Has H1N1 virus mutated? Man on Tamiflu tests +ve
4 Jul 2009, 0158 hrs IST, Pushpa Narayan, TNN
CHENNAI: The case of a 29-year-old man, who continued to remain H1N1 positive even after 2 week of treatment here, has doctors and health department officials in a tizzy.
Experts fear that this could be an indication of the virus either having mutated or developed resistance to the anti-viral drug, Tamiflu. Mutation and drug resistance have been major challenges in dealing with viruses across the world. The present A(H1N1) is a strain developed from an earlier type which caused the Spanish flu.
What has added to the confusion in health circles here is that the man was discharged from the Communicable Diseases Hospital in Tondiarpet, where he was quarantined.
Officials at the hospital said they had decided to discharge him based on a fax message they received from the National Institute of Communicable Diseases (NICD).
‘‘Though his throat swabs continue to show positive, he was not showing any clinical symptoms. We told him not to step out of his residence for a week and advised him to stay away from the rest of his family members, particularly his pregnant wife,’’ said Chennai corporation health officer, Dr B Kuganantham.
But the directorate of public health is panicky. ‘‘We are upset that the NICD has directly contacted the hospital without keeping the government in the loop.
The viral status of the patient is still positive, possibly because of a mutation or drug resistance. He could be a carrier who can spread the infection to other people,’’ said director of public health Dr S Elango.'
hat-tip Dutchy
Friday, July 3, 2009
Thailand confirms one more A(H1N1) virus fatality
[Well, he could not have been that sick if the Doctor mistook his ailments for Tonsilitis. He had been sick at this point for 8 days. Somewhere between his 8th and 10th day, he went downhill, and was hospitalized, dying one day later, a severe lung infection.
The Doctor must have missed it.]
BANGKOK, July 3 (TNA) Thailand's Ministry of Public Health (MOPH) confirmed Friday one more fatality from influenza A(H1N1), raising the country's death toll from the new virus strain to six.
Permanent Secretary for Public Health Prat Boonyawongvirot told reporters that the sixth victim was a 30-year old man who worked as a day labourer.
He visited a doctor at a Bangna hospital last Sunday (June 28) after showing flu-like symptoms since June 20.
The diagnosis showed him to be suffering from tonsilitis and was given medication by the doctor before he went home for recovery.
However, instead of getting better his symptoms worsened and he was admitted to hospital on Tuesday (June 30).
The doctor found that the patient experienced severe lung infection and died on July 1.
Dr. Prat explained that the death report was delayed because he was not in the MOPH list of influenza A(H1N1) victims and needed laboratory confirmation on July 2 before the announcement.
He said the victim was considered overweight at 123 kg and 165 cm height.
According to his medical record, doctors did not prescribe the anti-viral Oseltamivir to the patient as they had been trying to save his life from lung infection.
Meanwhile, Dr. Prasert Thongcharoen, president of the Virology Association (Thailand) said the ministry expected the outbreak of virus would last around one year and one million people could contract the influenza.
The virus was expected to spread into provinces within six months, he added.
Dr. Prasert, who also heads the ministry's Medical and Public Health Technical and Strategy Advisory panel on A(H1N1) influenza, said the country must wait for another six months before the arrival of vaccine.
Earlier on Friday, Deputy Public Health Minister Manit Nopamornbodhi reported 154 new Influenza A(H1N1) cases.
The new infections reported on the day raised the country’s total number of persons diagnosed with H1N1 to 1,760.
Twenty of the new flu patients remain in hospital. Of this number, one patient in Chonburi was being closely monitored as the patient’s condition was worrying. (TNA)
hat-tip Shiloh
The Doctor must have missed it.]
BANGKOK, July 3 (TNA) Thailand's Ministry of Public Health (MOPH) confirmed Friday one more fatality from influenza A(H1N1), raising the country's death toll from the new virus strain to six.
Permanent Secretary for Public Health Prat Boonyawongvirot told reporters that the sixth victim was a 30-year old man who worked as a day labourer.
He visited a doctor at a Bangna hospital last Sunday (June 28) after showing flu-like symptoms since June 20.
The diagnosis showed him to be suffering from tonsilitis and was given medication by the doctor before he went home for recovery.
However, instead of getting better his symptoms worsened and he was admitted to hospital on Tuesday (June 30).
The doctor found that the patient experienced severe lung infection and died on July 1.
Dr. Prat explained that the death report was delayed because he was not in the MOPH list of influenza A(H1N1) victims and needed laboratory confirmation on July 2 before the announcement.
He said the victim was considered overweight at 123 kg and 165 cm height.
According to his medical record, doctors did not prescribe the anti-viral Oseltamivir to the patient as they had been trying to save his life from lung infection.
Meanwhile, Dr. Prasert Thongcharoen, president of the Virology Association (Thailand) said the ministry expected the outbreak of virus would last around one year and one million people could contract the influenza.
The virus was expected to spread into provinces within six months, he added.
Dr. Prasert, who also heads the ministry's Medical and Public Health Technical and Strategy Advisory panel on A(H1N1) influenza, said the country must wait for another six months before the arrival of vaccine.
Earlier on Friday, Deputy Public Health Minister Manit Nopamornbodhi reported 154 new Influenza A(H1N1) cases.
The new infections reported on the day raised the country’s total number of persons diagnosed with H1N1 to 1,760.
Twenty of the new flu patients remain in hospital. Of this number, one patient in Chonburi was being closely monitored as the patient’s condition was worrying. (TNA)
hat-tip Shiloh
Recombinomics: Lesson Not Learned in H1N1 Tamiflu Resistant Spread
[bolding mine]
Commentary
The patient, who was admitted to Queen Mary Hospital for isolation, tested positive for the new H1N1 flu strain and opted not to take Tamiflu, Hong Kong's health department said. She had mild symptoms and was discharged upon recovery on June 18.
"The key point is whether the strains will become dominant and then we will have a problem," he said. "At this moment, I don't think there is cause for alarm. There is certainly cause for heightened surveillance."
"Constant, random mutation is the survival mechanism of the microbial world," WHO Director-General Margaret Chan said in an address to a meeting on the flu pandemic in Cancun, Mexico, yesterday. "Like all influenza viruses, H1N1 has the advantage of surprise on its side."
Studies have shown that Tamiflu-resistant bugs develop in 0.4 percent to 4 percent of adults and children treated for seasonal influenza, Claudia Schmitt, a spokeswoman at Roche, said by phone from Basel today.
The above comments on the emergence of H274Y and associated oseltamivir (Tamiflu) resistance clearly show that lessons were not learned from the spread of H274Y in seasonal flu (limited to H1N1). The spread of H274Y in seasonal flu destroyed the old paradigm of influenza evolution by selection of "random mutations", but as seen above, WHO is still citing that mechanism to try to explain the emergence of H274Y in pandemic H1N1 in Denmark, Japan, Hong Kong, and San Francisco.
Roche is still citing old data on the emergence of resistance in Japan years ago, when children were treated with sub-optical doses. That data provided a classical example of resistance, which was linked to the sub-optimal dosing, as well as mutations in H1N1 and H3N2 at multiple locations within each sero-type. However, those changes were only viable in the presence of Tamiflu, which killed off the competing wild type strains.
I
n 2005 when resistance developed in treated patients or contacts infected with H5N1 the same assurances on lack of fitness and failure to spread were offered. The first example was a patient on a prophylactic dose because her brother was a confirmed case. She developed an infection, but responded to a therapeutic dose, even though H5N1 with H274Y as well as N296S was identified in sub-clones from the patient.
Although the spread of resistant H5N1 in patients was not reported, the appearance of H274Y in H1N1 in wild birds later that year was cause for concern. The wild birds in Russia were not given oseltamivir, yet H5N1 was isolated from dead birds indicating H5N1 with H274Y was evolutionarily fit, leading to transmission between birds and fatal infections.
Concerns of H274Y were increased the following year when it was reported in seasonal flu in China. The clade 2C (Hong Kong strain) with H274Y was found in patients who were not taking Tamiflu, again showing that evolutionarily fit could transmit to humans who were not taking Tamiflu.
The following season (2006/2007), H274Y jumped to another H1N1 sub-clade (clade 1 - New Caledonia strain) in the United States and United Kingdom. The multiple sub-clades within clade 1 signaled multiple introductions into patients not taking Tamiflu.
The following season (2007/2008), H274Y jumped again. Initial cases in the United States were in Hawaii were clade 2B (Brisbane strain), but did not spread. However, the H274Y jumped onto another clade 2B sub-clade which did spread in the United States and Europe. This sub-clade was initially reported in Norway in early 2008, but had been silently spreading throughout the fall.
In the summer of 2008 the H274Y in combination with HA A193T emerged, which then led to the fixing of H274Y at levels approaching 100% of H1N1. The A193T, as well as several additional polymorphisms had been co-circulating on clade 2C. The acquisition of these polymorphisms, including three consecutive polymorphisms in NA signaled recombination, because the NA polymorphisms were not only consecutive, but included a synonymous change, which offered no obvious selection pressure.
Thus, the data was inconsistent with a "random mutation" mechanism. The key changes were co-circulating on a related sub-clade, and were appended onto a clade 2B backbone. The H274Y jumped from background to background in patients who were not taking Tamiflu. This spread of H274Y via recombination and genetic hitchhiking did not require de novo mutations. The key polymorphisms were already circulating in clade 2C, and had earlier been found in other H1N1 or H1N2 isolates.
The mechanism of evolution raised serious concerns when swine H1N1 acquire efficient transmission in humans. This transmission offered the opportunity of genetic exchanges between human seasonal H1N1 and swine H1N1 which was now also in humans. Dual infections would allow for H274Y jumping form seasonal flu to pandemic flu in patients infected with both viruses.
Thus, the detection of H274Y in Denmark this week was not a surprised. However, since the patient had been on a prophylactic dose of oseltamivir, the random mutation paradigm was used to explain the data and offer assurances that the resistance wouldn't spread. However, the appearance of H274Y in the treated patient raised concerns that H274Y was lurking in a minor sub-population that was missing in sequencing of untreated patients, and was detected only in treated patients.
The data from Denmark was repeated in Japan this week, when another patient being treated with a prophylactic dose of oseltamivir also gave rise to the detection of H274Y. However, the appearance of H274Y in the absence of other resistance changes raised concerns that H274Y had already been acquired via recombination and was silently spreading in association with wild type H1N1.
The concerns were increased by the announcement in Hong Kong at a traveler from San Francisco, who was not taking Tamiflu was harboring a resisitant sequence, which was almost certainly H274Y. The presence of resistance in a patient not taking Tamiflu indicated the pandemic H1N1 with H274Y was evolutionarily fit and not only was in Hong Kong, but was also in San Francisco, the origin of the traveler.
However, H274Y has not been reported in the United States, raising serious surveillance concerns. Most efforts are directed to hospitalized serious cases, and state across the country announced that they were no longer testing mild cases. However, the Hong Kong, ex-San Francisco case was mild, which may explain the lack of detection.
However, of greater concern is the ability of H274Y to jump from one background to another in the absence of oseltamivir selection.
However, statements above indicate the lesson from seasonal flu was not learned, and the old discredited random mutation explain is once again offered, along with assurances that the H274Y will not spread (even after it has been found or implied on three continents).
Increased surveillance will demonstrate not only that H274Y can spread, but that it has already spread, under the radar of the current surveillance system. Moreover, the reliance of the old "random mutation" paradigm will lead to more "surprises" but those who adhere to an paradigm which is inconsistent with the sequence data.
An increase in surveillance and sequencing will allow for more accurate products of future acquisitions, which are due to recombination and not due to de novo mutations, as repeated again and again by those who ignore the data, or quote those who ignore the data.
Media Links
Commentary
Recombinomics Commentary 18:26
July 3, 2009
The patient, who was admitted to Queen Mary Hospital for isolation, tested positive for the new H1N1 flu strain and opted not to take Tamiflu, Hong Kong's health department said. She had mild symptoms and was discharged upon recovery on June 18.
"The key point is whether the strains will become dominant and then we will have a problem," he said. "At this moment, I don't think there is cause for alarm. There is certainly cause for heightened surveillance."
"Constant, random mutation is the survival mechanism of the microbial world," WHO Director-General Margaret Chan said in an address to a meeting on the flu pandemic in Cancun, Mexico, yesterday. "Like all influenza viruses, H1N1 has the advantage of surprise on its side."
Studies have shown that Tamiflu-resistant bugs develop in 0.4 percent to 4 percent of adults and children treated for seasonal influenza, Claudia Schmitt, a spokeswoman at Roche, said by phone from Basel today.
The above comments on the emergence of H274Y and associated oseltamivir (Tamiflu) resistance clearly show that lessons were not learned from the spread of H274Y in seasonal flu (limited to H1N1). The spread of H274Y in seasonal flu destroyed the old paradigm of influenza evolution by selection of "random mutations", but as seen above, WHO is still citing that mechanism to try to explain the emergence of H274Y in pandemic H1N1 in Denmark, Japan, Hong Kong, and San Francisco.
Roche is still citing old data on the emergence of resistance in Japan years ago, when children were treated with sub-optical doses. That data provided a classical example of resistance, which was linked to the sub-optimal dosing, as well as mutations in H1N1 and H3N2 at multiple locations within each sero-type. However, those changes were only viable in the presence of Tamiflu, which killed off the competing wild type strains.
I
n 2005 when resistance developed in treated patients or contacts infected with H5N1 the same assurances on lack of fitness and failure to spread were offered. The first example was a patient on a prophylactic dose because her brother was a confirmed case. She developed an infection, but responded to a therapeutic dose, even though H5N1 with H274Y as well as N296S was identified in sub-clones from the patient.
Although the spread of resistant H5N1 in patients was not reported, the appearance of H274Y in H1N1 in wild birds later that year was cause for concern. The wild birds in Russia were not given oseltamivir, yet H5N1 was isolated from dead birds indicating H5N1 with H274Y was evolutionarily fit, leading to transmission between birds and fatal infections.
Concerns of H274Y were increased the following year when it was reported in seasonal flu in China. The clade 2C (Hong Kong strain) with H274Y was found in patients who were not taking Tamiflu, again showing that evolutionarily fit could transmit to humans who were not taking Tamiflu.
The following season (2006/2007), H274Y jumped to another H1N1 sub-clade (clade 1 - New Caledonia strain) in the United States and United Kingdom. The multiple sub-clades within clade 1 signaled multiple introductions into patients not taking Tamiflu.
The following season (2007/2008), H274Y jumped again. Initial cases in the United States were in Hawaii were clade 2B (Brisbane strain), but did not spread. However, the H274Y jumped onto another clade 2B sub-clade which did spread in the United States and Europe. This sub-clade was initially reported in Norway in early 2008, but had been silently spreading throughout the fall.
In the summer of 2008 the H274Y in combination with HA A193T emerged, which then led to the fixing of H274Y at levels approaching 100% of H1N1. The A193T, as well as several additional polymorphisms had been co-circulating on clade 2C. The acquisition of these polymorphisms, including three consecutive polymorphisms in NA signaled recombination, because the NA polymorphisms were not only consecutive, but included a synonymous change, which offered no obvious selection pressure.
Thus, the data was inconsistent with a "random mutation" mechanism. The key changes were co-circulating on a related sub-clade, and were appended onto a clade 2B backbone. The H274Y jumped from background to background in patients who were not taking Tamiflu. This spread of H274Y via recombination and genetic hitchhiking did not require de novo mutations. The key polymorphisms were already circulating in clade 2C, and had earlier been found in other H1N1 or H1N2 isolates.
The mechanism of evolution raised serious concerns when swine H1N1 acquire efficient transmission in humans. This transmission offered the opportunity of genetic exchanges between human seasonal H1N1 and swine H1N1 which was now also in humans. Dual infections would allow for H274Y jumping form seasonal flu to pandemic flu in patients infected with both viruses.
Thus, the detection of H274Y in Denmark this week was not a surprised. However, since the patient had been on a prophylactic dose of oseltamivir, the random mutation paradigm was used to explain the data and offer assurances that the resistance wouldn't spread. However, the appearance of H274Y in the treated patient raised concerns that H274Y was lurking in a minor sub-population that was missing in sequencing of untreated patients, and was detected only in treated patients.
The data from Denmark was repeated in Japan this week, when another patient being treated with a prophylactic dose of oseltamivir also gave rise to the detection of H274Y. However, the appearance of H274Y in the absence of other resistance changes raised concerns that H274Y had already been acquired via recombination and was silently spreading in association with wild type H1N1.
The concerns were increased by the announcement in Hong Kong at a traveler from San Francisco, who was not taking Tamiflu was harboring a resisitant sequence, which was almost certainly H274Y. The presence of resistance in a patient not taking Tamiflu indicated the pandemic H1N1 with H274Y was evolutionarily fit and not only was in Hong Kong, but was also in San Francisco, the origin of the traveler.
However, H274Y has not been reported in the United States, raising serious surveillance concerns. Most efforts are directed to hospitalized serious cases, and state across the country announced that they were no longer testing mild cases. However, the Hong Kong, ex-San Francisco case was mild, which may explain the lack of detection.
However, of greater concern is the ability of H274Y to jump from one background to another in the absence of oseltamivir selection.
However, statements above indicate the lesson from seasonal flu was not learned, and the old discredited random mutation explain is once again offered, along with assurances that the H274Y will not spread (even after it has been found or implied on three continents).
Increased surveillance will demonstrate not only that H274Y can spread, but that it has already spread, under the radar of the current surveillance system. Moreover, the reliance of the old "random mutation" paradigm will lead to more "surprises" but those who adhere to an paradigm which is inconsistent with the sequence data.
An increase in surveillance and sequencing will allow for more accurate products of future acquisitions, which are due to recombination and not due to de novo mutations, as repeated again and again by those who ignore the data, or quote those who ignore the data.
Media Links
Hawaii: Focus on swine flu sharpens
Hawai'i public health officials are turning their focus to spotting signs that might indicate a mutation and strengthening of the H1N1 virus, following a doubling of swine flu cases here in the past two weeks and Hawai'i's first death in which the virus was deemed a factor.
The state has 616 known cases of the H1N1 virus, according to the latest national count by the Centers for Disease Control and Prevention.
That's an increase of 113 cases since a June 24 tally by the state Department of Health, and double the number of illnesses from two weeks ago.
The increase is not surprising, said Dr. Sarah Park, chief of the Health Department's Disease Outbreak Control Division. From the beginning of the Hawai'i outbreak in May, she has said she expects more cases, hospitalization and deaths.
The only death here so far linked to the virus was that of a woman in her late 60s who died June 19 at Tripler Army Medical Center. The flu was a contributing factor, but the woman's health was already in decline because of multiple serious health issues.
The Health Department continues to monitor the disease's progress but has reduced testing and is focusing on priority groups that might be the first indicators that the virus is mutating and becoming more severe, Park said.
"It's a fear and it will be a fear until we pass through the fall," Park said, adding that a sure sign of change might be 50 hospitalized cases at once or a cluster of deaths.
The priority groups are patients with severe cases of the flu, people with high-risk conditions, people in high-risk occupations such as health care workers, travelers and people who are part of an outbreak investigation.
In the beginning, Park said, testing each suspected case was important to determine when the swine flu arrived in the Islands and how quickly it spread. With those answers the department can now focus its resources on tracking the possible changes in the disease that could blend with other flu strains, she said.
"There's always concerns that if it mixes with the regular seasonal flu ... that it could pick up worse genes," Park said, adding that it could all fizzle out but the state cannot count on that and neither should residents.
The CDC said swine flu is the predominant flu type circulating currently, with 10 states, including Hawai'i, reporting widespread cases. The other states are California, Connecticut, Delaware, Georgia, Maine, New York, Pennsylvania, Rhode Island and Virginia.
For a state-by-state count of swine flu cases in the United States, go to the CDC Web site at www.cdc.gov/h1n1flu/update.htm.
Park said she worries that some Hawai'i residents are still going to school and work when they are sick, which could worsen their condition and spread disease.
Individuals should treat this like hurricane preparedness and have enough food and drink to stay home for seven days, the recommended time to recuperate, Park said.
"I'd say the biggest task and the biggest hurdle is trying to get our community to prepare," she said.
Egypt: 4 suspected cases of bird flu a "lake"
Friday, July 3, 2009 - 20:21
Detained hospital fevers Damanhour 4 cases of suspected bird flu, after the emergence of the disease with similar symptoms of fever and pain in bones, severe stress and difficulty in breathing.
وقال الدكتور يسرى مبروك وكيل وزارة الصحة بالبحيرة إن الحالات هى: صباح عبد الحليم أبو شوكت (30 سنة)، وراندا رمضان البنا (18 سنة)، منة علام عدلى (سنتان)، أحمد عبد الرحيم (13 سنة)، وأوضح أنه تم احتجازهم بالمستشفى بعد أخذ عينة دم منهم لتحليلها بالمعامل المركزية بالقاهرة.
Said Dr. Yusri Congratulations Deputy Minister of Health that the lake cases are: Abd al-Halim Abu Shawkat (30 years), and Randa Ramadan al-Banna (18 years), of which Allam Adly (two years), Ahmad Abdul Rahim (13 years), had been detained in hospital After taking a blood sample for analysis, including central labs in Cairo.
Detained hospital fevers Damanhour 4 cases of suspected bird flu, after the emergence of the disease with similar symptoms of fever and pain in bones, severe stress and difficulty in breathing.
وقال الدكتور يسرى مبروك وكيل وزارة الصحة بالبحيرة إن الحالات هى: صباح عبد الحليم أبو شوكت (30 سنة)، وراندا رمضان البنا (18 سنة)، منة علام عدلى (سنتان)، أحمد عبد الرحيم (13 سنة)، وأوضح أنه تم احتجازهم بالمستشفى بعد أخذ عينة دم منهم لتحليلها بالمعامل المركزية بالقاهرة.
Said Dr. Yusri Congratulations Deputy Minister of Health that the lake cases are: Abd al-Halim Abu Shawkat (30 years), and Randa Ramadan al-Banna (18 years), of which Allam Adly (two years), Ahmad Abdul Rahim (13 years), had been detained in hospital After taking a blood sample for analysis, including central labs in Cairo.
Australia urges calm after child flu death
[saying twice as many could die. And...it still does not say he had any pre-existing medical conditions....]
02 July 2009
MELBOURNE: Australian authorities told parents not to panic over the spread of the H1N1 flu after the country recorded its first child death related to the virus.
Victoria state premier John Brumby described the death of a three-year-old boy who tested positive for A(H1N1) influenza as distressing, but emphasised that the virus was mild in most cases.
"(There's) no cause for alarm," Brumby said.
He said police and the coroner were investigating the case of the boy, who was reportedly found dead by his mother in their Melbourne home last Friday morning.
Authorities did not attribute the toddler's death to the H1N1 flu when they announced it late Wednesday, but also did not say he had pre-existing medical conditions, as has been the case in all other flu-linked deaths in the country.
It was the eighth fatality related to the disease in Australia, the worst-hit nation in the Asia-Pacific region with 4,370 cases.
Professor Robert Booy, an immunisation specialist at the Westmead Children's Hospital in Sydney, said the H1N1 flu was likely to kill twice as many children over the next 12 months as regular influenza.
Booy estimated 10 to 12 children could die from the virus, compared with five or six from regular influenza in a typical year, and said not all of those killed would have underlying medical conditions.
"It can occur in a healthy child, although most of them we believe will occur in a child with a problem, say a chronic heart problem, long-standing lung, kidney, liver (condition) or diabetes," he told ABC radio.
"The likelihood is with this virus we'll see more of the small number of severe (cases) than we do normally."
Victoria state's deputy chief health officer Rosemary Lester has urged parents to monitor their children and Brumby said they should implement basic hygiene measures.
"We are coming into flu season in the southern states and it's getting colder and wetter and families should take the precautions that we've been stressing, and that is basic hygiene and washing hands, cover your face when you cough and use tissues," he said.
Prime Minister Kevin Rudd said authorities were using the best available medical advice to respond to the H1N1 flu.
"This is a very, very difficult disease and it's affecting many countries around the world," he told reporters.
"This is very, very difficult and we will continue to take measures as recommended to us by the medical authorities."
02 July 2009
MELBOURNE: Australian authorities told parents not to panic over the spread of the H1N1 flu after the country recorded its first child death related to the virus.
Victoria state premier John Brumby described the death of a three-year-old boy who tested positive for A(H1N1) influenza as distressing, but emphasised that the virus was mild in most cases.
"(There's) no cause for alarm," Brumby said.
He said police and the coroner were investigating the case of the boy, who was reportedly found dead by his mother in their Melbourne home last Friday morning.
Authorities did not attribute the toddler's death to the H1N1 flu when they announced it late Wednesday, but also did not say he had pre-existing medical conditions, as has been the case in all other flu-linked deaths in the country.
It was the eighth fatality related to the disease in Australia, the worst-hit nation in the Asia-Pacific region with 4,370 cases.
Professor Robert Booy, an immunisation specialist at the Westmead Children's Hospital in Sydney, said the H1N1 flu was likely to kill twice as many children over the next 12 months as regular influenza.
Booy estimated 10 to 12 children could die from the virus, compared with five or six from regular influenza in a typical year, and said not all of those killed would have underlying medical conditions.
"It can occur in a healthy child, although most of them we believe will occur in a child with a problem, say a chronic heart problem, long-standing lung, kidney, liver (condition) or diabetes," he told ABC radio.
"The likelihood is with this virus we'll see more of the small number of severe (cases) than we do normally."
Victoria state's deputy chief health officer Rosemary Lester has urged parents to monitor their children and Brumby said they should implement basic hygiene measures.
"We are coming into flu season in the southern states and it's getting colder and wetter and families should take the precautions that we've been stressing, and that is basic hygiene and washing hands, cover your face when you cough and use tissues," he said.
Prime Minister Kevin Rudd said authorities were using the best available medical advice to respond to the H1N1 flu.
"This is a very, very difficult disease and it's affecting many countries around the world," he told reporters.
"This is very, very difficult and we will continue to take measures as recommended to us by the medical authorities."
Human infection with new influenza A (H1N1) virus: WHO Consultation on suspension of classes and restriction of mass gatherings to mitigate the impact
On 27 May 2009, WHO convened via teleconference a technical consultation of public health officials from 6 countries,(1) as well as experts(2) in law and ethics, disease prevention and control, and management of mass gatherings and emergency situations.
The purpose of the teleconference was to share experiences and early lessons learnt from recent outbreaks of new influenza A (H1N1) virus infection in communities or closed settings. As of 27 May 2009, >13 000 laboratory-confirmed cases of human infection with new influenza A (H1N1) virus had been officially reported to WHO.(3)
School settings
Countries in which laboratory-confirmed, albeit mild, cases of influenza A (H1N1) virus infection had occurred provided specific examples of outbreaks among schoolchildren or in academic settings, as well as the detailed measures taken to mitigate the spread of infection within schools and among communities. In most cases, decisions to suspend attendance at school had been taken by local rather than national authorities. The exception was Mexico, in which nationwide school closures had been mandated for 2 weeks in May 2009.
All countries agreed that school suspensions had been effective in mitigating the spread of influenza A (H1N1) virus infection; however, such measures were often prohibitively expensive.(4) School closures during the early phases of an outbreak had reduced transmission within schools, but had not always been effective (or their measurable effect) in reducing levels of community transmission.
The legal aspects of school closures and non-discrimination should be closely monitored. Epidemiological considerations should take precedence over racial or ethnic stereotypes, while at the same time recognizing that special provisions may be necessary for schools in countries or areas containing poor populations. While school closures may reduce transmission within school settings, such measures may not affect transmission in community settings. Care therefore needs to be taken when evaluating how school closures will impact transmission.
Mass gatherings
Countries reporting to WHO, with the exception of Mexico, had not instituted restrictions on mass gatherings and were maintaining vigilance for any upcoming events in their respective countries. In Mexico, public participation in mass gatherings during national football matches had been banned in May 2009.
Community-level social distancing measures and use of masks
The Government of Mexico has encouraged its citizens to use masks, particularly when in contact with cases of influenza A (H1N1) virus infection. In Japan, efforts to enact social distancing have included encouraging commuters, in particular, to wear masks. Additional guidelines established in Mexico for mitigating the spread of illness include recommendations on hygiene and implementation of hygiene measures, particularly in schools, as well as guidelines for social distancing in restaurants, stadiums and enclosed areas.
Recommendations
The WHO technical consultation made the following recommendations:
(1) Canada, Japan, Mexico, Spain, the United Kingdom and the United States.
(2) Representatives from the Johns Hopkins Bloomberg School of Public Health; the European Centre for Disease Control and Prevention; the Department of Health of Hong Kong SAR; and an independent consultant.
(3) Latest figures of laboratory-confirmed cases of new influenza A (H1N1) as officially reported to WHO by States Parties to the International Health Regulations (2005) are available at http://www.who.int/csr/don/en/ .
(4) For additional information on cost analysis of school suspensions and/or closures, see: Cauchemez S, et al [unpublished article]. Closing schools during an influenza pandemic: a review; Cauchemez S et al. Estimating the impact of school closure on influenza transmission from Sentinel data. Nature, 2008, 452(7188):750–U6; Cowling BJ et al. Effects of school closures, 2008 winter influenza season, Hong Kong. Emerging Infectious Diseases, 2008, 14(10):1660–1662; Heymann A et al. Influence of school closure on the incidence of viral respiratory diseases among children and on health care utilization. Pediatric Infectious Disease Journal, 2004, 23:675–677; Sadique MZ, Adams EJ, Edmunds WJ. Estimating the costs of school closure for mitigating an influenza pandemic. Public Health, 2008, 8:135; Vynnycky E, Edmunds WJ. Analyses of the 1957 (Asian) influenza pandemic in the United Kingdom and the impact of school closures. Epidemiology and Infection, 2008, 136(2):166–179.
hat-tip Ironorehopper
The purpose of the teleconference was to share experiences and early lessons learnt from recent outbreaks of new influenza A (H1N1) virus infection in communities or closed settings. As of 27 May 2009, >13 000 laboratory-confirmed cases of human infection with new influenza A (H1N1) virus had been officially reported to WHO.(3)
School settings
Countries in which laboratory-confirmed, albeit mild, cases of influenza A (H1N1) virus infection had occurred provided specific examples of outbreaks among schoolchildren or in academic settings, as well as the detailed measures taken to mitigate the spread of infection within schools and among communities. In most cases, decisions to suspend attendance at school had been taken by local rather than national authorities. The exception was Mexico, in which nationwide school closures had been mandated for 2 weeks in May 2009.
All countries agreed that school suspensions had been effective in mitigating the spread of influenza A (H1N1) virus infection; however, such measures were often prohibitively expensive.(4) School closures during the early phases of an outbreak had reduced transmission within schools, but had not always been effective (or their measurable effect) in reducing levels of community transmission.
The legal aspects of school closures and non-discrimination should be closely monitored. Epidemiological considerations should take precedence over racial or ethnic stereotypes, while at the same time recognizing that special provisions may be necessary for schools in countries or areas containing poor populations. While school closures may reduce transmission within school settings, such measures may not affect transmission in community settings. Care therefore needs to be taken when evaluating how school closures will impact transmission.
Mass gatherings
Countries reporting to WHO, with the exception of Mexico, had not instituted restrictions on mass gatherings and were maintaining vigilance for any upcoming events in their respective countries. In Mexico, public participation in mass gatherings during national football matches had been banned in May 2009.
Community-level social distancing measures and use of masks
The Government of Mexico has encouraged its citizens to use masks, particularly when in contact with cases of influenza A (H1N1) virus infection. In Japan, efforts to enact social distancing have included encouraging commuters, in particular, to wear masks. Additional guidelines established in Mexico for mitigating the spread of illness include recommendations on hygiene and implementation of hygiene measures, particularly in schools, as well as guidelines for social distancing in restaurants, stadiums and enclosed areas.
Recommendations
The WHO technical consultation made the following recommendations:
- When considering school suspensions and/or restrictions on mass gatherings, authorities should ask “what is the legal authority and what are the legal processes” for such suspensions and/or restrictions? Decisions should be consistent and well-documented, and be taken within the parameters of each country’s individual sovereignty and existing laws. Care should be taken to avoid discrimination based on nationality, ethnic origin, religion, gender and disability, etc. Furthermore, any decision that results in social isolation, restrictions on the right to travel and assemble, or impacts that commerce, trade and economic stability should be avoided.
- When considering mitigating the spread of influenza A (H1N1) virus infection in school settings, full school closures may not be warranted but class suspensions may be.
- Strategies regarding personal hygiene should be evaluated relative to the type of school (nursery/day care, elementary, junior, or senior high school) and their effectiveness in reducing transmission.
- Good communication is vital as situations surrounding this pandemic are fluid and change daily. Public health officials should convey strong, consistent, easily-understood and actionable messages to the general public and health-care providers. Messaging should encourage people to be aware of the potential for illness, to engage in conscientious public hygiene measures (for example, hand hygiene and cough etiquette) and to seek medical attention as needed. At the same time, public health announcements should reconcile the potential for indifference and the under-allocation of resources versus that of panic and over-allocation of resources.
(1) Canada, Japan, Mexico, Spain, the United Kingdom and the United States.
(2) Representatives from the Johns Hopkins Bloomberg School of Public Health; the European Centre for Disease Control and Prevention; the Department of Health of Hong Kong SAR; and an independent consultant.
(3) Latest figures of laboratory-confirmed cases of new influenza A (H1N1) as officially reported to WHO by States Parties to the International Health Regulations (2005) are available at http://www.who.int/csr/don/en/ .
(4) For additional information on cost analysis of school suspensions and/or closures, see: Cauchemez S, et al [unpublished article]. Closing schools during an influenza pandemic: a review; Cauchemez S et al. Estimating the impact of school closure on influenza transmission from Sentinel data. Nature, 2008, 452(7188):750–U6; Cowling BJ et al. Effects of school closures, 2008 winter influenza season, Hong Kong. Emerging Infectious Diseases, 2008, 14(10):1660–1662; Heymann A et al. Influence of school closure on the incidence of viral respiratory diseases among children and on health care utilization. Pediatric Infectious Disease Journal, 2004, 23:675–677; Sadique MZ, Adams EJ, Edmunds WJ. Estimating the costs of school closure for mitigating an influenza pandemic. Public Health, 2008, 8:135; Vynnycky E, Edmunds WJ. Analyses of the 1957 (Asian) influenza pandemic in the United Kingdom and the impact of school closures. Epidemiology and Infection, 2008, 136(2):166–179.
hat-tip Ironorehopper
Recombinomics: Surveillance Flaws Drive Silent Spread of Tamiflu Resistant H1N1
Recombinomics Commentary 15:18
July 3, 2009
The virus was isolated from the specimen taken from a 16-year-old girl coming from San Francisco. She was intercepted by Port Health Office at the Hong Kong International Airport on June 11 upon arrival. The girl was then admitted to Queen Mary Hospital for isolation. She was tested positive to HSI but opted not to take tamiflu. She had mild symptoms and was eventually discharged upon recovery on June 18.
July 3, 2009
The virus was isolated from the specimen taken from a 16-year-old girl coming from San Francisco. She was intercepted by Port Health Office at the Hong Kong International Airport on June 11 upon arrival. The girl was then admitted to Queen Mary Hospital for isolation. She was tested positive to HSI but opted not to take tamiflu. She had mild symptoms and was eventually discharged upon recovery on June 18.
The above comments from a Hong Kong DOH press release on Tamiflu resistance in pandemic H1N1 highlight severe limitations in worldwide surveillance. Although this case was identified by routine surveillance of H1N1 positive patients in Hong Kong, it is an effort largely focused on travelers. Like countries outside of the Americas, most efforts have focused on travelers and largely ignored local community spread. The recent explosion in cases in the UK has led to a focus on the community spread there, but many other counties in Europe are reporting low numbers of confirmed pandemic H1N1 because of limited testing in the community.
In the US, efforts are focused on the community, but severe cases are targetted. Most states have stopped reporting and testing mild cases, so real monitoring of this group is minimal. However, the case in Hong Kong originated in San Francisco and was mild. The United States has not reported any Tamiflu resistance. The CDC has tested over 200 isolates and failed to identify H274Y.
This may be due in part to virus mixtures. In Denmark and Japan the H274Y was discovered in patients undergoing Tamiflu prophylactic treatment. The Tamiflu treatment would reduce wild type H1N1 and allow a minor population with H274Y to expand and be detected. Therefore, it is likely that the H274Y is spreading silently and under the radar of the sequencing efforts, which are focused on the dominant (consensus) sequence.
The acquisition of H274Y by pandemic H1N1 was not unexpected. H274Y has a history of jumping from one sub-clade to another, as well as jumping to multiple different backgrounds within a subclade via recombination and genetic hitchhiking. This has produced resistance that is limited to H1N1 and H274Y within H1N1. The co-circulation of human H1N1 seasonal flu with swine H1N1 in humans, has created a favorable environment for the jump of H274Y from seasonal flu to pandemic flu. Moreover, the widespread use of Tamiflu in patients infected with pandemic H1N1 will drive the rate of spread in pandemic H1N1.
Although countries have been placing sequences on deposit in a timely manner, there are still major deficiencies in the surveillance program, as described above. Moreover, the recent reports of Tamiflu resistance in isolates in Denmark, Japan, and Hong Kong have not lead to the release of these sequences.
An increase in surveillance and release of full sequences is still necessary. The pandemic H1N1 is now rapidly spreading in the southern hemisphere, which is just beginning its flu season. Sequences from fatal and mild cases are required to determine important changes in pandemic H1N1 associated with increased virulence as well as increased spread.
A serious comprehensive surveillance program is long overdue.
In the US, efforts are focused on the community, but severe cases are targetted. Most states have stopped reporting and testing mild cases, so real monitoring of this group is minimal. However, the case in Hong Kong originated in San Francisco and was mild. The United States has not reported any Tamiflu resistance. The CDC has tested over 200 isolates and failed to identify H274Y.
This may be due in part to virus mixtures. In Denmark and Japan the H274Y was discovered in patients undergoing Tamiflu prophylactic treatment. The Tamiflu treatment would reduce wild type H1N1 and allow a minor population with H274Y to expand and be detected. Therefore, it is likely that the H274Y is spreading silently and under the radar of the sequencing efforts, which are focused on the dominant (consensus) sequence.
The acquisition of H274Y by pandemic H1N1 was not unexpected. H274Y has a history of jumping from one sub-clade to another, as well as jumping to multiple different backgrounds within a subclade via recombination and genetic hitchhiking. This has produced resistance that is limited to H1N1 and H274Y within H1N1. The co-circulation of human H1N1 seasonal flu with swine H1N1 in humans, has created a favorable environment for the jump of H274Y from seasonal flu to pandemic flu. Moreover, the widespread use of Tamiflu in patients infected with pandemic H1N1 will drive the rate of spread in pandemic H1N1.
Although countries have been placing sequences on deposit in a timely manner, there are still major deficiencies in the surveillance program, as described above. Moreover, the recent reports of Tamiflu resistance in isolates in Denmark, Japan, and Hong Kong have not lead to the release of these sequences.
An increase in surveillance and release of full sequences is still necessary. The pandemic H1N1 is now rapidly spreading in the southern hemisphere, which is just beginning its flu season. Sequences from fatal and mild cases are required to determine important changes in pandemic H1N1 associated with increased virulence as well as increased spread.
A serious comprehensive surveillance program is long overdue.
Media Links
Recombinomics: Tamiflu Resistant Swine H1N1 in Hong Kong and San Francisco
Commentary
Recombinomics Commentary 13:36
July 3, 2009
"This is the first time Tamiflu resistance in HSI virus found in Hong Kong," he said, adding that similar cases were also reported in Denmark and possibly Japan.
"Tests showed that this strain is sensitive to zanamivir (Relenza)," he said.
The virus was isolated from the specimen taken from a 16-year-old girl coming from San Francisco. She was intercepted by Port Health Office at the Hong Kong International Airport on June 11 upon arrival. The girl was then admitted to Queen Mary Hospital for isolation. She was tested positive to HSI but opted not to take tamiflu. She had mild symptoms and was eventually discharged upon recovery on June 18.
The spokesman noted that PHLSB conducted routine sensitivity tests on specimens taken from confirmed HSI patients.
The above comments from the Hong Kong Department of Health press release describe Tamiflu resistance (presumably H274Y, aka H275Y) in a patient arriving from San Francisco. The resistance was discovered during routine surveillance and there is no indication the patient was taking oseltamivir, indicating the pandemic H1N1 was evolutionarily fit.
The two other cases described this were (in Denmark and Japan) were in patients under prophylactic treat of Tamiflu. In both cases the resistance was due to H274Y (and discovered because of the prophylactic treatment).
Evolutionarily fit swine flu with H274Y is cause for concern. Last year seasonal H1N1 with H274Y spread worldwide. It had previous spread from one genetic background to another via genetic hitchhiking and recombination.
It is likely that H274Y in pandemic H1N1 will now follow a similar, but accelerated, pathway due to widespread use of oseltamivir to control the spread of pandemic H1N1.
The export of H274Y from San Francisco, and failure to identify the polymorphism in the United States, raises serious surveillance concerns.
Media Links
Chemical treated seeds kill birds
Source: Hueiyen News Service
Imphal, July 02 2009: Farmers sowing paddy seeds in the dry fields happen to be trap for to kill birds that eat the seeds.
Many birds died in some places in Imphal east where farmers sow paddy seeds in the fields as they could not wait for natural rain.
Losing patient in waiting the advent of rain and fear of late in cultivation works, in the fields where there is no irrigation facilities, farmers have started sowing paddy seeds in the dry land after treating the seeds with chemical insecticides so as to avoid attack by insects and others.
Many birds specially wild pigeon died of eating the chemical treated seeds in the field in the last few days.
Farmers said that they are sowing the seeds as the season for cultivation coming late and they have no irrigation facilities to fill their field with water which is necessary for sowing the paddy seeds.
The practice they are doing is an old method which their forefather practiced when experienced scanty rainfall trying their lucks.
"We are sowing the seeds not with the hope of getting fruits of their effort but trying luck if rain comes in the later stage of the season, Manglemjao, a farmer of Kaibi village located in Imphal east said.
The same practice is doing all the farmers of the area as they are expecting to get rain in later parts.
They said, as June month ended, there would no time for sowing paddy even though rainfall is expected.
They feel worried of not getting time for sowing.
Farmers have no hope of getting their share of paddy sapling which government is planning to grow in nursery fields at government expense.
Waiting for government supply would be like "Mangda mangra thanba (which can be meant as hoping to get something which is beyond expectation)", Manglemjao said.
Instead of wasting time thinking getting government assistant, it will be better to try our luck, Biren, another farmer said.
Before sowing the paddy seeds, farmer apply chemical insecticides of their choice which is a concern considering for the births and other harmless living things.
Birds eating the chemical apply seeds got killed.
Farmers have found many dead birth specially wild pigeon in the fields.
Another most concerning thing is that children use to collect the dead birds from the fields and after dressing and fried eat it.
According to farmers, children could collect more than 20 birds from the fields in a day.
But, so far there were no report of causing health problem to children who consumed the birth.
With regard to the application of insecticide before sowing, farmers said that they have been doing so as they fear of not growing well if sow without mixing with chemicals.
But, with the detection dead of birds, some farmers have started tilling the field after sowing the seeds so as to cover the seeds by soil.
The practice has been done with the believed that killing wild pigeon is not good in future.
Bangladesh-Swine flu cases rise to 16
Sixteen A/H1N1 (swine) flu cases have so far been confirmed in Bangladesh as seven more cases were detected in the last two days, a senior official said, reports Xinhua.
Mamun Rashid, a senior official of the Institute of Epidemiology, Disease Control and Research (IEDCR) under the health ministry told Xinhua on Thursday that three more cases were detected on Wednesday and four on Tuesday.
Among the seven Bangladeshi patients, two persons returned last week from Australia and the United States respectively, while the other five had close contact with their relatives who returned from abroad recently, Rashid said.
He said the patients are all at home now under appropriate treatment and also under supervision of health officials.
Meanwhile, the earlier nine A/H1N1 flu patients have almost all recovered, Rashid said.
The government on June 18 confirmed the country''s first flu case. The patient was an 18-year-old young man who returned from the US on June 14.
Bangladesh-Harijans in Barisal eat up thr pigs fearing drie
SWINE FLU SCARE
Our Correspondent . Barisal
Our Correspondent . Barisal
People of the Harijan community in Barisal have already started killing and eating their pigs beforehand fearing an anti-swine flu drive that might cull the animals.
There are six colonies of the Harijans, people of lower chaste, like cleaners and sweepers, in the Barisal city.
About 250 members of 75 families reside at the Harijan colonies, locally known as ‘Methor Patty’ or ‘Dom Patty’ at Nazirer Pol, Falpatty, Katpatty, Marok Khola, Kawnia Janoki Sen Road and Amir Kutir, in densely populated areas of the city.
Of the six Harijan colonies, three are at Marok Khola, Kawnia Janoki Sen Road and Amir Kutir, where they domestically raise pigs, mainly for own consumption and business.
Although the local Livestock Department office does not know the exact number of pigs raised by the Harijans, different sources said there are at least 500 pigs, hogs, boar, swine and porkers in these areas.
Following media report on detection of swine flu cases in the country, some of the Harijans hid their pig herds in fear of anti-swine flu drive by the health or livestock authorities and some started killing the domestic animals for consumption, sources said.
Babulal, a resident of Kawnia Harijan Patty, said, ‘We do not now anything about swine flu, but we are in fear of possible
anti-swine flu drive anytime.’
Residents of the Harijan colonies further said rearing of pigs is the part of their traditional, religious, economic and cultural life.
‘We eat pork, sacrifice pigs in our religious, social and cultural rituals and sell them at high prices to those who are in pork business,’ said Munna Dom, secretary of the local Harijan Sampraday.
‘Every year, after the breeding season, we collect herds of 10 to 12 young pigs or porkers from the Harijan Pallis in Faridpur, Madaripur, Rajbari, Tekerhut and Jessore at the rate of Tk30,000 to 35,000 each. After rearing, we sell the mature pigs at Tk 12,000 to 15,000 each ,’Munna said further. ‘We are engaged with the pig business traditionally, but never such a scare as swine flu has hit our trade before.’ he added.
Dr Harunur Rashid, divisional health director, Dhirendranath Sardar, director of Sher-e-Bangla Medical College Hospital, and Mrinal Kanti Mitra, scientific officer of Barisal livestock disease centre and laboratory, said that there is nothing to be afraid of so much as yet as no one in the country has been diagnosed with swine flu virus so far, other than those who came from abroad.
Mrinal Kanti said, ‘Although we have no swine flu testing kit or lab facilities, there is no reason as yet to suspect existence of swine flu virus in the pig herds of the local Harijans as they haven’t come from the counties attacked with the disease.’
‘However, the situation is now under out close observation,’ the added.
Flu death toll in Thailand rises to 6
- By: BangkokPost.com
- Published: 3/07/2009 at 07:12 PM
The Public Health Ministry on Friday afternoon revealed that a Thai man, aged 30, of Bangkok has died of H1N1 flu, adding up the death toll in Thailand to 6.
Earlier today, the ministry said another 154 Thai people were additionally listed as having had the H1N1 flu, bringing up the total to 1,710. As of Friday morning, the death toll was 5.
The World Health Organisation today disclosed that the global death toll stood at 337 while the number of people having contracted the flu in 121 countries was over 80,000.
Indonesia-Catch a plane, catch H1N1
Adianto P. Simamora and Andra Wisnu , The Jakarta Post , Jakarta Fri, 07/03/2009 2:56 PM Headlines
The number of people in Indonesia suspected of having contracted influenza A H1N1 continued to increase on Thursday, with five new hospital admissions in North Sumatra and four in Bali.
Adam Malik Hospital in Medan, North Sumatra, said the group of five had just returned from a holiday in Malaysia and Thailand.
"All five patients are still only suspect cases and are being monitored closely," hospital spokesman Atmawijaya said Thursday.
"We have isolated them in special rooms for swine flu and bird flu patients."
After returning to Medan on Tuesday, the patients were admitted to hospital on Wednesday afternoon with one of them suffering a high fever.
During their stay in Malaysia, the group had learned from local authorities that someone with a suspected case of influenza A H1N1 infection had been aboard their flight from Thailand, and they could have been exposed to the virus.
The five were in a relatively stable condition on Thursday and samples had been sent to the Health Ministry in Jakarta for laboratory tests, Luhur Soeroso, head of hospital's team of doctors handling influenza A H1N1 and H5N1 (bird flu) infections, said.
"We are treating this very seriously because these are the first *suspected* cases of H1N1 infection in Medan," Luhur said.
In Denpasar, Sanglah General Hospital announced Monday it had admitted four new patients believed to be infected with influenza A H1N1.
The four had recently arrived from Europe, the United States and Australia.
Previously, two Australian teens who had tested positive for the virus were released after showing signs of recovery.
Meanwhile, the health of 16 Indonesian students quarantined in a Singapore hospital had also improved and they were expected to return to Indonesia next week.
"The students are recovering well and we expect six of the 16 to be released, fully healthy, on Saturday," English First general manager Anders Bauer told The Jakarta Post on Thursday.
He said that the remaining eight would be most likely to be released later on Monday or Tuesday.
There were eight confirmed cases of influenza A H1N1 virus infection and an "indeterminable" number of suspected cases in Indonesia as of Thursday, Jakarta Health Agency spokeswoman Tini Suryanti said.
Sulianti Saroso Hospital for Infectious Diseases in North Jakarta had admitted six people suspected of having contracted influenza A H1N1, Tini said.
"They are in isolation chambers, but they are all doing OK," she said in a telephone interview.
The Health Ministry and its regional agencies were working to shorten response times to prevent a possible outbreak, with Jakarta Health Agency preparing special ambulances and readying Sulianti Saroso as a target hospital for patients with suspected H1N1 infections.
"Swine flu may have a low mortality rate, but that doesn't mean we should let our guard down," Tini said.
Vietnam-H1N1 enters highly contagious phase
WHO guarantees swine flu treatment for the Americas
| July 3, 2009 | ||
The World Health Organization on Thursday vowed poor countries in the Americas would receive enough antivirals to combat the swine flu outbreak, amid fresh concern over the pandemic's spread. During a summit in Cancun, Mexico, WHO director-general Margaret Chan said Swiss pharmaceuticals giant Roche had promised to supply 5.6 million Tamiflu treatments, which the WHO would distribute to developing countries. Chan added the WHO would hold talks with donors to buy additional antiviral reserves in order to handle demand in the coming months in anticipation of a surge in cases of A(H1N1), which has killed 332 people worldwide since emerging in Mexico in April. Policy makers and experts from 50 countries are meeting in the Mexican beach resort to discuss their response to this year's swine flu outbreak, as Latin America continues to be hit by new cases. | ||||
"The region is pretty well covered with antivirals, with equipment for diagnosis," Roses said. The Americas have been the hardest hit by the disease, with the United States, Mexico, Canada and Argentina suffering the vast majority of the world's fatalities, according to WHO figures. Argentina has seen a sharp rise in fatalities, with the number of dead rising from 26 to 43 in the last five days according to national figures. But Roses tried to assuage fears that the international community will be unable to deal with the outbreak if it continues to spread. "Our strategic reserves will be re-enforced by the WHO and with the donation that the US department of health has announced we have around one million treatments in our deposit in Panama," Roses said. "There is absolute equality (of coverage) between the 41 countries and territories," Roses said in addressing the concerns of developing nations. But the Cancun meeting also comes amid fears of a resurgence of the virus as the Northern Hemisphere's summer edges toward its end, and as Japan reported finding a swine flu strain that was Tamiflu resistant. The Kyodo news agency reported the patient -- a woman in Osaka prefecture -- was recovering after having been given Relenza, an alternative anti-flu marketed by GlaxoSmithKline. A spokeswoman for Swiss pharmaceuticals giant Roche, which makes Tamiflu, said the case was "absolutely normal," adding that "0.4 percent of adults develop resistance" to Tamiflu. |
Press Release Hong Kong: Detection of human swine influenza virus resistant to Tamiflu
A spokesman for the Department of Health (DH) said the department's Public Health Laboratory Services Branch (PHLSB) today (July 3) detected a strain of human swine influenza (HSI) virus which was resistant to oseltamivir (Tamiflu).
The virus was identified during PHLSB's routine sensitivity test of HSI virus to oseltamivir and zanamivir, the spokesman said.
"This is the first time Tamiflu resistance in HSI virus found in Hong Kong," he said, adding that similar cases were also reported in Denmark and possibly Japan.
"Tests showed that this strain is sensitive to zanamivir (Relenza)," he said.
The virus was isolated from the specimen taken from a 16-year-old girl coming from San Francisco. She was intercepted by Port Health Office at the Hong Kong International Airport on June 11 upon arrival. The girl was then admitted to Queen Mary Hospital for isolation. She was tested positive to HSI but opted not to take tamiflu. She had mild symptoms and was eventually discharged upon recovery on June 18.
The spokesman noted that PHLSB conducted routine sensitivity tests on specimens taken from confirmed HSI patients.
"This is the only Tamiflu-resistant strain so far among some 200 HSI samples tested in Hong Kong. Further tests are underway," he said.
Hong Kong has maintained an antiviral stockpile of both Tamiflu and Relenza.
The case will be reported to the World Health Organization (WHO), the spokesman said. He reiterated that Hong Kong had an intensive influenza surveillance system on antiviral resistant influenza viruses.
"We will closely liaise with WHO and overseas health authorities and monitor the global development of antiviral resistant HSI virus," he said.
hat-tip Ironorehopper
The virus was identified during PHLSB's routine sensitivity test of HSI virus to oseltamivir and zanamivir, the spokesman said.
"This is the first time Tamiflu resistance in HSI virus found in Hong Kong," he said, adding that similar cases were also reported in Denmark and possibly Japan.
"Tests showed that this strain is sensitive to zanamivir (Relenza)," he said.
The virus was isolated from the specimen taken from a 16-year-old girl coming from San Francisco. She was intercepted by Port Health Office at the Hong Kong International Airport on June 11 upon arrival. The girl was then admitted to Queen Mary Hospital for isolation. She was tested positive to HSI but opted not to take tamiflu. She had mild symptoms and was eventually discharged upon recovery on June 18.
The spokesman noted that PHLSB conducted routine sensitivity tests on specimens taken from confirmed HSI patients.
"This is the only Tamiflu-resistant strain so far among some 200 HSI samples tested in Hong Kong. Further tests are underway," he said.
Hong Kong has maintained an antiviral stockpile of both Tamiflu and Relenza.
The case will be reported to the World Health Organization (WHO), the spokesman said. He reiterated that Hong Kong had an intensive influenza surveillance system on antiviral resistant influenza viruses.
"We will closely liaise with WHO and overseas health authorities and monitor the global development of antiviral resistant HSI virus," he said.
hat-tip Ironorehopper
Tamiflu Resistance: Hong Kong coming from San Francisco
Friday, July 3, 2009
First Tamiflu-resistant swine flu case found in teenager
(10 mins ago)
A 16-year-old girl was found to be infected with a mutation of the swine flu virus that is resistant to the antiviral Tamiflu soon after arriving from San Francisco, the Department of Health said today.
It is the first such case in Hong Kong. Similar cases have been reported in Denmark and Japan.
The teenager was intercepted at the airport on June 11 and admitted to Queen Mary Hospital.
She opted not to be put on a course of Tamiflu before testing positive for the swine flu strain, which is known to be resistant to the antiviral.
She had mild symptoms and was discharged on June 18.
The case will be reported to the World Health Organization.
Danish health authorities have used Relenza, an alternative anti-flu medication, to successfully treat a female patient with the same strain.
The Japanese said a patient was found to be resistant to Tamiflu after being put on the drug since she was being diagnosed with the H1N1 virus around two weeks ago, Kyodo news agency reported yesterday.
The Osaka prefecture patient was recovering after having been given Relenza.
A spokeswoman for Swiss pharmaceuticals giant Roche, which makes Tamiflu, said the company had been informed of the case and described as ''normal'' such resistance to the drug.
''It is absolutely normal,'' she said, adding that ''0.4 percent of adults develop resistance'' to Tamiflu.
She said such cases do not indicate Tamiflu has become less effective against swine flu.
hat-tip Niman
First Tamiflu-resistant swine flu case found in teenager
(10 mins ago)
A 16-year-old girl was found to be infected with a mutation of the swine flu virus that is resistant to the antiviral Tamiflu soon after arriving from San Francisco, the Department of Health said today.
It is the first such case in Hong Kong. Similar cases have been reported in Denmark and Japan.
The teenager was intercepted at the airport on June 11 and admitted to Queen Mary Hospital.
She opted not to be put on a course of Tamiflu before testing positive for the swine flu strain, which is known to be resistant to the antiviral.
She had mild symptoms and was discharged on June 18.
The case will be reported to the World Health Organization.
Danish health authorities have used Relenza, an alternative anti-flu medication, to successfully treat a female patient with the same strain.
The Japanese said a patient was found to be resistant to Tamiflu after being put on the drug since she was being diagnosed with the H1N1 virus around two weeks ago, Kyodo news agency reported yesterday.
The Osaka prefecture patient was recovering after having been given Relenza.
A spokeswoman for Swiss pharmaceuticals giant Roche, which makes Tamiflu, said the company had been informed of the case and described as ''normal'' such resistance to the drug.
''It is absolutely normal,'' she said, adding that ''0.4 percent of adults develop resistance'' to Tamiflu.
She said such cases do not indicate Tamiflu has become less effective against swine flu.
hat-tip Niman
World health officials tackle swine flu challenges
Friday, July 3
CANCUN, Mexico – Swine flu is running wild in the Southern Hemisphere and is spreading rapidly through Europe, with Britain projected to reach 100,000 daily cases by the end of August. The virus is even showing signs of rebounding in Mexico.
World Health Organization Director-General Dr. Margaret Chan and health ministers from around the globe huddled Thursday in Cancun for a two-day summit to design strategies for battling the pandemic. Nations attending include the United States, Canada, China, Britain and Brazil.
"As we see today, with well over 100 countries reporting cases, once a fully fit pandemic virus emerges, its further international spread is unstoppable," Chan said during opening remarks.
Mexican officials wanted the meeting held in the Caribbean resort city of Cancun _ where tourism has plunged _ to highlight the country's success in controlling its epidemic with a five-day national shutdown of schools and businesses in May.
The measures were applauded by the U.S. Centers for Disease Control and international health officials.
"Our presence here is an expression of confidence," Chan said. "Mexico is a safe, as well as a beautiful and warmly gracious, place to visit."
But Mexico is starting to see an increase in swine flu cases in isolated areas. In southern Chiapas state and the state of Yucatan _ adjacent to Quintana Roo state, where Cancun is located _ cases have jumped more than 50 percent in a worrying sign that the country may see a resurgence, especially when its winter flu season begins in November.
In the space of a week ending Tuesday, the number of cases in Yucatan state jumped from 683 to 1,362, and in Chiapas from 492 to 1,079, Mexico's Health Department said. During the same week, Quintana Roo reported 102 new cases.
Yucatan and Chiapas officials blamed the spike on outbreaks in schools, which they closed a few weeks early for summer break.
"Unfortunately we let our guard down, especially after classes started, and the outbreak is unstoppable," Yucatan Health Secretary Alvaro Quijano told local news media.
Mexico has confirmed a total of 10,687 cases to date, including 119 deaths.
With the Southern Hemisphere in the midst of its winter flu season, Chan said officials are keeping a close watch on those countries. U.S. Health Secretary Kathleen Sibelius said the United States will give 420,000 Tamiflu treatments to the Pan American Health Organization to be distributed in Latin America and the Caribbean.
Chile's epidemic has followed closely behind outbreaks in Mexico and the United States. Cases in the South American country have swelled to 7,342, including 15 deaths. The government has predicted it could see as many as 140 children hospitalized a day.
Argentina, meanwhile, has 1,587 cases and now ranks first in South America with 26 deaths and third behind Mexico and the United States.
Under mounting public pressure, Argentina's government this week announced schools would close nationwide Monday for an extended winter break.
Britain, which has officially reported 7,447 swine flu cases, is the hardest-hit nation in Europe. Many flu experts believe numbers could jump exponentially now that the virus is entrenched.
British officials had been trying to contain the flu by liberally giving out the drug Tamiflu to all suspected victims and their contacts. Health minister Andy Burnham said Thursday that Britain will now only give the antiviral to people with the virus after forecasting 100,000 new swine flu cases a day by the end of August.
Experts questioned Burnham's prediction.
"It seems like a lot of mathematical modeling and not too much common sense," said John Oxford, a professor of virology at St. Bart's and Royal London Hospital.
Oxford predicted swine flu would taper off with summer's warm weather.
Australia has the most cases in the Asia-Pacific region, with more than 4,568 confirmed as of Thursday, an increase of 198 in one day. A 45-year-old man died in the intensive care ward of a Sydney hospital on Monday, becoming the 10th death.
Worldwide, there were 332 deaths and more than 77,000 confirmed cases as of Wednesday, according to the latest figures available from the WHO.
Still, Chan emphasized that most people recover from the illness without medical treatment and most who die have underlying medical conditions.
But she warned officials are concerned about the virus mutating.
"Like all influenza viruses, H1N1 has the advantage of surprise on its side," she said.
CIDRAP: Studies: Novel H1N1 affects deep lung tissue, transmits fairly well
Maryn McKenna and Lisa Schnirring * Staff Writers
Jul 2, 2009 (CIDRAP News) – The novel H1N1 (swine) influenza now circling the globe causes more serious lung disease than seasonal flu strains and sheds from the lung and throat tissue where it reproduces at higher rates, according to two animal studies published today—findings that could explain autopsies and case reports of severe pneumonia as well as the virus's rapid spread.
And while the studies, conducted in ferrets and mice, agree that the new flu passes fairly well between individuals, they disagree over the effectiveness of different modes of transmission.
A team from Erasmus Medical Center in the Netherlands found that the virus transmits easily between ferrets housed in cages whose walls are 4 inches apart. But a team from the Massachusetts Institute of Technology (MIT) and the Centers for Disease Control and Prevention (CDC) found that the novel virus only transmitted well when the ferrets shared direct contact—a sign, that team said, that the new virus has not yet fully adapted to mammals.
The European team, though, warned that the new H1N1 is adapted enough to compete with seasonal flu strains for turf in humans. It "has the ability to persist in the human population, potentially with more severe clinical consequences," they wrote.
Both studies were published online today by the journal Science.
CDC/MIT: Deeper infections with novel H1N1
In the study from the CDC and MIT group, investigators tested the ability of three different novel H1N1 isolates to cause disease in ferrets and mice and assessed the transmissibility of the new virus in ferrets by comparing it to a seasonal H1N1 virus.
Ferrets groups were inoculated intranasally with one of the four viruses, then 24 hours later were either placed in the same cage with flu-naive ferrets to gauge contact transmission or were placed in a cage adjacent to naive animals to test droplet transmission. Researchers monitored ferrets' clinical signs for 14 days.
Investigators measured transmission by assessing viral titers in nasal washes and by detecting viral antibodies in the blood of recovering animals.
The animals that received the novel flu viruses lost more weight than the ones that were infected with the seasonal flu strain. Viral shedding patterns were similar for the novel flu groups and the seasonal flu group.
Investigators, however, detected high titers of viruses in the lower respiratory tracts of animals infected with two of the three novel H1N1 viruses but not the seasonal flu virus. The group also found the novel flu virus in the intestinal tracts of the novel-H1N1–infected animals, consistent with gastrointestinal symptoms that have been reported in humans infected with the new virus.
Direct contact vs droplet spread
In the transmission comparison arm of the study, the researchers found that the seasonal H1N1 virus transmitted quickly and completely by droplet transmission and direct contact among the ferrets. However, the novel H1N1 viruses did not spread by droplets to all ferrets, and transmission was delayed by 5 or more days in two of six infected pairs.
The group wrote that their findings suggest the morbidity and lung viral titers are higher in ferrets infected with the novel H1N1 virus and that, while the virus spread completely among contact group, it did not always spread to the ferrets in the droplet transmission group.
"This lack of efficient respiratory droplet transmission suggests that additional virus adaptation in mammals may be required to reach the high-transmissible phenotypes observed with seasonal H1N1 or the 1918 pandemic virus," the group wrote.
In just one of the puzzles presented by the new virus, the CDC-MIT team found that the novel H1N1 lacks two genetic characteristics that normally encourage flu viruses to bind to the respiratory tract and replicate: an affinity for alpha-2,6 receptors in the lungs, and an amino acid substitution in a gene known as PB2 (for polymerase basic protein 2) that allows the virus to replicate at airway temperatures.
The lack of those two features suggests that the new flu has not completed its adaptation to humans, and "should be closely monitored as markers for enhanced virus transmission," the authors wrote.
Terrence Tumpey, PhD, the study's corresponding author and senior microbiologist in the CDC's influenza division, told CIDRAP News that the study shows that the new virus is transmitting, but not quite as well as seasonal strains. "Seasonal strains transmit like clockwork as soon as we push the cages together," he added.
Researchers who have worked with ferrets during influenza studies can readily tell the difference when they stand outside the cages and listen for sneezes, he said. Ferrets infected with seasonal strains sneeze frequently, those inoculated with avian influenza strains sneeze hardly at all, and those who are sick with the new H1N1 virus sneeze somewhere in between those two levels, Tumpey said.
"We think it [the new virus] could still make additional changes to become more transmissible," Tumpey said. "We need to keep a close eye on the virus and monitor for changes."
Dutch study: High transmission with droplets and aerosol
In the Dutch study, ferrets were inoculated with a novel H1N1 from the first known case in the Netherlands, a 3-year-old child who had developed a fever and respiratory symptoms and recovered. (Genomic analysis showed that the virus from the Dutch child was only minimally different from the California isolate used in the CDC study.)
The virus was administered to ferrets, and their course was compared to that of ferrets given a seasonal flu virus isolated in the Netherlands in the 2006-2007 season.
Across the board, the ferrets that received the novel H1N1 shed 1.5 times more virus from their respiratory tracts than ferrets infected with seasonal flu. Virus was present in their lungs and trachea, rather than just in their noses, and they also experienced more tissue damage that went deeper into their lungs.
In the most striking difference from the CDC group, the ferrets in the Dutch study caught the H1N1 flu from one another "via aerosol or respiratory droplets." In another difference, the Dutch study did not find any viral replication outside the animals' respiratory tracts; livers, spleens, kidneys and brains were free of H1N1 on necropsy. (There was no indication the Dutch team did pathology on their ferrets' intestinal tracts.)
Though the ferrets in the Dutch study were moderately ill at most, the authors warned that the novel H1N1's ability to transmit easily and replicate throughout the respiratory tract could make it a serious health threat in humans. Because seasonal flu strains replicate high in the nose and throat, and avian flu replicates deep in the airways, co-infection with either could product a reassorted virus that causes more serious human disease or picks up drug-resistance factors from currently circulating seasonal strains, they said.
Transmission around globe not slowing
Lending anecdotal credence to the transmissibility of novel H1N1 has been its continued spread among people worldwide. As community spread of the virus takes hold in more parts of the world, the virus is showing up anywhere that groups of people gather, such as:
* Summer camps. Officials from the Muscular Dystrophy Association shuttered the group's summer camps after the virus was detected at several locations, prompting the CDC to issue new guidance.
* Prisons. The virus struck a women's prison near Miami, sickening at least six women, with more than a dozen other suspected cases, and the virus is suspected at a facility in Queensland, Australia
* Athletic events. Members of a women's basketball team returning to Iraq were confirmed as the country's first cases, an Australian athlete was infected with the virus at the World University Games in Belgrade, and flu fears surfaced this week as some Wimbledon players became ill.
* Cruise ships. Three crew members on a Seattle-Alaska cruise were isolated in their rooms after testing positive for the virus, and a Dutch boat based in Aruba was turned away from different ports in the Caribbean after some crew and passengers began showing symptoms.
In addition, earlier this week, health authorities from Saudi Arabia warned high-risk groups to avoid the hajj pilgrimage that starts in late November because the crowded setting could post a flu-transmission risk. And a study that appeared this week in the New England Journal of Medicine showed that of 20 countries that had the highest travel volume to Mexico in 2007 and 2008, 16 had experienced recent novel H1N1 importations from the country.
Commenting on this community spread during the summer months, influenza expert William C. Schaffner, MD, told CIDRAP News, "This transmission in summer camps reminds us that not all summer camps are rural, with kids living in open cabins. There are many summer camps that resemble school—my grandchildren just went to theater summer camp; other kids go to computer or music summer camps.
"That plus the fact that this is a new virus, in a completely susceptible population, namely children and young adults, is clearly contributing to this ongoing transmission. I don't mind saying the degree of transmission has surprised me and frankly most of my colleagues also."
Schaffner, professor and chair in the department of preventive medicine at Vanderbilt University School of Medicine, added "I think the ongoing transmission this summer and what we know is happening in the southern hemisphere—in Argentina and in Australia and New Zealand—is going to be a harbinger of what is going to happen this next influenza season in the United States.
"We all anticipate that H1N1 will be a dominant if not the dominant influenza strain."
Maines TR, Jayaraman A, Belser J, et al. Transmission and pathogenesis of swine-origin 2009 A(H1N1) influenza viruses in ferrets and mice. Science 2009 Jul 2; early online edition: [Abstract]
Munster VJ, de Wit E, van den Brand JM, et al. Pathogenesis and transmission of swine-origin 2009 A(H1N1) influenza virus in ferrets Science 2009 Jul 2; early online edition: [Abstract]
See also:
Khan K, Arino J, Hu W, et al. Spread of a novel influenza A (H1N1) virus via global airline transportation. (Letter) N Engl J Med 2009 (published online Jun 29) [Full text]
hat-tip Shiloh
Jul 2, 2009 (CIDRAP News) – The novel H1N1 (swine) influenza now circling the globe causes more serious lung disease than seasonal flu strains and sheds from the lung and throat tissue where it reproduces at higher rates, according to two animal studies published today—findings that could explain autopsies and case reports of severe pneumonia as well as the virus's rapid spread.
And while the studies, conducted in ferrets and mice, agree that the new flu passes fairly well between individuals, they disagree over the effectiveness of different modes of transmission.
A team from Erasmus Medical Center in the Netherlands found that the virus transmits easily between ferrets housed in cages whose walls are 4 inches apart. But a team from the Massachusetts Institute of Technology (MIT) and the Centers for Disease Control and Prevention (CDC) found that the novel virus only transmitted well when the ferrets shared direct contact—a sign, that team said, that the new virus has not yet fully adapted to mammals.
The European team, though, warned that the new H1N1 is adapted enough to compete with seasonal flu strains for turf in humans. It "has the ability to persist in the human population, potentially with more severe clinical consequences," they wrote.
Both studies were published online today by the journal Science.
CDC/MIT: Deeper infections with novel H1N1
In the study from the CDC and MIT group, investigators tested the ability of three different novel H1N1 isolates to cause disease in ferrets and mice and assessed the transmissibility of the new virus in ferrets by comparing it to a seasonal H1N1 virus.
Ferrets groups were inoculated intranasally with one of the four viruses, then 24 hours later were either placed in the same cage with flu-naive ferrets to gauge contact transmission or were placed in a cage adjacent to naive animals to test droplet transmission. Researchers monitored ferrets' clinical signs for 14 days.
Investigators measured transmission by assessing viral titers in nasal washes and by detecting viral antibodies in the blood of recovering animals.
The animals that received the novel flu viruses lost more weight than the ones that were infected with the seasonal flu strain. Viral shedding patterns were similar for the novel flu groups and the seasonal flu group.
Investigators, however, detected high titers of viruses in the lower respiratory tracts of animals infected with two of the three novel H1N1 viruses but not the seasonal flu virus. The group also found the novel flu virus in the intestinal tracts of the novel-H1N1–infected animals, consistent with gastrointestinal symptoms that have been reported in humans infected with the new virus.
Direct contact vs droplet spread
In the transmission comparison arm of the study, the researchers found that the seasonal H1N1 virus transmitted quickly and completely by droplet transmission and direct contact among the ferrets. However, the novel H1N1 viruses did not spread by droplets to all ferrets, and transmission was delayed by 5 or more days in two of six infected pairs.
The group wrote that their findings suggest the morbidity and lung viral titers are higher in ferrets infected with the novel H1N1 virus and that, while the virus spread completely among contact group, it did not always spread to the ferrets in the droplet transmission group.
"This lack of efficient respiratory droplet transmission suggests that additional virus adaptation in mammals may be required to reach the high-transmissible phenotypes observed with seasonal H1N1 or the 1918 pandemic virus," the group wrote.
In just one of the puzzles presented by the new virus, the CDC-MIT team found that the novel H1N1 lacks two genetic characteristics that normally encourage flu viruses to bind to the respiratory tract and replicate: an affinity for alpha-2,6 receptors in the lungs, and an amino acid substitution in a gene known as PB2 (for polymerase basic protein 2) that allows the virus to replicate at airway temperatures.
The lack of those two features suggests that the new flu has not completed its adaptation to humans, and "should be closely monitored as markers for enhanced virus transmission," the authors wrote.
Terrence Tumpey, PhD, the study's corresponding author and senior microbiologist in the CDC's influenza division, told CIDRAP News that the study shows that the new virus is transmitting, but not quite as well as seasonal strains. "Seasonal strains transmit like clockwork as soon as we push the cages together," he added.
Researchers who have worked with ferrets during influenza studies can readily tell the difference when they stand outside the cages and listen for sneezes, he said. Ferrets infected with seasonal strains sneeze frequently, those inoculated with avian influenza strains sneeze hardly at all, and those who are sick with the new H1N1 virus sneeze somewhere in between those two levels, Tumpey said.
"We think it [the new virus] could still make additional changes to become more transmissible," Tumpey said. "We need to keep a close eye on the virus and monitor for changes."
Dutch study: High transmission with droplets and aerosol
In the Dutch study, ferrets were inoculated with a novel H1N1 from the first known case in the Netherlands, a 3-year-old child who had developed a fever and respiratory symptoms and recovered. (Genomic analysis showed that the virus from the Dutch child was only minimally different from the California isolate used in the CDC study.)
The virus was administered to ferrets, and their course was compared to that of ferrets given a seasonal flu virus isolated in the Netherlands in the 2006-2007 season.
Across the board, the ferrets that received the novel H1N1 shed 1.5 times more virus from their respiratory tracts than ferrets infected with seasonal flu. Virus was present in their lungs and trachea, rather than just in their noses, and they also experienced more tissue damage that went deeper into their lungs.
In the most striking difference from the CDC group, the ferrets in the Dutch study caught the H1N1 flu from one another "via aerosol or respiratory droplets." In another difference, the Dutch study did not find any viral replication outside the animals' respiratory tracts; livers, spleens, kidneys and brains were free of H1N1 on necropsy. (There was no indication the Dutch team did pathology on their ferrets' intestinal tracts.)
Though the ferrets in the Dutch study were moderately ill at most, the authors warned that the novel H1N1's ability to transmit easily and replicate throughout the respiratory tract could make it a serious health threat in humans. Because seasonal flu strains replicate high in the nose and throat, and avian flu replicates deep in the airways, co-infection with either could product a reassorted virus that causes more serious human disease or picks up drug-resistance factors from currently circulating seasonal strains, they said.
Transmission around globe not slowing
Lending anecdotal credence to the transmissibility of novel H1N1 has been its continued spread among people worldwide. As community spread of the virus takes hold in more parts of the world, the virus is showing up anywhere that groups of people gather, such as:
* Summer camps. Officials from the Muscular Dystrophy Association shuttered the group's summer camps after the virus was detected at several locations, prompting the CDC to issue new guidance.
* Prisons. The virus struck a women's prison near Miami, sickening at least six women, with more than a dozen other suspected cases, and the virus is suspected at a facility in Queensland, Australia
* Athletic events. Members of a women's basketball team returning to Iraq were confirmed as the country's first cases, an Australian athlete was infected with the virus at the World University Games in Belgrade, and flu fears surfaced this week as some Wimbledon players became ill.
* Cruise ships. Three crew members on a Seattle-Alaska cruise were isolated in their rooms after testing positive for the virus, and a Dutch boat based in Aruba was turned away from different ports in the Caribbean after some crew and passengers began showing symptoms.
In addition, earlier this week, health authorities from Saudi Arabia warned high-risk groups to avoid the hajj pilgrimage that starts in late November because the crowded setting could post a flu-transmission risk. And a study that appeared this week in the New England Journal of Medicine showed that of 20 countries that had the highest travel volume to Mexico in 2007 and 2008, 16 had experienced recent novel H1N1 importations from the country.
Commenting on this community spread during the summer months, influenza expert William C. Schaffner, MD, told CIDRAP News, "This transmission in summer camps reminds us that not all summer camps are rural, with kids living in open cabins. There are many summer camps that resemble school—my grandchildren just went to theater summer camp; other kids go to computer or music summer camps.
"That plus the fact that this is a new virus, in a completely susceptible population, namely children and young adults, is clearly contributing to this ongoing transmission. I don't mind saying the degree of transmission has surprised me and frankly most of my colleagues also."
Schaffner, professor and chair in the department of preventive medicine at Vanderbilt University School of Medicine, added "I think the ongoing transmission this summer and what we know is happening in the southern hemisphere—in Argentina and in Australia and New Zealand—is going to be a harbinger of what is going to happen this next influenza season in the United States.
"We all anticipate that H1N1 will be a dominant if not the dominant influenza strain."
Maines TR, Jayaraman A, Belser J, et al. Transmission and pathogenesis of swine-origin 2009 A(H1N1) influenza viruses in ferrets and mice. Science 2009 Jul 2; early online edition: [Abstract]
Munster VJ, de Wit E, van den Brand JM, et al. Pathogenesis and transmission of swine-origin 2009 A(H1N1) influenza virus in ferrets Science 2009 Jul 2; early online edition: [Abstract]
See also:
Khan K, Arino J, Hu W, et al. Spread of a novel influenza A (H1N1) virus via global airline transportation. (Letter) N Engl J Med 2009 (published online Jun 29) [Full text]
hat-tip Shiloh
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