Zoonotic H9N2 Avian Influenza Further Destabilises Pandemic Genetics

2010-03-31
Is the Pandemic Influenza Reservoir Stable?

If you enjoy counting, even measuring by observation, please continue reading.

But you must realize that the iota, the jot and even the title, will be considered of value in this forthcoming exercise. Some in the science community appear to find the process of discovery by observation just too tedious. If you are of that mindset, please direct your attention to any of the many “Science for Hire” venues where illogical, but comforting, summations are drawn from cleverly manipulated data streams. Science sells today. But we sometimes speculate that science is becoming just another sell-out, an industry pursuing profit over knowledge?

On the other hand, if careful examination, even hard work, is part of your daily lab book, you'll find evidence in this discussion to introspect.

Leading public health officials continue even today to indicate that the pandemic virus is unchanged. Keep that statement in mind as you read this analysis of heavy change activity in the pandemic reservoir, watching closely for the recent branching into genetic areas matching H9N2.

Also keep in mind that even single changes have demonstrated substantial importance.

Ongoing worldwide studies duplicated by independent, geographically dispersed laboratories, including the labs of those noted public health officials, indicate that a single polymorphism may produce a significant outcome within a Pandemic Influenza reservoir. Numerous accounts of important revisions are on record across a vast geography. 225G has produced a Vaccine Escape event in LvivN6, an elevated Case Fatality Rate and a substantial number of severe outcomes. Individual changes between 157 and 159 have also demonstrated “low reactor” status and registered as Vaccine Escape events. 230I entered the H5N1 Gharbiyah cluster in Egypt and the resultant Case Fatality Rate was 80% for that strain, a substantial increase from the accepted H5N1 CFR.

Three separate single genetic changes are well characterised in leading to various forms of Anti-Viral resistance. TamiFlu Resistance has now dispersed widely in a pattern following the rapid spread of resistance in seasonal influenza via the same Single Nucleotide Polymorphism coding for 275Y on the Neuraminidase. Emergent and attractant H1N1 strains (Triple Reassortments again) co-circulating alongside the pandemic reservoir also carry 275Y. H5N1 inclusions increase in the pandemic reservoir with a continuous flow. The PB2 627K is confirmed as leading to increased replication speed in humans and has recently been documented in a second pandemic sequence. As we have maintained from the beginning of this pandemic, TamiFlu Resistance and 627K are foregone conclusions according to our calculations.

Our team noted an increase in Avian inclusions and recently predicted HA 230I for ΣPF11. The polymorphism was documented last week in Wisconsin (US) on a background that does not deter transmission. The geographic area has a notable increase in cross-linked activity. The individual sample, A/Wisconsin/629-D00337, is primed for spread with 2 additional HA markers, 275A (TX, NM, CA and Sweden) and 377K (aggressively emerging). The NA carries 220K, a marker found on one cross-linked sequence from the Ukraine and across a wide US geographic pattern from December 2009 to the most recent 2010 sequences (North Carolina, New Hampshire, Wisconsin and Nebraska). We consider the Wisconsin0337 sample to be an excellent candidate as a universal donor of sorts due to limited polymorphisms and the fact that each revision is currently an emergent change.

H9N2, a "bird flu" serotype, has been recently evaluated for human pandemic potential. By all appearances, the present H9N2 reservoir is not becoming a pandemic virus, but is very much influencing the genetic acquisition cycle of the currently circulating PF11 pandemic virus. Which is worse, another species-jumping serotype entering the fray or a combinational virus with genetics from multiple pandemic potential reservoirs appending onto the current partially-adapted virus? In either case, the Hydra Effect appears to be operating in full force.

Given this information, obvious questions begin to form. If one genetic change may potentiate variant clinical outcomes, drug resistance or Vaccine Escape, what is the potential for multiple changes producing a variant outcome? And if a single genetic change and/or multiple changes are capable of producing large changes in behaviour, should we, in turn, have a very high and accurate level of surveillance on this reservoir? And what should we do with that important information? Should our public health officials speak from a platform of candor and accuracy when carrying out the responsibilities of their trusted positions?

Let’s investigate now if the viral reservoir is, in fact, unchanged?

More than 80% of the Hemagglutinin positions between 188 and 244, including antigenic areas of the RBD, are on record as polymorphic. Many positions rate multiple changes. Tracking these revisions against various baselines has informed our studies over the past year. One particular range of those variations is documented in the trailing data. For the sake of brevity, only one section of the HA gene segment is discussed. The list is certainly not comprehensive.

The positional summary may perhaps be instructive for those who hold the belief that the pandemic reservoir is stable. The report may provide reversing guidance for those who make public statements to the effect that pandemic H1N1 is not changing. Repetition of their “All Clear” social messaging cannot reverse the weight of the actual data. Repetition of an untruth does not create a fact, but that ongoing strategy of repetition is apparently very effective in managing the perception and manipulating the belief of the unsuspecting public.

The viral reservoir backing this present pandemic is far from stable and is actively acquiring new genetics. Current data does not indicate an immediate direction toward stability.

As is the nature with an IDRREAV, the positions reported here will not necessarily be the most important amino acid positions in the future. The reservoir will evade immunity and escape vaccine by heavily self-revising in the near future at key locations between 131 and 182 (emphasis at 155 to 177). Variation will occur with lower penetration at the head of the HA and from 272 downstream approximately 55 positions. Potential is very high that 22I will achieve density in one or more sub-clades. Expect 100N to spread and penetrate initially on sub-clades without the 22I appearances. South American polymorphisms from their fatal mid-pandemic strains of 2009 will recycle into the United States and other Northern Hemisphere nations with substantial thrust in the coming 90 days. Acceleration of the Avian based cross-linking will continue in the Western world.

Bear in mind also that a solid portion of the changes documented in this current list will become fixed even as additional donations are accumulated. The zoonotic movement from birds into human PF11 sequences is earnestly progressing in the most recent 45 days of available data. Several polymorphisms, HA and NA, from the Georgia hospitalization resurgence may have originated in Avian Influenza samples. Expect continued acquisition from Avian H5N1 and H1N1, and also watch the acceleration from one particularly new Avian donor serotype. H9N2 demonstrated a human jump in late 2008 and has very recently become fully engaged in ΣPF11 genetics with a well-defined etching on the newest cross-linked sequences. The reservoir flux will also be influenced by Swine H1N2 and H1N1 (emphasis on 3 particular emergent strains).

Is the Pandemic Influenza Reservoir Stable?

You decide . . .

188N SC16, SC31, NY3502, MA15, CatS1187, Milan433, Japan, S5
188I Growing in US on cross-linked background (4), BZSP53823
189V Sydney2503
189T Growing on US cross-linkage (4), H5N1 2009, H9N2 2008
189A synonymous (GCc), Georgia01_2010, swOR4060
190D synonymous (GAt) Milan326, 1918
190Y SwedenMalmoe1_2010_01_01
191R Chengdu18 (129P)
192Q synonymous (CAg) RomaISS50, Nebraska01_2010
193S synonymous (AGc) SC18, US 2010 (3), Milan294, Japan, H9N2
193G AR08
193N Washington72, H9N2
194I NC38E3, VA27, SC18, Bangladesh3009, StPete59, StPete99
194L synonymous (CTa) Japan4081
196Q synonymous (CAa) Wisc (3), Malaysia (2), Milan326
197T Malaysia4039
198V Malaysia5283, Malaysia9117
199N Milan80, Milan83
199D synonymous (GAc) swine Illinois, H5, H9N2
200T FL31, Asia (13), MilanUSHR1, H5, H9N2
200S NC57, SC46
201H Wisc1140, Darwin2140
202A MXinDRE797 2010 TmX, IA14, KY25, HK34360
202V synonymous (GTc) YAMAGATA778, YAMAGATA803, swIllinois
204V synonymous (GTa) PA31, SHIZUOKA1573, 1918, S7
205G synonymous (GGa) Texas76C2, S5, H9N2 (GCa)
206A CatS1161
206T Extensive
207S synonymous (TCg) California01_2010
208K US, UK, HK, MX, Italy (2), Australia (12), Asia (3), swOR4060
208S Australia43, Australia45, ChukkarH6N1
208G NY6292
208T Norway3440
210S synonymous (AGt) Bogota0466N, Malaysia9131, H9N2 (Aat)
210N Texas76C2
211K synonymous MXinDRE50617 (225G)
211R swOR4060_2009_12_31, 1918
212R swOR4060_2009_12_31, 1918
212E Vlad01 (225G), Argentina8574_41, IN21, Malaysia4039
212N MA15
212T Anadyr177_F (225G), CA07X179, CA07X181
213L TX15
213F synonymous StPete99 (225E)
214E Kurgan01, Moldova (3), swOR4060_2009_12_31
214N ENG92960012, SHIZUOKA1514
214Q Wisc0936 (237L)
214K synonymous (AAa) CatS1937, NM13, ENG620, China22811
215P synonymous (CCa) SC33, Eng616, GuangdongyunchengSWL51
215P synonymous (CCt) NY_WC37RG, MO02
216E synonymous (GAg) Moldova (4), Belarus, Bosnia (3, 225G), Indiana, H9N2 (GTg), tn
218A synonymous (GCg) Belarus, H9N2 (GGg)
218E Texas77 (159S, syn173G, 275A, 377K, 454I)
218T Hiroshima201 (225G)
218V GuangdongyunchengSWL51, Malaysia (2 mix wt) (GtA)
218V swIll02930, 2931, 2932, 2937 (2009-12-29, 30) (GTc)
219I synonymous Ancona451_F, Lyon2490
219T Wisc0134 (225E), RomaISS223, swOR4060_2009_12_31
220R synonymous (AGg) Mexico476, Malaysia9451
223V synonymous (GTa) Utah59
223M CA33
224K SC18_VxX
224M NY5186
225N BZ_SP53838, Ukraine mix wt, Victoria2125, Malaysia8860 et al
225E Extensive on multiple backgrounds
225G LvivN6_VxX with syn413K, UkDnip273 (GgT mix wt), H9N2
225G RomaISS1897 & 1941, EgyptVacsera138 (300S) ex225E (Gga)
225E+226R Russia (3), GermanyBY74, swMX4
226R Trabzon01 (Turkey), et al
227A swOR4060_2009_12_31, 1918
227V RomaISS50
227G Utah20 with wt mix
229R synonymous (AGg) swMX04 (225G, 226R)
230I Wisc0337_2009_12_15, H5 Gharbiyah 80% CFR, H9N2
231D Ankara05, OSAKA2143, H9N2 2008
231N CalifVRDL36
231K Wisc0853, Wisc1915, Wisc2337
232Y synonymous (TAc) Florida30, PuertoRico51, H9N2, H5, S9, S7, M7, Sask
233Y synonymous (TAt) AthensINS85, Hiroshima645, H9N2 2008
233H NC Duke (5, wt, 225G, 225N), AZ17 & Australia6
235A CatNS7632, CalifVRDL55
236V Eng93120020, ENG645, H9N2
237I Cal_SDINS69, England (2), Russia (4), Asia (2)
237L Wisc0936 (214Q), 1918, H5, tn
237V synonymous (GTg) Pennsylvania31, H9N2 (TTg), M7 (CTg)
238D Kaliningrad01 (225E+226R), tn
238K Wisc2485 (225E), Spain (2), China, swOR4060, H5, H9N2 2008
238E synonymous. Extensive and recently growing
239P synonymous (CCt) ENG621, swOR4060_2009_12_31
239P synonymous (CCa) Ancona508PG, Russia180, Australia60
240G synonymous (GGg) DC_INS24, H9N2, S9, S7, M7, Sask
241D synonymous (GAt) CatS1943, tn
241G NH17, ENG93040048
241E China22811
242K synonymous (AAg) swOR4060_2009_12_31
244I ThaiCU_H9
244T synonymous (ACt) CatS1935, CatS2120

The truth is in the sequences.

via email from NS1 -


Our analyses are intended to provide the most straightforward explanation possible . . . but as you must realise, the backing science of Influenza is far from robust. Simplicity is simply not attainable. Though the community produces thousands of point studies with valuable content data, a lack of cohesive framework results in frequent knowledge gaps. We are working to bridge those gaps, but today’s tools and the scarcity of data unfortunately limit the scope.

H5N1 and H9N2 are the two Influenza A serotypes considered most capable of reaching human pandemic status. Each is on record as zoonotic. H5N1 has been an active, but limited, contributor to ΣPF11. Throughout the current human pandemic, H9N2 has provided consistent influence as well. In the most recent sequences, a new trend is emerging as H9N2 accelerates to become a dominant contributor, especially on the cross-linked backgrounds.

If you’re able to review the idea of Influenza Flux at GeneWurx.com, you’ll begin to understand why an emergent contributor (H9N2) to a presently adapting viral reservoir is important. Every new combination presents the human immune system with a potentially separate challenge. An advancing Avian Influenza donor reservoir introduces new genetic material that is quite valuable to the virus, but quite dangerous to humans. Until the pandemic viral reservoir reaches a level of stability, an Omega state, the clinical outcomes may be highly variant with symptoms and outcomes that are beyond the normal parameters of seasonal influenza.

In a word, the pandemic virus is “confused”.

That’s what a pandemic is: a virus that doesn’t belong in humans, but really wants to belong. And, as you’ve seen, a pandemic reservoir is willing to do some work to become capable. This reservoir will continue to produce “confused” symptoms and “confused” outcomes until some reasonable stasis is achieved with the human host.

Yes, advancing H9N2 influence will be more of a problem. An accelerating donor pool from an Avian Influenza serotype is more likely than not to prolong the adjustment period.

Malaysia: Cluster & Deaths = 80

Cluster

54 yo (Mother)
Adm: 3/30
Notes: Diabetic
DOD: 3/31

29 yo (Daugher)
Adm: 3/30
Notes: Pregnant, baby saved, not infected
DOD: 4/2



March 02, 2010

Woman Latest H1N1 Death

KUALA LUMPUR, March 2 (Bernama) -- A 22-year-old woman died of H1N1-related illness at the Universiti Sains Malaysia Hospital (HUSM), Kubang Kerian, on Sunday.

Health Minister Datuk Seri Liow Tiong Lai said today the woman was admitted to the hospital on Feb 15 after having fever and cough for eight days.

She was treated at a private clinic and referred to the hospital the same day.

She was confirmed to be infected with Influenza A (H1N1) on Feb 16 and admitted to the intensive care unit (ICU) after suffering lung complications the following day, Lion said in a statement.

She died two weeks later and the cause of death was recorded as septicaemic shock with acute respiratory distress syndrome secondary to H1N1 infection.

Prior to this, the H1N1 death toll was 77.

Liow said although the H1N1 infection in this case was said to be secondary, it showed that although the spread of the disease was low, it could cause death if not treated early.

"Although not many H1N1 deaths occur now, the Health Ministry wants to stress that the disease is still active in Malaysia and hopes that the society will continue to adopt preventive measures to contain the disease," he said.

-- BERNAMA

hat-tip RoRo

Malaysia: H1N1 Cluster (Mother & Daugher) Die

UALA KUBU BARU: A 54-year-old woman and her 29-year-old daughter died of Influenza A (H1N1) related illnesses at the Malacca Hospital on March 31 and Friday respectively.

Health Minister Datuk Seri Liow Tiong Lai who confirmed the cases here Saturday, said both deaths were due to complications and were not direct H1N1 deaths.

Currently, the total H1N1 death remained at 77 cases, excluding the latest two cases, he told reporters after being briefed by the Kuala Kubu Baru Hospital staff.

Liow explained that the woman who had diabetes tested positive with the H1N1 virus when she was admitted at the hospital on March 31.

It was her diabetes, he said that had led to the complication of severe metabolicacidosis, causing an infection to the kidney and its eventual failure.

“Therefore, her death was due to diabetes complication,” he added.

The victim’s 29-year-old daughter was 36 weeks pregnant and was admitted on the same day at the hospital where she was diagnosed with Foetal Distress Syndrome. Later she showed symptoms of influenza-like illness (ILI) and tested positive with H1N1.

Urging the public not to panic, Liow said it was not a second outbreak of the virus.

He, however, said the ministry would issue a media statement every Wednesday or update on the situation to the media regularly.

“I hope everyone would take care of themselves and not to be in a crowd if they have fever and cough,” said Liow, reminding hospital management and medical officers to be on alert for suspected A(H1N1) cases.

Meanwhile, BERNAMA reported Education director-general Tan Sri Alimuddin Mohd Dom urging schools to take preventive measures to check the spread of A(H1N1).

“I urge schools to refer to the Education Ministry circular as the directive remained the same as that issued last year,” he told reporters after the opening of the National Co-curriculum Gala 2010 by Deputy Prime Minister Tan Sri Muhyiddin Yassin at Kem Tangok in Bachok, Kelantan here Saturday.

Alimuddin said the Health Ministry reported a rising trend for H1N1 since three weeks ago with 50 positive cases weekly.

Liow had said that there were 10 influenza like illness (ILI) cluster cases reported in Kelantan, Perak, Kedah, Selangor and Malacca last week.

They were at SK Selat Bagan Nyior, Pulau Dayang Bunting, Langkawi (48), SM Teknik Langkawi (43), Purnama Beach Resort, Pulau Pangkor (31) and SMK Langkawi Pulau Tuba, Langkawi (30 cases).

Hat-tip tetano

Malaysia: Schools Urged To Take Preventive Measures Against H1N1

2 hours 39 minutes ago

BACHOK, April 3 (Bernama) -- Director-General of Education Tan Sri Alimuddin Mohd Dom has urged schools to take preventive measures to check the spread of Influenza A H1N1.


"I urge schools to refer to the Education Ministry circular as the directive remained the same as that issued last year," he told reporters after the opening of the National Co-curriculum Gala 2010 by Deputy Prime Minister Tan Sri Muhyiddin Yassin at Kem Tangok here today.


Alimuddin said the Health Ministry reported a rising trend for H1N1 since three weeks ago with 50 positive cases weekly.


Health Minister Datuk Seri Liow Tiong Lai said there were ten influenza like illness (ILI) cluster cases reported in Kelantan, Perak, Kedah, Selangor and Melaka last week.


They were at SK Selat Bagan Nyior, Pulau Dayang Bunting, Langkawi (48), SM Teknik Langkawi (43), Purnama Beach Resort, Pulau Pangkor (31) and SMK Langkawi Pulau Tuba, Langkawi (30 cases).

Georgia (USA): Health officials urging H1N1 vaccination

Apr 2, 2010

By Johnny Jackson
jjackson@henryherald.com

State health officials are encouraging all residents to consider getting vaccinated against the novel Type-A H1N1 influenza virus.

H1N1 infection activity has been on an upward swing throughout the state this spring, according to Hayla Hall, risk communicator for District 4 Health Services, which includes Henry County. Hall said the virus has been associated with three deaths in Henry County alone, so far in 2010. The most recent death, a 51-year-old, occurred last week.

The Southeast region, compared to other parts of the country, has a smaller percentage of residents who have been vaccinated, according to a report released Friday by the Centers for Disease Control and Prevention (CDC).

The CDC’s Morbidity and Mortality Weekly Report revealed that during the period between October 2009 and January 2010, Georgia had the least H1N1 vaccination coverage among children ages six months to 17 years.

The report noted that Georgia’s rate of coverage for children during that window of time was 21.3 percent, compared to a nationwide median of 36.8 percent, and that only 15.3 percent of Georgia adults were reportedly covered by the H1N1 vaccine, compared to a 20.1 percent median.

Additionally, Georgia continues to be listed on the CDC’s Weekly Influenza Surveillance Report as one of a handful of states with regional influenza activity. Last week’s list included Alabama and South Carolina, both states having low rates of vaccination coverage among adults but higher coverage rates among children.

“The disease rates among children are high, but our death rates among adults — especially adults with underlying health conditions — are worrisome,” said Hall. “It is very important for people who are at high risk to get vaccinated.”

Hall said spring break is an opportune time for parents to have their children vaccinated against H1N1, and get the vaccination for themselves.

Health officials saw near-large scale H1N1 infections last spring and fall, and “we’re starting to see it coming back,” Hall said.

She said officials have continued to monitor the apparent rise in infections lately. She noted that the Georgia Department of Community Health recently reported 16 hospitalizations and one death associated with H1N1, for the week March 21-27.

The CDC recommends people practice good personal hygiene to stave off contracting H1N1, by washing their hands with soap and water, covering their nose and mouth when sneezing or coughing, and avoiding touching the eyes, nose, and mouth.

Residents can also find what facilities have the H1N1 vaccine available by using the Georgia Division of Public Health’s online H1N1 Influenza Vaccine Provider Locator, at http://health.state.ga.us/h1n1flu.

Malaysia: Mother, daughter die from H1N1 (2) articles

Apr 3, 10 4:39pm

The Health Ministry confirmed today the death of two persons, a mother and daughter in Malacca, from the Influenzae A(H1N1 virus) this week.

In a statement today, Health Minister Liow Tiong Tai said a 54-year-old woman was warded on March 30 with an 'Influenza-like Illness' (ILI).


Mother and daughter die of A(H1N1) illnesses
Saturday April 3, 2010 MYT 6:34:00 PM
By RACHAEL KAM
A woman and her daughter have died of A(H1N1)-related illnesses at the Malacca Hospital on March 31 and April 2 respectively, said Health Minister Datuk Seri Liow Tiong Lai.
More to come: http://thestar.com.my/news/story.asp?file=/2010/4/3/nation/20100403183943&sec=nation



map: http://www.malaysia-maps.com/malacca/

WHO Chart: Southern hemisphere circulation of influenza viruses

Graph produced: 30 March 2010

Malaysia: H1N1: Take precautions, people told

2010/04/03

By Annie Freeda Cruez

KUALA LUMPUR: At least 145 schoolchildren from several schools were reported to be suffering from suspected influenza A (H1N1) in another 10 new cluster cases reported within four days of this week.

Health Minister Datuk Seri Liow Tiong Lai said the cases whose victims, included primary and secondary school children, were reported in Kelantan, Perak, Kedah, Selangor and Malacca.

Another 48 victims included trainees at a national youth institute, residents in Jalan Jasin-Merlimau, staff of Purnama Beach Resort in Pulau Pangkor and workers of Madrasah Bustanul Ulum Abu Bakar in Malacca (see table).

Throat swabs have been taken from all of them who came to government hospitals and health clinics with influenza-like illness (ILI) to ascertain if they were victims of H1N1.

In view of many cluster cases, especially among schoolchildren and those in institutions, Liow called on parents to adhere to the following measures, namely:

- Schoolchildren with fever, cough and sore throat must get immediate medical treatment and remain at home. They are not to go to schools or universities. These students can only go to schools or colleges once they have fully recovered;

- They must wash their hands regularly with soap and water;

- They must cover their mouth and nose when coughing or sneezing and use face masks to avert spread of fever, cough and sore throat to other family members;

- They must adhere to the cough and sneeze etiquette at all times by using tissue or handkerchief. Throw used tissues into the rubbish bin and do not share used items with others, and;

- Take plenty of fluid, eat a balanced diet and have enough sleep.

Liow urged those who came in contact with people with H1N1 or ILI to adhere to social distancing, besides washing their hands with soap and water or using hand sanitisers after coming into contact with patients and touching things in public places.

"I call on the people to lead a healthy lifestyle by doing regular exercise, eating healthy and nutritional food, drinking lots of water and ensuring they have sufficient sleep."

He said those in the high-risk category, especially pregnant women and children, should take extra precautions so as not to be infected.

He also cautioned kidney failure patients, those with chronic diseases and individuals with morbid obesity to get themselves vaccinated against H1N1.

"High risk group people can get themselves vaccinated at any of the 104 government facilities," he said, adding that front liners must ensure that they were protected against the disease.

Liow reminded Malaysians that due to limited doses of vaccination available, it was on a first-come-first-serve basis.

"I must stress that the virus is still spreading very actively in Malaysia although the situation is still under control.

"It's important that Malaysians take all precautions to prevent being infected with the disease."

He added the pandemic was seeing an increase during the past three weeks, with an average of at least 50 positive cases being reported every week compared with 20 cases a week in January and February. Between May last year and April 1, a total of 12,688 people were infected with the diesease.

As of Thursday, 380 people had been warded in hospitals nationwide, with 32 of them confirmed positive for H1N1.

The death toll stands at 77.

Malaysia: H1N1 - Third Kedah school told to close

2010/04/02

LANGKAWI: Sekolah Menengah Teknik here has been ordered closed for three days from yesterday after 86 of its 616 students showed symptoms of influenza-like illness (ILI).

The school is the third in Kedah to do so to prevent a possible spread of the virus, a state health department said.

On Wednesday, SMK Langkawi Pulau Tuba and SK Bagan Selat Nyiur, both in Langkawi, were ordered closed for five days days after a number of their students showed symptoms of ILI.

Symptoms of influenza A (H1N1) and ILI are similar and they include fever, cough, sore throat, body ache, headache, chills and fatigue with some reporting diarrhoea and vomiting.

Malaysia: H1N1 - Health Ministry on high alert

Alert over new cluster cases
By Annie Freeda Cruez
KUALA LUMPUR: New influenza A (H1N1) cluster cases have been detected throughout the country, putting the Health Ministry on high alert. And for the first time, staff of a government hospital were also infected.

Between March 21 and 27 alone, 83 people in Selangor, Malacca and Terengganu were found to have the virus.

Health director-general Tan Sri Dr Ismail Merican said these cluster cases indicated that the H1N1 virus was still active. He, however, said the situation was under control.

Of the 83 people, 15 were staff of Hospital Serdang in Selangor, Sime Darby Merlimau Estate in Malacca (16), Madrasah Tahfiz Raudatul Muslihin Masjid Tanah in Malacca (31), IKM Jasin Malacca (7), Rumah Anak Yatim Vidyalaya Kuala Kubu Baru (9) and Sekolah Menengah Agama Rantau Abang in Dungun, Terengganu (5).

Dr Ismail said clinical analysis of throat swabs taken from confirmed victims of the disease showed no signs of a second wave.

However, the risk of a second wave among the people was still high due to them being susceptible to the infection.

On March 27, 371 people were admitted to 38 government and seven private hospitals nationwide with influenza-like illnesses. Of the total, 25 were found positive for H1N1 and eight are in the intensive care unit.

No new deaths have been reported.

Dr Ismail also called on the people to alert the nearest district health departments if they know of individuals or cluster of people with symptoms of the disease.

On the Kuala Kubu case where 59 pupils of Sekolah Jenis Kebangsaan (Tamil) Kuala Kubu Baru were placed in home quarantine after 47 were found with H1N1, he said only one was confirmed positive.

Two pupils are waiting the outcome of laboratory results while another 15, who were admitted with influenza-like illness, were discharged and were now in home quarantine.

Thirty-five other pupils have recovered from their illness but have been told to return to hospital if they had a recurrence of the symptoms.

"Parents of these pupils have been told to closely monitor them."

Malaysia: H1N1 Cases On The Rise

April 02, 2010 22:23 PM

KUALA LUMPUR, April 2 (Bernama) -- The Influenza A(H1N1) pandemic has shown signs of a resurgence, with an average of 50 cases a week in the past three weeks compared to 20 cases per week in January and February, Health Minister Datuk Seri Liow Tiong Lai said.

There were 12,688 cases reported so far this year, he said in a statement.

He said 380 patients with Influenza-like Illness (ILI) were still being treated in hospitals nationwide but the death toll remained at 77.

"Throughout the week, 10 ILI clusters have been reported in Kelantan, Perak, Kedah, Selangor and Melaka," he said.

As the clusters involved mostly schools, Liow advised students and their parents to practice preventive measures and seek early treatment should they experience ILI symptoms.
-snip-

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Vietnam: 25 yo Hanoi: Battle for survival for pregnant women three times 'encounter' death

She and her husband on the Marine Institute, with grandmothers and boys more than 4 months


Excerpt:

The patient rooms are always three doctors on duty day and night, regularly monitor indicators, adjust all sorts of machines plugged into the patient. Not to mention large numbers of foreign health workers in disease prevention and ran off to get supplies ... Hundreds of health workers to join treatment cases.
-snip-
According to Associate Professor Nguyen Gia Binh, the patient was saved thanks very much on the method of continuous dialysis with special effect filters, a new method of Japan. Prior to the survival of patients, doctors decided to try this new approach to the internal adsorption toxin circulating in the blood, reducing the inflammatory reaction and damage organs.

He also said that this method is widely used in Japan, treatment of all infections, viral ... However, this is the first application on bird flu patients.

"A patient's survival will open a new direction in the treatment of patients with multiple organs failure due to infection of H5N1, H1N1 ... The death rate in patients with multiple organs failure is very large, up to 90 %, even 100%, "said Associate Professor Binh

However, the cost of this technique is also very large, each filter costs $ 3,500, but patients often use 3-5 per fruit. In the case of patients Cards, treatment costs up to $ 10,500, equivalent to 200 million.

However, patients will be completely free, as prescribed by the Ministry of Health. While the filter is located in specialized hospitals cooperation project with Japan, should also free.

Vietnam: Survival of patients severe influenza A/H5N1 by dialysis

[A bit more on the 25 yo from Hanoi, that successfully beat H5N1]

(02/04/2010)
Dan - good luck this case the patient T. Nguyen Thi Thu (25 years) in Soc Son, Hanoi. This is influenza A/H5N1 patients had complications viscera failure was saved by using results filtering method was first applied in Vietnam.

Ms. T. infected after the family discovered dead chickens culled away. However, after five days to onset of symptoms of cough, high fever, severe shortness of breath, the pale, she moved to New Bach Mai Hospital (on 10-3).

The tests showed that the disease has turned the organ failure: respiratory failure, circulatory failure, kidney failure, blood clotting disorders, metabolic disorders, severe infections.

In the treatment of patients influenza A/H5N1, scientists have warned very clearly: Tamiflu works well when used within 48 hours after virus penetration body. Accordingly, Dr. Nguyen Gia Binh - Dean of intensive care, Bach Mai hospital - because she said T. too late to hospital, five days after the influenza A/H5N1 virus, so treatment with antiviral drug Tamiflu have very little effect. Not to mention, with a weak condition after birth (she is raising children Vol 3 months), patients face a high risk of death.

The doctors have decided to combine the treatment with Tamiflu use continuous dialysis method, using special filtering effect adsorption of toxins in the blood reduces the inflammatory response.

After 10 days of treatment, patients used three filtering effect and gradually recovered health. This morning, Ms. T. was discharged.

This is influenza A/H5N1 patients had complications viscera failure was saved by using results filtering method was first applied in Vietnam. It is known that adsorption filter result is the invention of Japanese scientists, effects and filters to keep the toxins circulating in the blood, reduces the organ injury. Price per fruit is 3.500USD filter.

U.S. influenza vaccination programs require further expansion

April 1, 2010
Coverage with the influenza A (H1N1) 2009 monovalent vaccine was less than 40% among health care workers in the United States, and varied considerably from state to state in the public, according to two CDC reports published today.

Data for the 2009-2010 influenza season indicated that among a nationally-representative cohort of 1,417 health care workers, seasonal influenza vaccination coverage was 61.9%, and influenza A (H1N1) vaccination coverage was 37.1%. The findings were published in the Morbidity and Mortality Weekly Report.

Occupational requirements for vaccination were linked to a three- to eight-fold increase in coverage, CDC officials wrote.

The seasonal vaccination coverage rate among health care workers was the highest ever, but it is still not sufficient, according to CDC officials. CDC recommends that influenza vaccination coverage should be prioritized by health care administrators.

A second analysis in the same issue examined influenza A vaccination uptake data from the Behavioral Risk Factor Surveillance System and the National 2009 H1N1 Flu Survey.

Data collected by CDC from November 2009 through February 2010 indicated that as of the end of January 2010, 23.9% (range, 12/9% to 38.8%) of U.S. adults and children older than 6 months had been vaccinated against influenza A (H1N1).

Among children aged 6 months to 17 years, coverage was 36.8%. For adults 18 years old or older, the rate was 20.1%.

State-by-state analysis indicated that coverage ranged from 19.4% in Mississippi to 57.5% in Rhode Island.

Harris KM et al. MMWR. 59:357-362

Lu PJ et al. MMWR. 59:363-368

Georgia: Coweta - Children hospitalized with breathing troubles

April 01, 2010

Coweta County authorities remain unsure what caused three children in the Shoal Creek neighborhood to have breathing difficulties and end up in an Atlanta hospital Wednesday, two of them flown by helicopter ambulance.

The Coweta County Fire Department's Hazardous Materials unit was dispatched to 153 Hazel Ridge Drive, in the neighborhood off Highway 34 East, after receiving reports that three children may have stopped breathing, according to Assistant Fire Chief Todd Moore.

"We don't receive these type of calls every day," said Moore. "From a fire department standpoint, we were initially looking at a possible environmental-type emergency."

Upon their arrival, they found the children conscious and ambulatory. They were immediately placed into awaiting ambulances for further evaluation.

The Haz-Mat crews used air monitors to check the residence for explosive gases and volatile organic compounds but found none, according to the assistant fire chief.

Two of the children were flown by air ambulance to Children's Healthcare of Atlanta hospital while the third child was transported by ground ambulance to the same location, according to Moore.

The incident also remains under investigation by the Coweta County Sheriff's Office.

Sheriff's Major James Yarbrough said Wednesday that sheriff's office officials remain unsure what caused the children's breathing difficulties. No criminal charges have been filed.

Georgia: H1N1 District 4

10 locals hospitalized for swine flu since May
March 31, 2010

Georgia is seeing a spike in swine flu hospitalizations, Associated Press reports. Georgia has recorded the most hospitalizations in the nation for three straight weeks.

"We are keeping up with the numbers," said Hayla Hall, spokesperson for District 4 Health Services.

"We have had 70 hospitalizations since May 2009" in District 4, she said. Ten of those were Coweta residents, she said.

"We have had 11 total deaths for the district since May 2009," said Hall. "Six of the 11 have occurred since January of this year. Two Coweta residents have died from influenza-associated illness."

One passed in October 2009, the other died earlier this month.
-snip-
"Unfortunately the increase in hospitalizations is in older adults with underlying medical conditions."
-snip-
There have been a total of 1,012 H1N1 hospitalizations and 72 influenza associated deaths in Georgia since April 2009.
-snip-

District 4
District 4 Public Health promotes wellness and protects the health and wellbeing of all people who live, work, and play in Butts, Carroll, Coweta, Fayette, Heard, Henry, Lamar, Meriwether, Pike, Spalding, Troup and Upson Counties of Georgia.
http://www.district4health.org/

U.S. Georgia: H1N1 On The Rise (3 articles)

H1N1 flu on the rise in the Georgia

Florida, Georgia, and Alabama are the three states on the CDC’s radar because of adult hospitalizations from the H1N1 flu

By Romney Smith
Tuesday, March 30, 2010 at 9:39 p.m.

The Center for Disease Control says adults in Georgia who are not diagnosed against the H1N1 virus are being hospitalized at the highest rate in the country.
The CDC is helping the Southwest Georgia Health Department investigate why so many adults are being hospitalized with the H1N1 flu. The CDC is looking at items like vaccination status, sex, race, underlying health conditions, and more to figure out if a pattern exists.

Dr. Brenda Greene with the Southwest Georgia Health Department has a theory on why we may be seeing an increase in hospitalizations. “We saw a lot of H1N1 in the fall and by the time the vaccine arrived people didn’t seem as alarmed by it because it had been circulating for quite some time at that point. That’s our theory at the moment, but we have no assurance of that” says Greene.
-snip-
http://www.mysouthwestga.com/news/story.aspx?id=437145


Rates of US Pandemic Influenza Vaccination Are Lowest in the South
April 1, 2010
At the end of January, 21.3% of the children of Georgia had been vaccinated against the pandemic A (H1N1) influenza virus, the lowest such immunization rate in the nation, the US Centers for Disease Control and Prevention (CDC) announced today.

In addition, when it comes to all individuals who were vaccinated, Georgia ranked fifth from the bottom, at 16.6%.

Lower vaccine uptake in Georgia and other southeastern states may help explain why the pandemic virus has produced an upswing in disease and hospitalization there over the past 2 months, Anne Schuchat, MD, director of the National Center for Immunization and Respiratory Diseases at the CDC, said at a press conference today. However, Dr. Schuchat noted that the rebound of the virus in that region also may represent the "third wave" of disease that public health officials have feared.

"It's possible (the rebound) is a herald for other states," she said.

Nationwide, the median vaccination rate for pandemic influenza was 23.9% for all individuals, 20.1% for those aged 18 years and older, and 36.8% for children aged 6 months to 17 years, according to the April 2 issue of the Morbidity and Mortality Weekly Report. The performance of individual states and regions varied widely. Rhode Island led the country, with an immunization rate for all individuals of 38.8% — 3 times that of Mississippi, which ranked last. The highest rates in all 3 categories occurred in New England, and the lowest in all categories were in the 5-state region consisting of Arkansas, Louisiana, New Mexico, Oklahoma, and Texas.

The southeastern states, including Georgia, posted the second-worst immunization rate for all individuals, at 20.1%. Georgia's neighbor Alabama had a total immunization rate of 15.7%, tying the state with Missouri for third worst.

Georgia, Alabama, and South Carolina have experienced a recent uptick in influenza-related illness, reporting regional influenza activity for the week ending March 27 that was one step below widespread activity. Hardest hit is Georgia, which has had more pandemic-related hospitalizations than any other state lately, and the most it has experienced since last October, when the virus was producing its second wave of illness nationwide. Since December 1, the virus has caused 357 hospitalizations and 22 deaths in that state, Dr. Schuchat said Thursday.

One reason why vaccination rates might be lower in Georgia and other southeastern states is that the second pandemic wave hit that region earlier than it did the rest of the country, Dr. Schuchat explained. By the time the pandemic influenza vaccine became available in large quantities, the wave had already passed, and demand for the vaccine waned as a result.
Morb Mortal Wkly Rep. 2010;59:363-368.
http://www.medscape.com/viewarticle/719680


West Georgia Flu Update: 39% of People Hospitalized Require Breathing Machines to Stay Alive
April 1, 2010

New data shows that nearly 40 percent of those hospitalized for flu illnesses in West Georgia require breathing support to stay alive, according to Pam Fair of the West Central Health District.

It is mostly those with chronic illnesses that end up hospitalized for flu in West Georgia.

This news comes as the rest of the state has seen record highs in hospitalizations since September, outpacing the rest of the nation. Most of those hospitalized are unvaccinated adults.

Free H1N1 vaccines are still available at the health department: 2100 Comer Ave., 2nd Floor, in Columbus.
http://www2.wrbl.com/rbl/news/local/article/west_georgia_flu_update_39_of_people_hospitalized_require_breathing_machine/142227/

Rapid Development of Drug-Resistant 2009 H1N1 Influenza Reported in Two Cases

For Immediate Release
Friday, March 26, 2010

Reevaluation of Treatment Strategies for Prolonged Infection Urged
Two people with compromised immune systems who became ill with 2009 H1N1 influenza developed drug-resistant strains of virus after less than two weeks on therapy, report doctors from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. Doctors who treat prolonged influenza infection should be aware that even a short course of antiviral treatment may lead to drug-resistant virus, say the authors, and clinicians should consider this possibility as they develop initial treatment strategies for their patients who have impaired immune function.

Both patients described in the new report developed resistance to the key influenza drug oseltamivir (Tamiflu), and one also demonstrated clinical resistance to another antiviral agent, now in experimental testing, intravenous peramivir, note senior authors Matthew J. Memoli, M.D., and Jeffery K. Taubenberger, M.D., Ph.D. This is the first reported case of clinically significant peramivir-resistant 2009 H1N1 illness, say the scientists. The report is scheduled to appear in print on May 1 in Clinical Infectious Diseases and is now online.

The people in the current case report had immune limitations due to blood stem cell transplants that occurred several years previously. Both recovered from their influenza infections.

"While the emergence of drug-resistant influenza virus is not in itself surprising, these cases demonstrate that resistant strains can emerge after only a brief period of drug therapy," says NIAID Director Anthony S. Fauci, M.D. "We have a limited number of drugs available for treating influenza and these findings provide additional urgency to efforts to develop antivirals that attack influenza virus in novel ways."

The 2009 H1N1 influenza virus is susceptible to just one of the two available classes of anti-influenza drugs, the neuraminidase inhibitors. Besides oseltamivir, other neuraminidase inhibitors are zanamivir (Relenza), which is inhaled, and the intravenously administered investigational drug peramivir. As the H1N1 influenza pandemic unfolded, laboratory tests of virus strains isolated from patients showed that some strains contained a genetic mutation (the H275Y mutation) that makes the virus less susceptible to some neuraminidase inhibitors.

The two people in the current case study had pre-existing medical conditions that impaired their immune system function before contracting 2009 H1N1 flu. Strains of 2009 H1N1 influenza containing the H275Y mutation had been reported previously in people with diminished immune function, but in previous cases the mutation arose after more than 24 days of continuous therapy. In the newly described cases, the mutation appeared after 14 days in one individual and after nine days in the second.

"Although the recommended length of treatment with oseltamivir is five days, it is common for physicians to continue giving this first-line drug longer if the patient does not improve," says Dr. Memoli.

Both people in the current report received oseltamivir for extended periods but they continued to shed virus in their nasal secretions throughout treatment. When one patient’s condition worsened despite 24 days of oseltamivir treatment, doctors administered peramivir for 10 days. The drug did not reduce viral shedding and the patient remained ill, demonstrating what the authors described as clinically significant resistance to peramivir. Next, doctors administered the only other available flu drug, zanamivir, for 10 days. The person then fully recovered.

"Additional, larger studies are needed to further refine our findings,” says Dr. Memoli. “But these cases of rapid appearance of drug-resistant 2009 H1N1 influenza in immune-compromised patients are worrisome and should prompt clinicians to reconsider how they use available flu drugs."

The mutation that allows 2009 H1N1 to resist oseltamivir also significantly reduces the virus's susceptibility to peramivir. If a relatively short course of oseltamivir causes a mutant flu strain to emerge in a particular patient, that person may not respond to peramivir. Zanamivir might be a good choice if a patient does not respond within a few days to oseltamivir, Dr. Memoli says. However, because zanamivir must be inhaled, patients who are very ill and whose breathing is mechanically supported cannot be given zanamivir.

"As clinicians, we should carefully consider our treatment options and use all the drugs available to us wisely. This is especially important in a patient with prolonged infection or when an antiviral drug fails to cure the patient after the recommended course of treatment," says Dr. Memoli.

NIAID scientist Rachel J. Hrabal contributed to this study along with Arash Hassantoufighi and Maryna C. Eichelberger, Ph.D., of the FDA.

Bird with H5N1 virus found in Bulgaria

Apr 1, 12:00 PM EDT

SOFIA, Bulgaria (AP) -- A dead bird found near Bulgaria's Black Sea port of Varna has tested positive for the deadly H5N1 virus, officials said Thursday.

The Agriculture Ministry said the tests on a common buzzard were conducted at the national veterinary.

No other cases of the highly pathogenic H5N1 strain of avian influenza were detected in Bulgaria, but farmers were alerted to the risks of transmission by migratory and wild birds.

-snip-

Tokoyo - international symposium on influenza pandemics

Excerpt:

The Philippines had the third lowest number of deaths per 100,000 population among 31 countries hit by the pandemic, according to a presentation by Dr. Hitoshi Oshitani of the Tohoku University Graduate School of Medicine, a co-organizer of the symposium.

Oshitani warned that governments and societies cannot afford to relax now. The history of past pandemics showed that they occurred with irregular intervals of 30 to 40 years, but if “pseudo-pandemics” will be included in the count, that would mean more frequent intervals of 11 to 18 years.

He reminded that the H5N1 influenza virus that spread in 2004 to 2008 is “still circulating” in certain bird species “and causing sporadic human cases.”

He said pandemic threats could come from H5N1 and 4 other subtypes of the swine and avian flu viruses (H9N2, H2N2, H2N1, and H7N7). “The next pandemic can be more virulent,” Oshitani warned.

Oshitani noted that “there were still many gaps” in responses to the pandemic, among them the unavailability of vaccines when the virus arrived and spread.

-snip-

Diversified reassortant H9N2 avian influenza viruses in chicken flocks in northern and eastern China.

Virus Res. 2010 Mar 25. [Epub ahead of print]

Huang Y, Hu B, Wen X, Cao S, Gavrilov BK, Du Q, Khan MI, Zhang X.

Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Science, Jinan, Shandong, 250001, China;; College of Veterinary Medicine, Sichuan Agriculture University, Ya'an, Sichuan, 625014, China;

According to our previous study of the M genes of H9N2 avian influenza viruses (AIV) in infected chickens, A/Quail/HongKong/G1/97 (G1 97)-like M genes newly emerged in northern and eastern China in addition to the existing A/chicken/HongKong/Y280/97 (Y280)-like lineage M genes. To systematically track the genesis and evolution of H9N2 viruses in this region, whole genome sequences of seventeen H9N2 isolates were obtained and their phylogenetic properties were determined. Phylogenetic analysis revealed several newly emerged lineages of gene segments in addition to the Y280-like and A/chicken/Shanghai/F/98(F 98)-like lineages, which are prevailing in northern and eastern China according to previous reports. Reassortments among these gene segments generated five novel genotypes of H9N2 viruses that have not been reported before in China. The emerging genotypes of H9N2 viruses in this region indicate that H9N2 virus genes undergo active evolution, particularly their internal genes, which raises concern for their likely contribution to gene reassortment and production of AIVs with new properties. Our study provides valuable insight into the prevalence of H9N2 viruses in northern and eastern China and demonstrates the need of long-term monitoring of the evolution of H9N2 AIV.

Copyright © 2010. Published by Elsevier B.V.

PMID: 20347894 [PubMed - as supplied by publisher]

Is the Pandemic Influenza Reservoir Stable?

2010-03-31
Zoonotic H9N2 Avian Influenza Further Destabilises Pandemic Genetics

Is the Pandemic Influenza Reservoir Stable?

If you enjoy counting, even measuring by observation, please continue reading.

But you must realize that the iota, the jot and even the title, will be considered of value in this forthcoming exercise. If fact-finding (science) is too tedious for you, please direct your attention to any of the many “Science for Hire” venues where illogical, but comforting, summations are drawn from cleverly manipulated data streams. Science sells today. But we sometimes speculate that science is becoming just another sell-out, an industry pursuing profit over knowledge?

Leading public health officials continue even today to indicate that the pandemic virus is unchanged.

Ongoing worldwide studies duplicated by independent, geographically dispersed laboratories, including the labs of those noted public health officials, indicate that a single polymorphism may produce a significant outcome within a Pandemic Influenza reservoir. Numerous accounts of important revisions are on record across a vast geography. 225G has produced a Vaccine Escape event in LvivN6, an elevated Case Fatality Rate and a substantial number of severe outcomes. Individual changes between 157 and 159 have also demonstrated “low reactor” status and registered as Vaccine Escape events. 230I entered the H5N1 Gharbiyah cluster in Egypt and the resultant Case Fatality Rate was 80% for that strain, a substantial increase from the accepted H5N1 CFR.

Three separate single genetic changes are well characterised in leading to various forms of Anti-Viral resistance. TamiFlu Resistance has now dispersed widely in a pattern following the rapid spread of resistance in seasonal influenza via the same Single Nucleotide Polymorphism coding for 275Y on the Neuraminidase. Emergent and attractant H1N1 strains (Triple Reassortments again) co-circulating alongside the pandemic reservoir also carry 275Y. H5N1 inclusions increase in the pandemic reservoir with a continuous flow. The PB2 627K is confirmed as leading to increased replication speed in humans and has recently been documented in a second pandemic sequence. As we have maintained from the beginning of this pandemic, TamiFlu Resistance and 627K are foregone conclusions according to our calculations.

Our team noted an increase in Avian inclusions and recently predicted HA 230I for ΣPF11. The polymorphism was documented last week in Wisconsin (US) on a background that does not deter transmission. The geographic area has a notable increase in cross-linked activity. The individual sample, A/Wisconsin/629-D00337, is primed for spread with 2 additional HA markers, 275A (TX, NM, CA and Sweden) and 377K (aggressively emerging). The NA carries 220K, a marker found on one cross-linked sequence from the Ukraine and across a wide US geographic pattern from December 2009 to the most recent 2010 sequences (North Carolina, New Hampshire, Wisconsin and Nebraska). We consider the Wisconsin0337 sample to be an excellent candidate as a universal donor of sorts due to limited polymorphisms and the fact that each revision is currently an emergent change.

Given this information, obvious questions begin to form. If one genetic change may potentiate variant clinical outcomes, drug resistance or Vaccine Escape, what is the potential for multiple changes producing a variant outcome? And if a single genetic change and/or multiple changes are capable of producing large changes in behaviour, should we, in turn, have a very high and accurate level of surveillance on this reservoir? And what should we do with that important information? Should our public health officials speak from a platform of candor and accuracy when carrying out the responsibilities of their trusted positions?

Let’s investigate now if the viral reservoir is, in fact, unchanged?

More than 80% of the Hemagglutinin positions between 188 and 244, including antigenic areas of the RBD, are on record as polymorphic. Many positions rate multiple changes. Tracking these revisions against various baselines has informed our studies over the past year. One particular range of those variations is documented in the trailing data. For the sake of brevity, only one section of the HA gene segment is discussed. The list is certainly not comprehensive.

The positional summary may perhaps be instructive for those who hold the belief that the pandemic reservoir is stable. The report may provide reversing guidance for those who make public statements to the effect that pandemic H1N1 is not changing. Repetition of their “All Clear” social messaging cannot reverse the weight of the actual data. Repetition of an untruth does not create a fact, but that ongoing strategy of repetition is apparently very effective in managing the perception and manipulating the belief of the unsuspecting public.

The viral reservoir backing this present pandemic is far from stable and is actively acquiring new genetics. Current data does not indicate an immediate direction toward stability.

As is the nature with an IDRREAV, the positions reported here will not necessarily be the most important amino acid positions in the future. The reservoir will evade immunity and escape vaccine by heavily self-revising in the near future at key locations between 131 and 182 (emphasis at 155 to 177). Variation will occur with lower penetration at the head of the HA and from 272 downstream approximately 55 positions. Potential is very high that 22I will achieve density in one or more sub-clades. Expect 100N to spread and penetrate initially on sub-clades without the 22I appearances. South American polymorphisms from their fatal mid-pandemic strains of 2009 will recycle into the United States and other Northern Hemisphere nations with substantial thrust in the coming 90 days. Acceleration of the Avian based cross-linking will continue in the Western world.

Bear in mind also that a solid portion of the changes documented in this current list will become fixed even as additional donations are accumulated. The zoonotic movement from birds into human PF11 sequences is earnestly progressing in the most recent 45 days of available data. Several polymorphisms, HA and NA, from the Georgia hospitalization resurgence may have originated in Avian Influenza samples. Expect continued acquisition from Avian H5N1 and H1N1, and also watch the acceleration from one particularly new Avian donor serotype. H9N2 demonstrated a human jump in late 2008 and has very recently become fully engaged in ΣPF11 genetics with a well-defined etching on the newest cross-linked sequences. The reservoir flux will also be influenced by Swine H1N2 and H1N1 (emphasis on 3 particular emergent strains).

Is the Pandemic Influenza Reservoir Stable?

You decide . . .

188N SC16, SC31, NY3502, MA15, CatS1187, Milan433, Japan, S5
188I Growing in US on cross-linked background (4), BZSP53823
189V Sydney2503
189T Growing on US cross-linkage (4), H5N1 2009, H9N2 2008
189A synonymous (GCc), Georgia01_2010, swOR4060
190D synonymous (GAt) Milan326, 1918
190Y SwedenMalmoe1_2010_01_01
191R Chengdu18 (129P)
192Q synonymous (CAg) RomaISS50, Nebraska01_2010
193S synonymous (AGc) SC18, US 2010 (3), Milan294, Japan, H9N2
193G AR08
193N Washington72, H9N2
194I NC38E3, VA27, SC18, Bangladesh3009, StPete59, StPete99
194L synonymous (CTa) Japan4081
196Q synonymous (CAa) Wisc (3), Malaysia (2), Milan326
197T Malaysia4039
198V Malaysia5283, Malaysia9117
199N Milan80, Milan83
199D synonymous (GAc) swine Illinois, H5, H9N2
200T FL31, Asia (13), MilanUSHR1, H5, H9N2
200S NC57, SC46
201H Wisc1140, Darwin2140
202A MXinDRE797 2010 TmX, IA14, KY25, HK34360
202V synonymous (GTc) YAMAGATA778, YAMAGATA803, swIllinois
204V synonymous (GTa) PA31, SHIZUOKA1573, 1918, S7
205G synonymous (GGa) Texas76C2, S5, H9N2 (GCa)
206A CatS1161
206T Extensive
207S synonymous (TCg) California01_2010
208K US, UK, HK, MX, Italy (2), Australia (12), Asia (3), swOR4060
208S Australia43, Australia45, ChukkarH6N1
208G NY6292
208T Norway3440
210S synonymous (AGt) Bogota0466N, Malaysia9131, H9N2 (Aat)
210N Texas76C2
211K synonymous MXinDRE50617 (225G)
211R swOR4060_2009_12_31, 1918
212R swOR4060_2009_12_31, 1918
212E Vlad01 (225G), Argentina8574_41, IN21, Malaysia4039
212N MA15
212T Anadyr177_F (225G), CA07X179, CA07X181
213L TX15
213F synonymous StPete99 (225E)
214E Kurgan01, Moldova (3), swOR4060_2009_12_31
214N ENG92960012, SHIZUOKA1514
214Q Wisc0936 (237L)
214K synonymous (AAa) CatS1937, NM13, ENG620, China22811
215P synonymous (CCa) SC33, Eng616, GuangdongyunchengSWL51
215P synonymous (CCt) NY_WC37RG, MO02
216E synonymous (GAg) Moldova (4), Belarus, Bosnia (3, 225G), Indiana, H9N2 (GTg), tn
218A synonymous (GCg) Belarus, H9N2 (GGg)
218E Texas77 (159S, syn173G, 275A, 377K, 454I)
218T Hiroshima201 (225G)
218V GuangdongyunchengSWL51, Malaysia (2 mix wt) (GtA)
218V swIll02930, 2931, 2932, 2937 (2009-12-29, 30) (GTc)
219I synonymous Ancona451_F, Lyon2490
219T Wisc0134 (225E), RomaISS223, swOR4060_2009_12_31
220R synonymous (AGg) Mexico476, Malaysia9451
223V synonymous (GTa) Utah59
223M CA33
224K SC18_VxX
224M NY5186
225N BZ_SP53838, Ukraine mix wt, Victoria2125, Malaysia8860 et al
225E Extensive on multiple backgrounds
225G LvivN6_VxX with syn413K, UkDnip273 (GgT mix wt), H9N2
225G RomaISS1897 & 1941, EgyptVacsera138 (300S) ex225E (Gga)
225E+226R Russia (3), GermanyBY74, swMX4
226R Trabzon01 (Turkey), et al
227A swOR4060_2009_12_31, 1918
227V RomaISS50
227G Utah20 with wt mix
229R synonymous (AGg) swMX04 (225G, 226R)
230I Wisc0337_2009_12_15, H5 Gharbiyah 80% CFR, H9N2
231D Ankara05, OSAKA2143, H9N2 2008
231N CalifVRDL36
231K Wisc0853, Wisc1915, Wisc2337
232Y synonymous (TAc) Florida30, PuertoRico51, H9N2, H5, S9, S7, M7, Sask
233Y synonymous (TAt) AthensINS85, Hiroshima645, H9N2 2008
233H NC Duke (5, wt, 225G, 225N), AZ17 & Australia6
235A CatNS7632, CalifVRDL55
236V Eng93120020, ENG645, H9N2
237I Cal_SDINS69, England (2), Russia (4), Asia (2)
237L Wisc0936 (214Q), 1918, H5, tn
237V synonymous (GTg) Pennsylvania31, H9N2 (TTg), M7 (CTg)
238D Kaliningrad01 (225E+226R), tn
238K Wisc2485 (225E), Spain (2), China, swOR4060, H5, H9N2 2008
238E synonymous. Extensive and recently growing
239P synonymous (CCt) ENG621, swOR4060_2009_12_31
239P synonymous (CCa) Ancona508PG, Russia180, Australia60
240G synonymous (GGg) DC_INS24, H9N2, S9, S7, M7, Sask
241D synonymous (GAt) CatS1943, tn
241G NH17, ENG93040048
241E China22811
242K synonymous (AAg) swOR4060_2009_12_31
244I ThaiCU_H9
244T synonymous (ACt) CatS1935, CatS2120

The truth is in the sequences.

Vietnam: 25 yo Hanoi survives H5N1

Mothers infected with influenza A/H5N1 think most survived viscera

(VNA) - Hospitalized in a state of high temperature 41 degrees, severe respiratory distress, heart palpitations, blood pressure dropped and then the organs but think most 25-year-old mother survived spectacular.

Bach Mai Hospital director Nguyen Quoc Anh ca survival has notified the magic of young mothers, aged 25, is nursing a child under three months, in Soc Son Ha Noi.

On 10 / 3, she was transferred from T North Thang Long Hospital intensive care to the Department, Bach Mai Hospital in critical condition: 41 degrees high fever, severe respiratory distress (severe difficulty breathing, pale) ; Find fast, circuit 120 -130 times per minute; 80-90/60 mmHg drop in blood pressure. Although the ventilation via mask with high oxygen concentration, combined with intravenous fluids and medications to improve blood pressure vasomotor T but she still worse developments. Blood oxygen levels of patients down very low, 43 mmHg (typically less than 50 mmHg are at risk of death). The disease has variable viscera failure: respiratory failure, circulatory failure, kidney failure, blood clotting disorders, metabolic disorders, severe infections.

In addition, the lungs of patients with severe injuries, forced to use breathing apparatus to replace however, patients who have complications from emphysema, pleural hydrocephalus in again hinders the use of breathing apparatus. In addition, the weak condition after birth, for the treatment of numerous difficulties encountered.

Prior to the survival of patients, doctors decided to use continuous dialysis methods used specifically to filter results of internal adsorption toxin circulating in the blood reduces the inflammatory reaction and damage the agencies. Also, the hospital also uses the treatment of organ support machine breathing assistance, set up and smoking pipes continuously to ensure no accumulation of gas in the pleural cavity of the threat of respiratory diseases Human; combined support liver, kidney support, anti-clotting disorders, anti-infective, antiviral drugs, raised ...

After 7 days of treatment, and three times the risk of death, respiratory failure and the status of organ failure of patients has gradually improved. And to day 10, the body (heart, lungs, liver, kidneys, blood coagulation ...) return to normal. The function of life support machines for T patients were completely removed. Ms. T was drama of danger.

The test of Hygiene and Epidemiology Institute said patients infected with influenza A/H5N1 T but treatment with antiviral drug Tamiflu have very little effect because the patient to hospital too late (5 days). Thus, the survival of T is her hope to the doctors in treating cases of influenza A/H5N1 later.

hat-tip Treyfish

Health Experts: Holistic Disease Tracking, Response Would Improve International Security

March 31st, 2010- by Homeland Security Blogwatch

America needs to start treating international health work as less of a charity and more of a national security priority or face the threat of conflict with poorer countries, experts said at a U.S. Institute of Peace discussion Tuesday.

While groups such as the World Health Organization and wealthy nations have made major advancements in their ability to track and respond to epidemics, those efforts have done more to heighten global tensions than to relieve them, said Harley Feldbaum, director of the Global Health and Foreign Policy Initiative at the Johns Hopkins Nitze School of Advanced International Studies.

Most nations with the ability to track diseases do so to protect their own populations, not those living in countries where health problems actually emerge, he said. As a result, global health could slip into the same political logjam as climate change, with poor countries angry and resentful of rich ones.

Egypt: Urgent health problems and method of response

March 31, 2010
Blog
Excerpt:

With regard to disaster response plan in case of a bird flu in Egypt to the B
Health experts are increasingly worried about the prospects in the world of a bird flu to become at any moment a deadly human pandemic. Has been advertised internationally for endemic bird flu in a number of countries, including Egypt. This is linked to global concern about what happened in the winter of 2006, when enabling a new type of influenza virus that is transmitted to humans Almkhalt of infected birds, and that this type tremendous shift in the composition thereby increasing the possibility of transmission from human to human.

One of the reasons growing fears that Egypt has become one of the first countries that could spread the disease in epidemic form, mutation of the virus in cases that are newly discovered and the death of 100% of those cases, unlike the cases were discovered in early 2006, which is likely the emergence of new strains resistant to treatment methods currently available, which means that the current virus is endemic in Egypt has evolved in his abilities differed in the patterns of what has discovered in the past year. But the most cause for alarm is the weakness of health awareness among citizens, which would lead to no reported cases of infection, and therefore did not deal with the spread of the disease as quickly as required, especially when shown by state agencies from the reaction of the irrational in the face of the disease in the last year.

According to international conventions, particularly with regard to bird flu, there is a set of preventive measures to be taken with these countries to protect the rest of the States, it is natural that such actions lead to serious economic repercussions in countries that will be classified in the affected areas.

The World Health Organization announced the start of the implementation of those regulations and procedures in the world in June 2007.

Based on the announcement by the World Health Organization, the world will need a number of years have been more than ten to the possibility of eliminating this disease. So have many governments rushed to bring in the expertise required in the face of disaster for the preparation of local plans to confront and contain the avian influenza pandemic in the movement of enmity from human to human.

In the opinion of the Democratic Front Party that is extremely important because the top of this community action plan in Egypt. It may be appropriate to treat the plan with three degrees of size commensurate with the scope of the epidemic spread illustrates the degree of (a) of the plan for the best and the degree of probability (c) of the plan for the worst. The degree of (b) ought to reflect the most likely. Should be prepared scenarios commensurate with the degree of each of these grades.

Despite the announcement by the Ministry of Health that there are national plans to tackle the disease in case of an outbreak of epidemic, but that the first Mhoshrat the existence of such plans is to be known to all the organs of the State and civil society institutions and local press and media, and the stages of the implementation of these plans and scenarios have been the experiences of many that there should be centers for disaster management or crisis in all public institutions and civil and private, whether the central or local level, and that all staff have been trained to implement these plans so that they can work and coordination with others from the first moment to announce the beginning of the epidemic. The party believes that the government has reached this level of preparation so far.

The party emphasizes the importance of the state dealing with the preparation and implementation of this plan, the concept of pan-national, as the State in its approach to manage this disaster must understand the importance of identifying priorities from the perspective of citizens, whether of the shooter to maintain human life and to contain human losses as much as possible, or maintain one of the important industries in Egypt, the poultry industry, which have much direct impact on the provision of food to low-income and economics of the business community, with the same degree of importance to deal with the potential affected industries, tourism, aviation and export the extent of the epidemic in Egypt.

The party sees the need to adopt the plan on a range of different nuances of the main axes.

First - the availability of information, experiences and possibilities in Egypt and Egypt and the outside world, through:

- The exchange of information among States on the development of disease and patterns of emerging viral disease.
- Determine the terms of the emergence of the disease and also periods of international siege.
- Re-examination of the geographic and demographic Egypt in order to identify areas most likely to spread of epidemic disease and determine how to contain and isolate these areas to contain the virus and eliminate it.
- Making use of technology in the upgrading of laboratories and factories.
Secondly - the medical setting:
- Design of a statistical number of people expected on the level of local units and, accordingly, determine the number of medical units required to be provided at the level of the Republic.
- Provision of doses and basic raw materials in large quantities, as well as medical supplies from the diagnosis and care, prevention and treatment.
- Preparation of training courses to deal with the health units may face crises.
- Training on prevention and treatment.
III - awareness-raising campaigns for citizens:
- And the potential seriousness of the disease transmissible between humans.
- Health procedures to be followed to reduce the chance of infection.
Tech and is used in visual media campaigns, schools, clubs and youth centers, along with relying on civil society organizations.
IV - Management services sectors and the economy in different circumstances, such as:
- Absenteeism of the workforce may range from 40% to 60%.
- Decrease in supply and demand by up to 50%.
- Restrictions on the movement of international transport and adverse impact on the movement of import to meet the needs commodity and production in Egypt.
- The collapse of export and tourism.
V. - to contain the spread of the disease, in particular:
- Procedures to be developed to regulate human traffic to and from the affected areas.
- How to deal with patients and other patients in the areas affected to a.

Hong Kong: H5N1 Confirmed in Swallow - Yuen Long

Barn swallow tests positive for H5N1 virus
Ends/Thursday, April 1, 2010

The Agriculture, Fisheries and Conservation Department said today (April 1) that a barn swallow found in Yuen Long was confirmed to be H5N1 positive after a series of laboratory tests.

The bird carcass was collected on March 26 at the Mai Po Section of Castle Peak Road, Yuen Long. Barn swallows usually visit Hong Kong in spring and summer.

A department spokesman reminded people to observe good personal hygiene.

"They should avoid personal contact with wild birds or live poultry and clean their hands thoroughly after coming into contact with them," he said.


hat-tip ironorehopper

Asia faces disease threat from animals

SINGAPORE. — Asia faces twin health problems of infectious diseases stemming from animals and the emergence of drug-resistant strains of viruses that make treatment difficult, a World Health Organisation official said.

Henk Bekedam, head of WHO’s health sector development, said 75 percent of new diseases such as H1N1, H5N1 and SARS stem from animals and the best way to prevent the spread is to properly separate animals and human beings.

"In China, Cambodia, Thailand, Laos, Vietnam, animals are still very close to people," Bekedam told Reuters in an interview yesterday on the sidelines of a health conference in Singapore. These are issues we need to continue taking up, and after SARS, we know the need to share information." The close proximity between humans and animals allows viruses and other micro-organisms to jump the species barrier. One example of this is the Severe Acute Respiratory Syndrome (SARS) virus, which spreaded around the world in 2003, killing more than 800 people.

Experts have long feared the avian H5N1 flu virus would trigger a pandemic, even though it is still a disease mostly confined to birds. The close proximity between chickens and people has allowed H5N1 to jump the species barrier and infect humans, who suffer a death rate of 60 percent from the virus. — Reuters.

Hong Kong: Suspected H5N1 in Swallow, Yuen Long

Nancy suspected with bird flu virus

[Date :2010-3-31 7:10:36]

Reader's Li Yuan, Shenzhen, reports a spokesman for the Hong Kong Agriculture, Fisheries and Conservation Department said yesterday, according to preliminary tests, one in Yuen Long Barn seized H 5 suspected of carrying bird flu virus, authorities are continuing to further confirmatory tests.
The dead bird was found on March 26, Castle Peak Road, Yuen Long, Mai Po was seized, swallow normally visit in spring and summer.
The spokesman said, "As a precautionary measure, the Mai Po Nature Reserve temporarily closed from 31, 21, we will closely monitor the situation due to review the closure period should be." It is understood, Fisheries and Conservation Department has been closely monitoring the area in Mai Po Nature wild birds, from the beginning the winter of 2002, and collected faecal samples for bird flu tests H 5.
The spokesman said the dead bird was found within three kilometers of where there are five chicken farms, the department has sent staff to inspect the farm and found no abnormal mortality or symptoms of any bird flu. AFCD will step up monitoring on the farms.

The spokesman said "In response to this case, the AFCD has phoned poultry farmers reminding them to strengthen precautionary and biosecurity measures against avian influenza. In addition to poultry farmers, we have to remind bird shop owners, license holders of pet poultry and racing pigeons to take appropriate precautions. "
The spokesman said the department will step up inspections of poultry farms, wholesale market and the Yuen Po Street Bird Garden, and to remind the industry to health, to take appropriate measures against avian influenza. AFCD will continue to closely monitor the wild birds.

Suspected of carrying bird flu received the Barn body, the Hong Kong authorities have to act. FEHD will monitor the import of live poultry and live poultry retail outlets, and to remind stall operators to maintain health. Department of Health will continue to implement public health education and distribute health advice leaflets. AFCD, FEHD, the Customs and Police, will continue its efforts to intercept illegal import of poultry to reduce the inspection and quarantine of the birds did not bring the risk of avian influenza outbreaks.

The spokesman reminded the public to observe good personal hygiene, avoid contact with wild birds and live poultry and their droppings, and should wash their hands thoroughly after contact with poultry, poultry meat and egg consumption should be thoroughly cooked. If they find dead or sick birds, including wild birds and poultry carcasses can contact the 1823 Call Center Department.

Egypt: Swine flu cases continue to drop substantially

26 March 2010
CAIRO: Swine flu in Egypt has substantially declined, announced the Central Operation Room of Crisis and Disaster Management at Information and Decision Support Center at the Cabinet of Ministers.

The Ministry of Health has announced that the number of swine flu cases in Egypt is substantially declining by nearly half.

The number of cases is now 16,164, according to the latest swine flu report; of these cases 15,891 have received treatment and recovered, which is 98.3 percent.

These include 5,615 cases reported in schools and 865 reported in universities. Due to the decline of the virus, during the second semester of the academic year, there will be no shutting down of any classrooms where the H1N1 virus appears. Precautionary measures will be limited to giving the student who exhibits swine flu symptoms one week off.

On the other hand, the death toll from the H1N1 virus has reached 273 with one swine flu related death during the past two weeks.

But despite the substantial decrease in the number of new swine flu cases since the beginning of February, the Ministry of Health still advises all citizens to take all the precautionary measures against he virus.

Meanwhile, the Ministry of Health has announced one death from bird flu, a four-year-old boy from the Bani Suef, raising the death toll from the virus to 33 since it first appeared in Egypt in 2006.

Inspection committees are currently going around the country inspecting bird farms at the different governorates which led them to discover bird flu centers, according to the IDSC.