Obama declares swine flu a national emergency

H1N1 matches seasonal flu peak months early: CDC

Friday, 23 Oct 2009 03:50pm EDT By Patricia Zengerle
WASHINGTON (Reuters) - U.S. President Barack Obama has declared 2009 H1N1 swine flu a national emergency, the White House said on Saturday.

The declaration will make it easier for U.S. medical facilities to handle a surge in flu patients by allowing the waiver of some requirements of Medicare, Medicaid and other federal health insurance programs as needed, the White House said in a statement.

The U.S. Centers for Disease Control and Prevention said on Friday that H1N1 swine flu has become widespread in 46 of the 50 U.S. states, a level comparable to the peak of ordinary flu seasons but far earlier and with more waves of infection expected.

Obama signed the statement on Friday night.

The White House statement said the declaration was intended to prepare the country in case of "a rapid increase in illness that may overburden health care resources." It was similar to disaster declarations issued before hurricanes hit coastal areas.

"It's important to note that this is a proactive measure -- not a response to a new development," an administration official said.

"H1N1 is moving rapidly, as expected. By the time regions or healthcare systems recognize they are becoming overburdened, they need to implement disaster plans quickly," he said.

Seasonal flu normally peaks sometime between late November and early March.

Swine flu has hit young adults and children the hardest, while seasonal flu normally is more dangerous for people over age 65.

H1N1 has killed more than 1,000 Americans and put more than 20,000 in the hospital in the United States since it emerged earlier this year, the CDC said. But health officials are quick to note that the actual number of cases cannot be measured.

H1N1 swine flu had been declared a public health emergency earlier in the year.

The new declaration clears the way for waivers of federal requirements that, for example, could prevent hospitals from establishing off-site, alternate care facilities that could help them deal with emergency department demands, the White House said.

Oseltamivir-Resistant Influenza A Pandemic (H1N1) 2009 Virus, Hong Kong, China

[Comment: We had a case of a 16 year old out of China this past August, with Tamiflu Resistance. This is an ahead of print citation. I won't post the whole document, you can read it by clicking on the title. I've bolded the most important information]

DOI: 10.3201/eid1512.091057
Suggested citation for this article: Chen H, Cheung CL, Tai H, Zhao P, Chan JFW, Cheng VCC, et al. Oseltamivir-resistant influenza A pandemic (H1N1) 2009 virus, Hong Kong, China. Emerg Infect Dis. 2009 Dec; [Epub ahead of print]

Honglin Chen, Chung Lam Cheung, Hung Tai, Pengxi Zhao, Jasper F.W. Chan, Vincent C.C. Cheng, Kwok-Hung Chan, and Kwok-Yung Yuen
Author affiliation: The University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China

Resistance to oseltamivir was observed in influenza A pandemic (H1N1) 2009 virus isolated from an untreated person in Hong Kong, China. Investigations showed a resistant virus with the neuraminidase (NA) 274Y genotype in quasi-species from a nasopharyngeal aspirate. Monitoring for the naturally occurring NA 274Y mutation in this virus is necessary


The patient in this study was not treated with oseltamivir. Therefore it is unlikely that the 274Y mutation was drug-induced.

Detection of mixed populations of 274Y and 274H in the NPA specimen before antiviral treatment suggests that the mutation occurs naturally, either before or during infection.

Although no experimental data exist that show the growth properties of this resistant variant, examination of the quasi-species population in the cell culture–propagated virus isolate showed that the 274Y variant has become the dominant population. This finding implies that the 274Y mutation does not compromise replication of pandemic (H1N1) 2009 virus in vitro.

Obama declares swine flu a national emergency

41 minutes ago

WASHINGTON — President Barack Obama has declared the swine flu outbreak a national emergency.

The White House on Saturday said Obama signed a proclamation that would allow medical officials to bypass certain federal requirements. Officials described the move as similar to a declaration ahead of a hurricane making landfall.

Swine flu is more widespread now than it's ever been and has resulted in more than 1,000 U.S. deaths so far.

Health authorities say almost 100 children have died from the flu, known as H1N1, and 46 states now have widespread flu activity.

The White House said Obama signed the declaration on Friday evening.

Copyright © 2009 The Associated Press. All rights reserved.

CDC notes change in ethnic pattern of H1N1 impact

Lisa Schnirring Staff Writer

Oct 22, 2009 (CIDRAP News) – The Centers for Disease Control (CDC) has seen a change in the ethnic distribution of fatal pandemic H1N1 influenza cases, a CDC official reported at a meeting of its vaccine advisory committee today.

In an update on epidemiologic patterns in the pandemic H1N1 outbreak, Lyn Finelli, PhD, head of surveillance for the CDC's Influenza Division, told the Advisory Committee on Immunization Practices (ACIP) that the high-risk groups haven't changed since the spring wave.

However, the impact of the virus on racial groups has changed some since the first wave, she told the group, whose meeting was streamed over the Web. Hispanic people had a higher proportion of deaths in the spring, probably because they had connections to people traveling to and from Mexico, where the outbreak is thought to have started. While the number of deaths in Hispanic people has fallen, since September the rate has risen among African Americans, Finelli said. She said the CDC tracks trends through the Behavioral Risk Factor Surveillance System.

Finelli said CDC data show only two deaths in the Native American population, though some members of the committee said some people who work with tribes have received anecdotal reports of higher death rates in Native Americans, and they voiced concern that state surveillance systems may be undercounting deaths and severe illnesses among the tribes.

Finelli noted that not all tribes report flu data to states and that not all states collect data on tribes the same way. The Council of State and Territorial Epidemiologists recently had a conference call to discuss how to improve flu monitoring in native populations, she said.

Also at the meeting, Nancy Cox, MD, director of the CDC Influenza Division, told the committee that the CDC has analyzed 1,280 pandemic H1N1 isolates, 407 of them from other countries. So far it has conducted complete genetic sequencing of 76 isolates, most of them from severe or fatal cases.

She said though the virus continues to evolve and CDC scientists are detecting minor variations, there is no evidence of reassortment or mutation, which is reassuring, because it points to a close match between the circulating strains and the virus in the vaccine.

The World Health Organization has received reports of 38 oseltamivir-resistant pandemic H1N1 cases, only four of which had no history of exposure to the drug, Cox said. "Exposure to the drug is a primary factor to the resistance marker," she said, adding that researchers still don't know why oseltamivir use can sometimes lead to resistant pandemic H1N1 strains but doesn't seem to be a factor in the development of resistant seasonal H1N1 flu viruses.

A variant of the seasonal H3N2 strain that was circulating in South America this past spring, an A/Perth/16/2009-like virus, has been included in the 2010 Southern Hemisphere flu vaccine, Cox said. Laos and southern China have reported circulation of the H3N2 strain. However, she said the CDC has detected only H3N2 A/Brisbane/10/2007, a component of this season's Northern Hemisphere vaccine, in the few seasonal flu strains that it has isolated so far this fall.

Cox said it's difficult to predict how the US flu season will play out on the basis of the Southern Hemisphere's experience this year. The United States had a spring wave of pandemic H1N1, whereas the Southern Hemisphere's H1N1 epidemic hit during the normal flu season. She pointed out that a map of current virus activity in the United States shows a patchwork of hot spots with plenty of places that haven't been hit hard.

Officials can't predict if the season will peak early, but if it does, "that leaves plenty of time for seasonal strains to circulate if the viruses are successful and the population is susceptible," Cox said.

Florida Hospitals Might Deny Some Patients In Flu Pandemic

Source: by Sheri Fink, Pro Publica Posted on: 21st October 2009

Florida health officials are drawing up guidelines that recommend barring patients with incurable cancer, end-stage multiple sclerosis and other conditions from being admitted to hospitals if the state is overwhelmed by flu cases.

The plan, which would guide Florida hospitals on how to ration scarce medical care during a severe flu outbreak, also calls for doctors to remove patients with a poor prognosis from ventilators to treat those with better chances of survival. That decision would be made by each hospital.

The flu causes severe respiratory illnesses in a small proportion of cases, and people who need ventilators and are deprived of them could die without the breathing help the machines provide.

In June, Florida Surgeon General Ana M. Viamonte Ros sent the draft guidelines (PDF), which already had undergone a series of internal revisions, to 16 state medical organizations for comment.

But the state has not yet publicized the guidelines or solicited input from the general public.

The Health Department released a version of the draft plan at the request of ProPublica.

The document, drawn up by a team from across Florida that included Orange County Health Director Dr. Kevin Sherin, addresses one of the most delicate issues in medicine: what to do if the number of severely ill people needing ventilators and other treatment dramatically exceeds what is available.

The goal, the plan says, is to focus care on patients whose lives could be saved and who would be most likely to function better if they were given whatever resources were available. It says those decisions are not to be made based on patients’ perceived social worth or social role, but the plan calls for different rules for some populations.

The list of conditions that disqualify hospital admission would be applied to most people only in the two most severe levels of a pandemic. However, they would be applied in the first level of a pandemic for people transferred to hospitals from “other institutional facilities” such as nursing homes and mental-health centers.

A flood of patients

Florida’s planning effort reflects a growing acknowledgment that the nation’s hospitals would be unable to cope with the flood of patients that a severe influenza pandemic such as the one that gripped the United States in 1918 would unleash. That resource gap is in the spotlight now, as the country is battered by a second wave of pandemic H1N1 influenza, informally known as the swine flu.

“What we have seen are real stresses, particularly on the emergency departments,” Thomas Frieden, Centers for Disease Control and Prevention director, said in a news conference last week.

The H1N1 flu is much milder than the 1918 flu, but a small percentage of H1N1 patients, including some who have no risk factors and are young and healthy, develop severe breathing problems requiring mechanical ventilation and life support.

So far, intensive-care units have not been overwhelmed with people in need of breathing support.

“That’s something that we’re tracking closely,” Frieden said.

In Winnipeg, Manitoba, all regional critical-care beds were full at the peak of the outbreak last spring, and in Mexico, patients experienced long delays before being admitted to ICUs. Four died before being transferred from the emergency room.

Florida health officials think that the number of severely ill flu patients will likely remain at a manageable level, provided residents gets vaccinated, that they follow advice about not spreading germs and about when to stay home (see myflusafety.com [2]) and the existing flu strain does not mutate into a more virulent form.

In the case of a much more severe scenario, Florida’s draft guidelines would call for hospitals to turn away anyone whose doctor has signed a “Do Not Resuscitate” order, which instructs rescuers not to revive a patient whose heartbeat or breathing stops. A recent report from a panel of national experts convened by the Institute of Medicine urged states not to use DNR orders for this purpose, because they reflect preferences and foresight about end-of-life planning “more than an accurate estimate of survival.”

The report also stressed that clinical scoring systems used to predict survival are imperfect and need more research.

The Florida plan calls for intensive-care patients and those using ventilators to be reassessed with a clinical scoring tool after 48 to 72 hours. Those whose prognoses have significantly worsened would be taken off the machines or discharged from critical care to make way for others who may have a better chance of survival. They would be given palliative care to keep them comfortable if needed.

Stretching resources

One goal of Florida’s plan is to “reduce or eliminate” the legal liability of health care workers who, in good faith, deny treatment or withdraw it from some patients in an emergency. The plan includes sample executive orders that the governor could issue to shield workers and authorize hospitals to implement the guidelines.

As to whether the governor would likely sign such an order, “it’s premature for us to say at this point,” Sterling Ivey, a spokesman for the governor’s office, said. He said it was likely the draft had not yet been sent to the governor, but that he would “look forward to reviewing the plan.”

The draft document also outlines how the health-care system should stretch critical resources, including oxygen, ventilators, medications, IV fluids and staffing, before moving to ration care. The guidelines suggest sterilizing and reusing some supplies, canceling surgeries and other procedures that are not absolutely necessary, and reassigning and training staff to perform critical tasks.

The general public’s responsibilities include treating certain sick family members at home and monitoring public-health messages.

State officials would not release the comments received from medical organizations so far. Health Department officials have yet to review those comments and a revised document, according to Viamonte Ros’ letter, “will be vetted through a series of workshops to receive a broader review” before being finalized.

Viamonte Ros will have final approval authority, and the plan will remain voluntary and subject to review and modification as necessary, according to Florida Department of Health information officer Doc Kokol.

However, staff at some county health departments appear unaware of the plans. Public-information officers working for the Seminole and Lake county health departments were unable to find health officials familiar with them. According to Kokol, a wider range of health departments will be contacted once the initial comments are incorporated.

Sherin, of Orange County, said his key concern is the availability of ventilators and critical-care beds in a pandemic.

“So far so good,” he said. “We haven’t had a lot of critically ill H1N1 patients that have required ventilation yet. But if you end up with a large number of very sick people, that would be the critical resource in the hospital.”

He added, “The public needs to lower expectations when we get to places of critical-resource shortages, and these guidelines would be helpful for hospitals, for EMS, for physicians, for emergency responders to be able to deal with the circumstances.”

Sherin said the draft still requires improvement and will benefit from a broad community process “where as many sets of eyes look at it as possible.”

The ‘greatest good’

Florida’s draft guidelines aim to provide the “greatest good for the greatest number” when doing the best for each patient is no longer possible.

That goal needs to be balanced with an effort to distribute scarce resources in the least discriminatory way, said professor Ken Goodman, director of University of Miami’s bioethics program, who was invited to comment on the draft.

“We want to make the most of our resources,” said Goodman, who also directs the Florida Bioethics Network. “Among the ways we can do that is to somehow take the evidence about what we think works and bolt it to the values that I think are uncontroversially shared: Namely, life is good, suffering is bad. And so how do we do it? It’s a very difficult problem to figure out how the world of science can help ensure that our strategies for allocating resources are fair and effective.”

The Florida Health Department’s original goal was to have a final draft of the plan ready by December. But with public-health workers scrambling to cope with other aspects of the H1N1 pandemic, that is now unlikely, state officials said.

Even so, the draft plan likely would shape the state’s response to a sudden, extreme surge in patients requiring hospital treatment.

“We’d certainly start the discussion with this document,” said Rhonda White, director of the Florida Health Department’s Office of Public Health Preparedness.

Gut-wrenching choices

Florida plans to accept public input after the guidelines are revised by health officials.

“The exact plan for engaging the public is still being discussed,” Kokol wrote in an e-mail, “but it will likely include regional meetings for public input as well as electronic receipt of comments.”

When Utah tested a similar plan against reality in a drill in late August, the results revealed the difficulties Florida clinicians and patients are likely to encounter if its plan is needed.

Utah family physician Pete DeWeerd had to tell the mother of a mock patient that her 7-year-old daughter, who had cerebral palsy and was suffering from the flu, would be turned away from the hospital and likely die.

“I don’t like to tell you this,” he said he told her. “It feels unfair, but our list is our list is our list.”

He added, “It was awful. You get a huge lump in your throat.”

Infectious-disease physician Tom Kurrus, medical director of St. Mark’s Hospital in Salt Lake City, called it “emotionally draining” when mock patients and family members yelled, screamed and took issue with who was denied treatment.

Kurrus said that although the exercise was covered widely in Utah’s media, the public isn’t aware of what the triage protocols contain.

“Even with the scenarios played out and the discussions entertained, they still don’t understand,” he said. “It’s, ‘Why can’t I get into the hospital? Why can’t Grandma get put on a respirator?’”

Goodman, the ethicist, said a frank discussion about the value-laden decisions surrounding who gets treatment in disasters is crucial. “This should be an ongoing process that includes new evidence as it becomes available and that includes, in an open society, the participation of citizens.”

Swine Flu Care May Swamp Health System, Senator Says (Update1)

By Pat Wechsler

Oct. 21 (Bloomberg) -- Swine flu “may be getting ahead of the public health system” because it is spreading so rapidly, causing illness and death, U.S. Senator Joe Lieberman told public health officials today.

Lieberman, an independent legislator from Connecticut, and Senator Susan Collins, a Maine Republican, said at a hearing in Washington that they weren’t sure the U.S. was ready to fight the disease, as H1N1 vaccine production has slowed with 25 percent less supply of the H1N1 vaccine at the end of October than health officials expected.

Hospital emergency rooms may not be prepared and there may also be a shortage of the pediatric version of the antiviral drug Tamiflu made by Roche Holding AG, Collins said at the hearing of the Senate Committee on Homeland Security and Governmental Affairs. The committee is investigating whether the U.S. can cope with the H1N1 flu, which has already killed almost 300 people in 28 states, according to U.S. Centers for Disease Control and Prevention, based in Atlanta.

“The flu is moving very rapidly and while it seems to be affecting most people mildly, it is still affecting a minority very severely,” said Lieberman, the committee’s chairman. Public health officials may not be prepared to “adequately treat” victims at the peak of the U.S. outbreak, he said.

‘Surge of People’

Connecticut may see more than one million people contract H1N1 flu, with 17,300 hospitalizations, Lieberman said, quoting a study by the Washington-based nonpartisan Trust for America’s Health. That number is “150 percent” of the state’s hospital- bed capacity, Lieberman said.

“I want to stress my concern that hospitals and public health departments won’t have the capacity to care for the surge of people who may need hospitalization,” he said.

Maine also may not be prepared, with insufficient vaccine to cover the populations considered most at risk, such as children and pregnant women, Collins said.

She noted an outbreak at Bates College in Lewiston, Maine, where the number of students with swine flu jumped from six to 245 in a week.

Health and Human Services Secretary Kathleen Sebelius said that while there are vaccine delays, the “good news” is that people over the age of 10 years will need only one dose and that the immune response is being detected in eight to 10 days rather than two weeks.

“This disease only surfaced in April and we already have a robust vaccine available,” Sebelius told the committee.

Senate Investigation

The Senate committee is investigating whether the U.S. is prepared to adequately handle the H1N1 flu, which has already killed almost 300 people in 28 states, according to U.S. Centers for Disease Control. As many as 5,000 have been hospitalized, with 53 percent of the patients under the age of 25, the CDC reported.

Sebelius said delays in vaccine shipments are occurring because of “glitches on the production lines.”

The U.S. has placed orders with at least four companies including Novartis AG in Basel, Switzerland; Sanofi-Aventis SA in Paris; AstraZeneca Plc in London, and CSL Ltd. in Melbourne.

“The fill and finish were not working as expected,” she said, referring to packaging of the vaccine. Sebelius said those problems have been addressed and the supply should increase “exponentially,” beginning next month.

Enough Vaccine Coming

“There will be enough vaccine for every American who wants to be vaccinated,” Sebelius said at the hearing.

The U.S. is too dependent on vaccine production in other countries as well as out-of-date technology, Sebelius said.

“We are committed to moving to cell-based technology,” she said. Vaccines are made now using eggs cultured with viruses. “We need something appropriate for the 21st century,” she said.

To help with the most severely ill flu victims, who sometimes don’t respond to antiviral medications or are too sick to take pills or use an inhaler, Sebelius told the committee that the U.S. Food and Drug Administration will push out intravenous medication that may prove to be more effective on an “emergency use authorization” rather than waiting for the testing to be completed.

“This is among the highest priorities with the FDA and CDC,” she said. Sebelius said approval is “imminent” and may be days away.

IV Medicine

Biocryst Pharmaceuticals Inc. is one of the companies testing an IV formulation of peramivir. While the drug performed no better than a placebo against seasonal influenza in a human medical trial, a CDC laboratory found it may work against swine flu, the Birmingham, Alabama company has said.

The antiviral drugs already in use include Roche’s Tamiflu pills and Glaxo’s Relenza, which is inhaled.

Homeland Security Secretary Janet Napolitano told the committee that the government was starting undercover operations to root out sellers of phony treatments for the flu.

To contact the reporters on this story: Pat Wechsler in New York at trandall6@bloomberg.net

Last Updated: October 21, 2009 14:13 EDT

Turkeys catch swine flu at Ontario farm

October 20, 2009
Theresa Boyle
HEALTH REPORTER


The Ontario government is investigating an outbreak of H1N1 influenza at a turkey farm.

The birds have been infected by the H1N1 virus but there has been no transmission to humans, a source confirms.

Cooking destroys the virus, so no one is at risk from consuming turkey, the source says.

The Chief Veterinarian for Ontario, Dr. Deb Stark, and Chief Medical Officer of Health, Dr. Arlene King, are holding a news conference on the issue at 2 pm Tuesday.

hat-tip Ironorehopper

CDC Health Alert Network (HAN) Info Service Message: Recommendations for Early Empiric Antiviral Treatment in Persons with Suspected Influenza who are

Distributed via Health Alert Network

October 19, 2009, 13:51 EDT

Summary Recommendations: When treatment of influenza is indicated in a patient with suspected influenza, health care providers should initiate empiric antiviral treatment as soon as possible. Waiting for laboratory confirmation of influenza to begin treatment with antiviral drugs is not necessary. Patients with a negative rapid influenza diagnostic test should be considered for treatment if clinically indicated because a negative rapid influenza test result does not rule out influenza virus infection. The sensitivity of rapid influenza diagnostic tests for 2009 H1N1 virus can range from 10% to 70%, indicating that false negative results occur frequently.

Situation

The 2009 pandemic H1N1 influenza virus continues to be the dominant influenza virus in circulation in the U.S. The benefit of antiviral treatment is greatest when it is initiated as early as possible in the clinical course. Several recent reports have indicated two problems related to antiviral treatment: (1) some patients with suspected influenza who are at higher risk of developing severe complications, including hospitalized patients, were not treated at all with antiviral medications because of a negative rapid influenza diagnostic test result and (2) initiation of treatment was delayed for some patients with suspected influenza who are at higher risk of developing severe complications, including hospitalized patients, because clinicians were waiting for results of real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) assay.

Who is prioritized for treatment with influenza antiviral drugs?

Most healthy persons (i.e., those without a condition which puts them at higher risk for complications) who develop an illness consistent with uncomplicated influenza do not need to be treated with antiviral medications and will recover without complications. However, clinical judgment should be the ultimate guide in making antiviral treatment decisions for ill persons who are not at higher risk for complications from influenza.

Early empiric treatment with oseltamivir or zanamivir is recommended for all persons with suspected or confirmed influenza requiring hospitalization. Prompt empiric outpatient antiviral therapy is also recommended for persons with suspected influenza who have symptoms of lower respiratory tract illness or clinical deterioration regardless of previous health or age.

Early empiric treatment should be considered for persons with suspected or confirmed influenza who are at higher risk for complications, even if not hospitalized, including:

o Children younger than 2 years old

o Adults 65 years and older

o Pregnant women

o Persons with the following conditions:

· Chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), or metabolic disorders (including diabetes mellitus);

· Disorders that that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders)

· Immunosuppression, including that caused by medications or by HIV;

· Persons younger than 19 years of age who are receiving long-term aspirin therapy, because of an increased risk for Reye syndrome.

When should health care providers start treatment with antiviral drugs?

Once the decision to administer antiviral treatment is made, oseltamivir or zanamivir should be initiated as soon as possible. Evidence for benefit from antiviral treatment in studies of seasonal influenza is strongest when treatment is started within 48 hours of illness onset. However, some studies of oseltamivir treatment of hospitalized patients with seasonal influenza have indicated benefit, including reductions in mortality or duration of hospitalization, even for patients whose treatment was started more than 48 hours after illness onset.

When treatment is indicated, health care providers should not wait for laboratory confirmation of influenza to begin oseltamivir or zanamivir treatment of patients with suspected 2009 pandemic H1N1 influenza virus infection. Patients with a negative rapid influenza diagnostic test should be considered for treatment if clinically indicated because a negative result does not rule out influenza virus infection. The sensitivity of rapid influenza diagnostic tests to detect 2009 H1N1 virus in respiratory specimens ranges from 10% to 70%, and therefore false negative results occur frequently. Similarly, false negative results can also occur with immunoflorescence assays.

What actions should health care providers take when waiting for influenza test results?

Health care providers should empirically treat persons with suspected influenza illness who are at increased risk for complications if clinically indicated while influenza test results are pending. Antiviral treatment is most effective when administered as early as possible in the course of illness. The rRT-PCR tests are the most sensitive and specific influenza diagnostic tests, but they may not be readily available, obtaining test results may take one to several days, and test performance depends on the individual rRT-PCR assay. Antiviral treatment should not be delayed until rRT-PCR test results are available.

For More Information

Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season: http://www.cdc.gov/H1N1flu/recommendations.htm

Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza Season: http://www.cdc.gov/h1n1flu/guidance/diagnostic_tests.htm

ECDC DAILY UPDATE Pandemic (H1N1) 2009 Update 20 October 2009, 09:00 hours CEST

excerpt:

Updates from U.S.A. and Canada
United States
Update Data as of 16 October 2009, for week ending 10 October 2009 (Week 40)

Virology: 100% of all subtyped influenza A viruses reported to CDC were 2009 influenza A (H1N1) viruses. 99.6% of all specimens were type A and 0.4% were type B. 2009 influenza A (H1N1) viruses continue to be similar to the strain chosen for the vaccine. Since September 1, 2009, four infections with oseltamivir resistant 2009 influenza A (H1N1) viruses have been identified in the United States, and a total of 13 cases have been identified in the U.S. since April 2009 (10 viruses identified by CDC and three viruses identified by additional laboratories).

The 13 cases represent an increase of one case over the previous week. All tested viruses retain their sensitivity to the neuraminidase inhibitor zanamivir. Eleven patients (including nine of the viruses detected at CDC and two viruses identified by the additional laboratories) had documented exposure to oseltamivir treatment or chemoprophylaxis, and the remaining two patients are under investigation to determine exposure to oseltamivir.

Since the emergence of the 2009 influenza A (H1N1), all isolates tested have been resistant to the adamantanes (amantadine and rimantadine). Currently, adamantane antiviral susceptibility testing has been suspended at CDC to allow a focus on neuraminidase inhibitors. Because of the low level of circulation of seasonal influenza A (H1N1), A (H3N2), and influenza B viruses, no samples collected since September 1, 2009 were available for antiviral resistance testing.

Mortality Surveillance:
Pneumonia and Influenza Hospitalization and Deaths: From 30 August – 10 October 2009, 4,958 laboratory-confirmed influenza associated hospitalizations, 292 laboratory-confirmed influenza associated deaths, 15,696 pneumonia and influenza syndrome-based hospitalizations, and 2,029 pneumonia and influenza syndrome-based deaths, were reported to CDC.

Pneumonia and Influenza (P&I) Mortality Surveillance:
During week 40, 6.7% of all deaths reported through the 122-Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 6.5% for week 40.

Influenza-associated Pediatric Deaths: Influenza-Associated Pediatric Mortality:
Eleven influenza-associated pediatric deaths were reported to CDC during week 40. Ten of these deaths were associated with 2009 influenza A (H1N1) virus infection and one was associated with an influenza A virus for which the subtype is undetermined. These deaths occurred between 30 August and 10 October 2009. Since 30 August 2009, CDC has received 43 reports of influenza-associated pediatric deaths that occurred during the current influenza season. (A total of 86 deaths in children associated with 2009 H1N1 virus have been reported to CDC.) Among the 43 deaths in children, 28 children had specimens collected for bacterial culture from normally sterile sites and seven (25.0%) of the 28 were positive; Staphylococcus aureus was identified in five (71.4%) of the seven children.

-snip-

http://www.nlm.nih.gov/medlineplus/staphylococcalinfections.html

Staphylococcal Infections

Also called: Staph

Staph is short for Staphylococcus, a type of bacteria. There are over 30 types, but Staphylococcus aureus causes most staph infections (pronounced “staff infections”), including

• Skin infections
• Pneumonia
• Food poisoning
• Toxic shock syndrome
• Blood poisoning (bacteremia)

Skin infections are the most common. They can look like pimples or boils. They may be red, swollen and painful, and sometimes have pus or other drainage. They can turn into impetigo, which turns into a crust on the skin, or cellulitis, a swollen, red area of skin that feels hot.

Anyone can get a staph skin infection. You are more likely to get one if you have a cut or scratch, or have contact with a person or surface that has staph bacteria. The best way to prevent staph is to keep hands and wounds clean. Most staph skin infections are easily treated with antibiotics or by draining the infection. Some staph bacteria are resistant to certain antibiotics, making infections harder to treat.

Nevada: More Than 2,000 Stand in Line for H1N1 Vaccine

Monday, October 19, 2009

More than 2,600 people stood in line — sometimes longer than two hours — to be among the first in southern Nevada to get the injectable swine flu vaccine.

Gwen Osburn, community health nurse at the Southern Nevada Health District, said more than 300 people were vaccinated in the first hour after opening on Saturday.

The health district has received more than 48,000 doses of the H1N1 vaccine, including an initial delivery of 20,000 FluMist doses, which are administered through the nose.

About 11,000 doses have been distributed to doctors' offices in Clark County that serve at-risk populations.

USDA Confirms H1N1 in Minnesota Pigs

Monday, October 19, 2009

The U.S. Department of Agriculture says at least one pig from the Minnesota State Fair has tested positive for the H1N1 virus, the first case of a pig contracting the virus in the United States.

Agriculture Secretary Tom Vilsack said in a statement Monday that USDA officials have begun to reach out to international organizations and are emphasizing that H1N1, also known as swine flu, cannot be contracted by eating pork products.

The USDA's National Veterinary Services Laboratories confirmed the presence of H1N1 after an initial test suggested that as many as three pigs may have had the virus.

USDA officials say the infection of a so-called show pig doesn't indicate an infection of commercial herds because show pigs are in separate segments of the swine industry.

U.S. Department of Education Issues Guidance On Swine Flu

October 19, 2009

The US Department of Education has issued guidance that discusses waivers from federal education requirements that may provide state or local educational institutions with the operational flexibility necessary to efficiently close schools and otherwise respond to the administrative challenges presented by a potential H1N1 outbreak such as: prolonged school closures, excessive absenteeism, or other disruptions in the regular delivery of educational services to students for a prolonged period of time.

The document, which is quite lengthly, contains advisory information on six sections: Elementary and Secondary education issues, adult education and career and technology issues, Federal Student Aid and other postsecondary education issues, grant administration requirements, Family Educational Rights and Privacy Act (FERPA) issues, and distribution of flu vaccines at school facilities. The document also addresses concerns for IEPs and Special Education student services which may be disrupted.

The Guidance is available here.

Mitchell H. Rubinstein

Links to Pneumonia, Rapid Effects on Young Noted

By Rob Stein
Washington Post Staff Writer
Saturday, October 17, 2009
http://www.washingtonpost.com/wp-dyn/content/article/2009/10/16/AR2009101601384.html

As swine flu continues to spread around the globe, a clearer and in some ways more unnerving picture of the most serious cases has started to emerge, indicating that the virus could pose a greater threat to some young, otherwise vibrant people.

The virus can cause life-threatening viral pneumonia much more commonly than the typical flu, prompting the World Health Organization on Friday to warn hospitals to prepare for a possible wave of very sick patients and to urge doctors to treat suspected cases quickly with antiviral drugs.

Experts stress that most people who get the H1N1 virus either never get sick or recover easily. But some young adults, possibly especially women, are falling seriously ill at an unexpectedly rapid pace and are showing up in intensive care units and dying in unusually high numbers, they say.

Although why a minority of patients become so sick remains a mystery, new research indicates that H1N1 is different from typical seasonal flu viruses in crucial ways -- most notably in its ability to penetrate deep into the lungs and cause viral pneumonia.

"It's not like seasonal influenza," Nikki Shindo of the World Health Organization said at the conclusion of a three-day meeting of more than 100 experts the WHO convened in Washington to review swine flu. "It can cause very severe disease in previously healthy young adults."

Meanwhile, the Centers for Disease Control and Prevention reported Friday that vaccine production was proceeding more slowly than hoped. Officials had predicted that about 40 million doses would be available by the end of October, but that projection will probably fall short by about 10 million to 12 million doses, said Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases.

"Eventually, anyone who wants to be vaccinated will be able to be, but the next couple of weeks will continue to be a slow start," she said. So far, 11.4 million doses have become available and states have ordered about 8 million doses, but the vaccine will not become available in large amounts until November, she said.

The WHO's warning came as U.S. health officials reported that the number of states reporting widespread flu activity was up to 41, including Maryland and Virginia, and that the death toll among children had climbed to 86. Maryland has reported 10 deaths and Virginia health officials say eight people, including one child, have died. There have been no reports of deaths among District residents.

So far, the virus does not seem to sicken or kill people more often than the typical flu. But the pattern of people getting seriously ill is far different than in typical flu seasons. The elderly, who are usually most vulnerable, are generally spared; children, teenagers, pregnant women and young adults are the most common victims.

Officials have been closely monitoring the virus for signs it has mutated into a more dangerous form, and they have also been testing animals for the virus because of fears that infected livestock could cause more-lethal mutations.

Federal agriculture officials said Friday that pigs from the Minnesota State Fair had tested positive for H1N1, which would make them the first documented pig infections in the United States, if follow-up tests confirm the results. But there are no signs that the pigs were sick or that the animals had infected any humans. Children staying near the fair had gotten the virus, but there was no sign they were infected by the pigs.

Seasonal flu viruses tend to infect primarily the upper respiratory system. But recent animal studies and autopsies on about 100 swine flu victims show that H1N1 infects both the upper respiratory tract, which makes it relatively easy to transmit, and also the lungs, which is more similar to the avian flu virus that has been circulating in Asia.

"It's like the avian flu on steroids," said Sherif Zaki, chief of Infectious Disease Pathology at the CDC. He noted that unusually large concentrations of the swine flu virus have been found in the lungs of victims: "It really is a new beast, so to speak."

About a third of patients who required intensive care had bacterial pneumonia, but H1N1's proclivity to infect lung cells makes it more likely than seasonal flu to cause viral pneumonia, which can lead to life-threatening lung damage.

"Remarkably different is this small subset of patients that presents very severe viral pneumonia," Shindo said.

One of those patients was Karen Ann Hays of Sacramento, Calif., an otherwise healthy nurse whose hobby was tackling grueling triathlons. Despite desperate measures to keep her alive, Hays, 51, died in July within days of coming down with swine flu.

"I have seen more cases like this in the last three months than I have in the last 30 years," said Peter Murphy, director of intensive care at the Mercy San Juan Medical Center in Carmichael, Calif., who tried to save Hays.

Although it remains unclear how frequently the virus makes people seriously ill, recent reports from Mexico, Canada, the United States, Australia and New Zealand indicate that perhaps 1 percent of patients who get infected require hospitalization. Between 12 to 30 percent of those hospitalized need intensive care, and 15 to 40 percent of those in intensive care die.

While about two-thirds of U.S. patients who were hospitalized in the spring had other medical conditions, the CDC reported this week that an analysis of more than 1,400 hospitalized victims found perhaps half had no serious health problems.

About one-third of those around the world who have died or became seriously ill from swine flu appear to have been vulnerable because they had heart or lung disease, chronic kidney problems, or other ailments that usually put people at risk. But others had conditions that many may not immediately associate with frailness, such as mild asthma, high blood pressure, high cholesterol and obesity.

"Many of these people look just like you or me," said Anand Kumar, an associate professor of critical care and infectious disease at the University of Manitoba in Winnipeg, Canada, which was hit hard by the pandemic's first wave last spring.

There appears to be no way to predict with certainty who may suffer serious, life-threatening complications, since some victims have had no other health problems.

For instance, Stacey Hernandez Speegle, 30, of Madison, Calif., who died in July, "was in great shape. She was on the softball team. She had two young children. She was renovating her house," said her mother, Tamara Brooks. "It's just so hard to believe."

Although it has been well publicized that pregnant women appear to be at increased risk, some evidence has started to suggest that being female may itself be a risk factor, for reasons that remain unclear.

"There's no question that women, and particularly young women, are getting hit disproportionately," said Kumar. He noted that women tend to have more fat tissue, which can help stimulate a dangerous inflammatory response to infections.

And some of those who develop serious illness deteriorate soon after starting to feel ill. They require oxygen masks, ventilator machines to pump oxygen into their lungs to keep them alive, and drastic, often rarely used measures to try to save them within days of the first fever, ache or cough.

"The rapidity of it is striking," said Andrew R. Davies, deputy director of intensive care at Alfred Hospital in Melbourne, Australia.

Some of the cases in Australia and New Zealand were so severe that doctors resorted to a much more aggressive, less commonly used treatment known as extracorporeal membrane oxygenation (ECMO). It involves siphoning patients' blood into a machine to remove carbon dioxide and then infuse it with oxygen before returning it to their bodies.

"It's quite an extreme form of treatment," said Steve Webb, a clinical associate professor at the Royal Perth Hospital in Australia.

Other doctors have tried administering nitric oxide and putting patients in a bed that turns them upside down to help their lungs work better. "Our back was against the wall," Murphy said, adding that after the deaths of patients such as Hays his hospital is working to make ECMO available.

"It's very difficult to get this double-barreled message out that: 'Yes, most cases are mild, but in a small percentage of cases these cases are disastrous,' " Vanderbilt University's William Schaffner said. "But the message is: Don't underestimate H1N1."

Of the at least 86 Americans younger than 18 who have died from H1N1, 11 deaths were reported in the past week. About half of the deaths in the past month were among teenagers, Schuchat said. Since Aug. 30, 43 pediatric deaths have been reported, including three in those younger than age 2, five among those ages 2 to 4, 16 in those ages 5 to 11, and 19 among those ages 12 to 17, she said.

"These are very sobering statistics," Schuchat said, noting that only about 40 or 50 children usually die during an entire flu season.

Virginia Health Commissioner Karen Remley said Friday that although the majority of H1N1 cases in the state are "mild and moderate," significant numbers have become seriously ill.

In Maryland, at least 257 people have been hospitalized with confirmed cases of H1N1 since June, health officials said.

At least 2,914 Americans have died from flu-related illnesses since the H1N1 began, the CDC said.

Staff researcher Madonna Lebling and staff writer Michael Laris contributed to this report.
hat-tip Pixie

Swine Flu Causes Unprecedented Amount Of Illness Early In Season

LAURAN NEERGAARD, AP Medical Writer
October 16, 2009

WASHINGTON -- The swine flu is causing an unprecedented amount of illness for this early in the fall, with the deaths of 11 more children reported in the past week. And less vaccine than expected will be ready by month's end, federal health officials said Friday.

Of the 86 children who have died since the new swine flu arose last spring, 43 deaths have been reported in September and early October alone, the Centers for Disease Control and Prevention reported. That's a startling number because in some past winters, the CDC has counted 40 or 50 child deaths for the entire flu season -- and no one knows how long this swine flu outbreak will last.

"These are very sobering statistics," said the CDC's Dr. Anne Schuchat.

Also surprising, about half of the child deaths reported since Sept. 1 have been teenagers. Until now, much of the attention has focused on younger children.

Overall, what CDC calls the 2009 H1N1 flu is causing widespread disease in 41 states, and about 6 percent of all doctor visits are for flu-like illnesses, levels not normally seen until much later in the fall.

There may be only 28 million to 30 million vaccine doses dispersed around the country by month's end, Schuchat said, short of the 40 million-plus the government had hoped. But more will continue to arrive weekly, and she urged patience as people await their turn.

As of Wednesday, states had ordered 8 million of the 11.4 million doses of swine flu vaccine the government has ready to ship.

Initial vaccine shipments were only of FluMist, the nasal spray version that can be used by only certain people -- those ages 2 to 49 who aren't pregnant and have no chronic illnesses such as asthma. But swine flu shots now are shipping, too, accounting for a bit more than half of the vaccine available today, Schuchat said.
hat-tip Pixie

Canada: Young man is first in Ontario with swine flu that doesn't respond to drug

Canada:

Tamiflu-resistant H1N1 in Hamilton


October 16, 2009

Joanna Frketich
The Hamilton Spectator
(Oct 16, 2009)

A young Hamilton man was infected with Ontario's first case of Tamiflu-resistant H1N1.

Only a few dozen people worldwide have been reported to have pandemic influenza resistant to the antiviral treatment. They include a 60-year-old Quebec man and an Alberta woman. Both recovered without being hospitalized.

The Hamilton man is in his 20s. Public health officials don't believe he spread it because no one he had contact with has become sick.

"People should take this seriously, but not panic," said Dr. Chris Mackie, Hamilton's associate medical officer of health.

The emergence of Tamiflu-resistant H1N1 comes at the same time local doctors have reported to the public health department that at least one company tried to pay for its staff to get prescriptions for the antiviral to prevent the flu.

"It sent a letter with all of their employees out to doctors saying we'll pay you $60 to give a 60-day prescription to prophylactics," Mackie said.
"This is exactly the sort of thing that generates resistance."

Tamiflu is only to be used as a treatment for high-risk patients with symptoms and not for prevention.

The H1N1 flu shot is the best way to protect against the pandemic and Mackie says he's hoping to announce today when it will be available and where.

He refused to provide any details about the young man who caught the Tamiflu-resistant strain. He wouldn't even say whether the man is dead or alive.

Normally, public health provides details about whether the person is in hospital or at home and how ill.

"For reasons of confidentiality, I'm afraid we can't say anything more about this individual case and I really apologize about that," said Mackie.

The Ministry of Health is confident it's an isolated case.

"At the moment there is no evidence of widespread resistance to Tamiflu anywhere," said ministry spokesperson David Jensen.

There are other antiviral treatments available when H1N1 is resistant to Tamiflu. However, it can take weeks to determine the strain is resistant. Often, the patient's illness gets worse and that's what prompts doctors to try other antiviral treatments.

So far, it hasn't been a big concern because there have been so few cases.

"This virus has been remarkably stable," said Dr. Michael Gardam, director of infectious disease prevention and control at Ontario's Agency for Health Protection and Promotion. "It hasn't shown any propensity at this point to easily develop resistance and then for those resistant strains to spread."
hat-tip Treyfish

Shortage of shots as more kids die of swine flu

Oct. 16, 2009

CDC: H1N1 virus causing unprecedented number of infections for early fall

WASHINGTON - Even as swine flu infections are causing an unprecedented amount of illness for this time of year — and a growing number of deaths, particularly among children — supplies of vaccine to protect against it will be delayed, government health officials said Friday.

In the past week, 11 more children have died from H1N1 influenza infections, an official from the Centers for Disease Control and Prevention said, bringing the total to 86 children since April. That's a startling number because in some past winters, the CDC has counted 40 or 50 child deaths for the entire flu season — and no one knows how long this swine flu outbreak will last.

"These are very sobering statistics," said Dr. Anne Schuchat, the CDC's director of immunization and respiratory diseases.

At the same time, drug manufacturers have told health officials to expect at least 25 percent less vaccine by the end of the month than anticipated. Instead of the 40 million doses projected by the end of October, only 28 million to 30 million doses may be available, said Schuchat.

"We aren't expecting widespread availability until the end of the month or until November," Schuchat said. "It will be pretty challenging to find vaccine."

She urged people anxious to get immunized to check back with their state and local health departments.

"Keep looking," Schuchat said.

Initial vaccine shipments were only of FluMist, the nasal spray version that can be used by only certain people — those ages 2 to 49 who aren't pregnant and have no chronic illnesses such as asthma. But swine flu shots now are shipping, too, accounting for a bit more than half of the vaccine available today, Schuchat said.

Vaccine manufacturers have told CDC that the yield of H1N1 antigen, the substance that produces infection-fighting antibodies, has been lower than expected.

Swine flu is now widespread in 41 states, CDC reported. And overall for the country, deaths from pneumonia and flu-like illnesses have passed what CDC considers an epidemic level. About 6 percent of all doctor visits are for flu-like illnesses, levels not normally seen until later in the fall. Half of the all the child deaths have been in teenagers.

Earlier this week, health officials said that almost half of the hospitalized adult swine flu patients had been healthy people who did not have asthma or any other chronic illnesses before they got sick.

Unpredictable nature
Separately, the World Health Organization said Friday although the H1N1 virus has killed fewer than 5,000 people so far this year worldwide, the influenza remains a cause for concern because of its unpredictable nature.

Most people who catch the H1N1 virus suffer mild symptoms.

But in contrast to seasonal flu strains which can be serious for elderly people, H1N1 can turn dangerous for some people with existing health conditions or otherwise healthy young adults.

"There is a small subset of cases that do and can progress quite rapidly to severe disease and this is sometimes in the space of less than 24 hours and it then becomes a big, big challenge to save the people," said WHO spokesman Gregory Hartl.

"This disease continues to cause concern because it doesn't act exactly like seasonal influenza and because it doesn't affect the same groups who are affected by seasonal influenza."
hat-tip Pixie

Australia: Piggery quarantined after swine flu outbreak

October 14, 2009

A PIGGERY near Toowoomba has been placed under quarantine after test results came back positive for swine flu.

Biosecurity Queensland chief veterinary officer Ron Glanville said given the widespread presence of H1N1 in the human population, the occasional case in piggeries was to be expected.

"Fortunately, influenza A H1N1 in piggeries can be managed relatively easily through routine biosecurity measures,'' Dr Glanville said.

Biosecurity officers are working with the owners in the latest case to implement on-site biosecurity measures to ensure the virus remains contained.

"This is not a human health issue and food authorities maintain that pork and pork products are safe to eat,'' he said.

"The infection should be self-limiting within the piggery and the response is designed to allow the disease to burn out as quickly as possible.''

Dr Glanville said this was only the second case of human pandemic (H1N1) 2009 influenza detected at a piggery in Queensland following the quarantine of a piggery near Dalby in August.

"That piggery has since been released from quarantine after the illness ran its course,'' he said.

"The pigs at this site are now all in good health.''

All pig owners should maintain strict biosecurity procedures on their properties and report anything unusual in their herds to the Emergency Disease Watch Hotline on 1800 675 888.

BAMC to Use CombiMatrix Influenza Array to Study Genetic Drift of H1N1 Swine Flu

October 13, 2009 6:00 AM ET

MUKILTEO, Wash., Oct. 13, 2009 (GLOBE NEWSWIRE) -- CombiMatrix Corporation (Nasdaq:CBMX) announced today that Brooke Army Medical Center ("BAMC") is using the CombiMatrix Influenza-Detection System to analyze influenza cases including those involving H1N1 Swine flu. BAMC is a military hospital that is investigating the feasibility of screening all patients presenting in its emergency room with symptoms of respiratory distress and consenting to nasal swabs, by both electrochemical array-based diagnostics and bead-based multiplex fluorescent methods.

While there are other flu tests including the fluorescent test used at BAMC that can identify the presence or absence of H1N1 Swine flu, they do not provide information on genetic drift of the virus. It is important to understand the genetic drift of rapidly mutating pathogens in general and of Swine flu in particular because of the potential for increased pathogenicity of a mutated virus.

Recent estimates by the President's Council of Advisors on Science and Technology indicate that millions of U.S. citizens might contract Swine flu, and nearly 1.8 million individuals might be hospitalized, with up to 90,000 deaths in the U.S. during this flu season. World-wide, there are already several hundred thousand confirmed cases, and the World Health Organization has declared a pandemic. Although some of these estimates might be high, the numbers clearly indicate that this viral disease is a major public health concern. Because Swine flu can be a rapidly mutating virus, concerns exist about mutations that might make it more pathogenic while maintaining its highly infectious nature.

"We are pleased to be working with BAMC to evaluate the genetic drift of the Swine flu virus," stated Dr. Amit Kumar, President and CEO of CombiMatrix. "Our influenza array has demonstrated its ability to provide tremendous genetic information regarding numerous infectious agents including Bird Flu, Swine flu, and other infectious agents. It is especially significant to note that our Influenza-Detection System was developed with funding from the U.S. Department of Defense, and it is now being used to evaluate infections in military, former-military, and government personnel. Also, we encourage interested parties to review information on the website of the U.S. Centers for Disease Control and Prevention to get an understanding of the limitations of currently available flu tests, especially what we feel is poor performance of many rapid flu tests," concluded Dr Kumar. The link for this information is as follows: http://www.cdc.gov/h1n1flu/guidance/diagnostic_tests.htm

According to Dr. Gerald Merrill, Laboratory Director for the Department of Clinical Investigation at BAMC, "We are already seeing a high percentage of novel H1N1 flu cases in the San Antonio military community this season. The CombiMatrix system allows us to screen for Swine flu versus seasonal influenza A and influenza B. Samples analyzed using the CombiMatrix system from last season allowed us to look at clustering of genotypes and to see patterns suggesting genetic drift in both the novel H1N1 Swine flu virus and the seasonal influenza A virus in San Antonio. This can be useful in spotting divergence of strains and possibly in identifying problems earlier than if we did not screen for such divergence," concluded Dr. Merrill.

ABOUT COMBIMATRIX CORPORATION

CombiMatrix Corporation is a diversified biotechnology business that develops proprietary technologies, including products and services in the areas of drug development, genetic analysis, molecular diagnostics, nanotechnology and defense and homeland security markets, as well as in other potential markets where our products and services could be utilized. The technologies we have developed include a platform technology to rapidly produce user-defined, in-situ synthesized, oligonucleotide arrays for use in identifying and determining the roles of genes, gene mutations and proteins. This technology has a wide range of potential applications in the areas of genomics, proteomics, biosensors, drug discovery, drug development, diagnostics, combinatorial chemistry, material sciences and nanotechnology.
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People at High Risk of Developing Flu-Related Complications

October 8, 2009, 12:45 AM ET

Most people who get the flu (either seasonal or 2009 H1N1) will have mild illness, will not need medical care or antiviral drugs, and will recover in less than two weeks. Some people, however, are more likely to get flu complications that result in being hospitalized and occasionally result in death. Pneumonia, bronchitis, sinus infections and ear infections are examples of flu-related complications. The flu can also make chronic health problems worse. For example, people with asthma may experience asthma attacks while they have the flu, and people with chronic congestive heart failure may have worsening of this condition that is triggered by the flu. The list below includes the groups of people more likely to get flu-related complications if they get sick from influenza.

People at High Risk for Flu Complications:

• Children younger than 5, but especially children younger than 2 years old
• Adults 65 years of age and older
• Pregnant women
• People who have:
  • Cancer
  • Blood disorders (including sickle cell disease)
  • Chronic lung disease [such as asthma or chronic obstructive pulmonary disease (COPD)]
  • Diabetes
  • Heart disease
  • Kidney disorders
  • Liver disorders
  • Neurological disorders (such as epilepsy, cerebral palsy, brain or spinal cord injuries, moderate to profound intellectual disability [mental retardation] or developmental delay)
  • Neuromuscular disorders (such as muscular dystrophy and multiple sclerosis)
  • Weakened immune systems (such as people with HIV or AIDS or who are on medications that weaken the immune system )

Antigenic Diversity Increases with 7 Novel H1 SNPs from Chengdu and Jiangyin

On 2009-10-06 China deposited 22 Hemagglutinin sequences and 23 matching partial Neuraminidase sequences from the areas of Chengdu and Jiangyin sampled respectively on 2009-07-26 and 2009-08-16. The Neuraminidase segments are far too limited in data for evaluation. The HA segments are remarkable due to the fact that 100% of the distinguishable SNPs are, on first inspection, novel introductions to ΣPF11. Changes directly upstream and downstream of the Receptor Binding Domain may affect Antigen match.

HA Protein Codings to 7 Novel Polymorphisms and 1 Mixed Signal
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