated Vaccine: Dosage, Administration, and Storage
The composition of the influenza A (H1N1) 2009 monvalent inactivated influenza vaccine varies according to manufacturer, and package inserts should be consulted. Inactivated vaccine formulations in multidose vials contain the vaccine preservative thimerosal; preservative-free, single-dose preparations also are available. Inactivated vaccine should be stored at 35°F to 46°F (2°C to 8°C) and should not be frozen. Inactivated vaccine that has been frozen should be discarded. Dosage recommendations and schedules vary according to age group (Table 1).
-snip-
Live Attenuated Influenza Vaccine (LAIV): Dosage, Administration, and Storage
Each dose of 2009 monovalent LAIV contains the same vaccine antigen used in the inactivated vaccine. However, the antigen is constituted as a live, attenuated, cold-adapted, temperature-sensitive vaccine virus. Providers should refer to the package insert, which contains additional information about the formulation of this vaccine and other vaccine components. LAIV does not contain thimerosal. LAIV is made from an attenuated virus that is able to replicate efficiently only at temperatures present in the nasal mucosa. LAIV does not cause systemic symptoms of influenza in vaccine recipients, although a minority of recipients experience nasal congestion or fever, which is probably a result of the effects of intranasal vaccine administration or local viral replication or fever.
LAIV is intended for intranasal administration only and should not be administered by the intramuscular, intradermal, or intravenous route. LAIV is not licensed for vaccination of children younger than 2 years or adults older than 49 years of age. LAIV is supplied in a prefilled, single-use sprayer containing 0.2 mL of vaccine. Approximately 0.1 mL (i.e., half of the total sprayer contents) is sprayed into the first nostril while the recipient is in the upright position. An attached dose-divider clip is removed from the sprayer to administer the second half of the dose into the other nostril while the recipient is in the upright position. LAIV is shipped at 35°F to 46°F (2°C to 8°C). LAIV should be stored at 35°F to 46°F (2°C to 8°C) on receipt and can remain at that temperature until the expiration date is reached.
[See site for Chart, click on title]
Tuesday, November 3, 2009
Questioning the CDC 36,000 Deaths from Seasonal Flu Figure
Tuesday, 03 November 2009 12:30
It’s cold and flu season and the news is filled with just how deadly influenza can be. A figure that is frequently repeated in most news outlets when talking about the flu is that 36,000 people die each year from the flu.
Fox News
“H1N1 has been getting top line publicity and it’s important to know that seasonal flu takes a toll year in and year out,” Sebelius said. “But each year, 36,000 Americans die from the seasonal flu.”
New York Times
“… seasonal flu, which kills about 36,000 people annually.”
Wall Street Journal
“The seasonal flu sends an average of 200,000 Americans to the hospital each year, and 36,000 of them die, according to the CDC”
Orlando Sentinel
“According to the Centers for Disease Control and Prevention, 5 percent to 20 percent of the U.S. population is infected with seasonal flu each year… about 36,000 people die — mostly elderly.”
All these news reports leave the reader with a very specific and definitive figure of 36,000 people dying each year directly from the flu. But where did this figure come from? Most people would probably assume that careful statistics are kept to arrive at this figure. However, this 36,000 number that is repeated so authoritatively is actually based on a single study published in 2003. A mathematical model was applied to estimate flu-related deaths by using death certificates where the cause of death was listed as respiratory or circulatory disease. From the CDC website:
“CDC estimated that about 36,000 people died of seasonal flu-related causes each year, on average, during the 1990s in the United States. This figure includes people dying from complications of seasonal flu. This estimate came from a 2003 study published in the Journal of the American Medical Association (JAMA), which looked at the 1990-91 through the 1998-99 flu seasons. Statistical modeling was used to estimate how many flu-related deaths occurred among people whose underlying cause of death on their death certificate was listed as a respiratory or circulatory disease. During these years, the number of estimated deaths ranged from 17,000 to 52,000.”
The fact is the 36,000 number of deaths is really an estimate and not an exact number as often it is represented. More importantly it is a mathematical estimate based on an assumption that if a death certificate had “respiratory or circulatory disease” listed as a cause of death that it should be counted as a “flu-related” death.
Just how many deaths are directly associated with the flu? According to Peter Doshi in the British Medical Journal:
‘… according to the CDC's National Center for Health Statistics (NCHS), “influenza and pneumonia” took 62,034 lives in 2001 - 61,777 of which were attributed to pneumonia and 257 to flu, and in only 18 cases was flu virus positively identified. Between 1979 and 2002, NCHS data show an average 1348 flu deaths per year (range 257 to 3006).’
So the real statistics show a far lower number of people dying from the flu with only a handful of cases being definitely identified as even having the influenza virus. 257 deaths from the flu in 2001 is only a fraction of the often cited 36,000. The CDC directly admits to using this model because most cases aren’t even tested to see if the flu virus was even involved.
‘In a written statement, CDC media relations responded to the diverse statistics: “Typically, influenza causes death when the infection leads to severe medical complications.” And as most such cases “are never tested for virus infection ... CDC considers these [NCHS] figures to be a very substantial undercounting of the true number of deaths from influenza. Therefore, the CDC uses indirect modeling methods to estimate the number of deaths associated with influenza.”’
An article published in Journal of American Physicians and Surgeons in 2006 is highly critical of the CDC methods.
“The CDC and news media frequently proclaim that there are about 36,000 influenza-associated deaths annually. Review of the mortality data from the CDC’s National Vital Statistics System(NVSS) reveals these estimates are grossly exaggerated. The NVSS reports preliminary mortality statistics and distinguishes between influenza-related deaths and pneumonia-related mortality. When the final report is issued, influenza mortalities are combined with the far more frequent pneumonia deaths, yielding an exaggerated representation of influenza deaths. Pneumonia related mortality due to immunosuppression, AIDS, malnutrition, and a variety of other predisposing medical conditions is therefore combined with seasonal influenza deaths. The actual influenza related deaths for the years 1997 to 2002 ranged from 257 to 1,765 annually. These values are further overestimated by combining deaths from laboratory-confirmed influenza infections with cases lacking laboratory confirmation.”
Looking at how the CDC website has changed over the years and how they report on the flu shows that there was a shift in 2002 from “influenza associated” to an absolute “die from the flu” statement. In 2003, the number of 20,000 was adjusted based on the discussed mathematical model to 36,000 “die from influenza”. The CDC website now currently and slightly more correctly notes that the deaths are “flu-related”.
Peter Doshi concludes in his paper that, “If flu is in fact not a major cause of death, this public relations approach is surely exaggerated. Moreover, by arbitrarily linking flu with pneumonia, current data are statistically biased. Until corrected and until unbiased statistics are developed, the chances for sound discussion and public health policy are limited.”
The figure of 36,000 deaths each year from the flu as reported is clearly not based on careful analysis of actual cases that are tested for the influenza virus. Instead, the number is a mathematical model estimate based on a single 2003 study that links death certificates that list “respiratory or circulatory disease” as a cause of death as proof of influenza as causing the death.
It’s cold and flu season and the news is filled with just how deadly influenza can be. A figure that is frequently repeated in most news outlets when talking about the flu is that 36,000 people die each year from the flu.
Fox News
“H1N1 has been getting top line publicity and it’s important to know that seasonal flu takes a toll year in and year out,” Sebelius said. “But each year, 36,000 Americans die from the seasonal flu.”
New York Times
“… seasonal flu, which kills about 36,000 people annually.”
Wall Street Journal
“The seasonal flu sends an average of 200,000 Americans to the hospital each year, and 36,000 of them die, according to the CDC”
Orlando Sentinel
“According to the Centers for Disease Control and Prevention, 5 percent to 20 percent of the U.S. population is infected with seasonal flu each year… about 36,000 people die — mostly elderly.”
All these news reports leave the reader with a very specific and definitive figure of 36,000 people dying each year directly from the flu. But where did this figure come from? Most people would probably assume that careful statistics are kept to arrive at this figure. However, this 36,000 number that is repeated so authoritatively is actually based on a single study published in 2003. A mathematical model was applied to estimate flu-related deaths by using death certificates where the cause of death was listed as respiratory or circulatory disease.
“CDC estimated that about 36,000 people died of seasonal flu-related causes each year, on average, during the 1990s in the United States. This figure includes people dying from complications of seasonal flu. This estimate came from a 2003 study published in the Journal of the American Medical Association (JAMA), which looked at the 1990-91 through the 1998-99 flu seasons. Statistical modeling was used to estimate how many flu-related deaths occurred among people whose underlying cause of death on their death certificate was listed as a respiratory or circulatory disease. During these years, the number of estimated deaths ranged from 17,000 to 52,000.”
The fact is the 36,000 number of deaths is really an estimate and not an exact number as often it is represented. More importantly it is a mathematical estimate based on an assumption that if a death certificate had “respiratory or circulatory disease” listed as a cause of death that it should be counted as a “flu-related” death.
Just how many deaths are directly associated with the flu? According to Peter Doshi in the British Medical Journal:
‘… according to the CDC's National Center for Health Statistics (NCHS), “influenza and pneumonia” took 62,034 lives in 2001 - 61,777 of which were attributed to pneumonia and 257 to flu, and in only 18 cases was flu virus positively identified. Between 1979 and 2002, NCHS data show an average 1348 flu deaths per year (range 257 to 3006).’
So the real statistics show a far lower number of people dying from the flu with only a handful of cases being definitely identified as even having the influenza virus. 257 deaths from the flu in 2001 is only a fraction of the often cited 36,000. The CDC directly admits to using this model because most cases aren’t even tested to see if the flu virus was even involved.
‘In a written statement, CDC media relations responded to the diverse statistics: “Typically, influenza causes death when the infection leads to severe medical complications.” And as most such cases “are never tested for virus infection ... CDC considers these [NCHS] figures to be a very substantial undercounting of the true number of deaths from influenza. Therefore, the CDC uses indirect modeling methods to estimate the number of deaths associated with influenza.”’
An article published in Journal of American Physicians and Surgeons in 2006 is highly critical of the CDC methods.
“The CDC and news media frequently proclaim that there are about 36,000 influenza-associated deaths annually. Review of the mortality data from the CDC’s National Vital Statistics System(NVSS) reveals these estimates are grossly exaggerated. The NVSS reports preliminary mortality statistics and distinguishes between influenza-related deaths and pneumonia-related mortality. When the final report is issued, influenza mortalities are combined with the far more frequent pneumonia deaths, yielding an exaggerated representation of influenza deaths. Pneumonia related mortality due to immunosuppression, AIDS, malnutrition, and a variety of other predisposing medical conditions is therefore combined with seasonal influenza deaths. The actual influenza related deaths for the years 1997 to 2002 ranged from 257 to 1,765 annually. These values are further overestimated by combining deaths from laboratory-confirmed influenza infections with cases lacking laboratory confirmation.”
Looking at how the CDC website has changed over the years and how they report on the flu shows that there was a shift in 2002 from “influenza associated” to an absolute “die from the flu” statement. In 2003, the number of 20,000 was adjusted based on the discussed mathematical model to 36,000 “die from influenza”. The CDC website now currently and slightly more correctly notes that the deaths are “flu-related”.
- Dec 16, 2001 - "In an average year, influenza is associated with more than 20,000 deaths nationwide"
- Jan 24, 2002 - "An average of about 20,000 people per year in the United States die from the flu"
- Feb 9, 2003 - "An average of about 36,000 people per year in the United States die from influenza"
- Nov 02, 2009 - "about 36,000 people die from flu-related causes."
Peter Doshi concludes in his paper that, “If flu is in fact not a major cause of death, this public relations approach is surely exaggerated. Moreover, by arbitrarily linking flu with pneumonia, current data are statistically biased. Until corrected and until unbiased statistics are developed, the chances for sound discussion and public health policy are limited.”
The figure of 36,000 deaths each year from the flu as reported is clearly not based on careful analysis of actual cases that are tested for the influenza virus. Instead, the number is a mathematical model estimate based on a single 2003 study that links death certificates that list “respiratory or circulatory disease” as a cause of death as proof of influenza as causing the death.
Source:
Orlando Sentinel, “Flu 101: What you need to know about seasonal and swine strains”, November 2009
Fox News, “Health Officials: Get Your Seasonal Flu Vaccine Today”, September 10, 2009
New York Times, “As Flu Vaccine Arrives for the Season, Some Questions and Answers”, October 9, 2009
“Two Flu Vaccines, Lots of Questions”, Wall Street Journal, October 18, 2009
Questions and Answers Regarding Estimating Deaths from Seasonal Influenza in the United States, http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm
Peter Doshi , Are US flu death figures more PR than science? BMJ, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1309667
Influenza Vaccination During Pregnancy: A Critical Assessment of the Recommendations of the Advisory Committee on Immunization Practices (ACIP), Journal of American Physicians and Surgeons, Volume 11,Number 2,Summer 2006, http://www.jpands.org/vol11no2/ayoub.pdf
Monday, November 2, 2009
U.S. Dept. Health & Human Svcs.: Initial Results Show Pregnant Women Mount Strong Immune Response to One Dose of 2009 H1N1 Flu Vaccine
News Release
FOR IMMEDIATE RELEASE | Contact: NIAID Office of Communications |
Healthy pregnant women mount a robust immune response following just one dose of 2009 H1N1 influenza vaccine, according to initial results from an ongoing clinical trial sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health.
“For pregnant women, who are among the most vulnerable to serious health problems from 2009 H1N1 infection, these initial results are very reassuring,” says NIAID Director Anthony S. Fauci, M.D. “The immune responses seen in these healthy pregnant women are comparable to those seen in healthy adults at the same time point after a single vaccination, and the vaccine has been well tolerated.”
According to the Centers for Disease Control and Prevention, since the outbreak began last spring, at least 100 pregnant women have been hospitalized in intensive care units in the United States and at the last official count, 28 pregnant women have died.
A preliminary analysis of blood samples taken 21 days post-vaccination from a subgroup of 50 pregnant women participating in the trial shows the following:
- In 25 women who received a single 15-microgram dose of the vaccine, the H1N1 flu vaccine elicited an immune response likely to be protective in 92 percent, or 23 of 25, of these women.
- In 25 women who received a single 30-microgram dose of the vaccine, the H1N1 flu vaccine elicited an immune response likely to be protective in 96 percent, or 24 of 25, of these women.
The trial began on Sept. 9 and reached its target enrollment of 120 volunteers in mid-October. All participants are between 18 to 39 years old and began the study in their second or third trimester (14 to 34 weeks) of pregnancy.
At entry into the study, the participants were divided at random into two groups: half are receiving two doses of a 15-microgram vaccine and the other half are receiving two doses of a 30-microgram vaccine. The two injections of vaccine are spaced three weeks apart.
Safety is being monitored closely in the trial, by the study investigators and by an independent panel of experts known as a safety monitoring committee. To date, the vaccine appears to be well-tolerated, and no safety concerns related to the vaccine have arisen.
The vaccine used in this clinical trial was manufactured by Sanofi Pasteur in its plant in Swiftwater, Pa., in the same manner as the company’s injectable seasonal influenza vaccine. Like the seasonal flu vaccine, the 2009 H1N1 flu vaccine contains a purified portion of the killed virus and therefore cannot cause infection. The vaccine does not contain the preservative thimerosal or an immune boosting substance known as an adjuvant.
NIAID is conducting this trial through five clinical sites affiliated with its longstanding clinical trials network known as the Vaccine and Treatment Evaluation Units. For additional information about the NIAID trial in healthy pregnant women, see the Sept. 9 NIAID news release http://www3.niaid.nih.gov/news/newsreleases/2009/H1N1pregnanttrials.htm and related Q&A http://www3.niaid.nih.gov/news/QA/H1N1pregnanttrials.htm .
For more information on influenza, including pandemic influenza and avian influenza, visit www.flu.gov. Also see NIAID’s influenza Web portal at http://www3.niaid.nih.gov/topics/Flu/ .
NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.
The National Institutes of Health (NIH)—The Nation's Medical Research Agency—includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.
Pediatric Graph Created By Poster
[I have been tracking at FluTrackers.com (Commonground), and this is a chart created by one of our fellow posters. A big hat-tip to Chuck. Click on Chart.]
Here is an updated chart comparing pediatric for the past several flu seasons. The seasonal flu information (in green) was derived from the CDC FluView chart of reported pediatric deaths. The H1N1 deaths (in red) were taken from this thread, U.S. Pediatric Deaths: [http://www.flutrackers.com/forum/showthread.php?p=313159&posted=1#post313159], the dead children thread: [http://www.flutrackers.com/forum/showthread.php?t=124781], and the US child death thread on the Pandemic Flu Information Forum. Note that the last green row and the first red row cover the same time period (the 2008-2009 flu season), just separating the seasonal flu deaths and the H1N1 flu deaths.
Here is an updated chart comparing pediatric for the past several flu seasons. The seasonal flu information (in green) was derived from the CDC FluView chart of reported pediatric deaths. The H1N1 deaths (in red) were taken from this thread, U.S. Pediatric Deaths: [http://www.flutrackers.com/forum/showthread.php?p=313159&posted=1#post313159], the dead children thread: [http://www.flutrackers.com/forum/showthread.php?t=124781], and the US child death thread on the Pandemic Flu Information Forum. Note that the last green row and the first red row cover the same time period (the 2008-2009 flu season), just separating the seasonal flu deaths and the H1N1 flu deaths.
Sunday, November 1, 2009
Cases of Tamiflu resistance H1N1 still scarce but some situations bear watching
The World Health Organization says relatively few cases of Tamiflu resistance have been found among pandemic H1N1 viruses, but there are some concerns that bear watching.
The agency says there have been 39 cases of Tamiflu resistance reported so far, seven of which are still being investigated.
Of the 32 for which details are known, 13 occurred in people taking the drug to prevent infection, a procedure called prophylaxis.
The WHO says while the numbers are low, resistance hasn't previously been seen in people taking the drug prophylatically and the fact it is now being seen is a concern.
And there have been three cases of drug resistance in people who hadn't taken Tamiflu, which is the brand name for oseltamivir.
The WHO says there's no evidence of ongoing spread of resistant viruses, but there is a strong suspicion that limited spread has occurred among close contacts in some cases.
Most of the viruses have been found in North America and in the Western Pacific region, though a few have been spotted in Europe.
H1N1 Swine Flu and Asthma are Deadly Combination
Asthma is more common in children than in adults, and swine flu seems to strike younger people more often than older ones. This is completely different than the seasonal flu, which affects less children and more adults.
In the study, 45 percent of the hospitalized patients were under age 18, and only 5 percent were 65 or older. "If you are a young adult and you have asthma, you are in double jeopardy," stated Richard Gower, M.D., the president of the American College of Allergy, Asthma and Immunology.
Asthma causes 4,000 deaths a year in the United States. This is without the added problem of the H1N1 swine flu. Asthma can occur in anyone at any time of life from infancy to adulthood. In some children with asthma, the disease goes away as they enter adolescence or adulthood. However, there is no cure for asthma, though symptoms sometimes decrease over time. Asthma is not contagious and poses no risk to others.
Many people experience similar symptoms when they get the H1N1 swine flu. This includes fever, congestion, and possibly nausea, diarrhea, and vomiting. Most of the time, swine flu symptoms can be successfully battled with bed rest and liquids. However, those who have asthma are at a higher risk of complications when they get the H1N1 swine flu.
Do you live in one of the Top 10 Asthma Cities?
People with asthma are at risk for breathing trouble with infections in general, not just the H1N1 swine flu. The best course of action for people with asthma during the H1N1 swine flu pandemic is to:
*Take asthma medication daily, even when not ill. It can help protect the lungs from triggers such as infections.
*Get vaccinated for the H1N1 swine flu. The CDC recommends the shot, not nasal spray, which is safer for asthmatics.
*Get treatment quickly if you get the H1N1 flu or symptoms and have asthma. Prevention is better than waiting.
The H1N1 swine flu is spreading rapidly across the United States. Those with chronic conditions such as asthma should be preventative and although patients do not always have to go into see their necessarily physician, they need to contact them if they have high risk conditions.
CDC provides H1N1 Social Media Tools
Tylenol may reduce effectiveness of H1N1 Vaccine in Children
Swine Flu a Threat to Pregnant Women
Cheryl Phillips
HULIQ.com
sources: AAFA, Health.com, Wikipedia
H1N1 update: 75 pediatric influenza deaths in 8 weeks
According to a weekly report released from the Centers for Disease Control, 75 children have died from influenza since August 30, 2009. Sixty five of those are confirmed H1N1 and 10 suspected H1N1.
The good part ...
Although the distribution of the H1N1 vaccination has been delayed, it is expected to be more available for the general public in the month of November. According to the H1N1 in PA Web site, the state is awaiting more vaccines from the suppliers. The site has been updated in the past week and it says they will post information identifying vaccination sites here http://www.h1n1inpa.com/vaccines/h1n1-vaccine-locations-in-pa/ when it is available. In the meantime they suggest talking to your doctor if you are in a high risk group to find out what local places will distribute the shot. If you are unable to find the vaccine in your area, the site said to call the Pennsylvania Department of Health at 1-877-PA-HEALTH (1-877-724-3258).
While nearly all the influenza cases identified are the 2009 H1N1 influenza A virus, the virus remains similar to the virus used to develop the H1N1 vaccine. Additionally, the virus remains highly susceptible to two of the antiviral drugs.
IV antiviral drug Peramivir was approved by the FDA this week for use in pediatric and adult patients admitted to the hospital for H1N1. The drug was issued an emergency approval and is currently the only antiviral drug administered intravenously.
Now the rest of the facts ...
The proportion of deaths attributed to pneumonia and influenza far exceeds what is normal at this time of the year. Twenty-two pediatric flu deaths were reported this week. Nineteen were confirmed H1N1 and the additional three are considered likely H1N1. The CDC said the H1N1 virus is the only flu virus circulating at the moment. Since April 2009, 114 laboratory-confirmed H1N1 cases have resulted in death of a child younger than 18 and another 12 more children died from suspected H1N1 virus.
The vaccine is still in short supply so health care officials are reminding people to seek treatment with any concerning symptoms. CDC officials said those with underlying health concerns or in high risk groups need to seek immediate medical treatment if they suspect the have the H1N1 flu. They stated a only half of the high-risk population is heading that advice and consequently, officials said the lack of medical attention is leading to more hospitalizations and complications. Emergency rooms are reporting high volumes however, so it is advised to seek care from your primary doctor or child's pediatrician unless severe symptoms are suspected.
The high risk groups are: pregnant women, persons six months to 24 years old, Health care providers and EMS personnel, parents, household members or caregivers of children less than six months and those under 65 with certain underlying medical conditions (including respiratory conditions like asthma).
Pediatric deaths from H1N1
Current influenza season (data from August 30)
75 suspected pediatric deaths (65 confirmed H1N1)
Since April 2009
114 confirmed H1N1 pediatric deaths
The good part ...
Although the distribution of the H1N1 vaccination has been delayed, it is expected to be more available for the general public in the month of November. According to the H1N1 in PA Web site, the state is awaiting more vaccines from the suppliers. The site has been updated in the past week and it says they will post information identifying vaccination sites here http://www.h1n1inpa.com/vaccines/h1n1-vaccine-locations-in-pa/ when it is available. In the meantime they suggest talking to your doctor if you are in a high risk group to find out what local places will distribute the shot. If you are unable to find the vaccine in your area, the site said to call the Pennsylvania Department of Health at 1-877-PA-HEALTH (1-877-724-3258).
While nearly all the influenza cases identified are the 2009 H1N1 influenza A virus, the virus remains similar to the virus used to develop the H1N1 vaccine. Additionally, the virus remains highly susceptible to two of the antiviral drugs.
IV antiviral drug Peramivir was approved by the FDA this week for use in pediatric and adult patients admitted to the hospital for H1N1. The drug was issued an emergency approval and is currently the only antiviral drug administered intravenously.
Now the rest of the facts ...
The proportion of deaths attributed to pneumonia and influenza far exceeds what is normal at this time of the year. Twenty-two pediatric flu deaths were reported this week. Nineteen were confirmed H1N1 and the additional three are considered likely H1N1. The CDC said the H1N1 virus is the only flu virus circulating at the moment. Since April 2009, 114 laboratory-confirmed H1N1 cases have resulted in death of a child younger than 18 and another 12 more children died from suspected H1N1 virus.
The vaccine is still in short supply so health care officials are reminding people to seek treatment with any concerning symptoms. CDC officials said those with underlying health concerns or in high risk groups need to seek immediate medical treatment if they suspect the have the H1N1 flu. They stated a only half of the high-risk population is heading that advice and consequently, officials said the lack of medical attention is leading to more hospitalizations and complications. Emergency rooms are reporting high volumes however, so it is advised to seek care from your primary doctor or child's pediatrician unless severe symptoms are suspected.
The high risk groups are: pregnant women, persons six months to 24 years old, Health care providers and EMS personnel, parents, household members or caregivers of children less than six months and those under 65 with certain underlying medical conditions (including respiratory conditions like asthma).
Pediatric deaths from H1N1
Current influenza season (data from August 30)
75 suspected pediatric deaths (65 confirmed H1N1)
Since April 2009
114 confirmed H1N1 pediatric deaths
H1N1 deaths jump by 700 in a week (42%)
GENEVA - The number of swine flu deaths jumped by 700 in a week, reaching more than 5,700 worldwide since the virus was first uncovered in April, World Health Organization data indicated Friday.
The biggest rise was recorded in the Americas region, where 4,175 deaths have now been reported to the WHO, up 636 from data published last week.
"In the temperate zone of the northern hemisphere, influenza transmission continues to intensify, marking an unusually early start to winter influenza season in some countries," said the WHO.
Fatal cases in Europe rose to at least 281, while those in Asia-Pacific rose to 1,070.
Amid the mounting death toll, the WHO said a single dose of vaccine would provide sufficient immunity.
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